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The District Health System in the Philippines

Basics of the District Health System, the District Health System in the Philippines, the Interlocal Health Zone

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The District Health System in the Philippines

  1. 1. THE DISTRICT HEALTH SYSTEM IN THE PHILIPPINES Paolo Victor N. Medina, M.D. Assistant Professor for Community Medicine University of the Philippines College of Medicine Former Municipal Health Officer Municipality of Quezon, Alabat Island, Quezon
  2. 2. OBJECTIVES
  3. 3. Objectives  To define the District Health System as per the World Health Organization.  Basic principles and concepts.  To discuss the District Health System within the Philippine Context.  Inter Local Health Zone  Devolution  The Role of DOH
  4. 4. Objectives  To share actual experiences from working in the Philippine District Health System.  Frontline rural health work experiences (as MHO)  Actual Inter Local Health Zone experience  Positives and Negatives  Opportunities for Growth and Change
  5. 5. Putting things into Perspective… CONTEXT
  6. 6. Context “Sixty percentof ourcountrymen who succumbto sicknessdie without seeing a doctor.” -Pres.Noynoy Aquino
  7. 7. WHO Health Systems Framework (The Building Blocks of Health) From the WHO WPRO Website: http://www.wpro.who.int/health_services/health_systems_framework/en/
  8. 8. The District Health System Basic Concepts
  9. 9. Why Organize Health Systems into Districts?  To implement the visions of Alma Ata there was a recognized need to re-orient, re- organize and strengthen district health systems  Not a new idea (even in 1988)  Arose from discussions/debates on centralization vs. decentralization  For Primary Health Care (PHC) to succeed:  Firm national policy as a cornerstone (full support from the ones on top)  Full realization – depends on people in the district who manage and implement PHC strategies  “It is in the district where top-down and bottom-up meet, if they are to meet at all”  Essentially an issue of management “The Challenge of Implementation: District Health Systems for Primary Health Care”. WHO. 1988
  10. 10. Why Organize Health Systems into Districts?  Districts provide an excellent organizational framework for introducing changes into the health system  Policies, plans and practical realities can meet  Feasible solutions can be developed  Human and material resources  Delegation of authority  Logistics, operations  Monitoring and evaluation
  11. 11. The District Health System (WHO 1986)  District Health System (summary def.) – WHO Global Programme Committee (1986)  “A more or less self-contained segment of the national health system, with a well-defined population comprising a clearly delineated administrative and geographic area, whether rural or urban, including all institutions and individuals whose activities contribute to improve health in the district whether governmental, societal, non- governmental, private or traditional.”  Large variety of interrelated elements that contribute to health in homes, schools, work places and communities  Includes health and non-health sectors  Self-care  All health workers and facilities up to and including the hospital at the first referral level  Laboratory, diagnostic, logistic support and services  An assigned officer coordinates the component elements and institutions of the district  Full and comprehensive range of promotive, preventive, curative and rehabilitative activities “The Challenge of Implementation: District Health Systems for Primary Health Care”. WHO. 1988.
  12. 12. The District Health System (WHO 1986)  Clearly defined administrative area  Usually between 50,000 to 500,000 population  Some form of local government takes over many responsibilities from central government sectors or departments  A general hospital for referral support exists  Actual organization depends on the specific situation and needs of the country and within the districts themselves  Administrative structure  Personalities, officials  Management  General Principles:  Based on Alma Ata:  Equity  Accessibility  Emphasis on health promotion and disease prevention  Intersectoral action  Community involvement  Decentralization  Integration of health programmes  Coordination of separate health activities
  13. 13. The District Health System (WHO 1986)  Main Pillars of the District Health System:  Organization, planning and management  Financing and resource allocation  Intersectoral action  Community involvement  Development of human resources http://www.slideshare.net/hmirzaeee/primary-level-eyecare-services
  14. 14. The DOH. LGUs. Interlocal Health Zones. Devolution The District Health System in the Philippines
  15. 15. The District Health System in the Philippines Primary Secondary Tertiary
  16. 16. The Levels of Referral in the Philippine District Health System:  Primary  Barangay Health Stations  Rural Health Units  Municipal/City Health Centers  Lying-in Clinics/Birthing Homes  Basic Emergency Obstetric and Neonatal Care (BEmONC) Centers
  17. 17. The Levels of Referral in the Philippine District Health System:  Secondary  Municipal/City Hospitals  District Hospitals  Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Centers
  18. 18. The Levels of Referral in the Philippine District Health System:  Tertiary  Provincial Hospitals  Regional Hospitals
  19. 19. The Interlocal Health Zone
  20. 20. The Interlocal Health Zone (ILHZ)  The Philippines’ version of the District Health System (?)  Clustering municipalities through inter-LGU cooperation  Central or core referral hospital
  21. 21. The Interlocal Health Zone (ILHZ)  Pseudo Legal Entity  (Ideally) An integrated health management and delivery system based on defined administrative and geographical area  District Hospital (core hospital) + surrounding/covered municipalities  Composed of adjacent municipalities with supposedly similar health needs  Resource sharing  Common health goals  Mutual planning, policy formulation, health operations implementation and monitoring and evaluation
  22. 22. The Composition of the Interlocal Health Zone (ILHZ)  People  Elected and Appointed government officials  Community members  Community Health Workers (BHWs, BNS, Health Workforce)  NGOs and CSOs  Private sector  Organization  Chairpersons: Local Chief Executives (Mayors)  Vice Chairperson: District Hospital Chief  Technical Committee: MHOs  DOH Representative: Development Management Officer (DMO)  Members – Local Health Board members of member-municipalities  District Hospital Staff
  23. 23. The Composition of the Interlocal Health Zone (ILHZ)  Boundaries  Usually consists of geographically contiguous municipalities/LGUs and their respective health systems  District hospital as core referral facility
  24. 24. The Composition of the Interlocal Health Zone (ILHZ)  Health Facilities  Primary  RHUs  Health Centers  Barangay Health Stations  Secondary  District Hospital (Core referral hospital)
  25. 25. The Composition of the Interlocal Health Zone (ILHZ)  District Health Team  All health workers in the District (ILHZ) should ideally be working in teams.  District Health Teams per LGU  ILHZ health workers should be a team as well
  26. 26. Minimum Health Services Delivered Within an ILHZ  Preventive and Promotive Health Services  Outpatient Services  General Consultations  Basic Laboratory and Radiologic Examinations  Inpatient Care  Medical and Surgical Services sufficient to provide emergency and non-emergency care for basic and potentially life-threatening conditions, obstetrics and trauma  Lab and Radiologic Services
  27. 27. The Core Referral Hospital  Main hospital for the ILHZ and its catchment population  Primary referral point for hospital services from the communities within the ILHZ  Private and public facilities and practitioners  Barangay Health Stations  Rural Health Units  Can handle basic emergency and non-emergency surgical, obstetric medical and trauma cases
  28. 28. The Importance of the ILHZ  Re-integration of hospital and public health services  Identification and utilization of areas of complementation and convergence of stakeholders in health  LGUs  DOH  PHIC  NGOs and CSOs  Private sector  Community
  29. 29. Expected Achievements of the ILHZ  Universal coverage of Social Health Insurance (PhilHealth)  Improved quality of hospital and RHU services  Effective referral system  Integrated health system planning  Effective and efficient health information system  Improved drug management  Developed human resources for health  Responsive and inspired health leadership and governance through inter-LGU cooperation  Financially viable or self-sustaining hospital  Integration of public health (mainly promotive and preventive) and the hospital (curative)
  30. 30. Frontline Experiences. Realities. Issues. Challenges. District Health Systems in the Philippines:
  31. 31. The Department of Health (DOH) Mandate (E.O. No. 119, Sec. 3):  The Department of Health (DOH) shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuances of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of 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.  THE DOH IS THE LEAD AGENCY FOR PHILIPPINE HEALTH CARE http://www.mb.com.ph/doh-denies-18-ebola-cases-in-qc/
  32. 32. Primary Goals of the Health Sector The primary goals of the health sector:  Better health outcomes  Attaining the best average level of health care for the entire population and attaining the smallest feasible differences in health status among individuals and groups  More responsive health system  Meeting the people’s expectations of how they should be treated by health providers and the degree by which people are satisfied with the health system  More equitable health care financing  Distributing the risk that each individual faces due to cost of health care according to ability to pay rather than the risk of illness Reference: DOH/DAP module for DTTBs – on Economics and Governance of Health Systems
  33. 33. That Thing Called DEVOLUTION  RA 7160 (Local Government Code of 1991)  The act by which the Philippine Government “devolved” basic services (health services, agriculture extension, livelihood development, forest management, barangay roads and social welfare) to Local Government Units (barangay, municipality/city, province)
  34. 34. That Thing Called DEVOLUTION Implementation of Devolution in 1992:  Management and delivery of health services  From DOH to locally elected provincial, city and municipal governments  4 Essential Health System Functions  Service provision  Resource generation  Financing  Stewardship
  35. 35. Major Features of RA 7160 (LGC of 1991) Devolved Basic Services  On Health and Social Services: 1. Implementation of programs and projects on primary health care, maternal and child care and communicable and non-communicable disease control services; 2. Purchase of medicines, medical supplies and equipment needed to carry out services; 3. Social welfare services which include programs and projects on child and youth welfare, family and community welfare, women’s welfare, elderly and disabled persons welfare  Negative effects on health care:  Vulnerability to patronage and traditional politics  Great variability in health care program planning, implementation and M&E across LGUs  Highly dependent on motivated, innovative, inspired and morally upright human resources  Some LGUs are “more equal than others”
  36. 36. Basic Organization
  37. 37. Hope Is Not A Strategy…  Pseudo legal status of ILHZ – much is left to hope  Vulnerable to patronage and traditional politics  LGUs are not created equal  Many LGUs unwilling or unable to do effective resource-sharing  Market-oriented and fragmented health system of the Philippines is a disempowering and disabling environment for the success of the district health systems  Virtually no participation of the private sector  No real consequences for failure
  38. 38. Let’s Recall… The WHO District Health System  District Health System (summary def.) – WHO Global Programme Committee (1986)  “A more or less self-contained segment of the national health system, with a well-defined population comprising a clearly delineated administrative and geographic area, whether rural or urban, including all institutions and individuals whose activities contribute to improve health in the district whether governmental, societal, non- governmental, private or traditional.”  Large variety of interrelated elements that contribute to health in homes, schools, work places and communities  Includes health and non-health sectors  Self-care  All health workers and facilities up to and including the hospital at the first referral level  Laboratory, diagnostic, logistic support and services  An assigned officer coordinates the component elements and institutions of the district  Full and comprehensive range of promotive, preventive, curative and rehabilitative activities “The Challenge of Implementation: District Health Systems for Primary Health Care”. WHO. 1988.
  39. 39. INTER LOCAL HEALTH ZONE
  40. 40. The DHS System in the Philippines is BROKEN  We NEED the DHS  It might well be the BEST foundation for the ideal Philippine Health Care System  Archipelago  Decentralized government  Much to be fixed yes…  But to start the change, we need PEOPLE
  41. 41. Primary Health Care  What good does it do to treat a person’s illness if he/she will return to the conditions that led to the illness in the first place? (paraphrasing F. Baum)
  42. 42. With you out there, you CAN and WILL make a DIFFERENCE! THE BOTTOMLINE…
  43. 43. The Challenge…  I am not saying everyone should be a Municipal Health Officer  We should respond to the needs of the country in terms of health care/health systems:  Public Health  Specialized/Clinical Care  Health Policy  Health Governance  Health Financing  Relevant Health Research  Dreams and aspirations ARE compatible with serving the underserved
  44. 44. The Challenge…  At the end of the day, it’s all about the principles of Equity and Justice and our subsequent role in ensuring these for every Filipino  Whatever kind of doctor we choose to be.  Wherever we may find ourselves in.
  45. 45. The Challenge…  For the Philippines and the Filipino…  How much are we willing TO DO?  How hard are we willing TO TRY?  How far are we willing TO GO?
  46. 46. QUESTIONS?
  47. 47. Where Will You Be?
  48. 48. Gmail, Facebook: paolo.medina.md@gmail.com Twitter: @lopaomd Instagram: @lopaomd #buhaymho #buhaypublichealth #buhayhealthprofessionseducator Maraming Salamat Po!!!
  49. 49. References  WHO. 1988. “The Challenge of Implementation: District Health Systems for Primary Health Care”.  https://www.scribd.com/doc/7342850/Philippine- Health-Care-System-2008

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