Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

August 6, 2021

DEPARTMENT MEMORANDUM
No. 2021 - ________

TO: ALL UNDERSECRETARIES; ASSISTANT SECRETARIES;

DIRECTORS OF CENTER HEALTH DEVELOPMENT,
BUREAUS, AND SERVICES; MINISTER OF HEALTH -
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
(MOH-BARMM); EXECUTIVE DIRECTORS OF SPECIALTY
HOSPITALS; CHIEF OF MEDICAL CENTERS, HOSPITALS,
AND SANITARIA; AND OTHERS CONCERNED

SUBJECT: Interim Guidelines for the Continuous Operations and Services of

Hemodialysis

I. RATIONALE

Hemodialysis (HD) remains to be an important intervention especially for patients

with End Stage Renal Disease (ESRD). Around 94% of ESRD patients need hemodialysis
sessions. In the current pandemic situation, HD patients, which usually have multiple
comorbidities, are part of the vulnerable population because of their high mortality rates for
COVID-19. HD treatment for these patients should continue despite community quarantine
restrictions. Hence, it is essential to ensure access to quality and safe dialysis services in HD
facilities.

In view of this, the DOH hereby issues these guidelines to ensure the continuity of
dialysis operations in hospital-based and stand-alone hemodialysis clinics during the
COVID-19 pandemic. The inclusion of public and private HD facilities in the Health Care
Provider Network (HCPN) aims to increase access to safe and quality dialysis services for
persons needing renal replacement therapy. An Administrative Order on the final guidelines
will follow.

II. SCOPE OF APPLICATION

These guidelines shall cover all private and public licensed Hemodialysis facilities,
whether hospital-based or Stand-alone, DOH Centers for Health Development, including the
Bangsamoro Autonomous Region of Muslim Mindanao.

III. GUIDELINES

To ensure the continuous operations and services of all private and public DOH
licensed Hemodialysis facilities, whether hospital-based or stand-alone, the following
concerned offices shall perform the following:

A. Centers for Health Development (CHDs) shall:

1. Create an inventory of hemodialysis facilities in their respective regions, including the
operating hours and capacities;
2. Monitor the functionality of the HCPN which should include the hospital-based and
stand-alone HD facilities in the province/ Highly Urbanized City;

Building # 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila • Trunkline: 651-7800 local 1113, 1108, 1125
Directline: 7119502; Telefax: (632) 7431829; 7431786 • URL: http://www.doh.gov.ph ; E-mail: ftduque@doh.gov.ph
 3. Conduct root cause study for HD facilities that stopped its operations;
4. Support DOH hospitals in sending their HRH for appropriate training;
5. Fast-track the approval of license ;
6. Assist both public and private hemodialysis facilities in planning for dialysis
requirements. An estimated demand of Hemodialysis Chairs for each region is
presented in Annex A.
7. Assist the Local Government Units (LGUs) to:
a. Include HD facilities in the HCPN of their respective catchment areas;
b. Fast-track the approval of necessary LGU permits for HD facilities;
c. Strengthen the referral system from primary and tertiary facilities to HD
facilities ensuring the efficient coordination across the health care facilities.
d. Ensure the availability of transportation for the LGU health workers in their
locality
8. Monitor the compliance of hemodialysis facilities to Department Memorandum No.
2020-0168 entitled, “Interim Guidelines for Dialysis Centers Catering to Suspect,
Probable, and Confirmed COVID-19 Cases”, and Department Circular No.
2020-0162 entitled, “Directive for the Continuous Operations of Dialysis Facilities in
the Philippines During the Enhanced Community Quarantine in light of the
Coronavirus Disease 2019 (COVID 19) Outbreak”

B. DOH hospitals especially those identified in Department Order No. 2021-0001 as

Specialty Centers for Renal Care shall:
1. Operate their hemodialysis centers 24/7 (24 hours, Monday-Sunday);
2. Facilitate the licensing requirements for additional hemodialysis chairs by:
a. Procuring the required equipment and supplies;
b. Negotiating with the service provider if the HD facility is outsourced or on
public-private partnership;
3. Support the training of human resources for health
a. If the hospital is a training institution, open training courses and prioritize the
HRH from regions or provinces where the demand for hemodialysis is high.

C. Health Facilities Enhancement Program of the DOH shall:

1. Support the upgrading of DOH hospitals identified as Specialty Centers for Kidney
Care; and
2. Endeavor to upgrade the existing and support the establishment of hemodialysis
facilities in DOH hospitals.

For your information and strict compliance.

By Authority of the Secretary of Health

LEOPOLDO J. VEGA, MD, FPCS, FPATACSI, MBA-H

Undersecretary of Health
OIC- Administration and Finance Management Team

Office HFDB HFIDT

Initial MA. THERESA G. VERA, MD, MSc, MHA, CESO III LILIBETH C. DAVID, MD, MPH, MPM, CESO I
Director IV Undersecretary of Health

Date

Keywords Hemodialysis Network, Hemodialysis, Covid-19,

Related Issuances Department Memorandum No. 2020-0168, Department Circular No. 2020-0162
Annex A: Estimated Demand for Hemodialysis Chairs per Region

Estimated
Estimated
Estimated No. of No. of HD
No. of HD
HD chairs Chairs 2017 Data on
Estimated No. Chairs
Region NEEDED Needed Supply based
of HD USE1 Needed
(M-S Ops, 2 (M-F Ops, 2 on PRDR5
(M-F Ops,
cycles)2 cycles)3
3 cycles)4

Region 1 124800 172 262 176 303

Region 2 46670 65 100 66 173
Region 3 289380 400 608 409 925
Region
IV-A 384020 528 802 536 1,129
Region
IV-B 75270 106 160 107 35
Region 5 145340 202 306 206 143
Region 6 188110 261 397 266 395
Region 7 187850 261 396 263 420
Region 8 111150 155 234 158 123
Region 9 129090 179 271 183 123
Region 10 119990 169 253 170 209
Region 11 125060 175 264 177 387
Region 12 118300 166 249 168 201
Region 13 65520 93 138 94 54
NCR 326560 456 688 462 1,990
CAR 43810 65 95 66 105
BARMM 100230 141 212 141 9
TOTAL 2581150 3594 5435 3648 6724

1
Describes the estimated number of HD machine usage or dialysis sessions per region for 365 days.
(Assumptions: All machines are operational all days in a year (24 hours/7 days, 4 hours/cycle/machine)
2
Describes the estimated demand of HD chairs if HD Centers operate from Monday to Sunday (7 days) for 8
hours/day; 1 machine can provide 2 cycles
3
Describes the estimated demand of HD chairs if HD Centers operate from Monday to Friday (5 days) for 8
hours/day; 1 machine can provide 2 cycles
4
Describes the estimated demand of HD chairs if HD Centers operate from Monday to Friday (5 days) for 12
hours/day if 1 machine can provide 3 cycles.
5
Supply data on available HD chairs based on Philippine Renal Disease Registry 2017