Practicum Manual

Transforming Your Provincial Health System
Towards Universal Health Care v1.1

A Practical Guide for Governors and Provincial Health Officers
Disclaimer: This practicum manual is a compilation of the current materials on

Universal Health Care in the Philippines and the experiences of the Zuellig Family
Foundation (ZFF) in local health systems development. It is an initial draft and a
working document that will be continuously improved for your perusal. The
authors have made every effort to ensure that the information in this manual are
correct at press time. ZFF welcomes suggestions for improvements and corrections
which may be emailed to: danyago@zuelligfoundation.org
Integrated Provincial Health Systems and Development Program
Foreword
For more than a decade, the Zuellig Family Foundation (ZFF) has learned from its previous health leadership and
governance programs and has proven that local government officials can champion and improve the health
outcomes of Filipino communities, especially the poor. The newly created Integrated Provincial Health Systems and
Development Program (IPHSDP) is anchored on the foundation’s overall strategies and the Health Change Model,
which still emphasizes the need for leadership and governance in creating local health systems to improve health
outcomes.
The IPHSDP Practicum Manual for Governors and Provincial Health Officers is for the exclusive use of IPHSDP
participants. It is intended to guide governors and provincial health officers in transforming their provincial health
systems and operationalizing Universal Health Care. All materials, including concepts and theories in the manual
were collated by the Zuellig Family Foundation from various sources for the sole purpose of enhancing knowledge
and skills on leadership and governance among the IPHSDP participants. Credit for outsourced materials, including
concepts and theories, found in the manual belong solely to the primary owners. Original sources are cited to lead
participants to further read and study the reference materials.
Table of Contents
Universal Health Care in the Philippines 7
The Provincial Health System as the Platform for Universal Health Care 8
The Zuellig Family Foundation Integrated Provincial Health Systems and 9

Development Program (IPHSDP)
What Can You Do To Ensure Universal Health Care For Your Provinces? 10
CHAPTER 1: Provincial Health Board 12

Establishing the Functional Expanded Local Health Board 15
Health Care Provider Network Governance Body or Management Group 22
CHAPTER 2: Local Investment Plan for Health 33

Provincial Investment Plan for Health 35
Municipal Investment Plan for Health 40
CHAPTER 3: Health Facility Accreditation 41
CHAPTER 4: Continuity of Care 49

Establishment of a Province-Led Service Delivery Network and 52
Functional Capacity of Curative Facilities
Functional Capacity of Preventive Facilities 56
CHAPTER 5: Special Health Fund 59
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CHAPTER 6: Provincial Health Information System 65

Provincial Health Information System For Curative Care 67
Provincial Health Information System For Preventive Care 70
Profiling, Tracking and Provision of Health Services to the Vulnerable Population 74
CHAPTER 7: No Balance Billing 102
CHAPTER 8: Health Human Resources 114

Performance Management System and Implementation 116
of Magna Carta for PHO Staff
Health Human Resources for Preventive Care 119
Health Human Resources for Curative Care 120
CHAPTER 9: Resilience Oriented Health System 131
CHAPTER 10: Essential Medicines 138

Functional Supply Chain Management 140
Policy Support on Medicines Management 142
Adequacy of Essential Medicines in the Municipalities 143
List of Tables 3
List of Figures 4
List of Acronyms 5-6
Reflection Questions 146-148
References 149-150
Acknowledgements 150
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List of Tables
Table 1. Three General Actions of a Governor/PHO Coinciding with the Bridging Leadership Process 10
Table 2. LIPH Planning Management Structure 36
Table 3. Sample Template for List of Service Providers 55
Table 4. Possible EMR providers for the province 71
Table 5. Recommended software and hardware requirements for iClincsys operation 73
Table 6. Minimum Competencies of a Barangay Health Worker 76-77
Table 7. Form A – Profiling the Vulnerable Population 79
Table 8. Form B – Master List of the Vulnerable Population 81
Table 9. Form C – Assignment of the BHWs to the Vulnerable Population 82
Table 10. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old 84
Table 11. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old (Nutritional Status) 85
Table 12. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old (Immunization Status) 86
Table 13. Sample Form D BHW Target Client List for Children Ages 12-59 Months (1 – 4 years old) 87
Table 14. Sample Form D BHW Target Client List of A Sick Child 88
Table 15. Sample Form D BHW Target Client List for Family Planning Services 89
Table 16. Sample Form D BHW Target Client List for Maternal Care Services 90
Table 17. Sample Form D BHW Target Client List for Senior Citizen Services 91
Table 18. Health Services Required in a BHS 94
Table 19. Health Services Required in a RHU 95
Table 20. Health Services Required for Hospitals 97
Table 21. Sample Monitoring and Reporting Template for Incoming and Outgoing Referrals 100
Table 22. Performance Indicators for NBB Monitoring 109
Table 23. Components of the integrated system for managing performance 116
Table 24. Mandated Allowances to Public Health Workers 118-119
Table 25. Sample Individual Performance Commitment and Review 120
Table 26. Hospital Services Based on Levels 121
Table 27. Standard Staffing Pattern for Hospitals in the Province 122-130
Table 28. Roles and Responsibilities of the DRRM-H Planning Committee 134
Table 29. Quick Assessment of the Local Drug Situation Tool 143-144
Table 30. Modified VEN Classification 144-145
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List of Figures
Figure 1. The IPHSDP Roadmap and the Provincial Health System Deliverables for UHC Implementation 10
Figure 2. Sample Executive Order Reorganizing and Expanding the Provincial Health Board 18
Figure 3. Sample PHB Meeting Attendance Sheet 20
Figure 4. Sample Minutes of the Meeting Format 21
Figure 5. Option 1: Proposed Structure of the Province-wide Health System (PWHS) 22
Figure 6. Option 2: Proposed Structure of the Province-wide Health System (PWHS) 22
Figure 7. Sample Organizational Structure for the SDN Management Group 24
Figure 8. Sample Executive Order on Establishing a Service Delivery Network 27-31
Figure 9. LIPH Planning Framework 37
Figure 10. LIPH Planning Workflow 38
Figure 11. Workflow Diagram in Formulating LIPH/AOP 39
Figure 12. Accreditation flow chart for Healthcare Institutions 45
Figure 13. Illustration of SDN referral system 53
Figure 14. Suggested Provincial Set-Up for the Special Health Fund 62
Figure 15. Implementing iHOMIS Process 68
Figure 16. Sample Letter of Intent or Request from the Hospital for iHOMIS 69
Figure 17. Framework for Profiling, Tracking and Provision of Health Services to the Vulnerable Population 75
Figure 18. Example of a Spot Map 80
Figure 19. DOH’s Health Programs Based on Person’s Life Cycle 83
Figure 20. Health Care Referral System 93
Figure 21. Sample Intra Health Facility Referral Form 98
Figure 22. Sample PhilHealth Access Form 105
Figure 23. Sample Non-Disclosure Agreement Form 106
Figure 24. Sample Member Data Record 107
Figure 25. Monitoring Tools used for NBB 108
Figure 26. Flowchart on the procedure of monitoring report submission for NBB 110-113
Figure 27. The Performance Management Cycle 117
Figure 28. DRRM-H Planning Process 135
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List of Acronyms
AQAS ACCREDITATION AND QUALITY ASSURANCE SECTION

ARSP ANTIMICROBIAL RESISTANCE SURVEILLANCE PROGRAM
BAS BENEFITS ADMINISTRATION SECTION
BLHSD BUREAU OF LOCAL HEALTH SYSTEMS AND DEVELOPMENT
BMU BENEFITS MONITORING UNIT
CAC CORPORATE ACTION CENTER
CDRA CLIMATE AND DISASTER RISK ASSESSMENT
CESPES CAREER EXECUTIVE SERVICE PERFORMANCE EVALUATION SYSTEM
CHD CENTER FOR HEALTH DEVELOPMENT
CHITS COMMUNITY HEALTH INFORMATION TRACKING SYSTEM
CHO CITY HEALTH OFFICE
CS CESAREAN SECTION
DC DILATATION AND CURETTAGE
DPRI DRUG PRICE REFERENCE INDEX
DRRM-H DISASTER RISK REDUCTION MANAGEMENT AND MANAGEMENT IN HEALTH
DTC DRUG THERAPEUTICS COMMITTEE
EB EPIDEMIOLOGY BUREAU
EMR ELECTRONIC MEDICAL RECORDS
eFHSIS ELECTRONIC FIELD HEALTH SERVICES INFORMATION SYSTEM
eMPAS ELECTRONIC MEDICAL POST-AUDIT SYSTEM
FFIED FACT-FINDING INVESTIGATION AND ENFORCEMENT DEPARTMENT
FHDB HEALTH FACILITIES DEVELOPMENT BUREAU
FHSIS FIELD HEALTH SERVICES INFORMATION SYSTEM
FOD FIELDS OPERATIONS DIVISION
FRP FINANCIAL RISK PROTECTION
4Ps PANTAWID PAMILYANG PILIPINO PROGRAM
GIDA GEOGRAPHICALLY ISOLATED AND DISADVANTAGED AREAS
HAI HEALTH CARE ASSOCIATED INFECTIONS
HCDMD HEALTH CARE DELIVERY MANAGEMENT DIVISION
HCP HEALTH CARE PROVIDERS
ICD INTERNATIONAL CLASSIFICATION OF DISEASES
ICHSP INTEGRATED COMMUNITY HEALTH SERVICES
iCLINICSYS INTEGRATED CLINIC INFORMATION SYSTEM
ICS INCIDENT COMMAND SYSTEM
IHCP INSTITUTIONAL HEALTH CARE PROVIDER PORTAL
iHOMIS INTEGRATED HOSPITAL OPERATIONS AND MANAGEMENT INFORMATION SYSTEM
IPHSDP INTREGRATED PROVINCIAL HEALTH SYSTEMS AND DEVELOPMENT PROGRAM
IRR IMPLEMENTING RULES AND REGULATIONS
KMITS KNOWLEDGE MANAGEMENT AND INFORMATION TECHNOLOGY SERVICE
LHIO LOCAL HEALTH INSURANCE OFFICE
LGU LOCAL GOVERNMENT UNIT
MDR MEMBERSHIP DATA RECORD
MMHR MANDATORY MONTHLY HOSPITAL REPORT
MNDRS MATERNAL AND NEONATAL DEATH REPORTING SYSTEM
MOA MEMORANDUM OF AGREEMENT
MPDO MUNICIPAL PLANNING AND DEVELOPMENT OFFICE
MSWDO MUNICIPAL SOCIAL WELFARE AND DEVELOPMENT OFFICE
NBB NO BALANCE BILLING
NHIP NATIONAL HEALTH INSURANCE PROGRAM
NHTS-PR NATIONAL HOUSING TARGETING SYSTEM POVERTY REDUCTION
NOSIRS NATIONAL ONLINE STOCK INVENTORY SYSTEM
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NSD NORMAL SPONTANEOUS DELIVERY

NTHC NATIONAL TELEHEALTH CENTER
OPES OFFICE PERFORMANCE EVALUATION SYSTEM
PCARES PHILHEALTH CUSTOMER ASSISTANCE RELATIONS AND EMPOWERMENT STAFF
PCB PRIMARY CARE BENEFIT
PHA PHILIPPINE HOSPITAL ASSOCIATION
PHC Primary Health Care
PHIC PHILIPPINE HEALTH INSURANCE CORPORATION
PHO PROVINCIAL HEALTH OFFICE
PMA PHILIPPINE MEDICAL ASSOCIATION
PMS PERFORMANCE MANAGEMENT SYSTEM
PNF PHILIPPINE NATIONAL FORMULARY
POAF PHILHEALTH ONLINE ACCESS FORM
PRC PROFESSIONAL REGULATIONS COMMISSION
PRMC PHILHEALTH REGIONAL MONITORING COMMITTEE
PWD PERSONS WITH DISABILITIES
QAC QUALITY ASSURANCE COMMITTEE
RHU RURAL HEALTH UNIT
SCM SUPPLY CHAIN MANAGEMENT
SLA SERVICE LEVEL AGREEMENT
SMD STANDARDS AND MONITORING DEPARTMENT
UCNCDRS UNIFIED CHRONIC NON-COMMUNICABLE DISEASE REGISTRY SYSTEM
UHC UNIVERSAL HEALTH CARE
WAH WIRELESS ACCESS FOR HEALTH
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Universal Health Care in the Philippines
The recent signing of Republic Act 11223 Universal Health Care (UHC) Act of 2019 last February 20, 2019
paves the way for key reforms in the Philippine Health Care System to be undertaken. The law both
reaffirms the right to health of all Filipinos, as well as reasserts the duty of the State to create the enabling
environment for the people to enjoy their health entitlements. It is in this spirit that the following are the
articulated general principles and policies of the law (Universal Health Care Act 2019)1:
a) An integrated and comprehensive approach to ensure that all Filipinos are health literate,
provided with healthy living conditions, and protected from hazards and risks that could affect
their health
b) A health care model that provides all Filipinos access to a comprehensive set of quality and cost-
effective promotive, preventive, curative, rehabilitative and palliative health services without
causing financial hardship, and prioritizes the needs of the population who cannot afford such
services
c) A framework that fosters a whole-of-system, whole-of-government, a whole-of-society approach
in the development, implementation, monitoring, and evaluation of health policies, programs and
plans; and
d) A people-oriented approach for the delivery of health services that is centered on people’s needs
and well-being, and cognizant of the differences in culture, values and beliefs
Thus, the UHC Act is an opportunity to address long-standing problems in Philippine Health Care (PHC):
1) The challenges of health governance, particularly the impact of devolution on health

2) The fragmentation of national, sub-national and local health care delivery systems, and
3) The inequities in health that are manifested in the marked differences in the way Filipinos
experience health and health care as determined primarily by their socioeconomic status2
Despite some differences in articulation, the concept of UHC in the Philippines has been essentially the
same over the last decade or so. From the Aquino Health Agenda (Kalusugang Pangkalahatan) in 2010, to
the Philippine Health Agenda of 2016, to the UHC Act of 2019; UHC has always meant the highest quality
of health services (service coverage), to all Filipinos (population coverage) without financial hardship
(financial coverage)1,4,5. Thus, the operationalization of UHC is predicated on how this vision is made into
a reality that benefits the Filipino people. The actualization of UHC then lies in who makes the decisions
for such to happen as well as what key decisions get to be made. In terms of organizing health systems,
this decision-making process is what defines Health Leadership and Governance.6
1 Philippines,
Government of the. Republic Act 11223; Universal Health Care Act 2019. 2019.
2 Medina PN. Are We Really on the Road to Health For All? Contextualizing the Philippine Health Agenda 2016-2022 (February 25, 2019).
4 Department of Health. Philippine Health Agenda 2016-2022. 2016.
5 Department of Health. Kalusugang Pangkalahatan; The Aquino Health Agenda. 2010.
6 Department of Health Regional Office 8 (2019). Executive Order No, 10-2018 Executive Order Re-organizing the Municipal Disaster Risk
Reduction and Management Council (MDRRMC) and Defining its Functions Pursuant to Republic Act 10121 of Pastrana, Leyte. Health
Leadership and Governance Program.
7
The Provincial Health System as the Platform for Universal Health Care
As with any worthy endeavor, “beginning with the end in mind” is an adage that is not only practical but
motivational as well. By clearly articulating the “What(s)”, the “How(s)” will follow. It is therefore very
important for the governor and the PHO to know what UHC is.
Chapter II (Sections 5 to 7) of the UHC Act seems to define UHC in a very straightforward manner by
contextualizing it within three basic coverage areas; namely Population, Service and Financial Coverage
(UHC Act 2019). However, despite having enumerated the said components, the law still does not quite
capture what really matters. What is “Universal Health Care” as perceived and experienced from the
Filipino citizen’s perspective? This is a question which inevitably segways to “What should provincial
governors, PHOs and their respective health governance teams be providing in terms of UHC for their
constituents?”
To answer this, it would be helpful for governors, PHOs and their respective health governance teams to
envision UHC as “The provision to every Filipino of the highest quality of health care that is accessible,
efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed
and empowered public”5. As such, UHC is manifested in Health Service Delivery; the most visible aspect
of a health system as per the World Health Organization’s Health Systems (6 health systems building
blocks) Framework6. The governor and PHO, with their health governance team, should begin with what
Health Service Delivery looks like in their province within UHC and work from there.
It goes without saying that national or local health systems can only be called UHC if they are well-
organized and subsequently, also well-performing. At the provincial level, UHC is the result when the
fundamental functions of the provincial health system are ensured through sound decision-making. These
include planning, resource generation, revenue collection, fund pooling, provision of personal and non-
personal health care, as well as stewardship and regulation.7 Thus the role of Health Leadership and
Governance in enabling a province-wide UHC system is to create an environment where 1) effective health
interventions and services are efficiently delivered – the right care is given at the right place and at the
right time; 2) the system is effectively managed so that services are better, faster, at lower cost and
equitable access to them is assured; and 3) the people/community are empowered to actively participate
in the decision-making for their health and health care by being fully informed, capacitated and provided
with the means of doing so within the health system.
Health Service Delivery is always a direct function of two (2) other health system building blocks, namely:
1) the Human Resources for Health (HRH) that provide the said services and 2) the Health Technologies,
Medicines and Equipment (including health infrastructure, programs, innovations, and good practices)
that they employ in carrying out the said services. The hiring and capacity building of HRH as well as the
obtaining of the essential medications, equipment, technologies and infrastructure will never happen
without the resources that come with sound Health Financing. The relevance, responsiveness and
appropriateness of such imply a dynamic process of decision-making and accountability that is guided by
systems which produce accurate, reliable and timely Health Information. Subsequently, the making of
these principled, smart and impactful decisions for health is the hallmark of good Health Leadership and
Governance.

6 Department of Health Regional Office 8 (2019). Executive Order No. 10-2018
7 Medina PN. Introduction to Health Systems Workshop; An Analysis of the Inquirer Article "A Filipino Horror Story" (May 14, 2019).
8
The Zuellig Family Foundation Integrated Provincial Health Systems and Development
Program (IPHSDP)
The Zuellig Family Foundation Integrated Provincial Health Systems and Development Program (ZFF
IPHSDP) is a thirty-six month capability-building program for the Governors, PHOs and mayors of selected
provinces, and is based on the Bridging Leadership (BL) Framework and competencies customized
according to the specific needs and expected performance of the participants. It aims to help prepare the
provinces lead the transition into a province-wide and resilience-oriented health system for Universal
Health Care, and contribute to the improvement of the priority health indicators of the provinces.
It is in this context that this guide to the operationalization of UHC was created. This is intended for
provincial governors and PHOs who have undergone Cycle 2 of the ZFF Provincial Leadership and
Governance Program (PLGP). By imbibing the prerequisite frameworks of PHC, Bridging Leadership and
Systems Thinking, the provincial health team, composed of the Governor, PHO, and their health
governance staff, is capacitated to become the catalyst for the realization of both the Department of
Health’s (DOH) Fourmula 1+ thrust for health and UHC. These are the fundamental elements of ZFF’s
IPHSDP within which UHC is to be operationalized. Through the leadership of the provincial governor and
PHO as health champions, together with their core team, an integrated provincial health system will be
set-up. The resulting provincial health system then enables the realization of UHC by delivering the three
(3) guarantees of the DOH Philippine Health Agenda namely: 1) Services for both well and sick available
throughout all life stages and addressing the triple burden of disease, 2) Functional Service Delivery
Networks (now known as Health Care Provider Networks (HCPN) with the UHC Act) and 3) Financial Risk
Protection4.
All in all, the interplay and relationships of the aforementioned health systems building blocks are what
should influence and guide the Governor, PHO and their team as they facilitate the setting up of UHC in
their province within the ZFF Integrated Provincial Health Systems Development Program. It is in this light
that the succeeding chapters of this guide aim to outline the steps to be undertaken by a provincial
government in making Chapter V of the UHC Act entitled, “Organization of Local Health Systems”, a
reality1.
1
Philippines, Government of the. Republic Act 11223; Universal Health Care Act 2019. 2019.
9
What Can You Do To Ensure Universal Health Care For Your Provinces?
Each chapter in this manual starts with your performance indicators, which are the bases for achieving
the IPHSDP roadmap deliverables and turning them from red to green. These will guide you to transform
your provincial health system towards UHC.
PROVINCIAL HEALTH SYSTEM DELIVERABLES FOR UHC IMPLEMENTATION

Resilience-oriented Health
Provincial Health Board Local Investment Plan for Health Health Facility Accreditation No Balance Billing
System
Provincial Support for

Provincial Investment Plan PHIC Accreditation of
Functional Local Health Board Building Resilient Health
for Health Governmant Hospitals
NBB in Government System
Hospitals
Municipal Support for
SDN Governance and Municipal Investment Plan PHIC Accreditation of all target
Building Resilient Health
Management Body for Health municipal health facilities
System
Provincial Heath Information Health Human Resource for
Continuity of Care Special Health Fund Essential Medicines
System Preventive and Curative Care
Provincial-led Service Performance
Adequate Essential
Delivery Network Health Information System for Management System and
Medicines and Supplies in
Preventive Care Implementation of Magna
municipalities
Carta for PHO Staff
Functional Capacity of
Established Provincial
Preventive Facilities Profiling of Vulnerable Health Human Resource Functional Supply Chain
Special Health Fund
Population for Preventive Care Management
Functional Capacity of Health Information System for Health Human Resource Policy Support on
Curative Facilities Curative Care for Curative Care Medicines Management
Figure 1. The IPHSDP Roadmap and the Provincial Health System Deliverables for UHC Implementation
Each chapter subsequently introduces you to the importance or rationale of each deliverable and why you
should address it. You may then begin your UHC journey and transform your roadmaps by following the
three (3) general actions which mirror the Bridging Leadership Process as applied to health systems
development in each chapter. These actions are shown in the following table:
Bridging Leadership Process Actions of a Governor or PHO

Ownership CHECK—investigate, inquire, understand, observe
Co-Ownership COLLABORATE— dialogue, partnerships, plan
Co-Creation EXECUTE—implement, conduct, monitor, evaluate
Table 1. Three General Actions of a Governor/PHO Coinciding with the Bridging Leadership Process
As the Governor or PHO, you should:
CHECK -- By checking certain aspects of your existing provincial health system, you are trying to
understand the reality in your province in terms of its health status and health service delivery
 Checking involves inquiring, observing, studying, investigating and identifying. The more you
understand the situation, the more your ownership of the health challenges deepens.
10
 It is also dependent on your recognition of your limitations and biases, which are things that could
hinder the better understanding and appreciation of both your current system’s strengths as well as
its weaknesses
 Complementing the assumption of responsibility/ownership, the deepening of one’s understanding
of the current situation also informs the decisions that a Governor/PHO has to make and consequently
the steps he/she has to take to better the status quo.
COLLABORATE -- By collaborating with stakeholders in your community, you draw more people to help
you address the more complicated health challenges in your province.
 Collaborating involves partnership, dialogue, establishing formal agreements, organizing and

identifying critical stakeholders. The more stakeholders, the better—especially if these stakeholders
can mobilize resources for you.
 The choice of which stakeholders to involve or engage with are a direct result of the processes in the
previous “Check” step.
 There is strength in numbers, but this necessitates strategizing and optimizing the collaborative
process, thus the importance of the “Check” step cannot be overemphasized.
EXECUTE -- Executing means to take actions within the executive powers and office of the governor
 This involves performing one’s duties and responsibilities as governor in 1) the context of the “Check”
and “Collaborate” processes and 2) the duty/obligation of enabling the implementation of health
programs and strategies in one’s area of jurisdiction.
Operationalizing Universal Health Care in one’s province can seem like a very tall order. By anchoring the
task on the general actions previously mentioned, coupled with acting within the framework of regarding
UHC as a manifestation of a well-organized provincial health system, the provincial health governance
team is poised to succeed in taking on the challenge for their constituents.
As previously stated, within the WHO Health Systems Framework, UHC will most readily be appreciated
in the quality of Health Service Delivery within a health system. Thus, it is advised that the provincial health
governance team undertake the CHECK-COLLABORATE-EXECUTE process as a firming up of what the
shared vision of UHC for the province is first and then working backwards as guided by the WHO six (6)
building blocks of health. It is with this premise that the succeeding parts of this guide are written.
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How do I change my Provincial Health Board Deliverable from Red to

Green?
Your Performance Indicators:
Establishing the Functional Expanded Local Health Board
 Issued an Executive Order indicating the composition of the PHB to ensure an expanded PHB
 Defined functions, roles and responsibilities for each member of the expanded PHB
 Documented monthly meetings led by the PHO with at least quarterly meetings presided by the
governor
 Issuance, implementation and review of provincial health policies
 Documented semi-annual discussions or meetings to review the performance of hospitals and

municipalities within the province
 The PHB oversees and coordinates the health services for a province-wide health system
(Province-wide Health Care Provider Network) composed of the municipal health systems, hospitals
and other health/health related institutions within the jurisdiction of the province
Health Care Provider Network Governance Body or Management Group
 Issued a PHB resolution on creation of the HCPN Governance Body or Management Group
 Recommended HCPN-related policies to the LHB
 HCPN processes and accountabilities are monitored and evaluated
 Approved 3-year Provincial Hospital Development Plan
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Why do I need to address the Provincial Health Board Deliverable?
The concept of health leadership and governance is to be found in Chapter V of the UHC Act 20191. Entitled
“Organization of Local Health Systems”, it has four (4) sections that cover the key areas that must be
decided on in setting up UHC. While all four (4) are leadership and governance matters, of interest to
governors and PHOs is Section 19, “Integration of Local Health Systems into province-wide and city-wide
health systems” since it effectively defines the governance entity which will take charge of seeing UHC
into reality. At the province level, this is what is known as the Provincial Health Board with the following
core functions1:
1. Oversee and coordinate the integration of health services for a province-wide health system
composed of municipal and component city health systems
2. Manage the Special Health Fund as defined by the UHC Act
3. Exercise administrative and technical supervision over health facilities and health human
resources within their respective territorial jurisdiction.
These essentially define what a Functional Provincial Health Board is, one of the targeted outcomes of
ZFF’s Integrated Provincial Health Systems Development Program3.
For the governor and the PHO, changing the PHB Deliverable from Red to Green in a Province-wide UHC
System involves the accomplishment of two (2) related main tasks. These are the establishment of 1) a
Functional Provincial Health Board and 2) a working Health Care Provider Network (HCPN) Management
Group.
An analysis of the organization or reorganization of Local Health Systems according to the UHC Act, points
to the overarching goal of bringing together the many health and health care providing institutions within
a province under a unified system. This integration requires the governance and vision provided by a
functional and well-represented PHB as earlier elucidated. However, with health service delivery being
the aspect of any health system that people readily appreciate and experience, this integration under UHC
is supposed to be manifested as reliable, timely, responsive, equitable and quality health services. This
has been a recurrent theme in Philippine health system reforms beginning with the first articulation of
UHC within the Kalusugang Pangkalahatan (KP) health agenda5 in 2010 up to the present with the UHC
Act.
Therefore, in the stocktaking of the current health system in the province, the following questions must
be answered. How does a person navigate his/her health system according to need? At the first contact
(primary level), are there enough facilities/providers for the population? If he/she needs to be sent to a
hospital or co-managed by a specialist, how does this happen? What about for specialized procedures or
medical examinations? What about diet plans, nutritional counseling and exercise regimens? Where do
people go? Who do people have to engage? In the status quo, these concerns are usually addressed by
referral systems. However, the present referral mechanisms are notorious for being greatly limited by the
disjointed, uncoordinated and poorly connected systems that we have.
1 Philippines, Government of the. Republic Act 11223; Universal Health Care Act 2019. 2019.
3 Zuellig Family Foundation. Briefer on the Integrated Provincial Health Systems Development Program. 2019.
13
Thus, the conversation on UHC requires more than just referral systems for health services. Since KP to
the current Philippine Health Agenda, the establishment of Service Delivery Networks or Health Care
Provider Networks has been identified as strategic ways of expanding access to and strengthening the
continuum of care for people across political and geographical boundaries4,5. By combining individual
health service delivery elements into a functioning interconnected network, quality care is provided
through a unified delivery system8, the specifics of which would be given in the succeeding parts of this
guide.

5 Department of Health. Kalusugang Pangkalahatan; The Aquino Health Agenda. 2010
8
Dorotan E, Zsolt M. Making Your Local Health System Work. German Agency for Technical Cooperation, 2005
14
I. Establishing the Functional Expanded Local Health Board
CHECK
 Does the province have a Provincial Health Board?
 Chapter 3, Title 5, Section 102 of the Local Government Code of 1991 mandates that all provinces
have a Provincial Health Board
 Who are the members of the current PHB? According to the Local Government Code the PHB should
be composed of the following:
o Governor as Chairperson
o Provincial Health Officer as the Vice Chairperson
o Members:
 Chairperson of the Sangguniang Panlalawigan Committee on Health (Provincial Board
Member for Health)
 Representative from the private sector, Non-government Organization (NGO) or Civil
Society Organization (CSO)
 Representative of the DOH to the Province (usually the Provincial DOH Team
Leader/Provincial DOH Officer)
ZFF recommends a functional expanded local health board with the following added
members:
 Representative of the provincial hospital

 IP representative for provinces with significant IP communities
 Representation of all the municipalities within the province
 Representation from the Provincial Disaster Risk Reduction and Management Office
 Extended members as approved by the Chairman upon recommendations of the members based
on priority programs (i.e. Liga ng mga Barangay Representative, Association of Municipal Health
Officers (AMHOP) provincial chapter president, Provincial Planning and Development Officer,
Provincial Social Welfare and Development Officer, Provincial Budget Officer, etc.)
Expanding the membership of the Provincial Health Board is in the spirit of ensuring representation of
different sectors and stakeholders in the process of decision-making for health. Striving to be as
inclusive as possible in addressing health matters, is one way of realizing what true community
participation in a health system is all about – and that is leadership and governance.
 When was the latest Executive Order regarding the PHB done? What was this about? Was it to update
the PHB based on the current health needs of the province?
 Is the PHB active? Is it involved in the making of decisions that concern health in the province?
 Is the PHB routinely engaged for the health endeavors that are done by the province? Are these
endeavors planned, implemented and evaluated by the or through the PHB?
15
 How is health legislation done in the province? Is the PHB, through the Sangguniang Panlalawigan
Chairperson of the Committee on Health, regularly involved in the crafting of relevant, timely and
responsive provincial laws on health?
 How is the relationship of the PHB with the different Municipal Local Health Boards in the province?
Are there open lines of communication? How does the PHB ensure that municipal health boards
operationalize the provincial health agenda/vision?
 How is the relationship of the PHB with the regional and national DOH offices? Are there open lines
of communication? Regular meetings? How does the PHB operationalize national/regional health
directives at the province level?
 All in all, the goal is for the province to have a Functional Provincial Health Board to direct the
transformation of its health system into one of Universal Health Care. To better visualize this, the
functions of the PHB as per the Local Government Code7 are juxtaposed with that of the UHC Act
2019:
UNIVERSAL HEALTH CARE ACT

Chapter 5, Section 19
LOCAL GOVERNMENT CODE OF 1991
 The DOH, Department of the Interior and
 To propose to the Sanggunian concerned, in
Local Government (DILG), PhilHealth and
accordance with standards and criteria set
the LGUs shall endeavor to integrate
by the Department of Health, annual
health systems into province-wide and
budgetary allocations for the operation and
city-wide health systems
maintenance of health facilities and services
 The Provincial and City Health Boards shall
within the municipality, city or province, as
oversee and coordinate the integration of
the case may be
health services for province-wide and city-
 To serve as an advisory committee to the
wide health systems, to be composed of
Sanggunian concerned on health matters municipal and component city health
such as, but not limited to, the necessity for,
systems and city-wide health systems in
and application of, local appropriations for
highly urbanized and independent
public health purposes; and
component cities, respectively.
 Consistent with the technical and
 The Provincial and City Health Boards shall
administrative standards of the Department
manage the Special Health Fund and shall
of Health, create committees which shall
exercise administrative and technical
advise local health agencies on matters such
supervision over health facilities and
as, but not limited to, personnel selection health human resources within their
and promotion, bids and awards, grievances
respective territorial jurisdiction provided
and complaints, personnel discipline, budget
that municipalities and cities included in
review, operations review and similar
the province-wide and city-wide health
functions systems shall be entitled to a
representative in the Provincial or City
Health Board, as the case may be
16
COLLABORATE AND EXECUTE
 How to Establish a Provincial Health Board?
 Establishing a Provincial Health Board for UHC is pretty straightforward. The governor is responsible
for issuing the executive order (EO) establishing (or re-establishing) the PHB as the case may be.
 All PHB members’ roles and responsibilities must be reflected in the created or revised EO, bearing in
mind the shared vision of establishing a Province-wide UHC Health System.
 How to expand the membership of the current Provincial Health Board?
 As earlier mentioned, the overarching thrust in forming the PHB is to ensure community
representation and participation in the making of decisions for the health system of the province.
Thus, the recommendation is always for an Expanded PHB to be established.
 To help guide the expansion of the members of the PHB, it would be helpful for the governor, the PHO
and their health governance team to assess the province’s health status quo and determine if there
are any priority areas, issues and concerns that need to be focused on in the implementation of UHC.
 Broadly, members of the expanded PHB could be chosen based on who are usually the key
stakeholders and actors in health care7 namely:
o The Population – beneficiaries of health care services
o The Providers – usually the Human Resources for Health (HRH) that provide the health care
services
o The Resource Generators – institutions which organize, finance and produce inputs for other
actors (e.g PhilHealth, legislators, foundations, private donors, etc.)
o Other Sectors which act in health – NGOs, CSOs, organized groups, etc.)
o The State – the “collective mediator”, including government agencies at the level of the
province that essentially do socioeconomic development work which greatly impacts health
(provincial DILG, DSWD, DA, DAR, DTI, etc).
 Since the PHB will essentially be the body managing the Province-Wide UHC System, it is essential
that representatives of the municipalities/component cities of the province as well as its hospital
system should be assured positions in the expanded PHB
 Expanding the PHB involves the issuance of the governor of an EO indicating new members and roles
 Another Sample EO for this purpose is provided below:
Note: Consider exploring the issuing of a combined EO for establishing the PHB/Expanded PHB
depending on the legislative practice in one’s province.
17
Republic of the Philippines

Province of ________________
Name
Governor
EXECUTIVE ORDER NO. ______
Series of [YEAR]
AN EXECUTIVE ORDER REORGANIZING AND EXPANDING THE COMPOSITION OF THE PROVINCAL HEALTH BOARD
I, [NAME, Position], by virtue of the powers vested in me by law and the sovereign will of the people, do hereby order:
SECTION 1. COMPOSITION. – The [PROVINCE] Health Board is hereby re-organized and shall be composed of the following:
Chairman: [NAME, Position]
Vice Chairman: [NAME, Position]
Members: [NAMES, Positions]
Functions and Responsibilities
SECTION 2. OTHER PROVISIONS. – All other provisions of [EXECUTIVE NO. AND SERIES OF EO CREATING THE CURRENT PROVINCIAL
HEALTH BOARD] are hereby maintained except effectivity.
SECTION 3. EFFECTIVITY. This Executive Order takes effect immediately.
Done this [DATE] at [PROVINCE], Philippines
[SIGNATURE]
Name, Governor
Figure 2. Sample Executive Order Reorganizing and Expanding the Provincial Health Board
PHB Meetings and Quorum
 The Local Government Code of 1991 states that the PHB shall meet at least once a month or as often
as necessary.
o It is recommended that the procedures/guidelines regarding the timing of both regular
meetings and as needed sessions should be formalized and agreed upon by the members of
the PHB.
 A majority of the members of the PHB shall constitute a quorum with usual meeting procedures
followed (validity of meeting, decision-making, voting, etc.). The chairperson (governor) or the vice
chairperson (PHO) must be present during meetings where budget proposals are being prepared or
18
considered. The affirmative vote of the majority of the members shall be necessary to approve such
proposals.
o PHB Meetings are for the discussion of crucial province-wide health systems issues as well as
the making of decisions regarding them.
o Ideally, health program planning, implementation and monitoring/evaluation for the health
programs of the province are guided by/directed/influenced by these PHB meetings.
 It would be strategic for the PHB to discuss the fulfillment of the health deliverables of the province
within UHC in terms of the ZFF IPHSDP as these are theoretically what need to be done to transform
the Provincial Health System into UHC.
ZFF recommends the following:
 Documentation that the PHB oversees and coordinates the health services for a province-wide
health system broadly composed of the municipal and component city health systems,
hospital/curative systems and other health/health related facilities in the province as aligned with
the provincial health agenda within UHC
 Documented monthly meetings led by PHO with at least quarterly meetings presided by the
governor
 Documented semi-annual discussion/meeting to review the performance of hospitals and
municipalities within the province
 Topics to be discussed: Issuance, implementation and review of provincial health policies as
anchored on UHC
 The performance of hospitals, municipal/component city health facilities within the province vis
a vis nationally and locally determined and agreed upon parameters, standards as aligned with
the provincial health agenda within UHC
 How to Properly Conduct an Expanded PHB Meeting?
 As with any other meeting, it would be strategic and efficient if the Expanded PHB meeting is
conducted in three general phases: Before, During, and After the Meeting
Before the Meeting

 Establish the objectives
 Create a specific agenda and identify if added participants, resource speakers or reporters need to be
invited
 Set the schedule, time and venue
 Inform all the participants on the details of the meeting, including the agenda
 Prepare the necessary printed, audio-visual, etc. so that these are on-hand during the meeting.
During the Meeting

 The Governor as chairperson, theoretically presides over the meeting but may delegate this task to
another (usually the vice chairperson; the PHO) as need be. The presider of the meeting acts as
facilitator for the PHB to achieve the objectives of the meeting. The facilitator should:
19
 Welcome and greet the participants as they enter the meeting place. Acknowledge any VIPs or
resource persons for the session, etc.
 Ask all the participants to sign an attendance sheet (a sample is provided below)
 Ensure that there is someone acting as documenter or secretariat who is responsible for the minutes
of the meeting (a sample is provided below)
ZFF highlights the importance of the minutes of the meeting because:
 It is a way to ensure accountability and assign responsibility as minutes of meetings keep track of
the issues tackled, decisions and actions agreed upon by the expanded PHB.
 It is also one way by which ZFF monitors, guides and verifies the good leadership and governance
being implemented in one’s province
 Start the meeting promptly and diligently

 Present the meeting objectives and agenda
 Encourage the participants to express their ideas and opinions, but also be cautious of the time
 Discuss issues and concerns following the agenda
 Be a listener or mediator and entertain their questions along the way
 Make sure that decisions are majority-based, if not consensual
 Always explain the winning decision if there is a tie
 Synthesize the session
 Recap the agreements and action points of the meeting
 Set the schedule, time and venue for the succeeding meeting
Figure 3. Sample PHB Meeting Attendance Sheet
20
REPUBLIC OF THE PHILIPPINES

Province of _________________
Municipality of _________________
MINUTES OF THE MEETING of the PROVINCIAL HEALTH BOARD

HELD AT _________________
ON _________________
Presents:
Name Chairman
Name Vice Chairman
[Fill as needed]
Members: Names
Secretariat: Name
Expanded Members of the Local Health Board:

Names
I. AGENDA
Time Activity Person/s Responsible
II. MINUTES AND PROCEEDINGS
III. AGREEMENTS
Issue/ Concern Response/ Agreement Deadline Person/s Responsible
--------------------------------------------------------Nothing Follows--------------------------------------------------------
Prepared by: Noted by:
[Signature] [Signature]
Name (Designation) Name (Designation)
Approved by:
[Signature]
Name (Designation)
Figure 4. Sample Minutes of the Meeting Format
After the Meeting

 Ensure that the undiscussed matters get to be included in the agenda of the next meeting
 Monitor and enforce the decisions and agreements made during the meeting
21
II. Health Care Provider Network Governance Body or Management Group
We have earlier established that the general direction and decision-making for the broader systems
elements for the delivery of health services under a province-wide UHC system should always emanate
from the PHB. However, good management practice dictates that the actual execution of such services,
especially in coordinating and unifying what are essentially unconnected/poorly connected facilities and
providers, necessitates the institutionalization of a body which would take care of this on a daily basis.
This body was originally called the Service Delivery Network (SDN) Management Group. Pending the
finalization of the UHC Act IRR at the time of this writing, the SDN is practically the HPCN thus, for the
purposes of this manual the governing body for the province-wide UHC system shall be called the Health
Care Provider Network (HCPN) Management Group. The UHC Act defined the health care provider
network as “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.” Thus, pending
definitive clarification from the official UHC Act IRR, SDNs and HCPNs appear to be synonymous.
Chapter V, Section 191 of the UHC Act states that a province-wide system shall be set up under the PHB.
The PHB has the technical and administrative supervision over the component health facilities and health
human resources within its jurisdiction which would then lead to the delivery of integrated health services
within the province. The following configurations are suggestions from the DOH on how to set up a
province-wide or city-wide UHC health system9.
Figure 5. Option 1: Proposed Structure of the Province-wide Health System (PWHS)
Figure 6. Option 2: Proposed Structure of the Province-wide Health System (PWHS)
1
9RTI International. Strengthening the Referral Mechanism in a Service Delivery Network: Experiences from USAID's Luzon Health Project.
Washington DC: USAID and DOH; 2018.
22
In both configurations, the recommendation is clear that the service provision component of the PHWS
be managed directly by the “Service Delivery Manager”. Given that these services are going to be
implemented by Provincial Hospitals, District Hospitals and Rural Health Units in what is supposed to be
a seamless, coordinated and integrated manner, the complexity of the undertaking requires as many
inputs as possible from the health facility administrators of these different facilities/institutions. It is in
this spirit of cooperation and collaboration that the HCPN Management Group should come in.
CHECK
 In the status quo, how much of the provincial health system is a functioning HCPN? Are the health
services in the province delivered in an integrated manner?
 Who is currently running this network of facilities? Is this directly under the PHO or the PHB? Is this
body/group representative of the institutions that comprise it?
 The Governor and PHO should begin with what the province already has and work from there in
establishing the HCPN Management Group. The group will serve as the management board that will
ensure the effectiveness and efficiency of health services through primary, secondary and tertiary
care.10 Subsequently, its organization/reorganization should be determined by the functions/purpose
of the group as per DOH AO 2017-001411
o The HCPN Management Group shall manage the administrative, financial and performance
measurement requirements of the HCPN
o It shall ensure the highest level of performance of its HCPN by planning for and evaluating network
results, processes and accountabilities
o Establish a Technical Management Unit (TMU) housed in the Apex Hospital or any designated
facility within the HCPN with the following functions.
o Manages gatekeeping and referral across HCPN component facilities
o May also manage HCPN Trust Funds
o Performance of additional functions deemed necessary for improving support to the
HCPN Management Group and component facilities.
o At the provincial level, the HCPN Management Group manages the:
o Private sector partners (facilities and providers) that are part of the provincial HCPN as
identified by the PHB in the organization of the PWHS
o Support services to patients needed in “navigating” what’s available within each care level
(primary to tertiary)
o Referral services
10
Beyond Hospital Beds: Equity. Province-Wide/City-Wide Health System (Asuncion, IL., interview by service and quality UP Manila RTD,
November 29, 2018).
11 DOH, USAID and Jhpiego. Guide in Establishing a Functional Service Delivery Network (SDN) for MNCHN-FP Services. Manila: Jhpiego
Philippines; 2016.
23
 Overall, the HCPN Management Group is in charge of establishing and sustaining a functional HCPN
within the PWHS by installing the following10:
 Organized HCPN management structure and policies

 Functional health systems instruments for HCPN
 Coordinated health and support service in all levels of care of the HCPN
 Technical, administrative and financial support systems are put into place
 Continuing quality improvement systems
 Dynamic and responsive health information systems
 Competent and responsive health care providers at all levels
 Mechanisms for ensuring availability of health commodities and resources
COLLABORATE
 Who are the suggested members of the HCPN Management Group11?
 It is recommended to be composed of the Provincial Health Officer, Apex Hospital Chief, Medical
Center Chiefs, PhilHealth representatives, private sector representative and CSO or religious group
member, 1 L1 Hospital Chief, 1 MHO, and 1 component CHO to ensure representation in decision
making for the HCPN (see Figure 7 below)
 The HCPN Management Group shall meet at least three (3) times a year
 To be effective in carrying out the expected roles and responsibilities of the HCPN Management
Group, the following must be considered10:
 Professional and technical competencies and personal attributes;

 Feasibility in calling for and/or attending meetings and HCPN events;
 Access to technical and administrative resources;
 Possess positive/progressive thinking and decision-making skills;
 Willingness to assume new and/or additional responsibilities;
 An active member of the private sector representative should be a member of the management
committee;
 Comfortable in working in teams and relating with various groups.
Figure 7. Sample Organizational Structure for the HCPN Management Group

10 Beyond Hospital Beds: Equity. Province-Wide/City-Wide Health System (Asuncion, IL., interview by service and quality UP Manila RTD,
November 29, 2018).
11
DOH, USAID and Jhpiego. Guide in Establishing a Functional Service Delivery Network (SDN) for MNCHN-FP Services. Manila: Jhpiego
Philippines; 2016.
24
Note: A group of seven to nine regular members for the HCPN Management Group will be a
functional size to provide both sectoral and technical representation. Private sectoral
representation in the context of setting up a UHC PWHS is essential.
EXECUTE
 The HCPN Management Board is tasked with achieving the desired health targets and outcomes of
the PWHS. These include the scaling-up of health services in the province’s component health facilities
through the dynamics of a functional HCPN10
 In 2017, the DOH updated the SDN by stating that the following are its functions11:
Population-wide and Individual Health Assessment

 All HCPNs facilitate the annual analysis and assessment of updated individual health profiles for
determining catchment population needs
Planning
 Drafting of a comprehensive medium-term investment plan responsive to key issues identified in the
catchment population.
Service Provision
 Population-wide and individual-level interventions
 Expand access to specialty services through practical technology, like but not limited to, telemedicine
 Ensure that patients always get timely and reliable access to appropriate facilities and needed quality
health care. This may include having centralized communication and referral systems
 Ensure that medical practice (and other related functions) within the system is within the limits of
what is allowable based on a facility’s licensing and accreditation classification. It should also be
consistent with clinical practice guidelines.
Referral and Transport

 Access to any trained health worker (pharmacists, midwives, nurses or primary care physicians) as
first point of contact within the health system should be assured. Subsequent navigation and
appropriate/timely referral to next level of care as needed should also be ensured.
 Health Information System
o Maintain health records and an updated registry of all patients within their catchment areas via
an interoperable health information system compliant with eHealth standards.
 Monitoring of Service Provision
o Regular assessment of quantity and quality of service provision, and attainment of the HCPN
targets in terms of health outcomes, financial protection and responsiveness.
November 29, 2018).
11 DOH, USAID and Jhpiego. Guide in Establishing a Functional Service Delivery Network (SDN) for MNCHN-FP Services. Manila: Jhpiego
Philippines; 2016.
25
 How to establish a HCPN Management Group?
 Upon deliberation and discussion of the PHB coupled with an analysis and stocktaking of the available
health services/institutions in the province, a PHB resolution should be crafted to establish the HCPN
Management Group
 Members and their respective roles should be included
 Convening of the HCPN Management Group for the first time should be included and, in that session,
it is recommended that the procedures/guidelines regarding the timing of both regular meetings and
as needed sessions should be formalized and agreed upon by the members of the HCPN Management
Group
 Please see, and modify as necessary, the following sample resolution/policy on establishing the SDN
(HCPN) from the City of Samal, Pangasinan for the establishment of the city’s SDN (HCPN) and
subsequent allowances/provisions made for the designation of its SDN (HCPN) Management Group.
26
27
28
29
30
Figure 8. Sample Executive Order on Establishing a Service Delivery Network / Health Care Provider Network
31
 Regular HCPN Management Group meeting (frequency) with documentation
 Importance of documenting the meeting (refer to the reminders of the PHB meetings above)
o The group shall meet at least three (3) times a year (quarterly)
 A majority of the members of the HCPN Management Group shall constitute a quorum and usual
meeting processes follow from there (validity of meeting, decision-making, voting, etc.).
 Ideally, the decisions of the HCPN Management Group regarding the health service delivery planning,
implementation and monitoring/evaluation for the health programs of the province in these meetings
are guided/directed/influenced by the general directions set by the PHB.
 It is strategic to discuss the fulfillment of the health service deliverables of the province within UHC in
terms of the ZFF IPHSDP as these are theoretically what need to be done to transform the Provincial
Health System into UHC.
 Sample of meeting documentation (see modify, as necessary, the sample meeting documentation of
the PHB)
 What to discuss during HCPN Management Group meetings?
 These are guided by the principles and concerns mentioned above:

o Determine HCPN related policies to be recommended to the PHB
o Monitoring of HCPN processes and accountabilities
 Implementation of directives from the PHB
 The HCPN M&E framework shall align with accepted indicators, indicator definition and targets of the
DOH
 Performance audits and progress monitoring shall be done by respective HCPN Management Groups
and Technical Management Units and concerned DOH offices
32
How do I change my Local Investment Plan for Health (LIPH) Deliverable

from Red to Green?
Provincial Investment Planning for Health
 Reviewed and approved Provincial Investment Plan for Health (PIPH) by the Provincial Health
Board (PHB)
 Prioritized health needs, interventions and support through evidence-based and participatory
approaches
 Integrated Provincial Investment Plan for Health with the Provincial Development Plan
 Reviewed, updated and approved Provincial Annual Operation Plan (AOP)
 LGU funded components of the AOP are integrated in the Annual Investment Plan (AIP)
 Timely and complete submission of accomplishment and validation reports
Municipal Investment Plan for Health
 75-100% of municipalities that have MIPHs
33
Why do I need to address the Local Investment Plan for Health Deliverable?
In a province-wide UHC health system, the PHB is at one end while the system’s realization – that of
integrated health service delivery for all – is at the other. The former is the bearer of the vision while the
latter is its manifestation. In between the two however, lie the processes, interventions, infrastructure,
reforms, resource utilization and decisions for the PHB to be able to catalyze the transformation of the
current provincial health system towards one that is UHC. Once the “Who” and “What” are clear, the
“How” usually follows.
It is in this context that the Local Investment Plan for Health (LIPH), composed of what should be an
overarching Provincial Investment Plan for Health (PIPH) and its component Municipal Investment Plans
for Health (MIPH), are undertaken by the health system actors in the province under the leadership of the
PHB. Resource allocation and utilization are a big part of it, hence the emphasis on health financing, but
the LIPH goes beyond that. Planning is but a manifestation of what decisions have been made and what
outcomes are to be expected. Once again under UHC, the question to be answered is; “What is the
experience of people in the province in terms of health and health care given an integrated province-wide
health system?”
Local Investment Planning for Health as a process requires the identification of needed resources to bring
effective and priority interventions to fruition for the attainment of national and local health goals and
objectives. It entails a three-year planning cycle that is applied to all levels in a locality. A province-wide
health system under UHC will essentially be anchored on this process. Consequently, the Annual
Operational Plans (AOPs) of the PWHS should be based on the LIPH.12
The LIPH is not explicitly stated in the UHC Act, but rather strongly hinted at in Chapter V, “Organization
of Local Health Systems” and its corresponding sections. These outline how the province’s health
infrastructure should be organized, the source of funding for the needed material and human health
resources, sustainability of the said resources and how these are to be allocated and utilized1. Pending
the release of the UHC Act’s Implementing Rules and Regulations (IRR) at the time of this writing, the
existing guidelines for the LIPH are what will be used for the governor, PHOs and their respective health
teams in the crafting of their province’s PIPH.
12 Department of Health. Framework for redefining the service delivery network. DOH Administrative Order 2017-0014. Manila; 2017.
34
I. Provincial Investment Plan for Health
CHECK
 What is the Provincial Investment Plan for Health?13
 It is a 3-year comprehensive plan, prepared by the province’s health system actors to be applied to all
levels in the province (from barangay, municipality/component city, district and province)
 The plan aspires to achieve the goals set in each of the elements that comprise a responsive health
system as indicated in the planning framework
 It is implied that an exemplary leadership and governance emanating from the PHB/provincial health
system leaders steers the health system in terms of service delivery, regulation, health financing,
health information system and human resources for health to ensure the desired health outcomes.
 Annual Operational Plans (AOP) are prepared for each year of the 3-year planning cycle of the PIPH.
 What is the AOP and how does it relate to the PIPH?13
 In the context of the PIPH, the AOP is a local policy instrument that allows the provincial government
to articulate local investment preferences and priority interventions for a specific year based on the
three-year strategic thrusts contained in the PIPH.
o The revised guidelines for LIPH further say these things about the AOP:
 Local expression of the DOH national implementation framework that in turn
supports the Philippine Development Plan (PDP) towards achieving SDG
 The AOP shall be institutionalized as the localization tool of national health programs,
which serves as the basis for resource mobilization and technical assistance provision
and allocation.
 It contains interventions and investments, including fund sources whether from LGUs, DOH,
development partners and other stakeholders.
 The AOP is expected to result in incremental changes leading to local health systems improvement as
demonstrated by available essential health products and appropriate technologies, improved
regulation, responsive health workforce and health care provider networks, equitable and sustained
health financing – all of these powered by transformational leadership and governance structures, all
captured by a robust local and national health information system.
 Does the province have a PIPH?
 Does the PHO collect and compile MIPHs? Is the PIPH used as an overarching planning guide by the
component municipalities and cities in the province? How are these MIPHs aligned with the PIPH?
o When was the last time the PIPH was updated? When was it last evaluated? Are there
functioning mechanisms for such?
o Does the province already have an approved PIPH? AOP?
o Has the province revised the PIPH and AOP to align with the Universal Health Care Act?
13ACCESS for Maternal and Neonatal Health. Changing Systems for Changing Lives; The Davao Toolbox to Promote Maternal and Newborn
Health. Davao: KOICA, USAID, Jhpeigo, WHO Philippines; 2018.
35
 Did the province already integrate the LIPH to the Provincial Development Plan?
 Did the province submit their fund utilization report?
COLLABORATE
 Who are the members that will contribute in developing the PIPH?
 Participation of key stakeholders encouraged throughout the PIPH/AOP processes, in particular:

o Inclusion of DOH Representatives/Development Management Officers (DMO), Regional
Program Managers (RPM), CHD and LGU Budget Officers and Accountants, PhilHealth
representatives, representatives from other government agencies in local consultations and
planning workshops
o Invitation to representatives of legislators, IP Mandatory Representatives (IPMR)/IP CSOs,
other champions in health development work in local consultations and planning workshops.
 It is very important that key players will be invited to develop the PIPH for the overarching purpose
of ensuring that the three-year plan (PIPH) and the yearly plans (AOP) on local investments for health
are relevant and responsive to the needs of the province13
o The following is the LIPH Planning Management Structure as suggested by the DOH in the
LIPH Handbook:
Level/Unit Proposed Composition

Barangay Barangay Captain, Barangay Councilor for Health, Community Health Team,
Rural Health Midwife, Barangay Health Worker
Municipal/City Health Officer, Budget Officer, Accountant, Treasurer, Planning Officer and
Municipal/City DOH Officer, Councilor for Health, Chief of LGU Hospital,
Representative/s from Indigenous People, People’s Organizations, Private
Sector
ILHZ/District ILHZ Technical Head, Health Officers, Chief of Hospital of the core referral
hospital, Municipal or Provincial DOH Officer
Provincial Health Officer, Budget Officer, Accountant, Treasurer, Planning Officer,
Provincial DOH Officer, Councilor for Health, ILHZ Technical Head, and Chief of
Provincial Hospital
Regional Office Assistant Regional Director, Planning Officer, LIPH Coordinator, Program
Managers and Provincial DOH Officer
Table 2. LIPH Planning Management Structure13
36
EXECUTE
 How do you come up with the PIPH?
 The specifics and particulars of crafting an LIPH are in the “Local Investment Planning for Health;
Handbook on Principles, Guidelines, Procedures and Processes13”, a publication available online and
in the DOH Bureau of Local Health Systems Development (BLHSD). The succeeding sections outlines
the basic principles in the creation of the PIPH as per the said resource.
 As earlier enumerated, the LIPH follows the planning process of situational analysis, identification of
needs based on accurate and verifiable data, identification of appropriate and evidence-based
strategies, determining investment costs and sources of funds.
 Situational analysis shall include a review of past PIPH/AOPs and other LGU health plans or health-
related plans
 It is hoped that the following are considered while making the PIPH; the process and principles of
participatory planning, focus on equity, and systems-thinking
 The following is a visual representation of the Planning Framework for the creation of the PIPH13:
Figure 9. LIPH Planning Framework13
 The general guiding principles to be used in the crafting of both the PIPH and the AOP are13:
o Both the PIPH and the AOP are anchored on national and local objectives for health, guided
by the vision and mission of the LGUs. In the case of the PWHS, the guiding vision and mission
are determined and formalized by the PHB.
o The PIPH and its component AOPs shall be evidence-based.
37
o The PIPH shall be guided by the logical framework of integration, coordination and
complementation.
o Development of the PIPH/AOP shall focus on institutionalization for sustainability.
o The PIPH financial plan is based on established strategies and critical interventions in order to
optimize the use of local and national fund sources.
o The PIPH shall exhibit the shared vision, common interests of stakeholders, critical
interventions and the required investments in the province.
o The PIPH and its component AOPs are aligned with both LGU and DOH budget timelines
o The Annual Operational Plan (AOP) is a detailed translation of the PIPH
o The PIPH shall be bound by continuous quality improvement focusing on equity, effectiveness
and efficiency
o The PIPH is an integrative tool, maximizing local and national resources toward the
development of a responsive and equitable health system
 The LIPH Handbook also mentions three (3) important pre-requisites in crafting the PIPH and the AOP.
These are: a) knowing the direction and workflow of planning, b) timing of planning, and c)
formulating or updating the LGU’s vision, mission and goals
o In the UHC context, the PIPH then is the vehicle for the actualization of the crucial decisions
of the PHB in terms of transforming the present health system to a province-wide UHC health
system.
o It is essentially the Planning Team composed of the governor, PHO and the rest of the PHB
that must have a clear sense of the where the planning process is headed. The following figure
depicts the rigorous, sequential, participatory and evidence-based
Figure 10. LIPH Planning Workflow13
 For the actual creation of the PIPH, the LIPH Handbook states that a planning workshop shall be
convened, with the following stakeholders, such as but not limited to:
o Component City and Municipal Health Officers
38
o Provincial/City/Municipal Health Board Members

o Provincial/City/Municipal Planning and Development Officer
o Chief of hospitals of the provincial, city, district, community and DOH-retained hospitals
o Administrative Officers of the provincial, city, district or community hospitals
o Provincial policy-making bodies such as the Sangguniang Panlalawigan/Panlunsod/Bayan
o DOH RO’s Planning Officer and Local Health System Coordinator
o DOH RO’s Development Management Officers (DMOs)
o Representatives of private sector, including people’s organizations, non-profit organizations,
hospitals, birthing homes, etc
o Other concerned government agencies
o Development partners and donors
 The following Figure shows the Workflow Diagram in Formulating the LIPH/AOP as per the LIPH
Handbook:
Figure 11. Workflow Diagram in Formulating LIPH/AOP13
39
 How do you integrate LIPH into the Provincial Development Plan?
 The vision for the provincial health system as articulated by the PIPH cannot be crafted outside the
overall development vision of the province. Especially with the learnings of the PHO and governor
from the PLGP Cycle 2 in terms of the Primary Health Care (PHC) Approach the recognition that good
health is a function of socioeconomic development only serves to underscore the necessity that the
PIPH is integrated within the Provincial Development Plan.
 As outlined in the LIPH Handbook the PIPH Planning team may adopt the following process in terms
of strategy formulation,13
o Develop local roadmaps aligned with national objectives and thrusts (e.g. NOH, PLGP road
maps, SDG provincial thrusts, etc.)
o Discuss and agree with NGAs, development partners, private sector and other stakeholders
for potential health investments.
 How do you monitor the approved PIPH?
 Once approved, the PIPH and its component AOPs, should be employed by the PHB in guiding its
decisions, behaviors and actions in its role of catalyzing the transformation of the provincial health
system into a province wide UHC system.
 An analysis of the coming together of provincial health indicators, health outcomes, resource
utilization, infrastructure development, human health resource hiring and deployment, etc. should
always be part of the essential functions of the PHB. The result of all of these is valuable health
information that feeds into the decision-making that characterizes the leadership and governance
function of the PHB.
II. Municipal Investment Plan for Health
Points to Consider:
 The different Municipal Investment Plans for Health (MIPH) will also follow the format and
template of the LIPH but the content is contextualized at the municipal level.
 Since the component MIPHs in a province ideally constitute the overall PIPH, an inventory or
monitoring report on the status of MIPH submission should be available at the provincial level. The
details and processes of such are detailed in the LIPH handbook
40
How do I change my Health Facility Accreditation Deliverable from Red to

Green?
 86-100% of government hospitals are PhilHealth accredited
 86-100% of municipalities have accredited facilities for:
1) PCB and TB-DOTS

2) MCP and NCP
41
Why do I need to address the Health Facility Accreditation Deliverable?
The end point of Leadership and Governance in a Province-wide Universal Health Care System is the
enjoyment of people in the province of their right to health. The strengthening and establishment of
HCPNs by the Governor, PHO and the rest of the PHB facilitate the delivery of quality preventive and
curative services in the province. Under Chapter 4 of RA 11223 Sections 17 and 18, health services are
generally identified as two types: (a) Population-based Health Services and (b) Individual-based Health
Services1.
Under Population-based Health Services, the UHC Act named the following minimum components: (a)
Primary care provider network with patient records accessible throughout the health system; (b) accurate,
sensitive, and timely epidemiologic surveillance systems; and (c) Proactive and effective health promotion
programs or campaigns. Individual-based Health Services, on the other hand, shall be accessed through
private, public, or mixed health care provider networks contracted by PhilHealth. The mechanisms and
processes to ensure that these components are present in the PWHS are the focus of the succeeding
sections of this guide.
As stated in the National Health Insurance Act of 2013 or RA 7875, health can be prioritized as a strategy
for bringing about faster economic development and improving quality of life. Overall development can
be brought about with a community that is healthy and productive. In this context, it is essential to be
able to adopt an integrated and comprehensive approach to health development and to provide universal
health care coverage.14
An important aspect of execution of UHC is to ensure health coverage for all Filipinos which can be done
by insuring everyone through the National Health Insurance Program (NHIP), more popularly known as
PhilHealth. PhilHealth seeks to provide comprehensive health care services to all Filipinos through a
socialized health insurance program where the health needs of the underprivileged, the sick, those who
are elderly, persons with disabilities (PWDs), women and children are prioritized and indigents are given
access to free health care services14. Since all Filipinos are to be mandatorily covered by PhilHealth under
the UHC Act1, responsible and effective allocation of national resources for health must be carefully
carried out. Despite building on PhilHealth, the UHC Law does not guarantee free access to health care
benefits to everyone, but rather, the objective is to help the people pay for health care services in a
predictable way according to their capacities, and in a way that will not push them into poverty due to
high and sudden out-of-pocket health spending. It is therefore important that health care providers in
UHC are monitored, regulated, and accredited to ensure that the citizens receive health care services that
are of the desired and expected quality.
In the setting up of the PWHS, one of the most crucial health governance processes that the Governor
and PHO have to oversee, monitor, and facilitate is accreditation of the government hospitals as well as
the municipal health facilities to ensure that their constituents get to enjoy their PhilHealth benefits. RA
7875 also states that PhilHealth shall be “compulsory in all provinces, cities and municipalities nationwide,
notwithstanding the existence of LGU-based health insurance programs14”, finalizing its enactment and
undermining hesitation or resistance that may arise. In this sense, the UHC Act can be viewed as the long
overdue full operationalization of PhilHealth especially within the framework of an Integrated Province-
wide Health System.
1Philippines, Government of the. Republic Act 11223; Universal Health Care Act 2019. 2019.
14Bureau of Local Health Systems Development. Local Investment Planning for Health; Handbook on Principles, Guidelines, Procedures and
Processes. Manila: DOH, 2015.
42
CHECK
 What does accreditation of health care providers mean?
 Accreditation of Health Care Providers is a process that verifies the qualifications and capabilities of
health care providers in accordance with the guidelines, standards and procedures set by PhilHealth
for the purpose of conferring upon them the privilege of participating in the Program and assuring
that health care services rendered by them are of the desired and expected quality.
 What are the different types of Accreditation14?
Initial Accreditation
 Given to qualified health care providers that are applying for the first time. Accreditation takes effect
upon compliance of the requirements.
Continuous Accreditation
 Given to accredited health care providers that complied with the requirements prescribed by the
Corporation that qualify them for uninterrupted participation to the Program, until accreditation is
withdrawn based on PhilHealth rules.
Re-accreditation
 Given to health care providers under any of the following conditions, or any other conditions as
determined by PhilHealth:
o Health care institutions whose previous accreditations have lapsed or whose subsequent
applications were denied;
o Health care institutions that failed to submit the requirements for continuous participation
within the prescribed period;
o Acquisition of additional service capability that would require change in license/certificate, as
applicable, issued by the relevant authority;
o Transfer of location. The health care institution must first secure a license to operate from
the DOH for the new facility prior to the date of transfer and apply for re-accreditation within
ninety (90) calendar days from the date of transfer. Beyond this period, the accreditation shall
automatically lapse, and all claims filed with PhilHealth shall not be paid. The health care
institution must inform PhilHealth of the planned transfer indicating the exact date of transfer
and address of the new site. The ninety (90) day grace period shall not apply to the new site
if it is not licensed;
o Upgrading of facility level or category;
o Change in the classification of health care institution;
o Change in ownership. The health care institution in good standing must apply within the
ninety (90) calendar days from actual change of ownership;
o Resumption of operation after closure/cessation of operation
o Professionals whose previous accreditations have lapsed or whose subsequent applications
were denied shall be re-accredited.
14Bureau of Local Health Systems Development. Local Investment Planning for Health; Handbook on Principles, Guidelines,
Procedures and Processes. Manila: DOH, 2015.
43
Note: When the accreditation of a health care institution lapsed due to the voluntary act of a health
care provider to evade the consequences of a previous violation or adverse findings indicating fraud, as
determined PhilHealth, the application for re-accreditation shall be denied.
Reinstatement of Accreditation
 This means restoration of accreditation after compliance to conditions following a suspension
imposed by PhilHealth.
 What is the PhilHealth accreditation status of your facility? Inventory of the accreditation status of
facilities (government hospitals and municipal facilities)
 Government Hospitals
 Municipal Health Facilities – are they PCB, MCP and TB-DOTS accredited?
 How about your private health facilities in the province? Are these also PhilHealth accredited?
 The following are the health care providers that can be accredited to participate in the Program14:
Health care institutions:

 Hospitals
 Out-patient clinics:
o Rural health units/health centers
o Dispensaries/infirmaries
o Birthing homes/facilities
o Medical out-patient clinics
o Other Primary Care Facilities licensed by DOH
 Free-standing dialysis clinics (FSDCs)
 Ambulatory surgery clinics (ASCs)
 Health Maintenance Organizations (HMOs)
 Community-based health care organizations (CBHCOs)
 Maternity clinics
 Anti-TB/DOTS Clinics
 Pharmacies
 Other health care institutions licensed by the DOH
Health care professionals:

 Physicians
 Dentists
 Nurses
 Midwives
 Pharmacists
 Other duly licensed health care professionals
14Bureau of Local Health Systems Development. Local Investment Planning for Health; Handbook on Principles, Guidelines, Procedures and
Processes. Manila: DOH, 2015.
44
COLLABORATE
 Do a stocktaking of the hospitals, RHUs, municipalities, and other health facilities in the province in
terms of their accreditation status. What are the reasons for non-accreditation of these facilities (if
applicable)?
 Who will do the accreditation of facilities?
 Third Party Accreditation – is the accreditation of health care institutions by a third party duly
recognized and authorized by PhilHealth exclusive of the decision-making function to grant or deny
accreditation to Program
 The third-party accreditation is to be done through the Hospital Accreditation Commission (HAC)15
EXECUTE
Figure 12. Accreditation flow chart for Healthcare Institutions15
 Through the PHB and HCPN Management group, develop actionable plans on initial, continuous and
re-accreditation how of provincial health facilities and institutions to ensure the integrity of the
provincial HCPN.
15Philippine Health Insurance Corporation (PhilHealth). The revised implementing rules and regulations of the National Health Insurance Act of
2013 (RA 7875 as amended by RA 9241 and 10606). Philhealth.gov. https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf. Accessed
May 31, 2019.
45
 What are the minimum requirements for Accreditation15?
 Pre-Accreditation Survey (PAS) - is a process of assessing health care institutions that are not
automatically accredited as defined by PhilHealth as well as those applying for advanced participation.
 SECTION 56. Accreditation Requirements for Health Care Institutions:
o Health Care Institutions must have been operating for at least three (3) years prior to initial
application for accreditation, with a good track record in the provision of health care services.
o The period of the three-year operation requirement shall be based on the effectivity date of
either the initial license, clearance to operate, certificate, or other proof of operation issued by
the DOH or other pertinent government agencies if applicable. HCI that have temporarily stopped
operation due to upgrading, expansion, change of ownership or any other causes shall have their
length of operation computed on a cumulative basis from the date of the initial operation of the
former institution.
o Must have license of certification from DOH
o They must comply with the provisions of the performance commitment. They must have their
own ongoing formal program of quality assurance that satisfy the PhilHealth’s standards.
o Any other requirements that may be determined by the PhilHealth.
 Exemption from the three-year operation requirement:
o Primary Care Benefit Providers with or without out-patient malaria package;
o TB DOTS providers;
o Non-hospital maternity care package providers;
o Animal bite treatment providers; and
o Such other health facilities as may be determined by the PhilHealth.
 Other conditions for exemption from the three-year operation requirement:
o Its managing health care professional has a working experience in another accredited health care
institution for at least three (3) years or a graduate of hospital administration or any related
degree;
o It operates as a tertiary facility or its equivalent;
o It operates in an LGU where the accredited HCI cannot adequately or fully service its population;
o Its service capability is not currently available in the LGU;
o It is an extension or branch of a health care institution that has been accredited for at least two
(2) years.
 For PCB Providers – The signed and duly accomplished Electronic Medical Record (EMR) Engagement
Form shall be submitted as an alternative document to the Memorandum of Agreement (MOA) and
Service Level Agreement (SLA) made between the management and EMR providers. In case the PCB
Provider fails to comply with any of these documentary requirements, the PCB Provider shall still be
deemed accredited to allow family/member assignment, but no PFP claims shall be processed. A
functional EMR system is required to proceed with enlistment and profiling (PC Advisory No. 2017-
0031).
 For TB DOTS Package providers - The DOH PhilCat TB DOTS Certificate must be updated. Should the
certificate expire within the year, the facility shall be given sixty (60) calendar days to submit the
updated certificate. Non-compliance within the aforementioned prescribed period shall result to
withdrawal of accreditation15.
15Philippine Health Insurance Corporation (PhilHealth). The revised implementing rules and regulations Philhealth.gov.
https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf. 2019.
46
o Initial Accreditation Requirements for TB DOTS and Animal Bite Package Providers:
 General Performance Commitment - duly signed by the owner/s and the head/s of the
facility
 Provider Data Record (PDR)
 Updated DOH Certificate as a TB DOTS or Animal Bite Treatment Center
 Proof of Payment of Accreditation Fee (TB DOTS: P1,000; ABP: P1000)
 Electronic copies (in JPEG format) of recent photos of the HCI
 Statement of Intent (SOI)
o Applicable only for applications filed within the last quarter of the year.
o Signed by the Medical Director/ Chief of Hospital/ Head of Facility or administrator
representative
o HCI shall choose only one option for the start of accreditation
 Location map – properly labeled and clearly illustrated
 Maternity Care Package (MCP) Providers and Newborn Care Package (NCP) Providers duly licensed by
the DOH may apply for automatic accreditation. These HCIs shall not undergo pre-accreditation survey
(PAS) to be accredited. Requirements are as follows:
o Updated DOH license to operate (LTO)
 Application for Initial accreditation in 2014 and onwards;
 Application for initial, continuous and reaccreditation in 2015 and onwards)
o Certificate of Compliance as BEmONC facility
o Newborn Screening (NBS) Certificate (issued by the Newborn Screening Reference Center (NSRC)
or temporary (NBS) Certificate issued by the Newborn Screening Center (NSC)
 A valid DOH license to operate (LTO) shall be a mandatory requirement for all Maternity Care Package
providers (MCP) / birthing home (BH) applying for initial, continuous, and reaccreditation.
o Initial Accreditation Requirements:
 General Performance Commitment - duly signed by the owner/s and the head/s of the
facility
 Provider Data Record (PDR)
 Updated DOH LTO
 Proof of Payment of Accreditation Fee (P1,500)
 Electronic copies (in JPEG format) of recent photos of the HCI
 Statement of Intent (SOI)
o Applicable only for applications filed within the last quarter of the year.
o Signed by the Medical Director/ Chief of Hospital/ Head of Facility or administrator
representative
o HCI shall choose only one option for the start of accreditation
 Location map – properly labeled and clearly illustrated
 Proof of training on IUD insertion of the health care Professional (only for HCIs with
capability)
o Physicians: graduate of Residency Training on Obstetrics and Gynecology OR with
Family Planning Competency Based Training (FPCBT) Level 2 certification
o Midwives: FPCBT Level 2 certification
15Philippine Health Insurance Corporation (PhilHealth). The revised implementing rules and regulations Philhealth.gov.
https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf. 2019.
47
 SECTION 64. Performance Monitoring System for Health Care Providers – A performance monitoring
system shall be implemented for all health care providers by PhilHealth:
o Periodic actual inspection of facilities and offices when necessary and appropriate;
o Analysis of mandatory monthly hospital reports and other reportorial requirements as
determined by PhilHealth;
o Periodic review of health facility data and patient’s chart review for purposes of determining
quality and cost-effectiveness as well as adherence to practice guidelines by health care
providers;
o Conduct of utilization review;
o Peer review, adverse reports and other pertinent information;
o Conduct of patient satisfaction surveys;
o Periodic assessment of the performance of all health care providers based on performance
commitment and standards;
o Inspection and audit of books, records, billing statements, medical charts, doctor’s notes, and
other documents and processes deemed important by PhilHealth to complete a thorough review;
o Inspection of books of accounts, ledgers, invoices, receipts and other accountable forms deemed
relevant by the Corporation; and,
o Other mechanism or analogous process, as may be determined by the Corporation that would
be necessary to conduct a complete audit and investigation.
 The monitoring of the facilities shall be anchored on PHIC’s Health Care Provider Assessment System.
 When can they apply?
 Those that are applying for initial accreditation or re-accreditation may submit anytime.
 Those applying for renewal:
o Hospitals, ASCs and FSDCs: January 1 to 31 of the succeeding year
o Outpatient Benefit Package providers, Maternity Care and Anti-TB/DOTS Package providers:
September 1 - 30 of the current year.
 What else can be done?
 Provide Manual of Procedure of the New Accreditation Process to hospitals and all health facilities
that are not yet accredited.
 Create a three-year plan with the HCPN Management Group (directors, owners, MHOs, etc.) to get
more than 85% of government hospitals and more than 85% of municipalities PhilHealth-accredited.
 Utilize list of accredited and eligible-for-accreditation HCIs in the establishment of the Health Care
Provider Networks (HCPNs) under the PWHS.
Points to Consider:
 All municipalities should have accredited health facilities for Primary Care Benefit Package
(PCB), Tuberculosis DOTS, Maternal Care Package (PCB).
 An inventory or monitoring report on the status of municipal health facilities accreditation
should be available at the provincial level.
48
How do I change my Continuity of Care Deliverable from Red to Green?
Establishment of a Provincial-Led HCPN
 Presence of guidelines on HCPN arrangements with sustainable blood network and referral
system
 Monitoring and evaluation of HCPN implementation
Functional Capacity of Curative Facilities
 Curative facilities are licensed according to function in the HCPN and are accredited according
their licenses
 Capable of rendering 24/7 CEmONC services
 Conducted dialogue with catchment areas for improvement of services at least semi-annually
Functional Capacity of Preventive Facilities
 86-100% of municipalities have functional preventive facilities: complete health service packages
for all life courses (maternal, child, adolescent and senior citizens)
49
Why do I need to address the Continuity of Care Deliverable?
Health service delivery in the Philippines has always been a challenge in terms of continuity of care. While
devolution ostensibly sought to allow communities to have a more direct participatory role in health
initiatives and outcomes, it has also enabled further fragmentation of the health system, adversely
affecting how people access health care. This three-tiered yet disconnected health system has weak
referral systems, lacks gatekeeping mechanisms to health care access, is disadvantageous to poorer
populations, and is notoriously inefficient. It also unnecessarily places patients at a high risk of financial
burden from out-of-pocket expenses.17 Moreover, devolution renders health care vulnerable to
patronage and traditional politics, effectively preventing the allocation of much needed resources to
improve health care delivery processes.16
Nonetheless, devolution supposedly aims to bring health closer to the people by enabling local
communities to own and manage their health systems. ZFF believes that decentralization can bring about
the improvement of health systems through strengthening the decision-making capabilities of the health
system leaders of local government units. According to the ZFF Health Change Model, “local leadership is
the key to creating healthcare systems that are responsive to the needs of the poor.18”
Strengthening local leadership leads to the establishment of effective and efficient health referral
systems. In these systems, health care professionals such as physicians, nurses, midwives, pharmacists,
dentists, barangay health workers, and other allied health professionals are empowered. These are the
foundations of a unified health service delivery in terms of both preventive and curative health. In the
context of a province, by ensuring that such is properly managed through good local health governance,
the goal of having an integrated province-wide universal health care system can be achieved1.
One of the biggest changes that the UHC Act seeks to achieve is in the organization of Local Health Systems
as outlined in Chapter 5 of the UHC Law1. Traditionally, the provincial government is only directly
responsible for district and provincial hospitals – effectively the secondary and tertiary levels of care in a
province – with token (if any) influence over primary care, which is left in the hands of municipal and
barangay local governments. This usually results in disconnected, uncoordinated, and inefficient health
care across public health facilities effectively fragmenting health care access16. Thus, the integration of
province-wide health systems is an important aspect of the UHC Act which seeks to address the
fragmentation of current health service delivery mechanisms.
This unified PWHS essentially integrates the preventive and curative health facilities in a province, unlike
the status quo where provincial health governance is essentially focused on curative health care (hospital
systems). An integrated PWHS creates opportunities to address health issues at the primary and
promotive levels, where ensuring overall population health takes precedence over curative care.
16 Philippine Health Insurance Corporation (PhilHealth). Manual of procedure of the new accreditation process. PhilHealth Circular 54 s. 2012 ‐
Provider engagement through accreditation and contracting for health services. PhilHealth.gov.
https://www.philhealth.gov.ph/downloads/accreditation/MOP_PEACHeS.pdf. 2013. Accessed May 31, 2019.
17 Medina PN. (2016). The district health system in the Philippines. Lecture slides.
18 Romualdez Jr. A, dela Rosa J, Flavier J, Quimbo S, Hartigan-Go K, Lagrada L, & David L. The Philippines health system review. Geneva: WHO
Press; 2011.
50
As previously discussed, such a system requires health governance that appreciates the
interconnectedness of municipal, component city and provincial health systems elements.This is the
crucial role of the Provincial Health Board, led by the Governor with the Provincial Health Officer, whose
leadership facilitates the reorganization of the existing province-wide health facilities/providers into a
unified system, catalyzing the establishment of an effective continuum of health care1,3.
Primary Care and its importance in establishing Universal Health Care and Continuity of Care
Primary health care, as stated in the Declaration of Alma-Ata19, refers to “essential health care based on
practical, scientifically sound and socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full participation and at a cost that the
community and country can afford to maintain at every stage of their development in the spirit of self-
reliance and self-determination.” While this definition somehow refers to health services, PHC as defined
by Alma Ata is more of an approach or a set of principles that recognizes that health is a function of
socioeconomic development. Supporting this is the very definition of health19, a fundamental human
right, as “a state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity.” By promoting primary health care, the State, in effect, is recognizing its role of
promoting the health of the country through its mandate of overall nation building.
Primary care, on the other hand, refers to the "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," as defined in RA 112231. Thus, since it is comprehensive, continuing, and most
importantly, first contact, Primary Care serves as the gateway to the rest of the health system. Therefore
logically, it also acts as the foundation of any health care system in the provision of universal health care.
The Primary Health Care – Primary Care dynamic is further emphasized with the Declaration of Astana20,
which states that “strengthening primary health care (PHC) is the most inclusive, effective and efficient
approach to enhance people’s physical and mental health, as well as social well-being, and that PHC is a
cornerstone of a sustainable health system for UHC and health-related Sustainable Development Goals.”
With regard to its focus and scope, unlike specialized care that mostly caters to severe and uncommon
illnesses and their complications, primary care gets to focus more on the person as a whole. The primary
care provider gives person-centered and coordinated care, referring to specialty care when necessary.
Patients return to and continue their care with primary care after specialty care has been provided.
Additionally, aside from the primary biomedical services of diagnosis and treatment of illness, primary
care providers also handle general community health promotion, disease prevention, health
maintenance, counselling, and patient education.
3
Zuellig Family Foundation. Briefer on the Integrated Provincial Health Systems Development Program. 2019.
19 Zuellig Family Foundation. (n.d.). Our approach: Health change model. Zuellig Family Foundation. Retrieved June 1, 2019 from
https://zuelligfoundation.org/our-approach-health-change-model/
20
Department of Health. Guidelines in Establishing Service Delivery Network. Doh.gov.
https://www.doh.gov.ph/sites/default/files/publications/Guidelines%20EstablishingSDN.pdf. 2019. Accessed May 31, 2019.
51
All in all, good primary care reflects good continuity of care21, indicating that the people have ready health
care access for most of their health care needs in a reliable and timely manner. This further highlights the
importance of strengthening primary care and primary care services in the context of setting up a system
for universal health care.
I. Establishment of a Province-Led Health Care Provider Network and Functional Capacity of

Curative Facilities
As previously discussed, the Governor, PHO and their health governance team, play a crucial role in the
establishment and maintenance of continuity of care within the PWHS. In this system, health care
institutions providing basic preventive and curative health services should be accessible to everyone,
highlighting the importance of strong Primary Care as the foundation of UHC. The role of Primary Care as
“the navigator for Filipinos from all life courses through the health care system, providing the care that
they need or otherwise pointing and guiding them to the appropriate higher levels of care as deemed
appropriate1” can only be realized within an effective and functional network of health facilities such as
an integrated PWHS.
The PHWS needs to be built upon a functioning and efficient health care provider network (HCPN). The
aim is to achieve a coordinated and unified health system within the jurisdiction of the provincial
government. In this regard, a province’s HCPN must be assessed to determine what components need to
be accomplished and improved. Some of these assessment questions are as follows:
 What is a Health Care Provider Network (HCPN) and does my province have one?
 In the years leading to the UHC Act, a key concept/element for enabling UHC was the Service Delivery
Network (SDN); a network of health facilities and providers within the province or city-wide health
systems, offering a core package of health care services in an integrated and coordinated manner
similar to the local health referral system22. With the UHC Act, this was further nuanced into the
Health Care Provider Network (HCPN) with its own specifications as per the official UHC Act IRR which
is as of this writing still not final. As earlier stated, for the purposes of this version of the manual, the
HCPN is synonymous with the SDN.
 It is a strategic mechanism to expand access to a continuum of health care beyond geographical and
political boundaries in order to address the existing uncoordinated health system and facilitate
provision of unified quality care to all Filipinos.8 The following is a depiction of the suggested referral
system in the HCPN, as adopted from the Service Delivery Network systems:
1
8 Dorotan E, Zsolt M. Making Your Local Health System Work. German Agency for Technical Cooperation, 2005.
21 Administrative Order No. 2014-0046 Defining the Service Delivery Networks (SDNs) For Universal Health Care or Kalusugan Pangkalahatan.
2014
22 Administrative Order No. 2017-0014 Framework for Redefining Service Delivery Networks (SDN). 2017.
52
Figure 13. Illustration of SDN Referral System10
CHECK23,24:
 What is the purpose of establishing HCPNs?
 The HCPN shall ensure access to quality care for every family in the PWHS for:
o Population Health Interventions, Primary Health Care and Primary Care, including family
planning/maternal, newborn, and child health and nutrition
o Emergency, medical/surgical interventions in general hospitals
o Referral links to Specialty Hospitals and other health facilities
 HCPNs shall provide a local health referral system that holistically caters to the varying health needs
of the population, tapping into both government and private health facilities and making health
service delivery more effective and efficient.
 The UHC with the HCPNs emphasize a need for strong Primary Care and shall be based on a Primary
Health Care Approach.
 Strong Primary Care shall ensure gatekeeping where the first-line providers serve as entry points to
the comprehensive services across the HCPN
 Primary Health Care (PHC) plays a key role in the achievement of UHC. It values human rights, dignity,
non-discrimination, participation and empowerment, access and equity, and partnership of equals,
and require people to be at the center of health care.
November 29, 2018).
23 Department of Health. (n.d.). What is an ILHZ?. DOH Website. https://www.doh.gov.ph/node/1205. Accessed June 2, 2019.
24 Department of Health. A Handbook in Inter-local Health Zones; District Health System in a Devolved Setting. Manila: DOH; 2002.
53
 What are the primary care services that the province needs the most?
 Does the province have available data and systems for collecting data regarding its health indicators?
 What do the latest available provincial epidemiologic data signify?
 Which of the province’s constituent municipalities have frontline health systems with limited
capability to deliver primary care and thus need to be prioritized?
 Is there an existing communication and transport system in the province to facilitate referrals? What
are the resources in place that can be tapped to establish this?
 Does the province have a sustainable blood network in place? Are there blood products available 24/7
and enough for the needs of the province?
 Do the provincial hospitals have updated licensing and accreditation statuses based on function in the
provincial HCPN? Are the hospitals capable to render 24/7 Comprehensive Emergency Obstetric and
Neonatal Care (CEmONC) services?
 Are the provincial hospitals able to conduct dialogues with their catchment areas for improvement of
service?
 What are the policies and programs in place that are supporting the province’s health needs? What
more can be done?
COLLABORATE
 Create and organize the HCPN Management Group with the following suggested members (see
Service Delivery Network Management Group above for details) .
 Provincial Health Officer, Apex Hospital Chief, Medical Center Chiefs, PhilHealth representative(s),
private sector representative, CSO or religious group member, 1 Level 1 Hospital Chief, 1 MHO and 1
component city CHO to ensure representation in decision making for the HCPN
o The HCPN Management Group will meet monthly or as often as deemed necessary then at
least 3x a year after the creation of HCPNs and completion of MOAs.
 HCPN may be initiated or composed by both public and private hospitals and other health care
facilities. The setup should be determined by the HCPN Management Group as guided by the PHB in
coordination with DOH based on the health needs in the province.
 Organize a 24/7 Emergency Transport System within HCPNs and available and nearby Ambulance
Services.
 Tap into possible sources of support and innovative service delivery (Telemedicine, solar powered
health stations, etc.) from government agencies such as DOST and NGOs.
EXECUTE
 Undertake a stocktaking of the province’s primary, secondary and tertiary care health facilities:
 Inventory municipal health facilities in terms of primary care capability, DOH licensing (TB-DOTS,
BEmONC, etc.) and PhilHealth accreditation.
 Inventory provincial hospitals in terms of secondary and tertiary care capability, DOH licensing as well
as PhilHealth accreditation
 Identify and inventory provincial health facilities and hospitals that are capable of 24/7 Basic
Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and
Newborn Care (CEmONC) services
54
 Establishment of the HCPN (see DOH Guidelines in Establishing Service Delivery Network for details22)
 Identify needs of priority groups and the general population to define service targets effectively
 Community needs are the gaps between what is and what should be, which can be felt by an
individual, a group, or an entire community.
 These can be as concrete as: need for medicines commodities, health center building, facility
accreditation for MNCHN-FP and other kinds of services, trained service providers; or as abstract as:
improved care-seeking behavior, community support, effectiveness of service providers, and specific
competence of health managers and training
 Identify available Community Resources and integrate these with the inventoried available health
care providers that can serve the needs of the province’s priority groups and the general population
Province:
City/Municipality:
Services Name and Type PHIC Clinic Cost of Contact
Address of (Public/ Accreditation Hours/ Services Person and
Facility Private) Status Schedule Number
(1) (2) (3) (4) (5) (6) (7)
Modern Family Planning
Antenatal Care
Maternal and Newborn Care
Table 3. Sample Template for List of Service Providers19
o Designate priority groups, general population to the health facilities within the HCPN to facilitate
efficient access to quality health services
o Undertake monitoring and evaluation of the HCPN
 Schedule semi-annual dialogues with catchment areas for improvement of services
 The HCPN Management Group shall lead the creation of the memorandum of agreement for the two-
way referral systems: (a) between RHUs and hospitals, (b) from RHU/provincial hospital to any
PhilHealth-accredited higher level referral facility, and (c) from RHU/provincial hospital to any
diagnostic facility for laboratory needs.
19 Zuellig Family Foundation. (n.d.). Our approach: Health change model. Zuellig Family Foundation. Retrieved June 1, 2019 from
https://zuelligfoundation.org/our-approach-health-change-model/
22 Administrative Order No. 2017-0014 Framework for Redefining Service Delivery Networks (SDN). 2017.
55
 HCPNs shall agree to establish a sustainable blood network with blood products available 24/7
o Municipalities, in coordination with blood banks, blood centers, and hospitals, shall assign a
month or a period of time dedicated to the promotion of blood donation with a target of least
1% of the provincial population as blood donors.
o Arrange blood drives and set up a station just for the identification of blood type with provision
of identification cards identifying the holder’s blood type and listing up to five possible donors in
case of emergencies.
 PHOs through the PHB, shall:
o Organize HCPNs for Barangays and Municipalities in the province in coordination with DOH
Regional Office
o Maintain list of HCPNs and covered priority groups and general population by
barangay/municipality and submit to RO annually
o Submit quarterly report on coverage, utilization and client satisfaction of HCPN services quarterly
to DOH RO
 Work and financial plans, accomplishment reports, and performance review reports shall be
submitted by the RHUs and health centers to the PHO monthly
II. Functional Capacity of Preventive Facilities
Pending the crafting of the formal IRR of the UHC Act, a model that provincial governments can refer to
in the reorganization of their health systems is the concept of the inter local health zone (ILHZ). Back in
the early 2000’s, this was a strategy adopted by the DOH, described as the clustering of adjacent LGUs
(municipalities or component cities of a province) with a designated central or core referral hospital.25 The
ILHZ is the adaptation of a district health system wherein LGUs cooperate with each other to deliver the
health needs of the community. It is also noteworthy that hospital and preventive primary public health
services are integrated in an ILHZ at the central hospital. Through the ILHZ, component cities aim to
promote equity and to provide an effective referral system. By following and eventually expanding the
ILHZ model, further and improved reorganization of health service delivery can be done with the provincial
government playing a key role in the collaboration and cooperation of different municipalities as per the
UHC Act.
With the emphasis of the UHC Act on good Primary Care as the foundation of a functioning integrated
health system, the PHB should seek to enable and capacitate its component municipal health systems as
they are directly responsible for the provision of promotive, preventive and curative services at the
primary level. With the PHB effectively engaging the Rural Health Units and Municipal Health Offices,
population-level and individual-level primary care services are linked to the curative and more specialized
services that are available in the province. The PWHS is then characterized by HCPNs which guarantee
services for both well and sick, through all life stages, addressing the triple burden of disease at all levels
of the health care system4.
4Department of Health. Philippine Health Agenda 2016-2022. 2016

25Health Metrics Network-WHO. Framework and Standards for Country Health Information Systems [Internet]. 2nd ed. Geneva: World Health
Organization; 2008 [cited 2019 Aug 2]. 62 p. Available from: http://www.who.int/about/licensing/copyright_form/en/index.html
56
CHECK
 Do all municipalities have functional preventive facilities that are able to provide complete health
service packages for the well and sick, through all life courses, and addressing the triple burden of
disease (Maternal, Child, Adolescent, Senior Citizens)?
 Do all municipalities have patient/client satisfaction or feedback mechanisms?
 Is the current manual of operations of RHUs still in line with the UHC Act?
 How effectively can RHUs refer patients to higher levels of care and other institutions as the need
arises?
 How robust are the communication processes from the RHUs to the PHB/provincial health
governance systems for health program evaluation, modification and improvement?
COLLABORATE
 Convene RHU representatives, discuss current RHU programs and services, and identify key issues in
the implementation of programs for each respective primary care/municipal/barangay catchment area.
 Identify existing monitoring tools and systems in each RHU for gathering of epidemiologic data to
determine which areas need more support for recording and monitoring.
 Identify existing patient/client satisfaction or feedback mechanism and see how recommended CSS
can be adopted.
 Review RHU manual of operations and revise according to current directions regarding the UHC Law.
 Obtain a copy of RHU List of Services or arrange for its creation with the help of RHUs if lacking.
 Feedback and health information should be provided to the PHB to aid in overall decision-making for
the PWHS.
EXECUTE
 Municipalities must have all of the following services in order to have complete primary health
service packages:
 Maternal – Pregnancy Tracking, Prenatal visits, Birth preparedness plan and referral, Nutrition
promotion and assessment, safe labor and delivery, Antenatal Care, Postpartum Care, Basic
Emergency Obstetric and Newborn Care
 Child – Growth monitoring or identified undernourished children, Promotion of infant and young child
feeding, Expanded Program on Immunization, Integrated Management of Childhood Illnesses,
Micronutrient Supplementation
 Adolescent – Youth-friendly services, Promotion of ASRH, Counseling for unintended pregnancies,
Counseling on prevention of teenage pregnancies, STI management
 Senior Citizens – Immunization
57
 Implementation of population-level preventive and promotive health programs are done primarily
by Municipal Health Offices through their respective Rural Health Units and Barangay Health Stations
 RHUs must have annual reports on the status of their services with proper documentation of delivery
to be submitted to the PHO team
 There must be a patient and Client Feedback mechanism in all RHU staff/LHB meetings with
corresponding plan of action (Source: Implementation of CSS to all Health facilities, Calbiga, Samar)
 Client satisfaction survey (CSS) – rapid and simple tool to solicit feedback from the community
regarding the staff, health facility, and services it offers. It shall look into the percentage of clients
satisfied vs. those who are not satisfied with the overall performance of the facility visited
o CSS will be done daily, with the accomplished form given to the RHU/health facility staff
responsible or dropped in a designated drop box
o Box will be opened weekly, in the presence of DOH Rep and/or a non-government official, if
available in the community
o Results will be tallied and get the average point of satisfaction. Official result should be signed by
the witness.
o A scoring system will be developed
58
How do I change my Special Health Fund Deliverable from Red to Green?
 Issued an Executive Order indicating the composition of the Technical Working Group of the
Special Health Fund
 Developed guidelines to establish the provincial Special Health Fund
59
Why do I need to address the Special Health Fund Deliverable?
One of the landmark provisions of the UHC Act 20191 is the inclusion of Sections 20 and 21 of Chapter V,
“Organization of Local Health System”. Entitled “Special Health Fund” and “Income Derived from
PhilHealth Payments” respectively, the two provisions when taken together, seemingly determine the
source of funding for the organization/re-organization of existing provincial health systems into UHC
systems. The details of the said sections are articulated below:
SECTION 20. Special Health Fund – “The province-wide or city-wide health systems shall pool and manage,
through a special health fund, all resources intended for health services to finance population-based and
individual-based health services, health system operating costs, capital investments, and remuneration of
additional health workers and incentives for all health works. Provided, that the DOH, in consultation with
the DBM and the LGUs, shall develop guidelines for the use of the Special Health Fund.
SECTION 21. Income Derived from PhilHealth Payments – “All income derived from PhilHealth payments
shall accrue to the Special Health Fund to be allocated by the LGUs exclusively for the improvement of the
LGU health system; Provided, that PhilHealth payments shall be credited to the annual regular income
(ARI) of the LGU
As of the time of the writing of this guide, the DOH has yet to issue the guidelines governing the
establishment and subsequent use of the Special Health Fund. Thus, what is written in this part of the
guide are based heavily on anticipating the financial needs of the provincial health system in the context
of the organization/reorganization towards UHC.
60
CHECK
 From the abovementioned provisions of the UHC Act, it seems that the provincial Special Health
Fund is the result of the pooling together of all resources for health in the province. Beyond this pooling
of resources though, what’s more important is the management of the said fund to address the need
of the UHC PWHS.
 There is a need to manage the Special Health Fund because ultimately, the organization of the
provincial health system into a UHC system will be reflected in the quality of health services people in
the province receive. Ostensibly, the financing of both population-based and individual-based health
services will be enabled by the Special Health Fund.
 By virtue of the law, PhilHealth payments shall accrue to the Special Health Fund and be considered
as Annual Regular Income (ARI) of the province, further increasing the source of the resources for
making the PWHS into a reality.
COLLABORATE and EXECUTE
 Without the official DOH body/group drafting the guidelines and procedures regarding the Special
Health Fund at the time of this writing, one can only assume that control and management over this
fund logically belongs to the PHB so that it can carry out its mandate of organizing, running and
maintaining a provincial health system. Thus, the Technical Working Group for the SHF may be the PHB
or one that is set up/determined by the PHB as per the need of the province.
 Technical Working Group (TWG) for SHF
 In the meantime, while there are no definite guidelines for the SHF, the governor and PHO can begin
consolidating efforts and activities to establish such a committee or group within the PWHS
 The selection of members for the TWG for the SHF should again follow the general principles of
technical competence, integrity and accountability, sectoral representation and community
participation. Pending the formal guidelines, this figure is supposedly a suggestion of the DOH in the
setting up of the SHF in the province:
61
Figure 14. Suggested Provincial Set-Up for the Special Health Fund9
 It is of note that from the Figure, an ordinance called the Appropriation Ordinance is something that
should be in place to 1) not only establish the Special Health Fund but 2) also show that the SHF, by
its very nature should be intimately connected to the PIPH.
 Thus, setting up the SHF in the municipality requires direction and leadership from the PHB to align
the subsequent planning, appropriation and utilization of the SHF to the PIPH.
o An Executive Order indicating the composition of the TWG of the Special Health Fund.
o Guidelines are developed by this TWG for the SHF of the province. These guidelines must be
aligned with the UHC Act 2019 SHF Implementing Rules and Regulations, while remaining
relevant to and grounded on the actual health needs of the people, families and communities
within the province’s territorial jurisdiction.
The Inter-Local Health Zone Experience; Cost-sharing Among LGUs for Health Systems Management
The prohibitive cost of health services, especially for an entity as big as a province, necessitates the
management of limited resources to obtain maximum benefits. The creation of the PWHS requires
integration of preventive, promotive, curative, palliative and rehabilitative services that are provided for
by all the health facilities/institutions in the province. Thus, funding also needs to be integrated, thus the
SHF. However, pending the creation of the actual guidelines of the said fund, we can look to the
experience of many provinces and LGU health systems with the Interlocal Health Zones (ILHZ) scheme
that was instituted for setting up District Health Systems in the past.
9RTI International. Strengthening the Referral Mechanism in a Service Delivery Network: Experiences from USAID's LuzonHealth Project.
Washington DC: USAID and DOH; 2018.
62
For the LGUs, the ILHZ system was envisioned to work in their favor. The system was supposed to be a
cost sharing among member LGUs which theoretically made it easier financially for poorer LGUs to attend
to their health problems. The sharing of human and material resources was supposed to help improve
health service delivery. The organization of LGUs into more central entities theoretically also made it
easier for ILHZs to receive funding/financing from external sources such as NGOs, development partners,
grants, etc.27
In the context of the setting up of the Special Health Fund as per the UHC Act, one pattern to explore is
the Cost-sharing of LGUs that was supposedly a hallmark of the ILHZ system. In this system, LGUs may
pool financial resources, manpower and equipment in an ILHZ to address priority health problems. Under
this cost-sharing scheme, the participating LGUs put up funds from their own budgets and other funds as
their counterpart to match the community contribution.27
 How to Enable Municipal LGUs to Consider Cost-sharing in a Province-wide UHC System?
For municipal LGUs to even consider cost-sharing, the need for the following has to be communicated to
them: current capabilities of the hospital, gaps between current and required services, plans to close these
gaps and funding requirements4. These can be shared to the concerned LGUs under the PIPH, especially
if during the process of crafting the said plan, the municipal/component city LGUs were already intimately
and actively engaged. This agains serves to underscore the importance of the functional PHB and active
HCPN Management Teams as platforms of governance for the operationalization of the PWHS.
However, in the spirit of equity, not all LGUs will have the same capacity/capability of giving up a portion
of its LGU funds for the SHF, so without the UHC Act IRR being clear about this, such will be a very difficult
challenge indeed. It is therefore up to the PHB and the subsequent technical working group/committee
in charge of the SHF to determine a fair and equitable formula or mechanism to identify LGU cost-sharing
responsibilities.27
 How to Manage the Special Health Fund in the Context of A Province-wide Universal Health Care
System?
A Caveat for the Governor and the PHO:
 As earlier mentioned, this is but a suggestion at the time of this writing pending the release of the
official IRR of the UHC Act, specifically that for the Special Health Fund
 The province most likely has more than enough experience, both positive and negative, on the
management (including funding) of Interlocal Health Zones, which the PHB can draw on for setting
up this SHF for the meantime.
4Department of Health. Philippine Health Agenda 2016-2022. 2016.

27Herman T, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health vertical programs in the Philippines:
an open-source experience. AMIA . Annu Symp proceedings AMIA Symp [Internet]. 2005 [cited 2019 Aug 2];2005:311–5. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/16779052
63
 Suggestions for SHF Management27:
 All funds may be deposited to the SHF account that will be set up by the PHB and disbursed in
accordance with the PIPH and its component AOPs. There should be a Technical Management
Committee (TMC) handling the fund
 The PHB and the TMC shall maintain separate books of account and keep financial records available
anytime for monitoring and auditing by an authorized agency. The TMC shall submit a financial
statement and narrative report at the end of every fiscal year
 Management of the SHF must abide buy sound accounting procedures and the Commission on Audit
rules and regulations
Best Practices from the Field: The Sta. Bayabas Inter-LGU Health System and the Bindoy
Ayungon-Tayasan ILHZ Experience26:
 The LGUs shall establish a Common Health Fund which may include: Individual LGU
Appropriation to the Trust Fund, Drug Revolving Fund, Health Insurance Fund, DOH Assistance
to LGU Fund, Community Health Care Financing Fund and other (Private Sectors) contributions
 All funds shall be deposited as “Trust Funds” exclusively for the use of the ILHZ. The ILHZ “Trust
Funds” must be disbursed based on the Integrated Work and Financial Plan
 These funds shall be transferred by the participating LGUs and must be deposited under one
collaborating LGU for convenience and practical purposes, as agreed upon by the participating
LGUs
 The Common Health Fund shall be managed by the ILHZ Fund Committee, designed and
established by the ILHZ/District Health Board in accordance with the Philippine Laws.
27Herman T, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health vertical programs in the Philippines:
64
How do I change my Provincial Health Information System Deliverable

from Red to Green?
Provincial Health Information System for Curative Care
 Adoption of the DOH-HOMIS or use of other hospital information system in the provincial
hospitals
Presence and use of a system for backing up municipal health information
 Presence and use of a system for relaying information from provincial to municipal, inter-local
health zones and barangays for feedback
Provincial Health Information System for Preventive Care
 Establishment of a functional information system for the municipalities
 Establishment of an electronic medical record system in the municipalities
 Presence and use of a system for backing up municipal health information
 Presence and use of a system for relaying information from provincial to municipal and inter-
local health zones and barangays for feedback
Profiling of Vulnerable Population
 Presence of annually updated profile OR list (with at least name, age, gender, address,
household head) of members of the following:
1. Pregnant and lactating women

2. Under-five children
3. People with disability (PWD)
4. Elderly
5. Out of school youth
6. Households with indigenous peoples (for LGUs with IP communities)
7. Households in remote areas (for LGUs with GIDA communities)
65
Why do I need to address the Provincial Health Information System deliverable?

According to the World Health Organization, a well-functioning health information system is one that
ensures the production, analysis, dissemination and use of reliable and timely information on health
determinants, health system performance and health status. In other words, better health information
means better decision-making, leading to better health24. However, it is also one of the key challenges in
the devolved health system of the Philippines. It was asserted that the devolution of health care to local
governments led to the emergence of “health information system islands” that were connected to vertical
national programs being implemented in decentralized health units25. These led to a huge amount of
“information work” to transform health information at the community level to become a meaningful
source of input to decision-making processes. This is critical because reliable and timely health
information is an essential foundation of public health action and health systems strengthening—
particularly when resources are limited, and funding-allocation decisions can mean the difference
between life and death25.

Chapter 8 Governance and Accountability
 Section 31 Evidence-Informed Sectoral Policy and Planning for UHC (a) All public and private,
national and local health-related entities shall be required to submit health and health-related data
to Philhealth, including, among others, administrative, public health, medical, pharmaceutical and
health financing data
 Section 32 Monitoring and Evaluation (b) The DOH shall publish annual provincial burden of disease
estimates using internationally validated estimation methods and biennially using actual private and
public sector data from electronic records and disease registries, to support LGUs in tracking
progress of health outcomes.
 Section 36 Health Information System. All health service providers and insurers shall each maintain
a health information system consisting of enterprise resource planning, human resource
information, electronic health records, and an electronic prescription log, consistent with DOH
standards, which shall be electronically uploaded on a regular basis through interoperable systems;
Provided, That the health information system shall be developed and funded by the DOH and
Philhealth: Provided, further, That the patient privacy and confidentiality, shall at all times be
upheld, in accordance with the Data Privacy Act of 2012.
24Department of Health. A Handbook in Inter-local Health Zones; District Health System in a Devolved Setting. Manila: DOH; 2002.
25Health Metrics Network-WHO. Framework and Standards for Country Health Information Systems [Internet]. 2nd ed. Geneva: World Health
Organization; 2008 [cited 2019 Aug 2]. 62 p. Available from: http://www.who.int/about/licensing/copyright_form/en/index.html
66
Since health care in the Philippines is devolved, health governance and accurate health data are key issues
in the setting up and operationalization of the country’s health care delivery systems. With the national
DOH primarily providing technical assistance and direction, provincial governments oversee the district
and provincial hospitals, while municipal governments have the responsibility over the rural health units
and barangay health centers. Thus, public health care is supposedly three-tiered with the availability of
primary, secondary, and tertiary/highly specialized care.
Given this organization of the existing public health infrastructure, it is logical that integration of these
elements be the objective, with primary care facilities providing first contact and continuing health
services while at the same time facilitating referrals to higher level facilities as the need arises. However,
the status quo is still characterized by 1) the lack of a formal unifying governance mechanism for the many
health facilities in the country because of lack of reliable and accurate data and 2) primary care is delivered
in practically all health facilities, from primary to tertiary, in what is often an uncoordinated, redundant
and inefficient manner. Without a proper provincial health information system, the result is still a
fragmented health care delivery system16.
I. Provincial Health Information System for Curative Care
CHECK
 The health information system for curative care is the medical record system used by hospitals
 What is iHOMIS?
 The Integrated Hospital Operations and Management Information System (iHOMIS) is a computer-
based information system developed by the DOH to support the hospital management by providing
timely, relevant and reliable information. It bundles a set of system solutions that includes Admitting
System, OPD System, ER System, Billing System, Cashiering System, Medical Records System, Nursing
Services System, Pharmacy System, Dietary System, Revenue Centers’ System like Radiology and
Laboratory, PhilHealth eClaim Systems and hospital statistical report (OHSRS), among others.
 Why do your hospitals need iHOMIS?
 It systemically records and collects, processes, stores, presents, and shares information on various
service delivery and management functions
 It helps improve, facilitate, and make cost-effective hospital transactions
 What benefits will you get from implementing iHOMIS in your hospital(s)?
 Quick access and faster retrieval of patient’s data

 Reduces processing time of hospital transactions like admission of patient, processing of billing and
payments
16Philippine Health Insurance Corporation (PhilHealth). Manual of procedure of the new accreditation process. PhilHealth Circular 54 s. 2012 ‐
Provider engagement through accreditation and contracting for health services. PhilHealth.gov.
https://www.philhealth.gov.ph/downloads/accreditation/MOP_PEACHeS.pdf. 2013. Accessed May 31, 2019.
67
 Lessens the paper-based transactions

o Generate hospital reports such as collections, revenues and expenses
o System distribution, installation, support, maintenance and upgrades are given for free by
DOH
 Do you have an Integrated Hospital Operations and Management Information System (iHOMIS) in
your hospitals?
 Are all your hospitals in the province iHOMIS-trained? What module/s?
Module 1: Patient Management Module

 Supports the outpatient and emergency room consultations, admission, discharge, billing payment,
medical records, PHIC claims processing, medical social services and referral system requirements
Module 2: Services Provision Module

 Ensures the efficient provision of clinical services to the patient throughout hospital stay
Module 3: Administration Module

 Management support and includes obligations accounting, budgeting, procurement, HR
management, materials management, fixed assets management, general ledger, accounts payable
 Are the iHOMIS-trained hospitals in your province implementing iHOMIS already?
COLLABORATE
 What offices do you need to engage in preparation for iHOMIS implementation in your hospital?
 Integrated Community Health Services Project (ICHSP)

 Health Facilities Development Bureau (HFDB)
 Knowledge Management and Information Technology Service (KMITS)
 Epidemiology Bureau (EB)FHDB
EXECUTE
 What needs to be done to be able to implement iHOMIS?
Letter of Processing of Hospital System

System
Intent/ KMITS and FHDB Infrastructure Required system Monitoring and
Installation/
Request from Assessment Validation Documents administra- Technical
Implementa-tion
the Hospital (Hospital) tion Training Support
Figure 15. Implementing iHOMIS Process
68
 Standard Operating Procedures for iHOMIS / Implementation Processes
1. Letter of Intent/Request from Hospital (See sample letter of intent below)

2. KMITS and FHDB to do the Assessment
 Assessment or evaluation of the Standard MOP of the Hospital
3. Infrastructure validation
 Assessment or evaluation of the existing hardware, network and database management
software of the hospital
4. Process required documents – Hospital
 MOA – three (3) copies
 SLA – three (3) copies
 Engagement Form – three (3) copies
Figure 16. Sample Letter of Intent or Request from the Hospital for iHOMIS
5. Proceed to system installation/implementation

 FHDB Assessment—Assessment and/or Evaluation of the Standard Manual Operating Procedures
of the Hospital
 KMITS Assessment—Assessment and/or evaluation of the existing hardware, network and
database management software of the hospital
 Decision Maker’s Workshop—Orientation, Preparation and Training of Decision Makers on
iHOMIS Implementation
 Implementor’s Workshop—Orientation, preparation and training of implementers on iHOMIS
implementation
 Technical Training—Development of knowledge and skills required to maintain the iHOMIS
software in the hospital
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 Software Installation—The iHOMIS database and programs are put in place in the hospital
 On-Site User’s Training—Actual users are trained on how to operate the iHOMIS software
 System Implementation—Users are now ready to operate and use the system
 System Maintenance—FHDB and IMS extend functional and technical support in iHOMIS
implementation
 System Monitoring and Evaluation—FHDB AND KMITS assess the implementation process
 What are the needed operational requirements?
 Hardware
 Software
 Local Area Network
 What should the facility provide?
 Server
 Computers
 Local Area Network
 Printers
 Scanners
 Internet Connection (for Online Submission of Claims)
 What are the necessary manpower requirements?
 Full time HOMIS System Administrator

 Back-up System Administrator
 Dedicated HOMIS end-users
II. Provincial Health Information System for Preventive Care
CHECK
 What is iClinicsys?
 An electronic medical record system for use by the RHUs and/or BHS. The system aims to automate
the registration, consultations and monitoring of patients
 It generates a digital copy of the traditional paper-based medical record of an individual and provides
the required data for submission to the national health data reporting, health information exchange,
and PHIC electronic claims and benefits requirements.
 What does iClinicsys do?
 The primary objective of iClinicSys is to efficiently and effectively support the functions of a clinic
health facility.
 What are some of its features?
70
 User-Friendly;
 Can be implemented in an online or offline (stand-alone) mode;
 Compliance to Health Data Standards:
o ICD-10
o National Health Facility Registry
o Philippine Standard Geographic Codes
 Ability to integrate/harmonize iClinicSys data with:
o The National Health Data Reporting on Injury/ Online National Electronic Injury Surveillance
System;
o The Maternal and Neonatal Death/Maternal and Neonatal Death Reporting System (MNDRS);
o The Field Health Services/Electronic Field Health Service Information System (eFSHIS) Program
o Unified Chronic Non-Communicable Disease Registry System (UCNCDRS)
o National Online Stock Inventory System (NOSIRS)
 Ability to integrate, harmonize and exchange iClinicSys data with PhilHealth data Membership
verification
 Ability to integrate/harmonize with the Pantawid Pamilyang Pilipino Program (4Ps) of the government
 Ability to track or monitor inventories received dispensed or distributed by the health facility; and
 Ability to send SMS Alert/Reminder.
 What are the benefits on using iClinicSys?
 Faster time to search a particular patient

 Improved quality of data in terms of accuracy, completeness and up to date
 Improved access and better control of information
 Improved patient satisfaction.
COLLABORATE
The Knowledge Management and Information Technology Service (KMITS), in collaboration with the
Epidemiology Bureau (EB), National Center for Disease Prevention and Control (NCDPC), Bureau of Local
Health and Development (BLHSD), has developed the Integrated Clinic Information System (iClinicSys) as
a tool to efficiently and effectively monitor patient cases in the Rural Health Units (RHU) or Health Centers
(HC).
 Who are some of the initial Electronic Medical Records (EMR) providers whose systems/software
have passed the validation testing that you can possibly engage?
Name of EMR Provider Validated EMR System

 Department of Health  iClinicSys
 University of the Philippines - NHTC  CHITS
 Segworks Technology  Seg-RHIS
 Ateneo de Manila - DOST  eHATID LGU
 Ateneo de Manila – Smart Telecommunications  SHINE OS+
 Wireless Access for Health  WAH-EHR
Table 4. Possible EMR providers for the province
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 Are there any more EMR providers other than the ones listed above?
 List of new EMR Providers who will pass the validation testing shall be regularly posted in the
PhilHealth portal or website. As such, PCB providers must check the said portal or website to confirm
the validation certification.
EXECUTE
 As a PCB Provider, which EMR system shall we use in our facility?
 PCB providers shall choose only (1) from among the validated EMR Systems for use within their
respective facilities. Providers shall comply with the electronic reporting requirements of PhilHealth
as prescribed under PhilHealth Advisory No. 11-01-2015
 What requirements do we need to secure from the patients? (PhilHealth Advisory No. 2016-0040)
 In compliance with RA 10173 or the Data Privacy Act of 2012, PCB Providers shall be required to
provide and ask the patients to review and sign an Informed Consent Form (Annex A - Approved
Informed Consent Form Template), and make sure that the patients understand its contents prior to
signing. Signed Informed Consent Forms shall be safely kept and made available by the PCB Providers
for legal or audit purposes.
 What appropriate written agreements should we make between our management and the EMR
Providers? (PhilHealth Advisory No. 2016-0040)
 PCB Providers shall ensure that there are appropriate Memorandum of Agreements (MOAs) and
Service Level Agreements (SLAs) made between their Management and EMR Providers.
 What should be included in the MOA?
 The MOA is a document in which the PCB Provider and EMR Provider agree to work together for a
common objective.
o It may define the working relationships, activities, deliverables, conduct of work, and other
vital requirements between the PCB Provider and EMR Provider.
o The MOA is based on a proposal which is to be accepted by a PCB Provider (to whom the
proposal is made) and an EMR Provider who makes the proposal.
o When the EMR Provider’s proposal is accepted, the MOA serves as a promise of parties to
each other, and to the provisions therein to which they have agreed upon.
o Both parties have the right to go to court in the event of non-performance of any provision of
the agreement.
 What is a Service Level Agreement (SLA) and what should it include?
 The SLA shall be part of the MOA where a service is formally defined such as the scope, quality, and
responsibilities of the EMR Provider are explicitly listed. Common features of the SLA are the
following:
o The contracted delivery time of the service or performance system uptime
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o Mean time between failures

o Mean time to repair or recovery
o Defining party that is responsible for reporting faults or paying fees, data rates, throughput, and
other measurable details as shall be agreed upon
 EMR System’s Training, provision for Software Operations or User’s Manual and Manual of
Operations, technical support, system availability, system security, and among others shall be
included in the Service Level Agreement between the PCB Provider and EMR Provider. The scope is
the use of the validated EMR System to meet the requirements of the PCB and other future
requirements.
 What are the basic operational requirements iClinicSys operation?
 Computer workstations located at the RHUs and BHS’s

 Server
 What are the recommended software and hardware requirements?
Equipment Minimum Specification(s)

Workstation  Pentium 4 or higher
 GHz or higher
 512mb RAM or higher
 At least 40 GB hard disk
Operating System  Windows Vista or higher
Internet Browser  Google Chrome
Interned Speed  384 kbps or higher
Printer  Any
Table 5. Recommended software and hardware requirements for iClincsys operation
 Is an internet connection necessary for its operation?
 The iClinicSys online version requires an internet connection and a user account and password to be
able to access the online version
 In the absence of an internet connection, the stand-alone version shall be installed on the computer
and can also be accessed by supplying a user account and password. The data can then be uploaded
to the server at a later time when an internet connection becomes available (e.g. internet shop, home
internet, etc.).
 Where is iClinicSys usually deployed?
 The system will be implemented in all Rural Health Units (RHUs) or Health Centers (HCs) nationwide,
Provincial Health Offices (PHOs), City Health Offices (CHOs) and Center for Health Development
(CHDs) offices will have access to the system online to conduct data monitoring and validation
submitted by the RHUs or HCs
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III. Profiling, Tracking and Provision of Health Services to the Vulnerable Population
CHECK
 Does the province have a list of its vulnerable population?
 Obtain the updated list of NHTS-PR poor households from the DSWD regional office. This should
contain:
o The number of NHTS-PR poor households per municipality, city and barangay
o The total population of NHTS-PR poor households; and
o The roster of heads and members of households including names, sex, and birthdates
 If the list of NHTS-PR poor households is not available, estimate the number of poor households of
each municipality/city by multiplying the poverty incidence (i.e. NSCB) to the total population (i.e.
latest census).
 Who are the vulnerable population groups in our province?
 The food threshold, as defined by the Philippine Statistics Authority is the minimum income required
to meet basic food needs and satisfying the nutritional requirements set by the Food and Nutrition
Research Institute (FNRI) to ensure that one remains economically and socially productive. A family
of five (5) with less than P7,337.00 to meet the basic food needs for a month is considered vulnerable.
(Philippine Statistics Authority, 2018)
 The poverty threshold, on the other hand, is the minimum income required to meet the basic food
and non-food needs. A family of five (5) with less than P10,481.00 to meet both basic food and non-
food needs for a month is considered vulnerable. (Philippine Statistics Authority, 2018)
 Pregnant and lactating women
 Under-five children
 Persons with disabilities (PWD)
o Psychosocial
o Mental
o Hearing
o Visual
o Learning
o Orthopedic
o Chronic Illness
o Speech
o Multiple
 Elderly
 Out of school youth
 Households with IPs (for LGUs with IP communities)
 Households in remote areas (for LGUs with GIDA areas)
 Who are the barangay health workers?
 According to the Republic Act 7883 or the “Barangay Health Workers’ Benefits and Incentives Act
of 1995”, a barangay health worker refers to a person who has undergone training programs
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under any accredited government and non-government organization, and who voluntarily
renders primary health care services in the community after having been accredited to function
by the local health board in accordance with the guidelines promulgated by the DOH.
 What are the barangay health workers’ roles in the provincial health information system?
 The barangay health workers act as the front-liners in the community in terms of providing
primary, promotive, curative, rehabilitative and palliative health care services to those in need.
They are knowledgeable about the health issues of the community, and are now being called to
be the primary “navigators” in UHC. Being part of the health care provider network entails them
to act as an information aid in the collection of basic data and information on patients, especially
the vulnerable who are hard to reach.
COLLABORATE
 What offices will we engage to provide us with a list and profile of the vulnerable population in our
municipalities and barangays?
 Rural Health Unit (RHU)

 Municipal Social Welfare and Development Office (MSWDO)
 Municipal Planning and Development Office (MPDO)
 DSWD
 PhilHealth
 CSOs (OSCA-Senior Citizen/ PWD Association)
EXECUTE
Figure 17. Framework for Profiling, Tracking and Provision of Health Services to the Vulnerable Population
75
The framework above is a guide to profile and track the poor in order for you to ensure that they are able
to access the health services in the province. The following sections will detail how each step is done with
the sample forms to be used. It is not enough that the vulnerable population are identified, but it is equally
important to monitor their health statuses in order for your province to attain UHC.
 Assess the Barangay Health Workers
 It is important to constantly assess if the number of barangay health workers in your province is
enough to provide for the municipalities. As the PHO, check how many health care workers does your
province have quarterly.
o Is your province complying with the standard ratio of BHW to households of 1:25, and that
the number of BHWs should not exceed 1% of the population?
 It is also important to ensure that their capabilities and skills set are up to date in order for them to
perform their roles and responsibilities:
o A BHW is an advocate of current health programs, projects and activities to improve access
and use of health services
o A BHW is an educator who will advise and counsel the community
o A BHW is a disseminator to maintain regular communication between local professional
health workers and their catchment households
o A BHW is a linker to facilitate access to or association of the community with relevant network
of health and non-health service providers within or outside their catchment areas
o A BHW is a record keeper to maintain updated lists/records of health data, health
activities/events in the community
 The MHO and BHW representatives should consolidate an inventory of BHW skills requirement, which
will be reported to the PHO annually. This will serve as your means of assessing if the BHWs’ skills and
capabilities are at par with the requirements, and to take action as necessary. Table 6 below shows
the competencies that a BHW has to have.
BHW Competency Areas Particulars

Knowledge and Skills  Health Systems and Social Determinants of Health
 Essential Health Worker Skills: blood pressure, heart rate,
respiratory rate, temperature), height and weight, growth
monitoring and assessment of a patient
 DOH Programs: Family Planning, Maternal Health and Pregnancy,
Newborn Health, Infant Health, Child Health, Adolescent Health,
Healthcare for Adults, Non-Communicable Diseases, Elderly Health
 Special Health Concerns in the Community: Environmental Health,
Violence Against Women and Children, Mental Health and
Community-Based Drug Rehabilitation, PhilHealth, Disaster Risk
Reduction
 First Aid Techniques for Common Conditions: Benign Febrile
Convulsion, Shock, Loss of Consciousness, Drowning, Poisoning,
Wounds, Bleeding, Fractures or Dislocations, Insect Bites, Burn
Injuries
 Effective Herbal and Complementary Medicines
Provision of Safe and  History-taking and Physical Examination
Quality Primary Care  Recognition and Referral
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 Administration of Initial Management

 Follow-up and Monitoring
 Health Education and Communication
 Records Management and Monitoring
 Teamwork and Collaborative Community Care
 Community Mobilizing
 Ethical Judgment and Decision-making
 Leadership and Management
 Professionalism
 Personal mastery and development
Table 6. Minimum Competencies of a Barangay Health Worker
 Because of the many tasks a BHW has to accomplish, it is equally important for you to ensure that the
accredited BHWs receive their benefits and incentives for the voluntary health services they have
rendered to the community. According to RA 7883, accredited BHWs are entitled the following:
o Hazard allowance – for BHWs exposed to situations, conditions or factors in the work
environment or place where foreseeable or unavoidable danger or risks exist which adversely
endanger his health or life and/or increase the risk of producing adverse effect on his person
in the exercise of his duties, to be validated by the proper authorities in an amount to be
determined by the Local Health Board and the local peace and order council of the LGU
concerned
o Subsistence allowance – for BHWs who render service within the premises of isolated
barangay health stations in order to make their services available at any and all
times equivalent to the meals they take in the course of their duty computed in accordance
with the prevailing circumstances as determined by the LGU concerned
o Training and education and career enrichment programs (TECEPS) - the DOH in accordance
with the Department of Education, and other concerned agencies and non-government
organizations shall provide opportunities for the following:
 Educational programs which shall recognize years of primary health care service as
credits to higher education in institutions with stepladder curricula that will entitle
BHWs to upgrade their skills and knowledge for community work or to pursue further
training as midwives, pharmacists, nurse or doctors
 Continuing education, study and exposure tours, training, grants, field immersion,
scholarships
 Scholarship benefits in the form of tuition fees in state colleges to be granted to one
child of every BHW who will not be able to avail of the above programs; and
 Special training programs such as those on traditional medicine, disaster
preparedness and other programs that address emergent community health
problems and issues
o Civil service eligibility – a second grade eligibility shall be granted to BHWs who have
rendered five (5) years continuous service as such, provided that should the BHW become a
regular employee of the government, the total number of years served as BHW shall be
credited to his/her service in computing retirement benefits
o Free legal services – legal representation and consultation services shall be immediately
provided by the Public Attorney’s Office (PAO) in cases of coercion, interference, and in other
civil and criminal cases filed by or against BHWs arising out of or in connection with the
performance of their duties as such
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o Preferential access to loan – The agencies providing loan services will set aside one per cent
(1%) of their loanable funds for organized BHW groups that have community-based income
generating projects in support of health programs or activities.
 Identify the Vulnerable Population
 You may refer to the current Community Health Profile process being done in your province, but there
should be a greater focus on the vulnerable population. The MHO, as lead, should have a strong
collaboration with the barangays through the BHWs.
 First, the BHWs will conduct an ocular survey of the entire purok or their assigned areas of
responsibility (AOR).
 Second, they will profile the vulnerable population by accomplishing Form A provided below. It may
take the BHWs two (2) to three (3) months to accomplish this for the first time. Afterwards, profiling
by the assigned BHW in the area will be updated weekly, and reporting to the midwife of their findings
is done every first Monday of the month.
78
FORM A – Profiling the Vulnerable Population

PROVINCE: TOTAL POPULATION: ACCOMPLISHED BY:
MUNICIPALITY: TOTAL POPULATION: ACCOMPLISHED ON:
BARANGAY: TOTAL POPULATION: SUBMITTED ON:
PUROK: TOTAL NO. OF HOUSEHOLDS: APPROVED BY:
Highest
Name Relationship Classification
HH Birthday Educational IP Water
GIDA HH (Surname, Given to the Gender Pregnant Monthly (NHTS, Non-NHTS Philhealth PWD Morbidity With Sanitary
Address Member (mm/dd/y Age Attainment Occupation (Identify Source
(Y/N) No. Name, Middle Household (F/M) (Y/N) Income poor or Non- No. (Specify) (Specify) Toilet (Y/N)
No.* yyy) (State if out of Group of IP) (I, II, III)
Name) Head NHTS)
school youth)
1 1.1
1.2
1.3
1.4
1.5
2 2.1
2.2
2.3
2.4
2.5
3 3.1
3.2
3.3
3.4
3.5
4 4.1
4.2
4.3
4.4
4.5
5 5.1
5.2
5.3
5.4
5.5
*1 – indicates the household head
Table 7. Form A – Profiling the Vulnerable Population
79
 Third, they will accomplish a spot map, may it be manual or electronic (i.e. geotagging) that contains
the following information:
o The complete name of the place including purok/ sitio, barangay, municipality and province
o The complete name of the BHW who surveyed the area and the assigned BHW for the area
(to be filled up after Assignment of the Vulnerable Population)
o All the structures in the community including roads, bridges, rivers, creeks, buildings,
institutions, houses, landmarks, etc.
o Assigned household numbers in sequence with the number above the house, and the family
name and first initial of the first name of the household head at the bottom of the house
o Indicate boundaries
o All roads must show the directions using arrows
o Legend for the spot map. Do not forget to include a specific legend for the vulnerable
population: pregnant and lactating women, under-five children, PWDs, elderly, out of school
youth, households with IPs and households in remote areas
Figure 18. Example of a Spot Map
 Fourth, the BHWs, with the supervision of their respective midwives, will accomplish a master list of
the vulnerable population using Form B, which is provided below.
80
E D C B A Barangay
Total No. of HH
Total HH with IPs
MUNICIPALITY:
Total HH in GIDA
SUBMITTED ON:
ACCOMPLISHED BY:
M 0-11
ACCOMPLISHED ON:
mos
F
M 1-5
y.o.
F
M 6-14
y.o.
F
M 15-49
y.o.
Population Group
F
M 50-59
y.o.
F
Table 8. Form B – Master List of the Vulnerable Population

M SC
F
Direct Philhealth
Members
Indirect
10-14 yo
15-19 yo Pregnant
20 and above
Below Poverty Line Monthly Income
Above Poverty Line
NHTS
Non-NHTS Poor Classification
Non-NHTS
Out of School Youth
HH with IPs
Psychosocial
Mental
Hearing
visual
PWD
FORM B – Master List of the Vulnerable Population
Learning
Orthopedic
Chronic Illness
Speech
Multiple
M Patients with TB
F
M Patients Managed on
HPN
F
M Patients Managed on
DM
F
M Palliative
F
I
II Water Source
III
With Sanitary Toilet
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Without
 Reporting to the Municipality
 ZFF recommends that the midwives and representatives of the vulnerable population be members of
the local health board to ensure that their concerns and issues will be voiced out.
 ZFF also recommends that the midwives report the findings in Form B to the local health board
monthly, and use their Spot Maps for necessary action.
 Assignment of the Vulnerable Population
 The midwife will assign and ensure that each vulnerable household has one (1) BHW. The assignments
will be recorded in Form C, provided below, and will be submitted to the MHO quarterly.
FORM C – Assignment of the BHWs to the Vulnerable Population

PROVINCE:
MUNICIPALITY:
BARANGAY:
RHU:
Midwife BHW Purok Household No.
Table 9. Form C – Assignment of the BHWs to the Vulnerable Population
 Weekly Visits to the Vulnerable Population
 The BHWs will conduct household visits and ensure that the vulnerable are seen.
 Since the BHWs are trained according to the different DOH programs according to a person’s life cycle
as seen in Figure 19 below, the BHWs will assess the vulnerable population’s health status and
accomplish their roles, accordingly.
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Figure 19. DOH’s Health Programs Based on Person’s Life Cycle
 The BHWs will then accomplish Form D based on the age and case of the patient. These forms are
largely based on the DOH Target Client List forms meant for the midwives to accomplish, but were
modified by ZFF to include other simplified indicators and referral columns. These forms are also
meant to track the patient while s/he is being provided the health services s/he needs.
83
FORM D – BHW Target Client List for Children 0-11 Months and 12 Months
PROVINCE: ACCOMPLISHED BY:
MUNICIPALITY: ACCOMPLISHED ON:
BARANGAY: SUBMITTED ON:
PUROK: APPROVED BY:
Child Protected at Birth Newborn (0-28 days old)

NHTS, (Place a ; counts should be consistent with maternal TCL Livebirths) Referrals
Non- TT3/ Td3 to (Date and Time of
HH NHTS Complete Status Referral, Reason for
Date of Date of Name of TT5/ Td5 (or Initiated Breast
No. Member Poor Sex Name of TT2/ Td2 given (Birth Referral,
Registration Birth Child (F/M) TT1/ Td1 to Length Weight Feeding
No. (mm/dd/yyyy) (mm/dd/yyyy) or (FN, MI, LN) Mother to the mother Weight) Immunization Immunization Health Facility Referred
(LN, FN, MI) TT5/ Td5) given Total at Birth at Birth immediately after
Non- a month prior L: Low BCG (date) Hepa B-BD (date) To and Patient
to the mother (cm) (kg) (<2500g) birth lasting for 30
NHTS to delivery N: Normal Outcomes)
anytime prior U: Unknown
minutes (date)
to delivery)
Table 10. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old
84
FORM D – BHW Target Client List for Children Ages 0-11 and 12 Months Old (Nutritional Status)
PUROK: APPROVED BY:
Nutritional Status Assessment Referrals
Vitamin A given/date given

Exclusively Breastfed up to 6
Introduction to Iron given if low birthweight
Length (cm)/date taken

Status
Complimentary (Date given) MNP
Status
(kg)/date taken
Feeding (when
Age in mos
UW-
Sex (M/F)
90
Weight
HH underweight
mos of age (Y/N)

Name sachets MAM SAM
No. S-Stunted 1mo 2mos 3mos are
O-Obese
NHTS/Non-
conitunuous
given)
NHTS
N-Normal
breastfed
2-never
Y/N
BF
1-
Table 11. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old (Nutritional Status)
85
FORM D – BHW Target Client List for Children Ages 0-11 and 12 Months Old (Immunization Status)
PUROK: APPROVED BY:
Status Immunization (Write the date given)

DPT-HiB-HepB OPV PCV IPV MMR FIC
Age in mos
HH Sex (M/F)
Birthdate
1st dose at 9
NHTS/Non-
Hepa B
2nd dose at
completed
Name
(1 ½ mos)
(2 ½ mos)
(3 ½ mos)
1st dose (1
2nd dose
2nd dose
3 ½ mos
BCG
3rd dose
3rd dose
1st dose
1st dose
12 mos
(2 ½ mos)
(3 ½ mos)
no.
NHTS
Date
mos
2nd dose
3rd dose
½ mos)
Table 12. Sample Form D BHW Target Client List for Children 0-11 and 12 Months Old (Immunization Status)
86
FORM D – BHW Target Client List for Children Ages 12-59 Months (1 – 4 years old)
PUROK: APPROVED BY:
Deworming
Nutritional Status Nutritional Services
Services
Vitamin A
NHTS/Non-NHTS
MNP (no. of sachets

Status given
Length in cm (date
Weight in kg (date
Age in mos
Sex (M/F)
UW- (date
Status
(date given)
(date given)
HH. Referrals
2nd dose
No. Name underweigh given_
1st dose
taken)
taken)
given)
No. (MAM, SAM, ADRs)
t
S-Stunted
2nd dose
1st dose
O-Obese
N-Normal
Table 13. Sample Form D BHW Target Client List for Children Ages 12-59 Months (1 – 4 years old)
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FORM D -- BHW Target Client List of A Sick Child

PUROK: APPROVED BY:
Date of
(M/F)
Birthdate Referred Cases to the Midwife/Nurse:
Sex
HH no. Registration Name Patient Outcomes
(mm/dd/yyyy) (Date and Time of Referral and Reason for Referral)
(mm/dd/yyyy)
Table 14. Sample Form D BHW Target Client List of A Sick Child
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FORM D -- BHW Target Client List for Family Planning Services

PUROK: APPROVED BY:
Date of SE FP Referred to
HH Age/ Birthdate Unmet Midwife/ Nurse
Registration Complete Name NHTS/Non- Type of Client Commodity of Remarks
no. (mm/dd/yyyy) Need (Date and Time of Referral
(mm/dd/yyyy) NHTS Choice and Reason for Referral)
Table 15. Sample Form D BHW Target Client List for Family Planning Services
89
FORM D -- BHW Target Client List for Maternal Care Services

PUROK: APPROVED BY:
Age Prenatal Check-up Referrals

Pregnancy Outcome
NHTS/Non-NHTS
EDC/ (Date and Time of
Birthdate Birth Referral, Reason for
HH No. Name LMP GP Referral,
(mm/dd/yyyy) plan
terminate
Health Facility
15- 19y/o
Score
3rd Tri (2)

10-14y/o
20-49y/o
3rd tri (1)
Delivery
Place of
Type of
Referred To and
1st Tri
2nd tri
Birth
Date
Patient Outcomes)
d
SE
Table 16. Sample Form D BHW Target Client List for Maternal Care Services
90
FORM D BHW Target Client List for Senior Citizens Services

PUROK: APPROVED BY:
Date of SE Status Others

Date of Birth Pneumococcal Vaccine
Age
Sex
HH no. Registration Name OSCA ID NHTS/Non (note if referred to midwife/ nurse for
(mm/dd/yyyy) (date given)
(mm/dd/yyyy) -NHTS other notifiable illness, or state)
1st Dose 2nd Dose
Table 17. Sample Form D BHW Target Client List for Senior Citizen Services
91
 Provision of Health Services to the Vulnerable Population
 A referral is the set of activities undertaken by a health care provider or facility in response to its
inability to provide the necessary medical intervention to respond to a patient’s need, whether real
or perceived. It is a regular daily activity of linking a patient to a needed service. It shall encompass
referrals all the way from the community to the highest level of care, and back (i.e., two-way referral);
and referrals within a health facility’s internal system. It also involves not only direct patient care but
support services as well (e.g., knowing where to get a transport facility to move the patient from one
facility to another)26
 It is important for health centers to refer only those patients for whom secondary or tertiary care is
essential. In general, referral from a health center to higher levels should occur in the following
situations:
o When a patient needs expert advise
o When a patient needs a technical examination that is not available at the health centers
o When a patient requires a technical intervention that is beyond the capabilities of the
health center
o When a patient requires in-patient care
 While the BHWs are mostly responsible for referring (and even accompanying) these patients to the
different health facilities, as the PHO, it is important for you to ensure that basic services are already
being provided for in the barangay health stations and rural health units. It is also important for you
to include the health human resources who are in charge of the community-based health services or
home remedies because some patients still prefer these types of services. Not only will this enhance
the primary health care in your province, but it will also strengthen your health care provider network.
o Community-Based Health Services or Home Remedies shall be composed of the following
personnel:
 Family or Family Health Aid
 Community-based Physical Rehabilitation Aide
 Barangay Health Workers (as the interface between community and RHU)
 Barangay Nutrition Scholars
 Microscopist (sputum collection, BSMP)
 Other traditional healers and midwives (“hilots”, “herbolarios”)
 Listed below are the minimum services and manpower needed in each health facility in a health
referral system. It is essential for you to work with the different health leaders in each level to ensure
that your health care provider network is in place.26
26Department of Health. Health Referral System Manual: Monitoring and Evaluation Tool For Health Care Financing. Santa Cruz, Manila
92
Figure 20. Health Care Referral System26
Barangay Health Stations (BHS)
 The BHS is the first facility in the public health system. It is manned by the BHWs under the supervision
of the RHM. The MHO normally conducts diagnostic consultations and gives prescriptions and
referrals on a regular basis in the BHS
 The BHS should have at least the following health human resources:
o Midwife
o BHW
o Traditional birth attendant
26
Department of Health. Health Referral System Manual: Monitoring and Evaluation Tool For Health Care Financing. Santa Cruz, Manila
93
 The following services should be in place in a BHS:
Health Services Particulars

Immunization  BCG
 DPT
 OPV
 Measles Vaccine
 Hepatitis B Vaccine
 Tetanus Toxoid
 Anti-Rabies Vaccine
Family Planning/ Reproductive  Couple’s Education
Health  Family Planning Methods
Nutrition Services (include growth  Operation Timbang
monitoring)  Food/ Nutrition Supplementation
 Micronutrients Supplementation
Essential Individual Clinical  Maternal and Child Health
Services o Prenatal
o Childbirth
o Post-Partum
 Common Illnesses
o Diarrhea
o Acute Respiratory Infection
o Measles
o Dengue
o Malnutrition
o Other endemic diseases of the area (i.e. Schistoosmiasis)
o Malaria
 Non-Communicable Disease Prevention Program
o Degenerative Diseases
o CVD Program (Hypertension, RHD)
o Cancer prevention and control
 Communicable Disease Prevention Programs
o Tuberculosis
o Leprosy
o Rabies Control
Table 18. Health Services Required in a BHS
Rural Health Unit (RHU)
 The RHU is a municipal level health facility, which may service only a portion or the whole municipality.
The focus of the RHU is preventive and promotive health and the supervision of barangay health
stations under its jurisdiction.
 An RHU should have the following health human resources:
o Rural Health Physician / Municipal Health Officer
o Dentist
o Public Health Nurse
o Sanitary Inspectors
o Medical Technologist
o Laboratory Technician
o Health Educator/ Community Organizer/ Liaison
94
o Support staff
 The MHO heads the RHU and is assisted by the PHN. It is the PHN who directly supervises the
midwives in running the BHS. Most RHUs are provided with an ambulance, either purchased by the
municipal government or donated by an external source. Communication facilities, which are critical
in a health referral system, should be present.
 The following services should be in place in a rural health unit:

Immunization  BCG
 DPT
 OPV
 Measles Vaccine
 Hepatitis B Vaccine
 Tetanus Toxoid
 Anti-Rabies Vaccine
School-Based Services  Reproductive health education and information
 Smoking, alcohol abuse and drug dependence
 Mental and oral health
Occupational Health  Pre-employment examination
 Annual physical examination
 Health education
Reproductive Health  Education
 STD
 Family planning methods
 Violence against women/ children (i.e. rape, domestic violence)
 Others: pap smear, gram stain
Medico-Legal Services  Post-mortem examination/ autopsy
 Physical examination
 Court representation
Nutrition Services (with  Operation Timbang
Growth Monitoring)  Food/ Nutrition Supplementation
 Malnutrition related diseases identification
 Micronutrients Supplementation
Environmental Health  Sanitation
Protection  Food Safety
 Safe Water Supply
 Safe Housing
Basic Laboratory Services  Urinalysis
 Blood Smear for Malarial Parasite (BSMP)
 CBC and Blood Typing
 Pregnancy Test
 Stool Examination
 Sputum Examination
Minor Surgeries  Circumcision
 Non-Life Threatening Injuries
Table 19. Health Services Required in a RHU
95
Extension Hospital
 This hospital is an outreach component of a regular hospital, usually the provincial hospital, to service
those coming from the remote areas of the province. It can also be the venue for medical-surgical
missions. Its inpatient capacity may be lower compared to the district or community hospital while
its diagnostic and treatment capability is limited to minor urgent emergency cases.
Municipal/ Medicare Hospital
 While smaller than a district hospital, having a capacity of 10-15 beds and a catchment area greater
than 25,000, the municipal hospital has almost the same capabilities as that of a district hospital
except that it does not have an OR. It can also serve as a venue for medical-surgical missions. The
medical staff of a municipal / Medicare hospital would be three (3) doctors and five (5) nurses.
District Hospital
 The standard district hospital has a capacity of at least twenty-five (25) beds and services a catchment
population of not less than 75,000. It is the core referral hospital in the ILHZ. It provides frontline
basic services in medicine, surgery, ob-gyn, and pediatrics. These services, however, may not
necessarily be departmentalized. The district hospital provides the venue for medical-surgical
missions.
 Ancillary services found at the district hospital are similar to those found in the provincial hospital.
The only difference in capability level is the absence of specialty level medical diagnosis and
treatment. Hence, the hospital can only execute minor surgeries and serve as the first referral or
contact hospital for serious emergencies before these cases are transferred to the provincial or other
tertiary hospitals.
 The usual district hospital would have a personnel complement of five (5) physicians, eight (8) nurses,
and five (5) administrative staff.
Provincial Hospital
 The standard provincial hospital is a tertiary referral hospital with at least seventy five (75) beds and
services the whole province. Hence, every province shall have at least one provincial hospital. To
enable the hospital to perform its functions effectively, it shall be provided with communication
linkages and transport services.
 The provincial hospital provides departmentalized specialty level diagnosis and management of cases
in the fields of internal medicine, pediatrics, ob-gyn, and surgery. It handles emergency cases, out-
patient consultations, in-patient care, referred cases, and rooming-in services. It also provides
training programs and limited residency training. Nursing services are departmentalized in this level.
 Ancillary facilities found in provincial hospitals include laboratory for routine microscopy, hematology,
chemistry, blood banking, and autopsy; radiology equipment; OR-DR, and premature nursery; heart
station, dietary, pharmacy, records and supply rooms, etc. Administrative, maintenance, engineering
support, and quarters for doctors and nurses are also standard facilities in the hospital.
 A standard provincial hospital is authorized to have as many as twenty (20) or more physicians, thirty
(30) or more nurses / nursing attendants and twenty (20) or more administrative support staff. In
addition, its plantilla includes a pharmacist, midwife, nutritionist, radiologist, and medical
technologist.
96
Hospitals, on the other hand, should provide in-patient care and diagnostic work up for possible referral
to higher levels of care. At the minimum, district hospitals should have the capability to respond to life-
threatening surgical emergencies, and should have the necessary expertise and facilities to be able to
respond to all of these.26

Basic Services  Surgery (major and minor), Pediatrics, OB-Gyne, Internal Medicine, Dental
Service, Emergency Service, Out-Patient Service, General Anesthesia
(Secondary Level)and Clinical Core (Secondary Level)
Medical Ancillary Services  Anesthesia, Radiology, Laboratory, Pharmacy and Nursing Services
Technical Requirements: Personnel
Administrative Personnel  Chief of Hospital, Administrative Officer, Accountant and Bookkeeper,
Cashier, Statistician, Admitting Clerk, Medical Record Officer, Medical
Social Worker, Dietician, Nutritionist, Cook, Food Service Worker, Building
Maintenance, Housekeeper, Storekeeper, Laundry Worker, Utility Worker
and Driver
Clinical / Medical  Chief of Clinics
 Medical Specialists in the following fields:
o Surgery, Radiology, Anesthesiology, OB-Gyne, Pediatrics, ENT,
Pathology and Internal Medicine
Ancillary  Radiology Technician, Medical Technologist and Pharmacist III/ II
 Nurse IV/ III/ II/ I and Nursing Attendant
Technical Requirements: Equipment/ Instrument (Per Area)
Equipment/ Instrument (Per  ER, OPD, OR/DR, Nursery, Wards, Dietetic Area and Hospital Maintenance
Area)
Technical Requirements: Physical Facilities
Technical Requirements:  Administration, Clinical Service, Nursing, Dietetic, Maintenance,
Physical Facilities Engineering and Housekeeping
Table 20. Health Services Required for Hospitals
 In each step of the referral, the BHW is expected to accomplish the entries of Form D and the health
referral forms, which enable tracking of the patient and the services rendered to him/ her.
26Department of Health. Health Rererral System Manual: Monitoring and Evaluation Tool For Health Care Financing. Santa Cruz,
Manila
97
[Health Facility Name]

[Health Facility Address]
INTRA HEALTH FACILITY REFERRAL SLIP
REFERRED TO: __________________ DATE: ____________ ADDRESS: _______________________________________________________________
PATIENT NAME: ________________________________(Last Name, First Name, MI)___________________________________ Age: _________ years old
ADDRESS: ___________________________________________________________________________________________________ Sex: _____ CS: _____
WORKING DIAGNOSIS: __________________________________________________________________________________________________________
BRIEF CLINICAL HISTORY AND PHYSICAL EXAMINATION. INCLUDE PAST AND PRESENT MEDICAL HISTORY
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
MANAGEMENT GIVEN
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
REASON FOR REFERRAL. INCLDUE SERVICE/ ACTION TO BE UNDERTAKEN.

______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
REFERRED BY AND DATE:

_____________________________
(Reply slip to be given back to the referring facility)
REFERRED TO: __________________ DATE: ____________ ADDRESS: _______________________________________________________________
PATIENT NAME: ________________________________(Last Name, First Name, MI)___________________________________ Age: _________ years old
ADDRESS: ___________________________________________________________________________________________________ Sex: _____ CS: _____
WORKING DIAGNOSIS: __________________________________________________________________________________________________________
VITAL SIGNS: __________________________________________________________________________________________________________________
PHYSICAL EXAMINATION: _______________________________________________________________________________________________________
MANAGEMENT GIVEN:
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
RESULTS OF ACTION UNDERTAKEN (EPIDEMIOLOGIC / SURVEILLANCE)

______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
RECOMMENDATION / SUGGESTIONS (include special instruction and alternative actions to be taken):
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
ATTENDING PHYSICIAN AND DATE:
___________________________________________
Figure 21. Sample Intra Health Facility Referral Form

98
 The BHWs are to report the consolidated Form D (see Table 21 below) to the midwives/ PHN monthly
with the Health Facility Referral Forms as annex.
 The BHWs are responsible for knowing the outcomes of the patients they referred, while the midwives
/ PHNs are responsible for ensuring the BHWs know these outcomes. A sample monitoring and
reporting template modified from the Health Referral System Manual of DOH in 2002 for incoming
and outgoing referrals is provided below.
99
Monitoring Template for BHW Outgoing Referrals

Impression
Method of Reply Slip
Date and Time Name of (Given by Referred Reason for
HH No. Age Sex Transport / (Returned or Patient Status as of Recording
Referred Patient Referring From Referral
Communication Not)
Facility)
Reporting Template for Incoming Referrals

Municipality/ Referred
Age Sex Specific Reason for Referral Classification of Case
Barangay From
Priority for
Admission
(M/F) Medicolegal OPD Case Others Med Ped OB-Gyne Surgery
(for hospital
only)
0-11 mos
1-5 years old
6-14 years old
15-49 years old
50-59 years old
Senior Citizens
Reporting Template for Outgoing Referrals
Municipality/
Age Sex Referred To Specific Reason for Referral Classification of Case
Barangay
Priority for
Admission
Medicolegal OPD Case Others Med Ped OB-Gyne Surgery
(for hospital
only)
0-11 mos
1-5 years old
6-14 years old
15-49 years old
50-59 years old
Senior Citizens
Table 21. Sample Monitoring and Reporting Template for Incoming and Outgoing Referrals
100
 The Midwives and/or PHN needs to ensure the data quality and accomplish FHSIS M1 form before
reporting to the MHO monthly.
 ZFF recommends that they also determine the top ten (10) leading cases for referrals and specify
how many cases per disease entity are present in their respective municipalities.
 Monitor and Evaluate
 In order to ensure that monitoring, tracking, evaluation and provision of health services to the
vulnerable population are being done, the MHO is to submit the completed FHSIS M1 form to the PHO
monthly.
 The expanded local health board with representative of the vulnerable population should also
conduct monthly meetings with an explicit agenda to address the vulnerable population’s needs using
the FHSIS M1, Forms B and D as references
101
How do I change my No Balance Billing Deliverable from Red to Green?
 Presence of a policy on the implementation and monitoring of case rates among government
hospitals
 Full implementation of no out-of-pocket expenditure system for PHIC-enrolled indigent patients
 Presence of a monitoring strategy on the number of facilities implementing NBB
102
Why do I need to address the No Balance Billing deliverable?
The Philippines continues to have a high proportion of household out-of-pocket payments for health
expenditures, comprising about 55% of the 2017 health expenditures overall27. This is unfortunate since
globally, there has been increasing attention to universal coverage, even among low income countries.
Universal coverage is seen as a means to reduce financial impoverishment caused by health spending and
increase access to key health services28. Although there is little consensus about how low-income and
lower-middle-income countries should structure reforms aimed at moving towards universal coverage,
the Philippines has looked at an approach to reduce the poor’s vulnerability to financial difficulties during
sickness. The No Balance Billing policy is a policy which provides that no other fees or expenses shall be
charged or be paid for by the indigent patients above and beyond the packaged rates during their
confinement period.

Chapter 1 General Provisions
 Section 2 (b) A health care model that provides all Filipinos access to a comprehensive set of quality
and cost-effective, promotive, preventive, curative, rehabilitative and palliative health services
without causing financial hardships, and prioritizes the needs of the population who cannot afford
such services;
 Section 3 (b) This act seeks to ensure that all Filipinos are guaranteed equitable access to quality
and affordable health care goods and services and protected against financial risk.
This policy not only enables the vulnerable sectors of the program such as the poor and the elderly to pay
no more in excess of their PhilHealth coverage when confined in government facilities, but also aids public
facilities improve their internal systems operations. More specifically, the NBB ensures continuity in inputs
and supply as their attention is called for in instances where they charge patients for a specific component,
or when they ask them to buy medicines or supplies outside due to unavailability in the hospital pharmacy.
Countless members and patients, especially the vulnerable and the poor, have acknowledged the role of
the NBB in preventing them from incurring debts that would have otherwise easily mounted.
27 Herman T, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health vertical programs in the Philippines:
28 PSA. Total Health Expenditures grew by 8.0 percent in 2017 | Philippine Statistics Authority [Internet]. Philippine Statistics Authority. 2017
[cited 2019 Aug 2]. Available from: https://psa.gov.ph/content/total-health-expenditures-grew-80-percent-2017
103
CHECK
 What are the benefits covered by the NBB policy?
 All Case Rates -- Case rates refer to the fixed amount that PhilHealth will reimburse for a specific
illness/case. These include medical case rates, procedure case rates, first case rate and second case
rate. (PH circular 0035, series of 2013)
 Z Benefit Packages -- Philhealth classification of illnesses which covers for a unique set of
catastrophic illnesses defined in PhilHealth Circular 30, series of 2012, e.g. Acute Lymphocytic /
Lymphoblastic Leukemia, Breast Cancer, Prostate Cancer, etc. (PhilHealth Circular no. 48 Series of
2012)
 Primary Care Benefit (PCB 1 Package) -- includes the following three (3) main provisions:
o Primary preventive services
o Diagnostic examinations
o Drugs and medicines for certain diseases
 Other covered benefits:
o Middle East Respiratory Syndrome Coronavirus (MERS-Co V) Benefit
o Ebola Virus Disease (EVD) Benefit Package
 Who are covered by the NBB policy benefits?
 Indigent
 Sponsored
 Domestic worker of Kasambahay
 Senior citizens
 Lifetime members
 What health care institutions are covered by the NBB policy?
 All accredited government health care institutions (HCIs) including all levels of hospitals and other
health facilities
 Accredited private health care institutions such as:
a. Contracted facilities for Z Benefit Packages
b. Ambulatory Surgical Clinics
c. Freestanding Dialysis Centers (FDCs)- starting April 1, 2017, the NBB policy shall apply to
both hospital-based and non-hospital-based FDCs
d. TB DOTS Centers
e. Birthing Home (for NBB eligible members only)
f. Infirmaries and dispensaries
 Does the province have a policy on the implementation of case rates among government
hospitals?
 Does the province have a monitoring strategy on the number of facilities implementing NBB?
104
 How can health care institutions in our province implement the NBB policy?
 Extend all medical and financial support to qualified NBB members and dependents
 Give NBB patients preferential access to their social welfare funds or other sources for financing,
which may be used to augment the benefit package provided in case of insufficiency to full cover all
facility charges.
 Should have the capacity to for real time verification of membership and eligibility
 Develop policies to ensure that NBB members and dependents are properly identified.
 Orient all PhilHealth members and dependents on PhilHealth benefits and NBB policies during
admission. All qualified NBB members and dependents shall be informed that NBB shall only be
applied for ward type accommodation and shall be forfeited if they opt admission in private room.
 What enabling mechanisms should we put in place to ensure that qualified NBB members and
dependents will not have any out-of-pocket expenditures?
A. Institutional Health Care Provider Portal (IHCP Portal)

It is a simple web-based system for online verification of membership and eligibility which only
requires a computer with internet connection. All accredited facilities must have this system in place.
 How do we register?
To register, the Institutional Healthcare Providers (IHCPs) must completely accomplish and submit the
following forms to the nearest PhilHealth Office.
1. Philhealth Online Access Form (POAF) No. 002 (See form below) downloadable at
https://www.philhealth.gov.ph/services/hci/AnnexA-POAF.pdf
Figure 22. Sample PhilHealth Access Form
105
2. Non-Disclosure Agreement Form (see form below) downloadable at

https://www.philhealth.gov.ph/services/hci/AnnexB-NDA.pdf
Figure 23. Sample Non-Disclosure Agreement Form
B. Member Data Record (MDR)

Indigent members may present their MDR as proof of membership and eligibility provided that MDRs
are valid within availment period. (See sample MDR below)
106
Figure 24. Sample Member Data Record
 How do we access MDR online?

For a step-by-step instruction on how to download MDR online, go to
https://myphilhealth.blogspot.com/2015/11/paano-makakuha-ng-philhealth-mdr-sa.html
C. Pantawid Parnilyang Filipino Program (4Ps) ID Card

Pursuant to PhilHealth Circular No. 24, s.2012, "Entitlement to NHIP benefits of all Pantawid
Pamilyang Filipino Program Beneficiaries of the DSWD", the hospital shall accept 4Ps identification
cards as proof of membership. The mere presentation of the card shall be treated with presumptive
validity and in good faith.
 How are Health Care Providers (HCPs) assessed?
 PHIC through the Standards and Monitoring Department (SMD) shall regularly conduct monitoring on
all hospitals and non-hospitals compliance to the NBB policy of PHIC.
 Monitoring and evaluation shall be in accordance with the current guidelines of the Corporation on
monitoring of HCP as per PHIC Circular No. 2018-0019 or Health Care Provider Assessment System
Revision 2
 What are the monitoring tools used, assessment period and schedule of feedback? (See attached
table below)
107
Figure 25. Monitoring Tools used for NBB
108
 What are the specific indicators for monitoring? (PhilHealth Circular 2018-0019)
 The performance of HCPs shall be assessed using a set of indicators that will guide in the analysis and
disposition of the output of the assessment. The set of performance indicators are grouped into the
following 4 domains:
o Quality of Care
o Patient Satisfaction
o Financial Risk Protection
o Fraud Detection
Table 22. Performance Indicators for NBB Monitoring
109
 What is the procedure of monitoring report submission? (See attached flow chart below)
HCP PERFORMANCE ASSESSMENT PROCESS—FLOW CHART
PCARES/
UHIO
CAC/
BAS SURVEYS PRMC
COMPLAINTS/
MEDICAL AUDIT REFERRALS/
REPORTS
HCDMD/
BAS/AQAS
Reviews/ AQAS
evaluates all
CLAIMS/SERVIECS/ submitted
MONTHLY REPORTS reports and FACILITY VISITS
REVIEW&PROFILING feedback to
concerned
office
PRMC
SECRETARIAT
NO
AQAS
With
PRMC Tag in
SECRETARIAT findings?
Accreditation
Database
YES
110
Needs
PRMC
SECRETARIAT additional NO
information?
PRMC
YES
AQAS/PAFT/PRO
SECRETARIAT/BAS Legal Office
Chart Review Field
Validation
PhilHealth Regional Monitoring Committee

(PRMC)
YES
Prepare
FRAUD?
a endorsement for
approval of RVP
PRMC
SECRETARIAT
Refer to FFIED
(Central Office)
111
NO
VIOLATION? File/send back
to PRMC
YES
FFIED
Feedback to HCP and request LEGAL PROCESS
for justification
PRMC
SECRETARIAT
YES
Justification
PRMC
Feedback to HCP accepted?
PRMC
SECRETARIAT NO
NO PRMC
Need expert Issue notice of warning
opinion?
YES
Tag in accreditation
Database
Refer to QAC (Central Office) AQAS
PRMC
Serving of Offense
(LEGAL PROCESS)
112
QAC
YES Secretariat
VIOLATION? Prepare resolution and

QAC
forward to PRMC for issuance
of Notice of Warning
PRMC
SECRETARIAT
NO
Prepare resolution and QAC

Tag in Accreditation
forward to PRMC Secretariat Database
PRMC
SECRETARIAT
Feedback to HCP Serving of Offense
(LEGAL PROCESS)
Figure 26. Flowchart on the procedure of monitoring report submission for NBB
113
How do I change my Health Human Resources for Preventive and Curative

Care Deliverable from Red to Green?
Performance Management System and Implementation of Magna Carta for PHO Staff
 Defined functions, roles and responsibilities of the provincial health staff

 Conducted competency-based evaluation for provincial health staff on a semi-annual basis
 Issued legislation on awards and recognition system for the provincial health workers
 Created staff development plan to address the identified gaps in leadership, management and
technical aspects
 The following benefits are fully given to all the permanent LGU-hired health workers: hazard
allowance, laundry allowance and subsistence allowance
Health Human Resources for Preventive Care
 Adequate human resources in RHUs based on the HRH requirements

 Adequate human resources in barangays based on the HRH requirements
 Competent primary health care providers
 Presence of a performance management system for municipal health workers
 Implementation of the Magna Carta for Municipal Public Health Workers in the Province
Health Human Resource for Curative Care
 Adequate human resources in the hospitals based on the HRH requirements

 Competent hospital providers
 Presence of a performance management system for hospital staff
 Implementation of the Magna Carta for hospital staff
114
Why do I need to address the Health Human Resources for Preventive and Curative Care
deliverable?
The availability of qualified health workforce, or health human resources, is a critical determinant of a
health system’s capacity to deliver services to the population. The shortage and maldistribution of health
personnel has lea to brain drain of highly specialized staff from public medical facilities to the private
hospitals, and eventually overseas29. In the Philippines rapid growth of export-oriented private training
has mitigated the effect of migration on the total stock of health workers, but poor regulation of private
training has compromised quality and contributed to overproduction of health workers with scarce
employment prospects30. According to the World Health Organization, a well-performing health
workforce is one that works in ways that are responsive, fair and efficient to achieve the best health
outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly
distributed; they are competent, responsive and productive).
 Chapter 1 Section 4 Definition of Terms. A health care professional, who may be a Doctor of
Medicine, nurse, midwife, dentist or any allied professional or practitioner duly licensed to practice
in the Philippines
 Chapter 6 Section 23 Human Resources for Health. National Health Human Resource Master Plan.
The DOH, together with stakeholders, shall ensure the formulation and implementation of a
National Health Human Resource Master Plan that will provide policies and strategies for the
appropriate generation, recruitment, retraining, regulation, retention and reassessment of health
workforce based on population health needs. To ensure continuity in the provision of the health
programs and services, all health professionals and health care workers shall be guaranteed
permanent employment and competitive salaries.
 Chapter 6 Section 24 National Workforce Support System. A National Health Workforce (NHW) shall
be created to support local public health systems in addressing their human resource needs:
Provided, that deployment to Geographically Isolated and Disadvantaged Areas (GIDAs) shall be
prioritized.
 Chapter 6 Section 25 Scholarship and Training Program. (a) The Commission on Higher Education
(CHED), Technical Education and Skills Development Authority (TESDA), Professional Regulation
Commission (PRC) and DOH shall develop and plan the expansion of existing and new allied and
health-related degree and training programs including those for community-based health care
workers and regulate the number of enrollees in each program based on the health needs of the
population, especially those in underserved areas.
29
Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: Health insurance reforms in nine
developing countries in Africa and Asia. Lancet. 2012;380(9845):933–43.
30 Labarda MP. Career shift phenomenon among doctors in Tacloban city, Philippines: lessons for retention of health workers in developing
countries. Asia Pac Fam Med. 2011;10(1):13.
115
I. Performance Management System and Implementation of Magna Carta for PHO Staff
CHECK
 What is Performance Management System (PMS)?
 Performance management is the process through which managers ensure that employees’ activities
and outputs contribute to the organization’s goals. It includes
o Planning work and setting expectations
o Continually monitoring performance
o Developing the capacity to perform
o Periodically rating performance in a summary fashion
o Rewarding good performance
 What does it aim to do?
 To align individual performance goals with the organization’s strategic goals/vision;

 To ensure organizational effectiveness by cascading institutional accountabilities to the various
levels of the organization’s hierarchy;
 To have performance management linked to other HR systems; and
 To link agency overall performance to the Organizational Performance Indicator Framework, to the
Agency Strategic Plan
 What are the components of the integrated system for managing performance?
Component Description
Career Executive Service Performance This is an evaluation system for measuring the performance of
Evaluation System (CESPES) the Directors or the third level officials of the Bureaucracy
Performance Evaluation System (PES) This is an evaluation system for measuring the performance of
the second level employees of the
government. There are two different tools currently being
employed for this purpose:
a. One is for measuring the performance of the Division
Chief (DCPES)
b. The other is for measuring the performance of the
staff below the DC level position, the Rank-and-File
employees (RF-PES)
Office Performance Evaluation System This is a system for measuring the collective performance of
(OPES) the individuals in the office or
divisions. It involves using a point system to simplify the
measurement process.
Table 23. Components of the integrated system for managing performance
 Do the members of the provincial health staff in the PHO have defined roles, and responsibilities?
 Does the Provincial Health Office have a competency-based evaluation for provincial health staff?
What is the frequency of the evaluation?
116
 Does the Provincial Health Office have legislation on awards and recognition system for the health
workers?
 Does the PHO implement fully the Magna Carta?
COLLABORATE
 Who should spearhead the establishment of the Performance Management System (PMS)?
 A Performance Management Team should spearhead the establishment of the PMS in the
organization.
 Who should comprise the Performance Management Team?
 Executive Official designated as Chairperson

 Highest Human Resource Management Officer
 Highest Human Resource Development Officer
 Highest Planning Officer - Secretariat
 Highest Finance Officer
 President of the accredited employee association in the agency or the authorized alternate
representative
EXECUTE
 How do we go about the PMS cycle/process?
1. Performance
Planning and
Commitment
4. Performance 2. Performance
Rewarding and Monitoring and
Development Coaching
Planning
3. Performance
Review and
Evaluation
Figure 27. The Performance Management Cycle
1. Performance planning and commitment
 In this stage, indicators are determined. Success indicators consisting of performance measure and
targets serve as bases in the office’s and individual employee’s preparation of their contract and rating
form
117
2. Performance monitoring and coaching
 Performance of the office and every individual shall be regularly monitored at various levels.
Monitoring and evaluation mechanisms ensure that timely and appropriate steps can be taken to
keep a program on track, and that its objectives are met in the most effective manner
 Managers and supervisors act as coaches and mentors to provide an enabling
environment/intervention to improve team performance
3. Performance review and evaluation
 This phase aims to assess both the office and individual employee’s performance level based on
performance targets and measure as approved in the office and individual performance commitment
contract
 Part of the individual’s evaluation is the competency assessment vs. competency requirements of the
job. The assessment shall focus on the strengths, competency-related performance gaps and the
opportunities to address these gaps, career paths, and alternatives.
4. Performance rewarding and development planning
 The results of the performance evaluation/assessment shall serve as inputs for the agency’s HR plan,
which includes identification and provision of developmental interventions, and conferment of
rewards and incentives.
 What are the Magna Carta Benefits that should be given to our public health workers?
 As mandated by law (RA No. 7305), public health workers are entitled, among others, to the following
allowances: hazard, subsistence and laundry allowances
Type of Allowance Who are Entitled? Recommended Allowance

Section 21—Hazard Public health workers in hospitals, sanitaria, rural Hazard allowances equivalent to at
Allowance health units, main health centers, health least 25% of the monthly basic
infirmaries, barangay health stations, clinics and salary of health workers receiving
other health-related establishments located in salary grade 19 and below; 5% for
difficult areas, strife-torn or embattled areas, health workers with salary grade
distressed or isolated stations, prison camps, 20 and above
mental hospitals, radiation-exposed clinics,
laboratories or disease-infested areas or in areas
declared under state of calamity or emergency
for the duration thereof which expose them to
greater danger, contagion, radiation, volcanic
activity/eruption, occupational risks or perils to
life
Section 22— Given when public health workers are required They shall be entitled to full
Subsistence Allowance to render service within the premises of subsistence allowance of 3 meals
hospitals, sanitaria, health infirmaries, main which may be computed in
health centers, RHUs and BHS, or clinics and accordance with prevailing
other health related establishments in order to circumstances
make their services available at any and all times
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Section 24—Laundry All public health workers who are required to They shall be entitled to laundry
Allowance wear uniforms regularly allowance equivalent to One
hundred twenty-five pesos
(P125.00) per month: Provided,
That this rate shall be reviewed
periodically and increased
accordingly by the Secretary of
Health in consultation with the
appropriate government agencies
concerned taking into account
existing laws and prevailing
practices.
Table 24. Mandated Allowances to Public Health Workers
II. Health Human Resources for Preventive Care
CHECK
 Do the RHUs in all municipalities of our province have adequate human resource for health (HRH)
based on recommended requirements?
 Do the RHUs in all municipalities of our province have competent primary health care providers?
 Do the RHUs in all municipalities of our province implement performance management system for
municipal health workers?
 Do the RHUs in all municipalities of our province implement Magna Carta for municipal health
workers?
COLLABORATE AND EXECUTE:
 What comprises a complete RHU staff complement?
 Physician, Public Health Nurse, Registered Midwife, Medical Technologist, Municipal Nutrition
Action Officer, Rural Sanitary Inspector, Pharmacist/Pharmacy Assistant (for municipal class lower
than 4)
 This would include all hired staff whether plantilla, contractual, or job order positions
 How do I ensure that the recommended Human Resource for Health to population ratio (as below)
is in place?
 Physician to Population Ratio: (LGU-hired permanent position) - 1: 20,000

 Nurses to Population Ratio: (LGU-hired permanent position) - 1: 20,000
 Midwives to Population Ratio: (LGU-hired permanent position) - 1: 5,000
 Dentist to Population Ratio: 1:50,000
 LGU hired/designated Health Emergency Management System Coordinator
 Health Human Resource (mixed personnel of physicians, nurses, midwives) to Population Ratio: (LGU
or Non-LGU hired, permanent or not permanent) - 19.4:10,000
119
 How do I ensure that our provinces have competent primary health care providers?
 Professional health care providers are accredited to make sure that members get the highest quality
of medical treatment and management from experts in various fields of medical practice
 Municipal health workers should be trained in mandatory service packages
o Family Planning, Antenatal Care, Essential Newborn Care, Expanded Program for
Immunization, First 1000 days for nutrition, Adolescent Sexual and Reproductive Health
 Conduct competency-based evaluation for municipal health staff on a semi-annual basis (see sample
below)
Table 25. Sample Individual Performance Commitment and Review
 Provision of Magna Carta for municipal health workers
III. Health Human Resources for Curative Care
CHECK
 What services and facilities should the hospitals in my province provide based on its level or
classification?
120
Table 26. Hospital Services Based on Levels
 What is the standard staffing pattern for our hospitals in our province? How is it determined?
 The staffing pattern of a hospital is determined based on the assigned classification, bed capacity and
organizational structure of the hospital
 The Philippine hospitals’ standard for medical staffing is derived from the study entitled “Developing
Metrics for Hospital Medical Workforce Allocation” (Shannon, et al, 2007) which is used
internationally.
 In addition, the DOH Administrative Order No. 2012-0012 dated July 18, 2012 entitled “Rules and
Regulations Governing New Classification of Hospitals and Health Facilities in the Philippines” is used
as reference.
121
122
123
124
125
126
127
128
129
Table 27. Standard Staffing Pattern for Hospitals in the Province
 Do the hospitals in our province have adequate HR based on requirements? Are the hospital
providers competent?
 Do hospitals in our province implement performance management system for hospital staff? Do
hospitals in my province implement Magna Carta for municipal health workers?
 How do I ensure the correct percentage distribution of our HR staff in our hospital according to its
classification?
 Do we have a policy on the physician’s schedule which should fulfill 24/7 requirement?
 How do we ensure that the schedules of the hospital physicians on duty are visible to the public?
Do the RHUs have copies of their schedules and contact numbers in case of referral?
 How do we ensure that hospital staff on duty is available 24 hours a day, 7 days a week?
 How to we ensure that the hospital staff are trained in the NALS, PALS, EINC, Lactation
Management, CPR?
 How do we ensure that a competency-based evaluation for hospital staff on a semi-annual basis is
regularly conducted?
 How do we ensure that the provision of Magna Carta for hospital staff – Hazard, Subsistence and
Laundry Allowance are given?
130
How do I change my Resilience Oriented Health System Deliverable from

Red to Green?
Provincial Support for Building a Resilient Health System
 Oriented on the Climated and Disaster Risk Assessment (CDRA) Tool

 Integrated the provincial DRRM-H plan to the Provincial Disaster Risk Reduction and
Management Plan
 Issued an ordinance adopting RA 10121 “Philippine Disaster Reduction and Management Act”
 Established an Incident Command System (ICS) Organizational Structure
 Issued an ordinance establishing the provincial health emergency management / disaster risk
reduction and management for health unit as integrated in the Provincial Disaster Risk Reduction
and Management Council
 Established a system for disease surveillance with mechanisms to disseminate surveillance
information
Municipal Support for Building a Resilient Health System
 86-100% of the municipalities or cities have have DRMM-H plans have incorporated the
barangay DRRM-H plans
131
Why do I need to address the Resilience-Oriented Health System deliverable?
A resilience-oriented health system is a health system which has the capacity to prepare populations in
advance of disasters with an emphasis on promoting individual and community resilience through inter-
sectoral collaboration among the different champions of the pillars in the province and the community
that will contribute to reduced morbidity, mortality and damages to ensure that institutional
arrangements and partnerships are sustained both before, during, and after disasters (IPHSDP Strategy
Paper, 2019)
 Chapter 1 Section 2 Declaration of Principles and Policies. 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, the state shall adopt:
(a) An integrated and comprehensive approach to ensure that all Filipinos are health literate,
provided with healthy living conditions and protected from hazards and risks that could affect
their health;
(b) A health care model that provides all Filipinos access to a comprehensive set of quality and cost
effective, preventive, promotive, curative, rehabilitative and palliative health services without
causing financial hardship, and prioritizes the needs of the population who cannot afford such
services;
(c) A framework that fosters a whole-of-system, whole-of-government and whole-of-society
approach in the development, implementation, monitoring and evaluation of health policies,
programs and plans; and
(d) A people-oriented approach for the delivery of health services that is centered on people’s
needs and well-being and cognizant of the differences in culture, values and beliefs.
132
CHECK
 What is a DRRM-H Plan?
 The Disaster Risk Reduction and Management in Health (DRRM-H) Plan is a plan that defines the
why, what, who, and how of the important phases of disaster risk reduction and management for
health.
 Plan serves as the health component of the Disaster Risk Reduction and Management Plan
 What are the goals of DRRM-H?
 Provide uninterrupted health services;

 Avert preventable morbidities and mortalities; and
 Ensure that no outbreaks occur secondary to disasters
 Do the LGUs (province and municipalities) already have a DRRM-H?
 How is the compliance of the LGU in RA 10121? Is there a local policy adopting the PDRM Act?
 Did the LGU (province and municipality) undergo orientation in Climate and Disaster Risk
Assessment (CDRA)?
 Has the LGU (province and municipality) appointed a full-time DRRM Officer and set up the Incident
Command System?
 Was the DRRMP-H plan reviewed by the Local Health Board?
 Has the staff undergone any training program related to DRRM?
COLLABORATE
 Who are the members of the DRRM-H (Provincial level and municipal level) Planning Committee?
 Health LGU officials

o Municipal level: MHO and other RHU staff, PHNs and RHMs, SB on Health
o Provincial level: PHO and other staff
 Non-health LGU officials
o Municipal level: MPDO, MDRRMO, MLGOO, RSI, MNAO
o Provincial level: PPDO, PDRRMO, etc.
 Head of the Office
o Hospital: Medical Center Chief/Chief of Hospital
o Provincial/City/Municipality: Governor/Mayor
o Barangay: Barangay Captain
 DRRM-H Focal Person: DRRM-H Manager/Health Officer and LGU-designated Manager
 Other DRRM Planning Technical Committee Members:
133
o Technical Personnel on Health Programs, Planning Officer, AO, Provincial/City/Municipal DRRM

Officer; and counterparts from Barangay
 What are the roles and responsibilities of the DRRM-H Planning Committee?
The Committee and its Members Roles and Responsibilities

DRRM-H Planning Committee  Develop, review and update the previous plan
 Gather required information and secure commitment of key people
and organizations
 Initiate testing of the plan for its functionality and adaptability to
current situation
 Develop annual operational plan and other plans relevant to health
emergencies and disasters
 Monitor and evaluate the plan
Chairperson  Preside the meeting and facilitate planning
 Provide feedback to the Head of Institution in relation to progress of
planning
Vice Chairperson  Assist the chairperson
 Take over the role of the Chairperson in his/her absence
Members  Provide necessary technical inputs
 Attend meetings regularly
 Assist the Chairperson in advocating the plan
Secretariat  Document minutes of the meeting
 Is responsible for safekeeping of documents and records
Table 28. Roles and Responsibilities of the DRRM-H Planning Committee
EXECUTE
 What are some key points that should be considered in the Planning Process?
 Evidence-based and inclusive planning – data is derived from the experience and resources of the LGU
and the community in relation to disaster management. Involvement of key health and non-health
LGU officials whose respective roles and work program are critical complimentary inputs.
 The drafted DRRM-H plan will be reviewed by the LHB and endorsed to the SB for approval through a
resolution or an ordinance for SB approval and budget appropriation
134
 What are the steps that we need to undergo in DRMM-H Planning?
Preparing
to Plan
Monitoring
Data
and
Gathering
Evaluating
and Analysis
the Plan
Developing/
Implementing
Updating
the Plan
the Plan
Translating
and
Integrating
the Plan
Figure 28. DRRM-H Planning Process
 What policies can we make to support the implementation of the DRRM-H Plan?
 EO on adoption of RA 10121
 EO establishing or re-organizing the Provincial/Municipal Disaster Risk Reduction and Management
Council
 EO establishing Operations Center
 EO establishing and popularizing the ICS and Early Warning System
 Local Health Board resolution to co-create an M&E system and implement a quarterly monitoring of
the status of implementation
135
Sample of Executive Order Re-organizing the Municipal Disaster Risk Reduction and Management
Council (MDRRMC) and Defining its Functions Pursuant to Republic Act 10121
1 2
3 4
136
5 6
 What are some Capacity Building activities that we can do to strengthen the implementation of the
DRMM-H Plan?
 Orientation on Climate and Disaster Risk Assessment tool
Points to Consider:
 All municipalities should submit their DRRM-H plan to the province

 An inventory or monitoring report on the status of DRMM-H plan should be available at the
provincial level.
137
How do I change my Essential Medicines Deliverable from Red to Green?
Supply Chain Management and Policy Support for Preventive Care
 Procured medications that are in-line with the Philippine National Formulary
 Presence of an evidence-based quantification of supply
 Conducted regular monitoring or reporting on the procurement performance
 Implemented good storage practices
 Conducted regular inventory of medicines and other health products (regular or manual method)
 Adopted the Daily Drug Use Record or Drug Utilization Report
 Created or revised the guidelines in acceptance of foreign and local drug donation
 Adopted the guidelines for disposal of unwanted or expired medicines
 Issued legislation on establishing drugs and therapeutics committee governing LGU
pharmaceutical related activities
 Issued legislation formalizing LGU protocols on pharmaceutical supply chain management
 Issued legislation adopting the national guidelines on the implementation of rules and
regulations on licensing of Retail Outlet for Non-Prescription Drugs
 Issued policy on emergency procurement, prepositioning and immediate replacement of
essential medicines and basic health emergency supplies
Supply Chain Management for Government Hospitals
 Procured hospital formulary that are in-line with the Philippine National Formulary and National
Standard Treatment Guidelines
 Developed and implemented guidelines and/or policy for tracking and inventory of supplies and
medicines
 Developed and implemented guidelines and/or policy on storage of supplies and medicines
Developed and implemented guidelines and/or policy on disposal of expired and unwanted
medicines
 Established Drug Therapeutics Committee with defined roles and functions
Adequacy of Essential Medicines in the Municipalities

 86-100% of RHUs in municipalities are properly stocked with all of the essential primary care
medicines
138
Why do I need to address the Essential Medicines deliverable?
Forty years after the concept of essential medicines was launched in 1977, there is good evidence that
these guidelines and lists of essential medicines, when properly developed, introduced, and supported,
improve prescribing quality and lead to better health outcomes31. A well-functioning health system
ensures equitable access to essential medical products, vaccines and technologies of assured quality,
safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use (WHO, 2007).
Medicines are crucial health care products in the Primary health care system. An important function of
any health care system is to deliver appropriate health products and services in an equitable, reliable and
efficient manner. The quality of a primary health care system is usually judged by patients on the basis of
appropriate medical staff and availability of needed medicines.
Essential medicines, as defined by the WHO, are those that satisfy the priority health care needs of the
population. They are selected with due regard to public health relevance, evidence on efficacy and safety,
and comparative cost-effectiveness. Essential medicines are intended to be available within the context
of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with
assured quality and adequate information, and at a price the individual and the community can afford.
Access to them is critical for reaching universal health coverage because they are important in addressing
health problems and improve quality of lives and health outcomes.
31Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, et al. Human resources for health in southeast Asia:
shortages, distributional challenges, and international trade in health services. Lancet [Internet]. 2011 Feb 26 [cited 2019 Aug
2];377(9767):769–81. Available from: https://www.sciencedirect.com/science/article/pii/S0140673610620351
139
I. Functional Supply Chain Management
CHECK
 What is a functional supply chain management?
 It is the entire process of how medicines are selected, procured, delivered, prescribed, administered,
and reviewed to optimize its contribution to desired outcomes of patient care
 Does the quantification of supply (consumption) follow the evidence-based approach?
 Do medicines in the government facility conform to DOH standards?
 Does the procurement of medicines follow the prevailing mechanism?
 Does the government facility conduct regular inventory of medicines?
 Does the government facility conduct regular monitoring on procurement performance?
 Does the government facility have guidelines on acceptance of foreign and local drug donation?
 Does the government facility have adopted guidelines for disposal of unwanted or expired
medicines?
 Does the government facility have a policy on good storage of medicines?
 How should quantification of supply and consumption be done?
 There should be a list of morbidities/disease or consumption methods

 Procured medications should be in-line with the Philippine National Formulary
(Philippine National Drug Formulary List of Essential Medicines downloadable at
http://apps.who.int/medicinedocs/documents/s19477en/s19477en.pdf)
 What should be considered in the procurement of medicines?
 Evaluation of bids and awarding of contracts must have a clear, transparent and effective workflow
 Bid prices from interested suppliers can be compared with and checked against the latest published
Drug Price Reference Index (DPRI) available at the DOH website, downloadable at
https://dpri.doh.gov.ph/download/2016%20DPRI%20Fourth%20Edition.pdf
 What are some important considerations when doing the inventory process?
 Should have a well-documented and effective system of receiving procured medicines
140
 Upon delivery of supplies, these should be inspected and checked against the specifications listed in
the purchase order
 Should have an electronic or manual method of conducting regular inventory of medicines
 An inventory software program is an efficient method for managing inventory
 In the absence of electronic system, other means like the stock cards and inventory logbooks
can be used.
 Daily drug use record or drug utilization report should be adopted.
Monitoring
 Review if LGU performs regular monitoring and reporting of procurement performance. Use key
indicators (e.g. supplier lead time, percentage of purchases made through bidding, planned vs. actual
purchases) and report performance indicators against targets.
Donation
 Create specific and clear guidelines regarding medicines donation, taking into the consideration the
policy of DOH (AO 2007-0017-Guidelines on the acceptance and processing of foreign and local drug
donations during emergency and disaster situations)
 Acceptance of donations shall be based on the expressed need of the community.
Disposal
 Develop a policy on the appropriate disposal of expired medicines

 Guided by the DOH and DENR joint policy on effective and proper handling, collection, transport,
storage and disposal of healthcare wastes (AO 02-2007)
o Determine if health personnel are trained on proper disposal of medicines
o Recommend to the LHB to execute policy that supports the training of health personnel and
ensures funding for the equipment and materials required in the proper disposal of expired
and unwanted medicines.
 Quarantine area for expired and damaged goods should be assigned to lessen chances of dispensing
unwanted medicines and to facilitate disposal
Storage
 Clear policies at the LGU level must be in place to protect the quality of medicines
 The LGU should invest in adequate facilities and equipment
141
II. Policy Support on Medicines Management
CHECK
 What is a Drug Therapeutics Committee (DTC) and what does it do?
 Drug Therapeutics Committee (DTC) is the committee that evaluates the clinical use of medicines,
develops policies for managing pharmaceutical use and administration, and manages the formulary
system
 Provides advice to the executive body for financial and policy support.
 Does the province have a functional DTC?
 Have you organized the committee and selected members based on their competence and roles
relevant to making Supply Chain Management (SCM) work?
COLLABORATE
 Who should comprise the Drug Therapeutics Committee (DTC)?
 PHO as Chairperson
 Assistant PHO
 Department Heads
 Pharmacist as Secretary – should undergo Pharmacy Service National Certificate III by the TESDA
 DMO of the DOH
 Midwife
 BAC representative
 Microbiologist or lab technologist
 DENR representative
 Chief of Hospital
EXECUTE
 What should we do in order to have a functional chain management?
 Draft and implement legislation on establishment of DTC which governs the LGU pharmaceutical
related activities (for provinces that do not have DTC yet)
o DTC recommendations should be dissemination to staff, PHB members and other concerned
parties
 Draft and implement legislation formalizing LGU protocols on pharmaceutical supply chain
management
o All DTC operating guidelines, policies and decisions should be documented
o Include agreed actions to be taken if decisions, guidelines or policies are not followed
 Draft and implement legislation adopting the national guidelines on the rules and regulations on
licensing of Retail Outlet for non-prescription drugs
142
III. Adequacy of Essential Medicines in the Municipalities
CHECK
 Do all municipalities in our province follow the standards on Supply Chain Management?
 Do all municipalities in your province follow the standards on Medicines Management?
 Are all municipalities properly stocked with all essential primary care medicines?
 Systematically assess the local drug management system:
Policy, Legislation and Regulation

 Are there existing local government drug policies or legislations?
 What is the percentage of unregistered drugs in private-sector sales outlets?
 Is there compliance with generic prescribing and dispensing?
Formulary, National Essential Drugs List and Drug Information
 Is there an existing provincial or hospital formulary?
 Is there a therapeutic manual based on the formulary?
 How many health facilities have therapeutic manuals?
 Is there a drug information center?
Health Budget and Finance
 What is the drug budget per capita?
 What is the percentage of total government budget used for health?
 What is the percentage of total health budget allocated to drugs?
 Who pays for drug purchases?
Drug Procurement
 What is the percentage of drug purchases not found in the formulary?
 What is the percentage by value of drugs purchased through a central procurement system?
 What is the percentage of average international price paid for last regular procurement of a set of
indicator drugs?
 What percentage of drugs is centrally purchased through competitive bidding?
 Are there differences in prices procured by different LGUs of same drugs?
Drug Logistics or Distribution
 What is the weighted average % of inventory variation in stock record-keeping system at the provincial,
district, municipal and district facilities?
 What is the percentage of a set of unexpired indicator drugs available in health facilities?
 What is the average percentage of time out-of-stock for indicator drugs?
Patient Access and Drug Utilization
 What is the population per health facility that dispenses drugs?
 What is the average number of drugs prescribed per curative outpatient encounter in health facilities?
 What is the percentage of drugs prescribed by generic name in health facilities?
 What is the percentage of outpatients prescribed injections in health facilities?
 What is the percentage of outpatients prescribed antibiotics in health facilities?
 What is the percentage of drugs prescribed that are actually dispensed in health facilities?
Product Quality Assurance
143
 Were there drug product quality checks made during the past year?
 How many drug products were tested?
 What was the total number of drug product quality tests performed?
 Is there a formal system for reporting product quality complaints?
Private-Sector Pharmaceutical Activity
 What is the population per licensed private-sector drug sales outlet ratio?
 How many licensed drug outlets (per FDRO)?
 What is the total value of private-sector retail pharmaceutical sales per capita?
 What is the value of government pharmaceutical expenditures and private-sector retail sales per capita?
 What is the percentage of licensed retail drug outlets where an antibiotic was available without a
prescription?
Table 29. Quick Assessment of the Local Drug Situation Tool
 VEN System
 Is a system which sets priorities for selection, procurement, and use according to the potential health
impact of individual drugs. It assigns each drug on the formulary or essential drug list to one of three
categories. The three categories are:
1. Vital Drugs—are safe and are clinically effective and potentially lifesaving (cure or prevent life
threatening disorders, (e.g. vaccines or antibiotics), or have significant withdrawal side effects
(making regular supply mandatory, e.g. high dose steroids)
2. Essential Drugs—are safe and clinically effective treatment against diseases which cause severe
disability if it is untreated or could reverse disability or impairment caused by incurable diseases.
3. Non-essential—safe and effective drugs are used for minor or self-limited illnesses.
Other Drugs—drugs with limited or questionable benefits, or harmful drugs, or poor value for
money preparations; have a comparatively high cost for a marginal therapeutic advantage.
Characteristics of Drug or
Vital Essential Non-Essential Other Drugs*
Target Condition
Severity of target condition
Life-threatening Yes Occasionally No Maybe
Severe acute or chronic Occasionally Frequently Rarely Maybe
conditions and disability
Moderately or lightly No Rarely Frequently Maybe
impaired quality of life and
daily functioning
Does the drug have clinically significant effect?
Prevent or completely cure Yes Occasionally Usually No Maybe
serious, and/or life-
threatening diseases, extend
life
Cures serious diseases or Occasionally Yes Rarely Occasionally
completely reverses
potentially severe chronic
conditions, substantially
improves quality of life and
daily functioning
144
Improves minor, self-limiting Maybe Rarely Frequently Maybe

conditions and/or slightly
improves quality of life
Safety/efficacy/effectiveness and cost-effectiveness
Has good safety records Usually Almost Almost Not always
Efficacy is based on good Yes Yes Yes Often/ usually
scientific evidence?
Effectiveness is based on Always Always Yes May or may not
sound scientific evidence? be
Is it cost-effective? Usually Usually Sometimes May or may not
be
Table 30. Modified VEN Classification
 What essential primary care medicines should we properly stock and ensure availability (of at least
1-month supply) in RHUs?
 EPI vaccines
 Supplements: Iron, folic acid and vitamin A
 Contraceptives
 Four (4) molecules: Losartan, Amlodipine, Metoprolol, Metformin
 TB Drugs
 Treatment for leading causes of morbidity
145
Stop and Think!
Among the many wins you have achieved this month, identify one significant or memorable
accomplishment and answer the questions below.
What is your significant accomplishment this month?
Describe the situation. What explains the challenge?
146
What are the tasks needed to be done?
What actions and adaptive responses did you take to accomplish your goals?
What innovations (if applicable) were you able to do in performing the tasks?
How can you and your team sustain the gains?
147
Developing BL Competencies
What BL competencies were you able to deploy/ develop/ improve from this experience?
What new milestone/s do you plan to achieve next month?
What support do you need to achieve your plans?
148
References
1. Philippines, Government of the. Republic Act 11223; Universal Health Care Act 2019. 2019.
2. Medina PN. Are We Really on the Road to Health For All? Contextualizing the Philippine Health Agenda 2016-
2022 (February 25, 2019).
3. Zuellig Family Foundation. Briefer on the Integrated Provincial Health Systems Development Program. 2019.
4. Department of Health. Philippine Health Agenda 2016-2022. 2016.
5. Department of Health. Kalusugang Pangkalahatan; The Aquino Health Agenda. 2010.
6. Department of Health Regional Office 8 (2019). Executive Order No, 10-2018 Executive Order Re-organizing
the Municipal Disaster Risk Reduction and Management Council (MDRRMC) and Defining its Functions
Pursuant to Republic Act 10121 of Pastrana, Leyte. Health Leadership and Governance Program.
7. Medina PN. Introduction to Health Systems Workshop; An Analysis of the Inquirer Article "A Filipino Horror
Story" (May 14, 2019).
8. Dorotan E, Zsolt M. Making Your Local Health System Work. German Agency for Technical Cooperation, 2005.
9. RTI International. Strengthening the Referral Mechanism in a Service Delivery Network: Experiences from
USAID's LuzonHealth Project. Washington DC: USAID and DOH; 2018.
10. Beyond Hospital Beds: Equity. Province-Wide/City-Wide Health System (Asuncion, IL., interview by service and
quality UP Manila RTD, November 29, 2018).
11. DOH, USAID and Jhpiego. Guide in Establishing a Functional Service Delivery Network (SDN) for MNCHN-FP
Services. Manila: Jhpiego Philippines; 2016.
12. Department of Health. Framework for redefining the service delivery network. DOH Administrative Order
2017-0014. Manila; 2017.
13. ACCESS for Maternal and Neonatal Health. Changing Systems for Changing Lives; The Davao Toolbox to
Promote Maternal and Newborn Health. Davao: KOICA, USAID, Jhpeigo, WHO Philippines; 2018.
14. Bureau of Local Health Systems Development. Local Investment Planning for Health; Handbook on Principles,
Guidelines, Procedures and Processes. Manila: DOH, 2015.
15. Philippine Health Insurance Corporation (PhilHealth). The revised implementing rules and regulations of the
National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606). Philhealth.gov.
https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf. Accessed May 31, 2019.
16. Philippine Health Insurance Corporation (PhilHealth). Manual of procedure of the new accreditation process.
PhilHealth Circular 54 s. 2012 ‐ Provider engagement through accreditation and contracting for health
services. PhilHealth.gov. https://www.philhealth.gov.ph/downloads/accreditation/MOP_PEACHeS.pdf. 2013.
Accessed May 31, 2019.
17. Medina PN. (2016). The district health system in the Philippines. Lecture slides.
18. Romualdez Jr. A, dela Rosa J, Flavier J, Quimbo S, Hartigan-Go K, Lagrada L, & David L. The Philippines health
system review. Geneva: WHO Press; 2011.
19. Zuellig Family Foundation. (n.d.). Our approach: Health change model. Zuellig Family Foundation. Retrieved
June 1, 2019 from https://zuelligfoundation.org/our-approach-health-change-model/
20. Department of Health. Guidelines in Establishing Service Delivery Network. Doh.gov.
https://www.doh.gov.ph/sites/default/files/publications/Guidelines%20EstablishingSDN.pdf. 2019. Accessed
May 31, 2019.
21. Administrative Order No. 2014-0046 Defining the Service Delivery Networks (SDNs) For Universal Health Care
or Kalusugan Pangkalahatan. 2014
22. Administrative Order No. 2017-0014 Framework for Redefining Service Delivery Networks (SDN). 2017.
23. Department of Health. (n.d.). What is an ILHZ?. DOH Website. https://www.doh.gov.ph/node/1205. Accessed
June 2, 2019.
24. Department of Health. A Handbook in Inter-local Health Zones; District Health System in a Devolved Setting.
Manila: DOH; 2002.
25. Health Metrics Network-WHO. Framework and Standards for Country Health Information Systems [Internet].
2nd ed. Geneva: World Health Organization; 2008 [cited 2019 Aug 2]. 62 p. Available from:
http://www.who.int/about/licensing/copyright_form/en/index.html
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26. Department of Health. Health Rererral System Manual: Monitoring and Evaluation Tool For Health Care
Financing. Santa Cruz, Manila
27. Herman T, Marcelo A, Marcelo P, Maramba I. Linking primary care information systems and public health
vertical programs in the Philippines: an open-source experience. AMIA . Annu Symp proceedings AMIA Symp
[Internet]. 2005 [cited 2019 Aug 2];2005:311–5. Available from:
28. PSA. Total Health Expenditures grew by 8.0 percent in 2017 | Philippine Statistics Authority [Internet].
Philippine Statistics Authority. 2017 [cited 2019 Aug 2]. Available from: https://psa.gov.ph/content/total-
health-expenditures-grew-80-percent-2017
29. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: Health
insurance reforms in nine developing countries in Africa and Asia. Lancet. 2012;380(9845):933–43.
30. Labarda MP. Career shift phenomenon among doctors in Tacloban city, Philippines: lessons for retention of
health workers in developing countries. Asia Pac Fam Med. 2011;10(1):13.
31. Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, et al. Human
resources for health in southeast Asia: shortages, distributional challenges, and international trade in health
services. Lancet [Internet]. 2011 Feb 26 [cited 2019 Aug 2];377(9767):769–81. Available from:
https://www.sciencedirect.com/science/article/pii/S0140673610620351
32. Hogerzeil H V. The concept of essential medicines: lessons for rich countries. BMJ [Internet]. 2004 Nov 13
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Acknowledgements
We would like to acknowledge and thank the following individuals for initiating and making this working
draft possible:
 Ernesto Garilao, Zuellig Family Foundation

 Anthony Faraon, MD, Zuellig Family Foundation
 Janet Clemente, Zuellig Family Foundation
 Danya Agatha Go, MD, Zuellig Family Foundation
 Jenilyn Dabu, MD, Zuellig Family Foundation
 Ilaw Rosimo, Zuellig Family Foundation
 Meredith Del Pilar Labarda, MD, University of the Philippines School of Health Sciences
 Paolo Victor Medina, MD, College of Medicine, University of the Philippines
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Transforming Your Provincial Health System

Towards Universal Health Care v1.1

Disclaimer: This practicum manual is a compilation of the current materials on

The Zuellig Family Foundation Integrated Provincial Health Systems and 9

CHAPTER 1: Provincial Health Board 12

CHAPTER 2: Local Investment Plan for Health 33

CHAPTER 3: Health Facility Accreditation 41

CHAPTER 4: Continuity of Care 49

CHAPTER 5: Special Health Fund 59

CHAPTER 6: Provincial Health Information System 65

CHAPTER 7: No Balance Billing 102

CHAPTER 8: Health Human Resources 114

CHAPTER 9: Resilience Oriented Health System 131

CHAPTER 10: Essential Medicines 138

List of Acronyms 5-6

Reflection Questions 146-148

AQAS ACCREDITATION AND QUALITY ASSURANCE SECTION

NSD NORMAL SPONTANEOUS DELIVERY

Universal Health Care in the Philippines

1) The challenges of health governance, particularly the impact of devolution on health

5 Department of Health. Kalusugang Pangkalahatan; The Aquino Health Agenda. 2010.

5 Department of Health. Kalusugang Pangkalahatan; The Aquino Health Agenda. 2010.

PROVINCIAL HEALTH SYSTEM DELIVERABLES FOR UHC IMPLEMENTATION

Provincial Support for

Bridging Leadership Process Actions of a Governor or PHO

As the Governor or PHO, you should:

 Collaborating involves partnership, dialogue, establishing formal agreements, organizing and

How do I change my Provincial Health Board Deliverable from Red to

Your Performance Indicators:

Establishing the Functional Expanded Local Health Board

 Issuance, implementation and review of provincial health policies

 Documented semi-annual discussions or meetings to review the performance of hospitals and

Health Care Provider Network Governance Body or Management Group

 Recommended HCPN-related policies to the LHB

 HCPN processes and accountabilities are monitored and evaluated

 Approved 3-year Provincial Hospital Development Plan

Why do I need to address the Provincial Health Board Deliverable?

4 Department of Health. Philippine Health Agenda 2016-2022. 2016.

I. Establishing the Functional Expanded Local Health Board

 Does the province have a Provincial Health Board?

 Representative of the provincial hospital

UNIVERSAL HEALTH CARE ACT

COLLABORATE AND EXECUTE

 How to Establish a Provincial Health Board?

 How to expand the membership of the current Provincial Health Board?

Republic of the Philippines

Chairman: [NAME, Position]

Vice Chairman: [NAME, Position]

Members: [NAMES, Positions]

Functions and Responsibilities

SECTION 3. EFFECTIVITY. This Executive Order takes effect immediately.

Done this [DATE] at [PROVINCE], Philippines

PHB Meetings and Quorum

ZFF recommends the following:

 How to Properly Conduct an Expanded PHB Meeting?

Before the Meeting

During the Meeting

ZFF highlights the importance of the minutes of the meeting because:

 Start the meeting promptly and diligently

Figure 3. Sample PHB Meeting Attendance Sheet

REPUBLIC OF THE PHILIPPINES

MINUTES OF THE MEETING of the PROVINCIAL HEALTH BOARD

Expanded Members of the Local Health Board:

II. MINUTES AND PROCEEDINGS