A Roadmap to

Universal Primary Care

The Coalition for Primary Care

 CONCEPTUAL FRAMEWORK
DOUBLE BURDEN OF
DISEASE

INEQUITY IN ACCESS
TO CARE

INEQUITY IN HEALTH
OUTCOMES
INEQUITIES IN HEALTHCARE
FROM WOMB TO TOMB
 CONCEPTUAL FRAMEWORK
DOUBLE BURDEN OF
DISEASE
In public sector
WORKFORCE SHORTAGE - Deficit of 60,000 MD’s
- Deficit of 100,000 midwives
In private sector
- Excess of nurses
- Excess of doctors
The situation will worsen!
INEQUITY IN ACCESS
TO CARE

INEQUITY IN HEALTH
OUTCOMES
 CONCEPTUAL FRAMEWORK
DOUBLE BURDEN OF
DISEASE

WORKFORCE SHORTAGE - 46 healthcare programs

POLICY FRAGMENTATION - Donor-driven
- Overlapping coverage
- Common resources

INEQUITY IN ACCESS
TO CARE

INEQUITY IN HEALTH
OUTCOMES
 CONCEPTUAL FRAMEWORK
DOUBLE BURDEN OF
DISEASE

WORKFORCE SHORTAGE - Decentralized system

POLICY FRAGMENTATION - 42,000 barangays
- LGU independence
ADMIN. FRAGMENTATION - Politicization of workforce

INEQUITY IN ACCESS
TO CARE

INEQUITY IN HEALTH
OUTCOMES
 CONCEPTUAL FRAMEWORK
PHILHEALTH
DOUBLE BURDEN OF
DISEASE
PRIMARY
CARE
WORKFORCE SHORTAGE FACILITIES
POLICY FRAGMENTATION
ADMIN. FRAGMENTATION PRIMARY
CARE
PROVIDERS

INEQUITY IN ACCESS
HEALTHCARE
TO CARE
NETWORKS

A UNIVERSAL PRIMARY
INEQUITY IN HEALTH CARE BENEFIT PACKAGE
OUTCOMES
 PRIMARY PRIMARY PRIMARY
HEALTH CARE CARE PREVENTION

A PHILOSOPHY A HEATHCARE SYSTEM A SERVICE

 A health philosophy: Includes public health
lessen health inequities, interventions, UHC,
promote universal access multi-sectoral roles, and
and self-reliance environment

A healthcare system: Includes curative aspects

holistic/first contact, PRIMARY of health care
steward of healthcare CARE

A preventive service: Vaccination, check-ups,

focused on healthy lifestyle advise,
people (vs. secondary treatment of risk
and tertiary prevention) factors

WHY FOCUS ON A PRIMARY CARE SYSTEM?

1. We have a shortage of primary care providers.
2. UHC will exacerbate this shortage.
3. Without the system, the philosophy and the service are just dreams
 What is Primary Care?

1° CARE

2° CARE

3° CARE
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE

RECRUIT Threshold density 5:1000

- Doctors (FM, pedia, IM, GP)
RETRAIN - Nurses
- Midwives
RETAIN - Community Health Workers

REGULATE Working in accredited private

REASSESSor public facilities
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE

RECRUIT Short Course Curricula:

- Infectious Diseases
RETRAIN - Maternal Health
- Child Health
RETAIN - Non-communicable Disease
- Health System Navigation
REGULATE
REASSESS
 Graduate Midwife

Primary Care Primary Care PC Provider

Workshop Certificate (Level 1)

Graduate Nurse

Graduate Physician

Primary Care Primary Care PC Provider

Workshop Certificate (Level 2)

Primary Care All Other

Residencies specialties
Master’s in
Primary Care

Family and Public Health Preventive Primary Care Primary Care

Community Med Medicine Medicine Internal Med Pediatrics

PC Provider
(Level 3)
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE

RECRUIT Short Course Curricula:

- Infectious Diseases
RETRAIN - Maternal Health
- Child Health
RETAIN - Non-communicable Disease
- Health System Navigation
REGULATE
REASSESS
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE

RECRUIT - Facilities paid by capitation

RETRAIN
with no fixed allocations
but with performance-
based payments
RETAIN - Primary Care Providers paid
by facilities through a
REGULATE negotiated arrangement
REASSESS- Just benefits provided
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE
Facilities
- infrastructure and supplies
RECRUIT - electronic records

RETRAIN
- Networking framework
- Non-visit encounters
- Quality assurance
RETAIN Providers
- training
REGULATE - accreditation
REASSESSBeneficiaries
- yearly assign to facility of choice
- must pass through primary care
- no annual check-ups
MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE
Pilot studies in urban, rural
and corporate setting
RECRUIT
RETRAIN
1. Caregiver knowledge
2. Quality of Care
3. Health outcomes
RETAIN 4. Patient utilization
5. Out-of-pocket expenses
REGULATE 6. Patient satisfaction
REASSESS7. Caregiver satisfaction
8. Administrative efficiency
 MILESTONES IN THE ROADMAP TO
UNIVERSAL PRIMARY CARE

RECRUIT
RETRAIN
RETAIN
REGULATE
REASSESS
 UNIVERSAL PRIMARY CARE
PhilHealth Members to be Total Cost (PhP1,800
Members Dependents
covered by TSeKaP Beneficiaries per family)
Informal Sector 2,023,696 2,662,266 4,685,962 PhP 3.64 B
Kasambahay, OGs,
72,074 60,134 132,208 0.13 B
Enterprise Owners & Drivers
Self-employed & Migrant
1,342,823 1,322,169 2,664,992 2.42 B
Workers
Senior Citizens &
4,460,554 1,488,061 5,948,615 8.03 B
Lifetime Members
Government Employees 1,952,447 3,771,110 5,723,557 3.51 B

Private Employees 11,003,394 10,222,297 21,225,691 19.81 B

TOTAL 20,854,988 19,526,037 40,381,025 PhP 37.54 B

 CONCEPTUAL FRAMEWORK
PHILHEALTH
DOUBLE BURDEN OF
DISEASE
PRIMARY
CARE
WORKFORCE SHORTAGE FACILITIES
POLICY FRAGMENTATION
ADMIN. FRAGMENTATION PRIMARY
CARE
PROVIDERS

INEQUITY IN ACCESS
HEALTHCARE
TO CARE
NETWORKS

A UNIVERSAL PRIMARY
INEQUITY IN HEALTH CARE BENEFIT PACKAGE
OUTCOMES