Dennis N.

Muñoz, RN, RM, LPT

Philippine Health Facilities Development Plan (PHFDP)for 2017-2022.

My take in this lesson pertains to Philippine Development Plan in

reference in Plan Development curtails in the Health Care setting since I am
Currently connected with the Department of Health, under Center for Health
Development in Region XI, Province of Davao de Oro. The Topic Which I
would like to present is on the Philippine Health Facilities Development Plan
(PHFDP)for 2017-2022.

The Philippine Hospital Development Plan (PHDP) supports the

national agenda of health sector reform through the establishment,
development and enhancement of the edificial and operational aspects of
hospitals as integral to the overall healthcare delivery.

The PHDP was first developed in 2000 as a ten-year plan to address

the transition scenario of the devolution of health service delivery by virtue of
R.A. 7160, or the Local Government Code of 1991. Health facilities
development, particularly the upgrading of hospitals in the periphery, including
provincial and district hospitals, was defined as a Department of Health (DOH)
policy thrust in A.O. 18 s. 1998, which articulated the vision of “quality health
care available to every Filipino especially the poor.” The Health Sector Reform
Agenda (HSRA), per A.O. 51 s. 1999 further defined areas of reform that
included upgrading critical capacities of public hospitals to improve quality of
services, improve efficiency, and adopt revenue enhancement measures.

The PHDP sought to contribute in enabling a responsive hospital

system that ensures equitable quality health care. Its objectives included
providing policy direction and technical support in health service planning,
upgrading of hospitals to meet standards according to respective service
capabilities, developing specialty and sub-specialty centers among the DOH
regional hospitals, and establishing the Philippine Center for Specialized
Healthcare as end-referral, training and research facility.

In 2000, the total estimated resources required for investments in

health infrastructure, medical and information technology equipment
amounted to 46.8 billion pesos for ten years. The estimates covered for 250
provincial and district hospitals, 15 city hospitals, and 72 DOH hospitals.
Between 2001 and 2006, capital outlay funds from the national government
were only minimal and sporadic, and some hospital upgrading projects
depended on foreign-assisted projects.

Income retention in DOH hospitals became a special provision in the

General Appropriations Act, FY 2003. A.O. 2005-0023 provided for the
implementation of FOURmulaONE for Health (F1 for Health), the medium-
term framework for health reforms from 2005 to 2010. To achieve the end
goal of a more responsive health system, and striving to ensure access to and
availability of essential and basic health packages, one strategy under health
service delivery was the upgrading of health facilities and strengthening of
corresponding human resource capability in order to comply with licensing
and accreditation requirements, as well as to assure the quality of both basic
and specialized health services.

In 2007, the PHDP expanded to include other hospitals under the

government agencies such as the Armed Forces of the Philippines, the
Philippine National Police, and those under State Universities and Colleges
(SUCs). In 2008, the plan further expanded to include health facilities such as
barangay health stations, rural health centers, health laboratories, blood
service facilities, among others. The PHDP served as the macro plan for the
Health Facilities Enhancement Program (HFEP). The HFEP‟s objectives
included upgrade of priority RHC‟s and BHS‟s to provide basic obstetrical and
neonatal care (BEmONC) services; upgrade of levels 1 and 2 government
hospitals to provide BEmONC and help decongest large tertiary hospitals;
upgrade of level 2 and tertiary government hospitals to provide
Comprehensive Emergency Obstetrical and Neonatal Care (CEmONC)
services; and upgrade of DOH medical centers and hospitals to provide
specialty and sub-specialty services.

HFEP sources of funding were mainly from the national government –

in the GAA, including Congressional initiatives, “Katas ng VAT”, and selected
programs of the DOH. Recognizing the gains from the implementation of the
HSRA and F1 for Health, but emphasizing that the country still needed a
breakthrough in the equity and access to critical health services of poor
Filipino families, A.O. 2010-0036 first enunciated the DOH agenda towards
achieving Universal Health Care, or Kalusugan Pangkalahatan. The agenda‟s
approaches included expanding the capacity of government owned and
operated hospitals and health facilities to provide quality services to help
attain the health-related targets of the Millennium Development Goals, attend
to traumatic injuries and other types of emergencies, and manage non-
communicable diseases and their complications. As also provided, the HFEP
shall leverage funds for improved preparedness of targeted facilities. Between
2010 and 2014, HFEP provided infrastructure funding to 1,199 hospitals and
infirmaries for 11.7 billion pesos, and to rural health units (RHU) and city
health offices (CHO) for 5.2 billion pesos.

Funding for medical equipment of 1,092 hospitals and infirmaries was

worth 6.3 billion pesos and 2.9 billion pesos for 3,154 RHU‟s and CHO‟s.
Infrastructure funding amounted to a yearly average3.4 billion pesos, and
equipment funding to 1.8 billion pesos. Aligned to the country‟s long-term
vision enshrined in AmBisyonNatin 2040, A.O. 2016- 0038 defined the
Philippine Health Agenda 2016-2022 (PHA), committed to make every
Filipino‟s right to health tangible, in line with the promise of real positive
change the people can feel.

Of the three guarantees of the PHA, health facility development serves

to contribute in the access to health interventions through functional service
delivery networks, where facilities in the network are ensured fully-equipped
and staffed, and primary care networks are linked to Level 3 hospitals and
centers that provide specialty care. The PHA guidelines also provide for the
transformation of select DOH hospitals into facilities with multi-specialty
training capabilities and reference laboratories.

The DOH‟s Health Facility Development Bureau (HFDB), in pursuit of

its mission to provide leadership and technical expertise for the continuous
development of health facilities as effective and dynamic providers of quality
care, is mandated to develop plans, policies, programs, projects and
strategies related to health facility development, planning, operation and
maintenance. It is in this context that the HFDB took the initiative and
facilitated the review and update of the PHDP as consistent with the PHA,
AmBisyon Natin 2040, as well as the country‟s commitment to the global 2030
Agenda for Sustainable Development. The PHDP 2017-2022 purposefully
focuses on the further development of DOH and other government hospitals
as intended in the HSRA, and 5 currently in the PHA, and its framework is
expected to pave strategic direction and consistent, complementing focus to
the development needs of the larger spectrum of health facilities in the
Philippines.

Rationale?

The PHA, marching under the banner of Healthy Philippines 2022,

trumpeting the clarion call “All for Health towards Health for All,” and taking
stock of the milestones and persisting challenges in the last thirty years of the
pursuit of health sector reform, recognizes issues that the sector needs to
address to meet our guarantee in responsiveness, or in the promotion and
delivery of healthcare through means that respect, value and empower clients
and patients as they interact with the health system. The addressing of needs
in the development of hospitals and other health facilities should step up to
the challenge, resolve the lingering perception of poor quality and undignified
provision of care as indicated by long queues and waiting times, poor keeping
of and irretrievable health records, overcrowding and under-provision of care,
among others. These are echoes from when the PHDP was formulated in
2000 to address the irrational distribution of services in the Philippine Hospital
System due to the devolution of health services, and the DOH only retaining
seven percent of the facilities.

Hospitals involve?

Currently, hospitals in the Philippines are classified according to

ownership, scope of services and functional capacity. Each has well defined
roles, functions, capabilities, facilities, organizational structure and staffing
standards. The rules and regulation for hospital classification are promulgated
to protect and promote the health of the public by ensuring a minimum quality
of service rendered by hospitals and to ensure safety of patients and
personnel. This is an efficient model because it is designed to treat patients at
the appropriate levels. The Philippine Hospital System is composed of
government and privately owned hospitals. These hospitals are classified into
general (Levels 1, 2 and 3) or specialty and either trauma-capable or trauma-
receiving. Based on the 2015 data of HFSRB, there are a total of 1,161
hospitals in the country, 405 of which are government owned. In comparison,
there are more privately owned hospitals (756) than government owned.

In order to be constantly alert and responsive to the health needs of the

people, the Department of Health shall evolve and adopt modes on
institutional operation for hospitals that embody the highest quality standards
of health services.

1. Manpower

 The hospital shall recruit and deploy officers and staff members based on
educational background, professional track record, personal attributes,
and commitment to the mission, goals and objectives of the Department of
Health.
 The hospital shall establish its own mechanisms for providing appropriate
incentives to ensure effective and efficient service to its employees.

 The Department of Health through the Human Resources for Health

(HRH) Development Plan of Health Human Resources Development
Bureau (HHRDB) shall form health teams composed of doctors, nurses
and other paramedical and health workers who have been trained to
assume expanded functions in health care delivery in order to address
shortages or imbalances of health manpower.

2. Physical Plant, Equipment and Materials

 The hospitals shall always keep their facilities clean, safe, secure and
ready to respond to patient needs.
 The hospitals shall practice preventive maintenance and make
contingency preparations for emergencies and disaster.
 The hospitals shall maintain an optimum inventory of drugs, medicines
and other supplies.

3. Finance

 Resource allocation for hospitals shall be based on their respective

authorized bed capacity, average bed occupancy rate, and per capita
income of patients served and Quantified Free Services (QFS).
 Income generated from PhilHealth reimbursements and from pay patients
shall be retained by the hospitals for operational expenses and
improvement of physical facilities.

4. Systems
 Modifications in the standard organizational structure shall be justified
based on programs, resources, physical plant, and the socio-demographic
and economic condition of its environment.
 Job descriptions shall be available and each position shall delineate
functions, specify authority and responsibilities, and qualification
requirements.
 Various organizational units shall formulate policies and procedures.
 Facilitating coordination and communication shall be continuing concern
of management.
 Consensus building, or at least consultation, shall be adopted in decision-
making.
 Special effort shall be exerted to develop hospital units that are weak, e.g.
medical records, pharmacy, etc.

5. Community Linkage
 Each Department of Health hospital shall encourage community-based
activities towards the support and promotion of hospitals.

6. Monitoring and Evaluation

 Appropriate management information systems shall be installed in all
hospitals in order to generate an organized body of information critical for
effective management, coordination, planning, and the monitoring of
internal activities and of roles and relationships within the national hospital
system.
 The hospital monitoring and evaluation system shall be particularly
concerned with the quality of medical care in the frontline services; and
with the fundamentals of health care, e.g. cleanliness, safety, etc.
 Further, the HFDB as proponent of PHDP 2017-2022, as initiator of this
plan development process, and in assuming its mandate in technical
leadership in health facility development, shall ensure that the annual
operations of the programs described below contribute in meeting the
plan‟s objectives, strategies and targets.