CHALLENGES IN HEALTH SERVICE DELIVERY

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1 CHALLENGES IN HEALTH SERVICE DELIVERY

2 HEALTH CARE DELIVERY SYSTEM

3 Organization of the Health System Dual health system consisting of the public sector and the private sector Public sector Largely tax-based financing Generally given free at point of service Socialized user charges introduced Private sector For-profit and non-profit providers Largely market-oriented Paid through user fees at point of service

4 Organization of the Health System (Public Sector) Devolution of health services under Local Government Code of 1991 leading to fragmentation of health services DOH as lead agency providing national policies and plans, regulations, standards and guidelines on health, including tertiary and specialized health care LGUs as direct providers of health services, particularly public health programs and primary, secondary and general tertiary hospital care

5 Office of Secretary of Health Regional Hospitals Medical Centers Sanitaria Provincial Hospitals Executive Committee for National Field Operations Regional Offices Provincial Health Offices City Health Offices District Health Offices City Hospitals Rural Health Units District Hospitals Municipal Health Offices Devolved to provincial government Devolved to city government Devolved to municipal government Barangay Health Stations Barangay Health Stations

6 Organization of the Health System (Social Health Insurance) Expansion of NHIP under National Health Insurance Act of 1995 leading to universal coverage PhilHealth as agency mandated to administer the program NHIP includes formal, informal, and sponsored sectors and non-paying members

7 Organization of the Health System (Private Sector) For-profit and non-profit health providers clinics and hospitals health insurance providers of health products research and academic institutions Individuals, families and communities consumers and seekers of health care partners in health care

8 Health Care Facilities Local health facilities are poorlyequipped and poorly-staffed. Regional and national hospitals are congested. Health facilities in the public and private sectors are unevenly distributed. National-local and public-private networking and patient referral systems are inadequate.

9 Number and Bed Capacity of Government and Private Hospitals, 2011 Hospital Number Percent Government Private 732 1, Total 1, Bed Capacity Number Percent Government Private 51, Total 101, Bed to Population Ratio = 1 bed per 960 population Source: Bureau of Health Facilities and Services

10 Health Human Resources The Philippines is producing more and better human resources for health, compared to most Asian countries Total RN as of 2010 = 645, 701 ; Total MD as of 2010 = 101,624 The Philippines is a major source of health professionals to other countries. Leading exporter of nurses to the world (12,618 nurses were deployed in 2008) Second major exporter of physicians Human resources for health are enormous but unevenly distributed in the country Large exodus of nurses and physicians (as nurses) in the last five years has been unparalleled in the migration history of the country. There is a need to ensure the production of health professionals to meet local needs and to contribute to the global demand. Sources: AAAH, 2011; PRC, 2011; DOH, 2011

11 Pharmaceutical Market Pharmaceutical market is approximately P104 B or approximately more than 40% of health spending Multinationals control around 68.6 percent of market sales Dominated by expensive branded medicines, making drug prices in the Philippines among the highest in Asia Generic products are gaining their market share

12 Pharmaceutical Market Drug distribution is controlled by a few big distributors Drugstores account for 80 percent of all drugs sold in the Philippines (with the rest served by private and government hospital pharmacies, dispensing doctors, clinics and other government agencies) A single retail chain that owns most of the big commercial outlets in large urban centers distributes about 67% of all drugs sold in drugstores.

13 Percentage Distribution of Pharmaceutical Outlets Private Hospital Pharmacy 10% Wholesale drugstore 20% Retail drugstore 66% Government hospital pharmacy 4%

14 HEALTH STATUS

15 Demographic Characteristics 2010 Projected Population: 92.34M (NSO) Population growth rate remains high at 2.04% ( data, PSY 2009) Half of the population is below 21 years old Proportion of older persons is growing from 3.83% in year 2000 to 4.19% in 2007 (NSO)

16 Overall health status of the Filipinos have improved Filipinos are living longer, with females having longer life expectancy at years than males at 66.1 years in (NSCB, 2011)

17 Aggregate improvements hide broad disparities in health outcomes Life expectancy Females in the Ilocos Region could expect to live 14 years longer than females in the ARMM (NSO, 2011) TFR, IMR, U5MR and NMR were significantly higher in rural areas; among women who had no education; and among the poorest income quintile (NDHS, 2008).

18

19 Infant Mortality Rate (IMR) and Under-five Mortality Rate (U5MR) have declined steadily over the past 15 years. (NSO, 2011) MMR has increased to 221 per 100, 000 live births in 2011 from 162 per 100,000 live births in 2006 (FHS, 2011)

20 INFANT AND UNDER-FIVE MORTALITY ( ) MDG Targets for 2015 (26.7 and 19) are ACHIEVABLE FHS 2011: NSO, DOH, USAID

21 Infant and Child Mortality Rate by Region, Philippines, 2008 Child Mortality - probability of dying between the first and fifth birthday Infant mortality - probability of dying before the first birthday Source: NDHS 2008

22

23 Antenatal Care Coverage 78% of pregnant women have at least 4 ANC visits TARGET: 85%

24 Skilled attendance and facility based births increased 11 percentage points increase in Facility Delivery 2015 TARGET: 85%

25 The Philippines continues to lag behind other countries in Southeast Asia 3rd highest total fertility rate (TFR); 4th highest IMR and U5MR; 5 th highest NMR, MMR, and percentage of underweight under-five children. The country needs to work harder to achieve MDG targets by 2015 especially on maternal mortality and access to reproductive health services Source: UNICEF, 2009

26 Burden of Disease Leading causes of morbidity are communicable diseases Leading causes of mortality are degenerative and other non-communicable diseases Double burden of disease places a great toll on the economy Threat from emerging and resurgent diseases

27 Source: Philippine Health Statistics, 2005

28 Top Ten Cause of Mortality Cause Total Rate 1. Diseases of the heart 70, Diseases of the vascular system 51, Malignant Neoplasms 40, Accidents 34, Pneumonia 32, Tuberculosis 26, Unclassified 21, Chronic lower respiratory diseases 18, Diabetes mellitus 16, Conditions originating from the perinatal period 13, Philippine Statistical Yearbook, 2009

29 National Malaria Data, Malaria Indicator No. of cases 37,011 41,352 43,416 46,352 35,405 (24% reduction from 2005) 36,235 (2.3% increase from 2006) 23,655 (35% reduction from 2007) 19,955 (15.6% reduction from 2008) 19,644 (2% reduction) 9,375 (53% reduc.) 7,9 61 Morbidity Rate (per 100,000 population) No. of deaths (19% reduction from 2005) 73 (42% reduction from 2006) 56 (23% reduction from 2007) 24 (57% reduction from 2008) 30 (25% inc.) 10 (67% reduc.) 13 Mortality Rate (per 100,000 population)

30 HIV and AIDS Philippines is one of nine countries with >25% increase of newly infected cases in 2011 from 2001 baseline (UNAIDS Global Report 2012) One (1) Filipino is infected with HIV every 1.5 hours in 2013 compared to 1 new case every 3 days in 2000 A total of 14,474 cases were reported to DOH (1984-July 2013) Growing rates of infection particularly in years old HIV epidemic are mostly concentrated in Highly Urbanised Cities Major driver of epidemic is unprotected sex between males Pediatric infection (mother-to-child) also a growing problem (PWID) Estimated cost of treatment for HIV and co-infections range from Php 30,000 70,000 per patient per year At present, antiretrovirals (ARV) are free to all PLHIV

31 HIV and AIDS Key Accomplishments % of patients eligible for treatment are started on antiretrovirals: 76% (2012) % of PLHIV on ARV enrolled to Philhealth HIV Benefit Package: 47% 18 HIV Treatment Hubs established nationwide 4,500,000 male condoms distributed to MSM and Sex Workers Organized outreach activities linked to HIV testing in high risk communities Mobilised individuals to volunteer as peer educators esp in high risk cities

32 PUBLIC RESPONSIVENESS OF THE HEALTH SYSTEM

33 Quality Health Care Delivery System 1: Upgrade/build & improve health facilities - Barangay Health Stations 1,567 - RHUs 1,642 - LGU Hospitals DOH Hospitals 45 2: Recruit, train deploy health human resources - Doctors to the Barrios RN Heals 21,434 - CHTs 36,760 3: Competent and skilled health workers and service providers 4: Ensure availability of drugs and medicines, vaccines - Compacks - chemotherapy e.g patients with breast cancer enrolled - vaccines for children, adolescents and senior citizens - vaccines for rabies 13

34 Utilization of Health Facilities Fairly widespread use of health facilities in the country with 77 % of households having used a health facility Higher for urban households (80 percent) compared to rural (72 percent) Government facilities were most frequented (50 %) compared to private facilities (42 percent) Traditional healers were visited by 7 percent of those who sought medical advice or treatment Source: NDHS, 2008

35 Services Provided by Health Facilities 63% of services provided by RHUs/BHSs are classified as preventive health services 66% of services provided by government hospitals and 69% of services by private hospitals The common reasons for seeking health care are illness or injury (68 percent), medical checkup (28 percent), dental care (2 percent), and medical requirement (1 percent), confirming that clients are bypassing lower level facilities that should offer these services Despite RHUs/ BHSs being most conveniently located with 94 percent of households having access within 15-min walk.

36 Satisfaction with Health Facilities Majority of Filipinos prefers to seek treatment in a government hospital (SWS, 2006) Affordability is the main reason for going to a government medical facility, while excellent service is the main reason for going to a private medical facility Private facilities are ranked superior on quality, at par with government facilities on convenience of location, but not as good on cost aspects.

37 The DOH has a net sincerity rating of + 60 in December 2012, considered very good compared to + 37 in 2009 (SWS on sincerity in fighting corruption) Best Performer among the DBM Account Management Team-guided Departments of 2012 disbursement performance First department declared compliant to the requirements of the Performance Based Bonus Net Public Satisfaction with Philhealth regarding the support and protection it provides to members and dependent s increased to + 82 in December 2012 from +60

38 Challenges Health human resource complement at different levels of care Reaching the NHTS Poor Information management system (MNDRS, Unified NCD Registry System, Oneiss)

39 Challenges... Persistence of stigma and discrimination in communities and health facility settings (HIV/AIDS, TB) Inadequate and ineffective communication and education strategies among target population Fast turn-over of staff, volunteers (CHTs, peer educators) healthcare workers are overburdened (counseling, education and information dissemination limited, recording and reporting) Sustaining disease free status (malaria, filaria, rabies) Forging of more initiatives with partners from the private sector and CSOs

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