Guidelines on Deployment of Physicians Graduating from Residency Training Programs in DOH-Retained Teaching and Training Hospitals

May 11, 2015

DOH ADMINISTRATIVE ORDER NO. 2015-0021

 

I. RATIONALE

In compliance with the provisions of Republic Act No. 10351 entitled "An Act Restructuring the Excise Tax on Alcohol and Tobacco Products by Amending Sections 141, 142, 143, 144, 145, 8, 131 and 288 of Republic Act No. 8424, otherwise known as the National Internal Revenue Code of 1997, as amended by Republic Act No. 9334, and for Other Purposes"; and Joint Circular No. 001.2014 or Implementing Rules and Regulations for Section 288, Subsections (B) and (C) of the National Internal Revenue Code, as amended by RA 10351 of the Department of Finance, Bureau of Internal Revenue, Department of Health, Department of Budget and Management, the DOH shall ensure the availability of skilled health professionals who can deliver quality health care services in health facilities.

As such the Department is exerting efforts to create responsive human resources for health. With the growing inequitable distribution of medical professionals in urban-rural areas, the Department is expanding its Residency Training Program in DOH-Retained Teaching and Training Hospitals and Medical Pool Placement and Utilization Program, including the deployment of resident physicians, as HRH complement in government hospitals in priority poor and underserved areas.

This Order establishes the Guidelines for the deployment of physicians undergoing residency training in DOH-Retained Teaching and Training Hospitals to LGU hospitals in priority poor and underserved areas under the Medical Pool Placement and Utilization Program (MPPUP). It revises AO 29 s. 1994, which aimed to provide medical officers and medical specialists in government hospitals.

II. OBJECTIVES

A. To prescribe guidelines for the deployment of physicians under residency training in DOH-Retained Teaching and Training Hospitals under the Medical Pool Placement and Utilization Program to identified LGU hospitals in priority poor and underserved areas

B. To provide an opportunity to assimilate graduates of residency training programs in DOH-Retained Teaching and Training Hospitals in LGU Hospitals where they are needed

C. To establish coordination mechanisms between DOH Health Human Resource and Development Bureau (HHRDB), DOH Regional Offices, DOH-Retained Teaching and Training Hospitals and Local Government Unit (LGU) Hospitals in providing for the adequate and appropriate physician complement in priority poor and underserved areas

III. SCOPE

This Order shall apply to the DOH Medical Pool Placement and Utilization Program and Level III DOH-Retained Teaching and Training Hospitals with accredited residency training programs in the four major specialties namely: Internal Medicine, Pediatrics, Obstetrics and Gynecology, and Surgery (refer to AO No. 2012-0012: Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines).

Recipient hospitals shall include LGU-owned provincial/city/municipal hospitals in identified priority poor and underserved areas.

IV. OPERATIONAL DEFINITION

A. Deployment — means by which select health professionals are physically transferred to areas of need to complement existing health care providers.

B. Development Management Officer — a representative of DOH Regional Office in Local Health Boards in provinces, cities and municipalities; serves as the direct link of the DOH to the local stakeholders especially the LGUs.

C. DOH-Retained Teaching and Training Hospital — hospitals that are solely funded and managed by the Department of Health following the enactment of Local Government Code of 1991.

D. Geographically Isolated and Disadvantaged Areas (GIDA) — communities with marginalized populations, physically and socio-economically separated from mainstream society such as island municipalities, up-land communities, hard-to reach areas, and conflict areas or zones. CAIHTE

E. Health Facilities Enhancement Program (HFEP) — refers to the financial assistance provided to government-owned health facilities to satisfy licensing and accreditation standards required by the DOH or its attached agencies.

F. Hospital — a place devoted primarily to the maintenance and operation of health facilities for the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity or in need of obstetrical or other surgical, medical and nursing care. It shall also be construed as any institution, building or place where there are installed beds, cribs or bassinets for 24-hour use or longer by patients in the treatment of diseases. It is classified according to ownership, scope of services and functional capacity (refer to AO No. 2012-0012: Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines).

G. Local Health Board (RA 7160) Composition: Local Chief Executive (Mayor/Governor) as Chairman; Municipal/City/Provincial Health Officer as Vice-Chairman; Sangguniang Bayan on Health, DOH Representative and non-government organization representative. The local health board serves primarily as:

• A policy recommending body on the planning and implementation of local health programs;

• A body that crafts budgetary allocation for the operation and maintenance of health facilities and services and;

• Adviser to the Sanggunian and other local government agencies.

H. Local Government Unit (LGU) — (NSCB definition) Local Government refers to the political subdivisions established by or in accordance with the Constitution. The five political subdivisions of the LGU are: 1) Regional, 2) Provincial, 3) City, 4) Municipal and 5) Barangay.

I. Medical Officer — based on Quality Standards of the Civil Service Commission, a physician who has passed the physician licensure examination, with or without previous clinical work experience.

J. Medical Pool Placement Utilization and Program (MPPUP) — a DOH program that deploys competent Medical Human Resource by providing medical officers replacement in provincial and district hospitals who are sending their service residents for training, augmenting medical specialist needed in government hospitals and providing items for residency training to identified physicians who have rendered government service.

K. Medical Residency — a clinical training leading to specialization in a particular medical field.

L. National Household Targeting System (NHTS) — a data bank and information management system managed by the Department of Social Welfare and Development (DSWD) that identifies who and where the poor are. The system generates and maintains the socioeconomic classification of poor households.

H. n  Organizational Structure and Staffing Pattern — a hierarchical arrangement that defines how roles and responsibilities are assigned and coordinated; and the required number, types and mix of personnel to fulfill those roles and responsibilities.

M. Team of physicians — a group of specialist physicians from various clinical specialties who can complement one another functionally (i.e., Obstetrician-Gynecologist-Pediatrician, Surgeon-Anesthesiologist).

N. Underserved areas — communities with documented low levels of health system performance as reflected in official government documents such as the LGU Scorecard, NHTS data or NSCB reports hence, considered priority areas for health service delivery.

V. GENERAL GUIDELINES

A. The deployment of physicians to LGU hospitals in priority poor and underserved areas shall fall within the scope of the residency training program in DOH-Retained Teaching and Training Hospitals and MPPUP.

B. Residents in DOH-Retained Teaching and Training Hospitals shall be deployed to LGU hospitals in identified priority poor and underserved areas for a minimum prescribed period of one year or as stipulated in their contract of service.

C. Salaries, allowances, per diems and benefits of deployed physicians holding a Medical Officer III position under DOH shall be drawn from the funds of DOH Rural Health Practice Program subject to financial resources allocated by RA 10351. DETACa

VI. SPECIFIC GUIDELINES

A. Selecting underserved areas for deployment

Recipient LGU hospitals in underserved areas shall be identified by Provincial Health Officers (PHO) based on, but not limited to, the following factors:

1. Geographic location and socio-economic classification of the area (GIDA, Indigenous Cultural Community/Indigenous People Area, and National Priority Area for Poverty Reduction (NAPR)) based on the National Household Targeting System (NHTS) and other similar targeting systems or programs.

2. Need for additional medical staff to cover the outpatient department, emergency room and inpatient areas in the four major specialties, but not limited to: Internal Medicine, Pediatrics, Obstetrics and Gynecology, and Surgery according to the prescribed Organizational Structure and Staffing Pattern for a given hospital level.

3. Need for additional staff in the following positions, but not limited to: chief of the medical service, head of a clinical department, medical officer of the pathology department, medical officer of the radiology department.

4. Ability to meet minimum DOH licensing requirements and PhilHealth Accreditation requirements.

5. Evidence of inclusion in the Province-wide Investment Plan for Health, and a fully or partially functional Human Resources for Health Management and Development System (HRHMDS) that include a HRH Planning System; Recruitment, Selection and Placement; Retention and Succession Planning to meet and finance the Organizational Structure and Staffing Pattern requirements of the hospital. When a HRHMDS is partially functional or absent, the Chief of Hospital, together with the Local Chief Executive, must provide evidence of efforts to fully install a HRHMDS or a justification on why they cannot finance the needed medical specialist/s.

B. Deployment of residents from Residency Training Programs in DOH-Retained Teaching and Training Hospitals to LGU Hospitals in identified priority poor and underserved areas

1. Prior to acceptance in the residency training program, the applicant shall sign a contract of service, which stipulates that the deployment and rendering of services to a rural and underserved LGU hospital is part of the residency training program, the roles and responsibilities of a deployed physician, duration of deployment and compensation. A contract shall be forged among the following: resident physician, Chief of the DOH-Retained Teaching and Training Hospital, DOH Regional Office Director, and DOH HHRDB Director.

2. Deployment to form/complement a team of physicians rendering services in the following clinical departments: Internal/Family Medicine, Pediatrics, Obstetrics and Gynecology Surgery, and Anesthesiology, at the minimum, shall be preferred but may include their sub-specialties and ancillary services depending on need.

3. Upon deployment, the physician shall occupy a full-time Medical Officer III position under the DOH serving a minimum of 40 hours per week.

C. Functions and Entitlements of Deployed Physician

The deployed physician shall:

1. Fulfil the requirements needed to enter into the Medical Pool Placement and Utilization Program

2. Perform duties and functions of a deployed physician in a designated LGU hospital for a minimum of one (1) year, or as stipulated in the contract

3. Receive salaries, allowances and other benefits of a Medical Officer III or its equivalent which shall be drawn from DOH Rural Health Practice Program funds subject to financial resources allocated by RA 10351

4. Receive a Certificate of Completion of Residency Training Program from the DOH and its corresponding Teaching and Training Hospital after a satisfactory completion of the residency training and one-year deployment service

5. Receive a Certification for services rendered from the recipient LGU hospital aDSIHc

VII. ROLES AND RESPONSIBILITIES

A. DOH-Retained Teaching and Training Hospitals shall:

1. Select applicants for residency who meet the minimum eligibility requirements with a preference to those who intend to practice in a rural and underserved area.

2. Implement and monitor the accredited residency training programs based on the standards set by the Specialty Boards and the Professional Regulatory Board of Medicine.

3. Coordinate with the DOH Regional Office for the matching of resident physician to a recipient LGU hospital.

4. Coordinate with the Development Management Officer of the DOH Regional Office for the performance evaluation of the deployed physician.

5. Sign a Certificate of Completion of Residency Training Program upon satisfactory completion of the residency training program and deployment services, and clearance from hospital accountabilities.

B. Recipient LGU hospital shall:

1. Submit a request for needed physician complement according to the prescribed Organizational Structure and Staffing Pattern of the hospital including an up-to-date HRHMDS report to the DOH Regional Office (Human Resource Development Unit) signed by the Chief of Hospital and Local Chief Executive. This request must be accompanied by a justification on why the needed physician complement could not be secured or financed by the hospital or local government.

2. Sign a contract or agreement with DOH Regional Office and DOH HHRDB which stipulates their duties and responsibilities with respect to the deployment of physician or team of physicians.

3. Support the Health Facilities Enhancement Program of the DOH to upgrade physical conditions and services as necessary.

4. Evaluate the performance of the deployed physician.

5. Issue a certificate of services rendered to the deployed physician/s upon satisfactory completion of the deployment service and clearance from hospital accountabilities. This certificate shall be signed by the Chief of Hospital, Local Chief Executive, and DOH Regional Director.

6. Endeavour to retain the deployed physician/s by providing employment and other incentive mechanisms.

C. The Local Health Board shall:

1. Nominate or endorse qualified physicians residing in their respective LGUs to the Development Management Officer of the DOH Regional Office for entry into the DOH Residency Training Program.

2. In coordination with LGU Hospital, endeavor to retain the physician/s by providing employment and incentive mechanisms.

D. The DOH Regional Offices shall:

1. Evaluate LGU requests based on the following criteria:

a. No available or vacant Medical Officer III items in the requesting LGU hospital

b. LGU hospital has an average of more than 100% occupancy rate per approved bed capacity

c. LGU qualifies as an underserved area according to this AO (A. Underserved areas for deployment) ETHIDa

2. Submit to DOH-HHRDB the list of recipient LGU hospitals and request for needed physician complement.

3. Coordinate with the LGU Hospital for the placement of residents to occupy Medical Officer Positions based on the allocated MPPUP items provided by DOH HHRDB.

4. In coordination with the recipient LGU Hospital, conduct social preparation and a pre-deployment orientation seminar for the deployed physician/s for the proper discharge of his/her functions according to the service needs of the area.

5. Conduct administrative procedures including processing of contracts and evaluation of recipient LGU hospitals.

E. DOH Health Human Resource Development Bureau shall:

1. Develop policies and standards for the implementation of the various deployment and placement programs for physicians.

2. Provide overall supervision and proper alignment of residency training programs in DOH-Retained Teaching and Training hospitals to MPPUP and deployment of physicians in LGU Hospitals in priority poor and underserved areas.

3. Provide distribution list and budget allocation to respective DOH Regional Offices for the implementation of this Order allocated through the RA 10351 funds.

4. Regularly evaluate the impact of the deployment programs for the continuous improvement of its policies and guidelines.

5. Issue a Certificate of Completion of Residency Training Program to resident physicians upon satisfactory completion of the residency training program and deployment service and clearance from hospital accountabilities. This certificate shall be signed jointly by the Department Chair, Training Officer, and Chief of Hospital of the DOH Teaching and Training Hospital, DOH HHRDB Director and Secretary of Health.

VIII. FUNDING SOURCE

Funds for the salaries, allowances and other benefits of deployed physicians shall be lodged under DOH-HHRDB's Rural Health Practice Program subject to financial resources allocated by RA 10351.

IX. TRANSITORY CLAUSE

Current resident physicians in training are not covered by this AO, but only incoming applicants to the MPPUP and residents who sign a contract of service.

X. REPEALING CLAUSE

Provisions of Administrative Order No. 29 s. 1994: "Medical Human Resource Development and Placement Program (MHRDPP) of the Department of Health," and all other issuances inconsistent with the provisions of this Order are hereby rescinded and modified accordingly.

XI. SEPARABILITY CLAUSE

If for any reason, any part or provision of this Order be declared invalid or unconstitutional, such shall not affect the other provisions which shall remain in full force and effect.

XII. EFFECTIVITY

This Administrative Order shall take effect fifteen (15) days after publication in an official online or print media of general circulation. cSEDTC

(SGD.) JANETTE LORETO-GARIN, MD, MBA-H

Secretary of Health

n Note from the Publisher: Copied verbatim from the official copy. Irregular alphabetical sequence.