Week 2-3 Politics and Governance PDF

POLITICS AND GOVERNANCE IN HEALTHCARE DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE COLLEGE OF DENTISTRY DAVID PABLO S. FERNANDEZ JR.,DMD  The Philippines An archipelago in the south east Asia region 119M as of 2024 92.2% Christian M...

POLITICS AND GOVERNANCE IN HEALTHCARE DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE COLLEGE OF DENTISTRY DAVID PABLO S. FERNANDEZ JR.,DMD  The Philippines An archipelago in the south east Asia region 119M as of 2024 92.2% Christian Malays 5.6% Muslim minority concentrated in Mindanao Adult literacy rate of 96.5%  The Philippines Filipinos tend to live longer now than in previous decades (Life expectancy of 62.2 years in 1980 vs 69.1 in 2016) Improving living conditions A shift from agricultural to an industrialized country  The challenges Combat against TB and pneumonia Growing incidence of NCDs Disaster risk (Philippines ranking 3rd in terms of exposure) Health inequity (governance associated) Main reason for health reform e orts ff  The Political Context Democratic and a republican state with a presidential form of government The president is both the head of state and the head of the government Power is equally divided in its three interdependent branches  Executive power Vested with the president of the republic, elected by popular vote Vice president 22 departments (o ce of the vice secretary, CHED, National Economic Development Authority) Necessary for the distribution of work of the President ffi  Executive power Cabinet secretaries act as alter ego of the President Through the authority of the President, execute the power of the OP in their respective departments LGUs exercise administrative and regulatory authority over the local health system  Legislative power Vested in the bicameral Congress of the Philippines Consists of the Senate and the House of Representatives  Legislative power In uences the health system by passing laws to improve the nancing, delivery and regulation of the health system EX Approval of budget of the DOH and health facilities fl fi  Judicial power Vested in the Supreme Court and in various lower courts Lower courts Court of appeals, RTCs, Municipal trial courts, Shari’a district courts, Municipal circuit trial courts Shari’a circuit trial courts  Branches of the Gov’t These powers are separated E ective collaboration between these branches will result in the passage of key legislations To further the goals of the health sector ff  Example The presidential pushed to pass the Sin Tax Law A law to reform the excise tax system Raises revenue for the UHC agenda This causes a widespread support for the House Bill 5727 in the house of representatives (as allies of the president) At the same time, the senate endorsed the Sin Tax Bill in 2012  Example The strong message from the President galvanized the Congress to pass the Sin Tax Law Deliberation ended after more than 15 years being lobbied A strong industry was keeping the prices of Sin Tax products the cheapest in the world  Reading assignment https://assets.tobaccofreekids.org/global/pdfs/en/ Philippines_Tax_Reform_Case_Study.pdf  Health status Life expectancy increasing from 62 (1980) to 69 (2016) Mortality rates declined from 291(m) and 209(w) per 1000m/w in 1980 to 261 (m) and 136 (w) in 2016 Leading cause of death is heart attack with rates steadily rising from 61 per 100,000 pop in 1980 to 133 per 100,000 pop in 2014 Followed by vascular diseases, neoplasms Health status  Health status There is notable shift in the leading cause of death from communicable diseases in recent times Infectious diseases continued to decline as a contributor to healthy lives lost to premature deaths  Health A basic human right, enshrined in the 1987 Phil Constitution “The State shall protect and promote the right to health of the people and instil health consciousness among them” Article II, Section 15  Health Under this mandate, the DOH, as the national technical authority on health, has the responsibility to ensure the Highest achievable standards of health care And from which the LGUs, NGOs, private and other sectors anchor their health programs  Department of Health Provides national policy direction and strategic plans Regulatory services Standards and guidelines for health Tertiary level hospitals  Department of Health Provides leadership, technical assistance, capacity building, linkages and coordination with other NGA, LGU and private entities in the implementation of national legislation on health  Overview of the health system A dual health system composed of public and private sectors Public sector Largely nanced through a tax based budgeting system Services are delivered by government facilities run by LGU and national o ces fi ffi  Overview of the health system Private sector For-pro t and non-pro t health care providers Market oriented Health care is generally paid for through user fees at point of service fi fi  Overview of the health system Private sector Extensive but fragmented Clinics, in rmaries, laboratories, hospitals, drugstores, pharmaceuticals Medical supply companies, health insurance companies Academic and research institutions fi  Overview of the health system Private, for-pro t Largely run by self employed health professionals Family owned businesses and corporate entities fi  Overview of the health system Private, non-pro t Run by charitable institutions Faith based organizations Civil society organizations Community based volunteer groups fi  Historical Background The Philippine Health System  Spanish colonial period The Philippine health system formally evolved when the rst hospital was built in _________ in 1565 It was later transferred to __________ as the seat of colonial government To cater to the needs of the Spanish army and navy fi  Spanish colonial period By 1578, the in uential Spanish clergy established the rst medical institutions San Juan De Dios Hospital - disabled, abandoned and the poor San Lazaro Hospital - lepers fi fl Spanish colonial period In 1800s, small pox vaccine was introduced in the country by Spanish royal decree Several other public health measures were introduced to control cholera and beri beri outbreaks  The Philippine Revolution and American Colonial period Toward the end of the 19th century, Filipinos declared independence on __________ The bureau of public health was organized by Gen. Emilio Aguinaldo However, hostilities between the Americans and Filipinos broke  The Philippine Revolution and American Colonial period The Americans took over the reins of government Eventually constituting the Board of Health for the Philippine Islands in July 1, 1901  The Philippine Revolution and American Colonial period Americans built more hospitals Implemented more public health measures Introduced medical education Provided more medical bene t to the Filipinos fi The Philippine Commonwealth and the Republic The Phil Commonwealth was established under president Manuel Quezon The Department of Health and Public Welfare was organized on May 31, 1939 The country gained additional health facilities, expansion of sanitation The Philippine Commonwealth and the Republic MCH services fell into disarray with the start of the WWII (Japanese occupation) The incidence of malaria, malnutrition, and other diseases increased during these years  The establishment of the Republic The liberation from the Japanese the govt started rebuilding from ashes On Oct 4, 1947, through EO No 94, the DOH was established The Department of Health Supervises over the bureau of quarantine, bureau of hospitals, and all other hospitals in the country With the enactment of the Rural Health Act of 1954 Puericulture centres in all cities and municipalities transformed to RHUs and health centeres  The Martial Law The declaration of the Martial Law in 1972, marked the shift to a parliamentary form of government in 1978 The DOH was transformed to the Ministry of Health Primary health care was adopted as a national policy in the late 1970s following the Alma Ata Declaration  Alma Ata Declaration Assignment  The Martial Law District health o cers were also organized Placed district hospitals and all municipal health o ces within the district’s catchment area Under the supervision of the district health o cer ffi ffi ffi People Power Revolution of 1986 Shifting back to the presidential form of government The Ministry of Health and its attached agencies were again reorganized as the DOH (EO 119, January 30 1987) The local government code (RA No 7160) was enacted in 1991 Gives the LGU the responsibility and autonomy to manage local health facilities and services  People Power Revolution of 1986 In 1995, the National Health Insurance Act (RA 7875) establishes PhilHealth as the national health insurance entity replacing Medicare Act of 1969 Ensures UHC through nancial access to quality and a ordable health care for all Filipinos ff fi  Novel times Responding to the challenges of the previous legislations, the DOH launched the Health Sector Reform Agenda in 1999 A major policy framework to improve the way health care was delivered, regulated, managed and nanced fi  Novel times Corollary to this, EO 102 was approved by President Joseph Ejercito Estrada on May 1999 This further restructured the functions and operations of the DOH In 2005, the DOH initiated the FOURmula One for Health FOURmula One for Health The operational framework for the health reform agenda Encompassing 4 strategic components Health nancing Health regulation Health service delivery Good governance in health fi  QUIZ 1.  DECENTRALIZATION & CENTRALIZATION Local government code of 1991 Mandated the devolution of health services from the NGU to the LGU Used to be a centralized health system run by the DOH DOH maintained its role as the steward of national policies, guidelines, plans, and regulations on health LGUs are the manages and providers of services at the local level  INTERSECTORALITY Health in all policies as a concept All sectors must take into account the health implications and impacts of policies and decisions  PRIORITIES OF DOH ENVIRONMENT/CLIMATE CHANGE TOBACCO CONTROL POVERTY ALLEVIATION HIV/AIDS  Health systems In a small country of 1 million people, there is just one hospital and nothing else in the health care sector, to take care of all the health needs of these people What happens?  Health systems Overcrowding Exhaustion of sta No supplies / lack of medications Unorganized information system Absence of referral system ff  Health care sector Complex system in a complex environment Many stakeholders / organizations Non linear interactions / interdependencies  Systems thinking A problem solving approach that analyses a problem within its system within its system Consisting of the elements that interact with the problem or are a ected by it Which together form a process that achieves the goal of the system ff  Systems thinking Brings together scientists from many disciplinary traditions, transfer methods from one discipline to another Or to work across and between disciplinary boundaries  Systems thinking When applied to a patient View a health intervention within the overall setting of health care to the patient Considering all the medical services that the patient is exposed to and is getting under the care of health professionals End goal of improving the patient’s health and safety  Systems thinking When applied to the health sector Look at the smaller systems, hospitals, physicians, pharmacies, primary care facilities, medical devices, suppliers, information experts  Health system All the activities whose primary purpose is to promote, restore or maintain health (WHO) The combination of health care institutions, human resources, nancing schemes, information systems, management structures fi  Health system Comprises all organizations, institutions and resources that produce action whose primary purpose is to improve health Goals of the health system 1. Improving the health of the population 2. Providing nancial risk protection 3. Responding to people’s expectation fi  Improving health Improving health and well being of the population Reducing disease Preventing premature deaths  Improving health Measures Morbidity and disability Life expectancy Nutritional status Burden of disease and non fatal outcomes (DALYs, HALE) Responding to expectations Level of satisfaction of clients with the goods and services expected in the health system Measures Population satisfaction surveys Customer exit surveys Financial risk protection Protection of the population from high and unexpected cost of serious illness Common barrier to use of health services Cause people to fall into poverty Financial risk protection Measures: Proportion of out of pocket expenditure Proportion of prepaid nancing fi