National Health Situation

THE NATIONAL HEALTH SITUATION

THE NATIONAL HEALTH SITUATION Demographic profile - Philippine is one of the populous countries in the world in 2000. - 75.3 million (NCSB, 2001) - projected to increase to 82,636,689 in 2004 (Natioanl Health Objectives, 1999)

THE NATIONAL HELATH SITUATION - 1999, average life expectancy at birth was 68.6 years * 71.28 for females * 66.03 for males - 249 people for every square kilometer of Philippine territory.

THE NATIONAL EHALTH SITUATION - Metro manila has the highest population density (16,051) - CAR has the lowest (75) (National Health Objectives). - from the 37% of the total population in 1984 (unicef, 1986) the figure increased to 44% ten years later. - annual population growth rate for the whole country is 2.3%; urban areas is 3.4 per year.

THE NATIONAL HELATH SITUATION - High population density transmission of infectious and communicable diseases. - Greater need for social services such as:

decent housing transportation communication

education health services

THE NATIONAL HELATH SITUATION - High level of stress in congested areas

leads to: disintegration of moral values and social institutions and contributes to the incidence of a number of health problems, including mental health problems.

THE NATIONAL HELATH SITUATION Health profile Birth and deaths Crude Birth Rate (CBR) in 1997 was 28.4 per 1000 population Crude Death Rate (CDR) 6.1 per 1000 population. The rate of natural increase in the country’s population for the same year was 22.3 (28.4 minus 6.1) for every 1000 population

THE NATIONAL HELATH SITUATION - Rural women have more children than

urban women. - Uneducated women also have more children than those who are with college education. - Those in the 25-29 age group have the highest fertility rate (national demographic and health survey, 1999)

THE NATIONAL HEALTH SITUATION In 1995, infant mortality rate (IMR) was 48.9 per 1000 live births, which is within the WHO global goal for IMR of less than 50/1000 live births. Under-five mortality rate or deaths of children below five years old in the same year was 67/1000 live births.

THE NATIONAL HEALTH SITUAION - Maternal mortality rate (MMR) was

1.8/1000 live births (DOH), 1995) or 18 maternal deaths for every 10,000 live births. - Death rate among males is higher than

females – referred as the “feminization” of old age.

THE NATIONAL HEALTH SITUATION Causes of morbidity and mortality Mortality (1997) 3. Diseases of the heart 4. Diseases of the vascular system 5. Pneumonias 6. Malignant neoplasms 7. TB, all forms

THE NATIONAL HELATH SITUATION 6. Accidents 7. Chronic obstructive and pulmonary diseases, and allied conditions 8.Other diseases of the respiratory system 9. Diabetes mellitus 10. Diarrheal diseases

THE NATIONAL HELATH SITUATION - Infant mortality rate is one of the most

sensitive indicators of health status of a country or community. Results from: 1. poor maternal conditions 2. unhealthy environment 3. inadequate health care delivery system

THE NATIONAL HELATH SITUATION leading causes of infant mortality in 1997 were: 2. Respiratory conditions of the fetus and newborn 3. Pneumonias 4. Congenital anomalies 5. Birth injury and difficult labor 6. Diarrheal diseases

THE NATIONAL HELATH SITUATION 6. Septicemia 7. Measles 8. Meningitis 9. Other diseases of the respiratory system 10. Aminovitaminosis and other nutritional deficiency. (1997 Philippine health statistics)

THE NATIONAL HELATH SITUATION Maternal mortality – major indicator of a woman’s health status – define by WHO as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to, or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

THE NATIONAL HEALTH SITUATION Leading causes of maternal mortality in 1997 1. Normal delivery and other complications related to pregnancy occurring in the course of labor, delivery and puerperium. 2. Hypertension complicating pregnancy, childbirth and puerperium 3. Postpartum hemorrhage

THE NATIOAL HEALTH SITUATION 4. Pregnancy with abortive outcome 5. Hemorrhages related to pregnancy Analysis of women’s poor health and maternal mortality should consider the overall social, cultural, and economic environment. (poor, low educational status, multipara, anemic)

THE NATIONAL EHLATH SITUATION Leading causes of morbidity (1997) 2. Diarrheas 7. chickenpox 3. Pneumonias 8. diseases of the 4. Bronchiolitis heart 5. Influenza 9. measles 6. TB, all forms 10. dengue H-fever 7. malaria

THE NATIONAL HEALTH SITUATION SARS – “scary” severe acute respiratory syndrome. Transmission of infectious diseases is facilitated by the increasing mobility of people and ease in traveling form one country to another.

THE NATIONAL HEALTH SITUATION AIDS – major public health problem, (urban areas) - increase in STD’s (syphilis, & gonorrhea due to unhampered prostitution in the country. - prostitution has always been identified as a consequence of poverty.

THE NATIONAL HEALTH SITUATION TUBERCULOSIS - Number one cause of mortality about 50 years ago continue to be a major killer of Filipinos. LEPROSY -MDT (multi-drug therapy) 1.7/10,000 (1995)

THE NATIONAL EHALTH SITUATION SCHISTOSOMIASIS - affect hundred of barangays in 24 endemic provinces. RABIES - incidence in the Philippines is one of the highest in the world. HEPATITIS B - 12% of the population are chronic carriers (hepatitis B and hepatic sarcoma)

THE NATIONAL HEALTH SITUATION *MOSQUITO* - malaria - filariasis - dengue fever

THE NATIONAL HEALTH SITUATION POVERTY AND HEALTH - illiteracy - unfounded health beliefs - harmful practices - inadequate nutrition - poor environmental sanitation - inadequate source of potable water supply

NATIONAL HEALTH SITUATION - congested housing unit - limited access to basic health services - inability to make decisions on matters which are important to health

THE NATIONAL HEALTH SITUATION CULTURAL INFLUENCES ON HEALTH - is a way of life - passed on from one generation to the next - includes beliefs, values and customs or practices - traditional

THE ANTIONAL HEALTH SITUATION ENVIRONMENTAL INFLUENCES ON HEALTH - unsanitary environment = major factor - breeding ground of animals and insects that harbor and transmit microorganisms. - deterioration of the ecosystem - exposure to chemicals and other air pollutants (cancer & respiratory diseases)

THE NATIONAL HEALTH SITUATION - industrialization - government policies - poverty and an uncaring attitude towards the environment.

THE NATIONAL HEALTH SITUATION POLITICAL INFLUENCES ON HEALTH - politics affects health - health policies emanate from congress, the executive department (DOH) - policies that affect health = health care delivery system and the practice of nursing in the Philippines

THE NATIONAL HELATH SITUATION - health budget is the most concrete expression of the government’s political will. - health spending has always

THE NATIONAL HELATH SITUATION

2.

3. 4.

policies that impact on people’s health directly National blood services Act (RA 7719) National diabetes Act (RA 8191) Salt iodization Act (RA 8172)

THE NATIONAL HELATH SITUATION Policies that affect health indirectly 2. Family and social relationship 3. Environment 4. Access to education 5. Malnutrition 6. Mental health problems 7. Cancer 8. Other lifestyle-related diseases

THE ANTIONAL HELATH SITUATION Laws that affect the delivery of health services 2. Local government code 3. National health insurance Act 4. Professional practice acts of the different professions

THE NATIONAL HEALTH SITUATION THE HEALTH CARE DELIVERY SYSTEM - is the totality of all policies, infrastructures, facilities, equipment, products, human resources, and concerns of all people

THE NATIONAL HEALTH SITUATION - preventive health care = concern of the government-owned health centers - curative care = provided by hospitals, both government and private

THE NATIONAL HEALTH SITUATION DEPARTMENT OF HEALTH - national government’s biggest health care provider - used to have control and supervision over all barangay health stations, rural health units and hundreds of hospitals throughout the country

THE NATIONAL HELATH SITUATION - Bureau of local health development - local health systems development - health care financing programs - quality improvement programs - intersectoral (public-private) coordination and local projects

THE NATIONAL HELATH SITUATION DEVOLUTION OF HEALTH SERVICES - RA 7160 = local government code - the code aims to: transform local government units into self-reliant communities and active partners in the attainment of national goals through a more responsive and accountable local government structure instituted through a system of decentralization.

THE NATIONAL HEALTH SITUATION - provincial, district and municipal hospitals provincial governments - rural health units (RHUs) and barangay health stations (BHSs) municipal governments

THE NATIONAL HEALTH SITUATION - provincial level > governor (chair) > provincial health officer (vice chair) > chairman of the Committee on Health of the sangguniang panlalawigan > DOH representative

THE NATIONAL HELATH SITUATION - City and Municipal level

> mayor (chair) > municipal health officer (vice chair) > chair of the committee on health of the sangguniang bayan > DOH representative and NGO representative

THE NATIONAL HEALTH SITUATION HEALTH SECTOR REFORM AGENDA AND NATIONAL OBJECTIVES FOR HEALTH - HSRA (1999-2004) - NOH (1999-2004)

THE NATIONAL HELATH STITUATION FIVE MAJOR REFORMS CONTAINED IN THE HSRA 2. Provide fiscal autonomy to government hospitals 3. Secure funding for priority public health programs 4. Promote the development of local health systems and ensure its effective performance

THE NATIONAL HEALTH SITUATION 4. Strengthen the capacities of health regulatory agencies 5. Expand the coverage of the National Health Insurance program

NATIONAL OBJECTIVES FOR HEALTH

Vision: Health for all Filipinos

NATIONAL OBJECTIVES FOR HEALTH

Mission: Ensure accessibility and quality of health care to improve the quality of life of all Filipinos, especially the poor

NATIONAL OBJECTIVES FOR HEALTH Principles  universal access to basic health services must be ensured.  the health and nutrition of vulnerable

groups must be prioritized.

NATIONAL OBJECTIVES FOR HEALTH  The epidemiologic shift from infectious to

degenerative diseases must be managed.  The performance of the health sector must

be enhanced.

NATIONAL OBJECTIVES FOR HEALTH GOALS AND OBJECTIVES 2. Improve the general health status of the population - reduce infant mortality rate - reduce child mortality rate - reduce maternal mortality rate - reduce total fertility rate - increase the life expectancy and the quality of life years 

NATIONAL OBJECTIVES FOR HEALTH 2. Reduce morbidity, mortality, disability and complications from the following diseases and disorders - pneumonias and acute respiratory infections - diarrheas and other food and water borne diseases like typhoid, cholera, and hepatitis A

NATIONAL OBJECTIVES FOR HEALTH - Tuberculosis - Dengue - Intestinal parasitism - STD’s, HIV-AIDS and other reproductive

tract infections - Hepatitis B - Asthma and chronic obstructive pulmonary diseases

NATIONAL OBJECTIVES FOR HEALTH - Nephritis and chronic diseases - Dental caries and periodontal diseases - Rheumatic heart disease and rheumatic

fever - Coronary artery disease, hypertension and hyperlipidemia - Stroke - Cancer

NATIONAL OBJECTIVES FOR HEALTH - Diabetes - Mental disorders - Protein-energy malnutrition - Iron-deficiency anemia - Obesity - Accidents, traumas and injuries

NATIONAL OBJECTIVES FOR HEALTH 3. Eliminate the following diseases as public health problems - Schistosomiasis - malaria - filariasis - leprosy - rabies

NATIONAL OBJECTIVES FOR HEALTH - vaccine-preventable diseases: measles,

tetanus, diptheria, and pertussis - Vitamin A deficiency - Iodine deficiency disorders

NATIONAL OBJECTIVES FOR HEALTH 4. Eradicate poliomyelitis 5. Promote healthy lifestyle - promote healthy diet and nutrition - promote physical activity and fitness - promote personal hygiene

NATIONAL OBJECTIVES FOR HEALTH - promote mental health and less stressful life - Prevent smoking and substance abuse - Prevent violent and risk-taking behaviors

NATIONAL OBJECTIVES FOR HEALTH 6. Promote the health and nutrition of families and special populations - neonatal and infant health - health of indigenous peoples - children's health - adolescent and youth health - adult health - women's health

NATIOANL OBJECTIVES FOR HEALTH - health of older persons - health of overseas Filipino workers - health of differently-abled persons - health of the rural poor - health of the urban poor

NATIONAL OBJECTIVES FOR HEALTH 7. Promote environmental health and sustainable development - healthy homes - healthy workplace and establishments - healthy schools - healthy communities, towns and cities

FOURmula ONE FOR HEALTH

FOURmula ONE

implementation framework for health sector reform

FOURmula ONE FOR HEALTH  GOALS  Better health outcomes  More responsive health systems  Equitable health care financing

FOURmula ONE FOR HEALTH 2. 3. 4. 5.

FOUR THRUSTS Financing (increased, better and sustained) Regulation (assured quality and affordability) Service Delivery (ensured access and availability) Governance (improved performance)

FOURmula ONE FOR HEALTH 2. 3. 4. 5.

STRATEGIC GUIDEPOSTS Building upon gains and lessons from major reform initiatives Focus on critical interventions to be implemented as a single package Sector wide management of FOURMULA ONE implementation NHP as the primary instrument

FOURmula ONE FOR HEALTH CONSTRAINTS 2. Restricted government health budgets - inflexible allocation across categories - allocation among programs not linked to performance 5. Difficulty in managing a highly decentralized system - steering various stakeholders (i.e. - local systems, private markets) - managing health finances from multiple sources

FOURmula ONE FOR HEALTH OPPORTUNITIES 2. Deeper understanding of and increasing leverage of the NHIP over health system performance. 2. Inroads in health reforms in at least 30 provinces resulting in improvements in health outcomes and providing invaluable lessons.

FOURmula ONE FOR HEALTH 3. Growing support for HSRA implementation from partners government agencies, external. 4. Deeper understanding of reform implementation requirements. 5. Revitalized support from national leadership.

FOURmula ONE FOR HEALTH CRITICAL COMPONENTS TO JUMP START fourmula one IMPLEMENTATION • Identifying critical components - sufficient groundwork and buy-in - triggers a chain reaction to spur other FOURmula ONE interventions - produces tangible results - generates public support

FOURmula ONE FOR HEALTH FINANCING GOAL Secure increased, better and sustained investments in health to improve health outcomes especially of the poor.

FOURmula ONE….FINANCING Rationalization of sources of health financing * out of pocket - shift of OOP to outpatient care (e.g. check-up, consultation, etc.) * Local government - focus subsidy on preventive and promotive health services

FOURmula ONE…FINANCING *National government - shift resources on regulation, governance and to teaching/training tertiary hospitals *Social health insurance - Focus on in-patient care

FOURmula ONE…FINANCING Local health financing reforms • Earmarking funds and prioritizing health services - social marketing advocacy to LGUs, NGO & private sector to earmark funds for priority health programs.

FOURmula ONE…FINANCING

- identify tools for prioritizing health services (e.g. segmentation and targeting the poor)

FOURmula ONE…FINANCING *Management/coordination of LGU health fund - integrate national and local investment plan - cost-sharing arrangements among LGUs - national and local coordination of funds (e.g. counterparting arrangements) - Rapid estimation of local health accounts

FOURmula ONE…FINANCING NATIONAL HEALTH FINANCING REFORMS 1.Public finance management system 2.Institutionalization of revenueenhancement measures *full retention of income *asset management

FOURmula ONE…FINANCING 3. Development of efficient and equitable allocation mechanics. -priority health programs -geographic -income -population groups

FOURmula ONE…FINANCING 4. Performance based-budgeting system -develop models for hospitals, public health and regulatory agencies -reform financial management and procurement system -develop / implement performance audit and review system

FOURmula ONE…FINANCING 2. 3. 4. 5.

IMPROVEMENT OF THE NHIP Increase membership and collections Enhance benefit package Improve utilization of reimbursements Enhance systems for regulation and governance

FOURmula ONE…REGULATION REGULATION GOAL Assure access to quality and affordable health products, devices, facilities and services especially those used by the poor.

FOURmula ONE…REGULATION 2.

3. 4.

5.

STRATEGIES Harmonizing & streamlining of systems, processes for licensing & accreditation and certification Developing a seal of approval Pursuing cost recovery with income retention for health regulatory agencies & other revenue generating mechanisms Ensuring access of the poor to essential health products

FOURmula ONE…REGULATION

3. 4. 5. 6.

COMPONENTS Programs include: one-stop shop Philhealth-sentrong sigla seal Unified seal of approval Botika ng barangay / pharma 50

FOURmula ONE…SERVICE DELIVERY SERVICE DELIVERY GOAL Improve accessibility and availability of basic and essential health care for all, especially the poor.

FOURmula ONE…SERVICE DELIVERY COMPONENTS 2. Public health development plan a. disease-free zone – “mopping-up” leprosy b. Intensified disease programs - TB, HIV/AIDS emerging infections c. Improving reproductive health outcomes – MMR, IMR, U5MR, TFR, CPR

FOURmula ONE…SERVICE DELIVERY d. Intensified promotion of healthy lifestyle – DM, HPN, CVD, breast and cervical cancer, anti smoking, safe water, sanitation, among others

FOURmula ONE…SERVICE DELIVERY 2. Health facilities development plan - critical upgrading of facilities through fund pool - rationalizing services in DOH-retained, local government & private facilities inside the 16 sites - Integrating wellness services in hospitals

FOURmula ONE…SERVICE DELIVERY 3. Establishment of National Health Promotion Foundation 4. Disaster preparedness and response system 5. Disease surveillance and networking system 6. Intensification of health promotion

FOURmula ONE…SERVICE DELIVERY STRATEGIES 1. Making available basic and essential health service packages by designated providers in strategic locations 2. Assuring the quality of both basic and specialized health services

FOURmula ONE…SERVICE DELIVERY 3. Intensifying current efforts to reduce public health threats 4. Disease –free zones a. Filariasis – endemic mapping with STH and Schistosomiasis programs, disability prevention

FOURmula ONE…SERVICE DELIVERY b. Leprosy – quality diagnosis & case management

c. Rabies – functional animal bite treatment centers, responsible pet ownership

FOURmula ONE…SERVICE DELIVERY d. Malaria – community participation in vector control elimination & surveillance activities. Malaria benefit package Insecticide Treated Nets (ITN), rapid diagnostic test.

FOURmula ONE…SERVICE DELIVERY e. Schistosomiasis – intensify surveillance of human cases and the snail vector 5. Intensifies disease prevention and control a. emerging infectious diseases – avian influenza task force at all levels, preparedness & response plan for pandemic influenza, philhealth benefit package

FOURmula ONE…SERVICE DELIVERY b. VPI – reaching every barangay, 4Bs (Bakuna, Bitamina A, Breastfeeding advocacy, purga sa Bulate), 100% Hepatitis B vaccines till 2010 c. Tuberculosis – nationwide implementation of DOTS, TB in children PPMDOTS

FOURmula ONE…SERVICE DELIVERY d. HIV / AIDS – social hygiene clinics, local AIDS councils, behavior change modification, Community based program, home base care

FOURmula ONE…SERVICE DELIVERY 6. Improving reproductive health outcomes a. Public-private partnership on women’ health b. Pre-pregnancy package c. Contraceptive delivery & logistic MIS d. Standard days method as NFP e. Paradigm shift – “high-risk” pregnancies to ALL PREGNANCIES ARE AT RISK

FOURmula ONE…SERVICE DELIVERY

f. mother and child book g. infant and young children feeding program

FOURmula ONE…SERVICE DELIVERY 7. Intensified promotion of healthy lifestyle a. tobacco management team at various levels b. smoking cessation clinics c. community-based NCD prevention and control program d. intensified promotion of healthy lifestyle –DM, HPN, CVD, breast & cervical cancer, antismoking, safe water, sanitation among others. e. strengthen national HL campaign

FOURmula ONE…GOVERNANCE GOVERNANCE GOAL Improve health system performance at the national and local levels

FOURmula ONE…GOVERNANCE COMPONENTS 1. Sectoral development approach for health 2. Health human resource masterplan 3. Establishment of 4-in-1 convergence sites 4. Philippine health information system 5. Procurement and logistics management system 6. Public finance management system

FOURmula ONE…GOVERNANCE Sectoral development approach for health 1. To strengthen government leadership in implementing a sector program where development partners cooperate and contribute accordingly - effective donor and LGU coordination towards financing a sector program - harmonizing procedures among donors and national government

FOURmula ONE…GOVERNANCE Health human resource masterplan 2. To maintain a national HHR masterplan in support of national & local health systems - HHR information system - competency-based recruitment & selection systems - training and development need analysis

FOURmula ONE…GOVERNANCE - Performance management system - Career development and management - Advocacy plan

FOURmula ONE…GOVERNANCE

2. 3. 4. 5.

Developing a localized health human resource strategy Health professional development and career track Identifying and providing venue for posting of vacancies Actively promoting LGU vacancies Support for developing local HR strategy

FOURmula ONE…GOVERNANCE

2. 3.

4.

Establishment of 4-in-1 convergence sites Health investment planning Developing appropriate governance and mechanisms, i.e., ILHZ convergence sites Helping mobilizing extra-budgetary resources for health at the local level

FOURmula ONE…GOVERNANCE 4. Improving procurement, devolving regulatory functions, linking, local regulatory policies with health programs and financing 5. Nationalizing the health delivery network, provision of basic health services 6. Monitoring & evaluation, i.e., LGU score card

FOURmula ONE…GOVERNANCE Philippine health information system 2. establishment, operationalization, & use of health portal and development of Philippine health information infrastructure - harmonization of info systems - human resource info system - vital registries, health statistics

FOURmula ONE…GOVERNANCE Philippine health information system 2. establishment, operationalization, and use of health portal and development of philippine helath information infrastructure 3. Development of manual of operations

FOURmula…GOVERNANCE 2. 3. 4. 5.

DOH procurement and logistics management system Inventory system, supply chain mechanism Efficient storage Database of goods / supplies (standard specifications) Procurement systems - pooling - monitoring - feedback mechanism

FOURmula ONE…GOVERNANCE - Disease surveillance - health accounts - health regulations - health facilities

FOURmula ONE…GOVERNANCE 5. Database of supplies with performance monitoring 6. Standardization of specifications and documents 7. Implementation of ethical practices framework

THE NATIONAL OBJECTIVES ON HEALTH

NATIONAL OBJECTIVES… NATIONAL OBJECTIVES FOR HEALTH 2005 TO 2010 -Provides the road map for stakeholders in health and health-related sectors to intensify and harmonize their efforts to attain its time-honored vision of health for all Filipinos and continue its avowed mission to ensure accessibility and quality of life of all Filipinos, especially the poor.

NATIONAL OBJECTIVES… It provides concrete handle that would guide policy makers, program managers, local government executives, development partners, civil society and the communities in making crucial decisions for health.

NATIONAL OBJECTIVES… 2. 3. 4. 5.

OBJECTIVES OF THE HEALTH SECTOR Improve the general health status of the population Reduce morbidity and mortality from certain diseases Eliminate certain diseases as public helath problems Promote healthy lifestyle and environmental health

NATIONAL OBJECTIVES… 5. Protect vulnerable groups with special health and nutrition needs 6. Strengthen national and local health systems to ensure better health service delivery 7. Pursue public health and hospital reforms 8. Reduce the cost and ensure quality esssential drugs 9. Institute health regulatory reforms to ensure quality and safety of helath goods and services

NATIONAL OBJECTIVES… 10. Expand the coverage of social health insurance 11. Mobilize efficiency in the allocation, production and utilization of resources for health