WHAT IS A HEALTH SYSTEM?

all the activities whose primary purpose is to promote, restore or maintain health
(World Health Report 2000)

the combination of health care institutions, supporting human resources, financing mechanisms, information systems, organizational structures that link institutions and resources, and management structures that collectively culminate in the delivery of health services to patients
(Lassey et al 1997)

FUNDAMENTAL OBJECTIVES OF HEALTH SYSTEMS

Improving the health of the population they serve

Responding to peoples expectations Providing financial protection against the costs of ill-health

FUNCTIONS OF HEALTH SYSTEMS

Service Provision
Delivering personal and non-personal health services

Financing
Resource Generation

Raising, pooling and allocating revenues to purchase services Investing in people, facilities and equipment Acting as overall stewards of the resources, powers and expectations entrusted to them

Stewardship

HEALTH SYSTEM GOALS:

HEALTH OUTCOMES

Improving aggregate health status

FINANCIAL FAIRNESS Improving financial risk protection CLIENT RESPONSIVENESS Improving client satisfaction

VISION/MISSION FOR THE HEALTH SECTOR VISION

Health for all Filipinos Ensure accessibility and quality of health care to improve the quality of life of all Filipinos especially the poor

MISSION

MILLENIUM DEVELOPMENT GOALS

Provides a benchmark for the Philippines and other countries in setting goals and targets to wipe out poverty and ensure human development by the year 2015

MDG GOALS BY 2015

Reduce by two-thirds the under five mortality rate Reduce by three-quarters the maternal mortality rate Halt the spread of HIV/AIDS, malaria and other major diseases Improve access to safe drinking water

NATIONAL OBJECTIVES FOR HEALTH

Sets the direction for the implementation of health sector reform

2005-2010 FOCUS: A. Public Health Program

and

B. Institutional management support systems

A. PUBLIC HEALTH PROGRAM

Prevention and Control of Infectious Diseases Prevention and Control of Degenerative Diseases and lifestyle related diseases Management of health risks and promotion of Healthy Lifestyle Protection and promotion of family health and health of special population

B. INSTITUTIONAL MANAGEMENT SUPPORT SYSTEMS

1. Health System
-Governance -Financing - Service delivery - Regulation

2. Management System
- Procurement - Knowledge management - Human Resource - Critical Infrastructure

Health Sector Reform Agenda

Health Financing

Public Health Program

Hospital

Health Regulation

Local Health Systems

FOURMULA ONE FOR HEALTH

Financing

Regulation

Governance

Public Health Program

Hospital
Service Delivery

FOURMULA ONE: OVER ALL FRAME

Goals
Better More

health outcomes

responsive health system health care financing

Equitable

HEALTH CARE FINANCING

to secure more, better and sustained investments in health to improve outcome especially of the poor

Mobilizing resources from extra budgetary resources

Coordinating local and national health spending

Focusing on direct subsidies to priority programs Adopting a performance-based financing system Expanding the National Health Insurance Program

HEALTH REGULATION
To assure access to quality and affordable health products, devices, facilities and services, especially those used by the poor.

Establish a one-stop shop for the licensing of health facilities Automate regulatory systems and processes Integrate accreditation and certification into a unified seal of approval Introduce intensive, less frequent incentive based regulatory procedures Decentralize regulatory functions to regional offices and LGUs

THE AVAILABILITY OF LOW-PRICED, QUALITY ESSENTIAL MEDICINES SHALL BE ASSURED:

Promoting high quality generic pharmaceutical products Expanding drug distribution networks (National & LGU hospital pharmacies, Botika ng Barangay, Botika ng Bayan)
Identifying alternative local and foreign sources of low-priced branded drugs

HEALTH SERVICE DELIVERY

to improve accessibility and availability of basic and essential health care for all, especially the poor

Ensuring availability of providers of essential health services in the locality. Designation of providers of specific and especial services in localities Intensified public health programs in targeted localities

INTENSIFIED PUBLIC HEALTH PROGRAMS IN SPECIFIC LOCALITIES:

Undertaking disease-free zones initiative Implementing intensified disease prevention and control strategy Enhancing health promotion and disease surveillance

GOVERNANCE
to improve local health system governance and coordination, enhance public-private partnership and improving central capabilities to manage the health sector

FOUR-IN-ONE advanced implementation sites LGU FOURmula ONE for Health Score card FOURmula ONE for Health Expanded Professional career track.

LOCAL HEALTH SYSTEMS

THE LOCAL GOVERNMENT CODE : RA 7160
Provided for devolution and decentralization of health services Autonomy and empowerment of LGUs

DEVOLUTION OF HEALTH SERVICES DEPARTMENT OF HEALTH

Office of the Secretary

Execom for National Field Operations

Centers for Health Development

LOCAL GOVERNMENT UNIT -DEVOLVED STRUCTURE

Office of the Provincial Governor

Provincial Health Board

Provincial Health Office

District Hospital

Provincial Hospital

District Hospital District Hospital

LOCAL GOVERNMENT UNITS - DEVOLVED STRUCTURE

Office of City / Municipal Mayor

City / Municipal Health Board

Health Center / RHU

City / Municipal Hospitals

BHS

BHS

BHS

SITUATION

FRAGMENTATION OF HEALTH SYSTEM BURDEN OF LOCAL HEALTH CARE FINANCING DID NOT MATCH IRA INTEGRATED HEALTH CARE PLANNING DISRUPTED REFERRAL SYSTEM BREAKDOWN HEALTH MANAGEMENT INFORMATION SYSTEM DISINTEGRATED DRUG PROCUREMENT PROBLEMS MISSED OPPORTUNITITES FOR SPECIALTY TRAININGS/LOSS OF CAREER PATH/DEVELOPMENT

CONSEQUENCES
LOW QUALITY OF HEALTH SERVICES

RE-EMERGING COMMUNICABLE DISEASES (Measles, TB) IMPROVEMENT IN IMR & MMR INDICES SLOWED DOWN

DEVOLUTION ALTERED THE MEANS, IT DID NOT CHANGE THE MISSION

Still the promotion of health Still the protection from disease Still assurance of good care Even more, the mission includes:

Goodness Fairness

in financial burden Meeting public satisfaction

LOCAL DRIVERS TO LOCAL HEALTH SYSTEM CHANGE

Local political interest in health New patterns of financing health Popular new health services introduced Local leaders catalyzing local health system Improved public health performance

STRATEGIC OPTION:

Re-establishment of District Health System in a Devolved Setting or ILHZ

The present concept of the Inter-Local Health Zone (District Health System in a Devolved Setting) uses the Inter-LGU Cooperation as the basic framework to attain agreement

ILHZ ORGANIZATIONAL FRAMEWORK

ILHZ BOARD CORE REFERRAL HOSPITAL (district/provincial hospital)
Technical Mgt. Committee

POLICY Implementation

RURAL HEALTH UNIT

RURAL HEALTH UNIT

RURAL HEALTH UNIT

BHS

BHS

BHS

BHS

BHS

BHS

Service Delivery

KEY PLAYERS IN ILHZ

LCEs, SPs, other Local Government Officials PHO, Chief of Hospital, MHOs, other Healthcare Providers and Support Staff DOH, PHIC, other Govt Agencies NGOs, POs, Private Sector Community Health Workers Community Members/Leaders

PROVINCE OF SAMAR 6 INTER-LOCAL HEALTH ZONES INTERLOCAL HEALTH ZONES DOHREP ASSIGNED I. ACTSS-ILHZ: 1. ALMAGRO 2. CALBAYOG CITY 3. TAGAPUL-AN 4. STA. MARGARITA 5. STO. NINO II. PGM-ILHZ 1. PAGSANGHAN 2. GANDARA 3. MATUGUINAO

MS. FERMINA CONEJOS DR. EUFEMIA ALCANTARA MS. FERMINA CONEJOS DR. EUFEMIA ALCANTARA MRS FERMINA CONEJOS

DR. CRISILDA AGUILAR

PROVINCE OF SAMAR- INTER LOCAL HEALTH ZONES

INTERLOCAL HEALTH ZONES

III. SAMAR CENTRAL- ILHZ: 2.CATBALOGAN 3.JIABONG 3. ZUMARRAGA 4. SAN JORGE 5. TARANGNAN IV. PAHIMOSAN 1.PARANAS 2.HINABANGAN 3.MOTIONG 4. SAN JOSE DE BUAN

DOHREP ASSIGNED

MS. JOCELYN NABONG MR. DOLPHY PATOSA MS. MARIETA CARPUENTE

MR. SANTIAGO GLORIA JR MS. CRISTITA GABON MS. CRISTITA GABON MR. SANTIAGO GLORIA JR

PROVINCE OF SAMAR INTERLOCAL HEALTH ZONES INTERLOCAL HEALTH ZONES V. SMB NET-ILHZ 1. CALBIGA 2. PINABACDAO 3. DARAM 4. SAN SEBASTIAN 5. VILLAREAL 6 TALALORA VI. SOUTH SAMAR ILHZ 1.. BASEY 2. STA. RITA 3. MARABUT DOHREP ASSIGNED

MS. DEOGENES DARADAL MS. ANNA LISSA BABON MS. DIVINA PISCOS

MS. ALMA BANDOY