HIS Shifting

parts of the health system

community, department or ministries of health, health care providers, health service providers, health service organizations, pharmaceutical companies, health financing bodies,

definition of a health system

The combination of resources, organization, financing and management that culminate the delivery of health services to the population”

Goals and Function of Health System

1. Improving the health of populations
2. Improving the responsiveness of the health system to the population it serves
3. Fairness in financial contribution

4 vital health system functions

1. Health service provision
2. Health service inputs
3. Stewardship
4. Health financing

Health service provision

delivering of health services

Health service inputs

assembling of essential resources for delivering health services

Stewardship

The overall system oversight sets the context and policy framework for the overall health system. This function is usually a government responsibility.

Revenue collection

- collection of money to pay for health care services.
- general taxation, donor financing, mandatory payroll contributions
- pooling of funds

Risk pooling

collection and management of financial resources in a way that spreads financial risks from an individual to all pool members

Strategic purchasing

the way most risk-pooling organizations or purchasers use collected and pooled financial resources to finance or buy health care services for their members

WHO health system framework

service delivery, health workforce, information, medical products, vaccines, and technologies, financing, leadership and governance

Service delivery

Those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources

Health workforce

One which works in ways that are responsive, fair, and efficient to achieve the best health outcomes possible, given the available resources and circumstances

Information

One that ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health systems performance, and health status

Medical products, Vaccines, and Technologies

Ensure equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy, and cost- effectiveness, and their scientifically sound and cost-effective use

Financing

Raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them

Leadership and Governance

Involve ensuring strategic policy framework exist and are combined with effective stewardship, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability.

1970

Primary Health Care for All

1979

Adoption of Primary Health Care

1982

Reorganization of DOH

1986

Milk Code 1986

1988

The Generics Act

1991

RA 7160 "Local Government Code"

1995

National Health Insurance Act

1996

Health Sector Reform Agenda

2005

FOURmula One (F1) for Health

2008

RA 9502 “Access to Cheaper and Quality Medicine Act”

2010

AO 2010-0036 “Kalasugang
Pangkalahatan”

2013

Sin Taxes for Health

2019

Universal Health Care Law

Primary Health Care for All

Developed a largely centralized government-funded and operated health care system

Adoption of Primary Health Care

Promoted participatory management of the local health care system

Reorganization of DOH

Integrated public health and hospital services

Milk Code 1986

Prevention and nutrition to promote breastfeeding

The Generics Act

Prescriptions are written using the generic name of the drug in an attempt to lower expenditure on drugs by promoting and purchasing non-branded medicines

RA 7160 "Local Government Code"

Transfer of responsibility of health service provisions to the local government units

National Health Insurance Act

Aims to provide all citizens a mechanism for financial protection with priority given to the poor

Health Sector Reform Agenda

Major organizational restructuring of the DOH to improve the way health care is delivered, regulated, and financed

FOURmula One (F1) for Health

Adoption of operational framework to undertake reforms with speed, precision, and effective coordination

RA 9502 "Access to Cheaper and Quality Medicine Act"

Promotes and ensures access to affordable quality drugs and medicines for all

AO 2010-0036 "Kalusugang Pangkalahatan"

Universal health coverage and access to quality health care for all Filipinos

Sin Taxes for Health

Generating extra revenue for the Department of Heath by discouraging harmful consumption of alcohol and tobacco

Universal Health Care Law

Enrolling all Filipino citizens automatically in the National Health Insurance Program administered by PhilHealth. All Filipinos are guaranteed equitable access to quality and affordable health care services

City Health Office (Chartered Cities)

city hospitals, health centers, barangay health stations

Provincial Health Office

provincial hospitals, inter-local health zones

City Health Office (Component cities)

city hospitals, health centers, barangay health stations

Municipal Health Office

Barangay Health Stations

Provincial hospitals

district hospitals are under:

The Department of Health has the duty in:

1. Developing health policies and programs
2. Enhancing partners’ capacity through technical assistance 3. Leveraging performance for priority health programs
among these partners
4. Developing and enforcing regulatory policies and
standards
5. Providing specific programs that affect large segments of
the population
6. Providing specialized and tertiary level care

Health Care System's Organizational Structure and Accountability

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The Philippine Health Agenda (DOH Administrative Order-2016-0038)

“All for Health Towards Health for All"

The Philippine Developmental Plan 2017-2022

This includes the four key medium-term plans to translate the vision of aspirations for the Filipinos and the country

NEDA AmBisyon Natin 2040

This is a collective long-term plan which envisions a better life for the Filipinos and the country in the next 25 years

Sustainable Development Goals 2030

This is a compilation of 17 developmental goals that targets to end poverty, fight inequality and injustice, and confront issues involving climate change and its effects.

Definition of Primary Health Care

The Declaration of Alma-Ata states that primary health care is essential health care based on scientifically sound and socially acceptable methods, universally accessible to individuals and families with their full participation at a cost that the community and country can afford in a spirit of self-reliance and self-determination

Primary Health Care (PHC)

- is essential health care made universally accessible and acceptable to individuals through full participation and at a cost the community and country can afford.
- It is an approach to health beyond the traditional health care system that focuses on health equity- producing social policy.

Health Care System

It refers to an organized plan of health services

Health Care Delivery

It is the rendering of health care services to the people

Health Care Delivery System

This is the network of health facilities and personnel which carries out the task of rendering health care to the people

Philippine Health Care System

It is a complex set of organizations interacting to provide an array of health services in the Philippines

Key elements to achieving the goal of primary health care

1. Universal coverage to reduce exclusion and social disparities in health
2. service delivery organized around people's needs and expectations
3. public policy that integrates health into all sectors
4. leadership that enhances collaborative models of
policy dialogue
5. increased stakeholder participation

Eight elements of primary-health care (PHC)

1. Education concerning prevailing health problems and the methods of identifying, preventing, and controlling them
2. Locally endemic disease prevention and control
3. Expanded program of immunization against major
infectious diseases
4. Maternal and child health care, including family
planning
5. Essential drugs arrangement
6. Nutritional food supplement, an adequate supply of
safe and basic nutrition
7. Treatment of communicable and non-communicable
disease and promotion of mental health
8. Safe water and sanitation

A health system based on primary health care will:

1. build on the Alma-Ata principles of equity, universal access, community participation, and intersectoral approaches
2. take account of broader population health issues, reflecting and reinforcing public health functions
3. create the conditions for effective provision of services to poor and excluded groups
4. organize integrated and seamless care, linking prevention, acute care, and chronic care across all components of the health system
5. continuously evaluate and strive to improve performance.

Principles of Primary Health Care Objectives

1. Improvement in the level of health care of the community
2. Favorable population growth structure
3. Reduction in the prevalence of preventable, communicable, and other diseases
4. Reduction in morbidity and mortality rates, especially among infants and children
5. Extension of essential health services with priority given to the underserved sectors
6. Improvement in basic sanitation
7. Development of the capability of the community aimed at self-reliance
8. Maximizing the contribution of the other sectors for the social and economic development of the community
9. Equitable distribution of health care
10. Community participation
11. Multi-sectional approach
12. Use of appropriate technology

Health care managers

Usually carry out the functions in the process of management

Planning

• Managers are usually required to set a direction and determine what needs to be accomplished
• It means setting priorities and determining performance targets

Organizing

• Management function on designing the organization or the specific division, unit, or service for which the manager is responsible
• It means designating reporting relationships and intentional patterns of interaction
• Determining positions, teamwork assignments, and distribution of authority and responsibility

Staffing

- Refers to acquiring and retaining human resources
- Developing and maintaing the workforce through various strategies and tactics

Controlling

Refers to monitoring staff activities and performance and taking the appropriate actions for corrective action to increase performance

Directing

Its focus is to initiate action in the organization through effective leadership and motivation of, and communication with, subordinates

Authority

Is a manager’s formal and legitimate right to make decisions, issue orders, and allocate resources to achieve organizationally desired outcomes.

Responsibility

Employee's duty to perform assigned task or activities

Accountability

Those with authority and responsibility must report and justify task outcomes to those above them in the chain of command

Management principles in relation to organizing

authority, responsibility, accountability

types of authority

line, functional, staff

Line authority

• Managers have the formal power to direct and control immediate subordinates
• The superior issues orders and is responsible for the results ---- the subordinate obeys and is responsible only for executing the order according to instructions

Functional authority

Where mangers have formal power over a specific subset of activities

Staff authority

• Is granted to staff specialists in their areas of expertise
• Not a real authority in the sense that a staff manger does not order or instruct but simply advises, recommends and counsels in the staff specialists’ are of expertise

Centralization

is the location of decision-making authority near top organizational levels

Decentralization

is the location of decision-making authority near lower organizational levels

Formalization

is the written documentation used to direct and control employees

Primary function of the Department of Health

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

Vision of DOH

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 of DOH

The mission of DOH, in partnership with the people, is 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

Primary level of health care facilities

Operated by the Department of Health:
Includes rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units

Secondary level of health care facilities

- Smaller, non-departmentalized hospitals
- Includes emergency and regional hospitals
- Services to patients with symptomatic stages of the disease, which require moderately specialized knowledge and technical resources for adequate treatment is offered

Tertiary level of health care facilities

- Medical centers and large hospitals that offer highly technological and sophisticated services
- Specialized national hospitals
- Services rendered at this level are for clients afflicted with diseases that seriously threaten their health and which require highly technical and specialized knowledge, facilities, and personnel for effective treatment

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

Village or Grassroot Health Care Workers

- They are the first contacts of the community and initial links of health care
- These include community health workers, volunteers, and/or traditional birth attendants

Intermediate Level Health Workers

- These workers represent the first source of professional health care
- They provide support to front-line health workers in terms of supervision, training, supplies, and services
- These workers may include medical practitioners, nurses, and midwives

First Line Hospital Personnel

- This set of workers includes physicians with specialty, nurse, dentist, pharmacists, and other health professionals
- They provide backup health services for cases that
require hospitalization
- They establish close contact with intermediate level health workers or village health workers

Health information technology

the area of IT involving the design, development, creation, use, and maintenance of information systems for the healthcare industry.

Electronic health record (EHR)

• The central component of the health IT infrastructure
• A person’s official digital health record and is shared among multiple healthcare providers and agencies

Key elements of the health IT infrastructure

- Personal health record (PHR)
- Health information exchange

Picture archiving and communication systems (PACS) and vendor neutral archives (VNAs)

- Two widely used types of health IT that help healthcare professionals store and manage patients’ medical images.
- Used in radiology, cardiology, and neurology

Health Information Ecosystem

a composition of individuals, systems, and processes that want to share, exchange, and access all forms of health information, including discrete narrative and multimedia

CHITS stands for

Community Health Information Tracking System

CHITS

an electronic model record (EMR)
developed through the collaboration of the Information and Communication Technology community and health workers, primarily designed for use in Philippine health centers in disadvantaged areas

111 government health facilities

CHITS is currently utilized in:

advantages of health informatics in the cloud

- integrated and efficient patient care
- better management of data
- error reduction