Health Care Delivery System 1

Definition of Terms

Health System

– Interrelated system in which a country organizes available resources for the maintenance and
improvement of the health of its citizens and communities.
– A health system comprises all organizations, institutions and resources devoted to producing
actions whose primary intent is to improve health.

Health Care System

– An organized plan of health services (Miller- Keane, 1987). Health Care Delivery – Rendering
health care services to the people (Williams-Tungpalan, 1981).

Health Care Delivery System

– The network of health facilities and personnel which carries out the task of rendering health
care to the people (Williams- Tungpalan, 1981).

Philippine Health Care System

– It is a complex set of organizations interacting to provide an array of health services (Dizon,

1977).

Philippine Health Care System Context

• Health as a basic human right.

• Department of Health is the lead agency.
• Local Government Code
– The Philippine Government devolved the management and delivery of health services from the
National Department of Health to locally elected provincial, city and municipal governments.

Philippine Health Care System Context

• Access to health care hampered by:

– high cost,
– physical and socio-cultural barriers, and
– health workforce crisis.

4 Essential Functions of Health System

1. Service provision
2. Resource generation
3. Financing
4. Stewardship

Health Care System Models

 1. Private Enterprise Health Care Model
2. Social Security Health Model
3. Publicly Funded Health Model
4. Social Health Insurance

1. Private Enterprise Health Care Model

– Purely private enterprise health care systems are comparatively rare – Where they exist, it is
usually for a comparatively well –off subpopulation in a poorer country with a poorer standard
of health care. – E.g. private clinics for a small, wealthy expatriate population in an otherwise
poor country

2. Social Security Health Model

– Where workers and their families are insured by the state – Refers to social welfare service
concerned with social protection, or protection against socially recognized conditions, including
poverty, old age, disability, unemployment and others.

3. Publicly Funded Health Model

– Where the residents of the country are insured by the state – Health care that is financed
entirely or in majority part by citizens’ tax payments instead of through private payments made
to insurance companies or directly to health care providers.

1 4. Social Health Insurance

– Where the whole population or most of the population is a member of a sickness insurance
company
– SHI is a method for financing health care costs through a social insurance program based on the
collection of funds contributed by individuals, employers and sometimes government subsidies.
– Characterized by the presence of sickness funds which usually receive a proportional
contribution of their members’ wages.
– With this insurance contributions, these funds pay medical costs of their members
– Affiliation to such funds is usually based on professional, geographic, religious, political and/or
nonpartisan criteria

Health Care Utilization

• Physical barriers

– geographical location patterns of health care consumers in relation to health providers

• Financial factors

– also exists that affect health seeking patterns of the Filipinos

Multisectoral Approach to Health

• The level of health of a community is largely the result of a combination of factors.

• Health, therefore, cannot work in isolation. Neither can one sector or discipline claim monopoly to
the solution of community health problems.
 • Health has now become a multisectoral concern.

Health System Structure/Composition Population

 Direct provision of health services

 Development and provision of manpower, supplies; financing support
 Research and development
 Coordinating, controlling and directing organizations and activities

Health Related Sectors

INTERsectoral linkages

 Local Governments
 Education
 Agriculture
 Public Works
 Population Control
 Social Welfare

Philippine Health Delivery System

It is a complex set of organizations interacting to provide an array of health services.

Public
 Largely financed through tax-based system

National

 DOH Specialty, retained and regional hospitals, medical centers, DOH representatives

Local

 LGU Provincial and district hospitals, RHUs, BHSs

Private
 Largely market-oriented

Profit
  Commercial, market orientation Private practitioners, private clinics and laboratories

Non- Profit

 Commercial, market orientation Private practitioners, private clinics and laboratories Non-
commercial, service orientation Socio-civic groups, religious organizations, or foundations

Global and Country Health Imperatives 2

Ongoing changes which exert a number of pressures on the public health system

1. Shift in demographic and epidemiologic trends in disease

2. New technologies for health care, communication and information
3. Existing and emerging environmental hazards with globalization
4. Health Reforms

In response, United Nations General Assembly

Common vision: Poverty Reduction and Sustainable Development

UNITED NATIONS MDGs

Target: Reduce global poverty and hunger

based on the fundamental values of:

• Freedom
• Equality
• Solidarity
• Tolerance
• Health
• Respect for nature
• Shared responsibility

UN Millennium Development Goals

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education
3. Promote gender equality and empower women – eliminate gender disparities in
primary/secondary education
4. Reduce child mortality by 2/3 among children under 5 yrs. old
5. Improve maternal health – reduce by ¾ the ratio of women dying in childbirth
6. Combat HIV/AIDs, malaria and other diseases
7. Ensure environmental sustainability – reduce to ½ proportion of people without access to safe
drinking water
8. Develop a global partnership

Sustainable Development Goals

Countries adopted a set of goals to end poverty, protect the planet, and ensure prosperity for all as part
of a new sustainable development agenda.
 Each goal has specific targets to be achieved over the next 15 years. For the goals to be reached,
everyone needs to do their part.

The Philippine Department of Health 3

Government agency mandated to PROTECT THE HEATLH OF THE PEOPLE Formerly known as:

• Bureau of Health
• Bureau of Health under Bureau of Public Welfare
• Ministry of Health • DEPARTMENT HEALTH (EO No. 119 “Reorganizing Ministry of
Health”

Primary Function

Promotion, protection, preservation or restoration of the health of the people through the provision and
delivery of health services and through the regulation and encouragement of providers of health goods
and services (E.O. No. 119, Sec. 3).

 A policy and regulatory body for health.

  A technical resource, a catalyzer for health policy and a political sponsor and advocate for
health issues in behalf of the health sector.
 Provides the direction and national plans for health programs and activities

With other health providers and stakeholders, the DOH shall pursue and assure the following:

• Promotion of the health and well-being for every Filipino;

• Prevention and control of diseases among population at risk;
• Protection of individuals, families and communities exposed to health hazards & risks; and
• Treatment, management and rehabilitation of individuals affected by diseases and
disability.

Vision by 2030

 A global leader for attaining better health outcomes, competitive and responsive health care
system, and equitable health financing.

Mission

 To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and
to lead the quest for excellence in health.

Core Values

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,
pro-action, 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.

Roles and Functions (EO 102)

1. Leadership in Health
2. Enabler and Capacity Builder
3. Administrator of Specific Services

DOH Offices
The DOH is composed of:

 17 central offices
 16 Centers for Health Development
 70 hospitals
 4 attached agencies

Center for Health Development/DOH Regional Office

• Responsible for field operations of the Department in its administrative region and for
providing catchment area with efficient and effective medical services.
• Tasked to implement laws, regulation, policies and programs.
• Tasked to coordinate with regional offices of the other Departments, offices and agencies as
well as with the local governments.
• Act as main catalyst and organizer in the ILHZ formation
• Provide technical support and advocacy for the development of local health management
systems and their integration in the context of the ILHZ.
• Review and approve ILHZ proposals for funding.
• Integrate local health plans into regional plans.
• Undertake monitoring of the development and implementation of ILHS.

DOH Hospitals

– Provides hospital-based care; specialized or general services, some conduct research on clinical
priorities and training hospitals for medical specialization.

Attached Agencies

1. The Philippine Health Insurance Corporation is implementing the national health insurance law,
administers the medicare program for both public and private sectors.
2. The Dangerous Drugs Board on the other hand, coordinates and manages the dangerous drugs
control program.
3. Philippine Institute of Traditional and Alternative Health Care
4. Philippine National AIDS Council
Goal:

Health Sector Reformed Agenda Describes the major strategies organizational and policy changes and
public investments needed to improve the way health care is delivered, regulated and financed.

Rationale for HSRA

• Slowing down in the reduction in the IMR and the MMR.

• Persistence of large variations in health status across the population groups and geographic
areas.
• High burden from infectious diseases.
• Rising burden from chronic and degenerative diseases.
• Unattended emerging health risks from environmental and work related factors.
• Burden disease is heaviest on the poor.

Reasons
 1. Inappropriate health delivery system as shown by an inefficient and poorly targeted hospital
system ineffective mechanism for providing public health programs on top of health human
resources maldistribution.
2. Inadequate regulatory mechanisms for health services resulting to: poor quality health care high
cost of privately provided health services high cost of drugs and presence of low quality of drugs
in the market
3. Poor health care financing and inefficient sourcing or generation of funds for health care.

FOURmula One for Health

Framework for HRSA

Intends to implement critical interventions as a single package.

Directed to ensuring

• ACCESSIBLE
• AFFORDABLE
• QUALITY health care especially for the more disadvantage and vulnerable sectors of the
population.

Goals of HSRA

1. Better health outcomes

2. More responsive health systems
3. Equitable health care financing

Elements of HSRA

1. Health Financing
2. Health Regulation
3. Health Service Delivery
4. Good Governance

1. Health Financing

Goal: To foster greater, better and sustained health investments in health

Key feature: Philippine Health Insurance Corporation through the NATIONAL HEALTH INSURANCE
PROGRAM

– Expand enrolment
– Improve benefits
– Leverage payments for quality of care

2. Health regulation

Goal: To ensure the quality and affordability of health goods and services

Components for Implementation: Quality seals for products and services (enhancing Pharma or GMA
50)- expanded
3. Health service delivery

Goal: To improve and ensure the accessibility and availability of basic and essential health care in both
public and private facilities and services

Components for Implementation: Quality seals for health provider

4. Good governance

Goal: To enhance health system performance at the national and local levels

Components for Implementation:

• Implement HSRA & FOURmula One as a single package

• Develop LGU score card • Local & management support (ILHZ, LHB, Councils)

National Objectives for Health (NOH) 2005 to 2010

• Sets target and the critical indicators, current strategies based on field experiences and laying down
new avenues for improved interventions.

Objectives of the Health Sector

1. Improve the general health status if the population

2. Reduce morbidity and mortality of certain diseases
3. Eliminate certain diseases as public health problems
4. Promote healthy lifestyle and environmental health
5. Protect vulnerable groups with special health and nutrition needs
6. Strengthen national and local health systems to ensure better health service delivery
7. Pursue public health and hospital reforms
8. Reduce the cost and ensure the quality of essential drugs
9. Institute health regulatory reforms to ensure quality and safety of health goods and services
10. Strengthen health governance and management support systems
11. Institute safety nets for the vulnerable and marginalized groups
12. Expand the coverage of social health insurance
13. 13.Improve efficiency in the allocation, production and utilization of resources for health

National Health Plan

• Is a long-term directional plan/blueprint for health covering the period of 1995-2020

• Formulation coordinated and facilitated by:

– National Health Planning Program

• A special project lunch by the DOH in line with the government’s thrust for PEOPLE
EMPOWERMENT

• County plan originated from multisectoral effort involving various disciplines and sectors

• Indicates general directions and broad strategies for an EFFICIENT AND EFFECTIVE HEALTH CARE
DELIVERY in the country.
Guiding Principles

• Health is a basic human right.

• Health is both a means and an end of development.
– Health is an integral part of development. It is affected by and in turn affects other components
of socio-economic system.
– Healthy population is a prerequisite to achieve development.

NP Vision

• A SOCIALLY and ECONOMICALLY productive population with longer life expectancy, low infant and
maternal mortality, less disability, with adequate shelter, education and means of livelihood.

Current Goals, Objectives, Strategic Thrusts & Strategies

To successfully implement the Aquino Health Agenda (AHA), the Philippine health system will require
the following components:

• enlightened leadership and good governance practices;

• accurate and timely information and feedback on performance;
• financing that lessens the impact of expenditures especially among the poorest and the
marginalized sector; competent workforce;
• accessible and effective medical products and technologies; and
• appropriately delivered essential services.

Overall Goal

The implementation of Universal Health Care shall be directed towards ensuring the achievement of the
health system goals of

• Better health outcomes;

• Sustained health financing; and
• Responsive health system

by ensuring that all Filipinos, especially the disadvantaged group in the spirit of solidarity, have equitable
access to affordable health care.

General Objective

Universal Health Care is an approach that seeks to improve, streamline, and scale up the reform
strategies in Health Sector Reform Agenda (HSRA) and Fourmula 1 (F1) for Health in order to address
inequities in health outcomes by ensuring that all Filipinos, especially those belonging to the lowest two
income quintiles, have equitable access to quality health care.

Aquino Health Agenda (AHA) and National Objectives For Health 2011-2016

• Is a focused approach to health reform implementation in the context of HSRA and F1, ensuring
that all Filipinos especially the poor receive the benefits of health reform.
Universal Health Care

• Also referred to as Kalusugan Pangkalahatan (KP)

• It is the provision to every Filipino of the highest possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an
informed and empowered public.

 Three Strategic Thrusts of UHC

1. Financial Risk Protection

2. Improved Access to Quality Hospitals and Health Care Facilities
3. Attainment of the Health-related MDGs

NHIP CHT HFEP

Local Health System 4

Devolution

 Refers to the act by which the National Government confers power and authority upon the
various local government units to perform specific functions and responsibilities, including the
provision and delivery of health care services
 Devolution made local government executives responsible to operate local health services.

Objectives of the Local Health System

• Establish local health systems for effective and efficient delivery of health care services.
• Upgrade the health care management and service capabilities of local health facilities.
• Promote inter-LGU linkages and cost sharing schemes including local health care financing
systems for better utilization of local health resources.
 • Foster participation of the private sector, non- government organizations (NGOs), and
communities in local health systems development.
• Ensure the quality of health service delivery at the local level.

Local Health Boards

 Each local government unit has a local health board which proposes annual budgetary
allocations for the operations of health services within the locality.

Provincial Health Board Organizational Structure

Governor->Provincial Health Office/Provincial Health Board-> Provincial Hospitals/District

Hospitals/Other Health and Medical Facilities

Chairman: Governor
Vice Chair: Provincial Health Officer

Members:

 Chairman on the Committee on Health of the Sangguniang Panlalawigan

 DOH Representative
 NGO Representative

Municipal Health Board Organizational Structure

Mayor ->Municipal Health Office/Municipal Health Board-> RHU/BHS

Chairman: Mayor

Vice Chair: Municipal Health Officer

Members:

 Chairman on the Committee of Health of the Sangguniang Panglungsod

 DOH Representative
 NGO Municipal Health Board Organizational Structure

Restructured Health Care Delivery System

• Adopted primary health care approach that integrates at the community level all elements
necessary to make impact upon the health status of the people.
• Is in effect the combination of main health center and satellite barrio health stations which is
essentially the basis for the implementation of the new system.

Objectives of RHCDS

• To strengthen the rural health services and to effect a more efficient and effective delivery care of
health services in the country

Main Health Center

– Location: municipality
– Own catchments area: 5,000 population more or less
 – Staff: complete team

Barrio Health Stations

– Located in a strategic area beyond 3-5 kilometer from MHC

– Catchments area: 5,000 population
– Staffed by RHM

Inter Local Health System

• It is a system of health care similar to district health system in which individuals, communities
and all other health care providers in a well-defined geographical area participate together in
providing quality, equitable and accessible health care with Inter Local Government Unit (ILGU)
partnership as the basic framework.
• Overall concept is the creation of an Inter Local Health System by clustering municipalities into
Inter Local Health Zone (ILHZ).

Inter Local Health Zone (ILHZ)

• Unit of the health system created for local health service management and delivery in the
Philippines.
• Has a defined population within a defined geographical area and comprises a central or core
referral hospital and a number of primary level facilities such as RHUs and BHS.
• Includes all stakeholders involved in the delivery of health services

 Importance of establishing an ILHZ

1. To re-integrate hospital and public health services for a holistic delivery of health services
2. To identify areas of complementation of the stakeholders – LGUs at all levels, DOH, PHIC,
communities, NGOs, private sector and others.

Composition of ILHZ

1. People

• The number of people may vary from zone to zone

• Community members, NGOs, people’s organizations, local chief executives, other gov’t
officials, private sector
• WHO ideal health district would have a population size between 100,000 to 500, 000 for
optimum efficiency and effectiveness

2. Boundaries

• Clear boundaries between ILHZ determine the accountability and responsibility of

health care services providers, geographical locations and access to referral facilities

3. Health facilities

4. Health workers
Core Referral Hospital

– Main hospital for ILHZ and its catchment population

– Main point of referral for hospital services from the community, private medical practitioner
and public health services at BHS and RHUs
– Minimum services
• Out-patient services
• Lab and radiological diagnostic services
• Inpatient care
• Surgical services sufficient to provide emergency care for basic life threatening
conditions, obstetrics and trauma

District Health System

– A contained segment of the national health system which comprises a well-defined

administrative and geographic area either rural or urban and all institutions and sectors whose
activities contribute to improve health (WHO).

Two-Way Referral System

– A two-way referral system need to be established between each level of health.

 Primary Level

1. Barangay Health Stations

2. Rural Health Units
• Devolved in cities and municipalities
• Provided by center physicians, RHNs, RHMs, BHWs, traditional healers
• First contact between the community members and other levels of health facility

Secondary Level

1. District Health Service

2. Provincial Hospitals
• Given by physicians with basic health training
• Serves a referral center of primary health care facilities
• Capable of performing minor surgeries and perform simple laboratory examinations

Tertiary Level

1. Regional Health Services

2. National Health Services
• Rendered by specialist
• Referral center of secondary care facilities

 New Classification Scheme of Health Facilities (DOH, 2012)

Classification of Health Facilities

Hospitals

General

• Level 1
• Level 2
• Level 3

Other Health Facilities

1. Primary Care Facility

- Without in-patient beds like health centers, out-patients clinics and dental
clinics With in-patient beds – short stay facility where the patient spends 1 to 2
days before discharge like infirmaries and birthing facilities
2. Custodial Care Facility
- custodial psychiatric facilities, substance/drug abuse treatment and
rehabilitation centers, sanitaria/leprosaria, and nursing homes
3. Diagnostic Facility
- laboratory, radiologic and nuclear medicine facility
4. Specialized Outpatient Facility
- dialysis clinic, cancer chemotherapy clinic, cancer radiation facility, physical
medicine and rehabilitation center/clinic

Primary Health Care 5

Definition

• The essential health care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the community
through their full participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of SELF-RELIANCE and self-
determination (Alma, Ata).
• An approach to health development which is carried through a set of activities and whose
ultimate aim is continuous improvement and maintenance of the health status of the
community (DOH).

Definition

• The collective impact of the community health nurses in PHC concept embraces the provision of
basic essential services – promotive, preventive, curative and rehabilitative – for the total
population at the local community level (Thompson).
• As an approach, requires the community health nurse to be competent in a number of
responsibilities including promoting self-reliance in health care among individuals and families,
collaborating with development sectors in promoting health and preventing diseases and
disability and extending health care coverage to all segments of the population especially
vulnerable groups (Rodolfo).
Primary Health Care Paradigm

Various Health Services-> High Level of Health-> Self reliance

 Available
 Accessible
 Affordable
 Acceptable
 Attainable

Rationale

a) Magnitude of health problems

b) Inadequate and unequal distribution of health resources
c) Increasing cost of medical care
d) Isolation of health care activities from other development

 Objectives

a) To develop and maximize people potential and self-reliance of the community for the
improvement of their own health.
b) To maximize the contributions of other sectors of health.
c) To maximize the extension of effective health care services to the periphery.

 Objectives

Others

– Improvement in the level of health care of the community.

– Favorable population growth structure.
– Reduction in the prevalence of preventable, communicable and other disease.
– Reduction in morbidity and mortality rates especially among infants and children.
– Extension of essential health services with priority given to the underserved sectors.
– Improvement in basic sanitation.
– Development of the capability of the community aimed at self- reliance.
– Maximizing the contribution of the other sectors for the social and economic development of
the community.

Mission:

– To strengthen the health care system by increasing opportunities and supporting the conditions
wherein people will manage their own health care.

Goal: Health for All by the Year 2000

Theme: Health for All and Health in the Hands of the People by the Year 2020

Key Strategy to Achieve Goal: Partnership with empowerment of the People

The strategy for achieving health for all is based on four basic points

a) Use of technology that is scientifically and socially acceptable as well as economically sound.
b) Political efforts to improve health, thus improving people’s economic and social status.
c) Cooperation of the health sector with other sectors such as education, agriculture, industry and
media.
d) Community and individual participation.

Basic Concepts

a. Health is related to social structures. Health problems are brought about by economic, political
and cultural problems and vice-versa.
b. Health and development are interrelated.
c. People’s participation is essential.
d. Community organizing is the core in PHC.
e. Use of appropriate technology. Making use of available resources is a step to self-reliance and
making the community aware of its potential and resources bring about self-appreciation.

 • Principles

a. People as the Center of Development

b. Center of Equity – Depressed, deprived and underserved (DDU) individuals, families and
communities are high in the agenda of the Department of Health
c. Respect for area-based knowledge and capacities
d. Social accountability to the Community
e. Devolution as an opportunity for Empowerment
f. Balancing Promotive/Preventive Care and Curative/Rehabilitative Care
g. Continuing concern for strengthening the capacity for PHC
h. Paradigm shift as a requirement of PHC

Components

– Education for Health

– Local Endemic Disease Prevention & Control
– Expanded Program on Immunization Maternal and Child Health/Family Planning
– Essential Drugs Provision/Herbal Medicines
– Nutrition
– Treatment of Communicable Diseases & Accidents
– Safe Water and Sanitation

Pillars

1. Use of appropriate technology

– This implies the use of methods, procedures, techniques, equipment or materials that are not only
scientifically sound, but also provides a socially and environmentally acceptable service or product
at the least economic cost.
 2. Multisectoral approach
a. Intersectoral linkages
b. Intrasectoral linkages
3. Active community participation
4. Support mechanisms made available

Criteria

a. Effectiveness and Safety

– produces the desired effect without harm.
b. Complexity
– simple and easy to apply by the health care providers and clientele.
c. Cost
– affordable for all people.
d. Scope of technology
– directly related to effectiveness, safety, appropriateness and affordability.
e. Acceptability
– understandable and attuning with the cultural practices of the people.
f. Feasibility
– compatible with the local condition of the community.

Strategies

a. Reorientation and reorganization of the national health care system

b. Effective preparation and enabling process for health action
c. Mobilization of the people to know their communities and identifying their basic health needs
d. Development and utilization of appropriate technology
e. Organization of communities arising from their expressed needs
f. Increase opportunities for community participation
g. Development of inter-sectoral linkages with other government and private agencies
h. Emphasizing partnership

• Other major strategies:

– Elevating health to a comprehensive and sustained national effort – Promoting and supporting
community managed health care – Increasing efficiency in health sector – Advancing essential
national health research

Social Mobilization

– It is a broad-scale movement to engage people’s participation in achieving a specific

development or health goal through self-reliant efforts — those that depend on their own
resources and strengths (UNICEF).
– It involves all relevant segments of society: policymakers and other decision-makers, opinion
leaders, the media, bureaucrats and technical experts, professional associations, religious
groups, the private sector, NGOs, community members, and individuals.
– It is a planned decentralized process that seeks to facilitate change through a range of players
engaged in interrelated and complementary efforts.
 – It takes into account the felt needs of the people, embraces the critical principle of community
involvement, and seeks to empower individuals and groups for action.

Can be done by:

• Establishment of an effective health referral system.

• Multi-sectoral and interdisciplinary linkages
• Information, education and communication support through multimedia.
• Collaboration between government and non- government organization.

Dimension Traditional PHC

Goal Absence of disease Development and preventive
health care
Focus of Care Sick Well and sick
Setting Urban-based hospitals, clinic, Rural-based satellite clinics
homes
Health of Posts Accessible only to a few Accessible to all community
health center
People Passive recipients and health Active participation in health
care and development
Structure Health isolated from other Health is an integral part of
sectors socio- economic development
Process Top-Down Bottom-top decision making
Technology Curative services based on Promotive and preventive
modern technology services blending traditional
and modern medicine
Jurisdiction Doctor dominated Acceptance of indigenous
practitioner; Appropriate
technology for frontline care
Outcome Reliance on health practitioner Self-reliance, socially and
economically productive

Types of Primary Health Care Workers

Vary according to:

a. Available health manpower

b. Local health needs and problem
c. Political and financial stability
1. Village Health Workers
2. Intermediate Level Health Workers
3. Health Personnel of First-Line Hospitals

Type Characteristics Examples

Village Health Workers  Initial link, 1st contact of  Trained Community Health
community worker
 Works in liaison w/ the local  Auxillary health volunteer
 health services workers  Traditional birth attendant
 Provides elementary Healers
curative and preventive
health care measures

Intermediate Level  1st source of professional  General Health Practitioners

health care  Public Health Nurses
 Attends to health problems  Midwives
beyond the competence of  RSI
village health workers
 Provides support to the
frontline health workers in
terms of supervision,
training, referral services
and supplies thru linkages
with other sectors

Health Personnel of First-Line  Establishes close contact  Physicians with

Hospitals with the village and Specialization
intermediate level health  Nurses
workers to promote the  Dentists
continuity of care from
hospital to community to
home
 Provides back-up health
services for cases requiring
hospitals or diagnostic
facilities not available in
health care