CBR 2.1: Organizational Structure of CBR in the PH and Introduction to RA 11223 PDF

CBR | 2.1 The Organizational Structure of CBR in the PH and Introduction to RA 11223 September 2024 MIDTERMS Prof. Tomas Pedro Regina...

CBR | 2.1 The Organizational Structure of CBR in the PH and Introduction to RA 11223 September 2024 MIDTERMS Prof. Tomas Pedro Reginaldo 3.1. LOCAL COMMITTEES ON DISABILITY AFFAIRS (LCDA) CBR Overseen by the local chief executive (i.e. Mayor), As a strategy for change: composed of the same seven subcommittees (of the RCDA) Breaking barriers Serves as a management, policy-making, and coordinating Addressing causes of disability body Rehabilitation activities Ensures the development and sustainability of CBR in the community Ensures plans and activities are carried out, monitored and ORGANIZATIONAL STRUCTURE OF CBR IN THE PHILIPPINES: sustained Addresses the causes of disability in the community, including barriers to inclusion 1. NATIONAL LEVEL 3.2. DPO LEADER AND CBR FOCAL PERSON 1.1. NATIONAL COUNCIL ON DISABILITY AFFAIRS (NCDA) LGUs are mandated to designate a CBR focal person or unit LGUs are encouraged to hire a PWD to work closely with the Government’s coordinating body mandated to formulate national CBR focal person to ensure the implementation of plans policies, propose legislations, and takes the lead in made by the LCDA implementing programs and services (using the CBR strategy) for the well-being of persons with disabilities 3.3. BARANGAY CBR COMMITTEE (BCC) Authorized to bring together various government agencies, civil Composed of representatives of the Barangay Council, sectors, business and DPOs DPOs, self-help groups, supervisors from line agencies, civil NCDA performs its duties based on the inputs from different society and religious groups, business and civic leaders, and subcommittees: professionals ○ Health (DOH) The BCC plans, implements and monitors activities at the ○ Education (DepEd) barangay level ○ Auxiliary Social Services (DSWD) More importantly, the BCC is in direct contact with PWDs in ○ Training & Employment (DOLE) the community ○ Advocacy (PIA) ○ Accessibility and Transportation (DPWH) 4. THE ROLES OF KEY PLAYERS IN THE LOCAL CBR ○ Information, Communication & Technology (DICT) PROGRAM ○ International Disability Network (DFA) 1.2. TRAINING AND DEVELOPMENT COMMITTEE (TDC) 4.1. DPO- Disabled Peoples Organization Composed of experts in: Guarantees that people with disabilities have the central ○ training and development, decision-making role in CBR ○ disability work, Guides LGUs in identifying needs of PWDs ○ education, curriculum design, Advocate for social change ○ community development, Also a source for: training, technical expertise, referrals, delivery ○ livelihood, and monitoring of services, addressing causes of disabilities, ○ health, and advocating for a barrier-free society ○ legislation, policy development and advocacy work Responsible for: 4.2. NGO-Non-Government Organization ○ training and curriculum development, ○ building a team of CBR trainers and managers, Helps LGU to implement and manage CBR ○ developing training resources, Most of the expertise in CBR are found with them ○ monitoring quality and effectiveness of training Invaluable as: trainer, referral agent, and catalyst in working with courses and modules DPO Provides expertise in delivering disability services, addressing causes of disability, and dismantling barriers to inclusion 2. REGIONAL LEVEL 4.3. THE PROFESSIONAL 2.1. REGIONAL COMMITTEES ON DISABILITY AFFAIRS(RCDA) Train and enables local communities to do most of the work and know when to refer to specialists Represents the NCDA at the regional level (regional and Provide specialized intervention provincial) Demystify the rehabilitation process Has the same subcommittees as the NCDA, except the Provide information which is easy to understand International Disability Network Assist in planning, implementing and evaluating quality services RCDA bridges the gap between the NCDA and the local Assist in developing a referral system communities 4.4. CBR WORKERS/VOLUNTEERS 2.2. RCDA CBR-TRAINING TEAM Initiate the BCC Composed of a leader (with training experience) from a Learn about disability, impairment, education and rehabilitation recognized DPO techniques, and how to identify the barriers that create disability Represent the TDC at the regional level Educate the community about the realities facing persons with Promotes and guides plans and activities at the regional disabilities level Assist the CBR Focal Person and DPO Conduct needs assessment 3. LOCAL LEVEL Train care-givers CBR works best when there is a decentralized local focus Prepare and implement individual and community activities for LGUs are encouraged (by the national government) to adopt PWDs and their families and oversee the CBR program Supervise and monitor the CBR program LGUs are responsible for allocating funds to support the program 4.5. CBR FOCAL PERSON AND DPO LEADER Oversee the implementation of services and programs Enable the DPO to take a management role Rogel :> 1 Prof. Market CBR to the local community ○ It provides whole-person care for health needs Mobilize resources to support and sustain CBR throughout the lifespan, not just for a set of specific diseases. 4.6. MEMBERS OF THE COMMUNITY ○ Primary health care ensures people receive quality CBR requests each person to change their attitude and actively comprehensive care as close as feasible to people’s uphold the rights of persons with disabilities everyday environment. Address the causes of disability PHC is rooted in social justice, equity, solidarity and Include accessibility features in public places participation. It is based on the recognition that the Early screening and intervention to prevent or minimize impact enjoyment of the highest attainable standard of health is one of impairments of the fundamental rights of every human being without distinction. As a way to move towards UHC, WHO recommends reorienting health systems using a primary health care (PHC) approach: ○ PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being. ○ PHC enables universal, integrated access to health services as close as possible to people’s everyday environments. ○ PHC also helps deliver the full range of quality services and products that people need for health and well-being, thereby improving coverage and financial protection. ○ Significant cost efficiencies can be achieved and most (90%) essential UHC interventions can be delivered Figure 1. Organizational Structure of CBR at the National Level. through a PHC approach. MacGlade, B., Mendoza, V. (Ed.). (2009). PHC entails three inter-related and synergistic components, including: 1. Comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces; 2. Multi-sectoral policies and actions to address the upstream and wider determinants of health; and 3. Engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health. For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to Figure 2. Organizational Structure of CBR at the Local Level. health, including health-in-all- policies, a strong focus on MacGlade, B., Mendoza, V. (Ed.). (2009). equity and interventions that encompass the entire life-course. An Introduction to the Universal Health Care Act of 2019 (RA WHY IS PHC IMPORTANT? 211223) PHC is critical to make health systems more resilient to Universal Health Coverage (UHC) situations of crisis, more proactive in detecting early signs of According to WHO, it means that all people have access to epidemics and more prepared to act early in response to the full range of quality health services they need, when and surges in demand for services. where they need them, without financial hardship. Although the evidence is still evolving there is widespread It covers the full continuum of essential health services, from recognition that PHC is the “front door” of the health system health promotion to prevention, treatment, rehabilitation, and and provides the foundation for the strengthening of the palliative care across the life course. essential public health functions to confront public health The delivery of these services requires health and care crises such as COVID-19. workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality assured products, and enjoying decent THE PHILIPPINE SITUATION work. The Philippine health system is now facing a triple burden: Protecting people from the financial consequences of paying health impacts brought about by urbanization, globalization, for health services out of their own pockets reduces the risk and climate change, the rise of noncommunicable diseases, that people will be pushed into poverty because the cost of and the re-emergence of communicable diseases. needed services and treatments requires them to use up Filipinos also continue to suffer a heavy financial burden their life savings, sell assets, or borrow – destroying their from health spending. The incidence of catastrophic futures and often those of their children. spending has been increasing for all income groups. In 2018, 53.9% of total health expenditure was from out-of-pocket Primary Health Care Approach: payments. The concept of PHC has been repeatedly reinterpreted and redefined in the years since 1978, leading to confusion about THE PHILIPPINE UNIVERSAL HEALTH CARE LAW OF 2019 the term and its practice. Republic Act 11223, “Universal Health Care Act” , signed WHO and UNICEF defines PHC as “ … a whole-of-society Feb 20, 2019 approach to health that aims at ensuring the highest possible This landmark legislation adopts a whole-of-system, level of health and well-being and their equitable distribution whole-of-government, whole-of-society, people centered by focusing on people’s needs and as early as possible approach to improve overall health system performance. along the continuum from health promotion and disease It aims to progressively realize UHC in the country, ensuring prevention to treatment, rehabilitation and palliative care, that all Filipinos are guaranteed equitable access to quality and as close as feasible to people’s everyday environment" and affordable health care goods and services, and are ○ PHC addresses the broader determinants of health protected against financial risk. and focuses on the comprehensive and interrelated The UHC Law mandates structural and functional changes in aspects of physical, mental and social health and health financing, service delivery, and governance, to wellbeing. address issues of the country’s fragmented health system Rogel :> 2 Prof. Major provisions of the UHC Law are focused reforms in 6 curricula for health professionals to focus on forming areas: essential primary care competencies, including physical 1. Leadership and Governance therapy courses. 2. Financing To further address health care worker deficiency in the short 3. Service Delivery Structure term, the DOH will expand its deployment programs to 4. Access to Medical Products augment workforce needs. All government- sponsored 5. Health Workforce scholars will be mandated to serve in DOH-identified areas 6. Health Information Systems for at least three years. In the long run, the law envisions that LGUs will be capable to independently finance and manage 1. LEADERSHIP AND GOVERNANCE their own health workforce. The Philippine health system is highly devolved, with 6. HEALTH INFORMATION SYSTEMS significant responsibilities held by the country’s municipalities. Relationships between the DOH and Health information systems have been challenged by lack of municipal, city, and provincial governments complicate policy structural and technical capacities, duplication of efforts, and implementation. Page 3 of 5 unconsolidated and incomplete data. Lack of interoperable The UHC Law aims to clarify and delineate the overlapping mechanisms to bring together multiple information systems functions of government agencies. The law re-envisions the lead to inefficiencies and restrict data consolidation. role of DOH to be more focused on regulation, policy The UHC Law mandates the maintenance of interoperable development, and standard setting, guiding implementation information systems and standardizes the necessary health at the local level, while PhilHealth transitions to become a data for collection from providers, which are required in stronger and more dominant national purchaser of services. licensing and contracting agreements. At the local level, the public system will be reorganized as province- or city-wide health systems, within which health IN SUMMARY care provider networks (HCPNs) will be formed. Municipal The success of the UHC Law is anchored on the three main pillars level governments that currently lead and manage local of PHC: health systems will transfer these functions to their 1. Primary care and essential public health functions as respective provincial and city governments, which will become the focal points of local health governance. the core of integrated health services: ○ The UHC Law seeks to re-integrate the Philippines’ 2. FINANCING highly devolved governance system into province-wide health systems. Under the UHC Law, all citizens are automatically entitled to ○ These integrated provincial health systems promise PhilHealth benefits, including comprehensive outpatient more efficient use of resources and delivery of services. PhilHealth will be responsible for purchasing all comprehensive care. individual-based services, including supplies, medicines, and ○ Resistance to change, and politics of intervening laws commodities, as well as maintenance and operating such as the Local Government Code stand in the way expenses of health facilities. The law strengthens PhilHealth by transforming it to become 2. Empowered people and communities: a national purchaser of individual-based health goods and ○ All Filipinos are automatically members of PhilHealth, services. To support this larger purchasing role, premium and are immediately entitled to benefits. contributions to PhilHealth will be complemented by ○ Families and households are also given the freedom increasing government contributions from sin taxes, annual to choose the primary care provider they prefer and appropriations, and revenues from the Philippine trust. Amusement and Gaming Corporation, and the Philippine ○ Patient involvement in key decision areas to directly Charity Sweepstakes Office. influence matters concerning their own health 3. SERVICE DELIVERY STRUCTURE contribute to a system that is truly responsive. ○ However, patient knowledge is coming from a rather The delivery of public PHC services is currently controlled at weak base. the barangay and municipality level. To address the fragmentation of service delivery and move 3. Multi-sectoral policy action: towards providing comprehensive and integrated care, ○ ​The UHC Law mandates the institutionalization of providers are encouraged to form province- and city-wide cooperative intergovernmental decision-making and HCPNs. These networks can be composed of public, private, implementation, particularly in areas such as health or a mixed set of providers that will deliver primary, impact assessment, health professional education, secondary, and tertiary services. HCPNs will prioritize strong and monitoring and evaluation of health system primary care. Primary care providers will deliver continuous, performance. comprehensive, and coordinated first contact care, as well ○ The private sector is also enjoined to respond to as manage navigation of a facilitated referral system. service delivery needs as health care provider 4. ACCESS TO MEDICAL PRODUCTS networks, and to generate evidence together with the academe through data sharing and commissioning of The Philippine market for medical products lacks effective relevant health policy and systems studies. government coordination and control, and its inefficiency has ○ Through these more inclusive and regular stakeholder led to uniquely high drug prices. The UHC Law mandates the engagement processes, strategic complementation establishment of a Health Technology Assessment (HTA) with partners within and outside government is Council to guide pharmaceutical procurement, which will encouraged. ensure that the most cost-effective and affordable medicines, ○ Differences in perspectives and interests are among supplies, and commodities will be purchased by the the greatest hurdles that affect cooperation and government. resource allocation. 5. HEALTH WORKFORCE There is a chronic deficiency of health care professionals, especially in geographically isolated and disadvantaged areas. Some of the main reasons for these include difficulty in attracting personnel, lack of resources to finance the positions, or weak prioritization by local government units (LGUs). Additionally, undergraduate training programs for health professionals in the country do not feature specific training for the provision of primary care. The law focuses on strengthening the provision of primary care through appropriate training of human resources. It mandates realignment of undergraduate and graduate Rogel :> 3