A. Geographically-Isolated and Disadvantaged Areas (GIDA)
Republic Act 11223 or the “Universal Health Care Act (UHC) of 2019” stipulates that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, protection against financial risk, and a health care delivery system that will afford every Filipino a primary provider. It further provides the formation of a Health Care Provider Network (HCPN) that ensures the integrated and coordinated manner of delivery of health services that must be centered on peoples’ needs and well-being, and cognizant of the differences in culture, values, and beliefs.
The UHC Act through its Implementing Rules and Regulations (IRR) has strengthened the DOH’s commitment to identify and prioritize the Geographically-Isolated and Disadvantaged Areas (GIDAs) including the Indigenous Cultural Communities/Indigenous Peoples (ICCs/IP) areas in the provision of assistance and support.
The DOH issued Administrative Order No. 2020-0023 "Guidelines on Identifying Geographically-Isolated and Disadvantaged Areas and Strengthening their Health Systems which contains criteria for identifying GIDA barangays and as priorities in the provision of assistance from the national government, local government, and other health partners.
AO No. 2020-0023 provides directions to improve access to quality health care, and ensure equitable and sustainable health financing in the identified GIDAs. It recommends strategies in strengthening GIDA health systems in terms of health service delivery, human resources for health, financing and resource allocation, pharmaceuticals and medical supplies, regulations of health facilities, leadership and governance, and health information systems
It is very crucial to identify and locate the marginalized and vulnerable population to be prioritized in the provision of health services to support the objectives of the UHC Act.
|What is GIDA||Refers to barangays which are specifically disadvantaged due to the presence of both physical and socio-economic factors.|
|1. Physical Factors – refer to characteristics that limit the delivery of and/or access to basic health services to communities that are difficult to reach due to distance, weather conditions, and transportation difficulties.|
2. Socio-economic Factors – refer to social, cultural, and economic characteristics of the community that limit access to and utilization of health services.
|Objective/s of GIDA Health Systems Strengthening|
a. To provide guidelines and directions for identifying GIDAs & strengthening their health systems; and
b. To improve access to quality health care through province-wide/city-wide health systems, and equitable and sustainable health care financing in GIDAs
|What is the Goal GIDA Program?||Better health service delivery and health outcomes for the residents in GIDA and ICCs/IPs|
|Criteria for Classification as GIDA|
|Current Policies/ issuances and Other Related Documents|
a. Administrative Order #2020-0023 dated 27 May 2020, “Guidelines on Identifying Geographically-Isolated and Disadvantaged Areas and Strengthening their Health Systems”
b. Department Memorandum #2020-0490 dated 6 November 2020, “List of Geographically-Isolated_and Disadvantaged Areas (GIDA) based_on Administrative Order No. 2020-0023, “Guidelines on Identifying Geographically-Isolated_and Disadvantaged Areas (GIDA) and Strengthening their Health Systems ”
c. Department Circular #2020-0192 dated 24 April 2020, “ Ensuring that people in GIDAs, Indigenous Cultural Communities/Indigenous Peoples are well-informed on COVID-19 and have access to Temporary Treatment and Monitoring Facilities and Referral Hospitals”
B. Indigenous Peoples’ Health
The Indigenous Peoples are among the most dis-advantaged of the Philippine populace, comprise around 13% of the entire Philippine population that are considerably vulnerable to inequities in health. The magnitude of poor health outcomes among IPs remains to be established since disaggregation of health data by ethnicity is not available and poses another form of inequity specific on health information. Current data from the DOH however reveals that municipalities and provinces considered to have a large GIDA and IP Population have poor health indicators compared to municipalities and provinces that are more accessible. The isolation of IPs contributes to the barriers in their access to health services. This can be attributed to physical segregation and socio-cultural exclusion.
In order to bring culture-sensitive and safe health services to IP Communities, DOH and LGU’s health programs were integrated to the culture-sensitive approach of the National Commission for Indigenous Peoples (NCIP).
|What is IP Health?||Refers to the delivery of basic health services to the Indigenous Cultural Communities/Indigenous People (ICC/IPs).|
|Objective/s of IP Health|
To provide directions for:
a. Making health services available and culture-sensitive;
b. Providing equitable distribution of needed health resources;
c. Ensuring non-discrimination of ICCs/IPs in the delivery health services;
d. Managing geographical, financial and socio-cultural barriers so that IPs can access basic health services; and
e. Strengthening recognition, promotion, and respect of safe and beneficial traditional health practices.
|What is the Goal/s of IP Health Program?||Better health service delivery and health outcomes for ICCs/IPs|
|What are the components of IP Health Program?|
a. Establishment of a mechanism for meaningful participation of ICCs/IPs in policy making and decision making as full partner in their own health development;
b. Address the shortage in quantity and quality of health human resources, health facilities and equipment in ICCs/IPs; and
c. Provision of essential medicines and development of safe and rational use of traditional and/or alternative medicines.
d. Establishment of quality control mechanisms that ensures essential health services to be accessible, adequate and appropriate for ICCs/IPs.
e. Establishment of a management systems, processes and procedures for the development and organization of health service delivery for IPs, i.e., health information, health facility, referral, health education and monitoring and evaluation.
f. Identify and allocate sources of funds and resource allocation for ICCs/IPs health services.
|Current Policies/ issuances and Other Related Documents|
a. DOH-NCIP-DILG Joint Memorandum Circular # 2013-01 dated 19 April 2013, “Guidelines on the Delivery of Basic Health Services for Indigenous Cultural Communities/Indigenous Peoples”
b. Department Memorandum # 2014-0383 dated 04 December 2014, “Indigenous Peoples Strategic Plan for Health”
c. Department Memorandum # 2015-0052 dated 17 February 2015, “List of Indigenous Peoples (IP) Areas”
d. Department Memorandum # 2018-0222 dated 23 May 2018, “Indigenous Peoples’ (IP) Strategic Plan for Health 2018-2022”
C. Urban Health System Development (UHSD) Program
In the Philippines, nearly 60% of the population in 2000 lived in areas classified as urban' and an estimated 28% lived in squatter and slum settlements. Urban Health System Development (UHSD) must help cities address the challenges of rapid urbanization.
Increased congestion, pollution and slum formation with wider inequity across social determinants of health are results of rapid urbanization. Urbanization has also increased risks, hazards and vulnerabilities to health of urban populations including communicable diseases, violence, traffic injuries, obesity, and settlement in unsafe areas.
The rapid rate of urbanization has outpaced the ability of governments to build essential infrastructure for health and social services. Thus, it will require more than the provision and use of health services to improve the health of urban populations.
|What is the Urban Health Systems Development Program?||The Urban Health Systems Development Program specifies the DOH approach to urban health systems putting emphasis on influencing social determinants of health in urban settings with focused application on urban poor populations particularly those living in slum communities/ settlements in order to reduce health inequities.|
|Urban health system refers to all entities and processes operating in urban settings to protect, restore or improve health.|
|Social determinants of health are those critical characteristics of societies and communities in which people live that have an impact on their health. These include the level of education, water and sanitation, housing, employment, food production, among others.|
|Equity in health mean - It implies that ideally, everyone could attain their full health potential and that no one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstance.|
|Healthy urbanization is the desired direction of urban health systems development that aims to protect and promote public health rather than threaten or erode health of individuals and communities in urban areas.|
|What is the Goal/s of UHSD Program?|
1. To improve health systems outcomes
2. To influence social determinants of health
3. To reduce health inequities
1. To establish awareness on the challenge of urban health
2. To initiate inter-sectoral approach to urban health systems development
3. To guide LGUs to develop sustainable responses to urban health challenge
|What are the components of UHSD Program?|
The components of the Urban Health System Development are:
1. Healthy Cities Initiative (HCI)
2. Environmentally Sustainable and Healthy Urban Transport (ESHUT)
3. Reaching Every Depressed (RED) Barangay
b. Planning Tools and Framework
1. Urban Health Equity Assessment and Response Tool (Urban HEART)
2. City-Wide Investment Planning for Health (CIPH)
c. Capacity Building
1. Short Course on Urban Health Equity (SCUHE)
|What is Healthy Cities Initiative (HCI)? Healthy Cities Initiative (HCI) is an approach that continually creates and improves physical and social environments to address social determinants of health and improve health of urban dwellers.|
|What is an Environmentally Sustainable and Healthy Urban Transport (ESHUT) Initiative? Any initiative that pertains to the development or enhancement of existing projects to improve the policy, design and practice of an urban transport system (e.g., decreasing air and noise pollution and greenhouse gas emission from motor vehicles, pedestrian footpaths, bicycle lane) and lead to improvement of health and safety of urban population.|
|What is Reaching Every Depressed (RED) Barangay? Reaching Every Depressed (RED) Barangay is a strategy that targets depressed communities in the delivery of special health services in order to reach the vulnerable groups and hidden slums.|
|What is Urban Health Equity Assessment and Response Tool (Urban HEART)? Urban Health Equity Assessment and Response Tool (Urban HEART) is a tool that measures performance in poor or vulnerable populations across health and socio-cultural indicators. It is used in situational assessment and monitoring for planning purposes in cities, in tandem with the LGU Scorecard. The key components are Intersectoral Technical Working Group (TWG), Data Collection, Data Assessment, and Response.|
|What is Short Course on Urban Health Equity (SCUHE)? Short Course on Urban Health Equity (SCUHE) is a 6-month course that aims to improve the knowledge, practice and skills of health practitioners, policy and decision-makers at the national, regional and city levels to identify and address urban health inequities and challenges, particularly in relation to social determinants of health.|
|Current Policies/issuances and Other Related Documents|
a. Administrative Order #2011-0008 dated 12 July 2011, “Guidelines on Urban Health Systems Development”
b. Department Memorandum #2010-0207 dated 20 August 2010, “Guidelines on the Use of the Urban Health Equity Assessment and Response Tool (HEART) in Highly Urbanized Cities”
Note: The Guidelines (AO) is still subject for revision, specifically the strategies such as RED, Urban HEART, and SCUHE.