10509275 philippine health delivery

8/17/2019 10509275 Philippine Health Delivery

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PHILIPPINE HEALTH DELIVERYPHILIPPINE HEALTH DELIVERY

CARE SYSTEMCARE SYSTEMandand

HEALTH SECTORHEALTH SECTOR

REFORM AGENDAREFORM AGENDA Isabelita M. Samaniego MD


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Session ObjectivesSession Objectives

1. To describe the Philippine Health1. To describe the Philippine Healthsituation.situation.

2. To describe the role of the DOH in the2. To describe the role of the DOH in thehealth care delivery system.health care delivery system.

3. To describe the effect of devolution .3. To describe the effect of devolution .

4. To describe the impact of the programs on4. To describe the impact of the programs onmaternal & child health.maternal & child health.

5. To describe the Health situation in the5. To describe the Health situation in theCity of ManilaCity of Manila


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The Philippines The Philippines

7,100 islands

1,700 LGUs

1 unitary/nationalgovernment


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General Health Status ofGeneral Health Status ofthe Filipinosthe Filipinos

Life Expectancy: 68.6 yrsLife Expectancy: 68.6 yrsFemale: 71.28 ; Male: 66.03Female: 71.28 ; Male: 66.03

Highest: Central LuzonHighest: Central LuzonSouthern TagalogSouthern Tagalog

Lowest: ARMM & Eastern VisayaLowest: ARMM & Eastern Visaya

Impact:Impact: Higher proportion of elderly in generalHigher proportion of elderly in general

populationpopulation

Need to increase health & other socioeconomicNeed to increase health & other socioeconomicinputs in some regionsinputs in some regions


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Crude Birth RateCrude Birth Rate

28.9/1000 population (1946)28.9/1000 population (1946)

30.5 (1950)30.5 (1950)

24.8% (197224.8% (1972lowest)lowest)

30.7 (1973 - 1979)30.7 (1973 - 1979)

Sex ratio: 109:100 (male)Sex ratio: 109:100 (male)


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Crude Death RateCrude Death Rate

1946 to present - steady decline1946 to present - steady decline1959 lowest decline - 7.3/10001959 lowest decline - 7.3/1000

1960 to 1990 - slow but steady1960 to 1990 - slow but steadydeclinedecline

Death Rates: (Death Rates: (highest)highest) infancy &infancy &early childhood, decline by age 10early childhood, decline by age 10and sharp rise by age 40and sharp rise by age 40

Male death rate: 5.6/1000Male death rate: 5.6/1000Female death rate - 3.9/1000Female death rate - 3.9/1000

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Total Fertility Rate Total Fertility Rate

Average number of births that a Average number of births that a woman would have at the end of woman would have at the end ofher reproductive lifeher reproductive life

Important in assessing impact ofImportant in assessing impact offamily planning and reproductivefamily planning and reproductive behavior behavior


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TFR highest in Asia TFR highest in Asia

1995-97: 3.7 children/woman1995-97: 3.7 children/woman

varies with education and location varies with education and location

Urban: 3 children/womanUrban: 3 children/woman

Rural: 4.7 children/womanRural: 4.7 children/woman

without education & with without education & withElementary education: 5/womanElementary education: 5/woman

High school: 3.64/womanHigh school: 3.64/woman

College: 2.9/womanCollege: 2.9/woman


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IMR =IMR = # of deaths below 1 yr xF# of live births


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Infant MortalityInfant MortalityRateRate

Philippines high compared toPhilippines high compared to Thailand, Singapore, Brunei, Japan Thailand, Singapore, Brunei, Japan

Rapid decline from 1970 to 1990Rapid decline from 1970 to 1990(62 & 36.8)(62 & 36.8)

Varies with socioeconomic & Varies with socioeconomic &demographic factorsdemographic factors

Rural - 40.2 ; Urban - 340.9Rural - 40.2 ; Urban - 340.9

MetroManila - lowest;MetroManila - lowest;Eastern Visayas - highestEastern Visayas - highest


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High IMRHigh IMR

low educational statuslow educational status

no antenatal and post natal careno antenatal and post natal care

40 y/o40 y/o

male , small or very small infantsmale , small or very small infants

birth order of 7 and above birth order of 7 and above

previous birth interval


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Impact of High IMRImpact of High IMR

improvement of maternal andimprovement of maternal andchild health carechild health care

uplifting socioeconomicuplifting socioeconomicconditionsconditions


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MMR =MMR =deaths among women directly due to

pregnancy &puerperium Total live births


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Maternal Mortality RateMaternal Mortality RateDeath of a woman duringDeath of a woman duringpregnancy, at childbirth or inpregnancy, at childbirth or inthe period after child birththe period after child birth

An indicator of nation’s health An indicator of nation’s health

1970 - 190/100,00 births1970 - 190/100,00 births1995 - 2nd to Indonesia1995 - 2nd to Indonesia179/100,000179/100,000

Lifetime risk of dying fromLifetime risk of dying frommaternal cause is 1:100maternal cause is 1:100


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Causes of Maternal DeathsCauses of Maternal Deaths

postpartum bleedingpostpartum bleedinghypertensionhypertension

sepsissepsis

obstructed laborobstructed laborcomplications from abortioncomplications from abortion


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TEN LEADING CAUSES OF MORBIDITYNo. & Rate/100,000 Pop!at"o#

P$ILIPPINES, %00%

CAUSECAUSE

MALEMALE FEMALEFEMALE BOTH SEXESBOTH SEXES

Rate**Rate** Rate**Rate** NumberNumber Rate*Rate*

1. Pneumonias1. Pneumonias !1.1!1.1 ""1.#""1.# #!$%&"1#!$%&"1 '$.('$.(

'. )iarreas'. )iarreas ""1.1""1.1 "$'.#"$'.# #'+%!1(#'+%!1( 1!.+1!.+

!. Bron,itis-Bron,ioitis!. Bron,itis-Bron,ioitis #$".1#$".1 #"."#"." +'%+"+'%+" #'.$#'.$

$. /n0uena$. /n0uena &+&.&+&. +''.#+''.# $"$%!""$"$%!"" +(.!+(.!

&. H23ertension&. H23ertension !!."!!." $'#.!$'#.! !($%+(!($%+( !"!.'!"!.'

+. TB Res3irator2+. TB Res3irator2 1+1.(1+1.( 11!.+11!.+ 11$%''111$%''1 1$!.#1$!.#

#. )iseases o0 te Heart#. )iseases o0 te Heart &".'&".' +#.(+#.( &'%'!#&'%'!# +&.#+&.#

". Maaria". Maaria &!.&&!.& $'.+$'.+ !%$!%$ &(.!&(.!

. Ci,4en3o5. Ci,4en3o5 !!."!!." !&.+!&.+ '"%+(('"%+(( !+.(!+.(

1(. Meases1(. Meases !(.&!(.& '.('.( '$%+!'$%+! !1.(!1.(

So'e( %00% F$SIS A##a! Repot

)) ate/100,000 o* +e-+pe'"' pop!at"o#


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TEN LEADING CAUSES OF MORTALITY BY SE

Ne, Rate/100,000 Pop!at"o# &

Pe'e#ta2eP3"!"pp"#e+, %00%

Ca+eCa+eMa!eMa!e Fea!eFea!e

Bot3 See+Bot3 See+

NeNe RateRate Pe'e#t)Pe'e#t)

1. Heart )iseases1. Heart )iseases !%&('!%&(' !(%+!+!(%+!+ #(%1!"#(%1!" "".'"".' 1#.#1#.#

'. 6as,uar S2stem'. 6as,uar S2stem)iseases)iseases

'#%&!+'#%&!+ '1%"!'1%"! $%&1$%&1 +'.!+'.! 1'.&1'.&

!. Mai7nant!. Mai7nantNeo3asmNeo3asm

'(%$$('(%$$( 1"%!"11"%!"1 !"%"'1!"%"'1 $"."$"." ."."

$. Pneumonia$. Pneumonia 1+%#'1+%#' 1#%$"1#%$" !$%'1"!$%'1" $!.($!.( ".+".+

&. A,,i8ents&. A,,i8ents '#%$$"'#%$$" +%1++%1+ !!%+1#!!%+1# $'.!$'.! ".&".&

So'e( %00% P3"!"pp"#e $ea!t3 Stat"+t"'+ ) pe'e#t +3ae *o tota! 4eat3+, a!! 'a+e+,

P3"!"pp"#e+

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Ne, Rate/100,000 Pop!at"o# &Pe'e#ta2e

P3"!"pp"#e+, %00%Ca+eCa+e Ma!eMa!e Fea!eFea!e

Bot3 See+Bot3 See+

NeNe RateRate Pe'e#t)Pe'e#t)

+. Tuber,uosis% a+. Tuber,uosis% a0orms0orms

1%'!1%'! %'1$%'1$ '"%&(#'"%&(# !&.!&. #.'#.'

#. COP) an8 aie8#. COP) an8 aie8,on8itions,on8itions

1!%((#1!%((# +%!1!+%!1! 1%!'(1%!'( '$.!'$.! $.$.

". Certain ,on8itions". Certain ,on8itionsori7inatin7 in teori7inatin7 in te3erinata 3erio83erinata 3erio8

"%&'("%&'( &%+"&%+" 1$%'(1$%'( 1#.1#. !.+!.+

. )iabetes Meitus. )iabetes Meitus +%&'$+%&'$ #%!"#%!" 1!%''1!%'' 1#.&1#.& !.&!.&

1(. Ne3ritis%1(. Ne3ritis%ne3riti, s2n8romene3riti, s2n8romean8 ne3rosisan8 ne3rosis

&%!&"&%!&" !%"!$!%"!$ %1'%1' 11.+11.+ '.!'.!

So'e( %00% P3"!"pp"#e $ea!t3 Stat"+t"'+

) pe'e#t +3ae *o tota! 4eat3+, a!! 'a+e+,P3"!"pp"#e+


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DISEASE PATTERNSDISEASE PATTERNS

Batt!eBatt!e

O*O*

T3e B2+T3e B2+

• E#5"o#e#ta! a#4O''pat"o#a! I++e+


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Main Causes of MaternalMain Causes of MaternalMortalityMortality

1. neonatal delivery & other complications1. neonatal delivery & other complicationsrelated to pregnancy occurring in the courserelated to pregnancy occurring in the courseof labor delivery & puerperium.of labor delivery & puerperium.

2. Hypertension complicating pregnancy ,2. Hypertension complicating pregnancy ,

child birth & puerperiumchild birth & puerperium 3. Post partum hemorrhage3. Post partum hemorrhage

4. Pregnancy with abortive outcome4. Pregnancy with abortive outcome

5. Hemorrhage related to pregnancy5. Hemorrhage related to pregnancy


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DISEASE PATTERNSDISEASE PATTERNS

Sa!!poSa!!po

Po!"o6e!"t"+Po!"o6e!"t"+

Ma!a"aMa!a"a

TBTB

P#eo#"aP#eo#"a

I#7e#8aI#7e#8a

Eo!aEo!a

AIDSAIDS

9a"a#t9a"a#tCe8*e!4+-Ce8*e!4+- :a'o :a'o

SARSSARS

B"4 F!B"4 F!


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Ten Leading Cause of Ten Leading Cause ofInfant MortalityInfant Mortality

1. Respiratory conditions of the fetus & the newborn1. Respiratory conditions of the fetus & the newborn

2. Pneumonia2. Pneumonia

3. Congenital anomalies3. Congenital anomalies

4. Diarrheal diseases4. Diarrheal diseases

5. Birth injury & difficult labor5. Birth injury & difficult labor 6. Septicemia6. Septicemia

7. Meningitis7. Meningitis

8. Avitaminosis & other nutritional disorders8. Avitaminosis & other nutritional disorders

9. Other diseases of the respiratory system9. Other diseases of the respiratory system 10 Measles10 Measles


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Health Care Delivery SystemHealth Care Delivery System

Significant Milestones in publicSignificant Milestones in publichealth care delivery system (25health care delivery system (25years)years)

Adoption of Primary Health Care in Adoption of Primary Health Care in19791979

Integration of public health andIntegration of public health andhospital services in 1983hospital services in 1983(EO 851)(EO 851)


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Reorganization of DOH in 1987Reorganization of DOH in 1987

((EO 119)EO 119)

Devolution of health services inDevolution of health services in

1992 to LGUs (Local Government1992 to LGUs (Local GovernmentCode of 1991 (Code of 1991 (RA 7160)RA 7160)

Streamlining of DOH’s organizationStreamlining of DOH’s organization

and functionsand functions(EO(EO 102)102)


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Department of Health(DOH)

Lead agency

Specialty and regional hospitals, andmedical center

Regional field office in regionsProvincial health teams involved incontrolling malaria and schistosomiasis

Devolution of health services to LGUs


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Provincial and district hospitals- Provincial government

Municipal health units and barangayhealth units - Municipal government

Private Sectorshave important rolesin the provision of health services

Clinics and hospitalsHMO

Manufacture of drugs, medicines & vaccine

Medical supplies & equipmentR & D ; HRD ; health related services


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Vision

The leader of health for all in the Philippines

Mission Guarantee equitable, sustainable and quality

health for all Filipinos, especially the poor, andto lead the quest for excellence in health.


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Overview of the General HealthStatus of Filipinos points toseveral Principles to

Improved Health

1..Universal access to basic healthservices must be ensured

2. The health and nutrition of vulnerable groups must be

prioritized.


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3.. The epidemiologic shift frominfectious to degenerative must

be managed.

4. The performance of the healthsector must be enhanced.


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GOALSGOALS

1. Improve the general healthstatus of the population:

Reduce infant mortality rate

Reduce child mortality rateReduce total fertility rate

Increase life expectancy and quality oflife years


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GOALSGOALS

2.Reduce morbidity, mortality,disability and complications fromthe following diseases anddisorders:

Diarrheas and other food and water borne diseases like typhoid, choleraand hepatitis A

Pneumonia and acute respiratory

infections Tuberculosis


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Dengue

Intestinal parasitism

Sexually transmitted diseases,HIV/AIDS, and other reproductivetract infections

Hepatitis B

Dental caries and other periodontaldiseases

Rheumatic heart disease andrheumatic fever

Coronary heart disease,hypertension and dyslipidemia


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Stroke

Cancer

Diabetes mellitus Asthma and chronic obstructivepulmonary diseases

Nephritis and other kidney diseases

Mental disorders

Protein-energy malnutrition

Iron deficiency anemia

Obesity Accidents, trauma, and injuries


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33..Eliminate the followingEliminate the following

diseases as public healthdiseases as public healthproblems.problems.Schistosomiasis, malaria,filariasis, Rabies, Leprosy

Vaccine preventable diseases:measles, tetanus, diphtheria andpertussis

Vitamin A deficiency and irondeficiency diseases


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4. Eradicate poliomyelitis

5. Promote Healthy life stylePromote healthy diet and nutrition

Promote physical activity and fitness

Promote personal hygienePromote mental health &less stressful life

Prevent smoking & substance abuse

Prevent violent & risk-taking behavior


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6. Promote the Health and Nutrition offamilies & special population

Neonatal & infant healthChildren’s health

Adolescent and youth health

Adult’s health

Women’s healthHealth of older people

Health of indigenous people

Health of overseas Filipino workers

Health of the disabled persons

Health of the rural and urban poor


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StrategiesIncreasing investments for PrimaryIncreasing investments for Primary

Health CareHealth CareDevelopment of National StandardsDevelopment of National Standardsand objectives for healthand objectives for health

Assurance of the Quality of Health Assurance of the Quality of HealthCareCare

Support to the Local Health SystemSupport to the Local Health System

DevelopmentDevelopmentSupport for frontline Health WorkersSupport for frontline Health Workers

Department of Health ProfileDepartment of Health Profile


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Department of Health ProfileDepartment of Health Profile

(Thrust for 2004)(Thrust for 2004)

The Department of Health (DOH) is the principalThe Department of Health (DOH) is the principalhealth agency in the Philippineshealth agency in the Philippines

Responsible for ensuring access to basicResponsible for ensuring access to basicpublic health services to all ilipinos throughpublic health services to all ilipinos throughthe provision of !ualitythe provision of !uality health care andhealth care andregulation of providers of health goods andregulation of providers of health goods andservices.services.


40/89

DOH RoleDOH Role sta"ehol#er in the health sector$ an#sta"ehol#er in the health sector$ an#

a policy an# regulatory bo#y for healtha policy an# regulatory bo#y for health

%s a &a'or Player %s a &a'or Player

technical resourcetechnical resource a catalyer for health policya catalyer for health policy

a political sponsor an#a political sponsor an#

a#vocate for health issues in behalf of thea#vocate for health issues in behalf of the

health sector*health sector*


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DOH OfficesDOH Offices

+, central offices+, central offices

+- .enters for Health Development+- .enters for Health Development

locate# in various regionslocate# in various regions

,0 hospitals an#,0 hospitals an#

4 attache# agencies*4 attache# agencies*


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Central OfficeCentral OfficeOffice of the /ecretary an# five ma'orOffice of the /ecretary an# five ma'or

function clustersfunction clusters

/taff support services/taff support services –Health mergency &anagement /taff Health mergency &anagement /taff

– 1nternal %u#it /taff$1nternal %u#it /taff$

– &e#ia Relations roup&e#ia Relations roup

– Public %ssistance roupPublic %ssistance roup

–&a'or 3onal Offices (uon$ 5isayas&a'or 3onal Offices (uon$ 5isayasan# &in#anao*)an# &in#anao*)


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Zonal OfficeZonal OfficeUndersecretary Undersecretary (head) supported by an(head) supported by an

Assistant Secretary. Assistant Secretary.

&an#ate# to coor#inate an# monitor&an#ate# to coor#inate an# monitor

the implementation of the ff6the implementation of the ff6 –Health /ector Reform %gen#aHealth /ector Reform %gen#a

–7ational Health Ob'ectives7ational Health Ob'ectives

– ocal overnment .o#e 8ith the variousocal overnment .o#e 8ith the various

.enters for Health Development.enters for Health Development


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/ectoral &anagement /upport/ectoral &anagement /upport.luster .luster

–Health Human Resource DevelopmentHealth Human Resource Development9ureau9ureau

–Health Policy Development an# PlanningHealth Policy Development an# Planning9ureau*9ureau*

1nternal &anagement /upport1nternal &anagement /upport.luster .luster –%#ministrative /ervice%#ministrative /ervice

– 1nformation &anagement /ervice1nformation &anagement /ervice

–inance /erviceinance /ervice

–Procurement an# ogisticsProcurement an# ogistics


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Health Regulation .lusterHealth Regulation .luster – 9ureau of Health acilities an# /ervices9ureau of Health acilities an# /ervices

– 9ureau of oo# an# Drugs9ureau of oo# an# Drugs

– 9ureau of Health Devices an# Technology*9ureau of Health Devices an# Technology*

:ternal %ffairs .luster:ternal %ffairs .luster –9ureau of ;uarantine an# 1nternational9ureau of ;uarantine an# 1nternational

Health /urveillanceHealth /urveillance

– 9ureau of 1nternational Health .ooperation9ureau of 1nternational Health .ooperation

– 9ureau of ocal Development9ureau of ocal Development

H lth PH lth P


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Health ProgramHealth ProgramDevelopment .luster Development .luster

7ational .enter for Disease Prevention7ational .enter for Disease Preventionan# .ontrolan# .ontrol

7ational pi#emiology .enter 7ational pi#emiology .enter

7ational .enter for Health Promotion7ational .enter for Health Promotion 7ational .enter for Health acilities7ational .enter for Health acilities

Development*Development*


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.enter for Health Development.enter for Health Development

ResponsibilitiesResponsibilities fiel# operations of the Department in itsfiel# operations of the Department in its

a#ministrative regiona#ministrative region

provi#ing catchment area 8ith efficient an#provi#ing catchment area 8ith efficient an#effective me#ical services*effective me#ical services*

Tas"sTas"s implement la8s$ regulation$ policies an# programs*implement la8s$ regulation$ policies an# programs*

coor#inate 8ith regional offices of the othercoor#inate 8ith regional offices of the otherDepartments$ offices an# agencies as 8ellDepartments$ offices an# agencies as 8ell as 8ith theas 8ith thelocal governments*local governments*

%ttache# %gencies%ttache# %gencies


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%ttache# %gencies%ttache# %gencies

The Philippine Health 1nsurance .orporationThe Philippine Health 1nsurance .orporation implement the national health insurance la8$implement the national health insurance la8$

a#ministers the me#icare program for botha#ministers the me#icare program for bothpublic an# private sectors*public an# private sectors*

The Dangerous Drugs 9oar#The Dangerous Drugs 9oar# coor#inates an# manages the #angerous #rugscoor#inates an# manages the #angerous #rugs

control program*control program*

Philippine 1nstitute of Tra#itional &e#icinePhilippine 1nstitute of Tra#itional &e#icine

%lternative Health .are an# the Philippine%lternative Health .are an# the Philippine7ational %1D/ .ouncil*7ational %1D/ .ouncil*


49/89

Health Regulation .lusterHealth Regulation .luster

– 9ureau of Health acilities an# /ervices9ureau of Health acilities an# /ervices

– 9ureau of oo# an# Drugs9ureau of oo# an# Drugs

– 9ureau of Health Devices an# Technology*9ureau of Health Devices an# Technology*

:ternal %ffairs .luster:ternal %ffairs .luster

–9ureau of ;uarantine an#9ureau of ;uarantine an# 1nternational1nternationalHealth /urveillanceHealth /urveillance

– 9ureau of 1nternational Health9ureau of 1nternational Health.ooperation.ooperation

– 9ureau of ocal Development9ureau of ocal Development

i iH lhS Ch i i


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Health System CharacteristicsHealth System Characteristics(Mainstream)(Mainstream)

Observations on Philippine Health CareObservations on Philippine Health CareSystem - 1992, SolonSystem - 1992, Solon Underinvestment in HealthUnderinvestment in Health

Unequal access to health servicesUnequal access to health services

Inefficiencies in health services utilizationInefficiencies in health services utilization

Regressive tax structureRegressive tax structure

Health Investments


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Health System Characteristics . . .Health System Characteristics . . .

DOH efforts to achieveDOH efforts to achievetechnical excellence andtechnical excellence andequityequity capability to deliver healthcapability to deliver healthservices that are technicallyservices that are technically

excellent at the tertiary levelexcellent at the tertiary level strong service orientation at allstrong service orientation at alllevels of health service deliverylevels of health service delivery

a functional structure of healtha functional structure of healthservices at all levels ofservices at all levels ofgovernment up to the barangaygovernment up to the barangay

levellevel WHO-DOH Study, 1995WHO-DOH Study, 1995


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Health System Characteristics . . .Health System Characteristics . . .

high public acceptance of the DOHhigh public acceptance of the DOH DOH commitment to devolutionDOH commitment to devolution

Devolve# Personnel 9u#get an# acilities


53/89

%.11T1/

HO/P1T% < -=>

RH?@&H.@9H/ < +2$AB0

Devolve# Personnel$ 9u#get an# acilities

RT%17D

HO/P1T%/ C/%71T%R1%

A0

Department of Health

+>>2

PR/O77

,B$0B0

D5O5D

4-$0B0

RT%17D

=2$000

9?DT

P +0*22, 9

D5O5D

HO/P1T% < A>A

RH?@&H.@9H/

+2$AB0

D5O5D

P 4*2+A

RT%17D

P -*0+2 9

. ti . t f D l #


54/89

.omparative .ost of Devolve#

Health unctions by 42? Type

(in 9illion Pesos)

.ities

=

Provinces

A>

&unicipalities

=B

P 2.441 B

P 1.583 B

P 0.109 B

Total Cost of Devolved Health Fuinctions P 4.1 B

Pe!centa"e to Total Cost of Devolved Functions #5.42$

DOH Devolve# .ost .ompare# to


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DOH Devolve# .ost .ompare# to

Other %gencies

(in 9illion Pesos)

DOH

66%

Other

Agencies

(DA, DSWD,

DENR, etc.)

34%

P 4.1 B

P 2.1 B


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HealthStructure(1993 PostHealthStructure(1993 Post


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Health Structure (1993, Post-Health Structure (1993, Post-devolution)devolution)

%

9 .

A Devolved toProv’l Gov’tB Devolved

to City Gov’t

C Devolved toMunicipalGov’t

Office of the /ecretary of Health

:ecutive .ommittee for7ational iel# Operations

+A Regionaliel# Offices

Regional Hosp*

&e#ical .enters

/anitaria

ProvincialHospitals

Provincial HealthOffices

.ity Health

Offices

DistrictHealthOffices

District

&e#icare C&unicipalHospitals

&unicipalHealthOffices

9H/s

ComparingGovernancetoHealthComparingGovernancetoHealth


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Comparing Governance to HealthComparing Governance to HealthStructureStructure

O1. O TH PR/1D7T H%TH /.RT%RE

7%T1O7%O5FT

%7.1/

O1.OR

P?91.H%TH

/R51./

O1. ORHO/P1< T%/

C%.11T1//R51./

O1. OR/T%7<

D%RD/ %7DR?%<

T1O7/

O1.OR

&%7%<&7T

/R51./

O1. OTH .H1O /T%

R1O7% H%TH

O1.

PRO517.1%H%TH O1.

.1TE H%THO1.

D1/TR1.T O1.

R?R% H%TH?71T

9%R%7%EH%TH /T%T1O7

R1O7% 5

PRO517.1%O5FT 5

.1TE O5FT5

&?71.1P% O5FT5

9%R%7%E OR51% 5

7%T1O7%

5

G.?T15 9R%7.H P?91. H%TH /E/T&

7%T1O7%O5FT

%7.1/

7%T1O7%O5FT

%7.1/

7%T1O7%O5FT

%7.1/


59/89

The Administration of The Administration ofDecentralization in HealthDecentralization in Health

Phasing of devolution processPhasing of devolution process Changeover and Transition period to take 5 yearsChangeover and Transition period to take 5 years

DOH and LGUs assumed a relationshipDOH and LGUs assumed a relationship

based on a “partnership” based on a “partnership” Assignment of representatives to LGUs Assignment of representatives to LGUssupervised by a central assistance andsupervised by a central assistance andmonitoring service.monitoring service.

Defining new roles and functions underDefining new roles and functions underdevolution; preparation of a strategy paperdevolution; preparation of a strategy paper


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Changeover to StabilizationChangeover to Stabilization

•Formaltransfer ofpersonnel,assets andliabilitiesfrom theNGA to LGUs

ChangeoverPhase

• Assisting LGUs

• Assuring health

services are notdisrupted

•Building theCapability ofLGUs to manage

health services•DOHrestructuring

TransitionPhase

StabilizationPhase

•FullyautonomousLGUs thatmanage localhealthservices

•DOH fullyexercising its

new functions

DOHMechanismsforDOHMechanismsfor


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DOH Mechanisms forDOH Mechanisms forPartnershipPartnership

Comprehensive Health CareComprehensive Health Care Agreements Agreements

Health Development FundHealth Development Fund

Regional Field Offices as TechnicalRegional Field Offices as TechnicalResource and Health HumanResource and Health HumanResource Development CentersResource Development Centers

Quick Health Response SystemQuick Health Response System


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A A..Comprehensive HealthComprehensive HealthCare Agreements (CHCAs)Care Agreements (CHCAs)

Articulates the roles and Articulates the roles andresponsibilities in theresponsibilities in theimplementation ofimplementation ofpriority health programspriority health programs

Province or city shall beProvince or city shall bedesignated as programdesignated as programcoordinatorcoordinator

LGUs to provideLGUs to provide

counterpart fundingcounterpart funding


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CHCA ...CHCA ...

Provinces will be responsible for insuringProvinces will be responsible for insuringcompliance by their municipalities withcompliance by their municipalities withthese agreementsthese agreements

Failure in compliance will result in partial orFailure in compliance will result in partial or

full suspension of the agreementfull suspension of the agreement Negotiations will be initiated with theNegotiations will be initiated with theexchange of an indicative CHCA packageexchange of an indicative CHCA package

with the LGUs local area-based health plan with the LGUs local area-based health plan

DOH and LGU shall reconcile plans at theDOH and LGU shall reconcile plans at the beginning of the fiscal year beginning of the fiscal year

B HealthDevelopmentB HealthDevelopment


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B. Health DevelopmentB. Health DevelopmentFund (HDF)Fund (HDF)

an anti-povertyan anti-povertyinvestment package forinvestment package forhealth to assist LGUs,health to assist LGUs,NGOs, POs and theNGOs, POs and the

basic sector basic sector

fund intended tofund intended tosupport community-support community-

based health programs based health programs


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HDF ....HDF ....

to be treated as trust fund byto be treated as trust fund byLGUsLGUs

covered by a MOA; LHBcovered by a MOA; LHBresolution is a prerequisiteresolution is a prerequisite

Provincial Health Board toProvincial Health Board tointegrate all HDF-relatedintegrate all HDF-relatedprojectsprojects

DOH to prepare guidelines forDOH to prepare guidelines for

utilizationutilization


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C. DOH Regional Field OfficesC. DOH Regional Field Offices

as Technical Resource andas Technical Resource andHealth Human ResourceHealth Human ResourceDevelopment CentersDevelopment Centers

RFOs serve as technical resourceRFOs serve as technical resourcemanagement centers directing themanagement centers directing theflow and utilization of DOH-flow and utilization of DOH-provided assistance to LGUsprovided assistance to LGUs

f


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Role of RFOsRole of RFOs

assess area-based plans of LGUsassess area-based plans of LGUs negotiate, conclude and monitor CHCAsnegotiate, conclude and monitor CHCAs with LGUs with LGUs

recommend HDF allocationsrecommend HDF allocations

mobilize technical and administrativemobilize technical and administrativeassistanceassistance

generate monitoring reportsgenerate monitoring reports

TechnicalResourceandTechnicalResourceand


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Technical Resource and Technical Resource andHealth Human Dev’tHealth Human Dev’t

Training programs for Training programs forlocal health personnellocal health personnelshall beshall becomprehensivecomprehensive

LGUs to provideLGUs to provideschedules of trainingsschedules of trainingsto LGUsto LGUs

Cost-efficiency inCost-efficiency in

training will be atraining will be aconsiderationconsideration

D QuickHealthResponseD QuickHealthResponse


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D. Quick Health ResponseD. Quick Health ResponseSystemSystem

to be based at RFOs and CO and consists ofto be based at RFOs and CO and consists ofa preventive element (Disaster Managementa preventive element (Disaster ManagementUnits) and a ready health team (STOPUnits) and a ready health team (STOPDeath)Death)

DOH reps to LHBs shall provide the link toDOH reps to LHBs shall provide the link toQHRS; make initial assessmentQHRS; make initial assessment

DOH to declare an epidemic or publicDOH to declare an epidemic or publichealth emergency in consultation withhealth emergency in consultation withLGUsLGUs

iQ ikH lhR


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Quick Health Response ...Quick Health Response ...

DOH to provide assistance even without aDOH to provide assistance even without aformal request from LGUformal request from LGU

DOH may provide continuing assistanceDOH may provide continuing assistancethough joint management by the higherthough joint management by the higher

LGU or DOHLGU or DOH Continuing consultation during theContinuing consultation during theduration of the joint managementduration of the joint management

l d iN R l dF ti


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New Roles and FunctionsNew Roles and Functions

Health Policy DevelopmentHealth Policy Development Guidelines, standard setting, andGuidelines, standard setting, anddevelopment of manuals of operationdevelopment of manuals of operation

Licensing and RegulationLicensing and Regulation

Promulgation of national standards,Promulgation of national standards,goals, priorities and indicatorsgoals, priorities and indicators

Development of special health programsDevelopment of special health programsand projectsand projects

Advocacy for health legislation Advocacy for health legislation National health campaignsNational health campaigns

Reorganized StructureReorganized Structure


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Reorganized StructureReorganized StructureOFICE OF THE

SEC ETA Y

Public Relations ?nit

Health mergency &gt* /taff 1nternal %u#it

%ttache# %gencies

/pecialty Hospitals

Health Human Resource 9ureau Health Policy DevFt an# Planning 9ureau

.enters for Health DevFt

Regional Hospitals$ &e#ical .enters an#

/anitaria

%#mi /ervice 1nfo* &gt* /ervice inance /ervice Procurement an#

ogistics /ervice

HealthRegulations

:ternal %ffairs Health Operations

%&'()*+(T*%)(, -T&CT&/- *) TH/%&'()*+(T*%)(, -T&CT&/- *) TH/


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,%C(, '%/&)/)T )*T-,%C(, '%/&)/)T )*T-

/ecutive Health ("enda

as dete!ined the ,ocalChief /ecutives and the,ocal Health %ffice

,e"islative Health ("endaas dete!ined theCoittee on Health ofthe ,ocal -an""unian

)'%6P!ivate

-ecto!6Counit Healtha"enda as dete!ined the P!ivate -ecto!s7 )'%&e!esentative

D%H Policies7 P!o"!as7P!io!ities th!ou"h D%H&e!esentative

Local Development Council

SanggunianPersonnel Division

Budget Division

Administrative Division

Planning Division

Other Offices with Health Related Concerns

- Office of the reasurer- Local !inance Council

- Population Office

- DS"D

- D#$R

- D#CS

H9

%TPT-

,ocal Health Plan P!o"!a P!io!ities7

&esou!ce (llocation

-uo!t -stes and

&esou!ces to Health Plan

CHC(

Lessonsfrom fiveyearsofLessonsfrom fiveyearsof


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Lessons from five years ofLessons from five years ofdecentralizationdecentralization

Pay attention to geography, because politicalPay attention to geography, because politicaladministration by local governments isadministration by local governments isgoverned by constituencies.governed by constituencies.

Decentralization is a process.Decentralization is a process.

Decentralizing hospitals results to greaterDecentralizing hospitals results to greatercomplexities in adapting to local governmentcomplexities in adapting to local governmentprotocolsprotocols

Equity in resource distribution; commensurateEquity in resource distribution; commensurateto burden of responsibilities transferredto burden of responsibilities transferred

LGUR f H lthLGUR f H lth


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LGU Resources for HealthLGU Resources for Health

Billions of Pesos

Year

1992 1993 1994 1995 1996 19970

+0

20

=040

A0

-0

,0B0

1992 1993 1994 1995 1996 1997

IRA

Requirement

ota! "armar#ed $or %ea!th

Amount Required for Local Health Amount Required for Local Health


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qq

ServicesServices versus versus Total Earmarked Total Earmarkedfor Healthfor Health

Billions of Pesos

Year

LL


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Lessons ...Lessons ...

Strategies for ensuring equity for health workersStrategies for ensuring equity for health workersand local government units should be in place.and local government units should be in place. allocation of resources and assistance based on LGUs relativeallocation of resources and assistance based on LGUs relativefinancial capabilities to fund devolved functionsfinancial capabilities to fund devolved functions

DOH uses the DFB Ratio (DevolutionFinancing Burden Ratio) as a basis forallocating resources and assistance to LGUs

• Health Development Fund

• Comprehensive Health Care Agreement• Financial Augmentation for Health Workers’Benefits

Rlti Fi ilC bilit f


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Relative Financial Capability ofLGUs to Fund Devolved Functions

D9

.ategoryProvinces &unicipalities .ities Total

% 4= 2AB 0 =0+

9 2= >,= + >>,. 4 222 -4 2>0

TOT% ,0 +4A= -A +ABB

* excluding ARMM Provinces, Municipalities and Cities

D9 .ategories 1nterpretation% ? nee#ing the most assistance form the 7ational overnment9 ? can partially cover .OD from its 1R% resources. ? is financially capable of financing all obligations

LLessons


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Lessons ...Lessons ...

Decentralization requires thatDecentralization requires thatpronouncements are madepronouncements are madeauthoritatively and consistently.authoritatively and consistently.

During the transition process, local andDuring the transition process, local and

national health agencies must reachnational health agencies must reachagreement on complementation of healthagreement on complementation of healthservices and technical assistance.services and technical assistance.

an agency, before it is decentralized, hasan agency, before it is decentralized, hasto have a vision and assign units andto have a vision and assign units and

managers to accomplish itmanagers to accomplish it

Whtli h dWhatliesahead


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What lies ahead What lies aheadContinuation of some major problemsContinuation of some major problems

inadequate financial base for devolved functionsinadequate financial base for devolved functions collateral actions working as a counter-stream tocollateral actions working as a counter-stream todecentralizationdecentralization

Changes in administration may resultChanges in administration may result

to changes in policies as well -to changes in policies as well -recentralization?recentralization?

But, devolution can still work.But, devolution can still work.

DecentralizationRecentralization

ROLEOFPHYSICIANROLEOFPHYSICIAN


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PATIENTPATIENT

FAMILY FAMILY

COMMUNITY COMMUNITY

PROFESSIONPROFESSION

$IMSELF$IMSELF

ROLE OF PHYSICIANROLE OF PHYSICIAN

RESPONSIBILITIES


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FOCUS OF CAREFOCUS OF CARE

T3e Pat"e#t "# Co#tetT3e Pat"e#t "# Co#tet

o* t3e Fa"!6o* t3e Fa"!6

T3e Fa"!6 U#"tT3e Fa"!6 U#"t T3e Co#"t6 a+ "tT3e Co#"t6 a+ "t

a;e't+ T3e Fa"!6a;e't+ T3e Fa"!6


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S


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CHALLENGES IN HEALTH CARECHALLENGES IN HEALTH CARE

Boa4e Pe+pe't"5e+ "# $ea!t3( G!oa!Boa4e Pe+pe't"5e+ "# $ea!t3( G!oa!a#4 Lo'a! C3a!!e#2e+a#4 Lo'a! C3a!!e#2e+

Peop!e Epo=ee#t "# $ea!t3 &Peop!e Epo=ee#t "# $ea!t3 &

Co#"t6 Pat"'"pat"o#Co#"t6 Pat"'"pat"o# E#5"o#e#tE#5"o#e#t


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StudentActivityStudentActivity


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Student ActivityStudent Activity

Describe the 6 goals of the DOH to solve theDescribe the 6 goals of the DOH to solve thehealth problems of the nation.health problems of the nation.

Describe 4 strategies to attain the goals .Describe 4 strategies to attain the goals .

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