Theory 2M: Healthcare Delivery Systems

Health Systems

Compromises all organizations, institutions and resources that produce actions whose primary purpose is to improve health.

Healthcare Delivery System

A mechanism for providing services that meet the health needs of individuals.

Six Building Blocks of a Health System

1. Service Delivery

2. Health Workforce

3. Information

4. Medical Products, Vaccines, and Technologies

5. Financing

6. Leadership and Governance or Stewardship

Essential Functions of Health Systems

1. Service Provision

2. Resource Generation

3. Financing

4. Stewardship

Health Care Systems Models

1. Private Enterprise Health Care Model

2. Social Security Health Model

3. Publicly Funded Health Model

4. Social Health Insurance Model

Key Elements to Achieve the Goal of Health for All

1. Reducing exclusion and social disparities (UHC).

2. Organizing health services around people's needs and expectations (Health Service Reforms).

3. Integrating health into all sectors (Public Policy Reforms).

4. Pursuing collaborative models of policy dialogue (Leadership Reforms).

5. Increasing stakeholder participation.

ELEMENTS

- EDUCATION about health problems and solutions

- Prevention and control of LOCALLY endemic diseases

- Provision of ESSENTIAL drugs

- MATERNAL and child care; reproductive health

- EXPANDED immunization against major diseases

- Adequate food supply and NUTRITION

- TREATMENT of common diseases and injuries

- Safe water and basic SANITATION

Driving Factors of Primary Health Care (PHC)

- Knowledge and capacity building

- Human resources for health

- Technology

- Financing

The 4A's of Primary Health Care (PHC)

o Accessibility

o Affordability

o Acceptability

o Availability

Key Principles of Primary Health Care (PHC)

• 4 A's

• Support Mechanism

• Multi-Sectoral Approach

• Community Participation

• Equitable Distribution of Health Resources

• Appropriate Technology

Intrasectoral

Within health sector.

Intersectoral

Encompassing other sectors aside from health; synergistic effect.

Criteria of Appropriate Technology

- Safety

- Effectiveness

- Affordability

- Simplicity

- Acceptability

- Feasibility and Reliability

- Ecological Effects

- Potential Contribution

Goal 1 of the UN

No poverty.

Goal 2 of the UN

Zero hunger.

Goal 3 of the UN

Good health and well-being.

Goal 4 of the UN

Quality education.

Goal 5 of the UN

Gender Equality

Goal 6 of the UN

Clean water and sanitation.

Goal 7 of the UN

Affordable and clean energy.

Goal 8 of the UN

Descent work and economic growth.

Goal 9 of the UN

Industry, innovation, and infrastructure.

Goal 10 of the UN

Reduced inequalities.

Goal 11 of the UN

Sustainable cities and communities.

Goal 12 of the UN

Responsible production and consumption.

Goal 13 of the UN

Climate action.

Goal 14 of the UN

Life below water.

Goal 15 of the UN

Life on land.

Goal 16 of the UN

Peace, justice, and strong institutions.

Goal 17 of the UN

Partnerships for the goals.

Target 3.1

Reduce maternal mortality. By 2030, reduce the global mortality ration to less than 70 per 100,000 live births.

Alma Ata Declaration on PHC

1. Health is a basic fundamental right.

2. Global burden of health inequalities among populations.

3. Economic and social development is of basic importance for full attainment of health for all.

4. Governments have a responsibility for the health of their people.

Target 3.2

End all preventable deaths of newborns and children under 5.

By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.

Target 3.3

Fight communicable diseases.

By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

Target 3.4

Reduce non-communicable diseases through prevention and treatment and promote mental health and wellbeing.

By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

Target 3.5

Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

Target 3.6

Reduce deaths and injuries from road traffic accidents.

By 2020, halve the number of global deaths and injuries from road traffic accidents.

Target 3.7

Universal access to sexual and reproductive care, family planning and education.

By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Target 3.8

Achieve universal health coverage.

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Target 3.9

Reduce and illnesses and death from hazardous chemicals and pollution.

By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.

Target 3.A

Implement the who framework convention on tobacco control.

Target 3.B

Support research, development and universal access to affordable vaccines and medicines.

Target 3.C

Increase health financing and support health workforce in developing countries.

Target 3.D

Improve early warning systems for global health risks.

World Health Assembly

The WHO's supreme decision-making body and consists of 194 Member States.

Executive Board

It is composed of 34 members technically qualified in the field of health, with members being elected for three-year terms.

Secretariat

It consists of the Director General, 5 Assistant Director Generals and 8,000 health experts/staff across 6 regional offices.

Public Sector

Consists of the national and local government agencies providing health services.

The Thirteenth General Programme of Work

It defines WHO's strategy for the five-year period, 2019-2023. It focuses on triple billion targets to achieve measurable impacts on people's health at the country level.

Private Sector

Largely market-oriented and health care is paid through user fees at the point of service.

TERTIARY

a) National Hospitals

b) National Medical Centers

c) National Specialized Hospitals

d) Regional Hospitals/Regional Medical Centers

e) Teaching and Training Hospitals

SECONDARY

a) Provincial Health Office

b) District Hospitals

c) Emergency Hospitals

d) Provincial Hospitals/Provincial Medical Centers

PRIMARY

a) Municipal Health Office

b) Rural Health Units

c) Health Centers

d) Barangay Health Stations

Vision of the DOH

Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040.

Mission of the DOH

To lead the country in the development of a productive, resilient, equitable and people-centered health system.

3 Major Roles in the Health Sector

1. Leadership in health.

2. Enabler and capacity builder.

3. Administrator of specific services.

Values of the DOH

1. Integrity

2. Excellence

3. Compassion and Respect for Human Dignity

4. Commitment

5. Professionalism

6. Teamwork

7. Stewardship of the health of the people.

RA 7160

The Local Government Code of 1991.

The act by which the national government vests power and authority upon local government units to perform specific functions and responsibilities.

Rural Health Unit

• "Health Center"

• Primary level health facility in a municipality.

• Focus: preventive, promotive and supervision of BHS.

• 1 : 20,000

• Complete staff

Barangay Health Station

• First-contact health care facility.

• Basic services in the barangay level (3-5 km from the RHU).

• 1 : 5,000 population

• Staff: RHM and BHW

RA 7305

Magna Carta for Public Health Workers

Administrator

✓ prepares the municipal health plan and budget

✓ monitors the implementation of basic health services

✓ management of the RHU staff

Community Physician

✓ conducts epidemiological studies

✓ formulates health education campaigns on disease prevention

✓ prepares and implements control measures or rehabilitation plans

Medico-Legal Officer

✓ signs our death certificates and other documents

Data Manager

Public health nurse that prepares the Field Health Service Information System (FHSIS) quarterly and annual reports

Health Care Provider

Public health nurse that uses the nursing process in responding to the health needs of individuals, families and communities including health promotion and disease prevention activities.

Collaborator

Public health nurse that collaborates with other stakeholders to address the community's health problems.

Rural Sanitation Inspector (RSI)

o Inspects water supply and unhygienic household conditions.

o Inspects food establishments and recommends the Sanitary Permit to Operate be approved by the MHO.

Inter Local Health Zone (ILHZ)

A clustering of contiguous local government units (municipalities, component cities of a province/s) with a core referral hospital (district or provincial hospital) wherein preventive primary public health care is integrated with hospital care.

Components of ILHZ

(1) People

(2) Boundaries

(3) Health facilities

(4) Health workers

Policy Board

It is made up of local officials of the component (LGUs, representatives of non-government organizations (NGOs), national agencies (NGAs), the private sector, and community).

Technical Management Committee

May be composed of the Chief of the Core Referral Hospital, MHOs, Representative Public Health Nurse (PHN), Chief Nurse of Core Referral Health, Representative Rural Health Midwife (RHM), Supervising Rural Sanitary Inspector (RSI), DOH Representative, Private Health Care Provider.

Three Domains of Benefits in a Functional ILHZ

1. Coordination for maximum improvement of population health

2. Coordination for continuity of care to individual patients

3. Coordination to manage and minimize total costs of full range of health provisions

General Hospital

A hospital that provides services for all kinds of illnesses, diseases, injuries or deformities. This type of hospital shall provide medical and surgical care to the sick and uninjured, maternity, newborn and child care.

Specialty Hospital

A hospital that specializes in a particular disease or condition or in one type of patient.

Level of Hospital

Defined as the service capabilities of hospitals reflected in the 2020 license to operate.

Category A - Primary Care Facility

o First-contact health care facility.

o Basic services: Emergency and Normal Deliveries

o Without in-patient beds: health centers, out-patient clinics, dental clinics.

o With in-patient beds: infirmaries and birthing / lying-in facilities (average 1-2 days)

Category B - Custodial Care Facility

o Long-term care due to chronic conditions.

o Assistance in ADL and in need of rehabilitation.

o Psychiatric facilities, substance/drug abuse treatment & rehabilitation centers, sanitaria/leprosaria & nursing homes.

Category C - Diagnostic/Therapeutic Facility

o Pre-analytical, analytical and post-analytical exam of human body specimen for diagnosis/treatment.

o Laboratory - clinical lab, HIV testing, blood service, drug testing, newborn screening, water analysis

o Radiologic - X-ray, CT scan, mammography, MRI, ultrasound

o Nuclear Medicine - radiotherapy

Category D - Specialized Outpatient Facility

o Highly specialized procedures.

o Outpatient basis.

o Dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic/radiation facility, physical or rehabilitation center clinic.

Referral

A process in which a health worker at a one level of the health system with insufficient resources (drugs, equipment, skills) to manage a clinical condition seeks the assistance of a better resourced facility at higher level to assist in, or take over the management of, the client's case.

Internal Referral

✓ Within the organization

✓ RHM to PHN

External Referral

✓ outside the organization

✓ RHU to District Hospital

Referral

A two-way process to ensure that continuum of care is covered. The process involves the public, private, community-based health care providers and health care facilities, which can take the form of a vertical, horizontal, or diagonal relationship/s.

Data Privacy Act (2012)

An act protecting individual personal information in information and communication systems in the government and the private sector.

Philippine Integrated Disease Surveillance and Response Project (PIDSR)

Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats.

Philippine Health Information System

Integrated electronic system for storing and sharing vital health indicators.

Field Health Service Information System (FHSIS)

o Official information system of the Department of Health.

o Enables the collection and translation of information from local to national level.

o Information to policy formulation and decision making.

Integrated Clinic Information System (iClinicSys)

Supports the functions of a clinic, i.e. barangay health station, rural health unit, or other health care facility that is primarily devoted to the care of outpatients by storing electronic record of health related data or information on an individual.

RxBox

A telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via internet to a clinical specialist in the Philippine General Hospital for expert advice.

Real Time Monitoring of Vital Maternal and Child Health Indicators through the Community Health Information Tracking System (rCHITS)

A free and open source software electronic health record system for local government health centers in the Philippines.

Surveillance in Post Extreme Emergencies and Disasters (SPEED)

Mobile and internet-based disease surveillance system for disasters by the DOH HEMS and WHO. It is conceptualized to provide real time health information reporting after a disaster.

Philippine Health Information Exchange

A platform for secure electronic access and efficient exchange of health data and/or information among health facilities, health care providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health.

Three Goals of the Philippine Health Agenda

1. Financial protection

2. Better health outcomes

3. Responsiveness

Values of the Philippine Health Agenda

1. Equity

2. Efficiency

3. Quality

4. Transparency

ACHIEVE

A → Advance health promotion, primary care and quality.

C → Cover all Filipinos against financial health risk.

H → Harness the power of strategic Human Resources for Health.

I → Invest in eHealth and data for decision-making.

E → Enforce standards, accountability and transparency.

V → Value clients and patients.

E → Elicit multi-stakeholder support for health.

Home-Based Mother's Record (HBMR)

A simplified record of the history of present and past pregnancies, when applicable, and the findings and measure of the TBA, BHW, or health professionals.

Essential Newborn Care

1. Immediate drying

2. Skin-to-skin contact

3. Proper cord clamping and cutting

4. Non-separation of baby from mother and breastfeeding initiation

6 Signal Obstetric Functions

1. Oxytocin in 3rd stage of labor.

2. Loading dose of anticonvulsants.

3. Initial dose of Antibiotics (all 3 via parenteral route).

4. Assisted deliveries (imminent breech delivery).

5. Removal of retained products of conception.

6. Manual removal of retained placenta.

RA 9288: Newborn Screening Act of 2004

By 2030, all Filipino newborns are screened; Strengthen quality service and intensify monitoring and evaluation of NBS implementation; Sustainable financial scheme; Strengthen patient management.