HIS-MLS Lecture 2: Introduction to Health Care System PDF

MT TERM HIS-MLS LECTURE \ ANIÑON 01...

MT TERM HIS-MLS LECTURE \ ANIÑON 01 HIS LESSON 2: INTRODUCTION TO HEALTH CARE SYSTEM (1) IMPROVING THE HEALTH POPULATIONS Improving population health is the overarching goal. OUTLINE Health status should be measured over the entire I Definition of Health Care System population and across different socioeconomic groups. A Goals and Functions of Health System The safety of populations must be protected from existing B 4 Vital Health System Functions health risks and emerging health risks. There should be II Revenue Collection, Risk Pooling & Strategic Purchasing preparations for resilience to future but still unknown III WHO Health System Framework IV Philippine Health System health risks. Health systems should strive for equity in A Historical Background health. Inequitable disparities in health are to be B Leadership and Governance minimized. C Decentralized and Centralized Sources of inequitable disparity in health may include: D Directions of the Philippine Health Sector Income Ethnicity Occupation i The Philippine Health Agenda Gender Geographic Location Sexual orientation ii The Philippine Development Plan 2017-2022 iii NEDA AmBisyon Natin 2040 iv Sustainable Development Goals 2030 (2) IMPROVING THE RESPONSIVENESS OF THE V Key Points to Remember HEALTH SYSTEM TO THE POPULATION IT SERVES Responsiveness represents the concept that the health system provides services in the manner that people want INTENDED LEARNING OBJECTIVES or desire and engages people as active partners. Define health system in the international, national, and It embodies values of: local perspectives. Respectfulness Humaneness Identify the goals and functions of a health system. Non-discrimination Confidentiality Explain the relationship between the system building Health systems have an obligation to respond to the blocks and health outcomes; and legitimate non-health desires and expectations of the Familiarize themselves with the structure of the Philippine population. Responsive health systems maximize Health System people’s autonomy and control, allowing them to make choices, placing them at the center of the health care DEFINITION OF HEALTH CARE SYSTEM system. According to Bertalanffy, a "system" is an arrangement of parts and their interconnections come together for a (3) FAIRNESS IN FINANCIAL CONTRIBUTION purpose Health system is "the combination of resources, An ideal health system will provide social and financial risk organization, financing, and management that protection in health and be fairly financed. Paying for culminate in the delivery of health services to the health care should not impoverish individuals or families. health population (Roemar, 1991).” All health systems must be financed, and there must be Health system is consisting of many parts such as the: adequate funding in the system to provide essential o Community services. o Department Or Ministries of Health A WHO definition of a fairly financed health system is one o Health Care Providers that does not deter individuals from receiving needed care o Health Service Organizations due to payments required at the time of service and one in o Pharmaceuticals Companies which each individual pays approximately the same o Health Financing Bodies percentage of their income for needed services. o Other Organizations Related to Health Care A health financing system that deters people from seeking Functions such as governance including policy-making needed services or impoverishes individuals and families and regulation, health care service provision including will worsen health outcomes. clinical services and health promotion, financing, and managing resources serve as the interconnections of a 4 VITAL HEALTH SYSTEM FUNCTIONS health system. 1. Health Service Provision In World Health Organization Report in 2000, health 2. Health Service Inputs system was defined as "all the organizations, 3. Stewardship institutions and resources that are devoted to producing health actions." 4. Health Financing On the other hand, health action is defined as "any effort, whether in personal health care, public health (1) IMPROVING THE HEALTH POPULATIONS services or through intersectoral initiatives, whose Public and private health service provision is the most primary purpose is to improve health." visible product of the health care system. The best systems also promote health and try to avert illness GOALS AND FUNCTIONS OF HEALTH SYSTEM through education and preventive measures. All these roles and activities mean that the system has to perform a WHO has identified 3 main goals for health systems: wide range of activities. 1. Improving the health of populations "Delivering health services is thus an essential part of what 2. Improving the responsiveness of the health system to the system does” but it is not what the system is" (WHO the population It serves 2000) 3. Fairness in financial contribution  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM (2) HEALTH SERVICE INPUTS (1) BRISMARCK MODEL Health service inputs or managing resources is the (Bismarck's Law on Health Insurance of 1883) assembling of essential resources for delivering health Named for the Prussian Chancellor Otto von Bismarck, services. who invented the welfare state as part of the unification of These include human resources, medications, and Germany in the 19th century. medical equipment. Despite its European heritage, this system of providing This function is generally outside the immediate control of health care would look fairly familiar to Americans. health system policy makers who have to respond to short- It uses an insurance system - the insurers are called term population needs with whatever resources are "sickness funds" - usually financed jointly by employers available. and employees through payroll deduction. Unlike the U.S. insurance industry, though, Bismarck-type (3) STEWARDSHIP health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be Stewardship or the overall system oversight sets the private in Bismarck countries; Japan has more private context and policy framework for the overall health system. hospitals than the U.S. This function is usually a governmental responsibility. o Although this is a multi-payer model, tight regulation Identifying the health priorities to which public resources gives government much of the cost-control clout that should be targeted, the institutional framework in which the the single-payer Beveridge Model provides. system and its many actors should function, activities that The Bismarck model is found in Germany, France, should be coordinated with other systems external of Belgium, Netherlands, Japan, Switzerland, and, to a health care and trends in health priorities and resource degree, in Latin America. generation and their implications are the core of the stewardship function. Furthermore, an additional central function of stewardship is generating appropriate data for policy-making ranging from public health surveillance data to health system performance and provide the basis for assessing health status, regulating the sector, and tracking health system performance, effectiveness and impact. (3) HEALTH FINANCING Health system financing includes collecting revenues, pooling financial risk, and allocating revenue. REVENUE COLLECTION This entails collection of money to pay for health care services. (2) BEVERIDGE MODEL Revenue collection mechanisms are: (from the report on Social Insurance and Allied Services of o General Taxation 1942-The Beveridge Report) o Donor Financing Named after William Beveridge, the social reformer who o Mandatory Payroll Contributions designed Britain’s National Health Service. o Mandatory or Voluntary Risk-Rated Contributions In this system, health care is provided and financed by the o Direct Household out-of-pocket Expenditures government through tax payments, just like the police o Other Forms of Personal Savings. force or the public library. Traditionally, each method of revenue collection is Many, but not all, hospitals and clinics are owned by the associated with a specific way of organizing and pooling government; some doctors are government employees, funds and buying services. but there are also private doctors who collect their fees o For example, public health systems are typically from the government. financed through general taxation, and social security o In Britain, you never get a doctor bill. These systems organizations are usually financed through mandatory tend to have low costs per capita, because the contributions from workers and employers (payroll government, as the sole payer, controls what doctors contributions). can do and what they can charge. Countries using the Beveridge plan or variations on it RISK POOLING include Great Britain, Spain, most of Scandinavia and This refers to the collection and management of financial New Zealand, Hongkong and Cuba (represents the resources in a way that spreads financial risks from an extreme application of the Beveridge approach wherein it individual to all pool members (WHO 2000). is considered as the world’s purest example of total Financial risk pooling is the core function of health government control.) insurance mechanisms. In most developing countries, multiple and fragmented Participation in effective risk pooling is essential to ensure forms of risk-pooling arrangements coexist. Population financial protection. participation in risk pooling is lowest in LICs and among It is also essential to avoid payment at the moment of the poor. It is also low in MICs among the informal and utilizing the services, which can deter people, especially self-employed population. the poor, from seeking health care when sick or injured. It is also a healthcare system in which the government Each society chooses a different way of pooling its provides healthcare for all its citizens through the income people’s financial risk to finance its health care system. tax payment. It is also designed by the national health service creator, Lord William Beveridge. This socializing Most high-income countries medicine model is currently found in Great Britain, Spain, follow one of the two main models: and New Zealand. Bismarck model (Bismarck’s Beveridge model Law on Health Insurance of1883) | 1D-MT 2  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM (4) MEDICAL PRODUCTS, VACCINES, AND TECHNOLOGIES ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use. (5) FINANCING raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. (6) LEADERSHIP AND GOVERNANCE involves ensuring strategic policy frameworks exist and are combined with effective stewardship, coalition STRATEGIC PURCHASING building, the provision of appropriate regulations and incentives, attention to system-design, and accountability. Strategic purchasing is the way most risk-pooling organizations or purchasers use collected and pooled PHILIPPINE HEALTH SYSTEM financial resources to finance or buy health care services for their members. 2.4.1 HISTORICAL BACKGROUND In the practical, day-to-day interaction between purchasers and providers, the purchaser, within a The major areas of the following health reform initiatives regulatory framework, plays a key role in defining a are the health service delivery, health regulation and substantial part of the external incentives for providers to health financing. These health reforms targeted to address develop appropriate provider-user interaction and health issues such as poor accessibility, inequity and inefficiency. service delivery models. o HEALTH REFORMS WHO HEALTH SYSTEM FRAMEWORK 1979: Adoption of Promoted participatory Primary Health Care management of the local health SYSTEM BUILDING OVERALL GOALS / care system. BLOCKS OUTCOMES 1982: Reorganization Integrated public health and Service Delivery of DOH hospital services. Health Workforce Access o Improved Health 1988: The Generics Prescriptions are written using (LEVEL AND EQUITY) Information Coverage Act the generic name of the drug. o Responsiveness Medical Products, Vaccines & → o Social and 1991: RA 7160 "Local Transfer of responsibility of Government Code" health service provisions to the Quality Financial Risk Technologies local government units. Safety Protection Financing o Improved 1995: National Health Aims to provide all citizens a Leadership / Act mechanism for financial Efficiency Governance protection with priority given to the poor. These system building blocks have the access coverage 1999: Health Sector Major organizational or quality safety for overall goals/outcomes. Reform Agenda restructuring of the DOH to For the purpose of clearly discussing what the World improve the way health care is Health Organization (WHO) will do to help strengthen delivered, regulated and health systems, the functions identified in the World health financed. report 2000 have been broken down into a set of six 2005: FOURmula Adoption of operational essential groups. These are needed to improve targeted One (F1) for Health framework to undertake reforms health outcomes or overall goals. with speed, precision, and effective coordination. (1) SERVICE DELIVERTY 2008: RA 9502 Promote and ensure access to those which deliver effective, safe, quality personal and "Access to Cheaper affordable quality drugs and non-personal health interventions to those who need and Quality Medicines medicines for all. them, when and where needed, with minimum waste of Act" resources. 2010: AO 2010-0036 Universal health coverage and "Kalusugang access to quality health care for (2) HEALTH WORKFORCE Pangkalahatan" all Filipinos. one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances. 2.4.2 LEADERSHIP AND GOVERNANCE For example, there are sufficient numbers and mix of staff, The Department of Health is mandated to provide fairly distributed; they are competent, responsive and national policy direction and develop national plans, productive. technical standards and guidelines of health. It also provides technical assistance, capacity building and (3) INFORMATION advisory services for disease prevention and control and one that ensures the production, analysis, dissemination supplies medicines and vaccines. and use if reliable and timely information on health Under the Local Government Code (1991), LGUs were determinants, health systems performance and health granted autonomy and responsibility for their own health status. services. National health programs are coordinate by the DOH through the LGUs. | 1D-MT 3  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM The LGUs make up the political subdivisions of the Philippines. LGUs are guaranteed local autonomy under the 1987 Constitution and the LGC of 1991. The Philippines is divided into: o 78 provinces headed by governors o 138 cities and 1496 municipalities headed by mayors o 42 025 barangays or villages headed by barangay chairpersons (NSCB, 2010). Legislative power at local levels is vested in their respective local legislative councils. Administratively, these LGUs are grouped into 17 regions. Within this decentralized setting, the LGUs continue to receive guidance from the DOH through its network of DOH representatives under the supervision of the regional health offices. Provincial governments provide hospital care through provincial and district hospitals and to coordinate health service delivery provided by cities and municipalities of the provinces. City and municipal governments provide primary care through public health and primary health care centers linked to peripheral barangay health centers (BHCs) or health outposts 2.4.4 DIRECTIONS OF THE PHILIPPINE HEALTH SECTOR 1. The Philippine Health Agenda (DOH Administrative Order 2016-0038) 2.4.3 DECENTRALIZED AND CENTRALIZED Under the decentralized or devolved structure, the state is represented by national offices and the LGUs, with provincial, city, municipal, and barangay or village offices. The DOH, LGUs and the private sector participate, cooperate and collaborate in the care of the population. Before devolution, the national health system consisted of a three-tiered system under the direct control of the DOH: tertiary hospitals at the national and regional levels; provincial and district hospitals and city and municipal health centers; and barangay (village) health centers. Since enactment of the 1991 LGC, the government health system now consists of basic health services “including health promotion and preventive units“ provided by cities and municipalities, province-run provincial and district hospitals of varying capacities, and mostly tertiary medical centers, specialty hospitals, and a number of re- nationalized provincial hospitals managed by the DOH. The DOH as mandated has the duty to: 1. Developing health policies and programs; The health system guarantees that we have the goals of 2. Enhancing partner's capacity through technical financial risk protection, better health outcomes, and assistance; responsiveness. 3. Leveraging performance for priority health Tagline: "All for Health Towards Health For All" rally programs among these partners; point for its vision of a Health Philippines by 2020. It 4. Developing and enforcing regulatory policies and standards; expanded the scope of the Universal Health Care (UHC) directions, particularly through a whole-of-government 5. Providing specific programs that affect large approach. segments of the population; 6. Providing specialized and tertiary level care. | 1D-MT 4  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM It has 3 key health system guarantees. These are: AMBISYON NATIN 2040 o Population and individual-level interventions for all life o Investing in People and Protection Against stages that promote health and wellness, prevent and Instability treat the triple burden of disease, delay complications, ▪ Universal Health Coverage rehabilitation and provide palliation. ▪ Strengthen Implementation of RPRH Law o Access to health interventions through functional ▪ War Against Drugs Service Delivery Networks (SDNs). ▪ Additional Funds from PAGCOR o Financial risk protection when accessing these interventions through Universal Health Insurance. Our Strategy (ACHIEVE) o A - Advance quality, health promotion and primary care Goal: Attain Health-Related SDG Targets o C - Cover all Filipinos against health-related financial o Financial Protection risk ▪ Filipinos, especially the poor, marginalized and o H - Harness the power of strategic HRH development vulnerable are protected from high cost of o I - Invest in eHealth and data for decision-making healthcare. o E - Enforce standards, accountability and transparency o Better Health Outcomes o V - Value all clients and patients, especially the poor, ▪ Filipinos attain the best possible health outcomes marginalized, and vulnerable with no disparity. o E - Elicit multi-sectoral and multi-stakeholder support o Responsiveness for health ▪ Filipinos feel respected, valued, and empowered Advance quality, health promotion and primary care in all of their interaction with the health system. 1. Conduct annual health visits for all poor families Values: Equity, Efficiency, Quality, Transparency and special populations (NHTS, IP, PWD, Senior The health system we aspire is for Citizens) o equitable and inclusive to all 2. Develop an explicit list of primary care entitlements o transparent and accountable that will become the basis for licensing and o uses resources efficiently contracting arrangements o provides high quality services 3. Transform select DOH hospitals into mega- hospitals with capabilities for multi-specialty During the last 30 years of Health Sector Reform, we have training and teaching and reference laboratory undertaken key structural reforms and continuously built 4. Support LGUs in advancing pro-health resolutions on programs that take us a step closer to our aspiration. or ordinances (e.g. city-wide smoke-free or speed COMMON MILESTONES limit ordinances) o Use of generics 5. Establish expert bodies for health promotion and o Milk Code surveillance and response o The department of health resources to promote local Cover all Filipinos against health-related financial risk health system development 1. Raise more revenues for health, e.g. impose o Fiscal autonomy for government hospitals health-promoting taxes, increase NHIP premium o Good governance programs (ISO, IMC, PGS) rates, improve premium collection efficiency. o PhilHealth (1995) – responsible for financing the health 2. Align GSIS, MAP, PCSO, PAGCOR and minimize needs of the Filipino community overlaps with PhilHealth o Devolution 3. Expand PhilHealth benefits to cover outpatient o DOH resources to promote local health system diagnostics, medicines, blood and blood products development aided by health technology assessment o Funding for UHC 4. Update costing of current PhilHealth case rates to ensure that it covers full cost of care and link Persistent Inequities in Health Outcomes payment to service quality o Every year, around 2000 mothers die due to 5. Enhance and enforce PhilHealth contracting pregnancy-related complications. policies for better viability and sustainability o A Filipino child born to the poorest family is 3 times more likely to not reach his 5th birthday compared to Harness the power of strategic HRH development the richest family. 1. Revise health professions curriculum to be more o 3 out of 10 children are stunted. primary care-oriented and responsive to local and global needs Restrictive and Impoverishing Healthcare Cost 2. Streamline HRH compensation package to o Every year, 1.5 million families are pushed to poverty incentivize service in high-risk or GIDA areas due to health care expenditures. 3. Update frontline staffing complement standards o Filipinos forego or delay care due to prohibitive and from profession-based to competency-based unpredictable user fees or co-payments 4. Make available fully-funded scholarships for HRH ▪ Even though doctors have the ability to prolong hailing from GIDA areas or IP groups life, Filipinos are not capable of having this kind of 5. Formulate mechanisms for mandatory return of treatment because of money. service schemes for all heath graduates o Php 4,000/month healthcare expenses considered Invest in eHealth and data for decision-making catastrophic for single income families. 1. Mandate the use of electronic medical records in all Poor quality and undignified care synonymous with health facilities public clinics and hospitals 2. Make online submission of clinical, drug o Long wait times dispensing, administrative and financial records a o Limited autonomy to choose provider prerequisite for registration, licensing and o Less than hygienic restrooms, lacking amenities contracting o Privacy and confidentiality taken lightly 3. Commission nationwide surveys, streamline o Poor record-keeping information systems, and support efforts to improve o Overcrowding & under-provision of care local civil registration and vital statistics 4. Automate major business processes and invest in “All for health towards health for all.” warehousing and business intelligence tools 5. Facilitate ease of access of researchers to available “Lahat Para sa Kalusugan Tungo sa Kalusugan Para data sa Lahat” | 1D-MT 5  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM Enforce standards, accountability and transparency (2) ZERO HUNGER. The number of undernourished 1. Publish health information that can trigger better people has dropped by almost half in the past two performance and accountability decades because of rapid economic growth and 2. Set up dedicated performance monitoring unit to increased agricultural productivity. Many developing track performance or progress of reforms countries that used to suffer from famine and hunger Value all clients and patients, especially the poor, can now meet their nutritional needs. Central and East marginalized, and vulnerable Asia, Latin America and the Caribbean have all made 1. Prioritize the poorest 20 million Filipinos in all health huge progress in eradicating extreme hunger. programs and support them in non-direct health Unfortunately, extreme hunger and malnutrition remain expenditures a huge barrier to development in many countries. 2. Make all health entitlements simple, explicit and widely published to facilitate understanding, & (3) GOOD HEALTH AND WELL-BEING. We have made generate demand great progress against several leading causes of death 3. Set up participation and redress mechanisms and disease. Life expectancy has increased 4. Reduce turnaround time and improve transparency dramatically; infant and maternal mortality rates have of processes at all DOH health facilities declined, we’ve turned the tide on HIV and malaria 5. Eliminate queuing, guarantee decent deaths have halved. Good health is essential to accommodation and clean restrooms in all sustainable development and the 2030 Agenda reflects government hospitals the complexity and interconnectedness of the two. It Elicit multi-sectoral and multi-stakeholder support for takes into account widening economic and social health inequalities, rapid urbanization, threats to the climate 1. Harness and align the private sector in planning and the environment, the continuing burden of HIV and supply side investments other infectious diseases, and emerging challenges 2. Work with other national government agencies to such as noncommunicable diseases. Universal health address social determinants of health coverage will be integral to achieving SDG 3, ending 3. Make health impact assessment and public health poverty and reducing inequalities. Emerging global management plan a prerequisite for initiating large- health priorities not explicitly included in the SDGs, scale, high-risk infrastructure projects including antimicrobial resistance, also demand action. 4. Collaborate with CSOs and other stakeholders on budget development, monitoring and evaluation (4) QUALITY EDUCATION. Since 2000, there has been enormous progress in achieving the target of universal primary education. The total enrolment rate in developing regions reached 91 percent in 2015, and the worldwide number of children out of school has dropped by almost half. There has also been a dramatic increase in literacy rates, and many more girls are in school than ever before. These are all remarkable successes. Progress has also been tough in some developing regions due to high levels of poverty, armed conflicts 2. The Philippine Developmental Plan 2017-2022 and other emergencies. In Western Asia and North This is the four key medium-term plans to translate the Africa, ongoing armed conflict has seen an increase in vision of aspirations for the Filipinos and the country. the number of children out of school. This is a worrying trend. While Sub-Saharan Africa made the greatest progress in primary school enrolment among all developing regions – from 52 percent in 1990, up to 78 percent in 2012 – large disparities still remain. Children from the poorest households are up to four times more likely to be out of school than those of the richest households. Disparities between rural and urban areas also remain high. 3. NEDA AmBisyon Natin 2040 This is a collective long-term plan which envisions a better (5) GENDER QUALITY. Ending all discrimination against life for the Filipinos and the country in the next 25 years women and girls is not only a basic human right, it’s o by formulating policies and implementing programs crucial for sustainable future; it’s proven that and implementing programs and projects to attain this empowering women and girls helps economic growth “ambisyon” and development. UNDP has made gender equality 4 areas central to its work and we’ve seen remarkable progress o Building a prosperous, predominantly middle-class in the past 20 years. There are more girls in school now society where no one is poor compared to 15 years ago, and most regions have o Promoting a long and healthy life reached gender parity in primary education. o Becoming smarter and more innovative. o Living in a high-trust society (6) CLEAN WATER AND SANITATION. Water scarcity affects more than 40 percent of people, an alarming 4. Sustainable Developmental Goals 2030 figure that is projected to rise as temperatures do. This is a compilation of 17 developmental goals that Although 2.1 billion people have improved water targets to end poverty, fight inequality and injustice and sanitation since 1990, dwindling drinking water supplies confront issues involving climate change and its effects. are affecting every continent. More and more countries (1) NO POVERTY. Eradicating poverty in all its forms are experiencing water stress, and increasing drought remains one of the greatest challenges facing humanity. and desertification is already worsening these trends. While the number of people living in extreme poverty By 2050, it is projected that at least one in four people has dropped by more than half – from 1.9 billion in 1990, will suffer recurring water shortages. Safe and to 836 million in 2015 – too many people are still affordable drinking water for all by 2030 requires we struggling to meet the most basic human needs. invest in adequate infrastructure, provide sanitation facilities, and encourage hygiene. Protecting and | 1D-MT 6  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM restoring water-related ecosystems is essential. rising populations and increasing migration—has led to Ensuring universal safe and affordable drinking water a boom in mega-cities, especially in the developing involves reaching over 800 million people who lack world, and slums are becoming a more significant basic services and improving accessibility and safety of feature of urban life. Making cities sustainable means services for over two billion. In 2015, 4.5 billion people creating career and business opportunities, safe and lacked safely managed sanitation services (with affordable housing, and building resilient societies and adequately disposed or treated excreta) and 2.3 billion economies. It involves investment in public transport, lacked even basic sanitation. creating green public spaces, and improving urban planning and management in participatory and inclusive (7) AFFORDABLE AND CLEAN ENERGY. Between 2000 ways. and 2016, the number of people with electricity increased from 78 to 87 percent, and the numbers (12) RESPONSIBLE CONSUMPTION AND PRODUCTION. without electricity dipped to just below one billion. Yet as Achieving economic growth and sustainable the population continues to grow, so will the demand for development requires that we urgently reduce our cheap energy, and an economy reliant on fossil fuels is ecological footprint by changing the way we produce creating drastic changes to our climate. Investing in and consume goods and resources. Agriculture is the solar, wind and thermal power, improving energy biggest user of water worldwide, and irrigation now productivity, and ensuring energy for all is vital if we are claims close to 70 percent of all freshwater for human to achieve SDG 7 by 2030. Expanding infrastructure and use. The efficient management of our shared natural upgrading technology to provide clean and more resources, and the way we dispose of toxic waste and efficient energy in all countries will encourage growth pollutants, are important targets to achieve this goal. and help the environment. Encouraging industries, businesses and consumers to recycle and reduce waste is equally important, as is (8) DECENT WORK AND ECONOMIC GROWTH. Over supporting developing countries to move towards more the past 25 years the number of workers living in sustainable patterns of consumption by 2030. extreme poverty has declined dramatically, despite the lasting impact of the 2008 economic crisis and global (13) CLIMATE ACTION. There is no country that is not recession. In developing countries, the middle class now experiencing the drastic effects of climate change. makes up more than 34 percent of total employment – Greenhouse gas emissions are more than 50 percent a number that has almost tripled between 1991 and higher than in 1990. Global warming is causing long- 2015. However, as the global economy continues to lasting changes to our climate system, which threatens recover we are seeing slower growth, widening irreversible consequences if we do not act. The annual inequalities, and not enough jobs to keep up with a average economic losses from climate-related disasters growing labour force. According to the International are in the hundreds of billions of dollars. This is not to Labour Organization, more than 204 million people were mention the human impact of geo-physical disasters, unemployed in 2015. which are 91 percent climate-related, and which (9) INDUSTRY, INNOVATION, AND INFRASTRUCTURE. between 1998 and 2017 killed 1.3 million people, and Investment in infrastructure and innovation are crucial left 4.4 billion injured. The goal aims to mobilize US$100 drivers of economic growth and development. With over billion annually by 2020 to address the needs of half the world population now living in cities, mass developing countries to both adapt to climate change transport and renewable energy are becoming ever and invest in low-carbon development. more important, as are the growth of new industries and information and communication technologies. (14) LIFE BELOW WATER. The world’s oceans – their Technological progress is also key to finding lasting temperature, chemistry, currents and life – drive global solutions to both economic and environmental systems that make the Earth habitable for humankind. challenges, such as providing new jobs and promoting How we manage this vital resource is essential for energy efficiency. Promoting sustainable industries, and humanity as a whole, and to counterbalance the effects investing in scientific research and innovation, are all of climate change. Over three billion people depend on important ways to facilitate sustainable development. marine and coastal biodiversity for their livelihoods. However, today we are seeing 30 percent of the world’s (10) REDUCED INEQUALITIES. Income inequality is on the fish stocks overexploited, reaching below the level at rise—the richest 10 percent have up to 40 percent of which they can produce sustainable yields. Oceans also global income whereas the poorest 10 percent earn only absorb about 30 percent of the carbon dioxide produced between 2 to 7 percent. If we take into account by humans, and we are seeing a 26 percent rise in population growth inequality in developing countries, ocean acidification since the beginning of the industrial inequality has increased by 11 percent. Income revolution. Marine pollution, an overwhelming majority inequality has increased in nearly everywhere in recent of which comes from land-based sources, is reaching decades, but at different speeds. It’s lowest in Europe alarming levels, with an average of 13,000 pieces of and highest in the Middle East. These widening plastic litter to be found on every square kilometre of disparities require sound policies to empower lower ocean. The SDGs aim to sustainably manage and income earners, and promote economic inclusion of all protect marine and coastal ecosystems from pollution, regardless of sex, race or ethnicity. Income inequality as well as address the impacts of ocean acidification. requires global solutions. This involves improving the Enhancing conservation and the sustainable use of regulation and monitoring of financial markets and ocean-based resources through international law will institutions, encouraging development assistance and also help mitigate some of the challenges facing our foreign direct investment to regions where the need is oceans. greatest. Facilitating the safe migration and mobility of people is also key to bridging the widening divide. (15) LIFE ON LAND. Human life depends on the earth as (11) SUSTAINABLE CITIES AND COMMUNITIES. More much as the ocean for our sustenance and livelihoods. than half of us live in cities. By 2050, two-thirds of all Plant life provides 80 percent of the human diet, and we humanity—6.5 billion people—will be urban. rely on agriculture as an important economic resources. Sustainable development cannot be achieved without Forests cover 30 percent of the Earth’s surface, provide significantly transforming the way we build and manage vital habitats for millions of species, and important our urban spaces. The rapid growth of cities—a result of sources for clean air and water, as well as being crucial for combating climate change. Every year, 13 million | 1D-MT 7  TRANS: INTRODUCTION TO HEALTH CARE SYSTEM hectares of forests are lost, while the persistent ! KEY POINTS TO REMEMBER ! degradation of drylands has led to the desertification of 3.6 billion hectares, disproportionately affecting poor Health system is defined as complex of resources, communities. organization, financing and management that come in same purpose of delivering health services to the population. (16) PEACE, JUSTICE, AND STRONG INSTITUTIONS. We According to World Health Organization Report in 2000, cannot hope for sustainable development without health system was defined as "all the organizations, peace, stability, human rights and effective governance, institutions and resources that are devoted to based on the rule of law. Yet our world is increasingly producing health actions." divided. Some regions enjoy peace, security and prosperity, while others fall into seemingly endless cycles of conflict and violence. This is not inevitable and The primary goals of the health system are: must be addressed. Armed violence and insecurity have improved attaining the best average level of health a destructive impact on a country’s development, health care for the entire population and affecting economic growth, and often resulting in outcomes attaining the smallest feasible grievances that last for generations. Sexual violence, differences in health status among crime, exploitation and torture are also prevalent where individuals and groups there is conflict, or no rule of law, and countries must more meeting the people's expectations of take measures to protect those who are most at risk. responsive how they should be treated by health The SDGs aim to significantly reduce all forms of health system workforce and the degree by which violence, and work with governments and communities people are satisfied with the health to end conflict and insecurity. Promoting the rule of law system and human rights are key to this process, as is reducing more equitable distributing the risk that each individual the flow of illicit arms and strengthening the participation health care faces to cost the health care according of developing countries in the institutions of global financing to the ability to pay rather than the risk of governance. illness (17) PARTNERSHIPS FOR THE GOALS. The SDGs can only be realized with strong global partnerships and The FOUR HEALTH SYSTEM FUNCTIONS are: cooperation. Official Development Assistance remained o delivery of health services (appropriate and steady but below target, at US$147 billion in 2017. While cost-effective delivery); humanitarian crises brought on by conflict or natural o resource generation (ensure the right level and disasters continue to demand more financial resources mix of inputs, particularly human resources, and aid. Many countries also require Official technology and capital); Development Assistance to encourage growth and o financing (focusing on two sub-functions): trade. The world is more interconnected than ever. “revenue collection and pooling (to improve Improving access to technology and knowledge is an sustainability and solidarity); important way to share ideas and foster innovation. o “purchasing (with an emphasis on effective Coordinating policies to help developing countries purchasing to improve allocative and technical manage their debt, as well as promoting investment for efficiency); and the least developed, is vital for sustainable growth and o stewardship and initiatives to strengthen development. The goals aim to enhance North-South governance, accountability and responsiveness. and South-South cooperation by supporting national plans to achieve all the targets. Promoting international trade, and helping developing countries increase their A health system consists of all organizations, people exports is all part of achieving a universal rules-based and actions whose primary interest is to promote, and equitable trading system that is fair and open and restore or maintain health. benefits all. This can be analyzed in its totality by using different groups or blocks such as leadership or governance, REFERENCES health care financing, health workforce, medical Notes from the discussion by: products, vaccines an technologies, health information Kristine Abegail Belicena Aniñon, RMT and service delivery. Reference book Health Information System for Medical The Department of Health (DOH) is the lead agency for Laboratory Science (Jose Jurel M. Nuevo) Philippine health care. According to the mandate (E.O. No. Online reference 119, Sec. 3), the DOH shall be responsible for the following: PASMETH Health Information System Student Portal : https://eruditedevforums.com. Formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs Issuance of rules and regulations, licenses and accreditations Promulgation of national health standards, goals, priorities and indicators Development of special health programs and projects and advocacy for legislation on health policies and programs | 1D-MT 8