NATIONAL HEALTH CARE PLAN

NATIONAL HEALTH CARE PLAN

Sixty percent of our countrymen who succumb to sickness die without seeing a doctor.
- PNoys Challenge

The government of the Philippines, elected in July 2010, identified universal health care (UHC)
as a priority goal. While the Philippines had made considerable progress in the health sector over
the previous decades, several important challenges remained. Poor households health outcomes
were three to four times worse than middle class families and the poor lacked proper financial
protection from debt accrued from out-of-pocket health expenses. To alleviate poverty, the
government prioritized enrolling poor households in the national health insurance program and
ensuring they had adequate access to quality health services and financial protection. The
government identified expansion of health insurance combined with sequenced service delivery
interventions as the main mechanism to accelerate progress on universal health care.
The Department of Health (DOH) is the principal health agency in the Philippines. It is
responsible for ensuring access to basic public health services to all Filipinos through the
provision of quality health care and regulation of providers of health goods and services.

Given the mandate, DOH is both a stakeholder in the health sector and a policy and regulatory
body for health. As a major player, DOH is a technical resource, a catalyzer for health policy and
a political sponsor and advocate for health issues in behalf of the health sector.

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I.

DEFINITION:

According to Wikipedia, Health care (or healthcare) is the diagnosis, treatment, and prevention
of disease, illness, injury, and other physical and mental impairments in humans. Health care is
delivered by practitioners in medicine, optometry, dentistry, nursing, pharmacy, allied health,
and other care providers. It refers to the work done in providing primary care, secondary care,
and tertiary care, as well as in public health.
Access to health care varies across countries, groups and individuals, largely influenced by social
and economic conditions as well as the health policies in place. Countries and jurisdictions have
different policies and plans in relation to the personal and population-based health care goals
within their societies. Health care systems are organizations established to meet the health needs
of target populations. Their exact configuration varies from country to country. In some countries
and jurisdictions, health care planning is distributed among market participants, whereas in
others planning is made more centrally among governments or other coordinating bodies. In all
cases, according to the World Health Organization (WHO), a well-functioning health care system
requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable
information on which to base decisions and policies; and well maintained facilities and logistics
to deliver quality medicines and technologies.
In the Philippines at present, 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.

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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.
One of the Universal Health cares aim is to enhance service packages delivered in a health
service delivery network. As such, it ensures that all programs/activities/projects are informed by
research, disease surveillance and public health service delivery. Service delivery in the
Universal Health Care boosts the availability of care in areas of high need and addressing health
care quality and disparity. CHD IV-B aims to support concentrated quality improvement in
service delivery programs and build a comparable focus on improvement of quality of behavioral
health services.
Programs Included (but are not limited to):

Infectious Diseases

Vector Borne Diseases

Non-communicable Diseases

Environmental and Sanitation

Family Health Maternal and Child Health

Oral Health

Health Emergency Management and Response

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II.

CONCEPTUAL FRAMEWORK:

Universal health care:

Access to effective preventive, curative and rehabilitative services (personal and nonpersonal care) for all people at an affordable cost
Equity in access that secures services to anyone when they need them
Equity in financing that implies households contribute on the basis of ability to
Equity in financing that implies households contribute on the basis of ability to pay

Four (4) indicators of universal coverage:

Out-of-pocket expense not to exceed 30-40% of total health expenditures
Total health expenditures at least 4-5% of GDP
Over 90% of population covered by prepayment and risk pooling schemes
Close to 100% coverage of the vulnerable population through social assistance and safety
nets

Six building blocks of a health system framework: service delivery, health human resource,
information, medical products and technologies, financing, leadership or governance

A health system consists of all organizations, people and actions whose

primary interest is to promote, restore or maintain health. This can be
analysed in its totality by using different groups or blocks. The six
building blocks are enumerated below.

Good health services are those which deliver effective, safe,

quality personal and non-personal health interventions to those who
need them, when and where needed, with minimum waste of
resources.

Link to health services

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A well-performing health workforce is one which works in ways

that are responsive, fair and efficient to achieve the best health
outcomes possible, given available resources and circumstances. I.e.
There are sufficient numbers and mix of staff, fairly distributed; they
are competent, responsive and productive.
Link to health workforce
A well-functioning health information system is one that
ensures the production, analysis, dissemination and use of reliable and
timely information on health determinants, health systems
performance and health status.
Link to health information
A well-functioning health system ensures equitable access
to essential medical products , vaccines and technologies of
assured quality, safety, efficacy and cost-effectiveness, and their
scientifically sound and cost-effective use.
Link to essential medicines
A good health financing system raises adequate funds for
health, in ways that ensure people can use needed services, and are
protected from financial catastrophe or impoverishment associated
with having to pay for them.
Link to health financing
Leadership and governance involves ensuring strategic policy
frameworks exist and are combined with effective oversight, coalitionbuilding, the provision of appropriate regulations and incentives,
attention to system-design, and accountability.
Link to governance

WHO insights on health systems and financing:

Health financing systems are critical for reaching universal health coverage.
Health financing levers to move closer to universal health coverage lie in three
interrelated areas:
raising funds for health;
reducing financial barriers to access through prepayment and
subsequent pooling of funds in preference to direct out-of-pocket
payments; and

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allocating or using funds in a way that promotes efficiency and

equity.

Health services cost money. Health financing aims to mobilize sufficient financial

resources for health.

Health finance is one of the essential components of the system and has its own

functions.
Pooling through prepayment is necessary.
Health financing is more than just raising money. It affects health and health system

reforms.
Governments role, commitment and actions to improve health systems and financing
will facilitate the attainment of national health policy goals and objectives.

Health financing strategies to increase access to health care:

Increase government investment and spending
Improve aid effectiveness
Increase efficiency and effectiveness of resource use
Support more prepayment and pooling mechanisms
Update payment methods
Strengthen safety nets and social security system as a whole
Improve evidence and information
Improve monitoring and evaluation

Global and regional data and evidence:

Insufficient government spending on health especially in low-income developing
countries; need more resources for health; OECD committed to allocate 0.7& of GNP

for ODA
Private spending is high, tends to be out-of-pocket, has large impoverishment effects
High OOP in Asia which leads to catastrophic expense
When tax collections are 20-30% of GDP, governments have the capacity to provide
additional budgetary resources for health

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If resources are spent on primary health care, preventive and promotive health care,

there will be better health outcomes

OECD countries allocate over 25% of health resources to primary health care; the
Philippines spends less than 10%

III.

VISION:

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VISION: Health for all Filipinos
VISION BY 2030: A global leader for attaining better health outcomes, competitive and
responsive health care system, and equitable health financing.
A Vision of how things ought to be, meaning 1) Filipinos are healthy, free from disease and
infirmity; 2) Filipinos have access to quality health services
IV.

POLICIES, THRUST AND STRATEGIES:

POLICIES

The priority health policy directions of the Aquino Administration are as follows:
1. Focus on refocusing the implementation of the National Health Insurance Program
2. Particular attention to the construction, rehabilitation and support of health facilities:
LGU/regional hospitals, rural health units, barangay health stations to enhance their
capacity in providing basic health services.
3. Attainment of Millennium Development Goals 4, 5, and 6: Reduction of maternal,
neonatal, and infant mortality and Support to contain/eliminate age old public health
diseases (malaria, dengue, TB)

Also intended to do the following:

Attain efficiency by using information technology (IT) in all aspects of health care
Increase attention to trauma, the 4th leading cause of death

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More aggressive promotion of healthy lifestyle to prevent non communicable
diseases: heart disease, stroke, diabetes, obesity
Attention to emerging diseases (Superbug, nosocomial diseases, A(H1N1), diseases
brought about by climate change)
Improve the access to quality affordable medicines
Continue efforts in improving governance and regulation to eliminate graft and
corruption in all areas of health care
Improve the plight of health workers through interventions in health education,
placement, compensation, among others

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THRUST

o Financial Risk Protection Strategies

1. Redirecting PhilHealth operations towards the improvement of the national and
regional benefit delivery ratios

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2. Expanding enrollment of the poor in the NHIP

3. Promoting the availment of quality outpatient and inpatient services through reformed
capitation and no balance billing arrangements for sponsored members
4. Increasing the support value of health insurance for the poor

o Health Facilities Enhancement Strategies

1. A targeted health facility enhancement program to improve facility preparedness for
trauma and the most common causes of mortality and morbidity;
2. Provision of grant mechanisms to support the immediate repair and rehabilitation of
selected priority facilities utilizing Public-Private Partnership approach;
3. Fiscal autonomy and income retention schemes for government hospitals and health
facilities;
4. Unified and streamlined DOH licensure and PhilHealth accreditation for hospitals and
facilities; and
5. Regional clustering of referral networks to address the fragmentation of services.

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o Achieving MDGmax

Deploying Community Health Teams;

Utilizing the life course approach in providing needed services

family planning
ante-natal care
delivery in health facilities
essential newborn and immediate postpartum care; and
Garantisadong Pambata package for children 0-14 years of age;

Aggressively promoting healthy lifestyle changes to prevent non-communicable

diseases;

Ensuring adequate surveillance and preparedness for emerging diseases; and

Harnessing the strengths of inter-agency and inter-sectoral approaches to health.

STRATEGIES:

Human Health Resources

With reasonable compensation, adequate facilities and opportunities for career growth
most of our human health resources will opt to remain in the Philippines

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Deployment and capacitating of nurses to areas with high MMR, in coordination with
the Department of Labor and Employment and the local government units.

Complementation of DOH and LGU human health resources with medical and allied
professions in other government agencies:
Doctors, nurses and dentists of the Department of Education for public school
children
AFP medical personnel for geographically isolated areas

STRATEGY # 1
Ensure that each family has an assigned competent primary health care provider,

Primary care provider shall be linked with the Service Delivery Network taking into
account the health team skill mix approach and engagement of both public and private
providers

Provide incentives to health professionals to facilitate deployment and retention,

especially in GIDAs

STRATEGY # 2
Produce health professionals that are responsive to the current needs of the health sector.

Revise curriculum in medical and allied health courses to include academic units on
health regulation and financing

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Develop competency-based courses upon entry to specific position or office

Link the medical and other allied health professional scholarships to HRH deployment

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program
STRATEGY # 3
Manage the exit or re-entry.

Institutionalize the Human Resource for Health Network

Establish a Health Worker Migrants Fund (HWMF) from mandatory fees in the issuance
of working visas for health professionals to fund HRH development such as training,
Magna Carta benefits, Rural Health Team Placement Program (RHTPP) and rationalized
scholarships

Advocate for the Philippine HRH Reintegration Program

HHR PROPOSED LEGISLATIVE AGENDA FOR HEALTH for

A comprehensive national policy on managing the countrys human resources for health
including the following:

1. Rationalization of the HRH (by population, geography, etc) for universal access
2. Career development opportunities for HRH

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3. Amendment to RA 7305 or the Magna Carta of Public Health Workers to fulfill salaries
and benefits due to public health workers (to remove subject to availability of funds
clause.
V.

OVER-ALL GOALS:

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.

VI.

BROAD OBJECTIVES:

General Objective: To promote equity in health through the provision of full financial
protection and improvement of access to priority public health programs and quality hospital
care especially for the poor.
Specific Objective: To utilize the instruments of Health Financing, Health Service Delivery
System, Human Resources for Health, Health Regulation, Governance for Health and Health
Information to achieve the following strategic thrusts:
Improve financial risk protection through a revitalized National Health Insurance Program by
expanding NHIP coverage, increasing availability of services and raising support value.

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Achieve Millennium Development Goal Max (MDGmax) targets on:

Maternal, Neonatal and Infant Mortality;

Malaria, HIV and TB;
Accidents and Injuries;
Lifestyle-related Non-Communicable Diseases such as Cerebro-Vascular Diseases,

Diabetes Mellitus, Chronic Obstructive Pulmonary Diseases and Cancers;

Emerging and re-emerging diseases.
Improve access to health services through upgrading of health facilities and capacities of
clinical/hospital care to respond to accidents/injuries and emerging/re-emerging diseases, and to
the most common causes of mortality and morbidity.
VII.

Implementation of Road Map

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This shows the current set up of our health care delivery system. Fragmentation of health
facilities has led to the neglect of some of our hospitals and health facilities.
Since June of 2010, the Department of Health, under Secretary Enrique T. Ona, has focused its
efforts on attaining Universal Health Care for all Filipinos.
Universal Health Care has three strategic thrusts, namely, 1) the expansion in PhilHealth
enrollment and benefits; 2) the improvement of government hospitals, health centers, and other
facilities; and 3) the attainment of DOHs health-related Millennium Development Goals,
including a reduction in maternal mortality and infant mortality rates, through the provision of
health services.
These three goals are among the hardest to achieve, but their impact on the lives of every
Filipino is far-reaching. For each of the countrys health problems, the Department of Health has
mapped out its strategic plans. However, implementing these plans is easier said than done. If the
solutions to our health problems were easy, then these diseases should have been eradicated
years ago.
Within two years, here are some of the things the DOH has achieved for universal health care:
More people enrolled in PhilHealth. Starting 2011, the national government has paid for the
PhilHealth membership of 5.3 million poorest families, comprising almost 25 million Filipinos,
as identified by the National Household Targeting System for Poverty Reduction of the
Department of Social Welfare and Development. For 2012, the premium subsidy of these
families was increased from P3.5 billion in 2011 to P 12.5 billion. These poor families are

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entitled to no-balance-billing (or walang dagdag bayad) when they are admitted in a ward bed in
any government facility.
Highest budget ever for DOH. Under Secretary Onas term, the DOH received the biggest
budget increase, which is P42 billion for 2012 and P53 billion for 2013. This figure is more than
twice the DOH budget of P23 billion in 2009. Secretary Ona once said, As a surgeon, I know
how much our people need hospital care and medicines. I will lobby for the DOH to get its
needed budget.
Improvement of health facilities. The DOH is in the process of enhancing and upgrading health
facilities to ensure that people have access to quality health care. The national government has
allotted P13.5 billion for 2013 for the improvement of the national and local government
hospitals, health centers, and barangay health stations. Secretary Ona has also started the
National Hospital Reform Program, wherein he has identified 25 to 30 DOH-retained hospitals
for modernization through private-public partnership (PPP). Seven of these hospitals will be
upgraded to give specialized care in heart surgery, oncology, and organ transplantation, so that
patients who will need these services need not come to Manila or Cebu anymore.
Attainment of the Millennium Development Goals. The DOH has employed more nurses and
health workers through the RN Heals volunteer nurses program. Batch 1 deployed 10,000
nurses, batch 2 had 11,500 nurses, and the latest batch 3 for 2012 will recruit 10,000 nurses and
3,000 midwives. Moreover, the DOH has deployed thousands of community health teams. These
teams of health workers travel house to house to teach people about vaccination, cleanliness,
maternal and child care, and common diseases.

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Seeing how the poor cannot buy their medicines, the DOH has also started a new program of
giving free maintenance medicines to poor patients. Called the ComPack (complete treatment
packs), this program has a budget of P500 million a year.
To reduce the deaths of our children from severe diarrhea and pneumonia, the DOH has included
in the national immunization program the rotavirus and pneumococcal vaccination initially for
700,000 infants belonging to the 5.2 million NHTS families, the first country in Southeast Asia
to do so.
Because of the departments efforts, the country is now closer to achieving Universal Health
Care by 2016. The DOH has laid the groundwork for making this dream a reality.
The health departments vision is to achieve the following results:
All Filipinos especially poor families will be enrolled in PhilHealth.
PhilHealth support value for the patients medical expenses will increase from 34% in 2009 to
60% by 2016.
Quality care will be provided in public facilities and public hospitals.
The DOH will reach out to the grassroots. Poor families will be informed and guided by
community health teams for their health needs.
Every family will have access to essential, quality, and affordable health services, both in the
prevention and treatment of diseases.

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In the words of Secretary Ona, The government cannot achieve this dream alone. Universal
Health Care will not be realized without the peoples commitment and partnership. We ask you,
the private sector, the media, and the people, to continue working with us with the same
enthusiasm and drive to help uplift the lives of the poorest members of our society.