office of the secretary - secretary of health

Republic of the Philippin

Department of Health

OFFICE OF THE SECRETARY

JUN 1 3 2016

ADMINISTRATIVE ORDER

No. 2016 -

SUBJECT: Standardization of Per a ita Bud et for Meal Provision of Patients

1. BACKGROUND AND RATIONALE

According to the Hospital Licensure Act (RA 4226) of 1971, the Nutrition and

Dietetics Service is one of the six (6) major services of a hospital and is integral to total

patient care. As such, the Nutrition and Dietetics Service of each hospital plays a crucial

role in quality patient care which includes provision of nutritious meals tailored to the

patient's specific health condition.

Studies show that malnutrition cases among hospital patients are at an alarming rate,

which may be starvation-related, chronic-disease related, or hospital-related. A I O-year

study conducted by St. Luke's Medical Center revealed that 45.6% of their patients were

malnourished while admitted in the hospital. Moreover, the Philippine Society for

Parenteral and Enteral Nutrition states that the rate of malnutrition in Philippine hospitals

is 35 to 50 0/0. This malnutrition rates are in fact reflective of undernutrition.

An analysis of the one-week cycle menu presented bv five

(S) (10) DOH Hospitals in Visayas and Mindanao regions that

kilocalorie daily allowance is met while fòr the macronutrient Intake, carbohydrates IS met

at 63%, prote:n at 70% and fats at 53% with the mean daily cost of the diet at Php 74.39

per patient. The cost of meal ranged from Php 45.20 to Php 61.68/ patient meal / day in

LGUfunded level I to 3 hospitals, while in DOH-funded Medical Centers and Regional

Hospitals the range was Php 61.63 to Php 68.79. (Evaluation ofDietary Services ofSelected

Hospitals, Philippines, 2014).

It is therefore imperative for government hospitals to be allocated with increased

per capita budget for meals to enable the Nutrition and Dietetics Service to achieve its goal

of providing patient-centered dietetics services which are focused on the quantity and

quality of meals served to inpatients.

11. OBJECTIVES

General Objective:

To prescribe and implement a standardized per capita budget fòr meals of Inpatients in

DOH and I-GU Hospitals.

and

2

OFFICE OF THE CHIEF

Specific Objectives:

l. To provide guidance to Hospital Administrators and Nutritionist-Dietitians on the

planning and implementation of interventions appropriate for hospital inpatients

within the recommended per capita budget.

2. To sucport budgetary increase and standardization for inpatient meals.

111. GUIDING PRINCIPLES

This Order is governed by the following principles:

1. Rights-based Approach. The provision of diet based on the disease condition of each patient

is anchored on respect for the rights to nutritionally adequate and sate "l stipulated in the

Philippine Constitution.

2. Systems Approach. Sustained provision of nutritionally adequate and appropriate

diet is contingent on the adoption of a systems approach that initiates fundamental

reforms in health and nutrition service delivery management.

3. Life-cycle Based Interventions. The health and nutritional care must be aligned with

the requirements and conditions of individuals at various stages of the life-cycle.

4. Equity. Population groups confined in DOH and LGU Hospitals with the least

access to quality health and nutritional care must be given top priority for provision

of meals and special dietary needs.

5. Comvlement of Interventions. Health and nutritional care must be complemented with

other dietetics services including nutrition counselling. case rcfQltal fc,ilow-up.

6. Evidence-based Interventions and Approach. This policy guideline was developed

based on 2013 Evaluation of Dietary Services of Selected Hospitals gathered by the

Food and Nutrition Research Institute-Department of Science and Technology and

from other relevant researches and studies.

Dietary Diversification. Meeting the prescribed energy and nutrient requirements of

in-patients can be facilitated through offerings of variety of food sources at minimal

cost. This is attainable through increased food production in the hospital and

establishment of sustainable food networks.

Iv. SCOPE AND COVERAGE

This Order shall apply to all Government Hospitals under the DOI l. National

Government Agencies (NGA) Hospitals, and the IX)cal Govetmment I those

under Government Owned and Controlled Corporations. The allocated per capita meal

budget covers both Regular and Special Diets as prescribed for inpatients.

Received

.l)ate:

3

V. DEFINITION OF TERMS

I. Adequate Nutrition - also known as good nutrition, attained through the right balance

of macronutrients and micronutrients to deliver the appropriate Recommended Energy

Nutrient Intake (REM) and Total Energy Requirement (TER) for the patient fast

recovery and reduced length of hospital stay.

2. Budgetary Meal Allowance - an estimated cost of meal/day which serves as basis for

comparison and control Of food expenses especially for expenditures at the Nutrition

and Dietetics Service.

3. Continuum of Care - is a concept involving an integrated system of care that guides

and tracks patients over time through a comprehensive array of health and nutrition

services spanning all levels of care.

4. Diet — a measured regimen of food and beverages a person eats and prescribed

period of time. This includes special or therapeutic dlets for inpatients.

5. Dietetic Intervention — refers to a plan of action designed with the intent of changing

dietary-related behaviours, risk factors, environmental condition and other aspects Of

nutrition and health affecting the status of an individual, group or population.

6. Food Quality and Safety Standards are tools/parameters/guidelines to food processing

and preparation, food labelling, food hygiene, food additives and pesticide iTRidues.

Policies on biotechnology and food for the management of governmental import and

export inspection and certification systems for foods are also covered.

7. Hospital Food Service — a section in the health care facility that plans, prepares, serves

meals according to acceptable standards of management such as aesthetics appeal, taste

sanitation, nutrition, budget and the Pac Illttes

8. Nutrition and Dietetics Service - is a section in the health care facility headed by a

permanent licensed Nutritionist —Dietitian that primarily provides quality and

nutritionally adequate diet for optimal nutrition among inpatients.

9. Recommended Energy and Nutrient Intake (REM) — is the daily requirement for

energy, protein, carbohydrates, fat, vitamins, electrolytes, minerals, and water.

10. Special Dietary Requirement — refers to the minimum amount of specific nutrients

needed by the body to attain a specified state of health. (See Annex A)

I l . Therapeutic Diet — is a meal plan which is a modification of regular diet prescribed

by a physician and planned by a Nutritionist-Dietitian that is tailored to fit the nutrition

need of a particular person based on his/her medical condition

4

G NERAL GUIDELINES

The following guidelines should be observed In all Hospi la:

1. Nutrition and Dietetics Service shall ensure delivery of health and nutrition care of

utmost quality that will provide patient's meals, especially those dietary

requirements and/or prescribed therapeutic diets to achieve the best possible

outcome.

2. Hospitals shall provide adequate budget appropriation based on the following:

a) Chiefs of Hospitals shall strictly enforce 1,800 kcalories as prescribed by the

physician for a normal and regular diet of an adult person using actual number

Of inpatients or an equivalent of at least the Php150 pesos/day meal allowance

for inpatient. Basis of computation is shown in Annex B and Annex C.

b) DOH and all other government hospitals shall earmark a per capita meal budget of at

least Php 150.00/day sourced from hospital Income, Philhealth general

appropriations (MOOE) and other possible sources.

c) This minimum rate shall apply to all patients regardless of capacity to pay or

income classification.

d) Adjustment of the per capita meal budget allowance shall be based on the

inflation rate of every three years.

e) Unless otherwise prescribed by the attending physician, DOH and government

hospitals shall serve inpatient meals of at least 1,800 kcalories per day of the

patient's energy requirement provided by the following major nutrients:

carbohydrates (60%), protein (15%) and fats (25%).

Q//IMPLEMENTING MECHANISMS

The oversight for the implementation of this policy shall rest 'A lth the Ilealth

Development Bureau under DOH Cluster Head of Office fòr Technical Services-B.

Recognized stakeholders based on their mandates shall assist in the implementation of the

policy nationwide.

In order to institutionalize the implementation of this Standardized Meal Allowance

Initiative, the DOH Central Office and attached agencies, DOH Regional Offices, DOH

Hospitals, Local Government Unit (LGU) Hospitals, and National Government Agencies

Hospitals (NGA) shall:

1. sseminate and inform staff about the Standardized Meal Allowance initiatives.

2. Ensure that the Hospital Finance Officer implements at least Php 150.00 pesos per patient per

day the policy for budget and procurement purposes. Other computation for the Total Energy

Requirement shall emanate from the or Recommende.l Energy Nutrient Intake (RENI) or based

from the prescribe diet ot the pli', a specific individual.

3. The amount of one hundred fifty pesos (Php 1 50.00) for 1,800 calories/dav as

prescribed by the physician is applicable to all diets, whether Regular Therapeutic,

and even for Tube feeding preparation in all kinds ot patients. c or paying.

4. Ensure that the Hospital Food Service shall serve meals to patients based on

guidelines prescribed by this Administrative Order.

5. Ensure that patient's adequacy of intake shall be monitored through plate food

waste, patients' satisfaction survey regularly done and analyzed by the

Nutritionist- Dietitian.

6. Ensure that the Chief Nutritionist-Dietitian of the hospital submits an annual

report to the Chief of Hospital concerning compliance with the Administrative

Order, copy furnished the Department of Health - Health Facility Development

Bureau.

VIll d(Roles and Responsibilities

A. Department of Health

I. Health Facility Development Bureau (HFDB)

The DOH- HFDB shall oversee the implementation of this Order. It will undertake

the following tasks:

a. Lead in the advocacy and dissemination of the policy in the DOH-Retained and

LGU Hospitals.

b. Coordinate and provide nutrition technical inputs for the operationalization of the

policy and other relevant initiatives.

c. Lead in the monitoring and evaluation of the policy implementation.

d. Lead in the periodic conduct of research and development strategies relative to the

policy implementation.

2. DOH -Regional Offices

a. Guide the implementation of the policy in all DOH and I-GU hospitals

within its

catchment areas.

b. Support the dissemination of the policy at the regional level.

c. Advocate for the adoption of the policy to LGUs.

d. ide technical assistance to LGUs on the provisions of the policy.

c. Support monitoring and evaluation of policy implementation.

f. Facilitate submission of reports from DOH Retained Hospitals and LGUs.

3. DOH Hospitals

a. Ensure the adoption and implementation of the policy.

b. Build capacities for the implementation of the policy.

e. Monitor the prescribed menu through the Chief Nutritionist-Dietitian of 1,800

kcalories with the equivalent of at least Php 150.00/day meal of a patient or as

prescribed by the physician or any other computation of Total Energy Requirements

(TER) of a patient.

d. Earmark appropriate budget for the policy operationalization

e. Monitor and evaluate the outcome and impact of the policy implementation.

f. Provide feedback for policy review and updating.

g. Prepare and submit reports of accomplishments.

4. Local Government Unit Hospitals

a. Ensure the adoption and implementation of the policy.

b. Advocate for the adoption of the policy through the issuance of Executive

Orders, ordinances, etc. to Local Chief Executives (LCEs).

c. Earmark appropriate budget for the policy operationalization.

d. Build capacities for the implementation of the policy.

e. Monitor and evaluate the outcome and impact of the policy implementation.

f. Provide feedback for policy review and updating.

g. Prepare and submit reports of accomplishments.

5. Philippine Health Insurance Corporation (PhilHealth)

a. Integrate the budget for the Nutrition and Dietetics Service in the computation

of rates and diagnosis- related groups (DRG).

b. Monitor the compliance of hospitals in the breakdown of budget allocation.

rx. REPEALING CLAUSE

All issuances inconsistent with this policy are hereby revised, modified, or rescinded

accordingly.

X. EFFECTIVITY DATE

This policy shall take effect immediately after publication in the DOH Intranet and in a

newspaper of general circulation.

JANETT1f P. LARIN, MD, MBA-H

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Annex B

JUSTIFICATION ON THE COMPUTATION OF MEAL ALLOWANCE AT THE

NUTRITION AND DIETETICS SERVICE FOR TIIE P150.OO/DAY/PATIENT

Breakfast Lunch Su er

Day

1

Day

2

Day

3

Day

4

Day

1

Day

2

Day

3

Day

4

Day

1

Day

2

Day

3

Day

4

37.21 52.62 44.93 53.42 52.46 48.82 49.72 44.22 57.71 43.91 52.07 47.41

Average cost: P47.50 Average cost: P48.81 Average cost: P50.27

Average cost: P 146.58/patient/dŽn

13-1

JUSTIFICATION ON THE COMPUTATION OF MEAL ALLOWANCE AT THE

NUT1eTION AND DIETETICS SERVICE FOR THE P150.OO/DAY/PATIENT

Day 1

BREAKFAST LUNCH SUPPER

1 .5 1

Cost of Raw Food 24.64 89

Cost of LPG 1.51 1.51

Cost of Water .14 .14 .14

Cost of Electricity 1.24 1.24 1.24

Cost of Labor 8.6 8.6 8.6

Others

Food Wrap .90 .90 .90

Liquid Soap .10 .10 .10

Annex B

Powdered Soap .04 04

02 Sodium Hypochlorite 02

Disposable hand gloves .02 .02 .02

37.21 52.46 57.71

TOTAL 147.38

13-2

Day 2


Cost of Raw

Food

40.05 36.25 31.34

Cost of LPG 1.51 1.51 1.51

Cost of Water .14

1.24

Cost of

Electricity

I .24


Otlærs

Food wrap .90 .90 .90

Liquid Soap 10 .10 .10

Powdered

Soap

.04 .04 .04

02 Sodium

Hypochlorite

.02 02

Disposable

hand gloves

.02 .02 .02

52.62 48.82 43.91

TOTAL 145.35

Day 3

02

Annex B


Cost of Raw

Food

32.36 37.15 39.5

Cost of LPG 1.51 1.51 1.51

Cost of Water .14 .14 14

Cost of

Electricity

I .24 1 24


Others

Food wrap .90 .90 .90


Powdered

Soap

.04 .04

Sodium

Hypochlorite

.02 .02 .02

Disposable

hand gloves

.02 02

44.93 49.72 52.07

TOTAL 146.72

Day 4


Cost of Raw

Food

40.85 31.65 34.84

Cost ofLPG 1.51 1.51 1.51

Cost of Water .14 .14 14

Cost of

ziectricity

1.24 1.24 1.24

Annex B

Cost of Labor 8.6 8.6

Others

Food Wrap .90 .90 .90


Powdered

Soap

.04

Sodium

Hypochlorite

.02 .02 .02

Disposable

hand gloves

.02 .02

.02

53.42

TOTAL 145.05

COST OF LPG

Ave. Consumption : Cylinders (50kg) in 3 days

• P2730/50kg cylinder

• P2730.OO X 2 cylinder = P5,460.OO

• P5460.OQ

3 days

• PI 820.00 400 pts.

• P4.55/2t

3 meals

Cost of LPG/Patient/Meal.• P 1.51 /Dt/meal

COST OF ELECTRICITY

Average Consumption:6 269.61 KwHR,/Month — P44 514.23/month

P44 514.23/month 30

days

P1483.81/day

3 meals

p494.6()

400 patients

Annex B

Cost of Electricity/Patient/Meal: = PI .24

COST OF WATER

Average Consumption:90 cu.m/month (P4.884.4())

P4 884.40

30 days

P 162.81/day

3 meals p 54.27

400 patients

Cost of Water /Patient/Meal. • —- PO.14

13-6

COST OF LABOR

Personnel No. of

Personnel

Rate /day Total

NutritionistDietitian

Il

3 I I R I

.00

NutritionistDietitian

-

Contractual

1 355.00 355.00

Cook 11 4 546.27 2185.08

Cook-Contractual 1 275.00 275.00

Office Aide 1 275.00 275.00

Food

ServerContractual

13 275.00

27500

3575.00

Encoder-

Contractual

10,333.80

Cost of Labor/Day/Patient

= 10,333.80

400 patients

Annex B

= 25.83/patient/dav

3 meals

Cost of Labor/Patient/Meal: P 8.61/patient/meal COST OF OTHER SUPPLIES

Cling Wrap

Average Consumption: 1 roll/meal

400 patients

Cost of other supplies/Patient/Meal: = PO.9()

Liquid Soap

Average Consumption: 1 pack (600mI)

P128.OO/pack

3 meals

P42.66

400 patients

Cost of Liquid soap (Patient/Meal: = PO.IO

Powdered Soap

Average Consumption: I bag (2000g) in 4 days

PI 69.00/bag

4 days

P42.25/bag

3 meals

p14.08

400 patients

Cost of powdered soap /Patient/Meal: = PO.04

Sodium Hypochlorite

Average Consumption: I gallon (4 liters) in 7 days

7 days

P22.43/day

3 meals

Annex B

P7.48/meal

400 patients

Cost of Sodium Hypochlorite / Patient/Meal: = po.02

Disposable Hand gloves

Average Consumption: I pack (100pcs) in 2 days

P45.00/ pack

2 days

3 meals

P7.50/mea1

400 meals

Cost of Disposable Hand Gloves /Patient/Meal: =

Annex

C

SAMPLE REGULAR MEAL PLAN (1800 KCAL)

Menu Exchange Kilocalorie ( osttng

BREAKFAST

Banana 40 4.3

Sliced Bread 2 slices bread 90 100 2.7

Arrozcaldo with I cu Lu aw 66.6 2

Hard cooked e I CE -medium 122 5

30 Chicken Breast 41 5.6

1 ts Oil 45 .5

Garlic, Onion, .5

Pe er, atis, salt .5

Coffee Mix I sachet Ko iko black 3 in I 90 4.15

Mar arine 90 2.19

p24.64

12.6

594.6 kcal

123 LUNCH

Ban s Sini an 2 1/2 NIBS Ban -El))

1/4 cu Radish & Kan on 8 2.00

Onion, Tomatoes, Sam alok I .00

Bihon Guisado 1/2 cu Bihon 50 2.16

10 s Chicken breast 13.6 1.23

1/4 cu of Cabba e, Sa Ote, Carrot 8 2.50

Onion, arlic, e er .50

1 ts Oil 45 .50

Rice 250 9.90

Tro ical Fruit Salad Watermelon, a a a, banana 40 4.5

4 ts Condensed milk 20 2

I tbs All Pu ose cream 45

19

602.6 kcal

DINNER

Bistek Tagalo 2 1/2 MBS Beef laman

123

Su ar, Pinea le Juice 12 3

2 ts . Oil 90 .5

Habitsuelas .5

Cornstarch 2.5 .3

Calamansi .5

Pe er, Garlic, Onion 2

To e-Carrots Guisado 1/2 cu To e 25 ) &carrot(20 16 4

5 Shrim s 500 : 100 ts 8.2 1.5

Su ar (60 : 100 ts 2.4 1

I ts .0il 45 .5

Patis .5

Onion, arlic

Rice I 1/4 cu

40

589. I kcal p45.14

Pa a a I slice 120 -AP)

Total 1786.3kcal PI 09.67

Annex C


Day 2

Menu Exchan e Kilocalorie Costin

BREAKFAST

Watermelon 1 slice 226 -AP 40

153.5

4.5

1 1.15

Rice 1 1/4 cu

Hotdo 2 cs Hotdo

I ts Oil

Milk with Su ar I sachet Bearbrand Swak, 33 s

1 sachet Brown su ar 20 2

643.8 kcal P40.05

LUNCH

Chicken Estofado 2 MBS Chicken 82 10

20 Saba 20 .5

20 Camote 16 .5

2 ts Oil 90 .50

Garlic, onion, bell er, laurel 1.5

So sauce ,Tomato sauce 1

Cornstarch 2.5 .5

Su ar 5

5 Pecha Guisado with 1/2 cu Pecha 16

45

Beef 15 Beef

I ts Oil

Garlic, Onion,tomatoes,bell e er 1.5

Patis .5

Rice 1 1/4 cu s 250 9.9

Pinea le I slice 40 4

587 kcal P36.25

DINNER

Breaded Fish 2 1/2 MBS Matambaka 102.5 12.5

2 ts Oil 90

10 s Flour (1k : 100 ts 4.5 .5

Cornstarch 2.5 .5

Banana heart with 1/2 cu Banana Heart 16 2

O ster sauce 1 ts Oil 45

Garlic, onion. bell e

Su yar

So sauce

c-2

Annex C



BREAKFAST

Pa a a 1 slice 120 40 1.44

Rice 1 1/4 cu 250 9.9

Corned beef Guisado 45 s Corned Beef 129 10

1 ts Oil 45

Onion , arlic, salt

Boiled E

93 Chocolate drink I sachet Milo,22 rms

679 kcal P 32.36

LUNCH

Chicken Afritada 2 MBS Chicken 82 14

1/4 cu Carrots ,

otato,

een eas 8 1

Onion ,salt .5

Su ar 2.5 .5

Catsu ,tomato sauce 1

I ts Oil 90 .5

Ginataan Kamansi 1/3 cu kamansi 16 2

2 ts Coconut milk 45

Dilis 1/4 kl:lOO ts

1/2 ts oil

Garlic, Onion, Ginger, Green

onions

Salt, su ar .5

Kalawa wder .5

Rice 250 9.90

Banana 40 4.3

563.95 kcal P37.15

DINNER

Fish Tausi 2 1/2 MBS Barileson 102.5 14

E 10 cs:lOO ts 12.2 .5

Su ar 1/4 cu : 100 ts 2.4 .1

Cornstarch 1k : 100 ts 2.5 .3

Flou 1k :100 ts 4.5

2 ts Oil 90

S uash-alu bati uisado 1/2 cu S uash and alu bati 16 1

1/2 ts Oil 22.5 .5

Garlic, onion

5

P39.5

Salt

Rice 1 1/4 cu

Ponkan

545.1 kcal

Total 1788.05kcal P109.01

Annex C


Da 4


BREAKFAST

Banana 40 4.3

Rice 1 1/4 cu Rice

250 9.9

Chicken Adobo 2 1/2 MBS Chicken 102.5 12

1 ts oil 45

.5

50 Potatoes 2 64

So sauce, Vine 'ar

Salt, Onion, Garlic, Pe er

Milk with su ar I ack Bearbrand swak, 33 s 150.15 11.15

1 sachet Sugar 20 1

633.29 kcal

LUNCH

Paksiw na Tulin an 2 1/2 MBS Tulin an 102.5 12.5

1 ts oil 45 .5

Vine ar, onion, P er .5

Squash-Stringbeans

Guisado

1/2 cup Squash & stringbeans 16 1

I ts oil 45 .5

9.9

Su ar 2.5

Onion, arlic, salt

Patis

Rice 1 1/4 cu Rice 250

Potato Salad 40 Potato, 20 carrots 28 2

10 Pinea le tidbits, 5 raisins 4+13.317.3

1 ts ma onnaise, 45 .5

1/2 tbs All Pu ose cream 22.5 1

10 Cheese 15 .5

2 ts Condensed Milk 20 .5

608.8 kcal P 31.65

DINNER

Beef Patties 75 Beeflaman 2 1/2 exch 123 19

Su ar 2.5 .5

2 ts . Oil 90 .5

Onion, arlic, er

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