Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

JAN 22 2020
ADMINISTRATIVE ORDER
No. 2049 2020- 0003

SUBJECT: Strategic Framework on the Adoption of Integrated People-Centered

Health Services in All Health Facilities

1. RATIONALE
The Department of Health (DOH), through the FOURmula One Plus for Health (F1+),
envisions Filipinos as “among the healthiest people in Asia by 2040 with a productive,
resilient, equitable, and people-centered health system for universal health care.” Republic
Act 11223, or the Universal Health Care Act (UHC), adopts approaches to ensure that all
Filipinos are health literate, living in healthy conditions, protected from health-affecting
hazards and risks, with health services centered on people’s needs and well-being. Executive
Order No. 5, series of 2016, emphasizes the vision of Filipinos to enjoy a strongly rooted,
comfortable, and secure life by 2040 through the Philippine Development Plan for 2017 to
2022 which calls for enhancing the social fabric (malasakit) for a people-centered, clean,
and efficient government.

The country’s commitment is also a response to the call from 69th World Health
Assembly (WHA) and the 31st ASEAN Summit to implement the Integrated People-
Centered Health Services (IPCHS) framework in accord with the national context and
priorities on universal health coverage, emphasizing on primary care, to build on its
foundation fosters a people-oriented and people-centered region. With the enactment of
Republic Act No. 11463, also known as the Malasakit Center Act, the Department of Health
shall be implementing the Malasakit Program, wherein the IPCHS is
used to address non-
clinical health sector outputs such as responsiveness of
all health facilities.

Responsiveness is
defined by the WHO as
the “ability of the health system to meet the
population’s legitimate expectations regarding their interaction with the health system, apart
from expectation for improvements in health or wealth.” It is an integral component of
stewardship in the health sector since it relates to the basic human rights. Because of this,
responsiveness has been made an intrinsic goal of health system performance measurement
and will be addressed by this Order.

Il. OBJECTIVE
This Order provides the framework that shall guide national and local actions towards
the institutionalization of integrated people-centered health services in all health facilities to
ensure that health facilities are responsive to the needs of clients. its
Il. SCOPE AND COVERAGE

This Order shall cover all health facilities including facilities owned and managed by
the DOH, other national government agencies, local government units (LGU), private
sector, and civil society organizations. This shall also apply to other DOH units, and other
relevant partners in the health sector.

SS

yei
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http:/Awww.doh.gov.ph; e-mail: ftduque@doh.gov.ph
IV. DEFINITION OF TERMS

1. People-Centered Health Services - “An approach to care that consciously adopts the
perspectives of individuals, families, and communities, and sees them as participants as
well as beneficiaries of trusted health systems that respond to their needs and preferences
in holistic and humane ways” (WHO, 2016).

2. Integrated Health Services- “Are health services that are managed and delivered in a
way that ensures people receive a continuum of health promotion, disease prevention,
diagnosis, treatment, disease management, rehabilitation and palliative services at
_
different levels and sites of care within the health system, and according to their needs
through their life courses” (WHO, 2016).

3. Patient Navigation System- Refers to the function of coordinating and directing the
individual to obtain health services needed to manage a wide range of health needs and
overcome barriers for timely, cost-effective and appropriate care.

V. GENERAL GUIDELINES
A. The Framework on Integrated People-Centered Health Services (IPCHS) shall guide all
initiatives that promote responsiveness to clients undergoing health services in the
health sector.

'B. The IPCHS Framework shall prescribe a unified client experience survey tool to
measure responsiveness be used by health facilities in planning, monitoring, awarding,
and regulatory processes within the Department of Health.

C. Strategies under the framework of IPCHS (See Annex A for specific activities per
strategy) are as follows:
1. Strategy 1: Promote an organizational culture geared toward responsiveness.
Each health facility shall ensure that the culture of responsiveness is promoted
and properly communicated throughout the entire organization through the
following:
a. Equipping its staff with the necessary skills/ training to ensure good interaction
with patients, their carers and their families. This will include but are not
limited to teaching empathy, communication skills, and development of
standardized scripts.
b. The human resource management shall assess their health facility staff on the
quality of their interaction with clients through patient feedback, and recognize
those who exhibit exemplary service as patient care champions.

2. Strategy 2: Ensure appropriate infrastructure and processes in health

facilities. Each health facility shall upgrade and maintain its infrastructure and
processes to adaptto the needs of its clients to implement the following:
a. Ensure that the physical condition will promote healing by addressing the
total sensory environment.
b. Establish effective and efficient Patient Navigation within and across Health
Facilities.
c. Employ patient flow analysis and data-driven facility management in
improving the overall operations of the facility and harmonizing processes to
reduce redundancy of work.

\ds hy
 3. Strategy 3: Promoting client engagement and empowerment. Each health
facility shall engage and empower its clients to promote an effective partnership
between people who need care and the people who will provide care, through the
establishment of the following:
a. Mechanisms to ensure that the patients, their carers, and family are informed
and are involved in the decision making for their health
of their condition
b. Mechanisms to create a participative environment for patients, their carers,
and family by engaging patient groups in the development of policies.
c. Incorporation of patient experience to measure the responsiveness of the
health facility to ensure that the needs of patients are being addressed using
the standardized client experience survey form. A separate issuance shall be
released for the specific guidelines on the reporting of the said tool.
d. Avenues for social responsibility programs that promote health and
strengthens good health seeking behavior

VI. SPECIFIC GUIDELINES

A. Applications of the IPCHS Framework

1. All DOH health facilities shall improve their health facility operations in
line with
the components of the IPCHS Framework, to be reflected in health facility and
network development plans.
Interventions and projects that address facility gaps highlighted in the IPCHS
Framework shall be considered critical to health service delivery and are allowed
for capital outlay investments, subject to existing rules and regulations.
All DOH offices shali incorporate components of the IPCHS framework in
monitoring, recognition or regulatory processes in
health facilities.
Separate issuances shall provided
be by relevant offices on development of these
aforementioned mechanisms.

B. Standardized Client Experience Survey to Monitor and Evaluate

Responsiveness
1. The DOH shallissue a standardized client experience survey that will measure
the responsiveness of each health facility, encompassing the components of the
IPCHS Framework.
2. Separate issuances on the standard client experience survey and provisions for
monitoring and evaluation shall be released by the DOH, updated at least every
three years.
3. All DOH Health Facilities shall use the standardized client experience survey for
accomplishment by
patients, and families, especially after discharge.
4. Non-DOH Health Facilities may adapt the standardized client experience survey
tool to ensure the responsiveness of their health facilities.

C. Monitoring and Evaluation of the Policy

1. The Health Facility Development Bureau (HFDB) shall lead in the monitoring
and evaluation of the implementation of the policy and issue guidelines on
monitoring the effectiveness of the strategies implemented in each DOH Health
Facility.
All DOH Health Facilities shall submit the consolidated responsiveness rating
from their clients, based on the aforementioned standardized client experience
survey form.
ay 3
 3. HFDB shall consolidate all reports and analyze its implications on the
implementation of this Order annually. It shall also provide feedback and
technical assistance to ensure that all DOH Health Facilities will be responsive to
the needs ofits clients in line with the framework

D. Roles and Responsibilities

1. Health Facility Development Bureau (HFDB) shall: |

a. Oversee the implementation of the strategic framework of IPCHS

b. Develop tools to assess and monitor health facilities for their compliance to
the policy
Establish systems and standards to support the effective realization of
IPCHS
Lead in the advocacy and dissemination of the policy in all health facilities
Coordinate and provide technical inputs for the operationalization of the
policy and other relevant initiatives
in
Lead the periodic conduct of research and development strategies relative
to the implementation and impact evaluation of the policy.

2. Health Promotion and Communication Service shall:

a. Lead the advocacy and dissemination of the policy to the general public
b. Provide technical assistance in the development of health promotion and
effective communication plan such as but not limited to key messages,
promotional materials, and advocacy training toolkits

3. Health Policy Development and Planning Bureau

a. Explore research opportunities defining the features and milestones of
exhibiting IPCHS of health facilities
b. Shall facilitate the conduct of policy impact analysis every five years in
terms of responsiveness, client satisfaction and other measures deemed
appropriate

4. Health Facilities and Services Regulatory Bureau

a. Integrate the framework for Integrated People-Centered Health Services in
their mechanism for awarding hospitals

5. Bureau of Local Health Systems and Development

a. Assist HFDB
Scorecard
in
facilitating the inclusion of responsiveness in the LGU

b. Assist HFDB and Health Human Resource Development Bureau (HHRDB)

in developing learning and development activities of the Development
Management Officers (DMO) that will enable them to assess and promote
IPCHS in local health systems
Gather LGU good practices on institutionalizing IPCHS that can serve as
standards that other LGUs may use
6. Center for Health Development (CHD)- Health Facility Development Unit
(HFDU)
a. Ensure the dissemination of the policy in all facilities
b. Train and actively support at least one official in each Province-wide or
City-wide Health System in the advocacy, assessment and improvement of
facilities within their jurisdiction
XN
4
 c. Coordinate with other units within their CHDs in the institutionalization of

d.
IPCHS
in other programs
Conduct monitoring of policy implementation and facilitate the timely,
accurate, and complete submission of reports from all healthcare facilities,
through the DMOs, within the region.

7. Field Implementation and Coordination Team

a. Monitor the overall adherence for all health facilities to the strategic
framework for IPCHS through HFDU, as part of the regular management
review of CHDs and DOH Hospitals.

8. All Health Facilities

a. Adopt and implement the policy, as evidenced by the formulation of plans,
procedures, protocols and monitoring and evaluation tools for internal
quality improvement and improved client satisfaction.
b. Allocate budget in support to this policy.
c. Regularly monitor the implementation of the policy within their facility.
d. In coordination with their local government units of jurisdiction, regularly
communicate to their catchment area the policies and standards of the
facility.
e. Provide feedback for policy review, enhancement of the program, and
dissemination of their notable good practices.
f. Regularly submit validated reports to their designated local planning and
development coordinator.

9. Local Government Units

a. Support local government health facilities in the implementation of people-
centered health care
b. Receive feedback from the general public and endorse complaints on the
quality of services in relation to IPCHS to the local health board for
corrective action
c. Receive feedback from the DOH in terms of the implementation of their
policies
d. Provide avenues for dialogue between facilities and the general public to
facilitate continuing improvement in the delivery of IPCHS

10. Civil Society Organizations and Patient Groups

a. Participate in the development of policies in their respective health
facilities and with the local government unit
b. Participate in the monitoring and evaluation of health facilities

11. Private Sector and Non-Government Organizations

a. Support and promote the implementation of IPCHS in Health Facilities
E. Funding
The DOH and CHD shall
provide the necessary funding for technical assistance,
advocacy, monitoring and promotion of the Integrated People-Centered Health Services.

VII. TRANSITORY PROVISION

Until the Standardized Client Experience Survey Form to measure responsiveness has
been issued, each health facility may continue to use their existing client satisfaction
Oe 5
 tool. In addition to this, each health facility shall incorporate provisions in the strategic
framework for IPCHS that are investment intensive in their health facility and network
development plan until 2022.

VIII. SEPARABILITY CLAUSE

In case any provision in this Order shall be deemed invalid, illegal, or unenforceable,
the validity, legality and enforceability of the remaining provisions shall not in any way be
affected or impaired thereby.

IX. EFFECTIVITY
This Order shall take effect immediately.

ISCO DUQUE TI, MD, MSc

'¥.

Secfetary of Health
 ANNEX A
LIST OF ACTIVITIES/ INTERVENTIONS PER STRATEGY

I, Strategy No. 1: Develop and Promote an organizational culture geared towards

responsiveness.

A component of IPCHS ispromoting a culture of responsiveness to

be able to address the needs
its
of clients. The following are suggested mechanisms to
uphold such culture

A. Develop and promote a culture of responsiveness by recognizing patient care champions

1. Integrate good client engagement on existing performance evaluation of healthcare staff
2. Recognize and award health facility staff who exhibit exemplary service in terms of
client interaction as patient care champions.
3. Provide communication skills training that incorporates empathy, dealing with difficult
patients and carers and the like
4, Provide standardized scripts in engaging patients, and/or carers

II. Strategy No. 2: Ensure appropriate infrastructure and processes in health facilities

An integral component of Integrated People-Centered Health Services is ensuring the physical

infrastructure and internal processes of each facility promote a healing environment and ensure
efficiency/ ease of transaction. Each Health Facility shall assess, plan and execute activities to
address the following:

A. Promoting a Healing Environment:

1. Ensure that spaces such as patient areas, administration & recreation areas, are designed
considering the positive effects of colors on patients and staff. Design mechanisms may
include furniture, soft furnishings, or textile.
a. For the color pallet used for the exterior and interior of the health facility, it shall
follow the Guidelines in the Implementation of the Unified Color, Signage
Features, and Design of Identified Interior Spaces by the Department of Health.
b. For furniture, soft furnishings, or textile health facilities may follow the following
suggestions

Type of Spaces Objective Color Palette Suggested For

Furniture, soft furnishing or Textile
Public Spaces such as Provision of positive Warm and visually comforting colors
lobbies waiting areas, distraction or cooler tones to suggest tranquility
corridors, cafeterias

Pediatrics Promote a welcoming Warm earth colors with vibrant accents

environment such as red, yellow, green, blue and
purple

Page 1 of 4
 Maternity, NICU, Should be soothing in Cool or comforting tones such as
Nurseries, Critical nature and address high shades of blue, green and violet
Care areas, Emergency stress situation
and treatment rooms

Surgical Areas Advocate for quiet and Neutral tones with accents of cool tones
relaxing tones such as greens, teals, and blues

Staff Areas such as Promote efficient work Whites, off-white, tan beige or gray
Nursing stations and environment tones
Laboratory

Staff Lounge Promote rest and/or Neutral tones with accents of cool tones
common activity among and vibrant colors in activity areas
staff

2. Provide acoustic control inall areas in the health facility will not exceed 60 DB based on
the sound level meter (Equivalent to average office noise, normal conversation)

3. Provide adequate ventilation and thermal control whether natural or artificial to ensure the
comfort of patients and workers. Recommended Ambient Temperature is 23-26 degrees
Celsius.

4. Provide and maintain a clean, safe and sanitary facility and environment for hospital
personnel, patients and clients, such as:
a. Stringent monitoring of the cleanliness of hallways, restrooms, and offices
b. Patient Feedback on the cleanliness included in the standardized client
c. Availability of functional and clean wash areas and restroom

5. Incorporate of murals, paintings, and photos to main hallways and floors

6. Dedicate 25% of the total land to vegetated open spaces/ efforts in increasing natural
spaces as well as the use of endemic plants

7. Provide child-friendly and spiritual/ religious spaces.

B. Establish efficient and effective Patient Navigation System within and across health
facilities

1. Establish a mechanism to facilitate patient navigation both within and across health
facility through:
a. Policy on Patient Navigation System
b. Monitoring of compliance with their policy on their Patient Navigation system
c. Membership to a Referral Network
d. Monitoring of incoming and outgoing referrals
2. Ensure that signage used within the health facility:

Page 2 of 4
 a. Follow the guidelines in the Implementation of the Unified Color, Signage
Features, and Design of Identified Interior Spaces by the Department of Health
b. Provide updated and clear routing information
3. Ensure a functional and visible Customer Service Unit by
a. Designating the appropriate person
b. Transparent Complaint Escalation Process
c. Monitoring of turnaround time

C. Patient Flow Analysis and Evidence-Informed Management

1. Conduct Patient Flow analysis to identify areas of delay

a. Patient flow analysis and Action Plan
b. Monitoring and Evaluation of the action plan on patient flow

2. Report and Utilize data on health facility operations based on performance measures for
hospitals and other health facilities.

3. Harmonize facility processes to reduce redundancy of work and increase patient

interaction
a. Presence of root cause analysis, and action planning to reduce redundancy of
work
b. Transitioning to Electronic Medical Record

III. Strategy No. 3: Client Engagement and Empowerment

Aside from improving

empower their clients in
theinfrastructure and processes, a crucial part of IPCHS
deciding for their health. Health facilities may
is
facilitate
to engage and
this through the
following:

A. Health Literacy and Self-care of Clients

Provide programs/ activities that promote health literacy, self-care management, and patient
rights. These programs may include but are not limited to:

1. Lecture series or advocacy campaigns with civic or patient groups/ organizations, carers,
whether formal or informal, and their family.
2. Provision of health literacy and self-care through social responsibility programs geared
towards improving health-seeking behavior, with preference to the underserved or
marginalized communities.
B. Improving Clinical Decision Making

1. Establish a case management protocol that includes:

a. Clinical Pathways
b. Multidisciplinary team approach
c. Family Meetings
2. Provide Personal Health Records

Page 3 of 4
C. Incorporate of Patient Experience in Overall Evaluation of Health Services

Incorporate the concept of patient experiencein client satisfaction through quantitative and
qualitative through the standardized client experience survey to measure responsiveness.

D. Engage Civic Organizations/ Patient Groups

Representation of recognized patient groups/ organization in policy development of the facility.

Page 4 of 4

Oe