HEALTH SECTOR

TASK ASSIGNMENT

PART MEMBER

Health Facilities (3) Espinola, Estacio, Penana

Health Manpower (2) Abara, Decena

Utilization Analysis (2) Nicolas, Remot

Health Financing (3) Suarez, Mercado, Roxas

Health Governance, Inter and Intra San Antonio, Tabungar

Relationship/Linkages, Current Projects
(2)

Proofreading, Formatting (1) Matoza

Oral Presenter (1) Donado

TASKS

TASKS DEADLINE

Task #1: DATA COLLECTION Data Collection Plan: March 27

- Assess completeness of data (sa assigned part
niyo pls know what data we already have and know
what data we need to outsource) CENTRAL 3B
DRIVE FOR SITUATIONAL ANALYSIS: CLICK
HERE
- For the data na sa tingin niyo kelangan i-outsource
from health centers, barangay, and other govt
offices na need mag-letter, please input them sa
Data Collection Plan Table sa baba.

TASK #2: DATA ANALYSIS, INTERPRETATION, INPUT Input sa Paper: April 14

SA PAPER, PPT Final Paper: April 16
PPT: April 17

Task #3: PROOFREADING (proofreader only) April 12

 CHAPTER V
ANALYSIS OF HEALTH SECTOR

I. HEALTH STRUCTURE AND GOVERNANCE

As shown in Figure X. the Philippines’ healthcare system is highly decentralized wherein

the responsibility is shared between the central government (Department of Health) and the
Local Government Units that have full autonomy to adapt national policies, standards, and
curricula to meet the health priorities of the communities within their jurisdiction. The City
Government of Manila headed by the City Health Officer, Dr. Arnold M. Pangan, is responsible
in providing primary care, including preventive and promotive health services and other public
health programs through rural health centers, barangay health stations and city hospitals. At the
barangay level, the barangay captain, Hon. Guillermo Friera, implements and conducts
administrative oversight over all the health-related programs and activities of the barangay
alongside a Kagawad for Health and Sanitation, Ms. Marvin Soriano, as well as one Barangay
Nutrition Scholar, one Barangay Health Worker, and the health personnel of the Rosario Reyes
Health Center.

Figure X. Philippines’ Health system structure (Devlin, Egan, Pandit-Rajani, 2016)

II. LINKAGES

Intrasectoral

Intrasectoral relationships refer to relationships between the different health sectors in

the community. With limited data, we cannot fully describe the relationships between these
different health sectors. However, we can note the relationship between the clerks of OM and
the BHWs in the rendering of medical services to the community. Ideally, we would like to
evaluate the operational relationship of other health facilities and health units, as well as the
present government policy towards the private health sector engaged in health service delivery,
training of health manpower and the manufacturing of drugs and equipment, and also the role of
insurance within the health sectors in the community.

Intersectoral

Intersectoral linkages refers to relationships between different sectors of the community,

and their role in the overall health of the community. With limited data, it is difficult to evaluate
the intersectoral relationships present in the community. Ideally, we would like to evaluate the
commitments of the health sector with other sectors. These sectors include but are not limited to
the LGU, DepEd and DSWD. For example, we would like to identify any local health programs
by the barangay LGU as well as city LGU. We can also identify programs in partner with DepEd
such as the deworming of students, and school based feeding programs. For DSWD, we can
review the implementation of the 4Ps program in the community. We would like to also assess
the membership of the health sector in multisectoral bodies, for example, in this case, the
COVID-19 response of the community.

III. HEALTH MANPOWER

Health manpower or workforce refers to “all people engaged in actions whose primary
intent is to enhance health” (World Health Organization, 2006). As main drivers of the health
system, the people that comprise health manpower play an essential role in how the health
system of Brgy. 704 is managed and how it operates (Department of Health, 2017). According
to the World Health Organization (2010), what constitutes health manpower often overlaps and
its boundaries or components can have various permutations depending on the community’s
situation. For the purpose of this analysis, this section will describe health manpower according
to composition and density, according to private-public sector affiliation, and according to other
manpower-related aspects like training and programs.

Composition and Density

According to Statista, there are 188,219 health professionals in the Philippines and
84.3% of that is made up of physicians, nurses, and midwives alone. In the health center of
Brgy. 704, there is no physician, nurse, or midwife but there is a barangay health worker and a
barangay nutrition scholar. In Rosario Reyes Health Center, there are two (2) physicians, three
(3) nurses, one (1) dentist, one (1) midwife, one (1) medical technologist, one (1) laboratory
aide, and one (1) administrative aide. Nurses outnumber other health workers in the country
according to WHO data (Baclig, 2021) and the same might be true in Brgy. 704 but this needs
more research. Based on the available data, there are 2 physicians per 10,000 population;
however, there may be more because this did not take into account those health workers
employed in privately-owned health facilities such as clinics, laboratories, and hospitals. The
Health Facilities located in or near Brgy. 704 have been discussed in an earlier section of this
paper. In contrast, the health provider density of the Philippines is 1.1 physicians per 10,000
population (Alliance for Improving Health Outcomes, 2017). There is no data about the rate of
retention nor satisfaction among health workers.

Affiliation

Health workers may be affiliated in institutions considered to be publicly-owned

(government) or privately-owned but they can also practice in both. According to the
Department of Health (2017), the bulk of government health workers is concentrated within
Metro Manila which makes up around 20%. For this community, the number of health workers
working in public health facilities is at least 12 while private health workers practicing in private
clinics, laboratories, and hospitals remain unknown. Therefore, an adequate comparison
between private and public cannot be made.

Other Aspects

Health workers require training and professional instruction and the available training
institutions for Brgy. 704 are primarily organized by the local government. Schools like
Pamantasan ng Lungsod ng Maynila and University of the Philippines are some of the training
institutions for physicians and nurses. It is not known how many of their annual graduates are
deployed or choose to be assigned to this community.

The barangay government through its Punong Barangay and Sangguniang Barangay
plays a role in the filling up of positions for health. There is one (1) Punong Barangay for Health.
The actual number of barangay positions dedicated for Health is unknown and so is the number
of occupied or vacant positions. In terms of development of health professionals, it is not known
whether there are or there have been projects or programs organized for health professionals
that seek to contribute to their development, health, or well-being.

In summary, the health manpower of Brgy. 704 is composed of 2 primary care workers
but this is augmented by a district-level facility. The physician density does not meet the
standard of the World Health Organization of at least 23 physicians per 10,000 population. As in
other communities, there is a local councilor for Health; however the existence of past or
present local programs aimed towards health professionals are unknown. There are training
institutions for physicians and nurses near the community but it is not known how many trainees
get assigned to this community after completion of their training. Finally, the number of private
health workers cannot be determined and comparisons between private and public health
workers cannot be made.
 IV. HEALTH FACILITIES

Immediately within the 3 km radius from Barangay 704 in Malate, Manila are 2 public
hospitals, 2 public health units, and several pharmacies, diagnostic centers, and private medical
and dental clinics.

Hospital Facilities

According to the data from last year’s group for Brgy 704, more than half (67%) of their
304 respondents generally preferred receiving treatment from public hospitals compared to the
15% who preferred private hospital treatment. Their choice is anchored mainly on the cost of
receiving treatment from the facility, with the majority of the interviewed households belonging to
low-income earning families, and the proximity of the hospital from Brgy. 704.

Among the health facilities, the nearest hospital is Ospital ng Maynila Medical Center
(OMMC) which is only around 650m away or about an 8-minute walk or a short tricycle/pedicab
ride from Brgy. 704. OMMC is a non-profit, general tertiary hospital that is fully supported and
subsidized by the city government of Manila and caters primarily to the admission and treatment
of bona fide residents of Manila. The 300-bed capacity hospital also serves as the partner
training hospital of medical students and health allied students from Pamantasan ng Lungsod
ng Maynila. An extension for OMMC, is the newly constructed ten-story fully air conditioned, 384
bed capacity, 12 ICU units, and 20 private room Bagong Ospital ng Maynila Medical Center
(BOMMC) that is set to open and operate within the year (Mendoza, 2022).

Figure X. The soon-to-open Bagong Ospital ng Maynila Medical Center (City of Manila, 2022).

Another hospital accessible to the residents of Brgy. 704, about 1.7km away, is the
state-owned and more than a 100-year-old Philippine General Hospital managed and operated
by the University of the Philippines (UP) System together with UP Manila. The PhilHealth-
accredited level 4 government hospital, according to the DOH hospital classification system, is
generally known as a hospital catering to the Philippines’ indigent patients providing 1000 beds
out of its 1,500 bed-capacity, of which 500 are allotted for private patients. The hospital is said
to serve 600,000 patients annually (Quodala, 2013)and has been serving as the country’s
CoVID-19 referral center in this time of the pandemic (Llaneta, 2020). The distance from Brgy.
704 would however require the residents to ride a jeepney or walk for about 20 minutes to get
treatment.

Figure X. The University of the Philippines-Philippine General Hospital (Llaneta, 2020).

Privately owned hospitals within the vicinity are also utilized by the community. Manila
Doctors Hospital, also known as “MaDocs”, is situated along United Nations Avenue in Ermita,
around 3km from Brgy. 704. The hospital is easily accessible via public transport through LRT1
UN or through public utility jeepneys along Taft Avenue. This tertiary hospital has 300-500 bed
capacity and around 130 medical doctors. The hospital provides various health facilities and
services which specifically include the following:

● Aesthetics Center ● Executive Health Check

● Cardiac Rehabilitation ● Hearing, Dizziness, Voice
● Cardiovascular and ORL Endoscopy Center
Catheterization Laboratory ● Heart Care Service
● Cardiovascular Center ● Hemodialysis
● Child Neurosciences Center ● Intensive Care Unit
● Clinical Nutrition ● Laboratory Services
Management Services ● Linear Accelerator
● Computerized Tomography ● Magnetic Resonance
● Coronary Care Unit / Imaging
Telemetry Unit ● Mammogram
● Corporate Health Services ● Marine Medical Services
● Dietary Department ● Neurophysiology Services
● Emergency Medicine ● Nuclear Medicine
● Endoscopy Unit ● Oncology Unit
 ● Pain Management ● Sports Medicine
● Pharmacy ● Ultrasound
● Pulmonary Physiology and ● Vision Center
Sleep Lab ● Wellness Hub
● Radiologic Imaging Center ● Wound Care Center
● Rehabilitation Medicine

Figure X. Manila Doctors Hospital

On top of the mentioned patient services, one of the hospital’s prominent programs
during the COVID-19 pandemic is the Roving Med Mobile Services, which primarily aims to
bring healthcare closer to the homes of the community. It was initiated in the year 2020, which
provides various services such as COVID-19 RT-PCR testing, laboratory services, medicine
deliveries, sleep study, 24h Holter monitoring, electrocardiogram, and vaccination.
 Figure X. Roving Med Mobile Services of Manila Doctors Hospital.

Another privately owned hospital within the area is Medical Center Manila, popularly
known as “Manila Med”. It is located in United Nations Avenue, Paco, Manila, which is within
2.4km from Brgy. 704. It can also be conveniently reached via public transport through LRT1
UN or through public utility jeepneys along Taft Avenue. This hospital has around 76 medical
doctors with 19 different centers and departments that include the following:

● Sport and Exercise Medicine Center ● The Life Care Center

● Gender Diversity Center ● Physical Medicine and Rehabilitation
● Cancer Care Center Department
● Ambulatory Care Center ● Pathology and Laboratories
● Would Care Unit Department
● Center for Women’s Health ● Child Development Enrichment
● Respiratory Therapy Department Center
● Brain Center ● Radiology and Imaging Department
● Diabetes Care Center ● Heart Station (Non-Invasive
● Eye Center Cardiovascular Diagnostic Center)
● Hemodialysis Unit ● Cardiovascular Catheterization
● Bone, Muscle, and Joint Center Laboratory And Intervention Center
 Figure X. Medical Center Manila

In order to fully assess the health facilities within the community and paint a better
picture of the current health situation, additional information is needed to be collected from the
hospitals and the city health office. Information with regards to the status of the facilities
including the repairs and the needed equipment for the facilities as well as the hospital statistics
including data on the discharge and admissions, outpatients and consultations, and average
length of hospitalization should have ideally been included in this report.

Clinics

On health units, the barangay has two health facilities: a local health center and a
barangay clinic. There are 12 health centers that cater to District V of Manila, but Rosario Reyes
Health Center (Figure x) is the most utilized by the residents of Brgy. 704.
 Figure x. Rosario Reyes Health Center (Google Maps, 2022)

In Figure y, we can observe that there are many health units immediately beside and
near the barangay. However, we know that health care services are free in health centers,
which is most likely the reason as to why a large part of the respondents utilize the Rosario
Reyes Health Center (Figure z). But there were also 55 out of the 304 respondents who also
said that they utilize private clinics, this may be attributed to the resident’s preference and/or the
availability of more specialized doctors for uncommon diseases.
 Figure y. A map showing the clinics and health center readily available to residents of Brgy.
704, Malate, Manila (Google Maps, 2022).

Figure z. Frequency of different health facilities utilized by households in Brgy. 704 Malate,
Manila.
 In terms of the barangay clinic, they have a health corner which serves as a health
bulletin board wherein posters and brochures regarding relevant health information are
available. Among these are the 10 Kumainments, HIV/AIDS, maternal health, dengue, and
hypertension.

Listed below are other medical clinics nearby Brgy. 704:

Agoncillo Medical Clinic Good Samaritan Clinic Prosperity Medical Clinic and
Laboratory Inc.

Carreon Medical Clinic Hannah Medical Clinic RB Joniga Medical Clinic &
Diagnostic Center

Clemen’s Medical Clinic Jose L. Guiterrez Clinic RGB Medical Clinic & Lab

Clinica Luisa Medical Clinic & Lifeway Clinic Rosario Reyes Health Center
Lying-in

ClinicOMed, Inc. Mabini Medical Clinic Saratan Medical Clinic

Detoxicare Malate Mary Chang Medical Clinic Sea Landers Diagnostic and
Treatment Center

El Roi Medical Clinic & Micah Medical Clinic and SM Lazo Medical Clinic, Inc.
Diagnostic Center, Inc Diagnostic Laboratory

Emmanuel Medical and Nordic Medical Clinic Snem Medical Clinic

Diagnostic Center

Pharmacies

Pharmacies easily accessible to the residents of Brgy. 704 are mostly located along the
San Andres street, corner Leveriza street. Among these are three private drug stores: Mercury
Drug, The Generics Pharmacy, and King Solomon’s Pharmacy. However, medical services are
available for free in both the barangay clinic and barangay health center. The barangay clinic
has a desk wherein barangay health workers provide first-aid measures such as nebulizers. The
barangay health center, on the other hand, provides a wider variety of medical services, such
as: free medications for hypertension and diabetes, services like dental and maternal check-
ups, vaccinations, and family planning when stocks are available.

V. UTILIZATION
Among the health facilities, Ospital ng Maynila Medical Center (OMMC) is the nearest
hospital around the barangay. It is located at 719 Quirino Avenue, corner Roxas Blvd, Malate,
Manila, 1004 Metro Manila. Ospital ng Maynila Medical Center is a non-profit tertiary level
hospital which provides standard medical care to a largely indigent population. The hospital
provides Clinical services in the following departments: Internal Medicine, Pediatrics, Surgery,
Obstetrics and gynecology, Anesthesia, Ophthalmology, Otorhinolaryngology, Pathology,
Radiology, and Emergency, as well as, Dental service, Psychiatric service, Medical social
service, and Hemodialysis. In this time of the pandemic, the OMMC also provides COVID-19
vaccines to both the pediatric and adult population (Ospital ng Maynila Medical Center - Journal
in surgery residency. Google Sites, 2022).
Rosario Reyes health center, on the other hand, is the nearest health center to
Barangay 704. It is located at 627 San Andres St, Malate, Manila, 1004 Metro Manila. It is a
government-owned facility which provides basic medical services such as check-ups, blood
pressure monitoring, vaccination, prenatal testing, weight-monitoring, dental services, and
provision of medicines to the general population around Barangay 704,Malate, Manila.
The frequency of health care services utilized by the 1,388 households comprising
Barangay 704 is currently unknown.

VI. HEALTH FINANCING

Sources of Funds
Residents of barangay 704 have access to a barangay health facility that offers free
basic health services. Patients whose needs are not satisfied by the health center may be
referred to other public or private healthcare facilities, or they may be referred to Ospital ng
Maynila Medical Center, the nearest hospital in Manila's Fifth District. This complex financing
scheme will be discussed further in this study.
Health financing and spending in barangay 704 is composed of various sources of
funds. All of these spending whether public or private is included in the Total Health Expenditure
(THE). Philippine health care financing can be categorized into 4 main groups; : (1) national and
local government, (2) insurance (government and private), (3) user fees/out of pocket and (4)
donors (DOH, 2007). In this study, we based our groupings according to a study done by Ulep &
Dela Cruz in 2013. The study stated that the THE in the philippines combines all of the
projected value of identified sources of funding, including: (1) national and local government
health expenditures; (2) social insurance; (3) private sources; and (4) others. Out-of-pocket
(OOP), private insurance, health maintenance groups, private businesses, and private schools
are all examples of private sources.

Figure X. Healthcare expenditure by source in Barangay 704

 In Figure X, we can see that the three most common sources of funds is Out-of-pocket
(OOP) which is utilized by 84.54% of the respondents, followed by PhilHealth (50.99%), and
Family and Friends (21.38%). Other sources of funds also utilized by residents of barangay 704
are HMO/Health Card (16.78%), Borrowed Money (15.13%), Free Hospital Services (10.86%),
Government/Politicians (7.24%), NGO (3.62%), Religious Groups (3.29%), Pawned ATM
Card(0.33%), and the Senior Citizen Association (0.33%). All of these sources add up to be the
THE of Barangay 704.
In a report by the PSA released in 2020, health spending in the Philippines grew by
10.9% in 2019 compared to the previous year. Expenditures were categorized into 3 main
groups; Household-out-of-pocket (OOP), Government schemes and compulsory health care
financing schemes, and voluntary health care payment schemes. Our findings coincides with
the findings of the report which showed that the highest utilized payments scheme is OOP. OOP
comprised about 47.9% of the total expenditures, followed by government schemes with 42.0%,
and Voluntary health care payment with 10.1%. Even with the establishment of the NHIP or
PhilHealth in 1995 and the signing of the UHC law in 2019, OOP spending still remains to be
the major source of healthcare funding among Filipinos up to 2019, which is also evident in
barangay 704. Although there is a decreasing OOP spending from a 2014-2020 timeline as
seen in figure XX, OOP still remains to be high even with the presence of alternative financing
schemes. A country with an ideal and effective financing scheme should be able to lower OOP
to about 15%-30% (Ulep & Dela Cruz, 2013)

Figure XX. Share of out-of-pocket health expenditure on the current health expenditure in the
Philippines from 2014 to 2020 (Statista, 2022)
The ideal health financing scheme should have a low OOP spending especially when
there are alternative financing schemes. The dependence of Filipinos to OOP can lead to
financial catastrophe and impoverishment (DOH, 2007). High out-of-pocket expenses have
negative consequences. Poverty has a lot of negative consequences, especially when it comes
to health, spending, and decision-making. (Ulep & Dela Cruz, 2013). Plumper and Neumayer
(2012) claim that a high OOP level is regressive. It is also harmful to the health of the
comparatively poor, as it increases mortality among marginalized groups. Other studies have
found that it raises death rates, particularly among the elderly, by lowering the poor's demand
for vital health-care services. Implications of a high OOP include income redistribution “to the
wrong direction” (i.e., from chronically ill to healthy individuals and, typically, from the relatively
poor to the relatively affluent groups [Plumper and Neumayer 2012]), tough health choices like
poor adherence to drug regimen due to high costs, foregoing necessities, or borrowing money,
skimping on medications and preventive tests, and an increase in financial burden to those with
insurance (Aji, 2013).
The high out-of-pocket spending in barangay 704 could be ascribed to a lack of free
services and facilities in the area, as well as instances not fully covered by PhilHealth or its
HMO. Expensive OOP may contribute to poor health-seeking behavior among residents; by
refusing to seek necessary care and treatment, these families may avoid high health-care costs,
perhaps leading to self-medication or total treatment avoidance. The signing of the UHC law,
which officially covers all Filipinos on certain services, drugs, supplies, diagnostic procedures,
and treatments to its members, may be linked to the use of PhilHealth, which is the second
most often used financing scheme. This coverage, however, may not be sufficient to cover all
circumstances, causing residents to resort to other options especially OOP spending. Residents
may also lack access to information that might persuade them to join the system voluntarily.
Family and friends are the third most prevalent source of funds. The bayanihan culture and tight
ties that Filipinos are known for are especially obvious in a community like barangay 704, which
translates to this source of money.
PhilHealth Categorization
In the latest PSA data (2020), household out-of-pocket payment is still the largest
(44.7%) among current health expenditures by financing agents. However, in the current health
expenditure by financing scheme, government schemes and compulsory contributory health
care financing schemes hold the highest share (45.7%), followed by household out-of-pocket
payment (44.7%) and voluntary healthcare payment schemes (9.6%).
In the gathered data in 2019, 78% of households are PhilHealth members (Figure X).
This is among the 50.99% respondents in 2019. Data in 2019, lists 238 (78.29%) of the 304
household respondents have at least one member of their household who is a PhilHealth
member, while the remaining 66 household respondents (21.71%) are non-PhilHealth members.

Figure X. Percentages of PhilHealth members and nonmembers among household respondents of

Barangay 704
 152 (63.87%) of the 238 households with PhilHealth members are active members. This
means that they were able to contribute for the last three months. This may be due to the
reason that a large percentage in the barangay are in the working population, which means that
they are automatically enrolled as contributors. This is followed by 41 (17.23%) PhilHealth
members who are senior citizens and 24 (10.08%) who are sponsored or have their card issued
within the year only. For the remaining 66 (21.71%) of the 304 household respondents who are
non-PhilHealth members and for the three household respondents who are inactive members.

Figure X. PhilHealth categories of the household residents of Barangay 704

Other Institutions as Source of Financial Help

Other sources of financial help in the barangay were unspecified. Two of the
respondents in Barangay 704 mentioned SSS as their source while another two respondents
mentioned that they were retired. It was unclear if they were obtaining financial help through
their pension or if it was part of their retirement package.
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