WORKIMM 3RDQ

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**HEALTH SYSTEM**

consists of all organizations, people, and actions whose primary intent is to **promote, restore, or maintain health.**

**Health System has 6 building blocks or components**

* Service delivery
* Health workforce
* Information
* Medical products, vaccines, and technologies
* Financing
* Leadership and governance or stewardship

**HEALTH CARE DELIVERY SYSTEM**

refers to the network of health facilities and personnel which carries out the task of **rendering health care** to the people.

**WORLD HEALTH ORGANIZATION (WHO)**

* specialized agency of the United Nations (UN)

Provides global leadership on health matters

***WHO Constitution:***

Its objective is the attainment by all people of the highest possible level of health

***WHO Constitution Core Functions***

1. provide leadership
2. shaping the research agenda
3. setting norms and standards and promoting and monitoring their implementation
4. Articulating ethical and evidence-based policy options
5. Providing technical support, catalyzing change, and building sustainable institutional capacity.

**SDG Goal 3**

**DEPARTMENT OF HEALTH (DOH)**

* The main governing body of health services in the country

**DEPARTMENT OF HEALTH (DOH)**

Provides guidance and technical assistance to LGUs through the Center for Health Development in each of the 17 regions

**DEPARTMENT OF HEALTH (DOH)**

* holds the overall technical authority on health as it is a national health policy-maker and regulatory institution.

DOH’s **3 MAJOR ROLES**

1. **leadership in health;**
2. **enabler and capacity builder;**
3. **administrator of specific services**

private sector

* Composed of for-profit and nonprofit agencies
* Provides all levels of services and accounts for a large segment of health service providers in the country

**Financing of Health Services (3 major groups):**

* Government (National and Local)
* Private Sources
* Social Health Insurance

**PHILIPPINE HEALTH INSURANCE CORPORATION**

Tax-exempt government corporation attached to the DOH for policy coordination and guidance

**DOH Administrative Order 2012-0012**

Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines

ENUMERATE HOSPITALS

1. General

* Level 1
* Level 2
* Level 3(teach/train)

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2. Specialty

enumerate other health facilities (4)

1. Primary Care Facility


2. Custodial Care Facility


3. Diagnostic and \n Therapeutic Facility


4. Specialized Outpatient Facility

**General Hospitals**

Provides services for all kinds of illnesses, injuries or deformities

**Specialty Hospitals**

Offers services for a specific disease or condition or type of patient (children, elderly or women)

**Primary Care Facility**

First-contact health facility that offers basic services including emergency services and provision for normal deliveries

**Custodial Care Facility**

Provides long-term care to patients with chronic conditions requiring ongoing health and nursing care due to impairment and a reduced degree of independence in ADLs, and patients in need of rehabilitation.

**Diagnostic/Therapeutic Facility**

for the examination of the human body, specimens from the human body for the diagnosis, sometimes treatment of disease, or water for drinking water analysis

**Specialized Outpatient Facility**

performs highly specialized procedures on an **outpatient basis**

**LEVEL 1 HOSPITAL**

* Most basic

Cater to patients who need minor care and supervision

**LEVEL 1 HOSPITAL**

* Must include:
* operating room
* post-operative recovery room
* maternity facilities
* Isolation facilities
* Dental Clinic
* Blood Station
* Clinical Laboratory
* Level 1 - Imaging facility
* X-ray
* Pharmacy

**LEVEL 2 HOSPITAL**

* Need for a referral from Level 1
* Contains all the facilities of Level 1

**LEVEL 2 HOSPITAL**

* Additional Facilities:
* ICU for critically ill patients
* NICU (Neonatal intensive care unit)
* HRPU (high risk pregnancy unit)
* Respiratory therapy services
* Specialist doctors for OB-Gyne, pediatric services, medicine, surgery, their subspecialty and ancillary services
* Clinical Laboratory
* Level 2 - Imaging facilities (mobile X-Ray and contrast examination)

**LEVEL 3 HOSPITAL**

* Teaching and/or training hospital
* Contains all the facilities of Level 2

**LEVEL 3 HOSPITAL**

* Specialized Facilities:
* Physical Medicine and Rehabilitation Unit
* Ambulatory Surgical clinic
* Dialysis facility
* Respiratory therapy services
* Blood bank
* Clinical Laboratory
* Level 3 Imaging facility (interventional radiology)

**Level of Hospital**

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

DOH

* responsible for leveling different hospitals

bones

Treatment of a particular **type of illness** \n ***government owned***

\
Philippine Orthopedic Center (FOR WHAT)

Communicable Diseases

Treatment of a particular **type of illness** \n ***government owned***

\
San Lazaro Hospital (FOR WHAT)

Cancer

Treatment of a particular **type of illness** \n ***government owned***

\
Benavides Cancer Institute (FOR WHAT)

Treatment of patients belonging to a **particular group**

* Philippine Children’s Medical Center
* National Children’s Hospital
* National Center for Geriatric Health
* Dr. Jose Fabella Memorial Hospital

\

**THE MANILA HEALTH DEPARTMENT**

The Department is concerned mainly on **promotion of health** and **prevention of diseases** to the Manila constituents with special focus on poor families.

Maternal and Child Health

Communicable Disease Control

 Non Communicable Disease Control

**Health Centers Thrust Program**

Communicable Disease Control

Tuberculosis

Communicable Disease Control

Leprosy

communicable disease control

std

communicable disease control

dengue prevention and control program

non communicable disease control

National Voluntary Blood Donation

RURAL HEALTH UNIT

Commonly known as a ***health center***

RHU

Primary level health care facility in the municipality

RA 7160

This will enable local governments to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals.

LOCAL HEALTH BOARD

* Creations of the:
* Provincial Health Board
* City/Municipal Health Board

**Provincial Governments**

Responsible for administration of provincial and district hospitals

**Municipal and City Governments**

* In charge of the Primary Care
* Rural Health Centers (RHU)
* Satellite Outposts - Barangay Health Stations (BHS)

**Devolution**

Act by which the national government **confers power and authority upon the various LGUs** to perform specific functions and responsibilities.

**Devolution**

* **Advantage: allowed local leaders to have a greater hand in the future of communities**

**Devolution**

**Disadvantage**: fragmentation of the health care delivery system in the Philippines

REFERRAL

Set of activities undertaken by a healthcare provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient’s need

**Functional Referral System**

* Ensures the continuity and completion of health and medical services
* Comprehensive, encompassing, promotive, preventive, curative and rehabilitative care
* Engages all health facilities from the lowest to the highest

**Two-way referral system**

* Movement of a patient from the health center of first contact and the hospital at first referral level.
* When hospital intervention has been completed, the patient is referred back to the health center

**Internal Referral**

Occur within the health facility, from one health personnel to another

**External Referral**

Movement of a patient from one health facility to another

**Vertical**

patient referral may be from a **lower** to a **higher** level of health facility or other way round

**Horizontal**

patient is referred between **similar facilities** in **different catchment areas**

**COMMUNITY**

* collection of people who interact with one another
* group of people who share something in common and interact with one another

**Community Immersion**

Implementation of intervention program to that identified problems in the community setting

**REHABILITATION SETTING**

* The world class and state of the art laboratory and classroom designed for Speech-Language
* Autism (person will special needs, person with disability)

**Psychosocial**

**past experiences**

**Neurologic**

**dysfunction**

RIGHTS

* what is just, reasonable, what is due, what ought to be, or what is justifiable
* a moral power or claim to do, to possess or receive from others as belonging or due to a moral agent
* a moral claim over something that has basis in the nature of a man that is, his being rational being called to pursue a higher vocation 

PATIENT’S RIGHTS

claims that patients may demand in order to promote their natural striving or advancement to health for as long as they are essentially life-saving

RIGHT TO APPROPRIATE MEDICAL CARE AND HUMANE TREATMENT

* without any discrimination and within the limits of the resources, manpower and competence available for health and medical care at the relevant time.

RIGHT TO APPROPRIATE MEDICAL CARE AND HUMANE TREATMENT

* If immediate treatment cannot be given, the patient needs to be referred or sent for treatment elsewhere, where the appropriate care can be provided.

RIGHT TO APPROPRIATE MEDICAL CARE AND HUMANE TREATMENT

* No deposit, pledge, mortgage or any form of advance payment for treatment during an emergency situation.


* hindi dapat nauuna ang pera kesa sa service.

. RIGHT TO INFORMED CONSENT

* The right to a **clear, truthful and substantial explanation,** in a manner and language understandable to the patient the ff:


1. proposed procedures, whether diagnostic, preventive curative, rehabilitative or therapeutic.
2. the person who will perform the said procedure shall provide his name and credentials to the patient.
3. possibilities of any risk of mortality or serious side effects
4. problems related to recuperation and probability of success and reasonable risks involved.

* Nature of Treatment
* Alternatives 
* Plan A, Plan B


* Benefits
* Opportunity for questions
* Risks

**Key aspects of informed consent**

RIGHT TO PRIVACY AND CONFIDENTIALITY

* freedom from __unwarranted public exposure__, *except* in the following cases:


1. when his mental or physical condition is in controversy and the appropriate court, in its discretion, order him to submit to a physical or mental examination by a physician; 
2. when the public health and safety so demand; and
3. when the patient waives this right in writing.

1. **will benefit public health and safety;**
2. when it is in the **interest of justice** and upon the **order of a competent court**; and 
3. when the **patients waives in writing the confidential nature of such information**;
4. when it is needed for **continued medical treatment or advancement of medical science** subject to de-identification of patient and shared medical confidentiality for those who have access to the information

__**When to disclose information?**__

RIGHT TO INFORMATION

RIGHT TO INFORMATION

* result of the evaluation of the nature and extent of his/her disease,
* any other additional or further contemplated medical treatment on surgical procedure/s;
* including any other additional medicines to be administered and their generic counterpart including the possible complications and other pertinent facts;
* statistics or studies regarding his/her illness;
* any change in the plan of care before the change is made

RIGHT TO INFORMATION

* the person’s participation in the plan of care and necessary changes before its implementation;
* The extent to which payment may be expected from Philhealth or any payor and any charges for which the patient may be liable;

RIGHT TO CHOOSE HEALTH CARE PROVIDER AND FACILITY

* freedom to choose the health care provider to serve him as well as the facility, **except** when he is under the care of a service facility or when public health and safety so demands or when the **patient expressly waives this right** in writing.

RIGHT TO CHOOSE HEALTH CARE PROVIDER AND FACILITY

the right to seek a second opinion and subsequent opinions, if appropriate, from another health care provider/practitioner

RIGHT TO SELF-DETERMINATION

* The right to avail of any recommended diagnostic and treatment procedures
* Any person of **legal** age and of **sound mind** may make an **advance written directive** for physicians to administer terminal care when he/she suffers from the terminal phase of a terminal illness.

RIGHT TO RELIGIOUS BELIEF

* right to refuse medical treatment or procedures which may be contrary to his religious beliefs, subject to the limitations such as:

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Provided, that such a right shall not be imposed by parents upon their children who have not reached the legal age in a life threatening situation as determined by the attending physician or the medical director of the facility.

RIGHT TO MEDICAL RECORDS

* Entitled to a summary of his medical history and condition.

RIGHT TO LEAVE

* Right to leave the hospital or any other health care institution regardless of his physical condition

1. INFORMED OF THE MEDICAL CONSEQUENCES
2. Releases those involved in his/her care from any obligation relative to the consequences of his decision;
3. his decision will not prejudice public health and safety (ex. COVID - walang right to leave)

Right to leave the hospital or any other health care institution regardless of his physical condition, provided that:

RIGHT TO REFUSE PARTICIPATION IN MEDICAL RESEARCH

right to be advised if the health care provider plans to involve him in medical research, including but not limited to human experimentation which may be performed only with the written informed consent of the patient

RIGHT TO CORRESPONDENCE AND RECEIVE VISITORS

The right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution.

RIGHT TO EXPRESS GRIEVANCES

The right to express complaints and grievances about the care and services received without fear of discrimination or reprisal and to know about the disposition of such complaints.

 **COMMUNICATION**

Any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including health professions and other disciplines

SENDER

* a person or group who wishes to communicate a message to another, can be considered the source-encoder.

MESSAGE

What is actually said or written

RECEIVER

* The third component of the communication process, is the listener, who must listen, observe and attend
* DECODER

FEEDBACK

* can be either verbal, nonverbal, or both. 
* allows the sender to correct or reword a message.

VERBAL

uses the spoken or written word;

**Nonverbal**

communication uses other forms, such as gestures or facial expressions, and touch.

**Nonverbal**

sometimes called **body language**, includes gestures, body movements, use of touch, and physical appearance, including adornment.

requires a systematic assessment of the person’s overall physical appearance, posture, gait, facial expressions, and gestures.

To observe nonverbal behavior efficiently

**PERSONAL APPEARANCE**

* Clothing and adornments can be sources of information about a person.
* Although choice of apparel is highly personal, it may convey social and financial status, culture, religion, group association, and self-concept.

**POSTURE AND GAIT**

The ways people walk and carry themselves are often reliable indicators of self-concept, current mood, and health

FACIAL EXPRESSION

* No part of the body is as expressive as the face.
* Feelings of surprise, fear, anger, disgust, happiness, and sadness

GESTURES

* Hand and body gestures may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign.

GESTURES

A father awaiting information about his daughter in surgery may wring his hands, tap his foot, pick at his nails, or pace back and forth.

**THERAPEUTIC COMMUNICATION**

Requires the use of verbal and non verbal techniques that are focused on client needs.