Health Service Delivery

Unified System of Governance of the P/CWHS, Private Sector Engagement, and Primary Care Strengthening

The delineation of functions between the Local Government Units (LGUs) and National Government Agencies (NGAs), and decentralization of powers, authority and resources to Local Government Units in 1991, pursuant to Republic Act (RA) No. 7160 (Local Government Code of 1991) resulted in the fragmentation of the public health system. To address the lack of coordination across the different levels of care and continuity in services provided, and to meet the demands and needs of constituents, there is a need to reintegrate hospital and public health services for a holistic delivery of health care.  In January 2000, Executive Order No. 205 was issued by the President which provided for the establishment of Inter-Local Health Zones (ILHZ) throughout the country. This was inspired by the concept of the District Health System that was introduced by the WHO. The ILHZs were created by clustering several adjacent municipalities and cities.   Each ILHZ has a defined population within a defined geographical area and is composed of a core referral hospital and several primary levels facilities, such as Rural Health Units (RHUs) and Barangay Health Stations (BHS). 

The Implementing Rules and Regulations (IRR) of RA No. 10354 (Responsible Parenthood and Reproductive Health Act of 2012) and RA No. 10351 (Sin Tax Law) in 2013 and 2014, respectively, provided for the establishment of Service Delivery Networks (SDNs) which aimed for an integrated, coordinated, and efficient provision of health care services. Consequently, as part of the Guarantees of the Philippine Health Agenda 2016-2022, Administrative Order No. 2017-0014 on Service Delivery Networks was issued in August 2017 by the Department of Health, through the Bureau of Local Health Systems Development (BLHSD).  This AO served as a guide in the organization and operationalization of SDNs.  In compliance with the abovementioned legislation and issuance, several provinces had already initiated the establishment of their respective SDNs, with assistance from the DOH-Centers for Health Development and some Development Partners.  Most of these provinces made use of the existing ILHZs or programmatic SDNs as the starting point for the type of SDNs that will provide a comprehensive set of health care services.

With the passage of RA No. 11223 (Universal Health Care Act) in 2019, the provision of continuous, coordinated, and integrated care will be further facilitated through the organization and functionality of Health Care Provider Networks (HCPNs). The HCPN has three (3) frameworks/ types as reflected in the image below.

 

Frameworks/ Types of Health Care Provider Network

The programs, projects, and activities (PPAs) of the Service Delivery Section (Section 1) are anchored on the Universal Health Care (UHC) Act, particularly Section 17 on the creation of Primary Care Provider Networks (PCPNs) to support the delivery of population-based health services, Section 19 on the organization of P/CWHS, and Section 22 on complementation of public and private health care providers and public or private health sector investments. This Section shall focus on the development of policies, researches, and other technical documents, provision of technical assistance, and conduct of monitoring and evaluation related to the establishment of the public HCPN or P/CWHS, and strengthening of local health systems through private sector engagement and implementation of primary care strategies. Given the devolved set-up of the health care delivery system, the attainment of the Section’s program objectives is through the cumulative and coordinated efforts among DOH, PhilHealth, LGUs, development partners, and other stakeholders.

 

Program Profile

Public Health Care Provider Network

The Public Health Care Provider Network (HCPN) is a type of HCPN that is owned and managed by the public sector. It is created by linking a group or cluster of public primary care providers and facilities with secondary and/ or tertiary care providers within defined geographic or political boundaries. The Public HCPN has two (2) sub-types, the Province-Wide Health System (PWHS) and City-Wide Health System (CWHS).

  • The Province-Wide Health System (PWHS) consists of the provincial, municipal, and component city health offices; provincial, district, and municipal hospitals; health centers; barangay health stations; and other LGU-managed health facilities and services.
  • The City-Wide Health System (CWHS) includes the city health office, hospitals, health centers, barangay health stations, and other city-managed health facilities and services in highly urbanized cities (HUCs) and independent components cities (ICCs).

The organization of the P/CWHS shall be first implemented in LGUs that expressed their commitment, otherwise known as the Universal Health Care Integration Sites (UHC IS), to determine the impact of an integrated local health system in improving overall health outcomes and to have readily available models that the rest of the LGUs can use as a guide to organizing their P/CWHS when nationwide roll-out is implemented. The status of each UHC IS in progressively realizing the integration reform will be tracked using the Local Health Systems Maturity Levels (LHS ML). The LHS ML outlines the ten (10) key integration characteristics, one of which is the Unified System of Governance of the Local Health Systems.

Unified System of Governance

It is a standardized structure of unified corporate governance at the provincial/ city level managing and aligning the efforts, resources, and other cooperations to organize and operate the Health Care Provider Network (HCPN) for the main purpose of efficiently and effectively delivering continuous and integrated health care services. This entity consists of representatives from relevant organizations in the delivery of health services at the local level, including service providers and communities. In the case of the Public HCPN, the UHC Act identified the Provincial/ City Health Boards (P/CHBs) which will be supported by their respective Provincial/ City Health Offices (P/CHOs) and Management Support Units (MSUs).
Management Structure under the Unified System of Governance
  • The Provincial/City Health Board (P/CHB) is the steward of the integrated local health systems and responsible for setting the policy and strategic directions of the P/CWHS.
  • The Management Support Unit (MSU) is the administrative secretariat of the health board and is responsible for assisting in its operations, in close coordination with the P/CHO.
  • The Provincial/City Health Office (P/CHO) is the technical secretariat of the health board and is responsible for the technical integration and supervision of the P/CWHS.
  • In provinces that opted to create Sub-Provincial Health Systems (SPHS), Technical Management Committee (TMC) is to be created to assist the P/CHO in supervising each SPHS. It is composed of technical staff from the member health facilities, DOH representatives, patient representatives, and others, and to be assisted by administrative staff designated by participating provincial, city, or municipality.
Need to establish a Unified System of Governance for the P/CWHS

A Unified System of Governance is needed to facilitate efficiency and responsiveness of the health care delivery system, specifically to:

  • Re-integrate hospital and public health services;
  • Improve and rationalize the coverage and utilization of health services;
  • Strengthen technical supervision and management of health activities;
  • Set up a structure to anchor the integrated health information system, referral system, primary health care initiatives, among others;
  • Improve responses to disaster and emergencies; and
  • Identify areas of resource complementation, including human resources, facilities, and budget, among the municipal, component city, provincial, and regional health systems (e.g., sharing of personnel, transport/ambulance, common health trust fund).
Private Sector Engagement
The country has a dual health system composed of public and private sectors. The importance of the private sector cannot be overemphasized since the public sector alone cannot provide all the needed health services of the whole population.  Both the public and private sectors have their own strengths and capabilities which must be recognized.

Given that certain health or health-related services may not always be available in public-owned and managed health facilities, the UHC Act highlighted the importance of complementation of resources and efforts between the public and private sectors to ensure the availability of quality health care services to all Filipinos, particularly the underserved and unserved areas. Thus, the public health facilities or networks may contract out certain services to the private sector to complete their health services.

In addition, the private sector can also establish their own health care provider networks to be contracted by PhilHealth for individual-based health services, which are mostly driven by market-based forces rather than geo-political boundaries.  Thus, it is also important to study and understand the existing and emerging models of purely private health care provider networks, which can serve as a guide for other private providers to form their networks.
Strengthening of Primary Care

The UHC Act has given due emphasis on strengthening primary care, especially that the Primary Care Provider Networks (PCPNs) serves as the foundation of the HCPNs. The PCPNs are coordinated groups of public, private, or mixed primary care providers that act as the navigator, initial and continuing point of contact of clients to the health care delivery system. It is, therefore, important that all Filipinos will be registered to their own Primary Care Provider of choice, whether public or private.  These PCPNs shall:

  • Serve as the gateway to the HCPN and coordinate the delivery of a continuum of services;
  • Guarantee the equitable access of the entire population to essential health and health-related services through the provision of these services in health centers and other care settings, such as homes, schools, and workplaces;
  • Facilitate social participation and inter-sectoral action through the development of ties with individuals, their families, and their community/ies, and with other social sectors; and
  • Ensure flow of information throughout the entire network, regardless of where care was delivered.

For these PCPNs to perform these expected functions, primary care strategies focus on ensuring the delivery of integrated and comprehensive primary care services, the presence of more strategic financing for primary care, and availability of safe, quality, and affordable primary care.

Related Policies/Issuances

  • Administrative Order No. 2020-0019 dated 14 May 2020, “Guidelines on the Service Delivery Design of Health Care Provider Networks”
  • Administrative Order No. 2020-0021 dated 22 May 2020, “Guidelines on Integration of the Local Health Systems into Province-wide and City-wide Health Systems”
  • Administrative Order No. 2020-0037 dated 13 August 2020, “Guidelines on Implementation of the Local Health Systems Maturity Levels (LHS ML)”
  • Department Memorandum No. 2020-0469 dated 30 October 2020, “Local Health Systems Maturity Levels (LHS ML) Monitoring Tool”
  • Administrative Order No. 2020-0024 dated May 22, 2020, “Primary Care Policy Framework and Sectoral Strategies”
  • Joint Administrative Order No. 2020-0001 dated December 28, 2020 “Guidelines on the Registration of Filipinos to a Primary Care Provider”
  • Department Circular No. 2021-0071 dated February 22, 2021 “FY 2020 LHS ML National Baseline Assessment Report for UHC-IS”