lOMoARcPSD|37456515

CHN Lecture - Module 2 - The Health Care Delivery System

Bachelor of Science in Nursing (University of Perpetual Help System DALTA)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university

Downloaded by ALLAN KARL N. YNGENTE ([email protected])
 lOMoARcPSD|37456515

MODULE 2:
The Health Care
Delivery System

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Module 2: The Health Care Delivery System

Lesson Content
A. World Health Organization
1. Millennium Development Goals
2. Sustainable Development Goals
B. Philippine Department of Health
1. Mission-Vision
2. Historical Background
3. Local Health System and Devolution of Health Services
4. Classification of Health facilities (DOH AO-0012A)
5. Philippine Health Agenda 2010-2022
C. Primary Health Care (PHC)
1. Brief History
2. Legal Basis
3. Definition
4. Goals
5. Elements
6. Principles and Strategies
D. Levels of Prevention
E. Universal Health Care (UHC)
1. Legal Basis
2. Background and Rationale
3. Objectives and Thrusts

A. World Health Organization

WHO is a specialized agency working with the UN system, countries, international
organizations, and institutions to direct and coordinate international health.
1. Millennium Development Goals
MDGs are the eight (8) goals that represent the global effort of 189 UN Member States in
response to the changes that affect the public health systems. These changes include:
• Shifts in demographic and epidemiological trends in diseases, including the
emergence & re-emergence of new diseases and in the prevalence of risk and
protective factors
• New technologies for health care, communication and information
• Existing and emerging environmental hazards, some associated with globalization
• Health reforms
In September 2000, world leaders came together at the United Nations Headquarters in
New York to adopt the United Nations Millennium Declaration, which identified the
fundamental values essential to international relations in the 21st century. These are:

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

freedom, equality, solidarity, tolerance, health, respect for nature, and shared
responsibility.
The MDGs are set to realize these values around the world by 2015. The eight goals are:
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, and other diseases
7) Ensure environmental sustainability
8) Develop a global partnership for development
The MDGs are inter-dependent; all the MDG influence health, and health influences all
the MDGs. Health is essential to the achievement of these goals, especially poverty
reduction.
Epidemiologic Shift – While the country is still contending with the burden of
communicable diseases, it is also at the same time contending with the devastation
brought about by non-communicable, chronic lifestyle-related diseases.
“Triple Whammy” – has a devastating effect brought about by epidemiologic shift and
emergence of plague-like infectious diseases such as Severe Acute Respiratory Syndrome
(SARS) and Avian Flu.
According to a WHO report, nurses have significantly contributed to achieving the health
outcomes of the MDGs (improvements in increased life expectancy, reduced child
mortality, getting more children into schools, reducing extreme poverty, and improving
access to safe water and sanitation).
References:
Category: Millennium Development Goals. (2017, May 15). Retrieved from MDG Monitor:
https://www.mdgmonitor.org/millennium-development-goals/
INTERNATIONAL COUNCIL OF NURSES. (2017). Nurse's Role in Achieving the Sustainable Development
Goals. Geneva, Switzerland.
Maglaya, A. S. (2009). Nursing Practice in the Community. Marikina: Argonauta Corporation.
Millennium Development Goals (MDGs). (n.d.). Retrieved from World Health Organization:
https://www.who.int/topics/millennium_development_goals/about/en/
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines. Manila:
National League of Philippine Government Nurses.
United Nations Millennium Declaration. (2000). Retrieved from Office of the High Commissioner for Human
Rights: https://www.ohchr.org/EN/ProfessionalInterest/Pages/Millennium.aspx

2. Sustainable Development Goals

Overview
• The Sustainable Development Goals are the blueprint to achieve a better and more
sustainable future for all. They address the global challenges we face, including poverty,
inequality, climate change, environmental degradation, peace and justice.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

• The United Nations Sustainable Development Goals (UN SDGs, also known as the Global
Goals) are 17 goals with 169 targets that all UN Member States have agreed to work towards
achieving by the year 2030.

GOAL 1. End poverty in all its forms everywhere

• More than 700 million people, or 10 percent of the world population, still live in extreme
poverty today, struggling to fulfil the most basic needs like health, education, and access to
water and sanitation, to name a few.

• Globally, the number of people living in extreme poverty declined, but the pace of change is
decelerating and the COVID-19 crisis risks reversing decades of progress in the fight against
poverty

• The UN COVID-19 Response and Recovery Fund aims to specifically support low- and
middle-income countries as well as vulnerable groups who are disproportionately bearing the
socio-economic impacts of the pandemic.

GOAL 2. End hunger, achieve food security and improved nutrition and promote
sustainable agriculture
• According to the World Food Programme, 135 million suffer from acute hunger largely due to
man-made conflicts, climate change and economic downturns. The COVID-19 pandemic
could now double that number, putting more people at risk of suffering acute hunger by the
end of 2020.
• These risks can be addressed by increasing agricultural productivity and sustainable food
production under the responsibility of the Food and Agriculture Organization.
GOAL 3. Ensure healthy lives and promote well-being for all at all ages
• Health has a central place in SDG 3, underpinned by 13 targets that cover a wide spectrum of
WHO’s work.

• The Goals within a goal: Health Targets for SDG 3

3.1 : By 2030, reduce the global maternal mortality ratio

3.2 : By 2030, end preventable deaths of newborns and children under 5 years of age
3.3 : By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases
and combat hepatitis, water-borne diseases and other communicable diseases.
3.4 : By 2030, reduce by one third premature mortality from non-communicable diseases and
promote mental health and well-being.
3.5 : Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol.
3.6 : By 2020, halve the number of global deaths and injuries from road traffic accidents.
3.7 : By 2030, ensure universal access to sexual and reproductive health-care services
3.8 : Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

3.9 : By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination.
3.A: Strengthen the implementation of the WHO Framework Convention on Tobacco Control
in all countries, as appropriate.
3.B: Support the research and development of vaccines and medicines for the communicable
and noncommunicable diseases that primarily affect developing countries.
3.C: Substantially increase health financing and the recruitment, development, training and
retention of the health workforce in developing countries, especially in least developed
countries and small island developing States
3.D: Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks.

GOAL 4. Ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all
• Education enables upward socioeconomic mobility and is a key to escaping poverty.
• To protect the well-being of children and ensure they have access to continued learning,
UNESCO in March 2020 launched the COVID-19 Global Education Coalition
• also scaled up its work in 145 low- and middle-income countries to support governments and
education partners in developing plans for a rapid, system-wide response including alternative
learning programmes and mental health support.

GOAL 5. Achieve gender equality and empower all women and girls
• Gender equality is not only a fundamental human right, but a necessary foundation for a
peaceful, prosperous and sustainable world
• Emerging data shows that, since the outbreak of the pandemic, violence against women and
girls – and particularly domestic violence – has intensified.
• UN Women has developed a rapid and targeted response to mitigate the impact of the
COVID-19 crisis on women and girls and to ensure that the long-term recovery benefits
them.

GOAL 6. Ensure availability and sustainable management of water and sanitation for all
• While substantial progress has been made in increasing access to clean drinking water and
sanitation, billions of people—mostly in rural areas—still lack these basic services.
• The COVID-19 pandemic has demonstrated the critical importance of sanitation, hygiene and
adequate access to clean water for preventing and containing diseases.
• UNICEF is urgently appealing for funding and support to reach more people with basic water,
sanitation and hygiene facilities, especially those children who are cut off from safe water
because they live in remote areas, or in places where water is untreated or polluted, or because
they are without a home, living in a slum or on the street.

GOAL 7. Ensure access to affordable, reliable, sustainable and modern energy for all
• Lack of access to energy may hamper efforts to contain COVID-19 across many parts of the
world. Energy services are key to preventing disease and fighting pandemics.
• The Special Representative of the UN Secretary-General for Sustainable Energy for All
outlined three ways to respond to the COVID-19 emergency:
o Prioritize energy solutions to power health clinics and first responders

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

o Keep vulnerable consumers connected

o Increase reliable, uninterrupted, and sufficient energy production in preparation for a more
sustainable economic recovery

GOAL 8. Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all

• The COVID-19 pandemic has caused a historic recession with record levels of deprivation
and unemployment, creating an unprecedented human crisis that is hitting the poorest
hardest.

• The United Nations released a socio-economic response framework which consists of five
streams of work:

o Ensuring that essential health services are still available and protecting health systems

o Helping people cope with adversity, through social protection and basic services

o Protecting jobs, supporting small and medium-sized enterprises, and informal sector
workers through economic response and recovery programmes

o Guiding the necessary surge in fiscal and financial stimulus to make multilateral regional
responses

o Promoting social cohesion and investing in community-led resilience and response

systems

GOAL 9: Industry, Innovation and Infrastructure

• Build resilient infrastructure, promote inclusive and sustainable industrialization and foster
innovation
• Unleash dynamic and competitive economic forces that generate employment and income
• Give investment to accelerate economic recovery, create jobs, reduce poverty and stimulate
productive investment
• Innovation and Technological Progress: key to find lasting solutions to both economic and
environmental challenges
• Least Developed Countries: improve development of manufacturing sector and scale up
investment in scientific research and innovation

COVID-19 RESPONSE:

• Communication Infrastructure – information and communication technologies accelerate

as many businesses and services goes virtually

NURSING PERSPECTIVE:

• Health Facilities and services must be conveniently and confidently be accessed

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

• On Remote locations, nearest major hospitals to provide quality and needed care requires
long drive away
o Many small towns’ local hospitals are unable to provide for major cases
o People living in rural areas have limited choices in regards to transportation
o Significant burden in terms of time and money
• Health Facilities and services must be conveniently and confidently be accessed
o Overall physical, social and mental health well-being
o Prevention of disease
o Diagnosis and treatment of disease
o Improved morbidity and mortality

GOAL 10: Reduced Inequalities

• No country is an exception towards the existence of inequality

• Reduce inequality within and among countries and to make sure the no one is left behind

COVID RESPONSE:

• Deepened existing inequalities hitting the poorest and most vulnerable communities the
hardest
• Highlights the economic inequalities and fragile social safety nets
• Call for extraordinary scale-up of international support and political commitment

o UN COVID-19 Response and Recovery Fund – support low and middle-income

countries and vulnerable groups

NURSING PERSPECTIVE:

• Affects not only life expectancy but also the quality of life
• Poor and socially disadvantages often receive differing options for treatment than those who
are the least disadvantaged
• Result of health systems not being set up or organized to deliver health services to people at
the bottom of the class structure

GOAL 11: Sustainable Cities and Communities

• Make cities and human settlements inclusive, safe, resilient and sustainable
• Increase of urbanization leads to increase of slum dwellers, inadequate and overburdened
infrastructure and services
• Cities and Metropolitan areas as powerhouses of economic growth

COVID-19 RESPONSE:

• Hunger and fatalities expected to rise in number in urban areas

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

• Most devasting for the poor and densely populated urban areas – overcrowding that leads to
incapability to strictly implement social distancing
• UN Habitat COVID-19 Response Plan
o Support local governments and community-driven solution in informal settlements
o Provide urban data, evidence-based mapping and knowledge for informed decision
o Mitigate Economic impact and initiate recovery
• UN-Habitat’s COVID-19 Policy and Programmer Framework – provides guidance for
global, regional and country-level action

NURSING PERSPECTIVE:

• Living in urban areas has been associated with improvement in income levels and health
outcomes
o Pressures on urban growth have contributed to the emergence of stark social and health
inequalities in cities around the world
• Rapid growth of population = major factor in disparity

GOAL 12: Responsible Consumption and Production

• As countries create progress in their economic and social area, environmental degradation
happens.
• Ensure sustainable consumption and production patterns.
• Worldwide Consumption and Production as a driving force of the global economy.
• Do more and better with less.
o Decoupling economic growth from environmental degradation
o Increase resource efficiency
o Promoting sustainable lifestyles
• Lessen case of poverty and attain the transition to low carbon and green economies
• Encouraging industries, businesses and consumers to recycle and reduce waste.

COVID-19 RESPONSE:

• Shows how humans have unlimited needs but the planet has limited capacity to satisfy them
• Understand and appreciate the limits to which humans can push nature before negative
impact occurs
o Reflected in our consumption and production patterns

NURSING PERSPECTIVE:

• Hospitals and Health Services are large consumers of resources and produce significant
amounts of waster
o Only 58% disposed wastes in the correct way (WHO) - Putting communities at risk from
cross contamination of waste from infectious and pathological waste, sharps-infected
injuries and poisoning from pollution from chemicals, pharmaceuticals, genotoxic and
radioactive wastes

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

• Medical waste incineration as the leading source of dioxin, a potent carcinogen.

• Achieving a number of goals such as virtually eliminating the use of mercury-based medical
equipment in the USA.

GOAL 13: Climate Action

• Take urgent action to combat climate change and its impacts

• Disrupts national economies and affecting lives
o Weather Patterns are changing
o Sea Levels are rising
o Weather Events becoming extreme
• Paris Agreement (2015) – aims to strengthen the global response to the threat of climate
change by keeping a global temperature rise this century well below 2 degrees Celsius above
pre-industrial levels.
o Appropriate financial flows
o New technology frameworks
o Enhanced capacity building frameworks

COVID-19 RESPONSE:

• Greenhouse Gas Emission expected to drop about 6% (2020) due to travel bans and economic
slowdowns
o Once global economy begins to recover it is expected for the emission to once again
increase
• 6 Climate-Positive Actions: to serve as guidance once governments decided to build back
their economies and societies
o Green transition - Investments must accelerate the decarbonization of all aspects of our
economy
o Green jobs and sustainable and inclusive growth
o Green economy
o Invest in sustainable solutions - fossil fuel subsidies must end and polluters must pay for
their pollution
o Confront all climate risks
o Cooperation

NURSING PERSPECTIVE:

• Adverse Effects that are Fundamental Determinants of Health

o Food
o Clean air
o Safe Water
o Secure Shelter
• Everyone is affected but there would always be someone who is more vulnerable than the
others
• 2008 Canadian Nurses Association: publish “The Role of Nurses in Addressing Climate
Change”

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

GOAL 14: Life Below Water

• Conserve and sustainably use the oceans, seas and marine resources for sustainable
development
• Care for our oceans and waterways is crucial
• 2 National Philippine Laws:
o National Integrated Protected Areas System Act (NIPAS) (RA 7586)
o Fisheries Code of the Philippines (RA 8550 as amended by RA 10654)

COVID-19 RESPONSE:

• Ocean conservation and action should not come to a halt

• UNESCO: can be an ally against COVID-19
o Bacteria found in the depths of the ocean are used to carry out rapid testing to detect the
presence of COVID-19
o Species Diversity found in the ocean can be utilized for future pharmaceuticals
• Time for the ocean to heal as human mobility and resource demands decrease

NURSING PERSPECTIVE:

• Source of protein and other micronutrients critical to health

• Provide natural resources including food, medicines, biofuels and other products
• Food Agriculture Organization: health of our planet as well as our own health and future
food security all hinge on how we treat the blue world

Goal 15: Life on Land

• Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage
forests, combat desertification, and halt and reverse land degradation and halt biodiversity
loss
• Source of the oxygen we breathe, helps to regulate our weather pattern, and is a source for
the food that we eat
• 75% Nature Alteration due to recorded man-made activities:
o Deforestation
o Desertification
• Forest – important to be cared for since it is the one that keeps weather climate in check
• Investing in Land Restoration is critical for improving livelihoods, reducing vulnerabilities
and reducing risks for the economy
• All aspects of human well-being depend on ecosystem goods and services, which in turn
depend on biodiversity

COVID-19 RESPONSES:

• Working with the Environment to Protect People – how to build back better guide
released by UNEP

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

o Helping nations manage COVID-19 waste

o Delivery a transformational change for nature and people
o Working to ensure economic recovery packages create resilience to the future crises
o Modernizing Global Environmental Governance
• Decade on Ecosystem Restoration (2021-2030) – globally-coordinated response by UN to
the loss and degradation of habitats will focus on building political will and capacity to
restore humankind’s relation with nature

NURSING PERSPECTIVE:

• Zoonotic Diseases – part of the adverse effects; it narrows the distance between animals
(especially those in wildlife) and human thus a greater risk of wildlife pathogens to make
contact directly to us and to our livestocks
• WHO reported that changes of landscape patterns as well as the biodiversity is a key
contributor to the outbreak of diseases like Ebola.
• Risk food and nutrition security as well as protection from natural disasters

GOAL 16: Peace, Justice and Strong Institutions

• Promote peaceful and inclusive societies for sustainable development, provide access to
justice for all and build effective, accountable and inclusive institutions at all levels
• Conflict, insecurity, weak institutions and limited access to justice are threats and obstacles
that prevent sustainable development to be attained
• Strengthening the rule of law and promoting human rights is key to this process, as is
reducing the flow of illicit arms and strengthening the participation of developing countries
in the institutions of global governance.

COVID-19 RESPONSE:

• Human rights help to create pandemic response

o Build more effective and inclusive solutions for the emergency of today and the recovery
for tomorrow
• Promote transparency, responsiveness and accountability of respective governments towards
COVID-19 response
o Ensure that any emergency measures are legal, proportionate, necessary and non-
discriminatory
• A call for Global Ceasefire
o UN Refugee Agency – provides health, water, sanitation and hygiene services to protect
refugees and displaced people, working with governments to ensure that people forced
to flee are included in COVID-19 preparation and response plans

NURSING PERSPECTIVE:

• Impact on mental health of the involved and victims of brutality, violence and the like

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

• Nurses as influencers for we have the public trust, we have seen the damage, we have the
mind fueled by convictions, we can provide solutions to aid individuals communities and
nations

GOAL 17: Partnerships for The Goals

• Sustainable Development Goals can only be realized when there is an existing global
partnership from one country to another along with both parties’ cooperation.
o Partnership must be present in global, regional, national and local levels that has the same
vision and goals
o This also includes shared accountability and risk management
• This partnership is not only enclosed under the business or financial area but rather the
variation of different resources, knowledge and perspective that can lead to better results and
innovative approaches

COVID-19 RESPONSE:

• A call for Global Solidarity – for everyone’s interest

o No country alone can overcome this pandemic without the support and help of other
countries.
• Most vulnerable populations at the center
• Verified - a website launched by UN to combat the spread of misinformation regarding
COVID-19 by providing trusted and accurate information with 3 themes:
o Science - to save lives
o Solidarity - promote local and global cooperation
o Solutions - advocated for support to impacted populations
• Response and Recovery Trust Fund - launched by UN to support low and middle-income
countries·
• The UN proposed a call for an extension of debt moratorium for all developing countries.
NURSING PERSPECTIVE:
• Prevention as the best option of action since it helps to reduce costs placed on the health
system and it improves people’s quality of life
• Health sector cannot give its best service if it functions separately and that we need to work
in tandem with industry and other government departments.
• According to the International Council of Nurses: “Nurses are said to be one of the keys to
attain these sustainable development goals and that there is a need of support and
investment of the government for it to be achieved.”

References:
Suistanable Development Goals Retrieved from https://www.un.org/sustainabledevelopment/
Suistanable Development Goals Retrieved from https://www.icn.ch/nursing-policy/icn-strategic-
priorities/sustainable-development-goalsNURSES’ ROLE IN ACHIEVING THE SUSTAINABLE
DEVELOPMENT GOALS Retrieved from https://www.icnvoicetolead.com/wp-
content/uploads/2017/04/ICN_AVoiceToLead_guidancePack-9.pdf

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

B. Philippine Department of Health

1. Mission
Guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor and shall
need the quest for excellence in health.
The DOH shall do this by seeking always to establish performance standards for health human
resources; health facilities and institutions; health products and health services that will produce
the best health systems for the country. This, in pursuit of its constitutional mandate to safeguard
and promote health for all Filipinos regardless of creed, status, or gender with special consideration
for the poor and the vulnerable who will require more assistance.
Vision
The DOH is the leader, staunch advocate, and model in promoting Health for All in the
Philippines.
2. Historical Background
I. Pre-Spanish and Spanish Periods (before 1898)
• use of herbs and rituals for healing
• 1577
o Western Concept of Public Health Services - first dispensary managed by
Franciscan friars for indigent patients of Manila
• 1876
o Medicos Titulares - similar to provincial health officers

• 1888
o Superior Board of Health and Charity - created by the Spaniards; gave rise to a
hospital system, a board of vaccination, etc.

II. June 23, 1898

• Department of Public Works Education and Hygiene
o conceived via virtue of a decree signed by President Emilio Aguinaldo shortly after
the Philippines proclaimed independence from Spain
o short-lived since the Americans took over

III. September 29, 1898

• Board of Health for the City of Manila - established as per General Orders No. 15 in
order to protect the American soldiers’ health

IV. July 1, 1901

• Board of Health for the Philippine Islands
o established through Act No. 157 due to the realization that American soldiers
cannot be protected if the natives aren’t
o functions as the local health board of Manila

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

o became an Insular Board of Health after the establishment of Provincial and

Municipal boards through Act Nos. 307 and 308, dated December 2, 1901, which
respectively completed the health organization in relation with the islands’
territorial division.
V. October 26, 1905
• Bureau of Health
o under the Department of Interior and through Act No. 1407, this replaced the
Insular Board of Health after the latter’s abolition.

VI. 1906
• Act No. 1487 - replaced the provincial boards of health with district health officers

VII. 1912
• Act No. 2156 (Fajardo Act) - compacted the municipalities into sanitary divisions and
constituted the Health Fund for travel and salaries

VIII. 1915
• Act No. 2468
o converted the Bureau of Health into Philippine Health Service—a commissioned
service which presented a systematic organization with corresponding civil service
grades and a secure system of civil service entrance and promotion depicted as the
“semi military system of public health administration.”
IX. August 2, 1916
• Passage of the Jones Law (Philippine Autonomy Act)
o showed the Filipinos’ struggle for independence during the American rule
o established a bicameral system of government formed due to the formation of the
elective Philippine senate completed and all Filipino assembly
brought about a major reorganization which resulted to the Administrative
Code of 1917 (Act 2711) - included the Public Health Law of 1917
X. 1932
• Act No. 4007 (Reorganization Act of 1932)
o reverted the Philippine Service back into the Bureau of Health and added the
Bureau of Public Welfare under the Office of the Commissioner of Health and
Public Welfare due to the need for better coordination when it comes to public
health and welfare services
Philippine Commonwealth and the Japanese Occupation (1935-1945)
XI. May 31, 1939
• Commonwealth Act No. 430
o created the Department of Public Health and Welfare
implemented through Executive Order No. 317 on January 7, 1941
o 1941
Dr. Jose Fabella: first department secretary of health and public welfare
XII. 1942 (Japanese Occupation)
• “various reorganizations and issuances for the health and welfare of the people were
instituted and lasted until the Americans came in 1945 and liberated the Philippines.”

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

XIII. October 4, 1947

• Executive Order No. 94
o provided for the postwar organization of the Department of Health and Public
Welfare which resulted in the divide of the department wherein the Bureau of
Public Welfare (which later became the Social Welfare Administration) and the
Philippine General Hospital were transferred under the Office of the President.
o Bureau of Hospitals/Bureau of Health
curative and preventive services were also split since curative services were
placed under the Bureau of Hospitals while preventive care services remain
under the Bureau of Health.
o EO No. 94 also set up the Nursing Service Division under the Office of the
Secretary.

XIV. January 1, 1951

• conversion of the Office of the President of the Sanitary District into a Rural Health
Unit which carried out 7 basic health services including: maternal and child health,
environmental health, communicable disease control, vital statistics, medical care,
health education, and public health nursing.
o carried out in 81 selected provinces
o due to the impact it made, it resulted into the Rural Health Act of 1954 (RA 1082).
paved the way for the creation of more rural health units and posts for municipal
health officers among other provisions.

XV. February 20, 1958

• Executive Order No. 288
o “most sweeping the organization in the history of the department” at that time
o came about in an attempt to “decentralize governance of health services”
all health services were decentralized to the regional, provincial, and
municipal levels.
o Office of the Regional Health Director was established in eight regions
o bureaus were limited to staff functions such as policy making and development of
procedures
o RHUs: made integral parts of the public health care delivery system

XVI. 1970
• Restructured Health Care Delivery System
o classified health services into primary, secondary, and tertiary levels of care
o further expanded the reach of the Rural Health Units
o public health nurse to population ratio was 1:20,000
o public health nurse’s expanded role was also accentuated

XVII. June 2, 1978

• Martial Law
o Presidential Decree 1397
renamed the Department of Health to the Ministry of Health
Secretary Gatmaitan: first Minister of Health

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

XVIII. December 2, 1982

• Executive Order No. 851 (Ferdinand E. Marcos)
o redefined the Ministry of Health as an integrated healthcare delivery system via
the creation of the Integrated Provincial Health Office which combines public
health and the hospital operations under the Provincial Health Officers.
XIX. April 13, 1987
• Executive Order No. 119, “Reorganizing the Ministry of Health” by Corazon C.
Aquino
o major change in the structure of the ministry; transformed the Ministry of Health
back to the Department of Health.
o clustered agencies and programs under the Office for Public Health Services,
Office for Hospital and Facilities Services, Office for Standards and Regulations,
and Office of Management Services.
o Field Offices were composed of the Regional Health Offices and National Health
Facilities.
NHF was composed of the National Medical Centers and the Special Research
Centers and Hospital.
o five deputy minister positions were also made available

XX. October 10, 1991

• Republic Act 7160 (Local Government Code provided for decentralization of the
entire government)
o major shift in the role and functions of the Department of Health
delivery of basic health services is now the responsibility of the LGUs
all structures, personal and budgetary allocations from the provincial health
level down to the barangays were devolved into the local government units
(LGUs) to facilitate health service delivery.
o Department of Health changed its role from one that is of implementation to one
that is of governance.

XXI. May 24, 1999

• Executive Order No. 102, “Redirecting the Functions and Operations of the
Department of Health” by Joseph E. Estrada
o allowed the Department of Health to proceed with its rationalization and
streamlining plan
laid out the current organizational staffing and resource structure in line with
its new mandate roles and functions post devolution
o de-emphasized direct service provision and program implementation and
emphasized policy formulation, standard setting and quality assurance, technical
leadership, and resource assistance.
o DOH’s new role as the national authority on health
providing technical and other resource assistance to concerned groups are
among their responsibilities
o mandates DOH to provide assistance to local government units, people's
organization, and other members of civic society who aim to effectively implement
programs, projects, and services that will:

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

promote the health and well-being of every Filipino;

prevent and control diseases among population at risk;
protect individuals, families, and communities exposed to hazards and risks
that could easily affect their health;
and treat, manage, and rehabilitate individuals affected by diseases and
disability.
XXII. 1999 to 2004
• Health Sector Reform Agenda
o describes the major strategies, organizational and policy changes, and public
investments required to improve the way health care is delivered, regulated, and
financed.
o overriding goal of the DOH

XXIII. 2005 ongoing

• development of a plan to rationalize the bureaucracy in an attempt to scale down,
including the Department of Health.
Reference: National League of Philippine Government Nurses. (2007). Public Health Nursing in
the Philippines. National League of Philippine Government Nurses.

3. Local Health System and Devolution of Health Services

• Over 40 years after post war independence, the Philippine health care system was
handled by a central agency based on Manila – there is singular sources of resources,
policy direction, technical and administrative supervision to nationwide health facilities.
• Republic Act 7160 – also known as Local Government Code passed on 1991, pertaining
to all structures, personnel and budgetary allocations from the provincial health level
down to the barangay were devolved (responsibility given to) to the local government
units, for health service delivery.
• Devolution – gave local government executive the responsibility to operate local health
care services.
• New centers of authority for local health services
o provincial - operates Provincial and District hospitals
o city & municipal government – operates Health Centers (HC)/ Rural Health Units
(RHU) and Barangay Health Stations (BHS)
o autonomous regional government
o metropolitan authority

Objectives: Local health systems are institutionalize within the context of local autonomy and
develop mechanisms for inter – LGU cooperation.
1. Establish local health systems for effective and efficient delivery of health care services.
2. Upgrade the health care management and service capabilities of local health facilities.
3. Promote inter – LGU linkages and cost sharing schemes including health care financing
systems for better utilization of local health resources.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

4. Foster participation of private sector, non –government organization (NGOs) and

communities local health systems development.
5. Ensure the quality of health service delivery at the local level.

Inter Local Health System

• espoused by the Department of Health in ensuring quality health care service at local
level
• the concept is the creation of Inter Local Health System (ICHS) through clustering
municipalities into Inter Local Health Zone (ILHZ)
• Inter Local Health Zone (ILHZ) comprises a central referral hospital and a number of
primary level facilities (Rural Health Units and Barangay Health Station)
• Importance of establishing Inter – Local Health System: in order to re – integrate hospital
and public health service for a holistic delivery of health services, to complement
stakeholders in the delivery of health services.
• Composition of Inter – Local Health Zone
1. People – number may vary from zone to zone
- ideal health district population size is between 100,000 and 500,000
2. Boundaries – clear boundaries determine accountability and responsibility of
health service providers, geographical locations and access to referral facilities
- district hospitals are the basic in forming boundaries
3. Health Facilities – district or provincial hospital (referral hospital for secondary
level of health care)
- Rural Health Units (RHU), Barangay Health Stations (BHS)
4. Health Workers – right unit of health providers for delivery of comprehensive
health services
- Groups of health providers forming ILHZ: Department of Health,
District Hospital, Rural Health Units, Barangay Health Stations, Private Clinic,
volunteer health workers, Non – government Organization (NGO), community-
based organization.
Levels of Health Care and Referral System
1. Primary Level of Care
o devolved to the cities and the municipalities
o health care provided by center physicians, public health nurses, rural health
midwives, barangay health workers, traditional healers and others
o barangay health stations and rural health units
o first contact between the community members
2. Secondary Level of Care
o given by physicians with basic health training
o given in private or government operated health facilities
o given in infirmaries, municipal and district hospitals and out – patient departments
of provincial hospitals
o referral center for the primary health facilities
o secondary facilities are capable of performing minor surgeries and simple
laboratory examinations
3. Tertiary Level of Care
o rendered by specialists in health facilities

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

o medical centers, regional and provincial hospitals and specialized hospitals (such as
Philippine Heart Center)
o referral center for the secondary care facilities
o complicated cases and intensive care requires tertiary care provided by tertiary care
facility

4. Classification of Health facilities (DOH AO-0012A)

DOH Administrative Order No. 2012-2012 - promulgated on July 18, 2012; effective on
August 18, 2012; transitory period up to December 31, 2017
Subject: “Rules and Regulations Governing the New Classification of Hospitals and
Other Health Facilities in the Philippines"
• this is pursuant to Section 16 of Republic Act No. 4226 otherwise known as Hospital
Licensure Act
• “The licensing agency shall study and adopt a system of classifying hospitals in the
Philippines as to:
1) general or special
2) service capabilities
3) size or bed capacity
4) classification of hospital whether training or not

• regulation of health facilities takes into account their service capacities and compliance
with standards for manpower, equipment, construction and physical facilities
• the rules and regulations are promulgated to protect and promote the health of the public
through minimum quality of service rendered by hospitals and other regulated health
facilities and to assure the safety of patients and personnel
• the rules and regulations are applied to all government and private hospitals and other
health facilities

Classification of Hospitals
a. According Ownership
1. Government – the hospital is created by law
- A government health facility may be under the National Government,
DOH, Local Government Unit (LGU), Department of Justice (DOJ),
State Universities and Colleges (SUCs), Government-owned and
controlled corporations (GOCC) and others
2. Private - Owned, established, and operated with funds from donation, principal,
investment, or other means by any individual, corporation, association, or
organization.
b.. According to Scope of Services
1. General Hospital - A hospital that provides services for all kinds of illnesses,
diseases, injuries or deformities
- It provides medical and surgical care to the sick and injured,
maternity, newborn and child care

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

- shall be equipped with the service capabilities needed to support

board certified/ eligible medical specialists and other licensed physicians rendering
services in, but not limited to the following:
o Clinical Services (Family Medicine, Pediatrics, Internal Medicine,
Obstetrics and Gynecology, Surgery)
o Emergency Services
o Outpatient Services
o Ancillary and Support Services (Clinical Laboratory, Imaging
Facility, Pharmacy)
2. Specialty - Specializes in a particular disease or condition or in one type of patient
- A specialized hospital may be devoted to the treatment of the following:
o Treatment of a particular type of illness or for a particular
condition requiring a range of treatment
Examples: Philippine Orthopedic Center, National
Center for Mental Health, San Lazaro Hospital
o Treatment of patients suffering from a particular diseases of a
particular organ or group of organs
Examples: Lung Cancer of the Philippines, Philippine
Heart Center, National Kidney and Transplant Institute
o Treatment of patients belonging to a group such as children,
women, elderly or others
Examples: Philippine Children’s Medical Center,
National Children’s Hospital, Dr. Jose Fabella
Memoraial Hospital
c. According to functional capacity
1. General Hospital
a. Level 1 - A level 1 General Hospital shall have as minimum:
1. A staff of qualified, medical, allied medical and administrative personnel
headed by a physician duly licensed by the PRC
2. Bed space for its authorized bed capacity, in accordance with DOH
Guidelines in the Planning and Design of Hospitals
3. An operating room with standard equipment and provisions for sterilization
of equipment and supplies in accordance with:
o DOH Reference Plan in the Planning and Design of an Operating
Room or Theater
o DOH Guidelines on Cleaning, Disinfection, and Sterilization of
Reusable Medical Devices in Hospital Facilities in the Philippines
4. A post-operative Recovery Room
5. Maternity Facilities consisting of Ward(s), Room(s), a Delivery Room,
exclusively for maternity patients and newborns
6. Isolation facilities with proper procedures for the care and control of
infection and communicable diseases as well as for the prevention of cross
infection
7. A separate dental section/ clinic
8. Provision for blood donation

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

9. A DOH-licensed secondary clinical laboratory with the services of a

consulting pathologist
10. A DOH licensed Level 1 imaging facility with the services of a consulting
radiologist
11. A DOH licensed pharmacy
b. Level 2 - As minimum, all of Level 1 capacity, including but not limited to:
1. An organized staff of qualified and competent personnel with Chief of
Hospital/Medical Director and appropriate board certified Clinical
Department Heads
2. Departmentalized and equipped with the service capabilities needed to
support board certified/ eligible medical specialties and other licensed
physicians rendering services in the specialties of Medicine, Pediatrics,
Obstetrics and Gynecology, Surgery, their subspecialties, and other
ancillary services
3. Provision for general ICU for critically ill patients
4. Provision for NICU
5. Provision for HRPU
6. Provision for Respiratory Therapy Services
7. A DOH licensed tertiary clinical laboratory
8. A DOH licensed level 2 imaging facility with mobile X-ray inside the
institution and with capability for contrast examinations
c. Level 3 - As minimum, all of Level 2, including but not limited to:
o Teaching and/or Training Hospital with accredited residency training
program for physicians in the four major specialties namely: Medicine,
Pediatrics, Obstetrics and Gynecology, and Surgery
o Provision for physical medicine and rehabilitation unit
o Provision for ambulatory surgical clinic
o Provision for dialysis facility
o Provision for blood bank
o A DOH licensed level 3 imaging facility with interventional radiology
2. Specialty Hospitals (same as stated on Specialty on According to scope of services)
o Trauma Capability of Hospitals The trauma capability of hospitals shall be
assessed in accordance with the guidelines formulated by the Philippine College
of Surgeons
o Trauma Capable Facility is a DOH licensed hospital designated as a Trauma
Center
o Trauma Receiving Facility is a DOH licensed hospital within the trauma service
area which receives trauma patients for transport to the point of care or a trauma
center

Classification of Other Health Facilities

a. Category A: Primary Care Facility – first contact healthcare facility, offers basic services
(emergency service and provision for normal deliveries)
1. With In – patient beds – short stay facility (average of one to three days) Examples:
a. Infirmary

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

b. Birthing Home - homelike

facility providing maternity
service on pre – natal and post
– natal care, normal
spontaneous delivery and care
of newborn babies.
2. Without beds – a facility where
medicine, medical and/or dental
examination/treatment is dispensed
o Medical Out – patient Clinic
o Medical Facility for Overseas
Workers and Seafarers
o Dental Clinic
b. Category B: Custodial Care Facility – health
facility providing long term care, including
basic human services like food and shelter
to patients which chronic or mental illness,
rehabilitation and for patients with ongoing
health and nursing care
o Custodial Psychiatric Care
Facility
o Substance/Drug Abuse
Treatment and Rehabilitation
Center
o Sanitarium/Leprosarium
o Nursing Home
c. Category C: Diagnostic/Therapeutic Facility –
facility for examining human body or
specimens from human body, test covers pre –
analytical, analytical and post – analytical
phases of examination.
1. Laboratory Facility
o Clinical Laboratory
o Human Immunodeficiency Virus
(HIV) Testing Laboratory
o Blood Service Facility
o Drug Testing Laboratory
o Newborn Screening Laboratory
o Laboratory for Drinking Water Analysis
2. Radiologic Facility
o Ionizing Machines as X – Ray, CT scan, mammography and others
o Non – Ionizing Machines as MRI, ultrasound and others
3. Nuclear Medicine Facility regulated by PNRI, applies radioactive materials in diagnosis
d. Category D: Specialized Out – Patient Facility – highly competent and trained staff that
performs highly specialize procedures on an out – patient basis.
o Dialysis Clinic

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

o Ambulatory Surgical Clinic

o In – Vitro Fertilization Center
o Stem Cell Facility
o Oncology Chemotherapeutic Center/Clinic
o Radiation Oncology Facility
o Physical Medicine and Rehabilitation Center/Clinic
Reference:
Administrative Order 2012-0012. Rules and Regulations Governing the New Classification of
Hospitals and Other Health Facilities in the Philippines. Department of Health
Philippines
National League of Philippine Government Nurses. (2007). Public Health Nursing in the
Philippines. National League of Philippine Government Nurses.

5. Philippine Health Agenda 2010-2022

• Healthy Philippines 2022
• “All for Health Towards Health for All”

THE HEALTH SYSTEM THEY ASPIRE FOR

1. Financial Protection - Filipinos, especially the poor, marginalized, and vulnerable are
protected from high cost of health care
2. Better Health Outcomes - Filipinos attain the best possible health outcomes with no
disparity
3. Responsiveness - Filipinos feel respected, valued, and empowered in all of their
interaction with the health system
4. Equitable & Inclusive to All
5. Transparent & Accountable
6. Uses Resources Efficiently
7. Provides High Quality Services

PERSISTENT INEQUITIES IN HEALTH OUTCOMES

• Every year, around 2000 mothers die due to pregnancy-related complications
• A Filipino child born to the poorest family is 3 times more likely to not reach his 5th
birthday, compared to one born to the richest family
• Three out of 10 children are stunted

RESTRICTIVE AND IMPOVERISHING HEALTHCARE COSTS

• Every year, 1.5 million families are pushed to poverty due to health care expenditures
• Filipinos forego or delay care due to prohibitive and unpredictable user fees or co-
payments
• Php 4,000/month healthcare expenses considered catastrophic for single income families

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

POOR QUALITY AND UNDIGNIFIED CARE SYNONYMOUS WITH PUBLIC

CLINICS AND HOSPITALS
• Long wait times
• Limited autonomy to choose provider
• Less than hygienic restrooms, lacking amenities
• Privacy and confidentiality taken lightly
• Poor record-keeping
• Overcrowding & under-provision of care

LAHAT PARA SA KALUSUGAN! TUNGO SA KALUSUGAN PARA SA LAHAT

Attain Health Related SDG Targets
- Financial Risk Protection
- Better Health Outcomes
- Responsiveness
Values
- Equity
- Quality
- Efficiency
- Transparency
- Accountability
- Sustainability
- Resilience
THREE GURANTEES
1. Guarantee 1: All Life Stages & Triple Burden of Disease
(Services for Both the Well & the Sick)
First 1000 days
Reproductive and Sexual Health
Maternal, Newborn, and Child Health
Exclusive Breastfeeding
Food & Micronutrient Supplementation
Immunization
Adolescent health
Geriatric Health
Health Screening, Promotion & Information
Communicable Diseases Non-Communicable Diseases Diseases of Rapid
and Malnutrition Urbanization and
Industrialization
• HIV/AIDS, TB, • Cancer, Diabetes, Heart Disease • Injuries
Malaria and their Risk Factors – obesity, • Substance abuse
• Diseases for smoking, diet, sedentary lifestyle • Mental Illness
Elimination • Malnutrition • Pandemics, Travel Medicine
• Dengue, Leptospirosis, • Health consequences of
Ebola, Zika climate change / disaster

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

2. Guarantee 2: Service Delivery Network

(Functional Network of Health Facilities)
Services are delivered by networks that are:
FULLY FUNCTIONAL - Complete Equipment, Medicines, Health
Professional
COMPLIANT WITH CLINICAL PRACTICE GUIDELINES
AVAILABLE 24/7 & EVEN DURING DISASTERS
PRACTICING GATEKEEPING
LOCATED CLOSE TO THE PEOPLE - Mobile Clinic or Subsidize
Transportation Cost
ENHANCED BY TELEMEDICINE

3. Guarantee 3: Universal Health Insurance

(Financial Freedom When Accessing Services)
Services are financed predominantly by PhilHealth
PhilHealth as the Gateway to Free Affordable Care:
• 100% of Filipinos are members
• Formal sector premium paid through payroll
• Non-formal sector premium paid through tax subsidy
Simplify PhilHealth Rules
•No balance billing for the poor/basic accommodation & Fixed co-payment for
non-basic accommodation
PhilHealth As Main Revenue Source for Public Health Care Providers
•Expand benefits to cover comprehensive range of services • Contracting
networks of providers within SDNs
THE STRATEGY (ACHIEVE)
A - Advance quality, health promotion and primary care
C - Cover all Filipinos against health-related financial risk
H - Harness the power of strategic HRH development
I - Invest in Health and data for decision-making
E - Enforce standards, accountability, and transparency
V - Value all clients and patients, especially the poor, marginalized, and vulnerable
E - Elicit multi-sectoral and multi-stakeholder support for health

C. Primary Health Care (PHC)

OVERVIEW
a) 30th World Health Assembly decided that
May 1977
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
b) First International Conference on Primary Health Care
with representatives from 134 countries

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Alma Ata, USSR on September 6 – 12, 1978 by WHO

Reason behind the declaration
: Global health situation was UNJUST
: Wide gap in the health of underdeveloped and developed countries and even
within countries
Goal
: “Health for All by the year 2000”
c) Letter of Instruction No. 949
Signed by President Marcos on October 19, 1979
“Health in the Hands of the People by 2020”
Honorable Enrique M. Garcia as Minister of Health
Ministry of Health was charged with the supervision and coordination of all health
and health-related activities within the Philippines
Objectives
Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable and other disease.
Reduction in morbidity and mortality rates especially among infants and children.
Extension of essential health services with priority given to the underserved
sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at self- reliance.
Maximizing the contribution of the other sectors for the social and economic
development of the community
Mission
To strengthen the health care system by increasing opportunities and supporting
the conditions wherein people will manage their own health care

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE

Magnitude of Health Problems
Inadequate and unequal distribution of health resources
Increasing cost of medical care
Isolation of health care activities from other development activities

OBJECTIVE
HEALTH FOR ALL FILIPINOS by the year 2000 and HEALTH IN THE HANDS
OF THE PEOPLE by the year 2020.
An improved state of health and quality of life for all people attained through SELF
RELIANCE

KEY STRATEGY TO ACHIEVE THE GOAL

Partnership with and Empowerment of the people that shall permeate as the core
strategy in the effective provision of essential health services that are community
based, accessible, acceptable, and sustainable, at a cost, which the community and
the government can afford

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Community health nurses subscribe to the BELIEFS articulated in the Declaration, specifically:
1. The promotion and protection of the health of the people is essential to sustained
economic and social development and contributes to a better quality of life and to world
peace
2. The people have the right and duty to participate individually and collectively in the
planning and implementation of their health care
3. PHC is premised on the spirit of social justice
4. PHC is an integral part of the country’s health system, and of the overall social and
economic development of the community (WHO/UNICEF 1978:2)

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

Barangay Health Workers – trained community health workers or health auxiliary
volunteers or traditional birth attendants or healers.
Intermediate Level Health Workers- include the Public Health Nurse, Rural Sanitary
Inspector, and Midwives.
References:
All For Health Towards Health For All. (n.d.). Retrieved from
https://www.doh.gov.ph/sites/default/files/basic-page/Philippine%20Health%20Agenda_Dec1_1.pdf
Cuevas, RN, MAN, F. (n.d.). Chapter II: The Philippine Health Care Delivery System. In Public Health
Nursing in the Philippines (10th Edition ed., pp. 30-31). Publications Committee, National League of
Philippine Government Nurses, Incorporated.
Cruz-Earnshaw, R. (n.d.). Chapter I Community Health Nursing: Context and Practice. In A. Maglaya
(Ed.), Nursing Practice in the Community (5th ed., pp. 30-31). Marikina City: Argonauta
Corporation.
Letter of Instruction No. 949, s. 1979. (1979, October 19). Retrieved from
https://www.officialgazette.gov.ph/1979/10/19/letter-of-instruction-no-949-s-1979/
Primary Health Care (PHC). (2017, July 04). Retrieved from https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/primary-health-care-phc/

2. Legal Basis
Letter of Instruction (LOI) 949
o President Ferdinand Marcos
o October 19, 1979
o Health in the Hands of the People by 2020
3. Definition
“essential health care based on practical, scientifically sound and socially acceptable
methods and technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community can afford to
maintain at every stage of their development in the spirit of self-reliance and self-
determination,” (WHO/ UNICEF, p. 16)

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Primary Health Care Primary Care

Focus of Client Family and community Individual
Focus of Care Promotive and preventive Curative
Decision-making Process Community-centered Health worker-driven
Outcome Self-reliance Reliance on health workers
Setting for Services Rural-based satellite clinics Mostly urban places
Development and preventive
Goal Absence of disease
care
4. Goals
Health for All by the Year 2000
5. Elements
Elements
1. Universal Coverage
2. Health Service Reforms
3. Public Policy Reforms
4. Leadership Reforms
5. Stakeholder Participation
8 Essential Health Services
1. E – Education for health
2. L – Locally endemic disease control
3. E – Expanded program for immunization
4. M – Maternal and child health including responsible parenthood
5. E – Essential drugs
6. N – Nutrition
7. T – Treatment of communicable and non-communicable diseases
8. S – Safe water and sanitation
Reference:
Famorca, Z. U., Nies, M. A., & McEwen, M. (2013). Nursing Care of the Community. Singapore: Elsevier.
Letter of Instruction 949. (n.d.). Retrieved October 09, 2020, from https://pdfslide.net/documents/letter-of-
instruction-949.html.
Maglaya, A. S. (2009). Nursing Practice in the Community (5th ed.). Marikina City: Argonauta Corporation.
Public Health Nursing in the Philippines. (2007). Manila: National League of Philippine Government Nurses.

6. Principles and Strategies

Key Principles of Primary Health Care
a. 4 A's -They should make use of the available resources within the community, wherein the
focus would be more on health promotion and prevention of illness.
• Accessibility
-distance/travel time required for people to get to a health care facility/service.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

-The health services should be present where the supposed recipients are.
-the home must be w/in 30 min. from the Brgy. Health Stations (BHSs)
• Affordability
- Consideration of the individual, family, community, and government can afford the
services
-The out-of-pocket expense determines the affordability of health care.
-In the Philippines, government insurance is covered through philhealth
• Acceptability - Health care services are compatible with the culture and traditions of the
population.
• Availability -A question whether the health service is offered in health care facilities or
is provided on a regular and organized manner.
Examples:
i. Botika ng Bayan and the Botika ng Barangay
▪ ensures the availability and accessibility of affordable essential drugs.
▪ It sells low-priced generic home remedies, OTC and common antibiotics.
ii. Ligtas sa Tigdas ang Pinas
▪ Mass door-to-door measles immunization campaign.
▪ Target age: 9 months-below 8 years old

b. Community Participation
-is the heart and soul of PHC
- A process in which people identify the problems and needs and assumes responsibilities
themselves to plan, manage, and control.
-individuals, families and communities are not considered as recipient of care but active
participants in achieving their health goals.
-Thus, the success of any mission that aims at serving the people is dependent on peoples
participation at all levels of decision-making; planning, implementing, monitoring and
evaluating.

c. Support Mechanism
-There are 3 major resources:
• People
• Government
• Private Sectors (e.g. NGO, socio-civic and faith groups)
-support and involvement of these three entities in health programs and project will result
to better output.

d. Multisectorial Approach
• Intrasectoral linkages (Two-way referral system)- communication, cooperation, and
collaboration within the health sectors.
• Intersectoral Linkages- between the health sector and other sectors like education,
agriculture, and local government officials. e.g. The Rabies Prevention and Control
Program.

e. Equitable distribution of health resources

-PHC advocates for care that is community-based and preventive in orientation.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

-there is a trend in which Doctors and Nursing graduates tend to flock in urban areas and
rural areas.
In consequence the creation of 2 DOH programs to ensure equitable distribution:
• Doctor to the Barrio (DTTB) Program
- The deployment of doctors to municipalities that are w/o doctors.
- Deployed to unserved, economically depressed 5th or 6th class municipalities for
2 years.
• Registered Nurses Health Enhancement and Local Service (RN HEALS)
- A training and program for unemployed nurse
- Deployed to unserved, economically depressed municipalities for 1 year.

f. Appropriate Technology - Health Technology includes:

• tools
• drugs
• methods
• procedures and technique
• people’s technology
• indigenous technology
-Criteria for Appropriate health technology
• Safety – minimal risk to the user and the positive effect outweighs the unintended
negative effects
• Effectiveness- accomplish what it is meant to accomplish
• Affordability
• Simplicity- simpler to use so that it is easily adopted by the community when and
where applicable.
• Acceptability
• Feasibility and Reliability- must be easy to apply since it is used in community,
workplace, school and home.
• Ecological effects
• Potential to contribute to individual and community development

Strategies of Primary Health Care

1. Reorientation and reorganization of the national health care establishment of functional
support mechanism in support of the mandate of system with the decentralization under the
Local Government Code of 1991.
- The Local Government Code was enacted into law, transferring control and responsibility
of delivering basic services to the hands of local government units (LGU).

2. Effective preparation and enabling process for health action at all levels.

3. Mobilization of the people to know their communities and identifying their basic health
needs with the end in view of providing appropriate solutions (including legal measures)
leading to self-reliance and self determination
- Existence of sustained health care facilities managed by the people is some of the major
indicators that the community is leading to self-reliance.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

4. Development and utilization of appropriate technology focusing on local indigenous

resources available in and acceptable to the community.

5. Organization of communities arising from their expressed needs which they have decided
to address and that this is continually evolving in pursuit of their own development.

6. Increase opportunities for community participation in local level planning, management,

monitoring and evaluation within the context of regional and national objectives.

7. Development of intra-sectoral linkages with other government and private agencies so that
programs of the health sector is closely linked with those of other socio-economic sectors
at the national, intermediate and community levels.

8. Emphasizing partnership so that the health workers and the community leaders/members
view each other as partners rather than merely providers and receiver of health care
respectively.

The framework for meeting the goal of primary health care is organizational strategy, which calls
for active and continuing partnership among the communities private and government agencies in
health development.

D. Levels of Prevention
1. Primary Prevention - Relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals.
-2 elements of primary prevention:
• health promotion- it enhance resiliency and protective factors and target essentially well
population
• Specific protection- it reduce or eliminate risk factors
2. Secondary Prevention - Early detection and prompt intervention during the period of early
disease pathogenesis.
- Implemented after a problem has begun but before signs and symptoms appear and targets
populations who have risk factors.
3. Tertiary Prevention - Targets populations that have experienced disease or injury and focuses
on limitations of disability and rehabilitation.
- Aim: Reduce the effects of disease and injury and to restore individuals to their optimum
level of functioning.
References:
Cuevas, RN, MAN, F. (n.d.). Public Health Nursing in the Philippines (10th Edition). Publications
Committee, National League of Philippine Government Nurses, Incorporated.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Famorca, Z. U., Nies, M. A., & McEwen, M. (2013). Nursing care of the community. Singapore:
Elsevier.
Letter of Instruction No. 949, s. 1979. (1979, October 19). Retrieved from
https://www.officialgazette.gov.ph/1979/10/19/letter-of-instruction-no-949-s-1979/

E. Universal Health Care (UHC)

1. Legal Basis
Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is the
“provision to every Filipino of the highest possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an
informed and empowered public”. The Aquino administration puts it as the availability and
accessibility of health services and necessities for all Filipinos. Duterte has just signed a Universal
Health Care (UHC) Bill into law (Republic Act No. 11223) that automatically enrolls all Filipino
citizens in the National Health Insurance Program and prescribes complementary reforms in the
health system.

It is a government mandate aiming to ensure that every Filipino shall receive affordable and
quality health benefits. This involves providing adequate resources – health human resources,
health facilities, and health financing.
Parliamentarians and health stakeholders have made concerted efforts to pass a UHC bill for
the past two years, but in reality, the Philippines has experienced a 50-year process of health

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

reform, under different names. The UHC Act is the culmination of decades of progress, and two
years of dedicated political and technical work.
It is the first UHC Act of its type in the Western Pacific region; this is particularly remarkable
considering the strong presence of the private sector in the Filipino health system existing in
parallel with a fragmented and devolved government health service. The Act prescribes system
reforms in accordance with the multiple financing and service delivery mechanisms at work in the
Philippines.
2. Background and Rationale
Health-related public policies and laws have provided the impetus for comprehensive reform
strategies identified in the Health Sector Reform Agenda (HSRA) launched in 1999 and its
implementation framework, the FOURmula One (F1) for Health in 2005. Since then, substantial
gains in health sector improvements have been achieved in the areas of social health insurance
coverage and benefits, execution of Department of Health (DOH) budgets and its use to leverage
local government unit (LGU) performance, LGU spending in health, systematic health investment
planning through the Province-wide Investment Plan for Health (PIPHy Citywide Investment Plan
for Health (CIPHy Annual Operational Plan (AOP) process, capacities of government health
facilities, and the implementation and monitoring of public health programs.
However, poor Filipino families have yet to experience equity and access to critical health
services, despite all of these achievements.
DOH and PhilHealth recently conducted a joint Benefit Delivery Review highlighting the need
to increase enrollment coverage, improve availment of benefits and increase support value for
claims in order for the National Health Insurance Program (NHIP) to provide Filipinos substantial
financial risk protection. More importantly, benefit delivery for the sponsored program (poorest
quintile) was found to be lowest among our people. To date, only 53 percent of the entire
population is covered by the program, with 42 percent availment rate, and 34 percent support value
or a total benefit delivery ratio of 8 percent.
Public hospitals and health facilities have also suffered neglect due to the inadequacy of health
budgets in terms of support for upgrading to expand capacity and improve quality of services. As
of October 2010, eight hundred ninety-two (892) rural health units (RHUs) and ninety nine (99)
government hospitals have yet to qualify for accreditation by PhilHealth. Data have also shown
that the poorest of the population are the main users of government health facilities. This means
that the deterioration and poor quality of many government health facilities is particularly
disadvantageous to the poor who needs the services the most.
Moreover, weaknesses in management and compensation of human resources for health have
not been adequately addressed and inadequacies in health information systems to guide planning
and implementation of health programs also need urgent attention.
Lastly, while the Philippines is on target for most of its Millennium Development Goals
(MDG), it is lagging behind in reducing maternal and infant mortality. These two indicators are
still at 162 per i00,000 live births and 25 per 1,000 live births respectively (2005 FPS and 2008
NDHS), with 2015 MDG targets at 52 and 19, respectively. There is also wide difference in
outcomes and program performance in these priority public health programs across geographic
areas and income groups that particularly affect the poor.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

To address these challenges, the Aquino Health Agenda (AHA) is being launched to improve,
streamline and scale up reform interventions espoused in the HSRA and implemented under Fl.
This deliberate focus on the poor will ensure that as the implementation of health reforms moves
forward, nobody are left behind.
To successfully implement the Aquino Health Agenda, the Philippine health system will
require the following components: enlightened leadership and good governance practices; accurate
and timely information and feedback on performance; financing that lessens the impact of
expenditures especially among the poorest and the marginalized sector; competent workforce;
accessible and effective medical products and technologies; and appropriately delivered essential
services.
3. Objectives and Thrusts
Overall Objective - The implementation of Universal Health Care shall be directed towards
ensuring the achievement of the health system goals of better health outcomes, sustained health
financing and responsive health system by ensuring that all Filipinos, especially the disadvantaged
group in the spirit of solidarity, have equitable access to affordable health care.
General Objective - Universal Health Care is an approach that seeks to improve, streamline, and
scale up the reform strategies in HSRA and Fl in order to address inequities in health outcomes by
ensuring that all Filipinos, especially those belonging to the lowest two income quintiles, have
equitable access to quality health care.
This approach shall strengthen the National Health Insurance Program (NHIP) as the prime
mover in improving financial risk protection, generating resources to modernize and sustain health
facilities, and improve the provision of public health services to achieve the Millennium
Development Goals (MDGs).
Thrusts
Financial Risk Protection
Protection from the financial impacts of health care is attained by making any Filipino eligible
to enroll, to know their entitlements and responsibilities, to avail of health services, and to be
reimbursed by PhilHealth with regard to health care expenditures.
PhilHealth operations are to be redirected towards enhancing national and regional health
insurance system. The NHIP enrollment shall be rapidly expanded to improve population
coverage. The availment of outpatient and inpatient services shall be intensively promoted.
Moreover, the use of information technology shall be maximized to speed up PhilHealth claims
processing.
Improved Access to Quality Hospitals and Health Care Facilities
Improved access to quality hospitals and health facilities shall be achieved in a number of
creative approaches. First, the quality of government-owned and operated hospitals and health
facilities is to be upgraded to accommodate larger capacity, to attend to all types of emergencies,
and to handle non-communicable diseases. The Health Facility Enhancement Program (HFEP)
shall provide funds to improve facility preparedness for trauma and other emergencies. The aim

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

of HFEP was to upgrade 20% of DOH-retained hospitals, 46% of provincial hospitals, 46% of
district hospitals, and 51% of rural health units (RHUs) by end of 2011.
Financial efforts shall be provided to allow immediate rehabilitation and construction of
critical health facilities. In addition to that, treatment packs for hypertension and diabetes shall be
obtained and distributed to RHUs.
The DOH licensure and PhilHealth accreditation for hospitals and health facilities shall be
streamlined and unified.
Attainment of Health-related MDGs
Further efforts and additional resources are to be applied on public health programs to reduce
maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and
incidence of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as
the prevention and control of non-communicable diseases.
The organization of Community Health Teams (CHTs) in each priority population area is one
way to achieve health-related MDGs. CHTs are groups of volunteers, who will assist families with
their health needs, provide health information, and facilitate communication with other health
providers. RNheals nurses will be trained to become trainers and supervisors to coordinate with
community-level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000
CHTs and 10,000 RNheals.
Another effort will be the provision of necessary services using the life cycle approach. These
services include family planning, ante-natal care, delivery in health facilities, newborn care, and
the Garantisadong Pambata package.
Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG,
would also be essential for the achievement of these MDGs.

4. UHC Progress

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

References:
World Health Organization (14 March 2019). UHC Act in the Philippines: a new dawn for health
care. Retrieved from: https://www.who.int/philippines/news/feature-stories/detail/uhc-act-in-
the-philippines-a-new-dawn-for-health-care.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])

 lOMoARcPSD|37456515

Department of Health (n.d.) Universal Health Care. Retrieved from:

https://www.doh.gov.ph/kalusugang-pangkalahatan.
The Filipino Times (2019, February 20). Duterte signs Universal Health Care Bill. Retrieved
from https://old.filipinotimes.net/news/2019/02/20/duterte-signs-universal-health-care-
bill/.

Downloaded by ALLAN KARL N. YNGENTE ([email protected])