National Objectives for Health (2011-2016)

Chapter 1 Philippine Health System at a Glance

I. HEALTH FINANCING
Four main sources of financing: national and local government insurance (government and private) user fees/out of pocket donors

 National Health Insurance Program (NHIP) -managed by Philippine Health Insurance Corporation (PHIC or PhilHealth) -institutionalized and signaled the movement towards a single-payer premium-based financing or insurance system. However, the current system continues to maintain a dual financing system existing parallel to each other.

II. HEALTH CARE DELIVERY SYSTEM

A. Health Facilities: government hospitals private hospitals primary health care facilities

 Hospital classification based on ownership: -public hospitals -private hospitals Both public and private hospitals can also be classified by the service capability At present, Level-1 hospitals account for almost 56 percent of the total number of hospitals (Department of Health, 2009; Lavado, 2010) which have very limited capacity, comparable only to infirmaries.

 The number of hospital beds is also a good indicator of health service availability. Per WHO recommendation, there should be 20 hospital beds per 10,000 population. Table 4 describes the

B. Health Human Resource

main drivers of the health care system and are essential for the efficient management and operation of the public health system health educators and providers of health services

C. Utilization of Health Facilities

50 percent of the clients who sought medical advice or treatment consulted public health facilities, 42 percent went to private health facilities, and almost 7 percent sought alternative or traditional health care Rural Health Units (RHUs) and Barangay Health Centers (33 percent) were the most visited health facilities in almost all the regions except for NCR and CAR thirty-six percent of infants are still delivered by hilots People with PhilHealth insurance are more likely to be confined in a private hospital (56 percent), than those without Philhealth insurance (28 percent)

D. Satisfaction with Health Facilities

Based on a survey by the Social Weather Station in 2006, majority of Filipinos specifically the low income households prefer to seek treatment in a government hospital if a family member needs confinement.

III. HEALTH OUTCOMES

A. Life Expectancy The projected average life expectancy of Filipinos in 2005 to 2010 is 68.8 years -males = 66.11 years -females = 71.64 years It is projected that the average life expectancy of Filipinos will increase to 70.38 years from 2010 to 2015 and 71.59 years from 2015 to 2020

B. Deaths and Births

C. Disease Trends in the Philippines

1. Communicable diseases

2. Non-communicable diseases
Around 75 percent of the total deaths can be attributed to NCDs which is similar to the estimates in most developing countries Around 5 percent of the population are now considered to be obese, 10 percent are diagnosed with hypercholesterolemia and 24 percent are considered hypertensive.

The Aquino Health Agenda:

Achieving Universal Health Care for All Filipinos

 Substantial gains in health sector -social health insurance coverage and benefits -execution of Department of Health (DOH) budgets -LGU spending in health, -systematic health investment planning -capacities of government health facilities -implementation and monitoring of public health programs.

I. BACKGROUND AND RATIONALE

DOH and PhilHealth recently conducted a joint Benefit Delivery Review to - increase enrollment coverage - improve availment of benefits and increase support value Benefit delivery for the sponsored program was found to be lowest among our people Public hospitals and health facilities have also suffered neglect The poorest of the population are the main users of government health facilities

I. BACKGROUND AND RATIONALE

To address these challenges, the Aquino Health Agenda is being launch The Philippine health system will require the following components -enlightened leadership and good governance practices - accurate and timely information and feedback on performance -financing -competent workforce; -accessible and effective medical products and technologies -appropriately delivered essential services

I. BACKGROUND AND RATIONALE

This Order provides the objectives, strategic thrusts, and implementation framework to implement the Universal Health Care

II. SCOPE AND COVERAGE

Apply to the entire health sector -public and private sectors - the DOH bureaus - national centers - hospitals attached -external development partners

II. SCOPE AND COVERAGE

Also provide for the guidelines, approaches and resources needed to -affect and influence public-private partnership -benefit families, civil society, private and public health care providers, and local government units

IlI. OVERALL GOAL AND OBJECTIVES

Overall Goal Universal Health Care shall be directed towards ensuring the achievement of the health system goals of better health outcomes, sustained health financing and responsive health system General Objective -to improve, streamline, and scale up the reform strategies in HSRA and Fl have

Benefit Delivery Ratio (BDR) IV.DEFINITION OF TERMS Catastrophic Expenditures Casemix system Community Health Team (CHT) Continuum of Services Geographically Isolated and Disadvantaged Area (GIDA) Income Quintiles Local health system Monitoring and Evaluation for Efficiency and

IV.DEFINITION OF TERMS
National Household Targeting System (NHTS) No balance billing policy Public Private Partnership (PPP) Service Delivery Package (SDP) Support Value Universal Health Care

V. GENERAL GUIDELINES
A.The Aquino Health Agenda (AHA) is a focused approach to health reform implementation 1. Financial risk protection through expansion in NHIP enrollment and benefit delivery 2.Improved access to quality hospitals and health care facilities 3.Attainment of the health-related MDGs B. The six (6) strategic instruments shall be optimized

V. GENERAL GUIDELINES
1.Health Financing 2. Service Delivery 3. Policy, Standards and Regulation 4. Governance for Health 5.Human Resources for Health 6.Health Information C. The success of the AHA shall be measured by the progress made in preventing deaths, controlling diseases, improvements in access ,increasing NHIP benefit delivery rate D. The DOH shall facilitate the implementation of the AHA

V. GENERAL GUIDELINES
E. DOH recognizes that LGUs have the primary mandate to finance and regulate local health systems F. Consistent with the Presidential commitment of zero-corruption in the government G. Broad and sustained participation among all stakeholders shall be purposive ,coordinative, harmonized and productive H. UHC shall be client-centered I. DOH shall engage local healthsystems

VI. SPECIFIC GUIDELINES

A. Financial risk protection through improvements in NHIP benefit delivery shall beachieved by: 1. Redirecting PhilHealth operations 2. Expanding enrolment of the poor in the NHIP 3. Promoting the availment of quality outpatient and inpatient services 4. Increasing the support value of health 5. A continuing study to determine the segments of the population to be covered for

VI. SPECIFIC GUIDELINES

B. Improved access to quality hospitals and other health care facilities shall be achieved by: 1. A targeted health facility enhancement program 2. Provision of financial mechanisms drawing from public-private partnerships 3. Fiscal autonomy and income retention schemes 4. Unified and streamlined DOH licensure and PhilHealth accreditation

VI. SPECIFIC GUIDELINES

C. Health-related MDGs shall be attained by: 1. Deploying Community Health Teams 2. Utilizing the life cycle approach in providing needed 3. Aggressively promoting healthy lifestyle changes 4. Ensuring public health measures 5. Harnessing the strengths of inter-agency and inter-sectoral cooperation to health

VII. ROLES AND RESPONSIBILITIES

A.DOH shall: 1. Develop guidelines and protocols 2. Institutionalize the PIPH/CIPH/AOP as a process 3. Utilize its resources for public health grants and commodities 4. Engage partners in policy development and implementation of strategies including the media 5. Advocate with Congress 6. Engage professional groups, the academe, NGOs and other private sector 7. Consolidate available resources and provide grants 8. Operate DOH-retained hospitals and facilities

VII. ROLES AND RESPONSIBILITIES

B.PhilHealth shall: 1. Expand NHIP coverage 2. Secure financial risk protection for outpatient services 3. Secure financial risk protection for inpatient services 4. Improve management of the NHIP 5. Seeking other financial instruments and strategies

VII. ROLES AND RESPONSIBILITIES

C. Local Government Units are encouraged and assisted to: 1. Develop policies and plans appropriate to their locality and consistent with the implementation of the AHA 2.Mobilize and utilize resources 3.Allow their local hospitals and other public health facilities appropriate incentives 4.Organize Community Health Teams and Service Delivery Networks in partnership with the private sector for effective delivery of health service packages, and whenever appropriate, contract private providers

VII. ROLES AND RESPONSIBILITIES

D. The Development Partners, within the context of Sector Development Approach for Health and subject to agreements with the DOH, shall: 1. Provide official development assistance consistent with the national thrusts and directions for health 2.Align and harmonize their systems and processes with government procedures and institutional reform processes 3.Cooperate in the establishment of 4. Ensure the sustainability and institutionalization of assistance projects

VIII. IMPLEMENTATION ARRANGEMENTS

1.DOH offices shall be clustered according to the three major strategic thrusts of UHC especially in ensuring access to health by the poor. a. Financial risk protection b. Attaining MDGs c. Health facilities enhancement 2.Strengthening of local health systems shall be facilitated and coordinated by the Centers for Health Development through the regional clusters. It shall assume the following functions: i. Oversee operations and concerns of hospitals covering the same catchment ii. Pool resources from the DOH Central Office, LGUs, PhilHealth, the private sector and development partners iii .Decide on equitable allocation of iv. Provide policy directions

VIII. IMPLEMENTATION ARRANGEMENTS

3. The UHC implementation plan and operational guidelines shall be jointly formulated by the DOH and other stakeholders within two (2) months after issuance of this AO 4. Progress of AHA implementation shall be monitored and evaluated quarterly

IX. REPEALING CLAUSE

The provisions of previous Orders and other related issuances inconsistent or contrary to the provisions of this Administrative Order are hereby revised, modified, repealed or rescinded accordingly

X. EFFECTIVITY
This Order shall take effect immediately

FINANCIAL RISK PROTECTION THROUGH THE NATIONAL HEALTH INSURANCE PROGRAM

The institutionalization of social health insurance in the country through the National Health Insurance Program (NHIP) was envisioned to reduce out-ofpocket spending, as well as the inequities in health financing.

However, growth in social health insurance expenditure relative to total health expenditure is not enough. Though there is a noticeable increase in HNIP members over the years, effective coverage rate remain to be low. A study revealed that there is a wide variation of NHIP coverage estimates.

Household surveys revealed that only one third of the population was covered by NHIP in 2008. through this estimate is contentiously low, it unmasked the existing problems on recall and membership awareness. On the other hand, a study commissioned by USAID suggested that the coverage rate was 53 percent in 2008 (Health Policy Development Program, 2010).

In addition to problems in coverage, awareness and low benefit packages which impact utilization, and deficiencies in health facilities, are some of the pressing issues in the Philippines health insurance system. The NHIP was not able maximize its role as a safety net. As a result, the duality of health financing system of the country continues existing parallel with other

funding sources which make the system inefficient for the government. The creation of NHIP should have signaled the country to move from tax-based financing to premiumbased insurance system but donations remain to be the main source of financing. Given these gaps in the health insurance system, the new administration is pushing for sustainable

programmatic and policy reforms to increase the efficiency of Phil Health as the main source of financing for health.

A) Increasing the coverage

Phil Health strategies to expand the coverage of the NHIP include mass media and advocacy programs for LGUs to institutionalize the implementation of the Sponsored Program. One of the main thrusts of Kalusugan Pangkalahatan is increasing financial protection and targets the NHIP as the main source of financing. The overall goal is to maximize government and Phil Health spending in order to

minimize out-of-pocket spending, thereby lessening the financial burden shouldered by the people. The poorest Filipinos, as identified by the National Household Targeting System-Poverty Reduction (NHTS-PR) list of the Department of Social Welfare and Development (DSWD), shall be targeted to gain intensified returns for health financing. The identified poor Filipinos shall be enrolled to the NHIP and

are expected to effectively utilize health services through this projected gain of financial risk protection.

B) Increasing utilization
Low NHIP utilization can be attributed to several factors like low benefits, lack of knowledge on healthcare benefits, tedious administrative requirements, among others. However, one of the most important reasons is the lack of

accredited health facilities. In 2010, Phil Health accredited 91% of private hospitals, 88% of government hospitals and 59% of RHUs (calculated from the Philippine Health Insurance Corporation data, 2010). However, inadequate health facilities remain in many rural areas. Even if they do exist, there are not enough health personnel and appropriate drugs and medicines available. The provision of health centers to regions with dismal health and

socioeconomic indicators continues to be a challenge for the national government and LGUs. Accredited hospitals remain concentrated in major regions like NCR and Region 10, and are found scarcer in regions like CARAGA and ARMM. A similar distribution applies for accredited RHUs, TB DOTS clinics, and other outpatient facilities. Other issues stem from deficient administrative and information systems. There is a need to improve

administrative efficiency, since processing still take an average of three months.

claims

C) Increasing the support value

In the Benefit Delivery Ratio study by the DOH and Phil Health, the average support value of NHIP benefits is only 35 percent. As one of the efforts to increase the financial protection, Phil Health just recently implemented the

No balance billing policy for all sponsored program members who are hospitalized in government facilities. Phil Health is now also shifting from fee for service to case rate system. Almost 23 case rate packages which comprise 50 percent of the benefits are now available in institutional health care facilities accredited by Phil Health (Philippine Health Insurance Corporation, Various years). Among the medical cases and the corresponding package rates are

for Dengue, Pneumonia, Essential, Cerebral Infarction, Cerebro-vascular Accident with Hemorrhage, Acute Gastroenteritis, Asthma, Typhoid Fever, and Newborn Care Package in Hospitals and Lying-in clinics.

Supportive Value OVERALL GOAL: To strengthen the NHIP as the prime mover in improving financial risk protection, generating resources to modernize and sustain health facilities, and improve the provision of public health services to achieve the Millennium Development Goals (MDGs).

STRATEGIES FOR 2011-2016 i. Universal NHIP coverage with priorities for the CCT families and the poor. ii.Communication and social marketing strategies to ensure that its members, especially those from the indigent sector, are utilizing Phil Health benefits. iii.Total market mobilization of all health facilities both from the public and private sector to be NHIP accredited and providers of quality care.

iv.Shift of payment to case payments and no balance billing especially for the indigent sector. v. Improving efficiency of the Phil Health operations to include creation of local insurance offices and e-claims.

IMPROVING ACCESS TO QUALITY HOSPITALS AND HEALTH SERVICES

Health Facilities OVERALL GOAL: Improved access to quality hospitals and health facilities by all Filipinos, especially the poor

STRATEGIES FOR 2011-2016 A health facility enhancement program that shall leverage funds for improved facility capacity to adequately manage the most common causes of mortality and morbidity, including trauma; Provision of financial mechanisms drawing from public-private partnerships to support the immediate repair, rehabilitation and construction of selected priority health facilities;

Pharmaceuticals OVERALL GOAL: Improve the safety and quality, access and availability, and rational use of medicines and ensure accountability and health systems support by concerned. STRATEGIES FOR 2011-2016 Strengthen education and advocacy campaigns to increase local acceptability of generic medicines. Enhance the monitoring and regulatory functions of the NCPAM.

 Improve the efficiency of existing institutions such as the FDA, the BNBs and BnBs and their coordination with other stakeholders such as MeTA. Gather relevant data for the formulation of evidence-based solutions in addressing the problem of irrational drug use and other barrier to drug access Sustain and manage the implementation of the law in the LGUs particularly the exercise of regulation by FDA

representatives in provinces and cities, as well as the investments for the management, drug procurement, and construction of new BnBs

Health Human Resources OVERALL GOAL: Guarantee adequate supply and equitable distribution of human resources for health in the country.

STRATEGIES FOR 2011-2016 Deploy CHTs and RNheals to the communities and enhance existing deployment programs such as the Doctors to the Barrios (DTTB), DTTBLeaders for Health (DTTB-LHP), Rural Health Team Placement Programs (RHTPP), and Specialist to the Provinces (STTP) aligning them to KP

objectives

Through the HRH network, make health

science education more communityoriented through a unified communitybased curriculum that produces a broad range of health workers with competencies that are relevant to the countrys needs. Prioritize the reduction of the percentage of vacancies of HRH in rural health facilities and other areas and also strengthen the capability of human resources to support national and local health systems

 Constantly update and utilize the National Database on Selected Human Resources for Health Information System (NDHRHIS) as a tool to address the inequitable HRH distribution Enhance personnel administration systems and processes to effect improvement of health workforce outcomes through incentive mechanisms

HEALTH RISKS AND DISASTERS

A. OCCUPATIONAL HEALTH RISKS
economic activity = the trends of occupational diseases, injuries and accidents *yet very few will have access to appropriate health care for
their occupation-related injuries or illnesses.

Individuals who are primary sources of income for their families - the victims of such incidents The additional cost and loss of working days becomes an added burden to individuals and the country as a whole.

 Workplace-acquired musculoskeletal diseases - most prevalent - accounting for 28.2 % of the total occupational diseases. Other types of diseases - accounted for more than 10 % of total reported occupational diseases. bronchial asthma (18.5%) infections (13.8%) essential hypertension (13.0 %) occupational dermatitis (12.6%)

B. DISASTERS AND EMERGENCIES

The country is located along the typhoon belt in the Pacific and within the circumferential Pacific Ring of Fire, which explains why the Philippines experiences about an average of 22 typhoons per year and constant threats from eruptions of its 300 volcanoes, 22 of which are currently active. Since 2005 number of natural disasters Since 2007 manmade emergencies Deaths due to disasters Since 2008 injuries have reached to 19,101 cases Typhoons caused a lot of damages in the country destroying public and private properties indiscriminately Reming (2006) Frank (2008) Ondoy (2009) Pepeng (2009)

Deaths due to disasters have been increasing since 2007 and injuries have reached to 9,101 cases for 2008 (see Figure 48).

A strategic tool used by The DOH in order to achieve the aim of Philippines to be the Western Pacific Regions model in Health Emergency Management. 10 Ps 1. Policies 2. Plans, 3. Procedures/ Protocols and Guidelines 4. People 5. Promotion and Advocacy 6. Partnership Building 7. Physical Facilities Enhancement 8. Program Development 9. Practices 10. Peso and Logistics.

C. CLIMATE CHANGE
From 1900 to 1950 country had experienced of 0.3472C in the mean temperature. From 1950 to 2006 of 0.8904C in the annual mean minimum and maximum temperatures was reported.

*placed the Philippines in a state of climate change These deviations pose a great threat as they inevitably affect human health directly and indirectly.

o Direct impacts include the effects of changes in exposure to extreme weather increased incidence of extreme weather events increased production of certain air pollutants and aeroallergens measurable, but are infrequent.

o Indirect impacts include changes in complex processes, such as the transmission of water, food, and vector-borne infectious diseases effect on regional food productivity. more prevalent, although harder to measure

*Technical gaps that must be addressed the implementation of a sectoral climate change adaptation framework

the need to create integrated systems and mechanisms

particularly national and local coordination mechanisms and private-public partnerships the issue of resilience and readiness of health facilities to respond to the effects of climate change.

Other issues include technical gaps such as: (1) the need for a national health assessment to look at the vulnerabilities both at the national and local level, while considering risk factors. (2) creation of means of assessment of the burden of climatesensitive health outcomes, which enable the measurement and identification of response mechanisms. (3) the necessity of continuous, more in- depth research and development in the climate change and health relationship. (4) correlation studies on zoonotic diseases, and on the connection between biodiversity and climate change and health impacts.

HEALTH OF POPULATION GROUPS

The approach to protect and promote the health of the vulnerable groups varies as one goes through the different stages of life. Health service packages specific for each stage differ and this should be made available to ensure a positive state of well-being of the individual. They require more focused preventive efforts as a group. Goal the health inequalities between socially defined groups ensure access to quality health care for adolescents, adult males and females and older persons.

A. ADOLESCENT AND YOUTH

Adolescence - the period of life between 10 and 20 years old - makes up 21% of the total population - considered as the healthiest age group
*Special characteristics possessed by adolescents that makes them vulnerable to certain health problems

1. Adventurous and bold behavior 2. Sexual curiosity combined with poor sexual and reproductive health education and services. Unwanted teenage pregnancies - It causes significant psychological distress - considered as a high-risk pregnancy 3. Attitudes and behavior of adolescents towards health that they carried over to adulthood. Youth - refers to those between 15 and 24 years old Young people - refers to both age groups - those aged 10 to 24 years.

B. THE ADULT MEN

- adult men ages 25-59 have poor health status - They display the highest level of health risk behavior and the lowest use of health services compared to other groups. - about 19% of the total population - Eight (8) out of ten (10) causes of the total deaths among adult males aged 25-59 are due to non communicable diseases where the cardiovascular diseases (19.94 percent) followed by accidents and injuries (12.44 percent) are the highest.

Tuberculosis and pneumonia - communicable diseases among the leading causes of deaths - diseases that are primarily of male concern In every 3 who die of lung cancer 2 are males.

RISK FACTORS LEADING TO DISEASES IN MEN

Smoking diet preferences and nutrition reproductive health habits risk-taking behavior occupational activities

C. THE ADULT WOMEN

- Not all females will pass through the stage of pregnancy and motherhood either by choice or biological reasons. - There are other health needs of the Filipino adult female population aged 25-59 years old that must be addressed: 1. their reproductive health 2. gender issues and diseases affecting this population group Cardiovascular diseases - leading causes of death among adult Filipino women

 Leading causes of death among females are mostly degenerative and lifestyle-related in nature TB and pneumonia are the only infectious diseases included in the leading causes of mortality among Filipino females. It can be observed that the only disease among the 10 leading causes of mortality that has higher percentage among females than among males are goiter, thyrotoxicosis, hypothyroidism and endocrine and other metabolic disorders wherein 55.62% of those who die of the said diseases are females. Malignant neoplasms are the second leading causes of death among adult Filipino females. females than males who die of diabetes mellitus and thyroid problems. percentages of females who die due to accidents and injuries

D. THE OLDER PERSONS

- Latest trend shows an increasing number of older persons and their longer life expectancy. - GOAL 1. to improve the quality of life of older persons 2. sustain their function, autonomy, self-esteem and life satisfaction - To undertake these goals to the DOH has developed a progressive older person health program. - Most of the leading causes of morbidity and mortality can be prevented and measures for health promotion and disease prevention for this population group are available, thus reducing the countrys burden of diseases is feasible. - In 2005, mortality data for older persons showed a preponderance of lifestyle related diseases as major causes of mortality while Pneumonia and TB are the main causes of death that are infectious in nature.