Reiteration of DOH Policies and Governance Procedures to Address Disease Outbreaks

October 21, 2015

DOH ADMINISTRATIVE ORDER NO. 2015-0044

 

I. Rationale

The essential governance mechanisms for both DOH and Local Government Units (LGUs) must function effectively and efficiently to prevent or control outbreaks. The Department of Health has issued policies on the prevention and control of various diseases, including dengue. Though our health sector is devolved, the Department may also exercise its control and oversight function to LGUs in times of calamities, including outbreaks, as provided under the IRR of the 1991 Local Government Code.

This Order shall reiterate guidelines and instructions to LGUs and relevant DOH offices to efficiently address outbreaks.

II. Objectives

A. To provide guidance to LGUs and other stakeholders in managing disease outbreaks relative to prevention, control and treatment in community settings

B. To clarify communication and reporting systems in the streamlined organizational set up of the DOH during surveillance and outbreak declarations

C. To enhance timely DOH response and guidance to LGUs during outbreaks

III. Scope

This Order covers all LGUs, concerned DOH offices and facilities, other public and private health facilities, other relevant national government agencies (NGAs), non-government organizations (NGOs), health partners, and all other health stakeholders.

IV. Definition of Terms

A. Epidemic or Outbreak — defined in Administrative Order (AO) No. 2007-0036, or "Guidelines on the Philippine Integrated Disease Surveillance and Response (PIDSR) Framework" as the occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy. The community or region and the period in which the cases occur are precisely specified. The number of cases indicating the presence of an epidemic/outbreak varies according to the agent, size, and type of population exposed; previous experience or lack of exposure to the disease; and time and place of occurrence. A community may refer to specific groups of people (e.g., those attending a social function and got ill from food poisoning). Epidemic or outbreak is used interchangeably, but the term outbreak will be used throughout this document for consistency. cSaATC

B. Alert threshold — defined in AO No. 2007-0036, as the level of disease that serves as an early warning for epidemics/outbreaks. An increase in the number of cases above the threshold level should trigger an epidemiologic investigation, assessment of epidemic/outbreak preparedness and implementation of appropriate prevention and control measures.

C. Epidemic threshold — defined in AO No. 2007-0036, as the level of disease above which an urgent response is required. The threshold is specific to each disease and depends on the infectiousness, other determinants of transmission and local endemicity levels. For some diseases, such as poliomyelitis or Severe Acute Respiratory Syndrome, one case is sufficient to initiate a response.

D. Functional surveillance system — A surveillance system is considered functional if it is able to perform its core surveillance activities as defined in AO No. 2007-0036. For Municipal/City Health Offices (MHOs/CHOs), this include: collecting, organizing, analyzing, and interpreting surveillance data in their respective areas; facilitating submission of weekly notifiable disease surveillance reports from public and private hospitals; and reporting all available essential information (e.g., clinical description, laboratory results, numbers of human cases and deaths, sources, and types of risk) immediately to the next level.

V. General Guidelines

A. Health professionals and government officials shall be ready not only for emergency response but more importantly for outbreak prevention.

B. DOH shall provide LGUs comprehensive technical expertise and assistance on prevention and control strategies to avert outbreaks, strengthen disease surveillance systems, and ensure readiness with treatment and rehabilitation in health facilities.

C. DOH Regional Offices (DOH-ROs) shall create and maintain Regional Epidemiology Surveillance Units (RESUs), and RESUs shall facilitate the establishment of Epidemiology Surveillance Units at the level of the LGUs. Department Circulars No. 11 Series 1993 and No. 293 Series 1997 may be referred to for further details.

D. The DOH Regional Offices shall facilitate the dissemination of updated and relevant information on the outbreak situation to their respective LGUs.

E. Outbreak detection and response, including the declaration of an outbreak, and containment should adhere to AO No. 2007-0036. LGUs shall access their respective alert and epidemic/outbreak thresholds from their respective RESUs.

F. A declaration of a state of calamity due to an outbreak shall likewise be consistent with these guidelines, as well as other related issuances of the DOH and other NGAs.

VI. Specific Operational Guidelines

A. Prevention and Control Measures

1. Epidemiology Bureau (EB), in coordination with Disease Prevention and Control Bureau, Bureau of Local Health Systems Development, Bureau of International Health Cooperation, other DOH offices, shall convene all relevant stakeholders to develop disease prevention and control plans to address the logistic and health human resource requirements of LGUs once the alert threshold for a specific disease has been reached or during actual outbreak situations.

2. Health Promotion and Communication Service shall lead the development of advocacy and educational materials in the most speedy and efficient manner to abate diseases that have reached at least alert threshold. It shall develop a risk communication plan to mitigate public panic in cases of emerging pandemic outbreaks.

B. Declaration of Epidemics

1. Outbreak declaration in communities, municipalities, provinces and regions shall be consistent with the adopted definition in this Order.

2. Detection, verification, and declaration of outbreaks shall be consistent with AO No. 2007-0036. These include the following:

a. MHOs/CHOs shall verify suspected outbreaks and notify the next higher level.

b. Detection of all suspected outbreaks shall be assessed by the EB in coordination with the DOH-ROs, LGUs, and government agencies and other parties involved.

c. Declaration of an outbreak:

i. Should be supported by sufficient scientific evidence which includes:

• surveillance information

• epidemiologic investigation (descriptive or analytic)

• environmental investigation

• laboratory investigation

ii. Can only be done by the MHO/CHO if it has a functional surveillance system, otherwise the next higher level may provide technical assistance (Administrative Order (AO) No. 2007-0036, or "Guidelines on the Philippine Integrated Disease Surveillance and Response (PIDSR) Framework)

iii. The DOH, through the Secretary of Health, has the final decision regarding the presence of an epidemic/outbreak and shall have the sole authority to affirm or reverse any declaration of an epidemic/outbreak (DOH Rules and Regulations Implementing the Local Government Code of 1991, Chapter 11, Section 44 c). cHDAIS

iv. Furthermore, the Secretary of Health has the sole authority to declare epidemics/outbreaks of national and/or international importance.

C. Managing Epidemics

1. EB in coordination with DOH-ROs shall ensure that the necessary reporting and communication protocols as provided in the PIDSR Manual are in place and complied on a regular basis.

2. EB shall heighten its disease surveillance activities through data report analysis and field investigations. Validation system for laboratory and health facility confinement shall be integrated in the report analysis and preparation.

3. DOH-ROs shall lead in disease containment in the region, in close coordination with all concerned stakeholders, using relevant program guidelines and shall promptly secure EB clearance as to its declaration of epidemic/outbreak-contained areas within their jurisdiction. Otherwise, the Secretary of Health reserves the right to declare epidemic/outbreak-containedareas for areas spanning more than one (1) region.

D. Monitoring and Evaluation (M&E)

1. National and regional Disease M&E Task Forces shall be organized within existing working committees to maximize human resource engagement and capacities (e.g., inclusion of disease monitoring reports in the Regional Development Council meetings).

2. Should there be an assessed need for a dedicated staff or team to undertake this task, EB and the DOH-RO shall contract additional staff to provide the needed services or assistance.

3. EB shall lead the M&E activities and shall work closely with the Office for Health Operations and the concerned LGUs.

VII. Roles and Responsibilities

Roles and responsibilities of stakeholders detailed in issuances cited in this Order still apply. However, the following roles are reiterated to ensure consistency in coordination during the validation of suspected outbreaks:

A. Department of Health

1. Epidemiology Bureau — validate all suspected outbreaks as may be reported by LGUs, DOH-ROs, and other health stakeholders

2. Regional Offices — conduct first level validation and act as primary facilitator between LGUs and the DOH Central Office during the final validation of suspected outbreaks and its management

B. Local Government Units — actively coordinate with ROs for validation of suspected outbreaks with EB

VIII. Repealing Clause

All issuances inconsistent with or contrary to this Order are hereby repealed, amended or modified accordingly. All other provisions of existing issuances which are not affected by this Order shall remain valid and in effect.

IX. Effectivity

This Order takes effect immediately.

(SGD.) JANETTE P. LORETO-GARIN, MD, MBA-HSecretary of Health