Compendium of Uhc Policies and Operational Guidelines Volume1

1
COMPENDIUM
OF
UNIVERSAL
HEALTH CARE
POLICIES
AND OPERATIONAL
GUIDELINES
VOLUME 1
2 COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
i
COMPENDIUM
OF
UNIVERSAL
HEALTH CARE
POLICIES
AND OPERATIONAL
GUIDELINES
Volume 1
ii COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES

AND OPERATIONAL GUIDELINES
Volume 1
Copyright© 2022
Department of Health
Philippines
Published by
Health Policy and Systems Development Team
San Lazaro Compound, Rizal Avenue, Sta. Cruz
Manila 1003, Philippines
Printed by
Inkwell Publishing Co., Inc.
8 San Pablo St., Kapitolyo, Pasig City
All rights reserved.

The mention of specific companies or certain products does not imply preferential endorsement or
recommendation by the Department of Health. This publication may be reproduced in full or in part for
non-profit purposes without prior permission, provided proper attribution to the Department is made.
Furnishing the Department a copy of the reprinted or adapted version will be appreciated.
iii
EDITORIAL TEAM
Editors
Mario C. Villaverde, MD, MPH, MPM, CESO I
Frances Rose Elgo-Mamaril, MPH
Napoleon S. Espiritu II, MPP
Rosa G. Gonzales, MSc
Editorial Staff
Roland Philip C. Javier, RMT, MPH

Emmylou N. Magbanua
Shyler Elaine Delos Santos
Ma. Angelica P. Guinto
Ethel B. Jardinero, MGM
Design
Harvey T. Bislumbre
The grant fund for the printing of this compendium was received from the Japan Fund for
Prosperous and Resilient Asia and the Pacific financed by the Government of Japan through the
Asian Development Bank.
JFPR
Japan Fund for Prosperous and
Resilient Asia and the Pacific
iv COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
v
TABLE OF CONTENTS
Message of the Secretary of Health ix

Message of the Undersecretary of Health xi
Foreword xiii
CHAPTER 1: FRAMEWORK AND MANDATES OF UNIVERSAL HEALTH CARE 1

IN THE PHILIPPINES
An Act Instituting Universal Health Care for All Filipinos, Prescribing
Reforms in the Health System, and Appropriating Funds Therefor
(Republic Act No. 11223) 5
Implementing Rules and Regulations of Republic Act No. 11223 39
CHAPTER 2: ORGANIZING THE LOCAL HEALTH SYSTEM 103

Guidelines on the Service Delivery Design of Health Care Provider
Networks [AO 2020-0019] 107
Guidelines on Integration of the Local Health Systems into Province-wide
and City-wide Health Systems (P/CWHS) [AO 2020-0021] 123
Guidelines on Identifying Geographically-Isolated and Disadvantaged
Areas and Strengthening their Health Systems [AO 2020-0023] 139
Policy Framework on Leadership and Governance for Health
(LeadGov4Health) Towards a Functional Local Health Board
[DOH-DILG JAO 2022-0001] 151
Roles, Functions, and Responsibilities of the Department of Health
Representatives [AO 2020-0029] 163
CHAPTER 3: UTILIZING LOCAL HEALTH SYSTEM MANAGEMENT TOOLS 177

Guidelines on Implementation of the Local Health Systems Maturity Levels
(LHS ML) [AO 2020-0037] 181
Guidelines on the Development of Local Investment Plans for Health 199
[AO 2020-0022]
Guidelines on Contracting Province-wide and City-wide Health Systems 217
[AO 2020-0018]
Guidelines on the Implementation of the Local Government Unit Health 223
Scorecard [AO 2019-0027]
vi COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
CHAPTER 4: ENHANCING PRIMARY CARE SERVICES 239

Primary Care Policy Framework and Sectoral Strategies [AO 2020-0024] 243
Rules and Regulations Governing the Licensure of Primary Care Facilities

in the Philippines [AO 2020-0047] 255
Amendment to Administrative Order No. 2020-0047 entitled, Rules
and Regulations Governing the Licensure of Primary Care Facilities
in the Philippines [AO 2020-0047-A] 263
Accreditation of Health Care Providers for PhilHealth Konsultasyong
Sulit at Tama (PhilHealth Konsulta) Package
[PhilHealth Circular 2020-0021] 267
Guidelines on the Certification of Primary Care Workers for Universal
Health Care [DOH-PRC JAO 2020-01] 275
Guidelines on the Registration of Filipinos to a Primary Care Provider
[DOH-PhilHealth JAO 2020-0001] 281
CHAPTER 5: DELIVERING POPULATION-BASED AND INDIVIDUAL-BASED

HEALTH SERVICES 287
Guidelines on the Classification of Individual-based and Population-based
Primary Care Service Packages [AO 2020-0040] 291
Health Promotion Framework Strategy in Province-wide and City-wide
Health System [AO 2020-0042] 309
Transformation of the Health Promotion and Communication Service
(HCPS) to the Health Promotion Bureau (HPB) [AO 2020-0058] 315
Guidelines on Healthy Settings Framework in Learning Institutions
[DOH-DSWD-DepEd-CHED-LEB-TESDA-DILG JAO 2022-0001] 323
National Policy Framework on the Promotion and Recognition of Healthy
Communities [DOH-DILG JAO 2021-0002] 333
Guidelines on the Institutionalization of Disaster Risk Reduction

and Management (DRRM-H) into Province-wide and City-wide Health
Systems [AO 2020-0036] 341
Governing Policies of the PhilHealth Konsultang Sulit at Tama (PhilHealth
Konsulta) Package: Expansion of the Primary Care Benefit to Cover
All Filipinos [Philhealth Circular 2020-0002] 349
Implementing Guidelines for the PhilHealth Konsultasyong Sulit at Tama
(PhilHealth Konsulta) Package [PhilHealth Circular 2020-0022] 353
vii
viii COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
ix
MESSAGE OF THE
SECRETARY OF
HEALTH
The passage of the Universal Health Care (UHC) Act and the issuance of its
Implementing Rules and Regulations in 2019 paved the way for the institutionalization of
a major national health reform roadmap.
Since then, the Department of Health has been engaging members of the health
sector and other stakeholders in developing operational policies and guidelines that
make tangible the provisions of the UHC Act. We are pleased to share with you this
Compendium, which is composed of two volumes. It is the companion publication of the
book entitled, “Universal Health Care in the Philippines: From Policy to Practice.”
This Compendium embodies a compilation of UHC policies and operational

guidelines that is meant to function as a complete reference material for health managers
and health workers. The purpose of which is to equip implementers with a handy
repository of information for their journey towards realizing UHC. This Compendium
will guide stakeholders as the health sector shifts focus towards the provision of primary
care services, integration of local health systems into province-wide and city-wide health
systems, and other health sector reform initiatives mandated by the UHC Act. Knowledge
on the new focus will very much contribute in delivering a continuum of care through a
people-centered and integrated health system; ensuring affordability and quality of health
services; enabling the generation of evidence-informed policies; and institutionalizing
measures for performance monitoring and accountability.
As we traverse this health reform roadmap, UHC is our legacy of hope for every Juan
and Juana. Through UHC, we look forward to building a healthier, stronger and more
resilient nation for all Filipinos.
FRANCISCO T. DUQUE III, MD, MSc

Secretary of Health
x COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
xi
MESSAGE OF THE
UNDERSECRETARY
OF HEALTH
In 2019, the Universal Health Care (UHC) Act was enacted into law. Immediately
thereafter, its Implementing Rules and Regulations was promulgated and the policies
and guidelines that will operationalize the various provisions of the law were issued. Such
operational policies and guidelines emphasize how our health system will be shifting from
merely targeting better health outcomes to including enhanced financial protection and
responsiveness; from just looking at effectiveness to ensuring cost-effectiveness of health
interventions; and above all, from highlighting the importance of treatment and cure to
prioritizing health promotion and disease prevention. These paradigm shifts along with
other UHC strategies, as embodied in the various operational guidelines, compose this
Compendium.
This Compendium is composed of two volumes. This first volume jumpstarts the
implementation of the law in terms of the framework and mandates of the UHC Act;
organizing the local health system; utilizing local health system management tools;
enhancing primary care services; and delivering population-based and individual-
based health services. The operational policies and guidelines have been compiled to
provide easy reference materials for use by officers and staff of the DOH, PhilHealth,
local government units, and other partners and stakeholders in the government and the
private sector. Understanding the guidelines provided in this Compendium is essential in
leveling off expectations in the implementation of the law, especially among key movers
in the health system. In the end, UHC is about inclusivity and solidarity in pursuit of a
health care system that is by the people and for the people.
I would like to express my utmost gratitude to all those who have unselfishly shared
their technical expertise, perspectives and diverse experiences for the development of the
UHC operational policies and guidelines. Special thanks is likewise extended to Secretary
Francisco T. Duque III, for the trust and opportunity to lead this endeavor.
MARIO C. VILLAVERDE, MD, MPH, MPM, CESO I

Underseecretary
xii COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
xiii
FOREWORD
The Compendium contains all Universal Health Care (UHC) operational policies
and guidelines which are sequentially organized and harmonized according to the
pillars of health system reforms. This shall serve as a reference for all Filipinos in
accessing information on UHC. Moreover, this Compendium will guide our local health
implementers and other partners in the public and private sector in ensuring alignment
of their priorities and strategies to sectoral goals in health.
After the successful passage of the UHC Act and its Implementing Rules and
Regulations, the DOH identified 60 critical policies and operational guidelines that
would support the implementation and realization of the goals and objectives of UHC.
These guidelines are anchored on the key provisions of the law that have been identified
in the UHC policy agenda. Following this agenda, the Health Policy and Systems
Development Team with its Health Policy Development and Planning Bureau organized
this Compendium. This will guide the Department of Health and other stakeholders
in the health sector in pioneering programs and strategies towards equitable access
to quality and affordable health goods and services, and the protection of all Filipinos
against financial risk.
We enjoin everyone to maximize the use of this Volume 1 of the Compendium

in enhancing their knowledge, expanding their perspective, and implementing critical
actions regarding UHC. In this regard, the HPDPB is committed to provide everyone
with policy facilitating actions and services to achieve UHC goals.
FRANCES ROSE ELGO–MAMARIL, MPH

Director IV
Health Policy Development and Planning Bureau
xiv COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
xv
President Rodrigo Roa Duterte signing the Universal Health Care Act (R.A. No. 11223)
at Malacañang Palace on 20 February 2019 with members of the Senate, the House of
Representatives, and Cabinet as witnesses.
Health Secretary Francisco T. Duque III signing the Implementing Rules and Regulations
of the Universal Health Care Act (R.A. No. 11223) at Manila Prince Hotel on 10 October
2019 in the presence of members of Congress and the DOH Executive Committee.
xvi COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
1
1 FRAMEWORK
AND MANDATES
OF UNIVERSAL HEALTH CARE
The Universal Health Care (UHC) Act, also known as Republic Act 11223, was signed
into law by President Rodrigo Roa Duterte on February 20, 2019. Its Implementing Rules
and Regulations was signed by Health Secretary Francisco T. Duque III on October 10,
2019, thus paving the way for the Philippines to embark on a major health reform under
the leadership of the Department of Health (DOH) and the Philippine Health Insurance
Corporation (PhilHealth).
The conceptual framework of the law is based on the World Health Organization’s
three dimensions of universal health coverage, namely population coverage, service
coverage, and financial coverage. The law mandated major areas of reform in the
health sector, such as the organization of the health system into health care provider
networks composed of primary, secondary and tertiary levels of care where primary care
facilities serve as the gatekeeper and navigator of health services within the network; the
classification of health services into two major groups of health care packages consisting
of population-based and individual-based health services; and the simplification of
health financing mechanisms where population-based health services will be generally
supported by tax-based financing while individual-based health services will be largely
financed through premium-based social health insurance scheme.
In line with the conceptual framework and the major provisions and key action points
provided by the law, the DOH and PhilHealth, in coordination with concerned agencies,
sectors, and stakeholders, developed several operational policies and guidelines to lead
the Philippines on a path toward progressive realization of universal health coverage.
FRAMEWORK AND MANDATES OF UNIVERSAL HEALTH CARE 3
MANDATES OF UNIVERSAL HEALTH CARE

IN THE PHILIPPINES
• An Act Instituting Universal Health Care for All Filipinos, Prescribing

Reforms in the Health System, and Appropriating Funds Therefor
(Republic Act No. 11223)
• Implementing Rules and Regulations of Republic Act No. 11223

IMPLEMENTING RULES AND REGULATIONS

OF UNIVERSAL
IMPLEMENTING HEALTH
RULES AND CARE
REGULATIONS OF THEACT
UNIVERSAL HEALTH CARE ACT (REPUBLIC ACT NO. 11223)
(REPUBLIC
IMPLEMENTING ACT
RULES AND NO. 11223)
REGULATIONS OF THE
UNIVERSAL HEALTH CARE ACT (REPUBLIC ACT NO. 11223)
RULEI. GENERAL PROVISIONS

RULEI. GENERAL PROVISIONS
Section 1. Title
Section 1. Title
1.1. Theserules and regulations shall be known as the Implementing Rules and Regulations
of Republic Act No. 11223, otherwise known as the Universal Health Care Act,
1.1. These rules and regulations shall be known as the Implementing Rules and Regulations
hereinafter referred to as the Act. Hereinafter, these rules and regulations shall be
of Republic
referred Act No.
to as the Rules. 11223,
otherwise known as the Universal Health Care Act,
hereinafter referred to as the Act. Hereinafter, these rules and regulations shall be
referred to as the Rules.
Section 2. Declaration of Principles and Policies
Section 2. Declaration of Principles and Policies

2.1. It is the policy of the State to protect and promote the right to health of all Filipinos and
instill health consciousness among them. Towards this end, these Rules shall enforce
It is the policy of the State to protect and promote the right to health of all Filipinos and
2.1. the
Act andits spirit in its entirety, embodying the following principles:
instill health consciousness among them. Towards this end, these Rules shall enforce
2.1.a.
the Act its spirit in itsandentirety,
An integrated
and comprehensive approach
embodying to ensure
the following that all
principles: Filipinos are
health literate, provided with healthy living conditions, and protected from
2.1.a. An integrated and comprehensive approach to ensure that all Filipinos are
hazards and risks that could affect their health;
health provided with healthyFilipinos and protected from
2.1.b. A health literate,
care model that provides all living conditions,
and risks that could affect their health;
access to a comprehensive set
ofhazards
quality and cost-effective, promotive, preventive, curative, rehabilitative
2.1.b. A health care model
and palliative health services withoutall
that provides Filipinos access
causing
to a comprehensiveand
financial hardship
set
of
prioritizes
and cost-effective,
quality the needs of the promotive,
population who preventive,
cannot afford curative, rehabilitative
such services;
2.1.c¢.
and palliative health services without causing
A framework that fosters a whole-of-system, whole-of-government, financial hardship andand
prioritizes the needs of theinpopulation who cannot afford such services;
the development, implementation, monitoring,
whole-of-society approach
2.1.c¢. A framework
and evaluation ofthat fosters
health policies,whole-of-system,
a whole-of-government, and
programs and plans; and,
A whole-of-society in the
approach for the development, implementation,
services that ismonitoring,
2.1.d. people-oriented approach delivery of health centered
of
2.1.d.
and evaluation
A people-oriented
health policies,
approach
programs
on people’s needs and well-being, and cognizant of
and plans; and,
the differences in culture,
for the delivery of health services that is centered
values, and beliefs.
on people’s needs and well-being, and cognizant of the differencesin culture,
values, and beliefs.
Section 3. General Objectives
Section 3. General Objectives
3.1. The objectives of these Rules are to:
3.1.a. universal health care in the country through a systemic
3.1. The objectives of these realize
Progressively Rules are to:
approach and clear delineation of roles of key agencies and stakeholders
3.1.a.
3.1.b.
Progressively
towards better performance
approach and clear in
realize universalthehealth
delineation
healthcare
of roles
Ensure that all Filipinos are guaranteed equitable
in the country through a systemic
system; and,
of key agencies and stakeholders
access to quality and
3.1.b.
towards better
affordable healthperformance in
the health
care goods and services and system; and, against financial risk.
protected
Ensure that all Filipinos are guaranteed equitable access to quality and
affordable health care goods and services and protected against financial risk.
Page 1 of 63
Page 1 of 63
Section 4. Definition of Terms
For the purposes of these Rules, the following terms are defined as such:
4.1. Abuse
ofauthority - Refers to an act of a person performing a duty or function that goes
beyond what is authorized by the Act and RA 7875 (National Health Insurance Act of
1995), as amended,
to the public.
or
their implementing rules and regulations (IRR), and is inimical
4.2. Amenities - Refer to features of the health service that provide comfort or convenience,
such as private accommodation, air conditioning, telephone, television, and choice of
meals, among others.
4.3. Basic or ward accommodation -Refers to the provision of regular meal, bed in shared
room, fan ventilation, and shared toilet and bath.
4.4, Co-insurance - Refers to a percentage of a medical charge that is paid by the insured,
with the rest paid by the health insurance plan.
4.5. Co-payment
-Refers to a flat fee or predetermined rate paid at point of service, as may
be determined by the Philippine Health Insurance Corporation (PhilHealth).
4.6. Complementation/complement — Refers to a strategic partnership of two or more

healthcare organizations, particularly public and private providers, to deliver a
comprehensive set
of health services to a given population or group of people.
4.7. Contracting - Refers to a process where providers and networks are engaged to commit
and deliver quality health services at agreed cost, cost sharing and quantity in
compliance with prescribed standards.
4.8. Direct contributors - Refer to those who have the capacity to pay premiums, are
gainfully employed and are bound by an employer-employee relationship, or are self-
earning, professional practitioners, migrant workers, including their qualified
dependents, and lifetime members.
4.9. Emergency - Refers to a condition or state of a patient wherein based on the objective
findings of a prudent medical officer on duty, there is immediate danger and where
delay in initial support and treatment may cause loss of life or permanent disability to
the patient, or in the case of a pregnant woman, permanent injury or loss of her unborn
child, or a non-institutional delivery.
4.10. Entitlement - Refers to any singular or package of health services provided to Filipinos
for the purpose of improving health.
Page 2 of 63
4.11. Essential health benefit package - Refers to a set of individual-based entitlements

covered by the National Health Insurance Program (NHIP) which includes primary
care; medicines, diagnostics and laboratory; and preventive, curative, and rehabilitative
services.
4.12. Financial integration - Refers to the consolidation of financial resources exclusively

for health services and health system development under a single planning and
investment strategy by the province-wide and city-wide health system.
4.13. Fraudulent act - Refers to any act of misrepresentation or deception resulting in undue
benefit or advantage on the part of the doer or any means that deviate from normal
procedure and is undertaken for personal gain, resulting thereafter to damage and
prejudice which may
be capable of pecuniary estimation.
4.14. Geographically Isolated and Disadvantaged Areas (GIDAs) - Refer to barangays

specifically disadvantaged due to the presence of both physical and socio-economic
factors. For a barangay to be classified as GIDA, both physical factor and socio-
economic factor must be present. The terms GIDA, unserved and underserved areas are
used interchangeably in these Rules.
4.14.a. Physical factors are characteristics that limit the delivery of and/or access to
basic health services to communities that are difficult to reach due to
distance, weather conditions, and transportation difficulties.
4.14.b. Socio-economic factors are social, cultural, and economic characteristics of
the community that limit access to and utilization of health services.
4.15. Health care provider - Refers to any of the following:

4.15.a. A health facility which may be public or private, devoted primarily to the
provision of services for health promotion, prevention, diagnosis, treatment,
rehabilitation and palliation of individuals suffering from illness, disease,
injury, disability, or deformity, or in need of obstetrical or other medical and
nursing care.
or a
4.15.b. A health care professional who may be doctor of medicine, nurse, midwife,
dentist, or other allied professional practitioner duly licensed to practice in
the Philippines.
4.15.c._ Community-based health care organization - Refers to an association of
members of the community organized for the purpose of improving the health
status of that community.
4.15.4. Pharmacies or drug outlets - Refer to establishments licensed under RA 9711
(Food and Drug Administration Act of 2009) which sell or offer to sell any
health product directly to the general public or entities licensed by
appropriate government agencies, and which are involved in compounding
and/or dispensing and selling of pharmaceutical products directly to patients
or end users as defined under RA 10918 (Philippine Pharmacy Act).
4.15.e. Laboratories and diagnostic clinics - Refer to licensed facilities where tests
are done on the human body or on specimens thereof to obtain information
Page 3 of 63
about the health status of

of diseases.
a patient for the prevention, diagnosis and treatment
4.16. Health care provider network (HCPN) - refers to a group of primary to tertiary care
providers, whether public or private, offering people-centered and comprehensive care
in an integrated and coordinated manner with the primary care provider acting as the
navigator and coordinator of health care within the network.
4.17. Health Maintenance Organization (HMO) - Refers to

an entity that provides, offers, or
covers designated health services for its plan holders or members for a fixed prepaid
premium.
4.18. Health Technology Assessment (HTA) - Refers to the systematic evaluation of

properties, effects, or impact of health-related technologies, devices, medicines,
vaccines, procedures and all other health-related systems developed to solve a health
problem and improve quality of lives and health outcomes, utilizing a multidisciplinary
process to evaluate the social, economic, organizational, and ethical issues of a health
intervention or health technology.
4.19. Indirect contributors -

Refer to
all others not included as direct contributors, as well as
their qualified dependents, whose premium shall be subsidized by the national
government including those who are
subsidized as a result of special laws.
4.20. Individual-based health services - Refer to services which can be accessed within a
health facility or remotely that can be definitively traced back to one (1) recipient, has
limited effect at a population level and does not alter the underlying cause of illness
such as ambulatory and inpatient care, medicines, laboratory tests and procedures,
among others.
4.21. Managerial integration - Refers to the consolidation of administrative, technical and

managerial functions of the province-wide and city-wide health systems over its
resources such as health facilities, human resources for health, health finances, health
information systems, health technologies, equipment and supplies.
4.22. Navigation - Refers to the function of coordinating and directing the individual to obtain
health services needed to manage a wide range of health needs.
4.23. Population-based health services - Refer to interventions such as health promotion,

disease surveillance, and vector control, which have population groups as
recipients.
4.24. Prepayment - Refers to an approach in the purchase of health services by which health
care providers are paid in advance for the cost of goods and services for a specific
packageof health benefits based solely on a pre-determined and fixed budget.
Page 4 of 63
4.25. Primary care - Refers to initial-contact, accessible, continuous, comprehensive and

coordinated care that is accessible at the time of need including a range of services for
all presenting conditions, and the ability to coordinate referrals to other health care
providers in the health care delivery system, when necessary.
4.26. Primary care provider - Refers to a health care worker, with defined competencies,
who has received certification in primary care as determined by the Department of
Health (DOH) or any health institution that is licensed and certified by the DOH.
4.26.a. Primary care practice - Refers to the exercise of duties and responsibilities
of multidisciplinary team of health workers which shall be eligible to be
assigned to a catchment area/population in a primary care facility.
4.26.b. Primary care facility - Refers to the institution that primarily delivers primary
care services which shall be licensed or registered by the DOH.
4.26.c. Primary care worker - Refers to a health care worker, who may be
professional or community health worker/volunteer, certified by
a
health
DOH to
provide primary care services.
4.27. Primary health care - Refers to a whole-of-society approach that aims to ensure the
highest possible level of health and well-being through equitable delivery of quality
health services.
4.28. Private health insurance - Refers to coverage of a defined set of health services
financed through private payments in the form of a premium to the insurer.
4.29. Prospective payment - Refers to a method of reimbursement in which payment based is

a
on a predetermined, fixed amount. The payment amount for particular service is based
on disease or diagnosis-related groupings and validated costing methodologies.
4.30. Public health emergency - Refers to an occurrence or imminent threat of an illness or

health condition that:
4.30.a. Is caused by any
of the following: (i) bioterrorism; (ii) appearance of a novel
or previously controlled or eradicated infectious agent or biological toxin;
(iii) a natural disaster; (iv) a chemical attack or accidental release; (v) a
nuclear attack or accident; or (vi) an attack or accidental release of
radioactive materials; and,
4.30.b. Poses a high probability of any of the following: (i) a large number of
deaths
in the affected population; (ii) a large number of serious injuries or long —
term disabilities in the affected population; (iii) widespread exposure to an
infectious or toxic agent that poses a significant risk of substantial harm to a
large number of people in
the affected population; (iv) international exposure
to an infectious or toxic agent that poses a significant risk to the health of
citizens of other countries; or (v) trade and travel restrictions.
4.31. Recidivist - Refers to one who, at

that time of hearing for an offense, shall have been
previously found liable with finality by the Adjudication Office or by the Board of
PhilHealth, for three (3) offenses, under these Rules.
Page 5 of 63
4.32. Unethical act - Refers to any action, scheme or ploy against the NHIP, such as
overbilling, upcasing, harboring ghost patients or recruitment practice, or any act
contrary to the Code of Ethics of the responsible person’s profession or practice, or
other similar, analogous acts that put or tend to put in disrepute the integrity and
effective implementation of the NHIP.
Page 6 of 63
RULE I. UNIVERSAL HEALTH CARE (UHC)
Section 5. Population Coverage
5.1. Every Filipino citizen shall be automatically included into the National Health
Insurance Program, hereinafter referred to as the Program.
5.2. The Philippine Health Insurance Corporation (PhilHealth), shall coordinate with other
national government agencies (NGAs) such as but not limited to the Department of
Social Welfare and Development (DSWD), Department of Foreign Affairs (DFA),
Department of Labor and Employment (DOLE), Department of Trade and Industry
(DTD, Civil Service Commission (CSC), Bureau of Internal Revenue (BIR), Philippine
Overseas Employment Administration (POEA), Overseas Workers Welfare
Administration (OWWA), Philippine Statistics Authority (PSA), Social Security
System (SSS), the Government Service Insurance System (GSIS), and health care
facilities towards the inclusion of
future laws
all in
Filipinos
affect the
at
its database no cost. This is without
identification
prejudice to or guidelines that may or enumeration
of Filipinos.
Section 6. Service Coverage
Immediate Eligibility to Benefits
6.1. Every Filipino shall be granted immediate eligibility and access to preventive,
promotive, curative, rehabilitative, and palliative care for medical, dental, mental and
emergency health services, delivered as population-based or individual-based health
services; Provided, That a fair and transparent health technology assessment (HTA)
process, as described in Section 34 of these Rules, shall govern the inclusion of health
goods and services to which every Filipino
DOH.
is eligible to access through PhilHealth and
6.2. The DOH

and PhilHealth shall definespecific health service packages for population-
based and individual-based health services in accordance with the provisions in
Sections 17 and 18 of these Rules, respectively.
Comprehensive Outpatient Benefits
6.3. Within two (2) years from the effectivity of these Rules, PhilHealth shall implement a
comprehensive outpatient benefit, including outpatient drug benefit and emergency
medical services, in accordance with the recommendation of Health Technology
Assessment Council (HTAC) as prescribed under Section 34 of these Rules. The
benefits shall include, but are not limited to: services of health care professionals;
diagnostic, laboratory, dental and other medical services; personal preventive services;
Page 7 of 63
prescription drugs and biologicals, subject to the limitations of the Act; and other
services deemed appropriate.
Provision of Primary Care Providers
6.4. The DOH andlocal government units (LGUs) shall endeavor to provide a health care
delivery system that shall afford every Filipino a primary care provider, as defined in
Section 4.26 of these Rules.
6.5. The primary care provider shall act as the navigator, initial and continuing point of
contact in health care delivery system; Provided, That except in emergency
or
serious
cases and when proximity is a concern, access to higher levels of care shall be
coordinated by the primary care provider.
Registration of Filipinos to Primary Care Provider Networks
6.6. Every Filipino shall register with a public or private primary care provider of choice
with due consideration to proximity and ease of travel of those seeking care, absorptive
capacity of the provider for quality care, and provider capability to deliver the required
services, among others.
6.7. The LGUs, with the assistance from DOH and PhilHealth, shall register their respective
constituents to a primary care provider within their territorial jurisdiction; Provided,
That the DOH, in coordination with PhilHealth, shall promulgate the guidelines on the
registration of every Filipino to a primary care provider that stipulate the standard
processes, procedures, guidelines, form, and data management, among others.
6.8. The DOH shall issue guidelines for the licensing of primary care providers in
accordance with Sections 27.4 and 27.5 of these Rules.
Section 7. Financial Coverage
7.1. Population-based health services shall be financed by the national government through
the DOH and provided free of charge at point of service for all Filipinos.
7.1.a. The DOH, in coordination with PhilHealth, Department of Budget and
Management (DBM) and the Department of the Interior and Local
Government (DILG), in consultation with LGUs and health care providers
and partners, shall identify the milestones for the transition of other sources
of financing of health facilities to improve the prospective PhilHealth
payment mechanism as described in Section 18 of these Rules.
7.1.b. Other NGAs, LGUs, international health partners, and other stakeholders
shall adhere to the UHC priorities set by DOH and ensure complementation
in health financing.
Page 8 of 63
7.2. The national government shall support LGUs in

and provision of population-based health services.
the financing of capital investments
7.3. Individual-based health services shall be financed primarily through prepayment

mechanisms such as social health insurance, private health insurance, and HMO plans
to ensure predictability of health expenditures; Provided, That the DOH and PhilHealth,
in consultation with the Insurance Commission, private health insurance and HMOs,
shall issue guidelines and monitoring schemes in to
order rationalize financing schemes
and to ensure that there is complementation in the financing coverage of individual-
based health services in accordance with Sections 18 and 28.23 of these Rules.
7.4. Province-wide and city-wide health systems, as described in Section 19 of these Rules,
shall ensure funding for effective health operations and conductof activities such as but
not limited to capacity building, research, and health promotion consistent with national
guidelines and with support from the DOH.
Page 9 of 63
RULE ITI NATIONAL HEALTH INSURANCE PROGRAM
Section 8. Program Membership
8.1. Membership into the Program shall be simplified into two (2) types, direct contributors
and indirect contributors, as defined in Section 4.8 and 4.19 of these Rules respectively,
with their qualified dependents, namely:
8.1.a. Legal spouse/s who is/are not an active member;
8.1.b. Unmarried and unemployed legitimate, illegitimate children, and legally
adopted or stepchildren below twenty-one (21) years of age;
8.1.c. Foster children as defined in RA 10165 (Foster Care Act of 2012); and,
8.1.d. Parents who are sixty (60)-years old and above, not otherwise an enrolled
member.
8.2. Direct contributors, including their qualified dependents shall be composed of, but not
limited to, the following:
8.2.a, Employees with formal employment characterized by the existence of an
employer-employee relationship, which include workers in the government
and private sector, whether regular, casual, or contractual, are occupying
either an elective or appointive position, regardless of the status of
appointment, whose premium contribution payments are equally shared by
the employee and the employer;
8.2.b. Kasambahays, as defined in RA 10361 (Domestic Workers Act);
8.2.¢. All other workers who are not covered by formal contracts or agreements or
who have no employee-employer relationship and whose premium
contributions are self-paid, and with capacity to pay premiums, such as the
following:
8.2.c.i. Self-earning individuals; and
8.2.c.ii. Professional practitioners;
8.2.d. Overseas Filipino Workers, as defined in RA 10022 (Migrant Workers Act)
and RA 10801 (OWWA Act) as,
such but not limited to:
8.2.d.i. Sea-based Filipino workers or seafarers; and,
8.2.d.ii. Land-based overseas Filipino workers;
8.2.€. Filipinos living abroad;
8.2.f. Filipinos with dual citizenship;
8.2.g. Lifetime members as defined in RA 10606 (National Health Insurance Act);
and,
8.2 h. All Filipinos aged 21 years and above who have the capacity to pay
premiums.
8.3. Direct contributors shall register and/or update their records and premium contributions
with PhilHealth upon the effectivity of these Rules.
Page 10 of 63
8.4. Indirect contributors, including their qualified dependents shall be composed of, but not
limited to, the following:
8.4.a. Indigents identified by the DSWD;
8.4.b. Beneficiaries of Pantawid Pamilyang Pilipino Program/Modified
Conditional Cash Transfer (4Ps/MCCT);
8.4.¢. Senior citizens who are not currently covered by the Program;
8.4.d. Persons with disability, as defined in RA 10754 (An Act Expanding the
Benefits and Privileges of Persons with Disability);
8.4.¢. All Filipinos aged 21 years old and above without the capacity to pay
premiums;
8.4.f. Sangguniang Kabataan officials, as defined in RA 10742 (Sangguniang
Kabataan Reform Act); and,
8.4.¢. Those previously identified at point-of-service (POS) or during registration,
members previously sponsored by LGUs and those who arenot yet in the
PhilHealth database and are financially incapable to pay premiums.
8.5. PhilHealth shall authorize the DSWD or social welfare officers of the LGUs to
determine those who are financially incapable to pay premiums.
Section 9. Entitlement to Benefits
Benefit Availment
9.1. Every member shall be granted immediate eligibility for health benefit packages
without the need of presenting the PhilHealth identification card under the Program;
Provided, That this does not preclude the necessity to present any valid identification
for purposes of proving identity. Those who are not in the PhilHealth database shall be
duly registered by health care facilities, subject to the guidelines that will be issued by
PhilHealth.
9.2. Failure to pay premiums shall not prevent the enjoyment of any Program benefits.
However, employers and self-employed direct contributors shall be required to pay
missed contributions with an interest, compounded monthly:
all
9.2.a. At least three percent (3%) for employers of private and government sector,
sea-based migrant workers; and kasambahays; and,
9.2.b. Not exceeding one and one-half percent (1.5%) for self-earning individuals,
professional practitioners, land-based migrant workers, Filipinos living
abroad; and Filipinos with dual citizenship.
9.3. Failure by the employer and self-employed direct contributors to pay premium
contributions shall constitute an offense as provided for under Section 38 of the Act.
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No Co-payment Policy
9.4. other fees or expenses, including professional fees, shall be charged to all members
No
admitted in any basic or ward accommodations.
9.5. Members who opt for basic or ward accommodations shall be provided all necessary
services and complete quality care to attain the best possible health outcomes.
9.6. In the absence of available beds and transfer to another facility is not feasible, members
who
opt for basic or ward accommodation but admitted in non-basic accommodation
shall be entitled to no co-payment for services, professional fees, and amenities.
9.7. In the event of change in level of care, members who opt for basic or ward
accommodation shall be considered as such unless otherwise chosen by the patient or
legal next of kin.
9.8. Members who optfor admissions in non-basic or non-ward accommodations may be

charged co-payments/co-insurance for services, professional fees, and amenities.
9.9. PhilHealth shall issue guidelines to operationalize the no co-payment policy.
Co-Payments and Co-Insurance
9.10. The DOH and PhilHealth shall prescribe the guidelines for co-payment orco-insurance
in determining the additional services that are not included in the minimum standards
of care in the management of the conditions and charges for amenities outside the basic
or ward accommodation.
9.11. The DOH, PhilHealth, and health facilities are required to regularly inform all members
of the co-payment or co-insurance scheme, as prescribed by DOH and PhilHealth, for
public health care providers and public-led health care provider networks, and of the
co-payment or co-insurance scheme agreed upon by PhilHealth with private health care
providers and private-led networks.
9.12. The DOH, PhilHealth, HMOs, and life and non-life private health insurance (PHIs) are
required to regularly inform all members of the complementation and co-insurance
policies as prescribed in Section 28.23 of these Rules.
PhilHealth Benefits
9.13. Existing benefit packages shall continue to be implemented or enhanced unless

otherwise recommended by the HTA process established in Section 34 of these Rules.
Page 12 of 63
9.14. PhilHealth shall issue the necessary guidelines on the additional Program benefits for
direct contributors, where applicable.
Section 10. Premium Contributions
Direct Contributors
10.1. Premium rates shall be in accordance with the following schedule, and monthly income
floor and ceiling, upon the effectivity of these Rules:
Year Premium Income Floor Income Ceiling

Rate
2019 2.75 % Php 10,000.00 Php 50,000.00
2020 3.00 % Php 10,000.00 Php 60,000.00
2021 3.50 % Php 10,000.00 Php 70,000.00
2022 4.00 % Php 10,000.00 Php 80,000.00
2023 4.50 % Php 10,000.00 Php 90,000.00
2024 5.00 % Php 10,000.00 Php 100,000.00
2025 5.00 % Php 10,000.00 Php 100,000.00
Direct contributors earning below the income floor shall pay their premium contribution
based on the income floor; Provided, That those earning above the income ceiling shall
pay their premium contribution based on the income ceiling; Provided further, That for
any income from the income floor to the income ceiling, the premium contribution shall
be computed based on the basic monthly income.
10.2. The following special provisions shall apply to the following:

10.2.a. Self-earning individuals and practicing professionals — The premium
contribution shall be computed based on the individual’s monthly income as
shown in documents prescribed by PhilHealth. Non-submission of
acceptable proof of actual income shall result in the charging of the rate based
on the income ceiling. PhilHealth shall establish guidelines defining the
acceptable proof of actual income.
10.2.b. Kasambahays - Premium payments or contributions of Kasambahays shall
be shouldered by the employer. However, if the kKasambahay is
wage of five thousand pesos (P5,000.00) and above per month, the
receiving a
kasambahay shall pay the proportionate share in the premium payments or

contributions, in accordance with RA 10361 (Domestic Workers Act).
Page 13 of 63
10.2.c. Overseas Filipino Workers - The premium contribution shall be salary-based

as prescribed by the Act and shall require submission of acceptable proof of
actual income. Non-submission of acceptable proof of actual income shall
result in the charging of the rate based on the income ceiling. The Philippine
Overseas Employment Administration (POEA) shall ensure that land-based
overseas Filipino workers, whether new hires or returning (balik
manggagawa), pay their PhilHealth premiums prior to issuance of the
Overseas Employment Certificate (OEC). Specific guidelines shall be issued
by the POEA and PhilHealth.
10.2.4. Persons with disability — Premium payments or contributions of formally
employed persons with disability shall be shared equally by their employers
and the national government.
10.2.e. All Filipinos aged 21 years and above who have the capacity to pay shall pay
their premiums based on PhilHealth guidelines.
Indirect Contributors
10.3. The premium subsidy for indirect contributors shall be gradually adjusted and included
annually in the General Appropriations Act (GAA) under theline item for PhilHealth
and shall be released directly to PhilHealth. The DOH, incoordination with PhilHealth,
may request Congress to appropriate supplemental funding to meet targeted milestones
of the Act.
10.4. in
For every increase the rate of contribution of direct contributors and premium subsidy
of indirect contributors, PhilHealth shall provide for a corresponding increase in
benefits, subject to financial sustainability; Provided, That PhilHealth shall coordinate
with the DBM on the budgetary requirements for such increase.
10.5. PhilHealth shall issue specific and necessary guidelines for direct and indirect
contributors with regard to membership registration and premium payment.
Section 11. Program Reserve Funds
11.1. PhilHealth shall set aside a portion of its accumulated revenues not needed to meet the
cost of the current year’s expenditures as reserve funds.
11.2. The total amount of reserves shall not exceed a ceiling equivalent to the amount
actuarially estimated for two (2) years’ projected Program expenditures.
11.3, Whenever actual reserves exceed the required ceiling at the end of the fiscal year, the
excess of the PhilHealth reserve fund shall be used to increase the Program’s benefits
and to decrease the amount of members’ contributions.
11.4. Any unused portion of the reserve fund that is not needed to meet the current
expenditure obligations or support the abovementioned programs shall be placed in
Page 14 of 63
investments to earn an average annual income

be referred to as the Investment Reserve Fund.
at prevailing rates of interest and shall
11.5. The Investment Reserve Fund shall be invested in
or
any all the following:
11.5.a. other evidences of indebtedness
In interest-bearing bonds, securities or of the
Government of the Philippines; Provided, That such investment shall be at
least fifty percent (50%) of the reserve fund;
11.5.b. In debt securities and corporate bonds of prime or solvent corporations
of
created or existing under the laws the Philippines; Provided, That:
11.5.b.i. The issuing or its predecessor entity shall not have defaulted in the
its
payment of interest on any of securities;
11.5.b.ii. The securities are issued by companies with high growth
opportunities and earning potentials; and,
11.5.b.iii. Such investments shall not exceed thirty percent (30%) of the
reserve fund;
11.5.c. In interest-bearing deposits and loans to or securities in any domestic bank
doing businessin the Philippines; Provided, That:
11.5.c.i. In the case of such deposits, this shall not exceed at any time the
unimpaired capital and surplus or total private deposits of the
depository bank, whicheveris smaller; and,
11.5.c.ii. The bank is designated as a depository for this purpose by the
Monetary Board of the Bangko Sentral ng Pilipinas;
11.5.d. In preferred stocks of any solvent corporation or institution created or
existing under the laws of the Philippines listed in the stock exchange with
proven track record or profitability over the last three (3) years and payment
at
of dividends for a period of least three (3) years immediately preceding the
in
date of investment such preferred stocks;
11.5.e. In common stocks of any solvent corporation or institution created or existing
under the laws of the Philippines listed in the stock exchange with high
growth opportunities and earnings potentials;
11.5.f. In bonds, securities, promissory notes, or other evidences of indebtedness of
accredited and financially sound medical institutions exclusively to finance
the construction, improvement and maintenance of hospitals and other
medical facilities: Provided, That:
11.5.f.1. Such securities and instruments are guaranteed by the Republic of
the Philippines or the issuing medical institution and the issued
securities are both rated triple ‘A’ by authorized accredited
domestic rating agencies; and,
11.5.f.ii. Said investments shall not exceed ten percent (10%) of the total
reserve fund; and,
11.5.g. In debt instruments and other securities traded in the secondary markets with
the same intrinsic quality as those enumerated in Sections 11.5.a. to 11.5.e.
of these Rules, subject to the approval of the PhilHealth Board.
Page 15 of 63
11.6. No portion of the reserve fund or income thereof shall accrue to the general fund of the
national government or to any of its agencies or instrumentalities, including
government-owned or -controlled corporations.
11.7. As
part of its investments operations, PhilHealth may hire institutions with valid trust
licenses as its external local fund managers to manage the reserve fund, as it may deem
appropriate, through public bidding. The fund manager shall submit an annual report
on investment performance to PhilHealth.
11.8. The PhilHealth shall set up the following funds:
11.8.a. A fund to secure benefit payouts to member prior to their becoming lifetime
members;
11.8.b. A fund to secure payouts to lifetime members; and,
11.8.c. A fund for optional supplemental benefits that are subject to additional
contributions.
11.9. A portion of each of the above funds shail be identified as current and kept in liquid
instruments. In no case shall said portion be considered part of invested assets.
11.10. The PhilHealth shall allocate a portion of all contributions to the fund for lifetime
members based on an allocation to be determined by the PhilHealth actuary based on a
pre-determined percentage using the current average age of members and the current
life expectancy and morbidity curve of Filipinos.
11.11. PhilHealth shall manage the supplemental benefits and the lifetime members’ funds in
an actuarially sound manner.
11.12. PhilHealth shall manage the supplemental benefits fund to the minimum required to
ensure that the supplemental benefit payments are secure.
11.13. PhilHealth shall formulate Specific Investment Guidelines with due and prudent regard
for the safety, growth, and liquidity of the Fund, subject to the approval of the
PhilHealth Board.
Section 12. Administrative Expenses
12.1. No more than seven and one-half percent (7.5%) of the actual total premium collected
from direct and indirect contributory members during the immediately preceding year
shall be allotted for the administrative cost of implementing the Program.
Section 13. PhilHealth Board of Directors
13.1. The PhilHealth Board of Directors, hereinafter referred to as the Board, is hereby
reconstituted to have a maximum of thirteen (13) members, consisting of the following:
Page 16 of 63
13.1.a. Five (5) ex officio members, namely: Secretary of Health, Secretary of Social
Welfare and Development, Secretary of Budget and Management, Secretary
of Finance; and Secretary of Labor and Employment;
13.1.b. Three (3) expert panel members with expertise in public health, management,
finance, and health economics; and,
13.1.c. Five (5) sectoral panel members representing the direct contributors, indirect
contributors, employers group; health care providers to be endorsed by their
national associationsof health care institutions and health care professionals;
and, representative of the elected local chief executives to be endorsed by the
League of Provinces of the Philippines, League of Cities of the Philippines
and League of Municipalities of the Philippines.
13.2. At least one (1) of the expert panel members and at least two (2) of the sectoral panel
members are women.
13.3. The sectoral and expert panel members must be Filipino citizens and of good moral
character.
13.4, The expert panel members must:

13.4.4. Be of recognized probity and independence and must have distinguished
themselves professionally in public, civic or academic service;
13.4.b. Be in the active practice of their professions for at least seven (7) years; and,
13.4.c. Not be appointed within one (1) year after losing in the immediately
preceding elections, whether regular or special.
13.5. The Secretary of Health shall be an ex officio nonvoting Chairperson of the Board.
13.6. All appointive members of the Board shall be required to undergo training in health
care financing, health systems, costing health services and HTA prior
to the start of
their term. Noncompliance shall be a ground for dismissal.
13.7. Within thirty (30) days following the effectivity of the Act, the Governance
Commission for Government-Owned or -Controlled Corporations (GCG) shall, in
accordance with the provisions of RA 10149 (Government-Owned or -Controlled
Corporations (GOCC) Governance Act of 2011), promulgate the nomination and
selection process for appointive members of
the Board with a clear set of qualifications,
credentials, and recommendation from the concerned sectors.
Section 14. President and Chief Executive Officer (CEQ) of PhilHealth
14.1. Upon the recommendation of the Board, the President of the Philippines shall appoint
the President and CEO of PhilHealth from the Board’s non-ex officio members:
Provided, That the Board cannot recommend a
President and CEO of PhilHealth unless
Page 17 of 63
the member is at
a Filipino citizen and must have least seven (7) years of experience in
the field of public health, management, finance, and health economics or a combination
of any of these expertise.
Section 15. PhilHealth Personnel as Public Health Workers.
15.1. All PhilHealth personnel shall be classified as public health workers in accordance with
the pertinent provisions under RA 7305 (Magna Carta for Public Health Workers) and
shall be entitled to Magna Carta benefits for public health workers.
Section 16. Additional Powers and Functions of PhilHealth
16.1. PhilHealth shall have the following additional powers and functions:
16.1.a. To fix the reasonable compensation, allowances and other benefits of all
positions, including its President and CEO, based on a comprehensive job
analysis and audit of actual duties and responsibilities, subject to the approval
of the President of the Philippines. The compensation plan shall be
comparable with government social security institutions and shall be subject
to periodic review by the Board no more than once every four (4) years
without prejudice to merit reviews or increases based on productivity and
efficiency;
16.1.b. To establish the organizational structure and staffing pattern of PhilHealth’s
central and regional offices to cover as many provinces, cities, and legislative
districts, including foreign countries, whenever and wherever it may be
expedient, necessary, and feasible; and to inspect or cause to be inspected
periodically such offices subject to the approval by the Board;
16.1.c. To maintain a Provident Fund which consists of contributions made by both
PhilHealth and its officials and employees and earnings thereon, for the
payment of benefits to such officials and employees or their dependents or
heirs under such terms and conditions as may be prescribed by the Board;
Provided, That any changes to the existing employer contribution shall be
subject to the approval of the President of the Philippines, upon the
recommendation of the PhilHealth Board; and,
16.1.d. To adopt or approve the annual and supplemental budget of receipts and
expenditures including salaries, allowances and early retirement of
PhilHealth personnel and to authorize such capital and operating
expenditures and disbursements as may be necessary and proper for the
effective management and operation of PhilHealth; Provided, That this shall
be subject to the budgetary limitations stated under Section 12 of these Rules;
Provided, further, That the submission of the corporate budget to the DBM
shall be for information purpose only.
Page 18 of 63
RULE IV. HEALTH SERVICE DELIVERY
Section 17. Population-based Health Services
Definition
17.1. Health services shall be classified

of the following criteria:
as population-based health services if they fulfill any
17.1.a. Intended to be received by populations or identified groups of people, of
which outcomes contribute to the general public health, safety and protection;
and,
17.1.b. Rendered in response to a public health emergency or disaster or any
circumstance of equal magnitude, such as diseases for elimination, that has
affected, or can potentially affect, a population.
Network Contracting
a
17.2. The DOH shall endeavor to contract province-wide and city-wide health systems as
described in Section 19 of these Rules, including BARMM, through legal instrument
to ensure shared responsibilities and accountabilities among members of the health
system for the delivery of population-based health services including those that impact
on the social determinants of health.
17.3. Province-wide and city-wide health systems shall have the following minimum
population-based health service components:
17.3.a. A primary care provider network, which refers to a coordinated group of
public, private or mixed primary care providers, as the foundation of the
health care provider network. The primary care provider network shall
provide primary care services; serve as initial contact and navigator to guide
patients’ decision making for cost-efficient and appropriate levels of care,
and coordinate patients to facilitate two-way referrals and remove barriers to
health services; enable patient records to be accessible throughout the health
system; and, implement public health services such as vector control and
sanitation as may be determined by the DOH;
17.3.b. Accurate, sensitive and timely epidemiologic surveillance systems, which
refer to the continuous systematic collection, analysis, interpretation, and
timely dissemination of health data for planning, implementation, and
evaluation of public health programs, in accordance with Sections 31 and 36
of these Rules;
17.3.c. Proactive, effective and evidence-based health promotion programs or
campaigns, including an analysis of and strategies to address social
determinants of health, as described in Section 30 of these Rules.; and,
17.3.d. Timely, effective, and efficient preparedness and response to public health
emergencies and disasters, and such other means to ensure delivery of
population-based health services.
Page 19 of 63
17.4. Tofacilitate the provision of population-based health services, a public health unit shall
be established in all hospitals to support the implementation of national public health
programs; institutionalize a coordination mechanism with primary care provider
networks; and provide a one-stop shop patient navigation support mechanism within
the hospital.
17.5. The DOH shall issue guidelines for contracting province-wide and city-wide health
systemsfor
the delivery of population-based health services.
Financing of Population-based Health Services
17.6. The DOH shall finance population-based health services and provide support in
financing capital investments, human resources for health capacity building, health
systems development, among others, to complement local government resources for
health.
Section 18. Individual-based Health Services.
Classifying Individual-based Health Services
18.1. Health services shall be classified as individual-based, whether accessed through health
care facilities or remotely through the use of digital technologies for health, if these can
be definitively traced back to one (1) recipient, has limited effect at a population level,
and does not alter the underlying cause of illness. Such services include, but are not
limited to, ambulatory and inpatient care, medicines, laboratory tests and procedures.
Network Contracting
18.2. PhilHealth shall endeavor to contract public, private, or mixed health care provider
networks through service-level agreements for the delivery of individual-based health
services; Provided, That the following conditions are present:
18.2.a.
18.2.b.
Members’ access to services shall not be compromised;
Networks agree to service quality, co-payment/co-insurance, and data
submission standards;
18.2.c. During the transition, PhilHealth and DOH shall incentivize health care
providers that form networks; and,
18.2.d._ Apex or end-referral hospitals, as determined by the DOH, may be contracted
as stand-alone health care providers by PhilHealth.
18.3. The DOH shall provide PhilHealth an updated list of public and private apex or end-
referral hospitals within the last quarter of every year.
Page 20 of 63
18.4, The contracted networks shall provide individual-based primary to tertiary health care
services with the following minimum components:
18.4.a. Assurance of member access to all levels of the health care provider
networks, including use of digital technologies for health;
18.4.6. A primary care provider network, as described in Section 17 of these Rules,
linked to secondary and/or tertiary care providers; Provided, That hospitals
shall focus on providing specialist outpatient services, except in selected
cases such as, but not limited to, gaps in the provision of primary care
services and where proximity is a concern, subject to issuance of guidelines
by DOH and PhilHealth;
18.4.c. A patient navigation and coordination system that ensures a continuum of
appropriate and coordinated care from primary to tertiary services, and back
to primary care;
18.4.d. Patient records management system, including electronic health records, that
ensures records are accessible by all facilities or providers within the health
care provider networks or among other facilities as necessary;
18.4.e. Provider payment mechanism as provided in Section 18.9 and 18.10 of these
Rules, based on the guidelines of PhilHealth, as appropriate;
18.4.f. Networks exhibiting proof of legal personality; and,
18.4.2. Mechanism of pooled fund management in the network.
18.5. Minimum requirements for contracting health care provider networks are as follows:
18.5.a. All health care facilities within the network shall be licensed or accredited by
the DOH, as
applicable; and,
18.5.b. All health care providers within the network shall execute or sign a
performance contract with PhilHealth.
18.6. Contracted networks and their health care provider members shall be subjected to the
quasi-judicial powers of PhilHealth.
18.7. The DOH and PhilHealth shall determine the standards on service quality and data
submission.
18.8. The DOH and PhilHealth shall incentivize health care providers that form networks in
accordance with the guidelines to be developed for the selection and payment ofhealth
care provider network based on Section 41.6 of these Rules.
Financing of Individual-based Health Services
18.9. PhilHealth shall:

18.9.a. Continue to finance individual-based health services utilizing current
payment mechanisms such as capitation and case rate payments. However,
for contracted networks and apex hospitals, it shall endeavor to shift to
paying providers using performance driven, closed-end, prospective
payments based on Diagnosis-Related Groupings (DRGs) and validated
Page 21 of 63
costing methodologies and without differentiating facility and professional

fees;
18.9.b. Develop differential payment schemes that give due consideration to service
quality, efficiency, equity, and public health outcomes; and,
18.9.c. Institute strong surveillance and audit mechanisms to ensure networks’
compliance to contractual obligations.
18.10. PhilHealth shall adopt any or a combination of closed-end, prospective provider

payment mechanisms, such as capitation, global budget, case-based payment, per diem
or daily charges, and other appropriate mechanisms; Provided, That PhilHealth, in
consultation with stakeholders, shall issue guidelines for the implementation of
provision.
18.11. All individual-based health services, including those transitioned from population-
based health services, shall be covered by PhilHealth; Provided, That all current benefit
packages of PhilHealth shall continue to be covered as individual-based services unless
reclassified by the DOHas population-based services.
18.12. Services that meet both population-based and individual-based health services criteria,
or neither of the criteria, shall retain its current financing mechanism; Provided, That
these health services shall be subject to assessments by the DOH in determining the
most efficient financing mechanism; Provided, further, That DOH and PhilHealth shall
issue the guidelines for implementing this provision.
Page 22 of 63
RULE V. ORGANIZATION OF LOCAL HEALTH SYSTEMS
Section 19. Integration of Local Health Systems into Province-wide and City-wide
Health System
Roles and Responsibilities in the Integration of Local Health Systems
19.1. The DOH, DILG, PhilHealth, and LGUs shall endeavor to integrate all local health
systems into province-wide health system to be composed of municipal and component
city health systems; and city-wide health systems to refer to Highly Urbanized City
(HUC)- and Independent Component City (ICC)-wide health systems.
19.2, The local health system refers to all health offices, facilities and services, human
resources, and other operations relating to health under the management of the LGUs
to promote, restore or maintain health; Provided, That community-based health care
facilities administered or operated by LGUs are considered to form part of the local
health system.
19.3. The private sector shall also be encouraged

system, which is a public-led health
to participate in the integrated local health
care provider network, through a contractual
arrangement with the province-wide or city-wide health system, subject to existing laws
and policies, Provided, That private health care providers, whether an individual
provider or a network of providers, may provide health services to complement health
services provided by public health. facilities; Provided, further, That other services to
support the management of the province-wide health system/city-wide health system
may also be contracted out to private entities.
19.4. In the case of the Bangsamoro Autonomous Region in Muslim Mindanao, the adoption
of the integrated province-wide and city-wide health systems shall be in accordance
with Article IX Section 22 of RA 11054 (Organic Law for the Bangsamoro
Autonomous Region in Muslim Mindanao) and subsequent laws and issuances to be
enacted by the Bangsamoro Government.
19.5. The DOH shall provide or facilitate the provision of necessary support and incentives
to assist the LGUsin integrating their local health systems into province-wide and city-
wide health systems that are resilient, sustainable, and responsive to the needs of the
population; Provided, That the assistance shall include financial and non-financial
matching grants to strengthen health systems management and health service delivery;
Provided, further, That the DOH shall provide an environment that promotes the
exchange of knowledge and good practices among the levels of the health care delivery
system.
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19.6. The DILG and the DOH shall facilitate the integration of local health systems into
province-wide and city-wide health systems through a mechanism of cooperative
undertakings among the LGUs to ensure the effective and efficient delivery of health
services, provided under Section 33 of RA 7160 (Local Government Code of 1991).
19.7. PhilHealth and DOH shall issue and provide incentives to health care providers that
would form networks, whether public, private, or mixed, in accordance with Section
18.2 of these Rules.
19.8. Province-wide and city-wide health systems shall deliver both population-based and
individual-based health services.
19.9, LGUs that commit to province-wide and city-wide integration shall ensure managerial
and financial integration and provide the needed resources and support mechanisms to
make the integration possible and sustainable.
Provincial Integration
19.10 The municipalities and component cities shall endeavor to integrate their Municipal
Health Offices, Component City Health Offices, Municipal Hospitals, Component City
Hospitals, and LGU-managed health care providers, with the Provincial Health Office,
Provincial Hospital(s), and District Hospitals to constitute the province-wide health
system. The municipal and component city shall retain their existing functions over
their respective health facilities and personnel under RA 7160 (Local Government Code
of 1991); Provided, That the Provincial Health Board shall exercise administrative and
technical supervision over health facilities and services, health personnel, and all other
health resources within their territorial jurisdiction; Provided, further, That the
concerned LGU may opt to transfer the control of such health resources and services to
the province-wide health system through a mechanism of cooperative undertakings
provided under Section 33 of RA 7160 (Local Government Code of 1991).
19.11. The province-wide health system, through the Provincial Health Office, shall be
responsible for the delivery of the promotive, preventive, curative, rehabilitative and
palliative components of health care within the province. The province-wide health
system shall be linked to at least one (1) apex or end-referral hospital.
19.12. The Provincial Health Office, headed by a Provincial Health Officer, shall be
responsible for health service delivery and health systems management; Provided, That
the appropriate organizational structure and staffing pattern shall be implemented in
consideration of the size, population and geography of the province, subject to the
minimum qualification standards and guidelines approved by the Civil Service
Commission (CSC).
19.12.a. Each Provincial Health Office shall have at least two (2) divisions, the Health
Service Delivery Division headed by an Assistant PHO, and the Health
Systems Support Division headed by another official of equivalent rank;
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19.12.b. An enabling provincial ordinance shall be passed to create the Assistant PHO
and another official of equivalent rank as plantilla items, if not yet existing,
subject to the minimum qualification standards and guidelines approved by the
Civil Service Commission (CSC);
19.12.c. The health service delivery function refers to the management of the health
service delivery operations of primary care provider networks, hospitals and
other health facilities, clinical services, and public health programs including
health promotion, epidemiologic surveillance, and disaster risk reduction and
management, within the province-wide health system;
19.12.d. The -health systems support function refers to the management of health
financing, health information system, procurement and supply chain for health
products and services, local health regulation, health human resource
development, and health resilience, among others, in close coordination with
the concerned offices of the provincial government; and,
19.12.e. In consideration of the size, population, and geography of the province, a group
of adjacent municipalities and component cities may form sub-provincial
health systemsfor effective health service delivery and management of health
systems.
City Integration
19.13. HUCs and ICCs shall endeavor to integrate their health offices, health centers or
stations, hospitals, and other city-managed health facilities to constitute the city-wide
health system; Provided, That the city-wide health system, through its City Health
Office, shall be responsible for the delivery of the promotive, preventive, curative,
rehabilitative and palliative components of health care within the city; Provided further,
That the city-wide health system shall be linked to at least one (1) apex or end-referral
hospital.
19.14, The City Health Office, headed by a City Health Officer, shall be responsible for health
service delivery and health systems management; Provided, That the appropriate
organizational structure and staffing pattern shall be implemented in consideration of
the size, population and geography
of the city, subject to the minimum qualification
standards and guidelines approved by the Civil Service Commission (CSC).
19.15. Each City Health Office shall have at least two (2) divisions, the Health Service
Delivery Division headed by an Assistant CHO, and the Health Systems Support
Division headed by another official of equivalent rank.
19.15.a. An enabling city ordinance shall be passed to create the Assistant CHO and
another official of equivalent rank as plantilla items, if not yet existing,
subject to the minimum qualification standards and guidelines approved by
the Civil Service Commission (CSC).
19.15.b. The health service delivery function refers to the management of the health
service delivery operations of primary care provider networks, hospitals and
other health facilities, clinical services, and public health programs including
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health promotion, epidemiologic surveillance, and disaster risk reduction and

management within the city-wide health system.
19.15.c The health systems support function refers to the management of health
financing, health information system, procurement and supply chain for
health products and services, local health regulation, health human resource
development, and health resilience, among others, in close coordination with
the concerned offices of the city government.
Provincial and City Health Boards
19.16. In addition to the existing composition in accordance with RA 7160 (Local

Government Code of 1991), municipalities and component cities included in the
province-wide health system shall be entitled to a representative in the Provincial
Health Board. As applicable, indigenous cultural communities or indigenous peoples,
in accordance with RA 8371 (The Indigenous Peoples’ Rights Act of 1997), shall also
be represented in the Provincial and City Health Boards.
19.17, The Provincial and City Health Boards, in addition to their existing functions and in
accordance with RA 7160 (Local Government Code of 1991), shall:
19.17.a. Set the overall health policy directions and strategic thrusts including the
development and implementation of the integrated strategic and investment
plans of the province-wide and city-wide health system;
19.17.b. Oversee and coordinate the integration and delivery of health services across
the health care continuum for province-wide and city-wide health systems;
19.17.c. Manage the Special Health Fund (SHF); and,
19.17.d. Exercise administrative and technical supervision over health facilities and
health human resources within their respective territorial jurisdiction.
19.18. The Provincial and City Health Board shall create its own management support unit to
assist its operations including the management of the SHF.
19.19, The Provincial and City Health Boards shall meet at least once a month or as often as
may be necessary.
19.20. A majority of the members constitutes a quorum for the purpose of conducting ordinary
business of the Provincial and City Health Boards; Provided, That the chairperson and
the vice chairperson must be present during meetings where local investment plan for
health (LIPH), annual operational plan (AOP) and annual budgetary proposals are being
prepared or considered. The affirmative vote of a majority of all members of the Board
is necessary to approve the health system plans and budgetary proposals; Provided,
further, That the affirmative vote of a majority of the members present
business.
is sufficient to
approve matters relating to ordinary
19.21. The chairperson, vice chairperson and members of the health boards shall perform their
duties without compensation or remuneration. Members thereof who are not
government officials or employees shall be entitled to necessary traveling expenses and
Page 26 of 63
allowances chargeable against the SHF, subject to existing budgeting, accounting, and
auditing rules and regulations.
19.22. The local health boards of the municipalities and component cities shall retain their
existing compositions and functions.
Section 20. Special Health Fund
20.1. The province-wide and city-wide health systems shall pool and manage all resources
intended for health services through a SHF. Sources for the SHF shall include financial
grants and subsidies from national government agencies such as the DOH in accordance
with Section 22 of these Rules; income from PhilHealth payments in accordance with
Section 21 of the these Rules; and other sources such as, but not limited to, financial
grants and donations from Non-Government Organizations, Faith-Based Organizations,
and Official Development Assistance; Provided, That the concerned LGUs may opt to
transfer their local budget intended for health to the SHF through a mechanism of
cooperative undertakings as provided under Section 33 of RA 7160 (Local Government
Code of 1991).
20.2. As determined and approved by the Provincial or City Health Board, the SHF shall be
allocated for:
20.2.a. Population-based and individual-based health services;
20.2.b. Capital investment such as, but not limited to, infrastructure, equipment, and
information technology;
20.2.c. Health system operating costs;
20.2.d. Remuneration of additional health workers;
20.2.e Incentives for all health workers in accordance with RA 7305 (Magna Carta
for PHW), RA 7883 (BHW Benefits and Incentives Act), PD 1569
(Strengthening Barangay Nutrition Program), RA 11148 (Kalusugan at
Nutrisyon ng Mag-Nanay Act) and other relevant laws.
20.3. The allocation of the financial grants from DOH and income from PhilHealth payments
shall be based on the contractual obligation of the Provincial and City Health Boards
with the DOH and PhilHealth for population-based services and individual-based
services, respectively; LIPH; and SHF guidelines.
20.4. The Provincial and City Health Boards shall assume full responsibility for the
management of the SHF.
20.5. The DOH and PhilHealth shall require the creation of a SHF for contracting city-wide
and province-wide health system; Provided, That LGUs shall appropriate, through an
ordinance, counterpart funding to finance health programs based on the local
investment plan for health; Provided, further, That the LGUs that opted to transfer the
control of health resources to the province-wide health system shall transfer the funds
intended for health to the SHF and shall be entitled to additional financial and non-
Page 27 of 63
financial incentives, given that these incentives shall be solely allocated for health-
related services; Provided, finally, That upon full financial integration, health
expenditures of participating LGUs that are in accordance with these Rules shall be
chargeable to the SHF.
20.6. The DOH and PhilHealth shall establish and maintain a SHF utilization tracking system to
allow real-time collection, consolidation, and analysis of data on the use of such fund.
Required data for this system shall be considered as health and health-related data as
described in Section 31.1 of these Rules.
20.7. For this purpose, the DOH and PhilHealth, in consultation with the DBM, DILG,
Department of Finance (DOF), Commission on Audit (COA) and the LGUs, shall issue
guidelines that specify the allocation and utilization of the SHF.
Section 21. Income Derived from PhilHealth Payments.
21.1. All income derived from PhilHealth payments of LGU-owned and managed health
offices, facilities, and services shall accrue to the SHFto
be allocated by the LGUs
exclusively for the operations and improvement of the province-wide and city-wide
health systems.
21.2. PhilHealth payments shall be credited to the annual regular income (ARI) of the
provinces, cities, and municipalities, subject to the SHF guidelines.
Section 22. Incentives for Improving Competitiveness of the Public Health Service Delivery
System
22.1. The national government, through the DOH, shall make available commensurate
financial and non-financial matching grants, including capital outlay, human resources
for health, health commodities, and such other management support and technical
assistance, to improve the functionality of province-wide and city-wide health systems;
Provided, That DOH shall issue the annual guidelines on the provision of such grants.
22.2. Underserved and unserved areas, as defined in Section 4.14 of these Rules, shall be
given priority in the allocation of grants.
22.3. The province-wide and city-wide investment plans for health, also known as the LIPH,
and the annual operational plans (AOP) shall serve as the basis for the grants from the
national government, to account for complementation of public and private health care
providers and public or private health sector investments to national investment plans.
22.4. Municipalities and component cities that opted to organize themselves to form sub-
provincial health systems shall submit a consolidated investment plan to the Provincial
Health Board as an input to the LIPH.
Page 28 of 63
RULE VI. HUMAN RESOURCES FOR HEALTH
Section 23. National Health Human Resource Master Plan
23.1. The DOH shall lead and institutionalize a multi-stakeholder Human Resources for
Health (HRH) Network, composed of both public and private organizations and
agencies, to formulate and oversee the sustainable implementation, monitoring,
periodic evaluation, and reformulation of the National Health Human Resource Master
Plan, a long term strategic plan for the management and development of HRH;
Provided, That the Plan shall be implemented at the national and local levels by both
government and private sectors; Provided, further, that the following components shall
be included:
23.1.a. Comprehensive health labor market study adopting a whole of society
approach;
23.1.b. Standards for HRH, inboth public and private sector, on staffing requirements,
appropriate generation, recruitment, retraining, regulation, retention,
productivity mechanisms, and reassessment of the health workforce that would
be updated to accommodate changing population health needs; and,
23.1.c. Outcomes pertaining to sustainable production, appropriate skill mix retention
in the health sector, equitable distribution and practice-ready training and
education for HRH.
23.2. The DOH, DBM and the CSC, shall establish mechanisms to create new positions as
necessary to meet staffing standards, as set by DOH, for health professionals and health
workers in government-owned and -controlled health facilities needed to provide health
services or implement health programs in priority areas of the government.
23.3. All health professionals and health workers required for continuity of health services
and implementation of health programs in priority areas shall be hired in permanent
positions in province-wide and city-wide health systems under CSC rules and
regulations and receive competitive salaries based on prevailing laws on salaries of civil
servants; Provided, That the DOH, DILG and other concerned agencies, shall issue and
enforce guidelines in accordance with Section 20 of these Rules and other relevant laws
and guidelines that provide standard and competitive benefits and incentives for public
health workers, barangay health workers and barangay nutrition scholars and, security
of tenure to those with eligibility.
23.4. All private and non-government health facilities, including laboratories, pharmacies,
and other such facilities licensed by the DOH, shall comply with the minimum required
health care professionals and health care workers based on staffing standards as set by
the DOH and shall ensure that those needed for continuity of health services are hired
under regular employment and provided with competitive salaries, as set by competent
government authorities.
Page 29 of 63
23.5. Relevant national government agencies, LGUs, and the private sector, shall ensure the
availability of sufficient resources to implement the National Health Human Resource
Master Plan; Provided, That the province-wide and city-wide health systems shall align
their investment needs with the Plan.
Section 24, National Health Workforce Support System
24.1. For purposes of these Rules, the National Health Workforce Support System refers to a
mechanism that includes: human resource management and development systems;
salaries, benefits, and incentives; and, occupational health and safety of deployed health
care professionals or health care workers to support equity in local public health
systems.
24.2. To augment health workforce needs of local public health systems, the DOH shall
secure positions to hire health professionals and health workers for deployment under
the National Health Workforce Support System.
24.3. Deployment of health professionals and health workers shall prioritize GIDAs;
Provided, That graduates of medical and allied health professions who
are recipients of
government-funded scholarship programs as defined in Section 25 of these Rules, shall
be prioritized in the recruitment and selection to the allocated positions.
24.4. Compensation rates of deployed health professionals and health workers shall follow
national rates.
24.5. Subject to the integration of the province-wide or city-wide health systems, LGUs shall
implement incremental creation of positions to hire the required health care professional
and health care worker based on standards, as determined by the DOH; Provided, That,
in the interim, LGUs thatare unable to achieve the standards for health care professional
and health care worker are eligible to receive deployment augmentation from the
National Health Workforce Support System.
24.6. The DOH shall assess the performance of the National Health Workforce Support
System and LGUs’ health workforce complement. The assessment shall also include
feasibility of hiring additional human resources for health in permanent positions under
province-wide or city-wide health systems to meet standard staffing requirements for
health facilities. Upon consideration of the assessment results, the DOH, DBM and
DILG shall determine the feasibility of absorbing public health workers under province-
wide or city-wide health systems.
Page 30 of 63
Section 25. Scholarship and Training Program.
Expansion of Degree and Non-Degree Training Programs
25.1. The CHED, TESDA, PRC and DOH shall

develop and plan the expansion of existing
and new allied and health-related degree and training programs based on the health
needs of the population especially those in GIDAs. It
shall be incorporated into the
National Health Human Resource Master Plan which becomes the basis of the number
and cadre, including categories, where applicable, of health care professionals and
health care workers needed to meet the health needs of the population, especially those
in underserved and unserved areas.
25.2. The PRC and its accredited organizations shall:

25.2.a. Review and update, if necessary, the accreditation standards and admission
policies or requirements for medical residency and sub-specialty training and
specialization tracks for allied health professions to support reducing trainee
attrition rates;
25.2.6. Regulate the number of trainees per program in favor of producing enough
medical and allied health professionals with appropriate competencies for
primary and specialty practice, based on the health needs of the population and
priorities identified by the DOH, especially those in GIDAs; and,
25.2.c. Assist national government agencies, LGUs, and the private sector in the
establishment of accredited programs for medical residency and sub-specialty
training, and specialization tracks for allied health professions, where feasible,
in provinces where specialists or sub-specialists and allied health professionals
are in shortage.
25.3. The Commission on Higher Education (CHED) and the Technical Education and Skills
Development Authority (TESDA) shall:
25.3.a. Review and update, as necessary, all recognition or accreditation policies and
guidelines for health education programs, prioritizing the expansion of
undersubscribed courses;
25.3.b. Develop support programs to
assist graduates acquire necessary and relevant
qualifications, such as professional licenses for practice or civil service
eligibility for those who wish to be employed in government;
25.3.c. Develop new programs in
coordination with the DOH to supply the health care
provider networks with practice-ready health and allied health care
professionals and health care workers to meet health workforce requirements;
25.3.d. Regulate the number of
enrollees per program in favor of producing sufficient
allied and health-related degree graduates based on the health needs of the
population, especially those in the underserved and unserved areas, and
enforce stricter admission policies and guidelines to reduce student and trainee
attrition rates;
25.3.e. Promote and support the establishment of medical and health science schools
and technology vocational training providers in regions where health care
professionals and health care workers are inadequate and production capacity
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is limited by the lack of accessible training facilities or health professional

education programs; and,
25.3.f. Regulate the quality of education of medical and allied health schools and
technical-vocational education and training providers and take necessary
actions to enforce quality standards.
25.4. The DOH shall:

25.4.a. Assist national government agencies, LGUs, and the private sector in the
establishment of accredited programs for medical residency and sub-
specialty training, and specialization tracks for allied health professions to
produce specialists and sub-specialists in underserved and unserved areas;
and,
25.4.b. Regularly provide updates to the PRC, CHED, and TESDA of the
and distribution of the health workforce to support the coordinated and
number
balanced production of health professionals and health workers, as well as

the health service needs of underserved and unserved areas and populations.
Expansion of Scholarships for Health

25.5. The DOH and CHED shall increase production of identified cadre of health
professionals and health managers as determined by the National Health Human
Resource Master Plan through the expansion and redirection of government-funded
scholarship programs that would support the production of needed cadre of health care
professionals, health care workers, and health managers and improve local retention.
25.6. The DOH and CHED shall source funds for scholarship grants; refer to a modality of
financial assistance that they provide to eligible individuals through government-
funded scholarship programs, which include full or supplementary payment for
subsidies to complete tuition fees and other school fees such as living, book and
uniform allowances; and require corresponding return service obligation to national
or local government; Provided, That bona fide residents of underserved and unserved
areas or members of indigenous peoples shall be prioritized for scholarship grants
from the national government, LGUs, NGOs or private entities, and international
bodies.
Registry of Health Professionals and Workers
25.7. The PRC and the DOH

professional societies
in
shall
coordination with duly registered medical and allied health
set up a registry of medical and allied health professionals
indicating, among others, their current number of practitioners and location of
practice.
25.8. The DOH shall determine the human resources for health data required for the national
health workforce registry, and act as a repository of the data collected and manager of
the registry.
Page 32 of 63
25.9. The PRC, together with their accredited medical and allied health professional
organizations and other national and local bodies, within their mandates, shall provide
the DOH with relevant health care professional and health care worker data. For this
purpose, the DOH is authorized to collect data and information for the national health
workforce registry from relevant agencies, including NGOs, private organizations and
facilities.
Inclusion of Primary Care Competencies in Health Professional and Health Worker

Curricula
25.10. The CHED, the PRC, and the DOH in coordination with duly registered medical and
allied professional societies, shall:
25.10.a. Reorient health care professional and health care worker curriculum towards
primary health care, with emphasis on public health and primary care;
25.10.b. Determine recommended areas of study in public health to be incorporated
in the curriculum of all health sciences education; and,
25.10.c. Incorporate educational outcomes focusing on primary care in the education
programs; scope of licensure examinations, continuing professional
development programs for health professionals; and, certification programs
for health care workers.
25.11. The DOH and the PRC shall issue guidelines for the eligibility requirements, standard
competencies, training mechanisms, and post-graduate certification process for
primary care workers. This is without prejudice to any transitory process that may be
adopted to implement Section 6 of these Rules.
Section 26. Return Service Agreement
26.1. All graduates of allied and health-related courses who are recipients of government-
funded scholarship programs, as described in Section 25 of these Rules, must enter
into a return service agreement (RSA) with both the academic or training institution
or training facility and the DOH. Graduates entering into an RSA shall be required to
serve in one of the DOH-specified priority health facilities or fields of practice, within
the public sector in the Philippines, on a full-time basis for at least three (3) full years,
within one (1) year upon graduation or acquiring the necessary license to practice;
Provided, That those who will serve for additional two (2) years shall be provided
with additional incentives as determined by the DOH.
26.2. The DOH shall issue guidelines that specify conditions for admission of scholarship
recipients into post-graduate degree programs
RSA.
orspecialty training courses under the
26.3. Graduates of allied and health-related courses who are recipients of government-
funded scholarship programs shall be prioritized for government employment and
Page 33 of 63
training opportunities, including permanent positions under province-wide or city-

wide health systems, positions for medical residency and sub-specialty training, and
specialization tracks for allied health professions in government facilities, and shall
receive standard compensation and benefits based on prevailing national rates for civil
servants.
26.4. The DOH and academic or training institutions, whether public or private, with
government-funded scholarship programs shall set up a monitoring system to track
scholarship recipients and graduates and monitor compliance to return service and
assess effectivity of the RSA.
26.5. The DOH and CHED, in consultation with State Universities and Colleges, Local
Universities and Colleges, and private academic and training institutions with health
professional education programs shall institutionalize mechanisms to encourage their
to
graduates in
serve priority areas and field of practice in the public sector.
26.6. The DOH, CHED, and PRC shall develop guidelines for noncompliance and
mechanisms to define obligations for recipients of scholarship grants who fail to
render return service.
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RULE VII. REGULATION
Section 27, Safety and Quality
PhilHealth Rating System
27.1. PhilHealth shall establish an incentive scheme for health facilities to provide better
service quality, efficiency, and equity based on a rating system.
27.2. The rating system shall include, but not limited to the following: measures on provision
of complete and appropriate care, health outcomes, patient satisfaction, fund utilization
and allocation of resources across health care providers and different levels of care;
compliance to standards of clinical practice as approved by DOH; submission of price
information of health goods and services; compliance to guidelines and standards as
prescribed by DOH and PhilHealth and other applicable laws; and, other measures or
indicators as deemed necessary.
27.3. PhilHealth shall prescribe the standards and requirements for third party accreditation
mechanisms. These may be used as basis for granting incentives to healthcare providers
to be identified by PhilHealth.
Licensing for Primary Care Facilities and Stand-Alone Health Facilities
27.4. The DOH shall institute a responsive licensing and regulatory system for stand-alone
health facilities, including those providing ambulatory and primary care services, and
other modes of health service provision such as, but not limited to, mobile health
services and digital technologies for health, subject to the appropriate regulatory
instruments.
27.5. The DOH shall issue a License to Operate and Certificate of Accreditation, as
appropriate, to these facilities that shall be valid for at least three (3) years, unless
otherwise provided by laws and issuances and shall be independent of permits,
registrations, and accreditations issued by other government offices.
27.6. The mandate and enforcement mechanisms of DOH to regulate health facilities and
services shall be expanded and strengthened. For this purpose, the DOH shall establish
line regulatory units up to the regional level to harmonize and enforce licensing
standards; and shall allocate funds and resources to support such regulatory mandate.
Page 35 of 63
Clinical Practice Guidelines
27.7, The DOH, in cooperation with professional societies and the academe, shall set
standards for clinical care through the development, appraisal, and use of clinical
practice guidelines (CPGs) based on best evidence, to assist practitioners in clinical
decision-making.
27.8. The DOH shall establish a mechanism for the development, adoption and dissemination
of CPGs; Provided, That DOH and Philhealth shall monitor compliance to such CPGs.
Section 28. Affordability
National Price Reference Indices for Drugs, Medical Devices and Supplies
28.1. The DOH shall

expand the current drug price reference index (DPRD implemented in
DOH-owned health facilities and develop price reference indices before mark ups for
drugs, medical devices and supplies.
28.2. In establishing the price reference indices for drugs, medical devices and supplies, the
DOH shall consider
all factors relevant to their costs.
28.3. The procurement price for innovative, proprietary, patented, and single-sourced drugs,
medical devices and supplies shall be centrally negotiated by a price negotiation board
to
at the lowest price that is most advantageous in
the government accordance with RA
9184 (Government Procurement Reform Act) and other Government Procurement
Policy Board (GPPB) issuances.
28.4. The DOH shallupdate the price reference indices at least every year and make them
public through various platforms, including web-based databases, price booklets, and
publication in major newspapers.
28.5. All DOH-owned health care facilities shall procure drugs, medical devices and supplies"
guided by the price reference indices in accordance with relevant laws, such as, RA
9184 (Government Procurement Reform Act) and RA 9502 (Cheaper Medicines Act of
2008).
28.6. Noncompliance by the DOH-owned health facilities with the published price reference
indices shall be subject to existing rules and administrative sanctions as stipulated in
these Rules and other relevant laws such as RA 9184 (Government Procurement
Reform Act), RA 9502 (Cheaper Medicines Act of 2008), and RA 7394 (Consumer Act
of the Philippines), among others.
28.7. The published price reference indices shall guide PhilHealth in setting payment rates
for drugs, medical devices and supplies for its contracted healthcare providers.
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Prescribed Mark-ups for Drugs, Medical Devices and Supplies
28.8. The DOH shall prescribe uniform rules and structures in setting mark-ups for drugs,
medical devices and supplies that shall be applied by DOH-owned health facilities on
top of the price reference indices to protect patients from excessive and unnecessary
charges.
28.9. All DOH-owned health care facilities shall submit to the DOH all relevant costs and
information necessary for the creation of a mark-up structure for drugs, medical devices
and supplies.
28.10. All DOH-owned health care facilities shall adhere to the price structure and shall not
go beyond the prescribed mark-ups for drugs, medical devices and supplies.
28.11. PhilHealth shall adopt the prescribed mark-ups issued by the DOH in setting payment
mechanisms for drugs, medical devices and supplies among its contracted DOH-owned
health care facilities.
28.12. Noncompliance to the prescribed mark-up structure shall be subject to existing rules
and administrative sanctions as stipulated in these Rules and other relevant laws such
as RA 9184 (Government Procurement Reform Act), RA 9502 (Cheaper Medicines Act
of 2008), and RA 7394 (Consumer Act of the Philippines), among others.
Central Price Negotiation for Health Technologies
28.13. An independent price negotiation board, composed of representatives from the DOH,
PhilHealth and the DTI, among others, shall be constituted to negotiate prices on behalf
of the DOH and PhilHealth, guided by certain parameters including new health
technology, innovator drugs, and sourced from a single supplier; Provided, That DOH
shall issue guidelines as to the structure and constitution of such board; Provided,
further, That the negotiated price in the framework contract shall be applicable for all
healthcare providers under DOH; Provided, finally, That the board shall adhere to the
guidelines issued by the GPPB.
Framework Contracting of Drugs, Medical Devices and Supplies
28.14. The DOH shall promulgate guidelines and procedures in implementing framework
contracting on drugs, medical devices and supplies.
28.15. Multi-year framework contracts may be implemented by the DOH in accordance with
RA 9184 (Government Procurement Reform Act) and other GPPB issuances to ensure
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the continuous availability of drugs, medical devices and supplies centrally negotiated
by
the
price negotiation board at affordable prices, which shall be applicable throughout
the term of the contracts.
Submission of Price Information by All Healthcare Providers
28.16. Healthcare providers and facilities shall be required to make readily accessible to the
public and patients and submit to DOH and PhilHealth, all pertinent, relevant, and up-
to-date information regarding the prices of health services, and all goods and services
being offered.
28.17. The DOH and PhilHealth shall issue the guidelines on submission of information and
public access to said information regarding the prices and charges for all goods and
services, including professional fees being offered by health care providers and health
care provider networks.
28.18. The DOH and PhilHealth shall issue policies and procedures, as well as establish
systems to undertake the following functions:
28.18.a. Monitor the prices of health services, which include among others, laboratory
fees, cost of procedures, cost of amenities, professional fees, and other health
services provided by hospitals and other health care providers; Provided, That
the collection, submission, and publication of price data as required by law
shall form part of data submission to PhilHealth; and,
28.18.b. Monitor the prices of all health goods such as drugs and medicines, health and
medical devices, and laboratory and medical supplies.
Mandatory Provision of Fairly Priced Generics
28.19, Drug outlets shall be required at all times to make available and offer fairly priced
generic equivalent of all drugs in the DOH Primary Care Formulary (PCF) based on the
local needs and prevailing disease patterns in the community.
28.20. Noretailer or drug outlet shall withhold from sale or refuse to sell to consumers fairly
priced generic equivalents of drugs in the PCF.
28.21. The DOH shall issue a list of generic drugs in the PCF with their corresponding fair
prices.
28.22. Noncompliance to this specific provision shall be subject to administrative sanctions

under these Rules and relevant laws such as the RA 9711 (Food and Drug
Administration Act of 2009), RA 9502 (Cheaper Medicines Act of 2008), and RA 7394
(Consumer Act of the Philippines).
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Complementation of Private Health Insurance and Health Maintenance Organizations
28.23. The DOH, PhilHealth, HMOs, and life and non-life PHIs, in consultation with the
Insurance Commission, shall establish a coordination mechanism, and develop
standards, policies and plans that complement the NHIP’s benefit schedule, with the
following as minimum requirements:
28.23.a. HMOs and life and non-life PHIs shall cover the cost of amenities and other
healthcare goods and services that are not covered by PhilHealth subject to the
contractual obligations entered into by the member with HMOs and life and
non-life private health insurance; and,
28.23.b. HMOs, life and non-life PHIs shall duly submit health and health-related data,
as prescribed in Section 31.1 of these Rules, in aid of developing policies,
standards, and plans.
Section 29. Equity
Preferential Licensing of Health Facilities
29.1. The DOH shall develop the framework and guidelines on appropriate service capability
in underserved and unserved areas, considering complementary infrastructure,
equipment and bed capacity, and number of health care professionals for purposes of
preferential licensing of health facilities and contracting of health services.
29.2. The DOH shall develop the guidelines for identifying GIDA barangays and update the
list of underserved and unserved areas annually.
29.3. The DOH shall develop a system to prioritize the processing of applications and
issuance of License to Operate and Certificate of Accreditation for health facilities in
these areas. PhilHealth shall establish an incentive scheme in contracting DOH-
licensed health facilities and services located in underserved and unserved areas that
shall ensure sustainability of provision of safe and quality health services.
29.4. The DOH, PhilHealth and LGUs shall prioritize GIDAs in the provision of assistance
and support, such as but not limited to, health human resources, infrastructure, medical
equipment and supplies to ensure equitable distribution of health services and benefits.
Bed Capacity of Hospitals
29.5. Government general hospitals, regardless of size and level, are required to operate not
less than ninety percent (90%) of their authorized bed capacity as basic or ward
accommodation.
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29.6. Specialty hospitals, either single-specialty or multi-specialty government hospitals as

designated by the DOH, are required to operate not less than seventy percent (70%) of
their authorized bed capacity as basic or ward accommodation.
29.7. Private hospitals are required to operate not less than ten percent (10%) of their
authorized bed capacity as basic or ward accommodation.
29.8. Currently licensed hospitals shall fully comply with the required allocation of beds for
basic or ward accommodation subject to the guidelines that will be issued by the DOH;
Provided, That the required allocation of beds for basic or ward accommodation shall
be immediately applicable to new hospitals applying for License to Operate.
29.9, All government general hospitals, specialty hospitals, and private hospitals are required
to annually submit a report, through a DOH online reporting system, on the allotment
and actual utilization of the authorized beds for basic or ward accommodation, in
compliance to licensing requirements.
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RULE VII. GOVERNANCE AND ACCOUNTABILITY
Section 30. Health Promotion
30.1. The DOH, being the overall steward for health care, shall strengthen national efforts in
providing a comprehensive and coordinated approach to health development with
emphasis on scaling up health promotion and preventive care to ensure that every
Filipino has access to information to build personal skills, opportunity to engage in
strengthening of community action, and enable participation in creation of supportive
environments as fundamental component of UHC.
30.2. The Health Promotion Bureau shall be established in the DOH from the existing Health
Promotion and Communication Service. The Health Promotion Bureau shall:
30.2.a. Be responsible for healthy public policy and reorient health systems to
prioritize health promotion and prevention, and increase health literacy;
30.2.b. Lead the formulation of a Health Promotion Framework Strategy which shall
serve as the national health promotion roadmap and the basis of all health
promotion policies and programs;
30.2.c. Implement population-wide health promotion policies and programs across
social determinants of health and behavioral risk factors;
30.2.d. Promote and provide technical, logistical and financial support to local
research and development of local policies and programs based on the Health
Promotion Framework Strategy and the local investment plans for health; and,
30.2.e. Exercise multisectoral policy coordination and enter into partnerships with
national government agencies, LGUs, the private sector, civil society
organizations, professional societies and academe, among others to ensure the
attainment of the Health Promotion Framework Strategy and its policies and
programs.
30.3. The DOH, together with DBM and other relevant agencies, shall identify and ensure
appropriate organizational structure with corresponding human resource complement
to support the mandate of the Health Promotion Bureau; Provided, That health
promotion capabilities, financial capacities, and human resources to support the
implementation of the Health Promotion Framework Strategy at the regional level shall
be strengthened and expanded.
30.4. Within two (2) years from the effectivity of these Rules, the DOH shall allocate at least
one percent (1%) of its total budget appropriations to the Health Promotion Bureau to
implement health promotion programs; Provided, That the succeeding budget
appropriations shall be in accordance with the Health Promotion Framework Strategy.
30.5. Province-wide and city-wide health systems are mandated to provide proactive and
effective health promotion programs and campaigns inaccordance with the requirement
of Section 17 of these Rules; Provided, That a Health Promotion Unit with appropriate
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human resource complement shall be established within the province-wide and city-
wide health systems to ensure sustainable implementation of health promotion and
improve health literacy.
30.6. The DepEd shall hereby designate schools as healthy settings based on the standards
set by the DepEd and DOH, where all members of the school community work together
to provide students, teachers, and staff, including those from alternative learning
systems, with integrated and positive experiences and structures which promote and
protect their health. Designation of schools as healthy settings shall be based on the
following minimum components: healthy school policies, physical school environment,
social school environment, health skills and education, links with parents and
community, and access to health services.
30.7. The DepEd, in coordination with the DOH, shall address public health problems
through the school systems by:
30.7.a. Intensifying the fight against the spread of communicable diseases through
promotive and preventive programs that include among others, personal
hygiene, oral health, access to safe water and sanitation, environmental
measures to prevent vectors-borne diseases, and vaccinations;
30.7.b. Enforcing measures to ban sale of, and prevent access to, tobacco products,
alcohol and illicit drugs in schools and immediate vicinity in coordination with
LGUs;
30.7.c. Promoting healthy lifestyle through physical activity, proper nutrition, injury
prevention and mental health programs, among others;
30.7.d. Ensuring the promotion of health of children with special needs, learning
disabilities or other developmental conditions to provide opportunities for
them to live productive lives;
30.7.e. Cultivating a healthy school environment and community;
30.7.f. Formulating and implementing school health and nutrition policies, programs,
and services; and,
30.7.g. Mobilizing community action on health promotion.
30.8. The DepEd shall formulate programs and modules on health literacy and health rights
that shall be integrated in formal and informal curricula, programs, and co-curricular
activities.
30.9. DepEd and DOH shall submit an integrated annual report on health promotion and
health literacy programs that they have respectively implemented including an
assessment of the impact thereof, to the President of the Philippines, the Senate
President, and the Speaker of the House of Representatives; Provided, That regular data
sharing on health promotion programs, projects, and activities between DepEd and
DOH
shall be established, in accordance with Section 31 of these Rules, relevant
provisions of RA 10173 (Data Privacy Act), and other relevant laws and policies.
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30.10. To implement the Health Promotion Framework Strategy, the CHED and TESDA are
enjoined to designate educational and training institutions as healthy settings based on
the standards set by DOH.
30.11. LGUs, guided by the Health Promotion Framework Strategy, shall issue and implement
effective health promotion policies and programs that promote health literacy and
healthy lifestyle among their constituents, prevent and control diseases and their risk
factors to advance population health and individual wellbeing.
30.12. The laws to the contrary notwithstanding, LGUs are directed to enact stricter ordinances
that strengthen and broaden existing health promotion policies and programs; Provided,
That LGUs shall prioritize the following: the reduction of the prevalence of tobacco
use, the reduction of the burden of alcohol use, the reduction of incidence of
communicable diseases and prevalence of non-communicable diseases, addressing
mental health issues, and the improvement ofhealth indicators.
30.13, To ensure compliance, the DOH and DILG shall formulate a joint administrative
issuance to implement, monitor, and evaluate health promotion policies and programs
in LGUs. An annual report on the policies adopted and programs undertaken, and an
assessment of the impact thereof, shall be submitted by the LGUs to the DILG, copy
furnished the DOH.
Section 31. Evidence-Informed Sectoral Policy and Planning for UHC
Submission of Health- and Health-related Data
31.1. For the purpose of these Rules, health and health-related data collectively refer to a set
of specific variables or parameters that relates to individual and population health and
well-being, including, but not limited to, administrative, public health, medical,
pharmaceutical and health financing data. Such data shall be submitted to PhilHealth
all
by health-related entities through a National Health Data Repository, in compliance
with guidelines that shall be jointly developed by DOH and PhilHealth, in consultation
with the Department of Information and Communications Technology (DICT) and the
National Privacy Commission (NPC); Provided, That submission of data by health-
related entities shall be a requirement in the licensing and contracting arrangements;
Provided, further, That health-related entities shall include, but not limited to, health
care facilities, national and local government agencies involved in the provision of
in
health services, and agencies involved the collection of health data; Provided, finally,
That PhilHealth shall provide the DOH access to the National Health Data Repository.
31.2. All health-related entities shall issue a proper notice to their clients that any collected
data or information shall be submitted to the National Health Data Repository, in lieu
of informed consent. Such notice shall state that these data or information shall be used
consistently with the objectives of this law, and in compliance with RA 10173 (Data
Privacy Act).
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Strengthening Health Policy and Systems Research
31.3. The DOH, PhilHealth, LGUs, and other DOH-attached agencies shall establish
mechanisms that integrate explicit use of evidence into the policy and decision-making
process, strengthen health policy and systems research, and support the growth of
research consortia in line with the vision of the Philippine National Health Research
System as stipulated in RA 10532 (Philippine National Health Research System Act of
2013).
31.4, The DOH shall allocate and manage funds for training grants to develop a pool of
health
policy and systems researchers, technical experts, and health systems managers;
Provided, That DOH and Department of Science and Technology (DOST) shall
establish the systems and procedures on the provision of such training grants.
31.5. The DOH, together with the DOST, shall identify academic or training institutions,
whetherin the Philippines or abroad, that are globally benchmarked and with relevant
curricula that are aligned with the health needs of the Philippines.
31.6. Recipients of training grants shall be required to serve for at least three (3) full years,
under supervision and with compensation, in DOH, PhilHealth and other relevant
government agencies; Provided, That those who will serve for additional two (2) years,
shall be provided with additional incentives as determined by the agency concerned.
31.7. A training registry shall be shared between the DOH and DOSTfor purposes of tracking
recipients of training grants, and monitoring compliance to return service obligations.
Access to Public Health and Health-Related Data
31.8. All health, nutrition and demographic-related administrative and survey data generated
using public funds shall be considered public records and be made accessible to the
public unless otherwise prohibited by law.
31.9. The Interagency Committee on Health and Nutrition Statistics (ACHNS), through the
PSA and DOH, shall formulate policies and guidelines on data access relative to the
covered public data.
31.10. All agencies responsible for the generation of covered administrative and survey data
shall make available to the general public, the government, and entities commissioned
by government all microdata and metadata in public use files (PUF), and in either
electronic format, or hard copies, subject to guidelines to be issued by DOH; Provided,
That any person who requests hard copies may be required to pay the actual costs of
reproduction and copying.
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Participatory Action Researches
31.11. Participatory action researches on cost-effective, high-impact interventions for health

promotion and social mobilization shall form part of the national health research agenda
of the Philippine National Health Research System which shall also be mandated to
provide adequate funding support for the conduct of these researches.
Section. 32. Monitoring and Evaluation,
Conduct of Surveys in Support of UHC

32.1. The PSA shall design and conduct relevant modules of annual household surveys in
close coordination with the DOH, consistent with overall monitoring and evaluation
plan, during the first ten (10) years of the implementation, and thereafter follow its
regular schedule.
32.2. The PSA shall include the costs of implementing the relevant modules of the household
surveys in its annual budgetary proposal under the GAA. The DOH may provide
supplementary funding, as deemed appropriate.
Burden of Disease Estimates
32.3. The DOH shall publish annual provincial burden of disease (BOD) estimates using
internationally validated estimation methods and biennially using actual public and
private sector data from electronic records and disease registries, to support LGUs in
tracking progress of health outcomes; Provided, That the DOH, in consultation with
relevant stakeholders, shall issue guidelines that specify procedures for BOD
estimation. For this purpose, BOD estimates shall refer to quantitative health
information concerning the distribution of and health loss attributable to diseases,
injuries, and risk factors.
32.4. The DOH, in coordination with PhilHealth, academic and research organizations, and
development partners, shall:
32.4.a. Produce annual BOD estimates through a systematic and transparent manner;
32.4.b. Build institutional and sectoral capacity for BOD research and analysis;
32.4.c. Promote the use of BOD estimates for policy and planning at national and local
levels; and,
32.4.d. Inform the improvement of existing disease-specific information systems.
32.5. All BOD estimates must be made accessible in public use format (PUF) and accessible
by the general public, in accordance to RA 10173 (Data Privacy Act) and existing laws.
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Section 33. Health Impact Assessment (HIA)
33.1. The DOH, in coordination with the NEDA, DILG, DENR, relevant LGUs and other
executive agencies, shall ensure that Health Impact Assessment (HIA) is conducted,
public health mitigation and management plans are implemented for all development
initiatives, and members of potentially affected communities are well-represented in
the process. Provided, That this is without prejudice to future amendments to the
guidelines that will be carried out in response to evolving needs and practices. For this
purpose:
33.1.a. Health impact assessment (HIA) shall refer to a means of assessing the health
impacts of policies, programs, and projects in diverse economic sectors before,
during, and after implementation. It provides practical and alternative
recommendations to increase positive health effects and minimize negative
health effects;
33.1.b. Public health mitigation and management plans (PHMMP) shall refer to a set
of actions necessary to routine operations that seeks to prevent or limit
negative public health impacts and losses associated with the risks involved in
the implementation of development initiatives; and
33.1.c. Development initiatives shall refer to all proposed and existing policies,
programs, and projects emanating from government and private sectors.
33.1.d. Health sensitive projects shall refer to projects whose raw materials, by
products, intermediate products, finished products, and other components and
processes during its construction, operation, and decommissioning phases
have potential to pose significant health risks to workers and potentially
affected communities;
33.1.e. Projects in health sensitive areas shall refer to projects located in areas
delineated as critical for health, such that significant health impacts can be
expected and vulnerable populations adversely affected due to implementation
of certain types of projects, or to any sudden changes to the natural and
community resources in which livelihood and health are also closely
dependent;
33.1.f. Non-health sensitive projects shall refer to projects that have low potential to
pose significant risks or impacts to the health of workers and potentially
affected communities, or to any of its determinants; and,
33.1.g. Potentially affected communities shall refer to groups of people who are on the
receiving end of the intended and unintended effects of the development
initiatives, and whose lives will be affected by the development initiative being
assessed.
33.2. For development initiatives classified as projects, the DOH shall convene a review
committee, and issue health impact clearance for projects upon positive
recommendation of the committee.
33.3. For development initiatives classified as policies and programs, findings from the
assessment and recommendations shall be appraised by relevant DOH offices and
formally endorsed to appropriate national government agencies.
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Section 34. Health Technology Assessment (HTA)
34.1. The DOH shall lead the health sector in the institutionalization of the HTA process as
a fair and transparent priority setting mechanism that shall be recommendatory to the
DOH and PhilHealth for the development of policies and
programs, regulation, and the
determination of a range of entitlements such as drugs, medicines, pharmaceutical
products, and other devices, procedures and services as provided for under these Rules.
34.2. Investments on any health technology or development of any benefit package by the
DOH
and PhilHealth shall be based on the positive recommendations of the HTA;
Provided, That:
34.2.4. Despite having undergone the HTA process, all health technology,
intervention or benefit package shall still be subjected to periodic review;
34.2.b. HTA may be conducted as new evidence emerges which may have substantial
impact on initial coverage decision by the DOH
the
or PhilHealth; and,
34.2.c. HTA process shall adhere to the principles of ethical soundness, inclusiveness
and preferential regard for the underserved, evidence-based and scientific
defensibility, transparency and accountability, efficiency, enforceability and
availability of remedies, and due process.
Criteria in the conduct of HTA
34.3. Responsiveness to Magnitude, Severity, and Equity - The health interventions must
address the top medical conditions that place the heaviest burden on the population,
including dimensions of magnitude or the number of people affected by a health
problem, and severity or health loss by an individual as a result of disease, such as death,
handicap, disability or pain, and conditions of the poorest and most vulnerable
population;
34.4. Safety and Effectiveness — Each intervention, especially drugs and medicines, shall
undergo Phase IV clinical trial, and systematic review and meta-analysis must be
readily available, as deemed necessary. For long term safety data, other sources of
clinical evidence may be used in the HTA process, such as reports of adverse drugs
events to the FDA, case reports, case series and real-world data; Provided, That for non-
drug interventions and technologies where clinical trials are not possible or practical to
conduct (e.g., surgical and medical procedures, medical device), the Health Technology
Assessment Council (HTAC) shall make use of the best available source of objective
evidence, including, but not limited to, observational studies and real world evidence.
The interventions must also not pose any harm to the users and health care providers
that would outweigh the benefits they provide.
34.5. Household Financial Impact - The interventions must reduce out-of-pocket expenses.
Interventions must have economic studies and cost-of-illness studies to satisfy this
criterion.
Page 47 of 63
34.6. Cost-effectiveness - The interventions must provide overall health gain to the health
system and outweigh the opportunity costs of funding drug and technology.
N
34.7. Affordability and Viability - The interventions must be affordable, and the cost thereof
must be viable to the financing agents.
Health Technology Assessment Council (HTAC)
34.8. The HTAC, to be composed of health experts, shall be created within the DOH and
supported by a Secretariat and a Technical Unit for Policy, Planning and Evaluation
with evidence generation and validation capacity. DOH and DOST shall
issue joint
guidelines on the implementation of this provision.
34,9, A HTAC shall be constituted within the DOH with the following functions:
34.9.a. Facilitate provision of financing and coverage recommendations on health
technologies to be financed by DOH and PhilHealth;
34.9.b. Oversee and coordinate the HTA process within DOH and PhilHealth; and,
34.9.c. Review and assess existing health technologies financed by DOH and benefit
packages of PhilHealth.
34.10. The HTAC shall consist of a core committee and subcommittees.

34.10.a. The core committee is composed of nine (9) voting members, which shall elect
from among themselves its Chairperson, namely: a public health
epidemiologist; a health economist; an ethicist; a citizen’s representative; a
sociologist or anthropologist; a clinical trial or research methods expert; a
clinical epidemiologist or evidence-based medicine expert; a medico-legal
expert; and a public health expert.
34.10.b. The subcommittees to be constituted may include, among others: Drugs,
Vaccines, Clinical Equipment and Devices, Medical and Surgical Procedures,
Preventive and Promotive Health Services, and Traditional Medicine. All
subcommittees shall have a minimum of one (1) and maximum of three (3)
non-voting members for each subcommittee. Qualifications of the
subcommittee shall be determined by the DOH and DOST.
34.11. The HTAC may call upon technical resource persons from the PhilHealth, Food and
Drug Administration (FDA), patient groups and clinical medicine experts as regular
resource persons; and representatives from the private sector and health care providers
as by-invitation resource persons.
Appointment and Remuneration of HTAC
34.12, The HTAC’s core committee and subcommittee members shall be appointed by the
Secretary of Health for a term of three (3) years, except for the medico-legal expert,
Page 48 of 63
ethicist, and the sociologist or anthropologist, who shall serve for a term of four (4)
years. No member shall serve for more than three (3) consecutive terms.
34.13. Members of the HTAC shall receive an honorarium in accordance with existing
policies.
34.14. The DOH, together with DOST, shall promulgate the nomination process for all HTAC
members with a clear set of qualifications, credentials, and recommendations from the
sectors concerned. Conflict of interest shall be managed by the HTA Office in
accordance with Section 35 of these Rules.
34.15. The Secretary of the DOST shall appoint the members of the HTAC upon its transition
into an attached agency under DOST, based on the established criteria and
demonstrated competencies by the DOH and DOST.
HTA Process
34.16. The HTA Technical Unit for Policy, Planning and Evaluation, in coordination with the
HTAC and other stakeholders, shall establish the process and methods to
guide the HTA
implementation. This shall be published and shall be reviewed periodically.
Legal Protection
34.17. All official actions of the HTAC shall be supported by appropriate legal staff as deemed
necessary.
Transition of HTAC from DOH to DOST
34.18 The HTAC, supported by its Secretariat and a Technical Unit for Policy, Planning and
Evaluation as created in Section 34.8 of this Rule, shall transition into an independent
entity separate from the DOH as an
attached agency of the DOST within five (5) years
after its establishment and operation subject to the joint guidelines for its
implementation.
Section 35. Ethics in Public Health Policy and Practice
Conflict of Interest Management
35.1. All stakeholders involved in policy-determining activities at all levels of policy-making

are required to act in a manner that shall serve the public’s best interest, and thus are
required to disclose and manage any real or perceived conflicts of interest. For the
purposes of these Rules:
Page 49 of 63
35.1.a. Conflict of Interest (COD shall refer to acts or omissions constituting a conflict
of interest under existing laws and civil service rules, including international
treaties where the Philippinesis a signatory. This definition shall be applicable
to reportable financial and non-financial interests of all public and private
stakeholders involved in policy-determining activities.
35.1.b. in
Policy-determining activities shall refer to actions taken aid of public policy
development leading to impartial decisions in adopting and implementing a
policy option or policy recommendation using the best available evidence.
all actual
|
35.2. Decision makers, policymakers, staffmembers, and consultants shall disclose

and potential conflicts of interest to their heads of office, as applicable.
35.3. The DOH shall issue guidelines that specify standards for receipt, assessment, and
management of declared COI, in consultation with the CSC and other relevant public
and private stakeholders.
Tracking Financial Relationships between Health and Health-Related Commodity

Manufacturers, Healthcare Providers, and Health Professionals
35.4. All manufacturers of drugs, medical devices, biological and medical supplies registered
by the FDA shall document, maintain records, and make publicly available the
information on all financial relationships directly or indirectly made with health care
professionals and healthcare providers in accordance with existing laws. For the
purposes of these Rules:
35.4.a. Financial relationship shall refer to any form of emolument that may be
contractual or non-contractual in nature, such as but not limited to cash, cash
equivalent, in kind, stock, stock option or any ownership interest, dividend,
profit or other return of investment, and transfers of value.
35.4.a1 Transfer of value shall refer to the direct or indirect transfer of
benefits or gains, whether in cash, in kind or otherwise, made,
whether for promotional purposes or otherwise, in connection with
the development or sale of drugs, medical device, and biological and
medical supplies.
35.4.b. Financial relationships shall cover the following:
35.4.b.i. For health care professionals: donations, educational grants,
research funding, sponsorships related to events, travel, and
accommodation, registration fees, honoraria, support for continuing
professional development (CPD), royalties, current or prospective
ownership or investment interest, consultancy/speakership fees, or
other contractual arrangements for health care provider services,
either given in cash or benefits in kind.
35.4.b.ii. For health care providers: sponsorship of events, research and
educational grants, payment of services, space rentals or facility
fees, and donations for patients, whether given in cash or in kind.
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35.5. All manufacturers of drugs, medical devices, biological and medical supplies covered
by these Rules shall submit reports of disclosures to the DOH subject to existing laws
of
and issuance a guideline.
Public Health Ethics Committee
35.6. A Public Health Ethics Committee shall be constituted as an advisory body to the
Secretary of Health to assess the ethical soundness of public health practice, through
monitoring and management of conflict of interest declaration and collecting and
tracking of financial relationships of manufacturers of drugs, medical devices, and
biological and medical supplies with healthcare professionals and providers.
35.7. The DOH shall issue guidelines on the composition and tenure of the members of the
Public Health Ethics Committee as well as the procedures for review and
recommendations for the development ofpolicies and programs.
Section 36. Health Information System
36.1. All health service providers and insurers are required to maintain a health information
system on enterprise resource planning, human resource information system, electronic
health records, and electronic prescription log, including electronic health commodities
logistics management information, which shall be electronically uploaded on a regular
basis through interoperable systems consistent with standards set by the DOH and
PhilHealth and in consultation with the DICT and NPC; Provided, That the applicable
standards shall be set depending on variables such as type and level of health care
providers.
36.2. The DOH and PhilHealth, in consultation with the DICT and NPC, shall issue detailed
guidelines on the scope and standards of electronic health records, enterprise resource
planning, human resource information system, electronic health records, and electronic
prescription log including electronic health commodities logistics management
information and maintenance of said health information system; Provided, That the
same shall be without prejudice to future amendments in response to evolving needs
and practices.
36.3. The DOH and PhilHealth shall fund and engage providers, through appropriate
mechanisms, to develop and upgrade information systems, which may
cost by health care providers and insurers.
be
availed at no
36.4. The DOH, PhilHealth, health service providers and insurers, shall ensure patient
privacy and confidentiality in the maintenance of health information systems, in
compliance with RA 10173 (Data Privacy Act).
Page 51 of 63
36.5. PhilHealth shall use its contracts to incentivize the incorporation of health information
systems, automation of clinical information, improvement of data quality, integration
and use of telemedicine, and participation in regional or national health information
networks.
36.6. The DOH and PhilHealth shall adopt efficient approaches to the best advantage of both
agencies in the development and implementation of health information systems based
on the result of feasibility studies.
36.7. The DOH and PhilHealth shall issue guidelines for the maintenance of the information
systems and access of healthcare providers and insurers.
Page 52 of 63
RULE IX. APPROPRIATIONS
Section 37. Appropriations
37.1. The amount necessary to implement these Rules shall be sourced from the following:
37.1.a. Total incremental sin tax collections as provided for in RA 10351 (Sin Tax
Reform Law); Provided, That the mandated earmarks, as provided for in RA
7171 (An Act To Promote the Development of the Farmers in the Virginia
Tobacco-Producing Provinces) and RA 8240 (An Act Amending Sections 138,
140, and 142 of the National Internal Revenue Code, as amended, and for other
purposes), shall be retained;
37.1 b. Fifty-percent (50%) of the national government share from the income of the
Philippine Amusement Gaming Corporation (PAGCOR), as provided for in
Presidential Decree No. 1869, as amended; Provided, That the funds raised for
the Act shall be transferred to PhilHealth at the end of each quarter subject to
the usual budgeting, accounting and auditing rules and regulations; Provided,
further, That such funds shall be used by PhilHealth to improve its benefit
packages;
37.1.c. Forty percent (40%) of the Charity Fund, net of Documentary Stamp Tax
Payments, and mandatory contributions of the Philippine Charity Sweepstakes
Office (PCSO), as provided for in RA 1169 (An Act Providing for Charity
Sweepstakes Horse Races and Lotteries), as amended; Provided, That the
funds raised for this purpose shall be transferred to PhilHealth at the end of
each quarter subject to the usual budgeting, accounting, and auditing rules and
regulations; Provided, further, That the funds shall be used by PhilHealth to
improve its benefit packages; Provided, finally, That the funds shall also be
attributed as part of PCSO’s Gender Equality, Diversity, and Social Inclusion
(GEDSI) Program, subject to applicable rules and regulations of RA 9710
(Magna Carta of Women).
37.1.d. Premium contribution of members;
37.1.e. Annual appropriations of the DOH included in the GAA; and,
37.1.f. National government subsidy to PhilHealth included in the GAA.
37.2. A joint guideline shall be issued by concerned national government agencies to ensure
that the funds from PCSO and PAGCOR, as provided under the Act, are accurately
assessed and timely transferred to PhilHealth in accordance with existing laws, rules,
and regulations.
37.3. The amount necessary to implement the provisions of the Act shall be included in the
GAA and shall be appropriated under the DOH and national government subsidy to
PhilHealth. In addition, the DOH, in coordination with PhilHealth may request

Congress to appropriate supplemental funding to meet targeted milestones of the Act.
Page 53 of 63
RULE X. PENAL PROVISIONS
Section 38. Penal Provisions
38.1. Any provisions of these Rules, after due notice and hearing, shall suffer
violation of the
the corresponding penalties as herein provided:
Offenses of Health Care Providers of Population-based Health Services
38.2. Any health care provider contracted for the provision of population-based health
services, who violates any of the provision in their respective contracts, shall be subject
to sanctions and penalties under each respective contract without prejudice to the right
of the government to institute any criminal or civil action before the proper judicial
individuals
body; Provided, That or corporate personalities may file complaints to the
DOH
regarding any violation of said contract; Provided, further, That the DOH may
pursue complaints as necessary.
Offenses of Health Care Providers of Individual-based Health Services
Classification of Offenses
38.3. Offenses committed by the health care provider for the provisions of individual-based
health services are classified as fraudulent acts, unethical acts, and abuse of authority.
Penalties
38.4. Offenses committed by a health care provider for unethical acts, abuse of authority
vested upon the health care provider, or performance of a fraudulent act, shall be
penalized a fine of Two hundred thousand pesos (Php 200,000.00) for each count, or
suspension of contract up to three (3) months or the remaining period of its contract or
accreditation, whichever isshorter, or both, at the discretion of PhilHealth, taking into
consideration the gravity of the offense.
38.5. If the health care provider is a juridical person, its officers and employees or other
representatives found to be responsible, who acted negligently or with intent, or have
directly or indirectly caused the commission of the violation shall be liable.
38.6. Recidivists may no longer be contracted as participants of the Program.
Page 54 of 63
Definition of Offenses
38.7. PhilHealth shall prescribe the definitions of specific offenses of health care providers
and members, rules on administrative cases, and the period to resolve from investigation
to the resolution of the cases including Rules on Preventive Suspension, Withdrawal of
Contract or Accreditation, and Temporary Suspension of Payment of claims pending
investigation; Provided, That non-compliance with the policy on no co-payment, co-
payment and co-insurance shall likewise be penalized.
Criminal Case
Violation of RA 7875 (National Health Insurance Act of 1995) and RA 11223 (Universal
Healthcare Act)
38.8. A criminal complaint shall be filed against the health care provider, and, if a juridical
person, the officers, employees or other representatives of the health facility,
community-based health care organization, pharmacy/laboratory and diagnostic clinic,
and health care provider network found to be responsible, who acted negligently or with
intent, or have directly or indirectly caused the commission of the violation referred to
in Section 38 (b) of the Act. A criminal violation is punishable by imprisonment ofsix
(6) months and one (1) day up to six (6) years, upon discretion of the court without
prejudice to criminal liability defined under the Revised Penal Code.
Civil Case
Filing of Civil Action
38.9. The filing of an administrative or criminal action does not preclude PhilHealth from
filing a separate civil action against the health care provider before the appropriate court
Offenses of Members
38.10. A member who commits any violation of the Act; fails to pay all missed contributions
with an interest, compounded monthly, as provided in Section 9 of the Act; or,
knowingly and deliberately cooperates or agrees, whether explicitly or implicitly, to the
commission of a violation by a contracted health care provider or employer, as defined
in this provision, including the filing of a fraudulent claim for benefits or entitlement
under the Act, shall be punished, after due notice and hearing, by a fine of Fifty
thousand pesos (Php 50,000.00) for each count or suspension from availment of the
benefits of the Program for not less than three (3) months but not more than six (6)
months, or both, at the discretion of PhilHealth.
Page 55 of 63
Offenses of Employers
Failure or Refusal to Register Employees
38.11. Any employer, officer, or responsible employee who deliberately or through

inexcusable negligence fails or refuses to register employees regardless of their
employment status shall be punished, after due notice and hearing, with a fine of Fifty
thousand pesos (P50,000.00) for every violation per affected employee, or
imprisonment of not less than six (6) months but not more than one (1) year, or both
such fine and imprisonment, at the discretion of the court.
Failure or Refusal to Deduct Contributions

inexcusable negligence fails or refuses to accurately and timely deduct contributions
from the employee’s compensation shall be punished, after due notice and hearing, with
a fine of Fifty thousand pesos (Php 50,000.00) for every violation per affected
employee, or imprisonment of not less than six (6) months but not more than one (1)
year, or both such fine and imprisonment, at the discretion of the court.
Failure or Refusal to Accurately and Timely Remit Contributions

inexcusable negligence fails or refuses to accurately and timely remit contributions
from the employee’s compensation shall be punished, after due notice and hearing, with
a fine of Fifty thousand pesos (Php 50,000.00) for every violation per affected
employee, or imprisonment of not less than six (6) months but not more than one (1)
year, or both such fine and imprisonment, at the discretion of the court.
Failure to Refusal to Submit Report

inexcusable negligence fails or refuses to submit the report of the contributions to
PhilHealth shall be punished, after due notice and hearing, with a fine of Fifty thousand
pesos (Php 50,000.00) for every violation per affected employee, or imprisonment of
not less than six (6) months but not more than one (1) year, or both such fine and
imprisonment, at the discretion of the court.
Presumption of Misappropriation
38.15. Any employer, officer, or employee authorized to collect contributions under these
Rules who, after collecting or deducting the monthly contributions from the employee’s
Page 56 of 63
compensation, fails or refuses for whatever reason to accurately and timely remit the
contributions to PhilHealth within thirty (30) days from due date shall be presumed
prima facie to have misappropriated the same and to have been obligated to hold the
same in trust for and in behalf of the employees and PhilHealth, and shall be
immediately obligated to return or remit the amount.
38.16. If the employer is

a juridical person, its directors, trustees, president, general manager,
partners, and other officers and employees or other representatives found to be
responsible, whether they acted negligently or with intent, or have directly or indirectly
caused the commission of the violation, shall be liable.
Unlawful Deduction
38.17. Any employer or

its officers or employees who deducts, directly or indirectly, from the
compensation of the covered employees or otherwise recover from them the employer’s
own contribution on behalf of such employees shall be punished, after due notice and
hearing, with a fine of Five thousand pesos (P5,000.00) multiplied by the total number
of affected employees or imprisonment of not less than six (6) months but not more
than one (1) year, or both such fine and imprisonment, at
the discretion of the court.
38.18, If the unlawful deduction is committed by an association, partnership, corporation or

any other institution, its managing directors or partners or president or general manager,
or other persons responsible for the commission of the act shall be liable for the
penalties provided for in the Act.
Offenses of Directors, Officers, or Employees of PhilHealth
38.19. Any officer or employee of PhilHealth who:

director,
38.19.a, Without prior authority or contrary to the provisions of the Act or these Rules,
wrongfully receives or keeps funds or property payable or deliverable to
PhilHealth, and who appropriates and applies such fund or property for
personal use; or shall willingly or negligently consents either expressly or
implicitly to the misappropriation of funds or property without objecting to the
same and promptly reporting the matter to proper authority shall be liable for
misappropriation of funds under these Rules and shall be punished, after due
to
notice and hearing, with a fine equivalent triple the amount misappropriated
per count and suspension for three (3) months without pay;
38.19.b. Commits an unethical act, abuse of authority, or performs
be administratively liable, after due notice and
a fraudulent act shall
hearing, to pay a fine of Two
hundred thousand pesos (Php 200,000.00) or suspension for three (3) months
without pay, or both, at the discretion of PhilHealth, taking into consideration
the gravity of the offense. The same shall also constitute a criminal violation
punishable by imprisonment for six (6) months and one (1) day up to six (6)
years, upon discretion of the court without prejudice to criminal liability
defined under the Revised Penal Code.
Page 57 of 63
Other Violations
38.20. Failure to submit health and health-related data to PhilHealth by health-related entities
shall be penalized, after due notice and hearing, with a fine of not less than Five
thousand pesos (Php 5,000.00) but not more than Twenty thousand pesos (Php
20,000.00), per count.
of
38.21. Other violations the provisionsof the Act orof the rules and regulations promulgated
by PhilHealth shall be punished, after due notice and hearing, with a fine of not less
than Five thousand pesos (Php 5,000.00) but not more than Twenty thousand pesos
(Php 20,000.00).
38.22. All other violations involving funds of PhilHealth shall be governed by the applicable
provisions of the Revised Penal Code
on collection, remittances, and
or other laws, taking into consideration the rules
investment of funds as may be promulgated by
PhilHealth.
Circumstances Affecting Penalties
38.23. PhilHealth shall prescribe and enumerate circumstances that shall mitigate or aggravate
the liability of the offender or erring health care provider, member or employer.
38.24. Individuals or corporate personalities may file complaints to the DOH or PhilHealth
regarding any violation; Provided, That the DOH or PhilHealth may pursue complaints
as necessary.
Effects of Cessation of Operation
38.25. Despite the cessation of operation by a health care provider or termination of practice
of an independent health care professional, while the complaint is being heard, the
proceeding shall continue until the resolution of the case.
Page 58 of 63
RULE XI. MISCELLANEOUS PROVISIONS
Section 39. Oversight Provision
39.1. A Joint Congressional Oversight Committee on UHC shall be created to conduct a

regular review, of the implementation of the Act which shall entail a systematic
evaluation of the performance, impact or accomplishments of these Rules and the
performance of the various agencies, such as but not limited to, DOH, PhilHealth,
LGUs, and the private healthcare providers involved in realizing UHC, particularly with
respect to their roles and functions.
39.2. The Joint Congressional Oversight Committee shall be jointly chaired by the
Chairpersons of the Senate Committee on Health and Demography and the House of
Representatives Committee on Health. It shall be composed of five (5) members from
the Senate and five (5) members from the House of Representatives, to be appointed by
the Senate President and the Speaker of the House of Representatives, respectively.
39.3. The National Economic and Development Authority, in coordination with the PSA,
National Institutes of Health, and other academic institutions shall undertake studies to
validate and evaluate the accomplishments of these Rules. These validation studies: and
annual reports, on the performance of the DOH and PhilHealth shall be submitted to .
the Joint Congressional Oversight Committee.
39.4. The DOH and PhilHealth shall allocate an adequate funding for the purpose of
conducting the studies provided under Section 39.3 of these Rules,
39.5 The Joint Congressional Oversight Committee shall commission an independent study
to evaluate the implementation of the Act.
Section 40. Performance Monitoring Division
40.1. The DOH

shall establish a Performance Monitoring Division (PMD) which shall be
responsible for:
40.1.a. Developing an inclusive and effective platform for monitoring and evaluating
the performance
these Rules;
of the health sector in the context of the implementation of
40.1.b Facilitating the engagement of third-party providers, as may be deemed

necessary, to ensure unbiased conduct of monitoring and evaluation activities;
40.1.c. Coordinating with other DOH offices, other national government agencies and
LGUs, development partners, civil society organizations and sectoral
Page 59 of 63
stakeholders, to ensure co-ownership of targets and complementation of

activities; and,
40.1.d. Operationalizing an assistance and feedback mechanism among various
stakeholders and particularly for patients, to ensure that implementation is
patient centered.
40.2. The DOH shallestablish performance monitoring units up to the regional level and in
all DOH hospitals to assist in the implementation of these Rules.
Section 41. Transitory Provision
41.1 Within thirty (30) days from the effectivity of the Act, the President of the Philippines
shall appoint the new members of the Board and the President of PhilHealth. The
existing board of directors shall serve in a hold-over capacity until a full and permanent
board of directors of PhilHealth is constituted and functioning.
41.2 All officers and personnel of PhilHealth, except members of the Board who shall be
governed by Section 41.1 of these Rules, shall continue to perform their duties and
responsibilities and receive their corresponding salaries and benefits; Provided, That
the approval of the Act and these Rules shall not cause any demotion in rank or
diminution of salary, benefits and other privileges of the incumbent personnel of
PhilHealth; Provided, further, That qualified officers and personnel may voluntarily
elect for retirement or separation from service and shall be entitled to the benefits under
existing laws; Provided, finally, That PhilHealth shall submit for approval the
compensation framework to the Office of the President, and the organizational structure
and early retirement program to the PhilHealth Board of Directors, within one (1) year
from the effectivity of these Rules.
41.3. All affected officers and personnel of the PCSO shall be absorbed by the agency without
demotion in rank or diminution of salary, benefits and other privileges; Provided, That
qualified officers and personnel of the agency may voluntarily elect for retirement or
separation from service based on PCSO Board-approved Early Retirement Incentive
Program (ERIP), utilizing internally-generated funds, or savings from its operating fund
or the Office of the President approved existing ERIP of the Agency; Provided, finally,
That the retirement benefit package shall be reasonable and within the bounds of
existing laws.
41.4. In the first six (6) years from the enactment of these Rules, the national government,
through the DOH, DILG and PhilHealth, shall provide technical and financial support,
in addition to support regularly provided, to selected LGUs that commit to province-
_
wide and city-wide integration, subject to further review after the lapse of six (6) years.
41.4.a. In the first three (3) years from the enactment of these Rules, the province-
wide and city-wide health systems shall exhibit managerial integration,
including technical integration, while within the next three (3) years thereafter,
the province-wide and city-wide health systems shall exhibit financial
Page 60 of 63
integration. Technical integration refers to the functional and efficient linking

of health service provision from primary to tertiary care, when appropriate,
across different levels of facilities, care settings, across a comprehensive
spectrum of care with primary care as the foundation and intersectoral
participation as one its
of key principles.
41.4.b. To effect a smooth and efficient transition without unduly prejudicing or
disrupting the delivery of health services, the integration process shall proceed
by phases. The implementation and completion of the minimum requirements
of each phase may proceed ahead of the recommended timeline.
41.4.b.i. Phase I. This shall include all the preparatory works needed to
facilitate local health systems integration, such as operational
guidelines, baseline studies, training needs assessment,
development of
local investment plan for health, and organization
of local health board and its support unit. The SHF shall also be
created.
~
41.4.b.ii. Phase If. This shall include the DOH provision of technical
assistance to the province-wide and city-wide health system in
building their capabilities in managing the integrated health
systems. Each province-wide and city-wide health system shall have
organized its primary care provider network(s), an improved
governance structure, and a functional health board managing the
SHF. The health care provider networks shall be contracted by
PhilHealth.
41.4.b.iii. Phase II. This shall include the monitoring of the functionality of
the integrated local health system.
41.4.¢ The DOH, in consultation with other stakeholders, shall issue guidelines to
determine managerial and financial integration in the province-wide and city-
wide health systems. At the minimum, managerial integration, which includes
technical integration, shall be characterized by the following:
41.4.c.i. Local ordinance(s) issued on the:
41.4.c.i.a. Integration of the municipalities’ and component cities’
local health systems to the province-wide health system;
41.4.c.i.b. Implementation of the province-wide and city-wide
health systems, in accordance with the Act and these
Rules;
41.4.c.ii. Unified governance of the local health system;
41.4.c.iii. Integrated management system, consisting of financing, human
resources for health management and development, strategic and
investment planning, information management, procurement and
supply chain management, and quality assurance/ improvement;
41.4.c.iv. Functional referral system;
41.4.c.v. Functional disaster risk reduction management for health system;
41.4.c.vi. Functional epidemiologic surveillance system; and,
41.4.c.vii. Proactive and effective health promotion programs or campaigns;
41.4.d. At the minimum, financial integration shall be characterized by the following:
Page 61 of 63
41.4.d.i. Creation of SHF;

41.4.d.ii. Issuance of health board resolution on the utilization of the SHF, in
strict adherence with the national guidelines; and,
41.4.d.iii. Funds exclusively used for health services and health system
development;
41.4.e. Upon positive recommendation by an independent study commissioned by the
Joint Congressional Oversight Committee on UHC of the overall benefit of
province-wide integration and the positive recommendation of the Secretary
of Health, all local health systems shall be integrated as prescribed by Section
19 of these Rules through the issuance of an Executive Order by the President.
41.5. In the first ten (10) years from the enactment of the Act, PhilHealth may outsource
certain functions to ensure operational efficiency and towards the fulfillment of the Act;
Provided, That any outsourcing shall comply with the provisions of RA 9184
(Government Procurement Reform Act), and its IRR.
41.6. In the first three (3) years

from the enactment of
these Rules, PhilHealth and DOH shall
provide reasonable financial and licensing incentives to contracted health care facilities
to form health care provider networks. Thereafter, these incentives shall be withdrawn
and providers shall be fully subject to the provisions of Section 19 of these Rules.
During the transition phase, PhilHealth may continue its accreditation process to ensure
that primary care facilities can still be contracted; Provided, That accreditation by
PhilHealth shall be applicable only in the following circumstances:
41.6.a. Absence of DOH licensing/certification process and/or standards for the type
of facility in relation to Section 6 of these Rules. PhilHealth may develop the
standards for accreditation of said facilities until such time that they are issued
licenses and certification by the DOH; or,
41.6.b. No contracted network is available or capable in the province or city to provide
the health services.
41.7. The HTAC under the DOH shall be established within one (1) year from the effectivity
of the Act: Provided, That the existing health benefit package shall be rationalized
within two (2) years from the establishment of the HTAC.
41.8. Within three (3) years from the effectivity of these Rules, all private insurance
companies and HMOs, together with DOH and PhilHealth, shall have developed a
system of co-payment that complements PhilHealth benefit packages. HMOs and
private insurance companies shall comply with guidelines prescribed by PhilHealth and
DOH on the application of benefits and to cover for amenities and out of pocket
expenses and services not covered by PhilHealth. PhilHealth shall coordinate with
HMOs and PHIs on the transfer of benefit packages currently covered by HMOs and
PHIs but are not covered by PhilHealth.
Page 62 of 63
41.9, Within ten (10) years from the effectivity of the Act, only those who have been certified
by the DOH and PRC to
primary care provider.
be capable of providing primary care will be eligible to be a
41.10. For the first two (2) years from the effectivity of the Act, the PCSO shall transfer at
least fifty percent (50%) of the forty percent (40%) of the charity fund per year, in
accordance with Section 37(c) of the Act, to enable the PCSO to conclude and liquidate
its Individual Medical Assistance Program At-Source-ang-Processjng (IMAP-ASAP)
obligations.
Section 42. Interpretation
42.1, All doubts in the implementation and interpretation of the Act, including these Rules,
shall be resolved in favor of upholding the rights and interests of every Filipino to
quality, accessible and affordable health care.
42.2. Nothing in these Rules shall be construed to eliminate or in any way diminish Program
benefits being enjoyed at the time of promulgation of the Act.
Section 43. Separability Clause
43.1. Ifany part or provision of the Act and these Rules is held invalid or unconstitutional,
the remaining parts or provisions not affected shall remain in full force and effect.
Section 44. Repealing Clause
44.1. Except as otherwise expressly provided in the Act or these Rules, all other laws,
decrees, executive orders, proclamations and administrative regulations
inconsistent herewith are hereby repealed or modified accordingly.
or
parts thereof
Section 45, Effectivity
45.1. These Rules shall take effect fifteen (15) days after its publication in the Official
Gazette or in any newspaper of general circulation.
Approved:
- DUQUE HI, MD, MSc

Secretary of Heaith
Page 63 of 63
103
2 ORGANIZING
THE LOCAL HEALTH SYSTEM
The service delivery design of Health Care Provider Networks (HCPNs) developed
by the DOH serves as the general framework for organizing health care providers into
networks and linking them to one or more apex or end-referral hospitals. In the public
sector, LGUs are endeavored to organize their fragmented local health systems within the
province, or highly urbanized or independent component city into integrated Province-
wide or City-wide Health Systems (P/CWHS). In the private sector, the organization of a
HCPN may or may not be limited to defined geopolitical boundaries. Its organization into
a network of private health care providers and facilities may be contingent on market-
based forces. In addition, a mixed-type HCPN composed of public and private health care
providers and facilities may be organized based primarily on a contractual arrangement
between public and private entities to provide health services jointly or cooperatively.
As the basic foundation of HCPNs, primary care providers and facilities are
organized as primary care provider networks (PCPNs) to serve as gatekeepers and
navigators of patients or constituents within the network. The implementing rules and
operational guidelines of the UHC Act also require all hospitals to establish public
health units in order to facilitate the provision of public health programs and services;
and to improve patient navigation within the hospital, and between the hospital and
primary care facilities. Moreover, the UHC Act requires prioritization of health services
in unserved and underserved areas to provide more equity to the marginalized sector
of the population. To this end, DOH is required to identify geographically isolated and
disadvantaged areas (GIDAs), improve their health system, and strengthen their links
within the HCPN.
ORGANIZING THE LOCAL HEALTH SYSTEM 105
LIST OF POLICIES AND OPERATIONAL GUIDELINES

ON ORGANIZING THE LOCAL HEALTH SYSTEM
• Guidelines on the Service Delivery Design of Health Care Provider

Networks [AO 2020-0019]
• Guidelines on Integration of the Local Health Systems into Province-

wide and City-wide Health Systems (P/CWHS) [AO 2020-0021]
• Guidelines on Identifying Geographically-Isolated and Disadvantaged

Areas and Strengthening their Health Systems [AO 2020-0023]
• Policy Framework on Leadership and Governance for Health

(LeadGov4Health) Towards a Functional Local Health Board
[DOH-DILG JAO 2022-0001]
• Roles, Functions, and Responsibilities of the Department of Health

Representatives [AO 2020-0029]
of the Philippines
Republic
OFFICE OF THE SECRETARY
MAY 14 2020
ADMINISTRATIVE ORDER
0014
No. 2020—_
SUBJECT: Guidelines on the Service Delivery Design of Health Care Provider

Networks
I. RATIONALE
The Universal Health Care (UHC) Act or Republic Act 11223 is anchored on an
integrated and comprehensive approach for
the health system to ensure that all Filipinos
are health literate, provided with healthy living conditions, and protected from hazards
and risks that could affect their health.
Section 18 of the UHC Act provides the formation of health care provider networks
(HCPNs) that ensure integration and effective and efficient delivery of population-
based and individual-based health services. HCPNs may be composed integrated of
local health systems (the province-wide or city-wide health systems), networks of
private health care providers to complement the health services provided by public
health facilities, or mixed public-private networks of health service providers. In
addition, the DOH is mandated to identify apex or end-referral hospitals for patients
needing specialized care not available within the HCPNs.
UHC Implementing Rules and Regulations (IRR) in Section 18 provides that HCPNs
shall receive performance driven, closed-end, prospective payments from PhilHealth
based on diagnosis-related groupings. Apex or end-referral hospitals may be contracted
as stand-alone facilities by PhilHealth.
To support the implementation of the UHC Act and its IRR, and to ensure that all
Filipinos have access to quality health care, the following guidelines are hereby issued.
II. OBJECTIVES
A. General Objective
This Order shall set the standards of HCPNs and apex hospitals to ensure that the
continuum of care is delivered through a people-centered and integrated health system.
B. Specific Objectives
To provide the requirements of the HCPNs;

To develop the mechanism for a functional referral system;
\
establish guidelines for the designation of apex hospitals; and,
BYNES
To
To provide guidelines for the establishment of
public health units in hospitals.
Syne
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http:/Avww.doh.gov.ph; e-mail: {tduque@doh.gov.ph
III. SCOPE OF APPLICATION
This Order shall apply to all Department of Health (DOH) offices and all
its units and
instrumentalities, including the Centers for Health Development (CHDs), hospitals,
PhilHealth, and other attached agencies. Likewise, this shall also apply to all public
and private health facilities, Local Government Units (LGUs), and other relevant
stakeholders on establishing HCPNs.
Iv. DEFINITION OF TERMS
A. Apex or End-Referral Hospital — The terms apex and end-referral hospital are used
interchangeably in these Guidelines. It refers to a hospital, offering specialized
services as determined by DOH, which is contracted as a stand-alone facility by
PhilHealth.
Specialty Center - a unit or department in a hospital that offers highly specialized

care addressing particular conditions and/ or providing specific procedures and
management of cases requiring specialized training and/ or equipment.
Health Care Provider Networks (HCPN) — a group of primary to tertiary care

providers, whether public, private or mixed, offering people-centered and
comprehensive care in an integrated and coordinated manner with the primary care
provider acting as the navigator and coordinator of health care within the network.
Public Health Unit (PHU) - a unit in the hospital facilitating the provision of
population-based services, implementation of national public health programs,
coordination with primary care provider networks, and provision of a one-stop shop
patient navigation system within the hospital.
Primary Care Provider Network (PCPN) — refers to a coordinated group of public,

private or mixed primary care providers, as the foundation of the HCPN.
Primary Care Facility — is a private or a public institution that primarily delivers

primary care services which shall be licensed or registered by the DOH with the
prescribed service capability (Annex A).
Health Station — is a private or a public health facility that functions to augment the
delivery of public health services of a Primary Care Facility (Annex A).
Referral — the process in which a health facility officially and appropriately

transfers the management of
a patient to a better or differently resourced facility,
and refers the patient back to the assigned primary care provider.
GENERAL GUIDELINES
A. Public, private, or mixed HCPNs shall be established to provide all population

groups with continuous health care from primary to tertiary, which shall be
delivered in a safe, efficient, and coordinated mechanism.
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B. All HCPNs shall have functional care coordination with the PCPN serving as the
patient’s initial-contact and navigator.
C. HCPNs shall establish a patient navigation and coordination system, patient

records management system, harmonized information and communication
technology, medical transport system, standardized network mechanisms for
operations, and financial and performance management.
D. Public HCPNs may complete their service capability through contractual

arrangements with the private sector or vice versa.
E. All HCPNs shall have primary

to
tertiary care providers with linkages to an apex
hospital and other facilities providing specialized services needed by its
catchment
population.
F. All DOH hospitals shall endeavor to become apex hospitals; Provided that, in the
interim, DOH Hospitals that currently do not qualify as apex hospitals may be
contracted by PhilHealth as stand-alone facilities.
G. The DOH
shall
determine eligible apex or end-referral hospitals. These apex or
end-referral hospitals shali be contracted as stand-alone facilities based on the
guidelines issued by PhilHealth.
H. All hospitals shall have a Public Health Unit to facilitate the implementation of
population-based health services and seamless patient navigation within the HCPN.
VI. SPECIFIC GUIDELINES
A. Components of the HCPN
The HCPN shall be composed of PCPN providing primary care service, and
hospitals delivering secondary and tertiary general health care.
1. The PCPN shall be composed of the following health facilities that provide
population and/or individual-based primary care services:
a. Primary Care Facilities, such as Rural Health Units, Health Centers, and
Medical Outpatient Clinics, which shall ensure proper coordination and
service delivery across the PCPN; and,
b. Other health facilities necessary for the delivery of primary care, such as
but not limited to, health stations, stand-alone birthing homes, stand-alone
laboratories, pharmaceutical outlets, and dental clinics.
2. The following health facilities, whether public or private, shall provide general
in-patient care services for the HCPN:
a. Infirmaries, if present in the existing geographic or political boundary;

and,
we cS
b. Hospitals, as classified by the DOH, which shall include:

1. At least one Level 1 providing secondary care; and,
2. At least one Level 2 or 3 hospital providing tertiary care.
B. Network-wide Requirements
All HCPNs shall have the following:

1. Licensed and accredited health facilities. All public and private health facilities
that are part of the network shall be licensed by DOH and accredited by
PhilHealth.
Service capability profiling. All HCPNs shall determine and continuously

monitor the services, human resources, equipment, and infrastructure of all its
health facilities.
All participating health facilities shall annually comply with the Health
Facility Profiling of DOH and PhilHealth.
A directory and map of all the health facilities in the HCPN with all the
services provided, address, clinic hours, and contact numbers shall be
posted in each health facility.
All HCPNs and their apex hospitals shall endeavor to meet access standards
for health facilities in alignment with the Philippine Health Facility
Development Plan, wherein people shall have access to a primary care
facility within thirty (30) minutes travel time and to a hospital within one
(1) hour.
Primary care-based coordination. The HCPN shall establish a functional

referral system rooted in effective primary care navigation across the network.
a. HCPNs shall develop localized referral protocols based on clinical practice

guidelines in consideration of the local context such as available road
networks, modes of transportation, availability of health human resources
including clear and standardized criteria for transfer of patients. An
algorithm for emergency and non-emergency referrals and patient flow in
the network shown in Annex B
HCPNs shall have a patient record management system with an

interoperable electronic medical record in all member health facilities
capable of real-time information-sharing. The system shall include patient
records, diagnostics, treatment history, and other pertinent medical
information that enables medical care, subject to guidelines to be developed
by DOH and PhilHealth, and in compliance with the Data Privacy Act or
RA 10173.
HCPNs shall ensure the availability of ambulances and patient transport

vehicles as necessary for its catchment population.
d. HCPNs shall standardize the process of communication:

i. Appropriate communication facilities available for contact during
operations (e.g. telephone number, cellular phone, two-way radio).
ii. Standardized communication tools for endorsements such as the
Situation Background Assessment Recommendation (SBAR)
communication tool (Annex C).
iii. Uniform referral form with minimum data components indicated in
Annex D and a back-referral form with follow-up and home
instructions, which may be transformed into an electronic report.
iv. Local call center/chat hotline for health ideally with a geographic
information system (GIS) that shall coordinate patient emergency
referral, in compliance with Executive Order 56, s. 2018, entitled:
“Tnstitutionalizing the Emergency 911 Hotline as the Nationwide
Emergency Answering Point, Replacing Patrol 117, and for Other
Purposes.”
4. Network-wide health facility operations. HCPNs shall standardize health

facility operations in its catchment to include the following:
a. Integrated financial management including pooled fund management,

provider payment mechanism, unified price structures of services, and
accounting processes across component facilities, among others;
b. Maintenance team in charge of local capital asset management especially

for equipment and infrastructure depreciation and obsolescence;
ce. Unified supply chain inventory management systems for essential

medicines, supplies, and equipment;
d. Systematic healthcare waste management for the network including proper

waste handling as indicated in the Health Care Waste Management Manual
and a sewage treatment plant for hazardous solid waste through in-house
treatment orthird party hauler;
e. Unified client satisfaction surveys and patient engagement programs in

line
with the Framework on Integrated People-Centered Health Services
analyzed at the HCPN level;
f. Unified Patient Safety Program with designated Patient Safety Officers

whoshail oversee and promote a culture of safety in each health facility;
and,
g. Capacity building and mentoring activities of all health facilities within the
network to improve service capability and health human resource
competencies.
5. Network-wide performance management. The HCPN shall ensure quality,

efficient, and effective services across health facilities through Management
Reviews in
the following components conducted at least quarterly:
en
a. Network-wide health outcomes including morbidity and mortality reviews,

compliance with financial risk protection measures, and patient care and
responsiveness;
b. Utilization of primary care providers by the catchment population as the

entry point of care;
ce. Evaluation of appropriateness and timeliness of referrals made within and

across the network;
d. Patient satisfaction rating using the standardized client responsiveness tool;
e. Compliance to basic accommodation requirements, no balance billing or

no co-payment policies, which may contribute to a reduction of out of
pocket expenses;
f. Adherence to clinical practice guidelines and referral protocols; and,
g. Accessibility and adequacy for health facilities and human resources for the
catchment population.
C. Completing Service Capability through Partnerships
1. HCPNs may partner through contractual agreements with other facilities to

complement its
service capability.
2. Public HCPNs shall follow current legal frameworks and policies for
partnership with the private sector including, but not limited to, the following:
a. Government Procurement Reform Act and its IRR for infrastructure,

equipment and services;
b. Public Private Partnership for Health through:

i. NEDA Joint Venture Guidelines, provided that the necessary
ordinances are in place; and,
ii. Build Operate and Transfer Laws; and,
ce. Guidelines for Local Government Units such as Public-Private Partnerships

for the People (LGU P4) as issued by the DILG.
D. Linkage of HCPNs to Apex Hospitals
1. Apex hospitals shall be linked to HCPNs and shall deliver specialty health care
services not expected to be provided in HCPNs.
a. The DOH shall determine eligible apex hospitals based on the following
service capability:
i. A single-specialty hospital that is designated by law or licensed by the
ii.
DOH,
or
A general hospital with the following:
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(it
113
1. Accredited teaching and training in at least the following four

major departments namely, Medicine, Pediatrics, Surgery, and
Obstetrics and Gynecology; and,
2. Atleast two Specialty Centers according to DOH standards.
b. Apex hospitals shall have the ability and commitment to provide

performance mentoring and technical assistance to the HCPNs in the
following areas:
i, Quality, efficient, and patient-centered clinical services;
ii. Teaching and training of human resources;
iii. Functionality of the referral system; and,
iv. Clinical, public health, and operations research.
ce. Apex hospitals may be owned and managed by DOH, other National
Government Agencies, State Universities and Colleges, or private entities.
d. The designation of apex hospitals by specialty shall follow this process:

i. Survey, mapping and evaluation of service capability of all Level 3
government hospitals and volunteer private hospitals;
ii. Approval of the list of eligible apex or end-referral hospitals by the
Secretary of Health through the DOH Executive Committee;
iti. Matching/linking of apex or end-referral hospitals to the HCPN assisted
by Centers for Health Development; and,
iv. Submission of the list of apex or end-referral hospitals with linkage to
HCPNs to PhilHealth for contracting;
e. HCPNs shall enter into a memorandum of agreement (MOA) with at least

one apex hospital.
2. All HCPNs shall have linkage with Drug Abuse and Treatment Rehabilitation
Centers, Blood Centers, among others.
E. Public Health Units in Hospitals
All hospitals shall have a Public Health Unit (PHU) to

facilitate the provision of
population-based health services and patient navigation.
1. The PHU shall ensure that hospital policies are aligned with national public
health programs.
The PHU shall assist the hospital management in ensuring surveillance and
reporting of notifiable diseases through the disease surveillance officer or
disease surveillance coordinator.
The PHU shall ensure proper referral and navigation of patients within the
hospital and from the hospital to primary care facilities and other necessary
facilities in the network.
4. The PHU shall be established under the Office of the Medical Center Chief or
Chief of Hospital with the following minimum dedicated or designated staff
(see Annex E):
a. Health education and promotion officer;
b. Care navigator/educator; and,
c. Administrative staff.
VIL. ROLES AND RESPONSIBILITIES
A. Health Facility Development Bureau (HFDB)
1. Survey, mapping, and evaluation of service capability of all Level 3 hospitals;
2. Annually submit to PhilHealth the eligible list of apex hospitals; and,
3. Issue guidelines for monitoring functionality and performance

facilities and hospitals, including apex hospitals.
of primary care
B. Field Implementation and Coordination Team (FICT)
1. Coordinate with concerned Central Office units for the provision of technical
assistance to CHDs, Local Health Systems, and HCPNs;
Coordinate with respective Central Office units for a systematic performance

monitoring of HCPNs;
Organize with respective Central Office units a harmonized capacity building

of CHD personnel for monitoring performance; and,
4. Organize with respective Central Office units capacity building of HCPNs.
C. Knowledge Management and Information Technology Service (AMITS)
1. Set interoperability and data standards for information and communication

technology systems in the network including patient record management
system.
D. Health Facilities and Services Regulatory Bureau (HFSRB)
1. Set licensing standards for primary care facilities and other health facilities in
the HCPN; and,
2. Ensure compliance of all licensed health facilities to DOH standards.
E. Bureau of Local Health Systems Development (BLHSD)

1. Formulate frameworks, policies, guidelines, and standards on Local Health

Systems.
F. Centers for Health Development (CHD)
1. Assess performance and monitor the functionality of HCPNs and apex

hospitals;
2. Guide the development of HCPNs according to their maturity grade, based on

the CHD capacity for assistance; and,
3. Provide and/or facilitate the provision of technical assistance to resolve issues,

concerns and problems on the development, utilization, and implementation of
the care coordination mechanisms within the network.
G. PhilHealth
1. Develop contracting guidelines and mechanisms for HCPNs and apex

hospitals;
2. Monitor financing performance indicators of HCPNs and apex hospitals (e.g.

utilization rates, out of pocket expenses, no balance billing);
3. Incentivize health facilities to become part of the HCPNs;
4. Incentivize contracted HCPNs and apex hospitals based on their performance;

and,
5. Provide pertinent data to DOH for selection of apex hospitals, oversight of

network performance and national-level monitoring and planning.
H. Local Government Units (LGUs)
1. Ensure that the HCPN design, requirements and support mechanisms are
available within their jurisdiction;
2. Provide the needed resources, including funds, to ensure the functionality of

the HCPN;
3. Endeavor to of
meet the gaps health facilities, human resources, equipment and
infrastructure within their jurisdiction; and,
4. Adopt appropriate ordinances for public-private partnership for health.
Vii. SEPARABILITY CLAUSE
If any part or provision of this Order is rendered invalid, by any court of law or
competent authority, the remaining parts or provisions not affected shall remain valid
and effective.
x. REPEALING CLAUSE
Ali Orders, rules, regulations, and other related issuances inconsistent with or contrary
to this Order are hereby repealed, amended, or modified accordingly. All other
provisions of existing issuances which are not affected by this Order shall remain valid
in
and effect.
EFFECTIVITY
This order shall take effect immediately.
FRANGASCO T/DUQUE IIL

Secrétary of Health
MD, MSc
10
Annex A. Primary Care Facility Services

(Refer to Primary Care Facility Manual)
Services Primary Care Facility* STMT ere

Medical outpatient Yes No
Lab services In-house or outsourced No
Imaging services In-house or outsourced No
Pharma services In-house

or outsourced Distribution of public
health programs
Birthing services In-house or outsourced No
Minor surgeries Yes No
Public Health services Yes, if government Yes
PT/OT/ST Optional No
Transport Ambulance (can be shared) Patient transport vehicle
Licensing Yes No
*Public Primary Care Facility shall deliver population-based services. *Can
be a one-stop shop service provider or not
Annex B. Patient Flow in the HCPN and Referral Algorithm

+
Single APEX OR END-
Specialty! REFERRAL
Multl-Specialty HOSPITAL
Hospital “stand-alone
.
(tt
L2 and 3 Hospital
“" “EH nw HEALTH CARE
PROVIDER
NETWORK
{HCPN)
==
Lt Hospitals &
ck Otherhealthfacllities —_ Global Budget
& *
¥wf
I~ ate
>
7
MOST CONCERNS I << PRIMARY CARE
NN PROVIDER
i primary Care Facility + NETWORK

{PCPN)
Services that may
Health Station be contracted
oe
Annex C. Referral Algorithm
ae
(stant) (a>
oN.
ed
A}
1
to refer
>1
DECIDE
RECORD Referral in the
4 Registry
SECURE informed t
consent
1
DECIDE
patient
to discharge
uN
FILL OUT Referral Form i
FILL OUT Back Referral
Form
MESSAGE 4
Is it an
“| Receiving
Facility for
INSTRUCT Patient about
Follow up
schedule
t
SEND patient home with
CALL Receiving Back Referral Form
4
4
TRANSFER Patient
RECORD back referral in
the Registry
:
Patient Arrives at the
Receiving Facility with
ee,
Coo)
Referral Form
White boxes — by Initiating Facility

Blue boxes — by Receiving Facility
"Steps may happen simultaneously (i.e. Call is made during transfer ofpatient)
Standard Communication Protocols

For Emergency and Non-Emergency Cases via phone
SITUATION
Iam (name), (position) of (initiating facility)
Iam calling about an emergency referral
Who
am I talking with? [Wait for Response 1]
S Patient is a (age), (sex) with chief
complaint/problem: (state chief complaint) Present
working impression is: (Working Impression)
Reason for referral is: (state reason)
Current vital signs are: (BP, HR, RR, O2 Sats, Temp)
we
B
-»| BACKGROUND. -
*..|-(Name of patient) nas
&-(Clinioal
Be
History)
us gcd
oo
os
Findings <age: (stat findings)
:
ASSESSMENT
A I think the problem/concern is: (describe)
(state issues for the referral)
‘RECOMMENDATION
.
|
a We would liké to transfer. the ‘patient immediately.

Ro
Response
1 Name of receiver and position
2 Yes, please transfer to our facility immediately.

No,
our facility's capacity is full. Please transfer to (specify another
facility)
Other instructions: (e.g. give medicines on the way)
So tyr
Annex D. Uniform Referral Form
HCPN Name of HEALTH CARE PROVIDER NETWORK

loGo REFERRAL FORM
Name of initiating facility Contact Number

Address
Date of Referral Time Called*

Name of receiving facility Receiving Personnel
Address Response
Referral Category 1 Emergency OF Outpatient

Working Impression
Reason forReferral O Consultation
© odiagnostics
O)treatment/P rocedure
O others
Name of Patient identity number

Age Sex O Male O Female
Address
Chief Complaint
Clinical History
Findings
Vital Signs: 8P. HR RR. O2 sats Temp Weight
(atta ch laboratory results)
Treatment Given
(atta ch treatment cards}
Print Name & Signature of Health Professional Date and Time

“for emergency cases
Return Slip
Action Point: Received
Referred
ANNEX E. Public Health Unit Staffing Pattern
Personnel Hospitals
Level 1 Level 2 Level 3
Health education
public Health Advisor
and promotion
Health education and Health education and
Health education promotion once promotion officer
and promotion officer/disease Disease surveillance
surveillance officer
:
officer surveillance
:
officer
Disease
coordinator Disease surveillance
surveillance
:
coordinator
:
coordinator
.
Care Navigator Care Navigator

Care Navigator/ Care Navigator (Nurse
Educator (Nurse or Social
Worker)
(Nurse or
Social
Worker)
or Social Worker)
Administrative Admin staff Admin staff Admin staff
|
yr
of the Philippines
Republic
MAY 22 2020
No. 2020 -_
ODA
SUBJECT: Guidelines on Integration of the Local Health Systems into Province-wide

and City-wide Health Systems (P/CWHS)
BACKGROUND
The Department of Health (DOH) was reorganized in 1987 to integrate hospital and public
health services at all levels of administration through Executive Order (EO) 119 or the
Reorganization Act of the Ministry of Health and EO 292-or the Administrative Code of
1987. The structural organization followed a vertical flow of command with the DOH
having the supervision and control over all health facilities and services through the
Integrated Provincial Health Offices. With the implementation of Republic Act (RA) 7160
or the Local Government Code (LGC) in
1991, the governance over the Philippine Public
Health System was divided between the National Government, through the DOH, and the
Local Government Units (LGUs) consisting of Provinces, Cities and Municipalities. The
LGUs are mandated
to
deliver primary and secondary care services through the rural health
units/health centers (RHUs/HCs), and hospitals, respectively. The DOH, on the other hand,
acts as the overall steward of the health system by setting the national policy direction,
plan, technical standards and guidelines for health. The regulation of health services and
products, as well as the management of
specialized tertiary health care facilities remained
with the DOH. The fragmentation of responsibilities and accountabilities in the public
health service delivery system led to health system inefficiencies, such as lack of
coordination across different levels of care, lack of continuity and presence of duplication
in services provided, and failure to meet the demands and needs of clients.
In order to address the fragmentation of the health systems, and to promote cooperation
among LGUs in addressing health issues at the local level, inter-local health zones (ILHZ)
were established nationwide through EO 205 s. 2000 and was one of the key pillars of the
Health Sector Reform Agenda (HSRA). Service Delivery Networks (SDNs) were also
mandated by RA 10351 or the Sin Tax Law, and RA 10354 or
the Responsible Parenthood
and Reproductive Health Act to be established for an integrated, coordinated, and efficient
provision of health care services. The AO 2017-0014 or the Framework for Redefining
Service Delivery Networks provided the specific guidelines on the organization of the
SDNs; while, AO 2018-0014 or the FOURmula One Plus for Health (F1Plus) further
reiterated that the SDNs shall be engaged to deliver comprehensive package of health
services.
With the passage of RA 11223 or the Universal Health Care (UHC) Act, the provision of
continuous, coordinated and integrated care will be further facilitated through the
integration of local health systems into Province-wide and City-wide Health Systems
(P/CWHS). The law intends to address fragmentation issues in service delivery by
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ¢ Trunk Line 651-7800 local 1113, 1108, 1135
Ir
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://Awww.doh.gov.ph; e-mail: ftdugue@doh.gov.ph
streamlining the management of the health system, rationalizing multiple payers of care,
and linking public and private providers.
Il OBJECTIVES
The objectives of this Order are as follows:
A. To provide the general procedures and mechanisms by which LGUs (i.e. provinces,
cities, and municipalities), national government agencies, and stakeholders can
integrate local health systems into P/CWHS.
B. To provide the scope and minimum level of functionality of an integrated local health
system.
NI. LEGAL FRAMEWORKS
A. Section 13, Article X of the 1987 Constitution states that “Local government units may
group themselves, consolidate or coordinate their efforts, services and resources for
purposes commonly beneficial to them in accordance with law”.
B. Section 33, Article II of the Local Government Code (RA 7160) states that “local
government units (LGUs) may, through appropriate ordinances group themselves,
consolidate, or coordinate their efforts, services, and resources for purposes commonly
beneficial to them. In support of such undertakings, the local government units involved
may, upon approval by the Sanggunian concerned after a public hearing conducted for
the purpose, contribute funds, real estate, equipment and other kinds of property and
appoint or assign personnel under such terms and conditions as may be agreed upon
by the participating local units through Memoranda of Agreement.”
C. Section 19, Chapter V of the UHC Act provides that “The DOH, Department of the
Interior and Local Government (DILG), PhilHealth and the LGUs shall endeavor to
integrate health systems into Province-Wide and City-Wide Health Systems” while
Section 19.6 of its IRR states that “The DILG and the DOH shall facilitate the
integration of local health systems into province-wide and city-wide health systems
through a mechanism of cooperative undertakings among the LGUs to ensure the
effective and efficient delivery of health services, provided under Section 33 of RA
7160”. :
IV. SCOPE OF APPLICATION
This Order shall apply to all offices and attached agencies under the DOH, all health care
providers and facilities (public and private), other National Government Agencies (NGAs),
Non-Government Organizations (NGOs), LGUs, health partners and donors, and all others
concerned.
In the case of Bangsamoro Autonomous Region for Muslim Mindanao (BARMM), the
adoption of the integrated P/CWHS shall be in accordance with Article IX, Section 22 of
RA 11054 or the Organic Law for BARMM and subsequent laws and issuances.
Vv. DEFINITION OF TERMS
For purposes of this Order, the following terms are defined as follows:
;
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ko
A. Co-Ownership — refers to ownership of health facilities and services within a network

by at least two or more juridical entities where the co-owners agree on their network
shares.
B. Local Health System - refers to all health offices, facilities and services, human
to promote, restore or maintain health.
C. Primary Care Provider — refers to a health care worker, with defined competencies, who
has received certification in primary care, as determined by the DOH,
institution that is licensed and certified by the DOH.
or any health
D. Primary Health Care Approach - refers to the concept that promotes maximum
community and individual participation in the planning, organization, operation, and
control of health care services, making optimal use of available resources, and
organized around the demands and expectations of the community, not merely on
disease
orfinancing.
E. Special Health Fund (SHF) - refers to a pool of financial resources at the P/-CWHS
intended to finance health services and health system operations.
VI. GENERAL GUIDELINES
A. The Province-wide Health System (PWHS) shall consist of the provincial, municipal
and component city health offices, provincial, district and municipal hospitals, health
centers, barangay health stations and other LGU-managed health facilities and services.
The city-wide health system (CWHS) shall include the city health office, hospitals,
health centers, barangay health stations and other city-managed health facilities and
services of highly urbanized cities (HUCs) and independent component cities (ICCs).
B. The P/CWHS are integrated local health systems in which health care providers deliver
continuous and integrated health services to individuals and/or communities in a well-
defined catchment area. These health systems are forms of progressive cooperative
undertakings among LGUs to complement the individual LGU’s health operations.
C. The private sector shall be encouraged to participate in the integrated local health
system through a contractual arrangement with the P/CWHS.
D. The P/CWHS shall be based on the Primary Health Care Approach that emphasizes
strong primary care.
E. The provinces, HUCs and ICCs that committed to integrate shall create a SHF and
strengthen their Provincial Health Office (PHO) City Health Office (CHO) by creating
at least two divisions, namely, Health Service Delivery Division (HSDD) and Health
Systems Support Division (HSSD).
F. In consideration of the size, population and geography of the province, a group of

adjacent municipalities and component cities may form sub-provincial health systems
for effective health service delivery and management of health systems.
yo }
G. provisions stipulated in AO 2018-0014, “Strategic Framework and Implementing

The
Guidelines for Fourmula One Plus (F1Plus) for Health,” shall likewise be followed.
VII. SPECIFIC GUIDELINES/ IMPLEMENTING MECHANISMS
A. Establishment of a Health Care Provider Network (HCPN)
The HCPN refers to a group of primary to tertiary care providers, whether public,
private or mixed, offering people-centered and comprehensive care in an integrated and
coordinated manner. The HCPN shall ensure that its catchment population has access
to all levels of care: (1) primary care; (2) secondary care; and (3) tertiary care.
Each HCPN shall

have primary care provider networks (PCPNs) as its foundation and
responsible for providing the primary level of care. These PCPNs are coordinated
groups of public, private or mixed primary care providers that act as the navigator,
initial and continuing point of contact of
clients to the health care delivery system.
Secondary and tertiary levels of care shall be provided by hospitals and other qualified
health facilities.
1. There are three types of HCPN, namely (see Figure 1):
a. Public HCPNor the Province-Wide and City-Wide Health System (P/C WHS)
i. A P/CWHS is created by grouping the public primary care providers and
facilities into PCPNs that are linked to secondary and tertiary care
providers within geographic or political boundaries.
ii. In consideration of the size, population, and geography of the province,
and based on the assessment and recommendation of the PHO, in
collaboration with the Center for Health Development (CHD), a group of
adjacent municipalities and component cities may form sub-provincial
health systems for effective health service delivery and management of
the health systems. The sub-provincial health system shall consist of the
PCPN linked to a secondary or tertiary care provider. Existing cooperative
undertakings such as ILHZ and SDN may transition to sub-provincial
health systems.
iii. The P/CWHS shall deliver both population-based and individual-based
health services and shall be linked to at least one apex hospital. The
hospitals or other qualified health facilities within the network shall
provide outpatient specialty care and/or inpatient care services, while the
primary care providers shall be responsible for primary care services.
iv. In the case that there are no LGU-owned/managed secondary or tertiary
care providers, the province/city may link with a DOHor private hospital
to complete its HCPN provided that the hospital shall be of the level and
service capability needed as identified by DOH standards. The proximity
between facilities shall also be taken into consideration.
v. The P/CWHS may engage private service providers, through contractual
arrangements, to complement health services provided by public health
of
facilities or to support in the management the P/CWHS.
b. Private HCPN
i. The configuration of the private HCPN is driven by market-based forces
and may not be limited to defined geo-political boundaries. It shall be
hes
contracted separately by PhilHealth to provide individual-based health

services at all levels of care, primary to tertiary.
ii. The private HCPN may engage public service providers, through
contractual arrangements, to complement health services provided by
private health facilities.
Mixed HCPN
Models for mixed HCPN shall be developed. Public and private entities shall
have co-ownership of all health facilities and services in the network capable
of delivering primary to tertiary care services
PUBLIC MIXED PRIVATE

Province-/City-Wide Health System
heath (PUBLIC/PRIVATE - owned)
no deiner Popaleaer ond individual bse to deliver Individual-based health services
Apex Apex
Hospital Hospital
Prssseverensee €--. CONTRACTUAL

ARRANGEMENT __iy heat en,
Public heatth care system may contract a
Seconda: "y private facility (and vice versa) to provide Secondary
Care services not avatlable/to augment existing Care
services within the network
Primary Care ry
Provider Network Provider Network
Geographic or Political Boundaries Market-Based Forces
Figure 1: Types of Health Care Provider Network
2. Network Contracting
a. Population-based health services
The DOH shall contract the P/CWHS through a legal instrument to ensure
shared responsibilities and accountabilities among members of the health
system for the delivery of population-based health services, including those that
impact the social determinants of health.
The following are the minimum components of a P/CWHS:

i. PCPN with patient records accessible throughout the health system. This
network shall provide primary care services, serve as initial contact and
navigator to guide patients’ decision making for cost-efficient and
appropriate levels of care, coordinate patients to facilitate two-way
referrals and implement public health services;
ii. Accurate, sensitive and timely epidemiologic surveillance systems;
iii. Proactive and effective health promotion programs or campaigns; and,
iv. Timely effective and efficient preparedness and response to public health
emergencies and disasters.
b. Individual-based health services

PhilHealth shall contract the public, private, or mixed HCPNs for the delivery
of individual-based health services. The contracted networks shall have the
following minimum components:
i. is
PCPN that linked to secondary and tertiary care providers;
ii. Assurance of member access to all levels of the HCPN, including the use
of digital technologies for health;
iti. Patient navigation and coordination system;

iv. Patient records management system, including electronic health records;
v. Provider payment mechanism;
vi. Proof of legal personality; and,
vii. Mechanism of pooled fund management within the network.
In addition, the following are the minimum requirements for contracting

HCPNs:
i. All health care facilities within the network are licensed or accredited by
ii.
the DOH, as applicable; and,
All health care providers within the network executed or signed a
performance contract with PhilHealth.
B. Management Structure of the P/-CWHS
1. The Provincial/City Health Board (P/CHB) shall be the steward of the

integrated
local health system and responsible for
setting the policy and strategic directions of
the P/CWHS:
a. Composition of the P/CHB

Position Province HUC/ ICC
= Provincial Governor
Chairperson: =
City Mayor
" Provincial Health
.
Vice-Chairperson:
:
_
Officer
“ci
City Health Officer
" Chair of Committee on "Chair of Committee on
Health-Sangguniang Health-Sangguniang
Panlalawigan Panlungsod
= DOH = DOH
Representative Representative
= PO, NGO
orPrivate =PO, NGO orPrivate
Sector Representative Sector Representative
Members:
= ICC/IP
representative,
as applicable
=
Representative/s of = ICC/IP representative,
municipalities and as applicable
component cities
included in PWHS
The selection of the Indigenous Cultural Communities/Indigenous Peoples

(ICC/IPs) representative shall be in accordance with Title H (The ICC/IP
Representative) of the National Commission on Indigenous Peoples (NCIP)
AO 3 series of 2018 or the “Revised National Guidelines for the Mandatory
Representation of Indigenous Peoples in Local Legislative Councils and Policy-
Making Bodies.”
ar
c
A consultation process must be undertaken in determining the appropriate

number of members, particularly the representative/s of municipalities and
component cities included in the PWHS, taking into consideration the quorum
and manageability of board meetings, and size and geography of the province.
b. Functions of the P/CHB

i. Propose to the Sanggunian concerned, in accordance with the standards
and criteria set by the DOH, annual budgetary allocations for the operation
and maintenance of health facilities and services within the province or
city
ii. Serve as an advisory committee to the Sanggunian concerned on health
matters such as, but not limited to, the necessity for, and application of
local appropriations for public health purposes
iii. Consistent with the technical and administrative standards of the DOH,
create committees which shall advise local health agencies on matters
such as, but not limited to personnel selection, bid and awards, grievance
and complaints, personnel discipline, budget review, operations review
and similar functions
iv. Set the overall health policy directions and strategic thrusts including the
development and implementation of the integrated strategic and
investment plans of the province-wide and city-wide health systems
v. Oversee and coordinate the integration and delivery of health services
across the health care continuum for province-wide and city-wide health
systems
vi. Assume full responsibility in the management of the SHF and ensure that
vii.
is
the SHF optimally utilized to help achieve the desired health outcomes
Exercise administrative and technical supervision over health facilities
and health human resources within their respective territorial jurisdiction.
This is to generally oversee the operations of the P/CWHS and ensure that
they are managed effectively, efficiently, and economically but without
interference with day-to-day activities. The health board may require the
submission of reports, cause the conduct of management audit,
performance evaluation, and inspection to determine compliance with
policies, standards, and guidelines of the DOH, and take such actions as
may be necessary for the proper performance of official functions. Such
actions, however, shall not extend to appointment and other personnel
actions which shall remain with the concerned LGU.
c. Meetings and Quorum

i. The P/CHB shall meet once a month or as often as necessary.
ii. A majority of the members of the board shall constitute a quorum, but the
chairperson and vice-chairperson must be present during meetings where
the Local Investment Plan for Health (LIPH), Annual Operational Plan
(AOP), and annual budgetary proposals are being prepared or considered.
The affirmative vote of a majority of all members
is
necessary to approve
health systems plans and budgetary proposals. The affirmative vote of a
majority of the members present is sufficient to approve matters relating
to ordinary business.
d. Conduct of General Assembly
fr
A General Assembly shall be conducted, at least twice a year, within the

P/CWHS toprovide the opportunity for all stakeholders to be informed and to
discuss the developments and concerms on health services and management of
the health system.
2. Creation/Strengthening of Support Units
a. Management Support Unit (MSU). An MSU shall be created under the

supervision of the P/CHB Board to serve as the Board’s administrative
secretariat and to assist in its operations. At the minimum, the MSU shallbe
composed of the following personnel: (1) Administrative Officer; (2)
Accounting Clerk; and (3) Liaison Officer. Depending on the size of the
province/city, the Board may decide to appoint, designate, or hire additional
staff, as deemed necessary.
The MSU shall perform its functions in close coordination with P/CHO, which
shall serve as the technical secretariat of the Board. The functions of the MSU
shall include, but not limited to:
i. Provision of assistance in the management of the SHF:

1) Preparation of the Board resolution on SHF budget.
2) Ensuring that budgetary documents are approved and signed by the
Provincial/ City Budget Officer, Treasurer and/ or Accountant.
3) Preparation, submission, and reporting of financial status and
physical accomplishments.
4) Coordination with concerned LGU Budget Officer, Treasurer,
Accountant and/ or Health Officer for the purpose of planning,
budgeting, utilization, and liquidation.
ii. Perform administrative and technical support:

1) Documentation of Board meetings and other activities relating to the
organization and functionality of the P/CWHS.
2) Preparation and submission of reports to the Board, DOH and
PhilHealth, among others, in close coordination with the P/CHO and
other concerned LGU offices.
3) Assist in the conduct of monitoring activities such as management
audits and performance evaluation reviews.
4) Preparation of other technical and administrative documents.
iii. Coordinate with the necessary P/CWHS stakeholders
To ensure proper accountability, the Board shall either designate or

appoint existing plantilla personnel from the Provincial/ City Government
as part of the MSU.
b. Provincial/City Health Office. The PHO/CHO shall act as the technical

secretariat of the Health Board, in close coordination with the MSU. The
PHO/CHO assisted by the Assistant Provincial/ City Officers, shall be
responsible for the technical integration and supervision of the P/CWHS. To
support its operation, the following shall be undertaken:
i. Establishment of atleast two technical divisions, namely:
131
1) Health Service Delivery Division (HSDD) - This Division shall

manage the health service delivery operations of PCPNs, hospitals,
and other health facilities, and oversee the implementation of public
health programs including health promotion, epidemiologic
surveillance and disaster risk reduction and management for health.
This shall be headed by the Assistant Provincial/City Health Officer.
2) Health Systems Support Division (HSSD) - This Division shall

manage the health financing (planning and budgeting), health
information system, procurement and supply chain for health products
and services, local health regulation, health human resource
development, and performance monitoring, among others, in close
coordination with the concerned offices of the provincial/ city
government. This shall be headed by an Officer of the same level as
the Assistant Provincial/City Health Officer.
An enabling ordinance shall be passed to create the Assistant

Provincial/City Health Officer and another official of equivalent rank, as
well as other necessary staff needed per division, as plantilla items if not
yet present. Until such time that the plantilla positions have been created,
existing personnel may be designated/ detailed.
In addition, the PHO/CHO shall have an administrative unit to render

administrative-related support.
ii. A Technical Management Committee (TMC) may be created to supervise

the operations of each sub-provincial health system, as applicable. At the
minimum, each TMC shall be composed of technical staff from the
member health facilities, DOH representatives of the municipal/
component city, patient representative and others, and shall be assisted by
administrative staff designated by the participating provincial, city or
municipality. Its functions shall include:
1) Initiate participatory health care needs assessment and integrated

health planning for both hospital and RHUs/HCs
health system
at the sub-provincial
2) Supervise navigation, coordination, and referral across component

facilities and ensure compliance with the referral system protocol
3) Recommend policies and guidelines for the establishment of
management support systems such as strategic and investment
planning, referral system, HRH development, logistics and supply
chain, and information systems
4) Advocate the approval of funds pertaining to the provision of health
services
5) Monitor and evaluate the integration of public health and hospital
services within the sub-provincial health system
6) Submit necessary reports and health data to the PHO
7
/ {
jens [Gon Center for Health Development jewas (Gon — Center for Heah Development
t
Ls ela
1
t
Local Health
____ Local Health
oH
Management
Support Unit Management
Support Unit
Technical ‘Technical Technical

Management Management Management
Comuuittee Committee Committee
Sub-Provincial Sub-Provincial Snb-Provincial

Heaith System Health System Health System
Figure 2: Structure of Support Units: P/CWHS (Note: Figure 2 reflects the

summary of the relationship among the
different support units.)
iii. The municipal/ component city health boards shall retain their existing
composition and functions stipulated in the LGC as
C. Characteristics of P/CWHS Integration
At the minimum, the integrated local health systems shall be characterized by the
following:
1. Managerial and Technical Integration. Managerial integration refers to the

consolidation of administrative, technical and managerial functions of the P/CWHS
over its resources such as health facilities, human resources for health, health
finances, health information systems, health technologies, and equipment and
supplies; while, technical integration refers to the functional and efficient linking of
health service provision from primary to tertiary care, when appropriate, across
different levels of facilities, care settings, across a comprehensive spectrum of care
with primary care as the foundation and intersectoral participation as one of key its
principles.
Minimum Characteristics:
a. Local ordinance(s) issued on the:
i. Integration of the municipalities’ and component cities’ local health
system to the province-wide health system; and,
ii. Implementation of the P/-CWHS;
b. Unified governance of the local health systems
c. Integrated management systems:

i. Health Financing;
ii. Human Resources for Health Management and Development;
iti, Strategic and Investment Planning;
iv. Information Management System;
4\
v. Procurement and Supply Chain Management System; and,
10
vi. Quality Assurance/ Improvement System;
d. Functional referral system;
e. Functional Disaster Risk Reduction and Management for Health (DRRM-H)

system;
f. Functional epidemiologic surveillance system; and,
g. Proactive and effective health promotion programs or campaigns
2. Financial Integration. Financial integration refers to the consolidation of financial

resources exclusively for health services and health system development under a
single planning and investment strategy by the P/CWHS, i.e. LIPH and AOP.
Minimum Characteristics:
a. Creation of SHF
b. Health Board Resolution on SHF budget and allocation
c. Funds exclusively used for health services and health system development
D. Implementation Arrangement
The following are the specific phases and strategies which are deemed essential in the
success of the integration of the local health systems into P/CWHS. The different
phases and strategies outlined herein may not necessarily follow the same order.
1. Phase 1: Preparatory Works
a. Getting the commitment

1. Secure the legal and political support of the provinces, HUCs, ICCs,
component cities, and municipalities to integrate their local health
systems. This involves engaging the LGUs through advocacies and
orientations on UHC Act, F1 Plus for Health, and other national policy
goals and directions.
ii. Formalize the LGU commitment to
collaborate with other LGUs.
b. Setting the baseline. Conduct of thorough assessment on the state of the local
health system which includes, among others:
i. Inventory and mapping
private health facilities;
of service availability and readiness of public and
ii. Assessment of capacities and training needs of health care providers;
iit. Population profiling and risk stratification; and,
iv. Presence/Functionality of management support systems, such
DRRM-H surveillance
as
a referral
system, system, epidemiologic system,
information system, health promotion programs, and campaigns, among
others.
c. Plan development. Based on

the results of the assessment:
il
i. Formulate the LIPH and annual operational plans in accordance with the
existing guidelines on the development of the LIPH and
AOPs. These plans shall be approved by the P/CHB.
its
corresponding
d. Organizing the management structure. Organize/ Strengthen policy and

technical management structures, such as:
i. Additional member/s to the P/CHB and creation of its MSU;
ii.
iii.
Establishment of
at least two technical divisions in the P/CHO; and,
Creation of the technical management committee, as deemed necessary.
e. Creation of SHF
2. Phase 2: Organization of the P/CWHS
a. Establish the network of health facilities and services

Ll Clearly identify the health facilities and services that will form each
PCPN. The geographical division of a province may serve
as
the basis for
identifying the group of public or private primary care providers in
adjacent municipalities and/ or component cities that will compose the
PCPN. The number of member municipalities and/ or component cities
shall depend on the proximity and access to the secondary or tertiary level
of care.
A group of public or private primary care providers within the territorial

jurisdiction of the
HUC/ICC can
be considered as a PCPN.
ii. Linking the PCPN to secondary or tertiary care providers.

The secondary
or
tertiary care providers shall serve as the referral facilities
of the PCPN. Geographical characteristics, road networks, availability of
transportation facilities, and availability of health services shall be
considered in choosing thereferral facilities of the PCPN. A MOA shall
be entered into by the PCPN members and theirreferral facilities.
iii. Identification of apex hospital.

The DOH shall provide the list of apex hospitals wherein the P/CWHS can
link for specialty care services. A MOA shall be entered into by the
P/CWHS with their identified apex hospital/s.
iv. Compliance of health facilities and providers to licensing, accreditation

andcertification requirements.
Implementation of policies, plans, manuals and other support mechanisms for

the organization of the integrated management support systems such as referral
system, DRRM-H system, epidemiologic surveillance system, information
system, health promotion programs, and campaigns, among others.
c P/CWHS contracted by DOH and PhilHealth.
d. SHF managed by the P/CHB.
3. Phase 3: Monitoring of the functionality of the integrated local health system.

To track the level of integration of the local health systems, the local health system
maturity model shall be used. In addition, the LGU Health Scorecard shall be
utilized to monitor health outputs and outcomes.
E. Performance Monitoring and Accountability
Forbetter execution of policies and programs in the DOH, AO 2019-0003 or the F1

Plus Monitoring and Evaluation (M&E) System and related issuances shall be used as
a guide to ensure that DOH programs, projects, and activities are being implemented in
accordance with the directions and goals of F1 Plus for Health. In addition, a separate
order shall be issued by the DOH on the monitoring and evaluation of the integrated
local health systems through the local health system maturity model.
VIII. ROLES AND RESPONSIBILITIES
A. Department of Health (DOH)
1. Field Implementation and Coordination Team (FICT) — shall oversee the integration
of local health systems through the Centers for Health Development
2. Centers for Health Development (CHDs)
a.
or
Provide facilitate the necessary technical support identified in the LIPH, and
advocate the development of integrated management systems
b. Review the LIPH and AOP, and recommend proposals for assistance aimed at
strengthening the delivery of health services and integration of the P/CWHS
c. Monitor the development and implementation of the systems integration

through the creation of a core group composed of
personnel from CHD units.
3. Bureau of Local Health Systems Development (BLHSD) — shall formulate policies

and standards relating to strategic investment planning and strengthening of local
health systems
4. The following Central Office Bureaus and Attached Agencies shall focus on the
development ofstandards and guidelines, the establishment of support mechanisms,
provision of technical assistance and capacity building activities, and/or monitoring
the implementation/ presence of integration characteristics:
a. Health Emergency Management Bureau (HEMB) for the

functionality of the
Disaster Risk Reduction Management for Health (DRRM-H) System;
b. Epidemiology Bureau (EB) for the functionality of the epidemiologic and

disease surveillance system;
c. Health Promotion Bureau (HPB) for the implementation of proactive and
effective health promotion programs or campaigns;
d. Health Facility Development Bureau (HFDB) for the development of health

facilities standards and health care provider network service delivery design;
\
ie b
13
e. Knowledge Management and Information Technology Service (KMITS) for the

functionality and interoperability of health information systems;
f. Health Human Resource Development Bureau (HHRDB) for

the crafting and
implementation of the National Health Workforce Support System, including
the HRH Master Plan;
g. Health Facilities and Services Regulatory Bureau (HFSRB) for the development
of licensing and regulatory systems for health facilities and services, including
that of the primary care facilities;
h. Health Policy Development and Planning Bureau (HPDPB) for the formulation
of the national health policies and directions, and integrated health planning and
resource allocation;
i. Disease Prevention and Control] Bureau (DPCB) for the primary care service
packages and standards, delineation of individual-based and population-based
health services, and development of clinical practice guidelines, in coordination
with medical societies; and,
j. PhilHealth for the formulation of guidelines on benefit packages, standards on

HCPN contracting, and establishment and maintenance of SHF utilization
tracking system, in coordination with the DOH.
B. Department of Interior and Local Governance (DILG)

-
shall make available support
mechanisms, such as policies, to facilitate the integration of local health systems into
P/CWHS. They shall likewise ensure that the monitoring and evaluation of the
integrated local health systems are included in the Seal of Good Local Governance.
C. Local and International Health Partners — shall align all their objectives, initiatives, and
programs/projects with the integration of local health systems
D. Local Government Units (LGUs)
1. Lead the integration of local health systems into P/CWHS
2. Provide the needed resources, including funds, and support mechanisms to make
managerial, technical and financial integration possible and sustainable
3. Ensure proper complementation of efforts at the local level
4. Monitor the development and implementation of the systems integration, together

with concerned DOH-CHD
IX. TRANSITORY PROVISION
For local health systems that did not commit to the integration, existing mechanisms shall
still be in effect.
14
Ah
SEPARABILITY CLAUSE
If any part or provision this Order is rendered invalid, by any court of law or competent
of
authority, the remaining parts or provisions not affected shall remain valid and effective.
XI. REPEALING CLAUSE
All Orders, rules, regulations, and other related issuances inconsistent with or contrary to
this Order are hereby repealed, amended, or modified accordingly. All other provisions of
existing issuances which are not in
affected by this Order shall remain valid and effect.
XIE. EFFECTIVITY DATE
SCO DUQUE
Y.
III, MD, MSe

Sécretary of Health
15
Republic of the Philippines

MAY 27 2020
No. 2020 - _00 43
SUBJECT: Guidelines on Identifying Geographically-Isolated and Disadvantaged

Areas and Strengthening their Health Systems
I. RATIONALE
Forthe past 30 years, the Department of Health (DOH) had undertaken key structural reforms and
continuously built on programs to achieve Universal Health Care (UHC). However, the health
situation in geographically-isolated and disadvantaged areas (GIDAs), which is generally
characterized by high morbidity and mortality resulting from poor access and delivery of quality
health services as well as lack of health facilities and inadequate logistical support, proves to be a
persistent concern. Additionally, the decentralized health system resulted to the fragmented
delivery of comprehensive primary care services.
As a response to reduce health inequity in GIDAs, the DOH issued AO 185 s. 2004 or the
“Establishment of the Geographically-Isolated and Disadvantaged Areas (GIDA) in Support to
Local Health Systems Development.” It was also issued to improve the availability of and access
to health resources and services as well as ensure the provision of culture-sensitive health services
for Indigenous Peoples (IPs). The strategy that would ensure that no one is
left behind as health
reform implementation moves forward pertains to GIDA health systems strengthening (HSS). It
recognizes vulnerable and hard-to-reach areas, such as, islands, mountainous areas, internally-
displaced persons (IDPs) in conflict-affected areas (CAAs) and IPs within the local health system.
Republic Act (RA) 11223 or the “Universal Health Care Act” and its implementing rules and
regulations (IRR) strengthened the commitment of
the DOH, together with PhilHealth and LGUs,
to prioritize GIDA through the provision of assistance and support such as, but not limited to,
health human resources, infrastructure, medical equipment and supplies towards the equitable
distribution of health services and benefits. In addition, section 29.2 of the IRR mandates the DOH
to develop the guidelines for identifying GIDA barangays.
Thus, this Order is

being issued to provide guidelines on the identification of GIDA in the country.
It also recommends strategies in the strengthening of GIDA health systems in terms of health
service delivery, human resources for health, financing and resource allocation, pharmaceuticals
and medical supplies, regulations of health facilities, leadership and governance, and health
information systems.
I. OBJECTIVES
This Order shal! provide the guidelines and directions for identifying GIDAs and strengthening
their health systems. Specifically, this Order aims to guide all stakeholders in improving access to
quality health care through province-wide/city-wide health systems, and equitable and sustainable
health financing in GIDAs.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ¢ Trunk Line 651-7800 iecal 1108, 1411 to 13
fey
Direct Line: 711-9502 to 03 Fax: 743-1829 © URL: http:/www.doh.goy.ph; e-mail: ftduque@doh.gov.ph
ii. SCOPE OF APPLICATION
This Order shall apply to DOH Central Office Bureaus, Services and Attached Agencies, Centers
for Health Development (CHDs), DOH hospitals, National Government Agencies (NGAs), Local
Government Units (LGUs), and other stakeholders that provide assistance related with the
development and strengthening the health systems in GIDAs.
In the case of Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), the adoption of
this Order shall be in accordance with RA 11054 or the “Bangsamoro Organic Act” and the
subsequent laws and issuances by the Bangsamoro government.
A. Culture-sensitive health services - refer to health services that are provided with
acknowledgement and respect for the cultural diversity among the populace.
B. Geographically Isolated and Disadvantaged Areas (GIDAs) - refer to barangays which are
specifically disadvantaged due to the presence of both physical and socio-economic factors.
C. Health Systems Strengthening — refers to initiating activities in the internationally accepted

core health systems functions, namely: human resources for health; financing and resource
allocation; leadership and governance; health information system; medical products, vaccines,
and technologies; regulations of health facilities; and, service delivery.
D. Physical factors — refer to characteristics that limit the delivery of and/or access to basic health
services to communities that are difficult to reach due to distance, weather conditions, and
transportation difficulties.
E. Primary Care — refers to initial-contact, accessible, continuous, comprehensive and

coordinated care that is accessible at the time of need including a range of services for all
presenting conditions, and the ability to coordinate referrals to other health care providers in
the health care delivery system, when necessary.
F. Socio-Economic factors — refer to social, cultural, and economic characteristics of the

community that limit access to and utilization of health services.
GENERAL GUIDELINES
A. The framework for defining a barangay as GIDA shall primarily consider both physical and
socio-economic factors that limit the availability of and accessibility to basic health services
among the population in that area. As such, a barangay identified as GIDA shall be a priority
in the provision of technical and financial assistance to improve health services, as stipulated
in Section 29.4 of the UHC Act IRR.
B. A GIDA information system shall be implemented

at the national and local levels to serve as
the core monitoring and evaluation system for determining current health status and health
intervention gaps. As such, its generated data shall be disseminated among concerned DOH
offices, NGAs, LGUs, and stakeholders through the DOH website and technical reports as their
basis for determining priorities.
a
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5
Page 2
C. The LGUs shall prioritize the health agenda of the Indigenous Cultural
Communities/Indigenous Peoples (ICC/IPs) and those who
are
living in GIDA. In
accordance
with Chapter IV Section 16 of RA 8371 or “The Indigenous Peoples’ Rights Act of 1997” and
Section 19.16 of the UHC Act IRR, IPs shall be represented in the Provincial and City Health
Boards where their representative shall initiate integration of IP/GIDA specific initiatives in
policies and plans of the LGUs through the Local Investment Plan for Health (LIPH) and the
Annual Operational Plan (AOP).
D. The health systems strengthening in GIDA shall be ensured by the LGU where all
people living
in GIDA have access to basic health services by improving the
core health system functions.
VI. SPECIFIC GUIDELINES AND IMPLEMENTING MECHANISMS
A. Criteria for Classification as GIDA
The CHDs,
AND
in coordination with the LGUs, shall classify a barangay as GIDA
socio-economic factors are present:
if both physical
1. Physical factor of a barangay - at least 25% of sitios/puroks should have no access to a

Rurai Health Unit (RHU) nor a hospital within 60 minutes of travel in any form of
transport, including walking;
2. Socio-economic factor of a barangay - at least ONE of the following conditions:
a. Atleast 10% of its population are IPs;

b. Atleast 10% its
of population are affected by Armed Conflict or Internally Displaced
is
or the barangay identified as a Communist Terrorist Group (CTG)/Local Extremist
Group (LEG) area by the National Intelligence Coordinating Agency (NICA);
c. At least 50% of its population are enrolled in Pantawid Pamilyang Pilipino

Program/Conditional Cash Transfer (4Ps/CCT);
d. The performance of the barangay, in at least four (4) out of the following indicators,
is less than their latest provincial data:
i. Infant Mortality Rate;
ii. Under Five Mortality Rate;
iii. Fully Immunized Child;
iv. Adolescent (Age 10-19) Birth Rate;
v. Contraceptive Prevalence Rate;
vi. Proportion of pregnant women with 4 or more pre-natal visits;
vii. Proportion of deliveries attended by skilled birth attendant; and,
viii. Household with access to improved water supply
B. GIDA Profiling
1. The LGUs, in partnership with the CHDs, shall conduct a thorough profiling of their
barangays using the GIDA Profiling Tool (i.e. to be issued by the DOH separately),
which shall be considered as a scoring system to use in decision-making for
-
prioritization. The profiling tool shall be able to:
Page 3
gy
a. Identify and validate GIDA barangays;
b. Analyze gaps in terms of the current availability and readiness of essential health
service delivery, human resources for health, health facilities, medicines and social
health insurance, among others; and,
c. Identify priority areas and their needs.
The DOH Central Office, through the Bureau of Local Health Systems Development
(BLHSD), shall issue an official GIDA list that shall be updated annually. The list, which
to
is considered to contain priority areas, shall be shared all stakeholders through the DOH
website and technical reports.
The CHDs shall issue individual certifications to the barangays that are identified as
GIDAs, asneeded.
The ICCs/IPs and those who are living in GIDA shall be considered as priority
beneficiaries of technical and financial assistance from both domestic and foreign assisted
projects on health.
The LGU, DOH, and other stakeholders shall use the GIDA profile in formulating
a
list of
priority interventions for sharing with different bureaus within DOH, other government
agencies, and stakeholders for the prioritization of their resources.
The CHDs, in coordination with the LGUs, shall conduct the mandatory GIDA profiling
once every three years as part of the monitoring, evaluation and further improvement of
GIDA health systems through the GIDA information system core component.
The CHDs may engage other stakeholders including the National Commission on
Indigenous Peoples (NCIP), National Mapping Resource Information Authority
(NAMRIA), and partners from the academe in
the conduct of GIDA mapping.
C. GIDA Health Systems Strengthening
1. The LGUs shall include all strategies and activities needed to strengthen the health systems
of GIDA barangays in
their respective LIPH and AOP.
The LGUs, in coordination with the DOH, shall ensure that people living in GIDA have
access to basic health services through the proposed strategies provided in Annex A, such
as, but not limited to, the following core health system functions:
a. Health Service Delivery - The LGUs, in coordination with the DOH, shall be enjoined
to develop a strategy in establishing an appropriate and efficient referral system within
the Primary Care Provider Network to ensure smooth delivery of services even in
emergency situation. This shall include services that are effective in promoting health
and wellness, prevention and treatment of
diseases and rehabilitation of complications
secondary
to these diseases.
Page
4 of p 4
b. Human Resources for Health - The DOH, through the National Health Workforce
Support System, shall promote and prioritize deployment of health workers to GIDAs.
This includes the Rural Health Midwives, Nurses, Doctors to the Barrios (DTTB) and
other human resources for health cadre that may be applicable.
c. Financing and Resource Allocation - The LGUs shall be enjoined to equitably allocate
funds across GIDA barangays specific to the health needs of each community. The
DOH
shall leverage its support by prioritizing GIDA for assistance.
d. Medical Products, Vaccines, and Technologies - the DOH shall augment LGU
supplies and prioritize GIDA in the distribution of medicines, vaccines, and other
commodities to ensure that the population living in GIDA has access to affordable
essential drugs on a sustainable basis.
e. Regulation of Health Facilities - Every GIDA shall have a Barangay Health Station
(BHS)birthing facility designed in compliance with DOH licensing standards,
PhilHealth accreditation, which provides culture-sensitive health services. Birthing
facilities in GIDAs shall be prioritized in the processing of applications and issuance
of a License to Operate and Certificate of Accreditation for health facilities.
f. Leadership and Governance - The LGU shall ensure thatthe health agenda of IPs and
GIDAs are being prioritized. As applicable, ICCs/IPs, in accordance with RA 8371,
shall also be represented in Provincial, City and Municipal Health Boards. The
representative shall initiate integration of IP/GIDA specific initiatives in the policies
and plans of the LGUs.
The LGU shall ensure that local officials in the GIDA(i.e. barangay council) are adept
in making appropriate and strategic plans for their respective area, which shall coincide
with the municipal/city development plans.
g. Health Information System — The LGUs shall utilize the GIDA information system as
the basis for identifying priority areas for financial and technical assistance.
D. Monitoring and Evaluation
The BLHSD shall lead the national level monitoring and evaluation of access, equity, and
responsiveness of GIDA health systems using the data generated from the GIDA Information
System. The parameters to be analyzed shall include health system elements indicators, health
outcomes and health service utilization indicators and fund utilization indicators.
VI. ROLES AND RESPONSIBILITIES
All concerned DOH bureaus/units and entities shall appropriate funds for the development of
GIDA health systems. The following are the roles and responsibilities of concerned DOH
Bureaus/units and other stakeholders in GIDA health systems strengthening:
A. Bureau of Local Health Systems Development (BLHSD)

1. Develop and update the GIDA Profiling Tool to be used by CHDs and LGUs;
Page 5 of 7
f ye
/
2. Develop, update, and maintain the GIDA information system in collaboration with
Knowledge Management and Information Technology Service (KMITS);
3. Interpret and analyze data, produce technical reports, and disseminate information in the
GIDA registry;
4. Issue an official GIDA List to stakeholders that shall be updated annually;
5. Develop strategies, interventions and recommend equitable allocation of resources based
on GIDA Profiling data, in coordination with other DOH Bureaus;
6. Develop guidelines to
identify priority areas based on the specific needs of identified GIDA
barangays; and,
7. Monitor and evaluate access, equity and responsiveness of GIDA health systems.
B. Other DOH Bureaus and Offices

1. Health Facilities Development Bureau (HFDB) shall develop standards for health facilities,
taking into consideration the different GIDA/TP settings.
2. Health Facility Enhancement Program-Management Office (HFEP-MO) shall allocate
funds for construction, and improvement of health facilities in GIDA or those serving GIDA
barangays.
3. Health Human Resource Development Bureau (HHRDB) shail develop policies and
programs for scholarships, human resource development, and HRH deployment prioritizing
GIDA barangays.
4. Health Policy Development and Planning Bureau (HPDPB) shall ensure the inclusion
and/or prioritization of GIDAs in sectoral policies and investments.
5. Disease Prevention and Control Bureau (DPCB) shall develop policy and guidelines on
primary care service packages and standards and delineation of population-based and
individual-based health services.
6. Knowledge Management and Information Technology Service (KMITS) shall assist in the
development and maintenance of the GIDA information system and capacity building of
BLHSD and the CHDs on the system.
7. Financial Management Service (FMS) shall support in the facilitation of the allocation of
appropriate funds in the development of GIDA health system.
8. Health Facilities and Services Regulatory Bureau (HFSRB) shall develop the framework
and guidelines on appropriate service capability in GIDA for purposes of preferential
licensing of health facilities and contracting of health services.
C. Centers for Health Development (CHDs)

1. Identify barangays as GIDA and issue certifications for such as needed;
2. Conduct GIDA profiling once every three years, together with LGUs;
3. Interpret and analyze data, produce technical reports with disaggregated data according to
the needs of stakeholders, and disseminate information in the GIDA registry;
4. Provide technical support to Local Health Boards (LHB) of alllevels through the DOH
Representatives to ensure GIDA health systems strengthening strategies are integrated to
higher-level plans such as LIPH/AOP; and,
5. Monitor and evaluate access, equity and responsiveness of GIDA health systems.
D. Philippine Health Insurance Corporation (PhilHealth)

1. Provide information to all members on the automatic inclusion of every Filipino into the
National Health Insurance Program and the available benefit packages; and,
2. Provide expedited accreditation process, if possible, that ensures culture-sensitive and
innovative interventions for health facilities in GIDA.
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ph
E. Local Government Units (LGUs)

1. Conduct GIDA profiling once every three years, together with the CHD;
id Develop strategies to ensure availability of essential health services in GIDA and referral
to higher level of care;
Develop GIDA HSS Plan in consultation with the community;
Ensure that the GIDA HSS Plan shall be integrated in the LIPH;
Ensure every GIDA has access at minimum to midwifery service at BHS;
NAYMSYH
Provide additional incentives for health workers serving in GIDA;

Inform the population in GIDAs of their PhilHealth membership, as well as the other
pertinent information such as available benefit packages; and,
Participate in DOH local governance training programs.
VIN. REPEALING CLAUSE
Administrative Order 185 s. 2004 dated 27 August 2004 or the “Establishment of the
Geographically-Isolated and Disadvantaged Areas (GIDA) in Support to Local Health Systems
Development” and other related orders, rules, regulations, and issuances pertaining to GIDA that
are inconsistent with or contrary to this Order are hereby repealed, amended, or modified
accordingly. All other provisions of existing issuances which are not affected by this Order shall
remain valid and ineffect.
IX. SEPARABILITY CLAUSE
If any part or provision of

this Order is rendered invalid by any court of law or competent authority,
the remaining parts or provisions not affected shall remain valid and effective.
X. EFFECTIVITY
This Order shall take effect immediately.
FRANCISCYT. DUQUE I, MD,

Secretary of Health
MSc
Page 7 of 7
Annex A. Proposed Strategies for GIDA Health Systems Strengthening

1. Health Service Delivery
a. Behaviour Change Communications (BCC): To promote healthy lifestyle which
includes proper hygiene and health education, nutrition counselling and desired health
seeking behaviour among others. BCC materials will be adapted to local language and
culture to create social mobilization effects.
b. Partnerships with private and traditional health service providers, religious leaders, IP
leaders and other community leaders whom the community trust should be considered
as part of strategic priority.
c. Enhanced functions of health services: To provide supplementary services, in addition
to essential health services, including:
* Nutrition specific programs for under-nourished children in coordination with
LGUs and otherrelevant agencies;
* Provide trained HRH and resources for emerging, re-emerging and infectious
diseases for internally-displaced populations (IDPs);
«
Set-up relocation sites and access to calamity fund to provide emergency health
in
provision conflict-affected and disaster-prone areas; and
* Work with DSWD
on regular and modified conditional cash transfer interventions
to promote health behaviour change among those who are economically or
culturally marginalized.
d. Adopt-a-Community Strategy: To provide direct health services, and/or assistance to
health facilities and community projects focusing on the marginalized and vulnerable
populations through a medium or long-term engagement among DOH, foreign-based
and local organizations and Local Government Unit. This strategy is done to ensure
continuity and sustainability of services provided by foreign and loca! missioners.
«
Medical, surgical, dental missions, and vaccination campaigns in hard-to-reach
areas
*
and
of
Make-shift satellite health facilities to provide the basic package health services;
" Mobile health clinics or teams

e. Community Organization and Mobilization: Mobilization of the community to
effectively participate in joint decision-making and guarantees its local health
development initiatives, including:
«
Participatory needs analysis and planning together with BHW and other relevant
stakeholders to identify health related-needs, community-driven solutions and
initiatives
=
Community-led resource mobilization and allocation from government and private
sector to support community health development initiatives; and
" Public Private Partnership with health service providers including NGOs, military,
other government agencies, businesses among others to enhance health service
delivery specifically in hard-to-reach areas
f. Health Care Provider Network (HCPN): The RHU/HC, with its barangay health
stations, and birthing facilities must be part of the Primary Care Provider Network that
is linked to secondary and tertiary care providers. This shall include the availability of
appropriate transport services and communication tools such as, but not limited to,
telemedicine. For landlocked or mountainside community, manual carriage, animal
driven carts or motorcycles must be made available. For shoreline and island
communities, river crafts or motorboats must be made available. Use of satellite
connection and wireless mesh network could be considered for areas without network
coverage.
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1
g. Hospitals shall have a Public Health Unit and a GIDA coordinator to ensure expedited
consultation or provision of referral services. This will facilitate access and utilization
of hospital services that is not readily available in the GIDA community.
2. Human Resource for Health (HRH)

a. Each GIDA barangay shall have at least a midwife who is trained and competent, either
as a resident or on scheduled basis, to provide consistent and regular service at least 3
of the 5 working days of the week. If feasible, the health worker may reside in the
GIDA community. Adequate amenities, safety, and privacy should be made available
for their accommodation.
b. Recognition and incentives for health workers serving in GIDA shall be supported by
the government. LGUs will be encouraged to provide additional incentives to those
assigned to GIDA. This can be in the following forms:
« Travel and/or hazard allowances;
«
Recognition and award system specific for GIDA health personnel. Awards can
be in the form of grant for special projects; and
=
Competency training such as BEmONC, scholarship for higher education, and
career development pathway.
c. Prioritize provision of scholarship programs for health-related courses to residents in
GIDA, volunteer health workers including BHW, nutrition scholar, community health
workers and their immediate family members. It may also include former traditional
birth attendants and their immediate family members. Return service agreement must
be signed and implemented.
" Selection of scholars shall focus on their willingness to serve and social
responsibility of the student, low socio-economic status of the family and
recommendations from the community.
" Scholarship should include full tuition and other school fees, accommodation, and
adequate living allowance.
3. Financing and Resource Allocation

a. The GIDA profiling tool shall be developed as a strategic tool that shall outline
financial and human resource commitments to support GIDA activities.
b. LGUs will be encouraged to allocate funds equitably across barangays with specific
attention to the health needs of GIDA communities. The mechanism of resource
allocation shall be documented in the Local Investment Plan for Health. Adequate
augmentation support by the DOH to LGUs should also be leveraged.
c. GIDA communities must be prioritized for PhilHealth enrolment.
d. The Philippine Health Insurance Corporation (PhilHealth) shall have an expedited
accreditation process that ensures culturally sensitive and innovative interventions for
health facilities in GIDA, including:
: A process to accredit network of health services, for example GIDA birthing
facility as extension of an accredited RHU birthing facility;
» Contracting health facilities (within HCPN) to provide regular mobile health
services to the communities, if possible; and
» Sub-contracting private health service providers and/or non-governmental
organizations (NGOs) to provide part of essential health services.
4. Medical Products, Vaccines, Technologies

a. Essential medicines shall be equitably allocated and distributed for GIDA communities
with health needs. Storage shall be located at an identified health facility nearest to the
Page 2 of 4
| yh
GIDA community. Dispensing of medicines must be done under the supervision of the
Municipal Health Officer.
b. Specific to GIDA with high proportion of IPs, the complementary role of
traditional/alternative medicines and healing practices to health services may be
recognized. Appropriate documentation/data gathering, with the corresponding
intellectual property protection, shall be a primordial concern.
5. Regulations of Health Facilities

a. Community-based Health Facility: Every GIDA must have a BHS/birthing facility
designed to provide the essential health services. Due considerations shall be given to
the increased cost of labor and hauling of construction materials due to the geographical
isolation. The BHS/birthing facility must be designed in compliance to licensing of
DOH and the accreditation standards of PhilHeath. In IP communities, the facility must
also be designed to allow culture-sensitive health services.
Ifa barangay considered as GIDA isunable to sustain a BHS/birthing facility operation,

adjoining GIDAs can form a small network, that is an inter-GIDA or inter-barangay
health zone, to share the operation and maintenance of a BHS/birthing facility.
6. Leadership and Governance

a. The expanded LHB shall include IP/GIDA representatives. He/she shall be provided
with orientation and/or training in basic development planning that pays close attention
to the specific needs of the GIDA community. He/she shall be responsible for
integrating GIDA specific initiatives, in consultation with the community, into the local
health plan. The representatives in the consultation should have a balanced
representation in terms of gender, age group and other social parameters. IP health plan
should also be included.
b. The plan should contain evaluation of the health services needs of the GIDA
community, the current health services in the community, identification of the gaps and
strategic interventions to address the gaps.It of
should also contain clear estimates the
costs ofall the strategic intervention and its funding source.
c. These initial steps are directed towards establishing a community-managed health
system. To fully realize this, the province and city/municipal LHB must establish clear
lines of accountability and support to HSS in GIDA. Point person for each strategic
intervention must be identified. Regular review of the implementation during LHB
meetings must be undertaken.
d. Aside from the LGU formal structures already mentioned, the LHB may also ask
assistance from other government and non-government agencies, as well as private and
public health service providers to develop, implement, and manage projects for GIDA
health systems.
7. Health Information System

Inaccessibility of health services, policies and programs that are not culturally-sensitive,
and inadequate health data specifically on IP are someof the main concerns in GIDA.
Itis necessary to bring health services closer to GIDA/IP communities through capacitating
potential health workers living in the area that they may deliver health services that are
adaptive to their needs, behavior, and cultural beliefs. The following concerns on health
information shall be given consideration:
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fe %u
. Provision of information technology hardware like laptop computers or tablets for the
GIDA health workers that they may use for reporting and evidence-based decision-
making;
. Provision of Basic Computer Training for midwives;
. Development of software application for mobile phones or tablets (e.g. Electonic
Medical Record (EMR)
. Health statistics and data, including medicine-reporting/recording, shall be
disaggregated for IPs and non-IPs to guide prioritization for future program
development and implementation.
. Data Utilization Training for planning and decision-making;
. Strengthening of surveillance system.
naesats ol,
of the Philippines
Republic
JUL 09 2028
No. 2020 — 094
SUBJECT: Roles, Functions and Responsibilities of the Department of
Health Representatives
I. RATIONALE
The Local Government Code (LGC) of 1991 granted autonomy to Local Government
Units (LGUs) and made them accountable for the delivery of basic government services,
including healthcare. This has transformed the
role of the Department of Health (DOH) from
direct provider of basic health services at
all levels to technical assistance provider to LGUs
and overall leader of the health sector, which protects and promotes people’s health through
the development and issuance of health policy agenda and national standards, among others.
In order to carry out these mandates, the Department assigned DOH Representatives in the
LGUs who are
delegated as members of
their respective local health boards (LHB).
The DOH Representatives link the DOH to the LGUs and help facilitate the
development, management and monitoring of their respective local health systems. In order
to support their roles in assisting the LGUs, the Department had been issuing policies and
implementing capacity-building interventions. However, consultations with the DOH
Representatives revealed that they have been faced with persistent challenges such as
political dynamics, work overload, overlapping functions with local health officers, and
inadequate capacity in providing technical assistance.
Section 19 of the Republic Act (RA) 11223 or the “Universal Health Care Act” and its
Implementing Rules and Regulations (IRR) mandate the DOH, Department the Interior of
and Local Government and LGUs to endeavor to integrate local health systems into
province-wide and city-wide health systems. Thus, it is imperative for DOH to provide
support mechanisms that would make the integration possible and sustainable. The DOH
Representatives are expected to technically assist LGUs in the fulfillment of the said
mandate.
In view of the above, the roles, functions and responsibilities of the DOH
Representatives are hereby reviewed in order for them to provide the necessary assistance
to LGUs relative to the mandate of the UHC Act. This would also enable them to respond
effectively as vital partners in health development of the LGUs in accordance with the
national strategic thrusts and directions health. for
Il. OBJECTIVES
A. General
To provide policies and guidelines on the roles, functions and responsibilities of DOH
Representatives.
we
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
B. Specific
1. To delineate the roles, functions and responsibilities of the DOH Representatives with
the local health officers and other personnel in the Centers for Health Development
(CHDs).
2. To align the roles of the DOH Representatives with the goals of the UHC Act and its
IRR.
II. SCOPE AND COVERAGE
This Order shall apply to all offices and attached agencies of the DOH, LGUs, the
Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) subject to
the applicable
provisions of RA 11054 or the “Bangsamoro Organic Act” and subsequent rules and policies
issued by the Bangsamoro government, and all other concerned.
DEFINITION OF TERMS
. DOH Representative - refers to a Development Management Officer (DMO) or other CHD

personnel designated to represent the DOH as member of the LHB and has the capacity to
vote on issues or act on matters pertaining to health on behalf of the DOH.
.
-
Local Health Systems refers to all health offices, facilities and services, human resources,
and other operations relating to health under the management of the LGUs to
promote,
restore or maintain health.
‘. Local Health Board — refers to a body constituted by virtue of the LGC Title V, Section
102 in each of the provinces, cities and municipalities in the country (including BARMM)
which proposes to the Sanggunian, in accordance with the standards and criteria set by the
DOH, annual budgetary allocations for the operation and maintenance of health facilities
and services; serves as an advisory committee to the Sanggunian concerned on health
matters; and creates committees which shall advise local health agencies consistent with
the technical and administrative standards of the DOH.
Technical Assistance (TA) — refers to activities/ programs/ projects which are needed
in
.
and/or requested by the recipient LGUs that can be the form of technical outputs (e.g.
reports, documentation, substantive participation in meetings or conferences), teaching or
coaching and facilitation of funding assistance and logistics support.
. Technical Assistance Plan — refers to the summary of technical assistance to be provided

by the DOH Representative to support the health plans of the assigned LGU.
Vv. GENERAL GUIDELINES
A. Qualification, appointment and designation of the DOH Representatives shall, at

all times,
conform with Chapter 12 Section 46 of the “DOH Rules and Regulations Implementing the
Local Government Code of 1991”, Omnibus Rules on Appointment and Other Human
Resource Actions and other relevant issuances of the Civil Service Commission.
The primary function of the DOH Representatives to the LGUs shall be to represent the
in
.
DOH the LHB.

C. The DOH Representatives shall provide technical assistance on the development,

management and monitoring of the local health systems, in partnership and coordination
with concerned local health officers.
D. The DOH Representatives shall serve as the technical resource person of CHDs on
information pertaining to their assigned LGUs (e.g. health status & resources,
demographics, etc.) and as the advocate for the adoption and implementation of the priority
health programs/projects in these LGUs.
E. In line with the UHC Act, the DOH Representatives assigned in provinces, highly
urbanized cities (HUCs) and independent component cities (ICCs) shall assist their
respective LGUs in complying with at least the minimum requirements in order to qualify
as integrated province-wide and city-wide health system (P/CWHS). Likewise, DOH
Representatives assigned in municipalities and component cities (CC) shall advocate for
the integration of their LGUs ofassignment into a PWHS.
A. The DOH Representatives’ shall perform the following roles, functions and responsibilities
in support of the:
1. Local Government Units:

a, Carry out the mandate of the DOH and act on itsbehalf as official representatives
to the LGUs through the LHB and other sectoral/ functional committees, as deemed
necessary based on the following main responsibility areas:
i. policy advocacy and development; and,
ii. networking and collaboration.
b. Provide technical assistance to the LGUs in the development, management and

monitoring ofthe local health systems which include the health facilities such as
the hospitals in accordance with the following main responsibility areas:
i. health leadership and governance;
ii. health promotion;
iii. investment planning and budgeting (i.e. local investment plans for health
(LIPH) and annual operational plans (AOPs));
iv. health program management and monitoring;
v. surveillance, disasters, and disease outbreaks; and,
vi. drugs and supplies management.
2. CHDs and Provincial/ City DOH Offices (P/CDOHO):

a. Act as technical resource on the geographical, socio-cultural, socio-economic,
political, and health dynamics of the LGUs that may affect the implementation of
health programs;
b. Assist the CHD program managers and technical units (e.g. TB program manager,
Health Facility Development Unit, etc.), in the monitoring and evaluation of health
programs/ projects (including data validation and analyses), and health facilities;
c. For Provincial/ City DOH Representatives, additional roles are as follows:
e Participate in the appraisal of LIPH/AOPs as members of the CHD Appraisal
Team;
e Supervise personnel and oversee daily operations of the P/CDOHO; and,
eer
d. Perform other functions as may be assigned by the Regional Director/ Assistant

Regional Director.
3. Implementation of the UHC Act:

a. As
of
one of the members the LHB, the Provincial/HUC/ICC DOH Representatives
shall manage the Special Health Fund (SHF) together with the other members of
the LHB;
Assist the LGUs in
attaining the minimum requirements of managerial and financial
integration;
Monitor the progress of the assigned LGUs, which have committed to the
of
integration their local health systems;
Endeavor municipalities and component cities to integrate in the province-wide
health system;
Advocate for the formation of sub-provincial health systems for effective health
service delivery as deemed necessary;
Assist in the organization of a P/CWHS, which includes the establishment of a
health care provider network, accessible health records throughout the system and
mapping of baseline resources (e.g. human resources, facilities, commodities);
Facilitate the integration of local health plans; and,
Advocate for local adaptation of national policies on UHC and monitor/feedback
challenges and innovations to CHDs.
Specific roles, functions and responsibilities of the DOH Representatives are detailed
in Annex A
B. A DOH Representative Coordinator shall be hired/ designated in order to monitor and

harmonize the activities of the DOH Representatives. They shall report directly to the
Regional Director or Assistant Regional Director for a systematic integration of necessary
activities in CHD operations. The functions of the DOH Representative Coordinator shall
include, but not limited, to the following:
1. Provide a venue that facilitates coordination among the DOH Representatives and CHD
Technical Units, including the timely updates on the different health programs/ projects;
2. Plan, coordinate and/or manage programs related to the continuing learning and
development of DOH Representative, including conduct of regular meeting and
coaching sessions;
3. Monitor the implementation of Provincial/ City DOH Representatives of their
P/CDOHO Work and
Financial Plans; and,
4. Maintain and update the database of DOH Representatives.
VII. ROLES AND RESPONSIBILITIES
A. The Health Policy and Systems Development Team (HPSDT) shall:

1. Lead the team in the development of policies and instruments necessary for the
implementation of this Order.
B. The Bureau of Local Health Systems Development (BLHSD) shall:

1. Lead in the development of policies, guidelines and tools to support DOH
Representatives in carrying out their functions; and,
2. Provide a venue for DOH Representatives to share knowledge, experience and best
practices in the field such as consultative meetings, forum or conference.
C. The Health Human Resource Development Bureau (HHRDB) shall:

1. Conduct job analysis and determine/ update the required competency standards for DOH
Representatives;
2. Assist in identifying competency-based learning and development interventions aligned
with the roles and functions of DOH Representatives; and,
3. Support capacity building and learning and development opportunities for DOH
Representatives.
er
D. The Office of the Secretary through the Field Implementation and Coordination Team
or its equivalent shall:
. Monitor and evaluate the implementation of this Order through the Centers for Health
Development;
2. Ensure that CHDs provide the necessary technical assistance to DOH Representatives;
3. Coordinate with other DOH units or agencies for the concerns raised by DOH
Representatives through their CHDs and provide appropriate and timely feedback; and,
4. Ensure that CHDs allocated specific annual budget for the operations of the P/CDOHO.
E. The Centers for Health Development (CHD) shail:

1. Issue a Regional Personnel Order with the names of the DOH Representatives and their
areas of assignment and endorse these to their respective Local Chief Executives;
2. Conduct regular meetings/sessions/conferences with DOH Representatives for
monitoring their performance and to provide updates on policies and guidelines that
need to be cascaded to the LGUs;
3. Allocate specific budget for the operations of the P/CDOHO which includes supplies,
equipment, representation and travel expenses and additional staff as needed. This shall
be incorporated in the annual CHD budget proposal to be submitted for inclusion in the
annual DOH budget proposal;
4. Act on requests for technical assistance raised by DOH Representatives for their
respective LGUs including mentoring/coaching of LGU officials;
5. Monitor the implementation of this Order and conduct regular performance assessment
including coaching and mentoring of DOH Representatives using the standard Strategic
Performance Management System (SPMS) forms;
6. Develop a career development plan and conduct learning and development needs
assessment, through the Human Resource Development Unit (HRDU), as basis for the
provision of learning and development interventions; and,
7. Determine the most practical ratio of LGU assignment per DOH Representative with
consideration of geography, population, level of urbanization and presence of
Geographically Isolated and Disadvantaged Areas (GIDA) barangays or Indigenous
Cultural Communities/Indigenous People communities; and in compliance to the
provision of the LGC DOH IRR Chapter 12 Section 49c that no same person as DOH
Representative shall be assigned to sit in more than five (5) LHB. In HUC/ICC where
clustering of facilities and services are deemed necessary by the LGUs, additional DOH
Representatives may also be assigned as determined by the Regional Director.
F. The Procurement and Supply Chain Management Team (PSCMT) shall:

1. Ensure availability of centrally procured health commodities through timely
procurement pursuant to the respective PPMPs of the programs; and
5
poe
8
2. Ensure accessibility through the timely and seamless distribution of the centrally
procured health commodities to the CHDs and LGUs.
G. The Local Government Units shall:

1. Ensure the functionality of the LHB;
2. Ensure the participation of DOH Representatives in other important health-related
bodies/council;
3. Provide the DOH Representatives access to local health-related data subject to the
provisions of RA 10173 or Data Privacy Act of 2012;
4. Provide office space/ work stations for DOH Representatives at
the local health offices;
and,
5. Ensure the welfare and security of assigned DOH Representatives and other DOH
deployed personnel against threat to safety.
VU. REPEALING CLAUSE
This Order repeals AO 2013-0017 (Revised Roles and Functions and Responsibilities
of the DOH Representatives (DOH Representatives) in Support of National Health Thrust),
AO 2013-0017A (Addendum to AO 2013-0017), AO 135 s. 2004 (Revised Roles and
Functions of the DOH Representatives in Support of National Health Thrust) and AO
1995 (Roles and Functions of the DOH Representatives to Local Governments and Support
s.
of the National and Regional Health Offices) and all other Orders, rules, regulations, and
of
related issuances inconsistent with or contrary to this Order. All other provisions existing
issuances which are not affected by this Order shall remain valid and in effect.
SEPARABILITY CLAUSE
in the event that any section, paragraph, sentence, clause or word of this Order is
declared invalid, other provisions not affected thereby shall remain in effect. Annexes of
this Order maybe amended through issuance of Department Memoranda.
EFFECTIVITY
This Administrative Order shall take effect after fifteen (15) days following its
publication in a newspaper of general circulation and upon filing with the University of the
Philippines Law Center of three (3) certified copies of this Order.
FRANCISCO T, UQUE IE, MD, MSc.

ecretary of Health
ANNEX A
SPECIFIC ROLES, FUNCTIONS AND RESPONSIBILITIES OF THE DOH REPRESENTATIVES
MAJOR PROVINCIAL DOH HUC/ ICC DOH MUNICIPAL/ CC DOH

RESPONSIBILITY REPRESENTATIVE REPRESENTATIVE REPRESENTATIVE
AREAS
Representation Represents the DOH in the e Represents the DOH in the Represents the DOH in the
Note: Guidelines on Provincial Health Board HUC/ICC Health Board municipal and componentcity
Special Health Fund Actively participates in local e Actively participates in local health boards
management shall be and sectoral councils and other and sectoral councils and other Actively participates in local and
issued separately inter-agency bodies where the inter-agency bodies wherethe sectoral councils and other inter-
presence of DOH needed presence of DOH needed agency bodies where the presence of
DOH
is
Together with the other e
is
Together with the other is needed
members of the LHB shall members of the LHB shall
managethe Special Health Fund manage the Special Health
(SHF) Fund (SHF)
Networking and Links and installs coordinative |e Links and installs coordinative Links and installs coordinative
Inter-sectoral mechanisms between and mechanisms between and mechanisms between and among the
Collaboration among provinces and other among the city and other LGUs municipality/ component cities and
stakeholders in the province as well as other stakeholders in other LGUsas well as other
(e.g. DILG) the city (e.g. DILG) stakeholders
in the municipality/
component cities (e.g. DILG)
Policy Advocacy and Advocate and disseminate e Advocate and disseminate Advocate and disseminate national
Dissemination national and regional policies national and regional policies and regional policies and thrusts,
and thrusts, including and thrusts, including including guidelines, standards and
guidelines, standards and guidelines, standards and operating procedures to
ORGANIZING THE LOCAL HEALTH SYSTEM
operating procedures to the operating procedures to the municipalities and component cities
province HUC/ICC
169
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2Y} SUIPNpoUT sontAjoe pue syoofod -uoyendod jo uonjejuewe dur -uoyejndod jo uojejowsdun
‘sureidoid uorjourold yy[eay opin Jay} Ut Aj OU] JSISse pue Tay} ut souraoid
COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES AND OPERATIONAL GUIDELINES
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YOMOWIRIY UOTIOWOAg UTeOH YlomoweL] UOTOWOIg YI]eeH YlomoureLy UOTOWLOIY YIPoH,
pezieoq] ay) 10 uondope syeyTIOR 3Y} JO UOHEZI]ed0] OY} SyeIPIOB,T oe OY} JO UOEZT] BIO] 9}
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Jeuoyjeu Suroddns/Zundope
so1orjod [eoo] Jo uoTR[NULIOY
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pu diysiopesy S9SINOD SOURLLIZAOS pus Wyeoy oatsuodsar pur sanjoajyo
pyesy satsuodses pur sayoajyo drysiopes] yyeoy sarsuodsas uo (sqcJ) SoaHnoexe Jory
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pue sisoyjo Yyeoy eso] pue sanoayye uo sqyT [Boo] pue sia91JZ0 WBeoy [edo] Jo
jo Zummen jusuroma oyeyIoe] pUe sI99]qJO YIjRaY [eso] Jo SUTUIeN AUAWT[OIUS oyeyy]IOe J
Aressooou SuLuIes JUSUT[OIUS ORION, Aressaoou pousop
peweep s? OHO /OHW 9} Arzessaoau poulsep se OHD su} S@
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YI WOTPUIpIo“o Ur joUUOSIed JoyjO UM UOHBUIpI00. Ut pouUOsied Ul JouUOsIed Joyo pue (OHd)
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24) 32 JUaUIdopSAOp suA}SAs TTEOY ye qusurdopaaop surajsAs yy[Ray ye quourdojoaap suaysAs Yy[eoy,
UO Wosis g ddINOSOY/JUR}{NSUOD UO UOSIeg SdINOSaY/jUeI[NSUOD Uo UosIag soINOsaY/jue]NsUOD aoUEUIZAOD pues
[eormyoa) se joy Jeoruysay se Oy oe
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HAILV LINAS adda HAILVINASTadaa SGALLVINGSTad aa ALITISGISNOdSAa
170
HOd 00 /TYd DINO HOd 091 /00H HOd TVIONIAOUd uorval
AREAS
programs, projects and activities programs, projects and social determinants of health and
including social determinants of activities including the social behavior risk factors
health and behavior risk factors determinants of health and
behavior risk factors
Investment planning Review and validate LIPH/AOP Review and validate Review and validate LIPH/AOP of
and budgeting of the province LIPH/AOP of the city the municipality/ component city
Assist the PHO identifying Assist the CHO in identifying Assist the MHOin identifying
Note: Guidelines on the
in
funding sources and capacity funding sources and capacity funding sources and capacity
Development of LIPH/ development opportunities development opportunities development opportunities
AOP shall be issued Ensure alignment of plans with Ensure alignment of plans with Ensure alignment of plans with
separately national health strategies and national/regional health provincial health strategies and
directions strategies and directions directions
Participate in the appraisal of Participate in the appraisal of Feedback to the MHO/CHO the
the LIPH/AOP as member of the LIPH/AOP as member of results of submitted LIPH/ AOP
the CHD Appraisal Team the CHD Appraisal Team (as Provide technical assistance to
Feedback to the PHO the results applicable) hospitals and laboratories especially
of submitted LIPH/ AOP Feedback to the CHO the in the investment planning,
Provide technical assistance to results of submitted LIPH/ AOP budgeting and networking
hospitals and laboratories Provide technical assistance to
especially in the investment hospitals and laboratories
planning, budgeting and especially in the investment
networking planning, budgeting and
networking
Health Program Facilitate timely submission of Facilitate timely submission of Facilitate timely submission of
Management and complete and accurate health complete and accurate health complete and accurate health reports
Monitoring reports in the province reports in the city in the municipality/ component city
Facilitate provision of learning Facilitate provision of learning Facilitate provision of learning and
and development interventions and development interventions development interventions based on
based on assessed needs of the based on assessed needs of the assessed needs of the MHO/ CHO
171
172

AREAS
PHO and staff including CHO and staff including and staff including deployed DOH
deployed DOH human resource deployed DOH human resource human resource in the municipality/
in the province on the different in the city on the different component city on the different
health programs health programs health programs
Coordinate with specific CHD Coordinate with specific CHD Coordinate with specific CHD
program coordinators for the program coordinators for the program coordinators for the
preparation of program-related preparation of program-related preparation of program-related
proposal and other technical proposal and other technical proposal and other technical
documents documents documents
Facilitate compliance to Facilitate compliance to Facilitate compliance to regulatory
regulatory requirements for the regulatory requirements for the requirements for the licensing of
licensing of facilities, including licensing of facilities, including facilities, including those providing
those providing ambulatory and those providing ambulatory and ambulatory and primary care
primary care services primary care services services
Facilitate establishment and Facilitate establishment and Facilitate establishment and
monitoring of feedback monitoring of feedback monitoring of feedback mechanism
mechanism for stakeholders and mechanism for stakeholders for stakeholders and partnersin
partners in health and partners in health health
Assist monitoring and Assist monitoring and Assist monitoring and evaluation of
evaluation of health programs evaluation of health programs health programs and health systems
and health systems using LGU and health systems using LGU using LGU Scorecard and other
Scorecard and other health- Scorecard and other health- health-related monitoring tools
related monitoring tools related monitoring tools Assist the MHO/CHO in the
Assist the PHO in the Assist the CHO in the interpretation of health data,
interpretation of health data, interpretation of health data, alignment to national strategies and
alignment
alignment to national strategies to national strategies translation to appropriate health plan

and translation to appropriate and translation to appropriate and policies
health plan and policies health plan and policies Facilitate the identification and
assist in the documentation of good
AREAS
Facilitate the identification and Facilitate the identification and practices within the municipality/
assist in the documentation of assist in the documentation of component city
good practices within the good practices within the city |* Recommend to the MHO/CHO
province Recommend to the CHO existing good practices of other
Recommend to the PHO existing good practices of other LGUs for possible replication in the
existing good practices of other LGUs for possible replication municipality/ component city
LGUs for possible replication in in the city
the province
Surveillance, Facilitate mobilization of Facilitate mobilization of Facilitate mobilization of resources
Disasters and Disease resources within the DOH as resources within the DOH for within the DOH for the municipal/
outbreaks needed by the provincial LGU the city LGU during disaster component city LGU during
during disaster and disease and disease outbreaks disaster and disease outbreaks
outbreaks Assist in the conduct of rapid Assist in the conductof rapid health
Validate and coordinate rapid health assessments in the city assessments in the municipality/
health assessmentsof the component city
province
Drug Supplies and Facilitate request of PHO for Facilitate request of CHO for Facilitate request of MHO for
Management health commodities centrally health commodities centrally health commodities centrally
procured by the DOH Central procured by the DOH Central procured by the DOH Central
Office and CHDs (program Office and CHDs (program Office and CHDs (program drugs or
drugs or population-based drugs or population-based population-based health
health commodities) health commodities) commodities)
Facilitate monitoring and Facilitate monitoring and Facilitate monitoring and
submission of utilization and submission ofutilization and submission of utilization and
inventory reports inventory reports inventory reports
Integration of Local Assist the province in the Assist the city in the e Assist the city in the organization
Health Systems organization and functionality organization and functionality and functionality of the province-
of the province-wide health of the province-wide health wide health system, particularly in
system, particularly in the system, particularly in the
173
174

AREAS
Note: Guidelines on the managerial and financial managerial and financial the managerial and financial
integration of local integration integration integration
health systems shall be Endeavorfor the inclusion of the
issued separately municipalities and component cities
in the PWHS
Advocate to municipalities/
component cities for their local
health budget be pooled in the
Special Health Fund
Facilitate the drafting of local
ordinances that support their
integration into the province-wide
health system
MANAGEMENT AND SUPERVISORY FUNCTIONS

Personnel Supervision Provide general administrative Provide general administrative Provide technical assistance for the
and Technical (including monitoring of (including monitoring of DOH personnel deployed in the
Assistance performance) and technical performance) and technical municipality/ componentcity
assistance to all DOH personnel assistance to all DOH personnel Assist MHO/CHO in supervising
in the PDOHO in the CDOHO (as applicable) DOH deployed
personnelin the
Assist PHO in supervising DOH Assist CHO in supervising municipality/ component city
deployed personnel in the DOH deployed personnel in the consistent with the existing HRH
province consistent with the city consistent with the existing Deployment Program guidelines
existing HRH Deployment HRH Deployment Program
Program guidelines guidelines
Formulate and monitor staff Formulate staff development

development plan by identifying plan by identifying and
and prioritizing learning and prioritizing learning and
development interventions in
‘a

AREAS
development interventions in coordination with HRDU, as
coordination with HRDU applicable
Office Operations Lead the development and Lead in the development and Implement programs and activities
in
implementation of PDOHO implementation of CDOHO in the PDOHO WFP pertaining to
Note: Guidelines on Work and Financial Plan (WFP) WFP applicable) the assigned LGUs
TA
(as
the developmentof Approve procurement and Approve procurement and Participate in the day to day
Plans will be issued distribution plan for supplies distribution plan for supplies operation of the P/CDOHO, as
separately and other needs of the PDOHO and other needs of the CDOHO assigned
Monitor implementation of (as applicable)
WFP and Staff Development Monitor implementation of
Plan WFPand Staff Development
Supervise and monitor the Plan (as applicable)
implementation of the Technical Managethe day to day
Assistance Plans of the DOH operation of the CDOHO(as
Representatives in the province applicable)
Manage the day to day
operation of the PDOHO
175
177
3 UTILIZING
LOCAL HEALTH SYSTEM
MANAGEMENT TOOLS
Several management tools can be used to guide the integration of local health systems
into Province-wide and City-wide Health Systems (P/CWHS) and to track the progress
of all programs and activities to realize the goals of UHC.
First is the Local Health Systems Maturity Levels (LHS ML) monitoring tool. This
monitoring tool can be used by LGUs to assess their current level of maturity concerning
the integration of their P/CWHS. By using this tool, LGUs can identify the strengths
and weaknesses of their local health systems and determine their level of compliance to
integration. The tool can also guide LGUs in developing programs and activities that can
be incorporated into their Local Investment Plan for Health (LIPH).
The LIPH is the second management tool. It is a medium-term public

investment plan for health that specifies the strategic direction of the P/CWHS.
With the development of the LIPH, a negotiation process can commence
among P/CWHS and DOH, PhilHealth, or other health partners to determine
available support mechanisms to implement the investment plan. The Terms of
Partnership (TOP) serves as the legal instrument or tool between DOH and the
P/CWHS for contracting the delivery of population-based health services. On the other
hand, the Service Level Agreement (SLA) serves as the legal instrument or tool between
PhilHealth and the P/CWHS for contracting the delivery of individual-based health
services.
Last among the tools is the LGU Health Scorecard. This is a performance monitoring
tool to evaluate or assess the outcomes of health reforms in the P/CWHS. The results
from the scorecard can aid local chief executives and local health managers in identifying
the gaps and action points in the implementation of local health programs.
UTILIZING LOCAL HEALTH SYSTEM MANAGEMENT TOOLS 179

ON UTILIZING LOCAL HEALTH SYSTEM
MANAGEMENT TOOLS
• Guidelines on Implementation of the Local Health Systems Maturity

Levels (LHS ML) [AO 2020-0037]
• Guidelines on the Development of Local Investment Plans for Health

[AO 2020-0022]
• Guidelines on Contracting Province-wide and City-wide Health

Systems [AO 2020-0018]
• Guidelines on the Implementation of the Local Government Unit

Health Scorecard [AO 2019-0027]
• LGU Health Scorecard Manual of Procedures [DM 2020-0275]

Note: The LGU Health Scorecard Manual of Procedures is accessible
at: https://bit.ly/LGUHSCMOP
Republicof the Philippines

AUG 19 2020
No. 2020 0637
_
—_
SUBJECT: Guidelines on Implementation of the Local Health Systems Maturity

Levels (LHS ML)
I. RATIONALE
With the intent of harmonizing the Local Government Units’ (LGUs) efforts toward
efficient health service delivery and health systems operations, Section 19 of Republic Act
No. 11223 or the Universal Health Care Act (UHC Act) provided that “the Department of
Health (DOH), Department of the Interior and Local Government (DILG), PhilHealth and
the LGUsshall endeavor to
integrate health systems into province-wide and city-wide health
systems”. Section 41.d of the said Act specified that the reform on integration shall be
implemented among LGUs that expressed their commitment, with support from the National
Government. This reform on local health systems integration shall be assessed through an
independent study to be commissioned by the Joint Congressional Oversight Committee on
Universal Health Care after six (6) years to evaluate the overall benefits of integration before
its nationwide implementation. Part of the review is to assess for managerial and financial
integration in these local health systems based on the characteristics specified under
Sections 41.4.c and 41.4.d of the UHC Act Implementing Rules and Regulations (IRR).
Administrative Order (AO) No. 2020-0021 on the Guidelines on Integration of the Local
Health Systems into Province-Wide and City-Wide Health Systems (P/CWHS) specified
the general procedures and mechanisms by which LGUs, national government agencies, and
key stakeholders can integrate local health systems into P/CWHS, and the scope and
minimum level of functionality of an integrated local health system. This Order aims to
supplement the abovementioned AO in guiding the LGUs on how track its status of to
integration. -
II. OBJECTIVES
A. To define the concept of maturity levels, its building blocks, characteristics, levels
of progression and key result areas
B. To provide the mechanisms in the implementation of the maturity levels as one of
the monitoring tools for the P/-CWHS
C. To guide prioritization of resources and support to facilitate the integration of the
|
local health systems
Ill. SCOPE OF APPLICATION
a
This Order shall apply to all offices and attached agencies under the DOH, all health care
providers (public and private), other National Government Agencies (NGAs), Non-
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829e URL: http://Awww.doh.gov.ph; e-mail: fiduque@doh.gov.ph
Government Organizations (NGOs), LGUs, health partners and donors, and all others
concerned. The use of the LHS ML in the Bangsamoro Autonomous Region for Muslim
Mindanao (BARMM) shall be in accordance with Article Ix, Section 22 of RA No. 11054,
otherwise known
issuances.
as
the “Organic Law for the BARMM”, and other subsequent laws and
IV. DEFINITION OF TERMS
A. Annual Operational Plan (AOP) — refers to the yearly translation of the Local
Investment Plan for Health, which details the programs, plans and activities, and
systems interventions that are to be implemented in the Province-Wide/ City-Wide
Health System in a particular year (AO No. 2020-0022).
B. City-Wide Health System (CWHS)

-
refers to the Highly Urbanized City (HUC)-
and Independent Component City (ICC)-wide health system. This includes the City
Health Office, health facilities and services, human resources, and other operations
relating to health under the administrative and technical supervision of the City
Health Board (CHB).
C. Health Partners — refer to local and international health stakeholders providing

technical and/ or financial support to any level of the government in order to
contribute in the improvement of
health outcomes and/or reduction of financial risks.
D. Health Systems Building Blocks — refer to the six (6) interrelated blocks that
compose
a
health system as identified by the World Health Organization (WHO).
This serves as basis in identifying the existing gaps and capacities, and defining
priorities to strengthen the health system.
E. LGU Health Scorecard — a tool used to assess and monitor the performance of LGUs
in the implementation of local health reforms and in meeting the national health
targets based on the priority programs, projects and activities of the DOH (AO No.
2019-0027).
F. Local Investment Plan for Health (LIPH) — refers to a medium-term public

investment plan for heaith that specifies the strategic direction of the concerned LGU
for the next three years in terms of improving health service delivery, strengthening
the health systems operations and addressing social determinants of health, and
specifies actions and commitments of different local stakeholders (AO No. 2020-
0022).
G. Province/ City DOH Office (P/CDOHO) refers to DOH field office in the
-—
provinces and cities headed by the DOH Representative who performs roles,
functions and responsibilities as specified in AO No. 2020-0029.
H. Province-Wide Health System (PWHS) - composed of municipal and component

city health systems. This includes the Provincial, Component City and Municipal
a
Health Offices, health facilities and services, human resources, and other operations
relating to health under the administrative and technical supervision of the Provincial
Health Board (PHB).
I. Local Health Systems Maturity Levels (LHS ML) - refers to the framework used to
monitor the progress of local health systems integration as provided by the UHC Act
and its IRR. |
:
V. GENERAL GUIDELINES
A. The LHS ML shall serve as the general framework in the monitoring and evaluation
of the progress of the LGUs that committed to the integration, and shall provide the
pathway to
progressively realize the integration of local health systems into P/CWHS.
It shall be used in complementation with the LGU Health Scorecard and other existing
monitoring and evaluation systems that track LGU performance.
B. The LHS ML shall be composed ofthe following: a) building blocks; b) characteristics

of an integrated local health system; and c) key result areas (KRAs) per level of
progression. All KRAs under each level contribute to the attainment of the KRAs
the succeeding level/s.
in
C. The implementation of the LHS ML shall be a collaboration between the DOH, LGUs,
and other health partners. The LGUs shall act as the lead implementers of the local
health systems integration. The DOH and other health partners shall serve as the
providers of the needed technical and financial support.
D. The LHS ML shall be the basis of all DOH units, attached agencies, development
partners and other stakeholders in formulating and updating their respective programs,
projects and activities in relation to the integration of the local health systems.
likewise serve as one of the instruments in determining the kind and level of
It
shall
assistance, incentives, and/ or recognition and awards to be provided to the LGUs in

support of the integration.
E. The P/CWHS shall outline in their LIPH the strategies, interventions and investment
needs based on the baseline assessment, situational analysis and status of integration.
F, The LHS ML shall be reviewed periodically by DOH to ensure its

alignment with the
UHC Act and other related laws, new policiesand plans of concerned DOH Central
Office (CO) Technical Bureaus, and directives of the Secretary of Health.
G. As deemed necessary, updating of the LHS ML shall be done by Bureau of Local

Health Systems Development (BLHSD) in
close coordination with the concerned
DOH CO Technical Bureau/s, and shall consider the feedback of the Centers for
Health Development (CHDs), Ministry of Health-BARMM (MOH-BARMM) and
P/CHB as
the implementing units. The LHS ML shall be updated through the issuance
of a Department Memorandum (DM).
yt
A. Components of the LHS ML
1. The LHS ML
components:
is a multi-tiered monitoring framework which has the following
a. Building Blocks - based on the WHO health system building blocks

framework which describes the health systems in terms of the following
fundamental components: i) Leadership and Governance; ii) Financing;
iii) Health Workforce; iv) Information; v) Medical Products, Vaccines and
Technologies; and vi) Service Delivery
b. Characteristic - based on Sections 41.4.c and 41.4.d of the UHC Act IRR
which describe the features of P/CWHS that
achieved managerial and
financial integration
c. Key Result Areas (KRAs) - refer to the minimum outputs expected to be
delivered by the P/CWHS that can facilitate the achievement of
integration
d. Levels of Progress - indicates the performance levels and corresponding
KRAs that should be present per characteristic
i. Level I (Preparatory Level) - covers KRAs relating to preparatory
works and other supporting mechanisms that are needed
the integration of local health systems
to
facilitate
ii. Level II (Organizational Level) — covers KRAs that are important

for the organization and management of integrated local health
systems. This also reflects other KRAs on reforms provided under
the UHC Act that have effects on the success of the integration
iii. Level III (Functional Level) — covers KRAs on the monitoring of
functionality of the integrated management support systems
2. Assessment and monitoring shall be done for each characteristic based on the
identified KRAs in the following Annexes:
Annex A. Leadership and Governance
op
Annex B. Financing
Annex C. Health Workforce
Annex D. Information
Annex E. Medical Products, Vaccines and Technology
mono
F. Service Delivery
Annex
3. The P/CWHS can have different levels for characteristics under the same
if is
Building Block. The P/CWHS considered to haveprogressed to a particular
level in a Building Block all the KRAs for all the characteristics in that level
have been undertaken or achieved. It shall likewise ensure that the KRAs for the
lower levels are maintained or sustained.
4. The P/CWHS shall be classified based on the attainment of the KRAs of all the
characteristics in all the six (6) building blocks as required for each level of
progress. The P/CWHS shall be categorized as follows:
44 fe
Level Category Description

All LGUs that committed to the integration were
Level 1
Readiness of the assessed on their readiness to managerially and
P/CWHS
financially integrate their local health systems.
The P/CWHS has available network-wide
Level 2 guidelines, resources and management
Organized P/CWHS
structures to facilitate and sustain the
integration.
.
The P/CWHS has operationalized the network-

Level 3 Functional P/CWHS wide management support systems, and has
its
ensured institutionalization.
B. Implementation Mechanism
1. The CHD/ MOH-BARMM shall create a core group composed, at

the minimum,
of technical personnel from CHD/ MOH-BARMM units primarily responsible for
the development, implementation and monitoring of the identified characteristics
of P/CWHS. A copy of the Regional Personnel Order shall be submitted to the
concerned Field Implementation and Coordination Team (FICT) Office and copy
furnished the BLHSD.
. The P/CHB, through the P/CHO, and assisted by the CHD/ MOH-BARMM core
group and P/CDOHO/ Integrated Provincial Health Office (IPHO), shall conduct a
baseline assessment of LGUs that committed to the integration using the LHS ML.
Monitoring of status shall be performed annually. To facilitate the assessment and
monitoring, a separate order shall be issued on the LHS ML Monitoring Tool/
Checklist.
. The P/CHB shall oversee the monitoring of integration of the local health systems
through annual self-assessment.
. The CHD/ MOH-BARMM core

group and P/CDOHO/ IPHO
shall perform the
validation and provide technical assistance, as necessary.
A. Department of Health
1. The FICT, through the CHDs, and the MOH-BARMM shall oversee the integration
of local health systems, including the assessment and monitoring of status of
integration.
2. The CHDs and MOH-BARMM, through the core group and P/CDOHO/ IPHO
shall:
i. Assist the LGUs in the integration of their local health systems, including
assessment and monitoring of the integration status;
ii. Provide the overall data management and analysis for the LHS ML
implementation within their respective regions; and
¥,
ili. Ensure that the needed investments and support for the integration of local
are
health systems reflected in the LIPH of the P/CWHS.
3. The Health Policy Development and Planning Bureau (HPDPB), in coordination

with the BLHSD, shall ensure that DOH units use the LHS ML as one of the bases
for their policy and plan formulation, and budget proposals.
4. The BLHSD shall:

1. In close coordination with the CHDs, MOH-BARMM,
concerned DOH CO
Bureaus, and attached agencies, facilitate the review, revision and updating
of the LHS ML andotherrelated issuances;
|
ii. Provide the overall data management and analysis for the LHS ML
implementation; and
|
iii. Develop guidelines on the identification and documentation of local health

systems good practices.
5. The following DOH CO Bureaus and attached agency shall ensure that the
corresponding guidelines, standards, technical assistance and capacity building
activities, and other support mechanisms related to P/CWHS characteristics are
available and updated as necessary, in close coordination with other DOH units:
P/CWHS Characteristics |
Lead Bureau(s)
Unified Governance of the Local Health
BLHSD
System
Strategic and Investment Planning BLHSD
Financial Management BLHSD and
PhilHealth
Human Resource for Health Management Health Human Resource Development Bureau
and Development (HHRDB)
Information Management System Knowledge Management and Information
Technology Service (KMITS)
Epidemiology and Surveillance System Epidemiology Bureau (EB)
Supply Chain Management Service (SCMS)
Procurement and Supply Chain Management Pharmaceutical Division (PD)
Health Facilities Development Bureau (HFDB)
Referral System Disease Prevention and Control Bureau (DPCB)
PhilHealth
Disaster Risk Reduction Management for Health Emergency Management Bureau
Health System (HEMB)
|
Health Promotion and Communication Service

Health Promotion Programs or Campaigns
(HPCS)
B. Local Government Units, through the P/CHB, shall:

1. Lead in the organization of the P/CWHS, including the monitoring of integration
of the local health systems using the LHS ML;
2. Ensure the efficient collection, validation and submission of LHS ML data using
the prescribed tool. They shall likewise make sure that supporting documents are
made available to the CHD/ MOH-BARMM core
group, P/-CDOHO/ IPHO and
other concerned stakeholders and health partners;
Le
3. Ensure that both the integration status and KRAs are considered during the
formulation of the LIPH/AOP; and
4. Provide needed resources, including funds, and support mechanisms for the
implementation of the LHS ML.
.
C. Health Partners shall:

1. Align their programs, projects and activities with the integration of the local health
systems; and
2. Provide necessary technical assistance and support to facilitate the organization and
functionality of the P/CWHS.
VIN. SEPARABILITY CLAUSE
is
If any part or provision of this Order rendered invalid, by any court of law or competent
IX. REPEALING CLAUSE
All Orders, rules, regulations, and other related issuances inconsistent with or contrary
to this Order are hereby repealed, amended, or modified accordingly. All other provisions
of existing issuances which are not affected by this Order shall remain valid and in
effect.
X. EFFECTIVITY DATE
FRANCASCO T/DUQUE III, MD, MSc

Sécretary of Health
188
Annex A. Leadership and Governance

MATURITY LEVEL:
Defining the Pathway to Progressively Realize the Integration of Local Health Systems
BUILDING BLOCK: LEADERSHIP AND GOVERNANCE

LEVELS OF PROGRESS (Key Result Areas)
CHARACTERISTICS I Il It
PREPARATORY ORGANIZATIONAL FUNCTIONAL
Unified Governance of 1. Commitment to integrate local health systems into 1. Organized Province-/City-wide Health System 1. Institutionalized P/CWHS through the
the Local Health System Province-Wide and City-Wide Health Systems, as (P/CWHS) through a Memorandum of Agreements issuance of local ordinances
expressed through: (MOA), with the following minimum contents:
a. Sanggunian Panlalawigan/Panlungsod (SP) a. Inter-LGU cooperation through the creation of 2. P/CWHS, through the P/CHB, contracted by
Resolution or Executive Order on integration of PCPNs linked to a secondary or tertiary care DOH for the delivery of population-based
local health systems b. Organizational and management structure: health services and by PhilHealth for the
b. Memorandum of Understanding (MOU) between i. Provincial/City Health Board (P/CHB) delivery of individual-based health services
the Provincial/City Government and DOH ii. Technical Management Committee (TMC) (if
specifying the commitment to implement Sub-Provincial Health Systems will be 3. P/CWHS Annual Accomplishment Report
integration of local health systems created) reflecting Health Service Delivery and Health
c. Resource sharing and coordination mechanisms Systems Performance, including health
2. Presence of technical working group/s (or similar d. Obligation and responsibilities of the province statistics, available health resources and yearly
group/s) to assist the P/CHB on matters relating to the and component LGUs (municipalities and/or comparative performance analysis
integration of local health system through an Executive component cities)
Order (EO) (Remarks: Depending on the decision of the P/CHB, this
2. Expanded P/CHB functions and members through an may be provided as a separate document or incorporated in
the LGU Annual Accomplishment Report, provided that the
Executive Order (EO), with the following minimum minimum contents are included.)
contents:
a. P/CHB having the mandate to fully manage the
SHF, and exercise administrative and technical
supervision over health facilities and health human
resources within the P/-CWHS
b. Representative/s of municipalities and components
cities
c. ICC/IP representative, as applicable
(Remarks: No prescribed number for the representative/s of

municipalities and component cities included in the PWHS)
3. Strengthened Provincial/ City Health Office

a. Creation of the Health Service Delivery Division
and Health Systems Support Division, and
corresponding functions through an ordinance
b. Creation, through an ordinance, and filling up of
plantilla positions for Assistant P/CHO and
Page 1 of 2
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__Amuex A. Leadership and Governance
MATURITY LEVEL:
Defining the Pathway to Progressively Realize the Integration of Locai Health Systems
BUILDING BLOCK: LEADERSHIP AND GOVERNANCE
CHARACTERISTICS I II Hil
another official of equivalent rank, if not yet
existing, and other personnel for the created
division
c. New organizational structure of the P/CHO
(Remarks: In addition to the two (2) divisions, an Epidemiology and

Surveillance Unit (ESU) and Health Promotion Unit (HPU) shall be
created within the P/CHO. These are reflected under the Information
Block and Service Delivery Block, respectively.)
4, Established Management Support Unit (MSU),

including personnel composition, and roles and
functions through an Executive Order (EO)
Strategic and Investment 1. Baseline assessment of LGU’s health systems capacity 1. Local Investment Plan for Health (LIPH) the 1.Summary of investment needs as reflected in
-
as AOP
Planning and corresponding investment needs for the integration strategic and investment plan of the P/CWHS througha the vis a vis actual expenditures (byfund
of the local health systems: resolution source)
a. Human resources for health, infrastructure
and equipment 2. LIPH/AOP concurred by concerned Center for Health
b. Service capabilities of health facilities and Development (CHD) as reflected in the concurred
services appraisal checklist
c. Status of licensing (DOH) and accreditation
(PhilHealth) of health facilities and services
d. Management support systems such as
human resources for health management
and development, information management,
procurement and supply chain management,
quality assurance/ improvement, referral
system, DRRM-H system, epidemiologic
surveillance system, and proactive and
effective health promotion programs/
campaigns
(Remarks: Other specific areas for gaps analysis and investment

needs assessment were reflected in the concerned building block.)
UTILIZING LOCAL HEALTH SYSTEM MANAGEMENT TOOLS
Page 2 of 2
189
\ ar
190
Annex B. Financing
MATURITY LEVEL:
BUILDING BLOCK: FINANCING
CHARACTERISTICS I II
PREPARATORY ORGANIZATIONAL
il
FUNCTIONAL
|
Financial Management 1. P/CHB Resolution on the opening of an SHF Bank 1. Exclusive use of the SHF budget for health
| Account in an authorized depository bank programs, projects and activities within the
P/CWHS, as reflected in:
| 2. Sanggunian Panlalawigan/ Panlungsod Resolution to a. P/CHB Resolution
|
endorse the P/CHB Resolution on the opening of an SHF b. Approved Work and Financial Plan
|
Bank Account (WFP)
| 3. SHF Bank account, including its authorized 2. SHF budget utilization, as reflected in the
|
signatories, as reflected in a certification from the quarterly Report of Utilization

|
authorized government depository bank
|
4. Separate book of account for SHF, including
| subsidiary ledgers for each fund source, as reflected in a
| certification from the Provincial/ City Accountant
|
5. Subsidiary ledger for SHF in the Trust Fund of
component LGUs as reflected in a certification from the
concerned LGU’s Accountant
6. With the following personnel in the MSU

|
to assist the
Board in the management the SHF:
of
a. Accountant
b. Administrative Officer
c. Liaison Officer
(Remarks: The personnel identified above, including the other

.
personnel that shall comprise the MSU, should be included in the
Executive Order that shall be issued based on Item 4, Organizational
Level, Unified Governance of the LHS under the Leadership and
Governance Block. )
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\
I
Annex C. Health Workforce
MATURITY LEVEL:
BUILDING BLOCK: HEALTH WORKFORCE

CHARACTERISTICS I II Ii
1. Baseline assessment, gaps analysis and identification 1. With available HRH plan, integrated in the Local 1, Permanent plantilla positions forHRH
Human Resources for
Health Management and of corresponding investment needs (based on P/CWHS Investment Plan for Health (LIPH), for the whole created through an ordinance, based on gaps/
Development needs, and standards of DOH and other agencies): P/CWHS reflecting the following minimum contents: needs identified
a. Distribution and staffing pattern (filled and a. Filling-up of vacant plantilla positions
unfilled positions) within the P/-CWHS b. Mechanism on HRH sharing within the health 2. Reports on:
(disaggregated by hiring authority) care provider network a. HRH to population ratios
b. Learning and development needs based on c. Incrementa! creation of plantilla positions for b. Trained HRH based on required
competency standards HRH competencies per cadre
d. Learning and development plan/ intervention c. HRHattrition rate
(Remarks: d. Patient satisfaction on HRH
sion bv hirine authority WO
LGU-hired planta, LGU
eeee ee eee INTE PEG, 2. Updated
P National Health Workforce Registry
gistry ( (VHWR) performance
eee
hired contract of.
services,
erg Ty DOH deployed, rotating HRH)
e. HRH satisfaction on HRH support
3. Harmonized competency-based HRH management provided by P/CWHS
and development system, and HRH performance
assessment system, including grievance redress
mechanisms, through an Executive Order (EO) or
Provincial/City Health Board Resolution
4, Presenceof health workers competent on

providing primary care services, as certified by the
DOHand PRC
Page 1 ot i
191
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192
MATURITY LEVEL:
BUILDING BLOCK: INFORMATION

LEVELS GF PROGRESS (Key Result Areas)
CHARACTERISTICS I iI
PREPARATORY
i
ORGANIZATIONAL FUNCTIONAL
Information 1.
Baseline assessment, gaps analysis and 1, Health information management/ ICT 1, Validated EMR system that links the members of the PCPN
Management System identification of corresponding investment development plan for the whole P/-CWHS to secondary and tertiary care providers within the P/CWHS as
needs on (based on P/CWHS needs, and evidenced by capacity to coordinate referrals from:
standards of DOH and other agencies): 2. Functional EMR system among health a. PCPN to referral facilities (secondary/ tertiary)
a. State of ICT governance in the P/CWHS, facilities within the P/CWHS as evidenced by b. Referral facilities (secondary/ tertiary) to Apex
including strategic and investment capacity to submit reports to DOH and hospital/s
planning for health information PhilHealth c. Referral facilities or Apex hospital/s to PCPN
management/ICT
b. Inventory of health facilities with service 3. Memorandum of Agreement (MOA)/ 2. Reports on:
and ICT capabilities, which include Service Level Agreements (SLA) on a. Percent of security incidents and personal data breaches
implemented systems/applications, ICT engagements with medical specialists for the detected and responded in a timely manner
to
equipment, internet connectivity, provision of telemedicine services b. Percent of health facilities providing telemedicine
availability of dedicated ICT personnel services
and other cross-cutting ICT issues such as 4. Presence of dedicated ICT personnel
standards compliance, privacy and data (Remarks:
1. Telemedicine service will be integrated asa functional module in the EMR
protection, etc.
system.
2. All security incidents and personal data breaches shall be acted upon
following the breach incident reporting and management protocal of the
National Privacy Commission as guided by existing laws, rules and guidelines.)
Epidemiologic 1. Baseline assessment, gaps analysis and 1. Epidemiology and Surveillance Units 1. Epidemiology and Surveillance System technical
Surveillance System identification of corresponding investment (ESUs) with dedicated personnel competent guidelines/manual of operations fully implemented within the
needs on (based on P/CWHS needs, and on basic epidemiology, disease surveillance P/CWHS through an ordinance
standards of DOH and other agencies): and event-based surveillance created through
a. Presence of epidemiology and ordinance/s: 2. Timely submission of reports through the following systems:
surveillance unit a. Provincial/ City ESUs (P/CESUs) a. Field Health Services Information System (FHSIS)
b. Availability of trained personnel on within the P/CHO b. Case-Based Surveillance Report through Philippine
epidemiology and public health b. Hospital Epidemiology and Integrated Disease Surveillance and Response (PIDSR)
surveillance Surveillance Unit (HESU)
c. Referral and coordination system among 3. Epidemiologic Surveillance Report

the Epidemiology and Surveillance 2. Technical guidelines/manual of operations
Units (ESUs) within the P/CWHS, on epidemiology and surveillance system 4. Event-Based Surveillance Report, as needed
including availability of ICT equipment,
_
reflecting the following minimum contents:
transportation and communication a. Case detection, notification and
facilities investigation
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MATURITY LEVEL:
Defining the Pathway to Progressively Realize the Integration cof Local Health Systems
BUILDING BLOCK: INFORMATION

CHARACTERISTICS I il Tit
d. Compliance to reporting requirements b. Flow of case reporting and
information feedback
c. Data management
d. Response to health event of public
health concern either a public health
emergency a public health threat
or
e. Monitoring and supportive
supervision over component LGUs’
ESU
f. Resources/ Logistics provision
strategy
193
Page 2 of Z
194
Annex E. Medical Products, Vaccines and Technology
MATURITY LEVEL:
BUILDING BLOCK: MEDICAL PRODUCTS, VACCINES AND TECHNOLOGY

CHARACTERISTICS I iI Il
Procurement and Supply 1. Baseline assessment, gaps analysis and 1. Procurement plan for the whole P/-CWHS 1. Interoperable electronic supply chain/
Chain Management corresponding investment needs on (based on logistics management system
P/CWHS needs, and standards of DOH and (Remarks: Individual LGUs shall still develop their own procurement plan.)
other agencies): 2. Reports on:

2. Technical guidelines/manual on the implementation of the a. Availability of essential medicines all
a. Supply of medicines, vaccines and other in
harmonized procurement and supply chain management with
health commodities public health facilities (% of public health
b. Availability of health equipment and
the following minimum contents: facilities with no stock-outs)
other technologies a. Delineation of functions and accountabilities among b. Near-expiry medicines, vaccines and
member LGUs health commodities, including the batch
c. Availability of designated area for
b. Demand planning and forecasting
proper storage of supplies, such number/ lot number, and name of
warehouses c. Warehousing, distribution centers and consumption manufacturer and distributor/ supplier
d. Trained personnel on procurement and monitoring
d. Inventory management (Remarks:
supply chain management
% Transportation strategies 1) Public health facilities = RHUs/Health Centers,
e. LGU-hired licensed
f. Proper storage and disposal of medicines and health infirmaries and hospitals;
pharmacist/pharmacy assistant vis-a-vis 2) Essential medicines = as determined by DOH and as
commodities (including expired products)
list of health facilities decided by the P/CHB based on latest epidemiological data
f. Availability of Transport Network 3) No stock-outs = facility did not experience having less
than one inonth buffer stock of identified essential medicines
Vehicle Service (TNVS) (Remarks: The technical guidelines/ manual shall specify if the P/CWHS will (definition was based on AO 2019-0027 — LGU Health
utilize the BAC of the Province/Citv, among others, or will it create its own Scorecard))
2. Pharmacy and Therapeutic Committee (PTC) BAC.)
with clearly defined functions relating to
procurement and supply chain management 3. Presence of pharmacist/ pharmacy assistant among LGUs
created through an Executive Order (EO).
4, Presence of dedicated trained personnel on procurement and
supply chain management the P/CHO
in
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VR
Annex F. Service Delivery
MATURITY LEVEL:
BUILDING BLOCK: SERVICE DELIVERY
CHARACTERISTICS I II Il
Referral System 1. Results of review of existing referral system which 1. Updated technical guidelines/manual on referral 1. Reports on the following:
include, but not limited to: systems specifying the following minimum contents: a. Rate (%) of coordinated referrals:
a. Service capabilities and available health services a. Directory of health facilities, including service i. PCPN to referral facilities
of health facilities within the P/-CWHS capabilities, available services and (secondary/ tertiary)
b. Communication and transportation arrangements corresponding prices, operating hours and ii. Referral facilities (secondary/
c. Availability of referral guidelines and case contact details tertiary) to other referral facilities
management protocols b. Roles and responsibilities of the referring and (secondary/ tertiary) or Apex
referral facilities, and other identified hospital/s
2. Groupings/ clustering of health care providers and stakeholders iii. Referral facilities or Apex
facilities (RHUs/ Health Centers and their referral c. Communication and transportation hospital/s to PCPN
hospitals) arrangements b. Leading causes of referrals
d. Standard referral forms to be used e Top reasons for declined referrals
3. With identified potential Apex Hospital/s d. Patient satisfaction rating on service
2. Clinical practice guidelines and other case delivery
management protocols adopted and implemented in the
P/CWHS 2. Registrationof all constituents to a primary
care provider within their territorial jurisdiction
3. P/CWHS health facility development plan
4, Public Health Units in LGU Hospitals created through

an Executive Order
5. Partnership with Apex Hospital/s through a

Memorandum of Agreement
6. Registration of indigents to a primary care provider

within their territorial jurisdiction
7. Technical guidelines on customer feedback

mechanism, including standard form and data utilization
mechanisms
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195
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196
Annex F., Service Delivery

MATURITY LEVEL:
CHARACTERISTICS I Il Til
Disaster Risk Reduction 1. Baseline assessment, gaps analysis and identification 1. Province/City-wide DRRM-H System have the 1. Province/City-wide DRRM-H System have
Management for Health of corresponding investment needs (based on actual following minimum requirements: the following additional characteristics:
(DRRM-H) System P/CWHS needs, and standards ofDOH and other a. Unified, comprehensive and coherent DRRM-H a. Self-sufficient Public Health and
agencies) Plan that is approved, updated, disseminated Hospital HERT with extensive trainings
and tested b. Available and accessible HEC as per
2. DRRM-H Program adopted through P/CHB b. Organized Public Health and Hospital Health DM 2018-0430 or the “Guidelines on
Resolution Emergency Response Team (HERT) with the List of Minimum Basic Logistics to
minimum required trainings be Procured/ Maintained” and its
c. Available and accessible health emergency revisions, and with arrangement for a
commodities (HEC) (i.e. medicines), and field implementation facility (either
presence of an equipped, servicing ambulance owned or through MOU/MOA with
or patient transport vehicle partners)
d. Functional Emergency Operations Center (OC) c. Health Operations Center under the
(under the management and supervisionof the management and supervision of the
P/CHO coordination with DRRMO OC) P/CHO
in
2. With dedicated P/-CWHS DRRM-H Manager 2. Additional reports on:
a. Program Implementation Review
3. Reports on: b. Health Situation Update, as needed
a. Program Accomplishment and Management
Reports
b. Field Health Emergency Alerting Report
System (HEARS) Reports
c. Rapid Health Assessment (RHA) Reports, as
needed
d. Post Incident Evaluations in public health
emergencies/ disasters, as needed
e. Performance Indicator for Operations
Monitoring Reports, as needed
Health Promotion 1. Baseline assessment on functional health literacy of 1. Health Promotion Unit (HPU) with dedicated trained 1. Additional reports/ portfolio on:
Programs or Campaigns the catchment population personnel within the P/CHO created through an a. Consolidated inputs and
ordinance recommendations to Health Impact
2. Health Promotion Committee (HPC) created through Assessment Reports vetted and signed
an Executive Order 2. P/CWHS Health Promotion Framework Strategy off by appropriate local health
Page 2 of 3
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Annex F. Service Delivery
MATURITY LEVEL:

CHARACTERISTICS I I Hi
3. At least three (3) modules from the Local Health authorities and duly submitted to the
|
3. Barangay Health Workers (BHWs) declared as on-the- System Health Promotion Playbook implemented Centers for Health Development, as
ground health promotion officers with clearly defined part of their participation in the HIA
Terms of Reference or Scope of Work 4. Reports/ Portfolio on: Review Process.
a. Annual accomplishments on health promotion
(Remarks: In compliance with Section 33.1 of the UHC Act
4. At least one (1) module from the Local Health System program submitted to DILG and DOH IRR, the DOH in coordination with the NEDA, DILG,
Health Promotion Playbook implemented b. Policies, programs and campaigns implemented, DENR, relevant LGUs and executive agencies shall
other
including documentation of community action ensure that Health Impact Assessment is conducted public
and social mobilization initiatives within the health mitigation and management plans are implemented
P/CWHS for all development initiatives, and membersof potentially
affected communities are well-represented in the process.)
(Remarks:
2. At least seven (7) modules from the Local
Item a: In compliance with Section 30.13 of UHC Act IRR.
Item b: Based on Section 30.12 of UHC Act IRR, priority shall be given Health System Health Promotion Playbook
to health promotion policies and programs related
to reduction of implemented
alcohol and tobacco use, reduction of incidence of communicable
diseases and prevalence of non-communicable diseases, addressing
mental health issues and improvement of health indicators)
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(\ 4X
—
MAY 2 1 2020
No. 2020-_O0QA)
SUBJECT: Guidelines on the Development of Local Investment Plans for Health
I. BACKGROUND
In 2005, initial 16 convergence provinces were guided to develop Province-wide

Investment Plans for Health (PIPH) to achieve health sector goals of better health
outcomes, financial risk protection and responsive health system. The strategy of health
investment planning was later expanded to
all other provinces, highly urbanized cities
(HUCs) and independent component cities (ICCs). The Province-/City-wide
Investment Plans (P/CIPH) for Health were key instruments in forging DOH and Local
Government Unit (LGU) partnership to achieve health sector goals.
The P/CIPH has since been institutionalized and renamed as Local Investment Plan for
Health (LIPH), a generic term to cover any level of LGU developing investment plan
for health. The time frame of the plan has also been changed to three years to coincide
its
with the term of the Local Chief Executives (LCEs).
In 2018, Administrative Order 2018-0014 or the “Strategic Framework and

Implementing Guidelines for FOURmula One Plus for Health” was issued. It mandates
that technical assistance from the DOH be consolidated and matched with the needs
outlined in the LIPH.
With the passage of RAi1223 or the Universal Health Care (UHC) Act and its
Implementing Rules and Regulations (IRR) in 2019, the significance of LIPH is
highlighted. Section 22 of the UHC Act states that “the national government, through
the DOH, shall! provide financial and non-financial matching grants .... in accordance
with the approved province-wide and city-wide health investment plans.”
There is an urgent need to update the LIPH guidelines to support the progressive
realization of the UHC goals and objectives.
IL. OBJECTIVE
This Order aims to

provide guidelines and procedures in the development of LIPHs and
Annual Operational Plans (AOPs) for partners and stakeholders in support of the
implementation and achievement of UHC.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila » Trunk Line 651-7800 local 1113, 1108, 1135 f
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http://www.doh.gov.ph, e-mail: ftduque@doh.vov.ph Ir
—
Til. SCOPE OF APPLICATION
This Order shall apply to offices and attached agencies under the DOH, other National
Government Agencies (NGAs), LGUs, Non-Government Organizations (NGOs) Civil
Society Organizations (CSOs), health partners and donors, and all others concerned.
adoption of the local investment planning for health for LGUs under the BARMM shall
be in accordance with RA No. 11054 or the Organic Law for BARMM and subsequent
laws and issuances.
A. Annual Operational Plan (AOP) — refers to the yearly translation of the Local
Investment Plan for Health, which details the programs, plans and activities
(PPAs) and systems interventions that are to be implemented in Province/City-
Wide Health Systems (P/CWHS) in
a particular year.
B. City-wide Health System (CWHS) — refers to the Highly Urbanized City
(HUC)- and Independent Component City (ICC)-wide health system. This

includes the health offices, health centers or stations, hospitals and other city-
managed health care providers under the administrative and technical
supervision of the City Health Board (CHB).
C. Contracting - refers to a process where providers and networks are engaged to

commit and deliver quality health services at agreed costs, cost sharing and
quantity in compliance with prescribed standards.
D. _Individual-based health services — refer to health services which can be

accessed within a health facility or remotely, through the use of digital
technologies, that can be definitively traced back to one recipient, has limited
effect at the population level, and do not alter the underlying cause of illness.
These services include ambulatory and inpatient care, medicines, laboratory tests
and procedures, among others.
E. LGU Investment Needs — refers to the matrix of needs/requirements to address

health gaps and meet targets and objectives, with corresponding fund
requirements and proposed fund sources, such as DOH, LGU and other
stakeholders
EF Local Heaith System - refers to all health offices, facilities and services, human
resources, and other operations relating to health under the management of the
LGUs to promote, restore or maintain health.
G. Local Investment Plan for Health (LIPH) — refers to a medium-term public
investment plan for health that specifies the strategic direction of the concerned
LGU for the next three years in terms of improving health service delivery,
strengthening the health systems operations and addressing social determinants
of health, and specifies actions and commitments of different local stakeholders.
Don ge
Menu
ofAssistance - Program priorities, directions and thrusts, and list of
available specific DOH support for LGUs, such as health facilities development
and information and communications technology (ICT), Human Resource for
Health deployment and scholarships, drugs/medicines and commodities, and
other forms of technical assistance, with corresponding unit cost and formula
used for LGU allocation, used as input to local planning
Population-based health services — refer to interventions such as health

promotion, disease surveillance, and vector control, which have population
groups as recipients.
Province-wide Health System (PWHS) — composed of municipal and

component city health systems; which includes: the Provincial, Component City
and Municipal Health Offices; Provincial, Component City, District and
Municipal Hospitals; Rural Health Units/Health Centers, Barangay Health
Stations; and, other LGU-managed health care providers under the
administrative and technical supervision of the Provincial Health Board (PHB).
Special Health Fund (SHF) — refers to a pool of financial resources at the

P/CWHS intended to finance health services and health systems operations.
Technical Management Committee (TMC) — composed of technical staff from

the member health facilities, DMO assigned in municipalities/component cities,
patient representative and others, health officers of member
municipalities/component cities, and representative from the private sector
M. Terms of Partnership (TOP) — refers to a legal instrument used to formalize

the agreement on the implementation of the AOP between the DOH and LGU.
GENERAL GUIDELINES
A. LIPH Development
1. The LIPH shall be anchored on the following UHC principles: (a)

integrated and comprehensive approach to ensure health literacy, healthy
living conditions, and protection from hazards and risks; (b) health care
model that provides comprehensive health services without causing
financial hardship; (c) whole-of-system, whole-of-government, whole-of-
society approach in the development, implementation and monitoring and
evaluation of health plans; and, (d) people-oriented approach centered on
people’s needs and well-being.
2. The LIPH process is a bottom-up planning procedure that allows lower

level units such as barangays, municipalities and component cities to have
their plans incorporated in the province-wide health plan; or in the case
of highly urbanized cities and independent component cities, to have their
plans consolidated in the city-wide health plan; It shall have clear health
goals and objectives as part of the overall 3-year strategic plan of the
LGU, which focuses on the strengthening of the local health system
covering all dimensions of the building blocks of the health system.
3. The LIPH shall be developed by every LGU based on the local health
epidemiology and situation, local objectives for health, and guided by the
AmBisyon Natin 2040, Sustainable Development Goals (SDG),
Philippine Development Plan (PDP), and the National Objectives for
Health (NOH).
4. The LIPH shall serve as the costed strategic plan of the P/-CWHS forthe
implementation of the UHC, covering the needs of all its municipalities
(for provinces) and barangays (for cities).
5. it
As the primary local! health plan reference, shall also serve as the basis
for health inputs to the Regional Development Plan, and the Local
Development Investment Program (LDIP)/Comprehensive Development
Plan (CDP).
6. The LIPH shall address the health needs of the majority of the local
population and equally provide consideration to the health needs of the
vulnerable population such as, but not limited to, population in
Geographically Isolated and Disadvantaged Areas (GIDA), Indigenous
Cultural Communities/ Indigenous Peoples (ICC/IP), indigents, senior
citizens, PWDs, women, and children. It shall also include activities on
intra-governmental, civil society engagement and private sector
of
collaboration to address the social determinants health.
B. LIPH Implementation
1, The LIPH shall maximize local and national resources towards the
development of
a responsive local health system.
2. The LIPH shall be translated into three Annual Operational Plans (AOPs).
3. The Terms of Partnership (TOP) shail serve as the contractual

arrangement between DOH and the LGUs in the
provision of grants.
C. Aligning DOH Plans and Budget to the AOPs

1. The AOPs shall be considered by the DOH in
with appropriate feedback provided to LGUs.
its yearly budget proposals,
2. The AOPs shall be the basis of financial and non-financial grants from the
National Government, particularly DOH, and other health partners.
A. Organization of LGU Planning Teams

1. To ensure the development, implementation, monitoring and evaluation
of the LIPH, an LGU planning team shall be organized which may be
composed of, but not limited to, the following:
phe fe
a. Municipality/Component City
i. Health Officer, Development Management Officer (DMO)
assigned in Municipal/City DOH Representative,
Municipal/City Planning and Development Coordinator,
Councilor for Health, Chief of LGU Hospital (if any),
Budget Officer/Accountant, and representative/s from
§6=
ICC/IP, NGOs/ CSOs, private sector, and other key partners;
b. Sub-provincial Health System, as applicable

i. Technical Management Committee (TMC), composed of
technical staff from the member health facilities, DMO
assigned in municipalities/component cities, patient
representative and others, health officers of member
municipalities/component cities, and representative from the
private sector;
c. Province/HUC/ICC
i. Health Officer, DMO assigned to the Province/City,
Planning and Development Coordinator, Councilor for
Health, Chief of Provincial/HUC/ICC Hospital, Budget
Officer/Accountant/ Treasurer, and representative/s from
ICC/IP, NGOs/CSOs, private sector, and other key partners.
2. The LGU Planning Team shall be supported by an appropriate policy such

as an Executive Order (EO) or a Sanggunian Resolution, which defines
the roles and responsibilities, the funding allotment, and other logistical
resources to
ensure the functionality of the team.
LIPH Development
The LIPH process (Figure 1) shall be participatory and inclusive, bottom-up, and
province/city-wide in scope.
Figure 1: LIPH Process

B1. CHD CALL
TO PLAN
B2. LGU PLANNING PROCESS

Situational Analysis
iD of gaps, Strategies to
address gaps, Cost
Requirements
ft
Consultation, Planning,
Consolidatio:
Pa NO
REVIEW
cHD. APPRAISAL YES=—H] 64. PLAN CONCURRENCE
NO <¢ Passed? —_=> YES

—
1. Call to Plan
a. The Center for Health Development (CHD) shall initiate the call
for LGUs to formulate their LIPH;
b. The Provincial/City Health Office shall initiate the formulation of

the LIPH of the P/CWHS. These plans shall be aligned with the
LDIP/CDP of the concerned LGUs;
c. Municipal and Component City Health Offices shall likewise

initiate the formulation of their municipal/city investment plans
for health.
Local Health Planning
The LIPH shall follow the planning process of situational analysis,

identification of needs based on accurate and verifiable data,
identification of appropriate and evidence-based strategies and
determining investment costs and sources of fund.
a. Situational Analysis
Situational analysis shall include a review of current local
program and health outcomes and system performance, namely:
SDGs; PDP; NOH; program strategic plans; Field Health Service
Information System (FHSIS); LGU Health Scorecard
benchmarks; previous LIPH/AOPs; and other LGU health or
health-related plans such as the Disaster Risk Reduction and
Management Plan for Health (DRRM-H), Executive Legislative
Agenda (ELA), LDIP, CDP, and Annual Investment Program
(AIP); and, social determinants of health and other health-related
data. This shall also include analysis of the internal and external
environment
Identification of gaps, LGU investment needs, strategies and cost

requirements
i. The vision, mission, goals and strategic objectives shall be
developed based on the local health situation;
ii. Strategies and interventions shall be identified based on
gaps and priorities;
iii. Strategies and interventions shall include both population-
based and individual-based health services;
iv. Where available, health needs/activities in Ancestral
Domain Sustainable Development and Protection Plan
(ADSDPP)/Ancestral Domain Investment Plan for Health
(ADIPH) shall be considered. Copies of these plans may
be secured from the National Commission on Indigenous
Peoples (NCIP) Provincial Service Centers;
v. DOH National program managers (NPMs) shall provide a
menu of assistance to CHD program managers; this shall
include program directions, priorities and thrusts, costing
and guide for computation for allocation of goods and

services, list/information on DOH commitment on
technical assistance (e.g. health facility development and
ICT, Human Resource for Health deployment,
commodities, training, others) or historical data on such, to
serve as guide for the LGUs during planning workshops;
vi. LGUs shall utilize the menu of assistance as one of the
bases for planning and costing of interventions;
vii. LGUs shall map available resources for health, such as
LGU
general fund, PhilHealth income, special health fund,
DOH
grants, and development partners’ assistance;
viii. Complementation of existing resources from the private
sector shall be taken into account; and,
ix. LGUs may include unfunded interventions in the LIPH for
fund sourcing.
c. Province/HUC/ICC consolidation, writing, and submission of

LIPH
i. The Province/HUC/ICC Planning Team shall consolidate
and incorporate health plans and health needs from the
different health units, hospitals and facilities, and consider
inputs from different stakeholders and population groups:
(a) Review of municipal/component city investment
plans for health shall be conducted by the DMO
assigned in Municipal/City, together with the LGU
planning team prior to submission to the
Province/HUC/ICC Planning Team for
consolidation;
(b) Municipalities and Component Cities that opted to
form sub-provincial health systems shall submit a
consolidated LIPH to the TMC; and,
(c) Review of the sub-provincial health system LIPH
shall be conducted by the TMC prior to submission
to the Province Planning Team for consolidation;
ii. The Province/HUC/ICC Planning Team shall submit the
consolidated LIPH to the Provincial/City DOH Office
(P/CDOHO) for joint review; and,
iii. Planning forms, content outlines, templates and timelines for
LIPH, and updates thereof, shall be issued separately by the
DOH.
3. Review and Appraisal of the LIPH
The LIPH of the P/CWHS shall undergo the following review and
appraisal process:
a. Review by the Province/HUC/ICC Planning Team and

Provincial/City DOH Representatives
i. Review of the plan shall be jointly undertaken by the
Province/HUC/ICC Planning Team and Program Managers
together with the DMO assigned to the Province/City, and

other stakeholders; and,
ii. Ifthe plan passes the review or has minor corrections only,
the PHO/CHO shall forward the plan to the CHD for
appraisal. Otherwise, the plan shall be revised to incorporate
corrections and recommendations. Technical assistance from
the DMO assigned tothe Province/City is critical in this case.
b. CHD Appraisal
i. Appraisal shall be undertaken by the CHD using an
tool, which shall be issued in a separate memorandum;
appraisal
ii. The CHD shall convene an Appraisal Team composed of, but
not limited to the following:
(a) Assistant CHD Director;
(b) Division Chiefs;
(c) LIPH Coordinator;
(d) Planning Officer;
(e) Cluster Heads/CHD PMs;
(g)
to
() DMO assigned the Province/City;
Hospital Representative/s; and,
(h) CHD Budget Officer/Accountant;
iii. Development Partners working with LGUs in the Region,
and other key stakeholders may be invited to participate in
the appraisal;
iv. Ifthe plan passes the appraisal or has minor corrections only,
the LIPH Coordinator shall return the plan to the PHO/CHO
to facilitate approval. Otherwise, the plan shall be revised to
incorporate corrections and recommendations. Technical
assistance from the Province/City DOH representatives and
CHD Program Managers is critical in this case.
4. Concurrence of the Plan

a. The Province/HUC/ICC Planning Team shall incorporate the
comments of the CHD Appraisal Team, if any, and submit the
revised/enhanced LIPH to the Provincial/City Health Board
(P/CHB) for approval;
b. The P/CHB shail endorse the approved LIPH to the CHD for
concurrence;
c. The P/CHB shall ensure the inclusion and harmonization of the

LIPH
in their LDIP/CDP.
W&M ge.o/
—
LIPH Implementation
The LIPH shall be translated into three detailed AOPs, for Year 1, Year 2 and
Year 3 of the LIPH period.
Figure 2: AOP Process
CHD CALL
TO PLAN
C1. TRANSLATION OF LIPH

into AOPs
LGU PLANNING PROCESS

Situational Analysis
€2, EXECUTION OF
iDof gaps, Strategies to TERMS OF
address gaps, Cost PARTNERSHIP between
Requirements CHD & PICWHS
e «Consultation, Planning,
Consolidation
v C3. PLAN
iMPLEMENTATION
REVIEW & CHD
APPRAISAL v
D. MONITORING OF PLAN
>|
IMPLEMENTATION
NO
Gem Passed? =—PYES PLAN
CONCURRENCE
1. Translation of the LIPH into the AOP
The AOP shall adopt the same LIPH process but with provisions for
contractual arrangement, plan implementation and monitoring (Figure 2):
a. The AOPs shall be anchored on the LIPH;
b. The Year 1 AOP shall be developed in the same year as the LIPH
is developed;
The Years 2 and 3 AOPs shall update the LIPH, highlighting

additional investments, which were not previously indicated in the
LIPH. Adjustments may include emerging needs, new priorities
and directions, availability of new sources of investment funding,
or unimplemented programs and projects from the previous year’s
AOP;
The AOP shall be aligned with the LGU’s Annual Investment Plan
(AIP) to ensure LGU budget allocation; and,
DOH for priorities and

A separate guideline shall be issued by the
thrusts, timelines, and revision/updating of planning forms for
each AOP year.
2. Contractual Arrangement
a. The P/CHB and the CHD represented by the Regional Director

shall enter into a contractual arrangement for the implementation
of the AOP;
b. The Terms of Partnership (TOP) shall be the legal instrument for

the contractual arrangement;
c. A separate policy for contracting P/CWHS and template for the

TOP shall be issued by the DOH.
Plan Implementation
The Province/City/Municipal Health Offices shall lead the AOP

implementation, in coordination with the CHD, and all other stakeholders.
D. LIPH Monitoring and Evaluation
1. The LIPH/AOP Monitoring Team shall be composed of LGU Health

Officers, Provincial/City DOH Representatives and CHD staff. Other
stakeholders shall be invited to participate in monitoring activities.
The following shall be covered in the monitoring:
a. Status of physical accomplishment of PPAs (e.g., PPAs of major

health programs implemented or not implemented on a target
period);
b. DOH assistance particularly for the major cost

drivers/investments, namely: health facilities development and
ICT, human resource for health, commodities, other technical
assistance and major programs, project, activities (PPAs) (e.g.,
comparison of LGU Investment Needs for major health programs
against actual assistance provided by the DOH thereto);
c. Local counterpart through the AIP (e.g. comparison of LGU

counterpart on major health programs against actual health
programs funded through the AIP);
d. Other areas that may be identified as necessary to be monitored
The monitoring may include the conduct of systems or program-based

Program Implementation Review (PIR), LGU Health Scorecard review,
regular staff meetings, submission of monitoring reports, review of
implementation evidences, among others.
"on
Aligning DOH Plans and Budget to the AOPs
The AOP shail be considered in the DOH and CHD budget proposals through
the following processes (Figure 3):
Figure 3: Aligning of DOW Plans and Budget to the AOP
CHD
call to plan
LGU Planning Process

oa E1. Submission of LGU Investment
ae’
Needs
J
Review and CHD Appraisal
E4
vy —v
National and CHD Program
E2-E3.
Managers Incorporate Investment
Needs in DOH Budget Proposal
NO | Passed! YES
i E4 b
E3. Submission of DOH Budget
Plan Concurrence
v v
Transtation of LIPH to AOP
¥
Execution of Terms of GAA
Partnership between CHD
and LGU
Pian Implementation
Monitoring of Plan
Implementation
1. LGU Submission of Investment Needs to CHDs
a. LGU investment needs with corresponding fund requirements

shall be identified based on situational and gaps analyses and
desired health targets and objects; the forms for the AOP and LGU
investment needs are the same.
b. LGU investment needs shall be categorized into the following:

i. health facility development and ICT;
ii. human resource for health deployment and scholarships;
iii. health commodities; and
iv. other technical assistance
c. Categorization of investment needs may be revised/updated, if

deemed necessary for ease of planning and submission.
d. Possible fund sources for these investment needs shall be

identified;
Spal
e. The Province/City Health Officer shall submit a copy of the LGU

investment needs to the DMO assigned to the Province/City.
f. The DMO assigned tothe Province/City shall review and validate

the LGU investment needs.
2. CHD Review of LGU Investment Needs
a. The DMO assigned to the Province/City shall forward the LGU

Investment Needs to the CHD, through the LIPH Coordinator,
who shall distribute these to the CHD program managers.
b. The CHD program managers shall review and validate the LGU
investment needs, and prioritize incorporation in the CHD Budget
Proposal and summarize Program Investment Needs per LGU.
c. The CHD program managers shall inform the LGUs of the specific
items included in the CHD Budget Proposal through the CHD
LIPH Coordinator which becomes the basis for AOP
revision/enhancement;
d. The CHD LIPH Coordinator and Planning Officer shall

consolidate the LGU investment needs, properly noting which of
these have been incorporated into the CHD Budget Proposal, for
submission to the Regional Development Council] (RDC);
e. The CHD Director shall endorse the LGU Investment Needs

DOH Central Office.
to the
3. Central Office Review
The CHD LIPH Coordinator shall forward the duly vetted LGU
Investment Needs to BLHSD.
a. The BLHSD shall distribute the LGU Investment Needs to

appropriate DOH Offices/national program managers (NPMs).
b. The national program managers shall review the LGU Investment

Needs and prioritize incorporation of these needs in the DOH
Central Office (DOH-CO) budget proposal.
c. The national program managers shall inform the CHD program

managers of the specific items included in the DOH-CO budget
proposal, copy furnished to the BLHSD.
d. The CHD program managers shall relay the same to the LIPH
Coordinator.
12
nl
e. The national program managers shall submit their respective

budget proposals to the Health Policy Development and Planning
Bureau (HPDPB).
f. The HPDPB shall follow the usual national planning process and
submission of national budget proposal to DBM.
4. Feedback to LGUs
a. The CHD LIPH Coordinators and program managers shall

consolidate feedback from national program managers and CHD
program managers by LGU (Province/HUC/ICC), and forward
these to the Province/City DOH Office and LGUs concerned, copy
furnished the BLHSD.
b. LGUs shall take note which of their proposals have been

incorporated in DOH-CO and CHD budget proposals and
update/revise their proposed AOPs.
c. The regular AOP process and timelines shall then follow.
The following shall be the roles and responsibilities of key offices and personnel
pertaining to LIPH and AOP processes:
A. DOH Central Office
1. Bureau of Local Health Systems Development (BLHSD)
a. Steer and spearhead the LIPH/AOP processnationally;
b. Develop guidelines on the LIPH/AOP process, including forms,

tools, and templates, in consultation with relevant stakeholders;
c. Provide technical assistance to DOH Central Office and Bureaus,

CHD LIPH Coordinators and key partners, as may be requested,
on the LIPH/AOP processes;
d. Lead in the conduct of monitoring of DOH CHDs, LGUs and

MOH-BARMM on LIPH/AOP implementation and set-up
feedback/reporting mechanisms.
2. Field Implementation and Coordination Team (FICT)
Oversee the development, implementation, monitoring and evaluation of

LIPHthrough the Centers for Health Development.
212
—
__
3. National Program Managers
a. Provide program directions and strategies, and information

needed for technical assistance in local planning workshops;
b. Furnish CHD program managers with menu of assistance and

commodities, with formulae and standard costs for the LGU’s
reference in identifying their needs;
c. Use the AOP/LGU investment needs to identify and allocate

assistance/support to LGUs through the CHDs;
d. Ensure that national budget proposals are based on AOP/LGU

investment needs.
4. Health Policy Development and Planning Bureau (HPDPB)
a. Steers and spearheads the overall health planning process;
b. Ensures the alignmentof national health plans to the LIPH through

guidelines, reviews and monitoring and evaluation;
c. Conducts assessments of the translation of investments into

desired health outcomes.
B. DOH Center for Health Development (CHD)
1. CHD Director
a. Steer and spearhead the LIPH/AOP process in the Region;
b. Provide directions to CHD PMs

program planning and budgeting;
to utilize the LIPHs/AOPs in
c. Advocate the LIPH process to the Local Chief Executives and

Local Health Officers;
d. Ensure the monitoring of LIPH implementation by facilitating the

necessary technical assistance, resources, and personnel
mobilization.
2. CHD LIPH Coordinator
a. Provide technical assistance to CHD staff, LGUs and key partners

in the region, as may be requested, on the LIPH/AOP processes;
b. Provide copies of LIPHs/AOPs/LGU investment needs to CHD

program managers, and key partners for use as basis for technical
assistance, and priority inclusion in the CHD budget proposal;
14
gn
.
c. Submit LIPHs/AOPs/LGU investment needs to DOH-CO

(BLHSD);
d. Coordinate with PDOHOs/DOH Representatives, CHD

Accountant/Budget Officers the submission of Fund Utilization
Report (FUR) for transferred funds;
e. Convene and coordinate activities of the CHD pertaining to

LIPH/AOP processes.
3. CHD Program Managers
a. Provide Provincial/City DOH Representatives and LGUs with

program directions, strategies, menu of assistance and
commodities, with formulae and standard costs for the LGU’s
reference in identifying their needs;
b. Provide technical guidance in the LGU Planning Workshops and

planning appraisal;
c. Review LIPHs/AOPs/LGU investment needs, prioritize and

incorporate these in the CHD budget proposal;
d. Incorporate the monitoring of LIPH/AOP implementation and

fund utilization as part of regular monitoring of program
implementation.
4. CHD Planning Officer
a. Work in partnership with the LIPH Coordinator in providing

technical assistance on plan development to
Provincial/City DOH
Representatives and LGUs, conduct of
appraisal of LIPHs/AOPs,
and monitoring and evaluation
b. Work together with the LIPH Coordinator in consolidating LGU

investment needs for submission to BLHSD
5. DMO
assigned in Municipalities/Cities
a. Assist LGUs in the development of their LIPHs/AOPs;

b. Review and validate LGU investment needs as appropriate to
LGUcontext and health situation, in coordination with local
health officers;
c. Organize Province/City level review of the LIPH/AOP;
d. ‘Facilitate the timely submission of LIPH/AOP/LGU investment

needs to the CHD LIPH Coordinator;
s
gO
Monitor plan implementation and fund utilization in partnership

and coordination with the PHO/CHO/ Budget Officer/Accountant
and the CHD LIPH Coordinator and Program Managers.
Submit reports on plan development, implementation, fund

utilization, and other reports, as may be required, to the CHD, on
a timely manner.
Cc Local Government Units
1. Province/HUC/ICC Health Boards
Set the policy directions for the development and implementation

of the LIPH/AOP;
Ensure the inclusion of the LIPH/AOP

(LDIP/AIP).
in local development plans
Ensure that development, approval and implementation of
LIPH/AOP and other matters relating thereto, are regularly taken
up in P/CHB meetings
2. Province /HUC/ICC Health Offices
a. Organize/mobilize teams for planning, implementation and

monitoring and evaluation;
b. Provide technical assistance to municipal/component

city/district/barangay, in coordination with the Provincial/City
DOH Office;
c. Include municipal/component city/district/barangay and hospital
plans in the Province/HUCs/ICC LIPH
d. Review and validate LGU investment needs prior to submission

to CHD;
e. Develop respective LIPH/AOP based on rational, realistic and

participatory planning;
f. Implement, provide counterpart funding, monitor implementation

and fund utilization of the LIPH/AOP.
VIII. SEPARABILITY CLAUSE
If any part or provision of this Order is rendered invalid by any court of law or
and effective.
provisions of existing issuances which are not affected by this Order shail remain valid
in
and effect.
EFFECTIVITY
ISCO J.DUQUE I,
Secretary of Health
MD, MSc
17

MAY 14 2020
No. 2020 -_
JIG
SUBJECT: Guidelines on Contracting Province-Wide and City-Wide Health
Systems
BACKGROUND
In 2005, the Department of Health (DOH) formulated the Fourmula One (F1) for Health
as the implementing framework for health sector reform. One main strategy is for the
DOH to assist Fl convergence sites by providing targeted support and focused
assistance toselected provinces. Convergence provinces developed five-year Province-
wide Investment Plans for Health (PIPH) with the assistance of DOH. The strategy of
investment planning was later expanded to all
other Provinces, Highly Urbanized Cities
(HUCs) and Independent Component Cities (ICCs), which likewise developed their
City-wide Investment Plans for Health (CIPH). The PIPH/CIPH was the key instrument
in forging DOH-LGU partnership to achieve health sector goals. In order to formalize
the partnership, a five-year memorandum of agreement (MOA) and an annual Service
Level Agreement (SLA) were signed between the DOH and the Province/HUC/ICC.
The PIPH/CIPH has since been institutionalized and renamed as Local Investment Plan
for Health (LIPH), a generic term to cover any level of Local Government Unit
developing its investment plan for health.
For the 2014-2016 LIPH period, the plan coverage was changed to three years to
coincide with the term of the Local Chief Executives (LCEs). The MOA and the SLA
were merged and renamed as the Terms of
Partnership (TOP).
With the passage of RA 11223 or the Universal Health Care (UHC) Act and its
Implementing Rules and Regulations (IRR) in 2019, the significance of LIPH is
highlighted. Section 22 of the UHC Act states that “the national government, through
the DOH, shall provide financial and non-financial matching grants .... in accordance
with the approved province-wide and city-wide health investment plans.” Section 17.2
of the IRR prescribes that the DOH shall contract “province-wide and city-wide health
systems..., through a legal instrument to ensure shared responsibilities and
accountabilities among members of the health system for the delivery of population-
based services including those that impact on the social determinants of health.”
In light of the above, there is a need for directions on how the DOH will contract or
engage province-wide and city-wide health systems for UHC implementation.
I. OBJECTIVE
To provide guidelines and mechanisms by which the DOH contracts Province-
J
wide/City-wide Health Systems (P/CWHS) for the delivery of population-based health
services.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ¢ Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: fidugue@doh.gov.ph
I. SCOPE OF APPLICATION
This Order shall apply to offices and attached agencies under the DOH, other National
Government Agencies (NGAs), Non-Government Organizations (NGO), Local
Government Units (LGUs), health partners and donors, and all others concerned.
contracting of DOH with BARMM shail
be in accordance with RA 11054 or the
Organic Law for BARMM and subsequent laws and issuances.
A. Annual Operational Plan (AOP) — the yearly operational translation of the Local
Investment Plan for Health; it details the programs, plans and activities (PPAs) and
systems interventions that are to be implemented in
a
particular year.
City-wide Health System (CWHS) — refers to the Highly Urbanized City (HUC)- and
Independent Component City (ICC)-wide health system. This includes the health
offices, health centers or stations, hospitals and other city-managed health care
providers under the administrative and technical supervision of the City Health Board
(CHB).
Contracting - refers to a process where providers and networks are engaged to commit
and deliver quality health services at agreed costs, cost sharing and quantity in
compliance with prescribed standards.
Local health system - refers to all health offices, facilities and services, human
to promote, restore or maintain health.
Local Investment Planning for Health (LIPH) — a bottom-up planning process that
allows lowerlevel units such as barangays, municipalities and component cities to have
their plans incorporated in the province-wide/city-wide plan. Itis institutionalized as a
sectoral endeavor involving not just the LGUs and DOH, but also key local stakeholders
(NGOs, CSOs, private sector, others) and development partners to attain national and
local health sector reform goals.
Local Investment Plan for Health (LIPH) - a medium-term public investment plan for
health of LGUs with a three-year strategic time frame, that governs the health
operations of the locality and health sector activities, and guides how health system
outcomes will be achieved with specific LGU, DOH and stakeholder actions.
Province-wide Health System (PWHS) — integrated local health system composed of

municipal and component city health systems. This includes the Provincial, Component
City and Municipal Health Offices; Provincial, Component City, District and Municipal
Hospitals; Rural Health Units/Health Centers, Barangay Health Stations; other LGU-
managed health care providers under the administrative and technical supervision of
the Provincial Health Board (PHB).
. Terms of Partnership (TOP) - legal instrument that formalizes the agreement between
the DOH and LGU to implement the AOP.
GENERAL GUIDELINES
The LIPH shall be the medium-term strategic and investment plan for the
at
.
implementation of the UHC the local level. It shall be the basis for the provision of
financial and non-financial grants from the national government.
. The P/CWHS shall be contracted by the DOH through its Provincial/City Health Board
(P/CHB). The P/CHB shall be the steward of the integrated local health systems and
responsible for setting the policy and strategic directions of the P/CWHS.
. The TOP shall be the legal instrument for contracting P/CWHS.
. Transfer/use of funds or commodities shall adhere to existing government budgeting,

accounting and auditing rules and regulations.
. For LGUs that have committed to the integration of the local health systems, a Special
Health Fund (SHF) shall be created in an authorized depository bank for the transfer of
funds.
. For LGUs that have not committed to the integration of the local health systems, the
existing mechanisms for contracting with, and transfer of funds from, the DOH shall be
maintained.
The LIPH shall be the medium-term strategic and investment plan for the
at
.
implementation of the UHC the local level, and basis for the provision of national
grants:
1. P/CWHS shall develop their three-year strategic plan or the LIPH and its yearly
translation into an AOP.
2. The LIPH shall contain the following, among others:
a. Population-based health services, which include:
i, Environmental health services, such as vector control, water
quality, sanitation, etc.;
ii. Health promotion programs/ campaigns;
iii. Disease surveillance;
iv. Services for disease elimination;
v. Disaster risk reduction and management for health; and,
vi. Other public health programs and services that satisfy the
criteria set for population-based health services, as stated in
Section 17 of the IRR of the UHC Act, and corresponding
guidelines that will be issued by DOH and PhilHealth
b. Individual-based health services;
c. Health system operating costs, including hospital investments and
operating costs;
d. Other health investments not enumerated above such as those that impact
social determinants of health;
3. The LIPH/AOP shall be the basis for:

a. Provision of grants from the national government; and,
b. Allocation and disbursement of funds from the SHF
4. The development of the LIPH and AOP follows aniterative process:
a. CHD
call
to plan;
b. LGU plan development (situational analysis, identification of gaps and
investment needs, strategies and cost requirements);
Review and appraisal;
Bp
Concurrence ofplan;
Plan implementation; and,
ho Monitoring of plan implementation.
5. Details on the development, implementation and monitoring of LIPH/AOP shall
be issued in a separate Order.
B. The P/CWHS, through itsP/CHB, shall be contracted by the DOH for the delivery of
population-based health services:
1. The P/CHB shall approve and endorse the AOP to the DOH CHD.
2. The P/CHB shall use the approved AOP as the basis for the contractual
arrangement with the DOH.
3. The P/CHB shall ensure the inclusion of the AOP in their Annual Investment
Program (AIP) for allocation and approval of the LGU
counterpart/commitments in the LGU’s budget.
The CHD shall prepare the TOP template for agreement of both parties.
The P/CHB, shall enter into agreement with the DOH, represented by the CHD
Director subject to the following:
a. P/CHB resolution on the approval of the TOP and the authorized
signatory/ies to the TOP
b. Approved fund allocations for the AOP from the LGU or the
Special
Health Fund
c. Other pre-requisites inherent to an LGU for entering into agreement
with a national government agency such as Sanggunian Resolution
Contracting shall be on an annual basis since it is based on the AOP and DOH
grants are released annually through the General Appropriations Act (GAA).
C. The shall be the legal instrument for contracting P/CWHS:

TOP
1. The TOP shall contain the following:
a. outputs and performance milestones to be attained;
b. roles and responsibilities of contracting parties, i.e., DOH and P/CWHS
c. amount of resources, whether financial or non-financial, that LGUs,
DOH, development partners, and other institutions shall provide; if the
amounts of approved national funds or grants are not yet available at the
time
of
signing, indicative amounts of resources shall be indicated based
on the approved AOP; and,
d. the conditions and requirements pertaining to the release of said funds.
2. Contracting and execution of the TOP shall be on an annual basis; and,
3. A Department Memorandum shall be issued for the template of the TOP.
D. Transfer and use of funds and other resources from DOH to LGUs shall adhere to
a
Ir
government budgeting, accounting and auditing rules and regulations, and other
relevant technical guidelines.
E. Creation of a SHF shall be a requirement for P;CWHS which have committed to the
integration of the local health systems.
1. The P/CWHS shail create a SHF in an authorized government depository bank
for the transfer of funds; and,
2. The guidelines for the SHF shall be issued in a separate AO.
F. Contracting with and transfer of funds from the DOH shall

follow the existing LIPH
and AOP guidelines for LGUs that have not committed to integration of local health
systems.
A. Field Implementation and Coordination Team (FICT)

1. Oversee the contracting process between P/CWHS and the CHD
B. Centers for Health Development (CHDs)
1. Ensure the development, review, and approval of the LIPH and AOPs;
2. Ensure the inclusion of priority health services in the AOP;
3. Provide or facilitate the necessary technical support and resources to enable the
P/CWHS to contract with the DOH;
NMS
The CHD Director as
shall represent the DOH
Facilitate the preparation and signing of the TOP;
signatory to the TOP;
Submit notarized copy of TOP to FICT copy furnished BLHSD;

Execute the TOP; and,
to
PN
Monitor the compliance of the P/CWHS the TOP.
C. Bureau of Local Health Systems Development (BLHSD)

1. Formulate policies and standards relating to LIPH/AOP and the contracting of
local health systems
D. Local Government Units (LGUs)

1. Provide the needed resources and support mechanisms for the P/CWHS to
contract with the DOH
E. Provincial/City Health Board

1. Ensure the development and approval of the LIPH and its AOP
2. Issue resolution on the approval of:
a. AOP asbasis for the contractual arrangement with the DOH;
b. Authorized signatory/ies for contracting;
c. The TOP;
we
4. Execute the TOP. ;

Create a SHF Account and,
VIII. SEPARABILITY CLAUSE
If any part or provision of this Order is rendered invalid, by any court of law or
and effective.
TX. REPEALING CLAUSE

provisions of existing issuances whichare not affected by this Order shall remain valid
in
and effect.
EFFECTIVITY DATE


AUS 07 2019
No. 2019-_O027
SUBJECT: Guidelines on the Implementation of the Local Government Unit Health

Scorecard
I. RATIONALE
Monitoring of local health system performance (province-wide and city-wide) enables
the tracking of national priorities towards responsive local health reforms; while evaluation of
local health system performance identifies critical areas for improvement to achieve better
health outcomes from the local to the national level.
The Local Government Unit (LGU) Health Scorecard (HSC) is a component of the
FOURmula One (F1) Plus for Health Monitoring and Evaluation (M&E) System. shall be It
used as a primary tool to assess and monitor the performance of LGUs the implementation in
of local health reforms within the province-wide/city-wide health system. It shall facilitate
reporting of LGU progress in meeting the national health targets based on the priority
programs, projects and activities of the Department of Health (DOH).
Il. OBJECTIVES
To provide the guidelines on the implementation of the LGU Health Scorecard.
Ill. SCOPE
This Order shall apply to all DOH-concerned units and instrumentalities including its
attached agencies, MOH- Bangsamoro Autonomous Region in Muslim Mindanao
(BARMM), LGUs, and other relevant partners.

1. Key Performance Indicators (KPIs) - quantitative or qualitative variables that are
subsets of the FiPlus for Health performance indicators defined in AO 2019-0003.
This set of indicators will be used to measure the contributions of the LGUs in
attaining the goals of the health sector.
2. National Baseline — initial measurements of data collected prior to the program
intervention.
Go
National Target — health outcomes to be achieved.
4. Province/City Wide Health System — composed of at
least a primary care provider
network with patient records accessible throughout the health system; an accurate,
sensitive, and timely epidemiologic surveillance systems; and a proactive and
effective health promotion programs or campaigns.
5. Local Health System — a health system at the sub-national level; refers to health
offices, facilities and services, human resources, and other operations relating to
health under the management of local government units. Local health system referred
in this policy refers to both province-wide and city-wide health systems.
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: hitp://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
re=
6. Health Scorecard -a tool for measuring and reporting the performance of

stakeholders in the healthcare system in a manner that clients can easily comprehend.
7. Health System Performance —the level of achievement of the health system relative
to resources; the degree to which a health system carries out its functions including
service provision, resource generation, financing and stewardship to achieveitsgoals.
8. External Performance Benchmark - compares the Province/City-Wide Health
9.
System Performance to the national target and the national baseline.
Internal Performance Benchmark - compares the Province/City-Wide Health
Systems’ current and previous year’s performance.
1. The LGU HSC shall be implemented in all province/city-wide health system of the
country to monitor and evaluate local health system performance;
2. It shall be representative of performance, where performance criteria and scoring are
linked to health system outcomes desired with the best evidence possible;
3. It shall be technically sound, where performance criteria and scoring have a logical
and statistical coherence;
4. It shall be presented in a way that can easily be understood by clients through the use
of color codes and directional arrows.
5. It shall be operationally viable, where processes to generate and publish the
performance tools operates within institutional mechanisms;
6. It shall be collected and reported annually.
VLSPECIFIC GUIDELINES
1. Performance Indicators
1.1. KPIs shall be utilized for monitoring and evaluating LGU performance in
carrying out priority health projects, programs and activities.
1.2, The LGU HSC shall have a set of performance indicators (see Annex A for the
list of indicators) consisting of input and intermediate outcome indicators to be
reported and published annually. It shall reflect the consolidated results of the
inputs, outputs, processes, and structures on local health reform initiatives.
1.3. The LGU HSC indicators shall be periodically reviewed in terms of its
alignment with the national health agenda defined through the national
objectives for health, UHC implementation, and the directives of the Secretary
of Health. The set of indicators may be updated ,upon recommendation of the
DOH M&E and Data Governance Technical Working Group and
with concerned program managers, through an issuance of a Department
in consultation
Memorandum approved by the Undersecretary of Health where the Bureau of

Local Health Systems Development (BLHSD) is lodged.
1.4. Indicators monitored in the national level shall use the Field Health Service
Information System (FHSIS) as its official data source or other information
systems of the DOH-CO defined in Section VII.3 of AO 2019-0003.
1.5. Official data report issued by the DOH- attached agencies including PhilHealth
and NNC shall be used as the final data to be reflected in the local health
systems performance M&E scorecard;
1.6. Nationwide publication and dissemination of results shall be done yearly
through the Centers for Health Development (CHDs) after the official release by _,
the DOH Central Office;
P 5 pM
1.7. Annual LGU HSC performance results shall be the general basis of
performance-based financing, allocations, awards, and other grants. Plans and
budget allocations should be consistent with annual results;
1.8. Adequate feedback mechanisms on the implementation of the policy through
consultative meetings and program implementation reviews, and performance
results through health summits and health managers’ meetings and other similar
activities shall be conducted annually;
1.9. Evaluation mechanisms at all levels (internal and external) on the impact of
LGU HSC implementation shall be conducted every three to five (3-5) years and
shall be facilitated by the BLHSD;
1.10. Nationwide publication and dissemination of the official evaluation report
released by the DOH to the CHDs shall be done within the second quarter of the
succeeding year.
2. Scoring System
Scoring and assessment of performance done at the DOH Central Office shall
be based on external and internal performance benchmarks and shall use the following
color-coding scheme and signs(see Annex B for the Scoring System):
2.1. External Performance Benchmark- shall compare the Province/City-Wide

Health System performance to the National Target of the same year and to the
2018 National Baseline
a. Red color- the current Province/City-Wide Health System performance is
lower than the national baseline.
a. Yellow color - the current Province/City-Wide Health System performance is
higher than the national baseline but lower than the national target for a
specific indicator.
b. Green color - the current Province/City-Wide Health System performance is
--
equal to or higher than the national target for a specific indicator.
c. Gray color if the indicator has no data.
d. Black color if the indicator is not applicable or non-endemic to the LGU.
2.2. Internal Performance Benchmark- shall compare the Province/City-Wide

Health System performance with its own past performance.
a. Arrow Up sign — the current Province/City-Wide Health System performance
is better than the previous year.
b. Equal sign - there is no change in current Province/City-Wide Health System
performance as compared to the previous year.
c. Arrow Down sign - the current Province/City-Wide Health System
performance is not as good as the previous year.
3. Tools
3.1. The LGU Health Scorecard for a particular LGU shall be issued to the concerned
PWHS/CWHS annually by the DOH — CO through its CHDs. The LGU HSC shall
contain a brief description of the LGU, its performance, and graphical
representations of performance for each KPI.
3.2. A standard tool shall be utilized by the DOH CHDs to
consolidate the performance
of all PWHS/CWHS within region.
the
[ ;
el
1. NATIONAL LEVEL
a. Bureau of Local Health Systems Development shall:
1. Develop policies on local health systems performance M&E;
2. Actas the secretariat in managing the development of the LGU HSC;
3. Provide assistance for managing the implementation of the LGU HSC;
4. Provide capacity-building activities to CHD/MOH-BARMM coordinators
and chief of technical services of Integrated Provincial Health Office
(IPHO) in BARMM;
5. Ensure integrity of results;
6. Endorse the results for approval of release by the Secretary of Health
through the Team Head;
7. Facilitate the conduct of internal and external evaluation of the program;
8. Provide report analysis to the EXECOM
b. Office for Strategy Management shall:

1. Issue a guideline to operationalize the F1 Plus M&E reporting which shall
include a well-defined reporting and process flow, prescribe structure and
roles of regional OSMs, and standard validation and vetting process;
2. Collect the health scorecard reports from the respective scorecard
managers for national and sub-national analysis including cross
referencing with other data sources specified in AO 2019-0003.
3. Together with the Epidemiology Bureau (EB), shall present a summary of
its findings to the concerned program managers and to the DOH M&E and
Data Governance Technical Working Group (TWG).
c. Health Policy Development and Planning Bureau shall:

Ensure that data collected from the LGU HSC shall be utilized as guide for
policy development on national health reforms.
d. Knowledge Management Information Technology Service shall:

Maintain and enhance the LGU HSC web-based system and assist in the
training of identified users of the said system.
e. DOH Attached Agencies (including PhilHealth and National Nutrition

Council) shall:
Submit official data disaggregated per municipality, component city,
independent component city, highly urbanized city, province and region to
within the agreed timeline.
/
BLHSD
2. CENTERS FOR HEALTH DEVELOPMENT MOH-BARMM shall:

a. Ensure efficient data collection, collation, validation and analysis prior to
encoding in the LGU HSC Web-Based System and submission to the BLHSD;
b. Utilize data from LGU HSC for efficient and effective implementation of local
health reforms including adequate funding support and prioritization;
c. Provide timely feedback and technical assistance to the city/provincial health
offices and LGU-managed health facilities through regular regional
pe
conferences in collaboration with the DOH-CO;
A
d. Provide technical assistance and capacity-building activities to LGUs on

program and policy implementation.
3. LOCAL HEALTH OFFICE (Province, Highly Urbanized Cities/Independent

Component Cities and Municipality/Component Cities)
a. Ensure the efficient collection, validation and consolidation of data using the
prescribed data capture forms prior to submission to the DOH-CHDs;
b. Analyze and utilize LGU HSC data for decision-making, planning and
formulation of Local Investment Plan for Health (LIPH) together with their
respective municipalities and LGU-managed health facilities in collaboration
with DOH-CHDs;
c. Regularly conduct LGU HSC review.
VIII. REPEALING CLAUSE

Provisions of A.O. 2008-0017 and other related issuances that are not consistent with
of
or contrary to the provisions this order is hereby repealed and modified accordingly.
IX. EFFECTIVITY
This Order shall take effect fifteen (15) days after its publication in the Official
Gazette.
9
228
ANNEX A. LGU Health Scorecard Indicators

BASELINE TARGET
INDICATOR DEFINITION FORMULA | |
(Year) 2019 2020 2021 2022
OBJECTIVE 1: ENSURE EQUITABLE HEALTH FINANCING
Sustainable investments to improve health, and the efficient and equitable use of resources
Indicator 1. Percentage of Refers to the proportion of LGU budget (Personnel Numerator: Total 22% 22% - Province/HUC/ICC
LGU allocated for Services, Maintenance & Other Operating Expense Province/City-wide (Province/ 15% - Municipalities/CC
budget
health (MOOE), and Capital Outlay) earmarked to health, Budget Allocated to HUC/ICC)
nutrition & environment (IRA + locally-generated health, nutrition &
159%
sources), expressed in percentage environment ali ties/
(Munici
1. Health Services (Family Planning, CC)
Adolescent Health and Development Denominator: Total
Program, Expanded Program on province/city-wide budget
| (2017)
Immunization, NewBorn Screening, Oral
Health, Maternal, Nutrition, Communicable Multiplier: 100
(Rabies, STI/HIV, TB), Non-Communicable
(Hypertension), Environmental
2. Philippine Integrated Disease Surveillance
and Response
3. Health Emergency
4. Health Promotion
Indicator 2. With complete The LIPH/AOP of province/HUC/ICC: LIPH has With concurred/endorsed LIPH 2017- LIPH AOP AOP LIPH
Local Investment Plan for passed through the DOH-CHD/MOH-BARMM LIPH- Green 2019 2020- 2021 2022 2023-
Health (LIPH) appraisal process and concurred/endorsed by the | Without concurred/ 2022 2025
concurred/endorsed by the CHD Director/MOH-ARMM Secretary (MOV: | endorsed LIPH- Red
CHD accomplished appraisal checklist signed by the CHD
Director/MOH-BARMM Secretary)
OBJECTIVE 2: LOCAL HEALTH SYSTEMS INTEGRATED INTO PROVINCE-WIDE AND CITY-WIDE HEALTH SYSTEMS
Accessible essential health services for all at the right place and time
Indicator 3. Presence of an The Local Health System refers to health offices, Numerator: Number of To be No 30% 60% 80%
Integrated Health System facilities and services, human resources, and other key features/ components determined target ofthekey ofthekey ofthe key
(Province/ HUC/ ICC) operations relating to health under the management of present features features features
the local government units. Pursuant to the UHC Act, prea m Pree m prea m
the local health systems shall be integrated Denominator: Total province’ province’ province
province-wide health system (PWHS) and city-wide

to number of
key features/ HUC/ HUC/ /HUC/
health system (CWHS). the PWHS Icc Icc ICC
components
of
and CWHS
The PWHS shall be composed of Component City and
Municipal Health Systems while the CWHS refers to
Multiplier: 100
BASELINE TARGET
INDICATOR DEFINITION FORMULA
(Year) 2019 2020 2021 2022
Highly Urbanized City Health System and
Independent Component City Health System.
Performance assessment is based on the presence of

the key features/ components of the PWHS and CWHS
set by the DOH.
OBJECTIVE 3: IMPLEMENT COMPREHENSIVE DEVELOPMENT PLAN FOR SERVICE DELIVERY NETWORK-
Accessible essential health services for all at the right place and time
Indicator 4. Percentage of Refers to the number of municipalities/component Numerator: Number of 12% 18% 21% 25% 30%
municipalities/component cities with adequate RHU/HC
to Population Ratio municipalities/component (September
cities with adequate Rural (1:20,000) among the total number of cities with less or equal to 2018)
Health Unit (RHU)/ Health municipalities/component cities in a province, 1:20,000 RHU/UHC
Center (HC) population expressed in percentage Population ratio
to
to
ratio
Municipal Health Center/City Health Center/Rural Denominator: Total
Health Unit — a health facility which provides basic number of
clinical, preventive, promotive, curative, and municipalities/component
rehabilitative services for the municipality/city. (R.A. vunieip mp
cities in the province
No. 1082)
Multiplier: 100
OBJECTIVE 4: LOCALIZE HIGH IMPACT HEALTH POLICY REFORMS
Indicator 5.Percentage of Refers to the number of local health Numerator: Number of To be 25% 50% 715% 100%
national health policies policies/ordinances issued by the LGUs among the local health determined
translated into local of total number national health policies identified
of policies/ordinances issued
policies/ordinances by the by the DOH as needing local policies/ordinances,
LGUs (Province/HUC/ ICC) expressed in percentage Denominator: Total
number of national health
policies identified by the
DOH as needing local
policies/ordinances
Multiplier: 100
229
230
BASELINE TARGET
INDICATOR DEFINITION FORMULA |
(Year) 2019 2020 2021 2022
OBJECTIVE 5: IMPROVE PERFORMANCE OF THE LGUs
Indicator 6. Percentage of Refers to the proportion of budget allocated for Numerator: Total health 1% OBUR OBUR OBUR OBUR
LGU health budget utilized health that was actually utilized for health, budget utilized (obligated, (2017) and and and and
(include data for obligation expressed in percentage disbursed) DBUR: DBUR: DBUR: DBUR:
100% 100% 100% 100%
rate, disbursement rate, and
absolute value) Obligation Rate is the percentage of obligated Denominator: Total
budget out of the total budget allocated for health health budget allocated for
health
Disbursement Rate is the percentage of disbursed
budget out of the total budget allocated for health Multiplier: 100
Indicator 7. F1 Plus for
Health target met
Indicator 7 Sub-Indicators:
A. Family Health:
1. Modern Contraceptive Refers to the proportion of women of reproductive
Prevalence Rate age (15-49 years old) who are using or whose Numerator: No. of
(mCPR) partner is using any modern FP method ata given women of reproductive 24.9% 27% 28% 29% 30%
point in time. age (WRA) who are using (mCPR among
(or whose partner isusing) all women,
Modern FP methods include the following: a modern FP method a
at 2017 NDHS)
1. Bilateral Tubal Ligation (BTL) or Female given point in time
Sterilization
2. Male Sterilization/ No Scalpel Vasectomy (NSV) Denominator:
3. Intrauterine Devices IUD) FHSIS 2018:
3.1 IUD-interval No. of WRA who are
3.2 IUD-post partum eligible to practice
4. Oral Contraceptive Pills contraception
4.1 Progestin-Only Pill (POP) (Total Population x
4.2 Combined Oral Contraceptive (COC) 25.854%)
5. Injectables
6. Implants NDHS:
7. NFP Methods
all WRAs
7.1 Cervical Mucus Method (CMM) Multiplier: 100

7.2 Basal Body Temperature (BBT)
7.3 Symptothermal Method (STM)
7.4Standard Days Method (SDM)
7,5Lactational Amenorrhea Method (LAM)
BASELINE TARGET
(Year) 2019 2020 2021 2022
2. Adolescent Birth Rate Births among adolescents Numerator: Total number $7/1,000 43/ 39/ 37/ 37/
Annual number of births to females aged 15-19 of livebirths to females 15 female 1,000 1,000 1,000 1,000
years per 1000 females in that age group (WHO - 19 years old 15-19 y/o female female female female
recommendation) Denominator: Total (2017 NDHS) 15-19 15-19 15-19 15-19
population of women 15- y/o y/o y/o y/o
19 years old
Multiplier: 1000
3. Percentage of Fully Refers to the proportion of infants and children who Numerator: No. Fully
of 69.9%
Immunized Child are Fully Immunized Child among the total Immunized Children (NDHS, 2017) 95% 95% 95% 95%
(FIC) estimated infants and children in the population,
expressed in percentage Denominator:
FHSIS 2018:
FIC is an infant whoreceived: Total Population x 2.056%
1 dose of BCG, doses of OPV, 3 doses of DPT- (target eligible population
3
HiB-HepB vaccines, and 2 doses of measles below 1 year old)
containing vaccine by 12 months
Multiplier: 100
B. Non-Communicable
Diseases
4. Percentage of adults Refers to the number of adults age 20 years old and Numerator: number of 13% 15% 20% 30% 70%
20 years old and above who were risk assessed using the Philippine adults age 20 years old and (6,449,286/
above who wererisk Package of Essential NCD Interventions (PhilPEN) above who were risk 49,164,831
assessed using the protocol among the total number
of adults 20 years assessed using PhilPEN *100)
PhilPEN protocol old and above the total population expressed in protocol
in
percentage
Denominator: Total
population X 58.064%
Multiplier: 100
231
232
BASELINE TARGET
(Year) 3019 2020 2021 2022
C. Communicable Disease
5. TB Case Notification TB, 100,000 Numerator: Total number thisisbased 20% 30% 40%
_ _ _
Numberof notified
]
all forms for every 1
10%
Rate population of notified TB cases, Increase increase inerease increase
all on the report fom from 2018 from 2018 from 2018
forms per LGU 018
Denominator: Total
Population
Multiplier: 100,000
6. TB Treatment Success Number of all forms of TB that were cured or Numerator: Number this is based
of >90% >90% >90% >90%
Rate completed treatment out of all those that were all forms of TB that were on the report
started on treatment. cured or completed per LGU
treatment
Denominator: All
registered TB cases
Multiplier: 100
D. Environmental
7. Percentage of Refers to the proportion of households using Numerator: Number of

households using improved water sources/services, meeting the households using safely 25% 40.0% 47.5% 55.0% 62.5%
safely managed required criteria among the total projected number managed drinking-water (APIS - PSA,
drinking-water of households for the given year expressed in services 2017)
services/sources percentage
Denominator: Projected
Criteria for safely-managed drinking-water services: number of households for
1. located inside the household or within its the given year
premises,
2. available at least 12 hours per day, and Multiplier: 100
3. the water supplied should be free of fecal
contamination (option: priority chemical)
BASELINE TARGET
(Year) 2019 2020 2021 2022
Drinking water-water used for drinking, cooking,
food preparation, and personal hygiene.
(1) Improved drinking water source: those
which by nature of their design, and
construction, have the potential to deliver
safe water such as level I,I, and III water
system
(2) Within the premises: when the water is
either piped into (Level ITD household
dwelling or inside the household premises
or the point source (Level I) is located
within the household premises.
(3) Available at least 12 hours per day
(4) Free of fecal contamination: water is free
from E. Coli as validated by RSI.
RSI Validation: done by random following
the protocol in the MOP for National
Drinking Water Quality Assessment. While
some water supply may require more than
one validation by the RSI, the report will be
based on the result of the last validation test.
Water supply found with E.Coli should be
corrected and subject to resampling based
on microbiological test.
Total number of water samples per month

e If municipality, total population divide
by 2000
e If city, total population divide by 5000
Allocation of samples by levels (I,IL,1D)

e Level I- percent of households using
level I multiply by total water samples.
e Percent of households using level I=
(total numberof households using level
divide by total number of households

using level I, II, I) multiply by 100
233
234
BASELINE TARGET
(Year) 019 7020 2021 2022
(5) Level of Priority Chemical (Arsenic): below
the maximum allowable level based on
PNSDW 2017
E. Logistics
8. Percentage of No stock-out means that there is an available one (1) Numerator: Number of To be 70%
facilities with no- month buffer stock of the centrally procured tracer recipient public health determined
stock out of the commodities facilities with no stock-
following outs during a specified
commodities: period
a. Family Planning
Pill (COC) Denominator: Total
b. DPT-HiB-HepB number
Vaccine of recipient public
health facilities
c. Losartan
d. Metformin «ae
Multiplier: 100
e. TB Drugs (Cat. 1)
.
F. Nutrition . 0
9. Prevalence of The percentage of children under-five categorized Numerator: Total number 12.9% 11.2% 10.4% 9.6% 8.8%
Stunting among under
with height-for-age below minus 2 standard of stunted children aged 0- (2017)
5 (0-59 months) deviations from the median WHO Child Growth 59 months
Denominator: Total
number of children aged 0-
59 months
Multiplier: 100
Indicator 8.With Organized Organized Epidemiology and Surveillance Unit. N/A 0 (2018) 2019:
Epidemiology Surveillance GREEN:
-
Unit Being a province with organized Epidemiology and Issued Executive Order (EO) or
Surveillance Unit, they should be able to have: Ordinance on establishing provincial
1. Direction: Executive Order
at the least ESU
(preferably Ordinance) establishment of - With issued provincial order
on
the Epidemiology and Surveillance Unit designating staff to ESU (composed of
(ESU) Team Leader, Surveillance Officer,
BASELINE TARGET
INDICATOR INIT
DEFINITION FORMULA
RM |
(Year) 2019 2020 | 2021 2022
ESU
Staff composed of:
|
Registered Med Tech, and Encoder)
Team Leader (preferably a Medical Doctor) trained on Basic Epidemiology
Disease Surveillance Officer (Public Health With Work and Financial Plan allotted
Nurse) with Provincial funds
Registered Medical Technologist With designated office space and ICT
Encoder equipment for use of provincial ESU
ESU YELLOW:
Staff competent on: Issued Executive Order or Ordinance
Basic Epidemiology
Disease Surveillance on establishing provincial
Event-based Surveillance Epidemiology and Surveillance Unit
Plan and Budget: Annual Work and With issued provincial order
Financial Plan with Allotment from the designating staff to ESU (composed of
Team Leader, Surveillance Officer,
local budget
Coordination: Link with Provincial trained on Basic Epidemiology
Hospital and other Health Facilities within RED:
the locality Absence of Policy/ Direction
Report: Disease and Event Surveillance No
staff designated/ trained at the unit
submitted in the prescribed timeline, and
released at least on a monthly basis to the 2020:
Local Health Board GREEN:
Issued Ordinance on establishing
provincial Epidemiology and
Surveillance Unit
With issued provincial order
designating staff to ESU (composed of
trained on Basic Epidemiology,
Disease Surveillance, and Event-based
Surveillance
With Work and Financial Plan allotted
with Provincial funds
With designated office space and ICT
equipment for use of provincial ESU
YELLOW:
Issued Ordinance on establishing
provincial Epidemiology and

Surveillance Unit
235
236
INDICATOR BASELINE TARGET

DEFINITION FORMULA
(Year) 2019 | 2020 | 2021 | 2022
- With issued provincial order
designating staff to ESU (composed of
trained on Basic Epidemiology,
Disease Surveillance, and Event-based
Surveillance
RED:
- Absence of Policy/ Direction, Or,
policy remained to be an Executive
Order
- No staff designated/ trained at the
unit; Or, with designated staff but only

trained on one
or twoof the following:
Basic Epidemiology, Disease
Surveillance, Event-based
Surveillance
Note: Specified criteria to receive "Yellow"

rating are core components that must be all
present to be considered as an organized
provincial ESU.WFP with budget, and
office and equipment, must be both present
as support to an organized ESU before a
province can be rated as "Green".
Indicator 9.Percentage of Institutionalized DRRM-H System means having Scoring: To be Atleast 70% to 100% of LGU’s local
LGUs (Province/ Cities/ the following four (4) minimum requirements: All or none scheme. Every determined government health facilities (health
Municipalities) with 1. Approved, updated, disseminated and tested LGU province, city and offices and licensed LGU-owned
institutionalized Disaster Risk Disaster Risk Reduction and Management in Heaith
-
municipality will have hospitals)
Reduction and Management in (DRRM-H) Plans their own separate scores, National Target: In 2022, 70% - 100% of
Health (DRRM-H) System 2. Organized and trained Health Emergency since every LGU has its Local Government Units (81 provinces,
Response Team on minimum required trainings: own health office and 145 cities [HUC — 33, ICC — 5, CC- 107],
Basic Life Support and Standard First Aid licensed local government 1,489 municipalities) are tagged
3. Available and accessible within 24 hours health facility/ies in its institutionalized with DRRM-H System.
essential health emergency commodities e.g. own catchment area
medicines such as cotrimoxazole, amoxicillin, Covered number of targeted LGUs is
mefenamic acid, paracetamol, oresol, lagundi, A. Getting an LGU Score 1,715. 70% of LGUs (1,200 LGUs) are
vitamin A and skin ointment Numerator: Total number expected to rate Green (with
4. Emergency Operations Center, functional with (1) of Local Government institutionalized DRRM-H System) by
9
BASELINE TARGET
INDICATOR DEFINITION FORMULA | | |
(Year) 2019 2020 2021 2022
Command and Control, (2) Coordination, (3) and Health Facilities (LGHFs) 2022
Communication of the LGU with
institutionalized DRRM-H National Target for the LGUs: Each year,
Institutionalized DRRM-H Systems means the System LGUs are expected to institutionalize
availability of ALL four criteria in each Province/ Denominator: Total with DRRM-H System the 70%-100% of
City (HUC,ICC, CC)/ Municipal Health Offices and number of LGHFs of the their LGHFs, to received a Green rating.
LGU-owned hospitals. Excluded are the Barangay LGU The number of LGHFs shall depend on
Health Stations and other Health Facilities (e.g. Multiplier: 100 their official list of health offices and
birthing homes, animal bite treatment centers, social licensed LGU-owned hospitals in the
hygiene clinics, treatment and rehabilitation centers year 2017. If there are newly licensed
and the like). B. Getting the National LGU-owned hospitals in the area in the
Score succeeding years, this shall not be
Coverage: As of year 2017 Numerator: Total number included in counting.
Local Government Units (1,715) of LGUs with
81 provinces institutionalized DRRM-H
145 cities System
* HUC — 33 Denominator: Total
*ICC—5 number of LGUs
¢ CC- 107 Multiplier: 100
1,489 municipalities
2,357 total Local Government Health Facilities Rating:
nationwide (note: number ofhealth office and Green: 70% - 100%
licensed LGU-owned hospitals for validation with LGHF of LGUs met all
LGUs) four (4) criteria of DRRM-
H Institutionalization
LGUs aresaid to have institutionalized DRRM-H Red: < 69 % of LGHF of
system when 70% - 100% of their respective Local LGUs met all four (4)
Government Health Facilities in their own criteria of DRRM-H
catchment areas meet the four criteria. Institutionalization
237
10
ANNEX B. Summary of LGU Health Scorecard Rating System
Color & Performance Level Relative Status and Action Point

Symbol Code
Current P/CWHS performance
lower than the national baseline
is Comparative weakness in performance and the
need for substantial efforts for improvement
Current P/CWHS performance is Comparatively good performance that must be
higher than the national baseline
but lower than the national target
maintained and optimized to reach target goals
Current P/CWHS performance is Comparatively excellent performance that

equal to or higher than the merits sustenance, or incentives forits
national target admirable contribution for the health system or
be a model site for other LGUs. Since the
national target has been reached already, the
LGU has
the capacity to be pilot sites for
innovative interventions.
No change in current LHS Comparatively good performance that must be
Il performance as compared to the maintained and optimized to reach target goals
>
previous year
Current LHS performance is
higher than the previous year
Comparatively excellent performance that
merits sustenance
current LHS performance is
as good as the previous year
not Comparative weakness in performance and the
need for substantial efforts for improvement
ee\¢ no data Need for data submission
not applicable or non-endemic

239
4 ENHANCING
PRIMARY CARE SERVICES
The UHC Act recognizes the crucial role of primary care provider networks (PCPNs)
as the basic foundation of Health Care Provider Networks (HCPNs). In this line, the
DOH developed the Primary Care Policy Framework, which highlights the sectoral
policies and strategies to make primary care services more responsive to people’s needs.
To ensure that primary care facilities within the PCPNs are providing effective, equitable,
and quality basic and essential health services, four critical requirements have been
mandated under the law.
The first requirement is the licensing of primary care facilities, such as health
centers, rural health units, and private medical clinics, as well as stand-alone birthing
facilities, dental clinics, laboratories and diagnostic facilities, to ensure that only safe
and quality primary care services are being delivered to the Filipino people. The second
requirement is the accreditation of these facilities by PhilHealth to qualify them to
provide the primary care benefit package under the Konsultasyong Sulit at Tama or
Konsulta Package, and other outpatient benefit packages. The third requirement is the
certification of primary care health workers, such as doctors, nurses, midwives and other
allied health professionals, to ensure that they have appropriate competencies and skills
to deliver quality standards of primary care. The fourth requirement is the registration of
every Filipino by LGUs, in coordination with DOH and PhilHealth, to a public or private
primary care provider of choice within their territorial jurisdiction.
ENHANCING PRIMARY CARE SERVICES 241

ON ENHANCING PRIMARY CARE SERVICES
• Primary Care Policy Framework and Sectoral Strategies [AO 2020-

0024]
• Rules and Regulations Governing the Licensure of Primary Care

Facilities in the Philippines [AO 2020-0047]
• Amendment to Administrative Order No. 2020-0047 entitled, Rules

and Regulations Governing the Licensure of Primary Care Facilities
in the Philippines [AO 2020-0047-A]
Note: The following annexes of AO 2020-0047-A are accessible at:

(https://bit.ly/2020-0047-A)
Annex A.rev 01 - Licensing Standards for Primary Care Facilities
Annex B - Assessment Tool for Licensing a Primary Care Facility
Annex C1 - Planning and Design Guidelines for Primary Care Facility
Annex C2 - Checklist for Review of Floor Plans of Primary Care
Facilities
• Accreditation of Health Care Providers for PhilHealth Konsultasyong

Sulit at Tama (PhilHealth Konsulta) Package [PhilHealth Circular
2020-0021]
• Guidelines on the Certification of Primary Care Workers for Universal

Health Care [DOH-PRC JAO 2020-01]
• Guidelines on the Registration of Filipinos to a Primary Care Provider

[DOH-PhilHealth JAO 2020-0001]

MAY 22 2020
No. 2020 -
024
SUBJECT: Primary Care Policy Framework and Sectoral Strategies
I. BACKGROUND
Primary Health Care (PHC), as articulated in the Alma Ata Declaration of 1978, redefined is
in the Philippine settings as health in the hands of the people. The Department of Health
(DOH) issued Administrative Order 11 s 1993, establishing primary care as the core strategy
in program thrusts of government at
national, local and community levels, in order to enable
people’s active participation and involvement for better health and self-reliance and create
structures to oversee its implementation.
PHC
signifies an important approach to
health care organization in which the primary or the
first contact level acts as the navigator, coordinator, and initial and continuing point of
contact within the healthcare delivery system. The principle of providing as much care as
possible at the first point of contact effectively backed up by secondary and tertiary level
facilities that concentrate on more complex care remains the key purpose in integrating a
local health system. From the perspective of the individual, primary care shall have service
delivery mechanisms that encourage continuity of care for an individual across health
conditions and across levels of care.
Strengthening the primary care level plays a crucial role in progressively realizing Universal
Health Care CUHC). Republic Act 11223 or the “UHC Act” stipulates that all Filipinos are
guaranteed equitable access to quality and affordable health care goods and services,
protection against financial risk, and a health care delivery system that will afford every
Filipino a primary care provider. This shift is consistent with global consensus that having
a strong primary care system is necessary to accelerate UHC.
The primary care provider networks (PCPNs) shall serve as foundation of health care
provider networks (HCPNs), whether public, private, or mixed, which the UHC Act
mandates to be established. In order to ensure the delivery of quality, efficient and
a
responsive primary care services in the PCPNs, primary care policy framework is hereby
issued.
Il. OBJECTIVES
A. To provide the framework, directions and strategies in the development and

implementation of policies, plans and programs to
strengthen primary care.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph, e-mail: ftduque@dok.gov.ph
B. To delineate roles and responsibilities of different offices/bureaus in the DOH, attached

agencies, local government units (LGUs), the private sector, and other stakeholders for
a collective effort to ensure efficient and quality primary care.
I. SCOPE OF APPLICATION
This Order shall apply to DOH Bureaus/Offices and its attached agencies, LGUs, other
national government agencies (NGAs), civil society organizations (CSO), health partners,
academe, private institutions, and all others concerned.
DEFINITION OF TERMS
For the purpose of this Order, the following terms are defined as follows:
A. Health Care Provider Network (HCPN) - refers to a group of primary to tertiary care
providers, whether public or private, offering people-centered and comprehensive care
in an integrated and coordinated manner with primary care provider acting as the
navigator and coordinator of health care within the network.
B. Primary Care - refers to initial-contact, accessible, continuous, comprehensive, and

coordinated care that is available and accessible at the time of need including a range
of services for all presenting conditions, and the ability to coordinate referrals to other
health care providers in the health care delivery system, when necessary.
C. Primary Care Facility - refers to the institution that primarily delivers primary care
services and licensed or certified by the DOH as such.
D. Primary Care Provider

who has - refers to a health care worker, with defined competencies,
received certification in primary care as determined by the DOH; or any
institution that is licensed and certified by the DOH.
E. Primary Care System - refers to the structural characteristics of primary care which
includes health systems financing; distribution of primary care resources; competency
of primary care providers; accessibility of services; and continuity of care
(ongitudinal/vertical integration).
F. Primary Care Worker

- refers to health care workers, including health and allied
health professionals and community health workers/volunteers, certified by DOH to
provide primary care services.
G. Primary Health Care (PHC)

- refers to a whole-of-society approach that aims to
ensure the highest possible level of health and well-being through equitable delivery of
quality health services.
H. Primary Care Provider Network (PCPN) refers to a coordinated group of public,

private, or mixed primary care providers, which serve as the foundation of a Health
Care Provider Network (HCPN).
GUIDING PRINCIPLES
A. PHC shall be the philosophy and approach of the health system in strengthening its
primary care as the foundation of the health care delivery system.
se
AE
1. Individual and community health and wellbeing do NOT depend solely on effective
health care services. Effective avenues for working closely with the community and
in partnership with a diversity of stakeholders within and outside of the health sector
shall be fostered.
2. Investments shall be primarily directed to shaping and supporting primary care-led

integration.
B. People’s needs shall be the centerpiece of the paradigm shift to primary care.
1, A people-centered approach to primary care shall ensure that Filipinos are

empowered to make their own decisions on their health-needs, well-being, and
provider preference.
2. The right of every Filipino to quality, accessible, and affordable health care shall be
ensured.
C. Equity and fairness shall guide the path towards access and universality.
1. All Filipinos shall have access to quality primary care services covered by the same
set of benefits under the UHC.
2. Recognizing limited resources, access and universality shall be progressively

realized by prioritizing the needs of the unserved, underserved and marginalized in
a fair and transparent manner.
GENERAL GUIDELINES
A. The health sector shall shift its efforts to attain a strong primary care-oriented system
that delivers and provides access to credible, understandable, relevant, and timely
information for primary care.
B. The full realization of primary care shall be accelerated using three (3) strategies,
namely:
1, Integrated and comprehensive primary care;
2. Strategic financing; and,
3. Quality, safe and affordable care.
C. Primary care providers, both in the public and private sector, shall act as the navigator,
coordinator, and initial and continuing point of contact in the healthcare delivery
system. These providers shall ensure accessible, continuous, comprehensive and
coordinated care regardless of conditions and concerns.
SPECIFIC GUIDELINES
A. All DOH bureaus/offices, units, hospitals, and attached agencies shall align their
policies, programs, and activities to the Policy Framework on Primary Care and
Sectoral Strategies (Figure I). They shall also advocate the policy framework and
3 yew
“y
strategies to all stakeholders and partners. Policies, programs and activities that are
adherent tothis Order shall be given priority in planning and budgeting.
Figure 1. Policy Framework for Primary Care
More Responsive Primary Care
Yuu
integrated and comprehensive Strategic Financing for Quality, safe and affordable
Primary care Primary Care primary caro
Delineation of financing of Enhance primary Establish

Provision of individual-based health services care standards
health services competencies of
‘i
for primary
‘
Transitioning of financing
in for primary care heatth workers care services
commodities
sor
Provision of population-based
" Ensure
Regulate primary affordable
-
health services. Streamlining procurement

of commodities care facilites access to
medicine
Principles. Primary Health Care Approach People Centered Approach| Cquily and Fairness
B. In pursuit of UHC, the primary care shall be strengthened through strategies that would
lead to the following strategic outputs: Integrated and Comprehensive Primary Care
Services; Strategic Financing for Primary Care; and, Quality, Safe and Affordable Care.
C. The Policy Framework for Primary Care provides the key strategies that lead to the
realization of the following strategic outputs:
1. Integrated and Comprehensive Primary Care Services
a. Provision of population-based health services. Primary care shall be

strengthened through the integration of public health functions in the local
health systems by:
i. Implementing proactive, effective and evidence-based health promotion
programs or campaigns through the development of the following:
a) Communication plan that shall promote positive social and
behavioral change to inform patients and providers the shift to a
primary care-centered health system, and the benefits which they can
of
avail; and,
b) Health promotion framework that shall serve as the national health
promotion roadmap and the basis of all
health promotion policies
and programs;
ii. Setting-up accurate, sensitive and timely epidemiologic surveillance
system; and,
iii. Establishing a timely, effective and efficient preparedness and response
to public health emergencies and disease;
iv. Strengthening other programs and strategies to ensure delivery of
population-based health services, such as vector control, water and
sanitation, and nutrition, among others.
pew
4
b. Provision of individual-based health services. Access to individual-based

primary care services shall be ensured by:
i. Setting up mechanisms for registration of every Filipino to a primary
care provider of choice;
ii. Developing comprehensive outpatient benefit package; and,
iii. Fostering a technology-enabled primary care system through
operationalization of electronic records management systems
(electronic health records, e-prescription, and enterprise resource
planning system) and telemedicine.
2. Strategic Financing for Primary Care
a. Delineation of financing of health services as follows:

i. DOH shall contract the province-wide and city-wide health systems for
the delivery of population-based health services, including those that

impact the social determinants of health, as reflected in the investment
plans for health; and,
ii. PhilHealth shall contract the public, private, or mixed HCPNs for the
delivery of individual-based health services.
b. Transitioning of financing for primary care commodities. Population-based

health services that are currently being funded by DOH, which eventually be
classified as individual-based services, shall be funded by PhilHealth through
the development of benefit packages. (Annex A}
c. Streamlining procurement of commodities. Pooled procurement platforms and

mechanisms at appropriate levels such as national, regional, hospitals and
HCPNs shall be supported through procurement and supply chain management
capacity building.
3. Quality, Safe and Affordable Primary Care
a. Enhance primary care competencies of health workers through:

i. Integration of primary care and public health in the curriculum of health
professional education, with eventual incorporation into the licensure
examinations;
ii. Development of learning packages as well as assessment and certification
process for primary care workers based on identified competencies;
iii. Setting standards and processes for engaging primary care workers, both
public and private, including mechanisms to ensure appropriate
remuneration and incentives; and,
iv. Re-designing health worker education towards development of
competencies for delivery of a patient-centered and comprehensive
primary care services.
b. Establish standards for primary care services through:

i, Development of primary care practice guidelines and other appropriate
policies; and,
ii. Establishment of health technology assessment processes to determine
cost-effectiveness of primary care interventions to be funded by the
government.
2AS
c. Regulate primary care facilities through:

i. Development of standards for primary care facilities; and,
ii. Institutionalization of licensing and regulatory system for stand-alone
health facilities including those providing ambulatory and primary care
services
d. Ensure affordable access to medicine through the establishment of appropriate

measures for affordable and quality drugs and medicines
D. The DOH shall use the following systems framework/dimension as a guide in

strengthening primary care:
1. Structure — refers to the basic conditions that enable a good functioning of primary
care, consisting of relevant policies and regulations as well as the availability of
financial, human and material resources. It
shall include the following features:
a. Governance;
b. Financing (economic conditions); and,
c. Human Resources (workforce development);
2. Process —includes dimension relevant to the services that are delivered. It shall
include the following features:
a. Accessibility (Access to services);
b. Continuity (Continuity of care);
c. Coordination (Coordination of care); and,
d. Comprehensiveness (Comprehensiveness of care);

3. Core Outcome — improved health of the population. It shall include the following
features:
a. Quality of care;
b. Efficiency of care; and,
c. Equity in health.
Please refer to the Systems Framework for Primary Care (Annex B).
E. Concerned DOH Bureaus/Offices and attached agencies shall develop and establish the
appropriate standards and guidelines, support mechanisms, technical assistance,
capability building and indicators for monitoring purposes.
F. Monitoring shall be in accordance with the directions and goals of Fourmula One (F1)
Plus for Health (AO 2018-0014) and shall utilize available monitoring and evaluation
mechanisms such as the F1 Plus for Health Monitoring and Evaluation Framework (AO
2019-0003), Field Health Service Information System (AO 2011-0010), LGU Health
Tor
Scorecard, (AO 2019-0027) and other special surveys (e.g NDHS, NNS, etc). Other
tools and indicators may be developed as needed.
A. The Department of Health and its

attached agencies shall formulate, plan, implement,
and coordinate policies and programs related to primary care.
1. Bureau of Local Health Systems Development (BLHSD)
a - Coordinate the implementation of

agencies, and other stakeholders
this framework with other DOH offices, attached
2. Centers for Health Developments (CHDs)
a. Coordinate and monitor the implementation of primary care policies and

strategies at the LGU level.
b. Provide technical assistance and capacity building to LGUs

health systems which includes PCPN
in the integration of
3. Disease Prevention and Control Bureau (DPCB)
a. Spearhead the development of guidelines to define primary care services, which

shall serve as the basis for comprehensive Primary Care Benefit (CPCB) Package
development and DOH programs.
b. Develop criteria and schedule for transitioning of financing of commodities.
c. Develop primary care practice guidelines to define the parameters of primary care
in terms of initial and continuing contact, coordinated and comprehensive care.
4. Epidemiology Bureau (EB)
Develop standards for the functionality of epidemiologic and disease surveillance

system in the context of province-wide and city-wide health systems
5. Health Policy Development and Planning Bureau (HPDPB)
a. Ensure the alignment of sectoral policies and investments to the Primary Care
Policy Framework.
b. Develop a health sector expenditure framework to include primary care
6. Health Human Resources Development Bureau (HHRDB)
a. Develop and standardize the competencies of primary care workers, with the
corresponding competency assessment tools and framework for certification of
primary care workers.
b. Develop learning packages for primary care workers based on standard Primary
Care competencies.
3%
Develop an intensive course needed

Care during the transition period.
to certify existing health workers on Primary
Develop policies, standards and guidelines to incorporate Primary Care in the
curriculum of health and allied-health education programs
Health Promotion Bureau (HPB)
a. Develop a primary care communication plan in coordination with PhilHealth

whichshall include both internal and external communication strategies to ensure
alignment within the DOH and the buy in of key stakeholders.
Develop the health promotion framework for

the implementation of proactive and
effective health promotion programs or campaigns.
Health Emergency Management Bureau
a. Develop standards for the institutionalization of disaster risk reduction and

management for health; and,
Ensure timely, effective and efficient preparedness and response during public
health emergencies and other means to deliver population-based health services
(UHC IRR Section 17.3d)
Health Facilities Development Bureau (HFDB)
Develop standards for primary care facilities
10. Health Facilities and Services Regulatory Bureau (HFSRB)
Develop licensing and regulatory system for stand-alone health facilities, including
those providing ambulatory and primary care services.
11. Health Technology Assessment Unit
Ensure primary care interventions seeking coverage from the government for
PhilHealth reimbursement and budget allocation are in accordance with health
technology assessment process.
12. Knowledge Management and Information Technology Service (KMITS)
a. Standardize mandatory health data for IT systems that shall be adopted or

implemented by the entire health sector.
Develop the standards for interoperable electronic management system such as

but not limited to electronic health records, e-prescription, and enterprise resource
planning system that shall be basic requirements for PCPNs
and coordination of care.
to ensure continuity
Cc. Develop guidelines for telemedicine.
ft
13. Pharmaceutical Division (PD)
a, Ensure alignment of the Primary Care National Formulary with the

comprehensive outpatient benefit package of PhilHealth.
b. Recommend maximum retail prices over any or all drugs and medicines in
accordance with RA 9502 or the Universally Accessible Cheaper and Quality
Medicines Act of 2008 and other related policies.
14. Philippine Health Insurance Corporation (PhilHealth)
a. Allocate resources to enable the shift towards primary care-oriented health

system.
b. Develop a capitation-based, disease-agnostic comprehensive Primary Care

Benefit Package (cPCB).
c. Develop standards for the accreditation/contracting of primary care providers.
d. Develop guidelines for registration of Filipinos to primary care providers, in

coordination with DOH.
e. Develop communication plan related to primary care in coordination with DOH
B. The Local Government Units shall implement policies and programs on primary health
care, provide primary care and public health services and prioritize its investment on
building and developing primary care as the foundation of the health care provider
network.
1, Provide individual-based and population-based health services
2. Align programs and projects on primary care with the primary care framework in this
Order
3. Ensure supply-side readiness through complementation of public and private health

related entities in the provision of primary care services.
C. Other Health Partners shall align all their objectives, initiatives and programs/projects
with the primary care framework.
IX. TRANSITORY PROVISIONS
A. Delivery of Primary Care Services
The services outlined in the AO 2017-0012 or the “Guidelines for the Implementation
of Primary Health Care Baseline Guarantees” shall be the basis of defining essential
health service packages subject to the issuance of new guidelines.
B. Primary Care Benefit Package
PhilHealth shall cover select primary care services through KONSULTA

(Konsultasyong Sulit at Tama) Package until December 2021. This benefit package shall
progressively be expanded to include the existing MDG benefits, individual-based

services funded by DOH, and other outpatient services as deemed appropriate through
health technology assessment.
C. Certification of Primary Care Workers
For 2020 HHRDB shall orient the health workers performing primary care functions in
the RHUs on primary care in the context of UHC thereafter a provisional primary care
certification is provided. And in 2023, these primary care workers shall undergo primary
care assessment and certification. While for non-RHU primary care workers, an
assessment process shall be done prior to certification.
D. Licensing and Accreditation
The PhilHealth accreditation of primary care facilities shall remain in effect until the
effectivity of a DOH licensing and regulatory system for primary care facilities.
X. SEPARABILITY CLAUSE
If any part or provision of this Order is rendered invalid, by any court of law or competent
All Orders, rules, regulations, and other related issuances inconsistent with or contrary to
this Order are hereby repealed, amended, or modified accordingly. All other provisions of
existing issuances whichare in
not affected by this Order shall remain valid and effect.
XII. EFFECTIVITY
FRAN ° III, MD, MSc

Secretary of Health
10
—
ANNEX
A.Transition Framework for Financing of Individual-based and Population-
based Services
Republic Act 11223 redefines health services as either individual-based health services or
population-based health services. Individual-based health services are services which can be
accessed within a health facility or remotely that can be definitively traced back to one
recipient, has limited effect at population level and does not alter the underlying cause of illness
such as ambulatory inpatient care, medicines, laboratory tests and procedures, among others.
On
the other hand, population-based health services are interventions such as health promotion,
disease surveillance, and vector control, which have population groups recipients. as
Population-based health services shall be jointly financed by DOH and LGUs, while PhilHealth
shall predominantly finance individual-based health services as a national single purchaser.
This can be viewed based on either the type of services, or the expenditure class.
Ua care
COPE TeeCl PUBLIC HEALTH PERSONAL CARE
(old)
Intervention
Classification POPULATION-BASED INDIVIDUAL-BASED
eth)
Secondary Care,
Level
evel of of C Care Primary
ary Care Primary
ary Care Tertiary Care
National Health Insurance Program

National Government and
Nae Local Gov ent Units
HMO, Private Health Insurance
Private Funds / Household Out-of-Pocket
* Mass Interventions (community

vaccination, vector control, water
quality, sanitation, and others)
lli
* * Screening and Diagnostics
Health Promotion and Communication
* Treatment
©
Epidemiologic and Disease Surveillance
* ° Rehabilitation
Disaster Risk Reduction and
Management ° Palliation
* Program management, research and
development, monitoring and
evaluation, capacity building and
training
=
©
=.
§=
ANNEX B. Systems Framework for Primary Care
Primary Care Structure
§=.
§=-
Governance Financing Human Resources
le §©6Government vision @ Allocation sufficient le Discipline recognized, responsibilities
published lo Benefit package available clear
le Policy environment le §=Incentives and remuneration ie Workforce diverse
enabling systems supportive fe Curriculum responsive
§=©
le Advocacy proactive le §=©Professional and academic status held in
le Data systems available high regard, adopted by universities
§©=.
§=—.
Primary Care Process
Accessibility Comprehensiveness Continuity Coordination

le §=6Available (volume |e Range of services for the le Longitudinal (taking |e Within primary care
& type) following defined care of cohort) team (skills mix)
le Accessible o First contact care and ie Informational (medical |e With specialists/
(distance) triage records shared across secondary care
le §=6Affordable o Diagnostic services providers) providers
(financial barriers) © Medical procedures e Relational (quality of |e With public health
le Acceptable © Treatment and follow- relationship between agencies
(satisfaction) up care provider and patient) |e Strong patient
le §=Accommodation of © Preventive, promotive navigation
accessibility © Disaster risk reduction/
(appointment, after management
hour, home visit) le Range of medical
equipment required
le Digital health
4
Primary Care Intermediate Outcome
Quality of Primary Care Efficiency of Primary Care Equity in Health

ie Necessity of prescribing le Patient: waiting time, expenditure, le Differences in health status
'e Avoidable hospitalizations outcome across populations
e Prevalence of chronic conditions |e PC team: number of consults,
duration, frequency of prescribing,
referral
Impact
Better Health Outcomes Financial Risk Protection Health System Responsiveness
a Vv
of the Philippines
Republic
SEP 2020
36
No. 2020 —-
0047
SUBJECT: Rules and Regulations Governing the Licensure of Primary Care

Facilities in the Philippines
I. RATIONALE/BACKGROUND
Section 27.b of the Universal Health Care (UHC) Act or Republic Act (RA) No. 11223
states that, “The DOH shall
institute a licensing and regulatory system for stand-alone health
facilities, including those providing ambulatory and primary care services, and other modes
of health service provision.”
The Department of Health (DOH), through the Health Facilities and Services
Regulatory Bureau (HFSRB) and Center for Health Development Regulation Licensing and
Enforcement Divisions (CHD-RLEDs), already regulates stand-alone health facilities
providing ambulatory services such as birthing homes, infirmaries, medical facilities for
overseas workers and seafarers, ambulatory surgical clinics, and hemodialysis clinics.
As listed in the 2020 National Health Facility Registry, there are 2,592 rural health
units (RHUs) classified as primary care facilities (PCFs) and are currently not being
regulated by DOH. These PCFs shall deliver initial-contact, accessible, continuous,
comprehensive and coordinated care to the communities they serve, as envisioned in the
UHC Acct. Thus, to
fulfill the DHC goals in ensuring that only safe and quality primary care
services are being delivered to every Filipino, PCFs will now be regulated and henceforth
_
must comply with the licensing standards and requirements in this Order.
Hi. OBJECTIVE
This Order aims to set the guidelines and the minimum standards and requirements for
licensing primary care facilities.
Hil. SCOPE
This Order shall apply to all government and private primary care facilities, and not to
the outpatient departments of hospitals and infirmaries that deliver primary care services.
A. Applicant the natural or juridical person who is applying for a License to

—
Operate or Certificate of Accreditation of a hospital or any other health facility.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1 11137
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
Assessment Tool — tlie checklist which prescribes the minimum standards and
requirements for licensure or accreditation of health facilities.
Department of Health-License to Operate (DOH-LTO) — a formal authority

issued by DOH
to an individual, agency, partnership or corporation to operate a
hospital or other health facility.
Department of Health — Permit to Construct (DOH-PTC) — a permit issued by

DOH
through HFSRB to an applicant who will establish and operate a hospital
or other health facility, upon compliance with required documents prior to the
actual construction of the said facility. A DOH-PTC
is also required for hospitals
and other health facilities with substantial alteration, expansion, renovation,
increase in the number of beds, transfer of site, or for additional services (add-
ons) beyond their service capability. It is a prerequisite for License to Operate.
Health Facilities — refers to facilities or institutions, whether stationary or

mobile, land based or otherwise, that provides any of the following services:
diagnostics, therapeutic, rehabilitative, and other health care services except
medical radiation facilities and hospital-based or stand-alone pharmacies.
Individual-based health services — refer to services which can be accessed within

a health facility or remotely that can be definitively traced back to one (1)
recipient, has limited effect at a population level and does not alter the
underlying cause of illness such as ambulatory and inpatient care, medicines,
laboratory tests and procedures, among others (RA 11223).
Initial Applications — refer to applications by newly constructed health facilities,

or those with changes in the circumstances of the facility, such as, but not
limited to, change of ownership, transfer of site, and increase in bed and major
alterations or renovations.
One-Stop Shop (OSS) Licensing System — a strategy of the DOH to harmonize

the licensure of hospitals, their ancillary and other health facilities including, but
not limited to, the clinical laboratory, HIV testing, drinking water analysis and
drug testing; blood bank, blood collection unit and blood station; dialysis clinic;
ambulatory surgical clinic; pharmacy; and medical x-ray facility; but excluding
hospital-based Medical Facilities for Overseas Workers and Seafarers
(MFOWS), hospital-based Drug Abuse Treatment and Rehabilitation Center,
hospital-based Stem Cell Facility, facilities for kidney transplantation, and
facility using radioactive material that are currently regulated by the Philippine
Nuclear Research Institute (PNRI). The OSS shall also apply to non-hospital-
based Medical Facilities for Overseas Workers and Seafarers, non-hospital-
based Ambulatory Surgical Clinics, non-hospital-based Dialysis Clinics,
Infirmaries and Birthing Homes. |
Population-based health services — refer to interventions such as_ health

promotion, disease surveillance, and vector control which have population
groupsas recipients (RA 11223).
ret
Primary Care — refers to initial-contact, accessible, continuous, comprehensive
and coordinated care that is accessible at the time of need including a range of
services for all presenting conditions, and the ability to coordinate
1
—
other health care providers in the health care delivery system, when necessary.
(RA 11223)
K. Primary Care Facility (PCF) — refers to the institution that primarily delivers
primary care services which shall be licensed or registered by the DOH (RA
11223 IRR).
L. Primary Care Provider Network (PCPN) — refers to a coordinated group of

public, private, or mixed primary care providers, which serve as the foundation
of a Health Care Provider Network (HCPN).
M. Primary Care Worker — refers to health care worker, who may be a health
professional or community health worker/volunteer, certified by DOH to provide
primary care services (RA 11223 IRR).
GENERAL GUIDELINES
A. All Primary Care Facilities (PCFs) shall secure a DOH-LTO and must be
compliant at all times with the licensing standards and requirements set forth by
HFSRB and FDA.
B. PCFs under the same management, but operating in separate premises, shall
secure separate DOH-LTOs.
C. A PCF can either be government-owned or privately-owned. It can be a rural
health unit, urban health center, private medical clinic, among others.
D. All government PCFs shall provide both individual-based and population-based

E. All private PCFs shall provide individual-based primary care services, based on
the guidelines set forth by DOH and PhilHealth.
F, All PCFs shall follow the guidelines for individual and population based
services set by DOH and Philhealth.
G. PCFs shall provide medical consultations and minor surgical services within
their premises and shall not be allowed to outsource these services.
|.
Ancillary services of a PCF shall include the following:
H.
Clinical laboratory
2. Diagnostic radiologic services
3. Pharmacy
4. Birthing services
5. Dental services
6. Ambulance service (Type 1)
I. Ancillary services shall comply with licensing standards set by DOH and/or
FDA, asapplicable.
ee
J. If the ancillary services are owned by the PCF and located within its premises
such as, clinical laboratory, pharmacy, birthing services, diagnostic
|
—
services, dental services, and ambulance service, the guidelines for the OSS
implementation based on AO No. 2018-0016, titled “Revised Guidelines in the
imipiementation of the One-Stop Shop Licensing System” shall be strictly
followed at the Center for Health Development — Regulatory Licensing and
Enforcement Divisions (CHD-RLEDs).
K. If ancillary services are outsourced and located either within or outside the
premises of the PCF, a valid Memorandum of Agreement (MOA) with DOH-
or FDA-licensed facilities, as applicable, shall be required.
L. If the PCF and the

ancillary services (located outside the premises of the PCF),
have the same owner, a valid MOA or its
equivalent shall still be required.
M. Barangay Health Stations (BHS) shall be under the supervision of their

respective rural health units/urban health centers and shall not secure their own
DOH-LTO.
|
N. All applications, whether for initial or renewal, shall be processed manually or

through the Online Licensing and Regulatory System (OLRS), once the system
is fully functional.
O. PCFs shall strictly follow the standards, criteria and requirements prescribed in
the Assessment Tool for Licensing of Primary Care Facilities (ANNEX B).
A. Licensing Standards
PCFs shall follow the standards, criteria and requirements prescribed in the
Licensing Standards for Primary Care Facilities (ANNEX A).
B. Assessment Tool
An Assessment Tool for Licensing of Primary Care Facilities (ANNEX B) shall

be used by regulatory officers and other stakeholders to evaluate compliance of
PCFs to DOH standards and technical requirements for safety. This particular
tool shall also serve as the Self-Assessment Tool to be used by owners of PCFs
prior to inspection or monitoring visits by the CHD-RLEDs.
C. Asingle DOH-LTO shall be issued to the PCF, and shall include:
1. Category of health facility;

2. Ownership; and
3. Validity period
D. Every PCF may be monitored by CHD-RLEDs.
E. PCF shall have a contingency plan in case of suspension or revocation of the

DOH or FDA LTO of any of its
ancillary services, whether located within or
outside its premises.
al
F. PCFs shall have a Manual of Operations, which shall include, but not limited to,
the standard operating procedures being implemented in the facility,
\4
guidelines and Manual of Procedures for primary care services, once available;
and copies of relevant laws and DOH issuances.
G. PCFs shall use only FDA

registered drugs and/or devices.
VII. PROCEDURAL GUIDELINES
_—
A. Application for DOH-PTC
l. A DOH-PTC shall be required for construction of new PCFs and for

renovation or expansion of existing PCFs.
2. A completely filled out application form for DOH-PTC, whether manual
or online, shall be submitted to the respective CHD-RLED.
3. The procedural guidelines for the processing of DOH-PTC shall be in

accordance with Administrative Order (AO) No. 2016-0042, also known
as, “Guidelines in the Application for Department of Health Permit to
Construct (DOH-PTC).”
B. Application For DOH-LTO
1. A completely filled out application form for DOH-LTO, whether manual

or online, shall be submitted to the respective CHD-RLED.
2. All applications, whether for initial or renewal, shall be processed

manually or through the OLRS, once the system is fully functional.
The licensing process, both for initial and renewal of DOH-LTO, shall be
in accordance with AO No. 2018-0016, also known as, “Revised
Guidelines in the Implementation of the One-Stop Shop Licensing
System.”
For ancillary services owned and located within the premises of the PCF,
the following documents shall be transmitted to CHD-RLED by the
following releasing offices either manually or through the OLRS, once
the system is fully functional:
Releasing Office Document

Food and Drug Administration - Certificate of Compliance for
Center for Device Regulation diagnostic radiology
-
Radiation Health Research (FDA-

CDRRHR)/ | |
FDA Regional Field Office

(FDA-RFO)
|
FDA
Regional Field Office Recommendation Letter/
Certificate of Compliance for
pharmacy
_
AA
74
—
C. Validity of DOH-LTO
The DOH-LTO of PCF shall be valid for three (3) years. Renewal of DOH-
LTO shall follow the annual cut-off dates as prescribed in AO No. 2019-
0004, titled “Guidelines on the Annual Cut-off Dates for Receipt of Complete
Applications for Regulatory Authorizations Issued by the Department of
Health.”
D. Fees
1. The DOH-LTO fee shall follow the schedule of fees prescribed by DOH.
2. The applicant, upon filing the application, shall pay the corresponding
fee to the CHD Cashier.
Vii. VIGLATIONS AND SANCTIONS
A. Any violations relative to the existing laws, rules and regulations of PCF and
its ancillary services shall be subjected to the corresponding sanctions stated in
their respective existing laws, rules and regulations, and this Order. The
sanctions shall be borne by the PCF, regardless of location and ownership.
B. The following shall be considered as a violation of PCF:
1. Noncompliance to any of the licensing standards indicated in the

Assessment Tool for Licensing of Primary Care Facilities (ANNEX B)
beyond the compliance period provided by CHD-RLED.
2. Noncompliance of an ancillary service, regardless of location and

ownership, beyond the compliance period provided by CHD-RLED or
FDA. However, if the PCF has more than one (1) outsourced clinical
laboratory, diagnostic radiologic services, pharmacy, birthing services,
dental services, and ambulance service (Type 1), with a valid MOA, the
PCF will not be sanctioned if at least one ancillary facility of the
appropriate category is fully compliant with existing rules and
regulations.
|
C. The following sanctions shall be imposed on PCFs found with violations:
1. For violation to any of the licensing standards indicated in the

Assessment Tool for Licensing of Primary Care Facilities (ANNEX B)
beyond the compliance period provided by CHD-RLED:
Number of Incidence
First Offense
Sanction
Written Warning
Second Offense Thirty thousand pesos
oo | |
(Php 30,000)
Third Offense Fifty thousand pesos
(Php 50,000)
Fourth Offense Suspension of thirty days
— _
(30 days) or revocation of LTO
ap
Vy
2. For noncompliance of an ancillary service, regardless of location and

ownership, beyond the compliance period provided by CHD-RLED or
FDA:
Number of
First Offense
Incidence Sanction
Written Warning
Second Offense Twenty thousand pesos
(Php 20,000)
Third Offense Additional twenty percent (20%)
of the previous fine
Fourth Offense and onwards Suspension of thirty days
(30 days) or revocation of LTO
D. The PCFs or the ancillary service/s shall be cleared of its violation after
complying with the necessary corrective actions and the prescribed sanction.
IX. APPEAL
Any PCF aggrieved by the decision

absence or unavailability or when delegated, the
of the Director IV of CHD, or in his/her
Director III of CHD, may, within ten (10)
days after receipt of the notice of decision file a notice of appeal to the Secretary of Health,
whose decision shall be absolute and executory. All pertinent documents and records of the
applicant shall then be elevated by the CHD.
X. TRANSITORY PROVISIONS
A. The requirement for DOH-PTC shall be waived for existing and operating PCFs
prior to the effectivity of this Order. In lieu of this requirement, an as-built plan
shall be submitted to the CHD-RLED.
B. The application fee for DOH-LTO and DOH-PTC for PCF shall be waived until
a new schedule of fees is issued by DOH.
C. Existing PCFs which cannot completely comply with the licensing standards of
ambulance service based on A.O. No. 2018-0001, also known as
and Regulations Governing the Licensure of Ambulances and Ambulance
“Revised Rules
Service Providers“, during initial application of DOH-LTO shall be given a

grace period until October 1, 2022. A DOH-registered Patient Transport Vehicle
shall serve as the transportation service of the PCF while complying with the
licensing standards of their ambulance service.
D. Furthermore, existing PCFs which cannot completely comply with the required
dental equipment and instruments in Annex B of this Order during initial
application of DOH-LTO shall be given a grace period until October 1, 2023, to
|
attain full compliance with the licensing standards set forth by this Order.
Provisions from previous issuances that are inconsistent or contrary to

provisions of this Order are hereby rescinded and modified accordingly. py
XII. SEPARABILITY CLAUSE
In the events that any provision or part of this Order is declared unconstitutional
or null and void or rendered invalid by any court of law of competent authority, those
provisions not affected by such declaration shall remain valid and effective.
XI. EFFECTIVITY
This order shali take effect fifteen (15) days after publication in the Official
Gazette or in a newspaperof general circulation. Copies of this Order shall be filed with the
U.P. Law Center pursuant to Book VII, Chapter 2, Sec. 3 of E.O. 292.
Secretary of Health

SEP 0 6 2071
No. 2020-0047-A
SUBJECT: Amendment to Administrative Order (A.O.) No. 2020-0047 entitled

“Rules and Regulations Governing the Licensure of Primary Care
Facilities in the Philippines”
Administrative Order (AO) No. 2020-0047, titled “Rules and Regulations Governing the
Licensure of Primary Care Facilities in the Philippines” was issued last September 30, 2020,
and took effect on October 30, 2020. To be licensed are all government and private primary
care facilities, which are the rural health units (RHU), urban health centers (UHCs) and
private medical clinics.
In 2021, the National Health Facility Registry (NHFR) listed 2,592 government-owned
primary care facilities (PCF), with indeterminate number of private medical clinics. As of
July 5, 2021, there is only one (1) DOH-licensed primary care facility. The most common
reason for the low rate of filing of application for DOH-LTO a PCF based on stakeholders
meetings organized by Center for Health Development (CHD) — Regulation, Licensing and
Enforcement Division (RLEDs), is the difficulty in complying with all the minimum
licensing requirements for PCF, particularly the ancillary services. The stakeholders are
requesting for extension of implementation of the licensing standards. Furthermore, based
on the discussions during the said stakeholders meeting, some of the
licensing standards on
personnel and physical plant needs to be updated and clarified, details of which are in the
revised Annexes.
Thus, the following provisions are being amended:
XXX-
Under Section VI. SPECIFIC GUIDELINES
Licensing Standards for Primary Care Facilities (ANNEX A).
B. Assessment Tool
An Assessment Tool for Licensing of Primary Care Facilities (ANNEX B) shall be
used by regulatory officers and other stakeholders to evaluate compliance of PCFs to
DOH standards and technical requirements for safety. This particular tool shall also
TT
serve as the Self-Assessment Tool to be used by the owners of the PCFs prior to
inspection or monitoring visits by the CHD-RLEDs.
pe |
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: fiduque@doh.gov.ph
r
The aforementioned provisions are hereby amended as follows:
-XXX-
Licensing Standards for Primary Care Facilities (ANNEX A. Rev. 01).
B. Assessment Tool
An Assessment Tool for Licensing of Primary Care Facilities (ANNEX B. Rev. 01)
shall be used by regulatory officers and other stakeholders to evaluate compliance of
PCFs to DOH standards and technical requirements for safety. This particular tool
shall also serve as the Self-Assessment Tool to be used by the owners of the PCFs
prior to inspection or monitoring visits by the CHD-RLEDs.
“XXX-
X. TRANSITORY PROVISIONS
A. The requirement for DOH-PTC shall be waived for existing and operating PCFs
prior to the effectivity of this Order. In lieu of this requirement, an as-built plan shall
be submitted to the CHD-RLED.
B. The application fee for DOH-LTO and DOH-PTC for PCF shall be waived until a
new schedule of fees is issued by DOH.
C. Existing PCFs which cannot completely comply with the licensing standards of
ambulance service based on A.O. No. 2018-0001, also known as “Revised Rules and
Regulations Governing the Licensure of Ambulances and Ambulance Service
Providers“, during initial application of DOH-LTO shall be given a grace period
until October 1, 2022. A DOH-registered Patient Transport Vehicle shall serve as the
transportation service of the PCF while complying with the licensing standards of
their ambulance service.
D. Furthermore, existing PCFs which cannot completely comply with the required
dental equipment and instruments in Annex B of this Order during initial application
of DOH-LTO shall be given a grace period until October 1, 2023, to attain full
compliance with the licensing standards set forth by this Order.
-XXX-
The following transitory provisions shall be added:
-XXX-
E. Existing PCFs which cannot comply with the licensing standards of birthing
facility based on Annex-C of AO No. 2012-0012 and clinical standards based on
AO No. 2021-0037, titled “New Rules and Regulations Governing the
Regulation of Clinical Laboratories, during initial application of DOH-LTO
shall be given a grace period until October 1, 2022.
F. Lastly, existing PCFs which cannot comply with the licensing standards of FDA
for pharmacy and/or radiologic services, during initial application of DOH-
LTO shall both be given a grace period until October 1, 2025: T
2023 TE d /
2
The schedule of deadline for compliance with all licensing standards of each
ancillary service is summarized below:
Ancillary Service End of Moratorium

Birthing Service
Ambulance Service October 1, 2022
Clinical Laboratory Service
Dental Service
Pharmacy October 1, 2023
Radiologic Service
G. Existing PCFs shall submit a duly notarized Memorandum of Undertaking

(MOU) to their respective CHD-RLEDs, expressing their commitment to
completely comply with all the licensing standards of the ancillary services
within the specified period provided.
H. The DOH-LTO of PCFs shall indicate which ancillary services are already
complied with and which have outstanding MOUs.
I. CHD-RLEDs shall monitor progress of compliance of licensed PCFs with MOU.

PCFs that are found to be noncompliant with the licensing standards of
ancillary services, as stated in their MOU, may issue a suspension of DOH-LTO
a PCF. The sanction shall be lifted upon complete compliance with the required
ancillary services within the compliance period provided by CHD-RLED.
“XXX-
All other provisions of A.O. No. 2020-0047 shall remain in effect and provisions/issuances
inconsistent or contrary to this Order are hereby rescinded or modified accordingly.
This order shall take effect fifteen (15) days after publication in the Official Gazette or in a
newspaper of general circulation and upon filing three (3) certified copies to the University
of the Philippines Law Center.
FRANCISCO T,/DUQUE III, MD, MSc

Secrofary of Health
iPhilHealth
Your Partner in Healil
DEPARTMENT OF HEALTH
PHILIPPINE HEALTH INSURANCE CORPORATION
DEC 2 8 2020
JOINT ADMINISTRATIVE ORDER

No. 2020-000)
SUBJECT: Guidelines on the Registration of Filipinos to a Primary Care
Provider
I. BACKGROUND
The Universal Health Care (UHC) Act (RA 11223) seeks to delineate the roles of key
agencies and stakeholders towards better performance in the health systems and ensure that
all Filipinos are guaranteed equitable access to quality and affordable health care goods and
services and protected against financial risk.
Section 6.6 of the UHC Act Implementing Rules and Regulations (IRR) provides that every
Filipino shall register with a public or private Primary Care Provider (PCP) of choice with
due consideration to proximity and ease of travel of those seeking care, the absorptive
capacity of the provider for quality care and provider capability to deliver the required
services, among others. Further provided, Section 6.7 identifies the LGU as the main
institution accountable for the registration of all Filipinos to their PCP of choice provided
that they receive assistance from DOH and PhilHealth.
As such,this Order
Filipinos to a PCP.
is being issued to provide the general guidelines on the registration of
II. OBJECTIVE
This Order aims to provide the guidelines and process to ensure that all Filipinos can register
to a PCP of their choice.

This Joint Administrative Order (JAO) shall apply to all Offices under the DOH, PhilHealth,
all primary care providers (public and private), Local Government Units (LGUs), and all
others concerned.
1
On.
A. individual-based health services — refers to services which can be accessed within a

health facility or remotely that can be definitively traced back to one (1) recipient, has a
limited effect at a population level, and does not alter the underlying cause of illness,
such as ambulatory and inpatient care, medicines, laboratory tests, and procedures,
among others
. Health Care Provider Network (HCPN) refers - to

a group of primary
providers, whether public or private, offering people-centered and
to
tertiary care
comprehensive care
in an integrated and coordinated manner with the primary care provider acting as the
navigator and coordinator of health care within the network
. Population-based health services — refers to the interventions or services that cannot be

specifically traced back to a single person or beneficiary, such as health promotion,
disease surveillance, and vector control, which have population groups as recipients
. Portability — refers to the enablement of a Filipino to avail of services outside the

territorial jurisdiction of the primary care provider to whom he/she is currently registered
. Primary Care Provider (PCP) - refers to a health care worker, with defined
competencies, who have received certification in primary care as determined by the
Department of Health (DOH), or any health institution that is
licensed by the DOH, or
otherwise provided.
V. GUIDELINES
A. All Filipinos are eligible to register to a DOH-licensed/certified and/or PhilHealth-

accredited/contracted PCP of their choice.
Local Government Units (LGUs), with assistance from DOH and PhilHealth, shall
within their
ensure and facilitate the registration of Filipinos living and residing
territorial jurisdiction to a PCP, whether public or private.
The PCP shall commit to keeping the personal information of all Filipinos registered in
the primary care facility confidential, secure, private, and affirm the fundamental rights
of all persons in compliance with Republic Act No. 10173 otherwise known as the Data
Privacy Act of 2012.
DOH and PhilHealth shall develop operational guidelines and tools on how to organize
the health system and health providers to accommodate and enable client choice
in
catchment
selecting PCPs, to consider proximity, ease of travel, and the maximum
population of the primary care facility.
PhilHealth shall make available multiple modalities that Filipinos can use to register to
a PCP. These include, but are not limited to, self-registration
and assisted registration.
The modalities shall be governed by policies and guidelines set forth by PhilHealth.
with
Further, these modalities have to consider enabling minors, senior citizens, persons
disabilities, indigents, and those without internet access to register to their PCP of
choice.
different
LGUs and DOH shall have access to all registration data captured through the
registration modalities in compliance with the Data Privacy Act of
2012. The captured
data shall be used by the different agencies for (1) approximating market
registration
2
Yop
A
‘saturation and identifying gaps in the health system, (2) planning and budgeting, (3)
designing and developing of health programs, and (4) research.
H. PhilHealth shall explore the mechanisms for the portability of benefits through
encouraging the interoperability of electronic health records/information, registration,
and access to services outside geopolitical boundaries.
I. Availment of Population-based Health Services
1. Filipinos who are registered to a public PCP for individual-based health services
shall receive population-based health services from the same public PCP. Filipinos
who are registered to a private PCP for individual-based health services shall
receive population-based health services from public PCPs within their geopolitical
boundary or catchment area.
PhilHealth shall make registration data available and accessible to DOH and LGUs
in facilitating the delivery of population-based health services. The data provided
should include the number of registered Filipinos in each city and municipality
regardless of whether they are registered to a publicly-owned or privately-owned
primary care facility.
J. Data Management
1. All Primary Care Providers shall have validated electronic health records (EHR)
for efficient and effective monitoring of health status and availment of services.
The EHR shall be utilized for patient navigation and coordination mechanism to
higher levels of care within the Health Care Provider Network (HCPN) and to
support continuity of care and the provision of comprehensive primary care.
VIY.
r
ROLES AND RESPONSIBILITIES
A. Department of Health (DOH)
1. Provide assistance to LGUs in registering Filipinos to PCPs, through the DOH-

Centers for Health Development.
2. Develop guidelines on defining conditionalities for access, which includes

assessing and determining the maximum registered Filipinos for each PCP based
on the primary care facility standards and the capability of the PCP, among others.
B. Philippine Health Insurance Corporation (PhilHealth)
1. Make available different registration modalities to enable the registration of all

Filipinos to a PCP.
Ensure that IT systems for registration to PCPs are in place and operational and
that LGUs and DOH have access to the data.
Ensure accessibility of information on the status and list of licensed/certified

and/or accredited/contracted PCPs for all Filipinos and the PCP applicants.
142
Provide communication support to and conduct activities with partners, including

LGUs, to facilitate registration.
Issue additional specific guidelines. information, and manual of procedures

related to registration to a PCP.
C. Local Government Units (LGUs)
1. Ensure that all Filipinos living and residing within their territorial jurisdiction are
registered to DOH-licensed/certified and/or PhilHealth-accredited/contracted
PCPs, whether public or private.
9 Ensure that there are information technology resources available to facilitate

registration.
Ensure that there is an adequate number of PCPs where Filipinos living and
residing within their territorial jurisdiction can register to.
Conduct events, activities, and education sessions with Filipinos and PCPs to
encourage registration.
Maintain a database of primary care providers within the province or city-wide

health systems.
D. Primary Care Providers (PCPs)

1. Potentially partner with DOH and PhilHealth as duly licensed/certified and/or
accredited/contracted PCPs.
No
Establish, maintain, and update the master list of its catchment population or
Filipinos registered in their facility.
Conduct events, activities, and education sessions with Filipinos and PCPs to
encourage registration.
Register and regularly update information on all health workers within their
primary care facility to the DOH database on human resources for health.
E. Filipinos
1. Register to a PCP of their choice.
SS
2. Regularly update their membership data record (e.g. additional dependents, etc)
—— CLAUSE
If any part or provision of this Order is
rendered invalid by any court of law or competent
{/lil. 2X’ REPEALING CLAUSE

All Orders, Rules, Regulations, and other related issuances inconsistent with or
contrary to this Order are hereby repealed, amended, or modified accordingly. All other
provisions of existing issuances that are not affected by this Order shall remain valid
and in effect.
{X. EFFECTIVITY
ATTY;DANTESIERRAN, CPA)
President and CEQ, PhilHealth
287
5 DELIVERING
POPULATION-BASED
AND INDIVIDUAL-BASED
HEALTH SERVICES
With the enactment of the UHC Act, health service packages are now classified as
either population-based or individual-based. Population-based health services are health
interventions which have population groups as recipients, such that services cannot
be specifically traced back to a single person or beneficiary. Health care providers,
particularly in the public sector, are required to provide health promotion programs and
campaigns, epidemiological and disease surveillance systems, and disaster risk reduction
and management in health. Water quality assurance, food sanitation, vector control,
among others, may also be included as critical population-based health services.
Individual-based health services, on the other hand, are health interventions that
can be accessed within a health facility or remotely, definitely benefiting one recipient,
and have limited effect at a population level. These health packages are exemplified by
medical and surgical procedures provided as inpatient services in a hospital setting, or
as outpatient services in ambulatory care facilities, or as health interventions provided
remotely through digital health services.
The classification of health service packages into population-based and individual-

based follows a set of criteria based on the economic concept of a public good. First is
the concept of rivalry, that is, if one person’s use of a health good or service diminishes
other people’s use. Second is in terms of excludability, that is, if the use of a health good
or service can be limited to only paying customers. Third is from the standpoint of
externality, that is, if there is minimal to no external effect beyond the one person availing
the health package. Health goods and services that are rival, excludable, with minimal
to no external effects to the general population, and with a sole intended recipient, are
classified as individual-based health services. Otherwise, they are classified as population-
based health services. Such classification is crucial in the context of the law’s mandate
for individual-based health services to be funded through premium-based financing by
PhilHealth in complementation with private health insurers and health maintenance
organizations (HMOs); and for population-based health services to be funded through
tax-based budget allocation by DOH in complementation with LGUs.
DELIVERING POPULATION-BASED AND INDIVIDUAL-BASED HEALTH SERVICES 289

ON DELIVERING POPULATION-BASED
AND INDIVIDUAL-BASED HEALTH SERVICES
• Guidelines on the Classification of Individual-based and Population-

based Primary Care Service Packages [AO 2020-0040]
• Health Promotion Framework Strategy in Province-wide and City-wide

Health System [AO 2020-0042]
• Transformation of the Health Promotion and Communication Service

(HCPS) to the Health Promotion Bureau (HPB) [AO 2020-0058]
• Guidelines on Healthy Settings Framework in Learning Institutions

[DOH-DSWD-DedEd-CHED-LEB-TESDA-DILG JAO 2022-0001]
• National Policy Framework on the Promotion and Recognition

of Healthy Communities [DOH-DILG JAO 2021-0002]
• The 2020 Revised Implementing Rules and Regulations of Republic Act

No. 11332, or the Mandatory Reporting of Notifiable Diseases and Health
Events of Public Health Concern Act
Note: The Implementing Rules and Regulations is accessible at:
https://bit.ly/RA11332IRR
• Estimation of Burden of Disease in the Philippines [DC 2021-0132]

Note: The interim guidelines on the estimation of burden of disease
is accessible at: https://bit.ly/BODEstimation
• Guidelines on the Institutionalization of Disaster Risk Reduction

and Management (DRRM-H) into Province-wide and City-wide Health
Systems [AO 2020-0036]
• Governing Policies of the PhilHealth Konsultang Sulit at Tama

(PhilHealth Konsulta) Package: Expansion of the Primary Care Benefit
to Cover All Filipinos [Philhealth Circular 2020-0002]
• Implementing Guidelines for the PhilHealth Konsultasyong Sulit at Tama

(PhilHealth Konsulta) Package [PhilHealth Circular 2020-0022]

SEP 07 2020
No. 2020-__ po 4o
SUBJECT: Guidelines on the Classification of Individual-based and
Population-based Primary Care Service Packages
BACKGROUND .
Republic Act (RA) No. 11223, otherwise known as the “Universal Health Care Act,”
in its declaration of policies and principles, emphasized primary health care (PHC)
concepts to promote the right to health of all Filipinos, and instill health literacy among
them. It is envisioned that this approach shall use a health care model that ensures all
Filipinos have equitable access to a comprehensive set of quality and cost-effective
preventive healthcare goods and services. This is a people-oriented approach for the
delivery of health services, centered on people’s needs and well-being, cognizant of
differences in culture, beliefs, and values.
These guidelines respond to Section 18.12 of the Implementing Rules and Regulations
(IRR) of Universal Health Care (UHC) Act, tasking DOH to
issue guidelines on the
classification of health services as either population-based or individual-based health
service and provide guidance on the best financing mechanism for such services. This
Order also references and clarifies provisions from DOH Administrative Order 2017-
0012 Guidelines on the Adoption of Baseline Primary Health Care Guarantees for All
Filipinos, to ensure efficient positioning of a standard package of quality preventative
health care services in primary care facilities. These services require different financing
and contracting mechanisms and best addressed if these services are properly
categorized as individual-based or population-based.
This Order focuses on strengthening primary care facilities, as gatekeepers of the

Philippine health care system. This strengthening shall be complimented with matching
competent health human resource, the mass promotion of active preventive health-
seeking behavior across all
age groups and life
stages, and a consistent, active financing
scheme.
iI. OBJECTIVE
This Order shall define comprehensive primary care service packages as either
individual-based or population-based health service in order to guide DOH, local
government units (LGUs), and PhilHealth on financing and contracting services
mandatory for accredited or licensed primary care facilities.
il. SCOPE AND COVERAGE |
This Order shall apply to all DOH offices, DOH health facilities and attached agencies,
Ministry of Health, Bangsamoro Autonomous Region of Muslim Mindanao (MOH-
BARMM), all public and privately-owned health facilities, LGUs and Other National
Government Agencies, development partners, civil society groups, the academe, and
j w/
all other stakeholders and concerned.
YS af
Cruz, 1003 Manila e Trunk Line 651-7800, Local V1 13,
I
Building 1, San Lazaro Compound, Rizal Avenue, Sta. 08,
URL: http://www.doh.gov.ph; e-mail address: ftduque
ips
oviph
Direct Line: 711-9502, 711-9503; Telefax: 743-1829 @

A. Individual-based health services refer to services can be definitively traced back
to an individual. These are services which can be accessed within a health facility
or remotely that can be definitively traced back to one (1) recipient, has limited
effect at a population level and does not alter the underlying cause of illness such
as ambulatory and in-patient care, medicines, laboratory tests, and procedures,
among others.
Population-based health services refer to interventions such as health promotion,

disease surveillance, and vector control, which have population groups as
recipients. These are services that cannot be specifically traced back to a single
person or beneficiary.
Primary health care refers to the whole-of-society approach that aims to ensure
the highest possible level of health and well-being through equitable delivery of
quality health services.
Primary care refers to initial contact, accessible, continuous, comprehensive, and

coordinated care that is accessible at the time of need including a range of services
for all presenting conditions, and the ability to coordinate referrals to other health
care providers in the health care delivery system.
Primary care facility refers to the institution that primarily delivers primary care
services which shall be licensed or registered by the DOH.
GENERAL GUIDELINES
A. Criteria for Identifying Individual-based and Population-based Health .
Services. Primary health care services are public goods—thus, Rivalry and
Excludability are essential qualities that should apply when classifying whether a
service is individual-based or population based, other than its external effects,
financing mechanism, and target population for which it
is intended.
CRITERIA INDIVIDUAL-BASED POPULATION-BASED
RIVALRY Individual-based health services Population-based health

are rival. services are non-rival. When
Guide question— one person receives a health
These health services may only service, it does not prevent
“Will there be rivalry
among recipients when this
be provided to one personat a others from accessing and
time to ensure that full benefits benefiting from it.
service is rendered?” of the good are imparted to the
receiver. When provided, the full
benefits of these health services
One person’s use of a health are enjoyed by more than one
service diminishes other person up to a maximum area
people’s use—which is why this of effect (and increases its
area
service is provided to one of effect when reinforced), and
personat a time’.
1
p, 228, Chapter 11 “Public Goods and Common Resources.” Principles of Economics, 7" Edition. N. Gregory
Mankiw, Joshua Gans, Martin Byford, Stephen King. 2014.
Nec
1%
ight
CRITERIA INDIVIDUAL-BASED POPULATION-BASED
that the administration of these

services are not compromised.
EXCLUDABILITY Individual-based health services Population-based health

are excludable. services are non-excludable.
Guide question—
Only persons who avail of these The benefits from population-
its
“Is this service and services may access and benefit based services may also be
benefit(s) only accessible by from individual-based health accessed and enjoyed by people
one person when services. not paying for these services.
rendered?”
EXTERNALITY Individual-based health services Population-based health

have no external effects. services have external effects.
Guide question—
“Are there external effects

Thereis little to no effectbeyond
health service
of Effect of health service
provided extends beyond the
provided
beyond one individual when the one person directly availing well-being of one person,
this service is rendered?” this. indirectly affecting the rest of
the population who neither pays
for nor is compensated for the
effect of the intervention.
Financed primarily through—

FINANCING e PhilHealth National government, in
e Other Prepayment support to Local Government
Mechanisms (e.g. social Units
health insurance, private
health insurance, and health
maintenance
|
organization/HMO plans)
TARGET POPULATION Individuals Communities
B. In the interim, individual-based health services shall continue to be covered by

PhilHealth and LGUs, until such time that PhilHealth can cover entire individual-
based health service package. On the
other hand, population-based health services
shall be financed or contracted by DOH and/or LGUs—who shall be supported by
the national government. A separate set of guidelines on national government,
DOH, and PhilHealth support to LGUs during this transition period, shall be issued
by the DOH. Refer to
Figure 1 for the illustration of service classification of primary
care services.
Me
vf A
Page 3 of 7
e Mass Interventions (e.g.

Insecticides, Bed Nets, Toilet Bowls,
Aquatab)
e Health Promotion &
Communication (Community e Counselling (e.g. Nutrition,
Engagement, Policy Making and Lifestyle Modification,
Enforcement, Social and Behavior
Reproductive Health, etc.)
Change Campaigns, and Identifying e Screening & Diagnostics (e.g. Test
Enablers for Health Needs) Kits, Reagents, Laboratory
e Program Management (e.g. Procedures, etc.)
Research and publication, Clinical e Treatment (e.g. Medicine, Minor
Practice Guidelines/CPG or Clinical
Surgeries, etc.)
Pathways, Monitoring and
Evaluation/M&E, Training &
Workshop, Surveillance, and
Disaster Risk and Reduction
Management inHealth/DRRM-H)
Figure 1. Classification of Individual-based and Population-based Primary Care Services.
C. All service package or commodities for public health interventions in all primary
care facilities are clinically-proven and cost effective. Primary care services shall
be regularly updated through a single, fair, and transparent health technology
assessment (HTA) in accordance with Section 34 of RA 11223, and related DOH
issuances.
D. Health services in an integrated province/citywide health system are classified as

population-based
V.A. hereof.
or
individual-based following the criteria in provided in Section
SPECIFIC GUIDELINES
A. Primary Care Service Package
1. This service package consolidates all
clinically-proven and cost-effective public
health programs that address 80 percent of the local disease burden through
health promotion, prevention, and detection. These primary care services shall
be present in standard primary care facilities, regardless of an LGU’s economic
capacity. This standard shall provide the basic package of preventive health
services in primary care facilities. The detailed list that illustrates the
recommended disease-agnostic health check-up services which take into
account the needs of various age groups and pregnant women,
of
to
track their
health status
~
and lead towards efficient, needs-based delivery primary care

services shall be included in the Manual of Procedures (MOP). The MOP
shall be issued by the DOH upon the
approval of
this Order.
2. The primary care package shall be delivered through local communities and
licensed primary care facilities. Specifically, individual-based interventions
shall be accessed through networks of both public (state) and private (non-state)
providers that are linked to high levels of service facilities in health care
provider networks (HCPN).
3. A standard package of health services shall be provided by primary care
facilities within health care provider networks. Annex A outlines the individual-
based health services, disaggregated by age groups (i.e. 0 to 17, 18 to 59 as the
working age group, and 60 years old and above) and services for pregnant
t
TMS
Page 4 of 7
women. The complete list of services is provided in Annex B, and shall be

further expounded in the MOP.
is
_
4. Should the services needed by clients extend beyond what offered by this
standard primary care package, Provincial, City, and/or Municipal Health
Offices shall ensure that client referrals shall be navigated to the appropriate,
suitable health facility and/or health provider within the HCPN.
B. Financing of Primary Care Service Package

1. The primary care service package shall serve as the basis for costing sector-
wide medium to long-term planning for DOH, PhilHealth, and LGUs.
Individual-based services shall be financed by PhilHealth. The national
government shall support LGUs in
the financing of capital investments and the
provision of population-based health services.
2. The primary care service package shall guide prioritization and rationalization
of DOH’s technical assistance to LGUs, and inform the expansion of the
primary care benefit package of PhilHealth.
C. Enabling Quality Access to Care and Ensuring Adequate and Appropriate

Provision of Health Services
1. All product registration, licensing, accreditation, and contracting standards for
both stand-alone primary care facilities and primary care networks, including
health profession education and training shall be aligned to the primary care
service package.
2. Provision of all primary care services shall be guided by locally-relevant clinical

practice guidelines and cost-effective, responsive clinical pathways.
3. All information and education campaign materials on primary care services
shall be developed using life stage approach and segmented by target audience
(e.g. health managers, health providers, and/or clients, and their families).
4. The effectiveness, efficiency, and equity dimensions of the implementation of
primary care service package shall be monitored by the DOH, PhilHealth, and
LGUs. All health information systems shall enable tracking of utilization of

A. The Health Technology Assessment (HTA) Unit shall recommend to the
financing agents—the DOH Secretary, the PhilHealth Board of Directors, and
LGUs through their local chief executives—the inclusion or exclusion of
interventions into the primary care service package, and classification of services
as individual-based or population-based, to be approved by the DOH Secretary.
B. Disease Prevention and Control Bureau (DPCB) shall develop plans, policies,
for disease
programs, clinical practice guidelines (CPGs), projects and strategies
prevention and control and health protection in the context of primary care. It
shall
also provide coordination, technical assistance, capability building, consultancy and
advisory services to CHDs related to disease prevention and control and health
protection at the primary care level.
)
Page 5 of 7
. Health Human Resources Development Bureau (HHRDB) shall ensure the

human resource complement in efficiently accomplishing the delivery of primary
care services through development of human resource for health and personnel
administration related policies, programs, systems, and standards to ensure
adequate, competent, committed, effective and globally competitive human
resource for health in collaboration with stakeholders, partners, and other sectors.
. Centers for Health Development (CHDs) shall work closely with the DPCB,
HFDB, and HFSRB in LGUs, in accordance with the issuances released by the
DOH. CHDs shall coordinate with LGUs, pursuant to Section 17, letters “h” and
“f? of RA 7160 (the Local Government Code of 1991).
. Health Policy Development and Planning Bureau (HPDPB) shall cost sector-
wide medium- and long-term plans to
direct service financing schemes of DOH,
PhilHealth, and LGUs to
ensure the universal delivery of primary care services.
. Health Facility Development Bureau (HFDB) shall provide standards for the
menu of services in primary care facilities through development of plans,
policies/standards, programs/projects, and strategies including technical
coordination/assistance, capacity building and consultation/advisory services
related to health facility development, planning and maintenance. HFDB shall also
advise concerned technical offices of the DOH on matters pertaining to health
facility development, planning, standards, and maintenance.
. Health Facility Services Regulatory Bureau (HFSRB) shall regulate primary

care services and facilities through setting minimum standards, and disseminate
regulatory policies and standards for information and compliance.
Health Emergency Management Bureau (HEMB) shall lead in the
institutionalization of Disaster Risk Reduction and Management in Health (DRRM-
.
H) into province-wide and city-wide health systems. In doing so, it shall maintain
its role as the DOH coordinating unit for all health emergencies and disasters,
provide technical assistance in the development of DRRM-H plan, protocols,
guidelines and standards for health emergency management and the implementation
of population-based health services in these instances. Further, HEMB shall assist
to mobilize resources, both human and non-human e.g. essential commodities,
equipment and supplies during disasters; and maintain a 24/7 Operations Center.
The HEMBshall also provide technical support to province-wide health systems

(PWHSs) and city-wide health care systems (CWHSs) on timely, effective, and
efficient preparedness and responseto public health emergencies and disasters, and
such other means to ensure delivery of population-based health services
Health Promotion and Communication Service (HPCS) shall maintain its role
in developing directions, policies, standards, and guidelines pertaining to health
promotion as a population-based health service, by taking leadership in the
implementation of national campaigns as determined by DOH management.
. Bureau of Local Health Systems Development (BLHSD) shall identify and

assess priorities in local health systems development, develop policies, guidelines,
and standards on sustainable local health systems, ensure multi-stakeholder
“ee
participation in local health systems development, and monitor and evaluate

functionality of local health systems.
. Knowledge Management and Information Technology Service (KMITS) shall

provide oversight to the management of health information systems to track the
utilization of primary care services.
Philippine Health Insurance Corporation (PhilHealth) shall develop benefit

It
.
packages that are responsive to the primary care needs of the population. shall
supervise the provision of health benefits and to set standards, rules and regulations
necessary to ensure quality of care, appropriate utilization of services, fund
viability, member satisfaction, and overall accomplishment of Program
objectives—and formulate and implement guidelines on contributions and benefits;
portability of benefits, cost containment and quality assurance; and health care
provider arrangements, payment, methods, and referral systems.
. Local Government Units (LGUs) are enjoined to provide a supportive

environment for the delivery of primary care services to its citizens through
issuance and enforcement of local ordinances, and invest in the augmentation of the
capacity of its health facilities to deliver individual-based and population-based
health services through the local investment plan for health (LIPH).
VIII. REPEALING CLAUSE

Provisions of previous Orders and other related issuances inconsistent or contrary to
the provisions of this Administrative Order are hereby revised, modified, repealed, or
rescinded accordingly. All provisions of existing issuances which are not affected by
this Order shall remain valid and in effect.
EFFECTIVITY
This Order shall take effect fifteen (15) days after its publication in the Official Gazette
or in any newspaper of
general circulation.
FRAN@®ISCO
T. QUE, TI, MD, MSc
of Health
Page 7 of 7
298
Annex A. Components of Individual-based Health Service Package?
General Services: Expounded in detail in the MOP—Components of Individual-based Health Service Package
Care of the Pregnant

Primary Care Services Woman and Newborn from
0-19 20-59 60 and above
Prenatal to Immediate
Post-Partum
History Taking/
Interview on Concerns
and Risks
Physical Examination Annual: Anthropometrics, Annual: Anthropometrics, Annual: Anthropometrics, Anthropometrics, including
including Mid-upper Arm including BMI, Eye, and including BMI, Eye, and BMI; ultrasound imaging.
Circumference measurement Clinical Breast Examination Clinical Breast Examination
(MUAC; for 6 months to 59
months old children) or BMI
Developmental and Evaluation of mental health, Evaluation of mental health. Evaluation of mental health. Evaluation of mental health.
Mental Health social behavior, and learning;
Evaluation development monitoring; and
development screening.
Screening Newborn hearing test, visual Voluntary HIV Screening, Cervical Cancer Screening, Cervical Cancer Screening.
activity (VA)
test using tools, Occupational Health and Prostate Cancer
and basic hearing tests Screening, Cervical Cancer Screening.
Screening, and Prostate
Cancer Screening.
|
Laboratory Examination Expanded Newborn CBC, FBS, Total Cholesterol Blood typing, CBC,
Screening, CBC, disease- & HDL Cholesterol, and Hemoglobin; includes
specific blood tests (Dengue Level of Serum Creatinine screening for confirmation of
and Hepatitis B). (Cr) for assessing renal
pregnancy and STIs.
The purpose of this table is to illustrate the general list of primary care services expected for general target populations. Refer to Annex C for the complete list of
recommended primary care services.
4
|
. Care of the Pregnant
Pp . Care
rimary Care Servi
Services Woman and Newborn from
0-19 20-59 60 and above
Post-Partum
:
| function
Laboratories applicable Kato Katz for Schistosomiasis, Malarial Smear, Filaria Smear, Slit-skin Smear, Rapid Plasma Reagin for Syphilis
to endemic areas
Vaccination for Recommended immunization Recommended immunization Pneumococcal and influenza Tetanus toxoid.
Disease(s) Prevention schedule. schedule. vaccination.
|
Counselling/Providing Parenting based on age Referral to mental health support, nutrition and exercise,
|
Recommendation and groups, by providing water, sanitation, and hygiene (WASH), oral and dental care,
|
Health Promotion developmental and learning prevention of accidents, addictive substance, sexual and
support, nutrition and | reproductive health--and referral to disease treatment,
|
exercise, water, sanitation, depending on results of examination and screening tests.
and hygiene (WASH), oral
and dental care, prevention
of accidents, addictive
substance, sexual and
reproductive health, and
referral to disease treatment,
depending on results of
examination and screening
tests.
Birthing Services for Mother: vitamin A and
Normal Low-risk Ferrous sulfate; Referral to
Spontaneous Delivery high facilities for complicated
birth cases
Newborn (within 24H):

Essential Newborn Care,
DELIVERING POPULATION-BASED AND INDIVIDUAL-BASED HEALTH SERVICES
Newborn Screening and

Hearing test, Vit K, BCG, and
299
ii of ii A.
| Annex Components of Individual-based Health Service Package
300
Care of the Pregnant

Primary Care Services Woman and Newborn from
~
0-19 20-59 60 and above
Post-Partum
| Hep B vaccine
Referral to support on
nutrition and exercise,
WASH, oral and dental care,
prevention of accidents,
addictive substance, sexual
and reproductive health--and
referral to disease treatment,
depending on results of
examination and screening
tests.
|
~ *
Provision of FP Applies to women and men of reproductive age. Applies to women and men
services of reproductive age.
iiofiii] Annex A. Components of Individual-based Health Service Package
A [pee
Annex B. Recommended Individual-based Health Service Package Across Life Stages
1. Recommended Individual-based Health Service Package for Infant, Children and Adolescent Age Groups (Age 0 - 19 Years)
Childhood Adolescence
Activities/ Services Months Years
2 6 6 7-8 9-10 i1 13-14] 15-17 18-19
* * * * * * *
T Interview
Examination
measurement
measurement
Head circumference measurement
Arm Circumference (MUAC) measurement
Mass Index - BMI
Growth Standards (CGS)
Blood Pressure measurement
and Mental Health Evaluation
Evaluation on mental health concerns, behavior and
Development monitoring
Development screening
Visual Activity (VA) test between 1-

Basic hearing tests * *
Newborn Hearing test

Examinations
Newborn Screening
CBC itime
IgM and IgG Dengue Test 1 month old once and manifest
Non-structural 1 Test 1 month old once and manifest
B test
for Disease(s) Prevention 24hrs weeks| weeks
old old old
BCG *
Hepatitis B *
Pentavalent Vaccine
Oral Polio Vaccine
Pneumococcal Conjugate Vaccine
Inactivated Polio Vaccine (IPV)
Vaccine
Measles -Rubella (MR) Vaccine
-Td
- HPV
Nutrition Services
- Vitamin A Supplementation -100,000IU - 200,000 IU 6mos thereafter
- Micronutrient powder
-lron low birth babies

- Weekly Iron and Folic Acid tablet, intermittenly given for
301
females (2 rounds; 1 tablet per week)
16
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Annex 2. Recommended Individual-based Health Service Package for Adult Group (Age 20-59 Years)
20-29 30-39 40 - 49 50-59

Activities/ Services
54] 55 56 [57] 58] 59
90] 21] 221 231 24] 25] 26] 27| 28| 29] 30| 31| 32| 33] 34 35 36| 37] 38 39 40) 41 42 43 44 45 46 47 48] 49150] 51] 52153]
«| +
History Taking/ Interview on concerns and risks (such as ete dedepaele] eta]
1 alalelelelalelelelaletedalalaelelelelaelelelede>elelel«leteled
Tuberculosis (TB), Jead exposure, and high cholesterol)
* * * * * * * * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * * *
‘ 2 Health Assessment
3. |Physical Examination
* * * * * * * * * * * * * * * * * * * * * * * * * *
* * * x * * * * * * * * * *
- Annual physical examination * * * * * * * * * * *
*x * * * * * * * * * * * * * * * * * * * * * * * * * * *
*
pe]
- Weight measurement De Pe fe pe fae pe fe pe pe tel ep
la fe le pepe
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i tat oe
inati ision 0 of . «bss
- Eye team under supervision *1 time if with signs and symptoms of visual disability
examination by ophthalmological th
ophthalmologist
- Clinical Breast Examination (CBE) physician / CBE trained Public * * ‘ * x ttime
Health staff
4 |Laboratory Examinations be fe fe fe fw pe poe Joe pe pe fx
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* * * * * * * * * * * x * * * * * * * x
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- Routine Urinalysis
* Applies to all men and women once signs and symptoms manifest
- Fecalysis
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5 |Cancer Screening
*
- Cervical cancer: Pap Smear
POLL
* * * * * * * * * * * *
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6 |Occupational Health Screening
* Applies who
7 _|STVHIV screening (voluntary) to all men and women from 15 years old and above consents for testing
|]
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of reproductive age TT Et tf
9 |Nutrition Services
tt
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10 |Oral and Dental Services
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
*
- Oral Examination *x
* * * * * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * *
« Oral prophylaxis/scaling
- Pit and Fissure sealant application Ed

* * * * * * * * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * *
- Atraumatic Restorative Treatment (ART)
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* * * * * x * * * * *
- Temporary filling * * x*
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* *
< Permanent Filling Ld * * *
* ae * * * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * *
- Gum treatment
- Oral Urgent Treatment (OUT): relief of pain, extraction of
unsavable teeth and referral of complicated cases to higher level
11 |Counselling and Health Education

* * * * * * x * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * * * * *
- Nutrition and exercise
*x Ed * * * * * * * * * * * * * * * *
*x * * * * * * * * * * * * * * * * * * *
*
- Water, sanitation and hygiene

* * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * * * * * * * * *
- Oral health and denta! care
ok * * * * * * * * * * x * * * * * * * * * *
* * * * * * * * * es] * * * * * * * *
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et et et et et et eced
- Addictive substance abuse (alcohol, drugs, tobacco) *Peletete eye etet eet
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304
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12. Note: Other laboratories applicable for endemic areas
»Sputum microscopy or Nucleic acid amplification test *Applies to all ages once signs and symptoms manifest
* Applies
13 _|Minor surgeries to all ages when applicable
* = Recommended doing
for
1 time = Recommended doing once period
for in specified
CBE Examination, FBS = Fasting Blood Sugar, VIA Test Visual Inspection with Acetic Acid Wash Test, FIT = Fecal immunochemical Test, DRE = Digital Rectal Examniation, ASB = Assymptomatic Bacteriuria
= Clinical Breast =
Other laboratory screening in endemic areas: Kato Katz for Schistosomiasis, Malarial smear & ROT, Filaria smear & RDT, Slit skin smear, Rapid plasma reagin for Syphilis
WRA = Women of Reproductive Age (15-49 y/o)
Annex3. Recommended Indinvidual-based Health Service Package for Elderly Group (Age 60+ Years)
Elderly
Activities/ Services 60... 64 65... 69 70 ... 80+
60 61 62 63 64165] 66 67 68 69 70 71| 72} 73 74|75|76|77| 78 79 80+
History Taking/ Interview on concerns and risks (such as Tuberculosis (TB), lead «
1 elaelalalselatelasedldlatedletlelsels«lelelelel«elald
exposure, and high cholesterol)
2 * * * * * * * * * * * * * * * * * * * * *
Health Assessment
3. |Physical Examination |
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- Annual physical checkup * * # * » « *
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4 |Laboratory Examinations
* * * * * * * * * * * * * * * * * * * * *
. CBC
* * * * * * * * * * * * * * * * * * * * *
- FBS
Pe pe) et ep eR Pe Ee] pe Pe PP
- Total Cholesterol & HDL Cholesterol * pepe pete * *
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- Level of serum creatinine and serum uric acid for assessing renal function *
eR
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* * * * * * * * * * * * * * * * * * * * *
. Routine urinalysis
- Fecalysis * Applies to all men and women once signs and symptoms manifest
5 |Cancer Screening
- Cervical Cancer: Pap Smear * *
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* * e ®
- Colorectal Cancer: FOBT
~ Colon Cancer: FIT * * * * * * * * * * * * * * * * * * * * *
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-
Prostate cancer: DRE |
6 |Vaccination for Disease(s) Prevention
- Pneumococcal vaccine *
~ Influenza vaccine * * * * * * * * * * * * * * * * * * * * *
7 |Oral and Dental Services
- Oral Examination * * * * * * * * * * * * * * * * * * * * *
- Oral Prophylaxis/scaling /
* * * * * * * * * * * * * * * * * * * * *
- Oral Urgent Treatment (OUT): relief of pain, extraction of unsavable teeth and
referral of complicated cases to higher level
elaedalelalelelsetle«etletls«lelaelaels«elaelalaedalds .
8 |Counselling and Health Education
_ Nutrition and exercise * * * * * * * * * * * * * * * * * * * * *
*7) ep Pep ey ey ef Re Pe Pe Pe Pep Pe] Te
- Water, sanitation and hygiene |e *
ep ep
ete
ep * ep ep ep et ep
ee
et ep ep
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* * * * * * * * * * * * * * * * * * * * *
- Mental health
ee
Pe Pe, ep ep ep ey ef eR Pe Pe oe Pe] eR
- Addictive substance abuse (alcohol, drugs, tobacco) * pee) *
ee] eT
9 |Note: Other laboratories applicable for endemic areas
* - Sputum microscopy or Nucleic acid amplification test * Applies
to all ages once signs and symptoms manifest
10 |Minor Surgeries
*Applies to all ages when applicable

*
= Recommended for doing
CBE = ClinicalBreast Examination, CBC = Complete Blood Count, FBS = Fasting Blood Sugar, VIA Test = Vaginal Inspection with Acetic Acid Wash Test, FOBT-FIT = Fecal Occult Blood Test-Fecal
Immunochemical Test, DRE = Digital Rectal Examination
305
Other laboratory screening in endemic areas: Kato Katz for Schistosomiasis, Malarial smear & RDT, Filaria smear & RDT, Slit skin smear, Rapid plasma reagin for Syphilis
Ar V
y
306
Annex 4, Recommended Individual-based Health Service Package for the Care of the Pregnant Women and Fetus, and Immediate Post-Partum
Pregnant Women, Fetus and Immediate Post-Partum
Activities/ Services First visit Second visit Third visit Fourth visit
8-12 weeks 24-26 weeks 32 weeks 36-38 weeks
History Taking/ Interview on concerns and risks * * ok *
Physical Examination
- Weight measurement
- Body Mass Index - BMI (Body Weight/ Height2)
- Mid-Upper Arm Circumference (MUAC) measurement
- Blood Pressure measurement
- Fetal growth and movement
Screening
- Pregnancy Test
- Syphilis, HIV and Hepatitis B
- Urinalysis
- Stool Exam
- Oral Glucose Tolerance Test (75g)
- Vaginal Inspection with Acetic Acid Wash
Laboratory Examinations
-
- Blood typing
- CBC
- Hemoglobin
Imaging
- Ultrasound
Vaccination for Disease(s) Prevention
- Tetanus Toxoid/ Tetanus+Diphtheria
Nutrition Services
- lron with Folic Acid (1 tablet, 200 mg containing 60 mg elemental iron and 400
mcg folic acid; 1 tablet daily)
- Calcium Carbonate (500 mg elemental calcium;
- lodine
1 tablet 3x daily) *
2 capsules taken as],
- Deworming
Oral and Dental Services
- Oral Examination * *
- Oral Prophylaxis/scaling & «|
#1]
- Gum Treatment *|
*]
#)
- Temporary Filling *
ei)
- Permanent Filling *
Counselling/ Health Education
- Birth plan
- Nutrition and Supplemental feeding, Breastfeeding counselling/ Lactation
management
- Oral health and dental care *
- Water, sanitation and hygiene *
QO
pe
x * * *
-FP
* * * *
- Post partum and Post-natal care
* * * *
- Sexual and Reproductive health
* * * *
- Mental health counselling
* * * *
- Addictive substance abuse (alcohol, drugs, tobacco)
* * * *
- Malaria prevention (in endemic areas)
10 Newborn
Birthing Services for Normal Low-risk Spontaneous Delivery Mother
At birth (within 24
Vitamin A*
Ferrous Sulfate
Essential Newborn Care RT
Newborn Screening (specimen collection only)

e)]
Vitamin K
ei
BCG
*
Hepatitis B
Note: If considered high risk, refer to higher facility
* = Recommended for doing

307

SEP 11 2020
No. 2020 - 0042
SUBJECT: Health Promotion Framework Strategy in Province-wide and

City-wide Health Systems
I. RATIONALE
Health Promotion is defined as the process of enabling people to increase control over, and to
improve their health by addressing its risk factors, determinants and root causes of health ill
(World Health Organization, 2005). Health Promotion covers a diverse range of behavioral,
environmental and legislative interventions that are designed and structured to protect the
community’s and individual’s health and quality of life by addressing the root causes of
health and health risk behaviors. Hence, the Philippines is compelled to broaden the health
ill
sector’s perspective of health promotion to pursue an integrated and comprehensive approach
in ensuring health literacy, healthy living and protection from risks of all Filipinos.
Guided by the Republic Act No. 11223 or the Universal Health Care (UHC) law, the
Department is shifting its health promotion strategy by simultaneously transforming the
Department’s organizational structure and management of health promotion and cascading
the implementation of health promotion in the Local Government Units (LGUs), specifically
in province-wide and city-wide health systems (P/CWHS). It
has also mandated the DOH
formulate a framework strategy for health promotion which shall serve as the basis for DOH
to
programs in increasing health literacy with focus on reducing non-communicable diseases,
implement population-wide health promotion programs and activities across the determinants
of health, exercise policy coordination across government instrumentalities to ensure the
attainment of the framework strategy and its programs, and promote and provide technical
support to local research and development programs and projects.
Il. OBJECTIVE
This Order aims to provide guidance and direction for P/CWHS

promotion as envisioned in the UHC law. It
operationalize health
shall define the Health Promotion Framework
to
Strategy (HPFS) and provide guidance in the design and implementation of strategic policies,
plans, and programs for Health Promotion in P/CWHS.
lil, SCOPE AND COVERAGE
This Order shall apply to DOH Central Office bureaus and units, DOH Centers for Health
Development, DOH Hospitals including the Bangsamoro Autonomous Region of Muslim
Mindanao, and shall cover all levels of local governance, concerned government sectors,
civil society organizations, academic institutions, private sector, health facilities within the
P/CWHS and all
others concerned.
\
Building 2,
1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111,
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
1413 | pil
A. Capacity Building for health promotion refers to the development of knowledge,

skills, commitment, structures, systems and leadership to enable effective health
promotion.
B. Health Promotion refers to the process of enabling people to increase control over,
and to improve their health by addressing
of ill health (WHO, 2005).
its
risk factors, determinants and root causes
C. Health Promotion Framework Strategy (HPFS) refers to a 10-year national

roadmap on health promotion, which shall be the basis of implementation of health
promotion in the country, nationwide and locally.
D. Health Risk Behaviors refers to behaviors that potentially have negative effects on
health such as but not limited to smoking, alcohol drinking, unhealthy diet, absence of
physical activity, risky driving, substance use, etc.
E. Healthy Public Policies refers to an approach to public policies across sectors that
systematically account for the health implication of decisions, seeks synergies and
avoid harmful health impacts in order to improve population health and health
equities (Helsinski Statement, 2013).
F. Province-wide or City-wide Health System refers to an integrated local health

system composed of all health systems within its jurisdiction. A province-wide health
system (PWHS) is composed of municipal and component city health systems. A
city-wide health system (CWHS) refers to Highly Urbanized City (HUC)- and
Independent Component City (ICC)-wide health systems.
G. Determinants of Health refers to those factors that have a significant influence,

whether positive or negative, on an individual or population’s health, which can
include biological, political, and social factors, among others.
GENERAL GUIDELINES
A. All P/CWHS health promotionpolicies, programs and activities shall be anchored on

the Health Promotion Framework Strategy (HPFS).
B. The envisioned P/CWHS health promotion goals shall be the following:

1. That all individuals are empowered to make healthy choices and choose healthy
lifestyles to curb risk factors;
2. That communities are informed, engaged, and mobilized in ensuring their health
and wellbeing;
3. That all settings wherein an individual lives, schools, and works foster an
environment that promotes health
C. P/CWHS shall implement the five action areas of the Ottawa Charter as the
underlying framework. These action areas are all interwoven and linked with one
another, which if implemented, can bring synergized and compounded impact on the
wer’Qe ‘y
health and health outcomes

shall be the action areas:
of Filipinos in line with the UHC’s goals. The following
1. Implementing healthy public policies to promote health and wellbeing.

Establishing healthy public policies that promote health and wellbeing forall is
critical in the implementation of health promotion. Healthy public policies will
promote healthier individual choices and eliminate barriers to behavioral
change.
2. Reorienting health services and communities to health promotion. For
effective behavioral change to happen, a reorientation and rebalancing of
resources among promotion, prevention and treatment services must be made
all levels of the health sector.
at
3. Strengthening personal and community health promotion capacity. Personal
skills and community development are necessary for health promotion action to
be successfully undertaken.
4. Fostering supportive and conducive environments/settings through the life
course. Environments and settings are influential in determining societal and
individual behavioral patterns. Conducive environments/settings for health are
necessary to lessen health inequities in a community.
5. Development of strong collaborative intersectoral partnerships and
collective efforts in the local setting. As factors influencing health are diverse
and numerous, collaboration and collective action among various stakeholders
and community members are vital to effectively address determinants of health,
and health risk behaviors promotion strategies and interventions.
D. P/CWHS shall provide population-based health promotion interventions, activities

and initiatives in the following strategic approaches:
1. Life-course Approach. All health promotion policies and programs shall
consider alllife course stages.
2. Lifestyle and Behavioral Approach. All health promotion policies and
programs shall target the behavior of individuals to promote enabling and
healthy choices to curb risk factors.
3. Sociological Approach. All health promotion policies and programs shall
consider the environment in which an individual lives, schools and works in,
as
this determines his or her overall well-being.
EK. The Health Promotion and Communication Service (HPCS) shall be transformed and
hereinafter referred to as “Health Promotion Bureau (HPB).”
A. Governance
1. The Provincial/City Health Board (P/CHB) shall oversee the implementation
and evaluation of local health promotion policies and programs in the P/CWHS.
2. A Health Promotion Committee (HPC) shall be created by P/CWHB to provide
guidance to the Local Health Board on health promotion-related issues
particularly involving the determinants of health and health risk factors. It shall
be composed of representatives of different sectors and organizations, such as
but not limited to the following:
a. Budget and Finance
i
fee yt
b. Interior and Local Government
c. Social Welfare f
d. Education
e. Transportation
f. Communication
g. Environment and Natural Resources
h. Trade and Industry
i. Private sector
j. Civil organizations
k. Provincial DOH Representative |
Provided That, the representatives from the private sector and civil society
organization shall represent no more than one-third of the committee
membership, and that the Health Promotion Committee shall be headed by the
Provincial/City Health Officer.
3. If a sub-provincial/city health system is formed in consideration of the size,
population and geography of the province, a sub-provincial Health Promotion
Committee shall also be formed.
4. The P/CWHB shall establish a Health Promotion Unit (HPU) under the Health
Service Delivery Division of the Provincial Health Office staffed with adequate
human resources for health complement. The HPU shall ensure the development
and implementation of health promotion policies and programs in P/CWHS, and
exercise coordination with local government and hospital Health Promotion and
Education Officers (HEPOs) and Barangay Health Workers (BHWs) as
barangay-level HEPOs.
5. A Manual of Procedures will be issued to include thefollowing:
a. Functions of the Health Promotion Unit
b. Composition and functions of the Health Promotion Committee
c. Roles of Health Promotion and Education Officers and Barangay Health
Workers as the designated-barangay level HEPOs
B. Policy, Planning and Program Implementation

1. The P/CWHS, through its LGUs, shall enact ordinances that strengthen existing
health promotion policies and programs;
2. It shall strengthen existing and develop new partnerships across all sectors to
ensure a comprehensive, consistent and effective approach to health promotion
by:
a. Involving all concerned sectors in the development and implementation
of healthy public policies including but not limited to counterpart
government agencies, civil organizations, private sector and education
institutions.
b. Engaging, empowering and mobilizing the community to implement any
societal action and behavioral change required.
c. Ensuring continuous and meaningful dialogue to address people’s issues
and concerns, and promote collective community participation and
behavioral change.
3. As mandated in the UHC law, the P/CWHS shall prioritize the following
policies and programs in communities, schools, workplaces and health facilities:
a. Ensuring measures to ban the sale of, and prevent access to, tobacco
products, alcohol and illicit drugs in schools and in the immediate
vicinity;
b. Promoting healthy lifestyle through physical activity, proper nutrition,
fw
injury prevention and mental health programs;
4
I
c. Intensifying the fight against the spread of communicable diseases

through promotive and preventive programs that include among others,
personal hygiene, oral health, access to safe water and sanitation,
environmental measures to prevent vector-borne diseases, and
vaccinations;
d. Strengthening existing health promotion policies and programs towards
the improvement of health indicators.
C. Financing
1. The management, operations, and implementation of health promotion policies,
programs and activities shall be funded from the Special Health Fund and other
local budgetary sources.
2. The DOH, through the Health Promotion Bureau, shall provide or facilitate the
provision of necessary support and incentives to assist P/CWHS. The assistance
shall include financial and non-financial matching grants through the Local
Investment Plan for Health (LIPH).
3. The P/CWHS may accept grants and sponsorships for health promotion from
development partners, the private sector, and organizations, Provided that such
grants and sponsorship are compliant with existing rules and regulations.
D. Monitoring and Evaluation

1. Provincial/City Health Board, through the HPC and HPU, shall monitor and
evaluate the implementation of health promotion in P/CWHS, and shall submit a
semestral report to DOH and DILG detailing the progress and impact of health
promotion policies.
A. The Health Promotion Bureau shall:

1. Formulate policies, standards, guidelines and capacity building programs for the
operationalization of health promotion in P/CWHS
2. Provide technical assistance to DOH Bureau and Services, CHDs, hospitals and
LGUs in the implementation of national policies, programs, projects and
initiatives on health promotion, healthy settings and the determinants of health
3. Monitor and continue to update the HPFS to include suggestions from the
evaluation reports of CHDs, LGUs and other concerned bodies
4, Establish a coordination mechanism with CHD - HPUs and the P/CWHS HPUs
B. The Bureau of Local Health Systems and Development shall:

1. Align the identified priorities based on HPFS with the priority local health
systems programs through the Local Investment Plan for Health
2. Provide technical assistance and support in cascading health promotion
interventions to local health systems
C. The Disease and Prevention Control Bureau shall:

1. Coordinate plans, policies, programs and projects for disease prevention and
control with the HPB, especially for implementation of such using the
healthy-settings approach
2. Provide technical assistance and support in the implementation of health
pee
promotion components of disease programs
\ ye "
D. The Centers for Health Development shall:

1. Establish a health promotion unit (HPU) for their respective regions
2. Facilitate implementation of the HPFS and national policies for regional and
local applications
3. Provide technical assistance for the implementation of health promotion
initiatives aligned with the HPFS to LGUs
4. Monitor the implementation of health promotion activities and projects in area
of assignment
5. Submit technical and evaluation reports in the implementation of health
promotion activities and projects
E. The Local Government Units and Province-wide/City-wide Health Systems shall:

1. Develop counterpart local ordinances to ensure compliance with national
directives at the local level
2. Coordinate with other LGUs and NGAs in
carrying out these guidelines
3. Monitor the implementation of LGU-specific health promotion activities
Vill, REPEALING CLAUSE
Other related issuances not consistent with the provisions of this Order are hereby
revised, modified, or rescinded accordingly. Nothing in this Order shall be construed
as a limitation or modification of existing laws, rules and regulations.
IX. SEPARABILITY CLAUSE
Should any provision of this Order or any part thereof be declared invalid, the other
provisions, insofar as they are separable from the invalid ones, shall remain in full
force and effect.
X. EFFECTIVITY
This Order shall take effect fifteen (15) days after publication to an official gazette or
a newspaper of general circulation.

DEC 7 1 2020
No. 2020 - 0058
Subject: Guidelines on the Transformation of the Health Promotion and

Communication Service (HPCS) to the Health Promotion Bureau
(HPB)
RATIONALE
Republic Act No. 11223 otherwise known as Universal Health Care (UHC) Act laid out
the strategic reform agenda of the nation’s health system to achieve our health goals
equitably. It embodies the concept that health and social wellbeing are determined by the
social determinants of health (SDH) which include many factors outside of the health
systems — including socioeconomic factors, globalization and urbanization, demographic
patterns, environments (physical, legal, economic, and political), patterns of
consumption (food, technology, and natural resources), commercialization and trade,
climate change, family structures, and the cultural and social fabric of societies.
The UHC Act also operationalized the need to invest in health promotion and protection
by mandating the (1) transformation of the existing Health Promotion and
Communication Service (HPCS) to the Health Promotion Bureau (HPB); (2)
requirement of health impact assessment (HIA) for policies, programs and projects that
are crucial in attaining better health outcomes or those that may have an impact on the
health sector as stated in Sec. 30 of the law; and, (3) support of participatory action
research (PAR) on cost-effective high impact interventions on health promotion and
social mobilization as stated in Sec. 31 of the law.
With this, there is a need to articulate the roles and responsibilities of the HPB, ensure
that all other functions that are no longer congruent to the said mandates are transferred
to respective DOH offices and bureaus, and that functions are clearly delineated with
other offices.
II. OBJECTIVES
This Order aims to provide guidance on the transformation of the HPCS to a full-fledged
HPB by virtue of the UHC Act. Specifically, this Order aims to:
1. Specify the expanded mandates of the HPB per UHC Act; and
2. Clarify HPB’s roles and responsibilities vis-a-vis other DOH Bureaus and
Services and Centers of Health Development (CHD) engaged in policy, research,
capacity building, monitoring and evaluation and communication functions in the
Department
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http://www.doh.gov.ph; e-mail: fiduque@doh.gov.ph
This Order shall apply to all DOH Central Office Bureaus and Services, DOH attached
agencies, Centers for Health Development, DOH Hospitals, Local Government Units
(LGUs), the Bangsamoro Autonomous Region in Muslim Mindanao, and all others
concerned engaged in policy and program development, research, communication,
monitoring and evaluation, and capacity building on health promotion and health impact
assessment.
A. Determinants of Health refers to those factors that have a significant influence,

whether positive or negative, on an individual or population’s health, which can
include biological, political, and social factors, among others
Disease Prevention refers to measures adopted in the prevention of disease
occurrence such as risk factor reduction, as well as prevention in disease progression
. Health Literacy refers to skills that empower individuals to gain access to,
understand and use information in ways which promote and maintain good health
outcomes
Health Policy refers to official documents and procedures within government and
non-government institutions which set health priorities in response to the needs of
the population and other sociopolitical factors
Health Promotion refers to the process of enabling people to increase control over
the determinants of health, and to improve their health.
Risk Communication refers to communication capacities used to encourage
informed decision making, during the different phases of a serious public health
event
IMPLEMENTING MECHANISMS
A. Transformation of HPCS to full-fledged HPB
1. The Health Promotion and Communication Service shall be transformed,

renamed, and hereafter referred to as “Health Promotion Bureau (HPB)”;
2. The DOH, together with the Department of Budget and Management (DBM)
and other relevant agencies, shall identify and ensure appropriate
organizational structure with corresponding human resource complement to
support the mandate of the HPB; Provided, that health promotion, capabilities,
financial capacities, and human resources to support the implementation of the
Health Promotion Framework Strategy (HPFS) at the regional level shall be
strengthened and expanded.
3. The HPB shall exercise the following additional mandates as enshrined in the
UHC Act Sec 30. and its implementing rules and regulations:
a. Be responsible for healthy public policy and reorient health systems to
prioritize health promotion and prevention, and increase health
literacy;
b. Lead the formulation of a Health Promotion Framework Strategy
(HPFS) which shall serve as the national health promotion roadmap
J
and the basis of all health promotion policies and programs;
c. Develop population-wide health promotion policies and programs
across SDH and behavioral risk factors; pr
}
2
]
d. Promote and provide technical, logistical and financial support to local

research and development of local policies and programs on health
promotion based on the HPFS and the local investment plans for
health; and
Exercise multi-sectoral policy coordination on health promotion and
enter into partnerships with national government agencies, LGUs, the
private sector, civil society organizations, professional societies and
academe, among others, to ensure the attainment of the HPFS through
adoption, implementation, enforcement and research of policies and
programs.
Furthermore, to operationalize the mandates on Participatory Action Research (PAR)

for health promotion and social mobilization and Health Impact Assessment (HIA)
under Section 31 and 33 of the UHC Act respectively, the HPB shall exercise the
following additional mandates:
1. Lead the development of policies and programs on HIA, and the management
of the overall HIA review process for development projects, policies and
programs; and
2. Lead the development of policies and programs to ensure conduct and funding
of participatory action researches on cost-effective, high-impact interventions
for health promotion and social mobilization, which shall form part of the
national health research agenda of the Philippine National Health Research
System.
B. Delineation of HPB Roles and Functions vis-a-vis other DOH Bureaus and
Services
1. Further to the mandates stipulated in Sec. V.A, the HPB shall perform the
following roles and functions within the Department of Health in coordination
with concerned DOH bureaus and services:
a. Lead in the development and coordination of health promotion and
intersectoral strategies, policies, plans, programs, standards, and social
and behavioral change campaigns (SBCC) directed to address
(a) underlying behavioral risk factors such as but not limited to
tobacco, alcohol and substance use, diet and physical activity, mental
wellness, violence and injury prevention, hygiene and health-seeking
behavior, (b) social determinants of health, (¢) functional health
literacy, and (d) healthy settings such as but not limited to schools,
communities and workplace;
Lead in risk communication of all health risks and hazards;
Build sectoral and institutional capacity on health promotion, HIA, and
PAR for health promotion and social mobilization;
Develop policy and research agenda for PAR on health promotion and
social mobilization which shall form part of the NUHRA of the
PNHRS, and implement mechanisms to provide adequate funding
support for the conduct of PAR;
Ensure monitoring and evaluation of health promotion, HIA and PAR
policies, plans and programs;
Provide clearance and support the development and implementation of
SBCC plan for public health programs as prioritized and approved by
the DOH Executive Committee;
LY
g. Provide content and materials for both social and behavioral change
and disease prevention/ program communications; and
h. Perform functional analysis and organization design of HPB and health
promotion units in hospitals, CHDs, and Province/City-Wide Health
Systems (P/CWHS) and define competencies and develop
competency-based job descriptions for health workers performing
health promotion functions in coordination with HHRDB.
2. The Disease Prevention and Control Bureau shall:

a. Lead in the development of disease prevention and control strategies,
policies, programs, and metrics (e.g. epidemiology, supply side,
demand side indicators) and provide technical inputs in the
engagement of stakeholders for diseases resulting from poor behavior
or specific disease-based programs;
Lead in enabling services at all levels of care such as: (a) development
of Clinical Practice Guidelines, (b) inclusion of essential medicines
into the Philippine National Formulary and availability of
nationally-negotiated price, (¢) inclusion into PhilHealth’s
reimbursement packages, (d) input to health care providers’ education
curriculum, and (e) proof-of-concept of for programs/services (e.g.
quitline).
Provide technical inputs to environmental health and clinical
health-related aspects of HIA Reports submitted by Project Proponents
and HIA Preparers;
Lead in the Environmental Health Impact Assessment (EHIA)
pursuant to the Implementing Rules and Regulations of the Code on
Sanitation of the Philippines (Presidential Decree No. 856), in support
to the Philippine Environmental Impact Statement System (Presidential
Decree No. 1586) of the Department of Environment and Natural
Resources (DENR); and
Develop setting-specific technical guidance on disease prevention and
control strategies, if applicable.
3. The Health Policy Development and Planning Bureau shall:

a. Lead in the coordination of organizational (DOH-wide) and
sector-wide policies, plans and programs;
b. Provide technical inputs to health systems-related aspects of HIA
Reports submitted by Project Proponents and HIA Analysts, and
submit to HPB for consolidation; and
Provide technical assistance on the conduct of PAR for health
promotion and social mobilization, as necessary.
The Bureau of Local Health Systems Development shall incorporate health

promotion principles and metrics of healthy communities into the local health
systems development policies, manuals, tools, and scorecard, where
applicable.
5. The Health Human Resource Development Bureau shall:

a. Provide technical assistance to HPB on the conduct of staffing studies
using human resource management tools;
b. In coordination with HPB, enhance and/or update existing competency

catalog, which includes the competency models and competency-based
job descriptions related to health promotion;
Provide technical assistance on the development of learning design and
packages, and on the evaluation of health promotion-related
curriculum, modules, courses and LDIs; and
Integrate health promotion initiatives in organizational and sectoral
HRH management and development systems, policies and programs in
collaboration with concerned offices.
6. The Health Emergency Management Bureau shall:

a. Lead in DRRM-H promotion and advocacy activities including those
for safe and resilient communities; and
b. Provide inputs to risk management strategies for all health hazards
across the disaster cycle.
7. The Knowledge Management and Information Technology Service shall:

a. Develop, manage, and maintain the official DOH website and other
identified digital health solutions for health promotion and
communication such as chatbot applications, online database systems,
and non-social media platforms, among others. This includes
digitalization of health promotion and communication materials into
ICT applications;
Implement the layout and design of the official DOH website and other
identified digital health solutions following the HPB functional and
technical requirements;
Provide the necessary ICT infrastructure, security and user analytics
data of the official DOH website and other identified digital health
solutions; and
C. Analyze monitoring and evaluation data together with HPB and CMU.
8. Media Relations Unit shall be transferred to the Office of the Secretary to

support public relations and communications of the DOH, and shall be
renamed to the “Communications Management Unit” (CMU) to accurately
reflect its functions. The CMU shall:
a. Develop corporate and crisis communication plans and manage and
facilitate the activation of crisis communication protocol for health
risks and hazards, and institutional reputational risks;
Perform internal communication functions within the DOH Central
Office and cascade to the regional Centers for Health Development and
attached agencies;
Develop and facilitate the approval of communication materials as
aligned with developed communication plans;
Facilitate the execution of editorial plans through coordination with the
appropriate DOH offices;
Provide capability-building sessions/workshops for media practitioners
and designated national and regional DOH spokesperson(s);
Assist in layout and design of the official DOH website and other
identified emerging media platforms in reference to Internal
Department branding, DICT guidelines, and other applicable policies;
Provide analysis of monitoring and evaluation of health information
platforms together with KMITS;
h. Monitor and evaluate developed editorial plans and communication

activities; and
1. Administrative management of social media platforms.
9. Centers for Health Development shall:

a. Establish a Health Promotion Unit under the supervision and
management of the Local Health Support Division of CHDs with the
following minimum four (4) dedicated or designated Health Program
Officers (HPOs) and/or Health Education and Promotion Officers
(HEPOs) to support the operationalization of health promotion in
province/city-wide health systems, and to perform the following
functions:
i. Lead risk communication within their respective jurisdiction;
ii. Facilitate implementation and evaluation of the HPFS and
national policies and campaigns for regional and local
applications;
iii. Provide technical assistance for the implementation of health
promotion initiatives aligned with the HPFS to LGUs;
iv. Build regional and local capacity on health promotion, HIA and
PAR for health promotion and social mobilization;
v. Monitor the implementation of health promotion activities and
vi.
in
projects the area of assignment;
Submit technical and evaluation reports in the implementation
of health promotion activities and projects; and
vii. Establish a regional network of health promotion champions
and partners that will support the HPU carrying out its
functions.
b. Establish a Communications Management Unit under the
supervision and management of the Office of the Regional Director of
the CHD with a minimum of two (2) dedicated or designated HPOs to
perform the following communications and media-related functions:
i. Lead crisis communication within their respective jurisdiction;
ii. Develop and adopt, localize, laymanize, reproduce and
disseminate communication materials in various traditional and
emerging media platforms;
iii. Develop and implement an external relations strategy that
enhances the DOH’s brand image among various stakeholders
and ensure adherence to DOH Brand Manual at all times;
iv. Develop and implement strategies to keep DOH employees
connected to the vision, mission and values and up-to-date on
latest policies and initiatives; and
v. Manage media relations.
VIL SEPARABILITY CLAUSE
If any provision of this Order is declared invalid, unenforceable or unconstitutional, the

validity or enforceability of the remaining provisions shall not be affected, and this
Order shall be interpreted as if it did not contain the particular invalid, unenforceable, or
unconstitutional provision.
1
Fall)
REPEALING CLAUSE
All issuances inconsistent with the provisions of this Order are hereby revised, modified
or rescinded accordingly. All other provisions of existing issuances not affected by this
Order shall remain valid and in effect.
EFFECTIVITY
This Order shall take effect fifteen (15) days after its publication to the Official Gazette
or a newspaper of general circulation.
FRANCISCO T. DUQUE III, MD, MS¢

Secretary of Health
DEPARTMENT OF
SOCIAL WELFARE AND DEVELOPMENT
DEPARTMENT OF EDUCATION
COMMISSION ON HIGHER EDUCATION
LEGAL EDUCATION BOARD
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY
DEPARTMENT OF
THE INTERIOR AND LOCAL GOVERNMENT
MAR 14 2022

No. 2022 -_DDQI|
SUBJECT: Guidelines on Healthy Settings Framework in Learning

Institutions
RATIONALE
Health and education come hand in hand. Health promotion in learning institutions
maximizes the positive impact of education in Filipino learners’ development.
Conversely, education can improve health literacy and behaviour. The settings-based
approach for health promotion focuses then on learning institutions which are built
environments that provide an avenue for population-based health interventions,
age-appropriate health education, and implementation of health-promoting policies.
Pursuant to Republic Act No. 11223 or the Universal Health Care Law, the
Department of Health (DOH) through the Health Promotion Bureau is committed to
operationalizing healthy learning settings mandated under Section 30 ofthis law. The
Implementing Rules and Regulations (UHC-IRR) Section 30.6-30.10 enshrines the
DOH’s partnership with education national government agencies, particularly the
Department of Education (DepEd), Commission on Higher Education (CHED), and
Technical Education and Skills Development Authority (TESDA), in promoting
health literacy and behavioursto their respective stakeholders.
In addition to these national government agencies, the crucial role of the Department
of Social Welfare and Development (DSWD) in monitoring and providing technical
assistance to the Child Development Centers, the Legal Education Board (LEB) in
supervising legal education institutions, as well as the role of the Department of the
Interior and Local Government (DILG) in enjoining local governments to support
learning institutions are also underscored. The aforementioned agencies have varying
degrees of implementation of policies, programs, and other efforts for health
education and promotion.
In line with this, the DOH together with the aforementioned agencies issue these
guidelines that aim to promote and strengthen health in learning institutions in the
Philippines.
IL. OBJECTIVES
This Order aims to provide a framework, through the coordination of DOH, DSWD,
DepEd, CHED, LEB, TESDA, DILG, and LGUs, for the establishment and/or
strengthening of healthy learning institutions across life stages in the Philippines in
support of the UHC Law.
Specifically, it aims to:

1. Outline guiding principles for the realization of healthy learning institutions as
envisioned in the UHC Act:
2. Provide a framework for development and prioritization of healthy learning
institution programs and/or standards in accordance with existing laws; and
3. Establish a national technical working group to serve as a platform for
coordination and sharing of health promotion strategies, interventions,
recognition mechanisms, and best practices.
iy. SCOPE OF APPLICATION
This Order shall apply to the DOH, DSWD, DepEd, CHED, LEB, TESDA, DILG,
their respective attached agencies and offices, Local Government Units, learning
all
institutions under their supervision, and other concerned entities.
DEFINITION OF TERMS
A. Health - refers to a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity (World Health Organization, 1948).
B.
-
Health Promotion Framework Strategy (HPFS) refers to the 10-year national
roadmap on health promotion, which shall be the basis of implementation of
health promotion in the country, nationwide and locally.
C. Healthy Learning Institutions - refer to learning institutions that foster health
and weil-being of learners and personnel. These are learning institutions that have
met the standards to be recognized or awarded as such.
D. Learning Institutions - refer to the institutions below that provide education to

Filipino students and are encompassed by this policy:
B.1 Child Development Centers - refer to early learning centers, public or

for
private, that offer early education and/or child care programs children zero
(0) to four (4) years old, who are taught by Child Development Teacher(s)/
Worker(s).
B.2 Community Learning Centers - refer to physical spaces to house learning

resources and facilities of a learning program for out-of-school children in
special cases and adults. These are venues for face-to-face learning activities
and other learning opportunities for community development and
improvement of the people’s quality of life.
4 2
B.3 Basic Education Institutions - refer to institutions that provide basic

education or education that is intended to meet basic learning needs which
provide the foundation on which subsequent learning can be based, including
institutions that provide kindergarten, elementary and/or secondary education,
as well as alternative learning systems for out-of-school learners and those
with special needs.
B.4 Higher Education Institutions (HEIs) - refer to educational institutions,

private or public, offering CHED-recognized higher education programs.
B.S Technical Vocational Institutions (TVI) - refer to institutions, whether

public or private, offering Technical Vocational Education and Training
registered program(s). These shall include TESDA Technology Institutions,
Private Technical Vocational Institutes, Higher Education Institutions (HEIs),
State Universities and Colleges (SUCs), Local Colleges and Universities
(LCUs), Training Centers, and enterprises.
B.6 Legal Education Institutions (LEIs) - referto institutions, whether public

or private, offering LEB-registered law programs.
V. GUIDING PRINCIPLES
A. Community Participation
1. Development and implementation of policies and programs pursuant to this
Order shall ensure that all learning institution stakeholders are involved in the
decision-making processes and implementation strategies. Learning institution
stakeholders shall include but are not limited to administrators, teachers and
faculty, non-academic personnel, parents/guardians, students, non-government
organizations, and the private sector.
2. Processes shall ensure that the aforementioned stakeholders are active actors
in the institutionalization of health promotion in learning institutions.
3. The resources of the learning institution shall be maximized to encourage
institutional participation, organization, and collaboration.
B. Partnership
1. Policies and programs shall be developed through intersectoral action and
collaboration of relevant stakeholders to ensure a whole-of-system approach.
The formation of partnerships between and among members of multiple
sectors, fields, and levels shall be encouraged to facilitate the realization of
advantageous health outcomes.
2. Stakeholders shall be proactive in safeguarding public health from
partnerships with a conflict of interest, such as, but not limited to tobacco,
breast milk substitutes and other products that are marketed to replace
breastfeeding, and alcoholic beverages industries. Both financial and
non-financial interests, as defined by DOH AO 2021-0011, or the
Implementing Guidelines of Section 35 of the Republic Act No. 11223,
otherwise known as the “Universal Health Care Act”, on Standards on
Receipt, Assessment, and Management of Conflict of Interest, will be
managed accordingly so as not to influence individual health behavior and/or
implementation of programs.
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C. Empowerment
1. Policies and programs shall endeavor to empower students, parents/guardians,
teachers, personnel, and administrators to exercise contro] and elicit change
over factors that determine their setting and health outcomes.
2. Policies and programs shall enable empowerment through continuous access
to accurate, relevant, and comprehensive information, learning opportunities
and skills for health, and funding support of other policies, plans, and
programs.
D. Equity
1. Recognizing that vulnerabilities are socially determined, it is important to be
cognizant of the equity considerations and implications of policies, plans, and
programs. The needs of the marginalised shall be prioritised in the formation
of policy and programs; and implementation of such to support equity in
health and education.
2. Actions taken as part of this issuance shall contribute to reducing gaps in
health and education access, opportunity, and outcomes.
GENERAL GUIDELINES
A. As the government institutions tasked with overseeing education and educational

institutions and promoting the public’s health and well-being, DSWD, DepEd,
CHED, LEB, TESDA, DOH, and DILG shall ensure the implementation and
enforcement of set guidelines and standards for healthy learning institutions,
provide support to learning institutions in order to achieve these goals, and create
and maintain a recognition or compliance system for individual institutions to be
recognized as healthy learning institutions, in accordance with existing laws.
B. The policies, activities, and implementation of the healthy learning institutions

framework shall be in line with the six pillars of the WHO Health Promoting
Schools Framework: 1) healthy school policies, 2) physical school environment,
3) social school environment, 4) health skills and education, 5) links with parents
and communities, and 6) access to health services.
C. The goals of the healthy learning institutions framework shall be guided by the
key priority areas in the HPFS, as well as other existing health programs. The
priority areas of the HPFS are: 1) Diet and Physical Activity, 2) Environmental
Health, 3) Immunization, 4) Substance Use, 5) Mental Health, 6) Sexual and
Reproductive Health, and 7) Violence and Injury Prevention. The overarching
goal of health literacy and knowledge of health rights shall also be integrated in
the curriculum, programs, and activities of the learning institution.
D. DOH, DSWD, DepEd, CHED, LEB, TESDA, and DILG shall ensure the
promotion of health of students, faculty, and personnel especially those with
disabilities, senior citizens, pregnant and lactating women, members of indigenous
groups, indigents, rebel returnees, and members who are part of the Lesbian, Gay,
Bisexual, Transgender, Queer or Questioning (LGBTQ+) Community and other
vulnerable individuals.
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=
VIL =SPECIFIC GUIDELINES
A. Implementation Strategies
1, Streamline Healthy Learning Institutions’ Governance Structure.

a. An inter-agency National Technical Working Group on Healthy Learning
Institutions (NTWG-HLI) shall be formed to provide a platform for
coordination of health promotion strategies, development of an annual
report of health promotion in learning settings, and monitoring and
evaluation of the healthy learning institutions framework. The TWG shall
be composed of a Chair, Co-Chair, members, and secretariat from relevant
offices from DOH, DSWD, DepEd, CHED, LEB, TESDA, and DILG.
DOH
shall chair the TWG as the technical authority on health and the
NTWG-HLI shall vote on a Co-Chair.
b. Learning Institution TWGs (LITWGs) shall also be formed within the
learning institution. These TWGs shall monitor and ensure the proper
adoption and implementation of the healthy learning institutions
framework. The concerned National Government Agencies shall ensure
the provision of guidelines for the creation and establishment of LITWGs
in learning institutions under their jurisdiction.
c. As necessary, depending on the structure of the respective agency,
regional, provincial or city level TWGs may be created by the respective
NGAs, in accordance with existing laws.
2. Formulate Standards and Indicators for Healthy Learning Institutions.

a. Each Education NGA shail formulate the standards and indicators that
learning institutions under their respective jurisdictions would need to be
recognized as healthy learning institutions. These standards shall be
developed with the DOH, developed based on best available evidence and
upon consultation with public health and education experts, learning
institutions, among other stakeholders. The content of such shall follow,
is
but not limited to, the six pillars of a Health Promoting School, and the
priority areas of DOH’s HPFS, as well as education indicators. Standards
ensuring the inclusion of health literacy and knowledge of health rights in
institutional curriculum shall be integrated into the standards for
designation as a healthy learning institution.
3. Develop and Implement Assessment and Recognition Mechanisms.

a. The standards and indicators developed by the education NGA and DOH
shall serve as criteria for recognizing compliant learning institutions as
healthy learning institutions. Each Education NGA shall ensure that
assessment mechanisms and recognition/compliance schemes for their
respective education sub-sector integrating the healthy learning institutions
standards and indicators are in place. The Education NGAs shall reassess
the recognition status and compliance of learning institutions every three
years, or more frequently, as may be necessary.
i
b. DSWD, DepEd, CHED, LEB, and TESDA shall serve as the
recognition/awarding bodies for their respective learning institutions.
\
c. As mandated by the UHC Law, an annual report of the assessments and

the progress of the learning institutions shall be submitted to the President
of the Philippines, Senate President, and Speaker of the House of
Representatives.
Monitor and Evaluate the Implementation of Healthy Learning

Institutions Framework
a. The healthy learning institutions framework shall be evaluated for the
effectiveness of methods, relevance of priority areas, and the framework in
its entirety using both education and health indicators. The implementation
of the healthy learning institutions framework shall be monitored and
evaluated by the NTWG-HLI and NGAs. Each NGA shall ensure that a
Monitoring and Evaluation Plan for the healthy learning institutions
framework is in place. These may be included in the Manuals of
Procedures. Monitoring and evaluation reports generated by NGAs will be
reviewed and compiled by the NTWG-HLI.
b. The NTWG-HLI or individual agencies may conduct and/or commission
research studies for comprehensive evaluation of the framework.
c. A compendium of best practices for implementers shall be maintained by
DOH, DSWD, DepEd, CHED, LEB, TESDA, and DILG to aid NGAs and
implementers in meeting the standards and to monitor successes of local
learning institutions. This shall be maintained in accordance with Section
31 of the UHC-IRR.
. Develop Manuals of Procedures.

a. Manuals of procedures detailing the standards, indicators, enabling
mechanisms, assessment mechanisms and monitoring and evaluation plan
shall be developed by the Education NGAs. These shall be developed to be
utilized by the agencies, relevant TWGs, LGUs, and learning institutions
in the implementation of the healthy learning institutions framework.
B. Enabling Strategies
1. Ensure the Implementation of Capacity Building Activities and Integrate

the Set Indicators and Standards.
a. The DOH, DSWD, DepEd, CHED, LEB, TESDA, and DILG shall ensure
that capacity building activities that focus on the healthy learning
institutions framework for administrators, teachers, parents/guardians, and
local chief executives are in place, and must be developed should there be
no existing interventions. These activities shall support them in achieving
the aforementioned priority areas and pillars and shall make these
stakeholders aware of their role in health promotion.
Provide Technical Assistance and Support.

a. The DSWD, DepEd, CHED, LEB, TESDA, and DILG shall develop, with
technical assistance from the DOH, a compendium of best practices for the
use of learning institutions to meet the standards for healthy learning
institutions. The DOHshall enter into partnerships with DSWD, DepEd,
CHED, LEB, and TESDA to provide support to individual learning
institutions for the implementation of health-promoting activities.
3. Develop Comprehensive Health Education, Advocacy and Information

Campaigns.
a. The NGAs shall cascade relevant health information to learning
institutions, teachers groups/unions, student councils, parents associations,
and other stakeholders to facilitate the institutionalization of this
framework. This information campaign shall encourage stakeholders to
ensure the achievement of healthy learning institutions.
A. DOH shall:
1. chair the NTWG-HLI,
2. provide technical assistance and capacity-building activities to partner NGAs
in the development of their respective Manuals of Procedures and other
deliverables;
3. implement capacity-building activities to local counterparts on providing
technical assistance for the implementation of this framework;
4. monitor and evaluate the HPFS to include suggestions from the evaluation
reports of learning institutions, LGUs and other concerned bodies; and
5. prepare and submit technical and evaluation reports on the implementation of
the framework to the NTWG-HLI.
B. DSWD, DepEd, CHED, LEB, and TESDA shall:

1. formulate and/or strengthen healthy learning institution standards, assessment
mechanisms, enabling strategies for learning institutions under their
jurisdiction to be designated as healthy;
2. implement capacity-building activities for their relevant agencies, offices and
respective learning institutions on the framework and how to become
learning institution;
a healthy
3. carry out information campaigns to their relevant stakeholders and provide

guidance to their respective learning institutions for implementation of this
framework;
4. implement the relevant assessment mechanisms for designating healthy
learning institutions under their jurisdiction; and
5. prepare and submit technical and evaluation reports on the implementation of
the framework to the NTWG-HLI.
C. DILG shall:
1. collaborate with and capacitate LGUs anent the implementation of the healthy
learning institutions framework;
2. provide policy issuance to ensure LGUs participation and resource support to
the healthy learning institutions initiatives and to ensure that said information
will be cascaded to all LGUs in the country; and
3. collate and submit feedback on the framework from LGUs tothe NTWG-HLI.
D. LGUs shall:
1. coordinate with and support learning institutions to meet the relevant standards
y
for healthy learning institutions;
2. develop counterpart local ordinances to ensure compliance with national

directives at the local level and implement relevant programs, projects, and
activities;
3. enforce pertinent issuances pertaining to the maintenance of healthy learning
environments, such as Executive Order No. 326, s. 1941 entitled “Regulating
the Operation of ‘Bars,’” or Executive Order No. 26, s. 2017 entitled
“Providing for the Establishment Smoke-Free Environments in Public and
Enclosed Spaces;”
4. provide feedback and evaluation on the framework to the DILG.
E. The National Technical Working Group on Healthy Learning Institutions
aren)
develop
2. provide
the
shall:
healthy learning institutions framework;
guidelines on the appropriate content and outline of the Manuals of
Procedures to be developed by the education NGAs;
3. provide a forum for information and knowledge sharing on national and
international developments in the field of health promotion in education;
4. collate technical and evaluation reports on the implementation of the
framework and evaluate and update the framework based on these reports.
F. The Learning Institutions Technical Working Group (LITWG) shall:

1. plan and ensure the proper implementation of the learning institution’s policies
and programs to be recognized as a healthy learning institution and coordinate
with the relevant Education NGA for recognition/awarding;
2. establish partnerships with internal and external stakeholders, including LGUs,
for more resources and fund support for policies and programs;
3. ensure the proper enforcement of pertinent issuances relating to the
maintenance of healthy learning environments, such as Executive Order No.
26, s. 2017 entitled “Providing for the Establishment Smoke-Free
Environments in Public and Enclosed Spaces;” and
4. provide feedback on the framework to the relevant Education NGAs.
IX. FUNDING
All agencies shall allocate necessary funding for the implementation of this policy.
Should any provision in this Order or any part thereof be declared invalid, the other
provisions, insofar as they are separable from the invalid ones, shall remain in full
force and effect.
If
XI. EFFECTIVITY
This Order shall take effect after fifteen (15) days following its publication in a
newspaper of general circulation and upon filing three (3) certified copies to the
University of the Philippines Law Center.
EF
CISCO T.
Secretary
QUE, Ill ANDO'D- BAUTISTA
Secretary
Khe
Department of Health Department of Social Welfare and
(ay
a
E.
Rei
J. PROSPERO DE VERA DI
Secretary Chairperson
Department of Education Commission on Higher Education
SAAS
ANNA MARIE MELANIE B. TRINIDAD ISIDRO S. LAPENA
Chairperson Director General
Legal Education Board Technical Education and Skills
Development Authority
Department of the
Interior and Local
Government
of
333
on
the
an d
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
DEC 87 201
No. 2021 - 0002
SUBJECT:
National Policy Promotion Recognition
Healthy Communities
I. RATIONALE
A healthy community is one wherein all sectors and systems are in synergy to foster an
environment that is promotive and protective of health. All sectors of society share a role in
Framework
enabling health and improving the quality of life of individuals and communities. This is
further strengthened by the World Health Organization's settings-based approach to health
promotion which gives premium to the integration of multisectoral action to address risk
factors and prevent disease.
Republic Act No. 7160 or the “Local Government Code” mandates Local Government Units
(LGUs) to ensurerand support, among others, the preservation and enrichment of culture, the
promotion of health and safety, the protection of the right of people to a balanced and
healthful ecology, the development of appropriate and self-reliant technological capabilities,
the improvement of public morals, enhancement of economic prosperity and social justice,
promotion full employment among their residents, maintenance of peace and order, as well as
the preservation of the comfort and convenience of their inhabitants (Chapter 2, Section 16).
Furthermore, guided by RA No. 11223 or the “Universal Health Care Act” and Implementing
Rules and Regulations, LGUs are directed to enact strict ordinances that strengthen and
broaden existing health promotion policies and programs (Section 30.12). This is further
emphasized with the signing of Executive Order 138 on full devolution, wherein LGUs are
mandated to provide the delivery of basic services and facilities in accordance with national
policies, guidelines, and standards.
The Department of Health (DOH) recognizes the instrumental role of LGUs creating such in
health-supportive environments. As such, the DOH and the Department of the Interior and
Local Government (DILG) formulate these guidelines to implement, monitor, and evaluate
health promotion policies and programs in LGUs, as well as provide a national policy
framework on the promotion and recognition of healthy communities in the Philippines.
II. OBJECTIVES
This Order aims to
provide a policy framework on the promotion and recognition of healthy
communities. Specifically, aims to: it
1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ® Trunk Line 651-7800 local {108, 1111, 1112,
1113
Building
Direct Line: 711-9502; 711-9503 Fax: 743-1829 URL: http://www.doh.gov.ph; e-mail: fiduque@doh.gov.ph
1. in
Set guiding principles which shall guide decision-making for LGUs the development,
implementation, and monitoring of their policies, plans, and programs for health and
development.
2. Provide the framework, and strategies to operationalize the promotion and recognition
of healthy communities; and
3. Delineate roles and responsibilities of key actors of the DOH, DILG, and LGUs to
collectively contribute to the promotion of healthy communities.
III. SCOPE AND COVERAGE

This Order shall apply to DOH, DILG and their respective units, attached agencies, and
counterpart ministires in the Bangsamoro Autonomous Region for Muslim Mindanao
(BARMM) pursuant to the provisions of RA No. 11054 (Organic Law for the Bangsamoro
Autonomous Region for Muslim Mindanao), LGUs, and all other concerned entities.
1V. DEFINITION OF TERMS

A. Determinants of Health - refer to factors that have a significant influence, whether
positive or negative, on an individual or population's health, which can include
biological, physical, psychological, social, cultural, political, and economic factors,
among others.
B. Healthy Community - refers to any level of local government unit where (1) the
physical, psychological, social, political, and economic factors that make up the
environment of the population are promotive and protective of health, and where (2)
health care is available, relevant, and accessible. LGUs shall be recognized as healthy
communities when these two main characteristics of a healthy community are achieved.
C. Primary care - refers to initial contact, continuous, comprehensive, and coordinated
care that is accessible at the time of need including a range of services for all
presenting conditions, and the ability to coordinate referrals to other healthcare
providers in the healthcare delivery system.
D. Primary Health Care - whole-of-society approach to health that aims at ensuring the
highest possible level of health and well-being and their equitable distribution by
focusing on people’s needs and as early as possible along the continuum from health
promotion and disease prevention to treatment, rehabilitation and palliative care, and as
close as feasible to people’s everyday environment.
V. GUIDING PRINCIPLES
The adoption and implementation of the provisions of this Order shall be guided by the
following principles:
A. Equity
1. Recognizing that vulnerabilities are socially determined, the needs of all
population groups (i.e. infants, children, adolescents, adults, and elderly),
especially the marginalised shall be prioritised in the formation and
implementation of policy and programs, and in the delivery of basic and regular
health facility-based services to promote equity.
2. Recognizing that gender norms and biases contribute to inequities in health
outcomes, gender equity in health shall be integrated into all plans, policies,
and
programs, projects, and activities with the objective of reducing unjust
avoidable disparities between cisgender women and men, as well as gender and
sexual minorities in health status and access to health services and rights.
383
3. Actions taken as part of this issuance shall contribute to reducing disparity in

health access, opportunity, and outcomes.
B. Empowerment
I. Policies and programs shall empower individuals and communities through
continuous access to information and services that enhance knowledge, attitudes,
and skills essential in understanding and adopting healthy practices, increase
capacity and self-efficacy to change oneself and one’s environments, and
encourage participation in health and health care decisions and activities.
2. LGUs and partner organizations that empower communities through their health
promotion interventions shall likewise be provided with technical and/or funding
support.
C . Community participation
1. Community involvement shall be institutionalized in local decision-making and
problem-solving processes for health, including in the development,
implementation, monitoring and evaluation of policies, plans, and programs.
2. Community resources shall be maximized to encourage community participation,
organization, and collaboration within and among communities.
D. Partnership
1. Policies and programs shall be developed through partnerships, intersectoral
action, and collaboration with relevant stakeholders from multiple sectors, fields,
and levels in order to ensure a whole-of-system approach in the operationalization
of this Order.
2. Policies and programs developed through partnerships and engagements shall

conform with our treaty obligations, domestic laws, rules and regulations
promoting and safeguarding public health from commercial interests. LGUs shall
adopt rules and policies that give effect, strengthen, and uphold our existing treaty
commitments promoting Filipinos' right to health.
VIL GENERAL GUIDELINES
A. All policies, programs, and activities to be developed for the promotion and recognition
of healthy communities shall be guided by the Healthy Communities Framework
provided in this Order.
An LGU shall be recognized as a Healthy Community if it is able to foster a health
promoting environment and ensure a responsive local health system.
The DOH and DILG shall ensure the implementation and enforcement of the Healthy
Communities Framework. The LGUs, mandated to provide the delivery of basic
services and facilities as well as promote and protect the welfare of their constituents,
shall be provided with support to operationalize the key strategies to create healthy
communities.
The strategies essential in the promotion of a healthy community shall be contextually
implemented in cities and metropolis, rural areas, Indigenous Cultural Communities/
Indigenous Peoples (ICCs/IPs), and Geographically Isolated and Disadvantaged Areas
(GIDA) and/or other socially, politically, economically depressed locations. The same
shall be contextually implemented in different settings within the community including,
but not limited to, local villages, island communities, workplaces, schools, health
facilities, prisons, and food marketplaces.
The DOH and DILG shall convene the relevant National Government Agencies
the
(NGAs), institutions, and organizations in operationalizing the strategies addressing
physical, psychological, social, political, and economic determinants of health for a
collaborative approach in promoting healthy communities.
VIL SPECIFIC GUIDELINES
A. The Healthy Communities Framework rests on two main pillars:
1. Health-Promotiing Environment. The physical, social, political, and economic

qualities that make up the environment of the local population shall be promotive
and protective of health. These qualities include:
a. Sustainable and resilient food systems that ensure food security; safe,
nutritious, and accessible food, clean and potable drinking water;
b. Open public spaces and infrastructures that promote active mobility, physical
activity, and leisure; and safe road use;
Clean and sustainable natural and built environments;
Smoke-free, vape-free, and drug-free environments that are conducive to
healthy growth and aging.
Affordable, accessible, and livable housing, shelter, or settlement;
Accessible and quality education that promote health literacy and knowledge
of health rights;
Living wages and income for a reasonable quality of life, and public support
for individuals who are unable to work or secure jobs;
Supportive environments that protect and promote local heritage and culture,
and that preserve cultural, historical, and indigenous significance of the
community; and
Safe neighborhoods from violence; and inclusive and harmonious for all ages,
genders, sexual orientations, social status, among others.
2. Responsive Local Health System. In addition to living, schooling, and working

environments that are promotive and protective of health, local health systems
shall be strengthened to be able to respond to health needs. A responsive local
health system shall ensure:
a. Efficient and quality essential health services, with emphasis on primary care,
backed up by secondary and tertiary levels of health services, are available and
accessible;
Availability and accessibility of essential health services to all community
members; and
Equitable health financing, thai no community member faces financial
hardship in seeking health services.
B. Guided by the action areas of the Ottawa Charter for health promotion, provided are the
key strategies that lead to the realization of the Healthy Communities Framework:
1. Developing Healthy Public Policies

a. Policies, programs, activities, and other interventions enacted or implemented
by LGUs and/or relevant NGAs for the promotion of healthy communities
within their respective jurisdictions shall prioritize the following: the reduction
of the prevalence of tobacco use, the reduction of the burden of alcohol use,
the reduction of incidence of communicable diseases and prevalence of
non-communicable diseases, addressing mental health issues, and the
improvement of health indicators.
b. Guided by the Health Promotion Framework Strategy, LGUs are enjoined to

implement health promotion interventions anchored on the priority areas: Diet
and Physical Activity, Environmental Health, Immunization, Substance Use
(reducing the prevalence of tobacco use and burden of alcohol and illicit drug
use), Mental Health, Sexual and Reproductive Health, and Violence and Injury
Prevention.
Building Supportive Environments

a. Relevant NGAs shall endeavor to incorporate health considerations in their
respective sectoral activities, by assessing the potential impacts of their
sectoral public policies, programs, and projects to health and its determinants.
LGUs shall likewise ensure the protection and preservation of their local
natural and built environments, by assessing the potential impacts to health
and its determinants, of development or infrastructure projects proposed for
implementation in their local communities.
Developing Personal Skills
a. LGUs, in collaboration with local academic institutions or other civil or non-~
governmental organizations shall conduct an assessment of the community
members’ literacy and knowledge, attitudes, and practices relevant to health.
Results of these assessments shall inform development and implementation of
evidence-based and targeted interventions on health promotion.
Guided by the results of the assessments, health literacy interventions, such as
social and behavioral change communication, shall also be implemented to
complement other health promotion interventions. These shall capacitate the
target audiences by strategically addressing identified gaps in knowledge,
attitudes, skills, and practices to improve health-related decision-making and
health-seeking behaviors.
Strengthening Community Action and Participation
a. The LGUs and partner communities, in collaboration with local academic
institutions or other non-governmental or civil society groups, shall conduct
participatory research or other data collection activities to co-generate
evidence and inform local policy and decision-making on health. Evidence
derived from community’s knowledge and lived experience shall form part of
the research output and presented on par with inputs of technical experts.
The LGUs shall also ensure that communication lines are provided, accessible,
active, and responsive in order to encourage feedback from the community
and enable reporting of questions and concerns related to local policies and
programs on health and its determinants.
S. Reorienting Health Services
a. The DOH, LGUs, relevant organizations shall increasingly shift efforts towards
health promotion and disease prevention by developing and implementing
proactive, effective, and evidence-based health promotion interventions.
LGUs shall ensure continuous capacity development, provision of just and
commensurate compensation, benefits, other forms of support, and dignified
and safe working conditions for community health workers and volunteers.
C. Implementation Mechanisms
1. Governance Structure
a. A Technical Working Group shall be convened by the DOH and DILG, for the
purpose of this Order. The Healthy Communities Technical Working Group
(HC-TWG) shall oversee the planning, implementation, and enforcement of
the Healthy Communities Framework.
The DOH shall chair the HC-TWG, with the DILG as co-chair, and relevant
NGAS
as sitting members.
Capacity Development
a.The DOH shall lead the provision of capacity development, and necessary
technical assistance and/or financial support to LGUs, relevant NGAs,
institutions, and organizations to assist in their operationalization of the key
strategies of the Healthy Communities Framework such as: building healthy
public policy, creating supportive environments, developing personal skills,
strengthening community action, and reorienting health services.
The DILG shall facilitate the provision of said capacity building initiatives to
the local governments.
Standards and Indicators
a. The standards and indicators for recognizing LGUs as healthy communities
shall be developed by the HC-TWG for the purpose of this Order.
b. Data for the standards and indicators shall be sourced from existing relevant
information systems, subject to the relevant provisions of the Data Privacy Act
and proprietary rights of the developers.
Monitoring and Evaluation

a.A Monitoring and Evaluation Plan for the Healthy Communities Framework
shall be provided in the Healthy Communities Manual of Procedures to be
developed by the HC-TWG.
LGUs shall submit an annual report to the DILG, copy furnished the DOH,
containing the health promotion policies adopted and programs undertaken, as
well as an assessment of the impact thereof.
Recognition
a. The DOH and DILG shall serve as the recognition/awarding bodies for LGUs
to be recognized as healthy communities based on the standards and indicators
set by the HC-TWG.
A platform for sharing of good practices shall be provided for LGUs to be
maintained by the DOH.
Manual of Procedures
a. A Manual of Procedures (MOP) detailing the governance structure, capacity
development, standards and indicators, monitoring and evaluation plan, and
recognition shall be developed by the HC-TWG. The HC-TWG shall
continually update the MOP as necessary and upon consultation with relevant
stakeholders.
LGUs shall utilize this Manual of Procedures in the implementation of the
Healthy Communities Framework.
Vil. ROLES AND RESPONSIBILITIES

A. The Department of Health (DOH) shall:
1. Chair the HC-TWG, unless otherwise determined by the special technical
working group;
2. Formulate policies, standards, guidelines, other references on health promotion
and Local Health Systems, including but not limited to the National Objectives
for Health, LGU Health Scorecard, HPFS, Playbooks, etc.;
Provide technical and financial assistance to Local Government Units in the
implementation of national health promotion policies, programs, and projects;
Provide technical assistance in enhancing local health system capacity, and
achieving the minimum components of primary health care systems as stipulated
in RA 11223.
Lead in the monitoring and evaluation of Local Health System capacity inclusive
of the implementation of health promotion policies, programs, and projects
across LGUs.
B. The DOH Centers for Health Development (CHDs) shall:

1. Cascade to the LGUs policies, standards, guidelines, other references on health
promotion;
2. Provide technical assistance to LGUs in the implementation of policies and
programs on health promotion, and in the planning, design, and implementation
of communication plans and activities;
Ensure functional coordination with DILG in providing technical assistance to
LGUs; and
Regularly monitor the implementation of health promotion policies, programs,
and projects among the LGUs within the region.
C. The DILG shall:
1. Co-chair the HC-TWG, unless otherwise determined by the special technical

working group;
2. Share relevant available data from existing information systems with the
HC-TWG for the standards and indicators of healthy communities;
Promote among LGUs the adoption of national policies, programs, and projects
on health promotion;
Ensure functional coordination with CHD in providing technical assistance to
LGUs; and
Assist in the monitoring and implementation of health promotion policies,
programs, and projects in LGUs.
D. The Healthy Communities Technical Working Group (HHIC-TWG) shall:

1. Develop implementation strategies for the promotion and recognition of healthy
communities;
2. Develop policies and standards for the implementation of the Healthy
Communities Framework;
Develop targets for monitoring and evaluation of the implementation strategies
for healthy communities;
4, Develop the recognition mechanisms for LGUs to be recognized as healthy

communities;
5. Coordinate with relevant NGAs and LGUs on plans for healthy communities and
other related policies, programs, activities, and services; and
6. Provide technical assistance for healthy communities plans, policies, programs,
activities, and services.
E. LGUs shall:
1. Adopt national policies, programs, and projects on health promotion, and develop
counterpart local ordinances to ensure alignment with national direction;
2. Lead in the implementation of health promotion policies, programs, and projects
at the local level;
3. Coordinate with the CHD and DILG in carrying out the health promotion
policies, programs, and projects;
4. Regularly monitor the implementation of local level health promotion policies,
programs, and activities;
5. Endeavor to establish a databasc to guide planners in coming up with timely
decision; and
6. Submit an annual report on the policies adopted and programs undertaken, and an
assessment of the impact thereof to the DILG and copy furnished to the DOH, as
mandated by the UHC Law.
Other related issuances not consistent with the provisions of this Order are hereby revised,
modified, or rescinded accordingly. Nothing in this Order shall be construed as a limitation or
modification of existing laws, rules and regulations.
Should any provision of this Order or any part thereof be declared invalid, the other
provisions, insofar as they are separable from the invalid ones, shall remain in full force and
effect.
XI. EFFECTIVITY
This Order shall take effect fifteen (15) days after publication to an official gazette or
newspaper of general circulation.
|
FRANC IFCO T.
/ Vv
0
ad PUQUE, 111, MD, MSc
Secretary
® 2
DILG-OSEC 1201202100)
Republic
y
of the Philippines
.
AUG 04 2020
No. 2020-0036
SUBJECT: Guidelines on the Institutionalization of Disaster Risk Reduction and
Management in Health (DRRM-H) in Province-wide and City-wide
Health Svstems -
I. RATIONALE
With the constant threat of emergencies and disasters in the country and their resultant
negative health consequences, Republic Act (RA) 10121 or the “Philippine Disaster Risk
Reduction and Management Act of 2010” and the Implementing Rules and Regulations
(IRR) of RA 11223, “Universal Health Care Act” stress the need to adopt an integrated
disaster risk reduction and management (DRRM) and climate change mitigation and
adaptation approach and to develop province-wide and city-wide health systems
(P/CWHS) with timely, effective, and efficient preparedness and response public health
emergencies and disasters; thus ensuring delivery of essential population-based health
to
services.
Further, the National Objectives for Health (2017-2022) espouses the development of
resilient health systems to manage health risks brought about by natural, biological,
technological and societal hazards. To support this, Administrative Order (AO) No. 2019-
0046 or the “National Policy on Disaster Risk Reduction and Management in Health”
provides strategies for the institutionalization of disaster risk reduction and management
in health (DRRM-H) at all levels of the health system.
To ensure that DRRM-H becomes an integral part of the health systems management and
service delivery functions of P/CWHS, the DOH hereby issues this Order to guide the
local government units (LGUs) in
the institutionalization of DRRM-H in P/CWHS.
Il. OBJECTIVES
A. General Objective
This Order shall provide guidance to LGUs, and key stakeholders in the
institutionalization of DRRM-H in P/CWHS.
B. Specific Objectives:
1. Provide an operational framework on the institutionalization of DRRM-H in

P/CWHS.
2. Define the scope and minimum level of functionality of an institutionalized
DRRM-H
in
a P/CWHS.
/va
Nee
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
LVM
7
aah
By
3. Identify relevant activities, mechanisms and resources to support the

institutionalization of DRRM-H in a P/CWHS.
4. Delineate the roles and responsibilities of key stakeholders on DRRM-H
institutionalization leading towards the development ofresilient health systems.
Hil. SCOPE OF APPLICATION
This policy shall apply to LGUs with public and private healthcare facilities; DOH
Central Office (DOH-CO), DOH-Centers for Health Development (DOH-CHDs), DOH
Hospitals, and DOH attached agencies; National Government Agencies (NGAs); local
_
and international Non-government Organizations (NGOs). This AO shall also cover the
Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) as provided for in
RA 11054 “Organic Law for the BARMM.”
IV. GUIDING PRINCIPLE
*Prevention and
Mitigation
*Preparedness
eResponse
*Recovery and
«Governance
*Service Delivery
*Resource
Management and
Mobilization
*DRRN-CH
Plan
*Health Emergency
Response Team
eHealth Emergency
Commodities
.
*Medical and
Public Health
*Nutrition
«Water Sanitation
and Hygiene
i
4 ff
|
Uninterrupted
Delivery of
Essential
Health .
ervices In
-
S
NO
|
S
Rehabilitation eInformation and *Functional *Mental Health and
Emergencies
!
Operation Center
«
Knowledge Psychosocial
}
and Disasters
|
Management or Emergency Support |
i Operation Center |
A ™, va en,
Figure 1. Operational Framework of DRRM-H Institutionalization into P/CWHS
Using the above operational framework, the institutionalization of P/CWHS shall

guarantee the uninterrupted delivery of essential health services during emergencies
and disasters. To contribute to the resiliency of health systems, objectives set in each
of the thematic areas of DRRM-H (prevention and mitigation, preparedness, response,
recovery and rehabilitation) have to be addressed. These can be concretized by the
conduct of core DRRM-H processes namely governance, service delivery, resource
management and mobilization and information and knowledge management. These
then are translated to the functionality of the DRRM-H system at the P/CWHS level as
evidenced through the following indicators: DRRM-H plan, health emergency response
teams, health emergency commodities; and a functional operations center.
Concomitantly, this should allow for the means and resources to deliver health sector
cluster services in emergencies and disasters: Medical and Public Health; Nutrition;
Water, Sanitation and Hygiene; and Mental Health and Psychosocial Support.
A hhe
“
» e
A. The P/CWHS shall institutionalize a functional DRRM-H System as key feature of

Universal Health Care managerial, technical and financial integration.
B. The P/CWHS shall install critical initiatives and operational mechanisms on the
DRRM-H core processes: Governance, Service Delivery, Resources Management
and Mobilization and Information and Knowledge Management.
The P/CWHS shall secure sustainable investments on DRRM-H to
outcomes and ensure efficient and equitable use of health resources.
improve health
In case of the BARMM, the adoption of

the integrated P/CWHS shall
accordance with Article [IX Section 22 of RA 11054 and subsequent laws and
be in
issuances as enacted by the Bangsamoro Government.
VI. IMPLEMENTING MECHANISMS _.

A. Managerial Integration in a Functional DRRM-H System
1. Implementation arrangement on institutionalizing DRRM-H system in
the P/CWHS
a. Institutionalization of a functional DRRM-H system shall be covered in
all phases of implementation arrangements of P/CWHS and integrated
within their Health Care Provider Networks (HCPN), based on AO No.
2020-0021 or the “Guidelines on Integration of Local Health Systems
into Province-wide and City-wide Health Systems,” to include a separate
compliance of minimum requirements for sub-provincial health system.
b. The P/CWHS shall enact through appropriate ordinances the adoption of
DRRM-H and mechanisms of cooperative undertakings, among LGUs
and their partners from the government or non-government
organizations, and/or private sector among others, to include pooling and
sharing of resources within the network to ensure effective and efficient
delivery of essential health services especially in emergencies and
disaster situations.
c. The Provincial/City Health Office under the stewardship of the
Provincial/City Health Board shall be responsible for the integration and
supervision to organize and manage the institutionalization of DRRM-H
in its P/CWHS, at the same time also represent the health sector in
relevant DRRM activities. A DRRM-H Manager shall be appointed to be
responsible for the development, improvement and overall management
of the DRRM-H Program
d. The P/CWHS performance shall be monitored based on latest standards
expected of LGUs based on AO No. 2019-0027 or the “Guidelines on the
Implementation of the LGU Health Scorecard,” the Local Health System
Maturity Model (LHSMM) guidelines, both its revisions and other
relevant issuances.
e. The Provinces and Cities that have not committed to the P/CWHS, shall
adopt the standards and provisions stipulated in AO 2019-0046.
vy Ww
2. Minimum requirements of a functional DRRM-H System in the

P/CWHS
a. P/CWHS shall institutionalize its DRRM-H
1.
it
and render functional.
DRRM-H Plan shall be unified (combined and agreed inputs of
the province, component cities and municipalities or the Highly
Urbanized Cities/ Independent Component Cities and their
barangays); comprehensive; and coherent (demonstrates
consistency in the convergence of efforts and network
arrangement).
ii. Health emergency response teams for public health and hospitals
shall
iii.
be organized, trainedand self-sufficient.
Essential health emergency commodities shall be available and
accessible along with an equipped, servicing ambulance or
patient transport vehicle and arrangement for a field
implementation facility.
iv. Functional Health Operations Center under the management and |
supervision of the Provincial/City Health Office

b. The minimum standards set in the LGU Scorecard and its monitoring
tools shall apply unless inconsistent with the requirements herein stated.
Checklists and monitoring tools shall be developed for its appraisal
separate from this issuance.
B. Technical Integration in a Functional DRRM-H System

The institutionalized DRRM-H P/CWHS shall be functional with guidelines and
procedures, mechanisms, resources and relevant activities.
1. P/CWHS shallstrengthen governance and drive better execution through

leadership and management capacities, coordination, and support
mechanisms necessary to enhance functionality.
a. Develop local ordinances or adopting policies, strategies and
commitment on DRRM-H P/CWHS
b. Organize a planning committee to formulate the P/CWHS strategic
DRRM-H Plan, as well as contingency plan, public service continuity
plan, communication and promotion plan among others.
Adopt an Incident Command System with structure and with defined
roles and responsibilities for command and control, coordination, and
communication.
Organize/strengthen functional local clusters on medical and public
health, nutrition, water sanitation and hygiene, and mental health and
psychosocial support.
Strengthen coordination with the local DRRM Office and forge
partnerships (public and private) with other stakeholders.
Develop and implement local monitoring and evaluation mechanisms
such as program implementation review and generating insights from
post-incident evaluations among others, and use of findings for policy
recommendation and program standardization and development.
Implement promotion and advocacy activities e.g. awards and
recognition of best practices, disaster risk communication and DRRM-
H campaigns.
2. P/CWHS
in public health emergencies and disasters, shall ensure the
availability and accessibility of essential quality health products and services
to the affected population at appropriate levels of care of the HCPN and /or
of the Apex Hospital.
a. Ensure primary health care providers and health facility workers shall
effectively and efficiently engage the resources of the P/CWHS
navigate affected population within the appropriate levels of the HCPN
to
or outside the network as necessary.
Deliver uninterrupted essential health services in a coordinated and
seamless manner as per AO No. 2017-0007 or the “Guidelines and
Standards on the Delivery of Essential Health Servicesin Emergencies
and Disasters” and its revisions while maintaining synchronized
response operations to include but not limited to local epidemiology
surveillance, disease prevention and control, health promotion and the
disaster risk reduction and management.
Establish mass casualty management approach which includes pre-
established procedures for resource mobilization, field management or
pre-hospital care in the management of affected population.
Reorganize management
emergencies and
of resources of the P/CWHS in responding to
disasters, while maintaining resource-sharing to non-
P/CWHS sites (“twinning’’).
Guarantee safety in the health facility through Administrative Order No.
2013-0014, “Policies and Guidelines on Hospitals Safe from Disaster”
and its revisions.
3. P/CWHS shall ensure reliable access to DRRM-H P/CWHS resources

through effective and efficient management and mobilization.
a. Develop manual of operations/process algorithms, as applicable based
on structure and arrangements in the P/CWHS.
b. Strengthen systems at the P/CWHS such as in logistics management,
e.g. contracting health supplies and services, utilizing local disaster risk
reduction and management fund; learning and development to improve
competencies of DRRM-H responders and workers; staffing needs to
address surge requirements.
Develop strategies for continuity of health services and mechanisms for
response and early recovery.
P/CWHS shall develop information and knowledge management systems to

serve as foundation for assessing, monitoring, analyzing and forecasting risk
trends, bolstering early warning systems, planning responses, coordinating
various actors and resources available during response, monitoring the
coverage of the various interventions, and evaluating performance.
a. Establish a functional Public Health Operations Center (PHOC)
P/CWHS' and maintain its counterpart in hospitals
at the
and
cities/municipalities for an effective and efficient command and control,
coordination, and communication; and dispatch.
Utilize a functional information/knowledge management system to
gather and utilize information (e.g. hazard, risk profiles, sex and age
disaggregated data, etc.) systematically as basis for decision making of
critical actions and services needed during crises, as well as in research
Oy
c. Upgrade and regularly update the reporting system on DRRM-H

capture and document post mission/action activities, lessons and
to
utilization of results to improve future implementation.
C. Financial Integration in a Functional DRRM-H System

1. P/CWHS in public health emergencies and disasters shall deliver population-
based health services financed by the government at the point of service.
Services not categorized as population-based such as hospitalization due to
trauma and other illnesses shall automatically be covered under individual-
based health services which shall be financed primarily through pre-payment
2.
mechanisms of Philhealth.
The P/CWHS Special Health Fund shall include financial resources for
establishing and sustaining a functional DRRM-H system.
3. P/CWHS shall invest on DRRM-H, and establish or enhance contingency
_ funding for disasters, through Local Investment Plan for Health (LIPH) and
other sources.
a. The participating LGUs shall commit to specify in its LIPH and annual
operational plans the resources necessary for the implementation of a
functional P/CWHS DRRM-H system.
b. The LGU shall earmark through an ordinance
a
portion of its
local health
budget to finance the institutionalization of a DRRM-H system and
strengthen its institutional capacities including the use of the Special
Health Fund for emergencies and disaster situations. Allocation of funds
and resources for DRRM-H shall be 70% for preparedness and 30% for
response activities.
c. In cases wherein participating LGUs opt to organize a sub-provincial
health system, the LGUs shall also submit a separate consolidated
investment plan for their network to the Provincial Health Board as an
input to the LIPH.
d. Other financing for DRRM-H and other sources such as but not limited
to donations, grants, and other forms of technical assistance shall be
identified in the aforementioned investment plan.
VIT. MONITORING AND EVALUATION
A. Specific policy statements shall have an equivalent Standard Operating Procedures

(SOPs) with a corresponding biennial report analysis of its adaptation and
implementation. Otherwise, this policy and its succeeding SOPs may be revised
accordingly based on new evidence, local and international developments on health
emergencies and disasters and actual experiences.
B. Ensure the institutional, operational monitoring and evaluation of DRRM-H in all levels
of governance, as well as in the P/CWHS.
C. Monitoring and formulating strategies shall be established to make LGUs, particularly

the P/CWHS perform better such as provision of incentives, conferment of awards or
recognition on good performance, or
publication of performance status.
ie
VIII. ROLES AND RESPONSIBILITIES OF KEY AGENCIES
A. Department of Health
1. The Health Emergency Management Bureau shall formulate policies and standards,
develop systems, and provide capability building interventions and other technical
assistance to CHDs including conduct of monitoring and evaluation.
2. Other Offices identified in AO No. 2019-0046 shall perform their corresponding
mandates as stipulated, in the P/CWHS.
3. The CHDs and its DOH Hospitals, shall adopt and cascade the national policies and
standards, and through its
Surveillance
DRRM-H Managers, trained Program Managers,
Officers, Health Education Promotion Officers and
Epidemiological
Development Management Officers provide the necessary technical assistance to
P/CWHS, especially, to spearhead the advocacy and promotion of DRRM-H
institutionalization.
B. Ministry of Health- Bangsamoro Autonomous Region in Muslim Mindanao
.-
(MOH-BARRM)
This Office shall adopt and cascade national policies and standards and shall
provide necessary technical assistance to its LGUs.
C. National Disaster Risk Reduction and Management Council Members

1. The NDRRMC or the National Council, in representation of all its members, shall
support DOH in itsinitiative in building and developing resilient health systems
and communities.
2. Together with DOH, make available support mechanisms, such as policies, to
facilitate institutionalization and integration of DRRM-H Planto
relevant plans.
3. Support the DOH in the conduct of monitoring and evaluation of P/CWHS with an
institutionalized DRRM-H system.
D. Department of
Interior and Local Government
Support the integration of local health systems into P/CWHS through mechanism
of cooperative undertakings among the LGUs and partners.
E. P/CWHS through the LGUs

1. Ensure managerial, technical and financial integration through their Provincial/City
Health Officers to enforce the implementation of P/CWHS functional DRRM-H
System and provide the needed resources and support mechanisms to make the
integration possible and sustainable.
2. Ensure compliance with the latest standards on DRRM-H.
Go
Together with the local Disaster Risk Reduction and Management Council/Office
and Public Health Units, Epidemiological Surveillance Units and Health Promotion
Units deliver the expected DRRM-H function, essential health service and products
in all phases of emergency/disaster.
Mn
Participate in the capacity and capability building activities.
Promote and advocate DRRM-H through various platforms applicable and
accessible in the respective LGUs.
6. Implement mechanisms to monitor and evaluate initiatives on the program and
report progress.
7. Collaborate and build DRRM-H capacities of P/CWHS through viable partnership.
OO’ Mio
'
8. Ensure the use and management of the Special Health Fund for DRRM-H activities.
9. Invest and upgrade systems on DRRM-H supported by the LIPH, Special Health
Fund and the local DRRM fund of the local government.
F. Private Institutions, Non-government Organizations, Civil Society Organizations

Engage in HCPN through provision of essential public health and hospital services;
and resource sharing.
The provisions from Administrative Order 168 s. 2004 and other related issuances that
are inconsistent or in contrary to this Order are hereby amended and modified
accordingly. Furthermore, all provisions of existing related issuances which are not
in
affected by this Order shall remain valid and effect.
X. EFFECTIVITY
This Order shall take effect immediately following its publication in a newspaper of
general circulation.
ecretary Of Health
Wie
361
UNIVERSAL HEALTH CARE

KALUSUGAN AT KALINGA PARA SA LAHAT


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1

COMPENDIUM OF UNIVERSAL HEALTH CARE POLICIES

All rights reserved.

Roland Philip C. Javier, RMT, MPH

Message of the Secretary of Health ix

CHAPTER 1: FRAMEWORK AND MANDATES OF UNIVERSAL HEALTH CARE 1

CHAPTER 2: ORGANIZING THE LOCAL HEALTH SYSTEM 103

CHAPTER 3: UTILIZING LOCAL HEALTH SYSTEM MANAGEMENT TOOLS 177

CHAPTER 4: ENHANCING PRIMARY CARE SERVICES 239

Rules and Regulations Governing the Licensure of Primary Care Facilities

CHAPTER 5: DELIVERING POPULATION-BASED AND INDIVIDUAL-BASED

Guidelines on the Institutionalization of Disaster Risk Reduction

This Compendium embodies a compilation of UHC policies and operational

FRANCISCO T. DUQUE III, MD, MSc

MARIO C. VILLAVERDE, MD, MPH, MPM, CESO I

We enjoin everyone to maximize the use of this Volume 1 of the Compendium

FRANCES ROSE ELGO–MAMARIL, MPH

MANDATES OF UNIVERSAL HEALTH CARE

• An Act Instituting Universal Health Care for All Filipinos, Prescribing

• Implementing Rules and Regulations of Republic Act No. 11223

IMPLEMENTING RULES AND REGULATIONS

RULEI. GENERAL PROVISIONS

Section 2. Declaration of Principles and Policies

Section 4. Definition of Terms

4.6. Complementation/complement — Refers to a strategic partnership of two or more

4.11. Essential health benefit package - Refers to a set of individual-based entitlements

4.12. Financial integration - Refers to the consolidation of financial resources exclusively

4.14. Geographically Isolated and Disadvantaged Areas (GIDAs) - Refer to barangays

4.15. Health care provider - Refers to any of the following:

about the health status of

4.17. Health Maintenance Organization (HMO) - Refers to

4.18. Health Technology Assessment (HTA) - Refers to the systematic evaluation of

4.19. Indirect contributors -

4.21. Managerial integration - Refers to the consolidation of administrative, technical and

4.23. Population-based health services - Refer to interventions such as health promotion,

4.25. Primary care - Refers to initial-contact, accessible, continuous, comprehensive and

4.29. Prospective payment - Refers to a method of reimbursement in which payment based is

4.30. Public health emergency - Refers to an occurrence or imminent threat of an illness or

4.31. Recidivist - Refers to one who, at

RULE I. UNIVERSAL HEALTH CARE (UHC)

Section 5. Population Coverage

Section 6. Service Coverage

Immediate Eligibility to Benefits

6.2. The DOH

Comprehensive Outpatient Benefits

Provision of Primary Care Providers

Registration of Filipinos to Primary Care Provider Networks

Section 7. Financial Coverage

7.2. The national government shall support LGUs in

7.3. Individual-based health services shall be financed primarily through prepayment

RULE ITI NATIONAL HEALTH INSURANCE PROGRAM

Section 8. Program Membership

Section 9. Entitlement to Benefits

admitted in any basic or ward accommodations.

9.8. Members who optfor admissions in non-basic or non-ward accommodations may be

9.9. PhilHealth shall issue guidelines to operationalize the no co-payment policy.

Co-Payments and Co-Insurance

9.13. Existing benefit packages shall continue to be implemented or enhanced unless

Section 10. Premium Contributions

Year Premium Income Floor Income Ceiling

2019 2.75 % Php 10,000.00 Php 50,000.00

2020 3.00 % Php 10,000.00 Php 60,000.00

2021 3.50 % Php 10,000.00 Php 70,000.00

2022 4.00 % Php 10,000.00 Php 80,000.00