Country's Health Care Delivery

system
 Health Care System
-system in which a country organizes available
resources of the maintenance and improvement
of the health of its citizens and communities.
- an organized plan of health services (Miller-
Keane, 1987)
-a health system comprises all organizations,
institutions and resources devoted to producing
actions whose primary intent is to improve
health. The four essential functions of a health
system have been defined as service provision,
resource generation, financing and stewardship
Health Care Delivery
- rendering health care services to the people
(Williams-Tungpalan, 1981)

Health Care Delivery System

- network of health facilities and personnel
which carries out the task of rendering health
care to the people.
 HEALTH CARE SYSTEM MODELS

• Private enterprise health care

• Social security health model
• Publicly funded health care model
• Social health insurance
Private Enterprise Health Care Model
-purely private enterprise health care systems
are comparatively rare.
-where they exist, it is usually for a
comparatively well-off subpopulation in a
poorer country with a poorer standard of
health care for instance, private clinics for a
small, wealthy expatriate population in an
otherwise poor country.
Social Security Health Model
• refers to social welfare service concerned with
social protection, or protection against socially
recognized conditions, including poverty, old age,
disability, unemployment and others.
• social insurance, where people receive benefits
or services in recognition of contributions to an
insurance scheme. These services typically
include provision for retirement, pensions,
disability insurance, survivor benefits and
unemployment insurance.
Publicly Funded Health Care Model
• where the residents of the country are insured
by the state
• health care that is financed entirely or in
majority part by citizens' tax payments instead
of through private payments made to
insurance companies or directly to health care
providers
Social Health Insurance
• where the whole population or most of
the population is a member of a sickness
insurance company (SHI) is a method for
financing health care costs through a social
insurance program based on the collection of
funds contributed by individuals, employers,
and sometimes government subsidies
characterized by the presence of sickness
funds which usually receive a proportional
contribution of their members' wages.
 Health Status Issues
• Birth
• Death
• Morbidity
• Mortality
• Nutrition
Health Sector
– refers to the groups of services or institutions in the
community or country which are concerned with the
health protection of the population
– May be public (government), private, and non-
governmental health organizations

Functions of the Health Sector

– Direct provision of health services: promotion, prevention,
Dx and Tx, medical rehabilitation
– Development and provision of health manpower, drugs
and medical supplies; financing support
– Research and development
– Coordinating, controlling and directing organizations and
activities associated with other functions
 The Health Sectors
• Government Sectors
• Non Government Sectors
• Private Sectors
 Government Sectors
• consists of the following resident institutional
units: all units of central, state or local
government; all social security funds at each
level of government; all non-profit, non-
market institution that are controlled and
financed by government unit.
• under this health system the public sector
consists of the DOH, LGUs and other national
government agencies providing health
services.
 Non Government Sectors
• any non-profit, voluntary citizens group which
is organized on a local, national or
international level
• sources of funding through membership dues,
private donations, the sale of goods and
services and grants
 Private Sectors
• provides health services in clinic and hospitals by
health insurance in the manufacture and
distribution of medicines, vaccines, medical and
development human resources development and
other health-related services.
• is largely market-oriented and where health care
is paid through user fees at the point of services
includes for profit and non-profit health providers
Health Human Resources
• The human resources for healthcare
enormous but unevenly
distributed. Most health practitioners are in
Metro Manila and other urban centers
• The availability of health professionals in the
domestic health care sector depends on the
number of schools offering health professional
education, the number of students admitted
into medical, nursing, dental and other health
professional schools, and the strictness of
the schooling and examination requirements.
Major Influences on the Health Care System
• Environmental
• Demographic
• Socio-Culture
• Political
• Economic
 Primary Strategies to Achieve Health Goals

• Support for health goal

• Assurance of health care
• Increasing investment for PHC
• Development of National Standard
 Referral System Levels Of Health Care

1. Barangay Health Station (BHS)

-under the management of Rural Health
Midwives ( RHM )
2. Rural Health Unit (RHU)
- under the management or supervision of the
PHN (Public Health Nurse), caters to 1:10000
population
- Acts as manager in the implementation of the
policies and activities if the RHU directly under
the supervision of mho (who acts as
administration)
 DEPARTMENT OF HEALTH
- is the principal agency in health in the
Philippines which is the primary function is to
promote, protect, preserve or restore the health
of the people through the provision and delivery
of health services and through the regulation and
encouragement of providers of health goods and
services (E.O. No. 119. Sec 3).
Vision
Health as a right. Heath for all Filipinos by the
year 2000 and Health in the Hands of the People
by the year 2020.
Mission
The mission of the DOH, in partnership with
the people to ensure equity, quality and
access to health care:
• By making services available
• By arousing community awareness
• By mobilizing resources
• By promoting the means to better health
 MNCHN Strategy aims to achieve the following
intermediate results:
• Every pregnancy is wanted, planned and supported;
• Every pregnancy is adequately managed throughout its
course;
• Every delivery is facility-based and managed by skilled
birth attendants/skilled health professionals; and
• Every mother and newborn pair secures proper post-
partum and newborn care with smooth transitions to
the women’s health care package for the mother and
child survival package for newborn.
MNCHN Service Delivery Network

1. Community Level Providers

-give primary health care services
- include outpatient clinics such as Rural Health Unit (RHU’s), Barangay Health
Stations (BHS) and private clinics as well as their staff (doctor, nurse and midwife)
and volunteer health workers.

Navigation functions include:

 informing families of their health risks,
 assisting families in health risks and needs assessment;
 assisting families develop health use plans such as birthing plans and facilitating
access by families to critical health services and financing sources (e.g. PhilHealth)
Basic service delivery functions include:
 Advocating for birth spacing and counseling on family planning services
 Tracking and master listing of pregnant women, women of reproductive age,
children below 1 yr of age
 Early detection and referral of high-risk pregnancies
 Reporting maternal and neonatal deaths
2. Basic Emergency Obstetrics and Newborn Care
(BEmONC)
 Capable network of facilities and providers can be
based in hospitals, RHUs, BHS, lying-in clinics or
birthing homes
 Facilities operate on 24-hour basis with staff
complement of skilled health professionals such as
doctors, nurses, midwives and medical technologists.
 Can be operated by a midwife who is either under
supervision by rural health physician or has referral
arrangements with a hospital or doctor trained in the
management of maternal and newborn emergencies
 Shall be supported by emergency transport and
communication facilities.
3. Comprehensive Emergency Obstetrics and Newborn Care
(CEmoNC)
 End referral facilities capable of managing complicated
deliveries and newborn emergencies
 Can be private or public secondary or tertiary hospital/s
capable of performing caesarean operations and
emergency newborn care.
 A CEmONC-capable facility is less than 2 hours from the
residence of priority populations or the referring facility.

Able to perform six signal obstetric functions :

 Provide caesarean delivery services
 Blood banking and transfusion services and
 Other highly specialized obstetric intervention
Inter Local Health Zone (ILHZ)
 Unit of the health system created for local health
service management and delivery in the Philippines
 Applied in many developing countries where
responsibility for health services has been
decentralized from national to local health authorities
 Has a defined population within a defined geographical
area and comprises a central or core referral hospital
and a number of primary level facilities such as RHUs
and BHS
 Clustering of municipalities
 Includes all stakeholders involved in the delivery of
health services including community-based and
accessible health care
Composition of ILHZ
1. People community members, CHWs, NGOs, people’s organizations, local
chief executives, other government officials, private sector
2. Boundaries clear boundaries between ILHZ
3. Health facilities
4. Health workers district health team

Core Referral Hospital

1. Main hospital for ILHZ and its catchment population
2. Main point of referral for hospital services from the community, private
medical practitioner and public health services at BHS and RHUs
3. Minimum services
4. Out-patient services
5. Lab and radiological diagnostic services
6. Inpatient care
7. Surgical services sufficient to provide emergency care for basic life
threatening conditions, obstetrics and trauma
 Levels Of Health Care Facilities ( General )

1. Primary Level Of Health Care Facilities

 Devolved to cities and municipalities
 Usually the first contact between the community members and other levels of
health facility
 Center physician, public health nurse, rural health nurse, rural health midwives,
brgy health workers, traditional healers

2. Secondary Level Of Health Care Facilities

 Given by physician with basic health training
 Usually given in health facilities either private owned or government operated
 Infirmaries, municipal, district hospital, out-patient departments

3. Tertiary Level Of Health Care Facilities

 Rendered by specialists in health facilities
 Referral system for the secondary care facilities
 Provided complicated cases and intensive care
 Medical centers, regional and provincial hospitals and specialized hospitals
 Factors contributing to the limited capacity of the country’s health
care system to deliver better health outcomes

1. poor health care financing

2. The inappropriate health service delivery system, where there is
excessive reliance on use of high-end hospital services rather than
primary care, including an ineffective mechanism for providing
public health programmers
3. the brain drain of health professionals
4. the excessively high price of medicines, leading to costly out-of-
pocket payments and inadequate and irrational use;
5. inadequate enforcement of regulatory mechanisms
6. the insufficient effort expended on prevention and control of new
diseases, particularly non-communicable diseases
7. Data adequacy, accuracy and timeliness are other important and
perennial issues to be addressed. The unavailability of timely and
accurate data/information makes it difficult to make appropriate
decisions on policies and programs to improve health care.
 ISSUES AND CONCERNS
Some of the major factors affecting the
country’s health status are as follows:
a) inappropriate health delivery system
b) inadequate regulatory mechanisms and
c) poor health care financing.
 Factors Affecting the Welfare Conditions of Midwives

1. Environment
a) Autonomy
b) Supervisor Support
c) Coverage of work place hazards
d) Communications with colleagues
e) Awards and incentives

2. Empowerment
a) Ability to conduct antenatal care
b) Ability to conduct normal delivery
c) Ability to perform perineal suturing
d) Provision of postnatal care
e) Newborn resuscitation
3. Encouragement
a) Salary packages of midwives
b) Opportunity for professional and
developmental growth
c) Access to continuing education
d) Opportunity for career development
 Barriers that may affect midwives to develop:
1. political threats
2. lack of diversity
3. lack of socialization
4. long duty hours and low remuneration
5. lack of a career ladder
6. natural barriers