Philippine Health Situation

OVERVIEW OF THE PHILIPPINEHEALTH SYSTEM

World Health Organization(WHO): “a health system is composed of all

activities whose primary purpose is to promote, restore or maintain health”.

composed of: health care institutions, supporting human resources, financing mechanisms, information systems, organizational structures

- Link together and collectively culminate in the delivery of health services to patients.

Dual health system Public health sector - largely financed through

taxes, allowing services to be given for free or following socialized user charges;

Private sector – largely market-oriented utilizes user fees to finance health services.

Devolution of health services under the Local Government Code of 1991, health services provided by the public sector became

shared by the Department of Health (DOH) and the local government units (LGUs).

DOH responsible for the development and implementation of

national policies and plans, regulations, standards and guidelines on health,

innovation of strategies in health to improve the effectiveness of health programs.

acts as the administrator of national health facilities, and sub-national health facilities

provides services for emergent health concerns that require complicated new technologies deemed necessary for public welfare upon the direction of the President of the Philippines and in consultation with the LGUs concerned.

Local Government Units (LGUs) assume primary responsibility over the

delivery of health services provision of health facilities devolved to them.

DOH in coordination with LGUs -design and instill mechanisms providing for an

integrated and comprehensive approach to health care delivery among LGUs, through the referral system and the networking of local health agencies.

FOURmula ONE for Health (F1) known as Sector Development Approach

for Health (SDAH) The DOH and SDAH partnership:

stimulate LGU participation to adopt F1 and national priorities in their respective localities such as: advocacy on the economic and socio-political

advantages of instituting health reforms, provision of incentives and forging

performance-based agreements between the national and local governments among others.

Goals of the Philippine Health System

Better Health OutcomesMain purpose :

to ensure that the health status of the people are as good as possible throughout their lifecycle by the appropriate use and adequate provision of health care.

More Responsive Health System Meet the expectations of the population it is

serving. Attending to the people’s expectation of how

they should be treated by the health service providers.

Focused on the client centeredness of health care. This includes the patients’ and their families’ right for choice, respect, dignity, confidentiality and quality health care.

Provide patients and their families greater public satisfaction in the overall performance of the health system.

Equitable Health Care FinancingFinancial risks are distributed in a population

based on an individual’s capacity to pay rather than his or her risk of illness.

Should ensure that an individual or family will not be forced into poverty due to the payment of health care or prohibited to avail of health care because of costs.

Financial risk protection is provided by risk spreading strategy wherein revenues from people are pooled and utilized for the payment of those who get sick.

Health Status of the Filipinos

Life Expectancy at Birth, Crude Birth Rate and Crude Death Rate are Improving

Average life expectancy at birth : 70.5 years in 2005. may be attributed to the improving health

status of the people and other socio-economic factors.

Crude birth rate (1980-2004) - decreased from 30.2 to 20.5 births per 1,000 population,

Crude death rate - decreased from 6.2 to 4.8 deaths per 1,000 population (Philippine Health Statistics, 2004).

Figure 1. Life Expectancy at Birth by Sex and by YearPhilippines, 1995-2005

58

60

62

64

66

68

70

72

74

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Male FemaleCalendarYears

Source: Philippine Statistical Yearbook, 2007

Figure 1. Life Expectancy at Birth by Sex and by YearPhilippines, 1995-2005

58

60

62

64

66

68

70

72

74

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Male FemaleCalendarYears

Source: Philippine Statistical Yearbook, 2007

Leading Causes of Morbidity

The leading causes of morbidity from infectious causes: acute lower respiratory tract infection

and pneumonia, bronchitis/bronchiolitis, acute watery diarrhea, influenza, pulmonary tuberculosis, acute febrile illness, malaria, chicken

pox, measles and dengue fever from 1996 to 2006.

Morbidity rates of these diseases have been observed to be declining over the last couple of years.

Leading causes of morbidity from non-communicable diseases h are hypertension and diseases of the heart.

Malaria is still the most common and persistent mosquito-borne infection in the country and drug resistant cases are on the rise.

Leading Causes of Mortality

Non-communicable diseases are responsible for majority of deaths in the country. Disease of the heart and malignant

neoplasm which comprise more than a third of the total causes of deaths.

Deaths from accidents doubled from 21.5 per 100,000 population in 1994 to 41.3 per 100,000 population in 2004 (Philippine Health Statistics, 2004).

Deaths caused by communicable diseases have been reduced by more than half in the

last twenty years. evident in the decrease of pneumonia deaths

from 86.4 per 100,000 population in 1984 to 38.4 per 100,000 population in 2004, a 55.5% reduction (Philippine Health Statistics, 2004).

Deaths from all forms of tuberculosis have also decreased by 40% in the last two decades Due to more aggressive disease prevention

and control efforts of the government and improvements in curative care.

Figure 2. Mortality Trends of Communicable Diseases, Malignant Neoplasm and Diseases of the Heart per 100,000 Population

Philippines, 1953-2004Source: Philippine Health Statistics, 2004

0

100

200

300

400

500

600

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

0

10

20

30

40

50

60

70

80

90

100

CommunicableDiseases

Malignant Neoplasm

Diseases of the HeartYears

Communicable Diseases

Malignant Neoplasm

Diseases of the Heart

Figure 2. Mortality Trends of Communicable Diseases, Malignant Neoplasm and Diseases of the Heart per 100,000 Population

Philippines, 1953-2004Source: Philippine Health Statistics, 2004

0

100

200

300

400

500

600

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

0

10

20

30

40

50

60

70

80

90

100

CommunicableDiseases

Malignant Neoplasm

Diseases of the HeartYears

Communicable Diseases

Malignant Neoplasm

Diseases of the Heart

Infant, Under-Five and Maternal Mortality

IMR and under-five mortality rate (UFMR) per 1,000 livebirths in the Philippines have been declining through the years, but the rate of decline has slowed down during the 1990s.

The IMR was estimated at 30 infant deaths per 1,000 livebirths in 1993 then decreased to 24 per 1,000 live births in 1996 (National Demographic Survey, 1993 and Family Planning Survey, 2006).

The three most common causes of infant deaths:pneumonia, bacterial sepsis, and disorders related to short gestation and low

birth weight. UFMR was estimated at 64 deaths per 1,000

livebirths in 1993 then declined to 24 per 1,000 livebirths in 2006. Most common causes of under-five mortality

are pneumonia, accidents, and diarrhea

Figure 3. Trends in Infant and Under-Five Mortality RatesPhilippines, 1993-2006

Source: National Demographic Survey, 1993; National Demographic and Health Survey, 1998 and 2003 and Family Planning Survey 2006

64

38

48

3540

29 32

24

0

10

20

30

40

50

60

70

1993 NDS 1998 NDHS 2003 NDHS 2006 FPS

Under-Five Mortality Rate Infant Mortality RateYears

Figure 3. Trends in Infant and Under-Five Mortality RatesPhilippines, 1993-2006

Source: National Demographic Survey, 1993; National Demographic and Health Survey, 1998 and 2003 and Family Planning Survey 2006

64

38

48

3540

29 32

24

0

10

20

30

40

50

60

70

1993 NDS 1998 NDHS 2003 NDHS 2006 FPS

Under-Five Mortality Rate Infant Mortality RateYears

Maternal MortalityFourteen percent of all deaths in women

aged 15-49 years are maternal deaths. The country’s maternal mortality ratio

(MMR) was estimated at 209 per 100,000 livebirths between 1987 and 1993 (National Demographic and Health Survey, 1993).

This improved to 162 per 100,000 livebirths in 2006 (Family Planning Survey, 2006).

Maternal deaths are mainly due to hypertension, postpartum hemorrhage and complications from abortions.

Figure 4. Trends in Maternal Mortality RatioPhilippines, 1993-2006

Source: National Demographic and Health Survey, 1993 and 1998 and Family Planning Survey, 2006

209

172162

0

50

100

150

200

250

1993 NDHS 1998 NDHS 2006 FPS

Year

Mat

erna

l Mor

talit

y R

atio

per

100

,000

live

birt

hsFigure 4. Trends in Maternal Mortality Ratio

Philippines, 1993-2006Source: National Demographic and Health Survey, 1993 and 1998 and

Family Planning Survey, 2006

209

172162

0

50

100

150

200

250

1993 NDHS 1998 NDHS 2006 FPS

Year

Mat

erna

l Mor

talit

y R

atio

per

100

,000

live

birt

hs

Figure 5. Infant Mortality Rates, Philippines and Regions, 2006

Source: Field Health Service Information System 2006, Department of Health, Philippines, 2006

4.47.4

5.212.9

8.28.9

11.56.7

11.210.6

11.57.5

5.16.5

10.610.1

21.710

0 5 10 15 20 25

ARMMCarag

XIIXIX

IXVIIIVIIVIV

IV-BIV-A

IIIIII

CARNCR

Philip

Figure 5. Infant Mortality Rates, Philippines and Regions, 2006

Source: Field Health Service Information System 2006, Department of Health, Philippines, 2006

4.47.4

5.212.9

8.28.9

11.56.7

11.210.6

11.57.5

5.16.5

10.610.1

21.710

0 5 10 15 20 25

ARMMCarag

XIIXIX

IXVIIIVIIVIV

IV-BIV-A

IIIIII

CARNCR

Philip

Figure 6. Maternal Mortality Rates, Philippines and Regions, 2006

Source: Field Health Service Information System 2006, Department of Health, Philippines, 2006

1.311.18

0.61.04

0.750.69

0.930.47

0.891.19

0.960.32

0.220.62

0.380.63

0.370.63

0 0.2 0.4 0.6 0.8 1 1.2 1.4

ARMM

Caraga

XII

XI

X

IX

VIII

VII

VI

V

IV-B

IV-A

III

II

I

CAR

NCR

Philippines

Figure 6. Maternal Mortality Rates, Philippines and Regions, 2006

Source: Field Health Service Information System 2006, Department of Health, Philippines, 2006

1.311.18

0.61.04

0.750.69

0.930.47

0.891.19

0.960.32

0.220.62

0.380.63

0.370.63

0 0.2 0.4 0.6 0.8 1 1.2 1.4

ARMM

Caraga

XII

XI

X

IX

VIII

VII

VI

V

IV-B

IV-A

III

II

I

CAR

NCR

Philippines

Disasters and Emerging/ Re-emerging Illness

The Philippines, being in the so-called Circum-Pacific belt of fire and typhoon, has always been subjected to:constant disasters and calamities such as

floods, typhoons, tornadoes, earthquakes, tsunamis, volcanic eruptions, drought, and flashfloods.

Man-made disasters such as land, air and sea disasters, civil and armed conflict also take their toll in lives and properties.

The country is also threatened by emerging and resurgent diseases.

Emerging infectious diseases:severe acute respiratory syndrome (SARS) 

Re-emerging infections are secondary to the reappearance of a previously eliminated infection or an unexpected increase in the number of a previously known infectious diseases:avian influenzamad cow diseasemeningococcemia

Responsiveness of the Philippine Health System

The responsiveness of the hospital inpatient and ambulatory health care services in the Philippines is generally acceptable as shown by the result of the World Health Survey in 2000.

There were less than half of the clients who rated with poor responsiveness the hospital in-patient care and ambulatory health services in the domains of the followingbeing provided prompt attention, respect for dignity, autonomy, privacy and confidentiality of records and availability of basic amenities and social support.

Satisfaction with the Health System In 2000, the Filipino Report Card on Pro-Poor

Services showed that there was a high level of overall satisfaction with health facilities. Satisfaction was significantly higher for private facilities than government facilities.

Profit hospitals were rated +96, Government hospitals were rated +79, Rural health units (RHUs) were rated +82

and Barangay health stations (BHS) were given a

rating of +74.

Although in the same survey, government hospitals got higher ratings from the rural households and those from the lower socio-economic class.

Private facilities when compared to government facilities ranked superior on quality aspects, at par on convenience of location but inferior on cost aspects.

Cost was the only categorical advantage of government facilities over private facilities.

Health services provided by public facilities were used mainly by those who could not afford the widely preferred private services.

Equity in Health Care Financing

In 2005, a total of P180.8 billion was spent on health related expenditures which is equivalent to 3.1% of the Gross National Product (GNP) in 2005.

59.1% or P106.9 billion was taken from private sources which include out-of-pocket, private insurance, health maintenance organizations, employee-based plans and private schools.

48.4% or P87.5 billion is primarily from out-of pocket which means that the burden of paying for health care is still predominantly shouldered by individual families instead of the government or insurance.

National and local governments spent a total of P51.9 billion, or 28.7% of total health expenditures, while social health insurance paid P19.9 billion or 11%. Other sources accounted for 1.2% or P2.1 billion

Figure 7. Distribution of Health Expenditure by Source of Funds

Philippines, 2005Source: Philippine National Health Accounts, 2005

Private Sources59.1%

Others1.2%

Local Government

12.87%

National Government

15.84%

Social Health Insurance

11.0%

Figure 7. Distribution of Health Expenditure by Source of Funds

Philippines, 2005Source: Philippine National Health Accounts, 2005

Private Sources59.1%

Others1.2%

Local Government

12.87%

National Government

15.84%

Social Health Insurance

11.0%

On the average, families spend only 1.9% of their annual family expenditures on health care, based on a survey conducted in 2000.

The average health expenditure amount of a family then was roughly P2,660 and ranged from P572 to P4,430. 46.4% was spent on drugs and medicines, 24.1% on hospital room charges, 21.7% on medical charges including the

doctors’ fees, 3.5% on medical goods, and 4.3% on combined expenses for dental charges,

contraceptives, and other health services.

Figure 8. Family Expenditure on Health by CategoryPhilippines, 2000

Source: Family Income and Expenditure Survey, 2000

Drugs and medicines46.4%

Expenses for dental charges,

contraceptives and other health services

4.3%

Other medical charges

3.5%

Medical charges21.7%

Hospital room charges24.1%

Drugs and medicines

46.4 %

Figure 8. Family Expenditure on Health by CategoryPhilippines, 2000

Source: Family Income and Expenditure Survey, 2000

Drugs and medicines46.4%

Expenses for dental charges,

contraceptives and other health services

4.3%

Other medical charges

3.5%

Medical charges21.7%

Hospital room charges24.1%

Drugs and medicines

46.4 %

Challenges of the Philippine Health System

Accessibility and quality of health products, facilities and services.

Access to cheaper but quality drugs and medicine is poor. In 2003, the Philippine pharmaceutical

market was estimated to be P65 to 70 billion and accounted for roughly 45% of health spending.

Despite the large pharmaceutical market, local drug prices are 2 to 30 times higher than in Canada or neighboring Asian countries. because of low cost quality generic medicines

comprise only 15 to 20 percent of the market while the rest are dominated by high-priced branded medicines.

drug distribution is controlled by a few big distributors, mostly private drugstores;

85% of all drugs sold in the country are dispensed from these private pharmacies.

Access to health facilities and health professional is also poor. In 2003, around 60% of all births were

attended by a trained health professional in a health facility

the rest were delivered by hilots or unlicensed midwives and other untrained attendants (NDHS 2003).

In the same year, around 34 out of 100 deaths from all causes and around 65% of deaths from certain conditions originating in the perinatal period were attended by a medical or health professional (PHS 2003).

Government primary health facilities are conveniently located as 94% of households are within 15-minute walking distance to a Rural Health Unit (RHU) or Barangay Health Station (BHS).

However, these facilities were frequently bypassed resulting in overcrowding of higher level facilities that are supposed to be reserved for more specialized care.

On health facility utilization, the Filipino Report Card on Pro-Poor Services in 2000 showed that 77% of households surveyed used health facilities of one type or another .

Urban households tend to use health facility services more compared to rural households.

Government facilities were more frequented than private facilities due to the cheaper cost of health services being offered.

Those who used the private facilities were predominantly rich households and urban respondents, although poor respondents reported using private facilities as well.

THANK YOU