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Report On A Health System In Philippines

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Report On A Health System In Philippines

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Discuss about the Report on a Health System in Philippines.

The Philippines is a group of 7000 islands, and its population is  103,633,870 as on May 27, 2017, which is growing faster, more than ever, sharing one third of the world population. 2, 3 Since the health denotes the overall development and well-being of a nation, it can never evolve in a vacuum. A  health governance, therefore, should have the capability to harness and employ the resources to improve the health of its people. This is done by becoming responsive to their expectations, through financial security, and fulfilling the societal goals 4. In the case of Philippine, the health governance means an action for bringing consensus and making partnerships, for a constructive health care outcome. 5. In the current decentralized health care sector, the Department of Health (DOH) acts as the central governing agency, while the local government units (LGUs) and the private sector, address the health care needs of the individuals and communities. The DOH is responsible for the national policy direction and plans, and has the authority to fix technical standards and issue guidelines on health. Though the LGUs have autonomy and can implement their own health services as per the provisions of Local Government Code of 1991, they must abide the stipulations given by the DOH, routed through the Centers for Health Development (CHDs). In this system, the secondary  hospital care is maintained by the Provincial governments, whereas,  the primary care, such as maternal and child care, nutrition programs, and other direct care services are extended by the city and municipal administrations. The private sector is larger than the public sector, involving both profit and non profit providers, and they cater to more than 30% of the population of the Philippines.6 The Department of Health, while burdened with macro-level functions, has to enter meaningful and strategic partnerships with LGUs to coordinate policy formation, health information gathering, and control over tertiary hospitals. The DOH cooperates at district levels, in order to strengthen the Interlocal Health Zones, as they have proved successful. The PhilHealth can optimize the local-national partnerships, through incentives granted to the well running local governments and setting accreditation standards for the LGU hospitals, so that the quality and safety in health care are ensured. By developing a political capital on health, the national and local politicians can collaborate to further the cause of better health outcomes. Similarly, a private sector association with the LGUs, like the Zuellig Family Foundation, can reduce the maternal and infant mortality to a great extent. 7
Service delivery:
A health system of a country covers all efforts of organizations and people for the promotion and maintenance of health. 7 As per the constitution of the Philippines, health is a basic human right, but the health disparities still remain, both in access and outcomes.   Most of the reforms of the government to lessen the inefficiencies and inequalities in delivering health care service  has only ended in attracting challenges from the decentralized system and the private sector quarters, resulting in the deterioration of care quality. However, the country is trying to overcome the challenges through repeated legislative actions. 7 The latest of such a legislation is the new classification and licensing system introduced to address the existing capacity gaps at all levels of the health sector.  Most of the population seek medical treatment from government hospitals, because of the affordability, and this resulted in an increase in the net satisfaction levels, from above 30 in 2005 to above 37 in 2006,  and so the  trend has continued, since then. 8 Philippine’s health service delivery, which  was founded on the Western biomedical model of the Spanish colonial era, has been superimposed by herbal medicines and traditional practice. Though the health status has improved after the 1970s, the disparities in health outcomes across different socioeconomic classes and geographical regions continue, unabated. 9 The local health facilities are poorer, without enough staffing, and all regional and national hospitals still remain congested. Moreover, the national-local, as well as the public-private networking are ineffective, and the referral systems are not at all adequate. 10
Health workforce
The DHO holds the view that the Filipino healthcare workers are a priority of Kalusugan Pangkalahatan, and is implementing a rationalization plan to  deal with the problem of inadequate staffing, while improving the working conditions and welfare of the workers. 11 The rationalization plan began in 2013 to increase the health facility, by hiring more health care workers to meet the requirement of the health sector. The DOH has recruited 8,203 midwives and 324 doctors immediately after 2010, thus making the total deployment of 63,932 nurses for the period from 2010 to 2014. Moreover, the PhilHealth funding also capacitates the LGUs to hire health workers. Many of these nurses will work in rural health units to perform immunization and prenatal checkups, along with their regular clinical duty. Due to the availability of  PhilHealth augmentation, the physicians will get compensation of PHP 100,000 each month. In addition, the modernization of hospitals and the rural health units have been given more priority under the Health Facilities and Enhancement Program. However, there is still uncertainty about the workforce continuing in service, due to  the lower salary in government service and the inadequate budgetary support, medical facilities, and provisions for professional growth. To overcome this issue, the DOH has taken steps to recruit more people in the health service and increase their salaries. 11 Moreover, the devolution made it easier for the LGUs to engage more in the hiring, deciding on the salary of health professionals. 12
Distribution of Human health and social work activities and establishments13
According to the 2010 Annual Survey of Philippine Business and Industry (ASPBI) on Human health and social work activities, there were 4,451 establishments that engage health care workers, as shown in Figures-3, 4, and 5. The highest number of professionals was found to be in medical and dental services. That means hospital activities require more workers, while the highest paid employees were those worked in other social work activities.
Distribution of employment in Human health and social work activities13
Distribution of Average Annual Compensation 13
The revenue from the whole health sector was PHP84.3 billion and its major share of 76.6 percent  was contributed by the hospital activities, while medical and dental practice, along with the social work activities provided 18.5 percent of the total revenue. The above data gives insight about the different service areas, where focus is needed for addressing the needs of the health workforce as well as the communities. This comparison is essential to identify the areas that contribute to constructing an equitable health system. 14
Health information system
The contemporary health service  is more dependent on information technology for improving patient care and also organizational settings. 15 Physicians and other professionals working in the Philippine health sector, have been relying on electronic medical records to improve their practice15 and decision making. Therefore, strengthening the information is identified as a major step for enhancing the competence of the workforce,  and effectiveness of the health care system.  The computer application, known as BLACKBOX, developed earlier for the DOH, focused on enhancing the management information system for all public health programs, statistics, mortality, and diseases, as well as analyzing the health problems of the Philippine population. 16 The PHIS is an innovative online system for analysis and dissemination of crucial health metrics, for the users, like policy makers, planners,  community leaders, and other development agencies. PHIS  can track governance and privacy, and also technological challenges of interoperability, while translating from one coding standard to another, automatically. However, this program requires assistance in finding solutions to address the technical issues, such as how to make incompatible information compatible, for working together to make it cost effective and resolving issues on governance and privacy 17. The Philippine Health Information Exchange (PHIE) is the latest program for protecting electronic access and flawless health data transmission across  different health facilities, workforce, other providers of health care and  organizations, and also the various government agencies for setting national standards for improving public health. The DOH and Philippine Health Insurance Corporations, with the help of the Department of Science and Technology intend to implement the PHIE as a vital health care delivery system for fulfilling Universal Health Care.18
Health financing
Health financing is an important challenge in innovating the Philippine health sector. Since the people are compelled to pay for the availed health care, most of them face financial difficulty, leading to low economic productivity. This, in turn, will limit the quality of people’s life.   The issue could be alleviated by implementing measures to reduce the out of pocket spending level of the people. Expanding coverage to meet the goal of the universal health care, improvements in all sorts of pharmaceutical and healthcare industries, and legislative and political interventions could enable overcoming these problems. While seeking different measures for facing these challenges, it is prudent to note that the overall development is the best cure for reduced economic productivity. It is because when a country journeys towards development, the health care will also improve with it. Nevertheless, many complex elements that are affecting the health care may go unnoticed from the gurus of health economics and also the public. Therefore, it is necessary to focus on the social determinants of health, which, among other things, connect directly with multi-sectoral and interdisciplinary aspects of development. Health financing in the Philippines needs a very elaborate and inquisitive approach for supporting the reforms in legislations that are intended to collect more revenue, for working towards the attainment of the three dimensions of universal coverage. To achieve this, the government should implement a less complex, flawless, innovative, and sustainable health insurance policy, for the Philippine people. 19  The health care financing for the 2010-2010 period has been formulated, keeping  these points in view. When the governmental expenditure in health sector remains low, it will result in under-investment, causing loss in health revenue.  The fragmentation in the health system has in effect thwarted the progress of the health care sector, due to the  hurdles in coordination and issues related to regulations. In addition to these are the many issues of weak protection to the sick households, inappropriate and insufficient service performance, and the inequalities in the buying capacity of the  marginalized people. 20
The following table provides an insight on how much money is spent for health care services and who is paying them.
How much money is spent for health care services?
This table, prepared as per the 2010-2020 Health Care Financing Strategy (HCFS) goals of DOH, provides a clear picture of the potential and efficiency of the health care financing system, as well as the different areas displaying inefficiencies. It also helps in determining the relevant interventions for delivering the health care and gives the inputs for evaluating various health programs in the Philippines. Additionally, it extends necessary help to determine the adequacy of health care spending from all sources, such as, the government, the private and social insurance sectors, as well as others. 21
Pharmaceuticals and medical devices
The Philippines has a significant role in the fastest growing pharmaceutical markets in Asia, recording $3.4 billion in 2015.  According to the GlobalData, with an annual growth rate of 3.7%, it is expected that the market will rise to $4.1 billion, within the next five years.  Since health expenditure reflects the government supporting of the heath care sector, the DOH received an allocation of $2.8 billion in 2016, which is 42% more than the previous year. The Philippine’s open economic environment promotes greater investment opportunities, and supports BOT systems with a 100% foreign investment in the pharmaceutical sector.  The country has become a much sought destination for global clinical trials recently, with a growth rate of 31% in 2009, and an investment of $22.6 million in research and development in the year 2013.22. The industry manufactures drug  products, including the over-the counter drugs and the drugs for using in the diagnosis, cure, or disease prevention in humans. It also produces the non-drug items, such as nutritional,  baby care, infant milk preparations cosmetics, and many more. The industry is more focused on ethical products, OTC, and nutritional.  Drugs and medicines contribute 46 percent of out-of-pocket medical expenses of Philippine households. 23
Philippine Pharmaceutical Market Share24
Pharmaceuticals are supplied to customers through the supply chain system, consisting of retailers and wholesalers. The drugstores have the largest share with 80.1% of the total market.  Both private and government hospitals, NGOs, clinics, and other government agencies share the remaining percentage.24
Challenges and opportunities
The Philippines embrace an  equity based economic and social growth pattern, focusing on social protection. To facilitate the modernization processes, the government has increased the health care insurance coverage.  As per the solidarity principle, all people are supposed to have health care access, without having to face any problems of illness cost. This principle envisages equity in financing and protection from financial risks. That means the people need pay only according to their financial ability. Since the country’s health system is fragmented, it affects the equity in access to the health care services, reflecting the out-of-pocket spending and the differences in  social security coverage. The territorial fragmentation originating from the sub national level, the disparities in health coverage represents the changes in the people’s socioeconomic conditions and geographical disadvantages. Thus, the Philippine health sector is confronted with varying health coverage levels, because of the economic inequalities and geographical indifferences. The increase in tax, limits the health care improvement and access to quality care. Therefore, it is imperative that the reforms should be broader for accelerating economic growth and social development. 25 Though the Philippines health sector has initiated many major reforms in the past, most of such  reforms still remain unattended.  The Millennium Development Goals (MDGs), for improving the poor households, are at risk, and to make matters worse is the increase in non-communicable diseases. The health spending ratio is the lowest with out-of-pocket (OOP) spending, compelling the financial protection, the least. 26  The PhilHealth can make the health care affordable and accessible, by enabling the private health care sector to associate with  the public sector. The increased government investment and contributions augment the health care delivery to bring positive outcomes. Moreover, the major business groups have already shown their green flag to their investment plans in the health care service, which ultimately will increase the sustained economic growth. 27
Draft Recommendations: Strengthening the health care system 
 Strengthen and improve governance in the health sector

 Implement long-term scenarios for the development of human resource
 Developing costing and cost analysis culture in health care system.
 Initiate a household health care expenditure plan for every household
Design new health care financing options for private and social health insurance schemes.
 Implement a patient-centered health care delivery strategy, with stakeholders’ partnerships.
Health care systems must be placed under leaders who avow health to all is their responsibility and strengthening it is their life mission
Put more investments in health care infrastructure and workforce
Build multidisciplinary-stakeholder health care settings for adequate representation of all system elements
Focus on local infrastructure that supports  the workforce and system management
Encourage multi-stakeholder engagement, which is vital for improving the health system.
Government alone cannot run the play and give care to all in every respect. It needs  public participation, and motivation from leaders.
Proper enacting laws and enforcing them scrupulously to check treatment costs and malpractices
Strengthening health systems with all available resources, including the existing disease-driven programs.
The public sector must prioritize access to quality services as the main health goals. Cutting edge and cost-effective interventions are required in health care promotion phases.
Encourage public–private partnership in health care service, especially in delivering them to marginalized people
Design necessary regulatory frameworks to affirm  quality service delivery.
Determine the quality oriented indicators for Universal Health Coverage
Encourage multidisciplinary group and multi-sectoral interaction to all operational areas, such as hospitals, clinics, government agencies, and the like
Health workforce should be provided adequately, at all health care settings. Their compensation should be realistic and manageable.
Public and private sector providers should collaborate in achieving better outcomes
Adhere to the percent of the GDP, stipulated by the World Health Organization
Maintain solidarity in funding health care services and the cross subsidy social health insurance must be improved.
Gray areas should be removed by identifying and fixing the responsibilities and roles of each player in the health sector.
Less choice, maximum protection.  The higher income strata’s choices should be curtailed, and instead, more choice and protection should be given to the marginalized people.
Equity in health care must be ensured with financial security to the vulnerable groups.
Speedy payment of the cost must be encouraged
Strengthen the local health sector through accreditation.28


Philippines Physical Map. [Internet]. Available from https://www.freeworldmaps.net/asia/philippines/map.html
2          Romulo A. Virola RA.  Statiscally Speaking. Philippine Statistics Authority.[Internet]. 2011.https://nap.psa.gov.ph/headlines/StatsSpeak/2011/071111_rav.asp

Worldometer. Philippines Population. [Internet], May 27, 2017.   https://www.worldometers.info/world-population/philippines-population/

Cruz, BD. Chapter 3. Governance in Health. (Internet). Available from https://www.ombudsman.gov.ph/UNDP4/wp-content/uploads/2013/01/Chap3.pdf

Lasco G. Three challenges for governance in health care in the Philippines. [Internet]. January 3, 2015. Available from https://www.gideonlasco.com/2015/01/three-challenges-for-governance-in.html
The Philippines health system review. Health Systems in Transition, Vol. 1 No. 2[Internet]. 2011. Avilable from https://www.wpro.who.int/asia_pacific_observatory/Philippines_Health_Syste         m_Re   view.pdf

I??k A, Gunda, A M & Topçu B. The Philippine Health Care Delivery System and Health Expenditure. Handbook of Research on Behavioral Finance and Investment      Strategies: Decision Making in the Financial Industry. 2015.        (pp.      271-283).         Hershey, PA: IGI Global. doi:10.4018/978-1-4666-  7484-4.ch016

The Philippine Health System at a Glance. Chapter 1.[Internet].  Available  from https://www.doh.gov.ph/sites/default/files/basic-page/chapter-one.pdf

Health Service Delivery Profile. Philippines. [Internet]. 2012/ Available from https://www.wpro.who.int/health_services/service_delivery_profile_philippines       .pdf

Challenges in Health Service Delivery. [Internet]. https://dirp4.pids.gov.ph/DPRM/dprm11/wp-content/uploads/2013/09/edited- mss-CHALLENGES-IN-HEALTH-SERVICE-DELIVERY.pdf

GOVPH. Healthcare workforce priority of Kalusugan Pangkalahatan. [Internet]. July  23, 2014. Available from  https://www.gov.ph/2014/07/23/healthcare-workforce- priority-of-  kalusugan-pangkalahatan/

Geronimo JY. Where are the health workers? Rappler. [Internet]. February 12, 2014. Available from https://www.rappler.com/nation/50267-health-workforce-      crisis

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