Republic of the Philippines Department of Health OFFICE OF THE SECRETARY

May 30, 2022

DEPARTMENT CIRCULAR No. 2022- 0293

ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES OF HEALTH; MINISTER OF HEALTH - BANGSAMORO AUTONOMOUS REGION IN MUSLIM MINDANAO; DIRECTORS OF BUREAUS, SERVICES, AND CENTERS FOR HEALTH DEVELOPMENT; CHIEFS OF DEPARTMENT OF HEALTH MEDICAL CENTER HOSPITALS; EXECUTIVE DIRECTOR OF SPECIALTY HOSPITALS, PRIVATE HEALTH FACILITIES, LOCAL GOVERNMENT UNITS, AND OTHERS CONCERNED

SUBJECT:

Interim Guidelines on the Assessment of Medical Certification of Cause of Death (MCCOD) in Health Facilities

I. RATIONALE

The Department of Health (DOH), guided by FOURmula One Plus for Health (F1 plus) ensures the generation and use of evidence in health policy development, decision-making, and program planning and implementation. One of the bases for health program management and policy development is the country's mortality data, particularly, the cause of death. With this, the DOH in collaboration with Bloomberg Philanthropies Data for Health Initiative (D4H) has initiated training activities and issued policies for the implementation of the MCCOD Program that aims to improve the country's mortality statistics. In addition, the DOH through the Knowledge Management and Information Technology Service (KMITS) issued Administrative Order No. 2020-0008, or The Rules on Medical Certification of Cause of Death (MCCOD) to provide a standard procedure for reporting, certifying, and reviewing the cause of death.

In support of these mandates, the Health Facility Development Bureau (HFDB) aims to institutionalize the process of the MCCOD monitoring system in the health facilities through the Hospital Health Information Management (HHIM). This is geared towards the HFDB's function in ensuring the development and management of health facility-based programs for the success and sustainability of its implementation.

While medical certification is for physicians, the HFDB through the HHIM has seen the opportunity to develop a layer of quality assessment in recognizing their role in the process of medical record management, morbidity statistics, and function in transcribing the data to an official death certificate. This will assure the MCCOD's accuracy and completeness before its registration to the Local Civil Registrar.

Hence, this aims to standardize the process of MCCOD assessment of health facilities and utilize the data towards improving the quality of the death certification. The establishment of the system is part of the continuous quality improvement of HHIM in providing quality health records and reliable data for health facility planning and decision making.

II. OBJECTIVES

This guideline is issued to provide the interim processes and procedures essential to adopt and implement the MCCOD assessment and monitoring in the Health Facilities.

III. SCOPE

The Department Circular shall apply to all government and private hospitals, and concerned entities, particularly those identified as certifiers and reviewers under Administrative Order 2020-0008, or the Rules on MCCOD.

IV. GENERAL GUIDELINES

A. All HHIM Staff must be trained on the Assessment of MCCOD. The e-learning modules for the Assessment of MCCOD can be accessed through the DOH Academy.
B. A trained HHIM staff shall be assigned to partner with the health facility's MCCOD-trained physician in the conduct of monthly death certificate assessment. A designated trained physician of the health facility shall review, assess, and endorse the data to the HHIM Staff for the encoding of reports.
C. The designated HHIM Staff shall prepare monthly death certificates to be assessed by the physician and encode the report in the MCCOD Assessment Module found on the DOH Data Collect (DDC) Hub at hfpddc.doh.gov.ph.
D. The assessment of death certificates by the health facilities shall be done on a monthly basis and the submission of the monthly assessment report shall be through the encoding of needed data on the MCCOD Assessment Module on or before the 15th of the following month. Annex A and Annex B provide the overall process flow on the death certificate sampling and assessment by Health Facilities.
E. The Centers for Health Development (CHD) and Ministry of Health Bangsamoro Autonomous Region in Muslim Mindanao (MOH-BARMM) through their Health Facility Development Unit (HFDU) shall monitor, ensure completeness, and validate the data submitted by the health facilities. The CHDs shall generate the annual report and submit it to HFDB on or before January 31st of the following year.
F. The DOH-HFDB in coordination with Knowledge Management and Information Technology Service (KMITS) shall collate and analyze the data for an annual report regarding the status of MCCOD implementation in the health facilities.

V. SPECIFIC GUIDELINES

A. Sampling Method

The total number of monthly death certificates to be assessed by the health facility shall be based on the following conditions:

Total Deaths per month in the Health Facility	Total Death Certificates to be assessed per month
>100	100 (selected through systematic random sampling)
≤100	All generated death certificates for the month

1. The health facilities shall use Systematic Random Sampling in the monthly selection of 100 death certificates to assess if the total number of deaths for the month is more than 100. The following process shall be followed (See Annex A for Process Flow):
- i. HHIM Staff shall make a list of the death certificates for the month in ascending order based on the date of certification. This means that earlier values precede later ones, e.g. 01/15/2021 will sort ahead of 01/16/2021.
- ii. To randomly select the 100 death certificates to be assessed, the assigned HHIM Staff shall select every 5th death certificate from the list prepared.
- iii. Continue selecting every 5th death certificate until you arrive at a total of 100 death certificates to assess.
- iv. Proceed with the Assessment of the 100 death certificates randomly chosen.

B. Conduct of MCCOD Assessment

The result of the monthly assessment of death certificates shall be encoded in the MCCOD Assessment module through the DDC Hub using the health facilities' account. The health facility must be registered in the National Health Facility Registry (NHFR) to have access to the DDC Hub.

The generated reports will show the errors and their frequencies which will be utilized to identify gaps in the implementation for the improvement of the death certification. All relevant materials may be accessed through the links below:

Orientation regarding the use of Health Facility Profiling System, now known as DOH Data Collect (DDC) Hub

Link: bit.ly/HFP-AVDrive

CRVS Technical Guide, Assessment of quality of medical certification practices: A quick reference guide (pdf file, 1.5 MB, 5 pages)

Link: https://bit.ly/TechnicalGuide MCCOD

Training on Medical Certification of Cause of Death for Licensed Physicians in the DOH Academy (Open access course)

Link: https://learn.doh.gov.ph/

C. Encoding and Generation of Reports

1. All Health Facilities shall:
- i. Accomplish the MCCOD Assessment module monthly, on or before the 15th of the following month. This shall be monitored by the HFDU.

Ex. For the monthly assessment of January Death Certificates, the health facility shall accomplish and encode the data on the DDC Hub on or before February 15.

ii. Ensure that complete data of the assessed MCCOD is encoded on the website.

2. All CHD-HFDU shall:

i. Monitor, verify, and follow up submissions of health facilities monthly.
ii. Generate annual report to be submitted to DOH-HFDB on or before January 31st of the following year.
iii. Refer to Annex C for the process flow on report generation and monitoring in the DDC Hub.

D. Prescribed Implementation Timeline

All Health Facilities and the HFDUs shall follow the timeline below:

2022
Q3	Policy Issuance/Dissemination and Capacity Building through DOH Academy E-Learning Platform
Q4	Implementation covering MCCOD Assessment reports starting 4th quarter of 2022.

For dissemination and strict compliance.

By Authority of the Secretary of Health

LILIBETH C. DAVID, MD, MPH, MPM, CESO I

Undersecretary of Health

Health Facilities and Infrastructure Development Team

ANNEX A.

Process Flow of systematic random sampling by Health Facilities for the selection of 100 death certificates to assess

HHIM Staffshall make a list of the death certificates for each month in ascending order based on the date of certification. This means that earlier values precede later ones e.g. O1/15/2021 will sort ahead of 01/16/2021.

Note: This is onty applicable to HFs with a total of more than !00 death certificates processed for the month,

To randomly select the 100 death certificates to be assessed, the assigned HHIM Staff shall select every 5th death certificate from the list prepared.

| Continue selecting every 5th death certificate until] you arrive at a total of 100 death certificates to assess.

Proceed with the Assessment of 100 death certificates. {Refer to AnnexB)

Note: Health Facilities with less than ¹⁰⁰ monthly death certificates shall assess and reportall generated death certificates for the month.

ANNEX B.

Process Flow on the Assessment of Death Certificates in Health Facilities

Person Responsible	Activity	Frequency
Trained HHIM Staff	Prepares the monthly certificates to be assessed through systematic random sampling. Endorses the death certificates to be assessed by the trained physician in the health facility.	Monthly
Designated Trained Physician	3. Performs the death certificate assessment based on the standard tool. 4. Endorses the result of the assessment to the HHIM Staff.	Monthly
Trained HHIM Staff	5. Encodes the monthly data on the MCCOD Assessment module on the DDC Hub.	Monthly (Deadline: on or before the 15th of the following month)
CHD-HFDU	6. Monitors, verifies, and follow up submission of Health Facilities.	Monthly
	7. Generate annual report to be submitted to DOH-HFDB.	Annually (on or before January 31 of the following year)

ANNEX C. Flowchart of Report Generation and Monitoring in the DOH Data Collect Hub

DC 2022-0293: Medical Certificate of Cause of Death

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