Philippine Health Sector Overview

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Questions and Answers

What is the primary goal of the Department of Health regarding the health care of Filipinos?

To increase the number of medical professionals in urban areas

To provide financial assistance to hospitals across the nation

To monitor health care expenditures by the government

To ensure quality health care for all Filipinos (correct)

By which year did the Department of Health aim for Filipinos to be among the healthiest in Southeast Asia?

2035

2022 (correct)

2040

2010

What is the overarching mission of the Department of Health?

To develop a productive and people-centered health system for Universal Health Care (correct)

To improve medical technology in the Philippines

To expand private health insurance coverage

To regulate pharmaceutical prices nationwide

Which of the following statements about the Department of Health’s vision is correct?

The vision includes making Filipinos among the healthiest in Asia by 2040 Signup and view all the answers

What does the Department of Health emphasize as part of its goal for Universal Health Care?

Enhancing health care quality through equitable access Signup and view all the answers

Which strategic goal focuses on providing a better structure for financing health initiatives?

Financing Signup and view all the answers

What is the main focus of the regulation aspect in achieving health goals?

Enhancing product quality and affordability Signup and view all the answers

Which of the following best describes a key component of service delivery in health care?

Accessibility to essential quality health services Signup and view all the answers

What aspect does 'Financing' emphasize to enhance health outcomes?

Sustainable investment and resource equity Signup and view all the answers

Which strategic goal addresses the need for equitable healthcare financing?

More Equitable Healthcare Financing Signup and view all the answers

Which facility characteristic is unique to Level 2 hospitals compared to Level 1 hospitals?

High-risk pregnancy unit (HRPU) Signup and view all the answers

What specifically is NOT included in Level 1 facilities?

Tertiary clinic laboratory Signup and view all the answers

Which of the following services is part of the Level 2 hospital classification?

Respiratory Therapy services Signup and view all the answers

Which of these characteristics does a Level 1 hospital share with a Level 2 hospital?

Bed space of its authorized bed capacity Signup and view all the answers

What defines the operational capacity of a Level 1 hospital?

A qualified staff Signup and view all the answers

Which service is provided by a primary care facility?

Normal deliveries Signup and view all the answers

What type of care is primarily offered by custodial care facilities?

Long term drug rehabilitation Signup and view all the answers

Which of the following best describes the primary function of a diagnostic/therapeutic facility?

Conducting clinical laboratory tests Signup and view all the answers

What distinguishes custodial care from primary care facilities?

Provision of long-term care Signup and view all the answers

Which of the following facilities would you associate with laboratory analysis for drinking water?

Diagnostic/therapeutic facility Signup and view all the answers

What is the main responsibility of the Department of Health's representatives in Local Health Boards?

Addressing health budget and health matters Signup and view all the answers

What significant change was brought about by the Local Government Code (RA 7160) regarding health services?

Decentralization of health services to Local Government Units Signup and view all the answers

Which entities form the public sector of the Philippine Health Care Delivery system?

National government agencies and Local health facilities Signup and view all the answers

Which of the following best describes the role of Local Government Units (LGUs) in the health care system following devolution?

They oversee the provision of basic health services within their jurisdiction Signup and view all the answers

What is a characteristic feature of the Philippine health care system's structure?

It is a mix of public and private sectors with varying agencies and services. Signup and view all the answers

What is one of the primary functions of Local Health Boards in relation to the Sanggunian?

Proposing annual budgetary allocations for health facilities Signup and view all the answers

In what capacity do Local Health Boards serve in relation to the Sanggunian?

As an advisory committee on health matters Signup and view all the answers

Which of the following is a responsibility of Local Health Boards regarding health service operations?

Creating committees to advise on health matters Signup and view all the answers

What role do Local Health Boards play in the budgetary process for health services?

They suggest budgetary allocations to the Sanggunian. Signup and view all the answers

Which of the following statements about Local Health Boards' advisory functions is true?

They advise local health agencies on operational matters. Signup and view all the answers

What is one of the main objectives of Republic Act No. 7305 related to health workers?

To enhance the social and economic status of health workers. Signup and view all the answers

Which of the following is NOT a goal of Republic Act No. 7305 as related to health workers?

To establish uniform job roles across different health sectors. Signup and view all the answers

How does Republic Act No. 7305 aim to assist health workers in delivering health projects?

By enhancing their skills and capabilities. Signup and view all the answers

In what way does Republic Act No. 7305 propose to enhance the working conditions of health workers?

By improving their social and economic well-being. Signup and view all the answers

Which of the following best describes a key purpose of Republic Act No. 7305 for health workers?

To enhance health workers' responsiveness in health care delivery. Signup and view all the answers

Which of the following groups is explicitly classified as 'health workers' under the Act?

Health-related administrative support personnel Signup and view all the answers

What is the employment status of health workers as defined by the Act?

Employment status does not affect classification Signup and view all the answers

Which setting is NOT explicitly mentioned as a place of employment for health workers under the Act?

Home care services Signup and view all the answers

Which professional group falls under the definition of health workers as per the Act?

Medical professionals including doctors and nurses Signup and view all the answers

What role do administrative personnel play in relation to health workers as defined by the Act?

They are included as part of the health worker classification regardless of location Signup and view all the answers

What condition must be met for married public health workers to be assigned in the same municipality?

They should be employed or assigned in the same municipality but not in the same office. Signup and view all the answers

Under what circumstance can a public health worker's employment not be terminated?

Without a cause provided by law and due process. Signup and view all the answers

What happens if a public health worker is unjustly dismissed from work?

They are entitled to back wages with 12% interest. Signup and view all the answers

Which statement accurately reflects the job security measures for public health workers?

Termination requires legal cause and due process. Signup and view all the answers

What is the role of the Civil Service Commission in relation to public health workers' employment status?

They can determine if a dismissal was unjust. Signup and view all the answers

Which of the following actions is explicitly prohibited for public health workers regarding their profession?

Discriminating against individuals based on ethnicity Signup and view all the answers

What is one of the key ethical obligations of public health workers as stated in their duties?

To discharge duties with a sense of dignity and respect for life Signup and view all the answers

Which of the following statements accurately reflects the status of public health workers concerning staffing levels?

Public health workers must not experience understaffing or overloading Signup and view all the answers

In discharging their duties, what should public health workers prioritize above all?

Maintaining the integrity of life without racial or social bias Signup and view all the answers

Which of the following is a requirement for public health workers when performing their functions?

To exercise their functions impartially, regardless of personal beliefs Signup and view all the answers

What is the maximum number of hours a public health worker can work in a week without entering overtime?

40 hours Signup and view all the answers

If a public health worker is required to work overtime, what compensation are they entitled to?

Additional compensation as per existing laws Signup and view all the answers

What percentage of the regular wage is a public health worker entitled to receive for each hour worked during night shifts?

10% Signup and view all the answers

Under what condition can a public health worker be required to work more than the normal daily hours?

When the exigencies of the service require it Signup and view all the answers

In which scenario would a public health worker NOT receive a night-shift differential?

When they work their normal shift from 9 AM to 5 PM Signup and view all the answers

What percentage of the monthly basic salary is provided as a hazard allowance for health workers with salary grade 19 and below?

25% Signup and view all the answers

How often is a health worker eligible for longevity pay, and what is the percentage of their monthly basic pay for that duration?

Every five years at 5% Signup and view all the answers

Which monetary benefit is specifically allocated for public health workers who wear uniforms regularly?

Laundry allowance Signup and view all the answers

Under what conditions must the hazard allowance rate for public health workers be reviewed and possibly increased?

Periodically by the Secretary of Health in consultation with government agencies Signup and view all the answers

What is the condition required for health workers to start receiving longevity pay?

Commencement with service after the approval of a specific Act Signup and view all the answers

What is the main requirement for doctors, dentists, nurses, and midwives to qualify for the remote assignment allowance?

They must accept assignments in remote areas that have been vacant for two years. Signup and view all the answers

Which of the following factors is NOT assessed when evaluating the microbial quality of water?

pH levels Signup and view all the answers

What financial incentive do healthcare workers in remote areas receive for transportation costs?

Reimbursement for reasonable transportation costs during official trips. Signup and view all the answers

Which parameter is included in the chemical and physical quality of water testing?

Mineral content levels Signup and view all the answers

What is the remote assignment allowance equivalent to for eligible healthcare workers?

50% of their basic pay Signup and view all the answers

What is the minimum distance required for washing and bathing activities from any source of drinking water?

25 meters Signup and view all the answers

Which of the following statements about well construction near sources of pollution is accurate?

There should be a minimum distance of 25 meters for well construction from pollution sources. Signup and view all the answers

In relation to food safety, what is required for an individual to work in any food handling capacity?

A health certificate issued by the City/Municipal Health Officer Signup and view all the answers

Which action is expressly prohibited in the context of personnel working at food establishments?

Handling food while sick with communicable diseases Signup and view all the answers

What is a specific requirement regarding the construction of dwellings related to protected spring water sources?

Dwellings need to be built at least 50 meters from a protected spring water source. Signup and view all the answers

What is the minimum time required for immersion of utensils in clean hot water at 77 degrees Celsius for effective bacterial treatment?

At least half a minute Signup and view all the answers

In what temperature range should lukewarm water containing chlorine solution be for it to be effective in bacterial treatment?

55-100 ppm Signup and view all the answers

Which of the following acts is strictly prohibited under the Solid Waste Management Act of the Philippines?

Open burning of solid wastes Signup and view all the answers

For effective sanitation, what is the minimum exposure time to steam required at 200 degrees Celsius?

5 minutes Signup and view all the answers

Which of the following locations is prohibited for constructing establishments related to solid waste management?

Within 200 meters from a dump or landfill Signup and view all the answers

What does the yellow bag with a black band specifically indicate in healthcare waste management?

Pharmaceutical, cytotoxic or chemical wastes Signup and view all the answers

Which of the following waste types is classified as radioactive in healthcare waste management?

Orange with radioactive symbol Signup and view all the answers

Identify the type of healthcare waste indicated by a yellow bag that is suitable for autoclaving.

Infectious wastes Signup and view all the answers

Which category does the color green represent in the classification of healthcare waste?

Nonhazardous biodegradable wastes Signup and view all the answers

What does a black or colorless designation signify in healthcare waste management?

Nonhazardous and nonbiodegradable wastes Signup and view all the answers

What is a critical factor for the construction of toilet slabs and pans?

They must be durable and easy to clean. Signup and view all the answers

Which feature is essential for the superstructure of a toilet?

Prevention of weather-related intrusions and pests. Signup and view all the answers

What aspect is particularly important in the design of toilets for diverse populations?

Providing context-appropriate facilities for hygiene. Signup and view all the answers

How frequently should toilets be maintained and cleaned to ensure safe usage?

Regularly and as needed for hygiene. Signup and view all the answers

What is a necessary security feature for public or shared toilets?

Lockable doors to ensure safety and privacy. Signup and view all the answers

What factors must be compared to establish the presence of an outbreak?

Current cases against historical data of the same period Signup and view all the answers

In the context of the epidemiologic triad, which element is crucial for the transmission of an infectious agent?

The interaction between the host and the external agent Signup and view all the answers

Which of the following is an essential preparation step for investigating a disease outbreak?

Understanding modes of transmission and risk factors Signup and view all the answers

What typically constitutes the basis for determining the expected number of cases in an outbreak investigation?

Surveillance data from previous comparable periods Signup and view all the answers

What aspect of the epidemiologic triad involves the environmental factors that facilitate disease transmission?

Environment characteristics Signup and view all the answers

What is the primary purpose of verifying a diagnosis in an outbreak investigation?

To ensure proper disease identification and rule out errors Signup and view all the answers

Which of the following accurately defines a 'probable case' in an outbreak setting?

A case with clinical features common to the disease but lacking lab confirmation Signup and view all the answers

What distinguishes passive surveillance from active surveillance in outbreak investigations?

Passive surveillance gathers data solely through pre-existing reports. Signup and view all the answers

In the context of descriptive epidemiology, which aspect is crucial for summarizing data during an outbreak?

Characterizing trends over time and identifying at-risk populations Signup and view all the answers

What is an essential component of constructing a working case definition in an outbreak investigation?

Specifying the time and place for the categorization of cases Signup and view all the answers

What is a plausible reason for reevaluating a hypothesis during epidemiological investigations?

The results may not clarify the relationships between variables. Signup and view all the answers

Which mode of presenting hypotheses is likely used when questioning the cause of an outbreak classified as bioterrorism?

Considering unusual modes of transmission. Signup and view all the answers

What is one of the primary methods for evaluating hypotheses in epidemiology?

Using established facts for comparison. Signup and view all the answers

When might analytic epidemiology be deemed ineffective, prompting a need for hypothesis revision?

When results do not clarify the transmission dynamics. Signup and view all the answers

In the context of epidemiological hypotheses, what does the term 'exposures' refer to?

The potential risk factors linked to a disease. Signup and view all the answers

Study Notes

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.

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Description

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.