ao deployment guidelines for public hearing

msp/psd/hhrdb/13-71 (Draft as of August 30, 2013, ver 4)

ADMINISTRATIVE ORDER

No. 2013 - ____________

SUBJECT: Guidelines on the Deployment of Human Resources for Health (DRAFT)

I. RATIONALE

Select cadre of Human Resources for Health (HRH) are being deployed by the Department of

Health to marginalized populations and other areas of need for the purpose of augmentation and

health service delivery. Currently, the department deploys nurses, doctors, midwives, and other

health professionals under the following programs: RN Heals Program, Doctors to the Barrios

Program, Medical Pool Placement Program and Rural Health Team Placement Program. Despite

these endeavors, equity and access to critical health services remains inadequately addressed.

With the commitment to attain universal health care, the HRH must be responsive to the needs of

our country and support the achievement of our MDG targets. This would require the right

quantity, quality and relevance of HRH to our health system needs. Therefore, there is a need to

harmonize the policies and processes for the placement and distribution of health professionals

through the deployment programs.

In order to ensure the success of HRH as a strategy for universal health care, there is a need to

create standard operational and administrative directions for all HRH deployed by DOH.

This Order aims to provide the structure and mechanism for the deployment of HRH managed by

DOH.

II. OBJECTIVES

General:

To provide policies and guidelines for implementation of the HRH deployment programs for the

purpose of improving access and health service delivery under universal health care.

Specific:

1. To provide guidelines for implementation to program managers and implementers.

Republic of the Philippines

Department of Health

OFFICE OF THE SECRETARY

Draft as of August 30, 2013, ver

4


2. To facilitate the implementation of deployment of HRH by influencing the manner by which

provinces and component LGUs and cities manage their local HRH

3. To provide a mechanism for program monitoring

III. SCOPE

This order shall apply to the entire public health sector, DOH bureaus, Centers for Health

Development, hospitals, DOH attached agencies including Philhealth, local government units,

and external development partners that are involved in the deployment of human resources for

health.

This order shall cover the implementation of deployment programs from the pre-recruitment to

program evaluation. This intends to unify existing guidelines for deployment of health

professionals for the purpose of improving access and health service delivery through provision

of HRH.

IV. DEFINITION OF TERMS

1. Community health team (CHT)- is a group of health volunteers assigned to each barangay/

priority population area led by a midwife that tracks eligible population for public health

services, assist families in assessing and acting on health needs, provides information on

available services in the locality and facilitates the organization of transportation,

communication systems, outreach services and linkages with other providers in the service

delivery network (Barangay health Station, Rural Health Unit, other small private and public

hospitals and facilities).

2. Deployment- means by which select health professionals are physically transferred in areas

of need to complement the existing HRH in health facilities and for effective and efficient

health service delivery.

3. Doctors to the Barrio Program- is a DOH program that deploys doctors to doctor-less

municipal health offices/ rural health offices as prioritized by the program to serve as their

municipal health officers or rural health physicians.

4. DOH retained hospital- refers to government hospitals managed and supervised by the DOH

5. Geographically isolated and disadvantaged area (GIDA)- communities with marginalized

population, physically and socio-economically separated from the mainstream society such

as island municipalities, up-land communities, hard-to reach areas, and conflict-affected

areas

6. Human Resources for Health (HRH) refers to health professionals currently engaged in

actions whose primary intent is to enhance health. They include physicians, nurses,

midwives, dentists, and allied health professions with valid license/registration from the

Philippine Regulatory Commission (PRC). They work in the different domains of the health

system including curative, preventive and rehabilitative care services as well as health

education, promotion and research. Under UHC it is an instrument to ensure that all Filipinos have access to professional health care providers capable of meeting their health needs at the appropriate level of care


7. Indigenous cultural communities/indigenous peoples -as defined in Republic Act No. 8371,

otherwise known as "The Indigenous Peoples Rights Act of 1997;"

8. Learning and development intervention– a process of imparting skills, knowledge or

competencies in order to improve performance and meet an agreed standard of proficiency.

This includes continuing professional education, training and other non-training

interventions.

9. Local health system- all organizations institutions and resources devoted to undertaking local

health actions. These include all provinces and their component LGUs, cities, private and

public health care providers local partners and families

10. Medical Pool Placement and Utilization Program- is a DOH program that deploys

physicians to government medical centers/ hospitals for augmentation of medical officers/

medical specialists

11. National Anti-Poverty Commission created by Republic Act No.8425 to serve as the coordinating and advisory body for the implementation of the Social Reform and Poverty Alleviation Program

12. National household targeting system (NHTS) a data bank and an information management

system managed by the Department of Social Welfare and Development (DSWD) that

identifies who and where the poor are. The system generates and maintains the

socioeconomic database of poor households

13. Poor families- refers families whose income fall below the poverty threshold as defined by

the National Economic and Development Authority and/or cannot afford in a sustained

manner to provide their minimum basic needs of food, health, education, housing and other

essential amenities of life

14. Registered Nurses for Health Enhancement and Local Service (RNHeals)-is a DOH

program that deploys registered nurses to government health facilities utilizing training cum

deployment approach.

15. Rural Health Midwife Placement Program- is a DOH program that deploys registered

midwives to RHUs and/or BEmONC facilities particularly in the far flung areas to provide

quality health services with focus on Maternal, Newborn, and Child Health Nutrition.

16. Rural Health Team Placement Program-is a DOH program that recruits and deploys allied

health professionals to complement existing workforce of hospitals and RHUs utilizing

training cum deployment approach. This may include dentists, nurses, pharmacists, medical

technologists, physical and occupational therapists, nutritionist-dieticians, midwives, and

sanitary inspectors.

17. Universal health care (UHC)- a focused approach to health reform implementation ensuring

that all Filipinos especially the poor receive the benefits of health reform

V. GENERAL GUIDELINES

1. All deployment programs for HRH shall promote improved access to professional health

care providers capable of meeting their health needs at the appropriate level of care

2. The success of the deployment programs shall then be monitored in terms of progress in

health outcomes, attainment of the MDGs, improvement in access to quality health facilities

and services and improvement of local health systems.

3. Deployment programs shall prioritize the poor and marginalized populations.


4. The DOH shall deploy appropriate HRH to either LGU health facilities or DOH- retained

hospitals.

5. The DOH shall engage local health systems and recognize that the LGUs have the primary

mandate to finance and regulate the local health systems including the provision of HRH

6. There shall be coordinated and harmonized participation of stakeholders, public and private

partnership; including academe, professional societies, non-government organizations

aligned to the objectives of the program.

VI. SPECIFIC GUIDELINES/IMPLEMENTING MECHANISMS

A. Organizational Structure

B. Roles and Functions

1. The Health Human Resource Development Bureau

a. Over-all management and supervision of the deployment of HRH

b. Formulate policies and guidelines relevant to the deployment program

c. Allocate funds for implementation of deployment programs.

d. Provide technical assistance and support services as may be necessary for the effective

implementation of the program

e. Conduct regular monitoring of program implementation.

f. It shall ensure that all skilled health professionals deployed possess the clinical

competencies required to deliver the health services in their facility or catchment area.

MUNICIPAL/

CITY HEALTH

OFFICE

HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

CENTERS HEALTH DEVELOPMENT

DOH/ DOH-RETAINED

CENTERS/ HOSPITALS

LGU

HOSPITAL


g. Decide on equitable allocation of deployed HRH

h. Provide policy directions that will ensure sustainability of programs and projects in

areas where HRH are deployed.

i. Provide learning and development interventions to select HRH

2. Recipient CHDs

a. Coordinate with the LGUs, hospitals, and DOH for strengthening of local health

systems in areas where HRH are deployed

b. Utilize funds for operationalization of deployment programs as allocated by DOH.

c. Facilitate deployment and conduct the HRH to areas

d. Determine the baseline competencies of the currently engaged HRH in relation to

needed health services in their area and provide for learning and development

interventions for the HRH.

e. Provide technical assistance and support services as may be necessary for the effective

implementation of the program

f. Conduct regular monitoring and evaluation of deployed HRH and overall program

implementation

g. Advocate and assist the LGU in the planning and implementation of retention

strategies

h. Conduct pre-deployment orientation of HRH

i. Conduct pre-deployment community preparation and LGU coordination through their

provincial health team office

3. Recipient Hospitals a. DOH retained hospitals and facilities shall endeavor to become effective instruments

to influence local health systems including but not limited to establishment of referral

systems and networks

b. Ensure proper coordination with DOH through the CHD and HHRDB for

implementation of deployment programs

c. Provide necessary capacity building for deployed HRH.

d. Conduct regular monitoring and evaluation of deployed HRH as scheduled by the

program and as necessary

e. Provide regular items within 3 years from the initial appointment of the deployed

personnel

f. Provide a hospital development plan in consonance with the national hospital

development plan

g. Participate in the registration and regular updating of health facility data to the

NDHRHIS

4. The LGU

a. Establish a functional local health board of which the deployed HRH shall be part

b. Utilize resources including but not limited to the following: internal revenue allotment,

Philhealth capitation fund, reimbursements, users fees and other sources to support

programs, activities, supplies, commodities, and incentives as support to the deployed

HRH


c. Allocate funds for honoraria, remote allowance, and other provisions of under the

Magna Carta for Public Health Workers as may be applicable.

d. Provide appropriate financial and logistic counterparts for the benefit and welfare of

the deployed HRH as stipulated in the governing laws for health workers including

but not limited to transportation, lodging and miscellaneous expenses related to

conduct of their duties.

e. Support learning and development interventions and other related opportunities of

deployed HRH by allowing them to attend such activities and providing needed

allowances

f. Support policies and plans aligned with the implementation of universal health care

and adoption of national health laws.

g. It shall endeavor to hire an adequate number of skilled health professional to attain

ideal ratio or staffing standard as prescribed by DOH

h. Ensure safety of deployed HRH

i. Encourage and support innovative projects for health systems development through

financial and administrative means including provision of incentives

j. Enter into and abide by a standard contract/ Memorandum of Agreement (MOA) with

the DOH

k. Provide feedback to CHDs on the performance of deployed HRH and program

implementation

5. Deployed HRH

a. Ensure client-centered delivery of services

b. Respond effectively and efficiently to the health needs consistent with accepted

standards of care

c. Aggressively promote healthy lifestyle to reduce and prevent non-communicable

diseases

d. Initiate and participate in public health measures to prevent and control of

communicable diseases and adequate surveillance and preparedness for emerging and

re-emerging diseases.

e. Promote inter-agency and inter-sectoral cooperation for health

f. Perform other functions as mandated under the existing pertinent national laws and

protocol (eg. Local Government Code, Hospital Institutional Policies, Civil Service

Code)

g. Enter into and abide by a standard contract/ Memorandum of Agreement (MOA) with

the DOH

h. Provide feedback to CHDs on the performance of recipient LGUs/ hospitals and

program implementation

6. PhilHealth and other development partners

a. Utilize financial instruments and strategies to motivate HRH and promote retention

through grants, incentives, capitation, and other means.

b. Allocate funds for improvement of health facilities and working environment/

conditions of deployed HRH

c. Provide support for the development of HRH and local health systems projects,

scholarships, and research.


d. Ensure the sustainability and institutionalization of assistance projects for HRH

e. Cooperate in the establishment of monitoring systems to track effectiveness of

development projects

C. Policies and Procedures

The manner of implementation shall include recruitment, selection, and deployment.

Criteria in Selecting Priority Areas for Deployment

The DOH shall determine the ideal number and type of HRH needed for the delivery of

health services based on the following criteria:

1. Estimated number of clients (based on population in catchment area)

2. Geographic and socio-economic distribution of the area (GIDA, CCT target areas,

NAPC target areas)

3. Presence of public and private providers in the area

4. Number of currently deployed HRH and staffing standards

The ideal number shall be based on ratio of 23 HRH per 10,000 populationi for rural

health units and on staffing standards set by NCHFD for hospitals as published and

disseminated to provide guidance to sustainable staffing plan of necessary skilled health

professionals.

5. Accreditation status (PhilHealth, specialty training program, or others as may be

applicable)

6. Specialized care or services as mandated by law (medical centers, provisions under

Responsible Parenthood and Reproductive Health law, Sin Tax law, and others as may

be applicable). Graduates of residency programs from DOH can be deployed as

specialists to LGU hospitals provided that it will not compromise the staffing standards

of the DOH facility.

Requirements to be submitted to CHD by requesting LGUs

The DOH may provide support to LGUs upon request in order to attain adequate

number of HRH through deployment of HRH provided that:

a. The LGU has met the criteria set by the program and after submission of required

documents including but not limited to the following:

a.1 Signed request from the head of office addressed to the CHD

a.2 Signed SB resolution supporting the request

a.3 Copy of the latest health budget reflecting the percentage of budget allocated for

health including for personnel services

a.4 Current HRH to population ratio

a.5 PhilHealth accreditation certificate (if applicable)

b. All existing and available plantilla positions have been filled and opportunities

provided under sec 325 of the local government code have been fully exhausted

c. Graduates of residency programs from DOH hospitals can be deployed for in service

training programs in LGU hospitals that require specialists and met other criteria as

prescribed by the program.


d. In addition, hospitals must submit hospital development plan in consonance with

national hospital development plan.

Procedures for Deployment

Pre-recruitment

A. Hospitals

1. Hospitals submit request for additional HRH to CHD

2. CHD evaluates and validates:

2.1 Hospital as a qualified recipient

2.2 Request for additional HRH

3. CHD submits to HHRBB a list of qualified recipients based on set criteria

along with required documents. It shall be submitted in within the 1st week

of the month of submission as prescribed by the program.

4. HHRDB evaluates request, finalizes number of HRH to be allocated for the

hospitals, the list of qualified recipients and their HRH allocation for

feedback to CHD. HHRDB shall publish and inform the CHDs of the

number of HRH allocated for the hospitals and LGU in their catchment

areas based on approved budget and number of positions for the current

year.

5. HHRDB shall validate the requests and finalize the list of qualified

recipients 1 month prior to the start of recruitment.

6. CHD coordinates results with requesting hospitals

7. The HHRDB and CHDs shall announce the opening of recruitment to their

target stakeholders.

B. RHUs and CHOs

1. LGUs submit requests for additional HRH to CHDs along with necessary

supporting documents

2. CHDs evaluate and validate:

a. LGUs as qualified recipients

b. LGUs’ request for additional HRH

3. CHDs submit a list of qualified recipients to HHRDB

4. HHRDB evaluates requests and finalizes the list of qualified recipients and

their HRH allocation for feedback to CHD

5. CHD coordinates results with requesting LGUs

Recruitment and Selection


The HHRDB shall open the application for the deployment programs on their

prescribed schedule. Job posting/ publication shall be done through the web page,

school announcements/ publication, contact persons, media, civil service

commission bulletin, as deemed appropriate. It shall include the requirements,

core competencies, and benefit package. The information on where to apply shall

also be included.

A. Hospitals

1. HRH applies to the hospital and undergoes hospital recruitment and selection

process.

2. Hospital endorses qualified HRH to DOH through the CHDs

3. CHDs validate the list of selected applicants and submit to HHRDB

4. For Physicians: HHRDB processes the appointment papers/ contracts of

selected HRH

5. For other HRH: CHD processes the appointment papers/ contracts of selected

HRH

B. RHUs and City Health Offices (CHOs)

1. HRH accomplishes the application form and undergoes recruitment and

selection process of the CHD-HRDU or through its extension offices. All

regional applicants must file a letter of application addressed to the regional

director.

2. CHD-HRDU recommends qualified HRH to the Regional Director

3. CHDs endorses the list of selected applicants to HHRDB

For Doctors: HHRDB processes the appointment papers/ contracts of selected

HRH

For Other HRH: CHD-HRDU processes the appointment papers/ contracts of

selected HRH

Pre-deployment

HHRDB shall conduct pre-deployment orientation for doctors.

CHDs will conduct regional pre-deployment orientation for other HRH to be

deployed in the RHUs and CHOs within their catchment areas. A maximum of 2

week regional orientation or exposure shall be observed provided that the necessary

preparations in the area of deployment and other conditions for deployment have been

met.

Hospitals shall also conduct institutional pre-deployment orientation

Deployment


A. Hospitals

For Physicians:

1. Upon approval of appointment or contract, HHRDB issues a Department

Personnel Order (DPO) relevant to their places of assignment

2. Physicians report to their areas of assignment

3. HRH submits daily report of attendance to Hospitals

4. Hospitals submit the monthly report of attendance to HHRDB

5. HHRDB process payments for deployed HRH

For Other HRH

1. HRDU submits list of selected HRH for approval of Regional director

2. CHD issues Regional Personnel Order relevant to their places of assignment

3. HRH report to their areas of assignment

4. HRH submits daily report of attendance to Hospitals

5. For DOH Hospitals: hospitals process payments in form of salary or stipend as

appropriate

For LGU Hospitals: hospital submits daily report of attendance to the CHDs.

CHDs process payments for the deployed HRH

B. RHUs and City Health Offices (CHOs)

For Physicians:

1. Upon approval of appointment or contract, HHRDB issues a Department

Personnel Order (DPO) relevant to their places of assignment

2. HHRDB conducts pre-deployment orientation

3. CHDs conduct necessary LGU preparation and coordination which

includes: orientation of LGU/ Health Board, processing of MOA, and social

preparation

4. Physicians report to their areas of assignment

6. Physicians submit daily report of attendance to their respective CHDs

7. CHDs submit the copy of the daily report of attendance to HHRDB

8. HHRDB process payments for deployed physicians

For Other HRH

1. Upon approval of appointment or contract, CHDs issue a Regional Personnel

Order (DPO) relevant to places of assignment of HRH

2. CHDs conduct pre-deployment orientation

3. CHDs conduct necessary LGU preparation and coordination which

includes: orientation of LGU/ Health Board, processing of MOA, and social

preparation


4. HRH report to their areas of assignment

5. HRH submit daily report of attendance to their respective CHDs

6. CHDs process payments for deployed HRH

Appointment/ Contract is evaluated yearly and renewed based on satisfactory

performance

Salaries and Benefits

Deployed HRH shall receive payments in the form of salary or stipends, whichever is

appropriate. HHRDB shall process payments for deployed physicians. CHD shall process

payments for other deployed HRH.

Deployed HRH with approved appointments under temporary regular items shall receive

other benefits as mandated by applicable laws (CSC, Magna Carta for Public Health

Workers, etc).

Deployed HRH with signed contracts shall receive other mandatory benefits as stated in

their contracts to include but may not be limited to PhilHealth and GSIS group insurance.

Sanctions

Any deployed HRH and concerned government personnel found and verified to have

violated provisions stated herein for purposes of graft and other related offense shall have

administrative liabilities subject to CSC rules and regulations, and implementing policies

and regulations in their respective health facility or institution.

Continuing Education and Capacity Building

DOH shall provide financial support for learning and development interventions (includes

trainings, continuing education, and other capacity building activities) pursuant to existing

guidelines. The LGU shall shoulder the transportation and living expenses of attending

HRH during the training as their counterpart.

Monitoring and Evaluation

1. The deployed HRH shall be monitored semi-annually and evaluated annually.

2. The monitoring should reflect availability of HRH, performance of HRH, factors

hindering utilization of health services in relation to HRH

3. Parties conducting monitoring shall utilize a prescribed monitoring tool prescribed

by the HHRDB.

4. HHRDB shall validate and monitor compliance of CHDs and Hospitals to

deployment guidelines

5. Results of the monitoring shall be forwarded to the HHRDB through a memo with a

monitoring report form provided by HHRDB. Likewise, the recommendations and

actions taken shall be included in the report.


Retention strategies

The recipient of deployed HRH shall support and endeavor to retain the deployed HRH in

their facility and abide by stipulations of their signed MOAs.

For Hospitals: Within 3 years from the date of initial appointment, shall endeavour to

provide regular items for deployed HRH

For RHUs and CHOs: Within 2 years from date of initial deployment, shall prepare ways and

means for hiring of deployed HRH

In cases, wherein the recipient facility fails to retain the deployed HRH from the national

government, it shall ensure that the loss of the HRH that will not result to the following:

a. Loss of existing PHIC accreditation of health facility

b. Discontinuation of development projects from funding of development partners

c. Compromise of critical health programs related to attainment and sustainability of

HRH

Logistical support, Funding Source, and Budget utilization a. The deployment of HRH shall be considered a special program under the HHRDB

b. All direct and incidental expenses related to deployment shall be charged against

DOH funds.

c. HHRDB shall sub-allot fund to CHDs for the payment of salaries or stipends of other

HRH and other related activities as specified by the program.

d. All direct and incidental expenses for activities conducted by CHD personnel related

to conduct of technical assistance, capacity building, monitoring, and providing

logistical support to deployed HRH shall be charged against CHD funds.

e. All direct and incidental expenses on activities conducted by HHRDB personnel

related to program implementation and monitoring shall be charged against HHRDB

funds.

f. Transportation expenses incurred during the initial deployment of HRH to the areas

of assignment and during the termination of the contract or end of appointment shall

be charged to DOH funds. Expenses incurred during attendance to learning and

development activities shall be charged to the sending office unless otherwise

specified by the sponsoring office.

Other special provisions

Recruitment of HRH for deployment programs shall prioritize recipients of national

scholarship programs. After having complied with the minimum requirements,

graduates from the scholarship programs sponsored and managed by DOH shall be

accepted in the HRH deployment programs.

The implementation shall be consistent with the government’s commitment to zero-

corruption and anchored on participatory governance transparency and accountability

in all levels.


VII. REPEALING CLAUSE

All other issuances inconsistent with the provisions of this Order are hereby repealed/rescinded

and modified accordingly.

VIII. SEPARABILITY CLAUSE

If for any reason, any part or provision of this Order be declared invalid or unconstitutional, such

shall not affect the other provisions which shall remain in full force and effect.

IX. EFFECTIVITY DATE

This Order shall take effect 15 days upon approval.

ENRIQUE T. ONA, MD, FPCS, FACS

Secretary of Health

Office HHRDB HPDPB ATC OSEC

Signature

Date

i The minimum threshold of 23 doctors, nurses and midwives per 10,000 population that was established by WHO as necessary to deliver essential maternal and child health services

ao deployment guidelines for public hearing

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