HEALTH CARE DELIVERY
SYSTEM
THE WORLD HEALTH ORGANIZATION (WHO)
• The WHO was the outcome of the discussion of the diplomats formed
by the United Nations to create a global health organization. It came
into full force on April 7, 1948. Since then, April 7 has been celebrated
each year as WORLD HEALTH DAY.
• It’s headquarters is in Geneva, Switzerland. WHO has 147 country
offices and 6 world regional offices for Africa, the Americas, Eastern
Mediterranean, Europe, Southeast Asia, and the Western Pacific.
Core functions of WHO
Providing leadership on matters critical to health and engaging in
partnerships where joint action is needed.
Shaping the research agenda and stimulating the generation,
translation, and disseminating valuable knowledge.
Setting norms and standards and promoting and monitoring their
implementation.
Articulating ethical and evidence-based policy options.
Providing technical support, catalyzing change, and building
sustainable institutional capacity.
Health Care Delivery System
• The totality of all policies, facilities, equipment, products, human
resources and services which addresses the health need, problems
and concerns of the people.
MAJOR PLAYERS
Public Sector-
largely financed thru tax-based budgeting
system at both the national and local levels and where health care is
generally given free at the point of service
• National Level – Department of Health as lead agency
• Local Health system run by local government units
Private Sector-
largely market-oriented and where health care is
paid through user fees at the point of service
THE PUBLIC SECTOR
Department of Health
• Vision: Filipinos are among the healthiest people in Southeast Asia by
2022, and Asia by 2040
• Mission: To lead the country in the development of a productive,
resilient, equitable and people-centered health system for Universal
Health Care
• GOALS: “Better Health Outcomes, More Responsive Health System,
More Equitable Health Care Financing”
OBJECTIVES
 Improve Health Status of the Population
a. Improve the general health status of the population
b. Reduce morbidity and mortality from certain diseases
c. Eliminate certain diseases as public health problems
d. Promote health lifestyle and environmental health
e. Protect vulnerable groups with special health and nutritional needs
 Ensure Quality Service Delivery
a .Strengthen national and local health systems to ensure better health service
delivery
b. Pursue public health and hospital reforms
c. Reduce the cost and ensure the quality and safety of health goods and services
d. Strengthen health governance and management support systems
 Improve Support system for the Vulnerable and Marginalized
Groups
a. Institute safety nets for the vulnerable and marginalized groups
 Implement Proper Resource Management
a. Expand the coverage of social health insurance
b. Mobilize more resources for health
c. Improve efficiency in the allocation, production and utilization of
resources for health
A. LEADERSHIP IN HEALTH
Functions:
1.LEADER in the formulation, monitoring and evaluation of national
health policies, plans and programs
2.ADVOCATE in the adoption of health policies, plans and programs to
address national and sectoral concerns
3.NATIONAL POLICY AND REGULATORY INSTITUTION where
local government units, nongovernmental organizations and other
members of the health sector involved in social welfare and
development anchor their thrusts and directions for health.
B. ADMINISTRATOR OF SPECIFIC SERVICES
• Functions:
1.MANAGE selected health facilities and hospitals
2.ADMINISTER direct services for emergent health concerns that require
new complicated technologies
3.PROVIDE emergency health response services including referral and
networking system for trauma, injuries and catastrophic events, and, in cases
of epidemic widespread public danger upon the direction of the President
and in consultation with the concerned LGU
4.ADMINISTER special components of specific programs like tuberculosis,
HIV-AIDS, etc.
C. CAPACITY BUILDER AND ENABLER
• Functions:
1.ENSURE highest achievable standards of quality health care, health
promotion and health protection
2.INNOVATE new strategies in health to improve the effectiveness of health
programs
3.INITIATE public discussion on health issues and disseminate policy
research outputs to ensure informed public participation in policy decisionmaking
4.OVERSEE implementation, monitoring and evaluation of national health
plans, programs and policies
FOURmula PLUS One (F1+)
• It is a strategic framework introduced by DOH with the vision of healthier
filipinos by achieving Universal Health Care.
STRATEGIC PILLARS
1. Good Governance – to enhance health system performance at the national
and local levels.
2. Health Financing – to foster greater, better and sustained investments in
health
3. Health Regulation – to ensure the quality and affordability of health goods
and services
4. Health Service Delivery – to improve and ensure the accessibility and
availability of basic and essential health care in both public and private
facilities and services
5. Performance Accountability- to use systems that would drive better
execution of policies and programs
Major Health Plans towards “Health in the Hands
of the People in the Year 2020”
1. A Healthy BARRIO should be:
a. Residents actively participate in attaining good health; they are PARTNERS
in health care.
b. Highlight Project: BOTIKA SA PASO CAMPAIGN
c. Goal: to maintain herbal plants in pots for family use
2. Healthy CITY should be:
a. The physical environment in the workplace, streets, and public places
promote health, safety, order and cleanliness through structural manpower
support
b. Health- Related Strategies: Construction of well-maintained, income
generating public toilets; designation of a “pook-sakayan, pook-babaan”
3. A Healthy EATING PLACE should be:
a. Eating place where:
• safe and properly prepared, stored and transferred foods
• nutritious foods and drinks are served.
b. Complies with the following sanitation standards:
• safe, environment-friendly
• with clean restrooms
• food handlers are medically fit
4. A Healthy MARKET should be:
a. Adequate water supply
b. Proper drainage
c. Well-maintained toilet facilities
d. Proper garbage and waste disposal
e. Cleanliness maintained
f. Affordable quality foods
5. A Healthy HOSPITAL should be:
a. A “Center of Wellness”
b. Promotes Preventive care
c. Patient-centered
6. A Healthy STREET should be:
a. Well-maintained roads and public waiting areas
b. Clean and obstruction free sidewalks
c. With minimal traffic problems
d. With adequate strict law enforcement
e. Project: Pook Tawiran
f. Goal: to promote and reorient people especially erring pedestrians on the
use of pedestrian crossings
3 Levels of Care
PRIMARY LEVEL
First contact between the community people and
other levels of health facility
SECONDARY LEVEL
Facilities that are capable of basic surgical
procedures and simple laboratory examinations
TERTIARY LEVEL
Rendered by specialists, serves as teaching and
training hospital
PRIMARY HEALTH
CARE
PRIMARY HEALTH CARE
The essential care made universally accessible to individuals and
families in the community through their full preparation.
Universal Goal: “Health For All by the Year 2000”
Conceptual Framework:
• Health is a fundamental human right
• Health is both an individual and collective responsibility
• Health should be an equal opportunity to all
• Health is an essential element of socio-economic development
PRIMARY HEALTH CARE (PHC)
• What: INTERNATIONAL CONFERENCE OF PHC
• When: September 6-12, 1978
• Where: Alma Ata, USSR (Russia)
• What: ADAPTATION OF PHC IN THE PHILIPPINES
• When: October 19, 1979
• Legal basis: LOI #949 (Legal basis of PHC)
• Theme: “Health in the hand of people”
PRIMARY HEALTH CARE
What: Renewal of PHC Commitment
When: October 25-16, 2018
Where: Kazakhstan
Highlight: 17 Sustainable Development Goals (SDGs)
Validity: Until 2030
8 MILLENIUM DEVELOPMENTAL GOALS (MDGs)
17 SUSTAINABLE DEVELOPMENTAL GOALS (SDGs)
PHC APPROACH
Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multi-sectoral
Emphasis on appropriate technology
CHARACTERISTICS OF PHC (4A’S)
ACCESSIBILITY
ACCEPTABILITY
AFFORDABILITY
AVAILABILITY
4 PILLARS OF PHC
1. ACTIVE COMMUNITY
PARTICIPATION
3. USE OF APPROPRIATE
TECHNOLOGY
2. INTRA AND INTER SECTORAL
LINKAGE
4. SUPPORT MECHANISM MADE
AVAILABLE
ELEMENTS AND COMPONENTS OF PHC
E ducation for health
L ocally endemic and communicable disease control
E xpanded program on immunization
M aternal and child health
E essential drug use
N utrition programs
T treatment of specific diseases
S afe water and sanitation
D ental health services
A ccessible sentrong sigla movement facility
M ental health services
WALONG WASTONG GAMOT PROGRAM
» C otrimoxazole
» A moxicillin and ampicillin
» R ifampicin
» I soniazid
» P yrazinamide
» P aracetamol
» O resol
» N ifidepine
TRADITIONAL MEDICINE
• Legal Basis: RA 8423 Traditional Alternative Medicine Act (TAMA)
Things to remember:
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Use claypot
Set fire on low level heat to reach boiling of plants
Use one plant per symptom
Don’t use plants treated with insecticides
MEDICINAL PLANT PREPARATION
DECOCTION
POULTRICE
INFUSION
TINCTURE
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Blumea basamifera
 Part of Plant: Roots, leaves
 Indication: Antiedema, Diuretic,
Antiurolithiasis
 Prep: Decoction
SAMBONG
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Cassia alata
 Part of Plant: Leaves
 Indication: Antifungal
 Prep: Poultrice
AKAPULKO
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Quisqualis indica L.
 Part of Plant: Seeds, roots
 Indication: Antihelminthic
 Prep: Decoction
NIYOG-NIYOGAN
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Ehretia microphylla Lam
 Part of Plant: Leaves
 Indication: Diarrhea, Stomachache
 Prep: Decoction
TSAANG GUBAT
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Momordica charantia
 Part of Plant: Leaves, fruit, root
 Indication: Diabetes Mellitus
 Prep: Decoction
AMPALAYA
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Vitex negundo
 Part of Plant: Leaves, root, flowers,
seeds
 Indications: asthma, cough &
colds, fever, dysentery, pain, skin
disease, wounds
 Prep: Decoction, Poultrice
LAGUNDI
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Peperomia pellucida Lim
 Part of Plant: Leaves, stem
 Indications: Decreases blood uric
acid
 Prep: Decoction
ULASIMANG BATO
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Allium sativum
 Part of Plant: Leaves, cloves
 Indications: Hypertension, lowers
blood cholesterol.
toothache
 Prep: Poultrice
BAWANG
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Psidium guajava
 Part of Plant: fruit, bark, leaves
 Indications: washing wounds,
diarrhea, toothache
 Prep: Decoction, Poultrice
BAYABAS
DOH APPROVED HERBAL PLANTS (SANTA LUBBY)
 SN: Cinopodium douglasii
 Part of Plant: leaves
 Indications: headache, stomachache,
cough & colds, rheumatism,
arthritis
 Prep: Decoction, Infusion
YERBA BUENA
UNIVERSAL
HEALTH CARE
UNIVERSAL HEALTH CARE UHC
• Legal basis: RA 1123 UNIVERSAL HEALTH CARE ACT
• All people having access to quality health services without suffering
the financial hardship associated with paying for care
• Also known as “Kalusugan Pangkalahatan”
UHC OBJECTIVES
• (a) Progressively realize universal health care in the country through a
systemic approach and clear delineation of roles of key agencies and
stakeholders towards better performance in the health system; and
• (b) Ensure that all Filipinos are guaranteed equitable access to quality
and affordable health care goods and services, and protected against
financial risk.
3 THRUSTS OF UHC
• 1. Financial risk protection through expansion in enrollment and
benefit delivery of the National Health Insurance Program
• 2. Improved access to quality hospitals and health care facilities
• 3. Attainment of health-related Millennium Development Goals
FAMILY HEALTH NURSING
WHAT IS FAMILY?
• A group of persons created by ties of marriage, blood or adoptions;
conducting a single household unit, interacting and communicating
with each other in their respective role, creating and maintaining a
common culture.
Universal Functions of the Family
• Reproduction or replacement of members of society.
• Status Placement
• Biological and Emotional Maintenance
• Socialization and care of children.
MAJOR FUNCTIONS OF THE FAMILY
• PHYSICAL FUNCTION
• ECONOMIC FUNCTION
• REPRODUCTIVE FUNCTION
• COMMUNICATION FUNCTION
• SOCIALIZATION FUNCTION
• MANAGEMENT FUNCTION
• BOUNDARY FUNCTION
• EMOTIONAL AND SUPPORTIVE FUNCTION
CLASSIFICATION OF FAMILY STRUCTURE
Based on Descent :
• Patrilineal- affiliates a person with a group of relatives
through his or her father.
• Matrilineal- affiliates a person with a group of relatives
through his or her mother.
• Bilateral- affiliates a person with a group of relatives
related through both his or her parents.
CLASSIFICATION OF FAMILY STRUCTURE
Based on Authority:
 • Patriarchal- authority is vested on the oldest male in the family,
often the father.
 • Matriarchal- authority is vested in the mother or mother’s kin.
 • Matricentric- prolonged absence of the father gives the mother a
dominant position in the family, although the father may also share with
the mother in decision making.
CLASSIFICATION OF FAMILY STRUCTURE
Based on Place of Residence
 • Patrilocal- requires the newly wed to reside near the groom’s
parents.
 • Matrilocal- near the bride’s parents.
 • Bilocal- provides the couple the choice to reside on either
parents.
 • Neolocal- permits the couple to reside independently of their
parents.
 • Avunculocal- prescribes the newly wed couple to reside with or
near the maternal uncle of the groom.
CLASSIFICATION OF FAMILY STRUCTURE
Based on Internal Organization or Membership
Childfree or Childless Family
Cohabitation Family
Nuclear Family
Extended or Multigenerational Family
Single-Parent Family
Blended Family
LGBT Family
Foster Family
Adoptive Family
STEPS IN FAMILY NURSING ASSESSMENT
Data Collection
- identify the types or kinds of data needed
Types of data:
1. First level assessment
2. Second level assessment
Data gathering Methods and Tools
1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory/Diagnostic Tests
Data Analysis
- sorts out and classifies or groups data by type or nature.
Sub Steps:
(1) Sorting of data for broad categories
(2) Clustering of related cues
(3) Distinguishing relevant form irrelevant data
(4) Identifying patterns
(5) Comparing patterns with norms or standards of health, family functioning
and assumption of health tasks
(6) Interpreting results of comparisons
(7) Making inferences or drawing conclusions about the reasons for the
existence of the health conditions or risks for non maintenance of
wellness states
The Typology of Nursing Problems in
Family Health Care
INITIAL DATA BASE
• Initial Data Base for Family Nursing Practice
A. Family Structure, Characteristics and Dynamics
B. Socio-economic and Cultural Characteristics
C. Home and Environment
D. Health Status of each Family Member
E. Values, habits, Practices on Health Promotion, Maintenance and
Disease Prevention
• First Level Assessment
A. Presence of Wellness Condition
B. Presence of Health Threats
C. Presence of Health Deficits
D. Presence of Foreseeable crisis
• Second Level Assessment
A. Inability to recognize the presence of the condition or problem
B. Inability to make decisions with respect to taking appropriate health
action
C. Inability to provide adequate nursing care to the sick, disabled,
dependent or vulnerable member of the family
D. Inability to provide a home environment conducive to health
maintenance and personal development
E. failure to utilize community resources for health care
FIRST LEVEL OF ASSESSMENT
• A. Presence of Wellness Condition
- Healthy lifestyle
- Health maintenance
- Parenting
- Breastfeeding
- Spiritual well-being
• B. Presence of Health Threats
- Risk factors of specific disease
- Cross infection
- Family size
- Accident hazards
• C. Presence of Health Deficits
- Diagnosed or Undiagnosed diseases
- Failure to thrive
- Disabilities
• D. Foreseeable Crisis
- Marriage
- Pregnancy
- Parenthood
- Adolescence
- Divorce
- Death of a member
SECOND LEVEL ASSESSMENT
• A. Inability to recognize the presence of the condition or problem
Factors
- Lack of or inadequate knowledge
- Denial
- Attitude or philosophy in life
• B. Inability to make decisions with respect to taking appropriate
health action
Factors
- Failure to comprehend the nature of the problem
- Low Salience of the problem
- Feeling of confusion
- Lack of knowledge
- Fear of consequences
• C. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable member of the family
Factors
- Lack of knowledge about the disease
- Lack of knowledge about child development
- Lack of knowledge about the facilities, equipment and supplies
• D. Inability to provide a home environment conducive to health
maintenance and personal development
Factors
- Inadequate Family resources
- Lack of knowledge on hygiene and sanitation
- Ineffective communication pattern
- Lack of support
- Negative attitudes
• E. Failure to utilize community resources for health care
Factors
- Lack of knowledge on the community resources
- Failure to perceive benefits
- Lack of trust
- Previous unpleasant experience
- Fear of consequences
Developing the Nursing Care Plan
FAMILY CARE PLAN
- is the blueprint of the care that the nurse designs to systematically
minimize or eliminate the identified health and family nursing
problems
Steps in developing a FNCP
1. prioritize conditions or problems
2. set goals and objectives of nursing care
3. plan interventions
4. plan for evaluation of care
PRIORITIZING HEALTH PROBLEMS
• Four Criteria for Determining Priorities
1. Nature of the condition or problem
presented – categories of health
problems
2. Modifiability of the condition or problem –
probability of success in enhancing the
wellness state.
3. Preventive Potential – nature and
magnitude of future problems
4. Salience – family’s perception and
evaluation of the condition or problem
Scale For Ranking Health Conditions and Problems
According to Priorities
weight
weight
Criteria
1. Nature of condition/problem presented
Scale**: wellness state
1
3
health deficit
3
health threat
2
foreseeable crisis
1
2. Modifiability of the condition/problem
Scale**: easily modifiable
partially modifiable
not modifiable
3. Preventive potential
Scale**: high
moderate
low
2
2
1
0
3
2
1
1
Criteria
weight
4. Salience
Scale**:- a condition/problem, needing immediate attention
weight
1
2
- a condition/problem not needing immediate attention
1
- not perceived as a problem or condition needing change
0
Scoring:
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply by the weight:
(score/highest score) x weight
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight
FAMILY-NURSE CONTACTS
• Clinic visit
• Group conference
• Written communication
• Home visit
Home Visit
• It is a professional,
purposeful
interaction
that takes place in the
family’s residence aimed
at promoting, maintaining
and restoring the health
of the family or its
members.
Purposes
•To give nursing care to the clients
•To assess living conditions of the patient and his family
•To give health teaching regarding the prevention and control of
diseases
Principles
• Home visit must have a purpose or objective
Planning should:
• Make use of all available information
• Involve the individual and family
• Give priority to the essential needs
Advantages
First-hand assessment
Can seek out previously unidentified needs
Promotes family participation
Teaching family members made easier
Provides family a sense of confidence
Interventions are based on the available
resources
Disadvantages
Time and Effort
More Distraction
Nurse’s Safety
Steps in conducting Home Visits
1. Greet the patient and introduce self
2. State the purpose of visit
3. Observe the client and determine health needs
4. Put the bag in a convenient place then proceed to perform the bag
technique
5. Perform the nursing care needed and give health teachings
6. Record all important data, observation, and care rendered
7. Make appointment for a return visit
Phases of Home Visit
1. Pre-visit Phase
-contacts the family, determine willingness, set an appointment
-plan for the home visit is formulated
-home visit plan must focus on identified family needs
-family should actively participate in the planning
-plan should be practical and adaptable
Phases of Home Visit
2. In-Home Phase
- seeks permission to enter and lasts until leaving the home
• Initiation – knocking the door, greetings, observes the environment,
establish rapport, state the purpose
• Implementation – application of the nursing process,
direct nursing care
• Termination – summarizing the events, recording findings
Phases of Home Visit
3. Post-visit Phase
- nurse returned to the health facility
- documentation of the visit