ACADEMIA Letters

SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT

AND PRACTICES OF DOH HOSPITALS TOWARDS
CLIMATE-SMART HEALTH FACILITY
June Philip Ruiz
Glenn Cruz
Roderick Napulan

The Global challenge of our time is climate change which disrupts the delivery of health care
services. The increased intensity of natural disasters challenges the structural integrity of
health care facilities and the infrastructure, support systems, and supply chains that health care
facilities and their communities depend upon. Health care facilities are also leading consumers
of energy, with a large environmental footprint that contributes to carbon emissions. Such
emissions can be mitigated by using renewable, sustainable, and clean energy. This can also
be achieved by using materials that reduce energy consumption.
Pursuant to the IRR of Republic Act (RA) No. 11285 “Energy Efficiency and Conser-
vation Act” Section 33 states that all energy users shall use every available energy resource
efficiency and promote the development utilization of new and alternative energy-efficient
technologies and systems, including renewable energy technologies and systems according to
RA 9513, otherwise known as the “Renewable Energy Act of 2008” across all sectors. Energy
efficiency has been part of the country’s response in balancing socio-economic development
with health and the environment. Republic Act (R.A.) No. 9513, the Renewable Energy
Act of 2008, for example, precedes R.A. No. 9729, the Climate Change Act of 2009. The
National Framework Strategy on Climate Change, which translated to the National Climate
Change Action Plan, established energy efficiency and conservation and renewable energy
as necessary in sustainable development as well as addressing the drivers of climate change.
The Philippines’ Department of Health as the Nation’s leader in health develops the Green and

Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: June Philip Ruiz, junephilipruiz.ppph.doh@gmail.com

Citation: Ruiz, J.P., Cruz, G., Napulan, R. (2021). SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT
AND PRACTICES OF DOH HOSPITALS TOWARDS CLIMATE-SMART HEALTH FACILITY. Academia
Letters, Article 1222. https://doi.org/10.20935/AL1222.
1
Safe Healthcare Facility Standards and Guidelines with the cooperation of the World Health
Organization which serves as a guide for health facilities in taking appropriate measures that
will reduce environmental footprint through climate-friendly technology and initiatives.
Several activities were undertaken to produce an evidence-based standard. From 2017 to
2019, several workshops and write shops were conducted and participated by several experts
in the field of health facility architecture, engineering, and hospital administration. Patients,
practitioners, non-government organizations were also part of the consultations. The princi-
ples of the developed standards are aligned with the existing national policies and international
standards. The latest evidence available was considered and adapted in the health care facil-
ities standards. Some of the DOH Hospital does green measures like reduction of energy
consumption, rainwater harvesting, energy audit, use of sustainable materials, handwashing
facilities, food safety, green procurement, use of renewable and clean energies, biophilic de-
sign, and healing gardens. The study recommends that more action needs to be done by
the DOH Hospitals towards sustaining the green and safe (climate-smart) health facility and
should also include funding for proper implementations.

Green and Safe Health Facility Development

Climate change interrupts health service delivery. Natural calamities are getting more se-
vere yearly, and they push health facilities to the limits of their structural soundness. Floods
damage hospital mechanical equipment, which is often located below grade. Prolonged high
winds during storms damage rooftop equipment, structures of buildings, electric transmission
lines, and other public infrastructure. As the health sector is significantly affected by the cir-
cumstances brought about by climate change, the Department of Health as the nation’s leader
in health is challenged to respond to this grave phenomenon by minimizing the carbon foot-
print of health facilities while delivering quality public health care. This remains the rationale
for developing green and safe (or climate-smart) standards for all hospitals and other health
facilities.
The DOH as the nation’s leader in health issued its National Health Sector Framework
on Climate Change in 2010. Two years after, in 2012, the DOH issued the National Policy
on Climate Change Adaptation for the Health Sector, and its subsequent operational guide-
lines. The policy defined service provision, capacity, and infrastructure enhancement as a key
strategy, wherein improvement of capacities, and upgrading of structural, non-structural, and
functional criteria of health facilities towards climate change resilience were directed.
Considering the significant global figures on the carbon footprint of health as an industry,
the Climate Change Commission strongly advocated for the health sector response to climate

Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: June Philip Ruiz, junephilipruiz.ppph.doh@gmail.com

Citation: Ruiz, J.P., Cruz, G., Napulan, R. (2021). SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT
AND PRACTICES OF DOH HOSPITALS TOWARDS CLIMATE-SMART HEALTH FACILITY. Academia
Letters, Article 1222. https://doi.org/10.20935/AL1222.
2
change, including climate-smart hospital development. The DOH committed to this agenda
for action at the National Staff Meeting on October 27, 2017.
The Health Facility Development Bureau (HFDB), in assuming the DOH’s technical lead-
ership in health facility development, convened the first Summit on Green and Safe Healthcare
Facilities on January 26, 2017, where then Senator Loren Legarda was the keynote speaker and
encouraged the direction being taken for green buildings in health care. After the Summit, a
technical working group was convened to push forward the agenda of standards and guidelines
development for green and safe hospitals and other health care facilities. The group engaged
architecture and engineering experts for this agenda, including those who contributed to the
PGBC’s formulation, and green certification systems EDGE and BERDE, the latter being the
recognized voluntary certification system in the country.
By February 20, 2018, the TWG and HFDB engaged national and local, public and pri-
vate hospitals, select government agencies, and civil society in a series of consultations, the
Green Healthcare Facility Standards Stakeholders Meetings. The guidelines criteria presented
included leadership and management, energy efficiency, water efficiency, site sustainability,
materials sustainability, solid waste management, and indoor environment quality.
Meanwhile, the DOH capital outlay funding program, Health Facilities Enhancement Pro-
gram, also issued its guidelines for the 2019 availment of the fund for infrastructure and equip-
ping projects. Among the priorities identified in the guidelines were for project proposals in
compliance with green building principles and standards.
With technical assistance from the World Health Organization, the proposed green and
safe guidelines proceeded towards the development of the Green and Safe Health Facilities
Manual, which was to include an accompanying Green Viability Tool to aid the manual’s ap-
plication. A round of consultations was held for review and feedback of the proposed manual,
whose contents expanded with equivalent provisions from the PGBC; developmental prin-
ciples consistent with the national climate change frameworks and plans; “Water, Sanitation
and Hygiene” or WASH as distinct from water efficiency; facility safety based from existing
standards, and guidelines and tools from the DOH Hospitals Safe from Disasters policy and
program; and the existing core programs of the HFDB. The performance standards (energy ef-
ficiency; water efficiency; water, sanitation, and hygiene; health care waste management; site
sustainability; materials sustainability; indoor environmental quality; and hospital safety) had
been incorporated in the Green and Safe Health Care standards and guidelines are attributed
to green hospitals and the development of the guidelines that will be incorporated in the green
viability assessment (GVA) tool.
On December 3, 2019, R.A. No. 11463, the Malasakit Centers Act was approved. To
support the fulfillment of the UHC, the law provides for the Integrated People-Centered Health

Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: June Philip Ruiz, junephilipruiz.ppph.doh@gmail.com

Citation: Ruiz, J.P., Cruz, G., Napulan, R. (2021). SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT
AND PRACTICES OF DOH HOSPITALS TOWARDS CLIMATE-SMART HEALTH FACILITY. Academia
Letters, Article 1222. https://doi.org/10.20935/AL1222.
3
Services (IPCHS) in DOH hospitals and the Philippine General Hospital. The law’s IRR and
a corresponding DOH administrative order identified green building principles and indoor
environment quality requirements as part of the IPCHS implementation.

Universal Health Care in Green and Safe Health Facilities

Evidence generation was needed by the standards and guidelines development process. Rapid
assessment surveys were usually employed among the DOH hospitals. The first rapid assess-
ment involved the green policy environments of the DOH hospitals and was then followed
by questionnaires to help the TWG and the experts to gain more insight on areas of facility
operations like energy and water consumption.
R.A. No. 11223, the Universal Health Care (UHC) Act, was approved in 2018. The DOH
has rearranged its functional organization towards the implementation of the new mandate.
Green and safe health facility development was pursued mindfully of the required integration
with related policies and initiatives in accordance with the UHC law. In 2019, the DOH issued
advisories to encourage health facilities for green certification of their infrastructure projects
and for DOH facilities to ensure green procurement regimes as was already provided as policy.
At the conclusion of the 17th Congress, the country also saw a robust enactment of leg-
islation for the upgrading and expansion of health facilities in the country. This provided
the HFDB opportunity to include directives toward green and safe buildings in implementing
rules and regulations (IRR) of the concerned DOH facilities, and encouragement of the same
as part of technical assistance to concerned local government health facilities.

Green and Safe Health Facilities Towards the New, Better Normal
The HFDB was facilitating a staging on multiple fronts when the public health emergency
due to the coronavirus 2019 (COVID-19) pandemic went down. These multiple fronts there
included the conduct of energy audits to be led by the Department of Energy; piloting of health
care waste audits in partnership with Health Care Without Harm; pilot implementation of
WASH in Health Facilities with the Disease Prevention and Control Bureau and development
partners; and alignment of HFDB’s work program with initiatives from the CCC’s climate-
smart hospitals initiative and Nationally Determined Contributions (NDC) support project.
The HFDB was able to facilitate the completion of compliance of DOH facilities to R.A.
No. 11285’s provision on the appointment of Energy Efficiency and Conservation Officers.
The update of the Health Care Waste Management Manual was also released, in time with
the DOH’s series of issuances on infection prevention and control measures (including waste

Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: June Philip Ruiz, junephilipruiz.ppph.doh@gmail.com

Citation: Ruiz, J.P., Cruz, G., Napulan, R. (2021). SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT
AND PRACTICES OF DOH HOSPITALS TOWARDS CLIMATE-SMART HEALTH FACILITY. Academia
Letters, Article 1222. https://doi.org/10.20935/AL1222.
4
management) among facilities that are designated COVID-19 referral and accepting hospitals,
and temporary treatment and monitoring facilities (TTMF).
Many multi-sector engagements were migrating to virtual conferencing platforms as with
the launch of the WASH pilot project. Then the Manual and its adjunct Green Viability Tool
were also piloted virtually to a DOH hospital and a treatment and rehabilitation center. All
other initiatives are still being prepared for virtual migration as in this report.

Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: June Philip Ruiz, junephilipruiz.ppph.doh@gmail.com

Citation: Ruiz, J.P., Cruz, G., Napulan, R. (2021). SUSTAINABLE DESIGN PRINCIPLES DEVELOPMENT
AND PRACTICES OF DOH HOSPITALS TOWARDS CLIMATE-SMART HEALTH FACILITY. Academia
Letters, Article 1222. https://doi.org/10.20935/AL1222.
5