Since the passage of the Universal Health Care (UHC) Act in February 2019, one of its key reforms has been the organization of a province-wide or city-wide Health Care Provider Network (HCPN)—a strong primary healthcare platform with integrated community engagement within the healthcare system. The HCPN is the backbone of the UHC.
Bataan, one of the pilot sites for implementing the UHC in Region 3, is currently focused on delivering primary care services. However, opportunities for improving the health system need to be maximized in order to improve patient journey and operationalization of Bataan’s UHC implementation.
Before the UHC law, first-contact care can be sought at any level, and there’s fragmented delivery of services at various levels of care. With UHC, there is a continuing, comprehensive, and coordinated referral system managed by a primary care provider. HCPNs are organized within province-wide or city-wide health systems.
Under the health systems framework of the World Health Organization (WHO), an effective and efficient referral system is one wherein the components of the functional health system are geared toward improved health, responsiveness, social and financial risk protection, and improved efficiency under service delivery. In the implementation of HCPN under UHC, these are inter-connected and inter-related to ensure the integration across the continuum of care and all service delivery settings.
As for its local context, the DOH suggested eight steps to establishing a functional Service Delivery Network. These are to be applied in the localities or in transforming LGUs’ focal or local initiatives into a health service delivery network to broaden the scope of services, service delivery points and population coverage.
REFERRAL WITHIN HCPN
Even before the patient visits the barangay health station or the Rural Health Unit, advanced information may be given to families, especially what services are available and schedule availability, including means of contacting emergency transport directly at the hospital or through the Metro Bataan Development Authority’s (MBDA) 911.
Barangay health workers can provide the information through house visits and related activities. The patient and his companion can call the MBDA 24/7 hotline or proceed to the RHU or hospital.
The MBDA shall act as a call center to mobilize patient transport in coordination with the nearest hospital. It shall also do signal activation of the Provincial Risk Reduction and Management Office. This can be the link to other agencies in the province that address other factors that can impact on health.
The MBDA will likewise enable a two-way communication between the different facilities and the command center, particularly if there are evolving health situations such as disease outbreak and more mass-casualty incidents.
This pathway also includes patients seeking care from the RHU or to the next level—higher health facilities.
The Provincial Health Officer shall facilitate coordination of the process, data and information, monitor, coordinate policy implementation, and facilitate issuance of policies and protocols.
The DOH shall provide technical assistance to the HCPN, particularly to the PHO and mobilize support from technical assistance providers to effectively sustain HCPN operation in Bataan.
We adopted the COVID-19 Patient Flow in Bataan HCPN based on the DOH’s Department Memorandum 2020-017 to optimize the model of care for Covid-19 and strengthen the health service response or system response within and across HCPNs.
We have designated primary care providers for individuals and families within their catchment who navigate patients for the appropriate facility across the levels of care.
For the non-COVID patient pathway within the HCPN, individuals who need medical attention for non-COVID-related symptoms need first to contact their chosen primary care provider in primary care facilities.
These primary care facilities ensure that the continuous service delivery of essential services and specialty care are provided, properly coordinated and documented in accordance with established clinical and referral standards.
Lastly, the existing challenges and/or areas of improvement of Bataan’s referral system are: 1) institutionalizing partnership with private hospitals and 2) strengthening the presence and role of the community and LGU and 3) updating on discharge sheets.
Toward better public health services delivery in LGUS, the following are the recommendations for Bataan’s HCPN:
1) Partnership with private hospitals and LGUs should be prioritized
2) Majority of the primary healthcare workers were appraised of their roles and responsibilities in the referral process and provide essential services as primary healthcare workers
3) MBDA plays an integral part in the improvement of the referral process
4) Discharge sheets and health profile of the population and information of availability of doctors and nurses should be regularly updated
5) Bataan’s online referral system implementation is still limited only to certain hospitals and RHUs
6) For the integration and approval of a simplified patient journey and gatekeeping for the province, the recommendations for the provincial government of Bataan include:
7) Patient seeks care
8) RHU provides care or refers to capable health facility
9) Hospital provides care or refers to capable health facility similar to the RHU
Recommendations for the LGUs of the province of Bataan are geared to develop policies and plans appropriate to their locality. They are consistent with WHO and DOH guidelines for the implementation of a referral system and quality standards. They are meant to organize communities and the private sector for the effective delivery of health service packages and for contract providers to supplement available services.
1. Address the challenges of service delivery and move towards providing comprehensive and integrated care. We need to fully operationalize the HCPN under the UHC law
2. An effective, efficient, responsive, community-based, and sustainable referral system for Bataan HCPN can still be established through stakeholder mobilization
3. There are still gaps and needs of the current healthcare system of Bataan that hinders its development of a referral system
We are hopeful of achieving all the Key Result Areas (KRAs) under the preparatory phase and as of this time, we have achieved 11 KRAs and five ongoing KRAs.