DOH PAFP

COLLABORATION
ON ENHANCING
UNIVERSAL
HEALTH CARE
THROUGH
PRIMARY CARE

FAMILY MEDICINE
RESIDENCY TRAINING
PROGRAM
ZORAYDA E. LEOPANDO, MD, MPH, FPAFP
PROFESSOR OF FAMLY AND COMMUNITY
MEDICINE, COLLEGE OF MEDICINE, UNIVERSITY
OF THE PHILIPPPINES MANILA
 Zorayda E. Leopando, MD, MPH, FPAFP
 Co Chair, DOH Technical Group for Family
Medicine Residency Training Program
 Chair, Subcommittee on Innovative Practice
Based Program, Editor in Chief of Textbook in
Family Medicine and Past President, Philippine
Academy of Family Physicians
 Co-editor in Chief, Asia Pacific Family Medicine
journal of World Organization of Family Doctors
(Wonca) and Chair, Wonca Working arty for
Family Medicine
 One of moving forces in ASEAN Region Primary
Care Physicians Association (ARPaC)
 Founding President, Foundation for Family
Medicine Educators

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 WHA62 IN
GENEVA,
22.05.09

Resolution

to train and retain adequate numbers of health workers, with

appropriate skill-mix, including primary health care nurses,
midwives, allied health professionals and family physicians, able
to work in a multidisciplinary context, in cooperation with non-
professional community health workers in order to respond
effectively to people’s health needs;

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 International Comparison of Primary Health
Care outcomes
Components of health care delivery system which
suggest greater differences in health between countries
• Equitable distribution and financing of health care
services
• Similar level of professional earnings of
primary care physicians and specialists
• Comprehensiveness of primary health care
services
• Primary care physicians provide first contact care
and entry into the health delivery system
• Person focused longitudinal care
Barbara Starfield, 1993

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 ZE Leopando

Global evidence on why primary care is

important

Betterhealth outcome
Lesser cost
Greater patient satisfaction
Less hospitalization
Greater equity in health
Barbara Starfield

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 World Health Report 2008

University of the Philippines Manila

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 Nations with universal health care
systems

» Nations with universal health care (determined by proxy of ≥90% skilled

birth attendance and ≥90% social insurance coverage)
» Nations with legislated mandate for Universal health coverage, but
which have not yet reached thresholds above

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Map of the world with FP

General Practice/
Family Physicians Family Medicine in
At Entry Point of National Health
care Service
Primary Care/
Family Physicians
Family
Family Physician Physicians
First contact in HMOs

Family Doctors Family General Practice/

And Family Health Physicians Family Medicine
Team

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 ZE Leopando

Health Transformation Program and

Reforms in Turkey

Major Reform Program for

the Health System Key Features
 Reconfiguring  Universal Health
Insurance
 Financing
 MOH as Health
 Delivery Sector steward
 Regulation  Provider autonomy
 Family Medicine and
Public Health
Reforms

University of the Philippines Manila

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 Cuban Health Care System
Hospitals/
Medical institutes

Policlinics
Policlinics

Consultarios Consultarios Consultarios Consultarios

Consultarios
Consultarios

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Experiences in Vietnam
 greater patient satisfaction among patients
seen by family medicine trained specialists
compared to those who are not trained
 more value for the amount of money spent
for consultations and other medical needs
compared to non-family physicians.
 Fam docs improve provider performance,
patient perceptions on quality of care, and
facilitation of health insurance transactions
Pham Thi Ngoc, Bich., 2008; Loan Thi Huong Luong , 2010,
Khuong van Nguyen, 2010

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Thailand : Primary Care Unit (PCU): Human
resource criteria (Hospital) doctor is included
a health structure
 a health service: service at the Health
Center and at the OPD of the hospital
(to make human resource criteria
possible)
 One physician (preferably family
physician) for approximately 10,000
inhabitants

Somjjit Prueksaritanond, 2013

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Changes in utilization of health services:
tertiary, secondary and primary care

2010
2000
Tertiary
1987 Secondary

1977 Primary

Somjit Prueksaritannd, March 2013

University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Percentage of Satisfaction
of UC People & Provider
Percent

100.0 89.3 89.8

88.3
90.0 83.0 83.4 83.2 84.0 83.1
80.0
70.0 78.8
60.3
60.0 50.9 56.5 50.7
45.6 47.7
50.0 39.3
40.0
30.0
20.0
10.0
0.0
2003 2004 2005 2006 2007 2008 2009 2010
UC People provider

Source:Patcharanarumol W, et al. Macroeconomics and UC in Thailand

University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 ZE Leopando

Taiwan: Integrated care plan through community

health care groups (CHCG)
 Revision of NHI law in 2011
 Evaluation: , 162  to advance family
physician accountability
articles surveyed from  preventive medicine
2004 to 2009  patient referral
 Result favors CHCG in 3  care quality
ways  doctor-patient
relationship
 Patient satisfaction  Continuation of the
 Collaboration with integrated care through
responsible hospitals CHCGs
 Pilot study of patient-
 Health promotion centered integrated care
in solo practice to
decrease unnecessary
medical expense
Brian Cheng, 2010

University of the Philippines Manila15

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
Historical Timeline:
Family Medicine in the Philippines
CHAMPION of Family’s Health/
Key to Universal health care >2011
Enhancing access
and equity to quality 2000’s
primary care
Professionalization of
primary care and
specialty organization
1990’s
Medical education and
standards for training 1980’s
& accreditation

Recognition
as specialty
1970’s
Building the 1960’s
foundation
 PAFP: Opportunities/ Attempts for
Partnership offered to DOH
Training of FM training in
1990s MHO on FM interlocal
through CME health zone
Integration of FM Innovative
2000s training in leadership practice based
program for DDTB FM training

UHC, PHC
Local assistance
2010s and FM
package for LGUs training

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 PAFP Initiatives on universal health
care
DECADE
1970s A family physician for every family
Standards in Family Medicine

1980s Primary Heath Care

Competencies of family physicians
Accreditation of training
Family Heath and Development  Orientation
1990s Strategic plan and NHIP
Competencies of gatekeepers

2000s Quality Assurance program

Workshops on Referral and Financing
Training of trainors for practice based program
2010s Workshop on UHC, Primary Care Benefits, family
registration
DOH FMRTP with PAFP
Primary Care Movement
University of the Philippines Manila
5 NHHR CONFERENCE
TH ZE Leopando www.upm.edu.ph
 PAFP’S INTERNATIONAL
AFFILIATIONS
 1972  Founding member of the World
Organization of national colleges and
academies of family physicians / general
practitioners ( WONCA)
 2007 Charter member of ASEAN Region Primary
Care Physicians Association (ARPAC)
 2011 + participate in WHO-ILO initiative on
integrating occupational health services in
primary care

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 VISION
We look forward to achieving the unifying
vision of a “Filipino Family Physicians for
every Filipino Family”.
We embrace and accept the challenge to be
CHAMPION family physicians leading and
innovating to improve the health care of
Filipino families and contributing to the
growth of family medicine at a local, national
and global level.” November 2010
University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Mission
An Organization of family doctors who share Common
values. We will move together to become Health Policy
shapers in an atmosphere of Academic Excellence. Our
concern is to effectively Manage health care resources as
Primary gatekeepers, practicing cost effective care without
compromising Patient safety. We also believe that sound
and judicious use of Information technology while
continuing to deliver Overall/ holistic/total patient care will
help improve the health outcomes for our Filipino patients,
families and communities. All care we give will be guided
and improved by New knowledge generated through
active research which can also help guide FM practice not
only locally but internationally as well.
November 2010

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 PAFP Accredited FAMILY MEDICINE RESIDENCY TRAINING
PROGRAMs

FM residency training 7
Practice Based Program

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 PAFP FAMILY MEDICINE RESIDENCY
TRAINING PROGRAM

FM residency training 7
Practice Based Program

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Pathways for specialization in Family Medicine
Regular Member
Filipino Physician, licensed
RESIDENCY INNOVATIVE
PATHWAY PATHWAY
CFP CFP
4-5 years
3 YEARS
Accredited training
Accredited training
Research

DIPLOMATE DIPLOMATE
3 YEARS 1 YEAR
CME Credits CME Credit
Passed exam Passed Exam

FELLOW
3 YEARS
CME CREDITS
Awards, Publication, leadership
Academic, Service
University of the Philippines Manila
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 Philippine Health Patient Needs/ Current Medical
Care Delivery Expectations , Training Knowledge
System Needs assessment

C F
O R
N A
C M
E E
P W
T O
U R
A K
L

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
  Length of training
 Amount of time
spent in the
hospital
 Trainors issues:
Supervision /
preceptorial/
mentoring / Issues to consider
protected time/ in training
incentives
 Learner’s concern:
documentation,
protected time for
learning

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 DOH TRAINING HOSPITALS AND OTHER GOVERNMENT
HOSPITALS WITH ACCREDITED FAMILY MEDICINE
PROGRAMS
Regions DOH Other government
3 Ospital ning Angeles
(Lazatin)

4 Angono Distriit
Hospital
6 West Visayas Medical
Center
West Visayas Sanitarium
Hospital
7 Vicente Sotto Memorial
Medical Center
8 East Visayas Region Medical
Center
University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 DOH TRAINING HOSPITALS AND OTHER GOVERNMENT
HOSPITALS WITH ACCREDITED FAMILY MEDICINE
MSc CMFCM student
curriculum, learning
PROGRAMS environment
Regions DOH Zamboanga peninsula
Other govennment
9 Zamboanga City Medical
Center
10 Northern Mindanao Medical
Center
11 Southern Philippines Medical SPMC- Digos ( to
Center start)
Davao Regional Hospital DRH-DOPH (3 mos
ongoing)
12 South Cotabato
Provincial Hospital
CARAGA Butuan Medical
Center

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 DOH TRAINING HOSPITALS AND OTHER GOVERNMENT
HOSPITALS WITH ACCREDITED FAMILY MEDICINE
PROGRAMS
Regions DOH Other government
NCR Veterans Memorial
Medical Center
Quezon City
Medical Center
Diosdado
Macapagal
Memorial Medical
Center
San Lazaro Hospital Ospital ng Maynila
Medical Center
Philippine General
Hospital

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 DO 2013 4453: Creation of DOH Family
Medicine Residency Training Program
 Purpose
 Need to improve competencies of
primary care physicians , particularly in
managing common family and
community health problems
 Need to develop rural health physicians
as Family Medicine specialists to attend to
families and communities in poor and
rural areas.

ESTABLISH AND EXPAND FAMILY MEDICINE RESIDENCY

TRAINING PROGRAMS IN DOH HOSPITALS
University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Started. Finalizing
Sequential establishment of FMRTP
documents for
submission for
REGION
accreditation 2013 2014
1 Region 1 Medical Center Ilocos Training and
Regional Medical
Center
Preparing curriculum
Mariano Marcos
and submitted
Memorial for
Medical
comments
Center
CAR Bagiuo Benguet Medical
Center
2 Cagayan Valley Medical
Center Recruited faculty, with
3 Jose B. Lingad Memorial salary, curriculum
Medical Center being finalized, JO for
Paulino Garcia Memorial salary of trainees
Medical Center

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Sequential establishment of
FMRTP Discussion with St
REGION 2013 Patrick Ongoing
2014
4 Batangas Medical
Center
5 Bicol Medical
Center
Bicol Training and
Research Center
6 Corazon
Montelibano
Memorial Medical
Center
12 Cotabato Medical
Center
CARAGA Caraga Medical Center
University of the Philippines Manila
5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Sequential establishment of
FMRTP Discussion with FEU
REGION 2014 NRMF ongoing
Point Person
NCR East Avenue Medical Center
Quiri Nardito Galera
no Memorial Medical Center Tricia Bautista
Jose Reyes Memorial Medical
Center
Rizal Medical Center Tricia Baautista
Amang Rodriguez Memorial
Medical Center

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph
 Every Filipino Family deserves a to be listed with
a primary care physician trained address
majority of their health problems when they see
them, thereby receiving care which is person-
centered, high quality , comprehensive and
continuing.

University of the Philippines Manila

5TH NHHR CONFERENCE ZE Leopando www.upm.edu.ph