DEPARTMENT OF HEALTH

BUREAU OF HEALTH FACILITIES AND SERVICES

Atty. Nicolas B. Lutero III, CESO III

Director IV

Regalla Towers, 29 July 2011

 Objectives

1. General

To acquire a broad-based view of the requirements for licensing of hospitals.

2. Specific

 To orient stakeholders on the licensing rules and requirements in hospital

planning and design;

 To clarify issues and enlighten stakeholders on the same.

 Acronyms

1. BHFS – Bureau of Health Facilities

and Services

2. CHD – Center for Health Development

3. CON – Certificate of Need

4. DOH-PTC – DOH Permit to Construct

5. OSS – One-Stop Shop

6. LTO – License to Operate

 Flow of Presentation

1. Certificate of Need

2. DOH – Permit to Construct

3. Guidelines in the Planning and Design of a Hospital

4. Evaluation Procedure

5. One-Stop Shop

6. Re-Centralization
  Definition of a Hospital

A place devoted primarily to the maintenance and operation of facilities for

diagnosis, treatment and care of individuals suffering from illness, disease, injury or
deformity or in need of obstetrical or other medical and nursing care.

 Definition of a Hospital

The term „hospital‟ shall also be construed as any institution, building or place
where there are installed beds or cribs or bassinets for 24 hour use or longer by patients in
the treatment of diseases, diseased-condition, injuries, deformities or abnormal physical
and mental states, maternity cases and sanitarial or sanitarial care infirmities, nurseries,
dispensaries and such other means by which they may be designated.

 Definition of a Hospital

The term „clinic‟ means a place in which patients avail of medical consultations or
treatments on an out-patient basis. However, any clinic or dispensary where there is at
least 6 beds or cribs or bassinets installed for 24 hour use by patients shall be construed to
fall within the definition of a hospital as described in this Act.

 Certificate of Need (CON)

A CON is a certificate issued by the CHD Regulatory Division for proposed construction of
a hospital that ensures that the facility will be needed at the time of its completion. The
certificate is issued to an individual or group intending to build a hospital to meet the
needs of a community.

A CON is required prior to securing a DOH-PTC for the construction of a hospital.

 CON

Criteria for the establishment of a new general hospital:

1. Bed to population ratio shall not be more than 1 bed per 1,000 population (1:1,000);

2. Travel time – proposed hospital shall be at least 1 hour away from the nearest
existing hospital;

3. Accessibility – strategically located;

 CON
Criteria for the establishment of a new general hospital: (cont.)

4. Integration with Provincial/ City Strategic Plan for the Rationalization of the Health
Care Delivery System Based on Health Needs;

5. Track record.

 CON

Requirements for general hospitals:

 Application form for CON

 Certification from the Provincial Planning and Development Office that the
proposed hospital is part of the duly approved Provincial Hospital/ Health Care
Delivery Plan (if available)

 DOH Permit to Construct (PTC)

An authorization issued by the DOH in compliance with the standards and technical
requirements particularly on zoning/ functional relationship of areas for the construction,
substantial alteration, expansion or renovation, change in classification and/ or increase in
bed capacity of hospitals and other health facilities.

It is a pre-requisite for the issuance of LTO/ certificate of accreditation.

 Coverage of DOH-PTC

 Ambulatory Surgical Clinic

 Dialysis Clinic

 Drug Testing Laboratories

 Drug Abuse Treatment and Rehabilitation Center

 Hospital

 Medical Facility for Overseas Workers and Seafarers

 Psychiatric Care Facility

 Composition of the Health Facility Establishment Review Committee (HFERC)

Chairman: Director of the BHFS (CO)

Chief, Licensing Regulation and Enforcement Division (CHD)

Members:

Architect Physician
Engineer Medical Technologist

Health Physicist Pharmacist

Nurse

 Application for DOH-PTC

 Classification of Hospitals

A. By function

1. General

2. Special

B. By service capability

1. Level 1

2. Level 2

3. Level 3

4. Level 4

5. Guidelines in the Planning and Design of a Hospital

 Planned and designed to observe appropriate architectural practices, to meet

prescribed functional programs, and conform to applicable codes as part of normal
professional practice

 References shall be made to the following:

PD 1096 – National Building Code of the Philippines + IRR

PD 1185 – Fire Code of the Philippines + IRR

PD 856 – Code on Sanitation of the Philippines + IRR

BP 344 – Accessibility Law + IRR

RA 1378 – National Plumbing Code of the Philippines + IRR

RA 184 – Philippine Electrical Code

RA 4226 – Hospital Licensure Act + IRR

Existing Local Codes and Ordinances

 Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design.
DOH, Manila. 1994

Signage Systems Manual for Hospitals and Offices. DOH, Manila. 1994

Health Facilities Maintenance Manual. DOH, Manila. 1995

Manual on Hospital Waste Management. DOH, Manila. 1997.

District Hospitals: Guidelines for Development. WHO Regional Publications, Western

Pacific Series. 1992

Guidelines for Construction and Equipment of Hospital and Medical Facilities. American
Institute of Architects, Committee on Architecture for Health. 1992

De Chiara, Joseph. Time-Saver Standards for Building Types. Mc Graw Hill Book
Company. 1980.

ENVIRONMENT

 Readily accessible to the community and reasonably free from undue noise, smoke,
dust, foul odor, flood and shall not be located adjacent to railroads, freight yards,
children‟s playgrounds, airports, industrial plants, disposal plants

OCCUPANCY

 Building(s) designed for other purpose(s) shall not be converted into a hospital.

 Comply with all local zoning ordinances

 Guidelines in the Planning and Design

SAFETY

 Provide and maintain a safe environment

 No hazards to life and safety

 Capable to withstand weight and elements to which they may be subjected to

☺ exits shall be restricted to the following types: door leading directly outside the
building, interior stair, ramp and exterior stair

☺ minimum of 2 exits, remote from each other for each floor of the building

☺ exits shall terminate directly at an open space to the outside of the building

 Guidelines in the Planning and Design

SECURITY
  Ensure security of person and property within the facility

LIGHTING

 Sufficient illumination to enable performance of work and to promote comfort,

healing and recovery of patients

VENTILATION

 Adequate ventilation

AUDITORY AND VISUAL PRIVACY

 Observe acceptable level and adequate visual seclusion to achieve the acoustical
and privacy requirements in designated areas allowing the unhampered conduct of
activities

 Guidelines in the Planning and Design

WATER SUPPLY

 Approved public water supply system

 Potable, safe for drinking and adequate and shall be brought into the building free
of cross connections.

SANITATION

 Utilities for the maintenance of sanitary system, including approved water supply
and sewerage system, shall be provided through the buildings and premises to
ensure a clean and healthy environment.

 Guidelines in the Planning and Design

WASTE DISPOSAL

 Liquid waste shall be discharged into an approved public sewerage system

whenever available.

 Solid waste shall be collected, treated and disposed of in accordance with

applicable codes, laws or ordinances.

 Guidelines in the Planning and Design

HOUSEKEEPING

 Provide and maintain a healthy and aesthetic environment

MATERIAL SPECIFICATION
  Floors, walls and ceilings shall be made of sturdy materials that allow durability,
ease of cleaning and fire resistance.

SEGREGATION

 Wards shall observe segregation of sexes.

 Separate toilet for patients and personnel, male and female with a ratio of 1 toilet
for every 8 patients and personnel

 Guidelines in the Planning and Design

FIRE PROTECTION

 Measures for detecting fire such as fire alarms in walls, peepholes in doors or smoke
detectors in ceilings

 Devices for quenching fire such as fire extinguishers or fire hoses that are easily
visible and accessible in strategic areas

PARKING

 Minimum of 1 parking space for every 25 beds

 Guidelines in the Planning and Design

NO SMOKING POLICY

There shall be a „no smoking policy‟ and that the same shall be strictly enforced.

SPACE REQUIREMENTS

 0.65/person – unit area/ person occupying the space at one time

 5.02/staff – work area/staff that includes space for 1 desk and 1 chair, space
for occasional visitor, space for aisle

 7.43/bed – clear floor area/bed that includes space for 1 bed, space for occasional
visitor, passage for equipment

 1.08/stretcher – clear floor area/stretcher that includes space for 1 stretcher

 3.72/bassinet – clear floor area/bassinet that includes space for 1 bassinet,

space for movement of person, and space for passage of equipment

 8.36/dental chair – clear floor area/dental chair that includes 1 dental chair, space
for movement of person, space for passage of equipment

 Evaluation of Floor Plan

  Compliance to requirements based on the checklist for review of floor plans (Level
1, Level 2, Level 3, Level 4 hospitals)

 Compliance to space requirements (ancillary service)

 Proper zoning of areas

 Functional relationship of areas

 Flexibility in the proposed nursing units/area

 Causes of Delay in Processing PTC

 Insufficient documents submitted

 Lack of floor plan submitted

 Scope of work not clearly stated

 Unlabelled floor plan

 Unsigned plan submitted

 Non-payment of PTC fee

 One-Stop Shop (OSS)

A strategy by the DOH to harmonize licensure of hospitals, its ancillary and other facilities,
such as but not limited to, the following:

 Clinical laboratory;

 HIV testing laboratory;

 Laboratory for drinking water analysis;

 Blood bank, blood collection unit, and blood station;

 Dialysis clinic;

 Ambulatory surgical clinic;

 Pharmacy;

 Medical x-ray facility.

 OSS Exclusion

OSS excludes the following:

 Hospital-based medical facility for overseas workers and seafarers;

 Hospital-based drug abuse treatment and rehabilitation center;

  Facility using radioactive material regulated by the PNRI;

 Performance of kidney transplantation;

 Drug testing laboratories.

 Rationale for Re-Centralization

1) There is a BHFS study mapping out all services and equipment available in
hospitals nationwide, particularly Levels 3 and 4 hospitals.

2) There is no approved, rationalized CHD staffing requirement after 2 ½ years

of decentralization.

3) The plantilla position at the CHD level revealed inadequate number of

technical staff in the Licensing and Enforcement Division.

4) The BHFS is the authorized regulatory body to undertake PTC and LTO
applications under Republic Act No. 4226 “Hospital Licensure Act of
1965.”

5) Transitory Provisions

6) The CHDs, shall submit to the BHFS an inventory report of all pending
applications for PTC, initial LTO and renewal of LTO of Levels 3 and 4
hospitals in their areas of jurisdiction since its decentralization last 1 January
2008.

7) All new requests for PTC, issuance of initial LTO of hospitals and renewal of
LTO of Levels 3 and 4 hospitals shall be directed to the BHFS after the 8th of
January 2011.

8) The foregoing provisions shall be temporary in nature and fulfillment of the

conditions under Section I Background a) to d) of AO No. 2010 – 0035 shall
merit the decentralization again of these functions to the CHDs.

 Draft Policy on Hospital Regulation

1) Streamlining of Licensure and Accreditation of Hospitals

 DOH licensed hospitals shall automatically be accredited as Centers

of Safety by PhilHealth

2) Applications for DOH-PTC of Level 1 and Level 2 government hospitals

identified and financed under the Health Facilities Enhancement Program
(HFEP) shall be decentralized to the CHD HFERC.

 ISSUES/ CONCERNS
cyros_2005@yahoo.com.ph

cyros88@gmail.com

711-9572, 651-7800 loc 2525

Standards Development Division

Bureau of Health Facilities and Services

Department of Health

 Bureau of Health Facilities

and Services (BHFS)

 DOH Website

www.doh.gov.ph

Doing Business

Licensing

BHFS Requirements

Hospitals and Other Health Facilities

Thank You.

DOH website: www.doh.gov.ph

Look for „Doing Business‟

Click „Licensing‟, Look for „Requirements for

Licensing…‟

Browse the page and click health facility of interest

 Bureau of Health Facilities and Services

 Guidelines in the Planning and Design

Management plan including, policies, procedures, programs, risk assessment, hazard

surveillance that address the following:

 Safety

 Security

 Disposal and control of hazardous materials/ biologic wastes – MOA/ contract of

outsourced services for waste management
 Emergency and disaster preparedness – check for exit plans, plans for earthquakes
and other disasters

 Fire safety – check for presence of fire extinguishers

 Radiation safety

 Utility systems

 Water safety – water analysis results