Philippine Health Care Delivery System - Final

PHILIPPINE
HEALTHCARE
DELIVERY
SYSTEM
TRENDS ISSUES CHALLENGES

RYAN MICHAEL F. ODUCADO, MAN, MAEd,
RN, RM, RPT
Lead Faculty, Community Health NursingWest Visayas State University
NNCCS, Master Trainer (Community/Public Health Nursing)
Seminar Outcome
After 30-minute seminar, the participants must
have:
1. identified the various trends, issues and
challenges confronting the Health Care Delivery
System contextualizing the discussion in the
Philippine setting;
2. recognized the pivotal role of nurses in
addressing these key issues and challenges; and
3. participated attentively in the exchange of
intellectual discussion in identifying possible
areas for improvement, research and knowledge
development in the area of health care system.
Declaration of
Interest
&
Disclosure
The presentation covers data available to the

public.
The presenter is a Master in

Community/Public Health Nursing working
collaboratively with the Department of
Health.
The presenter has projects geared toward

increasing Education, Nursing and Public
Health body of knowledge.
The presenter has no known or perceived

conflict of interest.
Content Outline
Pressures on the Public Health System (Cuevas, 2007)
1. Shift in demographic and epidemiologic trends in disease
Emerging disease like EBOLA, MERSCov, ZIKA
2. New technologies for health care, communication and

information
RxBOX, mhGAP, eHealth, EVP, BPO
3. Existing and emerging environmental hazards with

globalization
Climate Change, Disaster Preparedness
4. Health Reforms
SDGs, Duterte Health Agenda, ASEAN Integration
Content Outline
1. National Health Situation
2. Local Health Situation
3. Global Health Goals
4. National Health Goals
Philippine Health Care Delivery

System
It is a complex set of organizations interacting to provide an array of health
services.
Public
Private
Largely financed through tax-based system
Largely market-oriented
National
DOH
Local
LGU
Specialty, retained and

regional hospitals,
medical centers, DOH
representatives
Provincial and district

hospitals, RHUs, BHSs
Profit
Commercial,
market
orientation
Non-profit
Non-commercial,
service
orientation
Private practitioners,
private clinics and
Socio-civic groups,
religious organizations, or
Demographic and Epidemiologic Trends

Has experienced considerable improvements in
its health status for the past 50 years, yet also
decline in the recent years (Cuevas, 2007)
Experiencing epidemiologic shift
While contending with the burden of communicable diseases, it is
also the same time contending with non-communicable diseases.
Threatened
whammy
with
devastating
effect
of
triple
Philippine National Health Situation
Highest occurrences of deaths were among the elderly

persons, 70 years and over.
Death occurrence was least among age group 10-14 years.
Deaths among under 1 year old is more than twice the
number of deaths in ages 1-4 years.
Statistics show that the risk of dying is directly proportional
to age, starting with age 10 and up.
CALABARZON, NCR & Central Luzon: Deaths from

these three regions comprised to almost 40 percent
(39.1%) of the total deaths.
ARMM, CAR and CARAGA: These three regions were
consistently low in terms of the number of deaths
registered, which maybe a result of either effective
health intervention or under registration.
For several years now, statistics show that even in NCR, a highly urbanized
region and where both public and private health facilities are accessible, still, a
low percentage of attended death is recorded.
Dying without the attention of a medical doctor could be somehow an evidence
of unaffordable health cost in the country.
More than 81 percent of deaths registered in

2013 were attributed to the top 10 leading
causes of death for the year.
Diseases of the Heart had been consistently
the number one cause of death for several
years now.
Diseases of the Vascular System, Malignant
Neoplasm and Pneumonia remained in their
respective rankings for the past 4 years .
7 out of the 10 leading causes of deaths were

male dominated.
Men were almost 4 times more likely to die
from Accidents than women.
More deaths from the leading causes were not medically attended.
9 out of the 10 ten killer diseases were not attended by a medical doctor or
any allied health officer in anytime during their illness or injury.
Health Situation
in
Western Visayas
Renilyn P. Reyes,MD,MPA,DPPS
Head, Family Health and Nutrition Cluster
Sarabia Manor Hotel, Iloilo City
October 21, 2016
Department of Health-Regional Office VI
Total Population
(Projected 2015)
7,603,147
No. of
households
- 1,604,323
Total No. of
Brgys.
- 4,051
Total No. of BHS
- 2,059
Department of Health Regional Office VI
CRUDE BIRTH and CRUDE

DEATH RATE
Crude Birth Rate
20
17.88
15
Western Visayas, CY 2010-2015

17.19
18.18
18.22
17.46
16.88
16.24
Percentage
10
5
5.55
5.47
5.91
6.12
6.09
5.82
5.97
0
2009
2010
2011
2012
2013
2014
2015
Source:
Population:
7,603,147
Top Ten
Leading Causes of
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Morbidity
Causes
Female
Total
Western
Visayas, Male
CY 2015
1. Upper Respiratory Tract
Infection
61,743
71,206
132,94
9
2. Acute Lower Respiratory Tract

Infection & Pneumonia
20,789
22,253
43,042
3. Bronchitis / Bronchiolitis
11,127
18,752
29,879
9,734
15,402
25,136
14,287
9,808
24,095
6. Urinary Tract Infection
5,336
11,320
16,656
7. TB, All forms
8,037
4,652
12,689
8. Skin Diseases, All forms
4,413
4,413
8,981
9. Acute Watery Diarrhea
2,821
2,821
5,681
10. Diabetes Mellitus
1,801
1,801
4,498
4. Hypertension
5. Injuries, All forms
Top Ten
Leading Causes of
Mortality
Western Visayas,
CY 2015
Hypertensive Cardiovascular
Diseases (HCVD)
Pneumonia
Malignant Neoplasm (Cancer)
Injuries/Accidents
Kidney Diseases
Tuberculosis, All forms
Septicemia
Cerebrovascular Accident (CVA)
Diabetes
Chronic Obstructive Pulmonary Disease (COPD)
2252
2,158
1876
588
1346
947
1353
596
787
693
795
649
687
746
940
367
0
2,000
6394
5,280
4724
4,175
Population:
7,603,147
4,000
6,000
8,000
Infant and Under 5 Mortality

Rates
WESTERN
VISAYAS, 2015
live births
Westernper1,000
Visayas,
CY 2015
14.00
12.00
11.56
10.00
8.00
9.87
10.13
9.62
9.63
2011
2012
2013
2014
10.27
6.00
4.00
2.00
0.00
2010
2015
Year
There was a slight increase in the Infant Mortality Rate (IMR) of the region from 9.63 deaths per 1,000
live births in 2014 to 10.27 deaths per 1,000 live births in 2015. Between 2010 and 2015, IMR decreased
by 11% from 11.56 in 2010 to 10.27 in 2015.
Infant
Mortality Rate
WESTERN Western
VISAYAS, 2015 Visayas,
per province / HUCs
25
2015
20
19.1
15.1
15
Rate per 1,000 live births
13.8
13
10.6
10
MDG
Target
CY 17/1,000
LB
10.3
7.3
7.8
7.4
5
0
Iloilo City posted the highest IMR with 19.13 deaths per 1,000 live births.
Antique was at second with 15.06 and Bacolod was third at 13.82. On the
other hand, Capiz recorded the lowest IMR at 7.29. Overall, majority of the
LGUs had IMRs higher than the region.
Under
Five Mortality Rate
30
WESTERN Western
VISAYAS, 2015 Visayas,
per province / HUCs
2015
MDG Target
25.5/1,000
CY
LB
24.5
25
22.8
Rate per 1,000 live births

20
18.4
15
10
13.8
12.4
14.1
13.5
11.1
10
5
0
Iloilo City and Bacolod had the highest Under Five Mortality Rate in 2015 at
24.47 and 22.76, respectively while Negros Occ. was the lowest at 10.92.
100
FullyTOPImmunized
Child (FIC)
TEN LEADING CAUSES OF MORBIDITY
Coverage
(%)
Western Visayas, CY 2010-2015
80
80.57
60
85.73
73.67
82.41
73.39
Target
95%
67.06
40
20
0
2010
2011
2012
2013
2014
Year
2015
TARGET :
Maternal Mortality Ratio (MMR)
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
WESTERN
VISAYAS, 2015
Western Visayas, CY
2010-2015
100
80
77.55
Per 100,000 live births
60
76.80
82.74
90.01
72.87
71.33
40
20
Maternal
Mortality Ratio (MMR) increased from 71.33 per
100,000 live births in 2012 to 90.01 per 100,000 live births in
2014.0 Though it decreased to 72.87 per 100,000 live births in
2015, this was not enough to achieve the MDG target of 52.
2010
2011
2012
2013
2014
Year
2015
TARGET :
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
Maternal Mortality Ratio (MMR)

Per province/HUCs , CY 2015
200
174.2
180
160
140
138.8
120
100
94.1
92.5
80
60
40
72.3
42.4
17.7
20
0
72.9
In 2015, Bacolod City recorded the highest MMR at 174.22 maternal

deaths per 100,000 live births while Guimaras had the lowest with
zero maternal deaths. Three other LGUs namely Aklan, Antique and
Iloilo City had MMRs higher than the region.
Births Attendant
by Skilled Health
Professional
TARGET : 90%
Facility Based Deliveries
100.00
Western 84.85
Visayas,87.28
CY 2015
89.30
90.40
90.00
81.24
78.42
88.85
80.00
87.34
83.59
79.33
70.00
73.34
60.00
66.21
Percentage
50.00
40.00
30.00
90.40% of all births in the region were attended by Skilled
Health Personnel.
The proportion of births attended by
20.00
skilled health personnel increased from 78.42 in 2010 to 90.4
10.00
per cent in 2015.
0.00
2010
2011
2012
2013
2014
2015
Year
Skilled Birth Attendants

Facility Based Deliveries
Facility TOP
Based
Deliveries (%) TARGET : 90%
Per province/HUCs
, CY 2015
120
100
80
78.7
83.1
86.9
90.3
86.9
89.8
95.3
99.9
88.9
60
40
20
0
In 2015, more than three fourths (88.85%) of all births were delivered in a
health facility. This is higher than the 87.34% reported in 2014 and a significant
improvement from the 66.21% reported in 2010. Delivery in a health facility
was highest in Iloilo City at 99.9 percent and lowest in Aklan at 78.69 percent.
Contraceptive
Prevalence Rate
TARGET : 65%
(%)
60.00
Western Visayas, CY 2010- 2015
50.00
40.00
34.13
34.17
40.21
37.85
43.82
47.66
30.00
20.00
10.00
0.00
2010
Current use of contraception among married women in the

region has been increasing for the last five years. In 2015,
around 48 percent of married women were currently using a
modern family planning method, an increase of around four
percentage points from the 2014 CPR of 43.82 percent. From
2010-2015, there has been an increase of around three
percent annually in the regions CPR.
2011
2012
2013
2014
Year
2015
TB Mortality Rate by Province and Highly

Urbanized
City
28.00
Western Visayas,
CY 2015
TARGET : < 23 /100,000
27.50
27.00
27.08
26.00
Rate per 100,000 Population
25.94
25.00
24.00
23.00
22.00
21.00
The number of deaths caused by TB has

increased in the region from 1,728 in
2014 to 1,949 in 2015. This translated to
a TB Mortality Rate of 25.6 per 100,000
population, higher than the mortality rate
of 24.57 in 2014. TB Mortality Rate has
decreased by around two deaths per
100,000 population between 2010 and
2015.
2010
2011
2012
24.57
25.60
2014
2015
23.33
2013
Year
Mortality Rate from Rabies

1,000,000
Population
TOP TENper
LEADING
CAUSES
OF MORBIDITY
Western Visayas, CY 2010- 2015

2.50
2.25
TARGET : less than 1/million population

1.97
2.00
1.50
1.24
1.09
1.33
1.00
0.50
0.13
0.00
2010
2011
2012
2013
2014
Year
2015
No. of HIV/AIDS Cases

WesternTOP
Visayas,
CY 2010-2015
WESTERN VISAYAS,
2015
400
377
The estimated prevalence of HIV in the region is still low

350 but growing. The current incidence of HIV/AIDS in the
region is still within the MDG target of less than 1
300 percent of the total population in 2015. However, there
has been an overwhelming increase in the number of HIV
and AIDS cases in the region for the past five years from
250
only 43 new cases in 2010 to 377. Between 2014 and
Case
2015, the number of new HIV cases also increased by 53
200 percent from 247 new cases in 2014 to 377 in 2015. 176
247
193
149
150
89
100
42
50
0
336
58
43
61
2010
27
10
99
2011
2012
Year
2013
54
2014
HIV
41
2015
AIDS
Global & National Health Goals
set of goals toend poverty,protect

andensure prosperity for all.
the
planet,
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: governments, the private sector, civil society and
people like you.
Maraming
Salamat!
RYAN MICHAEL F. ODUCADO

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PHILIPPINE

TRENDS ISSUES CHALLENGES

The presentation covers data available to the

The presenter is a Master in

The presenter has projects geared toward

The presenter has no known or perceived

2. New technologies for health care, communication and

3. Existing and emerging environmental hazards with

Philippine Health Care Delivery

Largely financed through tax-based system

Specialty, retained and

Provincial and district

Demographic and Epidemiologic Trends

Philippine National Health Situation

Highest occurrences of deaths were among the elderly

CALABARZON, NCR & Central Luzon: Deaths from

More than 81 percent of deaths registered in

7 out of the 10 leading causes of deaths were

Department of Health-Regional Office VI

CRUDE BIRTH and CRUDE

Western Visayas, CY 2010-2015

Department of Health Regional Office VI

2. Acute Lower Respiratory Tract

6. Urinary Tract Infection

7. TB, All forms

8. Skin Diseases, All forms

9. Acute Watery Diarrhea

10. Diabetes Mellitus

Department of Health Regional Office VI

Department of Health Regional Office VI

Infant and Under 5 Mortality

Rate per 1,000 live births

Maternal Mortality Ratio (MMR)

In 2015, Bacolod City recorded the highest MMR at 174.22 maternal

Department of Health Regional Office VI

Skilled Birth Attendants

Department of Health Regional Office VI

Current use of contraception among married women in the

Department of Health Regional Office VI

TB Mortality Rate by Province and Highly

The number of deaths caused by TB has

Department of Health Regional Office VI

Mortality Rate from Rabies

Western Visayas, CY 2010- 2015

TARGET : less than 1/million population

Department of Health Regional Office VI

No. of HIV/AIDS Cases

The estimated prevalence of HIV in the region is still low

Global & National Health Goals

set of goals toend poverty,protect

Each goal has specific targets to be achieved over the next 15

RYAN MICHAEL F. ODUCADO

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