PH Health Ref

AO 2020-0003: Strategic Framework on Integrated People-Centered Health Services (IPCHS)

In this document:

  • •Republic of the Philippines Department of Health
  • •II. OBJECTIVE
  • •A. Applications of the IPCHS Framework
  • •C. Monitoring and Evaluation of the Policy

2 tables · ~3k words

Document Info

Category
policies
Year
2020
Status
current
Hospital Levels
L1L2L3
Issuing Body
Department of Health
Extracted
2026-04-23

Republic of the Philippines Department of Health

OFFICE OF THE SECRETARY

JAN 27 2020

ADMINISTRATIVE ORDER No. 2019// 2020 - 0003

SUBJECT: Strategic Framework on the Adoption of Integrated People-Centered Health Services in All Health Facilities

I. RATIONALE

The Department of Health (DOH), through the FOURmula One Plus for Health (F1+), envisions Filipinos as "among the healthiest people in Asia by 2040 with a productive, resilient, equitable, and people-centered health system for universal health care." Republic Act 11223, or the Universal Health Care Act (UHC), adopts approaches to ensure that all Filipinos are health literate, living in healthy conditions, protected from health-affecting hazards and risks, with health services centered on people's needs and well-being. Executive Order No. 5, series of 2016, emphasizes the vision of Filipinos to enjoy a strongly rooted, comfortable, and secure life by 2040 through the Philippine Development Plan for 2017 to 2022 which calls for enhancing the social fabric (malasakit) for a people-centered, clean, and efficient government.

The country's commitment is also a response to the call from 69th World Health Assembly (WHA) and the 31st ASEAN Summit to implement the Integrated People-Centered Health Services (IPCHS) framework in accord with the national context and priorities on universal health coverage, emphasizing on primary care, to build on its foundation fosters a people-oriented and people-centered region. With the enactment of Republic Act No. 11463, also known as the Malasakit Center Act, the Department of Health shall be implementing the Malasakit Program, wherein the IPCHS is used to address nonclinical health sector outputs such as responsiveness of all health facilities.

Responsiveness is defined by the WHO as the "ability of the health system to meet the population's legitimate expectations regarding their interaction with the health system, apart from expectation for improvements in health or wealth." It is an integral component of stewardship in the health sector since it relates to the basic human rights. Because of this, responsiveness has been made an intrinsic goal of health system performance measurement and will be addressed by this Order.

II. OBJECTIVE

This Order provides the framework that shall guide national and local actions towards the institutionalization of integrated people-centered health services in all health facilities to ensure that health facilities are responsive to the needs of its clients.

III. SCOPE AND COVERAGE

This Order shall cover all health facilities including facilities owned and managed by the DOH, other national government agencies, local government units (LGU), private sector, and civil society organizations. This shall also apply to other DOH units, and other relevant partners in the health sector.

IV. DEFINITION OF TERMS

    1. People-Centered Health Services "An approach to care that consciously adopts the perspectives of individuals, families, and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in holistic and humane ways" (WHO, 2016).
    1. Integrated Health Services- "Are health services that are managed and delivered in a way that ensures people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative services at different levels and sites of care within the health system, and according to their needs through their life courses" (WHO, 2016).
  • 3. Patient Navigation System- Refers to the function of coordinating and directing the individual to obtain health services needed to manage a wide range of health needs and overcome barriers for timely, cost-effective and appropriate care.

V. GENERAL GUIDELINES

  • A. The Framework on Integrated People-Centered Health Services (IPCHS) shall guide all initiatives that promote responsiveness to clients undergoing health services in the health sector.
  • B. The IPCHS Framework shall prescribe a unified client experience survey tool to measure responsiveness be used by health facilities in planning, monitoring, awarding, and regulatory processes within the Department of Health.
  • C. Strategies under the framework of IPCHS (See Annex A for specific activities per strategy) are as follows:
      1. Strategy 1: Promote an organizational culture geared toward responsiveness. Each health facility shall ensure that the culture of responsiveness is promoted and properly communicated throughout the entire organization through the following:
      • a. Equipping its staff with the necessary skills/ training to ensure good interaction with patients, their carers and their families. This will include but are not limited to teaching empathy, communication skills, and development of standardized scripts.
      • b. The human resource management shall assess their health facility staff on the quality of their interaction with clients through patient feedback, and recognize those who exhibit exemplary service as patient care champions.
      1. Strategy 2: Ensure appropriate infrastructure and processes in health facilities. Each health facility shall upgrade and maintain its infrastructure and processes to adapt to the needs of its clients to implement the following:
      • a. Ensure that the physical condition will promote healing by addressing the total sensory environment.
      • b. Establish effective and efficient Patient Navigation within and across Health Facilities.
      • c. Employ patient flow analysis and data-driven facility management in improving the overall operations of the facility and harmonizing processes to reduce redundancy of work.

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    1. Strategy 3: Promoting client engagement and empowerment. Each health facility shall engage and empower its clients to promote an effective partnership between people who need care and the people who will provide care, through the establishment of the following:
    • a. Mechanisms to ensure that the patients, their carers, and family are informed of their condition and are involved in the decision making for their health
    • b. Mechanisms to create a participative environment for patients, their carers, and family by engaging patient groups in the development of policies.
    • c. Incorporation of patient experience to measure the responsiveness of the health facility to ensure that the needs of patients are being addressed using the standardized client experience survey form. A separate issuance shall be released for the specific guidelines on the reporting of the said tool.
    • d. Avenues for social responsibility programs that promote health and strengthens good health seeking behavior

VI. SPECIFIC GUIDELINES

A. Applications of the IPCHS Framework

    1. All DOH health facilities shall improve their health facility operations in line with the components of the IPCHS Framework, to be reflected in health facility and network development plans.
    1. Interventions and projects that address facility gaps highlighted in the IPCHS Framework shall be considered critical to health service delivery and are allowed for capital outlay investments, subject to existing rules and regulations.
    1. All DOH offices shall incorporate components of the IPCHS framework in monitoring, recognition or regulatory processes in health facilities.
    1. Separate issuances shall be provided by relevant offices on development of these aforementioned mechanisms.

B. Standardized Client Experience Survey to Monitor and Evaluate Responsiveness

    1. The DOH shall issue a standardized client experience survey that will measure the responsiveness of each health facility, encompassing the components of the IPCHS Framework.
    1. Separate issuances on the standard client experience survey and provisions for monitoring and evaluation shall be released by the DOH, updated at least every three years.
    1. All DOH Health Facilities shall use the standardized client experience survey for accomplishment by patients, and families, especially after discharge.
    1. Non-DOH Health Facilities may adapt the standardized client experience survey tool to ensure the responsiveness of their health facilities.

C. Monitoring and Evaluation of the Policy

    1. The Health Facility Development Bureau (HFDB) shall lead in the monitoring and evaluation of the implementation of the policy and issue guidelines on monitoring the effectiveness of the strategies implemented in each DOH Health Facility.
    1. All DOH Health Facilities shall submit the consolidated responsiveness rating from their clients, based on the aforementioned standardized client experience survey form.

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  1. HFDB shall consolidate all reports and analyze its implications on the implementation of this Order annually. It shall also provide feedback and technical assistance to ensure that all DOH Health Facilities will be responsive to the needs of its clients in line with the framework

D. Roles and Responsibilities

1. Health Facility Development Bureau (HFDB) shall:

  • a. Oversee the implementation of the strategic framework of IPCHS
  • b. Develop tools to assess and monitor health facilities for their compliance to the policy
  • c. Establish systems and standards to support the effective realization of IPCHS
  • d. Lead in the advocacy and dissemination of the policy in all health facilities
  • e. Coordinate and provide technical inputs for the operationalization of the policy and other relevant initiatives
  • f. Lead in the periodic conduct of research and development strategies relative to the implementation and impact evaluation of the policy.

2. Health Promotion and Communication Service shall:

  • a. Lead the advocacy and dissemination of the policy to the general public
  • b. Provide technical assistance in the development of health promotion and effective communication plan such as but not limited to key messages, promotional materials, and advocacy training toolkits

3. Health Policy Development and Planning Bureau

  • a. Explore research opportunities defining the features and milestones of exhibiting IPCHS of health facilities
  • b. Shall facilitate the conduct of policy impact analysis every five years in terms of responsiveness, client satisfaction and other measures deemed appropriate

4. Health Facilities and Services Regulatory Bureau

a. Integrate the framework for Integrated People-Centered Health Services in their mechanism for awarding hospitals

5. Bureau of Local Health Systems and Development

  • a. Assist HFDB in facilitating the inclusion of responsiveness in the LGU Scorecard
  • b. Assist HFDB and Health Human Resource Development Bureau (HHRDB) in developing learning and development activities of the Development Management Officers (DMO) that will enable them to assess and promote IPCHS in local health systems
  • c. Gather LGU good practices on institutionalizing IPCHS that can serve as standards that other LGUs may use

6. Center for Health Development (CHD)- Health Facility Development Unit (HFDU)

  • a. Ensure the dissemination of the policy in all facilities
  • b. Train and actively support at least one official in each Province-wide or City-wide Health System in the advocacy, assessment and improvement of facilities within their jurisdiction

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  • c. Coordinate with other units within their CHDs in the institutionalization of IPCHS in other programs
  • d. Conduct monitoring of policy implementation and facilitate the timely, accurate, and complete submission of reports from all healthcare facilities, through the DMOs, within the region.

7. Field Implementation and Coordination Team

a. Monitor the overall adherence for all health facilities to the strategic framework for IPCHS through HFDU, as part of the regular management review of CHDs and DOH Hospitals.

8. All Health Facilities

  • a. Adopt and implement the policy, as evidenced by the formulation of plans, procedures, protocols and monitoring and evaluation tools for internal quality improvement and improved client satisfaction.
  • b. Allocate budget in support to this policy.
  • c. Regularly monitor the implementation of the policy within their facility.
  • d. In coordination with their local government units of jurisdiction, regularly communicate to their catchment area the policies and standards of the facility.
  • e. Provide feedback for policy review, enhancement of the program, and dissemination of their notable good practices.
  • f. Regularly submit validated reports to their designated local planning and development coordinator.

9. Local Government Units

  • a. Support local government health facilities in the implementation of peoplecentered health care
  • b. Receive feedback from the general public and endorse complaints on the quality of services in relation to IPCHS to the local health board for corrective action
  • c. Receive feedback from the DOH in terms of the implementation of their policies
  • d. Provide avenues for dialogue between facilities and the general public to facilitate continuing improvement in the delivery of IPCHS

10. Civil Society Organizations and Patient Groups

  • a. Participate in the development of policies in their respective health facilities and with the local government unit
  • b. Participate in the monitoring and evaluation of health facilities

11. Private Sector and Non-Government Organizations

a. Support and promote the implementation of IPCHS in Health Facilities

E. Funding

The DOH and CHD shall provide the necessary funding for technical assistance, advocacy, monitoring and promotion of the Integrated People-Centered Health Services.

VII. TRANSITORY PROVISION

Until the Standardized Client Experience Survey Form to measure responsiveness has been issued, each health facility may continue to use their existing client satisfaction survey

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tool. In addition to this, each health facility shall incorporate provisions in the strategic framework for IPCHS that are investment intensive in their health facility and network developmentplan until 2022.

VIII. SEPARABILITY CLAUSE

In case any provision in this Order shall be deemed invalid, illegal, or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

IX. EFFECTIVITY

This Order shall take effect immediately.

ISCO '¥. DUQUE TI, MD, MSc Secfetary of Health

ANNEX A LIST OF ACTIVITIES/ INTERVENTIONS PER STRATEGY

I. Strategy No. 1: Develop and Promote an organizational culture geared towards responsiveness.

A component of IPCHS is promoting a culture of responsiveness to be able to address the needs of its clients. The following are suggested mechanisms to uphold such culture

A. Develop and promote a culture of responsiveness by recognizing patient care champions

    1. Integrate good client engagement on existing performance evaluation of healthcare staff
    1. Recognize and award health facility staff who exhibit exemplary service in terms of client interaction as patient care champions.
    1. Provide communication skills training that incorporates empathy, dealing with difficult patients and carers and the like
    1. Provide standardized scripts in engaging patients, and/or carers

II. Strategy No. 2: Ensure appropriate infrastructure and processes in health facilities

An integral component of Integrated People-Centered Health Services is ensuring the physical infrastructure and internal processes of each facility promote a healing environment and ensure efficiency/ ease of transaction. Each Health Facility shall assess, plan and execute activities to address the following:

A. Promoting a Healing Environment:

    1. Ensure that spaces such as patient areas, administration & recreation areas, are designed considering the positive effects of colors on patients and staff. Design mechanisms may include furniture, soft furnishings, or textile.
    • a. For the color pallet used for the exterior and interior of the health facility, it shall follow the Guidelines in the Implementation of the Unified Color, Signage Features, and Design of Identified Interior Spaces by the Department of Health.
    • b. For furniture, soft furnishings, or textile health facilities may follow the following suggestions
Type of SpacesObjectiveColor Palette Suggested For Furniture, soft furnishing or Textile
Public Spaces such as lobbies waiting areas, corridors, cafeteriasProvision of positive distractionWarm and visually comforting colors or cooler tones to suggest tranquility
PediatricsPromote a welcoming environmentWarm earth colors with vibrant accents such as red, yellow, green, blue and purple

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Maternity,
NICU,
Critical
Nurseries,
Care
Emergency
areas,
and
treatment
rooms		Should
be
in
soothing
and
address
nature
high
situation
stress		Coolor
such
tones
comforting
as
shadesof
and
violet
blue,
green
Areas
Surgical		Advocate
for
and
quiet
tones
relaxing		of
Neutral
with
cool
tones
accents
tones
such
and
blues
teals,
as
greens,
Staff
Areas
such
as
stations
and
Nursing
Laboratory		efficient
work
Promote
environment		tan
Whites,
off-white,
beige
or
gray
tones
Staff
Lounge		and/or
Promote
rest
common activity
among
staff		of
Neutral
with
cool
tones
accents
tones
vibrant
and
colors
in activity
areas
    1. Provide acoustic control in all areas in the health facility will not exceed 60 DB based on the sound level meter (Equivalent to average office noise, normal conversation)
    1. Provide adequate ventilation and thermal control whether natural orartificial to ensure the comfort of patients and workers. Recommended Ambient Temperature is 23-26 degrees Celsius.
    1. Provide and maintain a clean, safe and sanitary facility and environmentfor hospital personnel, patients and clients, such as:
    • a. Stringent monitoring of the cleanliness of hallways, restrooms, and offices
    • b. Patient Feedback on the cleanliness included in the standardized client
    • c. Availability of functional and clean wash areas and restroom
    1. Incorporate of murals, paintings, and photos to main hallways and floors
    1. Dedicate 25% of the total land to vegetated open spaces/ efforts in increasing natural spaces as well as the use of endemic plants
    1. Provide child-friendly and spiritual/ religious spaces.

B. Establish efficient and effective Patient Navigation System within and across health facilities

    1. Establish a mechanism to facilitate patient navigation both within and across health facility through:
    • a. Policy on Patient Navigation System
    • b. Monitoring of compliance with their policy on their Patient Navigation system
    • c. Membership to a Referral Network
    • d. Monitoring of incoming and outgoing referrals
    1. Ensure that signage used within the health facility:

  • a. Follow the guidelines in the Implementation of the Unified Color, Signage Features, and Design of Identified Interior Spaces by the Department of Health

  • b. Provide updated and clear routing information

    1. Ensure a functional and visible Customer Service Unit by
    • a. Designating the appropriate person
    • b. Transparent Complaint Escalation Process
    • c. Monitoring of turnaround time

C. Patient Flow Analysis and Evidence-Informed Management

    1. Conduct Patient Flow analysis to identify areas of delay
    • a. Patient flow analysis and Action Plan
    • b. Monitoring and Evaluation of the action plan on patient flow
    1. Report and Utilize data on health facility operations based on performance measures for hospitals and other health facilities.
    1. Harmonize facility processes to reduce redundancy of work and increase patient interaction
    • a. Presence ofroot cause analysis, and action planning to reduce redundancy of work
    • b. Transitioning to Electronic Medical Record

III. Strategy No. 3: Client Engagement and Empowerment

Aside from improving the infrastructure and processes, a crucial part of IPCHS isto engage and empowertheir clients in deciding for their health. Health facilities may facilitate this through the following:

A. Health Literacy and Self-care of Clients

Provide programs/ activities that promote health literacy, self-care management, and patient rights. These programs mayinclude butare not limited to:

    1. Lecture series or advocacy campaigns with civic or patient groups/ organizations, carers, whether formal or informal, and their family.
    1. Provision of health literacy and self-care through social responsibility programs geared towards improving health-seeking behavior, with preference to the underserved or marginalized communities.

B. Improving Clinical Decision Making

    1. Establish a case management protocol that includes:
    • a. Clinical Pathways
    • b. Multidisciplinary team approach
    • c. Family Meetings
    1. Provide Personal Health Records

C. Incorporate of Patient Experience in Overall Evaluation of Health Services

Incorporate the concept of patient experience in client satisfaction through quantitative and qualitative through the standardized client experience survey to measure responsiveness.

D. Engage Civic Organizations/ Patient Groups

Representation of recognized patient groups/ organization in policy development ofthefacility.

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