Académique Documents
Professionnel Documents
Culture Documents
Isabelita M. Samaniego MD
Session Objectives
7,100 islands
1,700 LGUs
1 unitary/national
government
General Health Status of
the Filipinos
◆ LifeExpectancy: 68.6 yrs
◆ Female: 71.28 ; Male: 66.03
◆ Highest: Central Luzon
Southern Tagalog
◆ Lowest: ARMM & Eastern Visaya
◆ Impact:
❖ Higher proportion of elderly in general
population
❖ Need to increase health & other socioeconomic
inputs in some regions
Crude Birth Rate
❖ 28.9/1000 population (1946)
❖ 30.5 (1950)
❖ 24.8% (1972 lowest)
❖ 30.7 (1973 - 1979)
❖ Sex ratio: 109:100 (male)
Crude Death Rate
❖ 1946 to present - steady decline
❖ 1959 lowest decline - 7.3/1000
❖ 1960 to 1990 - slow but steady
decline
❖ Death Rates: (highest) infancy &
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early childhood, decline by age
10 and sharp rise by age 40
❖ Male death rate: 5.6/1000
❖ Female death rate - 3.9/1000
Total Fertility Rate
❖ Averagenumber of births that a
woman would have at the end of
her reproductive life
Source:
2002 FHSIS Annual Report
** rate/100,000 of sex-specific population
TEN LEADING CAUSES OF MORTALITY BY
SEX
Number, Rate/100,000 Population &
Percentage
Philippines, 2002
Both Sexes
Male Female
Cause Number Rate Percent*
3. Malignant
20,440 18,381 38,821 48.8 9.8
Neoplasm
Source:
2002 Philippine Health Statistics
* percent share from total deaths, all causes,
Philippines
TEN LEADING CAUSES OF MORTALITY BY
SEX
Number, Rate/100,000 Population &
Percentage
Philippines, 2002
Both Sexes
Cause Male Female
Number Rate Percent*
6. Tuberculosis, all
19,293 9,214 28,507 35.9 7.2
forms
8. Certain conditions
originating in the 8,520 5,689 14,209 17.9 3.6
perinatal period
10. Nephritis,
nephritic syndrome 5,358 3,834 9,192 11.6 2.3
and nephrosis
• Environmental and
Occupational Issues
Battle
Of
The Bugs
Main Causes of Maternal
Mortality
◆ 1. neonatal delivery & other complications
related to pregnancy occurring in the course
of labor delivery & puerperium.
◆ 2. Hypertension complicating pregnancy ,
child birth & puerperium
◆ 3. Post partum hemorrhage
◆ 4. Pregnancy with abortive outcome
◆ 5. Hemorrhage related to pregnancy
DISEASE PATTERNS
◆ Smallpox ◆ Ebola
◆ Poliomyelitis ◆ AIDS
◆ Malaria ◆ Variant
Creuzfelds-
◆ TB jacob
◆ Pneumonia ◆ SARS
◆ Influenza ◆ Bird Flu
Ten Leading Cause of
Infant Mortality
◆ 1. Respiratory conditions of the fetus & the newborn
◆ 2. Pneumonia
◆ 3. Congenital anomalies
◆ 4. Diarrheal diseases
◆ 5. Birth injury & difficult labor
◆ 6. Septicemia
◆ 7. Meningitis
◆ 8. Avitaminosis & other nutritional disorders
◆ 9. Other diseases of the respiratory system
◆ 10 Measles
Health Care Delivery System
◆ Significant
Milestones in public
health care delivery system (25
years)
❖ Adoption of Primary Health Care in
1979
❖ Integration of public health and
hospital services in 1983 (EO 851)
❖ Reorganization of DOH in 1987
(EO 119)
Mission
Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor, and
to lead the quest for excellence in health.
Overview of the General Health
Status of Filipinos points to
several Principles to
Improved Health
1 . Universal access to basic health
services must be ensured
◆ Responsible for ensuring access to basic
public health services to all Filipinos through
the provision of quality health care and
regulation of providers of health goods and
services.
◆ DOH Role
❖ stakeholder in the health sector, and
❖ a policy and regulatory body for health
◆ As a Major Player
❖ technical resource
❖ a catalyzer for health policy
❖ a political sponsor; and
❖ advocate for health issues in behalf of the
health sector.
DOH Offices
◆ 17 central offices
◆ 16 Centers for Health Development
located in various regions
◆ 70 hospitals; and
◆ 4 attached agencies.
Central Office
◆ Office of the Secretary and five major
function clusters
◆Staff support services
–Health Emergency Management Staff
– Internal Audit Staff,
– Media Relations Group
– Public Assistance Group
–Major Zonal Offices (Luzon, Visayas
and Mindanao.)
Zonal Office
◆ Undersecretary (head) supported by an
Assistant Secretary.
◆ Mandated to coordinate and monitor
the implementation of the ff:
–Health Sector Reform Agenda
–National Health Objectives
– Local Government Code with the various
Centers for Health Development
◆Sectoral Management Support
Cluster
–Health Human Resource Development
Bureau
–Health Policy Development and Planning
Bureau.
◆Internal Management Support
Cluster
–Administrative Service
– Information Management Service
–Finance Service
–Procurement and Logistics
◆Health Regulation Cluster
– Bureau of Health Facilities and Services
– Bureau of Food and Drugs
– Bureau of Health Devices and Technology.
◆External Affairs Cluster
–Bureau of Quarantine and International
Health Surveillance
– Bureau of International Health Cooperation
– Bureau of Local Development
Health Program
Development Cluster
◆ National Center for Disease Prevention
and Control
◆ National Epidemiology Center
◆ National Center for Health Promotion
◆ National Center for Health Facilities
Development.
Center for Health Development
◆ Responsibilities
❖ field operations of the Department in its
administrative region
❖ providing catchment area with efficient and
effective medical services.
◆ Tasks
❖ implement laws, regulation, policies and
programs.
❖ coordinate with regional offices of the other
Departments, offices and agencies as well as with
the local governments.
Attached Agencies
◆ The Philippine Health Insurance Corporation
❖ implement the national health insurance law,
administers the medicare program for both
public and private sectors.
◆ The Dangerous Drugs Board
❖ coordinates and manages the dangerous drugs
control program.
◆ Philippine Institute of Traditional Medicine
◆ Alternative Health Care and the Philippine
National AIDS Council.
◆Health Regulation Cluster
– Bureau of Health Facilities and Services
– Bureau of Food and Drugs
– Bureau of Health Devices and Technology.
◆ External Affairs Cluster
–Bureau of Quarantine and International
Health Surveillance
– Bureau of International Health
Cooperation
– Bureau of Local Development
Health System Characteristics
(Mainstream)
◆ Observations on Philippine Health Care
System - 1992, Solon
❖ Underinvestment in Health
❖ Unequal access to health services
❖ Inefficiencies in health services utilization
❖ Regressive tax structure
Health Investments
Health System Characteristics . . .
PERSONNEL FACILITIES
BUDGET
78,080 HOSPITAL - 639
P 10.227 B
RHU/MHC/BHS - 12,580
Provinces
59%
P
2.441
B
Municipalities
38%
Cities P 1.583 B
3%
P 0.109
B
DOH Devolved Cost Compared to
Other Agencies
(in Billion Pesos)
Other DOH
Agencies
66%
(DA, DSWD,
DENR, etc.) P 4.1 B
34%
P 2.1 B
DOH Structure (Pre-devolution)
Office of the Secretary of Health
Executive Committee for
National Field Operations
15 Regional
Field Offices
Regional Hosp.
Medical Centers
Sanitaria
Provincial Health
Offices
Provincial
Hospitals District
Health
Offices
City Health District
Offices Municipal
Medicare & Health
Municipal Offices
Hospitals
BHSs
Health Structure (1993, Post-
devolution)
Office of the Secretary of Health
Executive Committee for
A Devolved to
Prov’l Gov’t
National Field Operations
B Devolved
to City Gov’t
15 Regional
Field Offices
C Devolved to
Regional Hosp. Municipal
Gov’t
Medical Centers
Sanitaria
Provincial Health
Offices
Provincial
Hospitals District
A
Health
Offices
City Health District
Offices Municipal
Medicare & Health
Municipal
B
Offices
C
Hospitals
BHSs
Comparing Governance to Health
Structure
EXECUTIVE BRANCH PUBLIC HEALTH SYSTEM
OFFICE OF THE PRESIDENT NATIONAL HEALTH SECRETARY
LEVEL
NATIONAL NATIONAL NATIONAL NATIONAL OFFICE OFFICE FOR OFFICE FOR OFFICE OFFICE OF
GOV’T GOV’T GOV’T GOV’T FOR HOSPI- TALS STAN- FOR THE CHIEF
AGENCIES AGENCIES AGENCIES AGENCIES PUBLIC & DARDS AND MANAGE- OF STAFF
HEALTH FACILITIES REGULA- MENT
SERVICES SERVICES TIONS SERVICES
REGIONAL HEALTH
REGIONAL LEVEL OFFICE
PROVINCIAL PROVINCIAL
GOV’T LEVEL HEALTH OFFICE
CITY GOV’T CITY HEALTH
OFFICE
LEVEL
DISTRICT OFFICE
MUNICIPAL GOV’T RURAL HEALTH
UNIT
LEVEL
BARANGAY OR BARANGAY
HEALTH STATION
VILLAGE LEVEL
The Administration of
Decentralization in Health
◆ Phasing of devolution process
❖ Changeover and Transition period to take 5 years
◆ DOH and LGUs assumed a relationship
based on a “partnership”
◆ Assignment of representatives to LGUs
supervised by a central assistance and
monitoring service.
◆ Defining new roles and functions under
devolution; preparation of a strategy paper
Changeover to Stabilization
◆ fund intended to
support community-
based health programs
HDF ....
◆ to be treated as trust fund by
LGUs
◆ covered by a MOA; LHB
resolution is a prerequisite
◆ Provincial Health Board to
integrate all HDF-related
projects
◆ DOH to prepare guidelines for
utilization
C. DOH Regional Field Offices
as Technical Resource and
Health Human Resource
Development Centers
◆ RFOs serve as technical resource
management centers directing the
flow and utilization of DOH-
provided assistance to LGUs
Role of RFOs
Public Relations Unit Specialty Hospitals
Health Emergency Mgt. Staff Internal Audit
Health Human Resource Bureau Health Policy Dev’t and Planning Bureau
Centers for Health Dev’t
Regional Hospitals, Medical Centers and
Sanitaria
ORGANIZATIONAL
STRUCTURES IN THE LOCAL
GOVERNMENT UNITS
Local Development Council
◆ Executive Health
Agenda as Sanggunian
determined by
the Local Chief Personnel Division
Executives and Budget Division
the Local Health
Office Administrative Division
◆ Legislative Health Planning Division
Agenda as
determined by
the Committee on
LHB Other Offices with Health Related
Concerns
Health of the - Office of the Treasurer
Local Sanggunian - Local Finance Council
- Population Office
◆ NGO/Private
- DSWD
Sector/Communit
y Health agenda - DENR
as determined by OUTPUTS: - DECS
the Private - Local Health Plan
Sectors, NGO - Program
Representative Priorities,
Resource
◆ DOH Policies, Allocation
Programs, - Support Systems
Priorities through and
DOH Resources to
Representative Health Plan
- CHCA
Lessons from five years of
decentralization
◆ Pay attention to geography, because political
administration by local governments is
governed by constituencies.
◆ Decentralization is a process.
◆ Decentralizing hospitals results to greater
complexities in adapting to local government
protocols
◆ Equity in resource distribution; commensurate
to burden of responsibilities transferred
LGU Resources for Health
Billions of Pesos
80
IRA
70
Requirement
60 Total Earmarked for Health
50
40
30
20
10
0
1992 1993 1994 1995 1996 1997
Year
Amount Required for Local Health
Services versus Total Earmarked
for Health
Billions of Pesos
Year
Lessons ...
◆ Strategies for ensuring equity for
health workers and local government
units should be in place.
❖ allocation of resources and assistance based on
LGUs relative financial capabilities to fund
devolved functions
A 43 258 0 301
B 23 973 1 997
C 4 222 64 290
TOTAL *70 * 1453 65 1588
* excluding ARMM Provinces, Municipalities and Cities
DFB Categories Interpretation
A LGU needing the most assistance form the National Government
B LGU can partially cover CODEF from its IRA resources
C LGU is financially capable of financing all obligations
Lessons ...
Recentralization
Decentralization
ROLE OF PHYSICIAN
PATIENT
FAMILY
COMMUNITY
PROFESSION
HIMSELF
RESPONSIBILITIES
FOCUS OF CARE
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