Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
AUG 20 2020

ADMINISTRATIVE ORDER
No. 2020 - _003¢

SUBJECT: Guidelines on the Deployment of Human Resources for Health

under the National Health Workforce Support System

I. RATIONALE

Republic Act (RA) No. 11223, otherwise known as Universal Health Care (UHC) Act
of 2019, seeks to ensure that all Filipinos are guaranteed equitable access to a
comprehensive set of quality and cost-effective promotive, preventive, curative,
rehabilitative and palliative health care services without causing financial hardship. As
a critical component of health service delivery, it is imperative to have sufficient,
equitably distributed, skilled, and motivated health workforce to help improve health
service coverage and health outcomes, attain universal health care, and health-related
Sustainable Development Goals (SDGs).

Republic Act No. 7160, also known as the Local Government Code, provides that all
local government units (LGUs) shall promote health and safety within their territorial
jurisdictions (Sec 16). The LGUs are mandated to
be self-reliant and discharge
functions devolved to them including provision of health services and implementation
all
of health programs. However, most LGUs are unable to achieve the recommended
human resource for health (HRH) to support the mandates of UHC due
factors including, but not limited to, geographical location, income class of the
several to
municipality, existence of armed conflict, and certain provisions of national policies on
personnel services limitation. Health workforce occupying permanent plantilla
positions at the local level remains generally insufficient as evidenced by the number
of doctorless municipalities (278 municipalities as of January 2019), and municipalities
with HRH to population ratios below the National Objectives for Health (NOH) targets.

To support LGUs, the UHC Act mandates the creation of a National Health Workforce
System (NHWSS) which includes human resource management and development
systems; salaries, benefits, and incentives; and occupational health and safety of
deployed health care professionals or health care workers. In the interim, while LGUs
are unable to hire the required health care professionals and health care workers based
on standards, they shall be eligible to receive deployment augmentation from the
NHWSS. For this purpose, the DOH shall secure positions to hire and deploy health
professionals and health workers under the NHWSS to
promote equitable distribution
of health workforce especially in Geographically Isolated and Disadvantaged Areas
(GIDAs) and other marginalized, vulnerable populations of the country.

This Order aims to

provide the structure and mechanism for the deployment of HRH
under the NHWSS, as managed by the DOH.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503Fax: 743-1829 @ URL: http:/Avww.doh.gov.ph; e-mail: ftduque@doh.gov.ph
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I. OBJECTIVES

A. General:

To provide guidelines, structure, and mechanisms for the deployment of HRH under
the NHWSS, towards the attainment of Universal Health Care.

B. Specific:

1. To establish criteria for determining HRH requirements and priority areas for
deployment.
2. To provide operational guidelines for overall management and implementation
of deployment of HRH under NHWSS within province-wide and city-wide
health systems;
3. To establish the roles and responsibilities of different stakeholders in the
management and implementation of deployment of HRH.

Hil. SCOPE AND COVERAGE

This Order shall apply to DOH bureaus and centers, as well as attached agencies,
Centers for Health Development (CHDs), Ministry of Health — Bangsamoro
Autonomous Region in Muslim Mindanao (MOH-BARMM), public and private health
facilities, province-wide and city-wide health systems and LGUs that are involved in
the management and implementation of HRH deployment in
the public sector.

This Order shall cover the implementation and management of the HRH deployment
program and shall encompass program management processes from planning to
program evaluation. It shall also cover mobilization and hiring of HRH in cases of
public health emergencies and disasters.

IV. OPERATIONAL DEFINITION OF TERMS

For purposes of this Order, the following terms shall be defined as follows:

1. Critical HRH gap - occurs whenthe current number of HRH facility falls below
ina

50% of staffing standards; when the

facility has high workload pressure based on
workload assessment; or, when the HRH indicator in the local government
scorecard is “poor” (red) compared to NOH targets, or other requirements
prescribed by policies of the DOH.

2. Deployment - refers to the physical transfer and assignment of select medical and
allied health professionals to identified health facilities to complement the existing
HRH in health facilities and local health systems for effective and efficient health
service delivery.

3. Geographically Isolated and Disadvantaged Areas (GIDA) — refers to barangays/

disadvantaged due to presence of both physical and socio-
sitios specifically

Page 2 of 11 \
q *a
 economic factors that limit the delivery of and/or access to basic health care
services.

4. Human Resources for Health (HRH) - refers to medical and allied health
professionals who
are essential to the of
performance health systems. They include
workers in the different domains of the health systems, including preventive,
curative, rehabilitative, and palliative care services.

5. Learning and Development Interventions (LDIs) — refer to sets of learning

activities, events, and methods that teach skills, knowledge or competencies in

order
to improve performance and meet an agreed standard of proficiency. This includes
training and non-training interventions with defined learning outcomes.

6. National Health Human Resource Master Plan — refers to a long term strategic

plan that shall provide strategies for the appropriate generation, recruitment,
retraining, retention, and reassessment of health workforce based on population
health needs, formulated and implemented by DOH together with other
stakeholders, in public and private health sector (Sec 23 of RA No. 11223).

7. National Health Workforce Registry - a database of all medical and allied health
professionals indicating, among others, the current number of practitioners and
areas of practice (Sec 25.7 IRR of RA No. 11223)

8. Primary Care Facilities - refer to institutions that primarily deliver primary care
services which shall be licensed or registered by the DOH (Sec. 4.26.b IRR of RA
No. 11223)

9. Provincial or City Health Board (P/CHB) — refers to an advisory body for health
to the provincial or city government. It shall exercise administrative and technical
supervision over health facilities, personnel, and other health resources within their
territorial jurisdictions (Section 19 of RA No. 11223)
.

10. Province-wide and City-wide Health System (P/CWHS) - consists of the

provincial, municipal, and component city health offices, provincial, district and
municipal hospitals, health centers, barangay health stations, and other LGU-
managed health facilities and services. (as defined in DOH AO No. 2020-0021)

11.
-the
Public Health Emergency refers to an occurrence or imminent threat of an illness
or health condition that (as defined in Section 10.1 and Section 10.2, RA No. 11332):
11.a. Is caused by any of following: (i) bioterrorism; (ii) appearance of a novel
or previously controlled or eradicated infectious agent or biological toxin; (iii) a
natural disaster; (iv) a chemical attack or accidental release; (v) a nuclear attack or
accident; or (vi) an attack or accidental release of radioactive materials; and,
11.b. Poses a probability of any of the following: (i) a large number of deaths in the
affected population; (ii) a large number of serious injuries or long-term disabilities
in the affected population; (iii) widespread exposure to an infectious or toxic agent
that poses a significant risk to the health of citizens of other countries; or (iv) trade
or travel restrictions.

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12. Redeployment — refers to the transfer of assignment of deployed HRH from original
workstation to another area of need.

GENERAL GUIDELINES

A. Consistent with the DOH thrusts towards the implementation of the UHC Act, the
deployment of HRH under NHWSS shall promote equity in local health systems
and support primary care provider and healthcare provider networks.

B. The DOH shall secure positions to hire health professionals and health workers for
deployment under the NHWSS with the aim of making available competent HRH
capable of meeting the health needs and improving the access to health services at
the appropriate level of care.

C. The DOH shall deploy HRH to LGUs eligible to receive deployment augmentation
from NHWSS during the prescribed period of integration of the P/CWHS;
Provided, That the LGUs shall implement incremental creation of positionsto
based
hire
the required number of health professionals and health care workers on
standards (Sec. 24.5. IRR of RA No. 11223).

D. Graduates of medical and allied health professions who are recipients of

government-funded scholarships and graduates of DOH residency training
programs shall be prioritized in the recruitment and selection to the allocated
positions.

E. The deployment shall prioritize GIDAs, indigenous cultural communities, and other
priority areas for poverty reduction and peace-building efforts. Public primary care
facilities shall be the priority assignment of deployed HRH; and Level I and I
government hospitals, for graduates of residency training from the DOH Teaching
and Training Hospitals and Specialty Hospitals.

F. The compensation rates of deployed HRH shall follow the national rates. (Sec. 4.24.
IRR of RA No. 11223).

G. In case of a public health emergency, whether in national or global pandemic, the

DOH shall have the
discretion to mobilize and redeploy HRH in exigency
to be part of HRH augmentation for health emergency response.
of
service

H. The effectiveness of HRH deployment shall be evaluated in terms of progress in

health outcomes; attainment of universal health coverage and Sustainable
Development Goals; improvement in
access to
quality health facilities and services;
and, HRH absorption under the province-wide and city-wide health systems.

SPECIFIC GUIDELINES/ IMPLEMENTING MECHANISMS

A. Implementing Structure (Annex A)

.
1. DOH Health Human Resource Development Bureau (HHRDB) shall formulate

of 11

jx
Page 4
 the policies and guidelines relevant to the deployment of HRH under the
NHWSS.
technical
It shall secure positions for HRH, allocate funds, and provide
assistance and support services to CHDs and MOH-BARMM for the
effective deployment of HRH.
2. CHDs and MOH-BARMM shall manage the overall implementation of the
HRH deployment under the NHWSS, including the process of recruitment and
other human resource actions, and shall coordinate with the concerned
provincial/city health boards for the assignment and supervision of deployed
HRH.
3. The P/CWHS through its P/CHB shall determine priority areas, the cadre and
number of HRH needed within their areas of jurisdiction, as part of their
investment plan for health. It shall provide administrative and technical
supervision to deployed HRH.
4. Coordination and harmonization efforts of participating stakeholders such as,
but not limited to, academe, professional societies, non-government
organizations, other national and local agencies, and representatives from the
indigenous communities shall be encouraged for the optimal implementation of
deployment of HRH.

B. Criteria for Determining HRH Requirements and Priority Areas for

Deployment

1. Determining HRH Requirements

a. The number of required HRH shall be determined based on gaps from
the staffing standards for health facilities, HRH targets in the National
Objectives for Health, and assessment of current workload of health
staff.
b. The need for HRH augmentation shall be incorporated in the local
investments plans for health of the PCWHS, which should be congruent
with the National Health Human Resource Master Plan.

2. Determining Areas for Deployment

a. The areas for deployment shall be evaluated and determined based on
the following order of priority:
i. Difficulty in access to health services due to geographic location
and socio-economic classification of the area (GIDA, with
indigenous cultural communities, national priority areas for poverty
reduction and peace-building efforts);
ii. Critical gaps in current HRH vis-a-vis approved staffing standards
for hospitals and recommended HRH for Municipal Health
Offices/Rural Health Units/Barangay Health Stations;
iii. Unmet needs for specialized care or services as mandated by law

iv.
as
and part of the Philippine Hospital Development Plan; and,
Persistent failure of hospital or health facility to acquire licensing
or accreditation due to lack of needed HRH;
b. Graduates of residency training from the DOH Teaching and Training
Hospitals shall be deployed to identified priority Level I and II hospitals in
compliance with the provisions of Sec 8 of RA 10351(Sin Tax Law).
c. The CHD/ MOH-BARMM shall evaluate the HRH requests of the
province/city health boards based on above criteria and ensure that

Page § of 11
 allocation of deployed HRH shail be based on equity.

C. Recruitment, Selection and Deployment

1. The LGUs shall submit their requests for HRH augmentation indicating the
cadre and number needed, as indicated in
their respective Local Investment Plan
for Health, to the P/CHB under the PCWHS.
The P/CHB shall consolidate the requests and submit them to CHDs/MOH-
BARMM for validation using the prescribed template for evaluation and
prioritization, and allocation of HRH.
The CHDs/MOH-BARMM shall validate and endorse recommendations to
HHRDB for approval.
CHDs/MOH-BARMM/HHRDB shall conduct recruitment, selection, and
processing of the appointment of HRH for distribution to provinces.
The HRH to be deployed under the NHWSS shall be primarily sourced from:
a. Recipients of DOH scholarships program
As part of their Return Service Agreement with their academic
institution and DOH, all recipients of DOH scholarship program shall
be deployed for at least three (3) full years, within one (1) year upon
acquiring license to practice, to DOH-specified priority health facilities
within their areas of residence or origin or where their services are
needed, provided that the areas are validated and endorsed by CHD.
Those who will serve for additional two (2) years shall be provided with
additional incentives as determined by the DOH.
b. Graduates of Residency Training Program in DOH Teaching and
Training Hospitals and Specialty Hospitals.
Accepted HRH under NHWSS shall be primarily deployed in primary care
facilities, except graduates of DOH residency training, which shall be deployed
in priority government Level J and II hospitals. They shall not in any case be
deployed in private facilities, facilities run by non-government organizations,
faith-based non-profit institutions, PDOHO, PHO, and CHDs. However,
exemptions may be granted under the following conditions:
a. In cases of threats to life, the HRH may be temporarily deployed to
CHD/MOH-BARMM/PDOHO/PHO until such time that threats and
risks are cleared or if the HRH has been given a newarea of assignment;
b. HRH with primary function in managing health-related information
systems and consolidating health data may be deployed in
CHDs/PDOHO/PHOs, as determined by the DOH-HHRDB.
c. In cases of public health emergencies (See Section D).
The duration of the deployment of HRH to LGUs shall be prescribed by the
DOH. Hence, the LGUs shall implement the incremental creation of positions
to achieve the HRH staffing standards in LGUs.

D. Redeployment and Hiring of HRH during Public Health Emergencies

1. In case of the declaration of a State of Public Health Emergency throughout the

Philippines, the Secretary of Health, may direct mobilization of deployed HRH
in critical areas of need.

2. The DOH, through the CHD/MOH-BARMM, may augment HRH for public

Page 6 of 11
 health emergency response and for health response as a result of man-made
disaster (e.g. armed conflicts), through temporary redeployment of HRH from
primary care facilities or government hospitals to public or private facilities, or
through hiring of additional HRH for temporary deployment subject to the
following conditions:
|

a. There is critical gap in the number of local HRH in a specific area of

need to respond to sudden or overwhelming health needs;
b. There is an urgent need for additional HRH in specific hospitals,
facilities or areas; and
c. The number of HRH required to be hired for emergency response
exceeds the financial or administrative capacity of the concerned health
facility or P/-CWHS.
|

. The CHD/MOH-BARMM shall ensure the continuity of health services in both

hospitals and primary care facilities. Redistribution of HRH shall not result to
undue disruption of essential health services, both individual and population-
based, especially in GIDAs;
The CHDs/MOH-BARMM shall ensure security and safety of HRH to be
redeployed including provision of adequate logistics and supplies.

E. Safety Protocol for Deployed HRH

1. The respective Provincial or City Government/BARMM Provincial Offices

shall create a Safety and Health Committee and/or a Special Investigation
Committee which will conduct regular meetings and/or investigation on
occupation related accidents, injuries, illness and/or death as stated in CSC-
DOH-DOLE Joint Memorandum Circular (JMC) No. 1 s. 2020 or the
“Guidelines on the Occupational Safety and Health Standards (OSH) for the
Public Sector.” The said committee shall also be responsible for ensuring the
welfare and security of all deployed HRH by establishing and implementing a
safety protocol within their P/CWHS.

The Provincial or City Government/BARMM Provincial Offices shall ensure

the conduct of occupational safety awareness; work hazards analysis sessions;
identification of hazards and measures to be undertaken by deployed HRH in
case of emergency and other analogous incidents/circumstances.

The Provincial/City/Municipal Government /BARMM Provincial Offices shall

provide a reasonable working condition and ensure that the workplace is free
from hazardous and ensure that the workplace of deployed HRH is free from
hazardous conditions that will cause death, illness or physical injury/ies to the
deployed HRH;
DOLE JMC
It
1
shall implement all other guidelines stated in CSC-DOH-
No. s. 2020, as applicable, to ensure safety of all deployed HRH
within its jurisdiction;

The CHDs and MOH-BARMM, inconsultation with P/CHB and deployed

HRH, shall regularly evaluate the effectiveness of the safety protocol and shall
monitor and reassess the measures and outcomes regularly. Periodic meetings
with stakeholders, including the deployed HRH and concerned LGUs or health
facilities shall be conducted to provide feedback and make modifications as
necessary.

Page 7 of 11
 5. The Provincial or City Government/BARMM Provincial Offices through its
P/CHB shall report immediately to CHD/MOH-BARMM any issues,
recommendations
HRH.
oractions taken pertaining to safety and security of deployed

6. The CHDs/MOH-BARMM, shall provide technical assistance to P/CWHS on

issues raised by the P/CHB and decide on key personnel actions as necessary.
The Directors or the Minister of Health shall directly report to the Secretary of
Health details on the incident, including resolution and actions taken therein for
safety and security issues raised by the health boards.

7. When there is a threat to life, whether verified or not, the deployed HRH shall
be immediately pulled-out within 24 hours and an investigation shall be
conducted thereafter. Meanwhile, the HRH deployed shall report to the
PDOHO/IPHO/CHD orthe nearest DOH Regional hospital, in the case of HRH
deployedto hospitals, until such time that the threats and risks are cleared.

8. Transfer of assignments for deployed HRH is warranted when there is

indication of threat to life and safety such as, but not limited to, natural disasters,
industrial and transport accidents, civilian threats, insurgencies, or harassment.
Transfer may also be justified when there is any nature of political instability or
breach of Memorandum of Agreement (MOA) by either party.

F. Continuing Professional Development and LDIs for Deployed HRH

1. The HHRDB shall partner with Higher Education Institutions (HEIs) and LDI
providers in the provision of continuing professional development programs
and other appropriate LDIs for deployed HRH;

2. The HHRDB and CHD/MOH-BARMM/PHO shallprovide LDIs to deployed

HRH, such as, but not limited to, trainings or courses in primary care, health
governance and health systems management, based on assessed needs of the
province/region and as applicable to their functions.

3. The CHD/MOH-BARMM shall leverage the LGUs necessary financial

logistics and counterparts such as per diem, transportation and living expenses
of HRH attending capacity building activities and learning and development
interventions.

G. Monitoring and Evaluation

1. The CHDs and MOH-BARMM shall designate their respective Assistant

Regional Directors/Assistant Minister for Health or the next highest Medical
Officers as the CHD/MOH HR Coordinators. The HR Coordinator shall
oversee technical and managerial HR policies, program, and projects and shall
manage deployment of HRH in their respective regions in close coordination
with HHRDB.

2. The deployed HRH shall be monitored at least twice a year by CHD/MOH-

BARMM using prescribed monitoring and evaluation tools
the for
the program.

Page 8 of 11
 Likewise, the CHDs/MOH-BARMM shall monitor and evaluate at least once a
year, compliance of recipient health facilities to the provisions of the MOA,
support provided to the HRH in terms of learning opportunities and logistics,
safety protocol, and interventions that shall promote the retention of the
deployed HRH in the area.

The HHRDB shall validate and monitor compliance of CHDs and MOH-
BARMM to the deployment guidelines.

VII. ROLES AND RESPONSIBILITIES

A. Health Human Resource Development Bureau shall:

1. Formulate policies and guidelines relevant to the implementation and evaluation

of deployment of HRH under NHWSS;
2. Supervise CHDs and MOH-BARMM in the management of deployment of
HRH under NHWSS and their compliance to this Order;
3. Transfer/Disburse funds for the implementation of deployment of HRH under
NHWSS and monitor budget utilization of CHDs and MOH-BARMM;
4, Maintain a database for all deployed HRH;
5. Promote alignment of assistances from development partners to support
strategies for the welfare, development, and retention of deployed HRH; and
6. Evaluate effectiveness of the deployment of HRH in supporting goals of UHC.

B. Centers for Health Development, Ministry of Health Bangsamoro —

Autonomous Region in Muslim Mindanao, and Provincial DOH Offices shall:

1. Provide updated and validated list of priority cities/municipalities/provinces for

HRH deployment to HHRDB;
2. Facilitate the recruitment, selection, placement, appointments, orientation, and
deployment HRH based on prescribed guidelines;
Conduct orientation and social preparation for recipient LGUs
well as pre-deployment orientation for HRH utilizing the
or
recommended
hospitals as
outline;
Coordinate with the concerned P/CHB for the assignment and supervision of
deployed HRH;
Advocate and assist the P/CWHS in planning for the implementation of
retention strategies to deployed HRH, such as additional incentives and
incremental creation of positions to achieve HRH standards in facilities, and
absorbing deployed HRH, for the continuity and sustainability of health services
delivery;
Strictly implement sub-allotment/transfer guidelines for the operationalization
of HRH deployment program;
Determine the baseline competencies of the deployed HRH in relation to health
programs and services appropriate for the regional/provincial health profile and
provide pertinent LDIs as necessary;
Resolve and document issues/concerns that may arise in the course of the
implementation of deployment of HRH under NHWSS;

Page 9 of 11
Ze.
 9. Manage the implementation of the deployment of HRH in their respective
regions/provinces, provide technical assistance to P/CWHS, and monitor the
compliance of P/CWHS based on the guidelines provided by this Order;
10. Assess the performance of the NHWSS and LGUs’ health workforce
complement within the region; and
11. Provide feedback to HHRDB on the issues and recommendations for the
implementation of the deployment of HRH under NHWSS.

. Provincial Health Board/City Health Board, Recipient Local Government

Units and Hospitals under the Province-wide Health System and City-wide
Health System
|

1. Determine the available HRH within its jurisdiction by ensuring the registration
in
of all HRH, both private and public sector, to the National Health Workforce
Registry; and determine the HRH gaps within its jurisdiction, based on set
criteria;
Ensure equitable allocation and distribution of deployed HRH based on
identified needs and prioritization;
Provide administrative and technical supervision to HRH deployed within its
jurisdiction in close coordination with CHDs/MOH-BARMM;
Support policies and plans aligned with the implementation of the UHC Act;
Engage and support activities initiated by the deployed HRH for health systems
development;
Establish and implement a safety protocol to ensure the welfare and security of
all deployed HRH within their P/CWHS;
Provide appropriate financial and logistic support for all deployed HRH as
stipulated in the governing laws for health workers which includes
transportation, lodging and miscellaneous expenses related to the conduct of
to
their duties as well as attendance their learning and development activities;
Implement incremental creation of positions to hire the required health care
professional and health care worker based on the standards, as determined by
the DOH;
9. Endeavor to absorb deployed HRH for the continuity and sustainability of
health services delivery;
10. Conduct regular monitoring and evaluation of deployed HRH; and
11. Provide feedback on the performance of all deployed HRH through the
CHDs/MOH-BARMM.

. Deployed HRH shall:

1. Enter into and abide by a standard contract/Memorandum of Agreement with

the DOH;
2.
3.
Support the P/CHWS in the implementation of the UHC Act;
Ensure delivery of client-centered, evidence-based, quality healthcare services;
4. Respond efficiently and effectively to the health needs consistent with the
approved standards of care and guided accordingly by their corresponding
profession;
Initiate and implement public health measures to prevent and control diseases,
including emerging and re-emerging diseases;

Page 10 of 11 Be
 6. Assist in the implementation of the health surveillance systems and health
emergency preparedness and response;
7. Participates in national/regional/provincial health emergency response as part
of the Health Emergency Response Team, as directed by the DOH;
8. Attend Continuing Medical Education/LDIs/training based on assessed needs
of the HHRDB/CHDs/MOH-BARMM, as applicable to their functions;
9. Submit reports to LGUs/CHDs/MOH-BARMM/PDOHO/IPHO, as prescribed
by the program;
10. Register in the National Health Workforce Registry; and
11. Perform other functions as mandated under the existing pertinent and national
laws, protocol and guidelines such as but not limited to Local Government
Code, Civil Service Code, Administrative Order.

VIII. REPEALING CLAUSE

Provisions of AO No. 2014-0025 “Guidelines on the Deployment of Human Resources

for Health,” AO No. 2015-0021 “Guidelines on the Deployment of Physicians
Graduating from Residency Training Programs in Department of Health (DOH) —
Retained Teaching and Training Hospitals,” AO No. 2015-0026 “Implementing
Guidelines for the Public Health Associate Deployment Program,” and all other
issuances inconsistent with this Order are hereby repealed/rescinded and modified
accordingly.

IX. EFFECTIVITY DATE

This Order shall take effect fifteen (15) days after publication in a newspaper of
general circulation.

CISC@ T. DUQUE, TI, MD, MSc

Sedretaryof Health

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ey
d

Page 11 of 11
ANNEX A
A.O. No 2020- 0032

Implementing Structure of the Deployment of Human Resources for Health under the
National Health Workforce Support System

Health Human Resource Development Bureau

|
Centers for Health Development/BARMM
|

DOH Hospitals Provincial DOH/BARMM Offices

_ Province/City-Wide Health :
Systems
|
|
S

Local Government |

Municipal/ City
Hospitals Health Offices