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THEPHILIPPINE
CHAPTER II
HEALTH CARE
DELIVERYSYSTEM
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HEALTH CARE SYSTEM
Is the totality of service offeredby all health disciplines.
system was to provide care to illand injured.
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MAJOR PLAYERS:
PUBLIC SECTORWhich is largely finance through
both national and local levels.And were Health care is generally
given free at the point of service.
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Consist:
National and Local government agenciesproviding health services. It also contains
prov nc a ea eams ma e up orepresentatives to the local health boardsand personnel.
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PRIVATE SECTORLargely market oriented
and where Health care ispaid through user fees at
the point of service.
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Consists:
For profit and non-profit health providers. Itincludes providing health services in clinics andhos itals health insurance manufacture of
medicine, vaccine, medical supplies, equipmentand other health and nutrition products, researchand development, human resource development
and other health related services.
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stor ca
Backgroundof DOH
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Pre-spanish and spanish periods
Traditional health care practices specially theused of herbs and rituals for healing were widelypracticed during this period.
JUNE 23,1898- the DPWEH was created byvirtue of a decree signed by president EmilioAguinaldo.
SEPTEMBER 29,1898- With the primaryobjective of protecting the health of Americansoldiers Gen. Orders No.15 established theboard of health for city of Manila.
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JUNE 1,1901- Board of health for the Philippine
Islands was crated through Act No. 157.Thisfunctioned as the local health board of Manila.
OCT.26,1905- The insular board of health
proved to be inefficient operationally so it wasabolished and was replaced by the Bureau ofhealth under the Department of Interior through
.
1912- Act No. 2156 known as Fajardo Act,consolidated the municipalities into sanitarydivision and established as the Health Fund for
travel and salaries
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1915- Act No.2468 transformed the Bureau of
health into a commissioned service called ThePhilippine Health Service.
AUG.2,1916- The passage of the Jones Lawalso known as the Philippine Autonomy Act,filipino struggle for Philippine Independencefrom the American rule.
- .Reorganization Act. Of 1932, reverted back thePhilippine service into Bureau of Health, andcombined the Bureau of public welfare.
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PHILIPPINE COMMONWEALTH AND
JAPANESE OCCUPATION MAY31,1939- Commonwealth Act No.430
created the Department Health and Welfare butthe full implementation was only completedthrough the Exe. Order No.317
1942- During Japanese occupation, various
welfare were instituted and lasted untilAmericans came.
OCT4,1947- Exe. Order No. 94 provided for the
post-war reorganization of the DOH and publicwelfare
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JAN.1,1951- The office of the president of the
sanitary district was converted into RHU,carrying out 7 basic health services:
Mother and Child Services
Environmental Health Communicable disease control
Vital Statistics
Medical Care Health Education
Public Health Nursing
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FEB.20,1958- Exe. Order No. 228 Provided for
what is prescribed as the most sweepingreorganization in the history of DOH.
1970- The RHCDS was conceptualized.
Classified Health services into primary,secondary and tertiary level of care.
JUNE 2,1978-With the proclamation of Martial
Law, Pres. Decree 1397 renamed the DOH toMOH.
DEC.2,1982- Exe. Order No. 851 signed by
president Ferdinand Marcos reorganized theministry of health as an integrated HCDS.
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APR.13,1987- Exe. Order No. 119
Reorganizing the ministry of health bypresident Aquino saw in major change in thestructure of the ministry. Transformed the MOHback to DOH.
OCT.10, 1991- R.A. 7160 known as the LGCprovided for the decentralization of the entire
.the role and functions of DOH.
MAY24, 1999- Exe. Order No. 102 redirectingthe functions and operations of the DOH by
president Estrada granted the DOH to proceedwith its rationalization and streamlining plan.
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1999-2004- Development of HSRA which
described the major strategies, organizationaland policy changes and public investmentneeded to improve the way health care is
delivered, regulated and finance. 2005 ongoing- Development of a plan to
rationalize the bureaucracy in an attempt tosca e own nc u ng e .
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National authority on health
providing technical and otherresource assistance
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Three
SpecificRoles
In the HealthSector
Leadership
inHealth
Enabler
andCapacityBuilder
Administrator
ofSpecificServices
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Leadership in Health
Serve as the national policyand regulatory institution.
rov e ea ers p n t eformulation
Serve as advocate in theadoption
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Enabler and Capacity Builder
Innovate new strategies inhealth, initiate public,
policy research outputs.
Exercise oversight functionsEnsure the highest achievable
standards of quality.
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Administrator of Specific
Services
Manage selected nationalfacilities and hospitals with
.Administer direct services
for emergent health concernsAdminister health emergency
response services
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Vision and MissionVision
The DOH is theleader staunch
Mission
Guarantee equitable,sustainable and
advocate andmodel in
promotingHealth for All inthe Philippines.
qu y rall Filipinos,especially the poor
and shall lead thequest forexcellence in
health
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Goal: Health Sector Reform
Agenda
Sound organizationalDevelopment
rong o c esSystems and Procedures
Capable Human ResourcesAdequate Financial
Resources
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Rationale for Health Sector
Reform
Following Conditions
Slowing down in the reduction Persistence of large variations in health
u High burden
Rising burden
Unattended emerging health risks
Burden of disease
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Factors Affecting the
Conditions:
Inappropriate Healthdelivery system
na equa e regu a orymechanisms for health
servicesPoor health care financing
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Implications
There is poor coverageThere is inequality access
There is low and high qualitycost
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Framework for Implementation of
HSRA: FOURmula ONE for Health
Intends to implement critical interventions as
a single package backed by effectivemanagement infrastructure and financing
approach.
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Goals of FOURmula ONE for
Health
Better health outcomes
More responsive health systems
Equitable health care financing
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Four elements of the Strategy
1. Health financing
2. Health Regulation
3. Health service delivery
4. Good governance
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Key features of the FOURmula
ONE
Engagement of the National Health
Insurance Program (NHIP) as the mainlever to effect desired changes and
implementation components
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NHIP supports each of the
elements in term of:
1. Financing
2. Governance
3. Regulation
4. Service Delivery
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Roadmap for All Stakeholders in Health:
National Objectives for Health 2005-2010
NOH 2005-2010
Provides the road map for skateholders inhealth and health-related sectors to intensify
-honored vision of health for all Filipinos
Sets the targets and the critical indicators,
current strategies based on field experinces,and laying down new avenues for improvedinterventions
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Provides concrete handle that would guide
policy makers, program managers, localgovernment executives, development
,
making crucial decisions for health
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Objectives of the Health
Sectors
A. Improve the general health status of the
populationB. Reduce morbidity and mortality from certain
diseases
C. Eliminate certain diseasesD. Promote healthy lifestyle and environmental
health
E. Protect vulnerable groups with speacialhealth and nutrition needs
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F. Strengthen national and local health systemsto ensure better health service delivery
G. Pursue public health and hospital reforms
H. Reduce the cost and ensure the quality of
essential drugsI. Institute health regulatory reforms to ensure
quality and safety of health goods and
services
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J. Strengthen health governance andmanagement support systems
K. Institute safety nets for the vulnerable andmarginalized systems
.
insurance
M. Mobilize more resources for health
N. Improve efficiency in the allocation,production and utilization of resources forhealth
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LOCAL HEALTH SYSTEM
Historical background
1. Post war independence
- Philippine Health Care System was
a m n stere y a centra agency ase nManila
2. 1992
- Major shift took place in the Local GovernmentCode also known as Republic Act 7160. LGUruns the local health systems
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Objectives Establish local health systems for effective
and efficient delivery of health care services
Upgrade the health care management andservice capabilities of local health facilities
Promote inter-LGU linkages and cost sharingschemes
Foster participation of the private sector, non-
government organization (NGOs) andcommunities in local health systemsdevelopment
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Ensure the quality of health service delivery
at the local level
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Inter Local Health Systems
Being espoused by the DOH in order to
ensure quality of health care service at thelocal level.
health system in which individuals,communities and all other health careproviders in a well-defined geographical area
Expected Achievement of the
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Expected Achievement of the
Inter-Local Health System
Universal coverage of health insurance
Improved quality of hospital and Rural HealthUnits (RHU) service
ect ve re erra system Integrated planning
Appropriate Health Information System
Improved Drug Management System
Developed human resources
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Effective leadership through Inter-LGU
corporation Financially visible or self sustaining hospitals
ntegrat on o pu c ea t an curat vehospital care
Strengthened cooperation between LGU and
health services
G idi P i i l I D l i
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Guiding Principles In Developing
The Inter-Local Health System
Financial and Administrative autonomy of the
provincial and municipal administrations(LGUs)
Strategic synergies and partnerships
Community participation
Equity of access to health services by thepopulation, especially the poor
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Affordability of health services
Appropriateness of health programs
Decentralized management
Sustainability of health initiatives Upholding of standards of quality health
service
Composition of the Inter Local
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Composition of the Inter-Local
Health Zone
1. People
2. Boundaries
3. Health Facilities
4. Health Workers
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PRIMARY HEALTH CAREPRIMARY HEALTH CAREPRIMARY HEALTH CAREPRIMARY HEALTH CARE
AN APPROACH TO DELIVERY OF
HEALTH CARE SERVICES
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PRIMARY HEALTH CAREPRIMARY HEALTH CAREPRIMARY HEALTH CAREPRIMARY HEALTH CARE
Is an essential care made
DEFINITION
access e o e
community throughacceptable means
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HISTORY
H lth r ll Y r 2
Declared during First International Conference on Primary HealthCare
Held in Alma Ata, USSRHappened on September 6-12, 1978
Organized by the World Health Organization
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HISTORYLETTER OF INSTRUCTION 949
Philippines
HEALTH IN THE
HANDS OF PEOPLE
BY 2020
Yxw|tw XA `tvYxw|tw XA `tvYxw|tw XA `tvYxw|tw XA `tvOctober 19, 1979
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HISTORY
Wespite thefailure to realize the goal
2000, the altruisticendeavor has bear fruitas it has produced
progress in the lives ofpeople from thecommunities it hasinfluenced.
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CONCEPTS
PARTNERSHIP + EMPOWERMENT OF PEOPLE = PRIMARY HEALTH CARE
EFFECTIVE
ACCESSIBLE
ACCEPTABLE
SUSTAINABLE
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ELEMENTS AND COMPONENTS
1.Environmental sanitation
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ELEMENTS AND COMPONENTS
2. Control of Communicable Diseases
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ELEMENTS AND COMPONENTS
3. Immunization
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ELEMENTS AND COMPONENTS
4. Health Education
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ELEMENTS AND COMPONENTS
5. Maternal and Child Health and Family Planning
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ELEMENTS AND COMPONENTS
6. Adequate Food and Proper Nutrition
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ELEMENTS AND COMPONENTS
7. Provision of Medical Care and Emergency Treatment
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ELEMENTS AND COMPONENTS
8. Treatment of Locally Endemic Diseases
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ELEMENTS AND COMPONENTS
9. Provision of Essential Drugs
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STRATEGIES
national health care system withthe establishment of functional
support mechanism.
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STRATEGIES
and enabling processfor health action at alllevels.
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STRATEGIES
know their communities andidentifying their basic health
needs.
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STRATEGIES
appropriate technologyfocusing on local indigenous
resources available in andacceptable to the community.
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STRATEGIES
Or anization of
communities arising fromtheir expressed needswhich they have decided toaddress.
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STRATEGIES
participation in local level planning,management, monitoring andevaluation within the context of
regional and national objectives.
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STRATEGIES
-
linkages with othergovernment and private
agencies.
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STRATEGIES
mp as z ng par ners p sothat the health workers and thecommunity leaders/members
view each other as partners.
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FOUR PILLARS/CORNERSTONES
1. Active communityparticipation
2. Intra and inter-sectorallinkages
3. Use of appropriate
technology4. Support mechanism made
available
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TYPES OF WORKERS
Available health man ower resources
Local health needs and problems
Political and financial feasibility
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TYPES OF WORKERS
Physician
Nurses
Midwives
Traditional healers
Community health workers
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LEVELS OF WORKERS
Village or Barangay health workers.
ra ne commun ty ea t wor ers. ea t
auxiliary volunteer. traditional birthattendant or healer
Intermediate level health workers.
General medical practitioners or their assistants.Public health nurse. Rural sanitary inspectors
and midwives
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LEVELS OF HEALTHCARE
SYSTEM
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PRIMARY LEVEL CARE
Devolve to the cities and themun c pa es.
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SECONDARY LEVEL OF CARE
Is given by the physicians with basichealth tranin .
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TERTIARY LEVEL OF CARE
Is rendered by specialist in healthfacilities includin medical centers as
well as regional and provincialhospitals and specialized hospitals.
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LEVELS OF
SERVICES
National Health ServicesMedical Centers
Teaching Hosptials
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Regional Health ServicesRegional Medical Centers
And Training Hospitals
Provincial / City Health ServicesProvincial / City Hospitals
Emergency / District Hospitals
Rural Health UnitCommunity Hospitals and Health CentersPrivate Practitioners / Puericulture Centers
Barangay Health Stations
Levels of Health Care and Referral System
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On Duty Marcelino, Regine
Ortua, Justine Pearl
Pata oc Jan ss A ril
Pesebre, Johnette Vinluan, Sandi
II-AN