3 - Primary Health Care and the Philippine Health Care Delivery System PDF

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primary health care and the PH health care delivery systemLECTUREHEALTH CARE According to the Alma-Ata Declaration of 1978, health is a fundamental human right Most important global goal is for humans to reach the optimal level of their health Requires not only the action of the health sector but th...

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primary health care and the PH health care delivery system LECTURE HEALTH CARE • According to the Alma-Ata Declaration of 1978, health is a fundamental human right • Most important global goal is for humans to reach the optimal level of their health • Requires not only the action of the health sector but the collaboration among other sectors such as those in the social and economic sectors • Common concern of many countries: gross inequality in the people’s health status, which is not socially, economically, and politically acceptable • The government of each country has the duty and responsibility to institute adequate measures to promote and protect its people’s health, and thus achieve a better quality of life • Health care system – “an organized plan of health services” (Miller & Keane, 1987) • Health care delivery – “the rendering of health care services to the people.” (Williams & Tungpalan, 1981) • Health care delivery system – “the network of health facilities and personnel which carries out the task of rendering health care to the people” (Williams & Tungpalan, 1981) PRIMARY HEALTH CARE • Alma-Ata Declaration – primary health care as important health care derived from scientifically sound and socially acceptable methods. It must be universally accessible to all individuals and is based on what the community and country can provide • Deals with social policy which targets health equity • Ultimate goal of primary health care is better health for all • Key elements identified by WHO: o Universal coverage to reduce exclusion and social disparities in health o Service delivery organized around people’s needs and expectations o Public policy that integrates health into all sectors o Leadership that enhances collaborative models of policy dialogue o Increased stakeholder participation ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE Eight Elements of Primary Health Care: 1. Education concerning prevailing health problems and the methods of identifying, preventing, and controlling them 2. Locally endemic disease prevention and control 3. Expanded program of immunization against major infectious disease 4. Maternal and child health care including family planning 5. Essential drugs arrangement 6. Nutritional food supplement, an adequate supply of safe, and basic nutrition

7. Treatment of communicable and non-communicable disease and promotion of mental health 8. Safe water and sanitation Other Elements of Primary Health Care Include: 1. Expanded options of immunization 2. Reproductive health needs 3. Provision of essential technologies for health 4. Health promotion 5. Prevention and control of non-communicable diseases 6. Food safety and provision of selected food supplements PRINCIPLES OF PRIMARY HEALTH CARE • A conceptual shift in health care calls attention to the fact that primary health care should be integrated, and its principles guide the functions of the system as a whole • Health system should: o Consider principles of the Alma-Ata Declaration and other intersectoral approaches o Cover broader health issues of populations while reinforcing public health functions o Come up with programs that provide care and prevent diseases and provision for services especially for the poor and marginalized groups o Able to monitor programs for continuous improvement Basic Objectives to Launch and Sustain Primary Health Care as part of the Comprehensive Health System: 1. Improve the level of health care of the community 2. Promote favorable population growth structure 3. Reduce the morbidity and mortality rates especially among infants and children 4. Reduce prevalence of preventable, communicable, and other diseases 5. Improve basic sanitation 6. Extend essential health services especially to the underserved sectors 7. Develop the capability of the community to become selfreliant 8. Encourage the contribution of other sectors to the social and economic development of the community 9. Provide equitable distribution of health care 10. Ensure community participation and monitor adequacy and distribution of health workers who are supported locally and at the referral levels 11. Recognize that the formal health sector needs other sectors in the promotion of health (multi-sectoral approach) 12. Use the appropriate technology which are accessible, feasible, affordable, and culturally acceptable to the community

MANAGEMENT OF PRIMARY HEALTH CARE Health care managers usually carry out the following functions in the process of management: 1. Planning – setting priorities and determining performance targets. Managers are usually required to set a direction and determining what needs to be accomplished 2. Organizing – designing the organization or the specific division, unit, or service for which the manager is responsible. Furthermore, it means designating reporting relationships and intentional patterns of interactions, determining positions and teamwork assignments, and distributing authority and responsibility 3. Staffing – acquiring and retaining human resources, and developing and maintaining the workforce through various strategies and tactics 4. Controlling – monitoring staff activities and performance and taking the appropriate actions for corrective actions to increase performance 5. Directing – focuses on initiating action in the organization through the effective leadership, motivation, and communication of managers Below are the management principles in relation to organizing: 1. Authority, Responsibility, and Accountability a. Authority – formal and legitimate right of a manager to issue order, make decisions, and allocate resources to achieve desired outcomes of the organization b. Responsibility – duty of the employee to perform the assigned tasks and activities c. Accountability – reporting and justification of task outcomes to higher management by those people with authority 2. Types of authority a. Line authority – managers issue orders to their subordinates and are also responsible for the results b. Functional authority – for managers that have power only over a specific set of activities c. Staff authority – given to specialists in their areas of expertise. The staff manager simply advises, recommends, and counsels 3. Centralization, Decentralization, and Formalization a. Centralization – concentration of planning and decision-making to the top of the organization b. Decentralization – delegation of planning and decision-making to the lower branches of the organization c. Formalization – written documentation provided for the direct control of the employees 4. Staffing As regards to the process staffing, here is the list of functions of the manager: a. Assign individuals to respective positions identified in the management plan

b. Assess required competencies through § Identification of the key result areas (KRAs) per major activity § Determination of the competencies and qualifications c. Required qualified personnel d. Improve existing services and programs by § Reviewing and adjusting the requirements accordingly § Matching the competency requirements vis-àvis the responsible personnel assigned to the activity THE PRIMARY HEALTH CARE SYSTEM • “a complex set of organizations interacting to provide an array of health services” – Dizon (1977) • 1991 – LGUs took over the management of health service delivery but the issue of fragmentation has not been absolutely addressed • Health workforce – deals with the pressing issues of underemployed workers, limited resources, and unequal distribution • Private sector – said to compromise 50% of the overall health system is strongly involved in improving the delivery of health services, but the government’s power to regulate should be optimized DEPARTMENT OF HEALTH MANDATE • Executive Order No. 119, Sec 3 o Ministry of Health (DOH) has the responsibility to create, plan, implement, and systematize national health policies, advocacies, and programs • Primary function – promote, protect, and preserve or restore people’s health by giving health services and by monitoring and motivating health service providers • Responsible for the issuance of health-related licenses and accreditations and disseminating information about national health indicators DOH VISION AND MISSION • DOH Vision BY 2030 o A global leader for attaining better health outcomes, competitive, and responsible health care system, and equitable health financing • DOH Mission o To guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor and to lead the quest for excellence in health LEVELS OF HEALTH CARE FACILITIES 1. Primary Level of Health Care Facilities a. Units operated by the DOH which include the rural health units, their respective sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units b. Puericulture center operated by the League of Puericulture Centers

c. Units operated by the Philippine Tuberculosis Society such as the tuberculosis clinics and hospitals d. Clinics operated by the Philippine Medical Association e. Clinics operated by large industrial firms for their employees f. Health centers and community hospitals operated by the Philippine Medical Care Commission g. Other health facilities operated by voluntary religious and civic groups 2. Secondary Level of Health Care Facilities a. Smaller and non-departmentalized hospitals b. Emergency and regional hospitals where adequate treatments are offered for patients with symptomatic stages of diseases 3. Tertiary Level of Health Care Facilities a. Specialized national hospitals b. Patients who are afflicted with life-threatening diseases requiring highly technical and specialized knowledge, facilities, and personnel are treated here LEVELS OF HEALTH CARE WORKERS 1. Grassroot or Village Health Workers a. They are initial links of the community to health care b. Provide preventive health care measures and simple curatives to promote a healthy environment c. Encourage programs/activities such as food production programs to improve socio-economic level of the community d. Volunteers, community health workers, or traditional birth attendants 2. Intermediate Level Health Workers a. First source of professional health care b. Attend to health problems which are already beyond the competence of the village workers c. Provide supervision, training, supplies, and services that provide support to front-line health workers d. Medical practitioners, nurses, and midwives 3. First-line Hospital Personnel a. When hospitalization is required, they serve as the backup health service providers b. The intermediate level health workers or village health workers are in close contact with them c. They are the physicians with specialty, nurses, dentist, pharmacists, and other health professional Categories of health workers are affected by certain factors such as: 1. Availability of health manpower resources 2. Presence of health care concerns and need of the locality 3. Issue of financial and political feasibility KEY POINTS TO REMEMBER Health is a fundamental human right as cited in the Alma-Ata Declaration of 1978. Reaching the highest possible level of health is important worldwide

Primary health care (PHC) is essential health care made universally accessible through full participation of health care providers and at a cost that the community and the country can afford. The ultimate goal of primary health care is better health for all. The principles of primary health should guide the functions of the system as a whole. Management of primary health care includes planning, organizing, staffing, controlling, and directing. Health care facilities are categorized into primary, secondary, and tertiary levels. Primary health care workers are categorized as grassroot or village health workers, intermediate level health workers, and first-line hospital personnel. The Philippine health care system has progressed due to many challenges through time. The private sector has been strongly engaged but government regulation should be optimized. The primary function of the Department of Health (then Ministry of Health) indicated in EO no. 119 is to promote, protect, preserve, or restore people’s health by giving health services and monitoring health service providers....