The Philippine Health Care Delivery System

A Public Health Nurse does not function in a vacuum. She is a member of a

team working within the system. In order for the nurse to function effectively, she has
to understand the health care delivery system wherein she is working because it
influences her status and functions. She needs to properly relate with the dynamics
of political, organizational structure surrounding her position in health care system.
HEALTH CARE SYSTEM
-

an organized plan of health services (Miller-Keane, 1987)

HEALTH CARE DELIVERY

-

rendering health care services to the people (Williams-Tungpalan, 1981).

HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981

-the network of health facilities and personnel which carries out the task of rendering
health care to the people.
PHILIPPINE HEALTH CARE SYSTEM
-

is a complex set of organizations interacting to provide an array of health

services (Dizon, 1977).
Major Players
The Philippine health care delivery system is composed of two sectors:
1. PUBLIC SECTOR - largely financed through a tax based budgeting
system at both national and local levels and where health care is generally
given free at the point of service.
Consists of the National and Local Agencies

National Level The Department of Health (DOH) is mandated as the lead

agency in health. It has a regional field office in every region and maintains
specialty hospitals, region hospitals and medical centers. It also maintains
provincial health teams made up of DOH representatives to the local health
boards and personnel involved in communicable disease control, specifically
for malaria and schistosomiasis. Other national government agencies
providing health care services such as the Philippine General Hospital are
also part of this sector.

Local Level the local health system is now run by Local Government Units
(LGUs). The provincial and district hospitals are under the provincial

government while the city/ municipal government manages the health centers
/ rural health units (RHUs) and barangay health stations (BHUs). In every
province, city or municipaliy, there is a local health board chaired by the local
chief executive and the sanggunian or local legislative council on health related matters.
2. PRIVATE SECTOR largely market oriented and where health care is
paid through user at the point of service. The private sectors includes the
profit and non profit health providers. Their involvement in maintaining
the peoples health is enormous. This includes providing health services in
clinics and hospitals, health insurance , manufacture of medicines,
vaccines, medical supplies, equipment, and other health and nutrition
products, research and development, human resource development and
other health related services.
Components of Health Care Delivery System
The Department of Health Mandate:
The Department of Health shall be responsible for the following:
formulation and development of national health policies, guidelines,
standards and manual of operations for health services and programs;
issuance of rules and regulations, licenses and accreditations;
promulgation of national health standards, goals, priorities and indicators;
development of special health programs and projects and advocacy for
legislation on health policies and programs. The primary function of the
Department of Health is the promotion, protection, preservation or
restoration of the health of the people through the provision and delivery of
health services and through the regulation and encouragement of
providers of health goods and services (E.O. No. 119, Sec. 3).

Historical Background
Pre- Spanish and Spanish Periods (before 1898)
Traditional health care practices especially the use of herbs and rituals
for healing were widely practiced during these periods. The western
concept of public health services in the country is traced to the first
dispensary for indigent patients of Manila ran by ran by a Franciscan friar
that was began in 1577. In 1876, Medicos Titulares, equivalent to
provincial health officers were already existing. In 1888, a Superior Board
of Health and Charity was created by the Spaniards which established a
hospital system and a board of vaccination, among others.
June 23, 1898
Shortly after the proclamation of the Philippine independence from
Spain, the Department of Public Works, Education and Hygiene was

created by virtue of a decree signed by President Emilio Aguinaldo.

However, this was short lived because the Americans took over and
started a military and subsequently a civil government in the islands.

September 29, 1898

With the primary objective of protecting the health of the American
soldier, General Orders No. 15 established the Board of Health for the city
Manila.
July 1, 1901
Because it was realized that it was impossible to protect the American
soldiers without protecting the natives, a Board of Health for the Philippine
Islands was created through Act No. 157. This also functioned as the local
health board of Manila. It truly became an Insular Board of Health when
Act Nos. 307, 308 dated Dec. 2, 1901, established the Provincial and
Municipal Boards respectively completing the health organization in
accordance with the territorial division of the islands.
October 26, 1905
The Insular Board of Health proved to be inefficient operationally so it
was abolished and was replaced by the Bureau of Health under the
Department of interior through Act No. 1407. Act No. 1487 in 1906
replaced the provincial boards of health with district health officers.
1912
Act No. 2156 also known as the Fajardo Act, consolidated the
municipalities into sanitary divisions and established what is known as the
Health Fund for travel and salaries.
1915
Act No. 2468 transformed the Bureau of Health into a commissioned
service called the Philippine Health Service. This introduced a systematic
organization of personnel with the corresponding civil service grades and a
secure system of civil service entrance and promotion described as the
semi military system of public health administration.
August 2, 1916
The passage of Jones Law also known as the Philippine Autonomy Act,
provided the highlight in the struggles of the Filipinos for the independence
from the American rule. The establishement of an elective Philippine
Senate complemented an all Filipino Philippine Assembly that formed a
bicameral system of government. This ushered in a major organization

which culminated in the Administrative Code of 1917, which included the

Public Health Law of 1917.

1932
Because of the need to be better coordinate public helath and welfare
services, Act no. 4007 known as the Reorganization Act of 1932, reverted
back the Philippine Service into the Bureau of Health , and combined the
Bureau of Public Welfare under the Office of Commissioner of Health and
Public Welfare.
The Philippine Commonwealth and the Japanese Occupation (19351945)
May 31, 1939
Commonwealth Act. No. 430 created the Department of Public Health
and Welfare, but the full implementation was only completed through
Executive Order No. 317, January 7, 1941. Dr. Jose Fabella became the
first Department Secretary of Health and Public Welfare in 1941.
1942
During the period of the Japanese occupation, various reorganizations
and issuances for the health and welfare of the people were instituted and
lasted until the Americans came in 1945 and liberated the Philippines.
October 4, 1947
Executive Order No. 94 provided for the post war reorganization of the
Department of Health and Public Welfare. This resulted in the split of the
Department with the transfer of the Bureau of Public Welfare (which
became the Social Welfare Administration) and the Philippine General
Hospital to the Office of the President. Another split was created between
the curative and preventive services through the creation of the Bureau of
Hospitals which took over the curative services. Preventive care services
remained under the Bureau of Health. This order also established the
Nursing Service Division under the Office of the Secretary.
January 1, 1951
The Office of the President of the Sanitary District was converted
into a Rural Health Unit, carrying out 7 basic health services: maternal and
child health, environmental health, communicable disease control, vital
statistics, medical care, health education and public health nursing.This
was carried out in 81 selected provinces. The impact to the community

was so strong, it directly resulted in the passage of the Rural Health Act of
1954 (RA 1082). This Act created more rural health units and created
posts for municipal health officers, among other provisions.

February 20, 1958

Executive Order No. 288 provided for what is described as the
most sweeping reorganization in the history of the Department at that
period. This came about in an effort to decentralize governance of health
services. An Office of the Regional Health Director was created in 8
regions and all health services were decentralized to the regional,
provincial and municipal levels. Bureaus were decentralized to the
regional, provincial and municipal levels. Bureaus were limited to staff
functions such as policy making and development of procedures. RHUs
were made an integral part of the public health care delivery system.
1970
The Restructured Health Care Delivery System was
conceptualized. It classified health services into primary, secondary and
tertiary levels of care this further expanded the reach of the rural health
units. Under this concept the public health nurse to population ratio was
1:20,000. The expanded role of the public health nurse were highlighted.
June 2, 1978
With the proclamation of martial law in the country, President
Decree 1397 renamed the Department of Health to the Ministry of Health.
Secretary Gatmaitan became the first Minister of Health.
December 2, 1982
EO # 851 signed by President Ferdinand E. Marcos reorganized
the Ministry of Health as an integrated health care delivery system through
the creation of the integrated Provincial Health Office which combines
public health and hospital operations under the Provincial Health Officers.
April 13, 1987
EO # 119, Reorganizing the Ministry of Health by President
Corazon C. Aquino saw a major change in the structure of the ministry. It
transformed the Ministry of Health back to the Department of Health.
EO 119 clustered the agencies and programs under the Office for Public
Health Services, Office for Hospital and Facilities Services, Office for
Standards and Regulations and Office of Management Services. The Field

Offices were composed of the Regional Health Offices and National Health
Facilities. The latter was composed of National Medical Centers, the
Special Research Centers and Hospital. Five deputy minister positions
were also created.
October 10, 1991
Republic Act 7160 known as the Local Government Code
provided for the decentralization of the entire government. This brought
about a major shift in the role and functions of the Department of Health.
Under this law, all structures, personnel and budgetary allocations from the
provincial health level down to the barangays were devolved to the local
government units (LGUs) to facilitate health service delivery. As such,
delivery of basic health services is now the responsibility of the LGUs. The
Department of Health changed its role from one of implementation to one
of governance.
May 24, 1999
EO # 102 Redirecting the Functions and Operations of the
Department of Health by President Joseph E. Estrada granted the DOH to
proceed with its Rationalization and Streaming Plan which prescribed the
current organizational staffing and resource structure consistent with its
new mandate, roles and functions post devolution.
The shift in policy and functions is indicated in the de-emphasis
from direct service provision and program implementation, to an emphasis
on policy formulation, standard setting and quality assurance, technical
leadership and resource assistance. The shift in policy direction of the
DOH is shown in its new role as the national authority on health providing
technical and other resource assistance to concerned groups.
EO 102 mandates the Department of Health to provide
assistance to local government units, peoples organization, and other
members of civic society in effectively implementing programs, projects
and services that will promote the health and well being of every Filipino;
prevent and control diseases among population at risks; protect
individuals, families and communities exposed to hazards and risks that
could affect their health; and treat, manage and rehabilitate individuals
affected by diseases and disability.
1999-2004
Development of the Health Sector Reform Agenda which describes the
major strategies, organizational policy changes and public investments
needed to improve the way health care is delivered, regulated and
financed.
2005 ongoing

Development of a plan to rationalize the bureaucracy in an attempt to

scale down including the Department of Health.