CHN LEC - PRELIMS.pdf

COMMUNITY HEALTH NURSING NCM 104...

COMMUNITY HEALTH NURSING NCM 104 L E C / PROF. SANTOS ______________________________________________________________________________________________________________ PRELIMS The healthcare delivery system in the Philippines begins with WEEK 1 the WHO as this specialized agency of the United Nations (UN) provides global leadership on health matters. OUTLINE I. The Healthcare Delivery System In the Philippines, health services are provided by the: A. Factors that influence the healthcare  Government delivery system  Private sector- for-profit and nonprofit agencies. B. Definition of terms The latter are frequently referred to as non-governmental C. 6 building blocks of health system organizations or NGOs. D. 3 major groups of financing health services E. Components of the Health Care Delivery At the National level, the direction is set by the Department of System as mandated by the DOH Health (DOH). Under the mandate of the Local Government F. Primary function of DOH Code (R.A. 7160), local government units (LGUs) should have G. Millennium Development Goals an operating mechanism to meet the priority needs and service H. Sustainable Development Goals requirements of their communities. Basic health services are II. References regarded as priority services, for which LGUs are primarily responsible. THE HEALTHCARE DELIVERY SYSTEM Definitions of Terms A nation’s health care delivery system has a tremendous impact not only on the health of its people but also on their total Health System - Consist of all organizations, people, and development, including their socioeconomic status. A actions whose primary intent is to promote, restore, or maintain discussion of the health care delivery system often involves health. issues of cost and challenges. Nations go through a struggle to - Mechanisms that meet the needs of an overcome multiple forces in efforts to advance the nation’s individual. health within the context of their financial and political situations. Health Care Delivery System - It is the totality of all policies, FACTORS THAT INFLUENCE HEALTH CARE infrastructures, facilities, equipment, products, human DELIVERY SYSTEM resources, and services that address the health needs, problems, and concerns of all people. Anderson and Mc Earlane (2011) emphasized the role of the following factors in shaping 21st-century health that further Health Care System - an organized plan of health services influence the health care delivery system: (Miller_Keane, 1987). 1. Health care reforms Health Care Delivery - rendering health care services to the  Expand the ray of the healthcare provider people.  Give more care to the patients 2. Demographics Health Care Delivery System (Williams-Tungpalan, 1981) -  Records and studies the human population the network of health facilities and personnel, which carries out (age, race, sex) the task of rendering health care to the people.  Also includes employment, income, marriage, birth & death. Philippine Health Care System - is a complex of organizations 3. Globalization interacting to provide an array of health services (Dizon, 1977)  Interaction & Integration among nations  Allow the Philippines to communicate and 6 BUILDING BLOCKS/COMPONENTS OF HEALTH trade with other countries. SYSTEM  It is been effective in the Philippines and has made a lot of major changes since 1995 such 1. Service Delivery as more labor to help the economy in the  Number of distribution of healthcare facilities. Philippines. 2. Health Workforce 4. Poverty and Growing Disparities  Checks the population  It is notably measured using the distribution of  Checks the number of healthcare workers in income or the amount of money that people every 10,000 population. receive. 3. Information  Distribution of wealth – the amount of wealth  It reviews the information that is to be that people own disseminated to the community. 5. Social disintegration 4. Medical Products, Vaccines, and Technologies  Tendency for the society to decline.  Availability of medicines, vaccines, technologies, and other medical products 2N – SECTION A 1  5. Financing 5. Development of specialized health programs and  If the given budget is used correctly. projects and advocates for legislation on health policies 6. Leadership and Governance or Stewardship and programs.  Check the person who handles it. The nurse is an essential member of the health workforce in the The Primary Function of the Department of Health: country. For all the nurses to work efficiently within the health care delivery system, an understanding of the dynamic a. Promotion relationships among its components is needed. b. Protection c. Preservation d. Restoration of the health of the people through the provision and delivery of health services and the  The DOH serves as the main governing body of health regulation and encouragement of providers of health services in the country. goods and services (E.O. No. 119, Sec. 3).  The DOH provides guidance and technical assistance to LGUs through the Center for Health Development in Paradigm each of the 17 regions.  Provincial government is responsible for the administration of provincial and strict hospitals.  Municipal and city governments are in charge of primary care through rural health units (RHUs) or health centers.  Satellite outposts known as barangay health stations (BHSs) provide health services in the periphery of the municipality or city.  As mentioned earlier, the Local Government Code mandated the devolution or decentralization of basic health services.  This means that LGUs have the autonomy and responsibility to plan and implement basic health services (primary care) on behalf of their constituents.  This is a mandate for LGUs Depending on the Figure 1. THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM capability and political will of the municipality /city government, higher levels of services may be provided.  This sector provides all levels of services and accounts FIGURE 1. THE PHILIPPINE HEALTH CARE DELIVERY for a large segment of health service providers in the SYSTEM country.  About 30% of Filipinos utilize private health facilities. (Community Health Nursing Services in the Philippine  An estimated 60% of the national health expenditure Department of Health, 2000) goes to the private sector.  This sector also employs more than 70% of the health The pyramid is a graphic representation of our country’s vision professionals in the Philippines (Romualdez, 2011) and goal to achieve Health for all Filipinos and Health in the Hands of the People by the year 2020, with the mission to 3 MAJOR GROUPS OF FINANCING HEALTH SERVICES ensure accessibility and quality of life for all Filipinos, especially the poor. 1. Government (national and local) 2. Private sources THE HEALTH CARE DELIVERY SYSTEM 3. Social health insurance A. WHO - World Health Organization The National Health Insurance Act of 1995 (R.A. 7875) created the Philippine Health Insurance Corporation (Phil Health). It is a The specialized agency of the United Nation provides global tax-exempt government corporation attached to the DOH for leadership on health matters. policy coordination and guidance and aims for universal health -The WHO constitution came into force on April 7, 1948. Since coverage for all Filipino citizens. then, April 7 has been celebrated each year as -World Health Day (WHO, 2013a). With its headquarters in Geneva, -In the Philippines health care system is a complex set of Switzerland, WHO has 147 country offices and 6 world regional organizations interacting to provide an array of health services. offices for Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. Components of the Health Care Delivery System as -The Philippines is a member of the Western Pacific Region, Mandated by the DOH to be Responsible for which holds office in Manila (WHO, 2007b). -The WHO constitution states that its objective is the attainment 1. Formulation and development of national health by all peoples of the highest possible level of health (WHO, policies, guidelines, and standards 2006). 2. Manual of operations for health services and programs; 3. Issuance of rules and regulations, licenses, and accreditations; 4. Promulgation of national health standards, goals, priorities, and indicators; 2N – SECTION A 2  Core Functions: 7. Ensure environmental sustainability 8. Develop a global partnership for development 1. Providing leadership on matters critical to the health and engaging in partnerships where joint action is 2. SUSTAINABLE DEVELOPMENT GOALS needed. 2. Shaping the research agenda and stimulating the Known as the Global Goals are universal are a collection of 17 generation, translation, and dissemination of valuable global goals set by the United Nations Assembly in 2015 for the knowledge year 2030. The SDGs are part of Resolution 701 of the United 3. Setting norms and standards and promoting and Nations General Assembly monitoring their implementations. 4. Articulating ethical and evidence-based policy options. They are the blueprint to achieve a better and more sustainable 5. Proving technical support, catalyzing change, and future for all. They address the global challenges we face, building sustainable institutional capacity including those related to poverty, inequality, climate, environmental degradation, prosperity, and peace and justice. WHO strategy on research has 5 goals; The Goals interconnect and to leave no one behind, it is 1. Capacity about capacity building to strengthen national important that we achieved each goal and target by 2030 health research systems 2. Priorities to focus research on priority health needs, particularly in low-and middle-income countries 3. Standards to promote good research practice and enable the greater sharing of research evidence tools, and materials 4. Translation to ensure that quality evidence is turned into products and policy 5. Organization to strengthen the research culture within WHO and improve the management and coordination of WHO research activities 1. THE MILLENNIUM DEVELOPMENT GOALS In the past decade, WHO has worked as a partner of the Philippine DOH in the development and provision of services for the attainment of health-related Millennium Development Goals 17 Global Goals (Sustainable Goals / SGD (MDGs) 1. No poverty-end poverty in all its forms everywhere September 6-8, 2000- Millennium Summit. World leaders in the 2. Zero hunger-food security n improved nutrition UN assembly participated. United Nations Millennium 3. Good health and well-being Declaration. The world leaders recognized their collective 4. Quality Education responsibility to uphold the principles of human dignity, equality, 5. Gender equality and equity at the global level. 6. Clear water and sanitation 7. Affordable and Clean Energy The declaration expressed the commitment of the member 8. Decent Work and economic growth states to reduce poverty and achieve the 7 other targets. Now 9. Industry, Innovation, and infrastructure called Millennium Development Goals (MDGs) by the year 2015. 10. Reduces inequalities 11. Sustainable cities and communities Millennium Development Goals / MDG 12. Responsible consumption and production 13. Climate action 14. Life below water 15. Life on land 16. Peace justice and strong institution 17. Partnership for the goals III. REFERENCES Santos, M. (2022). The Healthcare Delivery System. PowerPoint Presentation. FEU-NRMF. 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women END OF WEEK 1 ♡ 4. Reduce child mortality 5. Improve maternal health-MMR n RH 6. Combat HIV/AID, malaria, and other diseases 2N – SECTION A 3  5. Providing administrative and technical leadership in WEEK 2 health care financing and implementing the National Health Insurance Law Functions of the DOH, as enabler and capacity builder: 1. Providing logistically support to LGUs the private OUTLINE sector, and other agencies in implementing health I. The Philippine Department of Health programs and services A. Mission and Vision 2. Serving as the lead agency in health and medical B. Historical Background research C. Local Health System and Devolution of 3. Protecting standards of excellence in the training and Health Services education of health care system II. References As administrator of specific services, the DOH is tasked to: III. Trans Authorship 1. Serve as administrator of selected health facilities at subnational levels that act as referral centers for local health systems, that is, tertiary and special hospitals, reference laboratories, training centers, centers for Philippine Department of Health health promotion, centers for disease control and prevention and regulatory offices The Department of Health (DOH) is the national agency 2. Provide specific program components for conditions mandated to lead the health sector towards assuring quality that affect large segments of the population, such as health care to all Filipinos. TB, malaria, schistosomiasis, HIV/AIDS and Vision: HEALTH FOR ALL BY 2000 & HEALTH IN THE micronutrient deficiencies HANDS OF THE PEOPLE BY 2020. 3. Develop strategies for responding to emerging health THE DOH is the leader, staunch advocate and model needs in promoting “Health for all in the Philippines. 4. Provide leadership in health emergency preparedness Mission: Ensure accessibility and quality of health care and response services, including referral and to improve the quality of life of all Filipinos. networking systems for trauma, injuries and Goal: To raise the level of health of the citizenry by catastrophic events. helping comm. & families to cope with the The DOH core values reflect adherence to the higher discontinuities in & threats to health in such a way as standards of work: Ei to maximize their potential for high-level wellness. 1. Integrity Guarantee equitable, sustainable and Equality health 2. Excellence for all Filipinos, especially the poor and shall lead the 3. Commitment quest for excellence in health 4. Professionalism In partnership with the people, provide equity & access 5. Teamwork & quality health services especially to the marginalized 6. Stewardship of the people segment of the population The DOH shall do this by seeking all ways to establish HISTORICAL BACKGROUND performance standards for health human resources; The DOH serves as the main governing body of health health facilities and institutions; health products and services in the country. health services that will produce the best health The DOH provides guidance and technical assistance to systems for the country. This, in pursuit of its LGUs through the Center for Health Development in each of constitutional mandate to safeguard and promote the 17 regions health for all Filipinos regardless of creed, status, or Provincial governments are responsible for administration of gender with special considerations for the poor and the provincial and district hospitals. vulnerable who will require assistance Pre-Spanish and Spanish Period (before 1898) Traditional health care practices especially the use of herbs MISSION AND VISION and rituals for healing were widely practiced during these The DOH VISION: is to be a global leader for attaining better periods. health outcomes, competitive and responsive health care The western concept of public health services in the country system, and equitable health financing. is traced to the first dispensary for indigent patients of Manila MISSION: statement is to guarantee equitable, sustainable, ran by a Franciscan friar that was began in 1577. and quality health for all Filipinos, especially the poor, and to In 1876 Medicos Titulares, equivalent to provincial health lead the quest for excellence in health. (DOH, 2012b) officers were already existing in 1888, a Superior Board of Major Roles: Health and Charity was created by the Spaniards which 1. Leader in health established a hospital system and a board of vaccination 2. Enabler and capacity builder among others. 3. Administrator of specific services The leadership role of the DOH is specifically elucidated in June 23, 1898 Executive Order 102. series of 1999 in terms of the following Shortly after the proclamation of the Philippine independence functions: from Spain, the Department of Public Works, Education and 1. Planning and formulating policies of health programs Hygiene was created by virtue of a decree signed by and services President Emilio Aguinaldo. 2. Monitoring and evaluating the implementation of health September 29, 1898 programs , projects, research training, and services With the primary objective of protecting the health of the 3. Advocating for health promotion and healthy lifestyles American soldiers General Orders No. 15 established the 4. Serving as a technical authority in disease control and Board of Health for the City of Manila. prevention 2N – SECTION A 4 July 1, 1901 January 1, 1951 A Board of Health for the Philippine Islands was created The office of the President of the Sanitary District was through Act No. 157. This also functioned as the local health converted into a Public health Unit, carrying out 7 basic health board of manila. It truly became an Insular Board of Health services: Maternal and child health, environmental health, when Act Nos 307,308 dated Dec. 2, 1901, established the communicable disease control, vital statistics, medical care, Provincial and Municipal Boards respectively completing the health education and public health nursing. This was carried health organization in accordance with the territorial division out in 81 selected provinces. The impact to the community of the islands. was strong. It directly resulted in the passage of the Rural October 26, 1905 health Act of 1954 (RA 1082). This Act created more rural The Insular Board of Health proved to be inefficient health unites and crated posts for municipal health officers operationally so it was abolished and was replaced by the among other provisions. Bureau of Health under the Department of Interior through Act February 20, 1958 No. 1407. Act No. 1487 in 1906 replaced the provincial Executive Order No. 288 provided for what is described as boards of health with district health officers the” most sweeping” reorganization in the history of the 1912 department at that period. This came about an effort to Act No. 2156 known as the Fajardo Act, consolidated the decentralize governance of health services. municipalities into sanitary divisions and established what is AN Office of the Regional Health Director was created in 8 known as the Health Fund for travel and salaries. regions and all health services were decentralized to the 1915 regional, provincial and municipal levels. Bureaus were Act No. 2468 transformed the Bureau of Health into a limited to staff functions such as policy making and commissioned service called the Philippine Health Service. development of procedures. RHUs were made as integral This introduced a systematic organization of personnel with part of the public health care delivery system. corresponding civil service grades and a secure system of 1970 civil service entrance and promotion described as the “semi- The Restructured Health Care Delivery System was military system of public health administration. conceptualized. It classified health services into primary, August 2, 1916 secondary, and tertiary levels of care. This further expanded The passage of the Jones Law also known as the Philippine the reach of the rural health units. Under this concept the Autonomy Act, provided the highlight in the struggle of the public health nurse to population ratio is 1:20,000. The Filipinos for Independence from the American rule. The expanded role of the public health nurse was highlighted. establishment of an elective Philippine Senate completed an June 2, 1978 all Filipino Philippine Assembly that formed a bicameral With proclamation of martial law in the country, Presidential system of government. This ushered in a major Decree 1397 renamed the Department of Health to the reorganization which culminated in the administrative Code Ministry of Health. Secretary Gatmaitan became the first of 1917 )Act 2711) which included the Public Health Laws of Minister of Health. 1917 December 2, 1982 1932 Executive Order No. 851 signed be the President Ferdinand Because of the need to better coordinated public health and E. Marcos reorganized the Ministry of Health as an integrated welfare services, Act No. 4007 known as the Reorganization health care delivery system through the creation of the Act of 1932, reverted back the Philippine Service into the Integrated Provincial Health Office which combines public Bureau of Health, and combined the Bureau of Public Welfare health and hospital operations under the Provincial Health under the Office of the Commissioner of the Health and Public Officers. Welfare April 13, 1987 1935-1945 Executive Order No.119 “Reorganizing the Ministry of Health The Philippine Commonwealth and the Japanese Occupation “by President Corazon C. Aquino saw a major change in the May 31, 1939 structure of the ministry. It transformed the Ministry of Health Commonwealth Act No. 430 created the Department of Public back to the Department of Health. Health and Welfare but the full implementation was only EO 119 clustered agencies and programs under the Office for completed through Executive Order No. 317, January 7, Public Health Services, Office for Hospital and Facilities 1941. Dr. Jose Fabella became the first Department Services. The Field Offices were composed of the Regional Secretary of Health and Public Welfare in 1941. Health officers and National Health facilities. The latter was 1942 composed of National Medical centers, the Special Research During the period of the Japanese occupation, various Centers and Hospitals. Five Deputy Minister Positions were reorganization and issuances for the health and welfare of the also created. people were instituted and lasted until the Americans came October 10, 1991 in 1945 and liberated the Philippines. Republic Act 7160 known as the Local Government Code October 4, 1947 provided for the decentralization of the entire government. Executive Order No. 94 provided for the post war This brought about a major shift in the role and functions of reorganization of the Department of Health and public the Department of Health. Under this law, all structures Welfare. personnel and budgetary allocations from the provincial This resulted in the split of the Department with transfer of the health level down to the barangays were devolved to the local Bureau of Public Welfare (which became the Social Welfare government units (LGUs) to facilitate health service delivery. administration) and the Philippine General Hospital to the The department of Health changed its role from one of Office of the President. implementation to one of governance Another was created between the curative and preventive May 24, 1991 services through the creation of the Bureau of Hospitals Executive Order No. 102 “and Operations of the Department which took over the curative services. Preventive care of Health” by President Joseph E. Estrada granted the DOH services remained under the Bureau of Health. to proceed with its Rationalization and Streamlining Plan This order also established the Nursing Service Division which prescribed the current organizational, staffing and under the Office of the Secretary. 2N – SECTION A 5  resource structure consistent with its new mandate, roles and What used to be a highly centralized health system run by the functions post devolution. DOH became a fragmented system consisting of more than EO 102 a thousand autonomous local health systems run by Mandates the Department of Health to provide assistance to provinces, cities and municipalities. local government units, people’s organization and other The DOH maintained its role as the steward of national members of civic society in effectively implementing policies, plans, standards and regulations on health, while the programs, projects and services that will promote the health LGUs were given the responsibility of being managers and and well-being of every Filipino; prevent and control diseases providers of direct health services at the local level among population at risks, protect individuals, families and After the devolution of health services, improvements in communities exposed to hazards and risks that could affect health outcomes and performance of health-care facilities their health and treat , manage and rehabilitate individuals and health workers at the local level have shown marked affected diseases and disability. variations across LGUs (Department of Health, 2012a). 1994-2004 Some LGUs have barely coped with their new Development of the Health Sector Reform Agenda which responsibilities, leaving some local health facilities poorly describes the major strategies, organizational and policy equipped and poorly staffed changes and public investments needed to improve the way As a result, major gaps in the quantity, quality and distribution health care is delivered, regulated and financed of essential health services at local levels have become 2005 ongoing persistent concerns of both the National and local Development of a plan to rationalize the bureaucracy in an governments. attempt to scale down including the Department of Health. The fragmentation of the healthcare delivery system most severely affected the provision of health services in LOCAL HEALTH SYSTEM AND DEVOLUTION OF geographically isolated and disadvantaged areas. HEALTH SERVICES These areas are generally characterized by high morbidity For over forty years after post war independence, the and mortality, lack of health facilities and health Philippine health care system was administered by a central professionals, and poor logistical support, resulting in poor agency based in Manila. access to quality health care (Department of Health, 2004). This control system was agency provided the singular One of the most significant laws that radically changed the sources, policy direction, technical and administrative landscape of health care delivery system in the country is RA supervision to all health facilities nationwide. 7160 or commonly known as Local Government Code. In 1991 the Philippines Government introduced a major The Code aims to: devolution of national government services, which included Transform local government units into self-reliant the first wave of health sector reform, through the introduction communities of the Local Government Code of 1991. Active partners in the attainment of national goals through a The Code devolved basic services for agriculture extension, more responsive and accountable local government structure forest management, health services, barangay (township) instituted through a system of decentralization. roads and social welfare to Local Government Units. In 1993, health services were devolved or transferred from In 1992, the Philippines Government devolved the the Department of health to the local governments and the management and delivery of health services from the rural health units (RHUs) and barangay health stations National Department of Health to locally elected provincial, (BHSs) to the municipal governments. city and municipal governments. For over forty years after post war independence, the Organizational Structure of the Provincial Government Philippine health care system was administered by a central agency based in Manila. This control system was agency provided the singular sources, policy direction, technical and administrative supervision to all health facilities nationwide. In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991, known as Republic Act 7160. Devolution made local government executives responsible to operate local health care services, new centers of authority for local health services emerged These consist of provincial, city, municipal governments, including an autonomous regional government and a metropolitan authority. Each center controls a portion of the health care system as This body is a good venue for making the local health system part of its political and administrative mandate. -Now, more responsive to the needs of the people. It is mandated to provincial governments operate the hospital system. propose annual budgetary allocations for the operation and Provincial and District Hospitals. maintenance of health facilities and services within the Municipal governments operate the Health Centers (HC) municipality, city or province. /Rural Health Units (RHU) and Barangay Health Stations At the provincial level, it is composed of the governor (chair), provincial health officer (Vice chair), chairman of the Local Health System and Devolution of Health Services Committee on Health of the Sanggunian Panlalawigan, DOH The enactment of the Local Government Code of 1991 representative and NGO representative. (Republic Act No. 7160) mandated the devolution of health At the city and municipal level, the LHB is composed of the services from the National Government to the LGUs. Committee on health of the Sanggunian Bayan, DOH representative and NGO representative. 2N – SECTION A 6  At the municipal level, many public health nurses have been WEEK 3 appointed as DOH representative. This means that they have been retained by the DOH. OUTLINE Many of them however dual functions-those of a public nurse and those of a DOH representative. I. The Philippine Department of Health There are LGUs that are committed to health and are D. Classification of Health Facilities innovative while they are those that re just interested in the E. New Classification of General Hospitals purchase of supplies and medicines, F. Philippine Health Agenda 2010 - 2022 Some LGUs have the financial capability to support their own II. References health care delivery system while others do not have III. Trans Authorship adequate financial resources. It has been established that a LGUs financial capability, a Philippine Department of Health dynamic and responsive political leadership and community CLASSIFICATION OF HEALTH FACILITIES empowerment are the important ingredients of an effective local health system. DOH issued Administrative Order 2012-0012 that provides for a new classification of health facility. DOH Administrative Order 2012 - 0012 (Rules and III. REFERENCES Regulations Governing the New Classification of Santos, M. (2022). The Philippine Department of Health. Hospitals and Other Health Facilities in the PowerPoint Presentation. FEU-NRMF Philippines). Category A The first -contact health care facility that Primary offers basic services including emergency Health Care services and provision for normal deliveries Facility 1. Without in-patient beds like health centers, outpatient clinics, and dental clinics 2. With in-patient beds- a short stay facility where the patient spends on the average of one or two days before discharge. Examples are infirmaries and birthing (lying in) facilities Category B A health facility that provides long term care, Custodial including basic services like food and Care shelter, to patients with chronic conditions Facility requiring ongoing health and nursing care due to impairment and a reduced degree of independence in activities of daily living and patients in need of rehabilitation Examples : are custodial psychiatric facilities, substance. drug abuse treatment and rehabilitation centers, sanitaria/ leprosaria and nursing homes Category C A facility for the human body, specimens Diagnostic / from the human body for the diagnosis, therapeutic sometimes treatment of disease, or water for facility drinking water analysis. The test covers the pre analytical, analytical and post analytical : 1. Laboratory facility such as but not limited to the following: 2N – SECTION A 7  A. Clinical laboratory First level X-ray Pharmacy B. HIV testing laboratory C. Blood service facility Level 2 Tertiary clinical laboratory D. Drug testing laboratory Second level X-ray with mobile unit E. Newborn screening lab. Level 3 Tertiary clinical laboratory with histopathology Blood bank Third level F. Laboratory for drinking water analysis PHILIPPINE HEALTH AGENDA 2010 - 2022 2. Radiologic facility providing In order to attain health-related sustainable development services such as X-ray, CT scan, goals, the A.C.H.I.E.V.E. strategy is followed: mammography, MRI, and ultrasonography 3. Nuclear medicine facility- a facility A Advance quality, health promotion and primary care regulated by the Philippine Nuclear Research Institute utilizing C Cover all Filipinos against health-related financial applications of radioactive risk materials in diagnosis, treatment or medical research, with the H Harness the power of strategic HRH development exception of the use of sealed radiation sources in radiotherapy I Invest in eHealth and data for decision-making as in internal radiation therapy E Enforce standards, accountability and transparency Category D A facility that performs highly Specialized specialized procedures on an V Value all clients and patients, especially the poor, outpatient outpatient basis marginalized, and vulnerable facility Examples are dialysis clinic, ambulatory surgical clinic, cancer E Elicit multi-sectoral and multi-stakeholder support for chemotherapeutic center/ clinic health cancer radiation facility and physical medicine and rehabilitation center/ clinic. With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with the values of Equity, Quality, NEW CLASSIFICATION OF GENERAL HOSPITALS Efficiency, Transparency, Accountability, Sustainability, Hospitals Clinical services for in patient Resilience towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”. Level 1 Consulting specialists in: Medicine Pediatrics Obstetrics Gynecology Surgery Emergency and out patient services Isolation facilities Surgical/maternity facilities Dental Facility Level 2 Level 1 plus: Departmentalized clinical service Respiratory unit General ICU High risk pregnancy unit NICU Level 3 Level 2 plus: Teaching /training with accredited residency training program in four major clinical services Physical medicine and rehabilitation unit Ambulatory surgical clinic Dialysis Clinic Ancillary services Level 1 Secondary clinical laboratory Blood station 2N – SECTION A 8  WEEK 4 factors that interdependently influence the health of the population , such as the environment, education, social services and politics/ leadership. OUTLINE I. Primary Health Care  A healthy population has the capability to contribute A. Brief History more to its development. By emphasizing the people’s B. Legal Basis of PHC in the Philippines right to health, the government is driven to increase C. Definition investment on health care. The WHO recommends D. Goals governments to allocate 5% of the gross national E. 5 key elements product (GNP) to health services from 2005 t 2007 was F. Principles of PHC and Strategies only 3.3 % of the GNP G. 5 A’s (4As) H. Multisectoral approach I. Community Participation The WHO defined PHC: J. Equitable Distribution of Health Resources  Essential health care made universally accessible to II. Levels of Prevention individuals and families in the community by means A. 3 Levels of Prevention acceptable to them, through their full participation and III. References at a cost that the community and country can afford at every stage of development. Primary Health Care  According to Alma Ata Declaration, PHC “is essential Brief History health care based on practical, scientifically sound and socially acceptable methods and technology made  The core strategy is the effective provision of essential universally accessible to individuals and families in the health services. community through their full participation and at a cost  PHC was declared during the First International to maintain at every stage of their development in the Conference on Primary Health Care held in Alma Ata, spirit of self-reliance and self-determination” USSR on September 6-12 1978 by WHO and UNICEF.  Together they expressed the need for concerted efforts Main Objectives: by all governments and health and development 1. Promotion of healthy lifestyles, workers for the protection and promotion of health of all 2. Prevention of diseases the people. 3. Therapy for existing conditions Legal Basis of PHC in the Philippines President Marcos signed the LOI 949 that has an underlying  Letter of instruction (LOI) 949 signed by Pres. theme” Health in the Hands of the People by 2020” Marcos on October 19, 1979. Making the Philippines the first country in Asia to embark on meeting the challenge of PHC. Goals  It must be noted that even prior to LOI 949, which provided impetus to the then Ministry of Health, Health for All by the year 2000 there were several health workers,  Health for all means an acceptable level of health for nongovernmental organizations (NGOs) and all the people of the world through community and church organizations offering community-based individual self-reliance and self determination health programs In the rural areas of Visayas and  This policy agenda of “health for all by the year 2000” Mindanao, applying the spirit of PHC even before technically was a global strategy employed for it was formally adopted by the government. achieving their main objectives. The Alma ATA Declaration on Primary Health Care emerged 5 Key Elements from this conference. The Alma Ata conference made the following declarations: The WHO has identified 5 key elements to achieving the goal “health for all” 1. Health is a basic fundamental right 2. There exists global burden of health inequalities 1. Reducing exclusion and social disparities in health among populations (universal coverage) 3. Economic and social development is of basic 2. Organizing health services around people’s needs and importance for the full attainment of health for all expectations (health service reforms) 4. Governments have a responsibility for the health of 3. Integrating health into all sectors (public policy reforms) their people. 4. Pursuing collaborative models of policy dialogue (leadership reforms)  Basic to the PHC declaration is the common view that 5. Increasing stakeholder participation health “is a state of complete , physical, mental, and social well-being , and not merely the absence of The Alma Ata Declaration listed 8 essential health services disease or infirmary “ using the ACRONYM (ELEMENTS)  Viewing health from holistic perspective, beyond just physical and mental maladies, the WHO has put equal E - Education for all emphasis on the social dimensions of health, that L- Locally endemic disease control wellness can be achieved by considering different E - Expanded Program for immunization 2N – SECTION A 9 M - Maternal and child health including responsible parenthood 3 Major Entities: E - Essential drugs N - Nutrition 1. People themselves T- Treatment of communicable and non-communicable 2. The government diseases 3. Private sector like NGOs and socio-civic and faith S - Safe water and sanitation groups. Principles of PHC and Strategies Multisectoral Approach 1. Accessibility, affordability, acceptability and availability As health and disease are outcomes of multiple interrelated 2. Support mechanism factors, PHC requires communication, cooperation and 3. Multisectoral approach collaboration within and among various sectors. 4. Community participation 5. Equitable distribution of health resources A. Intrasectoral Linkages 6. Appropriate technology B. Intersectoral Linkages 1. Intrasectoral Linkages 5 A’s (4As)  It refers to communication, cooperation and A. Accessible- The WHO guideline states that for these collaboration within the health sector: among the health care facilities to be considered accessible, they members of the health team and among health must be within 30 minutes from the communities. BHSs agencies. are facilities intended to provide accessible health  This is exemplified by team approach utilized by the services at the community level. personnel of a health center in dealing with health B. Attainable conditions and problems. C. Affordable- is not only in consideration of the  The two-way referral system, is necessary so that individual or family’s capacity to pay for basic health clients get the needed and desired care. services.  The two-way referral system ensures competent care, maximum use of availability of resources and continuity  Particularly for public health services, it is also a matter of care of whether the community or government can afford these services. One of the factors the WHO considers 2. Intersectoral Linkages in determining affordability of health care is the out of pocket expenses for health care.  One of the major criticisms against the traditional perspective in development is that the tools for analysis  This is the actual cost to the family for health services and strategies used are primarily economic in lea any coverage of insurance. In the Philippines, the orientation. government health insurance is covered through  The idea that the population is sick because they are Philhealth. There are other health insurance policies poor implies that illness or health is a result of offered by private companies or health management economic gains or the lack thereof. organization.  Intersectoral linkages encompasses that communication, cooperation and collaboration D. Acceptable- means that the health care offered in in between the health sector and other sectors of society consonance with the prevailing culture and traditions of like education, public works, agriculture, and local the population. government officials. E. Availability- is a question of whether the basic health  Example Rabies prevention and control program. It services require by the people are offered in the health requires collaborative effort among the Department of care facilities or id provided on a regular and organized Health (DOH), DA, DepEd and LGUs. The DOH manner. provides immunization or victims of animal bites. The DA provides outreach rabies immunization for dogs,  PHC as a service delivery policy of the DOH permeates while Dep ED and the LGUs are in charge of all strategies and thrusts of government health information campaign in schools and communities. programs from the national to the local and community  One of the major criticisms against the traditional levels perspective in development is that the tools for analysis  PHC is a complete turn-about from disease-oriented, and strategies used are primarily economic in curative, hospital based, and urban centered health orientation care to preventive, people centered, and community-  It encompass the communication, cooperation and based health care. collaboration between the health sector and other sectors of society like education, public works, Health programs according to the 4As agriculture and local government officials. 1. Botika ng Bayan and the Botika ng barangay 2. Ligtas sa Tigdas ang Pinas” mass measles Community Participation immunization campaign. Children aged 9 months to below 8 years old. The two were vaccinated against  A key to understanding the concept of PHC puts measles and rubella emphasis on how it is defined: that health is achieved through self-reliance and self-determination and that individuals, families and communities are not 2N – SECTION A 10  considered as recipients of care but active participants Example: Mammography, Blood pressure screening, newborn in achieving their health goals. screening and mass sputum examination for pulmonary  Community participation is an educational and tuberculosis empowering process in which people in partnership  Secondary prevention is also directed toward prompt with those who are able to assist them, identify the intervention to prevent worsening conditions of the problems and the needs and increasingly assume affected population. responsibilities themselves to plan, manage, control  This includes measures during the early stage of and assess the collective actions that are proved disease to prevent complications. necessary.  Teaching how to Oresol to her child suffering from diarrhea to prevent dehydration and administering Equitable Distribution of Health Resources vitamin A capsules to children with measles are examples. 2 programs TERTIARY PREVENTION 1. Doctor to the Barrios (DTTB) is the deployment of doctors to  Targets population that have experienced disease or municipalities that are without doctors. injury and focuses on limitation of disability and rehabilitation. DTTB volunteers are fielded to manage the RHU or health  Aims of tertiary prevention are to reduce the effects of centers in unserved, economically depressed fifth or 6th class disease and injury and to restore individuals to their municipalities for 2 years. optimal level of functioning. Examples: Teaching how to perform insulin injection techniques 2. Registered Nurses Health Enhancement and Local Service and disease management to a patient with diabetes, referring a (RN HEALS) patient with spinal injury for occupational and physical therapy and leading a support group for cancer patients who have  It is a training and deployment programs for undergone cancer treatment such as surgery, chemotherapy unemployed nurses. and radiation therapy.  They are volunteers are deployed to unserved, economically depressed municipalities for 1 year to address the inadequate nursing workforce in rural communities and health facilities. THE HEALTHCARE DELIVERY SYSTEM III. REFERENCES 3 LEVELS OF PREVENTION Santos, M. (2022).Primary Health Care. PowerPoint 1. Primary Prevention Presentation. FEU-NRMF. 2. Secondary Prevention 3. Tertiary Prevention PRIMARY PREVENTION Relates to activities directed to preventing a problem before it occurs for susceptible individuals. 2 Elements: 1. General health promotion 2. Specific protection Example: Promotion of good nutrition, provision of adequate shelter and encouraging regular exercise Specific Protection Efforts  Reduce or eliminate risk factors and include such measures as immunization, and water purification Primary Level Disease Prevention  Directed towards individuals who are at Risk of developing a disease or those who are in the pre- pathogenic stage; deals with the removal of risk factors of specific protection of individuals against these risk factors Example; immunization, food supplementation, and malaria chemoprophylaxis. SECONDARY PREVENTION  Refers to early detection and prompt intervention during the period of early disease pathogenesis.  It was implemented after a problem has just begun but before signs and symptoms appear and target those populations who have risk factors 2N – SECTION A 11  WEEK 5 2) It is not completely free  Contrary to what some people may think, UHC OUTLINE does not mean every single health expense will be made free. -The law outlines that basic services I. Universal Health Care accommodations will be covered by PhilHealth. A. 8 things to expect as a citizen  As a patient, that means that if you’re admitted in B. Legal Basis a hospital you can expect regular meals, a bed in C. Background and Rationale a shared room with fan ventilation, and a shared D. Objectives and Thrust toilet and bath to be covered. E. Strategic Thrust  All are also entitled to an “essential health benefit F. Strategic Instruments package,” which includes primary care, medicines, II. References diagnostic, and laboratory tests. It also includes preventive, curative, and rehabilitative services. Universal Health Care  It will no longer be free when one wants to stay in a hospital room offering private accommodation,  Filipinos will begin benefiting from the Universal Health air conditioning, telephone, television, and meal Care (UHC) Act this year, with every citizen entitled to choices, among others. health coverage that will lower out of pocket health  Meanwhile, public and private hospitals are expenses. expected to allocate a certain portion of their beds  The passage of the law was considered a landmark for as basic accommodations in the following the Duterte administration as lawmakers who amounts: championed the bill gathered in Malacañang for a Government hospitals – at least 90% of beds special ceremony last February 20. It was there that Specialty hospitals – at least 70% of beds President Rodrigo Duterte affixed his signature on the Private hospitals – at least 10% of beds long-awaited law.  As long as a patient avail of these basic  The passage of Republic Act No 11223 was no easy accommodations, it will be covered by PhilHealth feat. It was hailed as path-breaking as it set the whether in a public or private hospital. direction for the reform of the health care sector in the  The law also states that if patients need to pay for Philippines. extra expenses, their “co-payment” – or what is  The World Health Organization earlier urged the paid on top of basic services – should be regulated Philippine government to make a “real investment” in by the DOH in public hospitals. This means that health care, as it would save lives. you should know what to expect in terms of bills,  But ensuring universal health care for all Filipinos does as opposed to being shocked after treatment. not come cheap.  Aside from this, current case rates or packages PhilHealth has crafted for certain diseases will The following are the 8 things the Citizen to expect remain. But together with the DOH, PhilHealth is expected to work towards including more needs a 1) ALL Filipinos are covered person may have for a disease in its case rates. Every single Filipino citizen is automatically enrolled into the  The two agencies are also expected to craft and newly-created National Health Insurance Program (NHIP). implement outpatient benefit services to be covered by the National Health Insurance The program classified membership into two types: Programs within 2 years after the law takes effect. 1. Direct contributors – those who pay PhilHealth premiums, are employed and bound by an "employer-employee 3) PhilHealth will become the “national purchaser” of relationship," self-earning, professional practitioners, and health goods and services migrant workers. Members’ qualified dependents and lifetime  This means that PhilHealth will be in charge of members are also included. paying health care providers like hospitals and 2. Indirect contributors – those not considered as direct clinics for services given to Filipinos. This is contributors, along with their qualified dependents, whose health already a job PhilHealth carries out but the premiums are subsidized by the government. universal health care law wants to pool more funds so it can cover all Filipinos and eventually, more  All Filipinos will be granted “immediate eligibility” and services. access to the full spectrum of health care which  Allocating more funds to PhilHealth will also includes preventive, promotive, curative, rehabilitative, strengthen its negotiating power with health care and palliative care. This can be expected for medical, providers, which will foreseeably improve the dental, mental, and emergency health services. quality of services and lower health costs.  Filipinos will also be enrolled with a primary health care  Funds for PhilHealth will be sourced from the provider of their choice. The primary care provider is following: the health worker they can go and seek treatment from for health concerns. They will also serve as the person  Philippine Amusement and Gaming Corporation – in charge of referring and coordinating with other health 50% of national government’s share centers if patients need further treatment.  Philippine Charity Sweepstakes Office (PCSO)  Citizens will not need to present any PhilHealth ID to – 40% of its charity fund, net of document avail of these benefits. Meanwhile, poor Filipinos or stamp tax payments, and mandatory PCSO those who are located in geographically isolated areas contributions will also be given priority when ensuring access to  Premium contributions of direct contributory health services. members  By giving PhilHealth more funds, a goal of the UHC is to make PhilHealth the national purchaser 2N – SECTION A 12  of medicines. -This can lower the cost of  The HTAC will be responsible for assessing the safety medicines as these will be bought in bulk. and effectiveness of health technology, devices,  Another goal is to have quality of health services medicines, vaccines, health procedures, and other improve as PhilHealth can set as a requirement for health-related advances developed to solve health payment and contracting, standards for health problems. care providers.  Reviewing the social, economic, and ethical issues when using these technologies or programs is also 4) DOH will still be in charge of “population-based” health required. services  The HTAC will be attached to the DOH for the first 5  While PhilHealth, along with other private health years after the law is implemented. After this, it will insurance companies, is expected to cover become an independent body attached to the services for individuals, the DOH is still in charge Department of Science and Technology. of delivering health services that cover entire populations. 8) Health information will be collected  Think of these as programs for disease  Both public and private hospitals and health insurers surveillance, health promotion campaigns, and will be required to maintain a health information system mass immunization campaigns. that will contain electronic health records, prescription  The DOH will do this by contracting public health logs, and “human resource information.” care providers in cities and provinces.  This system will be developed and funded by DOH and PhilHealth. It will also be subject to patient 5) Health systems will become city-wide and province- confidentiality rules and data privacy laws. wide  Provinces and highly urbanized cities will now be in Legal Basis charge of overseeing health services in areas as opposed to the current set-up where municipalities are (Kalusugan Pangkalahatan) also called the Aquino Health tasked with managing their own health centers. Agenda is the latest in a series of continuing efforts of the  The DOH will need to work with the Department of the government to bring about sector reforms. Was launched Interior and Local Government (DILG) to have through Administrative Order 2010-0036 province- and city-wide health systems or networks in about two years after the law takes effect. UHC was built upon the strategies of two previous platforms of reform:  For this, one can imagine as an example, Rizal 1. The initial Health sector reform agenda (1999-2004) overseeing its province-wide health care network of 2. FOURmula One ( F1) for heath (2005-2010) clinics and hospitals compared to each municipality in Rizal taking care of its own health center alone. Similarly, highly urbanized cities like Cebu or Makati Background and Rationale will oversee their own health care network compared to single barangays being in charge of a health center. Rationale:  Having access to health networks province-wide can Health sector reforms are intended to bring about equity in address the problem of inadequate access to health health care delivery. Survey data show that this has not been services due to lack of funds in barangays or achieved as of yet, despite health sector reforms since 1999. municipalities.  Provincial and city health boards will be in charge of  A DOH and PhilHealth review highlighted the need to pooling and managing a special health fund to finance improve health-related financial risk protection among and improve health services for residents. PhilHealth’s Filipinos. income will also be channeled to this special health  More importantly, PhilHealth benefit delivery was found fund. to be the lowest among the target population-the 6) Return Service in the Public Health Sector poorest quintile.  Graduates of health and health-related courses who  The concern on inequitable access to health resources received government-funded scholarships will be has not been resolved. required to work in the public health sector for at least  Neglect of public hospitals and health facilities due to 3 full years. This will address the need for health inadequate health budgets has been observed. workers across the country.  As of October 2010, a total of 892 RHUs and 99  They will be paid by and under the supervision of the government hospitals had yet to qualify for DOH. Those who serve for an extra two years will also accreditation by PhiHealth. be given incentives, which will be determined by the  Data show that the poorest of the population are the DOH. main users of government health facilities. This means  Meanwhile, graduates of health courses in state that the deterioration and poor quality of many universities and colleges and private schools are government health facilities is particularly encouraged to work in the public sector. disadvantageous to the poor who needs the services the most. 7) A “Health Technology and Assessment Council” Finally, renewed efforts to achieve health related MDGs are in (HTAC) will be created order.  Another important feature of the law is the creation of The MDG 4 target is to reduce maternal mortality rate from 209 the HTAC – a group of health experts who will be maternal deaths /100,000 live births in 2990 to 52 deaths per responsible for evaluating latest health developments 100,000 live births by 2015. and recommending their use to DOH and PhilHealth. 2N – SECTION A 13  Objectives and Thrusts Goals: 1. Better health outcomes 2. Sustained health financing 3. A responsive health system by ensuring that all Filipinos, especially the disadvantaged group, have equitable access to affordable health care. Strategic and Thrusts 1. Financial risk protection through expansion in NHIPP enrollment and benefit delivery’ 2. Improves access to quality hospitals and health care facilities 3. Attainment of the health related MDGs Strategic Instruments 1. Health Financing- instrument to increase resources for health that will be effectively allocated and utilized to improve the financial protection of the poor and the vulnerable sectors 2. Service Delivery- instrument to transforms the health service delivery structure to address variations in health services utilization and health outcomes across socioeconomic variables. 3. Policy, Standards and Regulation- instrument to ensure equitable across to health services essential medicine and technologies of assured quality availability and safety. 4. Governance for Health- instrument to establish the mechanism foe efficiency, transparency, and accountability and prevent opportunities for fraud. 5. Human Resources for Health- instrument to ensure that all Filipinos have access to professional health care providers capable of meeting their health needs at the appropriate level of care. 6. Health Information- instrument to establish a modern information system that shall: a. Provide evidence for policy and program development b. Support for immediate and efficient provision of health care and management of province-wide health system  Filipinos will begin benefiting from the Universal Health Care (UHC) Act this year, with every citizen entitled to health coverage that will lower out of pocket health expenses.  The passage of the law was considered a landmark for the Duterte administration as lawmakers who championed the bill gathered in Malacañang for a special ceremony last February 20. It was there that President Rodrigo Duterte affixed his signature on the long-awaited law.  The passage of Republic Act No 11223 was no easy feat. It was hailed as path-breaking as it set the direction for the reform of the health care sector in the Philippines.  The World Health Organization earlier urged the Philippine government to make a “real investment” in health care, as it would save lives. II. REFERENCES Santos, M. (2022).Universal Health Care. PowerPoint Presentation. FEU-NRMF. 2N – SECTION A 14 CHN LECTURE Professor Marilyn Santos PhD., MAN., RN PRELIMS (WEEK 5) (IRRs) of RA 7305 or the Magna Carta of Public Health Workers stipulate that there be one TOPIC OUTLINE ★ 1 rural Health Physician to a population of 20,000 I. PRELIMS A. Topic 1 The Public Health Nurse (PHN) B. Topic 2 C. Topic 3 Supervises and guides all RHMs in the municipality II. MIDTERMS Prepares the FHIS quarterly and annual reports of the III. FINALS municipality for submission to the Provincial Health IV. REFERENCES Office V. TRANS AUTHORSHIP Utilizes nursing process in responding to health care needs, including needs for health in education and INTERPROFESSIONAL CARE ON THE COMMUNITY promotions of individuals, families, and catchment communities. Collaborates with other members of the health team, A. RURAL HEALTH UNIT government agencies, private business, NGOs and people’s organizations to address the community’s Commonly known as a Health Center, is a primary health level health facility in the municipality. The focus of the RHU is preventive and promotive ★ PHN- 1: 20,000 nurse population ratios health services and the supervision of BHSs under its jurisdiction. Registered Health Midwife (RHM) The recommended ratio of RHU to catchment Manages the BHS and supervises and trains the population is 1: RHU: 20,000 population BHW The BHS is the first contact health center facility that Provides midwifery services and executes health care offers basic services at the Barangay level. programs and activities for women of reproductive - It is a satellite station of the RHU. age, including family planning counseling and - It is manned by volunteer Barangay Health services Workers (BHWs) under the supervision of Conducts patient assessment and diagnosis for the Rural Health Midwife (RM) referral or further management Registered Health Midwife (RHM) The Rural Health Unit Personnel Performs health information, education, and The Municipal Health Officer (MHO) or Rural Health communication activities Physician heads the health services at the municipal level Organizes the community and carries out the following roles and functions: Facilitates barangay health planning and other Administrator of the RHU community health services A. Prepares the municipal health plan and budget B. Monitors the implementation of basic health ★ 1 RHM: 5,000 population services Rural Sanitary Inspector C. Management of the RHU staff