Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

Module 2
THE HEALTHCARE DELIVERY SYSTEM

MODULE DESCRIPTION

CE
DU
This module presents the policies, standards and legal basis regarding national
health programs, the elements of primary healthcare, level of prevention and universal
health care.

RO
LEARNING OUTCOMES
REP
Given actual clinical setting with supervision the Level II students will:
OT
1. Assume responsibility for lifelong learning, own personal development and
maintenance of competence.
ON

2. Engage in advocacy activities to influence health band social care service

policies and access to services.
3. Model professional behavior as a community health nurse.
ND

PRETEST
P-C

A link will be sent by your instructor.

UN

ACTIVITY

A separate activity will be given by the instructor.

 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

Topic I. The Health Care Delivery System

WORLD HEALTH ORGANIZATION

• Provides the environment that facilitates cooperation and sharing of resources to

promote and protect health and to resolve health problems and alleviate their
effects

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• WHO constitution came into force on April 7, 1948 (World Health Day)
• Headquarters: Geneva, Switzerland

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• 147 country offices and 6 world regional offices

WHO Core Functions

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Objective: the attainment by all people’s highest possible level of health (WHO,
2006) REP
1. Provide leadership and engage in partnerships on matters of health
2. Shape research agenda and promote knowledge
• 5 goals: Capacity, Priorities, Standards, Translation and Organization
3. Set and monitor standards
OT
4. Provide technical support, catalyze change and build sustainable capacity
ON

Sustainable Development Goals (SDGs), a universal call to action to end

poverty, protect the planet and ensure that all people enjoy peace and
prosperity.
ND

These 17 Goals build on the successes of the Millennium Development Goals, while including
new areas such as climate change, economic inequality, innovation, sustainable
P-C

consumption, peace and justice, among other priorities. The goals are interconnected – often
the key to success on one will involve tackling issues more commonly associated with
another.
UN
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

1. End poverty in all forms everywhere

1. End hunger, achieve food security and improved nutrition

and promotte sustainable agriculture

3. Ensure healthy lives and promote well-being for all at all ages

CE
4. Ensure inclusive and equitable quality education and

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promote lifelong learning opportunities for all

4. Achieve gender equality and empower all women and girls

RO
REP
4. Ensure availability and sustainable management of water
and sanitation for all

4. Ensure access to affordable, reliable, sustainable and

modern energy for all
OT

8. Promote sustained, inclusive and sustainable economic

ON

growth, full and productive employment and decent work for

4. Build resilient infrastructure, promote inclusive and

sustainable industrialization and foster innovation
ND

4. Reduce inequality within and among countries

P-C

4. Make cities and human settlements inclusive, safe, resilient

and sustainable
UN

4. Ensure sustainable consumption and production patterns

4. Take urgent action to combat climate change and its impacts

4. Conserve and sustainably use the oceans, seas and marine

resources for sustainable development
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

15. Protect, restore and promote sustainable use of terrestrial ecosystems,

sustainably manage forests, combat desertification and halt reverse land
degradation and halt biodiversity loss

16. Promote peaceful and inclusive societies for sustainable development, development,
provide access to justive for all and build effective, accountable and inclusive institutions
at all levels.

16. Strengthen the means of implementation and revitalize the

CE
global partnership for sustainable development.

DU
Topic II. PHILIPPINE DEPARTMENT OF HEALTH

RO
• GOVERNMENT: Department of Health and Local Government Units (LGU)
REP
– Local Government Code (R.A. 7160), Devolution: LGUs should meet the
priority needs of their communities by providing basic health services

• PRIVATE: for-profit and non-profit agencies

OT
– provides all levels of services and accounts for a large segment of health
service providers in the country
ON

• Financing is provided by 3 major groups

– government (national and local)

ND

– private sources
– social health insurance
P-C

• National Health Insurance Act of 1995 (R.A. 7875) created the Philippine Health
Insurance Corporation (PhilHealth)
UN

– aims for universal health coverage of all Filipino citizens (Congress of the
Philippines, 1995)

VISION: The DOH is the leader, staunch advocate and model in promoting
Health for all in the Philippines.
MISSION: Guarantee equitable, sustainable and quality health for all
Filipinos, especially the poor and shall lead the quest for excellence
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

 In order for public health nurse to fully appreciate the public health system in
this country, it is important to have an uderstanding of the development of the government
agency mandated to protect the health of the people. The following historical account on
the institutional development of the Department of Health was referenced from the
Souvenir Program published during the 1ooth year anniversary of DOH.

THE HISTORICAL BACKGROUND

CE
Pre-Spanish and Spanish Peiords (before 1898)
Traditional health care practices especially the use of herbs and rituals for healing

DU
were widely practiced during these periods. The western concept of public health services in
the country is traced to the first dispensary for indigent patients of Manila ran by a
Franciscan friar that was began in 1577. In 1876, Medicos Titulares, equivalent to provincial

RO
health officers were already existing. In 1888, a Superior Board of Health and Charity was
created by the Spaniards which established a hospital system and a board of vaccination,
REP
among others.

 September 29, 1898

With the primary objective of protecting the health of the American soldiers, General
OT
Orders No. 15 established the Board of Health for the City of Manila.

 1915: Act No. 2468 transformed the Bureau of Health into a commissioned service
ON

called the Philippine Health Services.

THE PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-1945)

ND

 May 31, 1939

Commonwealth Act No. 430 created the Department of Public Health and Welfare, but the
full implementation was only completed through Executive Order No. 317, January 7, 1941.
P-C

Dr. Jose Fabella became the first Department Secretary of Health and Public Welfare in
1941.
UN

 1970: The Restructured Health Care Delivery System was conceptualized.

 June 2, 1978
With the proclamation of martial law in the country, Presidential Decree 1397 renamed the
Department of Health to the Ministry of Health.

 December 2, 1982
Executive Order No. 851 signed by President Ferdinand E. Marcos reorganized the Ministry
of Health as an integrated health care delivery system.

 October 10, 1991

 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

Republic Act 7160 known as the Local Government Code provided for the decentralization
of the entire government.

 EO 102
Mandates the Department of Health to provide assistance to local government units,
people’s organization and other members of civic society.

DEVOLUTION OF HEALTH SERVICES

CE
 RA 7160 or Local Government Code – one of the significant laws that radically

DU
changed the landscape of health care delivery system.
This code aims to: transform local government units into self-reliant
communities and active partners in the attainment of national goals through a

RO
more responsive and accountable local government structure instituted through
the system of decentralization.
 Local Health Board is a good venue for making the local health system more
REP
responsive to the needs of the people and is mandated to propose annual
budgetary allocations for the operation and maintenance of health facilities and
services within the municipality, city or province.
1. At the Provincial level, it is composed of the governor (chair), provincial
OT
health officer (vice chair), chairman of the Committee of Health of the
Sangguniang Panlalawigan, DOH representative and NGO representative.
ON

2. At the municipal level, many public health nurses have been appointed as
DOH representatives. Many of them however, perform dual functions—those
of a public health nurse and those of a DOH representative.
ND

Topic III: PRIMARY HEALTH CARE

P-C

History of Primary Health Care

UN

 Alma Ata Conference of Sept. 6 -12, 1978 (Kazakhstan, formerly Kazakh Soviet
Socialist Republic)

 Alma Ata Declarations of PHC

– Health as Basic Fundamental Right

– Global Burden of Health inequalities
– Economic and Social Development
– Government responsibility
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

 LOI 949, PHC adopted in the Philippines

Health defined by WHO

In the PHC declaration, the WHO defined health as “a state of complete physical, mental and
social wellbeing, and not merely the absence of disease or infirmity”

CE
Public Health Care:

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Alma Ata Declaration: PHC “is essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally accessible to individuals

RO
and families in the community through their full participation and at a cost that the
community and country can afford to maintain at every stage of their development in the
spirit of self-reliance and self-determination”.
HEALTH FOR ALL: Universal Goal of PHC
REP
Health for all means an acceptable level of health for all the people of the world through
OT
community and individual self-reliance.
This policy agenda of “health for all by the
ON

year 2000” technically, was a global strategy

employed in achieving three main objectives:
(1) promotion of healthy lifestyles,
ND

(2) prevention of diseases, and

(3) therapy for existing conditions.
P-C

ELEMENTS/COMPONENTS OF PRIMARY HEALTH CARE

1. Environmental Sanitation (adequate supply of safe water and good waste
UN

disposal)
2. Control of Communicable Diseases
3. Immunization
4. Health Education
5. Maternal and Child Health and Family Planning
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency Treatment
8. Treatment of Locally Endemic Diseases
9. Provision of Essential Drugs
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

STRATEGIES
1. Reorientation and reorganization of the national health care system.
2. Effective preparation and enabling processes for health action at all levels.
3. Mobilization of the people to know their communities and identifying their basic

CE
health needs with the end in view of providing appropriate solutions.
4. Development and utilization of appropriate technology focusing on local indigenous

DU
resources available in and acceptable to the community.
5. Organization of communities arising from their expressed needs which they have
decided to address and that this is continually evolving in pursuit of their own

RO
development.
6. Increase opportunities for community participation in local level planning,
REP
management, monitoring and evaluation within the context of regional and national
objectives.
7. Development of intra-sectoral linkages with other government and private agencies.
8. Emphasizing partnership so that the health workers and the community
OT
leaders/members view each other as partners rather than merely providers and
receiver of health care respectively.
ON

KEY PRINCIPLES OF PHC

• Accessibility, affordability, acceptability, and availability

ND

• Support mechanisms

• Multisectoral approach
P-C

• Community participation

• Equitable distribution of health resources

UN

• Appropriate technology
Levels of Prevention (Leavell and Clark, 1958)
Reduce the effects of disease and injury, and
restore individuals to their optimal level of
functioning.

Early detection and prompt intervention.

General health promotion and specific

protection.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

Topic IV. Universal Health Care

• Kalusugan Pangkalahatan / Aquino Health Agenda (Administrative Order 2010-0036)

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provision of every Filipino of the highest possible quality of health care that is
accessible, efficient, equitably distributed, adequately funded, fairly financed, and

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appropriately used by an informed and empowered public

• Universal Health Care (UHC) Bill into law (Republic Act No. 11223) that automatically

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enrolls all Filipino citizens in the National Health Insurance Program and prescribes
complementary reforms in the health system. REP
• Goal and objectives

– Equity in access to health services – those who need the services should get
them, not only those who can pay for them
OT
– That quality of health services is good enough to improve the health of
those receiving services; and
ON

– Financial-risk protection – ensuring that the cost of using care does not put
people at risk of financial hardship.
ND

• 3 strategic thrusts

– Financial risk protection

P-C

– Improved access to quality hospitals and health care facilities

– Attainment of the health-related MDGs
UN

Public Health Programs

1. THE MATERNAL HEALTH PROGRAM
The overall goal of the program is to improve survival, health and
well-being of mother and unborn through a package of services for
the pre pregnancy, prenatal, natal and post-natal stages.

Essential health service packages available in the health care facilities

a. Antenatal Registration: Every woman has to visit the nearest health facility for
antenatal registration to avail prenatal care services.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

b. Tetanus Toxoid Immunization: This is considered one of the public health

concerns that we need to address among newborns. To protect them from
deadly disease tetanus toxoid immunization is important for pregnant women
and child bearing age women.
c. Micronutrient Supplementation: This is vital for any pregnant woman. These
are necessary to prevent anemia, vitamin A deficiency and other nutritional
disorders.

CE
d. Treatment of Diseases and Other Conditions
e. Clean and Safe Delivery

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2. THE FAMILY PLANNING PROGRAM
The overall goal of Family Planning program is to provide

RO
universal access to family planning information and services
wherever and whenever these are needed.
Family Planning aims to contribute to:
- Reduce infant death
REP
- Neonatal deaths
- Under-five deaths
OT
- Maternal deaths

3. THE CHILD HEALTH PROGRAMS (NEWBORNS, INFANTS AND CHILDREN)

ON

Its main goal is to reduce morbidity and mortality rates for

children 0-9 years with the strategies necessary for program
implementation.
ND

a. Infant and Young Child Feeding: To improve the survival of infants and young
children by improving their nutritional status, growth and development
through optimal feeding.
P-C

b. Newborn Screening: To reduce the preventable deaths of all Filipino newborns

due to more common and rare congenital disorders through timely screening
and proper management.
UN

c. Expanded Program on Immunization: This program aims to reduce the

morbidity and mortality among children against the most common vaccine-
preventable diseases.
d. Management of Childhood illnesses: The Integrated Management of Childhood
Illnesses (IMCI) has been established as an approach to strengthen the
provision of comprehensive and essential health package to the children.
e. Micronutrient Supplementation: This is one of the interventions to address the
health and nutritional needs of infants and children and improve their growth
and survival.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

f. Oral Health: The delivery of basic oral health is the responsibility of the local
government under the Local Government Code of 1991.
g. Child Health: The treatment and care of children.

4. THE ADOLESCENT HEALTH PROGRAM

The program aims to reduce the incidence of teenage pregnancies,

CE
early sexual involvement, early marriages and other reproductive
health problems such as sexually transmitted infections and HIV/AIDS

DU
among others.

5. THE ADULT MEN AND WOMEN

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The essential components of the health care package for adult men
and women is similar to the health services provided to women,
except maybe for gender specific services related to the reproductive
system.
REP
ESSENTIAL HEALTH CARE PACKAGE FOR THE ADULT MEN AND WOMEN
a. Management of Illness
OT
b. Counseling on Substance abuse, sexually and reproductive tract infections
c. Nutrition and diet counseling
d. Mental Health
ON

e. Family planning and responsible sexual behavior

f. Dental care
g. Screening and management of lifestyle related and other degenerative diseases.
ND

6. THE OLDER ADULT

The goal is to reduce morbidity and mortality of older persons and
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improve their quality of life.

7. OTHER HEALTH PROGRAMS

UN

a. Botika ng Barangay: refers to a drug outlet managed by a legitimate

community organization/NGO or the Local Government Unit, with a
trained operator and a supervising pharmacist.
b. Blood Donation Program: Republic Act No. 7719 (NATIONAL BLOOD SERVICES ACT
OF 1994), promotes voluntary blood donation to provide sufficient supply of safe
blood and to regulate blood banks.
c. Dengue Control Program: Early case detection, diagnosis ad correct fluid
management are key factors in reducing dengue morbidity and mortality.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

POSTTEST

A link will be sent by your instructor.

CE
EXTERNAL RESOURCES

DU
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www.who.int › whr › media_centre › 50facts)

apps.who.int › iris › bitstream › ccsbrief_phl_en REP

https://www.rnpedia.com/nuring-notes/community-health-nursing-
notes/community- health-nursing-overview/
OT
REFLECTION
ON

As a nursing student, how much contribution can you give to your community in
implementing the above public health programs.
ND

REFERENCES
P-C

Bailon-Reyes, S.G. (2006). Community health nursing the basics of practice. Philippines:
UN

National Book Store.

Cuevas, FP L., Reyala, J.P., Cruz-Earnshaw, R., Bonito,S., Sitioco, J.M., Serafica, L.C., (2007)
Public Health Nursing in the Philippines. Philippines. National League of Philippine
Government Nurses, Incorporated.
Maglaya, Araceli S. (2004) Nursing practice in the Community. 4th ed. Manila, Philippines:
Argonauta Corporation.