MODULE 3:The Philippine Health Care Delivery System, National Objectives for Health, DOH Programmes

health system

* consists of all the organizations, institutions, resources and people whose primary purpose is to improve health.
* delivers preventive, promotive, curative and rehabilitative interventions through a combination of public health actions and the pyramid of health care facilities that deliver personal health care — by both State and non-State actors

building blocks of a health system

1. Service delivery
2. Health workforce
3. Health information systems
4. Access to essential medicines
5. Financing
6. Leadership/governance

Philippine health system

* is characterized as a dual health system composed of the public sector and the private sector.
* Public sector - largely financed through a tax-based budgeting system, where health services are delivered by government facilities run by the National and local governments.
* Private sector - consisting of for-profit and nonprofit health- care providers, is largely market-oriented where health care is generally paid for through user fees at the point of service (Department of Health, 2005)

Health

* a basic human right is enshrined in the 1987 Philippine Constitution (Article II, Section 15), which declares “the State shall protect and promote the right to health of the people and instill health consciousness among them”

The Public Sector

* Both the national government and LGUs manage the delivery of promotive, preventive, curative and rehabilitative health services.
* The DOH supervises the government corporate hospitals, specialty and regional hospitals while the Department of National Defense (DND) runs the military hospitals.

The Private Sector

* caters to only about 30 percent of the population but is far larger than the public system in terms of financial resources and staff (Oxford Business Group, 2018).
* It provides healthcare that is generally paid through user fees at point of service. About 65 percent of the 1,224 hospitals in the country in 2016 were private (DOH- HFSRB, 2016)
* consists of clinics, infirmaries, laboratories, hospitals, drugstores, pharmaceutical and medical supply companies, health insurance companies, academic and research institutions involved in health and other service providers that include traditional healers (herbolarios) and traditional birth attendants (hilots).

National Health Insurance Act of 1995

* created the Philippine Health Insurance Corporation (PhilHealth) to provide health insurance coverage for all Filipinos but enrolment was not made compulsory. In 2013, it was amended, expanding the contribution based national health insurance program (NHIP) beyond formal employment to include the underprivileged, sick, elderly, persons with disabilities (PWDs) and women and children.
* PhilHealth serves as the national social health insurance agency which purchases services from public and private providers on behalf of its members. However, healthcare provision, health regulation, facility improvements and human resource deployment as well as capacitation are still subsidized by the government, mainly through the DOH.

National Objectives for Health (NOH) 2017–2022

* serves as the medium-term roadmap of the Philippines towards achieving universal healthcare (UHC)
* It specifies the objectives, strategies and targets of the Department of Health (DOH) FOURmula One Plus for Health (F1 Plus for Health) built along the health system pillars of financing, service delivery, regulation, governance and performance accountability.

purpose of the National Objectives for Health:

the DOH hopes to ensure uniform understanding of the F1 Plus for Health and guide agencies, local government units (LGUs) and other stakeholders in translating medium-term health policy directions, strategies and benchmarks into concrete programs and projects that will allow all Filipinos, especially the poor, to readily access and use aff ordable quality care, and thereby boosting universal healthcare

three major goals that the Philippine Health Agenda

1. Better health outcomes with no major disparity among population groups;
2. financial risk protection for all especially the poor, marginalized and vulnerable.
3. responsive health system which makes Filipinos feel respected, valued and empowered.

challenges and implications of the current health status of the country

1. Mixed health outcomes
2. Disjointed health system
3. High out of the pocket expenditures

Mixed health outcomes

* The country only had modest gains in selected health outcome indicators and weak performance in others. These were not enough to realize the country’s targets in the NOH 2011-2016 and the Millennium Development Goals (MDGs). Availability, accessibility and affordability of quality healthcare have impeded healthcare utilization
* The archipelagic nature of the country, uneven distribution of its population and the varying levels of economic growth in the regions led to human resource for health maldistribution, with health workers, particularly doctors and nurses, concentrated in more urbanized and economically developed areas.

Disjointed health system

Overlapping and sometimes, conflicting mandates of the DOH and LGUs on health owing to devolution led to the disintegration of the originally integrated referral system that linked public health services and hospital services

High out of the pocket expenditures

More than half of health expenditures remained to be funded by out-of-pocket (OOP) payments despite increased resources for health in recent years

FOURmula One Plus (F1 Plus) for Health

hich aims to provide Universal Health Care (UHC) for all Filipinos in the medium to long term. The national policy on UHC espouses three strategic thrusts: better health outcomes, responsive health system, and equitable and sustainable health financing.

NATIONAL SAFE MOTHERHOOD PROGRAM

* For Filipino women to have full access to health services towards making their pregnancy and delivery safer
* provide rational and responsive policy direction to its local government partners in the delivery of quality maternal and newborn health services with integrity and accountability using proven and innovative approaches

Maternal, Neonatal and Child Health and Nutrition (MNCHN) Service Delivery Network

refers to the network of facilities and providers within a province and (chartered) city health system offering integrated MNCHN services in a coordinated manner, including the supporting financing, communication and transportation systems. Such network includes the BEmONC- CEmONC network (a network of facilities providing emergency obstetric and newborn care) and matches the Inter-Local Health Zone (ILHZ) arrangement.

Basic Emergency Obstetrics and Newborn Care (BEmONC) Provider

is a capable private health facility or an appropriately upgraded public health facility that is either a Rural Health Unit (RHU) and/or its satellite Barangay Health Station (BHS) or Hospital capable of performing the following emergency obstetric functions:


1. parenteral administration of oxytocin in the third stage of labor;
2. parenteral administration of loading dose of anti-convulsants;
3. parenteral administration of initial dose of antibiotics
4. performance of assisted deliveries in imminent breech;
5. removal of retained placental products
6. manual removal of retained placenta.

Comprehensive Emergency Obstetrics and Newborn Care (CEmONC) Provider

* A regional hospital or medical center, either provincial or private, can perform emergency obstetric functions, provide surgical delivery and blood bank transfusion services, and offer specialized neonatal care. It can also provide high volume intra-uterine device (IUD) and voluntary surgical contraception services.


* It is also able to provide emergency neonatal care, which include the minimum:


1. newborn resuscitation;
2. treatment of neonatal sepsis/infection;
3. oxygen support; and,
4. antenatal administration of (maternal) steroids for threatened premature delivery.

UNANG YAKAP (ESSENTIAL NEWBORN CARE: PROTOCOL FOR NEW LIFE)

is a simple cost-effective newborn care intervention that can improve neonatal as well as maternal care. IT is an evidence-based intervention that emphasizes a core sequence of actions, performed methodically (step -by-step); is organized so that essential time bound interventions are not interrupted; and fills a gap for a package of bundled interventions in a guideline format.

Ways:


1. Through drying
2. Properly cord clamp tuned
3. Skin to skin
4. Non separation of new born

NEWBORN SCREENING PROGRAM

* The Newborn Screening Act of 2004 integrated the Philippines into its public health delivery system. The Department of Health (DOH) collaborates with other agencies to ensure early detection and management of congenital metabolic disorders. This service has been part of routine newborn care in developed countries for five decades and is available in the Philippines since 1996.

EXPANDED PROGRAM ON IMMUNIZATION

was established in 1976 to ensure access to routinely recommended vaccines for infants, children, and mothers. In 1986, 21.3% of children under fourteen months were fully immunized, representing 14% of global total mortality in children under five years.

GOAL: to reduce the morbidity and mortality among children against the most common vaccine-preventable diseases

Needed vaccines for immunization

* BCG
* DPT
* Measles
* Hepa
* PCV
* Polio

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

One million children under five die annually in less developed countries due to five common diseases, often malnutrition. The strategy, developed by the World Health Organization and UNICEF, aims to address these conditions and promote child survival and healthy growth. In the Philippines, was started as a pilot in 1996, with more health workers and hospital staff trained.

Objectives of INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

* Reduce death and frequency and severity of illness and disability
* Contribute to improved growth and development

LIFESTYLE-RELATED DISEASES

Non-communicable diseases (NCDs) include cardiovascular conditions (hypertension, stroke), diabetes mellitus, lung/chronic respiratory diseases and a range of cancers which are the top causes of deaths globally and locally. These diseases are considered as lifestyle related and is mostly the result of unhealthy habits. Behavioral and modifiable risk factors like smoking, alcohol abuse, consuming too much fat, salt and sugar and physical inactivity have sparked an epidemic of these NCDs which pose a public threat and economic burden.

NATIONAL FAMILY PLANNING PROGRAM

Vision

For Filipino women and men achieve their desired family size and fulfill the reproductive health and rights for all through universal access to quality family planning information and services.

Mission

In line with the Department of Health FOURmula One Plus strategy and Universal Health Care framework, the National Family Planning Program is committed to provide responsive policy direction and ensure access of Filipinos to medically safe, legal, non-abortifacient, effective, and culturally acceptable modern family planning (FP) methods

NATIONAL TUBERCULOSIS TB CONTROL PROGRAM

Vision \n TB -free Philippines \n Mission \n • To reduce TB burden (TB incidence and TB mortality) \n • To achieve catastrophic cost of TB-affected households \n • To responsively deliver TB service

SMOKING CESSATION PROGRAM

The global tobacco use is a major health issue, with an estimated 1.3 billion smokers and 4.9 million deaths annually. The World Health Organization's 2003 policy recommendation for smoking cessation and treatment of tobacco dependence emphasized the need for adult smokers to quit. Population surveys show that one-third of smokers attempt to quit each year, but only a small percentage achieve lasting abstinence. Support for smoking cessation includes motivation, advice, counseling, telephone and internet support, and appropriate pharmaceutical aids. The Philippine Global Adult Tobacco Survey in 2009 revealed that 28.3% of the population aged 15 and over currently smoke tobacco, with 47.7% being men and 9.0% women. The survey revealed that 21.5% of ever-daily smokers have quit, and 60.6% are interested in quitting. The Department of Health needs to build the capacity of health workers to help smokers quit, and the Tobacco Regulations Act mandates the establishment of withdrawal clinics.

HIV/STI PREVENTION PROGRAM

**Objective:** \n - Reduce the transmission of HIV and STI among the Most At Risk Population and General \n - Population and mitigate its impact at the individual, family, and community level.

MENTAL HEALTH PROGRAM

Mental health is crucial for the achievement of the SDGs, and addressing mental health issues contributes to the attainment of these goals. A comprehensive mental health program, including promotive, preventive, treatment, and rehabilitative services, is implemented at various levels and supported by various government agencies and CSOs.

EMERGING AND RE-EMERGING INFECTIOUS DISEASE PROGRAM

The Philippines is facing numerous outbreaks of emerging infectious diseases, including leptospirosis, dengue, meningococcemia, and tuberculosis, which pose a significant threat to public health. The country faces a need for improved preparedness at local, national, and international levels to prevent future pandemics. Social determinants contributing to these outbreaks include demographics, international travel, socio-economic factors, and environmental factors like urbanization. To address these risks, proactive systems and multi-disciplinary preparedness are needed to mitigate the public's health threats.

Health service delivery

Free of charge by policy to members of community

Primary health

* health promotion\\preventive
* NGO and Rural health unit

Secondary health

* Curative\\disease prevention
* Provincial health service and Emergency hospital

Tertiary health

* rehabilitation
* Rural health unit, community hospital, barangay health service

5 A’s of healthcare delivery system

* acceptable
* Attainable
* Available
* Affordable
* Accessible

Elements of FOURmula 1

* good governance - key player in PH health
* Health financing - Phil health independent
* Health regulation - quality and affordable
* Service department - accessibility and availability of health services

DOH Vision and Mission

Leadership

Advocate

Model

\
Equitable

Sustainable

Quality

For filipinos especially for the poor

National dengue prevention and control program

4’s in dengue prevention

* search and destroy
* Seek immediate consultation
* Support fogging
* Self protection