This presents the trends, issues, and challenges in the Philippine Health Care Delivery System. The data were mostly taken from the Philippine Department of Health (DOH) website and DOH Region VI Office.

1. RYAN MICHAEL F. ODUCADO, MAN, MAEd, RN, RM, RPT
TRENDS  ISSUES  CHALLENGES
Lead Faculty, Community Health NursingWest Visayas State University
NNCCS, Master Trainer (Community/Public Health Nursing)

2. Seminar Outcome
After 30-minute seminar, the participants must have:
1. identified the various trends, issues and challenges
confronting the Health Care Delivery System
contextualizing the discussion in the Philippine
setting;
2. recognized the pivotal role of nurses in addressing
these key issues and challenges; and
3. participated attentively in the exchange of
intellectual discussion in identifying possible areas
for improvement, research and knowledge
development in the area of health care system.

3. Declaration of Interest & Disclosure
• The presentation covers data available to the public.
• The presenter is a Master in Community/Public
Health Nursing working collaboratively with the
Department of Health.
• The presenter has projects geared toward
increasing Education, Nursing and Public Health
body of knowledge.
• The presenter has no known or perceived conflict of
interest.

4. Content Outline
Pressures on the Public Health System (Cuevas, 2007)
1. Shift in demographic and epidemiologic trends in disease
Emerging disease like EBOLA, MERSCov, ZIKA
2. New technologies for health care, communication and information
RxBOX, mhGAP, eHealth, EVP, BPO
3. Existing and emerging environmental hazards with globalization
Climate Change, Disaster Preparedness
4. Health Reforms
SDGs, Duterte Health Agenda, ASEAN Integration

5. Content Outline
1. National Health Situation
2. Local Health Situation
3. Global Health Goals
4. National Health Goals

6. Philippine Health Care Delivery System
It is a complex set of organizations interacting to provide an array of health services.
Public Private
Largely financed through tax-based system Largely market-oriented
National Local Profit Non-profit
DOH
Specialty, retained and
regional hospitals, medical
centers, DOH representatives
LGU
Provincial and district
hospitals, RHUs, BHSs
Commercial, market
orientation
Private practitioners, private
clinics and laboratories
Non-commercial,
service orientation
Socio-civic groups, religious
organizations, or foundations

7. Demographic and Epidemiologic Trends
• Has experienced considerable improvements in its
health status for the past 50 years, yet also decline in
the recent years (Cuevas, 2007)
• Experiencing epidemiologic shift
While contending with the burden of communicable diseases, it is also the
same time contending with non-communicable diseases.
• Threatened with devastating effect of “triple whammy”

8. Philippine National Health Situation

16. •Highest occurrences of deaths were among the elderly persons, 70 years and over.
•Death occurrence was least among age group 10-14 years.
•Deaths among under 1 year old is more than twice the number of deaths in ages 1-4
years.
•Statistics show that the risk of dying is directly proportional to age, starting with
age 10 and up.

17. •CALABARZON, NCR & Central Luzon: Deaths from these three regions
comprised to almost 40 percent (39.1%) of the total deaths.
•ARMM, CAR and CARAGA: These three regions were consistently low in
terms of the number of deaths registered, which maybe a result of either
effective health intervention or under registration.

18. •For several years now, statistics show that even in NCR, a highly urbanized region and where both public and
private health facilities are accessible, still, a low percentage of attended death is recorded.
•Dying without the attention of a medical doctor could be somehow an evidence of unaffordable health cost in
the country.

19. •More than 81 percent of deaths registered in 2013 were
attributed to the top 10 leading causes of death for the year.
•Diseases of the Heart had been consistently the number one
cause of death for several years now.
•Diseases of the Vascular System, Malignant Neoplasm and
Pneumonia remained in their respective rankings for the past 4
years .

20. •7 out of the 10 leading causes of deaths were male dominated.
•Men were almost 4 times more likely to die from Accidents
than women.

21. •More deaths from the leading causes were not medically attended.
•9 out of the 10 ten killer diseases were not attended by a medical doctor or any allied health officer in
anytime during their illness or injury.

23. Department of Health-Regional Office VI
Health Situation
in
Western Visayas
Renilyn P. Reyes,MD,MPA,DPPS
Head, Family Health and Nutrition Cluster
Sarabia Manor Hotel, Iloilo City
October 21, 2016

24. Department of Health – Regional Office VI
Total Population
(Projected 2015)
7,603,147
No. of households
- 1,604,323
Total No. of Brgys.
- 4,051
Total No. of BHS
- 2,059

25. Source:
17.88 17.19
18.18 18.22 17.46 16.88 16.24
5.55 5.47 5.91 6.12 6.09 5.82 5.97
0
2
4
6
8
10
12
14
16
18
20
2009 2010 2011 2012 2013 2014 2015
Percentage
Crude Birth Rate
Crude Death Rate
Department of Health – Regional Office VI
CRUDE BIRTH and CRUDE DEATH RATE
Western Visayas, CY 2010-2015

26. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Causes Male Female Total
1. Upper Respiratory Tract Infection 61,743 71,206 132,949
2. Acute Lower Respiratory Tract Infection &
Pneumonia
20,789 22,253 43,042
3. Bronchitis / Bronchiolitis 11,127 18,752 29,879
4. Hypertension 9,734 15,402 25,136
5. Injuries, All forms 14,287 9,808 24,095
6. Urinary Tract Infection 5,336 11,320 16,656
7. TB, All forms 8,037 4,652 12,689
8. Skin Diseases, All forms 4,413 4,413 8,981
9. Acute Watery Diarrhea 2,821 2,821 5,681
10. Diabetes Mellitus 1,801 1,801 4,498
Population: 7,603,147
Department of Health – Regional Office VI
Top Ten Leading Causes of Morbidity
Western Visayas, CY 2015

27. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Population: 7,603,147
Department of Health – Regional Office VI
Top Ten Leading Causes of Mortality
Western Visayas, CY 2015
367
746
649
693
596
947
588
2,158
4,175
5,280
940
687
795
787
1,353
1,346
1,876
2,252
4,724
6,394
0 2,000 4,000 6,000 8,000
Chronic Obstructive Pulmonary…
Diabetes
Cerebrovascular Accident (CVA)
Septicemia
Tuberculosis, All forms
Kidney Diseases
Injuries/Accidents
Malignant Neoplasm (Cancer)
Pneumonia
Hypertensive Cardiovascular…
Male Female

28. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Infant and Under 5 Mortality Rates
Western Visayas, CY 2015
11.56
9.87 10.13 9.62 9.63 10.27
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
2010 2011 2012 2013 2014 2015
Year
Infant Mortality…
There was a slight increase in the Infant Mortality Rate (IMR) of the region from 9.63 deaths per 1,000
live births in 2014 to 10.27 deaths per 1,000 live births in 2015. Between 2010 and 2015, IMR decreased
by 11% from 11.56 in 2010 to 10.27 in 2015.
per1,000 live births

29. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Infant Mortality Rate
per province / HUCs Western Visayas, CY 2015
10.6
15.1
7.3
13.0
7.8 7.4
13.8
19.1
10.3
0
5
10
15
20
25
Aklan Antique Capiz Guimaras Iloilo Negros
Occidental
Bacolod
City
Iloilo City Western
Visayas
Rateper1,000livebirths
Iloilo City posted the highest IMR with 19.13 deaths per 1,000 live births. Antique was at second with
15.06 and Bacolod was third at 13.82. On the other hand, Capiz recorded the lowest IMR at 7.29. Overall,
majority of the LGUs had IMRs higher than the region.
MDG Target
17/1,000 LB

30. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
13.8
18.4
12.4
13.5
11.1 10.0
22.8
24.5
14.1
0
5
10
15
20
25
30
Rateper1,000livebirths Under Five Mortality Rate
per province / HUCs Western Visayas, CY 2015
Iloilo City and Bacolod had the highest Under Five Mortality Rate in 2015 at 24.47 and 22.76, respectively
while Negros Occ. was the lowest at 10.92.
MDG Target
25.5/1,000 LB

31. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Fully Immunized Child (FIC) Coverage (%)
Western Visayas, CY 2010-2015
Target
95%
80.57
73.67
85.73 82.41
73.39
67.06
0
20
40
60
80
100
2010 2011 2012 2013 2014 2015
Year

32. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Maternal Mortality Ratio (MMR)
Western Visayas, CY 2010-2015
77.55 76.80
71.33
82.74
90.01
72.87
0
20
40
60
80
100
2010 2011 2012 2013 2014 2015
Per100,000livebirths
Year
TARGET :
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
Maternal Mortality Ratio (MMR) increased from 71.33 per 100,000 live births in 2012 to
90.01 per 100,000 live births in 2014. Though it decreased to 72.87 per 100,000 live births
in 2015, this was not enough to achieve the MDG target of 52.

33. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Maternal Mortality Ratio (MMR)
Per province/HUCs , CY 2015
TARGET :
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
138.8
94.1
42.4
0
17.7
72.3
174.2
92.5
72.9
0
20
40
60
80
100
120
140
160
180
200
Aklan Antique Capiz Guimaras Iloilo Negros
Occidental
Bacolod City Iloilo City Western
Visayas
In 2015, Bacolod City recorded the highest MMR at 174.22 maternal deaths per 100,000 live
births while Guimaras had the lowest with zero maternal deaths. Three other LGUs namely
Aklan, Antique and Iloilo City had MMRs higher than the region.

34. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Births Attendant by Skilled Health Professional
Facility Based Deliveries
Western Visayas, CY 2015
78.42 81.24 84.85 87.28 89.30 90.40
66.21
73.34
79.33 83.59 87.34 88.85
0.00
20.00
40.00
60.00
80.00
100.00
2010 2011 2012 2013 2014 2015
Percentage
Year
Skilled Birth Attendants Facility Based Deliveries
90.40% of all births in the region were attended by Skilled Health Personnel. The
proportion of births attended by skilled health personnel increased from 78.42 in
2010 to 90.4 per cent in 2015.
TARGET : 90%

35. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Facility Based Deliveries (%)
Per province/HUCs , CY 2015
78.7
83.1 86.9
90.3 86.9 89.8
95.3
99.9
88.9
0
20
40
60
80
100
120
Aklan Antique Capiz Guimaras Iloilo Negros
Occidental
Bacolod
City
Iloilo City Western
Visayas
In 2015, more than three fourths (88.85%) of all births were delivered in a health facility. This is higher than
the 87.34% reported in 2014 and a significant improvement from the 66.21% reported in 2010. Delivery in a
health facility was highest in Iloilo City at 99.9 percent and lowest in Aklan at 78.69 percent.
TARGET : 90%

36. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
Contraceptive Prevalence Rate (%)
Western Visayas, CY 2010- 2015
34.13 34.17
37.85 40.21
43.82
47.66
0.00
10.00
20.00
30.00
40.00
50.00
60.00
2010 2011 2012 2013 2014 2015
Year
Current use of contraception among married women in the region has been
increasing for the last five years. In 2015, around 48 percent of married women
were currently using a modern family planning method, an increase of around four
percentage points from the 2014 CPR of 43.82 percent. From 2010-2015, there has
been an increase of around three percent annually in the region’s CPR.
TARGET : 65%

37. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
27.50
27.08
25.94
23.33
24.57
25.60
21.00
22.00
23.00
24.00
25.00
26.00
27.00
28.00
2010 2011 2012 2013 2014 2015
Rateper100,000Population
Year
The number of deaths caused by TB has increased in the
region from 1,728 in 2014 to 1,949 in 2015. This
translated to a TB Mortality Rate of 25.6 per 100,000
population, higher than the mortality rate of 24.57 in
2014. TB Mortality Rate has decreased by around two
deaths per 100,000 population between 2010 and 2015.
TB Mortality Rate by Province and Highly Urbanized City
Western Visayas, CY 2015
TARGET : < 23 /100,000

38. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
2.25
1.24
1.09
0.13
1.33
1.97
0.00
0.50
1.00
1.50
2.00
2.50
2010 2011 2012 2013 2014 2015
Year
Mortality Rate from Rabies
per 1,000,000 Population
Western Visayas, CY 2010- 2015
TARGET : less than 1/million population

39. TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Department of Health – Regional Office VI
No. of HIV/AIDS Cases
Western Visayas, CY 2010-2015
1 3 10
27
54
4142
58
89
149
193
336
43
61
99
176
247
377
0
50
100
150
200
250
300
350
400
2010 2011 2012 2013 2014 2015
Case
Year
HIV AIDS
The estimated prevalence of HIV in the region is still low but growing. The
current incidence of HIV/AIDS in the region is still within the MDG target of less
than 1 percent of the total population in 2015. However, there has been an
overwhelming increase in the number of HIV and AIDS cases in the region for
the past five years from only 43 new cases in 2010 to 377. Between 2014 and
2015, the number of new HIV cases also increased by 53 percent from 247 new
cases in 2014 to 377 in 2015.

40. Global & National Health Goals

42. A set of goals to end poverty, protect the planet, and ensure
prosperity for all.
Each goal has specific targets to be achieved over the next 15 years.
For the goals to be reached, everyone needs to do their part:
governments, the private sector, civil society and people like you.

62. Maraming
Salamat!
RYAN MICHAEL F. ODUCADO