PHILIPPINE DEVELOPMENT OF HEALTH

BRIEF BACKGROUND:
PRE-SPANISH ERA (BEFORE 1565)
 Ancient Filipinos regarded health as a harmonious relationship with the environment,
both natural and supernatural (example: kalinga’s bulul and offerings)
 Mumbaki of the Ifugaos or native priests that perform “Ketama” or a divination ritual
performed for illness caused by ancestral spirits 
 Like most indigenous peoples, our ancestors put faith in nature not only for physical
but also for spiritual sustenance (“babaylan” or priestess), use of herbal medicines
such as the leaves on anonas used as a topical and applied to the stomach of
children suffering from indigestion
SPANISH ERA (1565-1898)
 San Lazaro Church and Hospital represents early medical healthcare in the Spanish
era
 Babaylans were replaced by Spanish friars, which led the Filipino people in the
rituals of the Catholic faith
 HOSPITAL REAL – the very first hospital in the Philippines (Cebu, 1565), built
under the supervision of Miguel Lopez de Legazpi
 Used to cater the needs of the Spanish army and navy
 HOSPITAL DE NATURALES – established by Fray Clemente, a lay brother and
botanist, comprised of two wards of nipa and bamboo, in the walled city of
Intramuros
 Burned in 1603 and was relocated to the district of Dilao, known as present-day
Paco, under the name Hospital De San Lazaro
HEALTHCARE UNDER THE AMERICANS (1898-1918)
 More hospitals, formal medical education and more medical benefits were given to
the Filipinos
 General Order No. 15 (September 29, 1898) – Board of Health – headed by Dr.
Frank Bourns
 August 26, 1899 – Dr. Guy Edie – appointed as the first Commisioner of Health and
led the campaign against smallpox
 Act No.157 – Board of Health for the Philippine Islands → Insular Board of Health –
creation of provincial and municipal health boards
 Cholera Epidemic (1902-1905) – worst epidemic in the Philippine history; 200, 222
deaths, including 66, 000 children
 Act No. 1711 (Leper Law) – compulsory apprehension, detention and segregation
of lepers at the Culion Leper Colony and San Lazaro Hospital
FILIPINIZATION OF HEALTH SERVICES
 Jones Law (1916) – US commitment towards granting Philippine independence
 Birth of Jose R. Reyes Memorial Medical Center (JRRMMC)
 Dr. Vicente de Jesus – first Filipino Director of PGH, January 1, 1919
 UP College of Medicine and Surgery (1905) – designed under the blueprint of the
best medical school at that time, the John Hopkins University
 May 31, 1939 – Department of Health and Public Welfare was born by virtue of
Commonwealth Act 430
DEPARTMENT OF HEALTH (DOH)
 Is the national agency mandated to lead the health sector toward assuring quality
health care for all Filipinos
 Serves as the main governing body of health services in the country
 Provides guidance and technical assistance to LGUs through the Center for Health
Development in each of the 17 regions
Provincial governments – responsible for administration of provincial and district
hospitals
1. Municipal and city governments are in charge of primary care through rural health
units (RHUs) or health centers
2. Barangay Health Stations (BHSs) – provide health services in the periphery of the
municipality or city

3. Mission-Vision

DOH VISION:
Is to be a global leader for attaining better health outcomes, competitive and responsive
health care system, and equitable health financing
DOH MISSION:
To guarantee equitable, sustainable and quality health for all Filipinos, especially the
poor, and to lead the quest for excellence in health
4. Historical background
Historical Background

June 23, 1898

Creation of the Department of Public Works, Education and Hygiene (now the
Department of Public Works and Highways, Department of Education Culture & Sports,
and Department of Health) through the Proclamation of President of Emilio Aguinaldo.

September 29, 1898

Establishment of the Board of Health for the City of Manila under General Orders No. 15

1899 - 1905
Abolition of the Board of Health and appointment of Dr. Guy L. Edie as the first
Commissioner of Public Health

Act No. 157 of the Philippine Commission]

Creation of the Board of Health for the Philippine Islands; it also acted as the Board of
Health for the city of Manila

Acts Nos. 307, 308 and 309

Establishment of the Provincial and Municipal Boards of Health, completing the health
organization in accordance with the territorial division of the Islands.

Act No. 1407

also the Reorganization Act
Abolition of the Board of Health and its functions and activities were taken over by the
Bureau of Health.

1915
Changing of the name of the Bureau of Health to the Philippine Health Service, which
was later on changed to its former name.

January 1, 1941
Creation of the Department of Health and Public Werfare for in Executive Order No.
317, series of 1941.

1947
Reorganization of government offices under Executive EO no. 94, series of 1947 with
the transfer of the Bureau of Public Welfare to the Office of the President and the
Department was renamed Department of Health (DOH)

1950
Under E.O no. 392, s. 1950, the Department of Health gained additional functions
brought by the transfer of the Institute of Nutrition, together with the Division of
Biological Research and the Division of Food Technology from the Institute of Science,
and the Public Schools Medical and Dental Services from the Office of the President of
the Philippines and the Bureau of Public School respectively to the DOH.
1958
The creation of eight regional health offices and two Undersecretaries of Health; the
Undersecretary of Social Services.
1982
Under E.O. No. 851, the Health Education and Manpower Development Service was
created, and the Bureau of Food and Drugs assumed the functions of the Food and
Drug Administration.
1986
The Ministry of Health became Department of Health again.
1987
Another re-organization under E.O No. 119, which placed under the Secretary of Health
five offices headed by an undersecretary and an assistant secretary.
1991
Full implementation of R.A. No. 7160 or Local Government Code. The DOH changed its
role from one of implementation to one of governance.

5. Local health system and Devolution of Health Services

Inter-Local Health Zones in the Context of Health Systems Development

What is Health System? 

 The combination of health care institutions, supporting human resources, financing
mechanism, information system, organizational structures that link institutions and
resources, and management structures that collectively culminate in the delivery of
health services to patients. 
Fundamental Objectives of Health Systems
1. Improvement of health outcomes of the population they serve.
2. Providing financial protection against the costs of ill health (the poor need it more)
3. Responding to people’s expectations (public satisfaction in performance).
Levels of Governance, Health Delivery Systems
1. Nation-wide Health System
2. Region-wide Health System
3. Local Health System (City, Province, Municipal, Barangay, Inter-Local cooperation
systems)
What are the Local Health System?
 A health system at the sub-national level (Dorotan, et al)
 The core element of local or district health system is the integrated primary health
care and the first referral hospital serving a well-defined population (Segall, 2003).
The Basic Framework of LHS
 The basic framework of local health system is inter-LGU partnership.
 Inter-LGU coordination: The actions of two or more LGUs to joinly adapt and
implement in a coordinated manner a common set of policies, programs, projects or
activities in order to achieve common health goals or purposes.

Devolution of Health Services

6. R.A. 7160 or Local Government Code was enacted to bring about genuine and
meaningful local autonomy. This will enable local governments to attain their fullest
development as self-reliant communities and make them more effective partners in
the attainment of national goals. It mandates devolution of basic services from the
national government to LGUs. Devolution refers to the act by which the national
government confers power and authority upon the various LGUs to perform specific
functions and responsibilities (Congress of the Republic of the Philippines, 1991). 
7. R.A. 7160 provided for the creation of the Provincial Health Board and the City/
Municipal Health Boards, or Local Health Boards. The chairman of the board is the
local executive-the Provincial Governor/ Mayor. The Provincial/City/Municipal Health
Officer serves as vice chairman. Members of the board are composed of the
chairman of the committee on health of the Sanggunian, a representative from the
private sector or NGO involved in health services, and a representative of the DOH
(Congress of the Republic of the Philippines, 1991).

8. Classification of Health Facilities (DOH AO-0012A)

The functions of Local Health boards are as follows: 
1. Proposing to the Sanggunian annual budgetary allocations for the operation and
maintenance of health facilities and services within the province/city/ municipality;
2. Serving as, an advisory committee to the Sanggunian on health matters; and 
3. Creating committee that shall advise local health agencies on various matters related
to heal.th service operations.
The Health Referral System
 Implemented since 1992 devolution has brought decision making and accountability
on basic government services closer to the people. This has allowed local leaders to
 have a greater hand in the future of communities. However, it has brought about
fragmentation of the health care delivery system in the Philippines. It resulted in a
three-level system where local and national governments are responsible for
independent services. Also, municipalities/cities began operating separately from
each other causing further segregation of public health services (DOH, 200I).
Two Referral System (DOH, 2001)
 Referrals may be internal or external.
 Internal Referrals occurs within the health facility, from one health personnel to
another
 External Referrals is a movement of a patient from one health facility to another. It
may be vertical, where the patient referral may be from a lower to a higher level of
health facility or the other way round.

The Inter-Local Health Zone 

 As stated earlier, devolution has resulted in a fragmented health care system and
segregation of public health services among different LGUs. The referral system
functioning within the context of the Inter-Local Health Zone (ILHZ) provides a
means for consolidating health care efforts.
 The ILHZ is based on the concept of the District Health System.
 It is a district health system in a devolved setting, a generic term used by WHO to
describe an integrated health management and delivery system based on a defined
administrative and geographical area
The ILHZ has the following components (DOH, 2002):
 People. Although WHO has described the ideal population size of a health district
between 100,000 and 500,000, the number of people may vary from zone to zone,
especially when taking into consideration the number of LGUs that will decide to
cooperate and cluster.
 Boundaries. Clear boundaries between ILHZs establish accountability and
responsibility of health service providers.
 Health facilities. RHUs, BHSs, and other health facilities that decide to work
together as an integrated health system and a district or provincial hospital, serving
as the central referral hospital, make up the health facilities of an ILHZ.
 Health workers. To deliver comprehensive services, the ILHZ health workers
include personnel of the DOH, district or provincial hospitals, RHUs, BHSs, private
clinics, volunteer health workers from NGOs, and community-based organizations.
Health sector reform: Universal Health care
 Previous efforts at health sector reform have brought about substantial gains in
health sector improvements. Universal Health Care (UHC) (Kalusugan
Pangkalahatan) also called the Aquino Health Agenda, is the latest in a series of
continuing efforts of the government to bring about health sector reforms. UHC was
 built upon the strategies of two previous platforms of reform: the initial Health Sector
Reform Agenda (1999-2004) and FOURmula One (Fl) for Health (2005-2010). UHC
is planned for implementation until 2016 (DOH, 2010).

Goals and objectives

 UHC is directed towards ensuring the achievement of the health system goals of :
1. Better health outcomes,
2. Sustained health financing, and
3. A responsive health system by ensuring that all Filipinos, especially the
disadvantaged group, have equitable access to affordable health care (DOH, 2010).

DOH Administrative Order 2012-0012

“New Classification of Hospitals and Other Health Facilities”
CLASSIFICATIONS OF HOSPITAL
 General Hospital Provides services for all kinds of illnesses, injuries or deformities
 Specialty Hospital Offers Services for a specific disease or condition or type of
patient such as the children, elderly, or woman

Summary of the New Classification Hospitals and Health Facilities

DOH Administrative Order 2012-0012

classifies Other HEALTH FACILITIES as follows:
Category A
Primary Care Facility
A first contact health care facility that offers basic services including emergency
services and provision for normal deliveries.
1. With in patient beds – a short stay facility where the patient spends on the average of
one to two days before discharge
2. Without in-patients beds like health centers, out patient clinics, and dental clinics.
Category B
Custodial Care Facility
facility that provides long-term care, including basic services like food and shelter, to
patients with chronic conditions requiring ongoing health and nursing care due to
impairment and a reduced degree of independence in activities of daily living and
patients in need of rehabilitation
Category C. Diagnostic/therapeutic facility
facility for the examination of the human body, specimens from the human body for the
diagnosis, sometimes treatment of disease, or water for drinking water analysis. The
test covers the pre analytical, analytical, and postanalytical phases of examination.
This category is further classified into:
 1. Laboratory facility
2. Radiologic facility
3. Nuclear medicine facility
Category D
Specialized outpatient facility
a facility that performs highly specialized procedures on an outpatient basis.

New Classifications of General Hospital

9. Philippines Health Agenda 2010-2022
Motto: All for Health towards Health for All
Goals: Attain Health-Related SDG Targets 
 Financial Risk Protection
 Filipinos, especially the poor, marginalized, and vulnerable are protected from high
cost of health care
 Better Health Outcomes
 Filipinos attain the best possible health outcomes with no disparity
 Responsiveness 
 Filipinos feel respected, valued, and empowered in all of their interaction with the
health system
Values: 
EQUITABLE & INCLUSIVE TO ALL
TRANSPARENT & ACCOUNTABLE
USES RESOURCES EFFICIENTLY
PROVIDES HIGH QUALITY SERVICES
3 Guarantees
Guarantee #1: ALL LIFE STAGES &TRIPLE BURDEN OF DISEASE (Services for both
the well & the sick)
 First 1000 days
 Reproductive and sexual health
 maternal, newborn, and child health
 exclusive breastfeeding
 food & micronutrient supplementation
 Immunization
 Adolescent health
 Geriatric Health
 Health screening, promotion & information
TRIPLE BURDEN OF DISEASE
 COMMUNICABLE DISEASES
• HIV/AIDS, TB, Malaria 
• Diseases for Elimination
• Dengue, Lepto, Ebola, Zika

 NONCOMMUNICABLE DISEASES & MALNUTRITION

• Cancer, Diabetes, Heart Disease and their Risk Factors – obesity, smoking, diet,
sedentary lifestyle 
• Malnutrition
 DISEASES OF RAPID URBANIZATION & INDUSTRIALIZATION
• Injuries 
• Substance abuse 
• Mental Illness 
• Pandemics, Travel Medicine 
• Health consequences of climate change / disaster

Guarantee #2: SERVICE DELIVERY NETWORK (Functional Network of Health

Facilities)
Services are delivered by networks that are:
 Fully functional (complete equipment, medicines, health professional)
 Compliant with clinical practice guidelines
 Available 24/7 & even during disasters
 Practicing gatekeeping
 Located close to the people (mobile clinic or subsidize transportation cost)
 Enhanced by telemedicine
Guarantee #3: UNIVERSAL HEALTH INSURANCE (Financial Freedom when
Accessing Services)
PHILHEALTH AS THE GATEWAY TO FREE AFFORDABLE CARE
• 100% of Filipinos are members 
• Formal sector premium paid through payroll 
• Non-formal sector premium paid through tax subsidy
SIMPLIFY PHILHEALTH RULES
• No balance billing for the poor/basic accommodation & Fixed co-payment for non-
basic accommodation
PHILHEALTH AS MAIN REVENUE SOURCE FOR PUBLIC HEALTH CARE
PROVIDERS
• Expand benefits to cover comprehensive range of services 
• Contracting networks of providers within SDNs
STRATEGY:
 A- Advance, health promotion and primary care
C- Cover all Filipinos against health-related financial risk
H- Harness the power of strategic HRH development
I- Invest in eHealth and data for decision-making
E- Enforce standards, accountability and transparency
V- Value all clients and patients, especially the poor, marginalized, and vulnerable
E- Elicit multi-sectoral and multi-stakeholder support for health

A- Advance quality, health promotion and primary care

1. Conduct annual health visits for all poor families and special populations (NHTS, IP,
PWD, Senior Citizens) 
2. Develop an explicit list of primary care entitlements that will become the basis for
licensing and contracting arrangements 
3. Transform select DOH hospitals into mega-hospitals with capabilities for multi-
specialty training and teaching and reference laboratory 
4. Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-wide
smoke-free or speed limit ordinances) 
5. Establish expert bodies for health promotion and surveillance and response
C- Cover all Filipinos against health-related financial risk
1. Raise more revenues for health, e.g. impose healthpromoting taxes, increase NHIP
premium rates, improve premium collection efficiency. 
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with PhilHealth 
3. Expand PhilHealth benefits to cover outpatient diagnostics, medicines, blood and
blood products aided by health technology assessment 
4. Update costing of current PhilHealth case rates to ensure that it covers full cost of
care and link payment to service quality 
5. Enhance and enforce PhilHealth contracting policies for better viability and
sustainability

H- Harness the power of strategic HRH development

1. Revise health professions curriculum to be more primary care-oriented and
responsive to local and global needs 
2. Streamline HRH compensation package to incentivize service in high-risk or GIDA
areas 
3. Update frontline staffing complement standards from profession-based to
competency-based 
4. Make available fully-funded scholarships for HRH hailing from GIDA areas or IP
groups 
5. Formulate mechanisms for mandatory return of service schemes for all heath
graduates
I- Invest in eHealth and data for decision-making
1. Mandate the use of electronic medical records in all health facilities 
2. Make online submission of clinical, drug dispensing, administrative and financial
records a prerequisite for registration, licensing and contracting 
3. Commission nationwide surveys, streamline information systems, and support efforts
to improve local civil registration and vital statistics 
4. Automate major business processes and invest in warehousing and business
intelligence tools 5. Facilitate ease of access of researchers to available data

E- Enforce standards, accountability and transparency

1. Publish health information that can trigger better performance and accountability 
2. Set up dedicated performance monitoring unit to track performance or progress of
reforms
V- Value all clients and patients, especially the poor, marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and support them in
non-direct health expenditures 
2. Make all health entitlements simple, explicit and widely published to facilitate
understanding, & generate demand 
3. Set up participation and redress mechanisms 
4. Reduce turnaround time and improve transparency of processes at all DOH health
facilities 
5. Eliminate queuing, guarantee decent accommodation and clean restrooms in all
government hospitals

E- Elicit multi-sectoral and multi-stakeholder support for health

1. Harness and align the private sector in planning supply side investments 
2. Work with other national government agencies to address social determinants of
health 
3. Make health impact assessment and public health management plan a prerequisite
for initiating large-scale, high-risk infrastructure projects 
4. Collaborate with CSOs and other stakeholders on budget development, monitoring
and evaluation
With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with
the values of Equity, Quality, Efficiency, Transparency, Accountability, Sustainability,
Resilience towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”.