Health Care Delivery system in the Philippines

The Philippines has a dual health system consisting of the public and private sectors.

The public sector is largely financed through a tax-based budgeting system at the national and local levels. In this sector, health care is generally given free at the point of service, although socialized user charges have been introduced in recent years for certain types of services. The private sector consists of for-profit and non-profit providers. It is largely market-oriented; health care is paid through patient´s fees at the point of service (Rosell-Ubial 2008).

In public sector, there are also three largely independent segments or sets of providers: (1) national government providers, which include, among others, hospitals run by national government agencies (e.g., hospitals of the Department of Health and

55

the Department of National Defense), and central and regional offices of the Department of Health; (2) provincial government providers, which include provincial hospitals, provincial blood banks and the provincial health offices; and (3) local (municipal or city) government providers, including rural health units or RHUs, city health centres and barangay health stations or BHSs (WHO- country 2011).

Furthermore, there are three levels of healthcare workers; the first level, which is the primary healthcare workers, who are the first contacts to the communities and reside in the rural health clinics. They participate not only in community healthcare and midwifery but also assist in the efforts to improve the community such as food production. The next level is the intermediate healthcare workers who are the first source of professional healthcare and attend to problems beyond the scope of the first level. They provide support to the first line of workers that includes training, services and supplies. The third level consists of the hospital personnel who include specialty doctors, dentists, pharmacists and well-schooled health professionals. They provide back up for cases that require hospitalization and work closely with the intermediate level healthcare workers (Health Care 2012).

4.2.1 Organization of Health Services

The control and influence of the Department of Health, the executive department charged with looking after the health concerns of the people, lessened significantly with the transfer of responsibility for health to about 1,600 local government units (LGUs) under the Local Government Code of 1991. With the decentralization of health services to LGUs, fragmentation of services became evident. The provincial governments now supervise provincial and district hospitals, while the municipal governments handle rural health units (RHUs) and barangay (village) health stations (see figure 6) (WHO 2011).

In spite of this, the Department of Health still maintains specialty hospitals, regional hospitals and medical centres (see figure 7).

56

Figure 7: Organization of Health Services

Health service provision is regarded as 'dual', consisting of both the public and private sectors. The public sector has three largely independent segments or sets of providers:

(1) national government providers, which include, among others, hospitals run by national government agencies (e.g., hospitals of the Department of Health and the Department of National Defense), and central and regional offices of the Department of Health; (2) provincial government providers, which include provincial hospitals, provincial blood banks and the provincial health offices; and (3) local (municipal or city) government providers, including rural health units or RHUs, city health centres and barangay health stations or BHSs. Each BHSs is staffed by a midwife, and each RHU is staffed by a doctor, a nurse and midwives (WHO 2011).

The Department's role after transfer the devolution of responsibility to LGUs is focused on regulation, technical guidelines/orientation, planning, evaluation, and inspection, while the provincial government takes responsibility for provincial and municipal hospitals, health centres and health posts, although funding flows do not exactly match it.

57

The role of the municipal-government level is not well described and their capacity to perform is reportedly weak. With decentralization of health service delivery, local chief executives became core players in the health sector. The number of actors involved multiplied and hence the need for coordination and policy monitoring (WHO 2011).

Under a devolved setting, the LGUs serve as agents of the local health system and as a result they are required to formulate and enforce local policies and ordinances related to health, nutrition, sanitation and other health-related matters in accordance with national policies and standards. They are also in charge of setting up an

environment conducive to establishment of partnerships with all sectors at the local level (WHO 2011).

4.2.2 Human resources for health

The Philippines is purportedly the leading exporter of nurses to the world and the second major exporter of physicians. Paradoxically, there are shortages of physicians and a fast turnover of nurses in the country, especially in rural areas. The high

unemployment rate among health professionals, in spite of the considerable number of vacancies in rural areas, is another irony. Prevailing challenges include unmanaged emigration of Filipino health workers, weak and inadequate human resources for health (HRH) information system, and the existing distribution imbalance, among others (WHO- Philippines 2011).

4.2.3 Health referral system impacts

Grundy et.al (2003) remarked that, the distinction between levels of health service was being lost in the Philippines because understaffing (despite high expenditure on personnel), critical lack of operating expenses and decaying infrastructure. In many cases primary and secondary hospitals were sited next to rural health units, but were largely performing the same basic outpatient health center functions. Referral systems

58

lacked clear definition. Under- financing and under-resourcing had resulted in the primary and secondary hospitals no longer having the capability of providing referral services to the health centres in rural areas. The result of this was reduced access to essential surgical and obstetric services in the primary/secondary hospitals. As well as, access to essential obstetric care was dictated less by need and more by the ability to pay for care in more distant towns and cities.

The continuing reforms in health service delivery are designed in improving the accessibility and availability of basic and essential health care for all, particularly the poor. Public primary health facilities are apparent as being low quality, and are thus frequently bypassed. Clients are displeased due to long waiting times; alleged inferior medicines and supplies; poor diagnosis that result in repeated visits; and obvious lack of medical and people skills of the personnel available, especially in rural areas.

Consequently, the result is that secondary and tertiary facilities are flooded with patients needing primary health care. Since public primary facilities are more

accessible to households and are mostly visited by the poor, improving the quality of those services particularly demanded by the poor would improve their health.

Furthermore, referral mechanisms among different health facilities across local government units need to be strengthened (WHO 2011).