Revised Rules and Regulations Governing Accreditation of Medical Facilities for Overseas Workers and Seafarers

September 9, 2004

DOH ADMINISTRATIVE ORDER NO. 2004-0181

 

I. Rationale:

The growth and modernization of the shipping industry brought about many opportunities for Filipino seafarers who had been known and preferred for their adaptability, good communication skills, congeniality and love of work. As of year 2000, the Philippine Overseas Employment Administration (POEA) recorded 198,324 seafarers deployed, of which 12% are marine officers and 24% are ratings. An annual average deployment growth rate of 4% was observed from 1996 to 2000. This sector comprises 20% of the world's maritime labor force. These figures show that the Philippines provide the strongest manpower resource for the shipping industry, making the country "The Ship Manning Capital of the World".

The Philippine government remains sensitive to the needs of the Filipino seafarers, both domestic and international. To address the needs in current development and changes in the maritime industry A.O. 85-A s. 1990, "Revised Rules and Regulations Governing Accreditation of Medical Clinics and Hospitals and the Conduct of Medical Examination of Overseas Workers and Seafarers" is revised.

II. Objective:

These rules and regulations are promulgated to regulate and continuously improve the standards of medical service for land-based overseas workers and seafarers for inter-island/overseas employment.

III. Coverage:

These rules and regulations shall apply to all medical facilities performing pre-employment medical examinations of land-based overseas workers and seafarers for inter-island/overseas employment.

IV. Definition of Terms:

Accreditation — a formal authorization issued by the DOH to an individual, partnership, corporation or association to operate a medical facility for overseas workers and seafarers.

Accredited Medical Facility — a DOH accredited clinic authorized to conduct PEME for land-based overseas workers and seafarers.

Affiliated Specialist — a physician with appropriate specialization who provides further evaluation on PEME borderline result and management of cases on temporary unfitness.

Agency — private recruitment entity, employment agency or manning agency duly authorized/licensed by the POEA, and Department of Labor and Employment to recruit and deploy workers for overseas.

BHFS — acronym for Bureau of Health Facilities and Services. A regulatory body of the DOH that will exercise accreditation and regulation function under these rules and regulations.

CHD — acronym for Center for Health Development, which is the DOH Regional Field Office.

DOH — acronym for Department of Health

Medical expert — a physician who is either a diplomate or fellow of a specialty board and a recognized authority of a particular field of medicine. He/she shall be a member of the Peer Review Committee.

PEME — acronym for Pre-employment Medical Examination. It refers to the complete medical examination during screening to determine physical and mental fitness to work.

PTC — acronym for Permit to Construct. It is a formal authorization issued by the DOH to any person, association, partnership, corporation desiring to construct, alter, expand or renovate an existing medical facility. It is a prerequisite for the accreditation of a facility.

Seafarer — can either be an inter-island or overseas seafarer.

a. Inter-island seafarer — sailing/working within the Philippine seas.

b. Overseas seafarer — sailing/working outside the country.

Secondary clinical laboratory — a laboratory that provides the following:

a. Routine hematology (complete blood count or CBC) — includes hemoglobin mass concentration, erythrocyte volume fraction (hematocrit), leucocytes number concentration (white blood cell or WBC count) and leucocytes type number fraction (differential count), qualitative platelet determination.

b. Routine urinalysis

c. Routine fecalysis

d. Blood typing — hospital based

e. Quantitative platelet determination — hospital based

f. Routine clinical chemistry — includes blood glucose substance concentration, blood urea nitrogen concentration, blood uric acid

g. substance concentration, blood creatinine concentration, and blood total cholesterol concentration.

h. Cross matching — hospital based.

V. Policies and Guidelines:

A. Classification:

1. Regular Medical Facility for Overseas Workers and Seafarers — conducts PEME for land-based overseas workers and seafarers for inter-island/overseas employment,

2. Special Medical Facility for Overseas Workers and Seafarers —

2.1 Seafarer's Medical Facility — conducts PEME exclusively for seafarers for inter-island/overseas employment.

2.2 Land-based Medical Facility — conducts PEME exclusively for land-based workers for overseas employment.

B. Technical Requirements:

All Medical Facilities for Overseas Workers and Seafarers are required to:

1. comply with the Technical Requirements for Accreditation stated in Annex A

2. follow the operational guidelines prescribed by the DOH in the conduct of PEME as stipulated in Administrative Order No. 1 s. 2003.

3. have a Quality Standard System that is well documented and implemented.

C. Certificate of Accreditation:

1. The Certificate of Accreditation shall be granted in accordance with prescribed accreditation requirements and on the basis of specific conditions and limitations.

2. The accreditation as herein granted as well as any right under the accreditation cannot be assigned or otherwise transferred directly or indirectly to any party.

3. A separate accreditation shall be required for all medical facilities or branches maintained in separate premises but operated under the same management.

4. Change in location as well as change of regular/retainer staff/personnel shall be prepared and submitted in writing fifteen (15) days from the effectivity of such change for BHFS approval.

5. Filing of application for renewal of accreditation may be made ninety (90) days prior to its expiration. A Certificate of Accreditation not renewed after expiration is considered lapsed. Such application shall be treated as new application.

6. The Certificate of Accreditation shall be posted in a conspicuous space readily seen by the public. A copy of these rules and regulations shall be readily available for reference and guidance of the staff and personnel.

VI. Procedural Guidelines:

A. Issuance of PTC

1. Applicant requests relevant information and prescribed form from the BHFS in person, or through mail, email or internet.

Documentary requirements:

1.1 Duly accomplished and notarized application for PTC.

1.2 Four (4) sets of Floor Plans signed and sealed by an Architect and/or Engineer.

1.3 DTI/SEC registration

2. Applicant accomplishes required documents and submits them to the BHFS. Upon filing of application, the applicant pays the PTC fee of three hundred pesos (Php300.00) to the DOH cashier in person or through postal money order.

3. The BHFS reviews the floor plan and approves or disapproves the issuance of PTC.

• If approved, the BHFS issues a PTC to the applicant.

• If disapproved, the BHFS returns the floor plan together with their findings and recommendations to the applicant. The applicant makes necessary revisions as prescribed in the documents. The applicant submits the revised documents to the BHFS for another review.

B. Issuance of Certificate of Accreditation

1. Applicant requests for relevant information and prescribed form from the BHFS.

Documentary Requirements:

1.1 Duly accomplished and notarized application form. The application shall include a statement that the applicant has fully complied with all the requirements for accreditation based on the self-assessment done.

1.2 Photocopy of PTC (initial accreditation only)

1.3 Photocopy of License to Operate/Certificate of Accreditation of the following services:

• x-ray facility

• secondary clinical laboratory

• HIV testing laboratory

1.4 Location map or sketch of the location of the medical facility (initial accreditation only)

1.5 List of personnel and appropriate permits (valid Professional Regulation Commission Identification Card, PTR, Certificates of Specialty Board)

1.6 List of equipment

1.7 QSS Manual (initial accreditation only)

1.8 Current Quality Standard System Certification (renewal only)

2. Applicant accomplishes required documents and submits them to BHFS

3. The applicant pays the application fee of six thousand pesos (Php6,000.00) to the DOH in person or through postal money order payable to the DOH. An additional fee of three thousand pesos (Php3,000.00) shall be paid for re-survey.

4. The BHFS surveys the medical facility. Survey shall be done after a self-assessment to determine compliance with the requirements had been done.

5. The BHFS approves or disapproves the issuance of certificate of accreditation.

* If approved, the BHFS registers the medical facility and issues the certificate of accreditation upon deposit of fifty thousand pesos (Php50,000.00) cash bond. The initial certificate of accreditation shall be effective for two years. However, the medical facility must have a Quality Standard System in place certified by a DOH recognized certifying body. Failure on the part of the medical facility to obtain such certification within six (6) months from date of issuance of the certificate of accreditation will cause its revocation.

* If disapproved, the BHFS sends a copy of survey findings and recommendations to the applicant for compliance.

VII. Monitoring:

1. All Medical Facilities for Overseas Workers and Seafarers shall be monitored regularly and records shall be made available to determine compliance with these rules and regulations.

2. The BHFS shall be allowed to monitor the facility at any given time.

VIII. Validity:

The certificate of accreditation is valid for two (2) years

IX. Violations and Penalties:

1. Violation of the rules and regulations governing accreditation of medical facility for overseas workers and seafarers and/or commission of the following acts by persons operating the medical facility or persons under their authority shall be penalized:

1.1 Change of ownership or location of the medical facility without notifying the BHFS.

1.2 Operating unauthorized branches for examination of overseas workers/seafarers.

1.3 Refusal to allow survey or monitoring of the facility by persons authorized by the BHFS Director during working hours.

1.4 Failure to correct deficiencies within reasonable time after due notice from the BHFS.

1.5 Absence of QSS Certification.

1.6 Issuance of medical and/or laboratory examination reports that are not performed.

1.7 Allowing the use of the official medical examination forms by other medical facilities.

1.8 Use of pre-signed medical certificate and other forms.

1.9 Any act contrary to the accepted medical protocol/clinical laboratory practices such as but not limited to cutting of reagent strips, serum pooling or use of expired reagents.

2. Any violation committed/omitted under this Administrative Order and other issuances, regulations, orders or memoranda of the DOH or the BHFS shall be a ground for suspension and revocation of the certificate of accreditation.

Penalties to be imposed:

First Offense	Php50,000.00
Second Offense	suspension and fine of Php100,000.00
Third Offense	closure

X. Investigation of Charges or Complaints:

The BHFS upon receipt of complaints or charges against an accredited medical facility by any person or interested party, shall investigate the complaints or charges.

The BHFS Director shall impose the corresponding sanctions enumerated therein without prejudice to referring the case to judicial authorities for criminal action for a medical facility found violating any of the provisions of the rules and regulations, circulars, and issuance or order.

XI. Appeal:

Any medical facility, or any of its personnel aggrieved by the decision of the BHFS may, within ten (10) days after receipt of the notice of decision, file a notice of appeal in the Office of the Secretary and serve a copy of the notice of appeal to the BHFS. Thereupon, the BHFS shall promptly certify and file a copy of the decision, including the transcript of the hearings on which the decision is based, with the Office of the Secretary, for review. The decision of the Office of the Secretary shall be final and executory.

XII. Implementing Guidelines:

1. Responsibilities of Medical Facilities:

In addition to complying with all the above requirements, it shall be the responsibility of an accredited medical facility to:

1.1 Ensure compliance by its staff with the Code of Ethics of their respective professions in the Philippines.

1.2 Submit to the BHFS a monthly report on the following:

1.2.1 workers/seafarers examined per agency/company. A separate monthly report for seafarers and land-based workers is also required.

1.2.2 reagents procured and used

1.2.3 all procedures done and quantity

1.2.4 repatriated worker issued medical certificate by the medical facility, if any.

1.3 Continually upgrade its facilities and the competence of its medical staff.

1.4 Ensure the PEME of workers/seafarers are done at its medical facility by registered staff duly identified in the latest application for accreditation

1.5 Ensure that workers/seafarers are not subjected to unnecessary additional medical examinations.

1.6 Ensure prompt result of PEME within seventy-two (72) hours from the time of examination.

1.7 Issuance of official receipts to applicants.

1.8 For medical facility attached to a hospital, it shall ensure that laboratory and x-ray services for its applicant shall be a priority.

1.9 Follow strictly the schedule of fees as prescribed by the BHFS for the charges for PEME of overseas workers and seafarers.

2. Responsibilities of the DOH:

2.1 Issue PTC and Certificate of Accreditation.

2.2 Authenticate medical and AIDS clearance certificates secured by duly accredited medical facilities, if so required by the country of destination, upon payment of authentication fee of fifty pesos (Php50.00) for each.

2.3 Make the final decision whenever the PEME result is contested by an applicant, recruitment agencies/companies or their interested parties. In making decision, the BHFS shall be assisted by the different Peer Review Committees composed of medical experts.

2.4 Prescribe PEME charges for overseas workers and seafarers.

2.5 Conduct investigation on complaints or charges.

2.6 Publish the list of accredited medical facilities periodically.

XIII. Separability Clause:

In the event that any rule, section, paragraph, sentence, clause or word of these rules and regulations is declared null and void for valid reason(s), the other provisions thereof shall not be affected thereby.

XIV. Repealing Clause:

These rules and regulations shall repeal and supercede all administrative orders and other issuances inconsistent thereof.

XV. Moratorium:

All DOH accredited medical clinics and hospitals for overseas workers and seafarers are hereby given until December 31, 2005 to comply with the new requirements as stipulated in these rules and regulations.

XVI. Effectivity

These rules and regulations shall take effect fifteen (15) days after its publication in the official gazette or in a newspaper of general circulation.

 

(SGD.) MANUEL M. DAYRIT, M.D., MSc.Secretary of Health

ANNEX A

Technical Requirements:

1. Service Capability

1.1 General Administrative Service

1.2 Clinical Service

1.2.1 Physical examination to include

1.2.1.1 Hearing examination

1.2.1.2 Visual acuity and color perception examinations

1.2.1.3 Electro cardiogram examination

1.2.2 Dental examination

1.2.3 Psychological evaluation

1.3 Ancillary Service — separate licenses shall be secured for the following services (no affiliation shall be allowed):

1.3.1 X-ray service

1.3.2 Secondary clinical laboratory service

1.3.3 HIV testing service

2. Physical Plant — The medical facility (excluding x-ray and clinical laboratory services) shall have a minimum floor area of 50 square meters covering the following:

2.1 Reception area

2.2 Consultation area/follow-up area

2.3 Physical examination room/area (separate for male and female)

2.4 Dental section

2.5 Psychological testing room

2.6 Audiometry room

2.7 Optical area

2.8 ECG area

2.9 Comfort room (separate for male and female)

*For x-ray and clinical laboratory services, the medical facility shall comply with the prescribed licensing requirements for physical plant set by the DOH.

3. Equipment/Instruments — The medical facility shall have the following:

3.1 Examining table

3.2 Stethoscope

3.3 Mercury sphygmomanometer

3.4 Clinical scale (with height and weight measurement)

3.5 Dental unit

3.6 Examining light

3.7 Snellens and Jaeger's Chart

3.8 EENT diagnostic set

3.9 ECG machine

3.10 Registered Psychological Test Battery

3.11 Audiometer — optional for land-based medical facility

3.12 ISHIHARA Testing Material Book — optional for land-based medical facility

*For x-ray, clinical laboratory and HIV testing services, the medical facility shall comply with the prescribed licensing requirements for the equipment set by the DOH.

4. Personnel

4.1 Full time clinic staff:

4.1.1 Two examining registered physicians, one male and one female with minimum of two-year active practice and of good moral character.

4.1.2 Licensed nurses — minimum of one (1) nurse. Ratio is 1 nurse: 20 applicants per day

4.1.3 Licensed dentist

4.1.4 Psychologist — Masteral course in psychology or had teaching load on psychology subjects for at least 2 years or government service as psychologist for at least 3 years as a psychologist.

4.1.5 Receptionist clerk

4.1.6 Cashier

4.1.7 Optometrist — required for medical facilities with more than 50 applicants per day.

4.2 Retainer specialists

4.2.1 Pathologist

4.2.2 Radiologist

4.3 A team of affiliated specialists oriented on the medical guidelines pertaining to Maritime Medicine.

Cardiologist, Eye Specialist, Ear, Nose, Throat Specialist, Infectious Disease Specialist, General Surgeon, Urologist, Nephrologist, Gastro-Intestinal Specialist, Endocrinologist, Hematologist.