The Philippines Health System Review - WHO Western Pacific ...

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Figure 1-4Total desired fertility rate vs. total fertility rate, by wealthindex quintile, 2003 & 20087No. of children per woman6543215.95.23.83.34.64.23.13.33.53.32.62.42.82.2 2.2 2.7 1.7 2.0 1.6 1.901st 2nd 3rd 4th 5thDFR 2003 TFR 2003 DFR 2008 TFR 2008Note: DFR – Desired Fertility Rate; TFR – Total Fertility Rate.Source: NDHS 2003 & 2008, NSO.Social, economic, and geographic barriers result in inequity in accessto services and explain the inequity in health outcomes. Poor peoplein greatest need for health care, namely, pregnant women, newborns,infants, and children, are underserved. Based on the 2008 NDHS, 66.0%of women in the lowest quintile in the country received iron tablets orsyrup, whereas 91.5% of women from the top quintile obtained this vitalsupplement. While 83.0% of children age 12-23 months from top quintilehomes received the EPI vaccines (BCG, measles and three doses eachof DPT and polio vaccine) in 2003, only 55.5% of those from low quintilefamilies did so. For maternal health, the most striking comparisonis regarding place of delivery, with 83.9% of highest quintile womendelivering in health facilities compared to just 13.0% of those in thelowest wealth index quintile. During deliveries, 94.4% of highest quintilewomen were attended by a doctor, nurse or midwife, compared to only25.7% of lowest quintile women.To summarize, inequity in health status and access to services isthe single most important health problem in the Philippines. As thesucceeding sections will show, this inequity arises from structural defectsin the basic building blocks of the Philippine health system, including thelow level of financial protection offered – problems which until recentlyhave been inadequately addressed by reform efforts.12
2. Organization and Governance2.1 Section SummaryIn its current decentralized setting, the Philippine health system has theDepartment of Health (DOH) serving as the governing agency, and bothlocal government units (LGUs) and the private sector providing servicesto communities and individuals. The DOH is mandated to provide nationalpolicy direction and develop national plans, technical standards andguidelines on health. Under the Local Government Code of 1991, LGUswere granted autonomy and responsibility for their own health services,but were to receive guidance from the DOH through the Centres forHealth Development (CHDs). Provincial governments are mandated toprovide secondary hospital care, while city and municipal administrationsare charged with providing primary care, including maternal and childcare, nutrition services, and direct service functions. Rural health units(RHUs) were created for every municipality in the country in the 1950s toimprove access to health care.The private sector, which is much larger than the public sector in termsof human, financial and technological resources, is composed of for-profitand non-profit providers that cater to 30% of the population. Although theprivate health sector is regulated by the DOH and the Philippine HealthInsurance Corporation, health information generated by private providersis generally absent in the information system of the DOH. Regulationof health science schools and universities is under the Commission onHigher Education, while the regulation of health professionals is carriedout by the Professional Regulation Commission.PhilHealth introduced health technology assessment (HTA) in the early2000s to examine current health interventions and find evidence to guidepolicy, utilization and reimbursement. As a third party payer, PhilHealthregulates through the accreditation of health providers that are incompliance with its quality guidelines, standards and procedures. TheFood and Drug Administration (FDA) regulates pharmaceuticals alongwith food, vaccines, cosmetics and health devices and equipment.13
Page 1: Health Systems in TransitionVol. 1
Page 5 and 6: ContentsPreface....................
Page 7 and 8: List of TablesTable 1-1 Population/
Page 9 and 10: Figure 4-2 Number of beds in govern
Page 11 and 12: A standardized profile has certain
Page 13 and 14: Peer Reviewers on behalf of the Asi
Page 15 and 16: CPRDALEDBMDHSDILGDODOFDOHDOLEDOSTDT
Page 17 and 18: OOPOut-of-pocketOPBOutpatient Benef
Page 19 and 20: AbstractHealth status has improved
Page 21 and 22: the principle governing agency of t
Page 23 and 24: Hospital admissions data from PhilH
Page 25 and 26: 1. Introduction1.1 Geography and So
Page 27 and 28: Indicator 1970 1980 1990 2000 2005
Page 29 and 30: Table 1-2 Economic indicators, 1970
Page 31 and 32: Women tend to live longer than men
Page 33 and 34: Rate per 100 000 population (Rank)R
Page 35: Table 1-7 Maternal and child health
Page 39 and 40: Rural Health Act, which transformed
Page 41 and 42: that supplement PhilHealth coverage
Page 43 and 44: plan, covering all government emplo
Page 45 and 46: The DOH has attempted to address th
Page 47 and 48: 2.7 Regulation2.7.1 Overview and hi
Page 49 and 50: through the institutionalization of
Page 51 and 52: Figure 2-3 Nursing Licensure Examin
Page 53 and 54: epresent another level of regulatio
Page 55 and 56: The law stresses the need for a hig
Page 57: coverage of the population vary, th
Page 60 and 61: Figure 3-1Health expenditure as a s
Page 62 and 63: Figure 3-2Financial FlowsOut-of-poc
Page 64 and 65: the results are promising. As of Ap
Page 66 and 67: Table 3-6 PhilHealth Special Benefi
Page 68 and 69: Taxes or contributions pooled by a
Page 70 and 71: Table 3-8 Allotments, obligations &
Page 72 and 73: LGUs procure all commodities throug
Page 74 and 75: payment of salaries and other allow
Page 76 and 77: Accreditation contracts are renewed
Page 78 and 79: 3.6 Voluntary Health InsuranceBased
Page 80 and 81: pricing in local hospitals, observe
Page 82 and 83: 4. Physical and Human Resources4.1
Page 84 and 85: Figure 4-1 Number of government and
Page 86 and 87:
Table 4-2 Beds in government and pr
Page 88 and 89:
Table 4-4 Patient care utilization
Page 90 and 91:
Figure 4-3DOH total appropriations
Page 92 and 93:
4.2.3 Medical Equipment, Devices an
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attempted to document the number of
Page 96 and 97:
Health Worker DistributionSince dat
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(Figure 4-6). As for the nurse-to-p
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Figure 4-9 Ratio of pharmacists per
Page 102 and 103:
of 2002. While CNS is essentially a
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To manage migration flows of health
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5.2 Public HealthImproving access t
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• The prevention of cardiovascula
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Private sector health professionals
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Access to essential drugs is constr
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5.9 Palliative CareIn 1991, the Phi
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5.12 Alternative/Complementary Medi
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drug stores. Later in 2009, the DOH
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Year Reform Brief description2005 F
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health care approach of putting hea
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asic health packages. To this end,
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The Generics Act of 1988 aims to pr
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know the generics of oral/suspensio
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As a result of these strategies, th
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Improvements in the delivery of key
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7.4 Allocative and Technical Effici
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8. ConclusionsAs measured by standa
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Further elaboration of the Human re
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De Rosas-Valera M (2009). Health te
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Gonzaga E, Navarra D (2004). The Re
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National Statistics Office (2006).
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Taguiwalo M (2004). Strategy for Lo
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9.2 Useful websitesAvailable in Eng
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The World Bankhttp://www.worldbank.
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Jennifer Frances E. dela Rosa is a
Page 155:
The Asia Pacific Observatory on Hea
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