The document discusses various aspects of health policy in the Philippines, including its history, goals, and strategies. It outlines the country's epidemiological transition over time from communicable to non-communicable diseases. It also summarizes the government's plans to achieve universal health care through expanding PhilHealth coverage, improving health facilities, deploying more health workers, and ensuring financial protection for citizens' health needs. The ultimate goals are to achieve public health targets while providing accessible, quality care and minimizing out-of-pocket costs.

1. Health Policy
and
Kalusugan Pangkalahatan

2. What is Health Policy?

3. 0 10025 x 1,000 km 75
Parameter 25 75 100
Life Event Manufacture to
Prime
Middle Age Resale / Trade-in /
Scrap
Care
Provider
“Casa” “Talyer” / Self-repair ?
Dx, Tx, Rx Preventive
Maintenance
(e.g., Oil Changes)
Brake Pad
Replacements,
Recalibrations
Overhauls
Costs of
Care
+ +++ +++++
Financing Co-pay Co-pay, Insurance Co-pay, Insurance
Catastrophe MV “Crash” (Damage)
Regulation LTO, LTFRDB, MMDA, etc.

4. 0 10025 x 1 year 75
Parameter 25 75 100
Life Event Birth to Early
Adulthood
Middle to Old Age (Very) Old Age
Care
Provider
Clinics
(OB, Pedia, Surg)
Clinics / Hospitals
(IM, Surg)
Hospitals
(IM, Surg, Patho)
Dx, Tx, Rx Outpatient > Inpatient
(Vaccines, Vitamins, etc)
Outpatient = Inpatient
(“Maintenance” Meds,
etc)
Outpatient <<
Inpatient
(ACLS, Critical Care, etc)
Costs of
Care
+ +++ +++++
Financing OOP vs. Insurance OOP vs. Insurance OOP vs. Insurance
Catastrophe MV “Crash” (Trauma)
Regulation PRC – Board of Medicine, DOH (incl. FDA), PHIC, etc.

5. Demystifying and De-medicalizing
 The allocation of resources must be explicit
 Decision-making at all levels must be open
 Medicine must be de-mystified and health de-
medicalized, for professionals, patients, the general
public and politicians alike
 Public health / health policy is thus multi-disciplinary, and
multi-stakeholder
Reference: Gray, 2004 (pp. 317-318), modified

6. “Pharmacology” of Health Policy
 DYNAMICS and the mechanism of action:
 Will an intervention reduce the risk?
 KINETICS and the response of the system:
 Will the intervention for the main concern increase other
risks? (i.e., adverse effects)
 THERAPEUTICS and delivery:
 Is it operationally possible to introduce the intervention?
Reference: Gray, 2004 (p. 296), with modification

7. Health Policy:
Scope, Scale, and Stakeholders

8. Factors in Health Policy Change
OLD
POLICY
NEW
POLICY
Ideological
inspirations
Change in
circumstances
Evidence
Common sense
From
research
From experience
Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292)
NOTE: Policy makers operate on a
timescale that does not generally admit
of delays that research will take.

9. How has health policy
developed over time
in the Philippines?

10. Historiography of PH Public Health
 Spanish era: reordering of Philippine society
 American era: a civilizing mission to prepare Filipinos for
independence; governance through sanitation, health,
hygiene, medical and scientific institutions, medical and
health professions
 Public schools and school children as agents for public
health work
 Educational, medical, and scientific research institutions as
training and preparation “laboratories”
 Leading to “Filipinization” of the bureaucracy
Reference: Planta, 2008

11. History of Philippine Health Reform
 1960s: Medicare
 1970s: Population Policy
 1980s: Generics Act of 1988
 1990s:
 Local Government Code of 1991
 National Health Insurance Act of 1995
 2000-present:
 HSRA  F1  KP
Reference: Romualdez, 2011
FINANCING
SERVICE
DELIVERY

12. Epidemiological Transition
0
10
20
30
40
50
60
70
80
90
100
110
0
100
200
300
400
500
600
1954 '57 '60 '63 '66 '69 '72 '75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 2008
Deathsper100,000population
(non-communicablediseases)
Deathsper100,000population
(communicablediseases)
Year
Communicable Diseases Malignant Neoplasm Diseases of the Heart
Source: Philippine Health Statistics, various years

13. Is Universal Health Care
more fun in the Philippines?

14. Areyougettingwell?
Can you pay for the services?Reference: Berman, 2012

15. Improved Health
Outcomes and
Minimal Financial
Risk
Use of Quality
Services
Reduction of
Exposure to
Health Risks

16. Start with the Poor and Vulnerable
Q1
Poorest
Q2 Poor
Q3 Middle
Income
Q4 Rich Q5 Richest
16
Note: Population counts projected for FY 2013 (except for DSWD numbers); rounded off to the nearest
million.
• Poverty incidence by NEDA/NSO is only a statistical estimate
• DSWD’s NHTS-PR and 4Ps/CCT, while with data on
names, faces, and places, may not have enlisted all the “real
poor”
• The DOH thus uses Q1 + Q2 for planning estimates, with
reliance on the DSWD’s NHTS-PR and 4Ps/CCT for
targeting/identification
Identified by DSWD

17. 1.0
Public Health MDGs
Achieved
1.1 - Reduce
Maternal and
Child Mortality
1.2 - Control
and Eliminate
Infectious
Diseases
1.3 - Promote a
Healthy
Lifestyle and
Prevent NCDs
2.0
Financial Risk
Protection
Improved
2.1 - Expand
PhilHealth
Coverage
2.2 - Improve
PhilHealth
Benefit
Package
3.0
Quality Care
Delivery System
Accessible
3.1 - Upgrade
and Improve
Health Units
and Hospitals
3.2 - Deploy
Human
Resources for
Health
4.0
Health
Governance
Improved
4.1 – Improve/
Reform Health
Systems
4.2 – Maintain
an Effective
Health
Regulatory
System
Outcomes and Strategies

18. How will we achieve
public health MDGs?

19. 1.0
Public Health
MDGs Achieved
1.1 - Reduce
Maternal and
Child Mortality
1.2 - Control
and Eliminate
Infectious
Diseases
1.3 - Promote a
Healthy
Lifestyle and
Prevent NCDs
Package
of actions
and
population
coverage:
• Increase facility-based deliveries and
family planning services, commodities
and counseling for Q1 and Q2 mothers
& women of reproductive age
• Immunize all infants according to the
Expanded Program on Immunization
(EPI) & provide pneumococcal and
rotavirus vaccines among susceptible
communities
• Immunize poor senior citizens (influenza
and pneumococcal vaccines)
• Provide vitamins & minerals to all
children (<5 y/o)

20. Carpi
o
RPRH Law?
April 8, 2014 (Tuesday)

21. 1.0
Public Health
MDGs Achieved
1.1 - Reduce
Maternal and
Child Mortality
1.2 - Control
and Eliminate
Infectious
Diseases
1.3 - Promote a
Healthy
Lifestyle and
Prevent NCDs
Package
of actions
and
population
coverage:
• Treat all diagnosed TB cases
• Eliminate malaria in endemic provinces
• Improve HIV/AIDS prevention, screening,
diagnosis, and treatment
• Provide rabies vaccine for dog bite victims
and coordinate with DA for dog
vaccination
• Eliminate filaria and other intestinal
parasites

22. Susceptible
Population
Not detected or false
negatives on screening,
hence not treated;
Or self-medicated
MDR TB Mortality
Treatment
Success
Rate
(TSR)
Case Detection Rate (CDR)
Prevalence
RateIncidence
Rate
TB Infection
Cycle
Failed
treatment
Spontaneous
remission
Case Notification Rate (CNR)
Cure Rate
(CR)

23. 1.0
Public Health
MDGs Achieved
1.1 - Reduce
Maternal and
Child Mortality
1.2 - Control
and Eliminate
Infectious
Diseases
1.3 - Promote a
Healthy
Lifestyle and
Prevent NCDs
Package
of actions
and
population
coverage:
• Promote key health messages (on Healthy
Lifestyle, preventing disease and injury,
available health services)
• Establish, link, and maintain non-
communicable disease registries in
provinces
• Provide access to screening services for
NCDs for the poor through PhilHealth
Primary Care Benefit package

25. How will we improve
Financial RisK Protection?

26. Who pays for the cost of health care?
National
Government
12%
Local
Government
15%
Social Health
Insurance
(PhilHealth)
9%Private OOP
53%
Others
11%
Source: 2011 Philippine National Health Accounts

27. 2.0
Financial Risk
Protection
Improved
2.1 - Expand
PhilHealth
Coverage
2.2 - Improve
PhilHealth
Benefit
Package
Package of
actions and
population
coverage:
• Expand coverage of all Filipinos,
especially the poor and near-poor
(14.7M)
• Inform and guide all members on
PhilHealth availment procedures and
benefits
• Improve access to primary care benefit
package for the poor (drugs &
diagnostics)
• Increase PhilHealth share in total health
care costs, to minimize out-of-pocket
payments
Increased Fiscal Space:
 “Tuwid na Daan”
 Sin Tax Reform of 2012
 National Health
Insurance Act of 2013

28. How do we make a Quality Care
Delivery System Accessible?

29. 3.0
Quality Care
Delivery System
Accessible
3.1 - Upgrade
and Improve
Health Units
and Hospitals
3.2 - Deploy
Human
Resources for
Health
Package of
actions and
population
coverage:
• Upgrade, build, and enhance:
• Barangay health stations as well
as rural and city health units to
deliver preventive health services
• LGU district and provincial
hospitals for quality outpatient
and inpatient care
• DOH regional hospitals and
medical centers to make
specialized care more affordable
• Distribute complete treatment packs
(for common diseases like infections,
diabetes, hypertension, heart
diseases, etc) to poor patients

30. 3.0
Quality Care
Delivery System
Accessible
3.1 - Upgrade
and Improve
Health Units
and Hospitals
3.2 - Deploy
Human
Resources for
Health
Package of
actions and
population
coverage:
• Deploy human resources for health
(Physicians, Nurses, and Midwives)
nationwide, properly distributed with
priority to NHTS and other priority areas
• Train and deploy Community Health
Teams (CHTs) to reach families with key
messages and basic preventive care

31. Public/Gov’t Health Facilities

32. Office of Secretary of Health
Attached Agencies
Regional Offices
Provincial Health Offices
City Health Offices
(Component Cities)
Inter-local Health Zones
City
Hospitals
Health
Centers
Barangay
Health
Stations
District
hospitals
Municipal health
offices/ Rural
Health Unit
Barangay Health
Stations
Provincial
Hospitals
Regional hospital
Medical Centers
Sanitaria
City Health Offices
(Chartered Cities)
City
Hospitals
Health
Centers
Barangay
Health
Stations
References: Kelekar and Llanto, 2013; Khemani, 2010

34. The Five-Star Doctor
Roles
 Health Care Provider
 Teacher
 Researcher
 Social Mobilizer
 Manager / Policy
Maker
Examples of
Leaders
 Expert Clinicians
 Deans and Professors
 Principal Investigators
 Health Advocates
 DOH Officials / Staff

37. AlbertDomingo.com
facebook.com/aedomingo
twitter.com/AlbertDomingo
Open Forum / Q&A