THE PROBLEM

RECORDKEEPING
IN PUBLIC
HOSPITALS
SUBMITTED BY:
JULIA FRANCHESCA BORROMEO
SETH NAPIER DALLEGO
JOSE GATBONTON
CHRISTINE MARIANO
MATTHEW ROTEA

SUBMITTED TO:
LISHA BORNILLA
 INDUSTRY BACKGROUND

The healthcare sector of every nation plays a vital role in maintaining and promoting the health
and well-being of all their citizens. In order to achieve this, everyone should have access to the
healthcare system, especially quality medical products and services. In effect, diseases,
medical conditions, and/or outbreaks can be prevented and managed effectively.

However, in the context of the Philippines, this is still far from reality given the uneven
distribution of healthcare resources (Flores, 2020).

The poverty incidence of a particular municipality affects the place’s healthcare system. Urban
areas, with low poverty incidence, have ease of access to more healthcare facilities (i.e.
hospitals, small-scale clinics, barangay health centers) than rural areas where poverty
incidence is high. For instance, most private hospitals are located in big cities, such as in Metro
Manila, Cebu, Iloilo, and Davao rather than in remote areas like Agusan del Sur, Aurora, and
Isabela (Flores, 2020).

To further understand the situation of the healthcare system of the country, two separate
reports by the World Bank and the United Nations showed the following information: First, in
terms of bed capacity in hospitals, “most municipalities [in the Philippines have only] one bed
per 1 000 people'' (Flores, 2020). Secondly, the nearest hospitals in most municipalities are “13
km away on average”, and this poses a problem to areas with minimal to no modes of
transportation (Flores, 2020). Third, there are only “two nurses and midwives per 10 000
people”, which makes us fall behind among all the countries in Southeast Asia (Magsambol,
2020). Lastly, there are approximately 13 physicians per 10 000 people. All of these indicators
(a) reflect how the Philippine government invests and gives importance in this sector, and (b)
how other factors such as the poor working conditions experienced by healthcare
professionals have made them result in seeking opportunities abroad.

In an interview by Rappler to a healthcare professional whose alias name is Mae, the latter
stated that her income, as a nurse, does not suffice and match the risk she is being exposed to
in her workplace— in the ward of patients who contracted coronavirus disease (COVID)
(Magsambol, 2020). To be exact, her net income is only around PHP 19 000 per month, and
although this is the case, she refused to leave her job as she found the purpose of her life in it
(Magsambol, 2020).

Mae is just one of the many Filipino healthcare workers who experiences such poor working
conditions. The government and the private sector’s failure to increase their salary has
resulted in them opting to work overseas which offer a better pay.

Overall, the healthcare system in the Philippines still needs to be improved in both sides of
patients (citizens) and healthcare workers. It is essential that the government and the private
sector invest more in (a) constructing quality healthcare facilities and infrastructures, and (b)
providing a more conducive workplace to healthcare workers by raising their salaries/wages
with the primary goal of providing healthcare which is accessible to all, regardless of status
and geographical location. If the problems mentioned are continually neglected, more
healthcare workers will continually seek for opportunities abroad when in fact they should be
serving their own country men. More marginalized Filipinos will suffer from medical conditions
which have long been preventable and curable. More Filipinos will die without even receiving
proper medical attention.

Healthcare is for everyone. It should never be a privilege where only the few can have access
to it. And during this COVID-19 pandemic, healthcare is more important than ever.
 SYSTEMS APPLICATION

In the initial phase of brainstorming, the group created a mind map* which contained
the following components of the healthcare system in the Philippines:
1. The problems being faced by the Filipinos, the healthcare workers, and healthcare facilities
2. The types of services offered by the hospitals;
3. The different types of healthcare providers;
4. The common departments in hospitals;
5. The authority who is responsible for reforms and regulations, and;
6. The inputs, processes, and outputs involved in the system

Foremost, the Department of Health (DOH) is the governing agency of the Philippines who is
responsible for leading and building the capacities of the health sector, administering specific
services, and regulating health services and products. They do these by “[developing] national
plans, technical standards, and guidelines on health” (“DOH PROFILE”, n.d.).

The health sector will not function without the healthcare providers, who are at the forefront in
dealing with patients. Every patient has varying needs and conditions. Hence, it is important
that the healthcare provider/s who will attend to them correspond to their situation in order to
achieve the best results.

Likewise, healthcare facilities or infrastructures are essential in delivering healthcare products

and services. They also serve as the place of appointment between the patients and the
healthcare providers. Additionally and as shown in the mind map, there are types of hospital
which are best suited for a particular condition of a patient.

Correspondingly, for any organization or healthcare facility to function effectively and

efficiently, they should make use of a structure to identify the person or group of people who
are accountable and responsible for supervising and accomplishing specific tasks. The
researchers’ group (“group”) was able to research a detailed list of departments in one of the
hospitals in the Philippines ― the Bataan General Hospital and Medical Center (BGHMC).
Instead of visiting a hospital to gather data, the group decided to just search online and utilize
the available information of BGHMC, which is accredited by the DOH.

Aside from the stakeholders involved in the Philippine healthcare system, a research was also
conducted to identify and understand the problems of the sector. For instance, graduates of
health-related fields (i.e. nursing, medicine) opt to work and render their service overseas due
to the unfavorable working conditions which they have experienced, namely low pay, long
hours of work, and limited benefits. Hence, it can be said that this is a contributing factor to the
low ratio of nurses and midwives per sampling population (Magsambol, 2020). In effect, this
may affect how marginalized Filipinos, who live in remote areas, access healthcare resources.
Overall, these factors shall be taken-action by the DOH.

Lastly, the group recalled their visit to a hospital which have made them identify the inputs,
processes, and outputs involved in availing a healthcare service (i.e. check-up). The following
are the inputs:

1. Human capital – healthcare providers, 4. Physical capital – building/healthcare

nurse/nursing attendants, general staff
2. Intellectual capital – knowledge, skills,
information
3. Financial capital – payment (i.e. cash on
hand)
facilities, equipment, vehicles
5. Medical tools and supplies
6. Technology
*mind map is on the google drive
file name: MIND_MAP.jpg
 SYSTEMS APPLICATION

The components of the human capital attend and offer their intellectual capital to the
patients.

The intellectual capital includes the following: (a) The information pertains to the written
basic information of the patient, and/or the statements told to the latter by anyone in the
component of human capital, and; (b) The knowledge and skills of the healthcare
provider/s.

First, the information given by the patient gives an overview of his profile to the
healthcare provider. This enables the latter to assess certain risk factors or possible
conditions which the patient may have been experiencing. Moreover, the record form
also serves as a material which can be reviewed for future purposes, such as check-ups.

The financial capital refers to the payment for the service/s rendered by the healthcare
provider.

The physical capital refers to the structure of the healthcare facility, where the patient
went to in order to access healthcare service/s.

The technology and medical tools and supplies are utilized by healthcare providers to
assess the condition of the patient. For instance, a stethoscope and an
electrocardiogram machine is used to check the heartbeat.

Meanwhile, the set of processes is based on how the members of the researchers’
group have experienced it. As a note, they are non-policy holders.

First, communication involves the exchange of information, and for patients who are
not knowledgeable on what type of healthcare provider is compatible to the
condition/disease/illness they are experiencing, they may ask the information
department to assist them. Then, they may ask for the availability of the healthcare
provider, and eventually set an appointment.

Secondly, data management is evident when pieces of information are collected from
the patient. This is done by asking the latter to fill out a general data information form
which will serve as his record to the health provider who will attend to him.

Third, in the consultation, the patient informs his healthcare provider about his present
condition/s (e.g. experiencing pain in a particular part of the body), and if necessary, his
past condition/s. Then, the healthcare provider examines the patient, shares his findings,
and the medical condition and the prescriptions are documented on the patient’s record.
However, additional examinations or procedures may be recommended, and once
accomplished, the patient should return for further evaluation. Through this, the
condition is monitored and appropriate interventions can be done.

Lastly, payment has to be settled, if applicable. There are some doctors who opt not to
be paid.

Overall, the patient should experience relief and comfort, and a better health status after
he has gone through the mentioned processes.
 SYSTEMS APPLICATION

After the mind map has been created, the group has chosen to focus on the aspect of
how healthcare facilities (i.e. public hospitals, barangay health centers) manage the
records of patients.

Patients proceed Does the The secretary finds

to the clinic room patient have a YES the General Data
START of the healthcare record Information Form
provider already? (GDIF) of the patient
in the storage
equipment
NO

The secretary
gives a
General Data
Information Form
(GDIF) to the
patient

FIGURE 1. RECORD KEEPING

The patient
fills out the form

The patient waits

The patient for their
submits the form appointment with
to the secretary the healthcare
provider

The healthcare
A The secretary will
keep the GDIF in
the storage
END
provider attends
to the patient
equipment.

The healthcare
provider gives a The healthcare
separate copy of provider fills out the
the prescription to GDIF with their
the patient diagnosis and/or
prescriptions for
the patient

A
 FIGURE 1. RECORD KEEPING

Figure 1 shows the flow of how the record of a patient is created. First, he has to
proceed to the clinic room of the healthcare provider. Then, the secretary will ask the
patient if the latter has an existing record with the healthcare provider who will attend to
him. If there is none, the secretary will give out a general data information form (GDIF) to
the patient. Once filled out, the patient has to submit it. However, if he already has an
existing record, the secretary will ask for the patient’s name and the record will be
searched for in the storage equipment (e.g. cabinet). Afterwards, the patient has to wait
for his appointment Upon consultation, the patient informs his healthcare provider about
his present condition/s (e.g. experiencing pain in a particular part of the body), and if
necessary, his past condition/s. Then, the healthcare provider examines the patient,
shares his findings, and the medical condition and the prescriptions are documented on
the patient’s record. This will be kept by the secretary in the storage equipment. A
separate copy of the prescription is given to the patient for his reference.

Similar to what has been discussed above, the inputs, processes, and outputs remain the
same.

The patient returns to the clinic for a follow-up check up and the process in figure 1
starts again. This part of the process is the one that sometimes causes delays because
some hospitals do not have good recordkeeping system. Most of the time, it takes them
long to find the record of the patient. This is because most hospitals, especially public
ones, do not have an electronic system.

IMPORTANCE OF RECORD KEEPING

It is common that the records of patients are being kept solely by the clinic, which serves
as the meeting place between the healthcare provider and the patient. The hospitals and
other healthcare facilities, which the members of the researchers’ group have gone to, do
not have a single database where other healthcare providers can access the historical
records of patients, should they opt to switch to another healthcare provider. Hence, there
is a high probability that examinations/procedures and medications will be repeated. This
also means that the patient has to spend again.

According to an article titled “Record Keeping and Documentation”, the following are the
advantages of having a good record keeping: First, “[it] makes the continuity of care
easier” as it enables data to be shared across healthcare professionals (Nabwami, 2018).
When there is a centralized database for all the records of the patients, healthcare
professionals can avoid doing procedures which have been done and medications which
are ineffective. Additionally, this allows them to closely monitor the condition of the patient.
However, it is important to inform and to ask for the consent of the patient first before
disseminating his medical record.

Secondly, “[it] shows how decisions were made relating to the patient’s care” (Nabwami,
2018). This is only possible when the medical records contain a clear and detailed
documentation of the patient’s medical history, past and present diagnosis, diseases,
medications (“This is Why Medical Records are Important”, 2018). Through this, other future
healthcare providers can trace the development in the patient’s condition, and be able to
make sound judgment on what to do next.
 Lastly, if there are future problems which may arise due to the medications given and/or
medical malpractice, it will be easy to identify who is accountable (Nabwami, 2018).

TARGET MARKET

The target market “Public Hospital Community" can be broken down into two subgroups:
Doctors and Patients. These two subgroups comprise the market, though from different
perspectives of service provider and recipient respectively. Doctors, specifically those
employed in public hospitals such as Philippine General Hospital (PGH), can be classified as
medical professionals engaged in consultations, rounds and overall patient care. On the
other hand, patients are classified as someone seeking diagnosis, check-ups or treatment
for an illness.

The representative of the market is Matthew Rotea’s tito Rosel Doval Santos (Doctor in
PGH).

GAPS

Lack of coordination between hospitals in order to address lack of facilities.

Hospitals have a hard time communicating essential information to each other
such as occupancy, free space, and availability of physicians. This is especially
important during this pandemic where hospitals often reach their maximum
patient capacity, so with the lack of coordination between hospitals, trouble
may arise as to where to redirect the patient. This becomes a problem
especially when the patient is in need of immediate medical attention. In worst
cases, the patient will just keep moving from hospital to hospital only to never
see a doctor in the end. (Guerra, 2020)

Lack of an efficient platform for seeking doctors and booking an

appointment. While there are websites such as See You Doc, and iCliniq, that
help patients look for online consultations, only certain hospitals such as
Cardinal Santos and The Medical City provide their own online services.
However, these are not completely accessible to all people in the Philippines.

Difficulty in getting an appointment with a doctor. It’s been known

throughout the years that Filipinos experience difficulty in meeting with a doctor
due to inefficient systems. (Team micaPH, 2015) Doctor appointments,
especially during these times, can be difficult to organize because of a lack of
avenues for communication between the hospital and the patients. Sometimes
appointments will have too long of a waiting time, because some doctors also
are late to their appointments, or patients have a limited schedule that hinders
them from getting an appointment. In worse cases, some patients go to the
hospital for a consult but are asked to come back another day because no one
can accommodate them.
 Understaffed hospitals. The Philippines has always lacked medical staff.
According to Philippine Overseas and Employment Administration, every year,
“around 13,000 Philippine health care workers go abroad, aggravating a
domestic shortage of 290,000”. (Venzon, 2020) Because of this, the Philippines
entered a state of crisis for the health sector during the pandemic, because of
the increasing number of patients being brought in on a daily basis.

Unorganized patient records database. When going to different hospitals, one

has to keep making a new health profile with the hospital meaning that the
patient could have incomplete records that could be a risk to the patient’s
safety. While private hospitals like Medical City have their own online
infrastructure for record keeping, smaller public hospitals do not have access to
this. Problems could also arise when one’s personal doctor transfer’s hospitals
taking your history with him. While there have been government efforts in
creating an eHealth system in the country, there is still room for much
improvement as up to now patient records still get misplaced or are lacking in
information. (Mundin, 2019)

Availability of medicine and pharmaceutical supplies. When diagnosing

patients, some hospitals do not have the available medicine that they are
prescribing in their own pharmacies. Other times, patients cannot afford their
prescribed medicine and have to turn to lower quality medicines for treatment.
This is especially true in more rural areas where hospitals are often smaller.

VERDICT
Among the gaps identified, “Unorganized patient records database” is the most
feasible to solve. Other Gaps identified are heavily influenced by either lack of funds,
factors of insurance or government involvement which adds too many variables to
account for. By focusing on record keeping the group can maintain a tighter view of
the system that it is in. As a team, members have experience in graphic design, data
visualization & spreadsheets which can help in formulating a solution.

WHAT'S NEXT?

After introducing the industry, the gaps the we would like to address, and our target
market, pages 8-9 are empathy maps of our target market. This is to gain deeper
understanding of the people we are trying to deal with. Second, pages 11-12 are the
user personas illustrate the way we understand the target market and their needs.
Lastly, we will present supporting research to back up the gaps that we presented in
the earlier parts of this paper.
THINK AND FEEL?
Patients do not want to be patients.
They want to be healthy.
Feeling anxious about their condition;
“Sana wala lang 'to”
Scared of price “Magkano kaya bayad”
Hassle having to go to the hospital +
waiting times & procedures
“Baka magka COVID pa ako dito”
PUBLIC
HOSPITAL
PATIENTS
HEAR? SAY AND DO?
Medical news and stories (Ex. COVID-19)
People talk about your conditions
(“'Yung pamangkin ko nagka-ganyan”)
Positive hospital experiences of others;
leading to referrals and recos (“Magaling
si Doc X”)
Negative hospital experiences of others
(“llang oras na ako naghihintay dito”)
“Lakad mo lang yan” / “Wala yan”
Hear all these from friends, family,
colleagues and online.
GAINS
In and Out as fast as possible
Successfully prescribed/treated
SEE?
Hospital Environment
High amount of people (fellow patients)
in the hospital
Staff like Doctors & Nurses
News and social media online
They have their own personal lives, jobs
and careers they would rather prioritize.
Patients having to travel to hospital or
use an online set-up.
Filling out forms and records +
gathering info (ex. height & weight)
Recalling information “Ano nga blood
type ko?”, “next time ko nalang I-
update”
Talk to doctors and staff
PAINS
Long waiting time
Too many forms & data sheets
Being around sick people
Potential High Price
THINK AND FEEL? SEE?

Recognition as a notable person in their Hospital environment

field
Simply helping others (worth it mindset)
Stress from poor patient interaction,
lack of coordination, communication
and logistics, lack of time for self
Konw-it-all patients
Physical ailments of patients
Physical records and documents
Illegible record inputs / missing records
Outdated information

PUBLIC
HOSPITAL
DOCTORS
HEAR? SAY AND DO?

Stressful environment (working with Talk to patients

data of all sorts) Conduct rounds
Different cases and background of Study cases
patients Act in emergency situations
Patient accounts inconsistent to patient Coordinate with other departments
records Prescribe medicine
Give consultations and medical opinion
Gather information
Request for record

GAINS PAINS
Frustration from inconsistencies and
More accurate data
outdated records
Less Stress
Process slowed down by gathering
More efficient performance
information (record retrieval or fill-out
Better Knowledge of patient
forms)
Faster flow of data
Too many types of records for one
person
 ROSEL DOVAL
SANTOS
PHYSICIAN, PGH

BIO
The way we do things in Filipino hospitals is still
very traditional. We still lack the technology to
PERSONAL venture into new systems that are up to date,
INFORMATION even if the government has the funds to improve
our healthcare system. Nevertheless, we public
AGE : 62 YEARS OLD hospital doctors make do with the technology and
STATUS : MARRIED systems we have to give our patients proper
# OF CHILDREN: 3 healtcare
LOCATION: QUEZON CITY
FRUSTRATIONS

LONG LINES
Lines for some doctors are still long even
TRAITS if there are other doctors of the same
CONFIDENCE specialty available.

PUNCTUALITY
Some doctors are always late.
EMPHATHY

UNORGANIZED RECORDS
COMPASSION Digging up the patient's records takes too
much time which delays other patients.

HONESTY MESSY SYSTEM

Hospitals do not have a system yet where
patients can see doctors' schedule within
different departments thus they cannot
RESPECT make an appointment ahead of time

GOAL/S
ATTENTION TO DETAIL
TO GIVE PATIENTS PROPER HEALTHCARE
Although in providing proper healthcare, it is
not just about the success of the treatments
we do, but also the process by which we
interact with the patients

PERSONAL
INFORMATION
AGE : 45 YEARS OLD
STATUS : SINGLE
# OF CHILDREN: N/A
LOCATION: MAKATI CITY
TRAITS
BUSYNESS
PATIENCE
GOAL/S
EARN MONEY.
I need to earn money so that I
can afford necessities such as
food and clothes, but, more
importantly, for emergencies
when I need to go to the hospital
for a check-up or need to be
hospitalized.
MARY GRACE
CARO
WORK HELPER
BIO
Life is full of struggles. My family in the province
depends on me for money. It's a good thing I was
able to get a job as a live-in house helper in the
city, because my expenses are less and I now
have the money to save.
However, prices just keep going up, so I just have
to keep working hard in order to survive.
FRUSTRATIONS
SCHEDULE
For check-ups in the public hospital, I need
to take a day off work and am not paid for
the day, because I have to go to the
hospital in the morning just to try to get an
appointment because of long lines, and I
come out of the hospital late in the
afternoon already
DELAYS
Sometimes, the doctors work really slow
and are not on schedule so there are
delays
UNGUARANTEED SLOTS
Even if I already have an appointment
scheduled after my last, sometimes, it is
not guaranteed depending on the new
schedule of the doctor
 SUPPORTING RESEARCH

The following articles give a background on the current state of healthcare in the
Philippines because of the pandemic.

According to Manila Bulletin’s article “The Medical City: At the Frontlines for the Filipino”,
The Medical City is only one of the few hospitals that is going online for consultations
and prescriptions which addresses the fact that because of COVID, many people are still
reluctant to go outside for their safety.

(https://mb.com.ph/2021/02/04/the-medical-city-at-the-frontlines-for-the-
filipino/)

Based on the surveys conducted by Philippine Society of Medical Oncologists, 46.76%

patients are hesitant to visit a hospital due to COVID, 74% of them either died or got
worse because they were not able to get urgent treatment from hospitals. Thus, one of
the most suggested options is telemedicine. However, technical glitches and the fact
that patients are not thoroughly examined are also some of the problems that are faced
by this kind of set up right now.

https://businessmirror.com.ph/2021/01/28/checkups-in-the-time-of-covid-19-3-
things-you-can-do/

Gap: Unorganized patient records database

The Department of Health (DOH) uses the Integrated Hospital Operations and
Management Information System (iHOMIS) which holds patients’ medical histories and
encounters. It also functions as an “electronic medical record, hospital information
system and health information system.” As of March 2016, this system is only being
used by 91 DOH and LGU hospitals.

Currently, there is the Integrated Clinic Information Systems (iClinicSys) used at health
centers that functions as a system for scheduling patients, tracking vaccine histories,
and verifying those who are part of the government’s 4Ps program and other PhilHealth
programs. It also links the patients’ post-prescription modules to another system called
National Online Stock Inventory Reporting System (NOSIRS).

Dayrit, Manuel M., et al. "The Philippines health system review." (2018).

This article provided a list of benefits of the eHealth system. This includes: improved flow
of health information because of the institutionalized sharing of information among all
stakeholders leading to a more coordinated service; more equitable health care access
as it will be a way to improve IT infrastructure in the health sector; Lastly, support on
other health laws such as the Universal Health Care Act.

https://www.dataguidance.com/opinion/philippines-developing-ehealth-
infrastructure
 SUPPORTING RESEARCH

According to the latest report by the Philippine Medical Association made in 2014, our
eHealth system is still messy. With information coming from various locations, the data
formats are all different, they lack data harmonization, and the quality are not that
reliable and accurate. As of report writing, stakeholders still do not have a clear solution
on how they would participate in a larger eHealth program. (Upon checking, there is still
no follow up report by PMA).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375261/

House Speaker Alan Peter Cayetano proposed in 2019 House bill 8 which will establish
the National Health Passport System and strengthen primary healthcare system. The
passport "which provides each Filipino with a document that reflects each individual’s
full medical history and other relevant data." can help Filipinos in recordkeeping and
making sure their medical history is available anytime. This bill has passed first reading.

https://businessmirror.com.ph/2019/10/10/cayetano-pushes-house-passage-of-
national-health-passport-system/

https://www.philstar.com/headlines/2019/10/19/1961498/proposed-e-health-
system-hurdles-house

PROBLEM STATEMENT

How might we increase the efficacy of the record keeping process done in
hospitals so that patients and their respective doctors have immediate access to
the records when needed?

SOURCES

Classification of Philippine Hospitals. ROJoson's Writings on Hospital Administration.

(2013, September 17).
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DOH Attached Agencies: Department of Health website. DOH Attached Agencies |

Department of Health website. https://doh.gov.ph/doh-attached-agencies-directory.

Flores, L. J. (2020, July 24). Hospitals in the Philippines: Where they are – and aren't.
Rappler. https://www.rappler.com/newsbreak/in-depth/locations-mapping-
hospitals-healthcare-facilities-philippines.

Instructor's Manual Chapter 1: Concepts of Quality Management - ppt video online

download. SlidePlayer. https://slideplayer.com/slide/2801158/.
 SOURCES

Magsambol, B. (2020, August 16). Low pay, high risk: The reality of nurses in the
Philippines. Rappler. https://www.rappler.com/newsbreak/iq/salary-nurses-
philippines.

Magsambol, B. (2020, July 30). Health care in Philippines, Myanmar 'concerning' – UN

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systems-concerning-southeast-asia-un-report.

Medical Specialties. Filipino Doctors. https://filipinodoctors.org/.

Quality through Design and Planning. Health Care Service Delivery. (2020, December 25).
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Record Keeping and Documentation. Ausmed.

https://www.ausmed.com/cpd/articles/record-keeping-documentation.

Services. https://bataangeneralhospital.doh.gov.ph/index.php/services.

Theera-Ampornpunt, N. (2014, September 12). Development and Management of

Information Systems in Healthcare. SlideShare.
https://www.slideshare.net/nawanan/development-and-management-of-
information-systems-in-healthcare.

This is Why Medical Records are Important. Bridge Clinic.

https://www.thebridgeclinic.com/blog/this-is-why-medical-records-are-important.

U.S. National Library of Medicine. Types of health care providers: MedlinePlus Medical
Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/001933.htm.

World Health Organization. 3 out of 10 health care facilities in the Philippines lack access
to clean toilets. World Health Organization.
https://www.who.int/philippines/news/detail/04-04-2019-3-out-of-10-health-care-
facilities-in-the-philippines-lack-access-to-clean-toilets.

[PDF] Significance of Systems Theory to Health Care Management - Free Download PDF.
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management.