PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE SERVICES
Primary Health Care (WHO)
- Essential health care made universally accessible to individuals and families in the
community by means acceptable to them through their full participation and at a cost
that the community and country can afford at every stage of development.
- PHC was declared during the First International Conference on Primary Health Care held
in Alma Ata, USSR on September 6-12, 1978 by WHO. The goal was “Health for all by the
year 2000”. This was adopted in the Philippines through Letter of Instruction 949 signed
by President Marcos on October 9, 1979 and has an underlying theme “Health in the
hands of the People by 2020.”
- The concept of PHC is characterized by partnership and empowerment of the people
that shall permeate as the core strategy in the effective provision of essential health
services that are community based, accessible, acceptable and sustainable at a cost
which the community and the government can afford.
- It is a strategy, which focuses responsibility for health on the individual, his family and
the community. It includes the full participation and active involvement of the
community towards the development of self-reliant people, capable of achieving an
acceptable level of health and well being. It also recognizes the interrelationship
between heath and the overall political, socio-cultural and economic development
society.
ELEMENTS/COMPONENTS OF PRIMARY HEALTH CARE
1. Environmental Sanitation (adequate supply of safe water and good waste disposal)
2. Control of Communicable Diseases
3. Immunization
4. Health Education
5. Maternal and Child Health and Family Planning
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency Treatment
8. Treatment of Locally Endemic Diseases
9. Provision of Essential Drugs
Strategies
1. Reorientation and reorganization of the national health care system with the
establishment of functional support mechanism in support of the mandate of devolution
under the Local Government Code of 1991.
2. Effective preparation and enabling process for health action at all levels.
3. Mobilization of the people to know their communities and identifying their basic health
needs with the end in view of providing appropriate solutions (including legal measures)
leading to self-reliance and self determination.
4. Development and utilization of appropriate technology focusing on local indigenous
resources available in and acceptable to the community.
5. Organization of communities arising from their expressed needs which they have
decided to address and that is continually evolving in pursuit of their own development.
6. Increase opportunities for community participation in local level planning, management,
monitoring and evaluation within the context of regional and national objectives.
7. Development of intra-sectoral linkages with other government and private agencies so
that programs of the health sector is closely linked with those of other socio-economic
sectors at the national, intermediate and community levels.
8. Emphasizing partnership so that the health worker and the community
leaders/members view each other as partners rather than merely providers and receiver
of health care respectively.
The framework for meeting the goal of primary health care is organizational strategy, which
calls for active and continuing partnership among the communities, private and government
agencies in health development.
FOUR CORNESTONES/PILLARS OF PRIMARY HEALTH CARE
1. Active community participation
2. Intra and inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available
TYPES OF PRIMARY HEALTH CARE WORKERS
Various categories of health workers make up the primary health care team. The types vary
in different communities depending upon:
Available health manpower resources
Local health needs and problems
Political and financial feasibility
In general, the PHC team may consist of physician, nurses, midwives, nurse auxiliaries, locally
trained community health workers, traditional birth attendants and healers.
Two levels of Primary Health Care workers have been identified:
1. Village or Barangay Health Workers (V/BHWs). This refers to trained community health
workers or health auxiliary volunteer or a traditional birth attendant or healer.
2. Intermediate level health workers. General medical practitioners or their assistants.
Public Health Nurse, Rural Sanitary Inspectors and Midwives may compose these groups.
LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
1. Primary Level of Care
Primary care is devolved to the cities and the municipalities. It is health care provided by
center physicians, public health nurses, rural health midwives, barangay health workers,
traditional healers and others at the barangay health stations and rural health units. The
primary health facility is usually the first contact between community members and the
other levels of health facility.
2. Secondary Level of care
Secondary care is given by physicians with basic health training. This is usually given in
health facilities either privately owned or government operated such as infirmaries,
municipal and district hospitals and out-patient departments of provincial hospitals. This
serves as a referral center for the primary health facilities. Secondary facilities are
capable of performing minor surgeries and perform some simple laboratory
examinations.
3. Tertiary Level of Care
Tertiary care is rendered by specialties in health facilities including medical centers as
well as regional and provincial hospitals, and specialized hospitals such as Philippine
Heart Center. The tertiary health facility is the referral center for the secondary care
facilities. Complicated cases and intensive care requires tertiary care and all these can be
provided by the tertiary care facility.
LEVELS OF HEALTH CARE SERVICES
Health problems that are beyond the capability of PHC units and beyond the competence of
PHC workers are referred to an intermediate health facility, usually a Rural Health Unit (RHU)
located in a town or población. The RHU team generally consists of the physician, dentist, public
health nurse, midwife, sanitarian and other health workers. The District Community Hospital
attends to cases needing hospitalization. Higher echelons of health services at the provincial,
regional and national levels, provide secondary or tertiary care to complete the health care
given at district and peripheral levels.
The higher the level, the more qualified the health personnel and the more sophisticated the
health equipment. Under this structure, health care provided by the suitable health facility on
the basis of health need. There is better utilization of scarce health resources.
More than ever, primary health care puts the concept of teamwork to the fore. Team planning
by health personnel in the same level and the various health levels will be essential for the
effectiveness and efficiency of health services. For example, as a nurse you will plan family
health care with the midwife and community health workers. Together, you will set common
objective, delineate task, allocate resources and evaluate family services. You may need to
consult the hospital nurse for referral of seriously ill patients or coordinate with the sanitary
inspector for basic sanitation problems. The chief nurse of a public health agency regarding a
home care program. Likewise, the Medical Health Officer plans priority community health
programs with the other members of the health team.
Teamwork in primary health care entails joint planning, implementation and evaluation of
community activities by the team members with the community health needs/problems as
bases of action. Joint efforts in the implementation of health programs is demonstrated by the
health team in the expanded immunization program where the nurse as team leader works with
the midwife and other community health workers.
World Health Organization in the Philippines
The World Health Organization (WHO)
The World Health Organization (WHO) was established on 7 April 1948 as the directing and
coordinating authority in global public health within the United Nations system. Working at
three levels in the Organization (global, regional and country), more than 7000 WHO staff
worldwide collaborate with the governments of 194 Member States and other partners to
achieve the WHO founding vision of the attainment of the highest possible level of health by all
people.
WHO presence in the Philippines
In recent years, the Philippines has undergone astounding economic and social development,
recording the greatest growth among emerging Asian economies in 2016. Rapid economic
growth and strong country capacity have contributed to Filipinos living longer and healthier.
However—despite substantial progress—achievements in health have not been uniform, and
challenges remain. The Philippines–WHO Country Cooperation Strategy 2017–2022 sets out
how WHO will work with the Philippines over the next six years to realize the vision of the
Philippine Health Agenda 2016–2022 as a stepping stone towards the health-related Sustainable
Development Goals.
The Philippines, one of the WHO founders, joined WHO on 9 July 1948.
On 1 June 1951, the Philippine Government and the World Health Organization signed a Host
Agreement for the establishment of the Regional Office in Manila.
The WHO Representative Office for the Philippines was established in Manila in January 1973.
Philippines-WHO Country Cooperation Strategy 2017-2022
In recent years, the Philippines has undergone astounding economic and social development,
recording the greatest growth among emerging Asian economies in 2016. Rapid economic
growth and strong country capacity have contributed to Filipinos living longer and healthier.
However—despite substantial progress—achievements in health have not been uniform, and
challenges remain.
The Philippines–WHO Country Cooperation Strategy 2017–2022 sets out how WHO will work
with the Philippines over the next six years to realize the vision of the Philippine Health Agenda
2016–2022 as a stepping stone towards the health-related Sustainable Development Goals.
National health agenda in the Philippines
The Philippine Health Agenda 2016–2022, launched by the Secretary of Health in September
2016, provides the strategic framework for achieving national health targets. Under the motto
All for Health towards Health for All, universal health coverage is the platform for health and
development in the Philippines – driven by action within and outside the health sector.
Reducing health inequities is singled out as the most important priority among three health
guarantees:
Ensuring financial protection for the poorest people
Improving health outcomes with no disparities
Building health service delivery networks for more responsiveness
Strategic priorities for WHO collaboration with the Philippines
Priority 1: Save lives: ensure full access to immediate-impact interventions
Priority 2: Promote well-being: empower people to lead healthy lives and enjoy responsive
health services
Priority 3: Protect health: anticipate and mitigate disasters, and environmental and emerging
health threats
Priority 4: Optimize health architecture: overcome fragmentation to achieve universal health
coverage
Priority 5: Use platforms for health: support health in all settings, policies and sectors
DEPARTMENT OF HEALTH
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 this periods.
- The western concept of public health services in the country is traced to the first
dispensary for indigent patient of Manila 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 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 soldiers, General
Orders No. 15 established the Board of Health for the City of 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 commissioned service called the
Philippine Health Service. This introduced a systematic organization of personnel with
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 the Jones Law also known as the Philippine Autonomy Act, provided the
highlight struggle of the Filipinos for Independence from the American rule. The
establishment of an elective Philippine Senate completed an all Filipino Philippine
Assembly that formed a bicameral system of government.
- This ushered in a major reorganization which culminated in the Administrative Code of
1917 (Act 2711), which included the Public Health Law of 1917.
1932
- Because of the need to better coordinate public health 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
the Commissioner of Health and Public Welfare.
The Philippine Commonwealth and the Japanese Occupation (1935-1945)
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, Janaury
7, 1941. Dr. Jose Fabella became the first Department Secretary of Health and Public
Welfare in 1941.
1942
- During the period of 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 Secretary.
January 1, 1951
- The Office of the President of Sanitary District was converted into a Rural Health Unit,
carrying out of 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 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 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 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, Presidential Decree 1397 renamed the
Department of Health to the Ministry of Health. Secretary Gatmaitan became the first Minister
of Health.
December 2, 1982
- Executive Order No. 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 3, 1987
- Executive Order No. 119, “Reorganizing the Ministry of Health” by President Corazon 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 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
(LGU) 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 governance.
May 24, 1999
- Executive Order No. 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
Streamlining 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,
people’s 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 he Health Sector Reform Agenda which describes the major strategies,
organizational and 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
Roles and Functions
The Department of Health, in its new role as the national authority on health providing
technical and other resource assistance to concerned groups as mandated by Executive Order
102 has identified the following general functions under its three specific roles in the health
sector.
1. Leadership in Health
Serve as the national policy and regulatory institution from which the local government
units, non government organizations and other members of the health sector involved in
social welfare and development will anchor their thrusts and directions for health.
Provide leadership in the formulation, monitoring and evaluation of national health
policies, plans and programs. The DOH shall spearhead sectoral planning and policy
formulation and assessment at the national and regional levels.
Serve as advocate in the adoption of health policies, plans and programs to address
national and sectoral concerns.
2. Enabler and Capacity Builder
Innovate new strategies in health to improve the effectiveness of health
programs, initiate public discussion on health issues and undertaking and
disseminate policy research outputs to ensure informed public participation in
policy decision-making.
Exercise oversight functions and monitoring and evaluation of national health
plans, programs and policies.
Ensure the highest achievable standards of quality health care, health promotion
and health protection.
3. Administrator of Specific Services
Manage selected national health facilities and hospitals with modern advanced
facilities that shall serve as national referral centers (ie., special hospitals); and,
selected health facilities at sub-national levels that are referral centers for local
health systems (ie., tertiary and special hospital, reference