Philippine Health Sector Overview

Department of Health (DOH) Mandate

• The Department of Health (DOH) is the national agency responsible for leading the Philippine health sector.
• The DOH is tasked with ensuring quality healthcare for all Filipinos.
• The DOH aims to achieve the following:
  • "Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040".

DOH Mission

• The DOH strives to lead in developing a health system that is:
  • Productive
  • Resilient
  • Equitable
  • People-centered
• The DOH's vision is to achieve Universal Health Care (UHC).

Strategic Goals in Healthcare

• The text highlights three key strategic goals in healthcare: better health outcomes, a more responsive health system, and more equitable healthcare financing.

Financing

• Sustainable investment secures improved health outcomes.
• Efficient and equitable use of health resources is essential.

Service Delivery

• Accessibility to essential quality health services should be ensured.
• Appropriate levels of care need to be provided.

Regulation

• High quality and affordable health products, devices, facilities, and services are crucial.

Classification Scheme of Health Facilities

• Hospitals are classified into levels based on their capabilities and resources.
• Level 1 hospitals represent the basic level of hospital care.
• Level 1 hospitals have qualified staff, a designated bed capacity, an operating room, a post-operative recovery room, an isolation room, and other essential facilities.
• Level 2 hospitals encompass all the features of Level 1 hospitals and expand upon them.
• Level 2 hospitals include specialized units like a Neonatal Intensive Care Unit (NICU), a High-Risk Pregnancy Unit (HRPU), and Respiratory Therapy services.
• Level 2 hospitals also feature a tertiary clinic laboratory, providing a wider range of diagnostic and treatment capabilities.

Level 1 Hospitals

• Have basic essential facilities for providing general medical and surgical care.

Level 2 Hospitals

• Offer more specialized care for complex conditions, including neonatal, pregnancy, and respiratory needs.
• Have advanced diagnostic capabilities with a tertiary clinic laboratory.

Primary Care Facilities

• Provide basic emergency services.
• Deliver normal babies.

Custodial Care Facilities

• Provide long-term care, including drug abuse treatment and rehabilitation services.
• Nursing homes provide custodial care.

Diagnostic/Therapeutic Facilities

• Offer diagnostic tests like clinical laboratory testing, drug testing, and water analysis.

Philippine Health Care Delivery System

• Composed of agencies, personnel, and services.
• Divided into two sectors: public and private.

Public Sector

• National (Department of Health, DOH)
• Local government agencies (Rural Health Units, RHUs, and Barangay Health Stations, BHS)
• Provide health services to the public.

DOH and Local Health Boards

• DOH representatives participate in Local Health Boards.
• Local Health Boards oversee health budgets and health matters within their locality.
• Members include the Mayor, Municipal Health Officer (MHO), DOH representative, and a councilor assigned to health.

Local Government Code (RA 7160)

• Enacted in 1991 to bring about local autonomy and devolution of basic services.
• Mandates the transfer of responsibility for basic services, including health, from the national government to Local Government Units (LGUs).

Devolution of Health Services

• Transfers control and responsibility for health services to LGUs.
• Local health system is now administered by LGUs after devolution.

Local Health Board Functions

• Proposes annual budget allocations to the Sanggunian (local legislative body) for health facilities and services within the province/city/municipality.
• Acts as an advisory committee to the Sanggunian on health-related matters.
• Creates committees that provide advice to local health agencies on various aspects of health service operations.

Republic Act No. 7305 - The Magna Carta of Public Health Workers

• Promotes the social and economic well-being of health workers.
• Aims to improve living and working conditions.
• Focuses on improving terms of employment for health workers.
• Develops skills and capabilities of health workers.
• Enhances the ability of health workers to deliver health projects and programs.

Health Worker Definition

• The term "health workers" encompasses all individuals involved in health and related work.
• This definition includes personnel employed in government-owned and operated health facilities.
• These facilities consist of hospitals, sanitaria, health infirmaries, health centers, rural health units, barangay health stations, clinics, and other health-related establishments.
• The definition explicitly includes medical professionals, allied health professionals, administrative staff, and support personnel.
• The inclusion extends to personnel employed regardless of their employment status, which may include permanent, temporary, or contractual employees.

Married Public Health Workers

• Public health couples should ideally be assigned to the same municipality to promote family well-being.
• Couples should not work in the same office, potentially preventing conflicts of interest or favoritism.

Security of Tenure

• Public health workers with regular employment status enjoy job security and should only be terminated for valid reasons outlined by law.
• Due process must be followed before termination, ensuring fair treatment for the worker.
• If an employee is unjustly dismissed, the Civil Service Commission will investigate.
• Unjustly dismissed workers are entitled to reinstatement, full seniority privileges, and back pay with 12% interest.
• Interest on back pay is calculated from the date compensation was withheld until reinstatement.

Discrimination Prohibited

• Public health workers are protected from discrimination based on gender, marital status, religious or political beliefs, and ethnicity.
• This protection applies to their professional activities.

Staffing Standards

• Adequate staffing levels are crucial for public health workers.
• Understaffing or overloading is not acceptable and could impact quality of care.

Duties and Obligations

• Public health workers are expected to perform their duties humanely, with dignity, and respect for life.
• They must act with impartiality, regardless of a person's race, gender, religion, nationality, political affiliation, social status, or ability to pay.

Normal Working Hours

• Public health workers are limited to an eight-hour workday and a forty-hour workweek.

Overtime Work

• Public health workers can be required to work overtime if urgent demands arise.
• Overtime work is compensated at a higher rate, adhering to existing legal frameworks and industry standards.

Night Shift Differential

• Public health workers receive a ten percent (10%) increase in their regular hourly wage for all hours worked during night shifts.
• This night shift differential is applied based on hospital-specific night shift schedules.

Hazard Allowance

• Health workers in designated high-risk areas are eligible for a hazard allowance.
• The allowance is calculated as 25% of the monthly basic salary for those with salary grade 19 and below, and 5% for those with salary grade 20 and above.
• These designated areas include hospitals, sanitariums, rural health units, and other similar facilities located in regions facing challenges like armed conflict, natural disasters, or outbreaks.

Longevity Pay

• Public health workers receive a monthly longevity pay of 5% of their basic salary for every five years of continuous, efficient, and meritorious service.
• The chief of the relevant office must certify the worker's service record for eligibility.

Laundry Allowance

• Public health workers required to wear uniforms regularly receive a monthly laundry allowance of ₱125.
• The Secretary of Health reviews the allowance periodically and adjusts it accordingly, considering relevant laws and practices.

Remote Assignment Allowance

• Doctors, dentists, nurses, and midwives who accept remote assignments in areas that have been unfilled for two years receive a 50% bonus of their basic pay.
• They are also reimbursed for transportation to and from the remote post, upon assuming or leaving the position and during official trips.

Water Quality

• Water quality considers availability, volume, mineral content, toxic chemical pollution, and pathogenic microorganism levels.
• The following factors are checked to determine water safety for human consumption:
  • Microbial quality: Total coliform, fecal coliform, and heterotrophic count.
  • Chemical and Physical quality: pH, color, odor.
  • Radiological quality: Gross alpha activity, gross beta, and radon.

Water Safety Prohibitions

• No washing or bathing within 25 meters of any well or drinking water source.
• Construction of wells (artesian, deep, or shallow) is prohibited within 25 meters of pollution sources, including septic tanks and sewerage systems.
• Drilling wells within 50 meters of a cemetery is prohibited.
• Construction of dwellings within the catchment area of a protected spring water source is prohibited.

Food Safety Rules

• Food establishments must have a sanitary permit.
• Employees in food establishments must possess a health certificate issued by the City/Municipal Health Officer.
• Individuals with communicable diseases are prohibited from working in food handling roles.

Utensil Sterilization Methods

• Hot Water Immersion: Utensils can be sterilized by immersion in clean hot water at 77°C for at least 30 seconds.
• Chlorine Solution Immersion: Alternatively, utensils can be sterilized by immersion in lukewarm water containing 55-100 ppm of chlorine solution for at least one minute.
• Steam Exposure: Sterilization can also be achieved by exposing utensils to steam for at least 15 minutes at 77°C or for 5 minutes at 200°C.

Solid Waste Management Prohibited Acts (Philippines)

• Open Burning: Burning solid waste in the open is strictly prohibited.
• Open Dumping: Dumping solid waste in open areas without proper containment is illegal.
• Burial in Flood-Prone Areas: Burying solid waste in areas prone to flooding is prohibited.
• Squatting in Landfills: Residing or occupying areas designated for landfill operations is illegal.
• Landfill Operations on Aquifers/Reservoirs/Watersheds: Constructing landfills on aquifers, groundwater reservoirs, or watersheds is prohibited.
• Construction near Landfills: Constructing any establishment within 200 meters of a landfill is prohibited.

Waste Color Coding in Healthcare

• Black or Colorless represents nonhazardous and nonbiodegradable wastes, such as plastic packaging or paper.
• Green indicates nonhazardous biodegradable wastes, such as food scraps and garden waste.
• Yellow with biohazard symbol signifies pathological or anatomical wastes, including human tissues, organs, or body fluids.
• Yellow with a black band designates pharmaceutical, cytotoxic, or chemical wastes and requires separate labeling.
• Yellow bags that can be autoclaved are used for infectious wastes, such as contaminated dressings or needles.
• Orange with a radioactive symbol identifies radioactive wastes and is reserved for hospitals with nuclear medicine departments.

Toilet Design and Construction

• Toilets should be designed to safely separate users from excreta.
• Toilet slabs and pans should be constructed of durable, easily cleanable materials.
• Toilet superstructures should prevent rain and storm water intrusion, as well as access by animals and insects.
• Toilets should offer safety and privacy, with lockable doors for shared or public toilets.

Toilet Features

• Toilet design should include culturally and contextually appropriate facilities for anal cleansing, handwashing, and menstrual hygiene management.

Toilet Maintenance

• Regular cleaning and maintenance are essential for safe and healthy toilet use.

Pathogen Transmission

• Pathogens can be transmitted at any point during an infection, depending on the specific pathogen.

Epidemiologic Triad

• This model explains the factors that contribute to infectious disease outbreaks.
• Three key components are:
  • Susceptible Host
  • External Agent (pathogen)
  • Environment that brings the host and agent together.

Disease Outbreak Investigation: Steps

• Preparation
  • Requires knowledge of the disease, including:
    • Sources of the outbreak
    • Modes of transmission
    • Risk factors
  • Requires essential supplies and equipment, like personal protective equipment (PPE).
• Establish Outbreak Existence
  • Compare observed cases with expected cases.
  • Expected number of cases can be obtained from previous weeks, months, or years.
  • For notifiable diseases, expected numbers are based on surveillance data.

Verifying the Diagnosis

• Verifying a diagnosis is crucial to ensure the disease is correctly identified.
• It helps rule out potential errors in laboratory testing.

Constructing a Case Definition

• A case definition is a tool for classifying individuals as having or not having a disease.
• In outbreak investigations, the case definition includes time and place.
• Case definitions are typically categorized during early stages of investigation.
  • Suspected case: has a few of the typical clinical features.
  • Probable case: has typical features of the disease without laboratory confirmation.
  • Confirmed case: laboratory verification of the disease.

Finding Cases Systematically and Recording Information

• Investigators use passive surveillance, sending out information about the outbreak and requesting reports of similar cases.
• Active surveillance involves visiting facilities to gather information about the outbreak.
• Forms or questionnaires are often used to collect detailed information on clinical symptoms.
• Laboratory specimens may be collected for analysis.
• Individuals identified as cases are encouraged to refer others with similar symptoms for investigation.

Performing Descriptive Epidemiology

• Summarizing data provides a comprehensive understanding of the outbreak.
• This includes trends over time, geographical distribution, and affected populations.

Hypothesis Development

• Hypotheses should address the source of the agent, mode of transmission, or exposures causing the disease.
• Hypothesis development depends on pre-existing knowledge of the disease or condition.
• Intentional outbreaks or bioterrorism require consideration of unusual transmission patterns.

Hypothesis Evaluation

• Hypothesis evaluation employs two primary methods:
  • Comparing hypotheses against established facts.
  • Using analytic epidemiology to quantify relationships and assess chance.

Hypothesis Refinement

• Unrevealing analytic epidemiology findings require hypothesis reevaluation.
• Reconsidering modes of transmission, refining control groups, and assessing agent and host factors are crucial for refining hypotheses.

This quiz explores the mandate and mission of the Department of Health (DOH) in the Philippines. It covers key goals for improving healthcare quality and access for Filipinos, focusing on achieving Universal Health Care. Test your knowledge on the DOH's aims and vision for the national health system.