Achieving universal health care shall be pursued under the Aquino Health Agenda (AHA). This aims to improve, streamline, and scale up reform interventions espoused in the Health Sector Reform Agenda (HSRA) and implemented under FOURmula One (F1) for health, with particular focus on the poor. This will ensure that as health reforms move forward, the poor are not left behind. The successful implementation of the AHA will restructure the following health system components: good leadership and governance practices; accurate and timely information and feedback on performance; financing that reduces the burden of health spending especially among the poorest, the marginalized IS and the middle class; a well-performing workforce; affordable and high quality medical products and technologies; and appropriately delivered essential services.
The implementation of the Universal Health Care (UHC) shall ensure better health conditions, fair financing and a responsive health system. The objective UHC is to promote equity in health through the provision of full financial protection and improvement of access to priority public health programs and quality hospital care, especially for the poor. Its strategic thrusts are as follows:
1. Protect the poor from the financial burden of health care use by improving the BDR of the National Health Insurance Program (NHIP):
a) Redirect PhilHealth operations towards the improvement of the national and regional BDRs;
b) Attain and sustain universal coverage of NHIP (expansion of coverage to include the poor and the informal sector);
c) Promote availment of quality outpatient and inpatient services at accredited facilities through reformed capitation, with no balance billing or zero co-payment arrangements for sponsored members; and
d) Increase the support value of health insurance for the poor through ICT upgrading to fast track Philhealth claims processing.
2. Improve access to quality hospitals and health care facilities by upgrading or expanding government-owned and-operated hospitals and health facilities as well as providing quality services to help attain the MDGs; attending to traumatic injuries and other types of emergencies; and managing noncommunicable diseases and their complications:
a) Enhance targeted health facility programs that shall leverage funds to improve facility preparedness for trauma and the most common causes of mortality and morbidity;
b) Provide grant mechanisms from PPPs to support immediate repair and rehabilitation of selected priority facilities;
c) Promote fiscal autonomy and income retention schemes for government hospitals and health facilities;
d) Unify and streamline DOH licensing and PhilHealth accreditation for hospitals and facilities; and
e) Cluster referral networks by region to address the fragmentation of services.
3. Attain the MDGs for health by focusing public health programs on maternal and child mortality; morbidity and mortality from TB, dengue and malaria, and the prevalence of HIV-AIDS, in addition to emerging diseases; and prevention and control of noncommunicable diseases, particularly cardiovascular diseases, cancer, diabetes mellitus, and end-stage renal disease.
a) Deploy Community Health Teams to actively assist families in assessing and acting on their health needs;
b) Utilize the life-cycle approach when providing needed services, such as family planning, antenatal care, delivery in health facilities, essential newborn care, immediate postpartum care, and Garantisadong Pambata package for children 0-14 years of age;
c) Aggressively promote healthy lifestyle changes to minimize noncommunicable diseases;
d) Ensure adequate surveillance and preparedness for emerging diseases; and
e) Harness the strengths of interagency and intersectoral approaches to health.
To achieve the above strategic thrusts, the following instruments shall be utilized:
1. Health Financing. This increases resources for health that will be effectively allocated and utilized to improve the financial risk protection of the poor and the vulnerable sectors. Strategies and activities include achieving universal health insurance coverage, increasing public investments for health, allocating health resources to appropriate financing agent, and securing fiscal autonomy of government health facilities and shifting to new provider payment mechanism.
2. Service Delivery. This seeks to transform the health service delivery structure to address variations in health service utilization and health outcomes across socioeconomic variables and across geographic boundaries. Strategies and activities will aim to ensure that appropriate health services are available at all levels of health care by:
a) Transforming the health service delivery system from providing several individual health providers or facilities to service delivery network;
b) Enhancing the service packages delivered by the service delivery network to achieve the country's MDG commitments, eliminate endemic diseases as public health threats, intensify disease prevention and control for both communicable and noncommunicable diseases, and manage health emergencies and disasters; and
c) Investing in a health facility enhancement program that defines a unified and rationalized health facility blueprint; strengthening the gate-keeping function of lower level facilities; increasing the capacities of centers of excellence for specialty hospitals; enhancing the quality assurance system for public outpatient facilities like rural health units (RHU)s and barangay health stations (BHS); ensuring that hospitals are safe from disasters; and providing incentives to promote PPP ranging from investments for tertiary care to involving private practice midwives in the delivery of primary services;
3. Human Resources for Health. This will ensure that all Filipinos have access to professional health care providers to meet their health needs at the appropriate level of care. Strategies include ensuring that each family has assigned competent primary health care providers and producing health professionals responsive to the current needs of the health sector. To address distribution concerns of health human resources, the following strategies will be pursued: providing incentives for deployment in underserved areas; using ICT to direct health workers to local job offerings; and using of global market forces like medical tourism to keep highly-trained health workers and reduce turnover rates.
4) Policy, Standards and Regulation. These instruments aim to ensure equitable access to essential medicines, health services and technologies of good quality, availability and safety. Strategies include:
a) Increasing the availability of cheaper quality medicines through efficient and reliable procurement and distribution systems; improving the affordability of essential medicines through assured delivery of entitlements to specific treatment packages; linking the PhP100 Program with PhilHealth benefit package in all levels of care; and promoting generics;
b) Monitoring and boosting the rational use of drugs and technology through implementation of clinical practice guidelines; regulating over-the-counter nonessential drugs, nutraceuticals and alternative health services; and regulating product and health service advertisements, to reduce the risk of misleading and biased promotional information reaching the consumers and professionals;
c) Ensuring the quality of essential medicines, food, technology and services by strengthening regulatory agencies of DOH, such as the Food and Drug Administration (FDA) and the Bureau of Health Facilities and Services (BHFS), and the post-marketing surveillance system;
d) Strengthening the regulatory functions of DOH agencies standards and processes for licensing, certification and accreditation of public and private health facilities, such as lying-in clinics, Basic Emergency Obstetric and Neonatal Care (BEmONC), Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) and hospitals; and
e) Reviewing and updating the laws and guidelines governing practice by health professionals to allow flexibility in the delivery of health services, especially in resource-poor areas (e.g., performance of lifesaving functions by midwives).
5. Governance for Health. This establishes the mechanisms for efficiency, transparency and accountability, thus preventing fraud. Under this instrument, initiatives shall be undertaken towards enhancing the health system to better respond to inequities in health. The institutionalization of the Sector-wide Development Approach for Health (SDAH) systems shall also be undertaken aside from strengthening the governance structures for managing the health sector at the national and local levels. Better performance, accountability and internal management control mechanisms and stronger client-centered services shall also be undertaken.
6. Health Information. The instrument to establish a modern information system that will provide evidence for policy and program development to improve performance levels, distribution and equity, and support for immediate and efficient provision of health care and management of province-wide health systems. ICT shall be used to implement UHC, together with reliable and timely data. Investments on the automation of health information in all health facilities shall be encouraged.
To support the Health Information System, core agencies and partners of the Philippine National Health Research System (PNHRS) shall share their resources and mutually complement their health research. The following specific strategies shall be adopted by the PNHRS:
a) The science community shall address the gaps in the access to essential medical products, vaccines and technology, and the health information system. Health technology development shall focus on diagnostics, vaccines, drugs, use of ICT in health care (telehealth), and traditional and alternative health care. For health information systems, the science community shall focus on building information content and providing access to relevant, current, and accurate health information;
b) CHED shall focus on education-related research to produce competent health workforce, while the DOH will focus on health systems and operations research, to address health services, health financing, leadership and governance; and
c) To create and sustain a critical mass of researchers and mentors, capacity-building programs that involve local and international scholarships, fellowships, training and twinning arrangements shall be continued and enhanced. These shall focus on expertise in the research continuum, from conceptualization and stakeholder engagement, to writing, implementation, dissemination of research results, and technology commercialization, where applicable, in order to increase research relevance and visibility, and translate results into policies and actions.