Guidelines on the Adoption of Baseline Primary Health Care Guarantees for All Filipinos

August 3, 2017

DOH ADMINISTRATIVE ORDER NO. 2017-0012

 

 

I. Rationale

The Philippine Health Agenda 2016-2022 seeks to uphold every Filipino's right to health consistent with the International Alma-Ata Declaration that health is a fundamental human right. This underscores the need for (1) a health system that is built on health promotion and strong primary health care with referral systems to higher levels as needed, and (2) citizens engaged and empowered to demand for their entitlements. To this end, the PHA commits to guarantee an explicit and comprehensive set of primary health care interventions — both population and individual level — that will ensure healthy lives and promote well-being for all Filipinos at all ages. Moreover, Republic Act 10606 mandates that the Philippine Health Insurance Corporation (PhilHealth) shall finance health services deemed cost-effective through health technology assessment. HTcADC

II. Objectives

A. To define the guaranteed population-based and individual-based primary health care interventions for each life stage;

B. To identify the health financing agent/mechanism for the identified primary health care interventions; and

C. To facilitate the citizens' knowledge and understanding of their health guarantees.

III. Scope and Coverage

This issuance shall apply to all concerned and relevant stakeholders of primary health care such as, but not limited to, DOH central office bureaus and units, regional offices, retained hospitals, national reference centers, laboratories, diagnostics clinics, drug outlets, and attached agencies of the Department of Health, other key government agencies, local government units (LGUs), public and private hospitals and health care facilities, health care providers, civil society organizations (CSOs), medical societies, development partners, academe, individuals, families and communities.

The issuance shall guide all investments required to make possible delivery of primary health care.

IV. Definition of Terms

A. Health Guarantees (List) — pertains to a package of population-based and individual-based services that the state commits to providing all Filipinos. These services shall be geographically accessiblewith the least financial burden, specifically at no cost when accessed in public health facilities, and at fixed co-payment when accessed inprivate health facilities.

B. Health Technology Assessment (from DOH AO 2016-34) — refers to the systematic evaluation of properties, effects and/or impacts of health technology to inform policy decision making.

C. Primary Health Care (PHC) — 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 (Alma-Ata Declaration VI)

D. Primary Care (PC) — is first-contact, accessible, continued, comprehensive and coordinated care. First-contact care is accessible at the time of need; ongoing care focuses on the long-term health of a person rather than the short duration of the disease; comprehensive care is a range of services appropriate to the common problems in the respective population and coordination is the role by which primary care acts to coordinate with other specialists that the patient may need. PC is a subset of PHC (WHO, n.d.).

E. Primary Care Facilities (from DOH AO 2012-0012) — a first-contact healthcare facility that offers basic services including emergency service and provision for normal deliveries. It is subdivided into:

1. With in-patient beds — a short stay facility where patients can be admitted for a period of 1 to 3 days. Examples are infirmary, dispensary and birthing home.

2. Without beds — a facility where medical and/or dental examination and treatment and minor surgical procedures are rendered without confining the patient. Examples are Medical Outpatient Clinic, OFW Clinics, and Dental Clinics.

V. General Guidelines

1. The health guarantees are organized per life stage. All interventions are classified as population-based interventions, or health care services that cannot be specifically traced back to a singular person/beneficiary or individual-based interventions, or health care services that can be definitively traced back to a singular person.

2. The baseline set of guarantees is summarized in Annex A, initially developed by a technical working group participated in by various offices of the DOH and its attached agencies, in consultation with key stakeholders.

3. The baseline set of primary health care guarantees shall be regularly updated through a single, fair, and transparent priority setting process or health technology assessment. An Evidence Appraisal Group (EAG) shall be constituted to recommend to the financing agents — DOH (Secretary of Health), PhilHealth (PhilHealth Board of Directors), and LGUs (Local Chief Executives) on inclusion/exclusion of additional interventions into the primary health care guarantees list.

VI. Specific Guidelines

A. Baseline Health Guarantees

1. The baseline set of primary health care guarantees consist of all existing public health programs of the Department of Health, as well as clinically and cost-effective interventions that address 80% of the local disease burden (Wong et al., 2015). These encompass total of 48 communicable, non-communicable and urbanization and globalization-related conditions (See Annex B).

2. The baseline set of primary health care guarantees are organized according to the following life stages, namely: (1) Pregnancy — Labor/delivery and post-partum; (2) Children — neonate (0-28 days), infant (0-12 months old), child (1-4 years old), school-age (5-9 years old), and adolescent (10-19 years old); and (3) Early Adulthood men and women between 20-59 years old; and (4) Late Adulthood — men and women over 60 years old.

3. Population-based interventions fall under the following broad classification: (1) Surveillance and monitoring (2) Prevention and control of epidemics (3) Assurance of quality and accessibility of services (4) Health communication and dissemination (5) Community Mobilization (6) Public Policy Development and (6) n Disaster Preparation and Response.

4. Individual-based services are further classified as well or sick services. These include primary care or outpatient visits and appropriate referral to higher levels of care. Specifically, outpatient consults encompass clinical, laboratory, pharmacy services which includes required drugs and medicines.

B. Financing of Health Guarantees

1. The primary health care guarantees shall serve as a basis for costing sector-wide medium to long term planning for DOH, PhilHealth and LGUs.

2. By 2022, all population-level interventions shall be financed jointly by the DOH and Local Government Units while all individual-level interventions shall be financed by the PhilHealth.

3. In the interim, financing for identified primary health care guarantees shall be gradually streamlined and detailed out in a Health Sector Financing Strategy to be developed in close coordination with the Department of Finance, Department of Budget and Management, National Economic Development Authority, and PhilHealth.

4. The primary health care guarantees shall guide prioritization and rationalization of DOH's technical assistance to LGU.

5. The primary health care guarantees shall inform the expansion of the primary care benefit package of PhilHealth.

C. Enabling Quality Access and Ensuring Adequate and Appropriate Provision

1. The primary health care guarantees shall be delivered through local communities and health facilities. Specifically, individual-based interventions shall be accessed through networks of both public (state) and private (non-state) providers that are linked to higher levels of service facilities in service delivery networks.

2. All product registration, licensing, accreditation, and contracting standards for both stand-alone primary health care facilities and primary care networks, including health professions education and training shall be aligned to the primary health care guarantees.

3. Provision of all primary health care guarantees shall be guided by locally-relevant clinical practices guidelines and cost-effective, responsive clinical pathways.

4. All information and education campaign materials on primary health care guarantees shall be developed using life stage approach and segmented by client, e.g., health managers, health providers, and client/families.

5. The effectiveness, efficiency, and equity dimensions of the primary health care guarantees implementation shall be monitored by the DOH, PhilHealth, and LGUs. All health information systems shall enable tracking of utilization of health guarantees.

VII. Roles and Responsibilities

A. The Department of Health shall: aScITE

1. Define the baseline primary care guarantees and facilitate expansion through the HTA process;

2. Formulate and review strategic and operational policies, plans, and programs related to the primary health care guarantees;

3. Ensure standards, regulations, and technical assistance to LGUs to strengthen the implementation of the primary health care guarantees;

4. Monitor and assess provision of the health care guarantees; and

5. Advocate strong support from all stakeholders on the implementation of the primary health care guarantees.

B. The Philippine Health Insurance Corporation (PHIC) shall:

1. Develop the primary care benefit package in line with the primary health care guarantees and facilitate expansion though the HTA process;

2. Continually update its accreditation standards in accordance to the primary health care guarantees; and

3. Design contracting arrangements that would provide incentives for the access and quality provisions of the guarantees.

C. The Local Government Units shall:

1. Enact local legislation and ensure availability of essential inputs and investments to realize the primary health care guarantees; and

2. Ensure that all RHUs are included in networks of primary care providers.

D. The Civil Society Organizations shall:

1. Participate in the advocacy and/or delivery of the primary health care guarantees; and

2. Hold DOH, PHIC, and LGUs accountable in the quality provision of primary health care guarantees.

E. The Development Partners shall:

1. Adopt, develop, and implement supporting operational policies, plans, and programs consistent with the primary health care guarantees.

VIII. Repealing Clause

The provisions of previous Orders and other related issuances inconsistent or contrary to the provisions of this Administrative Order are hereby revised, modified, repealed or rescinded accordingly. All provisions of existing issuances which are not affected by this Order shall remain valid and in effect.

IX. Effectivity

This Order shall take effect immediately.

 

(SGD.) PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO IISecretary of Health

 

Primary Health Care Guarantees for All Life Stages

 

Early Adulthood-Late Adulthood

 

ANNEX B

Philippine burden of disease data — 2013 Global Burden of Disease (GDB)

 

Table 1. List of top 48 diseases and corresponding Disability Adjusted Life Year (DALY)

Rank	Disease	Average DALYs
1	Ischemic Heart Disease	81,154.23
2	Lower Respiratory Infections	58,443.47
3	Tuberculosis	39,219.37
4	Diabetes mellitus	35,905.89
5	Hemorrhagic Stroke	35,039.81
6	Low Back Pain	32,836.87
7	Preterm Birth Complications	30,386.48
8	Chronic obstructive pulmonary disease	25,596.92
9	Ischemic Stroke	24,223.59
10	Iron-Deficiency Anemia	21,621.58
11	Asthma	17,578.61
12	Congenital Heart Anomalies	16,644.77
13	Major Depressive Disorder	14,467.71
14	Diarrheal diseases	14,406.30
15	Hypertensive Heart Disease	14,163.26
16	Tracheal, bronchus, and lung cancer	13,975.65
17	Neonatal encephalopathy due to birth asphyxia and trauma	13,937.39
18	Migraine	13,675.00
19	Drowning	10,632.21
20	Neonatal sepsis and other neonatal infections	10,436.84
21	Neck Pain	10,355.23
22	Typhoid Fever	9,570.98
23	Motor vehicle road injuries	9,468.65
24	Exposure to forces of nature, disaster	9,268.86
25	Breast Cancer	8,704.22
26	Anxiety Disorders	8,609.30
27	Peptic ulcer disease	7,906.25
28	Measles	7,892.11
29	Schizophrenia	7,848.88
30	HIV/AIDS resulting in other diseases	7,645.69
31	Chronic kidney disease, unspecified	7,481.54
32	Assault by sharp object	7,202.83
33	Assault by firearm	7,087.89
34	Epilepsy	6,764.62
35	Collective violence and legal intervention	6,736.24
36	Colon and rectum cancer	6,676.77
37	Leukemia	6,298.18
38	Rheumatic Heart Disease	6,200.77
39	Alzheimer Disease and other Dementias	6,146.69
40	Self-Harm	5,952.66
41	Uncorrected refractive error	5,893.98
42	Protein-energy malnutrition	5,740.97
43	Dermatitis	4,821.35
44	Trichuriasis	4,759.89
45	Bipolar Disorder	4,269.72
46	Dysthymia	4,174.31
47	Falls	4,095.21
48	Dengue	4,090.93

 

Reference:

Wong, J.Q. Technical Assistance to the Philippine Health Insurance Corporation in Developing a Benefit Development Plan — Phase 1. EpiMetrics. pp. 17-23.ac

n Note from the Publisher: Copied verbatim from the official copy.