CHN Lecture Module 2 The Health Care Delivery System
CHN Lecture Module 2 The Health Care Delivery System
CHN Lecture Module 2 The Health Care Delivery System
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
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
• 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.
• 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.
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
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
• 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:
NURSING PERSPECTIVE:
• 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
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
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
• 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:
• 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
• 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
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:
• 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:
NURSING PERSPECTIVE:
• 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
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
• 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:
NURSING PERSPECTIVE:
• Impact on mental health of the involved and victims of brutality, violence and the like
• 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
• 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:
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
• 1888
o Superior Board of Health and Charity - created by the Spaniards; gave rise to a
hospital system, a board of vaccination, etc.
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.”
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
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.
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
• 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
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
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)
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)
-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.
-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.
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.
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.
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.
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/
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
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.
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
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
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.