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System based on Health Needs) and AO 4-A and 4-B of 2006 (Guidelinesfor the Issuance of Certificate of Need to Establish a New Hospital).The Rationalization Plan serves as a requirement for the crafting of theProvince-wide Investment Plan for Health (PIPH) by provinces, cities orILHZs.The AO on the Certificate of Need (CON), also created in 2006, stipulatesthe requirements for establishing new hospitals, upgrading or convertingthem, and increasing the bed capacity of existing hospitals. This policyapplies to both government and private hospitals. The proposed healthfacility’s catchment population, location and the LGUs’ commitmentto fund and maintain the health facility are all taken into account. Forsecondary and tertiary hospitals, utilization rate, number of staff andbed-to-population ratio are also considered. Each CON is evaluated inthe context of the Province/City/ILHZ Strategic Plan for Rationalization ofHealth Care Delivery System.The regulation of hospitals, on the other hand, is mandated by R.A.4266 or the Hospital Licensure Act. To support the implementation ofthe law, Administrative Order 147 series of 2004 was crafted to governthe registration, licensing and operation of hospitals and other healthfacilities.2.6 Health Information Management2.6.1 Information SystemsThe current state of health information systems closely reflects thelarger health system. The national and local health information systemsare poorly integrated and are weakly governed (Marcelo, 2005). Thesenegative conditions create information gaps at the national and locallevels. The lack of health informatics standards -- which prevents anysystem from scaling at a faster rate or inter-operating with anothersystem – is a key issue. Vertical disease surveillance systems also haveproduced redundancies and duplications. Some of these systems includethe (a) NDRS, FHSIS or Notifiable Disease Reporting System of the FieldHealth Service Information System; (b) NESSS or National EpidemicSentinel Surveillance System; (c) EPISurv or Expanded Programmeon Immunization diseases targeted for eradication or, EliminationSurveillance System; and (d) IHBSS or Integrated HIV/AIDS Behaviouraland Serologic Surveillance System.20
The DOH has attempted to address this fragmentation by developingthe Philippine Integrated Disease Surveillance and Response Project orPIDSR (Tan, 2007). The PIDSR aims to establish a surveillance system thatenables early detection, reporting, investigation, assessment, and promptresponse to emerging diseases, epidemics and other public health threats(Figure 2-2). This was followed by a DOH-led Philippine Health InformationNetwork (PHIN) in 2008 which designed and now implements the PhilippineHealth Information System (PHIS). The PIDSR, PHIN and PHIS clearlydocument the health information strategy at the national and regionallevels but the specifics and operational aspects at the field level (barangay)and among individual patients are vague at best.At the local level, the information gap in rural health information systemsis to some degree being addressed by the University of the PhilippinesManila’s Community Health Information Tracking System or CHITS(Tolentino, 2004), which provides as an electronic medical records systemfor rural health units. CHITS is now operating in several health centres.As it is free and is an open source software, it allows partnerships withother universities who then embed CHITS into their undergraduate healthand IT professions education. Lessons from the implementation of CHITSshow the importance of preparing trainee health workers on how to useelectronic medical records as documentation and quality assurance toolsfor health care.The experience of vertical information systems at the DOH provides aconcrete example of the problems associated with the lack of healthinformatics standards, mentioned above. The Electronic TB (Tuberculosis)Registry and the Philippine Malaria Information System or PhilMIS areDOH-implemented projects supported by the Global Fund and the WorldHealth Organization. Both systems are now being maintained by theDOH’s National Epidemiology Centre (NEC). Unfortunately, private sectorinformation, which forms a large bulk of actual transactions with familyphysicians and general practitioners, is essentially absent in these DOHsystems. This is partly due to weak enforcement of information-sharingregulations but also reflects a preference for proprietary software in privatefacilities, which limits the ability of the DOH to obtain assistance from otherIT specialists in other sectors.The Philippine Health Insurance Corporation has the largest clinicaldatabase in the country and has one of the most sophisticated informationtechnology infrastructures. Yet it still manages claims manually, using21
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 and 36: Table 1-7 Maternal and child health
Page 37 and 38: 2. Organization and Governance2.1 S
Page 39 and 40: Rural Health Act, which transformed
Page 41 and 42: that supplement PhilHealth coverage
Page 43: plan, covering all government emplo
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
Page 94 and 95:
attempted to document the number of
Page 96 and 97:
Health Worker DistributionSince dat
Page 98 and 99:
(Figure 4-6). As for the nurse-to-p
Page 100 and 101:
Figure 4-9 Ratio of pharmacists per
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of 2002. While CNS is essentially a
Page 104 and 105:
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
Page 124 and 125:
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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