Guidelines in the Conduct of the Surgical Caravan "ToDOH Alaga, May TSeKaP na, May Operasyon Pa!"

June 23, 2017

DOH ADMINISTRATIVE ORDER NO. 2017-0009

 

I. BACKGROUND/RATIONALE

The Philippine Health Agenda (PHA) 2016-2022 was officially introduced to all health partners during the National Health Summit held in September 15, 2016. The PHA-Checkup was among the commitments for the first 100 days of the current administration, which exemplified the first guarantee of providing services especially among the poor, both well and sick. The DOH Regional Offices in collaboration with the local government units provided essential package of health services to the 20 million poorest of the poor and marginalized Filipinos across the country from September to December, 2016. HSAcaE

The Surgical Caravan "ToDOH Alaga, May TSeKaP na, May Operasyon Pa!" is a follow-up program of the PHA-Checkup to realize the provision of surgical intervention to those who need them. This Surgical Caravan also enhances the service delivery of LGU Hospitals through the technical assistance from DOH Hospitals, and provides support to LGUs for the continuity of the PHA's three (3) guarantees: (1) provide health care across all stages of life; (2) establish Service Delivery Network; and (3) improve universal health insurance coverage.

II. OBJECTIVE

This issuance aims to provide guidance for the conduct of the Surgical Caravan "ToDOH Alaga, May TSeKaP na, May Operasyon pa!".

III. SCOPE

This order shall apply to all DOH Clusters, Bureaus, Offices, Services, DOH Hospitals, Regional Offices including DOH ARMM, Philippine Health Insurance Corporation and Local Government Units.

IV. DEFINITION OF TERMS/ACRONYMS

A. Visiting Hospital (VH) — DOH Hospital deployed to a specific province to assist the Host Hospital in the conduct of Surgical Caravan.

B. Host Hospital (HH) — DOH Hospital or LGU Hospital that will serve as the venue for the Surgical Caravan.

C. Health Care Institution (HCI) Portal — a system deployed by PhilHealth in Health Care Institutions which is capable of providing membership and eligibility details necessary for benefit availment.

D. Cataract Pre-Surgery Authorization (CPSA) — authorization granted by PhilHealth prior to cataract surgery/ies to ensure the quality and appropriateness of the proposed service/s and to safeguard against possible abuses and unethical practices. CPSA must be granted for a cataract surgery to ensure that the procedure is reimbursable.

E. Medical Assistance Program (MAP) — a DOH program that provides grants for medical assistance to indigent and poor patients.

F. Point-of-Service Program (POS) — a PhilHealth coverage system which grants access to quality health care benefits to financially-incapable individuals. AScHCD

G. Composite Team — a Team composed of selected Medical Center Chiefs, representative/s from Regional Office, Office for Field Implementation Management, and representatives from technical bureaus concerned.

V. GENERAL GUIDELINES

A. The Surgical Caravan shall consist of three phases: Pre-Surgical Caravan, Surgical Caravan Proper and the Post-Surgical Caravan for synchronized and effective conduct of the caravan.

B. All DOH Hospitals shall participate in the Surgical Caravan as visiting hospitals (VH), while selected LGU Hospitals shall participate as host hospitals (HH). A separate issuance shall be disseminated for the specific assignment of hospitals (VH/HH) per province.

C. The DOH Regional Offices, DOH Hospitals, PhilHealth, and LGUs (Provincial and Municipal) shall collaborate for: fund/resource sharing; identification and clearance of beneficiaries; and implementation arrangements.

D. Priority beneficiaries are those identified from the PHA-Checkup conducted by the Regional Offices. Patients who are not in the priority list may also be provided the service as long as they undergo the process of screening.

E. The target number of surgeries for the Surgical Caravan shall take into consideration the need of the patients and the capacity of both the visiting and host hospitals.

F. The following surgical procedures/cases shall include but are not limited to the following:

1. Major

a. Thyroidectomy

b. Cleft lip repair, cleft palate repair

c. Cataract surgery (in selected areas only)

d. Herniorrhaphy

e. Hydrocoelectomy

f. OB-Gyne cases

g. Cholecystectomy

h. Hemorrhoidectomy

i. Mastectomy

2. Minor

a. Excision of breast mass

b. Excision of soft tissue masses

c. Circumcision

d. Bilateral tubal ligation

e. Vasectomy

G. The DOH Regional Offices and DOH hospitals may opt for additional activities (i.e., advocacy & health promotion) during the launching as well as Surgical Caravan proper. HESIcT

VI. SPECIFIC GUIDELINES

A. Pre-Surgical Caravan

The Visiting Hospitals, DOH Regional Offices, Host Hospitals, LGU Representatives shall meet and coordinate to plan out all logistics needs including food and accommodation of surgical team, local travels and security arrangements. The following pre-surgical activities shall be undertaken:

1. Identification of the Host Hospital — The DOH RO, in coordination with the VH will identify the HH based on accessibility, OR capacity and PhilHealth accreditation.

2. Preparation of Action Plans — All VH shall prepare and submit the Action Plans to their respective DOH ROs (See Annex A).

3. Preparation of a Memorandum of Agreement (MOA) — The DOH RO shall facilitate the signing of the MOA between the Regional Director, Medical Center Chief of the VH, Chief of Hospital of the HH and Governor which outlines the expected roles and responsibilities, and counterparting of resources for the Surgical Caravan (See Annex B).

4. Preparation of Host Hospital — The DOH RO in collaboration with the VH shall ensure the preparedness of the HH.

a. The VH shall conduct an ocular visit to the HH to identify needs for the conduct of the Surgical Caravan.

b. The HH shall prepare its facility (health human resources, supplies and medicine, and equipment as agreed upon), and ensure that its facility is capable of PhilHealth's Point-of-Service Registration.

b.1. PhilHealth shall facilitate POS Registration with HH through the PhilHealth Regional Offices (PROs).

b.2. PROs shall facilitate installation of the HCI Portal and the activation of the CPSA module, which will then be deactivated once the surgical caravan has ended. However, the HH will still need to formally request CPSA module installation/activation from their respective PRO. AcICHD

b.3. The list of the members of the HH Team shall be submitted by the chief/head of the HH to the DOH RO, which shall then provide said copy to the VH.

5. Preparation of Beneficiaries/Cases

a. Enlistment of surgical beneficiaries — DOH RO shall provide the list of potential surgical beneficiaries using the template provided by PhilHealth for database checking and enlistment to POS for those not enrolled (see Annex C).

b. Initial screening — The HH will conduct the initial screening of these beneficiaries. Annex D lists the minimum laboratory work-up required.

c. Finalization of list of surgical beneficiaries — The VHs shall issue the final clearance of patients, which shall be the basis for the list of surgical beneficiaries. The team leader of the VH shall approve the final list of surgical beneficiaries.

d. Point-of-Service (POS) Registration — PhilHealth shall facilitate POS registration of Surgical Caravan beneficiaries in close coordination with HH and PRO.

e. Identified surgical beneficiaries that cannot be accommodated shall be referred to the nearest and most capable DOH Hospital for management.

f. In complicated cases, patients with special needs shall be brought to the Visiting Hospital for management.

6. Preparation of Visiting Surgical Teams

a. Identification of Surgical Team — VHs shall identify surgical teams consisting of the appropriate medical and surgical specialists, nurses, and technicians. All members of the VH team shall be PhilHealth-accredited.

b. Orientation and Briefing of Surgical Teams — The VH Team Leader shall orient and brief the surgical team prior to their deployment.

B. Surgical Caravan Proper

1. Major surgeries shall be performed by the appropriate specialist. Resident Physicians may perform surgeries under the supervision of the consultants.

2. All PhilHealth claims to be made under the Surgical Caravan shall be clearly marked/stamped as "DOH Surgical Caravan."

3. Filing of PhilHealth claims shall be done by the HH. Item 9 of Claim Form 2 should strictly use the Relative Value Scale (RVS) codes, then signed by the surgeon. caITAC

4. The VH shall attend to the immediate post-operative care (including complications) of all surgical patients with the assistance of HH, after which care must be formally transferred/endorsed to the HH.

5. All excised masses shall undergo histopathologic analysis to be done by the Regional Medical Centers or by another health facility as mutually agreed upon by the DOH RO, VH, and HH.

Results of the histopathologic analysis shall be sent to the HH.

6. The VH shall document the conduct of the Surgical Caravan with the assistance from the DOH RO.

C. Post-Surgical Caravan Activities

1. The DOH RO shall conduct a post-activity evaluation and debriefing of the Surgical Caravan Team before the latter leave the area.

2. Departure of VH team shall be closely coordinated with the relevant DOH RO and LGU.

3. The VH shall submit a post-activity report to the concerned DOH RO, which shall then submit the consolidated regional accomplishment report to OFIM within 2 weeks after the Surgical Caravan (see Annex E).

D. Financing

1. The Surgical Caravan shall be carried out using existing DOH RO and Hospital budgets to be augmented by the DOH Central Office.

2. All surgical procedures done during Surgical Caravan using government funds in accredited government facilities shall be compensable with PhilHealth.

3. Other laboratory and diagnostic procedures, drugs, medicines, and supplies; and professional fees incurred pre- or post-operatively may also covered by the MAP funds. AO 2017-0003 "Guidelines for the Implementation of the 2017 Medical Assistance Program (MAP) in DOH Hospitals and Other Selected Government Health Facilities" provides guidance on the use of MAP funds.

4. Income derived or amount reimbursed by PhilHealth for the Surgical Caravan shall be left to the HH as additional funds to further improve their services, facilities, among others. TAIaHE

E. Roles and Responsibilities

1. DOH Regional Offices

a. Coordinate with DOH Hospitals, PhilHealth Regional Office, LGUs, and other National Government Agencies, as necessary;

b. Submit the list of the surgical patients from the PHA-Checkup to OFIM for consolidation;

c. Provide additional funding, logistics and human resources, as appropriate;

d. Conduct program for the launching of the Surgical Caravan; and

e. Submit the consolidated regional post-activity report to OFIM.

2. DOH Hospitals

a. Provide funding, logistics and human resources among others;

b. Provide technical assistance to partner Host Hospital (i.e., preparatory, ocular inspection, etc.);

c. Conduct Surgical Caravan in partnership with the DOH RO, and LGU;

d. Ensure proper endorsement after post-operative surgery; and

e. Submit post-activity report to the DOH RO concerned.

3. DOH Central Office — Support the Surgical Caravan through:

a. Office for Field Implementation Management (OFIM)

i. Provide technical support in the pre-surgical, surgical proper, and post-surgical activities; and

ii. Monitor and report overall performance of the Surgical Caravan to Execom.

b. TWG on Hospital Matters

i. Develop plans, policies, systems and operational implementation of the Surgical Caravan in coordination with the HFDB.

c. Health Facility Development Bureau (HFDB)

i. Provide input to TWG on Hospital Matters in planning, policies systems and operational implementation of the surgical caravan; and

ii. Ensure sustainability of surgical caravan through technical assistance and health facility enhancement in coordination with DOH Hospitals, DOH ROs, and LGUs. ICHDca

d. Bureau of Local Health Systems Development (BLHSD)

i. Ensure that the Surgical Caravan is included in the Service Delivery Network policy for sustainability; and

ii. Assist in the development of monitoring tools and procedures for the Surgical Caravan using the SDN Framework.

e. Financial Management Service (FMS)

i. Sub-allot Central Office funds to DOH Hospitals needing augmentation funds for the Surgical Caravan; and

ii. Monitor fund utilization.

f. Health Promotion and Communication Service (HPCS)

i. Overall in-charge in the promotion of the surgical caravan;

ii. Lead the conduct of Surgical Caravan Launching;

iii. Develop IEC materials and advertisements; and

iv. Include the accomplishment of Surgical Caravan in its publication.

g. Composite Team

i. Provide overall oversight of the conduct of the Surgical Caravan; and

ii. Ensure that implementation of intensified regional and hospital operation for Surgical Caravan is organized, standardized and efficient.

4. PhilHealth

a. Facilitate Point-of-Service registration of patients;

b. Facilitate claims reimbursement of beneficiaries of the Surgical Caravan through their PROs;

c. Issue necessary guidelines for implementation of their PROs; and

d. Participate in the post-evaluation of the program.

5. Local Government Units

a. Engage all local health officials and personnel to support the conduct of the Surgical Caravan;

b. Augment resources as needed and may be agreed upon with the DOH Hospitals and DOH ROs;

c. Assist in the logistical arrangements for the Surgical Caravan, including security arrangements for the surgical team; and

d. Facilitate transportation for patients as may be agreed upon with the DOH RO and HH. cDHAES

VII. REPEALING CLAUSE

Administrative Order 2015-0047 "Guidelines on the Implementation of the Kapit Bisig Para sa Kalusugan Pangkalahatan (Medical-Surgical Caravan)" is hereby repealed. All other provisions of existing issuances which are inconsistent with this Order are hereby repealed, amended or modified accordingly. All other provisions or issuances which are not affected by this Order shall remain valid and in effect.

VIII. EFFECTIVITY

This Administrative Order shall take effect immediately.

(SGD.) PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO II

Secretary of Health

ANNEX A

Action Plan

 

Activity	Target/s	Timeline/s	Needed Resources	Amount/Source of Fund	Person/s Responsible

ANNEX B

MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This agreement is entered into and executed by and between:

The DOH REGIONAL OFFICE ___, with office address ___________, represented herein by Name of Regional Director, in his/her capacity as the Regional Director and in representation of the Department of Health, herein referred to as the "FIRST PARTY,"

-and-

The DOH HOSPITAL, a DOH Hospital operating by virtue of Administrative Order No. _____, with office address at ____________________________________, represented herein by Name of MCC/COH, in his/her capacity as Designation, and herein referred to as the "SECOND PARTY,"

-and-

The HOST HOSPITAL, a hospital operating by virtue of ______, with office address _____________________, represented herein by Name of COH/MCC, in his/her capacity as DESIGNATION, and herein referred to as the "THIRD PARTY,"

-and-

The Province of ______, represented by its duly elected governor, Name of Governor, authorized by the Sangguniang Panlalawigan through Resolution No. ___ dated ___, with postal address at________________________________, herein referred to as the "FOURTH PARTY."

WITNESSETH:

WHEREAS, the FIRST PARTY, as a Regional Office of the DOH, facilitates the provision of direct service delivery in government hospitals and health care facilities; TCAScE

WHEREAS, the SECOND PARTY, being a DOH Hospital, shall share its technical expertise and resources;

WHEREAS, the FIRST and SECOND PARTIES are authorized to enter into a Memorandum of Agreement (MOA) with Local Government Units (LGUs), and Local Government Unit (LGU) Hospitals for the conduct of the Surgical Caravan "ToDOH Alaga, May TSeKap na, May Operasyon Pa!";

WHEREAS, the THIRD and FOURTH PARTIES, are responsible for the management and direct provision of health services at the Provincial and/or District Levels;

WHEREAS, to ensure the effective and efficient implementation of the Surgical Caravan as part of the Philippine Health Agenda, this MOA is being entered into by the said Parties.

NOW THEREFORE, for and in consideration of the foregoing premises, the parties hereby as follows:

1. Responsibilities of the FIRST PARTY. — The FIRST PARTY shall:

a. Coordinate with DOH Hospitals, PhilHealth Regional Office (RO), LGUs, and other National Government Agencies, as necessary;

b. Consolidate and submit the list of the surgical patients from the PHA-Checkup and submit to the Office for Field Implementation Management (OFIM) for consolidation;

c. Provide additional funding, logistics and human resources, as appropriate;

d. Conduct program for the launching of the Surgical Caravan; and

e. Submit post-activity report to OFIM.

2. Responsibilities of the SECOND PARTY. — The SECOND PARTY shall: ASEcHI

a. Provide funding, logistics and human resources among others;

b. Provide technical assistance to partner Host Hospital (HH) (i.e., preparatory, ocular inspection, etc.);

c. Conduct Surgical Caravan in partnership with the ROs, and LGUs;

d. Ensure proper endorsement of patients after post-operative surgery; and

e. Submit post-activity report to RO concerned.

3. Responsibilities of the THIRD PARTY. — The THIRD PARTY shall:

a. Prepare its facility (i.e., health human resources, supplies and medicine, and equipment as agreed upon), and ensure that it is capable of PhilHealth's Point-of-Service (POS) Registration.

b. Facilitate POS Registration of all beneficiaries of the Surgical Caravan;

c. Facilitate the necessary pre-operative care laboratory and diagnostic examinations of beneficiaries using the Medical Assistance Program;

d. Provide post-activity evaluation of the Surgical Caravan; and

e. Receive the full PhilHealth compensation for claims made for surgical procedures done during the Surgical Caravan.

4. Responsibilities of the FOURTH PARTY. — The FOURTH PARTY shall: cTDaEH

a. Engage all local health officials and personnel to support the conduct of the Surgical Caravan;

b. Augment resources as needed and may be agreed upon with the DOH Hospitals and ROs;

c. Assist in the logistical arrangements for the Surgical Caravan, including security arrangements for the surgical team; and

d. Facilitate transportation for patients as may be agreed upon with RO and HH.

5. Effectivity & Duration. — This Agreement shall take effect upon the signing by authorized representatives of the parties, and shall continue to be valid binding until terminated by any of the parties, or automatically terminated pursuant paragraph 7 of this agreement.

6. Amendment, Modification, Addition or Deletion. — Any amendment, modification, addition, or deletion of any provision of this Agreement shall be agreed upon by the parties in writing.

7. Termination. — This Agreement shall automatically terminate upon the completion of the Surgical Caravan (i.e., all patients have been discharged from the Third Party's facility), including its post-activities.

8. Settlement of Disputes. — The parties shall exert effort to amicably settle any dispute arising out of or in connection with this Agreement or its interpretation. However, its adjudication shall be in accordance with PD 242.

IN WITNESS WHEREOF, all parties have signed this Memorandum of Agreement on (date) at (place)

 

_________________	_______________________
NAME	NAME
Governor, Province	Regional Director, DOH RO ___
__________________	_______________________
NAME	NAME
Designation, Host Hospital	Designation, DOH Hospital

SIGNED IN THE PRESENCE OF:

_________________________	_________________________
Finance Officer, Host Hospital	Finance Officer, DOH Hospital

ACKNOWLEDGEMENT

Republic of the Philippines)

_____________________ ) S.S

BEFORE ME, a Notary Public, this ____th day of ______, 2017 in ________, personally appeared the following persons:

 

NAME	Government Issued I.D.	Place/Date of Issue

 

known to me to be the same persons who executed the foregoing Memorandum of Agreement, consisting of ___ (no. of pages) including this page, and acknowledged to me that the same is their own free voluntary act and deed and that of the institutions they respectively represent, and of the institutions they respectfully represent. ITAaHc

IN WITNESS WHEREOF, I have hereunto set my hand and seal this ________________ in ____________.

Doc. No. ____:

Page No. ____:

Book No. ____:

Series of 2017

ANNEX C

Listing of Surgical Caravan Beneficiaries Template

ANNEX D

Laboratory Work-Up for Pre-Operative Evaluation

ANNEX E.1

Surgical Caravan "ToDOH Alaga, May TSeKap na, May Operasyon Pa!"

FORM E.1.1

DOH Hospitals Report on Financing-Sources Used for Charging Surgical Operation Expenses

 

ANNEX E.2

Surgical Caravan "ToDOH Alaga, May TSeKap na, May Operasyon Pa!"