National Health Situation

THE NATIONAL HEALTH THE NATIONAL HEALTH SITUATIONSITUATION


Demographic profileDemographic profile

- Philippine is one of the populous countries in - Philippine is one of the populous countries in the world in 2000.the world in 2000.

- 75.3 million (NCSB, 2001)- 75.3 million (NCSB, 2001)

- projected to increase to 82,636,689 in 2004 - projected to increase to 82,636,689 in 2004 (Natioanl Health Objectives, 1999)(Natioanl Health Objectives, 1999)

THE NATIONAL HELATH THE NATIONAL HELATH SITUATIONSITUATION

- 1999, average life expectancy at birth was - 1999, average life expectancy at birth was 68.6 years68.6 years

* 71.28 for females* 71.28 for females

* 66.03 for males* 66.03 for males

- 249 people for every square kilometer of - 249 people for every square kilometer of Philippine territory.Philippine territory.

THE NATIONAL EHALTH THE NATIONAL EHALTH SITUATIONSITUATION

- Metro manila has the highest population density - Metro manila has the highest population density (16,051) (16,051)

- CAR has the lowest (75) (National Health - CAR has the lowest (75) (National Health Objectives).Objectives).

- from the 37% of the total population in 1984 - from the 37% of the total population in 1984 (unicef, 1986) the figure increased to 44% ten (unicef, 1986) the figure increased to 44% ten years later.years later.

- annual population growth rate for the whole - annual population growth rate for the whole country is 2.3%; urban areas is 3.4 per year.country is 2.3%; urban areas is 3.4 per year.


- High population density - High population density transmission of infectious and transmission of infectious and communicable diseases.communicable diseases.

- Greater need for social services such as:Greater need for social services such as:

decent housing educationdecent housing education

transportation health servicestransportation health services

communication communication


- High level of stress in congested areas High level of stress in congested areas leads to:leads to:

disintegration of moral values and disintegration of moral values and social institutions and contributes to the social institutions and contributes to the incidence of a number of health problems, incidence of a number of health problems, including mental health problems.including mental health problems.


Health profileHealth profile Birth and deathsBirth and deathsCrude Birth Rate (CBR) in 1997 was 28.4 Crude Birth Rate (CBR) in 1997 was 28.4

per 1000 populationper 1000 populationCrude Death Rate (CDR) 6.1 per 1000 Crude Death Rate (CDR) 6.1 per 1000

population.population.The rate of natural increase in the country’s The rate of natural increase in the country’s

population for the same year was 22.3 population for the same year was 22.3 (28.4 minus 6.1) for every 1000 population(28.4 minus 6.1) for every 1000 population


- Rural women have more children than Rural women have more children than urban women.urban women.

- Uneducated women also have more Uneducated women also have more children than those who are with college children than those who are with college education.education.

- Those in the 25-29 age group have the Those in the 25-29 age group have the highest fertility rate (national demographic highest fertility rate (national demographic and health survey, 1999)and health survey, 1999)


- In 1995, In 1995, infant mortality rate (IMR)infant mortality rate (IMR) was was 48.9 per 1000 live births, which is within 48.9 per 1000 live births, which is within the WHO global goal for IMR of less than the WHO global goal for IMR of less than 50/1000 live births.50/1000 live births.

- Under-five mortality rate or deathsUnder-five mortality rate or deaths of of children below five years old in the same children below five years old in the same year was 67/1000 live births. year was 67/1000 live births.

THE NATIONAL HEALTH THE NATIONAL HEALTH SITUAION SITUAION

- Maternal mortality rate (MMR) was Maternal mortality rate (MMR) was 1.8/1000 live births (DOH), 1995) or 18 1.8/1000 live births (DOH), 1995) or 18 maternal deaths for every 10,000 live maternal deaths for every 10,000 live births.births.

- Death rate among males is higher than Death rate among males is higher than females – referred as the “feminization” of females – referred as the “feminization” of old age.old age.


Causes of morbidity and mortalityCauses of morbidity and mortality

Mortality (1997)Mortality (1997)

1.1. Diseases of the heartDiseases of the heart

2.2. Diseases of the vascular systemDiseases of the vascular system

3.3. PneumoniasPneumonias

4.4. Malignant neoplasmsMalignant neoplasms

5.5. TB, all formsTB, all forms


6. Accidents6. Accidents

7. Chronic obstructive and pulmonary 7. Chronic obstructive and pulmonary diseases, and allied conditionsdiseases, and allied conditions

8.Other diseases of the respiratory system8.Other diseases of the respiratory system

9. Diabetes mellitus9. Diabetes mellitus

10. Diarrheal diseases10. Diarrheal diseases


- Infant mortality rate is one of the most Infant mortality rate is one of the most sensitive indicators of health status of a sensitive indicators of health status of a country or community. country or community.

Results from:Results from:

1. poor maternal conditions1. poor maternal conditions

2. unhealthy environment2. unhealthy environment

3. inadequate health care delivery system3. inadequate health care delivery system


leading causes of infant mortality in 1997 leading causes of infant mortality in 1997 were:were:

1.1. Respiratory conditions of the fetus and Respiratory conditions of the fetus and newbornnewborn

2.2. PneumoniasPneumonias

3.3. Congenital anomaliesCongenital anomalies

4.4. Birth injury and difficult laborBirth injury and difficult labor

5.5. Diarrheal diseasesDiarrheal diseases


6. Septicemia6. Septicemia

7. Measles7. Measles

8. Meningitis8. Meningitis

9. Other diseases of the respiratory system9. Other diseases of the respiratory system

10. Aminovitaminosis and other nutritional 10. Aminovitaminosis and other nutritional deficiency. (1997 Philippine health deficiency. (1997 Philippine health statistics)statistics)


Maternal mortalityMaternal mortality – major indicator of a – major indicator of a woman’s health status – define by WHO woman’s health status – define by WHO as the death of a woman while pregnant or as the death of a woman while pregnant or within 42 days of termination of pregnancy within 42 days of termination of pregnancy from any cause related to, or aggravated from any cause related to, or aggravated by the pregnancy or its management, but by the pregnancy or its management, but not from accidental or incidental causes.not from accidental or incidental causes.


Leading causes of maternal mortality in Leading causes of maternal mortality in 19971997

1. Normal delivery and other complications 1. Normal delivery and other complications related to pregnancy occurring in the related to pregnancy occurring in the course of labor, delivery and puerperium.course of labor, delivery and puerperium.

2. Hypertension complicating pregnancy, 2. Hypertension complicating pregnancy, childbirth and puerperiumchildbirth and puerperium

3. Postpartum hemorrhage3. Postpartum hemorrhage

THE NATIOAL HEALTH THE NATIOAL HEALTH SITUATIONSITUATION

4. Pregnancy with abortive outcome4. Pregnancy with abortive outcome

5. Hemorrhages related to pregnancy5. Hemorrhages related to pregnancy

Analysis of women’s poor health and Analysis of women’s poor health and maternal mortality should consider the maternal mortality should consider the overall social, cultural, and economic overall social, cultural, and economic environment. (poor, low educational environment. (poor, low educational status, multipara, anemic)status, multipara, anemic)

THE NATIONAL EHLATH THE NATIONAL EHLATH SITUATIONSITUATION

Leading causes of morbidity (1997)Leading causes of morbidity (1997)

1.1. Diarrheas 7. chickenpoxDiarrheas 7. chickenpox

2.2. Pneumonias 8. diseases of the Pneumonias 8. diseases of the

3.3. Bronchiolitis heartBronchiolitis heart

4.4. Influenza 9. measlesInfluenza 9. measles

5.5. TB, all forms 10. dengue H-feverTB, all forms 10. dengue H-fever

6.6. malariamalaria


SARS – “scary” severe acute respiratory SARS – “scary” severe acute respiratory syndrome. Transmission of infectious syndrome. Transmission of infectious diseases is facilitated by the increasing diseases is facilitated by the increasing mobility of people and ease in traveling mobility of people and ease in traveling form one country to another.form one country to another.


AIDS – major public health problem, (urban AIDS – major public health problem, (urban areas) areas)

- increase in STD’s (syphilis, & gonorrhea - increase in STD’s (syphilis, & gonorrhea due to unhampered prostitution in the due to unhampered prostitution in the country.country.

- prostitution has always been identified as - prostitution has always been identified as a consequence of poverty.a consequence of poverty.


TUBERCULOSISTUBERCULOSIS- Number one cause of mortality about 50 Number one cause of mortality about 50

years ago continue to be a major killer of years ago continue to be a major killer of Filipinos.Filipinos.

LEPROSYLEPROSY

-MDT (multi-drug therapy) 1.7/10,000 (1995)-MDT (multi-drug therapy) 1.7/10,000 (1995)

THE NATIONAL EHALTH THE NATIONAL EHALTH SITUATIONSITUATION

SCHISTOSOMIASISSCHISTOSOMIASIS

- affect hundred of barangays in 24 endemic - affect hundred of barangays in 24 endemic provinces.provinces.

RABIESRABIES

- incidence in the Philippines is one of the highest - incidence in the Philippines is one of the highest in the world.in the world.

HEPATITIS BHEPATITIS B

- 12% of the population are chronic carriers - 12% of the population are chronic carriers

(hepatitis B and hepatic sarcoma)(hepatitis B and hepatic sarcoma)


*MOSQUITO**MOSQUITO*

- malariamalaria

- filariasis- filariasis

- dengue fever- dengue fever


POVERTY AND HEALTHPOVERTY AND HEALTH - illiteracy- illiteracy - unfounded health beliefs- unfounded health beliefs - harmful practices- harmful practices - inadequate nutrition- inadequate nutrition - poor environmental sanitation- poor environmental sanitation - inadequate source of potable water - inadequate source of potable water

supplysupply

NATIONAL HEALTH SITUATIONNATIONAL HEALTH SITUATION

- congested housing unit- congested housing unit

- limited access to basic health services- limited access to basic health services

- inability to make decisions on matters - inability to make decisions on matters which are important to healthwhich are important to health


CULTURAL INFLUENCES ON HEALTHCULTURAL INFLUENCES ON HEALTH

- is a way of life- is a way of life

- passed on from one generation to the - passed on from one generation to the nextnext

- includes beliefs, values and customs or - includes beliefs, values and customs or practicespractices

- traditional- traditional

THE ANTIONAL HEALTH THE ANTIONAL HEALTH SITUATIONSITUATION

ENVIRONMENTAL INFLUENCES ON ENVIRONMENTAL INFLUENCES ON HEALTHHEALTH

- unsanitary environment = major factor- unsanitary environment = major factor

- breeding ground of animals and insects - breeding ground of animals and insects that harbor and transmit microorganisms.that harbor and transmit microorganisms.

- deterioration of the ecosystem- deterioration of the ecosystem

- exposure to chemicals and other air - exposure to chemicals and other air pollutants (cancer & respiratory diseases)pollutants (cancer & respiratory diseases)


- industrialization- industrialization

- government policies- government policies

- poverty and an uncaring attitude towards - poverty and an uncaring attitude towards the environment.the environment.


POLITICAL INFLUENCES ON HEALTHPOLITICAL INFLUENCES ON HEALTH

- politics affects health- politics affects health

- health policies emanate from congress, - health policies emanate from congress, the executive department (DOH)the executive department (DOH)

- policies that affect health = health care - policies that affect health = health care delivery system and the practice of nursing delivery system and the practice of nursing in the Philippinesin the Philippines


- health budget is the most - health budget is the most concrete expression of the concrete expression of the government’s political will.government’s political will.

- health spending has always - health spending has always been inadequate.been inadequate.


policies that impact policies that impact on people’s health on people’s health directlydirectly

1.1. National blood National blood services Act (RA services Act (RA 7719)7719)

2.2. National diabetes National diabetes Act (RA 8191)Act (RA 8191)

3.3. Salt iodization Act Salt iodization Act (RA 8172)(RA 8172)


Policies that affect health indirectlyPolicies that affect health indirectly1.1. Family and social relationshipFamily and social relationship2.2. Environment Environment 3.3. Access to educationAccess to education4.4. MalnutritionMalnutrition5.5. Mental health problemsMental health problems6.6. Cancer Cancer 7.7. Other lifestyle-related diseasesOther lifestyle-related diseases

THE ANTIONAL HELATH THE ANTIONAL HELATH SITUATIONSITUATION

Laws that affect the delivery of health Laws that affect the delivery of health servicesservices

1.1. Local government codeLocal government code

2.2. National health insurance ActNational health insurance Act

3.3. Professional practice acts of the different Professional practice acts of the different professionsprofessions


THE HEALTH CARE DELIVERY SYSTEMTHE HEALTH CARE DELIVERY SYSTEM

- is the totality of all policies, - is the totality of all policies, infrastructures, facilities, equipment, infrastructures, facilities, equipment, products, human resources, and concerns products, human resources, and concerns of all peopleof all people


- preventive health care = concern of the - preventive health care = concern of the government-owned health centersgovernment-owned health centers

- curative care = provided by hospitals, - curative care = provided by hospitals, both government and privateboth government and private


DEPARTMENT OF HEALTHDEPARTMENT OF HEALTH

- national government’s biggest health - national government’s biggest health care providercare provider

- used to have control and supervision - used to have control and supervision over all barangay health stations, rural over all barangay health stations, rural health units and hundreds of hospitals health units and hundreds of hospitals throughout the countrythroughout the country


- Bureau of local health development- Bureau of local health development

- local health systems development - local health systems development

- health care financing programs- health care financing programs

- quality improvement programs- quality improvement programs

- intersectoral (public-private) - intersectoral (public-private)

coordination and local projects coordination and local projects


DEVOLUTION OF HEALTH SERVICESDEVOLUTION OF HEALTH SERVICES - RA 7160 = local government code- RA 7160 = local government code - the code aims to: transform local - the code aims to: transform local

government units into self-reliant government units into self-reliant communities and active partners in the communities and active partners in the attainment of national goals through a attainment of national goals through a more responsive and accountable local more responsive and accountable local government structure instituted through a government structure instituted through a system of decentralization.system of decentralization.


- provincial, district and municipal hospitals- provincial, district and municipal hospitals

provincial governmentsprovincial governments

- rural health units (RHUs) and barangay - rural health units (RHUs) and barangay health stations (BHSs) municipal health stations (BHSs) municipal governmentsgovernments


- - provincial levelprovincial level

> governor (chair)> governor (chair)

> provincial health officer (vice chair)> provincial health officer (vice chair)

> chairman of the Committee on Health > chairman of the Committee on Health

of the sangguniang panlalawiganof the sangguniang panlalawigan

> DOH representative> DOH representative


- City and Municipal levelCity and Municipal level

> mayor (chair)> mayor (chair)

> municipal health officer (vice chair)> municipal health officer (vice chair)

> chair of the committee on health of the > chair of the committee on health of the sangguniang bayansangguniang bayan

> DOH representative and NGO > DOH representative and NGO representativerepresentative


HEALTH SECTOR REFORM AGENDA HEALTH SECTOR REFORM AGENDA AND NATIONAL OBJECTIVES FOR AND NATIONAL OBJECTIVES FOR HEALTHHEALTH

- HSRA (1999-2004)- HSRA (1999-2004)

- NOH (1999-2004)- NOH (1999-2004)

THE NATIONAL HELATH THE NATIONAL HELATH STITUATIONSTITUATION

FIVE MAJOR REFORMS CONTAINED IN FIVE MAJOR REFORMS CONTAINED IN THE HSRATHE HSRA

1.1. Provide fiscal autonomy to government Provide fiscal autonomy to government hospitalshospitals

2.2. Secure funding for priority public health Secure funding for priority public health programsprograms

3.3. Promote the development of local health Promote the development of local health systems and ensure its effective systems and ensure its effective performanceperformance


4. Strengthen the capacities of health 4. Strengthen the capacities of health regulatory agenciesregulatory agencies

5. Expand the coverage of the National 5. Expand the coverage of the National Health Insurance programHealth Insurance program

NATIONAL OBJECTIVES FOR NATIONAL OBJECTIVES FOR HEALTHHEALTH

Vision: Health for all FilipinosVision: Health for all Filipinos


Mission: Ensure accessibility and quality Mission: Ensure accessibility and quality of health care to improve the quality of life of health care to improve the quality of life of all Filipinos, especially the poorof all Filipinos, especially the poor


PrinciplesPrinciples universal access to basic health universal access to basic health

services must be ensured.services must be ensured.

the health and nutrition of vulnerable the health and nutrition of vulnerable groups must be prioritized.groups must be prioritized.


The epidemiologic shift from infectious to The epidemiologic shift from infectious to degenerative diseases must be managed.degenerative diseases must be managed.

The performance of the health sector must The performance of the health sector must be enhanced.be enhanced.


GOALS AND OBJECTIVESGOALS AND OBJECTIVES

1.1. Improve the general health status of the Improve the general health status of the populationpopulation

- reduce infant mortality rate- reduce infant mortality rate

- reduce child mortality rate- reduce child mortality rate

- reduce maternal mortality rate- reduce maternal mortality rate

- reduce total fertility rate- reduce total fertility rate

- increase the life expectancy and the quality of - increase the life expectancy and the quality of life yearslife years


2. Reduce morbidity, mortality, disability and 2. Reduce morbidity, mortality, disability and complications from the following diseases complications from the following diseases and disordersand disorders

- pneumonias and acute respiratory - pneumonias and acute respiratory infectionsinfections

- diarrheas and other food and water - diarrheas and other food and water borne diseases like typhoid, cholera, and borne diseases like typhoid, cholera, and hepatitis Ahepatitis A


- TuberculosisTuberculosis- DengueDengue- Intestinal parasitismIntestinal parasitism- STD’s, HIV-AIDS and other reproductive STD’s, HIV-AIDS and other reproductive

tract infectionstract infections- Hepatitis BHepatitis B- Asthma and chronic obstructive pulmonary Asthma and chronic obstructive pulmonary

diseasesdiseases


- Nephritis and chronic diseasesNephritis and chronic diseases- Dental caries and periodontal diseasesDental caries and periodontal diseases- Rheumatic heart disease and rheumatic Rheumatic heart disease and rheumatic

feverfever- Coronary artery disease, hypertension and Coronary artery disease, hypertension and

hyperlipidemiahyperlipidemia- StrokeStroke- CancerCancer


- DiabetesDiabetes- Mental disordersMental disorders- Protein-energy malnutritionProtein-energy malnutrition- Iron-deficiency anemiaIron-deficiency anemia- ObesityObesity- Accidents, traumas and injuriesAccidents, traumas and injuries


3. Eliminate the following diseases as public health 3. Eliminate the following diseases as public health problemsproblems

- Schistosomiasis- Schistosomiasis - malariamalaria - filariasis- filariasis - leprosyleprosy - rabiesrabies


- vaccine-preventable diseases: measles, vaccine-preventable diseases: measles, tetanus, diptheria, and pertussistetanus, diptheria, and pertussis

- Vitamin A deficiencyVitamin A deficiency

- Iodine deficiency disordersIodine deficiency disorders


4. Eradicate poliomyelitis4. Eradicate poliomyelitis

5. Promote healthy lifestyle5. Promote healthy lifestyle

- promote healthy diet and nutrition- promote healthy diet and nutrition

- promote physical activity and fitness- promote physical activity and fitness

- promote personal hygiene- promote personal hygiene


- promote mental health and less stressful - promote mental health and less stressful lifelife

- Prevent smoking and substance abusePrevent smoking and substance abuse

- Prevent violent and risk-taking behaviorsPrevent violent and risk-taking behaviors


6. Promote the health and nutrition of 6. Promote the health and nutrition of families and special populationsfamilies and special populations

- neonatal and infant health- neonatal and infant health - health of indigenous peoples- health of indigenous peoples - children's health- children's health - adolescent and youth health- adolescent and youth health - adult health- adult health - women's health- women's health

NATIOANL OBJECTIVES FOR NATIOANL OBJECTIVES FOR HEALTHHEALTH

- health of older persons- health of older persons

- health of overseas Filipino workers- health of overseas Filipino workers

- health of differently-abled persons- health of differently-abled persons

- health of the rural poor- health of the rural poor

- health of the urban poor- health of the urban poor


7. Promote environmental health and 7. Promote environmental health and sustainable developmentsustainable development

- healthy homes- healthy homes

- healthy workplace and establishments- healthy workplace and establishments

- healthy schools- healthy schools

- healthy communities, towns and cities- healthy communities, towns and cities

FOURmula ONE FOR HEALTHFOURmula ONE FOR HEALTH

FOURmula ONEFOURmula ONE

implementation framework for health implementation framework for health sector reformsector reform


GOALSGOALS

Better health outcomes Better health outcomes More responsive health systemsMore responsive health systems Equitable health care financingEquitable health care financing


FOUR THRUSTSFOUR THRUSTS

1.1. Financing (increased, better and Financing (increased, better and sustained)sustained)

2.2. Regulation (assured quality and Regulation (assured quality and affordability)affordability)

3.3. Service Delivery (ensured access and Service Delivery (ensured access and availability)availability)

4.4. Governance (improved performance)Governance (improved performance)


STRATEGIC GUIDEPOSTSSTRATEGIC GUIDEPOSTS

1.1. Building upon gains and lessons from Building upon gains and lessons from major reform initiativesmajor reform initiatives

2.2. Focus on critical interventions to be Focus on critical interventions to be implemented as a single packageimplemented as a single package

3.3. Sector wide management of Sector wide management of FOURMULA ONE implementationFOURMULA ONE implementation

4.4. NHP as the primary instrumentNHP as the primary instrument


CONSTRAINTSCONSTRAINTS1.1. Restricted government health budgetsRestricted government health budgets - inflexible allocation across categories- inflexible allocation across categories - allocation among programs not linked to - allocation among programs not linked to

performanceperformance2.2. Difficulty in managing a highly decentralized Difficulty in managing a highly decentralized

systemsystem - steering various stakeholders (i.e. - local - steering various stakeholders (i.e. - local

systems, private markets)systems, private markets) - managing health finances from multiple - managing health finances from multiple

sourcessources


OPPORTUNITIES OPPORTUNITIES

1.1. Deeper understanding of and increasing Deeper understanding of and increasing leverage of the NHIP over health system leverage of the NHIP over health system performance.performance.

2. Inroads in health reforms in at least 30 2. Inroads in health reforms in at least 30 provinces resulting in improvements in health provinces resulting in improvements in health outcomes and providing invaluable lessons.outcomes and providing invaluable lessons.


3. Growing support for HSRA 3. Growing support for HSRA implementation from partners - implementation from partners - government agencies, external.government agencies, external.

4. Deeper understanding of reform 4. Deeper understanding of reform implementation requirements.implementation requirements.

5. Revitalized support from national 5. Revitalized support from national leadership.leadership.


CRITICAL COMPONENTS TO JUMP CRITICAL COMPONENTS TO JUMP START START fourmula onefourmula one IMPLEMENTATION IMPLEMENTATION

• Identifying critical componentsIdentifying critical components

- sufficient groundwork and buy-in- sufficient groundwork and buy-in

- triggers a chain reaction to spur other - triggers a chain reaction to spur other FOURmula ONE interventionsFOURmula ONE interventions

- produces tangible results- produces tangible results

- generates public support- generates public support


FINANCINGFINANCING

GOALGOAL

Secure increased, better and sustained Secure increased, better and sustained investments in health to improve health investments in health to improve health outcomes especially of the poor.outcomes especially of the poor.

FOURmula ONE….FINANCINGFOURmula ONE….FINANCING

Rationalization of sources of health Rationalization of sources of health financingfinancing

* out of pocket* out of pocket

- shift of OOP to outpatient care (e.g. - shift of OOP to outpatient care (e.g. check-up, consultation, etc.)check-up, consultation, etc.)

* Local government* Local government

- focus subsidy on preventive and - focus subsidy on preventive and promotive health servicespromotive health services

FOURmula ONE…FINANCINGFOURmula ONE…FINANCING

*National government*National government

- shift resources on regulation, governance - shift resources on regulation, governance and to teaching/training tertiary hospitalsand to teaching/training tertiary hospitals

*Social health insurance *Social health insurance

- Focus on in-patient care- Focus on in-patient care


Local health financing reformsLocal health financing reforms• Earmarking funds and prioritizing health Earmarking funds and prioritizing health

servicesservices

- social marketing advocacy to LGUs, NGO - social marketing advocacy to LGUs, NGO & private sector to earmark funds for & private sector to earmark funds for priority health programs.priority health programs.


- identify tools for prioritizing health - identify tools for prioritizing health services (e.g. segmentation and services (e.g. segmentation and targeting the poor)targeting the poor)


*Management/coordination of LGU health *Management/coordination of LGU health fundfund

- integrate national and local investment - integrate national and local investment planplan

- cost-sharing arrangements among - cost-sharing arrangements among LGUsLGUs

- national and local coordination of funds - national and local coordination of funds (e.g. counterparting arrangements)(e.g. counterparting arrangements)

- Rapid estimation of local health - Rapid estimation of local health accountsaccounts


NATIONAL HEALTH FINANCING NATIONAL HEALTH FINANCING REFORMSREFORMS

1.Public finance management system1.Public finance management system

2.Institutionalization of revenue-2.Institutionalization of revenue-enhancement measuresenhancement measures

*full retention of income*full retention of income

*asset management*asset management


3. Development of efficient and equitable 3. Development of efficient and equitable allocation mechanics.allocation mechanics.

-priority health programs-priority health programs

-geographic-geographic

-income-income

-population groups-population groups


4. Performance based-budgeting system4. Performance based-budgeting system

-develop models for hospitals, public -develop models for hospitals, public health and regulatory agencieshealth and regulatory agencies

-reform financial management and -reform financial management and procurement systemprocurement system

-develop / implement performance audit -develop / implement performance audit and review systemand review system


IMPROVEMENT OF THE NHIPIMPROVEMENT OF THE NHIP

1.1. Increase membership and collectionsIncrease membership and collections

2.2. Enhance benefit packageEnhance benefit package

3.3. Improve utilization of reimbursementsImprove utilization of reimbursements

4.4. Enhance systems for regulation and Enhance systems for regulation and governancegovernance

FOURmula ONE…REGULATIONFOURmula ONE…REGULATION

REGULATIONREGULATION

GOALGOAL

Assure access to quality and affordable Assure access to quality and affordable health products, devices, facilities and health products, devices, facilities and services especially those used by the services especially those used by the poor.poor.


STRATEGIESSTRATEGIES1.1. Harmonizing & streamlining of systems, Harmonizing & streamlining of systems,

processes for licensing & accreditation and processes for licensing & accreditation and certificationcertification

2.2. Developing a seal of approvalDeveloping a seal of approval3.3. Pursuing cost recovery with income retention Pursuing cost recovery with income retention

for health regulatory agencies & other revenue for health regulatory agencies & other revenue generating mechanismsgenerating mechanisms

4.4. Ensuring access of the poor to essential health Ensuring access of the poor to essential health productsproducts


COMPONENTSCOMPONENTS

Programs include:Programs include:

1.1. one-stop shopone-stop shop

2.2. Philhealth-sentrong sigla sealPhilhealth-sentrong sigla seal

3.3. Unified seal of approvalUnified seal of approval

4.4. Botika ng barangay / pharma 50Botika ng barangay / pharma 50

FOURmula ONE…SERVICE FOURmula ONE…SERVICE DELIVERYDELIVERY

SERVICE DELIVERYSERVICE DELIVERY

GOALGOAL

Improve accessibility and availability of Improve accessibility and availability of basic and essential health care for all, basic and essential health care for all, especially the poor.especially the poor.


COMPONENTSCOMPONENTS1.1. Public health development planPublic health development plan a. disease-free zone – “mopping-up” a. disease-free zone – “mopping-up”

leprosyleprosy b. Intensified disease programs - TB, b. Intensified disease programs - TB,

HIV/AIDS emerging infectionsHIV/AIDS emerging infections c. Improving reproductive health c. Improving reproductive health

outcomes – MMR, IMR, U5MR, TFR, outcomes – MMR, IMR, U5MR, TFR, CPRCPR


d. Intensified promotion of healthy d. Intensified promotion of healthy lifestyle – DM, HPN, CVD, breast and lifestyle – DM, HPN, CVD, breast and cervical cancer, anti smoking, safe water, cervical cancer, anti smoking, safe water, sanitation, among otherssanitation, among others


2. Health facilities development plan2. Health facilities development plan

- critical upgrading of facilities through - critical upgrading of facilities through fund poolfund pool

- rationalizing services in DOH-retained, - rationalizing services in DOH-retained, local government & private facilities inside local government & private facilities inside the 16 sitesthe 16 sites

- Integrating wellness services in hospitals- Integrating wellness services in hospitals


3. Establishment of National Health 3. Establishment of National Health Promotion FoundationPromotion Foundation

4. Disaster preparedness and response 4. Disaster preparedness and response systemsystem

5. Disease surveillance and networking 5. Disease surveillance and networking systemsystem

6. Intensification of health promotion6. Intensification of health promotion


STRATEGIESSTRATEGIES

1. Making available basic and essential 1. Making available basic and essential health service packages by designated health service packages by designated providers in strategic locationsproviders in strategic locations

2. Assuring the quality of both basic and 2. Assuring the quality of both basic and specialized health servicesspecialized health services


3. Intensifying current efforts to reduce 3. Intensifying current efforts to reduce public health threatspublic health threats

4. Disease –free zones4. Disease –free zones

a. Filariasis – endemic mapping with STH a. Filariasis – endemic mapping with STH and Schistosomiasis programs, disability and Schistosomiasis programs, disability preventionprevention


b. Leprosy – quality diagnosis & case b. Leprosy – quality diagnosis & case managementmanagement

c. Rabies – functional animal bite treatment c. Rabies – functional animal bite treatment centers, responsible pet ownershipcenters, responsible pet ownership


d. Malaria – community participation in d. Malaria – community participation in vector control elimination & surveillance vector control elimination & surveillance activities. Malaria benefit package activities. Malaria benefit package Insecticide Treated Nets (ITN), rapid Insecticide Treated Nets (ITN), rapid diagnostic test.diagnostic test.


e. Schistosomiasis – intensify surveillance of e. Schistosomiasis – intensify surveillance of human cases and the snail vector human cases and the snail vector

5. Intensifies disease prevention and control5. Intensifies disease prevention and control a. emerging infectious diseases – avian a. emerging infectious diseases – avian

influenza task force at all levels, influenza task force at all levels, preparedness & response plan for preparedness & response plan for pandemic influenza, philhealth benefit pandemic influenza, philhealth benefit packagepackage

FOURmula ONE…SERVICE FOURmula ONE…SERVICE DELIVERY DELIVERY

b. VPI – reaching every barangay, 4Bsb. VPI – reaching every barangay, 4Bs

(Bakuna, Bitamina A, Breastfeeding (Bakuna, Bitamina A, Breastfeeding advocacy, purga sa Bulate), 100% advocacy, purga sa Bulate), 100% Hepatitis B vaccines till 2010Hepatitis B vaccines till 2010

c. Tuberculosis – nationwide c. Tuberculosis – nationwide implementation of DOTS, TB in children implementation of DOTS, TB in children PPMDOTSPPMDOTS


d. HIV / AIDS – social hygiene clinics, d. HIV / AIDS – social hygiene clinics, local AIDS councils, behavior change local AIDS councils, behavior change modification, Community based program, modification, Community based program, home base carehome base care


6. Improving reproductive health outcomes6. Improving reproductive health outcomes

a. Public-private partnership on women’ a. Public-private partnership on women’ healthhealth

b. Pre-pregnancy packageb. Pre-pregnancy package

c. Contraceptive delivery & logistic MISc. Contraceptive delivery & logistic MIS

d. Standard days method as NFPd. Standard days method as NFP

e. Paradigm shift – “high-risk” pregnancies e. Paradigm shift – “high-risk” pregnancies to ALL PREGNANCIES ARE AT RISKto ALL PREGNANCIES ARE AT RISK


f. mother and child bookf. mother and child book

g. infant and young children feeding g. infant and young children feeding programprogram


7. Intensified promotion of healthy lifestyle7. Intensified promotion of healthy lifestyle

a. tobacco management team at various levelsa. tobacco management team at various levels

b. smoking cessation clinicsb. smoking cessation clinics

c. community-based NCD prevention and c. community-based NCD prevention and control programcontrol program

d. intensified promotion of healthy lifestyle –DM, d. intensified promotion of healthy lifestyle –DM, HPN, CVD, breast & cervical cancer, anti-HPN, CVD, breast & cervical cancer, anti-smoking, safe water, sanitation among others.smoking, safe water, sanitation among others.

e. strengthen national HL campaigne. strengthen national HL campaign

FOURmula ONE…GOVERNANCEFOURmula ONE…GOVERNANCE

GOVERNANCEGOVERNANCE

GOALGOAL

Improve health system performance at Improve health system performance at the national and local levelsthe national and local levels


COMPONENTSCOMPONENTS1. Sectoral development approach for health1. Sectoral development approach for health2. Health human resource masterplan2. Health human resource masterplan3. Establishment of 4-in-1 convergence sites3. Establishment of 4-in-1 convergence sites4. Philippine health information system4. Philippine health information system5. Procurement and logistics management 5. Procurement and logistics management

systemsystem6. Public finance management system 6. Public finance management system


Sectoral development approach for healthSectoral development approach for health

1. To strengthen government leadership in 1. To strengthen government leadership in implementing a sector program where implementing a sector program where development partners cooperate and contribute development partners cooperate and contribute accordinglyaccordingly

- effective donor and LGU coordination towards - effective donor and LGU coordination towards financing a sector program financing a sector program

- harmonizing procedures among donors and - harmonizing procedures among donors and national government national government


Health human resource masterplanHealth human resource masterplan

1.1. To maintain a national HHR masterplan To maintain a national HHR masterplan in support of national & local health in support of national & local health systemssystems

- HHR information system- HHR information system

- competency-based recruitment & - competency-based recruitment & selection systemsselection systems

- training and development need analysis- training and development need analysis

FOURmula ONE…GOVERNANCE FOURmula ONE…GOVERNANCE

- Performance management systemPerformance management system- Career development and managementCareer development and management- Advocacy planAdvocacy plan


Developing a localized health human Developing a localized health human resource strategyresource strategy

1.1. Health professional development and Health professional development and career trackcareer track

2.2. Identifying and providing venue for Identifying and providing venue for posting of vacanciesposting of vacancies

3.3. Actively promoting LGU vacanciesActively promoting LGU vacancies4.4. Support for developing local HR strategySupport for developing local HR strategy


Establishment of 4-in-1 convergence Establishment of 4-in-1 convergence sitessites

1.1. Health investment planningHealth investment planning

2.2. Developing appropriate governance and Developing appropriate governance and mechanisms, i.e., ILHZ convergence mechanisms, i.e., ILHZ convergence sitessites

3.3. Helping mobilizing extra-budgetary Helping mobilizing extra-budgetary resources for health at the local levelresources for health at the local level


4. Improving procurement, devolving 4. Improving procurement, devolving regulatory functions, linking, local regulatory functions, linking, local regulatory policies with health programs regulatory policies with health programs and financingand financing

5. Nationalizing the health delivery network, 5. Nationalizing the health delivery network, provision of basic health servicesprovision of basic health services

6. Monitoring & evaluation, i.e., LGU score 6. Monitoring & evaluation, i.e., LGU score cardcard


Philippine health information systemPhilippine health information system

1.1. establishment, operationalization, & use establishment, operationalization, & use of health portal and development of of health portal and development of Philippine health information Philippine health information infrastructureinfrastructure

- harmonization of info systems- harmonization of info systems

- human resource info system- human resource info system

- vital registries, health statistics- vital registries, health statistics


Philippine health information systemPhilippine health information system

1.1. establishment, operationalization, and establishment, operationalization, and use of health portal and development of use of health portal and development of philippine helath information philippine helath information infrastructureinfrastructure

2.2. Development of manual of operationsDevelopment of manual of operations

FOURmula…GOVERNANCEFOURmula…GOVERNANCE

DOH procurement and logistics management DOH procurement and logistics management systemsystem

1.1. Inventory system, supply chain mechanismInventory system, supply chain mechanism2.2. Efficient storageEfficient storage3.3. Database of goods / supplies (standard Database of goods / supplies (standard

specifications)specifications)4.4. Procurement systemsProcurement systems - pooling- pooling - monitoringmonitoring - feedback mechanism- feedback mechanism


- Disease surveillance- Disease surveillance

- health accounts- health accounts

- health regulations- health regulations

- health facilities- health facilities


5. Database of supplies with performance 5. Database of supplies with performance monitoringmonitoring

6. Standardization of specifications and 6. Standardization of specifications and documentsdocuments

7. Implementation of ethical practices 7. Implementation of ethical practices frameworkframework

THE NATIONAL OBJECTIVES THE NATIONAL OBJECTIVES ON HEALTHON HEALTH

NATIONAL OBJECTIVES…NATIONAL OBJECTIVES…

NATIONAL OBJECTIVES FOR HEALTH 2005 NATIONAL OBJECTIVES FOR HEALTH 2005 TO 2010TO 2010

-Provides the road map for stakeholders in health -Provides the road map for stakeholders in health and health-related sectors to intensify and and health-related sectors to intensify and harmonize their efforts to attain its time-honored harmonize their efforts to attain its time-honored vision of health for all Filipinos and continue its vision of health for all Filipinos and continue its avowed mission to ensure accessibility and avowed mission to ensure accessibility and quality of life of all Filipinos, especially the poor.quality of life of all Filipinos, especially the poor.


It provides concrete handle that would It provides concrete handle that would guide policy makers, program managers, guide policy makers, program managers, local government executives, development local government executives, development partners, civil society and the partners, civil society and the communities in making crucial decisions communities in making crucial decisions for health.for health.


OBJECTIVES OF THE HEALTH SECTOROBJECTIVES OF THE HEALTH SECTOR

1.1. Improve the general health status of the Improve the general health status of the populationpopulation

2.2. Reduce morbidity and mortality from certain Reduce morbidity and mortality from certain diseasesdiseases

3.3. Eliminate certain diseases as public helath Eliminate certain diseases as public helath problemsproblems

4.4. Promote healthy lifestyle and environmental Promote healthy lifestyle and environmental healthhealth


5. Protect vulnerable groups with special health 5. Protect vulnerable groups with special health and nutrition needsand nutrition needs

6. Strengthen national and local health systems to 6. Strengthen national and local health systems to ensure better health service deliveryensure better health service delivery

7. Pursue public health and hospital reforms7. Pursue public health and hospital reforms

8. Reduce the cost and ensure quality esssential 8. Reduce the cost and ensure quality esssential drugsdrugs

9. Institute health regulatory reforms to ensure 9. Institute health regulatory reforms to ensure quality and safety of helath goods and servicesquality and safety of helath goods and services


10. Expand the coverage of social health 10. Expand the coverage of social health insuranceinsurance

11. Mobilize efficiency in the allocation, 11. Mobilize efficiency in the allocation, production and utilization of resources for production and utilization of resources for healthhealth

Documents

National Health Situation