Health Care Delivery System Handout PDF

The Health 02 Care Delivery System The Health Care Delivery System - The totality of “societal services and activities designed to protect or restore the health of individuals, families, groups, and communities (Banta, 1986).  The Health Care Delivery System A nation’s health care...

The Health 02 Care Delivery System The Health Care Delivery System - The totality of “societal services and activities designed to protect or restore the health of individuals, families, groups, and communities (Banta, 1986).  The Health Care Delivery System A nation’s health care delivery system has a tremendous impact not only to the health of its people but also on their total development including their socioeconomic status. Anderson and Mcfarlene (2011) emphasized the role of the following factors in shaping 21st century health that further influence health care delivery system: 1. Health care “reforms” 2. Demographics 3. Globalization 4. Poverty and growing disparities 5. Social disintegration  World Health Organization WHO Dr Tedros Adhanom Ghebreyesus A part of the United Nations that deals with major health issues around the world. The World Health Organization sets standards for disease control, health care, and medicines; conducts education and research programs; and publishes scientific papers and reports A specialized agency in the United Nations (UN) provides global leadership on health matter in the Philippines.  VISION STATEMENTS A world in which everyone can live healthy, productive lives Placing health at the center of the global agenda Engaging countries and strengthening partnership  MISSION STATEMENT To oversee global health issues while leading research initiatives To publicize fact-based policy options so all information is disseminated globally To aid individual countries to cope with health issues within their borders World Health April 7, 1948 Day The WHO constitution came into force on April 7, 1948. Since then April 7 has been celebrated each year as World Health Day. Objective Attainment by all peoples of the highest possible level of health. To attain its objective, WHO carries out the following core functions: Providing leadership on matters critical to health and engaging partnerships where joint action is needed. WHO has 193 members of countries and 2 associate members. WHO and its members work with UN agencies, NGO’s and the private sector. The WHO country focus is directed toward providing technical collaboration with member states with accordance with each country’s needs and capacities.  Shaping the research agenda and stimulating the generation, translation, and disseminating valuable knowledge. The WHO strategy on research for health has 5 goals: 1. Capacity- in reference to capacity-building to strengthen the national health research system 2. Priorities – to focus research on priority health need 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.  Setting norms and standards and promoting and monitoring their implementation. WHO develops norms and standards for various health and health –related issues, such as pharmaceutical products including vaccines and other biological products used in immunization, practices in maternal and child care, and environmental conditions.  Articulating ethical and evidence-based policy options. Through its Department of Ethics and Social Determinants, WHO is evolved in various issues on health ethics. In collaboration with other governmental and nongovernmental organizations, WHO has worked on bioethical concerns such as those related to human organ and tissue transplantation, reproductive technology and public health response to threats of infectious diseases like AIDS, influenza, and tuberculosis.  Providing technical support, catalyzing change, and building sustainable institutional capacity. WHO offers technical support training to its member countries in the fields of maternal and child health, control of diseases, and environmental health services. WHO is involved in monitoring the health situation and assessing health trends. WHO has developed guidance and tools and measurement, monitoring and evaluation. The Millennium Development Goals The declaration expressed the commitment of the 191 member states, including the Philippines, to reduce extreme poverty and achieve seven other targets - now called the Millennium Development Goals (MDG’s) by the year  The Millennium Development Goals 2015 Signed by 189 UN member countries in September 2000 Aims to achieve a set of eight measurable goals that combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women, by 2015. THE 8 MDG TARGETS  Agenda 2030 The Sustainable Development Goals (SDGs) aim to transform our world. They are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity. It is critical that no one is left behind. 3.5. Substance abuse Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.6. Road traffic By 2020, halve the number of global deaths and injuries from road traffic accidents. 3.7. Sexual and reproductive health By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. 3.8. Universal health coverage Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. 3.9. Environmental health By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. SDG 3 TARGET: ENSURE HEALTH AND PROMOTE WELL-BEING FOR ALL AT ALL AGES 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100.000 live births 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3.3. Infectious diseases By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, and combat hepatitis, waterborne diseases and other communicable diseases. 3.4. Noncommunicable diseases By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well-being. DIFFERENCE OF MDG TO SDG  The Philippine Health Care Delivery System The DOH serves as the main governing body of health services in the country. The DOH provides guidance and technical assistance to LGUs through the center for health development in each of the 17 regions. Provincial governments are responsible for administration of provincial and district 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. Health services are provided by the;  government and  private sector -for profit as well as non-profit too as Non- Government Organizations (NGO). Financing of health services is provided by three major groups: 1. The government (national and local) 2. Private sources 3. Social health insurance. The National Insurance Act of 1995 (R.A. 7875) created by the Philippine Health Insurance Corporation (PhilHealth). It is tax-exempt government corporation attached to the DOH for policy coordination and guidance, and aims for universal health coverage of all Filipino citizens.  DOH DEPARTMENT OF HEALTH September 10, 1898  Department of Health DOH Dr. Teodoro Herbosa On the national level, director is set by department of health (DOH) by virtue of mandate of the Local Government Code (R.A.7160) LGU’s should have operating mechanism to meet the priority needs and service requirements of their communities. Basic Health Services are regarded as priority services for which LGU’s are primary responsible. DEPARTMENT OF HEALTH The Department of Health (DOH) is the principal health agency in the Philippines. It is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services. On the national level, director is set by department of health (DOH) by virtue of mandate of the Local Government Code (R.A.7160) LGU’s should have operating mechanism to meet the priority needs and service requirements of their communities. Basic Health Services are regarded as priority services for which LGU’s are primary responsible. DEPARTMENT OF HEALTH The DOH is the national agency mandated to lead the health sector towards assuring quality health care for all Filipinos. DOH Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040 DOH Mission: To lead the country in the development of a productive, resilient, equitable and people-centered health system for Universal Health Care HISTORY OF DOH  In the pursuit of its vision and execution of its mission, the DOH has the following major roles: 1. Leader in health 2. Enabler and capacity builder 3. Administrator of specific services  BASIC HEALTH SERVICES UNDER DOH E ducation regarding HEALTH wellness L ocal endemic cases M ental health promotion E xpanded program on immunization M aternal and child health services E ssential drugs and herbal plants N utritional health services (PD 491) : Creation of Nutrition Council of the Philippines T reatment of communicable and non- communicable diseases S anitation of the environment (PD 856): Sanitary Code of the Philippines  PRINCIPLES TO ATTAIN THE VISION OF THE DOH EQUITY – equal services for all – no discrimination QUALITY – DOH is after the quality of service not the quantity PHILOSOPHY OF DOH – Quality is above quantity ACCESSIBILITY – DOH utilize strategies for delivery of health services  Local Health System and Devolution of Health Services RA 7160 THE 1991 LOCAL GOVERNMENT CODE  was enacted to bring about genuine and meaningful local autonomy. This will enable local governments to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals.  Devolution refers to the act by which the national government confers power and authority upon the various LGU’s to perform specific functions and responsibilities.  R.A 7160 provided for the creation of the Provincial Health Board and the City/Municipal Health boards, or Local Health Boards.  The chairman of the board is the local executive- the Provincial Governor/ Mayor. The Provincial/ City/ Municipal Health Officer serve as vice chairman.  Members of the local health board are composed of the chairman of the committee on health of the Sanggunian, a representative from private sector or NGO involved in health services, and a representative of the DOH. The functions of local health boards are as follows: 1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of health facilities and services within the province/city/municipality; 2. Serving as an advisory committee to the Sanggunian on health matters; and 3. Creating committees that shall advise local health agencies on various matters related to health service operations. The Rural Health Unit The RHU, commonly known as health center, is a primary level health facility in the municipality. The focus of RHU is preventive and promotive health services and the supervision of BHSs under its jurisdiction. The recommended ratio of RHU to catchment population is 1 RHU: 20,000 populations. The Barangay Health Station The BHS is the first contact health care facility that offers basic services at the barangay level. It is a satellite station of the RHU. It is manned by Volunteer Barangay Health Workers (BHW’s) under the supervision of Rural Health Midwife (RHM).  The Rural Health Unit Personnel The Municipal Health Officer (MHO) or Rural Health Physician heads the health services at the municipal level and carries out the following roles and functions: 1. Administrator of the RHU a. Prepares the municipal health plan and budget b. Monitors the implementation of basic health services c. Management of the RHU staff 2. Community physician a) Conducts epidemiological studies b) Formulates health education campaigns on disease prevention c) Prepares and implements control measures or rehabilitation plan 3. Medico-legal officer f the municipality. The revised implementing rules and regulations (IRRSs) of R.A. 7305 or the Magna Carta of Public Health Workers stipulate that there be one rural health physician to a population of 20,000.  The Rural Health Unit Personnel The Public Health Nurse (PHN): 1. Supervise and guides all RHMs in the municipality. 2. Prepares the FHIS (Field Health Service Information System) quarterly and annual reports of the municipality for submission to the Provincial Health Office. 3. Utilize the nursing process in responding to health care needs, including needs for health education and promotion of individuals, families and catchment community. 4. Collaborate with the other members of the health team, government agencies, private business, NGO’s and people organizations to address the community’s health problems.  Classification of Health Facilities ( DOH AO – 2012- 0012 ) Forms of Health Service Delivery in the Philippines Public Sector Private Sector Financed through taxes Profit and non-profit health Budgeting is done at local and provider national level Usually market-driven Healthcare services are free at the Services are not free point of care LGU direct delivery of public health services DOH – provides technical assistance Levels of Health Care Services and Facilities The DOH issued Administrative Order 2012-0012 (Rules and Regulations Governing the new Classification of Hospitals and Other Health Facilities in the Philippines) that provides for a new classification scheme of health facilities.  CLASSIFICATION OF HOSPITALS A. ACCORDING TO OWNERSHIP Government Private B. ACCORDING TO SCOPE OF SERVICE General Facilities/Hospitals – PGH, JRMMC Specialty Centers/Hospitals – PHC, NKTI, PCMC C. ACCORDING TO FUNCTIONAL CAPACITY  DOH administrative Order 2012-0012 classifies other health facilities as follows: Category A. Primary Health Care Facility – a first contact health care facility that offers basic service including emergency services and provision for normal deliveries. 1. Without in-patient beds like health centers, out-patient clinics, and dental clinics. 2. With in-patient beds – a short-stay facility where the patient spends on the average of one to two days before discharge. Ex: Infirmaries and birthing (Lying-in) facilities. Category B. Custodial Care Facility – a health facility that provides long-term care, including basic services like food and shelter, to patients with chronic conditions 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. Ex: Custodial health care facilities, substance/drug abuse treatment and rehabilitation centers, sanitaria, leprosaria, and nursing homes. Category C. Diagnostic/Therapeutic Facility - a facility for the examination of the human body, specimens from the human body for the diagnosis, sometimes treatment of disease or water for drinking analysis. The test covers the preanalytical, analytical and post analytical phases of examination. This category is further classified into: 1. Laboratory Facility, such as, but not limited to the following: a) Clinical laboratory b) HIV/testing laboratory c) Blood service facility d) Drug testing laboratory e) Newborn screening laboratory f) Laboratory for dringking water analysis. 2. Radiologic facility providing services such as X-ray, CT scan, mammography, MRI, and ultrasonography. 3, Nuclear medicine facility- a facility regulated by the Philippine Nuclear Research Institute utilizing applications of radioactive materials in diagnoses, treatment, or medical research, with the exception of the use of sealed radiations sources in radiotherapy as in internal radiation therapy. Category D. Specialized outpatient facility – a facility that performs highly specialized procedures on a outpatient basis. Ex: Dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/clinic, cancer radiation facility, and physical medicine and rehabilitation center/clinic. The Health Referral System  A referral is a set of activities undertaken by a health care provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient’s need.  A functional referral system is one that ensures the continuity and complementation of health and medical services.  It usually involves movement of a patient from the health center of first contact and the hospital at first referral level.  When hospital intervention has been completed, the patient is referred back to the health center. This accounts for the term two-way referral system.