EFFECTIVENESS AND EFFICIENCY OF THE HEALTH CARE …
EFFECTIVENESS AND EFFICIENCY OF THE HEALTH CARE DELIVERY SYSTEM OF THE MUNICIPALITY OF ALFONSO, CAVITE
Lacel C. Dan
Jora Marjorie M. Dimayuga
Paolo N. Dimero
An undergraduate thesis submitted to the faculty of the Cavite State University College of Nursing, in partial fulfillment of the requirements for graduation with the degree of Bachelor of Science in Nursing. Prepared under the supervision of Mrs. Lenila de Vera, R.N., MPH and Mrs. Nenita Panaligan, R.N., MAN.
INTRODUCTION
Alfonso, Cavite is an upland town consisting of thirty two barangays with a total population of 47, 973 and is situated at the southwestern portion of the Cavite province. With its developing community, which has evolved into a second class municipality, the responsibility of the local government in providing the basic human right for health care in an improved way arise.
In the Philippines, primary health care is the partnership approach to the effective provision of essential health services that are community based, accessible, acceptable, sustainable and affordable. Although promotive and preventive measures are emphasized in community health the availability and accessibility of curative and rehabilative services also affect people's health.
The Health Care Delivery System, as defined by Williams-Tungpalan, 1981, is the network of health facilities and personnel which carries out the task of rendering health care to the people. Through the devolution made on the health services, the local system is now run by the Local Government Units or LGUs. The provincial and district hospitals are under the provincial government while the municipal or city government manages the health centers/rural health units (RHUs) and barangay health stations.
Since the delivery of health care services plays a great role in maintaining the community health, evaluation on its effectiveness and efficiency is necessary. Strengthened health services ensure equity, quality and access to health care, and promote the means to better health.
Statement of the Problem
This study involves the evaluation of the effectiveness and efficiency of the health care delivery system in the municipality of Alfonso, Cavite.
It will try to seek to answer the following:
1. What are the health services offered under the local health system?
2. Are these services being utilized by the community?
3. What is the satisfaction level of the residents with regards to the health care delivery system of the municipality?
4. Is the output of the health care delivery system greater than its input?
Objectives of the Study
Generally, this study was geared to evaluate the health care delivery system in the municipality of Alfonso, Cavite in order to determine its effectiveness and efficiency.
Specifically, this study aims to:
1. determine the health services offered under the local health system;
2. determine whether these services are being utilized by the community;
3. determine the satisfaction level of the residents with regards to these services; and
4. determine whether the output of the health care delivery system is greater than its input.
Importance of the Study
Significantly, the result of the study will be of great importance to the following:
1. Health Care Team – Through this study, people involved in the delivery of the health care services, not only in the town of Alfonso, will be able to review their delivery system, thus, identifying possible faults and making improvement for better services.
2. People in the Community – Better health services will be given to the people of the community when an evaluation on the effectiveness and efficiency of the health care delivery system is done. Improved health status of the people will then arise.
3. Provincial Health Office – In this study, the provincial health office will ensure that better services for health will be given for the community people. And as a member of the health care team seeking for better responses to the health needs, they will be able to enhance their knowledge and skills in terms of alleviating diseases and provision of quality care.
4. Department of Health - In line with this study, the Department of Health will be able to cooperate harmoniously with the local government units to implement certain programs and to emphasize the needs of the health care delivery system to be change in responds to the people’s health and improvement of services they offer.
Scope and Limitations
This study was conducted to determine effectiveness and efficiency of the health care delivery system of the municipality of Alfonso, Cavite. It focused on assessing the satisfaction and utilization of the community of health services rendered by the RHU in order to review its effectiveness.
Also this study will focus on assessing whether the outcome, consisting not only the satisfaction of the community but also their general health status, is greater than the system’s input, which consists of the effort and cost utilized, so as to reflect the its efficiency.
It does not, however, tries to appraise the major processes involved in the delivery of services and the possible factors affecting it.
Time and Place of the Study
This study entitled “Effectiveness and Efficiency of the Health Care Delivery System of the Municipality of Alfonso, Cavite” will be conducted at the town of Alfonso, Cavite from May 2009 to October 2009.
Definition of Terms
1. Acceptability – a criteria or a characteristic of health services of being tolerable for the community.
2. Accessibility - the extent to which services are available for individuals who need care.
3. Affordability – those needing health care services are able to manage to pay for the services needed.
4. Availability – needed services area available and may be obtained by those in need of it.
5. Effective –pertains to the health services that the community can easily access, avail, afford, and accept to help them alleviate their health problems.
6. Efficient - productive of desired effects without waste.
7. Health care - efforts made to maintain or restore health especially by trained and licensed professionals.
8. Health Care Delivery System – the manner of rendering health care services.
9. Health Care Team - a group of professionals and non-professionals with special skills who work together to meet a one’s health care needs. They may include doctors, nurses, midwives, and other professionals.
10. Health Status – describes the current state of your one’s health. In this study, the definition is broadened into the present rate of mortality and morbidity of the community so as to reflect the general effectiveness of the health care system.
11. Morbidity - An actuarial determination of the incidence and severity of sicknesses and accidents in a well-defined class or classes of persons.
12. Mortality - An actuarial determination of the death rate at each age as determined from prior experience.
Conceptual Framework
Effectiveness
Efficiency
|INPUT |
|Efforts (activities, |
|seminars, campaign ) |
|Budget |
|OUTPUT |
|General health status (morbidity, mortality |
|rate) |
The diagram under effectiveness, there is the Health Care Team who provides health services which in turn is utilized by the community. The different categories to be measured are the services’ accessibility, availability, affordability, and acceptability.
On the next diagram, human efforts and the budget serve as the input for delivering the health care services to the community. The general health status of the community will then reflect whether the system has been efficient.
REVIEW OF RELATED LITERATURE
Philippine Health Care Delivery System
According to Dizon, 1977, The Philippine Health Care Delivery System which is a complex set of organizations interacting to provide an array of health services has undergone several transformations since established by the Americans more than a century ago. The concepts and principles may still be the same, but the face and structure have to change in order to address the changing needs of the society.
With the mission of the DOH, in partnership with the people to ensure equity, quality and access to health care, of making services available, arousing community awareness , mobilizing resources, and promoting the means to better health, having an effective health care delivery system is important.
The health care system includes all the key parts of the delivery of health care services. It includes how it is funded or paid for, how services are delivered, what services and benefits are provided, how the various parts are coordinated, and the what data and information is needed for it to function effectively as a system. It includes services provided by both public and private organizations (Public Health Nursing in the Philippines, 2007).
Restructuring the health care delivery system may be needed in order to spread the benefits of medical car, especially in the rural barangays. Such implementation of an updated program of health service delivery may be done firstly by accelerating the Rural Health Unit and the District Hospital. (Annual Report, Bayawan City, 2007)
Characteristics of an Effective Health Care Delivery System
The Oregon Health Council has identified the six quality criteria of an effective health care delivery system. This includes chasm report: safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity.
They also added that the system’s ability to wok in collaboration with foundations, policy institutes, research programs, and policy makers seeks to develop unbiased information about health policy issues and alternatives with the goal of improving health and the manner in which health care and financing systems. This also matters in order for the system to be called effective.
In line with this, Dr. Fineberg stated on the National Conference that the environment in which health care is delivered is a factor for an effective health care delivery system. According to him, the system must be able to redesign care processes based on best evidence, can make effective use of information technology, can manage clinical knowledge and skills, can develop effective teams, coordinates care across conditions, services and settings, and measures and improves performance and outcomes.
Jack Ebeler, President of the Alliance of Community Health Plans, added that to make significant improvement in the delivery, leadership and a sense of urgency is needed. In addition, while group-level capitation may be helpful in creating performance incentives, the structure of payments to physicians within groups is also important. (Improving Quality and Efficiency in Health Care, March 17, 2004).
Characteristics of an Efficient Health Care Delivery System
Generally, an efficient Health Care Delivery System is that which accomplishes health-related goals not only within the desired span of time, but has rendered sufficient services without spending too much and less effort but has produced the looked-for outcome or even better that what is expected.
During a conference sponsored by the Alliance of Community Health Plans, encouragement on the discussion of the need and means to transform health care delivery, integrating and organizing them for improved quality and efficiency was proposed. The conference aimed to answer what evidences exist about the impact of delivery system structure on cost and quality and what policymakers and purchasers can do to encourage greater delivery system integration (Improving Quality and Efficiency in Health Care, March 17, 2004).
Current health care systems provide enormous benefits, but there are substantial opportunities for reforms that would reduce costs, increase access, enhance quality, and improve the health of people.
An individual’s health can be maintained or improved in many ways, including through changes in personal behavior and through the appropriate consumption of health care services. While there are substantial health care services, the importance of health does provide a strong rationale for this level of spending. But because health care financing and delivery are often inefficient, there are opportunities to advance health and access to health care services without further growth in spending.
As a solution, they came up with the following key points. First, health can be improved not only through the consumption of health care services, but also through individual behavior and lifestyle choices such as quitting smoking, eating more nutritious foods, and getting more exercise, health care has enhanced the health of our population; greater efficiency in the health care system, however, could yield even greater health for Americans without increasing health care spending, rapid growth in health care costs and limited access to health insurance continue to present challenges to the health care system, and that administration policies focus on reducing cost growth, improving quality, and expanding access to health insurance through an emphasis on private sector and market-based solutions. (Economic Report of the President, 2006)
Determinants of Effective and Efficient Health Care Delivery System in the Philippines
The Department of Health has established a strategic thrust for the year 2005-2010. In relation to the effectiveness and efficiency of health care delivery system, they have included mobilization of more resources for public health programs to support cost-effective public health interventions geared towards eliminating selected diseases as major public health threats, developing essential public health program packages for all levels of health care delivery, and strengthening public-private collaboration in health service delivery and financing.
In addition to this, they have set the following objectives. First is the improvement of allocation of resources for public health interventions and enhanced access of vulnerable population to quality public health programs and services.
METHODOLOGY
Research Design
Since this study needs no experimentation or manipulation of the study subjects and its purpose is to observe, describe, and document the aspects of the situation as it naturally occurs, the researchers are going to utilize a descriptive approach under the non-experimental research Here, there is a broad set of category, detailed observations, descriptions & documentation of existing variables can be done without manipulating independent variable or the subjects, and justification and assessment of current condition is made since little is known about the phenomenon.
A community survey will be used to gather and interpret data.
Sample Size, Sampling Design and Technique
The town of Alfonso, Cavite has a total household population of 10, 469. In order to extract the sample size, the researchers used the Slovin’s formula as illustrated below.
n = N / ( 1 + (N*e^2))
Where:
n = sample size
N = total population
e = margin of error (0.05)
The following solves for the needed sample size of the study.
n = 10,469 / (1 + (10,469 *0.05^2))
n = 10,469 / 27. 1725
n = 385
Therefore, the study needs 385 samples to represent the characteristic of the population.
For the sampling design and technique, the researchers will use the Probability sampling specifically Cluster sampling. Since the town is composed of 32 barangays and 385 samples are needed, it means that a sample of 12 will be obtained in each barangays. The remaining one subject will be randomly selected also under a randomly selected barangay.
Study Subjects
The 385 sample subjects will represent the population of the town of Alfonso, Cavite. Each of them will be selected from every barangays as mentioned earlier. These samples are the one to respond to the questions, such as their satisfaction, that will reveal a conclusion on how effective the health care delivery of the town is regarding the provision of services. Also, a sample of health care workers will be interviewed to obtain information on the human efforts and the estimated cost used while delivering the health services.
Research Instruments
In order to answer the aforementioned objectives of this study, questioning method is to be used. A questionnaire will be prepared wherein respondents will be asked to write their own answers. It is composed of two three parts. First is the general information section containing the family number, since the family names will not be asked anymore for confidentiality purposes, their address, and a summary of their utilization of the local health services.
The second part, on the other hand, is regarding the accessibility, availability, affordability, and acceptability of the health services. Respondents must list and rate each services they will include.
A 5-point scale will be used to measure objectively the answers of the respondents in this section.
5 - Always
4 - Frequent
3 - Occasional
2 - Seldom
1 - Never
The average computed scores will be converted to this norm to interpret rating:
4.2 - 5.0 – very effective
3.4 - 4.19 – effective
2.6 – 3.39 – either effective or not
1.8 – 2.59 – fairly effective
1.0 - 1.79 – not effective
The third part is almost the same with the second part in a sense that respondents are going to put ratings. However, the third part deals mostly on the delivery and the system itself.
A 5-point scale is also to be used to measure objectively the answers of the respondents.
The scale is represented as:
5 - Always
4 - Frequent
3 - Occasional
2 - Seldom
1 - Never
The average computed scores will be converted to this norm to interpret rating:
4.2 - 5.0 – very effective
3.4 - 4.19 – effective
2.6 – 3.39 – either effective or not
1.8 – 2.59 – fairly effective
1.0 - 1.79 – not effective
Data Gathering
The data to be gathered will be obtained from the selected residents of each barangay at Alfonso, Cavite. A direct collection of data is to be used in the study with the help of questioning tool. Subjective data will then give information on every subject’s awareness, values, judgments, and feelings toward the topic being investigated.
Republic of the Philippines
CAVITE STATE UNIVERSITY
(CVSU)
DON SEVERINO DE LAS ALAS CAMPUS
INDANG, CAVITE
COLLEGE OF NURSING
EFFECTIVENESS AND EFFICIENCY OF THE HEALTH CARE DELIVERY SYSTEM OF THE MUNICIPALITY OF ALFONSO, CAVITE
Family Number:
Name (Pangalan):
Address (Tirahan):
Number of family members (Bilang ng miyembro ng pamilya):
Estimated monthly family income (Tantyang kita ng pamilya sa isang buwan):
I. Direction: Kindly answer the following questions. Write your answer on the space provided after each questions or, when needed, pit a check mark on those choices that may apply.
(Sagutin ang mga sumusunod na katanungan. Ilagay ang sagot sa patlang pagkatapos ng bawat tanong, o kung kinakailangan, lagyan ng tsek sa tapat ng napiling sagot.)
1. a. Do you approach the Rural Health Unit or the Barangay Health Centers when seeking health care? (Pumumunta ba kayo sa Rural Health Unit o Barangay Health Center upang magpatingin ng inyong kalusugan?)
YES (OO) NO (HINDI) ____
b. If yes, why? (Kung Oo, baki?)
____ Madaling puntahan
____ May tiwala sa mga manggagamot
____ Makakatipid
b.1. How often? (Gaano kadalas?)
____ Sa tuwing may mararamdamang di maganda
____ Isang beses sa isang linggo
____ Isang beses sa isang buwan para sa buwanang eksamen
Others, specify: _____________________________
c. If not, why? (Kung hindi, bakit?)
____ May ibang pinupuntahang pagamutan
Specify: ______________________
____ Malayo sa bahay
____ Hindi bilib sa kakayahan ng mga manggagamot sa RHU o health center
2. Usual reasons for seeking care (Mga karaniwang dahilan ng inyong pagkunsulta)
a.
b.
c.
d.
3. Are you satisfied with the services and accommodation given by the local health unit?
(Kuntento ka ba sa serbisyong pangkalusugang at pagaasikasong ibinibigay ng local nay unit pangkalusugan?)
YES (OO) NO (HINDI) ____
Why? (Bakit?)
| |OO |HINDI |
|Maayos akong naasikaso mula sa aking pagdating hanggang matapos ang pagtingin sa’kin | | |
|Naibigay ang aking pangkalusugang pangangailangan | | |
|Nalaman ko kung ano ang nagging problema sa aking kalusugan | | |
|Nalaman ko kung ano ang mga dapat kong gawin upang ako ay gumaling | | |
|Nalaman ko kung paano ko na maiiwasan ang pagkakasakit muli | | |
II. Accessibility, Availability, Affordability, and Acceptability of Health Services
Direction: Please rate the following Health Services according to its accessibility, availability, affordability, and acceptability using the scale provided below. (Bigyan ng grado ang mga sumusunod na serbisyong pangkalusugan gamit ang sumusunod na grado)
5 – Always (Palagi)
4 – Frequent (Madalas)
3 – Occasional (Paminsan-minsan)
2 - Seldom (Madalang)
1 - Never (Hindi kailanman)
|Service |Accessibility |Availability |Affordability |Acceptability |
|Education for Health(Edukasyong | | | | |
|pangkalusugan) | | | | |
| |5 |4 |3 |2 |
| |5 |4 |3 |2 |1 |
|The health care team is easy to approach | | | | | |
|(Madaling lapitan ang mga tagapagbigay ng serbisyong medikal) | | | | | |
|Presence of competitive medical staff. | | | | | |
|(May sapat na kakayahan at kaalaman ang mga empleyado) | | | | | |
|Availability of medical drugs. | | | | | |
|(Mayroong sapat na dami ng gamot para sa lahat) | | | | | |
|Use of appropriate technology | | | | | |
|(Paggamit ng angkop na teknolohiya) | | | | | |
|Services offered really accommodate the community’s health care need (Nasasagot ng mga serbisyo ang mga | | | | | |
|pangangailangan ng komunidad) | | | | | |
|Supports health care as a basic human right for all people regardless of ability to pay. | | | | | |
|(Sinusuportahan ang kalusugan bilang karapatang pantao ng hindi tinitingnan ang estado sa buhay) | | | | | |
|Health care team give the necessary care to the community needs despite of their status in life. | | | | | |
|(Hindi tinitingnan ang estado sa buhay sa pagbibigay ng serbisyong pangmedikal) | | | | | |
|Supports efforts to eliminate unnecessary health care expenditures (Sinusuportahan ang mga gawain upang | | | | | |
|maiwasan ang dagdag gastos) | | | | | |
|Maximally meets diverse health needs and efficiently achieves such needs (Naibibigay ang iba’t ibang | | | | | |
|pangkalusugang pangangailangan) | | | | | |
|Use of different strategies in delivering health care services. | | | | | |
|(Gumagamit ng iba’t ibang stratehiya upang maipaabot sa tao ang mga serbisyong pagkalusugan) | | | | | |
|Conducts seminar/health education for the community. | | | | | |
|(Nagsasagawa ng mga seminar tungkol sa kalusugan) | | | | | |
|Health educations and seminars conducted are of great help to the community and are suitable for existing | | | | | |
|phenomena. | | | | | |
|(Angkop ang mga pagtuturong isinasagawa sa kung ano ang kasalukuyang nararanasan) | | | | | |
|At times of calamity, the health care team hurriedly respond to it. (Umaaksyon agad sa panahon ng kalamidad) | | | | | |
|Organization of administration. | | | | | |
|(Kaayusan ng pamamalakad) | | | | | |
|Mobilization of the people. | | | | | |
|(Nagagawang pakilusin ang komunidad) | | | | | |
|Attainment of goals and objectives. | | | | | |
|(Nagagawang maabot ang mga layunin) | | | | | |
-----------------------
VISION
A premier university in historic Cavite recognized for excellence in the development of morally upright and globally competitive individuals.
Community
Community
Services’
ACCESSIBILITY
AVAILABLITY
AFFORDABLITY
ACCEPTABILITY
Health Care Team
MISSION
Cavite State University shall provide excellent, equitable and relevant educational opportunities in the arts, science and technology through quality instruction and relevant research and development activities.
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