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THE NATIONAL HEALTH SITUATION

Philippine Scenario

In the past 20 years some infectious
degenerative diseases are on the rise.
Many Filipinos are still living in remote
and hard to reach areas where it is
difficult to deliver the health services
they need
The scarcity of doctors, nurses and
midwives add to the poor health delivery
system to the poor

The Philippines is an archipelago of 7,107
islands with a total land area, including
inland bodies of water, of approximately
300,000 square kilometers (116,000 square
miles).
Located in the Pacific Ring of Fire and is
exposed to almost the full array of natural
hazards (earthquakes, typhoons,
landslides, floods, etc.)
Highest number of disasters
per country in 2009
Demographic profile
Philippines is one of the most populous
country in the world.
2000 population was 75.3 million
Projected to increase to 82,636,689 in 2004
Aug 2007: 88.57M
Projected 2010 population: 94.01M
2.04% annual growth rate (2000-2007)
PRESENT: July 27, 2014 = 100,000,000


THE NATIONAL HELATH SITUATION
- High population density transmission of
infectious and communicable diseases.

- Greater need for social services such as:
decent housing education
transportation health services
communication
THE NATIONAL HELATH SITUATION
- High level of stress in congested areas leads
to:
disintegration of moral values and social
institutions
contributes to the incidence of a number of
health problems, including mental health
problems.
Countrys population very young
39% - of the total population in 1994 was
estimated to be in the 0 - 14 age group.
Only 5% were 60 years old and above.
Dependency ratio 79/100
(0 - 14 years & 60 y/o and above)
dependent
15 - 59 y/o productive age group
About 249 people for every square kilometer of
Philippine territory.
Metro Manila has the highest population density
(16,051)
CAR has the lowest (75)
High density population density facilitates
the _______________of __________ and
______________ ____________________.


There is a greater need for social services:
________ ______, _________, ________,
________, and ______ ________.
LIFE EXPECTANCY
1999
68.6 71.28 for females
66.03 for males
Up from 61.6 years in 1980

THE NATIONAL HELATH SITUATION
Health profile
Birth and deaths
Crude Birth Rate (CBR) in 1997 was 28.4 per 1000
population
Crude Death Rate (CDR) 6.1 per 1000 population.
The rate of natural increase in the countrys
population for the same year was 22.3 (28.4
minus 6.1) for every 1000 population

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

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

THE NATIONAL HELATH SITUATION
- Rural women have more children than urban
women.
- Uneducated women also have more children
than those who are with college education.
- Those in the 25-29 age group have the
highest fertility rate (national demographic
and health survey, 1999)
THE NATIONAL HEALTH SITUATION
- In 1995, infant mortality rate (IMR) was 48.9 per
1000 live births, which is within the WHO global
goal for IMR of less than 50/1000 live births.

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



THE NATIONAL HELATH SITUATION
- Infant mortality rate is one of the most sensitive
indicators of health status of a country or
community.
Results from:
1. poor maternal conditions
2. unhealthy environment
3. inadequate health care delivery system
Last update: January 11, 2007
leading causes of infant mortality in 2003 were:
1. Other perinatal conditions
2. Pneumonia
3. Bacterial sepsis of newborn
4. Congenital malformation of the heart
5. Diarrhea and gastroenteritis of presumed
infectious origin.
Infant mortality
6. congenital pneumonia
7. other congenital malformation
8. respiratory distress of newborn
9. neonatal aspiration syndromes
10. disorders related to short gestation and
low birth weight.
Causes of morbidity & mortality
2003 causes of mortality among Filipinos
1. diseases of the heart
2. diseases of the vascular system
3. malignant neoplasm
4. accidents
5. pneumonias
6. TB, all forms
7. symptoms, signs and abnormal clinical, laboratory
findings, NEC
8. chronic lower respiratory system diseases -
obstructive & pulmonary diseases
9. diabetes mellitus
10. certain conditions originating in the perinatal period
Leading causes of morbidity
1. diseases of the heart
2. diseases of the vascular system
3. pneumonias
4. cancer
5. accidents
6. TB
7. COPD
8. DIABETES mellitus
9. diseases of the respiratory system
10. nephritis/ nephrotic syndrome & nephrosis
Most of the top ten leading causes of
morbidity are non-communicable
disease
These include heart problem, HPN,
accidents and malignant neoplasms

The top 10 leading causes of mortality are
due to non CD
Diseases of the heart and vascular system are
the 2 most common causes of deaths.
Pneumonia, PTB and diarrheal diseases
consistently remain the 10 leading causes of
deaths.

THE NATIONAL HELATH SITUATION
Maternal mortality major indicator of a
womans health status
defined by WHO as the death of a woman
while pregnant or within 42 days of
termination of pregnancy from any cause
related to, or aggravated by the pregnancy or
its management, but not from accidental or
incidental causes.
THE NATIONAL HEALTH SITUATION
Leading causes of maternal mortality in 2003
1. Postpartum hemorrhage
2. Eclampsia
3. Retained placenta
4. Uterine atony
5. Placenta previa


THE NATIOAL HEALTH SITUATION

Analysis of womens poor health and maternal
mortality should consider the overall social,
cultural, and economic environment. (poor, low
educational status, multipara, anemic)
THE NATIONAL HEALTH SITUATION
AIDS major public health problem, (urban
areas)
- increase in STDs (syphilis, & gonorrhea due
to unhampered prostitution in the
country.
- prostitution has always been identified as a
consequence of poverty.

THE NATIONAL HEALTH SITUATION
TUBERCULOSIS
- Number one cause of mortality about 50 years ago
continue to be a major killer of Filipinos.

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

THE NATIONAL HeALTH SITUATION
SCHISTOSOMIASIS
- affect hundred of barangays in 24 endemic
provinces.
RABIES
- incidence in the Philippines is one of the highest in
the world.
HEPATITIS B
- 12% of the population are chronic carriers
(hepatitis B and hepatic sarcoma)
THE NATIONAL HEALTH SITUATION
*MOSQUITO*
- malaria
- filariasis
- dengue fever
THE NATIONAL HEALTH SITUATION
POVERTY AND HEALTH
- illiteracy
- unfounded health beliefs
- harmful practices
- inadequate nutrition
- poor environmental sanitation
- inadequate source of potable water supply
Political system
first automated election last 10 May 2010
The country is made up of political local
government units of provinces, cities,
municipalities and barangays (villages).
Local Government Code of 1991

THE NATIONAL HEALTH SITUATION
POLITICAL INFLUENCES ON HEALTH
- politics affects health
- health policies emanate from congress, the
executive department (DOH)
- policies that affect health = health care delivery
system and the practice of nursing in the Philippines

Economy
69 million Filipinos
(80% of population) struggle to survive on
Php 96 (1.3 Euro) or less a day
46 million Filipinos go hungry every day (i.e.,
unable to meet minimum nutritional needs)

THE NATIONAL HELATH SITUATION
- health budget is the most concrete
expression of the governments
political will.

- health spending has always been
inadequate.
WAGES
Wages are not enough to sustain a decent life.
June 2008:
Living Wage -------------------------------P 911.00 (16
Euros)
(NCR, family of 6 according to the Natl Wages and
Productivity Commission)
Daily Minimum Wage---------------- P 382.00 (6.7 Euros)
(NCR, including COLA)
NOT ENOUGH--------P 529.00 (9.3 Euros)
Prices of basic goods are rising faster than wages.

While the rich are getting richer
Net worth of 10 richest Filipinos:
US$12.4 billion or 10B Euro (2006)

Equivalent to the combined annual income of
poorest 9,600,000 families (approximately 49
million Filipinos)
(Ibon Databank 2007)

UNEMPLOYMENT
MIGRATION
No. 1 Exporter of Nurses
An estimated 85% of employed Filipino nurses
(more than 150,000) are working internationally.
(Aiken et al 2004)
70% of all Filipino nursing graduates are working
overseas. (Bach 2003)
No. 2 Exporter of Doctors
68% of Filipino doctors work overseas, next to
India. (Mejia, WHO 1975)
Health Human ResourceS
200 hospitals have closed down within the past
two years no more doctors and nurses

800 hospitals have partially closed (with one to
two wards closed) lack of doctors and nurses

Nurse to patient ratios in provincial and district
hospitals now 1: 40 to 1: 60
Loss of highly skilled nurses in all hospitals across
the country
(Galvez-Tan, 2009)

Doctor, doctor where are you?
According to the Regional Coordinator of
Pinoy MD Program Dr. Genelyn Herrera, at
least 18 towns in Eastern Visayas have no
doctors.
This means that around 720,000 people in the
region have no access to basic medical
services.
Dr. Melchor Rey Santos, president of the
Philippine Medical Association (PMA),
reported that of the 35,000 doctors in the
PMA roster, 6,000 are now working
abroad.
Another 4,000 have opted to retrain and
shift to the nursing profession, in
preparation for an overseas job as a
nurse.
Health Education

Decreasing passing rate in the national nursing
licensure examinations
1970s - 80s: 80%-90%
1991: below 61%
2001-2003: 44%-48%
2004: 55.9%
2005: 49.7%
2006: 41%

The number of nursing schools have
increased
1970s: only 40
1990s: 170
June 2003: 251
April 2004: 370
June 2005: 441
June 2006: 470
(PRC 2008)

Spending for health
In 2007, the governments allocated budget
for health was a meager P11.5
billion (compare this to the P54.3 billion
share of the Department of National
Defense).


THE ANTIONAL HELATH SITUATION
Laws that affect the delivery of health services
1. Local government code
2. National health insurance Act
3. Professional practice acts of the different
professions
ISSUES AND CONCERNS
Some of the major factors affecting
the countrys health status are as
follows:
inappropriate health delivery system
inadequate regulatory mechanisms
and
poor health care financing.

THE HEALTH CARE
DELIVERY SYSTEM

Health System
Interrelated system in which a
country organizes available
resources for the
maintenance and
improvement of the health
of its citizens and
communities.
THE HEALTH CARE DELIVERY SYSTEM
- is the totality of all policies, infrastructures,
facilities, equipment, products, human resources,
and concerns of all people


This approach has influenced many
countries including the Philippines.
Its innovativeness is indicated by the call for
participatory development management since
community members are expected to take an
active role in managing their own health
requirements, instead of depending on the
government.
PHC also gives importance to the participation
of various sectors of government and the
private sector in local health activities.


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

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


The DOH is the principal agency in
health in the Philippines.

HISTORICAL BACKGROUND
For over 40 yrs after post war independence, the
Phil. Health Care system was administered by a
central agency based in Manila
Central control agency provided all the
resources, policy direction, technical and
administrative supervision to all health facilities
nationwide.
Milestone in Health Care Delivery System
RA 1082 - RHU Act
RA 1891 - Strengthen Health Services
PD 568 - Restructuring HCDS
RA 7160 - LGU Code

DEPARTMENT OF HEALTH
- national governments biggest health care provider

- used to have control and supervision over all
barangay health stations, rural health units and
hundreds of hospitals throughout the country
- Bureau of local health development
- local health systems development
- health care financing programs
- quality improvement programs
- intersectoral (public-private)
coordination and local projects
Three divisions of Health Care Delivery System
1. Government
2. Mixed Sectors
3. Private Sectors
Major players
1. PUBLIC SECTOR
Largely financed through a tax-based budgeting
system at both the national and local levels
Where health care is generally given for free at the
point of service
National and local government agencies
DOH national level mandated as the lead agency
in health.
2. PRIVATE SECTOR
Largely market-oriented and where health
care is paid for through user fees at the point
of service.
PRIVATE SECTORS
1. Socialized Medicine- funded by general taxation,
emphasis on prevention
2. Compulsory Health insurance- law requires people to
subscribe to health insurance plan, usually government
sponsored; covers only curative and rehabilitative
medicine; preventive services provided by government
agencies
3. Voluntary Health insurance- government only encourages
people to subscribe to health insurance
4. Free Enterprise- people have to take care of their medical
needs.
3. MIXED SECTORS
PTS- Philippine Tuberculosis society
PCS- Philippine Cancer Society
PNRC- Philippine National Red Cross
PMHA- Philippine Mental Health
Association
PHA- Philippine Heart Association

devolution
Refers to the act by which the
national government
confers power and authority upon
the various local government units
to perform specific functions and
responsibilities,
including the provision and delivery
of basic health services.
Devolution of health services
October 10, 1991
RA 7160 LOCAL GOVERNMENT CODE
Provided for the decentralization of the entire
government
The local health system is now run by LGUs.
AIM - to build the capabilities of local governments
for self-governance and to develop them as fully
self-reliant communities.

DEVOLUTION OF HEALTH SERVICES
- RA 7160
= local government code
- the code aims to:
transform local government units into self-reliant
communities and
active partners in the attainment of national goals
through a more responsive and accountable local
government structure instituted
through a system of decentralization.
DEVOLUTION

Direct responsibility for PHC is
now assumed by mayors of
municipalities and cities due to the
Local Government Code of 1991.


Implications of Devolution on PHC

Lack of understanding and appreciation by
local chief executives of health services of
PHC as an innovative strategy.

The government launched the Minimum
Basic Needs (MBN) approach as the
management technology for supporting the
Social Reform Agenda to improve the quality
of the poorest of the poor.


Self-Reliant, Healthy Filipino
NGO/PS
LGU
DOH
10/11/2014 67
The
Health
Sector
Provincial and district hospitals
under the provincial government
City/ municipal government
manages the health centers/ rural
units and barangay health stations
in every province, city or
municipality
- provincial, district and municipal hospitals
provincial governments

- rural health units (RHUs) and barangay health
stations (BHSs) municipal governments
provincial level

> governor (chair)
> provincial health officer (vice chair)
> chairman of the Committee on
Health of the sangguniang panlalawigan
> DOH representative
City and Municipal level

- > mayor (chair)
> municipal health officer (vice
chair)
> chair of the committee on health
of the sangguniang bayan
> DOH representative and NGO
representative
LEVELS OF HEALTH CARE & REFERRAL
SYSTEM
N ATIONAL HEALTH
SERVICES
REGIONAL HEALTH
SERVICES & TRAINING
CENTERS
PROVINCIAL/ CITY HEALTH
SERVICES
PROVINCIAL/ CITY HOSPITALS
EMERGENCY/ DISTRICT
HOSPITALS
RURAL HEALTH UNIT
COMMUNITY HOSPITALS & HEALTH CENTERS
PRIVATE PRACTITIONERS/ PUERICULTURE CENTERS
BARANGAY HEALTH STATIONS
1. Primary Level of Care
It is health care provided by
center physicians, public health nurse,
rural midwives, barangay health
workers, traditional healers and others
at the barangay health stations and
rural health units.
First contact between the community
members and the other levels of health
facility


2. Secondary level of care
Given by physicians with basic health training.
It is usually given in health facilities privately owned or
government operated such as infirmaries, municipal
and district hospital and out-patient departments of
provincial hospitals.
This serves as the referral center for the primary health
facilities.
Secondary facilities are capable of performing minor
surgeries and perform some simple laboratory
examinations
3. Tertiary level of care
Tertiary care is rendered by specialist in
health facilities including medical centers
as well as regional and provincial hospitals
and specialized hospitals.
Complicated cases and intensive care
requires tertiary care and all these can be
provided by the tertiary care facility


According to Increasing Complexity
of the Services Provided
According to the Type of
Service
Type Service Type Example
Primary Health Promotion, Preventive
Care, Continuing Care for
common health problems,
attention to psychological
and social care, referrals

Health
Promotion
and illness
Prevention
Information
Disseminatio
n
Secondary Surgery, Medical services by
Specialists
Diagnosis and
Treatment
Screening

Tertiary Advanced, specialized,
diagnostic, therapeutic &
rehabilitative care
Rehabilitation PT/OT
10/11/2014 79
Public sector
GOAL OF DOH implementation of health
sector reforms through the Health Sector
Reform Agenda (HSRA):
Areas to be reformed
1. local health systems
2. hospital systems
3. public health programs
4. health financing
5. health regulation
Framework for the
implementation of the hsra
FOURmula ONE for health
The National Objectives for Health
Fourmula one for health
Intends to implement critical interventions as
a single package backed by effective
management infrastructure and financing
arrangements thru a sector wide approach.
This is directed towards ensuring accessible
and affordable quality health care, especially
for the more disadvantaged and vulnerable
sectors of the population.
It has 4 ELEMENTS = Go Go FIRES
Memory aid = go go fires
Good Governance to enhance health
system performance at the national and local
levels.
Key players for this element include:
A. Philippine Health Insurance Corporation
(PHIC), through the National Health
Insurance Ptogram (NHIP).
B. DOH through sector-wide policy support.
HEALTH FINANCING to foster greater,
better, and sustained investments in health.
HEALTH REGULATION to ensure the quality
and affordability of health goods and
services.
HEALTH SERVICE DELIVERY to improve and
ensure the accessibility and availability of
basic and essential health care in both public
and private facilities and services.
NATIONAL OBJECTIVES FOR HEALTH
Provides the roadmap for stakeholders in
health and health-related sectors to intensify
and harmonize their efforts to achieve Health
for All Filipinos.


Vision:
Health for all Filipinos


The Health Sector
Department of Health
Vision: Leader and staunch advocate and model in
promoting Health for ALL in the Philippines

Mission: Guarantee equitable, sustainable, and quality
health for all Filipinos, specially the poor and shall
lead the quest for excellence in health
10/11/2014 85
NATIONAL OBJECTIVES FOR HEALTH


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

NATIONAL OBJECTIVES FOR HEALTH
Principles
universal access to basic health services must be
ensured.

the health and nutrition of vulnerable groups must
be prioritized.


NATIONAL OBJECTIVES FOR HEALTH
The epidemiologic shift from infectious
to degenerative diseases must be
managed.

The performance of the health sector
must be enhanced.
NATIONAL OBJECTIVES FOR HEALTH
GOALS AND OBJECTIVES
1. Improve the general health status of
the population
- reduce infant mortality rate
- reduce child mortality rate
- reduce maternal mortality rate
- reduce total fertility rate
- increase the life expectancy and the
quality of life years
NATIONAL OBJECTIVES FOR HEALTH
a. Reduce morbidity, mortality, disability
and complications from the following
diseases and disorders
- pneumonias and acute respiratory
infections
- diarrheas and other food and water
borne diseases like typhoid, cholera, and
hepatitis A
NATIONAL OBJECTIVES FOR HEALTH
b. Eliminate the certain diseases as public health
problems

- Schistosomiasis
- malaria
- filariasis
- leprosy
- rabies

NATIONAL OBJECTIVES FOR HEALTH
c. Eradicate poliomyelitis
- vaccine-preventable diseases: measles,
tetanus, diptheria, and pertussis

- Vitamin A deficiency

- Iodine deficiency disorders


NATIONAL OBJECTIVES FOR HEALTH
d. Promote healthy lifestyle and emotional
health
- promote healthy diet and nutrition
- promote physical activity and fitness
- promote personal hygiene
- Prevent smoking and substance abuse
- Prevent violent and risk-taking behaviors
- - promote mental health and less stressful life



NATIONAL OBJECTIVES FOR HEALTH
f. Promote the health and nutrition of
families and special populations
(vulnerable group)
- neonatal and infant health
- health of indigenous peoples
- children's health
- adolescent and youth health
- adult health
- women's health
NATIOANAL OBJECTIVES FOR HEALTH
- health of older persons
- health of overseas Filipino workers
- health of differently-abled persons
- health of the rural poor
- health of the urban poor
2. Ensure Quality Service delivery
a. Strengthen national and local health systems to
ensure better service delivery.
b. Pursue public health and hospital reforms
c. Reduce the cost and ensure the quality of
essential drugs.
d. Institute health regulatory reforms to ensure
quality and safety of health goods and services.
e. Strengthen health governance and
management support systems.
3. improve support system for the vulnerable
and marginalized groups
Institute safety nets for the vulnerable &
marginalized groups

4. implement proper resource management.
Expand the coverage of social health
insurance.
Mobilize more resources for health.
Improve efficiency in the allocation,
production, and utilization of resources for
health.
NATIONAL OBJECTIVES FOR HEALTH
5. Promote environmental health and
sustainable development
- healthy homes
- healthy workplace and establishments
- healthy schools
- healthy communities, towns and cities
Definition of Primary Health Care (PHC):

World Health Organization (WHO)
defines PHC as
essential care made universally
accessible to individuals and families in the
community by means acceptable to them
through their full participation and at a cost
that the community and country can afford at
every stage of development.

Background:

Primary Health Care (PHC) was declared
during the First International Conference on
Primary Health Care held in Alma Ata, Russia on
September 6-12, 1978 by the World Health
Organization (WHO).
- The goal was Health for All by the Year 2000.
This was adopted by the in the Philippines through
Letter of Instruction 949 signed by President
Marcos on October 19, 1979 and has an underlying
theme of Health in the Hands of the People by
2020.
Primary Health Care (PHC) as an
approach to delivery of health
care services

Elements/Components of PHC
1. Health Education
2. Control of communicable disease
3. Expanded Program on immunization (EPI)
4. Locally Endemic Disease Treatment
5. Environmental sanitation
5. MCH and Family Planning
6. Essential Drugs & herbal plants Provision
7. Nutrition and Adequate Food Provision
8. Treatment of Locally Emergency cases
Provision of Medical Care



Four Cornerstones
or Pillars in PHC
1. Active community participation
2. Intra and inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

SGD
What are the priority programs of the DOH?
List down the objective/s and activities of
each program.
SUBMISSION: Sec. A: Jun 3 @ 8 am
Sec. B: Jun 4 @ 8 am
SGD
Discuss the FOURmula ONE for Health(F1) over-all goals,
objectives
Discuss the four components of F1as to:
A. Strategies
B. Activities
C. Govt structure implementing the activities
D. Available DOH program in the implementation of activities

SUBMISSION: Sec. B: Jun 4 @ 8 am

FOURmula ONE FOR HEALTH
FOURmula ONE


implementation framework for health
sector reform
FOURmula ONE FOR HEALTH

GOALS

Better health outcomes
More responsive health systems
Equitable health care financing
FOURmula ONE FOR HEALTH
FOUR THRUSTS
1. Financing (increased, better and sustained)
2. Regulation (assured quality and
affordability)
3. Service Delivery (ensured access and
availability)
4. Governance (improved performance)
FOURmula ONE FOR HEALTH
STRATEGIC GUIDEPOSTS
1. Building upon gains and lessons from major
reform initiatives
2. Focus on critical interventions to be implemented
as a single package
3. Sector wide management of FOURMULA ONE
implementation
4. NHP as the primary instrument
FOURmula ONE FOR HEALTH
CONSTRAINTS
1. Restricted government health budgets
- inflexible allocation across categories
- allocation among programs not linked to
performance
2. Difficulty in managing a highly decentralized
system
- steering various stakeholders (i.e. - local systems,
private markets)
- managing health finances from multiple sources
FOURmula ONE FOR HEALTH
OPPORTUNITIES
1. Deeper understanding of and increasing leverage
of the NHIP over health system performance.

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

FOURmula ONE FOR HEALTH
3. Growing support for HSRA implementation
from partners - government agencies,
external.

4. Deeper understanding of reform
implementation requirements.

5. Revitalized support from national leadership.
FOURmula ONE FOR HEALTH
CRITICAL COMPONENTS TO JUMP START fourmula
one IMPLEMENTATION
Identifying critical components
- sufficient groundwork and buy-in
- triggers a chain reaction to spur other FOURmula
ONE interventions
- produces tangible results
- generates public support
FOURmula ONE FOR HEALTH
FINANCING

GOAL

Secure increased, better and sustained
investments in health to improve health
outcomes especially of the poor.
FOURmula ONE.FINANCING
Rationalization of sources of health financing
* out of pocket
- shift of OOP to outpatient care (e.g. check-up,
consultation, etc.)
* Local government
- focus subsidy on preventive and promotive health
services
FOURmula ONEFINANCING
Local health financing reforms
Earmarking funds and prioritizing health services

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


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



FOURmula ONEFINANCING
*Management/coordination of LGU health fund
- integrate national and local investment plan
- cost-sharing arrangements among LGUs
- national and local coordination of funds (e.g.
counterparting arrangements)
- Rapid estimation of local health accounts
FOURmula ONEFINANCING
NATIONAL HEALTH FINANCING REFORMS
1.Public finance management system
2.Institutionalization of revenue-enhancement
measures
*full retention of income
*asset management
FOURmula ONEFINANCING
3. Development of efficient and equitable
allocation mechanics.
-priority health programs
-geographic
-income
-population groups
FOURmula ONEFINANCING
4. Performance based-budgeting system
-develop models for hospitals, public health and
regulatory agencies
-reform financial management and procurement
system
-develop / implement performance audit and
review system
FOURmula ONEFINANCING
IMPROVEMENT OF THE NHIP
1. Increase membership and collections
2. Enhance benefit package
3. Improve utilization of reimbursements
4. Enhance systems for regulation and
governance
FOURmula ONEREGULATION
REGULATION

GOAL

Assure access to quality and affordable health
products, devices, facilities and services especially
those used by the poor.
FOURmula ONEREGULATION
STRATEGIES
1. Harmonizing & streamlining of systems,
processes for licensing & accreditation and
certification
2. Developing a seal of approval
3. Pursuing cost recovery with income retention for
health regulatory agencies & other revenue
generating mechanisms
4. Ensuring access of the poor to essential health
products
FOURmula ONEREGULATION
COMPONENTS
Programs include:
1. one-stop shop
2. Philhealth-sentrong sigla seal
3. Unified seal of approval
4. Botika ng barangay / pharma 50
FOURmula ONESERVICE DELIVERY
SERVICE DELIVERY

GOAL

Improve accessibility and availability of basic
and essential health care for all, especially
the poor.
FOURmula ONESERVICE DELIVERY
COMPONENTS
1. Public health development plan
a. disease-free zone mopping-up leprosy
b. Intensified disease programs - TB, HIV/AIDS
emerging infections
c. Improving reproductive health outcomes
MMR, IMR, U5MR, TFR, CPR
FOURmula ONESERVICE DELIVERY
d. Intensified promotion of healthy lifestyle
DM, HPN, CVD, breast and cervical cancer,
anti smoking, safe water, sanitation, among
others
FOURmula ONESERVICE DELIVERY
2. Health facilities development plan
- critical upgrading of facilities through fund pool
- rationalizing services in DOH-retained, local
government & private facilities inside the 16 sites
- Integrating wellness services in hospitals
FOURmula ONESERVICE DELIVERY
3. Establishment of National Health Promotion
Foundation
4. Disaster preparedness and response system
5. Disease surveillance and networking system
6. Intensification of health promotion
FOURmula ONESERVICE DELIVERY
STRATEGIES
1. Making available basic and essential health
service packages by designated providers in
strategic locations

2. Assuring the quality of both basic and
specialized health services
FOURmula ONESERVICE DELIVERY
3. Intensifying current efforts to reduce public
health threats

4. Disease free zones
a. Filariasis endemic mapping with STH and
Schistosomiasis programs, disability
prevention
FOURmula ONESERVICE DELIVERY
b. Leprosy quality diagnosis & case
management


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

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


FOURmula ONESERVICE DELIVERY
e. Schistosomiasis intensify surveillance of human
cases and the snail vector

5. Intensifies disease prevention and control
a. emerging infectious diseases avian influenza
task force at all levels, preparedness & response
plan for pandemic influenza, philhealth benefit
package

FOURmula ONESERVICE DELIVERY
b. VPI reaching every barangay, 4Bs
(Bakuna, Bitamina A, Breastfeeding advocacy,
purga sa Bulate), 100% Hepatitis B vaccines till 2010

c. Tuberculosis nationwide implementation of
DOTS, TB in children PPMDOTS
FOURmula ONESERVICE DELIVERY
d. HIV / AIDS social hygiene clinics,
local AIDS councils, behavior change
modification, Community based
program, home base care
FOURmula ONESERVICE DELIVERY
6. Improving reproductive health outcomes
a. Public-private partnership on women health
b. Pre-pregnancy package
c. Contraceptive delivery & logistic MIS
d. Standard days method as NFP
e. Paradigm shift high-risk pregnancies to
ALL PREGNANCIES ARE AT RISK
FOURmula ONESERVICE DELIVERY


f. mother and child book
g. infant and young children feeding program

FOURmula ONESERVICE DELIVERY
7. Intensified promotion of healthy lifestyle
a. tobacco management team at various levels
b. smoking cessation clinics
c. community-based NCD prevention and control
program
d. intensified promotion of healthy lifestyle DM, HPN,
CVD, breast & cervical cancer, anti-smoking, safe water,
sanitation among others.
e. strengthen national HL campaign
FOURmula ONEGOVERNANCE
Sectoral development approach for health
1. To strengthen government leadership in implementing a
sector program where development partners cooperate
and contribute accordingly
- effective donor and LGU coordination towards
financing a sector program
- harmonizing procedures among donors and national
government
FOURmula ONEGOVERNANCE
Health human resource masterplan
1. To maintain a national HHR masterplan in support
of national & local health systems
- HHR information system
- competency-based recruitment & selection
systems
- training and development need analysis

FOURmula ONEGOVERNANCE
- Performance management system
- Career development and management
- Advocacy plan
FOURmula ONEGOVERNANCE
Developing a localized health human
resource strategy
1. Health professional development and career
track
2. Identifying and providing venue for posting
of vacancies
3. Actively promoting LGU vacancies
4. Support for developing local HR strategy

FOURmula ONEGOVERNANCE
Establishment of 4-in-1 convergence sites
1. Health investment planning
2. Developing appropriate governance and
mechanisms, i.e., ILHZ convergence sites
3. Helping mobilizing extra-budgetary resources for
health at the local level
FOURmula ONEGOVERNANCE
4. Improving procurement, devolving regulatory
functions, linking, local regulatory policies with
health programs and financing
5. Nationalizing the health delivery network, provision
of basic health services
6. Monitoring & evaluation, i.e., LGU score card
FOURmula ONEGOVERNANCE
Philippine health information system
1. establishment, operationalization, & use of health
portal and development of Philippine health
information infrastructure
- harmonization of info systems
- human resource info system
- vital registries, health statistics

FOURmula ONEGOVERNANCE
Philippine health information system
1. establishment, operationalization, and use
of health portal and development of
philippine helath information infrastructure
2. Development of manual of operations
FOURmulaGOVERNANCE
DOH procurement and logistics
management system
1. Inventory system, supply chain mechanism
2. Efficient storage
3. Database of goods / supplies (standard
specifications)
4. Procurement systems
- pooling
- monitoring
- feedback mechanism
FOURmula ONEGOVERNANCE
- Disease surveillance
- health accounts
- health regulations
- health facilities
FOURmula ONEGOVERNANCE
5. Database of supplies with performance
monitoring
6. Standardization of specifications and
documents
7. Implementation of ethical practices
framework
THE NATIONAL OBJECTIVES ON
HEALTH



NATIONAL OBJECTIVES

NATIONAL OBJECTIVES FOR HEALTH 2005 TO 2010
-Provides the road map for stakeholders in health and
health-related sectors to intensify and harmonize
their efforts to attain its time-honored vision of
health for all Filipinos and continue its avowed
mission to ensure accessibility and quality of life of
all Filipinos, especially the poor.
NATIONAL OBJECTIVES

It provides concrete handle that would guide
policy makers, program managers, local
government executives, development
partners, civil society and the communities
in making crucial decisions for health.
NATIONAL OBJECTIVES
OBJECTIVES OF THE HEALTH SECTOR
1. Improve the general health status of the
population
2. Reduce morbidity and mortality from certain
diseases
3. Eliminate certain diseases as public helath
problems
4. Promote healthy lifestyle and environmental
health

NATIONAL OBJECTIVES
5. Protect vulnerable groups with special health and
nutrition needs
6. Strengthen national and local health systems to ensure
better health service delivery
7. Pursue public health and hospital reforms
8. Reduce the cost and ensure quality esssential drugs
9. Institute health regulatory reforms to ensure quality
and safety of helath goods and services
NATIONAL OBJECTIVES
10. Expand the coverage of social health
insurance
11. Mobilize efficiency in the allocation,
production and utilization of resources for
health
Primary health care
As a strategy
PHC
Definition of Primary Health Care (PHC):

World Health Organization (WHO)
- essential care made universally
accessible to individuals and families in
the community
- by means acceptable to them
- through their full participation and
- at a cost that the community and
country can afford at every stage of
development.

BACKGROUND:

Primary Health Care (PHC) was declared
during the First International Conference on
Primary Health Care
- held in Alma Ata, Russia
- on September 6-12, 1978 by the World Health
Organization (WHO).
-The goal was Health for All by the Year 2000. This
was adopted by the in the Philippines through Letter
of Instruction 949 signed by President Marcos on
October 19, 1979 and has an underlying theme of
Health in the Hands of the People by 2020.
This approach has influenced many
countries including the Philippines.
Its innovativeness is indicated by the call for
participatory development management since
community members are expected to take an
active role in managing their own health
requirements, instead of depending on the
government.
PHC also gives importance to the participation
of various sectors of government and the
private sector in local health activities.

Problems/Issues
The implementation of PHC has not been spared from
problems and difficulties.

Lack of political will of the top leadership of the DOH for the
continued implementation of PHC.

Passage of BHWs Incentives Act which violated the principle of
volunteerism and could be a tool for politicking by local
executives since the volunteer workers could beholden to them
instead of the community.

The transfer of responsibility of PHC to local executives under
devolution is not easy. PHC could not be fully achieved if the
bureaucracy itself is not empowered.


Levels of Health Care
Referral System
Problems/Issues
The implementation of PHC has not been spared from
problems and difficulties.

Lack of political will of the top leadership of the DOH for the
continued implementation of PHC.

Passage of BHWs Incentives Act which violated the principle of
volunteerism and could be a tool for politicking by local
executives since the volunteer workers could beholden to them
instead of the community.

The transfer of responsibility of PHC to local executives under
devolution is not easy. PHC could not be fully achieved if the
bureaucracy itself is not empowered.

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