NCM 204

Health Care Delivery System

Bevan B. Balbuena, RN, MN

Learning Objectives
At the end of the lesson, the BSN 2 students will:
1. describe the health care delivery system of the country
2. determine the MDG’s and SDG’s as well as the imperatives leading to its
formulation
3. explain DOH mission, vision, major roles, and goals
4. classify the different types of health facilities known in the country based on DOH
AO 2012-0012.
5. discuss the goals, values, guarantees, and strategy of the Philippine Health Agenda
2016-2022; and
6. discuss the essence of Primary Health Care, its goals, essential elements, and
principles.
The Health Care Delivery System

A health care delivery system is an

organization of people, institutions, and
resources to deliver health care services to
meet the health needs of a target population.
 World Health Organization (WHO)
• a specialized agency of the United Nations that provides
global leadership on health matters

• Working with 194 Member States, across six regions, and

from more than 150 offices, WHO staff are united in a
shared commitment to achieve better health for
everyone, everywhere.
• The Constitution of the WHO was adopted by the
International Health Conference held in New York on
June 19 – July 22, 1946 signed by the representatives of
61 States and entered into force on April 7, 1948.

Source: https://www.who/constitution
World Health Organization (WHO) …

Guiding principle: all people should enjoy the highest

standard of health, regardless of race, religion, political
belief, economic or social condition.

Objective of the World Health Organization: the

attainment by all peoples of the highest possible level of
health.

Source: https://www.who.int/about/who-we-are/constitution
WHO remains firmly committed to the principles set out in the preamble to
the Constitution

• Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard of health is one of the

fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition.

• The health of all peoples is fundamental to the attainment of peace and security
and is dependent on the fullest co-operation of individuals and States.

• The achievement of any State in the promotion and protection of health is of

value to all.

• Unequal development in different countries in the promotion of health and control

of diseases, especially communicable disease, is a common danger.
• Healthy development of the child is of basic importance; the ability to live
harmoniously in a changing total environment is essential to such
development.

• The extension to all peoples of the benefits of medical, psychological and

related knowledge is essential to the fullest attainment of health.

Informed opinion and active co-operation on the part of the public are of
the utmost importance in the improvement of the health of the people.

• Governments have a responsibility for the health of their peoples which

can be fulfilled only by the provision of adequate health and social
measures.
 Building blocks
A health system of the health system
consists of all
organizations,
Health
people, and Service Health
information
actions whose delivery workforce
systems
primary intent is
to promote,
restore, or Medical Leadership
maintain health. products,
vaccines & Financing and
technologies governance
 • A common vision of poverty
reduction and sustainable
MILLENIUM development in response to the
DEVELOPMENT global and country health trends.
GOALS
• based on the fundamental values
(MDG) of freedom, equality, solidarity,
tolerance, health, respect for
nature, and shared responsibility.
Imperatives leading to the formulation of
MDGs:
• shift in demographic and epidemiological trends in
disease

• new technologies for healthcare, communication and

information

• existing and emerging environmental hazards

• health norms
 MDGs
1. Eradicate extreme poverty
and hunger
2. Achieve universal primary
education
3. Promote gender equality
and empower women.
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria
& other diseases
7. Ensure environmental
sustainability
8. Develop a global
partnership for
development.
Sustainable
Development
Goals
(SDG)
Philippine Health Care Delivery System

A nation’s health care delivery system has a

tremendous impact on the health and
development of its people.

Health care reforms, demographics,

globalization, poverty and growing disparities,
and social disintegration influence health care
delivery system in the 21st century (Anderson &
McFarlane, 2011 as cited in Famorca, 2013)
Definition:

Health care delivery system is the totality of all policies,

infrastructures, facilities, equipment, product, human
resources, and services that address the health needs,
problems and concerns of the people.
Composed of 2 sectors
a. Public sector
• largely financed through tax-based budgeting system at both
national and local levels and where health care is generally
given free at the point of service

b. Private sector
• largely market-oriented and where health care is paid through
user fees at the point of service
 Department of Health (DOH)

• national government’s biggest health care provider

• exercises regulatory powers of health facilities and products

• takes the lead in the formulation of policies and standards

related to health facilities, health products and health human
resources
 Vision Mission
To guarantee equitable, sustainable, and
The DOH is the quality health for all Filipinos, especially the
leader, staunch poor and shall lead the quest for excellence in
advocate and model health
in promoting • by making services available
HEALTH FOR ALL • by arousing community awareness
in the Philippines • by mobilizing resources
• by promoting the means to better health
 Major Role of DOH

1. Leader in health DOH CORE VALUES

Integrity
2. Enabler and Excellence
capacity builder Compassion and respect
for human dignity
3. Administrator of Commitment
Professionalism
specific services Teamwork
Stewardship of the health
of the people
GOAL
Overriding goal of the DOH is the Health Sector Reform Agenda
(HSRA), the five major reforms of which are:

• provide fiscal autonomy to government hospitals

• secure funding for priority public health programs

• promote the development of local health systems and ensure its

effective performance

• strengthen the capacities of health regulatory agencies

• expand the coverage of the National Health Insurance Program

Framework for Implementation of HSRA

FOURmula ONE for Health (F1)

• It is the strategy for implementing health reforms .

• Spells out the program imperatives of the health sector

• Intends to implement critical interventions as a single
package backed by effective management of infrastructure
and financing arrangements following a sectoral approach
Goals of FOURmula ONE for Health (F1)

• Better health outcomes

• More responsive health systems

• Equitable health care financing

Principles of F1
• Universal access to basic health services must be ensured.

• The health and nutrition of vulnerable groups must be

prioritized.

• The epidemiologic shift from infectious to degenerative

diseases must be managed.

• The performance of the health sector must be enhanced

Goals and Objectives of HSRA
• Improve the general health status of the population.

• Reduce morbidity and mortality from certain diseases

• Eliminate certain diseases as public health problems

• Promote healthy lifestyle and environmental health

• Protect vulnerable groups with special health and nutrition
needs
 Local Health Systems

• A health system at the sub-national level

• The core element of local or district health system is the
integrated primary health care and the first referral
hospital serving a well-defined population (Segall, 2003).

• The inter-local health zone (ILHZ) is the ideal governance

structure for local health system development. It is a
district health system in a devolved setting. It addresses
the problem of fragmentation of the delivery of health
services
Inter-Local Health Zone

Any form of organized arrangement for coordinating the

operations of an array and hierarchy of health providers
and facilities serving a common population within a local
geographic area under the jurisdictions of more than one
local government (DOH, CY 2006)
Composition of an ILHZ
1. Primary Health Care Providers (Barangay Health Station, Rural
Health Unit, health centers, community hospital, private
practitioners, traditional/alternative providers, caregivers,
household

2. Core referral hospital(s): District Hospital or Provincial Hospital

3. End referral hospital(s): Higher level hospitals

Guiding Principles for ILHZs
1. Voluntary actions for mutual benefits

2. Flexible forms of organization

3. Results-oriented

4. Sustained and evolutionary

5. Purposive and developmental

6. Universal and non–partisan
 Devolution of Health Services

RA 7160 - Local Government Code

• one of the significant laws that radically changed the landscape of health care
delivery
• enacted to bring about genuine and meaningful local autonomy
• mandates devolution of basic services from the national government to LGUs

Aim:
• To transform local government units into self-reliant
communities and active partners in the attainment of national
goals through a more responsive and accountable local
government structure instituted through a system of
decentralization
• Devolution – refers to the act by which the national
government confers power and authority upon the various
LGUs to perform specific functions and responsibilities
(Congress of the Phils., 1991)

• 1993- Health services were devolved or transferred from

the DOH to the LGU - all provincial, district and municipal
hospitals to the provincial governments and the rural
health units (RHUs) and barangay health stations (BHSs) to
the municipal governments.
 LEVELS OF HEALTH CARE & REFERRAL SYSTEM

PRIMARY LEVEL OF CARE

• Health services offered at this level are to individuals in fair health

and to patients with diseases in the early symptomatic stage

• Primary care is devolved to the cities and the municipalities.

• It is the health care provided by center physicians, public health

nurses, rural health midwives, BHWs, traditional healers.
SECONDARY LEVEL OF CARE

• Service offered to patients with symptomatic stages of disease which

require moderately specialized knowledge and technical resources for
adequate treatment

• Is given by physicians with basic health training.

• This is usually given in health facilities either owned or government

operated such as infirmaries, municipal, and district hospitals, OPD of
provincial hospitals.
• Capable of performing minor surgeries and perform some simple
laboratory examinations.
TERTIARY LEVEL OF CARE

• Are the highly technological and sophisticated services offered by

medical centers and large hospitals. These are specialized national
hospitals.

• Services are for clients afflicted with diseases which seriously

threaten their health & which require highly technical and specialized
knowledge, facilities and personnel to treat effectively.
Referral
• Referral is a set of activities undertaken by a health care
provider or facility in response to its inability to provide the
necessary the necessary health interventions to satisfy a
patient’s need.
Classification:

• Internal Referral – referral that occurs within the

health facility from one personnel to another.
• External Referral – a movement of a patient from one
health facility to another .
 Classification of Health Facilities
(DOH AO-0012a)

HOSPITALS OTHER HEALTH FACILITIES

General hospital A. Primary Care Facility
• Level 1 B. Custodial Care Facility
• Level 2 C. Diagnostic/ Therapeutic
• Level 3 (teaching/ training) Facility
Specialty hospital D. Specialized Outpatient Facility
Classification of hospitals

General hospitals – provide services for all kinds of illnesses,

injuries or deformities
• Services offered are classified as level 1, level 2 or level 3

Specialty hospital – offers services for a specific disease or

condition or type of patient, such as children, elderly or
women (DOH, 2012a)
 Classification of general hospitals (DOH, 2012)
Hospitals Clinical Services for inpatients Ancillary services
Level 1 Consulting specialists in Medicine, Pedia, OB-Gyne, Surgery Secondary clinical laboratory
Emergency & outpatient services Blood station
Isolation facilities First level X-ray
Surgical/ maternity facilities Pharmacy
Dental clinic
Level 2 Level 1 plus: Tertiary clinical laboratory
Departmentalized clinical services Second-level X-ray with mobile
Respiratory unit unit
General ICU
High-risk pregnancy unit
NICU
Level 3 Level 2 plus: Tertiary clinical laboratory with
Teaching/training with accredited residency training program in 4 histopathology
major clinical services Blood bank
Physical medicine and rehabilitation unit Third-level X-ray
Ambulatory surgical unit
Dialysis clinic
 Further Classification:
such as, but no limited to the ff.
Laboratory Facility Clinical Laboratory
HIV Testing Center
Blood Service Facility
Drug Testing Laboratory
Newborn Screening Laboratory
Laboratory for drinking water analysis

Radiologic Facility X-ray, CT scan, Mammography, MRI, ultrasonography

Nuclear Medicine a facility regulated by the Philippine Nuclear Research

facility Institute utilizing radioactive materials in diagnosis,
treatment, or medical research.
Classification of other health facilities
(DOH AO 2012-0012)

Category A – Primary care facility

• A first-contact health care facility that offers basic services

including emergency services and provision for normal deliveries

• E.g health center, outpatient clinics, dental clinics, birthing/lying-

in facilities
Classification of other health facilities
(DOH AO 2012-0012)

• Category B – Custodial care facility

• A health facility that provides long-term care, including basic

services like food and shelter, to patients with chronic conditions
requiring ongoing health and nursing care due to impairment and
reduced degree of independence in ADL, and patients in need of
rehabilitation

• E.g. custodial psychiatric facilities, nursing homes

Classification of other health facilities
(DOH AO 2012-0012)

Category C – Diagnostic/therapeutic facility

• A facility for the examination of the human body, specimens from

the human body for diagnosis, treatment of disease, or water or
drinking water analysis.

• E.g. Laboratory, radiologic, & nuclear medicine facility

Classification of other health facilities
(DOH AO 2012-0012)

Category D – Specialized outpatient facility

• A facility that performs highly specialized procedures on an

outpatient basis

• E.g. dialysis clinic, ambulatory surgical clinic, cancer

chemotherapeutic center, cancer radiation facility
 Philippine Health Agenda 2010-2022
Government efforts to bring about health sector reforms

• Health Sector Reform Agenda (1999-2004)

• FOURmula One for Health (2005-2010)

• Universal Health Care/ Aquino Health Agenda (2010-2015)

• Philippine Health Agenda (2010-2022)

 Primary Health Care (PHC)

1.Brief History
2.Legal Basis
3.Definition
4.Goals
5.Elements
6.Principles and Strategies
Brief History of PHC
❑ May 30, 1977 World Health Assembly decided that the main health target
of the government and WHO is the attainment of a level of health that
would permit them to lead a socially and economically productive life by
the year 2000.
❑ September 6-12, 1978 – First International Conference on PHC in Alma
Ata, Russia (USSR)
❑ Initiated by WHO and United Nations Children’s Fund (UNICEF)
❑ The Alma Ata Declaration stated that PHC was the key to attain the
“health for all” goal
 Alma Ata declaration on Primary Health Care

• Health is a basic fundamental right

• There exists a global burden of health
inequalities among populations
• Economic and social development is of basic
importance for the attainment of health for
all
• Governments have a responsibility for the
health of their people
Legal Basis

• October 19, 1979 – Letter of Instruction (LOI) 949, the

legal basis of PHC was signed by Pres. Ferdinand E.
Marcos,

• LOI 949 adopted PHC as an approach towards the design,

development and implementation of programs focusing
on health development at the community level.
Definition

PRIMARY HEALTH CARE is an essential health care

made universally accessible to individuals and families
in the community by means acceptable to them, through
their full participation and at a cost that the community
can afford at every stage of development. (WHO)
 HEALTH FOR ALL FILIPINOS by the
year 2000 and
HEALTH IN THE HANDS OF THE MAIN OBJECTIVES

Goals PEOPLE by the year 2020. • Promotion of healthy

of lifestyles
PHC An improved state of health and • Prevention of diseases
quality of life for all people
• Therapy for existing
attained through SELF RELIANCE.
conditions
 Education for Health

Locally Endemic Disease Control

Expanded Program on Immunization

Elements
of Maternal and Child Health and Family Planning

Primary Environmental Sanitation and Promotion of

Health Safe Water Supply

Care Nutrition and Promotion of Adequate Food

Supply

Treatment of Communicable Diseases and

Common Illnesses

Supply of Essential Drugs

 Principles of PHC
1. 4 A’s = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services.
2. Community Participation
3. People are the center, object and subject of
development.
4. Self-reliance
Principles…
5. Partnership between the community and the health
agencies in the provision of quality of life.
6. Recognition of interrelationship between the health and
development
7. Social Mobilization
8. Decentralization
9. Equitable distribution of resources
10. Appropriate technology
Principles
9. Equitable distribution of resources
• PHC advocates for care that is community based and
preventive in orientation
Two Programs of DOH to ensure distribution of
manpower to the rural areas

• Doctor to the Barrios (DTTB) Program – DTTB volunteers

are fielded to manage the RHU of 5th or 6th class
municipalities for 2 years and have the option to be absorbed
with competitive compensation by the DOH and LGU

• Registered Nurses Health Enhancement and Local Service

(RN HEALS) – deployment of nurses for 1 year to address the
inadequate nursing workforce in rural communities
10. Appropriate technology
• People’s technology or Indigenous technology

Criteria:
• Safety
• Effectiveness
• Affordability
• Simplicity
• Acceptability
• Feasibility and reliability
• Ecological effects
 Major Strategies of Primary Health Care

• Elevating health to a comprehensive and sustained

national effort.
• Promoting and supporting community managed
health care
• Increasing efficiencies in the health sector
• Advancing essential national health research
 LEVELS OF PREVENTION
Primary Prevention

• relates to activities directed at preventing a problem before it

occurs by altering susceptibility or reducing exposure for
susceptible individuals.

• It is consist of 2 elements :
a) general health promotion – good nutrition, adequate shelter, regular
exercise
b) specific protection - eliminate risk factors and includes such measure
immunization, water purification
Secondary Prevention
• refers to the early detection and prompt intervention
during the period of early disease and pathogenesis .

• It is implemented after a problem has begun but before

signs and symptoms appear and targets those population
who have risk factors

Ex. mammography, BP monitoring, mass sputum examination

Tertiary Prevention
• targets the population that experienced disease or injury
and focuses on limitation of disability and rehabilitation .

• Aims are to reduce the effects of disease and injury and

to restore individuals to their optimal level of functioning

Ex. performing insulin injection , referring patient with spinal

cord injury to PT .