Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 8

LESSON TITLE: Health Care Delivery System Materials:

Pen, paper, index card, book, and class List
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Discuss the Health Care Delivery System; Reference:
2. Enumerate the Millennium and Sustainable Development Famorca, Z. U., Nies, M. A., & McEwen, M. (2013).
Goals; Nursing Care of the Community. Elsevier
3. Outline the three major roles of DOH in the health sector; Gezondheidszorg.
and,
1. Explore the categories of the Health Care Delivery System.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What is the main purpose of the National Health Insurance Act of 2013?
_________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

MAIN LESSON (30 minutes)

Health Care Delivery System refers to the totality of all policies, equipment, products, human resources and services which
address the health needs of people.

1. World Health Organization (WHO)

A. It is the global health organization formed in April 1948. Its objective is the attainment by all people of the highest
possible level of health
B. Millennium Development Goals (MDGs) are created in order to uphold principles of human dignity, equality, equity at
the global level.

Eight (8) Millennium Development Goals by 2015

1. Promote gender equality and empower women
2. Achieve universal primary education
3. Develop a global partnership for development
4. Ensure environmental Sanitation
5. Reduce Child Mortality
6. Improve Maternal health
7. Combat HIV/AIDS, Malaria and other diseases
8. Eradicate extreme poverty and hunger

C. Sustainable Development Goals (SDGs) is a set of adopted goals in 2015 to end poverty, protect the planet and ensure
prosperity for all as part of a new sustainable development agenda

Seventeen (17) Sustainable Development Goals (SDGs) by 2030.

1. No poverty
2. Zero Hunger
3. Good health and Well-being
4. Quality Education

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 1 of 8
 5. Gender Equality
6. Clean water and Sanitation
7. Affordable and Clean Energy
8. Descent work and Economic growth
9. Industry, Innovation and Infrastructure
10. Reduced inequalities
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace, justice and strong institution
17. Partnerships for the goals

2. Philippine Health Care Delivery System

A. Department of Health serves as the main governing body of health services in the country.
• Vision
 Old: The DOH is the leader, staunch advocate and model in promoting health for all in the Philippine
 New: Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040
• Mission
 Old: Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall
lead the quest for excellence in health.
 New: To lead the country in the development of a productive, resilient, equitable and people-centered
health system

The Department of Health (DOH) holds the over-all technical authority on health as it is a national health policy-maker and
regulatory institution.

Basically, the DOH has three major roles in the health sector:
1. leadership in health;
2. enabler and capacity builder; and 3. administrator of specific services.

Its mandate is to develop national plans, technical standards, and guidelines on health. Aside from being the regulator of all
health services and products, the DOH is the provider of special tertiary health care services and technical assistance to
health providers and stakeholders.

While pursuing its vision, the DOH adheres to the highest values of work, which are:
 Integrity – The Department believes in upholding truth and pursuing honesty, accountability, and consistency in
performing its functions.
 Excellence – The DOH continuously strive for the best by fostering innovation, effectiveness and efficiency, proaction,
dynamism, and openness to change.
 Compassion and Respect for Human Dignity – Whilst DOH upholds the quality of life, respect for human dignity is
encouraged by working with sympathy and benevolence for the people in need.
 Commitment – With all our hearts and minds, the Department commits to achieve its vision for the health and
development of future generations.
 Professionalism – The DOH performs its functions in accordance with the highest ethical standards, principles of
accountability, and full responsibility.
 Teamwork – The DOH employees work together with a result-oriented mindset.
 Stewardship of the Health of the People – Being stewards of health for the people, the Department shall pursue
sustainable development and care for the environment since it impinges on the health of the Filipinos.

National Objectives
1. Improve the general health status of the population (reduce infant mortality rate, reduce child mortality rate, reduce
maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality-of-life years).
2. Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal
Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases,

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 2 of 8
 Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic
Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, and Iron Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
 Schistosomiasis
 Malaria
 Filariasis
 Leprosy
 Rabies
 Measles
 Tetanus
 Diphtheria & Pertussis
 Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health &
less stressful life & prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health,
women’s health, health of older persons, health of indigenous people, health of migrant workers and health of different
disabled persons and of the rural & urban poor.
7. Promote environmental health and sustainable development through the promotion and maintenance of healthy
homes, schools, workplaces, establishments and communities’ towns and cities.

Basic Principles to Achieve Improvement in Health

 Universal access to basic health services must be ensured.
 The health and nutrition of vulnerable groups must be prioritized.
 The epidemiological shift from infection to degenerative diseases must be managed.
 The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals

 Increasing investment for Primary Health Care.
 Development of national standards and objectives for health.
 Assurance of health care.
 Support to the local system development.
 Support for frontline health workers.

Together with its attached agencies, the DOH – constituted of various central bureaus and services in the Central Office,
Centers for Health Development (CHD) in every region, and DOH-retained hospitals – performs its roles to continuously
improve the country’s health care system.

The Health Sector Reform Agenda (HSRA)

HSRA is the overriding goal of the DOH. Support mechanism will be through sound organizational development, strong
policies, system and procedures, capable human resources and adequate financial resources
Rationale: slowing down in the reduction in the infant mortality rate and maternal mortality health, persistence of large
variation in health status across population groups and geographical areas, high burden from infectious diseases, rising
burden from chronic and degenerative diseases, unattended emerging health risk for environmental and work-related
factors, burden of diseases is heaviest on the poor

Framework for Implementation of HSRA: FOURmula ONE for Health

 Goals:
 Better health outcomes
 More responsive health system  Equitable health care financing
 Elements of the strategy:
 Health financing
 Health regulation

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 8
  Health care delivery
 Good Governance

B. The Philippine Health Care Delivery System is composed of two sectors:

 Public Sectors, which is largely financed through a tax0based budgeting system at both national and local levels and
where health care is generally given free at the point of services
1. DOH
2. Region Hospitals
3. Medical Centers
4. Philippine General Hospital

 Private Sectors, which is largely market-oriented and where health care is paid through user fees at the point of service
1. Profit and non-profit health providers
2. Clinics and hospitals
3. Health Insurance
4. Manufacture of Medicine
5. Vaccine
6. Medical supplies and equipment
7. Nutrition products
8. Research and Development
9. Human Resource Development

C. Categories of Health Care Delivery System (According to the type of service provided)

Type Services Level of prevention Example Location

 Common Health  RHU

Problems  Health
 Health promotion  Community health
 Health  Education Hospital
Primary  Illness prevention
 Education  Immunization
 Puericulture /Lying
 Preventive care Clinics

 Diagnosis &  Prompt Treatment  District Hospital

 Medical Services Treatment  Contact Tracing  Municipal Hospital
Secondary
 Surgery  Complication  Case Finding  Provincial Hospital
Prevention  Screening  City Hospital
 Regional Medical
Center
 Advanced and  Disability  PT/OT
 Specialized
Tertiary Specialized prevention and  Facility
Medical Center
Services rehabilitation Employment
 National
Health Center

D. Rural Health Unit (RHU)

 Commonly known as health center; headed by municipal health officer (MHO) or RHU Physician
 Focus: Preventive and promotive health services and supervision of Barangay Health Station (BHS) under its
jurisdiction.
 Recommended ratio is 1 RHU is to 20,000 catchment population (1:20,000)
E. Barangay Health Station (BHS)
 Is the first contact health care facility that offers basic services at the barangay level
 Is a satellite station of RHU, manned by BHWs under the supervision of the Rural Health Midwife. F. Ratio
of Health Care Professionals to Population

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 8
  Midwife – 1:5,000 population
 Nurse- 1: 10,000 population (old), 1: 20,000 population (new, Famorca, 2013)
 Physician- 1:20,000 population

CASELET
You are a nurse assigned to a rural health care facility. While on duty, Miguel Anseilmo, a 70-year-old patient, arrives with
multiple chronic conditions. Unfortunately, the facility lacks the required specialized medical equipment for the patient’s
conditions and must refer the patient to a distant tertiary hospital. However, Anseilmo cannot afford the travel expenses.

QUESTION
How can you address the challenges faced by patients in rural areas and ensure equitable access to quality healthcare
services within the Philippine healthcare delivery system?

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are
given 20 minutes for this activity:

Multiple Choice

1. In order to solicit cooperation /assistance of the community in the environmental sanitation program, which of the following
needs to be done first?
a. Create public awareness on the environmental sanitation problems
b. Form working groups or committees
c. Solicit the help of the municipal and barangay officials
d. Involve community members in the sanitation program
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

2. The RHU team consist of the following except:

a. Community health workers
b. Public health nurse
c. Health axillary volunteer
d. Respiratory therapist
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. Tertiary Care by the home health nurse is directed towards children with: a.
Problem in mobility
b. Minor problems
c. Short-term needs
d. Clinically apparent disease
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. Nurse Nicolas is scheduled for Pap smear. She has a strong family history for cervical cancer. This is an example of? a.
Secondary prevention
b. Primary prevention
c. Tertiary prevention

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 5 of 8
 d. Health screening
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

5. Which of the following is the new Mission of the DOH?

a. Promote healthy lifestyle
b. Ensure accessibility and quality of health care
c. Equitable and people-centered health system
d. Improve general’s health status of the people
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

6. The new vision of the DOH is:

a. Health for all Filipinos by 2012
b. Leader, staunch, advocate and model in promoting health for all in the Philippines
c. Guarantee equitable and quality health for all Filipinos
d. Healthiest people in Southeast Asia by 2022, and Asia by 2040
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

7. If the primary level of care is not capable of solving the problem, where would you prefer for secondary level of care? a.
Rehabilitation center
b. Barangay captain house
c. Doctor’s clinic in the municipality
d. District hospital
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

8. Health sectors reform has been formulated because of the following excepts:
a. Persistence of large variations in health status across population groups and geographic areas
b. Arising burden from chronic and degenerative diseases
c. High burden from infectious disease
d. Burden from disease is heaviest among middle class families
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

9. The DOH adopted which of the following as the framework for the implementation of the health sector reform? a.
FOURmula One for Health
b. National Health Insurance Program (NHIP)
c. High Five Formula
d. Healthcare system upgrading plan ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 6 of 8
10. Health care services were devolved to the Local Government Units (LGU) for the following reasons except: a. To
transform LGU into self- reliant communities
b. To involve people in the development and progress of their communities
c. Empower local health officials
d. To provide people better access to decision making ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 7 of 8
 _____________________________________________________________________

10. ANSWER: ________

RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track
how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

AL Activity: Turn and Talk

Instruction: The instructor will pose and prompt a question and you will have to discuss it with for 2 minutes.

Question: As a future professional what is/are the most ideal steps for the DOH to improve our health care delivery system.
Explain.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 8 of 8