The Philippine health care system is composed of public, private, and social health insurance models. The Department of Health is the lead agency and oversees a network of hospitals, offices, and attached agencies. In 1991, health services were devolved from the national to local government level. The health system aims to provide universal access through primary, secondary, and tertiary levels of care. Challenges include high costs, barriers to access, and health workforce shortages.

1. Philippine Health Care System
Polly T. Chua-Chan, MD, MPH, MHA, FPAFP

2. SESSION OBJECTIVES:
• The student should be able to:
- Define Phil Health Care System
- Discuss the factors affecting health care
system
- Describe Phil health care delivery system
- Discuss the structure, functions, activities
and programs of the Dept. of Health

3. HEALTH SYSTEM
• Interrelated system in which a country
organizes available resources for the
maintenance and improvement of the health
of its citizens and communities.
• A health system comprises all
organizations, institutions and resources
devoted to producing actions whose primary
intent is to improve health.

4. DEFINITION OF TERMS
HEALTH CARE SYSTEM
• an organized plan of health services (Miller-
Keane, 1987)
HEALTH CARE DELIVERY
• rendering health care services to the people
(Williams-Tungpalan, 1981)

5. DEFINITION OF TERMS
HEALTH CARE DELIVERY SYSTEM (Williams-
Tungpalan, 1981)
• the network of health facilities and personnel
which carries out the task of rendering health
care to the people.

6. Philippine Health Care System Context
• Health as a basic human right
• Department of Health is the lead agency
• Local Government Code
• Access to health care hampered by high
cost, physical and socio-cultural barriers, and
health workforce crisis

7. Devolution
• In 1991 the Philippine Government introduced a
major devolution of national government
services, which included the first wave of health
sector reform, through the introduction of the Local
Government Code of 1991.
• The Code devolved basic services for agriculture
extension, forest management, health
services, barangay (township) roads and social
welfare to Local Government Units.

8. Devolution
• In 1992, the Philippine Government devolved
the management and delivery of health
services from the National Department of
Health to locally elected provincial, city and
municipal governments.

9. 4 Essential Functions of Health System
• Service provision
• Resource generation
• Financing
• Stewardship

10. Health Care System Models
• Private enterprise health care
• Social security health model
• Publicly funded health model
• Social health insurance

11. Private Enterprise Health Care Model
• Purely private enterprise health care systems
are comparatively rare
• Where they exist, it is usually for a
comparatively well –off subpopulation in a
poorer country with a poorer standard of
health care – e.g. private clinics for a
small, wealthy expatriate population in an
otherwise poor country

12. Social Security Health Model
• Where workers and their families are insured
by the state
• Refers to social welfare service concerned
with social protection, or protection against
socially recognized conditions, including
poverty, old age, disability, unemployment
and others

13. Publicly Funded Health Care Model
• Where the residents of the country are
insured by the state
• Health care that is financed entirely or in
majority part by citizens’ tax payments instead
of through private payments made to
insurance companies or directly to health care
providers

14. Social Health Insurance
• Where the whole population or most of the
population is a member of a sickness
insurance company
• SHI is a method for financing health care costs
through a social insurance program based on
the collection of funds contributed by
individuals, employers and sometimes
government subsidies.

15. Social Health Insurance
• Characterized by the presence of sickness
funds which usually receive a proportional
contribution of their members’ wages. With
this insurance contributions these funds pay
medical costs of their members
• Affiliation to such funds is usually based on
professional, geographic, religious, political
and/or non partisan criteria

16. Health Care Utilization
• Physical barriers – geographical location
patterns of health care consumers in relation
to health providers
• Financial factors also exists that affect health
seeking patterns of the Filipinos

17. MULTISECTORAL APPROACH TO
HEALTH (NLGNI, 8th edition, 1995)
• The level of health of a community is largely
the result of a combination of factors.
• Health, therefore, cannot work in isolation.
Neither can one sector or discipline claim
monopoly to the solution of community
health problems. Health has now become a
multisectoral concern.

18. Health System Composition
1. Health sector – refers to the group of services
or institutions in the community or country
which are concerned with the health
protection of the population
- may be public (government), private and
non-governmental health organizations
2. Health –related sectors

19. Functions of the Health Sector
• Direct provision of health services:
promotion, prevention, diagnosis and
treatment, medical rehabilitation
• Development and provision of
manpower, drugs and medical supplies;
financing support
• Research and development
• Coordinating, controlling and directing
organizations and activities associated with
other functions

20. 1. Intersectoral Linkages
• Primary Health Care forms an integral part of the
health system and the over-all social and economic
development of the community. As such, it is necessary
to unify health efforts within the health organization
itself and with other sectors concerned. It implies the
integration of health plans with the plan for the total
community development.
• Sectors most closely related to health include those
concerned with: a. Agricultural b. Education c. Public
works d. Local governments e. Social Welfare f.
Population Control g. Private Sectors

21. 2. Intrasectoral Linkages
• In the health sector, the acceptance of primary
health care necessitates the restructuring of the
health system to broaden health coverage and
make health service available to all.
• There is now a widely accepted pyramidal
organization that provides levels of services
starting with primary health and progressing to
specialty care.
• Primary health care is the hub of the health
system.

22. DEPARTMENT OF HEALTH
• Principal agency in health in the Philippines
• Responsible for ensuring access to basic
public health services to all Filipinos through
the provision of quality health care and
regulation of providers of health goods and
services
• A policy and regulatory body for health

23. DEPARTMENT OF HEALTH
• A technical resource, a catalyzer for health
policy and a political sponsor and advocate for
health issues in behalf of the health sector
• Provides the direction and national plans for
health programs and activities

24. Department of Health
Vision:
• Health as a right. Health for All Filipinos by the year 2000
and Health in the Hands of the People by the year 2020.
Mission:
In partnership with the people to ensure equity, quality and
access to health care:
• by making services available
• by arousing community awareness
• by mobilizing resources
• by promoting the means to better health

25. E.O. No. 119, Sec. 3
• The primary function of the Department of
Health is the promotion, protection,
preservation or restoration of the health of
the people through the provision and delivery
of health services and through the regulation
and encouragement of providers of health
goods and services

26. DOH Offices
• The DOH is composed of about 17 central
offices, 16 Centers for Health Development
located in various regions, 70 hospitals and 4
attached agencies.

27. Center for Health Development
• Responsible for field operations of the
Department in its administrative region and
for providing catchment area with efficient
and effective medical services.
• Tasked to implement laws, regulation, policies
and programs.
• Tasked to coordinate with regional offices of
the other Departments, offices and agencies
as well as with the local governments.

28. Center for Health Development
• Act as main catalyst and organizer in the ILHZ
formation
• Provide technical support and advocacy for the
dev’t of local health management systems and
their integration in the context of the ILHZ
• Review and approve ILHZ proposals for funding
• Integrate local health plans into regional plans
• Undertake monitoring of the development and
implementation of ILHS

29. DOH Hospitals
• Provides hospital-based care; specialized or
general services, some conduct research on
clinical priorities and training hospitals for
medical specialization.

30. Attached Agencies
• The Philippine Health Insurance Corporation is
implementing the national health insurance
law, administers the medicare program for both
public and private sectors.
• The Dangerous Drugs Board on the other
hand, coordinates and manages the dangerous
drugs control program.
• Philippine Institute of Traditional and Alternative
Health Care
• Philippine National AIDS Council

31. District Health System
• “A contained segment of the national health
system which comprises a well defined
administrative and geographic area either
rural or urban and all institutions and sectors
whose activities contribute to improve health”
- World Health Organization

32. District Health System is subdivided
into 3 levels of referral:
• Primary – barangay health stations and rural
health units
• Secondary – district/provincial hospitals
• Tertiary – provincial and regional hospitals

33. 1. PRIMARY LEVEL OF HEALTH CARE
FACILITIES
the rural health units, their sub-centers, chest
clinics, malaria eradication units, and schistosomiasis
control units operated by the DOH; puericulture
centers operated by League of Puericulture Centers;
tuberculosis clinics and hospitals of the Philippine
Tuberculosis Society; private clinics, clinics operated
by the Philippine Medical Association; clinics
operated by large industrial firms for their employees;
community hospitals and health centers operated by
the Philippine Medicare Care Commission and other
health facilities operated by voluntary religious and
civic groups (Williams-Tungpalan, 1981).

34. 2. SECONDARY LEVEL OF HEALTH
CARE FACILITIES
• are the smaller, non-departmentalized
hospitals including emergency and regional
hospitals.
• Services offered to patients with symptomatic
stages of disease, which require moderately
specialized knowledge and technical resources
for adequate treatment.

35. 3. TERTIARY LEVEL OF HEALTH CARE
FACILITIES
• the highly technological and sophisticated
services offered by medical centers and large
hospitals. These are the specialized national
hospitals.
• Services rendered at this level are for clients
afflicted with diseases which seriously threaten
their health and which require highly technical
and specialized knowledge, facilities and
personnel to treat effectively (Williams-
Tungpalan, 1981)

36. A PYRAMIDAL HEALTH STRUCTURE
Tertiary
National
Health
Health
Services Care
Regional Health
Services
Secondary
District Health Health
Services Care
Rural (Local
Hospital) Services
Primary
Rural Health Units Health
Barangay health Stations
Care

37. Inter Local Health Zone (ILHZ)
• Unit of the health system created for local
health service management and delivery in
the Philippines
• Applied in many developing countries where
responsibility for health services has been
decentralized from national to local health
authorities

38. ILHZ
• Has a defined population within a defined
geographical area and comprises a central or
core referral hospital and a number of primary
level facilities such as RHUs and BHS
• Clustering of municipalities

39. ILHZ
• Includes all stakeholders involved in the
delivery of health services including
community-based NGOs and the private
sectors (foreign and/or local)
• Provides quality, equitable and accessible
health care

40. Composition of ILHZ
• People – community
members, CHWs, NGOs, people’s
organizations, local chief executives, other
gov’t officials, private sector
• Boundaries – clear boundaries between ILHZ
• Health facilities
• Health workers – district health team

41. Importance of establishing an ILHZ
• To re-integrate hospital and public health
services for a holistic delivery of health
services
• To identify areas of complementation of the
stakeholders – LGUs at all
levels, DOH, PHIC, communities, NGOs, private
sector and others

42. Expected achievement of the ILHZ
• Universal coverage of health insurance
• Improved quality of hospital and RHU services
• Effective referral system
• Integrated planning
• Appropriate health information system

43. Expected achievement of the ILHZ
• Improved drug management
• Developed human resources
• Effective leadership through inter-LGU
cooperation
• Financially viable or self-sustaining hospital
• Integration of public health and curative
hospital

44. Core Referral Hospital
• Main hospital for ILHZ and its catchment
population
• Main point of referral for hospital services
from the community, private medical
practitioner and public health services at BHS
and RHUs

45. Core Referral Hospital
• Minimum services:
• Out-patient services
• Lab and radiological diagnostic services
• Inpatient care
• Surgical services sufficient to provide
emergency care for basic life threatening
conditions, obstetrics and trauma

46. Minimum Package of Activity for PHC
services
• Pre-natal care
• Normal delivery and post-partum care
• Immunization
• Family planning
• Nutrition – Vit. A & iron supplementation
• Growth monitoring
• Control of communicable diseases
• Minor surgery – suturing , draining of abscess, circumcision
• Dental health
• Appropriate referral
• Environmental health services

47. Minimum Package of Activity for PHC
services
• Basic laboratory services
• Health promotion and education
• Management of public health services,
coordination with NGOs and the private medical
sector, participation in ILHZ management
• Training of human resources
• Supervision of health services and human
resources within the municipal catchment area

48. Complementary Package of Activity for
Core Referral Hospitals
• Outpatient consultations for patients referred from the
primary level
• Inpatient medical and surgical care
• Emergency room care
• Minor surgery (placental extraction, excision, suturing
, D&C
• Anesthesia
• Major emergency surgery (CS, trauma
surgery, appendectomy)
• Complicated deliveries
• Basic orthopedics (ex. Setting of simple fractures

49. Complementary Package of Activity for
Core Referral Hospitals
• Nutrition services
• Referral of more urgent cases to a higher level of care
• X-ray
• Laboratory services
• Blood transfusion
• Pharmacy services
• Management of hospital services and participation in
ILHZ management
• Public health promotion and education
• Coordination with public health services
• Transport and communication linkages

50. Tertiary Package of Activity for
provincial Gov’t Referral Hospital
• Pediatric, surgical, medical, orthopedic obstetric and gynecology
departments
• Expanded surgical capability (burns)
• Intensive care, neonatal intensive care, coronary care
• Ophthalmology
• Rehabilitative medicine (physiotherapy, occupational therapy)
• A full range of dental services
• Advanced diagnostics
• Public health laboratory (malaria, schistosomiasis, water
analysis, referral laboratory of RHUs and core referral hospitals
• Blood bank and transfusion services

51. Tertiary Package of Activity for
provincial Gov’t Referral Hospital
• Medical social services, veterans, senior citizens
medical services
• Pharmacy services
• Dietary and nutrition services
• Wellness center program
• Hospital administration and management
services
• Emergency transport
• In-house engineering and maintenance

52. FACTORS ON THE VARIOUS
CATEGORIES OF HEALTH WORKERS
AMONG COUNTRIES AND
COMMUNITIES
1. available health manpower resources
2. local health needs and problems
3. political and financial feasibility

53. Philippine Health Human Resource
• Labor Force – 34.2 M (42% of the total
population)
• 8.83% comprise Health Human Resource
• Unemployment Rate – 12.7%
• 1 out of 5 is underemployed/underpaid

54. Stock of Filipino Health Workers
• Nurses (10,000/year) from 350 nursing
colleges
• Doctors (2000/year) from 30 medical schools
• Midwives (1500/year) from 129 schools
• Dentists (2000/year) from 31 dental schools
• Pharmacists (1500/year) from 35 pharmacy
colleges

55. Philippine Health Human Resource
• Biggest provider of overseas nurses
• Underlying reasons affecting nurse
recruitment, retention and fast turn-over:
- low pay - low morale
- insufficient resources - stress
- poor job prospect - poor staffing
- increase work loads

56. Comparative Advantage of Filipino
Health Workers
• Well trained
• Highly skilled
• Fluent in English
• Postgraduate training in the US, Canada, etc.
• Competent, caring, compassionate

57. Philippine Health Human Resource
Factors attributed to the migration of the
professionals include:
• Weak health systems
• Economic need
• Professional and career development
• Attraction of a better quality life or a higher
standard of living

58. THREE LEVELS OF PRIMARY HEALTH
CARE WORKERS
A. BARANGAY HEALTH WORKERS
• first contacts of the community and initial links of
health care.
• Provide simple curative and preventive health
care measures promoting healthy environment.
• Participate in activities geared towards the
improvement of the socio-economic level of the
community like food production program.
• Community health worker, volunteers or
traditional birth attendants.

59. B. INTERMEDIATE LEVEL HEALTH
WORKERS
• represent the first source of professional
health care
• attends to health problems beyond the
competence of village workers
• provide support to front-line health workers in
terms of supervision, training, supplies, and
services.
• Medical practitioners, nurses and midwives.

60. C. FIRST LINE HOSPITAL PERSONNEL
• provide back up health services for cases that
require hospitalization
• establish close contact with intermediate level
health workers or village health workers.
• Physicians with specialty, nurses, dentist,
pharmacists, other health professionals.

61. Barangay Public 2 F 3 F
P Health Health n
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Worker d a
O Nurse c
d
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P H i
U H i
Barangay RHU e l
L
Physician e l
Health Midwife a i
A Station a i
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T l t
t y
I t y
h
O RHS Sanitary h
Midwife Inspector
N

62. TWO-WAY REFERRAL SYSTEM (Niace,
et. al. 8th edition 1995)
• A two-way referral system need to be
established between each level of health
facility e.g. barangay health workers refer
cases to the rural health team, who in turn
refer more serious cases to either the district
hospital, then to the provincial, regional or the
whole health care system.

63. THE NATIONAL HEALTH PLAN
• the blue print which is followed by the
Department of Health.
• It defines the country’s health problems,
policy thrusts, strategies and targets.

64. POLICY THRUSTS AND STRATEGIES
1. Information, education, and communication programs will
be implemented to raise the awareness of the
public, including policy makers, program planners and
decision makers;
2. An update of the legislative agenda for health, nutrition and
family planning (HNFP), and stronger advocacy for pending
HNFP
related legislations will be pursued;
3. Integration of efforts in the health, nutrition and family
planning sector to maximize resources in the delivery of
services through the establishment of coordinative
mechanisms at both the national and local levels;
•

65. POLICY THRUSTS AND STRATEGIES
4. Partnership between the public and the
private sectors will be strengthen and
institutionalized to effectively utilize and
monitor private resources for the sector;
5. Enhancement of the status and role of
women as program beneficiaries and program
implementers will be pursued to enable them
to substantially participate in the
development process.

66. Major Influences in the
Health Care System
• Environmental
• Demographic
• Socio-cultural
• Political
• Economic

67. Other Health-
related Systems
(gov’t / private)
Ways of Health
Community
the People Care
Health
(Cultural) System
Environment
(Social, Economic, Physic
al, etc)

68. Factors contributing to the limited
capacity of the country’s health care
system to deliver better health
outcomes
• poor health care financing
• The inappropriate health service delivery system,
where there is excessive reliance on use of high-
end hospital services rather than primary care,
including an ineffective mechanism for providing
public health programs
• the brain drain of health professionals

69. Factors contributing to the limited
capacity of the country’s health care
system to deliver better health
outcomes
• the excessively high price of medicines, leading to
costly out-of-pocket payments and inadequate and
irrational use;
• inadequate enforcement of regulatory mechanisms
• the insufficient effort expended on prevention and
control of new diseases, particularly non-
communicable diseases

70. Factors contributing to the limited
capacity of the country’s health care
system to deliver better health
outcomes
• Data adequacy, accuracy and timeliness are
other important and perennial issues to be
addressed. The unavailability of timely and
accurate data/information makes it difficult to
make appropriate decisions on policies and
programs to improve health care.

71. ISSUES AND CONCERNS
• Some of the major factors affecting the
country’s health status are as follows:
□inappropriate health delivery system
□inadequate regulatory mechanisms and
□poor health care financing