Guidelines in the Implementation of Philippine Health Agenda's (PHA) Check-Up Service for All Filipinos

December 15, 2017

DOH ADMINISTRATIVE ORDER NO. 2017-0024

 

I. RATIONALE

The Philippine Health Agenda (PHA) aims to ensure the best health outcomes for all, by providing care at all life stages, made accessible through a functional service delivery network, and sustainably financed through universal health insurance. The strong support from the different stakeholders marked the 103.71% (21,226,370) accomplishment exceeding the estimated target of 20 million poorest Filipinos in 2016. Department Memorandum No. 2017-0268 entitled "Implementation of the 2nd Round of Philippine Health Agenda's (PHA) Annual Health Check-Up for Filipinos" directs the DOH-Regional Offices (DOH-ROs), including to conduct the second round of implementation for the current year.

Primary care, being the first step in the continuing health processes delivers a broad spectrum of preventive, promotive, curative and palliative care across the life-course. It serves as an entry point for any Filipino into the healthcare system by being the first and regular source of care for priority health needs, accessible within the people's community. Primary care is a component of the primary health care approach in which the community's health needs, not merely the diseases, are addressed.

The PHA recognizes the robust evidence available indicating that health system founded on strong primary care results to better health outcomes at lower cost and is proven to effectively alleviate the impact of poverty on health. As such, the PHA Check-Up Service is being established to guarantee universal access to quality primary care services within their community. caITAC

II. OBJECTIVE

This AO aims to ensure that primary health care guarantees for Filipinos are realized within each community. It shall provide guidelines to the health sector and other stakeholders in the implementation of the PHA Check-Up Service for All Filipinos.

III. SCOPE OF COVERAGE

This AO shall apply to all DOH offices, specialty and retained hospitals, DOH-attached agencies, other key national government agencies, local government units (LGUs), public and private hospitals and health care facilities, civil society organizations (CSOs), health care providers, development partners and all other groups/organizations/institutions including volunteers that shall perform various roles and responsibilities in the implementation of this Order.

IV. DEFINITION OF TERMS

A. Philippine Health Agenda (PHA) Check-Up — is a regular and thorough medical, physical and mental examination or assessment of individuals packaged according to the needs of each life stages of the DOH AO No. 2017-012 "Guidelines on the Adoption of Baseline Primary Health Care Guarantees for All Filipinos" (http://home2.doh.gov.ph/ais_public/aopdf/ao2017-0012.pdf).

B. Universal Access — access that is optimized for the patient in a health system by accounting for its five different dimensions: affordability, availability, geographic accessibility, accommodating, and acceptability (Penchansky and Thomas, 1981).

C. Poor/marginalized — individuals or family members that are listed in "Listahanan" of Department of Social Welfare and Development (DSWD), poor indigenous peoples, illiterate, out of school youths, fisher folks, small scale farmers, laborers, those in isolated islands and mountainous barangays, victims of torture, persons with disability and those with at least one member with severe, debilitating chronic illness that impoverishes the family such as but not limited to tuberculosis, major organ damage, child undernutrition, and those in institutions such as prisons, treatment and rehabilitation centers, home for the aged and orphanages.

D. Electronic Medical Record (EMR) (from DOH, DOST, PHIC-JAO No. 2016-0002) — a medical or health record which is received, recorded, transmitted, stored, processed, retrieved or produced electronically through computers or other e-devices.

E. Primary Health Care (PHC) Approach — a concept that promotes maximum community and individual participation in the planning, organization, operation and control of health services, making use of available resources, and organized around the demands and expectations of the community, not merely on disease or financing.

F. Primary Care (from DOH AO No. 2017-0012) — is the first-contact care that guarantees continued and equitable access to comprehensive and coordinated care accessible at the time of need. Comprehensive care shall be the range of appropriate services while coordinated care is the role of linking other specialists and services at different levels of care to meet patient needs.

G. Primary Care Benefit Package (from PHIC Circ. No. 10- S. 2012) — is an enhanced Out-Patient Benefit (OPB) package by PHIC that provides primary preventive services, diagnostic examinations and drugs and medicines for certain diseases.

H. PHA Health Team — team of health professionals/volunteers qualified and equipped to deliver primary care services within public and private health facilities; includes physicians, nurses, medical technologists, midwives, dentists, barangay health workers, sanitary inspectors and allied health professionals.

I. Regional Coordinating Team — is the regional PHA Check-Up coordinating body headed by the Office of the Regional Director. It shall consolidate municipal and provincial-level reports of public and private health care providers from both EMR-based and manually-encoded data.

J. Service Delivery Network (SDN) — a network of organizations that provides or makes arrangements to provide equitable, comprehensive, integrated and continuous good quality health services to a defined population, with minimum duplications and inefficiencies. ICHDca

V. GENERAL GUIDELINES

1. The PHA Check-Up shall:

A. Be available for all Filipinos, well and sick.

B. Be delivered in all accredited health facilities — barangay health stations (BHSs), rural health units/urban health centers (RHUs/UHCs), OPD clinics in hospitals, private facilities, temporary fixed sites such as barangay/town halls and through domiciliary visits or as may be determined by the local health unit.

C. Include services outlined in the "AO No. 2017-0012 — Guidelines on the Adoption of Baseline PHC Guarantees for All Filipinos" (see Annex A).

D. Be made available for all Filipinos for free (or zero out-of-pocket) in public facilities or at fixed co-payment in PHIC accredited in private facilities.

E. Prioritize the poor and marginalized individuals in the public health facilities. The PHA Check-up service for public and private employees shall be the responsibility of the employer.

2. A PHA Check-up point person shall be designated at all levels. He/she shall be responsible for coordinating and monitoring the PHA Check-up activities in their respective area of coverage.

3. The PHA check-up shall be conducted every July to December each year. Schedule of checkups shall be distributed throughout these months and conducted until all poor individuals in the barangays and institutions are saturated.

4. All service providers shall ensure that social and cultural factors such as language, gender, ethnicity or religion are observed.

VI. SPECIFIC GUIDELINES

A. Leadership and Governance

1. The DOH shall develop standards for health facilities or networks of facilities rendering primary care services, including financial management.

2. Each DOH-Regional Office shall create a PHA Check-up Regional Coordinating Team headed by the Office of the Regional Director, which shall:

a. Issue supplementary guidelines, as may be needed

b. Engage and orient all public healthcare providers both public, including the Development Partners, CSOs and other private partners in the PHA Check-up service provision

c. Collect and analyze data submitted by healthcare providers

d. Coordinate and streamline DOH technical assistance

e. Provide timely feedback to the LGU PHA Check-up Coordinator and DOH-CO

3. Planning for the PHA Check-up activity shall be done by the different LGUs prior to its conduct.

4. Each LGU shall designate a PHA Check-up Coordinator, who shall:

a. Ensure completeness of data submitted

b. Communicate to the MHOs and LCEs the requirements for check-up success

c. Provide timely feedback to DOH and PHIC

5. The PHA Check-Up Service which is under the supervision and management of the Disease Prevention and Control Bureau (DPCB), shall be the de-facto secretariat.

B. Service Delivery

1. The physicians and trained nurses shall conduct the comprehensive assessment using the PHA Individual Health Profile and Assessment Form (Annex B), during the PHA Check-up. Subsequent follow-ups can be sought from any qualified member of the PHA Health Team.

2. The PHA health team shall also be responsible for the following:

a. Navigate, facilitate and ensure that all clients needing services that are unavailable in the facility are referred to and received by the higher level health facility, such as those needing tertiary level of care. Referral of individuals found sick or ill during the conduct of PHA Check-up shall follow the existing referral system of the SDN (DOH AO No. 2017-0014), be scheduled for the DOH Surgical Caravans (DOH AO No. 2017-0009) or make arrangements if the SDN if not yet in place.

b. Ensure that within 3 years, all citizens within their catchment area have undergone Check-up and availing the services every year.

c. Provide services to all clients regardless of PHIC membership status, but shall also be responsible for enrolling these clients to PHIC following existing guidelines.

d. Make arrangements to extend usual service hours to accommodate clients' needs. TCAScE

3. Individuals diagnosed to have chronic diseases such as but not limited to hypertension, diabetes and tuberculosis shall be managed by health facilities based on the clinical practice guidelines/program protocol.

C. Financing

1. The PHA Check-up in public facilities shall be funded/supported through LGU budgets, PHIC PCB capitation fund, and DOH technical and commodity assistance.

a. The DOH shall coordinate and streamline all technical assistance being provided by the DOH to LGUs in order to ensure sustainability of the PHA Check-up service.

b. All LGUs shall maximize their trust funds and shall allocate funds for the PHA Check-up package prior to receiving DOH grants (if any) and/or PHIC PCB capitation.

c. DOH and PHIC shall issue the specific guidelines on technical assistance and capitation fund respectively.

d. All LGUs shall be required to provide utilization report detailing the use of the technical assistance/capitation to DOH and PHIC respectively.

2. The PHA Check-up services rendered in private facilities shall be reimbursed through the following mechanisms:

a. Based on existing guidelines on PHIC reimbursements

b. Private health insurance and Health Maintenance Organizations (HMOs)

D. Medicines and Equipment

1. All providers of PHA Check-up shall only use medicines included in the Philippine National Drug Formulary (PNDF).

2. Covered medicines under the PCB package shall be made available in the health facility or network.

3. Screening medical equipment and supplies for use during the conduct of the PHA Check-up shall be made available in the facility or network

4. DOH shall augment these with medicines, vaccines and equipment included in the national programs.

E. Human Resource

1. The PHA health team shall receive regular updates on PHA check-up and training on case management of common illnesses and other relevant training including use of electronic medical record systems.

2. The DOH shall invest in training of selected PHA team members involved in ICD-10 coding.

3. The DOH shall formalize primary care trainings into stepladder certification programs as a means of ensuring qualifications of PHA health teams.

F. Information Systems, Monitoring and Evaluation

1. All healthcare providers rendering PHA Check-up shall use EMRs that use ICD-10 coding.

2. All healthcare providers rendering PHA Check-up shall submit aggregated clinical and administrative data.

a. For those with electronic medical records providers:

i. Clinical data and administrative data shall be consolidated and automatically submitted via the EMR to the DPCB via KMITS.

b. For those without electronic medical records (EMR) providers:

i. Clinical data and administrative data shall be submitted in .xls format to the DPCB via KMITS.

3. The PHA Check-up Secretariat shall consolidate regional and national data and benchmark regions and provinces against each other. The DOH Regional Coordinating Team shall consolidate municipal and provincial-level data of public and private health care providers from both EMR-based and manually-encoded data, analyze these, and benchmark providers and LGUs against each other (Annex C-Reporting Mechanism).

4. The Epidemiology Bureau shall analyze all clinical data and provide appropriate analysis.

5. The HPDPB Health Sector Performance Monitoring Unit shall analyze all administrative data for appropriate policy actions.

6. The PHA Check-up shall adopt indicators from DM 2017-0216: PHA 2017-2022 Performance Indicators and Data Monitoring Tool for the Regional Health Sector Performance Monitoring Unit (RHSPMU) and LGU reports. The monitoring and evaluation template based on the conceptual framework (Annex D) shall be used for reporting.

VII. KEY ROLES AND RESPONSIBILITIES

A. Department of Health

1. Office for Technical Services (OTS) shall provide the technical oversight in the entire implementation of this AO. It shall ensure proper coordination within the DOH and other stakeholders and partners (i.e., NGA such as DSWD, DepEd, DILG). cTDaEH

2. Disease Prevention and Control Bureau (DPCB), in addition to their regular functions, shall formulate/develop and update technical guidelines. It shall also provide list of selected commodities, technical assistance and training to the implementing partners, as necessary.

3. Bureau of Local Health Systems Development (BLHSD) shall lead in policy and systems development and evaluation of SDNs, including the Primary Care Service Facilities (PCSFs) that will deliver the PHA Check-up services.

4. Health Facility Development Bureau (HFDB) shall provide technical assistance and standards on Health Facilities Enhancement to health facilities.

5. Health Human Resource Development Bureau (HHRDB) shall develop competency standards of the health care providers.

6. Knowledge Management and Information Technology Service (KMITS) shall provide a pathway of data collection and feedback in the national, regional, provincial, municipal and barangay levels. It shall also ensure that Data Privacy Act is implemented. It shall update any changes, in coordination with OTS and PHIC, in the iClinicsys. It shall also ensure proper dissemination of the updates among other EMRs.

7. Epidemiology Bureau (EB) shall coordinate with the DPCB the status and analysis of PHA Check-Up-related accomplishments, per DOH-RO/Province.

8. Health Promotion and Communication Service (HPCS) shall develop a communication plan for the implementation of the PHA Check-Up. It shall develop the prototype material in various formats for information dissemination at the national and regional level, including online media. It shall consolidate documentations (e.g., photo, write-ups, videos) conducted by DOH ROs.

9. Office for Field Implementation Management (OFIM) shall oversee the dissemination of information, updates, and follow-up of verified submissions of the DOH-ROs and DOH retained hospitals through the four (4) operations cluster.

10. Office of Administration, Finance and Procurement (OAFP) shall sub-allot fund to DOH Regional Offices as necessary and monitor procurement and distribution of DOH commodity assistance.

11. DOH Regional Offices (DOH-ROs), in addition to their regular function, shall advocate and encourage, on its full potential, the active involvement of all stakeholders and agencies at the Regional level in the implementation of the PHA Check-up in their respective area of jurisdiction. It shall provide technical assistance and additional funds for the orientation and planning workshop conducted by the different provinces for their respective cities and municipalities.

12. Provincial DOH Offices (PDOs), through the Development Management Officers (DMO), shall provide technical assistance to the PHOs during the provincial planning workshop of the CHOs/MHOs, and other RHU health professionals, in coordination with the following: DOH Deployed HRH, DSWD Municipal Link, MSWDO, Sangguniang Bayan Chairperson on Health, and Municipal Planning and Development Coordinator, ABC President, BHW Federation President, private sector, civic organizations.

B. Philippine Health Insurance Corporation (PHIC) shall (1) review and expand the PCB Package as per the AO and future updates (2) provide KMITS access to all EMR data through the PHIE, and (3) ensure increased access through accreditation of both public and private facilities.

C. Commission on Population (PopCom) shall advocate, issue and disseminate policies to their local counterparts in support to the operationalization and sustainability of the implementation of this AO. It shall also provide assistance to the PHA Check-Up by giving IEC materials and conduct lectures on responsible Parenthood and Family Planning, KATROPA (Kalalakihang Tapat sa Responsibilidad sa Pamilya), Parent Education on Adolescent Health and Development and other relevant topics.

D. Local Government Units (LGUs) as the primary implementer of the PHA Check-Up services, shall ensure that each of its constituents are provided with essential health services at all levels, including post check-up care (e.g., maintenance of drugs, etc.). It shall also provide human and financial resources, and utilize capitation funds from PHIC reimbursements in the implementation of this AO.

• Provincial Health Offices (PHOs) shall provide supervision and technical assistance in coordination with the Provincial DOH Officers (PDOHOs) to the provincial/district/community hospitals and rural health units/city health offices.

• Municipal/City Health Offices (M/CHOs) shall provide supervision and technical assistance in coordination with the DMOs and PHA Health Team to the health centers.

E. Development Partners, in accordance with their agreements with the Government, shall:

a. Adopt, develop and implement supporting operational policies, plans and programs in support to this AO.

b. Develop technical packages and assist in building the capacity to implement the foregoing guidelines. cSaATC

F. Civil Society Organizations (CSOs) and Private Sectors, in close coordination with DOH, PHIC and LGUs shall:

a. Participate in the provision of PHA Check-up service for all Filipinos, including families in the far-flung areas without health care service providers.

b. Use its technical capabilities, including research, academic and media (including online media) to influence the national discourse regarding the impact and benefits of PHA Check-up service.

c. Support functionality and sustainability of SDN.

VIII. REPEALING AND SEPARABILITY CLAUSE

The provisions within the Department Memorandum No. 2017-0268 dated July 03, 2017 entitled "Implementation of the 2nd Round of Philippine Health Agenda's (PHA) Annual Health Check-Up for Filipinos" and other related issuances inconsistent or contrary to the provisions of this Administrative Order are hereby repealed, rescinded, revised or modified accordingly. In the event that the provision or part of this Order was declared unauthorized or is rendered invalid by any court of law or competent authority, the provisions that are not affected by such declaration shall remain valid and effective.

IX. EFFECTIVITY

This Order shall take effect fifteen (15) days after its publication in the official gazette or two (2) newspapers of general circulation.

(SGD.) FRANCISCO T. DUQUE III, MD, MSc.Secretary of Health

Please use as a reference for the list of services to be provided in the primary care facilities and networks as per DOH Administrative Order 2017-0012(Guidelines on the Adoption of Baseline Primary Health Care Guarantees for ALL Filipinos).

ANNEX A

Primary Health Care Guarantees for All Life Stagesto be delivered by the Primary Care Networks

Pregnancy

 

Early Adulthood-Late Adulthood

ANNEX B

Individual Health Profile & Assessment Form

ANNEX C

Reporting Mechanism

ANNEX D

Conceptual Framework for PHA Check-Up

 

PHA Check-up Monitoring and Evaluation Reporting Schedule of Administrative Data