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Philippine Healthcare System - Coggle Diagram
Philippine Healthcare System
History
Spanish colonial period
public health measures were introduced
vaccination for smallpox
control cholera and beriberi outbreaks
Hospital De San Juan De Dios (1578)
first hospital for civilians, cater for infectious diseases; degree of nursing
San Lazaro Hospital (1578)
referral hospital for infectious diseases even way before
used as an isolation facility for leprosy cases
because of trade, the diseases were transferred here such as leprosy
leprosy was orignated from japan
Hospital Real (1565) - cebu then transferred to intramuros in 1571 to cater to the spanish army and navy
Philippine Revolution and American Colonial Period
Department of Public Works, Education and Hygiene (1898)
aguinaldo gov
included in this department are ensuring sanitation and engineering of sewage systems
Board of Health for the Philippine Islands (1901 July)
Philippine General Hospital (1907)
became national referral hospital
Designation of Culion Island as Culion Leper Colony (1907)
medications for leprosy are tested in this island
Philippine Commonwealth
Department of Health and Public Welfare (1939)
additional health facilities, expansion of sanitation services
creation of this department is due to the prevalence of infectious diseases at that time due to uncontrolled pop and filth
World War II
Increase in incidence of tuberculosis, malaria, malnutrition, and other diseases
Philippine Republic
Department of Health (1947)
supervision over the Bureau of Health, Bureau of Quarantine, Bureau of Hospitals and all local health offices in the country
was transformed into the Ministry of Health during martial law
Primary health care approach was adopted as a national policy following the Alma Ata Declaration (1970s)
dual health system composed of
public sector
largely financed through a tax-based budgeting system
financed by the GAA of the country
finances all of the needs of the health systems, not only the health sector
private sector
largely market-oriented where healthcare is generally paid for through user fees at the point of service
kung ano need ng market, ayun lang ipprovide nila
fragmented, meaning you need to pay each requirements for your health needs
types
for profit
self-employed health professionals, family-owned businesses and corporate entities
non-profit
charitable institutions, faith-based organizations, civil society organizations (CSOs) and community-based volunteer groups
no VAT upon billing
accounts for 60% of the national expenditures on health
employs over 70% of all health professionals in the country
provides services to an estimated 30% of the population who can afford to pay user fees
Department of Health
carved out from the Department of Health and Public Welfare in 1941 as the national technical authority on health
mandate: to develop national plans, technical standards, and guidelines on health
supervised the implementation of health programs in LGUs
overall technical authority as it is a national health policymaker and regulatory institution
responsible for accreditation of health facilities
they can provide support to the facilities, but the management is on the LGU
major roles in the health sector
leadership in health
enabler and capacity builder
responsible for increasing the knowledge of healthcare providers
they also do capacity building for local chief executives
administrator of specific services
when the government become devolved, they found that not all of the activities can be done by the LGUs, some are by DOH
vision
filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040
mission
to lead the country in the development of a productive, resilient, and equitable and people-centered health system
to provide technical assistance to LGUs and monitor field operations
17 regional health offices
ex. LHBs of LGUs has representative from regional offices
manages and operated several regional hospitals, medical centers, sanitaria, TRCs, and special hospitals that provide tertiary specialized health services and specialty training to health professionals
autonomous agencies: National Nutrition Council, Philhealth, PITAHC, four highly specialized corporate hospitals
they are all under the DOH
HT policy and strategy cluster: to determine which site to implement specific UHC strategies
health packages can be implemented in this areas to see what will be the changes in different levels
public health services cluster
disease and control bureau
all programs on HIV, disease control are under this cluster
they provide technical support in LGUs to implement health programs
they give them the capacity for them to implement the programs (e.g., reqs for rooms, drugs to procure etc)
epidemiology bureau
hospitals submit data on disease cases
health promotion bureau
responsible for enhancing communication strategies
corporate owned hospitals: allowed to have income and invest that income
GOCCs
PhilHealth
there's an issue regarding on unused funds that transferred to the government
Hospitals
Lung Center of the Philippines
National Kidney transplant Institute
Philippines Children's Medical Center
Philippine Heart Center
should expand its capacity to evolve the health system due to changing needs
Pharmaceutical Division
formerly called the National Center for Pharmaceutical Access and Management (NCPAM) through RA 9502 or the Universally Accessible Cheaper and Quality Medicines Act of 2008
National Drug Policy (1987) Pillars
People empowerment to assist patients in making informed choices with regard to their medicines
Quality assurance of drugs
Rational use by health professionals and consumers
Self sufficiency in the manufacture and supply of drugs
Tailored procurement to achieve efficiency and economies of scale in pharmaceuticals
not happen at all because the procurement is fragmented
drives the vision of the country on what they want to do with the medicines
drives the creation of Generics Act
ensure that the drugs are bioequivalent
ensures that health professionals give alternatives for the patients
ensures the rational prescribing
gives us options on how and where to purchase cheaper medicines
Pillars of the Philippine Medicines Policy 2022- 2030
Collaboration on availability and affordability
Commitment to the rational use of medicines
Effective networking, partnerships, and governance
included here is how to partner effectively with private sector
for example, for RHU to be accredited, it must have complete services (lab, pharmacy). but there's some cannot afford this; hence the government allowed partnerships with private companies fulfill the services and be completed
Sustainable financing for medicines
we have financing packages but not yet implemented
Strengthening health systems
will enhance the utilization of medicines
Assurance of safety, efficacy, and quality
provides framework on how to access medicines for certain number of years
roles can be transferred to other agencies
Powers and Functions
to
implement, strategize, maximize and monitor the impact of RA 9502
to manage and implement the National Drug Policy
to undertake appropriate
policy
studies to provide evidence in conceptualizing and implementing strategies that will
improve access to essential medicines, especially for the poor
this year, PD partnered with CP to assess these policies
to
engage and coordinate with relevant stakeholders
to build coalitions, forge agreements and for other purposes as necessary in line with MDG8
to provid
e secretariat support to any council or body created
in pursuit of the effective implementation of RA 9502
pricing council know how to compute prices and the secretariat provide support
to facilitate the processing, coordinating, generating and analyzing inter-agency
price monitoring reports from DTI and local government units
to regularly
review and update the essential drug list
to make it responsive to the needs to the people
HTA is designated to DOST to avoid conflict of interest -> approve HT are submitted to pharmaceutical division to implement or include in the formulary
to perform such other functions as may be incidental to the above or as may directed by the secretary of health
related sector
Food and Drug Administration
Philippine International Trading Corporation
Bureau of Internal Revenue
Department of Trade and Industry
Philippine Health Insurance Corporation
provides pricing of medicines
craft AMS programs for health facilities
works with other agencies of the government
FDA
regulate the effectiveness and safety of the drugs
Philippine International Trading Corporation
regulates importation and trading of drugs
Bureau of Internal Revenue
VAT exemption for drugs
will reduce the price
Department of Trade and Industry
oversee the consumer goods, which is drugs fall under
Philippine Health Insurance Corporation
provide financing
Intellectual Property
generics can be made in emergency situation even the IPO is still not expired
Devolution
happens due to
RA 7160: Local Government Code of 1991
municipal governments
mandated to provide primary care, including preventive and promotive health services and other public health programs through RHUs, health centers, and BHSs
focuses on primary care
Highly urbanized and independent cities
given the responsibilities for providing both hospital services and primary care services
Inter-local Health Zone (ILHZ)
an organized arrangement for coordinating the operations of an array and hierarchy of health providers and facilities, serving a common population within a local geographic area under the jurisdiction of more than one local government
to improve the efficiency of health services through inter-LGU sharing of limited resources and providing economies of scale, thus resolving certain issues brought about by the fragmentation of health services
they can provide their own health services just like the highly urbanized
but this has yet to realize, it's all in paper
Local Governemnt Units
LGUs shall have 40% share in the national internal revenue taxes based on the collection of the third fiscal year preceding the current fiscal year
internal revenue allotment (IRA)
Mandanas-Garcia Ruling
declares unconstitutional the phrase "internal revenue" to include all collections of national taxes in the computation of just share for the LGUs
national tax allotment
2 more items...
pera ng mga LGUs
provincial governments
given the responsibility for managing and operating primary- and secondary-level hospital (at least lvl III; must be referral) services through the district and provincial hospitals
LGU want to have autonomy under the area of their supervision
LGU has now the power to implement health programs
ex. HPV vaccine: DOH and LGU have their own vaccines but the implemention and efforts of LGU are different depending on their willingness to implement the programs
only technical support is given by the DOH and other health agencies but the implementation of health programs is in the hand of the LGUs
more effective expression of preferences with respect to public goods and services
ability to internalize both externalities and spillover effects
internalize the benefits of services
externalities: the benefit of the services
example: gumaling ang tao dahil sa health services -> become productive -> benefits the society
spillover: the campaign is spillover to other LGUs
the concept of devolution is not bad but the implementation makes it bad
assumptions
LGUs are closer to the people
more responsive to citizens
better able to match services to citizen preferences
ex. school based vaccination did not went well because it should be community based
difficult for the national government to see
more accountable to voters
effects
improves services and resource-allocation efficiency
foster innovation and efficiency
in reality, different LGUs has its own vision, some of them neglecting healht programs, affecting the performance of their health
concerns
quantity, quality and distribution of essential health services at local levels
severely affected geographically isolated and disadvantaged areas
opportunistic political leaders employ some element of decentralization for their own gain
clientelism: in exchange of political support
justified on the groups of urgency of local action in providing health services without the need for higher level government intervention
LGU has the autonomy to provide health services
can mobilize services based on the needs; can declare state of calamity without waiting for the natl gov to declare so
solution to existing problem
fine-tuning decentralization
setting a clear and reasonable power sharing between and among tiers of government, business sector, and civil society should be complemented with parallel reforms and integrity and accountabiltiy mechanism
Improvements in health outcomes and performance of healthcare facilities and health workers at the local level showed marked variations across LGUs
Major gaps in quantity, quality and distribution of essential health services at local levels have become persistent concerns of both the National and local governments
ex. problem in supply chain
The fragmentation of the healthcare delivery system most severely affected the provision of health services in geographically isolated and disadvantaged areas
inequity in budget allocations: cities benefit more than the poor rural areas