Decent Work and Employment - Human Rights

**DECENT WORK AND EMPLOYMENT** **Human Rights** - (UN Nations) are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status. **International Human Rights --** promote and protect human rights and fundamental freedoms o...

**DECENT WORK AND EMPLOYMENT** **Human Rights** - (UN Nations) are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status. **International Human Rights --** promote and protect human rights and fundamental freedoms of individuals or groups - Civil - Economic - Political - Social **Universal Declaration of Human Rights (UDHR) --** milestone document in history of human rights. - Proclaimed by United Nations General Assembly in Paris (Dec 10, 1948) by General Assembly Resolution 217 A (III) - **Resolution 217 A (III)** -- common standard of achievements for all peoples and all nations 1. **Economic, Social and Cultural Rights** - Right to work in just and favorable conditions - right to social protection - right to education and enjoyment of benefits of cultural freedom and scientific progress 2. **Civil and Political Rights** - Freedom of movement - Equality before the law - Right to a fair trial and presumption of innocence - Freedom of thought, conscience and religion - Freedom of opinion and expression - Peaceful assembly - Freedom of association - Participation in public affairs and elections - Protection of minority rights 3. **Human Rights and Right to Health** - Right to health is indivisible from other human rights (education, participation, food, housing, work, and information) - Also includes freedoms and entitlements - Human rights-based approach = **PROACTIVE!** **Core Components of Rights to Health:** - Availability - Accessibility - Assessing - Acceptability - Quality (safe, effective, people-centered, timely, equitable, integrated) - Efficient **Human Rights Treaties which include Right to Health** - **International Covenant on Economic, Social and Cultural Rights (Article 12) -** everyone has the right to the highest attainable standard of physical and mental health - **Elimination of All Forms of Racial Discrimination (Article 5 (e) IV) -** prohibit and to eliminate racial discrimination in all its forms and to guarantee the right of everyone, without distinction as to race, colour, or national or ethnic origin, to equality before the law - \(e) Economic, social and cultural rights, in particular: - \(iv) The right to public health, medical care, social security and social services - **International Convention on the Elimination of All Forms of Discrimination Against Women (Article 11 (1)(f), 12 and 14 (2)(b))** - (Article 11) to eliminate discrimination against women in the field of employment in order to ensure, on a basis of equality of men and women, the same rights - \(f) The right to protection of health and to safety in working conditions, including the safeguarding of the function of reproduction. - (Article 12) to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning - (Article 14-2) to eliminate discrimination against women in rural areas in order to ensure, on a basis of equality of men and women, that they participate in and benefit from rural development - \(b) To have access to adequate health care facilities, including information, counselling and services in family planning - **Convention on Rights of the Child (Article 24) -** right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health - ensure that no child is deprived of his or her right of access to such health care services. - **International Convention on the Protection of Rights of All Migrant workers and Members of their Families (Article 28, 43 (e) and 45 (c))** - (Article 28) right to receive any medical care that is urgently required for the preservation of their life or the avoidance of irreparable harm to their health on the basis of equality of treatment with nationals of the State concerned. - (Article 43-e) Migrant workers shall enjoy equality of treatment with nationals of the State of employment in relation to: Access to social and health services, provided that the requirements for participation in the respective schemes are met - (Article 45-c) Members of the families of migrant workers shall, in the State of employment, enjoy equality of treatment with nationals of that State in relation to: Access to social and health services, provided that requirements for participation in the respective schemes are met. - **Convention on the Rights of Persons with Disabilities (Article 25) -** persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. **WHO Responses:** - Communication campaign - Right based-approach to health - Awareness of health related-human rights - Provide evidence, analysis and recommendations related to health and human rights - Mental and sexual health or reproductive health - Ensure human rights are recognized as fundamental foundation to effective health service delivery **1987 Philippine Constitution** - Sec 15: "State shall protect and promote the right to health of the people and instill consciousness among them" - Sec 16: "State shall protect and advance the right of the people to a balanced and healthful ecology in accord with the rhythm and harmony of nature" **SDG 3: Good Health and Well-being -** to ensure healthy lives and promote well-being for all at all ages - bold commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030 - achieve universal health coverage, and provide access to safe and effective medicines and vaccines for all **NOTE (Philippine Health Care Delivery System)** **Factors that Influence 21^st^ Century Health:** (Anderson & McFarlene, 2011) - **Health Care Reforms -** the process of changing healthcare system to improve its quality, efficiency, and accessibility - Reducing corruption - Increasing transparency - Changing goals from treating diseases to maintaining wellness - **Demographics -** plays an important role in determining an individual\'s potential health problems - Age, gender, race, ethnicity, geographic area - **Globalization -** increases medical access for people and countries that may not have access or may not be able to afford care. - Increases world's knowledge and allows collaboration between nations - Influence use of health technology, service system, new diseases and other social conditions - **Poverty -** affects health by limiting access to proper nutrition, shelter, safe neighborhoods to learn, live and work, clean air and water, etc. - **Social Disintegration -** are non-medical factors that influence health. SDH include the conditions in which people live, work, grow, and age, as well as the forces and systems that shape daily life. **WHO** (World Health Organization) specialized agency in UN provides global leadership on health matters in the Philippines **DOH** (Department of Health) is the lead agency for health on national level **RA 7160 (Local Government Code of the Philippines)** - **LGUs** employ operating mechanisms to meet their community needs - Basic health services as priority needs **Health System -** all organizations, people, and actions that aim to promote, restore, or maintain health. - Has 6 building blocks (WHO, 2007): -service delivery -health work force -information -medical products, vaccines, and technologies -financing -leadership and governance or stewardship **World Health Organization (WHO)** - Came into force on April 7, 1948 (WHO day) - Geneva, Switzerland (WHO Headquarters) - Philippines is a member of the Western Pacific Region **WHO Objective:** Attainment by all people of highest possible level of health **WHO Core Functions:** - Provide leadership on matters critical to health - Shaping research agenda and stimulating the generation, translation, and disseminating valuable knowledge - Setting norms and promoting and monitoring their implementation - Articulating ethical and evidenced-based policy options - Providing technical support **WHO Strategy on Research for Health (5 Goals):** - **Capacity** in reference to capacity-building to strengthen national health research system - **Standards** to promote good research practice - **Priorities** to focus research on priority health needs particularly in low- and middle-income countries - **Translation** to ensure that quality evidence is turned into products and policy - **Organization** to strengthen the research culture within WHO and improve the management and coordination of WHO research activities **Sustainable Development Goals 2030** - Formerly known Millenium Development Goals - To continue gains achieved thru MDGs implemented from 2000 to 2015 - Contain 17 goals from 2016-2030 - SDG3 focuses on ensuring health and well-being of population **History of Philippine Health Care Delivery System** - Public health services date back to Spanish regime, **1577, Franciscan Friar Juan Clemente** opened medical dispensary in Intramuros for the indigent. - **1690, Dominican Father Juan de Pergero,** installed water system in San Juan del Norte - **1805, Dr. Francisco de Balmis** (personal Physician of King Carlos IV)**,** introduced smallpox vaccination at Manila - **1876,** first Medicos Titulares were appointed by Spanish Government, which worked as provincial health officers - **1888,** UST offered 2-yr program of fundamental medical and dental courses, graduates were known as **Cirujanos Ministrates,** male nurses and sanitation inspectors - **1901, United States Philippine Commission** (Act 57) created Borad of Health of the Philippine Islands -- w/ Commissioner of Public Health as CEO - Borad of Health is now DOH - **Fajardo Act of 1912,** created sanitary divisions made up of one to four municipalities (president-physician) - **1915, Philippine General Hospital** extend PHN services by organizing Social Home Care Services - **1905, Association Feminista Filipina** founded Puericulture center -- provide maternity and infant care - **La Gota de Leche,** first center dedicated to service of mothers and babies - **1947, DOH** was reorganized into bureaus: Quarantine, Hospitals, and health with sanitation divisions - **1954, Congress** passed the **RA 1082** (Rural Health Act) -- creation of RHU in every municipality, also for the employment of physicians, PHN, midwives, and sanitation inspectors **-**also provided for PHO for each province and Public health dentist for each congressional district - **RA 1891,** enacted in **1957**, created 8 categories of RHU corresponding to the population size of municipalities - **1958,** Regional offices were created causing decentralization. - **1970,** Philippine health care delivery system was restructures, where health services are classified as: Primary, Secondary, Tertiary levels - **RA 7160** Local Government code enacted in **1991** -- mandated devolution of basic services to local government units and establishment of local health board **Components and Sectors of Health Care Delivery System** - **Public Sector -** national and local government agencies providing health services. (DOH, national level) - financed through a tax based budgeting system at both national and locals - through devolution of health services, local health system is run by LGU - Provincial and District hospitals are under provincial government - City/Municipal government manages health centers/RHU and BHS - Every municipality or province, there is local health board chaired by local chief executive, to serve as advisory body to local executive and sanggunian or local legislative council on health-related matters - **Private Sector -** market-oriented and health care is paid through user fees at the point of service. - Involved in maintaining people's health: -providing health insurance -manufacture of medicines, vaccines, and medical supplies, equipments and other nutritional products -research and development - composed of for-profit and non-profit agencies - employs more than 70% of the health professionals in the country Other notes: - provincial government are responsible for administration of provincial and district hospital - municipal and city governments are in charge of primary care through BHS and RHU - **BHS** (satellite outpost) provide health services in the periphery of the municipality or city - **LGU** has the autonomy and responsibility to plan and implement basic health services **Financing of Health Services:** - Government (National and Local) - Private sources - Social Health Insurance **RA 7875: National Health Insurance Act of 1995** - Created the Philippine Health Insurance Corporation (PhilHealth) - tax-exempt government corporation attached to the DOH for policy coordination and guidance, and aims for universal health coverage of all Filipino citizens (PhilHealth) **Department of Health** - national agency mandated to lead the health sector towards assuring quality health care for all Filipinos **DOH Vision:** "Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040" **DOH Mission:** "Lead the country in the development of a productive, resilient, equitable, and people-centered health system" **DOH Major Roles:** - Leader in health - Enabler and Capacity builder - Administrator of Specific services **Leadership role of DOH, Functions** (EO 102, s. 1999): - Planning and formulating policies of health programs - Monitoring and evaluating of implementations - Advocating for health promotion and healthy lifestyle - Serving as technical authority in disease control and prevention - Providing administrative and technical leadership in health care financing and implementing national health insurance law **DOH Core Values:** - Integrity - Excellence - Compassion and respect for human dignity - Commitment - Professionalism - Teamwork - Stewardship of health of the people **Local Health Boards** - **RA 7160 (Local Government Code)** = Local Autonomy - It mandates devolution of basic services from the national government to LGUs - **Devolution --** act by which national government confers power and authority upon various LGUs to perform specific functions and responsibilities - Created the Provincial Health Board and the City/Municipality Health Boards or Local Health Boards - **Chairman of board:** Local executive -- **Provincial Governor or Mayor** - Provincial/City/Municipal Health Officer serves as Vice chairman **Members of Board:** - Chairman of Committee on health of Sanggunian - Representative from private sector of NGO involved in health services - Representative of DOH **Functions of Local Health Boards:** - Proposing to sanggunian annual budgetary allocations for the operation and maintenance of health facilities - Serving as advisory committee to sanggunian on health matters - Creating communities that shall advise local health agencies on various matters related to health service operations **Rural Health Unit** - Known as health center - Primary level health facility in the municipality - Focus: preventive and promotive health services and the supervision of BHSs under its jurisdiction - 1 PHN: 10,000 population ratio - 1 RHU: 20,000 population ratio - 1 BHS: 5,000 population ratio - **BHS** first-contact health care facility that offers basic services at the barangay level. Satellite station of RHU **-**it is manned by volunteer BHWs under supervision of RHM - **Municipal Health Officer (MHO) or Rural Health Physician** heads the health services at he municipal level and carried other functions: **-**Administrator of RHU **-**Community physician **-**Medico-legal Officer of the Municipality - **Public Health Nurse:** -Supervises and guides all RHMs in the municipality -Prepares the FHSIS quarterly and annual reports of municipality for submission to PHO -Utilizes nursing process in responding to health care needs -Collaborates with other members of health team, government agencies, private business, NGOs **NDP (Nurse Deployment Project) --** due to limitations of LGU to finance health human resource, DOH has launched NDP to augment efforts of PHNs in their areas of jurisdiction - Aims to assign, community-oriented and dedicated nurses to difficult areas - Provide access to health services for marginalized population - "volunteer nurses for a fee" - Improvement of local health system and support to the attainment of Universal Health Care or Kalusugan Pangkalahatan - Nurses are hired under contract w/ position of PHN II for 6months and can be renewed on very satisfactory performance - PHN II with salary grade 17 **Functions of NDP:** - Implement programs, health education - Conduct regular visits to priority households under National Household Targeting System for Poverty Reduction (NHTS-PR) - Plan interventions - Assist in conduct of disease surveillance - Maintain BHS **RA 7883 (Barangay Health Workers' Benefit and Incentive Act) --** entitles BHW to hazard and subsistence allowances and other benefits - 1 BHW: 20 Household - BHW are considered as interface between community and RHU - Trained in preventive health care (Maternal and child care, Family planning and reproductive health, nutrition, and sanitation) - Assist in providing basic services at BHS and RHU **Levels of Health Care, Services, and Facilities** - Hospitals are broadly classified as General or Specialty Hospitals - **General Hospital --** provides services for all kinds of illnesses, injuries, or deformities **Administrative Order 2012-0012 (DOH) --** provides for new classification scheme of health facilities - **Category A (Primary care Facility) --** first contact health care facility that offers basic services (emergency services and normal deliveries) - **Category B (Custodial care Facility) --** provides long-term care (basic services like food and shelter to patients w/ chronic conditions) - **Category C (Diagnostic/Therapeutic Facility) --** for examination of human body, specimens from human body for diagnosis or treatment of disease. - Laboratory facility - Radiologic facility - Nuclear medicine facility - **Category D (Specialized outpatient facility) --** performs highly specialized procedures on an outpatient basis **Inter Local Health Zone** - (ILHZ) aby form of organized arrangement for coordinating the operations of an array and hierarchy of health providers and facilities w/n local geographic area - network of health facilities that provide range of services to meet health needs of community - it has a central or core referral hospital and number of primary level facilities (RHU and BHSs) **ILHZ Functionality:** - improved health status and coverage of public health intervention of zone population - access by everyone in the zone to qualify care - efficiency in the operations of inter-local health services **RA 11223 (Universal Health Care Law) --** with this implementation, re-alignment of these facilities is expected to ensure more responsive healthcare delivery to communities. **Components of ILHZ:** - **People --** ideal population size of health district is 100,000-500,000 - **Boundaries --** establish accountability and responsibility of health service providers - **Health Facilities --** RHU, BHS that work together as an integrated health system and a district/provincial hospital serving central referral hospital - **Health workers --** deliver comprehensive services (personnel of DOH, hospitals, RHU, BHS, etc) **Health Referral System** - Implemented since **1992** - **3 level system** where local and national governments are responsible for independent services. - Provisions from LGC were made that present built-in mechanism for referral system among different government agencies - **Referral** -- set of activities undertaken by health care provider or facility in response to its ability to provide necessary health intervention - ensures continuity of services - promotive, preventive, curative, and rehabilitative care - engages health facilities from lowest to highest level - movement of a patient from health center of first contact and the hospital at first referral level, once intervention is completed, patient is referred back to health center **(two-way referral system).** - **Internal referrals --** w/n the facility, from one health personnel to another. Made to request for an opinion or suggestion - **External referrals --** from one health facility to another. **Vertical**, referred from lower to higher level of facility or vice versa. **Horizontal,** referred between similar facilities in different catchment - This process affords optimal utilization of limited resources of family and community **Health Sector Reform** - **Fourmula One** (2005-2010) - **Kalusugan Pangkalahatan** (2011-2015) - **Duterte Health Agenda or Philippine Health Agenda** (2016) - **FOURmula One Plus -- F1 Plus** (2017-2022) -- built from of two previous platforms of reform: Fourmula One for health + Kalusugan Pangkalahatan or Aquino Health Agenda - Intended to bring equity in health service delivery - **Administrative Order 2018-0014** "Strategic Framework and Implementing Guidelines for FOURmula One Plus (F1 Plus) for Health -- provided guideline to help achieve Universal Health Care in the Philippines **3 Goals of Administrative Order 2018-0014:** - Better health outcomes - More responsive health system - More equitable healthcare financing **DOH** organized health sectors initiatives into **4 Pillars:** - Financing - Service delivery - Regulation - Governance - Cross-cutting initiative on performance accountability **Universal Health Care in the Philippines** - **Universal Health Coverage (UHC) --** all individuals and communities receive the health services they need w/o suffering financial hardship - Major milestone is the ratification of **RA 11223** on **Feb 2019 --** automatically covers all Filipinos under the National Health Insurance Program of Philippines or PhilHealth **UHC Objective:** provide all Filipinos access to comprehensive and cost-effective health care that covers all spectrums of services: promotive, preventive, curative, rehabilitative, and palliative care. - Priority is given to marginalized and those cannot afford healthcare **Eligibility, Membership and Types of Service:** - Filipinos are automatically enrolled - Membership to Philhealth is likewise simplified thru RA 11223 - **Direct contributors --** employed - **Indirect contributors --** senior citizens, PWDs, and those unemployed. Their premiums are automatically shouldered by national government - Population-based will be funded by national government, while Individual-based health service will be funded thru social health insurance (Philhealth or private insurance) - Hospitals public and private are mandated by UHC law to establish public health unit that will implement national health program like immunizations **Organization of local Health System:** - **RA 11223 (UHC Law)** signed in **October 2019,** with timeline coverage of 6 yrs - All municipal health offices will be placed under the province-wide health system - And all City health offices will be combined to form city-wide health system **Health Promotion and Human Resource for Health:** - Close coordination between DOH and DepEd is also required by UHC law to foster health consciousness in basic education program - Scholarships will be provided with a return service agreement scheme to supply growing need for human resource for health **Source of Funding:** - Revenue of government from Sin Tax Reform Law (RA 10351) - 50% of PAGCOR Income - 40% of PCSO Charity fund - DOH funding from national budget - Philhealth subsidy from national government - Premium contributions from Philhealth members