PRIMARY HEALTH CARE PDF

PRIMARY HEALTH CARE Politics and Governance Submitted By: Group 4 DMD 1-1 Members: Andrin, John Gaspar F. Avengoza, Gian Marcus C. Cabrillas, Kevynn Moirra C. Del Rosario, Stephanie C. Manapul, Gabriel Ross C....

PRIMARY HEALTH CARE Politics and Governance Submitted By: Group 4 DMD 1-1 Members: Andrin, John Gaspar F. Avengoza, Gian Marcus C. Cabrillas, Kevynn Moirra C. Del Rosario, Stephanie C. Manapul, Gabriel Ross C. Policarpio, Cassandra Shane P. Reyes, Alyanna Nicole P. Submitted To: Dr. David Pablo S. Fernandez Jr., DMD November 2024 CONTENT: Provisions of health services by local and national government Primary Care Maternal Care Services Child Health Services LEARNING OUTCOMES: Explain the importance of primary care Evaluate the efficiency of maternal and prenatal care services Identify the roles of local and national agencies in health service delivery CANVA LINK: https://www.canva.com/design/DAGVMQH2Btc/Eidzn3ZOOtCAmSeI3BGuIQ/edit?utm_cont ent=DAGVMQH2Btc&utm_campaign=designshare&utm_medium=link2&utm_source=shareb utton OVERVIEW OF HEALTH SERVICES PROVISION IN THE PHILIPPINES The healthcare system in the Philippines is characterized by a mix of public and private providers, with the government playing a crucial role in delivering health services at various levels. The Department of Health (DOH) oversees public healthcare delivery, which is organized into a tiered structure that includes barangay health stations, rural health units, and hospitals. Despite significant improvements in health outcomes in recent decades, challenges remain, particularly regarding access to quality care, especially in rural and underserved areas (Netherland Enterprise Agency, 2021). The implementation of the Universal Health Care (UHC) Law in 2019 marked a significant milestone in the country's health reform efforts, aiming to ensure that all Filipinos have access to comprehensive and affordable health services. However, the effective implementation of this law continues to face obstacles, including inadequate health infrastructure, a shortage of healthcare professionals, and financial constraints that hinder access to primary care services (Asian Development Bank, 2022). PROVISION OF HEALTH SERVICES BY LOCAL AND NATIONAL GOVERNMENT Role of the Local and National Government in Health Services ○ National government refers to the governmental body that is in charge of an entire nation. ○ Local government describes the administration of a town, city, township, municipality, district, or other local political unit within a state (IGI Global, n.d.). ○ Both governments coordinate with each other and play a crucial role in providing and disseminating health informatics and healthcare services around the country. 1  Role of Local Government in Health Services ○ Local governments play a vital and diverse role in fostering healthy communities, acting as the first line of defense for the general public's health and well-being. Leaders in government have the exceptional capacity to execute plans, strategies, and projects that are customized to the particular requirements and features of their local communities (Figliola, A., 2023). ○ According to the Public Health Law Center (n.d.) and ICMA (n.d.) These are: 1. Regulation and Enforcement Laws and rules pertaining to public health are upheld by local governments. This can involve putting in place rules governing food safety, cleanliness, managing disease outbreaks, and enforcing smoking restrictions. 2. Community Health Programs Public health initiatives are frequently customized by local governments to match the unique needs of their communities, with a special emphasis on vulnerable groups. They sponsor programs pertaining to mental health, physical exercise, nutrition, and addiction assistance. 3. Health Education and Advocacy By offering public health education, local governments assist individuals in making knowledgeable decisions regarding their health. Additionally, they favor laws that advance public health objectives like housing, clean water and air, and access to healthcare services. Role of National Government in Health Services ○ National government bears the obligation of attaining the Sustainable Development Goals inside their nation. Its responsibility is the assistance for health and wellbeing (World Health Organization, n.d.) 1. Policy and Regulation: The national government establishes national health priorities and rules to guarantee healthcare quality and safety, thereby setting the general foundation for healthcare programs. It creates and implements legislation pertaining to public health, including those that control health insurance, disease control, and medication safety. (WHO, 2022). 2. Funding and Resource Allocation:Healthcare systems are financed by national governments, frequently through national insurance programs or taxes. They provide funds for public hospitals, healthcare facilities, and medical research in order to guarantee that everyone in a region has fair access to healthcare. (Bipartisan Policy Center, 2019). 3. Public Health Programs: Public health emergencies are handled by the government, which also spearheads national public health projects including immunization campaigns and illness prevention activities. National governments were instrumental in coordinating reactions, delivering vaccines, enforcing lockdowns and other public health measures during the COVID-19 epidemic, for instance. (Harvard Public Health, 2021). 2  Coordination Between Local and National Agencies: ○ In the Philippines there are laws that are related to the coordination between the local and national government and agencies: 1. Local Government Code of 1991 (Republic Act No. 7160) A key piece of legislation that governs the coordination between local and national agencies in health service provision. This law mandates the decentralization of governance and empowers local government units (LGUs) to manage their health services, thereby facilitating a more localized approach to healthcare delivery (the Official Gazette, 1991) 2. Republic Act No. 8425 (Social Reform and Poverty Alleviation Act) This law emphasizes the importance of community participation in health programs and requires national agencies to coordinate with LGUs for effective implementation of health initiatives (Philippine Institute for Development Studies, 2017). 3. Republic Act No. 11223 (Universal Health Care Act) This recent law aims to ensure that all Filipinos have access to comprehensive health services and outlines the responsibilities of both national and local government agencies in achieving this goal (The Official Gazette, 2019). CHALLENGES IN HEALTH SERVICE PROVISION Health service provision in the Philippines faces several challenges, particularly in the coordination between local and national agencies. One major issue is the uneven distribution of health resources, such as infrastructure, healthcare workers, and medicines, which creates disparities in access to quality care across different regions. Rural areas, in particular, struggle with limited access to secondary and tertiary healthcare services, often requiring patients to travel long distances for specialized treatment. Additionally, the decentralization of health services has led to fragmented service delivery between local government units (LGUs) and national agencies, complicating the management and oversight of healthcare programs (World Health Organization, 2015) Other challenges include underfunding, lack of equipment, poor healthcare infrastructure, and difficulties in maintaining a consistent supply of medicines and vaccines. In some remote areas, geographical isolation and poor transportation infrastructure further limit access to health services, especially during emergencies or natural disasters. These factors contribute to poor health outcomes, particularly for marginalized populations who cannot afford private healthcare or are geographically distant from healthcare facilities. (Tejada & Cordero, 2022) Moreover, local beliefs and practices, such as the preference for traditional healers, also affect the effectiveness of modern healthcare delivery, especially in rural communities. Poverty, lack of electricity, and unreliable transportation further exacerbate the difficulty of accessing necessary health services in these areas (Philippine Institute for Development Studies, 2021). 3  PRIMARY HEALTH CARE The first point of contact for individuals entering the healthcare system and provide continuous care for people with undiagnosed signs, symptoms, or health concerns. These services encompass health promotion, disease prevention, health maintenance, counseling, patient education, and the diagnosis and treatment of both acute and chronic illnesses across various healthcare settings (e.g., clinics, hospitals, critical care, long-term care facilities, home care, schools, and telehealth). Additionally, they are part of an interconnected system of referral networks (American Academy of Family Physicians, n.d.) EIGHT (8) KEY COMPONENTS OF PRIMARY HEALTH CARE AND THEIR IMPORTANCE 1. PUBLIC EDUCATION Health education empowers individuals to make informed decisions about their health and well-being. By increasing awareness about disease prevention, healthy lifestyles, and the use of healthcare services, public education reduces the incidence of preventable diseases. Educated populations are better equipped to manage their own health, seek appropriate care, and adhere to treatment plans, leading to improved health outcomes and reduced strain on healthcare systems. 2. PROPER NUTRITION Adequate nutrition is essential for the growth, development, and maintenance of overall health. It strengthens the immune system, reduces susceptibility to illness, and ensures physical and cognitive development, particularly in children. Malnutrition, whether due to undernutrition or poor-quality diets, can lead to a host of health problems, including stunted growth in children, weakened immune function, and chronic diseases. Proper nutrition prevents these issues and promotes long-term well-being. 3. CLEAN WATER AND SANITATION Access to clean water and proper sanitation are fundamental for preventing waterborne diseases such as cholera, dysentery, and diarrhea, which are leading causes of morbidity and mortality, especially in low-income countries. Ensuring safe drinking water and sanitation reduces the spread of infectious diseases, improves hygiene, and contributes to overall community health. It also lowers the healthcare burden by preventing diseases linked to poor sanitation. 4. MATERNAL AND CHILD HEALTHCARE Maternal and child health services are essential for reducing maternal and infant mortality and ensuring healthy pregnancies, safe deliveries, and early childhood development. This includes prenatal care, safe childbirth practices, and postnatal care for both mothers and infants. Comprehensive maternal and child healthcare ensures the survival and healthy development of children, reduces complications during childbirth, and improves long-term outcomes for both mothers and their children. 4 5. IMMUNIZATION Immunization is a key preventive measure that protects individuals, especially children, from vaccine-preventable diseases such as measles, polio, and diphtheria. It contributes to herd immunity, which helps protect entire communities, including those who cannot be vaccinated. Immunization programs have drastically reduced the incidence of many infectious diseases worldwide, preventing millions of deaths each year and contributing to global health security by controlling outbreaks as well as enhancing public health security which prepares everyone for health crises such as epidemics and pandemics. 6. LOCAL DISEASE CONTROL Many regions face specific health challenges due to endemic diseases (e.g., malaria, tuberculosis). Local disease control programs target these conditions, preventing their spread and reducing the disease burden. Effective local disease control prevents outbreaks, reduces transmission of infectious diseases, and promotes healthier communities. These programs also improve resilience to future health crises by controlling ongoing public health threats. 7. ACCESSIBLE TREATMENT Providing accessible treatment for common diseases ensures that people can seek timely medical care for illnesses such as respiratory infections, diarrhea, and other non-communicable diseases like hypertension or diabetes. Early treatment prevents complications and improves recovery rates. Accessible treatment reduces hospitalizations, prevents diseases from becoming life-threatening, and enhances the overall quality of life. It also alleviates the financial burden on individuals and health systems by minimizing the need for more advanced, costly care. Accessible to a diverse population, especially to the vulnerable and marginalized sectors of our community, ensuring that everyone receives necessary health services. They engage with local communities to deliver culturally sensitive and appropriate care. PHC providers consider the social determinants of patients, such as their income, education, and housing in their care approaches. By considering this, they can help mitigate health inequities and provide support for patients’ overall well-being. PHC promotes patient-centered care, which involves understanding and respecting patients' unique needs, preferences, and values. This approach empowers patients to participate actively in their healthcare decisions, ensuring that care is tailored to their specific circumstances. Many PHC systems aim to minimize private or out-of-pocket costs for patients, making it more affordable for individuals to access necessary health services. This financial accessibility is essential for equity in healthcare. 8. DRUG PROVISION Ensuring the availability of essential medicines is crucial for effective treatment and management of diseases. Access to safe, affordable, and effective medicines is a fundamental part of quality healthcare. 5  The provision of essential drugs enables healthcare providers to treat illnesses effectively, control symptoms, and manage chronic conditions. It ensures that necessary medications are available for everyone, contributing to equitable healthcare access. ANALYSIS OF PRIMARY CARE ACCESSIBILITY AND EFFECTIVENESS IN THE PHILIPPINES The Philippines is facing a challenge in the accessibility and effectiveness of primary healthcare (PHC) in the Philippines (ThinkWell Global, 2020). Primary healthcare services are delivered in 1,488 municipalities, specifically in the rural health units (RHUs) and barangay health stations (BHSs). In 2017, there is an average of one (1) doctor, two (2) nurses, and five (5) midwives in every RHU. Moreover, there is a lack of doctors in geographically isolated and disadvantaged areas. This is mitigated by the Department of Health (DOH) by deploying an average of 320 doctors to RHUs every year as per Health Worker Augmentation Program of the department. Although Rural Health Units (RHUs) and Barangay Health Stations (BHSs) are conveniently located, they are often underutilized due to a shortage of senior or specialized staff. Patients have also reported issues such as unavailable and poorly maintained equipment, as well as low-quality and insufficient medicines and supplies. These factors contribute to the frequent bypassing of primary care facilities. In a 2016 survey of medical students, only 14% expressed a preference for practicing in rural health settings (Nicodemus, Tabios, and Tantengco et al., 2018). Furthermore, in 2017, only 9% of doctors and 26% of nurses in the Philippines were employed in primary care settings (Dayrit, Lagarda, and Picazo et al., 2018). These statistics highlight the country's reliance on a predominantly hospital-based and curative service delivery model, underscoring the fragility of its primary care infrastructure. OVERVIEW OF MATERNAL CARE SERVICES IN THE PHILIPPINES Launched in 2011 to improve the health system and protect the poor from financial risks. Government subsidies for health insurance aimed to increase healthcare access and sustainable financing. Aligned with UHC, focusing on reducing unmet family planning needs and promoting facility-based deliveries. (Paredes, 2016) Aims to achieve Millennium Development Goals 4 (Reduce child mortality) and 5 (Improve maternal health). (Tulali, n.d.) Health services ensuring the well-being of mothers during pregnancy, childbirth, and postpartum. 6  GOVERNMENT PROGRAMS AND POLICIES Maternal, Newborn, and Child Health and Nutrition (MNCHN) Strategy ○ This policy aims to reduce maternal and neonatal deaths by delivering a comprehensive package of maternal, newborn, child health, and nutrition (MNCHN) services. ○ The objective is to significantly lower maternal and neonatal mortality rates through the effective, widespread provision and utilization of integrated MNCHN services tailored to the specific needs of each community. Maternity Care Package (MCP) ○ A PhilHealth benefit that covers essential health care services for women during pregnancy and normal delivery (antenatal care, intrapartum and immediate postpartum periods) within 72 hours and 7 days after delivery, regardless of the health care facility. CASE STUDIES OR STATISTICS ON MATERNAL CASE OUTCOMES According to the Field Health Service Information System (2022), the infant mortality rate stands at 10.36 per 1,000 live births, below the national target of 15. Similarly, the maternal mortality rate (MMR) has been reduced to 64.68 per 100,000 live births, meeting the target of 70, while the adolescent birth rate is 24.36 per 1,000 females aged 15-19 years, also below the target of 37. Compared to the past data (2000 - 2001), the Infant Mortality stood at 29.82 per 1,000 live births, MMR at 136 per 100,000 live births. (MacroTrends, 2022) These figures indicate that the Philippines has made important national progress in maternal and child health. However, regional disparities are concerning, with MMR in subnational areas ranging from 29 to 152 per 100,000 live births. These variations reflect the significant differences in access to healthcare services between urban and rural areas. (Paredes, 2016) For instance, Women from a poor background are less likely to deliver in a health facility and to be assisted by a skilled provider. Women with higher income choose to deliver in a private health facility compared to poorer women who deliver in a public health facility or at home. (MNCH, 2021) Compared to the global MMR average of 158.8 deaths per 100,000 live births in 2021 (Bill & Melinda Gates Foundation, n.d.), the Philippines is doing relatively well on the national level. However, when compared to other countries in Southeast Asia, it still lags behind nations like Vietnam and Thailand, which have significantly lower MMRs (Vietnam: 46 women die per 100,000 live births, Thailand: 29 women die per 100,000 live births) due to more robust health systems and greater investment in maternal health programs​. CHILD HEALTH SERVICES This refers to the medical services provided to children by healthcare professionals aimed at preventing or treating diseases and infections. Child healthcare encompasses various aspects, including physical, behavioral, social, mental, emotional, and developmental health (Childhope Philippines, 2023). 7  1. Immunization - Vaccination is the process by which a person is protected from disease through immunization (Center for Disease Control and Prevention, 2021). Vaccines are vital for preventing severe illnesses in children, especially those with developing immune systems. Diseases like tuberculosis, polio, hepatitis B, and measles can be avoided through proper vaccination, ensuring that children have a better chance of growing into healthy adults (UNICEF, 2022). 2. Dental Care - Dental services for children involve a range of oral health practices for infants, children, and adolescents. These include routine check-ups, preventive care (like cleanings and fluoride treatments), restorative procedures (such as fillings), orthodontic assessments, and oral hygiene education, all aimed at promoting healthy dental development and preventing diseases (American Academy of Pediatric Dentistry, 2020). Healthy teeth and gums are essential for overall health; issues like injured or poorly developed teeth can lead to poor nutrition, painful infections, speech development problems, jaw bone issues, low self-esteem, and bad bites (MedlinePlus, 2024). 3. Nutrition Services - Nutrition services for children include programs that aim to provide adequate nutrition, promote healthy eating habits, and address malnutrition among children. These services often involve nutritional assessments, education, meal provision, and community support initiatives to improve dietary practices and overall health (Department of Health, 2022). 4. Free Check ups - Free checkup services for children to medical examinations provided at no cost to parents or guardians. These services are typically offered through government health facilities, such as barangay health centers or public hospitals, and aim to monitor children's growth and development, identify health issues early, and provide necessary interventions. These checkups often include physical examinations, assessments of developmental milestones, and referrals for further medical care if needed (Department of Health, 2024). PROGRAMS RELATED TO CHILD HEALTH SERVICES 1. The Supplementary Feeding Program - provides additional food, in the form of hot meals, to children currently enrolled in bulilit centers and public schools. These meals, recommended by the Food and Nutrition Research Institute (FNRI), are served during break times and aim to support the regular diet of the children (DSWD, 2024). The program’s objectives include not only improving the nutritional status of children but also enhancing the knowledge, attitudes, and practices of children, parents, and caregivers through nutrition and health education. It also aims to address medical and nutrition-related issues by referring children to health units when needed. 2. "Nutrition in the First 1,000 Days" Program - focuses on providing critical health and nutrition support for children from conception up to two years old, a period considered vital for their physical and cognitive development. This initiative, also known as the "Kalusugan at Nutrisyon ng Mag-Nanay Act" (Republic Act 11148), aims to ensure proper nutrition and healthcare for mothers during pregnancy and for children in their early years (Philippine 8  Pediatric Society, 2017). It includes interventions such as breastfeeding promotion, vitamin supplementation, immunization, and health education to reduce malnutrition and support long-term well-being. 3. “Chikiting Ligtas” Program - a nationwide supplemental immunization campaign launched by the Department of Health (DOH) in partnership with UNICEF and WHO. The program aims to vaccinate children against highly contagious diseases like measles, rubella, and polio, which saw a rise in cases due to missed immunizations during the COVID-19 pandemic. The campaign seeks to restore routine immunization coverage, prevent future outbreaks, and strengthen public trust in vaccines​. 4. “KliniKalye” Program - this operates weekly across Metro Manila, using a Mobile Health Clinic to provide free medical services to street children. It offers one-on-one consultations with a doctor and first aid responder, delivering personalized care while also educating children and their families on hygiene and proper diet to prevent illness (Global Giving, 2024). BEST PRACTICES AND AREAS FOR IMPROVEMENT Best Practices Several best practices have emerged in the delivery of primary and maternal healthcare: ○ Community Health Programs: Initiatives like the "Buntis Congress" have effectively educated women about maternal health, leading to increased service utilization. ○ Telehealth Services: The integration of telehealth has improved access to care, particularly in remote areas where healthcare providers are limited. This approach has been instrumental during the COVID-19 pandemic, allowing continued access to care (UNFPA, 2021) Areas for Improvement Despite progress, several areas require attention: ○ Infrastructure Development: Increasing investment in healthcare infrastructure, particularly in rural areas, is essential for improving access and quality of care. ○ Public Awareness Campaigns: Enhancing public knowledge about available health services, especially for maternal health, can lead to higher utilization rates. ○ Training and Retention of Healthcare Workers: Addressing staffing shortages through improved training and incentives is vital for ensuring quality care in both primary and maternal health services (ADB, 2021). 9  A LAW THAT INSURES FOR DENTAL SERVICES Since present coverage is inadequate, policymakers and health activists in the Philippines have become more in agreement that dental treatment should be expanded under the country's Universal Health treatment (UHC) Act. The Universal Health Care (UHC) Law, also known as Republic Act 11223, currently only covers basic dental services like cleft palate surgeries and tooth extractions; it does not cover necessary services like oral health examinations and procedures performed in private clinics. Furthermore, in order to allow the Philippine Health Insurance Corporation (PhilHealth) to provide more extensive dental health care, including free dentures, Senator Raffy Tulfo has submitted Senate Resolution No. 1021, which aims to modify the UHC Act. Tulfo emphasized that since many employers view dental health as a prerequisite for employment, poor dental care has an impact on both individual health and economic productivity. Additionally, PhilHealth’s current Comprehensive Outpatient Benefit Package (COBP), or "Konsulta," includes primary care services like consultations and diagnostics but has limited offerings for dental care. This is designed to offer primary care services at recognized primary care institutions, such as consultations, tests, and some drugs. However, Konsulta does offer a variety of providers, including private outpatient clinics, specialist outpatient centers, and rural health units. However, comprehensive dental care is still only partially covered. 10  REFERENCES Bordey, H. (2024, May 6). PhilHealth coverage for dentures, dental services pushed in Senate. GMA News Online. https://www.gmanetwork.com/news/topstories/nation/905863/philhealth-coverage-for-dentu res-dental-services-pushed-in-senate/story/ BusinessMirror. (2024, October 5). Go secures PhilHealth’s commitment to increase services | BusinessMirror. https://businessmirror.com.ph/2024/10/04/go-secures-philhealths-commitment-to-increase- services/ GMA Integrated News. (2024, May 16). Senators discuss PhilHealth coverage for basic dental services. GMA News Online. https://www.gmanetwork.com/news/topstories/nation/907053/senators-discuss-philhealth-c overage-for- basic-dental-services/story/ PHILIPPINE HEALTH INSURANCE CORPORATION. (2021). PHILHEATLH Circular No. 2022-0032. https://www.philhealth.gov.ph/circulars/2022/circ2022-0032.pdf Senate of the Philippines. (2024, May 6). Tulfo pushes for free dentures, preventive dental care PhilHealth coverage. https://legacy.senate.gov.ph/press_release/2024/0506_tulfo1.asp 11