Operational Guidelines for Green, Safe, and Climate-Resilient Health Facilities
In this document:
- •B. Virtual Validation
6 tables · ~3k words
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OPERATIONAL GUIDELINES GREEN, SAFE, AND CLIMATE-RESILIENT HEALTH FACILITIES
Department of Health Health Facility Development Bureau 2023
Operational Guidelines for Green, Safe, and Climate-Resilient Health Facilities
A copy of these Operational Guidelines can be downloaded athttps://bit.ly/GREENsystem
Section 1.0: Title
This document shall be known as the Operational Guidelines for green, safe, and climate-resilient health facilities, to be hereinafter referred to as the Green Assessment Rating System.
Section 2.0: Introduction
The global challenge of our time is climate change which disrupts the delivery of health care services. The increased intensity of natural disasters challenges the structural integrity of health facilities, as well as the infrastructure and support systems. Health facilities are also leading consumers of energy, with a large environmental footprint that contributes to greenhouse gas emissions. Such emissions can be mitigated by using renewable, sustainable and clean energy. As the health sector is significantly affected by the circumstances brought about by climate change, the Department of Health as the nation's leader in health is challenged to respond to this phenomenon by minimizing the carbon footprint of health facilities while delivering quality health care.
As one of the strategic thrusts of the Health Sector Strategy 2023-2028, in order to protect Filipinos from health risks, the health system shall have the preparedness for future disasters and pandemics, and the capacity for recovery and adaptation. In line with the objective of health facilities and services that are safe and of high quality, one of the strategic interventions is to build green, resilient health facilities.
In line with the Department of Health (DOH) vision towards achieving universal health for all, as well as, following its new mandate under the Universal Health Care Act that fulfills F1 Plus, health facilities (HFs) must be responsive in reducing the vulnerability to climate change and disaster impacts by seeking people's access and equity to health.
The Department of Health through the Health Facility Development Bureau developed the technical guidelines and standards for the green and safe health facilities to respond to the global call of minimizing the carbon footprint of the health sector while still continuing to provide quality health care to the people, thereby setting the minimum green and safe standards for all hospitals and other health facilities. The Green and Safe Health Facilities Manual accompanied by the Green Viability Assessment tool was released through Department Circular No. 2021-0437, and contains performance standards in Governance, Energy Efficiency, Water Efficiency, Sanitation and Hygiene, Health Care Waste Management, Environmentally Resilient Health Facility, Site Sustainability, Materials Sustainability, and Indoor Environmental Quality.
The main purpose why we need to comply with the provisions of this Green Manual is to lower the carbon footprints generated by HFs in order to protect our environment. Reducing a health facility or system's climate impact requires understanding where your greenhouse gas (GHG) emissions originate and setting your starting point. Climate Impact Checkup is a calculator that helps health care institutions anywhere in the world measure their GHG footprint1. Thereby, all HFs are encouraged by the DOH to implement the Green and Safe Health Facilities Manual, 1st edition.
Consequently, in alignment to Section. 8.1 of Green Building Code, the DOH Green and Safe Health Facilities Manual or the "Green Manual" shall only apply to all new construction and/or with alteration of buildings in the following classification which fall over the benchmark of the required total gross floor area (TGFA) for institutional Building, such that those hospitals and other institutional buildings with at least 10,000 square meters of TGFA as defined by National Building Code (NBC). Therefore, the provisions of the compliance to the provisions of Philippine Green Building Code (PGBC) of HFs that do not meet the benchmark aforementioned is voluntary.
Section 3.0: Definition of Terms
Health Facility
- Health care provider which may be public or private, devoted primarily to provision of services for health promotion, prevention, diagnosis, treatment, rehabilitation and palliation of individuals suffering from illness, disease, injury, disability, or deformity, or in need of obstetrical or other medical and nursing care2
- An institution that has health care as its core service, function or business. Health care pertains to the maintenance or improvement of the health of individuals or populations through the prevention, diagnosis, treatment, rehabilitation and chronic management of disease, illness, injury and other physical and mental ailments or impairments of human beings.3
Green Star Rating
- weighted percentage of the health facility obtained during the green viability assessment system using the star matrix
Green Viability Assessment System
- a process of monitoring and evaluation of hospital and other health facilities' initiatives and practices to be recognized as a green, safe, and climate-resilient health facility.
Green Viability Assessment Tool
_
<sup>1 Health Care Without Harm, 2022, Climate Impact Check-up Health care's GHG emissions calculator, accessed through https://greenhospitals.org/checkup 2 Sec. 4.k.1 of Republic Act 11223, Universal Health Care Ac
<sup>3 DOH Administrative Order 2019-0060, Guidelines on the Implementation of the National Health Facility Registry
- developed tool based on the technical guidelines and standards of Green and Safe Health Facilities Manual
Green, Safe, and Climate-Resilient Health Facility
- a recognized hospital and other health facilities based on the green viability assessment system with at least 3 green stars;
- Initiatives of health care provider institutions to establish and sustain their respective green building practices as stewards of human health and environment
Section 4.0: Objective
The Green Assessment Rating System is developed to assess and recognize the green, safe, and climate-resilient hospitals and other health facilities based on their compliance to the technical standard and guidelines.
Section 5.0: Facilities' Use/Occupancy Coverage and Application
Provisions of PD No. 1096, its IRR, and the GB Code as the referral code of the NBCP shall be supplementary to this Green Manual. Per its Sections 8.1, 8.2, 8.3 and 8.4, the GB Code shall apply to all new construction and/or alteration of buildings, which fall over the benchmark of the required total gross floor area (TGFA) for institutional/health facility. Compliance of HFs that do not meet the benchmark shall be voluntary. Therefore, with regard to compliance with this Green Manual:
- (a) All new HFs with 10,000 square-meter (sqm) TGFA constructed after the effectivity of the Manual are required to comply with all the appropriate provisions;
- (b) All existing HFs with 10,000 sqm TGFA constructed after June 2015 but before the activity of this Green Manual shall be required to retrofit;
- (c) All existing HFs with 10,000 sqm TGFA constructed before June 2015 shall be voluntary; and;
- (d) All HFs with less than 10,000 sqm TGFA shall be voluntary.
Section 6.0: Green Viability Assessment System
The DOH shall create a Technical Working Group (TWG) under the Health Facility Development Bureau (HFDB) that will be in charge of ensuring the conduct of assessments, compliance of health facilities, and recommend green rating based on the green viability assessment system of hospitals and health facilities.
The TWG will be selected among the accredited technical experts and/or green building professionals. The TWG will assist the monitoring team in the conduct of assessments to the health facilities on their compliance to green, safe, and climate-resilient Health Facilities.
The DOH through HFDB will be collecting the accomplished self-assessment green viability tool of the hospitals and other health facilities. The accomplished green viability assessment (GVA) tool will be reviewed by the following: HFDB, Center for Health Development - Health Facility Development Units, and/or accredited green building professionals. They will review and assess the GVA tool and provide the equivalent rating per performance standards of the green, safe, and climate-resilient. The hospitals and other health facilities shall ensure that their submission is complete prior to undergoing the next stage of the Green Viability Assessment System. The GVA tool is composed of general information (form A) and Performance standards assessment (form B).
Table 1: Equivalent Rating per Category of the Green Manual
| CATEGORIES/PARAMETERS | Weighted Rating |
|---|---|
| Governance | 10% |
| Energy Efficiency | 17% |
| Water Efficiency, Sanitation, and Hygiene | 13% |
| Health Care Waste Management | 13% |
| Environmentally Resilient Health Facility | 12% |
| Material Sustainability | 11% |
| Site Sustainability | 11% |
| Indoor Environmental Quality | 13% |
Table 1 shows the equivalent rating of the performance indicator of the GVA Tool. The magnitude of the ratings was agreed upon by consulting the green building professional experts who were part of the initial assessment team for the technical assistance of the project of World Health Organization.
Higher ratings were assigned to those criteria which the team see as a significant factor to be monitored for the green viability of the health facilities. In addition, in one of the capacity building of the project, all the participants in the focused specialized training/orientation on green, safe and climate-resilient health facilities were requested to evaluate the weighted ratings for each categories/parameter and the results of the evaluation were also considered in the final weighted ratings.
Table 2: Sample Computation for Determination of Green Viability Ratingof Health Facility
| Categories | Total Number of Questions per Category (A) | Rating per Category (B) | Weighted Percentage (C) | Equivalent Rating (D) D= B x C x 100 |
|---|---|---|---|---|
| Governance | 10 | 10% | 9% | |
| Energy Efficiency | 12 | 17% | 13.46% | |
| Water Efficiency, Sanitation, and Hygiene (WASH) | 15 | 13% | 10.83% | |
| Health Care Waste Management | 11 | 13% | 10.64% | |
| Environmentally Resilient Health Facility | 8 | 12% | 9.75% | |
| Material Sustainability | 9 | 11% | 8.56% | |
| Site Sustainability | 6 | 11% | 7.33% | |
| Indoor Environmental Quality | 11 | 13% | 10.05% | |
| Initial Rating (Example) | 100% | 79.62% |
Table 2 shows a sample computation to determine the final rating of a certain facility based on their assessment using the GVA Tool.
Included in the table is the total number of questions per category, the rating per category, the weighted percentage and the equivalent rating. To obtain the rating per category (B), the total number of questions per category will be divided into the total number of questions (A). Then, multiply the rating result (B) with the weighted percentage (C) times 100 to get the equivalent rating (D).
The team who will review the submission of the hospitals and other health facilities and prioritize to validate the rating of at least 75% rating. This is to determine who will qualify for the recognition of best, good, and above-average green and safe health facility.
Table 4 below shows the different green rating of hospitals based on the score or final rating that they will garner from the GVA Tool. For example, if the Health Facility will get the overall rating between 96% - 100%, then a Best Practice recognition shall be issued by the DOH after the assessment. The other ranges of scores/ratings are shown below with its respective recognition and green assessment rating
Table 4: Green Star Rating and its Equivalent Recognition
| Green Rating | Score (%) | Assessment |
|---|---|---|
| For Monitoring | ||
| 1 Green Star | 55-65 | Minimum practice |
| 2 Green Stars | 66-75 | Average Practice |
| For Recognition | ||
| 3 Green Stars | 76-85 | Above Average Practice |
| 4 Green Stars | 86-95 | Good Practice |
| 5 Green Stars | 96-100 | Best Practice |
The team who will be validating the hospitals and other health shall ensure that all the means of verification (MOV) will be shown during the actual validation either faceto-face or virtual. The MOV will be compiled by the hospital or other health facilities and will be shared with the validating team for submission to the Green and Safe TWG and HFDB.
The Green and Safe TWG will evaluate and recommend to the HFDB through the Green and Safe Health Facilities Program the final green rating of the hospital and other health facilities based on the technical standards and guidelines of the Green and Safe Health Facilities Manual.
This will be the basis of the program to recognize the health facilities for their initiatives and compliance. Below is the standard format for the certificate of recognition.
Health facilities with 10,000 square meters TGFA and those who voluntarily request for an assessment and validation will follow the "Frequency of Site Assessment based on Garnered Green Viability Assessment".
After the validation of the team or after the recognition of health facilities based on the Green Assessment Rating System will automatically consider the re-assessment for the sustainability of the green and safe health facilities.
Certificate of Recognition on attainment of best, good, and above-average practice for Green and Safe Health Facilities.
Frequency of Site Assessment Based on Garnered Green Viability Assessment
- 5 Green Stars – re-assessment of HF will be 3 years after initial visit
- 4 Green Stars – re-assessment of HF will be 2 years after initial visit
- 3 Green Stars – re-assessment of HF will be 1 year after initial visit
- 2 Green Stars – re-assessment will be 9 months after initial visit
- 1 Green Star – re-assessment will be 6 months after initial visit
The hospitals and other health facilities recognized for their best practices in the Green Assessment Rating System may be considered to be certified for the green building system by third parties (i.e BERDE certification, GREEEN Certification, etc).
A. On-site Validation
Table 5 below shows the flow of activities during site assessment of health facilities. Initially, there will be a courtesy call to the Medical Center Chief or Chief of the Hospital to be assessed. Immediately, the main objective or purpose of the visit will be discussed including other details.
Then, the interview will be conducted as well as the verification of documents or proof of evidence. It will be followed by the actual site visit assessment, then preparation of the initial findings and the conduct of the exit conference.
Table 5: Flow of Activities During Site or Virtual Assessment of Health Facilities
| TIME | ACTIVITIES | ||
|---|---|---|---|
| Travel Time | |||
| AM | |||
| 15 minutes | Courtesy Call to the Head of the Health Facility | ||
| 15 minutes | Presentation of the Objective of the Online Assessment – c/o Team Leader | ||
| 15 minutes | Presentation of the basis to be used during the Online Assessment | ||
| 3 hours | Assessment/interview together with the HF representatives | ||
| PM | |||
| 1 hour | Consolidating of Means of Verification | ||
| 20minutes | Drafting of the initial report of findings | ||
| 20 minutes | Exit conference - presentation of the initial findings to the Head of the HF based on the assessment/interview conducted | ||
| 5 minutes | Closing |
During Courtesy Call:
The Team Leader will introduce the team members to the MANCOM/EXECOM /representative of the Health Facility and then allow the Medical Center Chief or the Chief of Hospital to introduce the participants from their hospitals. Then, a brief presentation of the project will be conducted. Finally, he/she will present the assessment plan as well as the flow of activities during the actual visit.
During the Actual Site Assessment:
The Team Leader will assign members who will assess the compliance of the Health Facility on the 8 parameters/standards of the green, safe, and climate-resilient health facilities. The assigned member of the team will also check/request the evidence or proof of compliance to the designated personnel to be assessed. The DOH-HFDB may request observers and representatives from the other government agencies, non-government organizations (NGOs) or funding donors like WHO, USAID, PSSE, HCWH, PHA, etc. who will join the members of the team during the actual visit for transparency purposes.
Drafting of Initial Report:
Immediately after the assessment of the assigned areas in the facility the Team Leader including the assigned members will be given ample time to draft his/her initial report. He/she will include in the report the team's findings and recommendations for further improvement on its compliance to Green Manual.
During the exit conference:
The Team Leader will allow each member to present his/her initial findings to the management of the Health Facility. He/she will summarize the report and made the final conclusions and recommendations. He/she will then thank the management for their full support and cooperation during the actual site assessment.
Preparation and Presentation of the Final Report:
The Team Leader will be in-charge in the preparation and submission of the final report of the group findings and analysis of the visited facility. He/she will submit the prepared findings and analysis to the TWG or Committee under the HFDB.
B. Virtual Validation
The Table 6 below shows the flow of activities during the online assessment of health facilities. Initially, there will be a courtesy call to the Medical Center Chief or Chief of the Hospital to be assessed. Immediately, the main objective or purpose of the visit will be discussed including other details.
Table 6: Flow of Activities During Online Assessment of Health Facilities
| TIME | ACTIVITIES |
|---|---|
| 5 minutes | Courtesy Call to the Head of the Health Facility |
| 5 minutes | Presentation of the Objective of the Online Assessment – c/o Team Leader |
| 5 minutes | Presentation of the basis to be used during the Online Assessment |
| 3 hours | Assessment/interview together with the HF representatives |
| 10 minutes | Drafting of the initial report of findings |
| 20 minutes | Exit conference - presentation of the initial findings to the Head of the HF based on the assessment/interview conducted |
|---|---|
| 5 minutes | Closing |
Then, the assessment team will be divided based on the number of health facilities to be assessed simultaneously. The team will proceed to their respective assigned breakout rooms together with the representatives of the health facilities. An assessment/interview will be conducted as well as the verification of documents or proof of evidence, based on the Green Viability Assessment (GVA) tool. It will be followed by the preparation for the exit conference.
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Published by
Department of Health San Lazaro Compound Rizal Avenue, Sta. Cruz, Manila 1003 PHILIPPINES
PRODUCTION CREDITS
Project Leader: Dr. Ma. Bituin Reyes
Engr. June Philip Ó. Ruiz
Copy Editor: Mr. Glenn A. Cruz
Ms. Joana Joy A. Lico
Development of this Operational Guidelines was initiated, completed and subsequently published through the HFDB.
For inquiries, contact the Bureau: Phone: +63 2 8651 7800 locals 1401, 1403, 1408
Email Address: hfdb@doh.gov.ph