NCM 231 Unit II (1) PDF

Unit II The Health Care Delivery System Health Care System Refers to all the components providing health care in a country or locality. Defined by WHO as a health system as all organizations, people and actions whose primary intent is to promote, restore or maintain health. ...

Unit II The Health Care Delivery System Health Care System Refers to all the components providing health care in a country or locality. Defined by WHO as a health system as all organizations, people and actions whose primary intent is to promote, restore or maintain health. Health Care Delivery Rendering health care services to the people (Williams-Tungpalan, 1981). Philippine Health Care Delivery System This refers to the network of health facilities and personnel which carries out the tasks and services of rendering health care to the people. Global Scenario and Health Facts Our goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well- being. Millennium Declaration: adopted/agreed to by all Governments in 2000, the MDGs represent the commitments of UN Member States, that is, to reduce extreme poverty and its many manifestations: hunger, disease, gender inequality, lack of education and access to basic infrastructure, and environmental. The millennium goals are eight development goals agreed upon by UN members to achieve by 2015. They were adopted at the Millennium Summit in 2000. Goal 1 is to eradicate extreme poverty and The target of reducing extreme hungry. poverty rates – people living on just $1.25 (70 pesos) a day – by half was met five years ahead of the 2015 deadline. Globally the number of people living in extreme poverty has fallen from 1.9 billion in 1990 to 836 million in 2015. Goal 2 is to achieve universal primary education by ensuring that all boys and girls complete a full course of primary schooling. The primary school enrolment rate in developing regions reached 91 per cent this year, up from 83 per cent in 2000. Goal 3 is to promote gender equality and empower women. Only 74 girls were enrolled in About two two-thirds of developing primary school for every 100 boys countries achieved gender parity in in 1990. Today, 103 girls are primary education. enrolled for every 100 boys. Goal 4 is to reduce child mortality among children under five by two thirds. The global under-five mortality rate has declined by more than half – dropping from 90 to 43 deaths per 1,000 live births. Meaning, 16,000 children under-five continue to die every day from preventable causes. A terrible reality made worse by the fact we know what each one of these major killers are, and what can be done to thwart them. Goal 5 is to improve maternal health. The maternal mortality ratio has been cut nearly in half. This is an impressive result, but as well with goal 4 it falls short of the two-thirds reduction that was aimed for. Goal 6 is to combat HIV/AIDS, malaria and other diseases. According to the UN, over 6.2 million malaria deaths have been averted by 2015 especially in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 per cent and the mortality rate by 58 per cent Goal 7 is to ensure environmental sustainability. By 2015, 2.6 billion people gained access to improved drinking water, meaning access to safe water was achieved and improved sanitation. Goal 8 is to develop a global partnership for development. Official development assistance from wealthy countries to developing countries increased by 66 per cent in real terms between 2000 and 2014, reaching $135.2 billion. How successful was Millennium Development Goals (MDGs) in the Philippines? The Philippines has made considerable progress in attaining the Millennium Development Goals (MDGs). However achieving all the targets remains a daunting challenge, with goals for poverty, education and maternal mortality unlikely to be attained by 2015. Philippine Department of Health The Department of Health is the executive department of the government of the Philippines responsible for ensuring access to basic public health services by all Filipinos through the provision of quality health care, the regulation of all health services and products. Founded: June 23, Department executive: Hon. 1898 Teodoro “Ted” Herbosa, Secretary Headquarters: San Lazaro of Health Compound, Rizal Avenue, Santa Cruz, Manila Annual budget: ₱296.3 billion (2023) Philippine Department of Health: Historical Background Philippine Local System and Devolution of Health Services Health devolution or decentralization of health services was initially geared towards efficiency and effectiveness of health service delivery by reallocating decision-making capability and resources to LGUs (Grundy et al. 2003; Galvez-Tan et al. 2010). Why is the local health system and devolution of health services initiated? To improve the efficiency and effectiveness of health service provision by reallocation of decision making and resources to peripheral areas. This is because the local units would know the current health situation in their own localities. What is the local health system in the Philippines? Public healthcare in the Philippines is administered by PhilHealth, a government-owned corporation. PhilHealth subsidizes a variety of treatments including inpatient care and non- emergency surgeries. Both local citizens and legal residents are entitled to join a PhilHealth program. What is the purpose of local health system? Local health departments work with emergency management and other local officials to plan for and respond to natural disasters, novel disease outbreaks, and bioterrorism threats that can dramatically impact health. What are the problems with healthcare in the Philippines? The shortage of hospitals and surgical equipment are the primary barriers to quality healthcare in the Philippines. Half of the people who live in the Philippines reside in rural areas of the country where there are sometimes no licensed medical doctors and ill-equipped facilities with broken medical devices. Classification of Hospitals 1. According to Ownership 1.1 Government. Created by law under the national government, DOH, LGU, DND, PNP, and SUCs. 1.2 Private. Owned, established and operated with funds through donation, principal, investment or other means by any individual, corporation or investment. 2. According to Scope of Services 2.1 General. Provides services for all kinds of illnesses, diseases, injuries or deformities. 2.2 Specialty. A hospital that specializes in a particular disease or condition or in one type of patient. 2.2.1 Treatment of a particular type of illness or for a particular condition requiring a range of treatment. 2.2.2 Treatment of patients suffering from diseases of a particular organ or groups of organs. 2.2.3 Treatment of patients belonging to a particular group such as: 3. According to Functional Capacity 3.1 General Level 1 hospital Hospitals that do not require an ICU, and cater to clients who need minor care (Dr. Hartigan-Go). If there is a need for a referral, clients can go to a Level 2 hospital. Level 2 hospital contains all the elements of Level 1, as well as additional facilities like an ICU for critically ill patients and specialist doctors for gynecology and pediatric services. Level 3 hospitals are tertiary hospitals and one that can provide all services. Most Level I are trauma centers also. 3.2 Specialty 3.3 Trauma Capability of Hospitals 3.3.1 Trauma Capable Facility. A DOH licensed hospital designated a Trauma Center 3.3.2 Trauma-Receiving Facility. A DOH licensed hospital which receives trauma patients for transport to the point of care or a trauma center. Classification of Other Health Facilities Primary Health Care The essential care made universally accessible to individual and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development (WHO). What is primary health care in the Philippines? “Primary health care means multiple sectors working together to bring care closer to home, with the involvement of the community. The UHC Act is just the beginning of our journey to health for all Filipinos.” Background of PHC: PHC was declared during the First International Conference held in Alma Ata, Russia on September 6-12, 1978 by the WHO. What was the significance of the Alma- Ata conference? The International Conference on PHC in Alma-Ata, Kazakhstan, in 1978, brought together 134 countries and 67 international organizations (China was notably absent). The conference defined and granted international recognition to the concept of primary health care (PHC) as a strategy to reach the goal of “Health for All in 2000”, as indicated in the Declaration released at the conclusion of the conference. Framework of Primary Health Care Goal: Health for all Filipinos and Health in the hands of the people by the year 2020 Mission: to strengthen the health care system by increasing opportunities and supporting conditions wherein people will manage their own health care.  Concept: Primary Health Care (PHC) characterized by partnership and empowerment of people shall permeate as core strategy in effective provision of essential health services Concept: Primary Health Care (PHC) characterized by partnership and empowerment of people shall permeate as core strategy in effective provision of essential health services What is it the relationship between PHC and the Millennium Development Goals? The Millennium Development Goals are a commitment made by the world's nations to improve the health and well-being of people throughout the world, including reducing poverty, infant and maternal mortality and the spread of HIV by 2015. Legal Basis for PHC. October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed by then Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level. October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed by Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level. In PHC, these are strategies aimed at improving the living conditions of communities, reducing the burden of disease, and favoring equity in health. Due to its capacity for strengthening health services, PHC can become a basic strategy for the achievement of these internationally agreed-upon objectives. Why did the Philippines Adopted PHC? Reasons for adopting PHC Magnitude of health problems Inadequate and unequal distribution of health resources Increased cost of medical care Isolation of health care activities from other developmental activities. Principles of PHC 1. 5 A’s = Accessibility, Availability, Acceptability, Appropriateness of health services. Acceptability is “an overall ability of the patient / family / community / barangay or caregiver to use programs under the PHC. Appropriateness meaning services should be properly selected and carried out by trained personnel in the proper way. A nurse should know how to give an injection correctly and safely, Educating children and family or community 2. Partnership between Identification Training of community and of priority community health agencies in needs health workers provision of quality, Developmen basic and t of essential care Recognition promotive, Supervision preventive, and of traditional curative & evaluation of healers in rehabilitativ BHW delivery of e health 3. Community participation (the involvement of people in a community in projects to solve their own problems). Community Mass health discussions campaigns & Awareness community and Selection of mobilization conscious of Building & CHealth Health the health organizing, Workers Committees issues in the planning, community & actions, organizations monitoring & establishmen evaluation t Barriers of Community Participation and Involvement Boredom, stress, burnout, feeling overwhelmed, and a lack of clear goals can lead to a lack of motivation. 4. Self- Income reliance generating projects Training community leaders on leadeship Community Mobilizatio supports n of health for health resources care 5. Recognition of interrelation of health and development Health being a social Development is the quest phenomenon recognizes for an improved quality of the interplay of political, life and it is socio-cultural and multidimensional. economic factors. It has political, social, Good Health is manifested cultural, institutional and by the progressive environmental dimensions improvements in the living (Gonzales 1994). Therefore, conditions and quality of it is measured by the ability life enjoyed by the of people to satisfy their community residents. basic needs. 6. Social mobilization The facilities, providers People and suppliers and the participatio Networking health insurer or plan n and in Health has contracted with to Involvemen Care provide health care t services. Developing Governmen Secondary t support Leaders 7. Decentralization Ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level political structures with more substantive responsibilities for development initiators. This also facilities proper allocation of budgetary resources. Elements of PHC 1. Education for Health Promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. 2. Expanded Program of Immunization BCG- bacillus calmette guerin OPV- oral polio vaccine AMV- anti-measles vaccine DPT- diphtheria pertussis tetanus Anti-Hep B 3. Maternal Child Health and Family Planning The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood. 4. Environmental Sanitation and Promotion of Safe Water Supply Safe Water and Sanitation is necessary for basic promotion of health. 5. Nutrition and Promotion of Adequate Food Supply Kwashiorko Goiter r 6. Locally Endemic Disease Control Malaria. Endemic in Palawan and Mindanao Filariasis. Endemic in southern Luzon, Mindanao, Mindoro, Palawan, Samar, Leyte, Sorsogon and Bohol. Schistosomiasis. Endemic in Mindoro, Sorsogon, Samar, Leyte, Bohol and Mindanao. 7. Treatment of Communicable Diseases and Common Illness The top three causes of death in the country were ischemic heart diseases, cerebrovascular diseases, and neoplasms. 8. Supply of Essential Drugs Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide, Ethambutol, Streptomycin, Albendazole (Schistosomiasis), Quinine (Malaria) Strategies of PHC 1. Elevating Health to a Comprehensive and Sustained National Effort. Participation in health Empowerment to and health related parents, families and programs communities to make decisions of their health 2. Promoting and Supporting Community Managed Health Care The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels. 3. Increasing Efficiencies in the Health Sector Using appropriate Development of technology will make human resources services and that correspond to resources required the needs of the for their delivery, people and the effective, affordable, policies that accessible and considers the culturally people. acceptable. Continuous DOH support and assistance both in public and private sectors in health development, enhancement and development of standard teaching materials. 4. Advancing Essential National Health Research Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery. Pillars of PHC Universal Health Care UHC Law provides that all citizens are automatically entitled to PhilHealth benefits, including comprehensive outpatient services. PhilHealth will be responsible for purchasing all individual-based services, including supplies, medicines, and commodities, as well as maintenance and operating expense of health facilities. When was the UHC law implemented in the Philippines? The Philippines has taken great strides in moving towards universal health coverage. In 2019, the Philippine Universal Health Care Act (UHC), or Republic Act 11223, was signed and the planned implementation in January 2020 was disrupted by the COVID-19 pandemic What are the objectives of UHC in the Philippines? It aims at ensuring that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and are protected against financial risk. What are the goals and objectives of universal health care? Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children. What are the three thrusts of universal health care? National Health Insurance Program (NHIP) Improving the national and regional PhilHealth benefit delivery Upgrade RHU/Health Centers and Hospitals to meet quality standards and PhilHealth accreditation Mobilize community health teams to inform families. Advocate and mobilize community and lobby groups. Strong partnership with DepEd, DILG, DSWD, academe for health service delivery. Formulate Disaster Preparedness Plan with funding support. Encourage “Hataw” activities, sportsfest in communities and offices. Ensure that poorest families are reached by health services. Funding support and continuing training and updates for local health personnel.