t

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
AU6 q 3 2017

ADMINISTRATIVE ORDER
No.2017- 0ttl2

SUBJECT: Guidelines on the Adontion of Baseline Primarv Health Care

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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 (l) 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.

II. Objectives

A. To define the guaranteed population-based and individual-based primary health care

interventions for each life stage;
B. To identiff the health financing agenVmechanism 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 accessible with the least financial burden, specffically at no cost
when accessed in public healthfacilities, and at /ixed co-payment when accessed in ,F

Building l, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila o Trunk Line 651-7800 local l l l3, t 108, 1135 (
Direct Line: 7ll-9502:71l-9503 Fax:743-1829 o URL: http://www.doh.gov.ph; e-mail: officeofsoh@doh.gov.ph
 private 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 I 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

l. The health guarantees are organized per life stage. A11 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

l. The baseline set of primary health care guarantees consist of all existing public
health progftrms of the Department of Health, as well as clinically and cost-
effective interventions that address 80% of the local disease burden (Wong et al, &
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 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 (a) Late Adulthood -
men and women over 60 years old.
3. Population-based interventions fall under the following broad classification: (l)
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) 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 individuallevel 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

l. The primary health care guarantees shall be delivered through/ocal 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,

14(l
e.g. health managers, health providers, and clienVfamilies.
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:
l. 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, ffid 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:
l. 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:
l. 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:
l. Participate in the advocacy and/or delivery of the primary health care
guarantees; and
2. Hold DOH, PHIC, and LGUs accountable in the quahty 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.

V[I. 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 immediatelv.

h r,r -^.
PAULYN
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Secretarv of Health
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ANNEX B: Philippine burden of disease data - 2013 Global Burden of Disease (GDB)
Institute of Health Metrics and Evaluation EHIME)

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

Rank Disease Averase DALYs

Ischemic Heart Disease 8r.r54.23
2 Lower Respiratory Infections 58"443.47
J Tuberculosis 39.2r9.37
4 Diabetes mellitus 35,905.89
5 Hemorrhaeic Stroke 35.039.81
6 Low Back Pain 32.836.87
7 Preterm B irth Comolications 30.386.48
8 Chronic obstructive pulmonary disease 25.596.92
9 Ischemic Stroke 24.223.59
l0 Iron-Deficiency Anemia 2t.621.58
ll Asthma r7.578.6r
12 Consenital Heart Anomal ies 16.644.77
l3 Maior Deoressive Disorder 14.467.71
t4 Diarrheal diseases 14.406.30
l5 Hwertensive Heart Di sease t4.163.26
l6 Tracheal. bronchus. and lune cancer 13.975.65
t7 Neonatal encephalopathy due to birth asphvxia and trauma 13.937.39
l8 Migraine r3.675.00
l9 Drownins 10.632.21
20 Neonatal sepsis and other neonatal infections 10.436.84
21 Neck Pain 10.355.23
22 Tvohoid Fever 9.s70.98
23 Motor vehicle road iniunes 9.468.65
24 Exposure to forces ofnature. 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 7.892.1r
29 Schizophrenia 7.848.88
30 HIV/AIDS resulting in other diseases 7,645.69
3l Chronic kidnev disease. unsoecifi ed 7.481.54
32 Assault by sham obiect 7.202.83
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JJ Assault bv firearm 7,087.89
34 Epileosv 6"764.62
35 Collective violence and legal intervention 6.736.24
36 Colon and rectum cancer 6.676.77
JI 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
4l Uncorrected refractive error s.893.98

Page 1 of 2
 42 Protein-energy malnutrition 5.740.97
43 Dermatitis 4.82r.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 Assisatnce to the Philippine Health Insurance Corporation in Developing
a Benefit Development Plan - Phase 1. EpiMetrics. pp. 17-23

Page 2 of 2