Office: of The Secretary

of the Philippines
Republic
Department of Health
OFFICE OF THE SECRETARY
December 29, 2021

DEPARTMENT CIRCULAR
No. 2021-_ 0523
TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

DIRECTORS OF BUREAUS, SERVICES, AND CENTERS FOR
HEALTH DEVELOPMENT; MINISTER OF HEALTH _—
BANGSAMORO AUTONOMOUS REGION MUSLIM. _IN__
MINDANAO; LOCAL GOVERNMENT UNITS; PRIVATE

SECTOR PARTNERS; AND OTHERS CONCERNED
SUBJECT: Dissemination of the Manual for Primary Care Managers
This Department Circular issues the Manual for Primary Care Managers as tool in the
implementation of Republic Act 11223 or the Universal Health Care (UHC) Act. This
a
is the first of a two-part series of manuals on primary care to be used by managers of
public primary care facilities.
The Manual aims to guide the public primary care managers in the management and
administration of a healthcare facility within the Primary Care Provider Network
(PCPN). Specifically, this Manual aims to:
1. Provide a set of guidelines on the critical managerial competencies of a Primary
Care Provider in primary care facilities;
2. Provide a reference for the management of health facilities and programs,
specifically in terms of governance, health services delivery, access to medicines
and products, health Information systems, human resources for health, and health
financing; and
3. Provide a summary and integration of memorandums, administrative orders, and
other laws relevant to primary care management and provision
Attached is the Manual for reference.

Dissemination of the information to all concerned is requested.
By
the Authority of the Secretary of Health.
MARIA ROSARIO VERGEIRE, MD, MPH, CESO

§.
0
Undersecretary of Heplth
Public Health Servicds Team
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila # Trunk Line 651-7800 focal 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
a
for
Manual
Primary Cave Managers

In collaboration with
unicef €2)
for every child
Manual for Primary Care Managers
Foreword
With the signing of Republic Act 11223 or the Universal Health Care (UHC) Act in
2019, the Philippines took a leap forward in a much awaited turning point in the
Philippine Health System - the progressive realization of health care for all Filipinos.
The UHC Act promises to provide high quality health care services for all individuals,
especially those from Geographically Isolated Disadvantaged Areas (GIDA), across all
life stages from preventive, promotive, rehabilitative, and palliative.
One crucial element the success of the UHC Act

in
and
the
the
is
emphasis on strengthening primary care
workforce that serve as the primary navigators and
coordinators of the health care provider network. The
Department of Health (DOH) recognizes this important
role and aims to equip them with the adequate
knowledge and skills in the provision of health care
services by supplying comprehensive, evidence-based,
policy-backed capacity building and training.
Further, the DOH recognizes the importance of the

Primary Care Providers’ managerial role in the primary
care facility and network.
However, effective management of

primary care
enables the delivery of quality services that are
safe, effective, and patient-centered, while
optimizing the utilization of resources. It is
therefore the aim of this manual to provide
insights and information on the managerial
aspects of primary care in the public setting and
moving beyond just
the clinical facet of health.
This will be of significant relevance to Primary
Care Providers in guaranteeing equitable access
to quality and affordable health care and
protection against financial risk.
Through this manual, we hope to be a step

closer to our shared UHC aspirations of creating
a Healthy Pilipinas for every Juan and Juana.
FR ISCO T. BUQUE
III, MD, MSc
Secretary of Health
Department of Health, Philippines

jal for Prim
Acknowledgement
This manual was developed and produced by the Disease Prevention and Control
Bureau (DPCB) in collaboration with the United Nations Children's Fund (UNICEF). This is
made possible through the purposeful dedication of Directors Beverly Lorraine C. Ho and
Cherylle G. Gavino, in promoting and uplifting primary care and ultimately, the goal of
Universal Health Care. We would like to express our heartfelt gratitude to Dr. Mariella
Castillo and Dr. Michael Caampued for
painstakingly guiding and assisting the team in the
development
encompasses
ofthis manual, from its inception to its completion, for making sure that
allthe important aspects of a manager’s role in primary care, for ensuring
it
relevance and usefulness of
this manual. We would also like to thank the Technical Review
Team who lent their valuable time and expertise
a more comprehensive perspective.
in
their respective fields to help us develop
We would also like to acknowledge and reiterate

our appreciation to our different
partners from Phitheatth, Department of Interior and Local Government (DILG), Association
of Municipal Health Officers of the Philippines (AMHOP) including the Doctors the Barrios to
(DTT8), and the Philippine Alliance of Patient Organizations (PAPO), who assisted us in
shaping the manual into a significant, product that may be adopted in the community.
This manual underwent several consultations and revisions during the transition of the
bureau's leadership. Finally, the team's hard work has come to
fruition. The following are the
members and contributors of the Technical Working Group (TWG) and Technical Reviewing
Team:
Technical Working Group Technical Reviewers

Dr Ruth Divine Agustin Ms
Joan Langaman Dr Ivy Grace Agus
Dr Ann Ysabel Andres Dr Rochelle Pambid Ma, Graziella Aytona
Engr Sonabel Anama Dr Jutie Mart Rubite
Ms Camille
Ms
Mary Anne Milliscent Castro
Batadjay Mr Aldrin Reyes
Dr Janis Bunoan-Macazo
Ms Michelle Mae Daabay
Dr Kim Patrick Tejano Mr Ulysess Gato
Michael Caampued (UNICEF)
Dr
Luz Tagunicar
Dr Clarito Cairo
Ms
Ms BarbaraMichelle de Guzman
Dr Maria Rosario Sylvia Uy
Dr Mariella Castillo (UNICEF)
Dr
Jan Aura Ltevado
Dr Minerva Vinluan Ms Joanna Mari Lunar
Ms, Dulce Elfa
Ms
Sarah Manga
Mr Roberto Wilmer Matala
Dr Samanta Eumir Nolasco
Contributors Dr Faith Obach
Dr Carlo Panelo
Dr Joannah Kaye Borallo Ms
Irene Manalo
Ms
Allene
Espiritu Ms Gina Muega
Ms Rosemarie Holandes Dr Diana Jean Vasquez
nt of Healt Otite atin

User’s Guide to the Manual

This is the first of a two-part series of manuals on primary care to be used by
managers ofpublic primary care facilities. This focuses on their managerial role over Primary
Care Providers and since this also entails knowledge in the emerging design of the Philippine
health system, they will also be introduced to concepts such as Primary Care Provider
Networks. The clinical aspects of primary care service provision will be discussed in the
second part entitled Manual on the Standards and Procedures of Primary Care Service
Delivery. Readers and users are encouraged to further refer to the policies being referenced
within the text to broaden understanding. A summary list of these policies are in Appendix B
and most can be accessed from the Department of Health online database (doh.gov.ph).
In recent years, the Philippines has sought to integrate care through models that allow
continuous and comprehensive access to appropriate care. The Universal Health Care Act of
2019 has added elements in care integration that this manual shall refer to as managed care
instruments. This UHC model of integrated care now applies integrated approaches to
financing and delivery that, apart from continuous and comprehensive access, also seeks to
control costs and ensure quality, equity, and ensure attainment of population outcomes.
Across the chapters, readers will encounter the various managed care instruments which
they can study and later use as a manager of a primary care facility or network to drive the
performance and manage the quality and costs within your health care provider network. For
this inaugural edition, the manual will focus more on guiding public providers and will only
touch on some topics concerning private sector delivery of primary care. Most materials,
however, cover foundational aspects of understanding management of primary care systems,
hence, can still be useful to the private sector and other relevant stakeholders such as other
primary care workers, local chief executives, local administrative officials, partners and other
collaborators in primary care.

Acronyms
—
AO Administrative Order KMITS Knowledge Management and Information
Technology Service
CHO City Health Office LDC Local Development Council
COA Commission on Audit LGU Local Government Unit
cal Continuous Quality Improvement LHB Local Health Board
—_
CSC Civil Service Commission LHS ML Local Health System Maturity Level
DBM Department of Budget Management LIPH Local Investment Plan for Health
DC Department Circular MCP Maternal Care Package
DepEd Department of Education MHO Municipal Health Officer
DILG Department of Interior and Local MOA Memorandum of Agreement
Government
DM Department Memorandum NCP Newborn Care Package
DOH Department of Health NCIP National Commission on Indigenous
Peoples
Dec Data Quality Check NDP National Development Plan
DRRM-H Disaster Risk Reduction and Management NHWR National Health Workforce Registry
in Health
FDA Food and Drug Administration PCF Primary Care Facility
FHSIS Field Health Service Information System PCP Primary Care Provider
GIDA Geographically-lsolated & Disadvantaged PCPN Primary Care Provider Network
Area
HCPN Health Care Provider Network PICWHS. Provincial/City-wide Health System
HCWM_ Health Care Waste Management PHIC Philippine Health Insurance Corporation
HERT Health Emergency Response Team PIDSR Philippine Integrated Disease Surveillance
and Response
HFDB Health Facility Development Bureau PPMP Project Procurement Management Plan
HFIDT Health Facilities and Infrastructure PPP Public- Private Partnership
Development Team
HFSRB Health Facility Standards and Regulation PRC Professional Regulation Commission
Bureau
HHRDB_ Health Human Resource Development RA Republic Act
Bureau
HRH Human Resource for Health RHU Rural Health Unit
HRM Human Resource Management SCIV Standard Conformance and Interoperability
Validation
ICT Information and Communication SLA Service Level Agreement
Technology
IP Indigenous People TB DOTS Tuberculosis Directly Observed Treatment
Short Course
IRR Implementing Rules and Regulations TESDA Technical Education and Skills
Development Authority
ISO International Organization for TOP Terms of Partnership
Standardization
JAO Joint Administrative Order TWG Technical Working Group
JMC Joint Memorandum Circular UHC Universal Health Care
UNICEF United Nations Children’s Fund

Definition of Terms
Primary Health Care -refers to a whole-of-society approach that aims to ensure the highest
possible level of health and well-being through equitable delivery of quality health services
Primary Care -refers to initial-contact, accessible, continuous, comprehensive, and

coordinated care that is available and accessible at the time of need including a range of
services for all presenting conditions, and the ability to coordinate referrals to other health
care providers in the health care delivery system, when necessary.
Primary Care Manager

care providers.
- refers to a health care worker who
is in charge of managing primary
Primary Care Provider refers to a health care worker, with defined competencies, who has
-
received certification in primary care as determined by the DOH; or
any institution that is
licensed and certified by the DOH.
Primary Care Facility - refers to the institution that primarily delivers primary care services
and
is licensed or certified by the DOH as such.
Primary Care Workers - refers to health care workers, including health and allied health
professionals and community health workers/volunteers, certified by DOH to provide primary
care services.
Health Care Provider Network refers to a group of primary to tertiary care providers,
-
whether public or private, offering people-centered and comprehensive care in an integrated
and coordinated manner with primary care providers acting as the navigator and coordinator
of health care within the network.
Primary Care Provider Network - refers to a coordinated group of

public, private, or mixed
primary care providers, which serve as the foundation of a Health Care Provider Network.

Table of Contents
Foreword 3
Acknowledgements 5
User’s Guide to the Manual 6

Acronyms 7
Definition of Terms 8
Table of Contents 9
Background 12
Objectives 12
Methodology 13
Introduction 13
Chapter 1: From Governance
to Leadership to Managing the Primary Care Providers 15
Chapter 2: The Formation of a Primary Care Provider Network 21
Chapter 3: Shaping Investments and Financial Management for Primary Care 25
Chapter 4: Integrating Service Delivery and Care Pathways for Better Access 29
Chapter 5: Requirements, Competencies, and Cooperation of Human Resources for Health 35
Chapter 6: Applying Standards and Policies to Regulate Quality and Costs 39
Chapter 7: Making Use of eHealth Systems for Primary Care 43
Chapter 8: Mobilizing the Community for Primary Care and Public Health 47
Chapter 9: Monitoring and Evaluating Performance & Responsiveness of Primary Care 51
Summary Note 55
References 56
Appendix A. Competency Checklist for Primary Care Workers 57
Appendix B. Policy Reference Checklist for Primary Care Managers 58
Appendix C. Operations Checklist for Primary Care Managers 59
Appendix D. DOH Template for P/CWHS in entering into Terms of Partnership 60

Background
The Republic Act 11223 or the Universal Health Care Act (UHC) aims to ensure that
all Filipinos have equitable access to quality and affordable health care, goods and services,
as well as gain protection from financial risk. In the heart of this, the role of Primary Care
Providers (PCP) is crucial in the implementation of these provisions. As stipulated in The
UHC Implementing Rules and Regulations (IRR), PCPs shall act as the navigators and
coordinators, initial and continuing point of contact in the healthcare delivery system. They
are also responsible for ensuring that access to higher levels of care shall be provided to
those in need. With that, it is of great importance to equip them with quality materials and
to
resources assist them in providing a holistic service delivery to every Filipino.
The Department of Health (DOH)

and
is further required to establish a mechanism for the
dissemination of standards and guidelines.
development, adoption Among
the strategies of DOH to accomplish this is the development of a two-part manual for
Primary Care: Part 1: Manual for Primary Care Managers which aims to provide an
introduction on the multi-faceted role of a primary care manager (PC Manager); and Part 2:
Manual on the Standards and Procedures for Primary Care Service Delivery which aims to
provide primary care workers with evidence-based standards of preventive health care as
well as prevention, screening, diagnosis, treatment, palliation, and rehabilitation of the
different diseases in the community.
This Manual for Primary Care Managers takes into account the six building blocks of a
health system as identified by the World Health Organization (WHO), namely: governance,
financing, health service delivery, human resource for health, access to medicines and
products, and health information systems. This rich material provides an overview
in
discussion, directions, and practical must-knows the work of PC managers.
Objectives
The Manual for Primary Care Managers aims to guide the public primary care manager
in the management and administration of a healthcare facility within its Primary Care
Provider Network (PCPN). Specifically, this manual aims to:
1. Provide a set of guidelines on the critical managerial competencies of a Primary
Care Provider in primary care facilities;
2: Provide a reference for the management of health facilities and programs,
specifically in terms of governance, health services delivery, access to medicines
and products, health Information systems, human resources for health, and health
financing; and
3: Provide a summary and integration of memorandums, administrative orders, and
other laws relevant to primary care management and provision.

Methodology
An approved revised concept for the Manual for Primary Care Managers intended
this version to be concise, easy-to-use, and mainly covering the managerial aspects in public
primary care provision. It took into account the World Health Organization’s six building
blocks of health systems that
are also ascribed within the UHC Act. The concept was vetted
with and assigned to a technical working group (TWG) within the Department of Health -
Disease Prevention and Control Bureau (DPCB). A project strategic work plan was
formulated, and consultative TWG meetings and writeshops were set up. Data was
collected from the consultations and the review of relevant literature and latest policies
provided the technical underpinnings for the writing of this manual. Contents were validated
with a team of technical reviewers and the final draft was further refined through gathering
of recommendations from a multi-stakeholder consultation.
Introduction
The Philippine health care system has been challenged by inequities in health
outcomesthat have resulted from a range of health system weaknesses such as poor access,
fragmentation of care, supply-side maldistribution, and low financial risk protection and care
coverage (Marfori et al. , 2019). Often, marginalized populations at higher risk for disease
experience delays, denial, or even absence of care services. Since 2019, the country has
taken a leap in reforming the system to address these deeply-rooted issues through the
passing of the UHC Act.
Individual and community health and well-being do not depend solely on effective
health care services. Hence, the law espouses Primary Health Care (PHC) as its philosophy,
adopting a whole-of-society approach in addressing inequities and achieving better health
for all Filipinos through more proactive roles in health protection, promotion, and disease
prevention (RA 11223). Various country experiences have demonstrated that working
closely with the community and being in partnership with diverse stakeholders within and
outside of the health sector positively influence health outcomes. The World Health
Organization (WHO) recognizes three main elements countries aspire for to implement PHC:
(1) integrated delivery of primary care and essential public health functions; (2)
multi-sectoral policies and action; and (3) community empowerment (World Health
Organization, 2018). Strengthening primary care serves as the foundation for implementing
PHC and achieving UHC. According to the DOH Administrative Order 2020-0024 (AO
2020-0024), the full realization of primary care in the country shall be accelerated through 3
strategic outputs:
e Integrated and comprehensive primary care: this helps ensure access and universal health
coverage with “no one left behind.” This also means moving away from services that
merely focus on certain diseases or conditions and rather, attempt to cover the majority of
presenting health concerns of an individual and the community factors affecting their
health. This is directed towards shaping and supporting a primary care-led integration.
e Strategic financing: this is about streamlining investments towards cost-effective primary

care and essential public health interventions that would generate a larger population
health impact.

e Quality, safe and affordable care: this means identifying sets of services and programs that
require minimum resources but are equally able to meet recognized standards.
about setting up a facilitative environment that encourages excellence and adherence to
is also It
recognized standards of care (i.e. training, staff qualifications, etc.).
Primary Care (PC) can be defined as the accessible first point-of-contact linking a
patient to comprehensive, coordinated, and continuous care regardless of conditions or
concerns. PCPs and PCPNs are those who have agreed to be accountable in delivering
individual-based and population-based services to an assigned population within a defined
geo-political area. PCPs and PCPNs are also responsible for initiating and sustaining
partnerships with patients, families, and their communities to improve their health outcomes
(World Health Organization, 2018). Both public and private providers can participate as
PCPs according to the UHC Act. Once linked to a patient or population, the PCP shall then
act as their navigator, coordinator, and initial and continuing point of contact within the
health care provider network (HCPN).
Apart from PHC, other guiding principles prescribed within AO 2020-0024's

framework for primary care include people-centeredness and equity (Figure 1). A
people-centered approach ensures that Filipinos become more capable of making their own
informed decisions regarding their health needs and well-being. Equity on the other hand,
builds the foundation towards achieving universal access, preferentially providing access to
those who are marginalized or at greater risk. Since health is the right of every Filipino,
access to affordable and quality primary care services must be guaranteed.
HE More Responsive Primary Care
Integrated and
comprehensive primary care
Provision of individual-basad
services
:
= Financing for
Care
Ail
ervices
rimon
Delineation of Financing and Health
Transitioning of financing for primary

|[ Quality, safe and affordable
primary care
Enhance primary
ir
care competencies
of health workers
for
primary care
services
|
Establish standards
care commodities
Provision of Population-based Regulate Primary Ensure affordable
services Streamlining procurement
:
of Care facilities access to medicines

commodities
Tait
dee a Aa uke eels) el Tere)
eC) elees- (ase Lis Tt Bley
Figure 1. Policy Framework for Primary Care (AO 2020-0024)

The above figure (Figure 1) consolidates all the aforementioned concepts into one
framework, highlighting nine key strategies for the attainment of the three strategic outputs
of Philippine Primary Care. Further elaboration on these nine strategies can be found in the
succeeding chapters of this manual. It is expected that PC Managers and actors within a
PCPN shall align themselves
to
this framework.

Chapter 1
From Governance to Leadership to Managing

the Primary Care Providers
Chapter 1: FromGovernance to Leadership to Managing the

Primary Care Providers
(Managed care instruments: alignment tools, contracts: Terms of Partnership,
service level agreement)
National policies that shape primary care
RA 11223: UHC Act
PC Managers need to understand the legal backdrop that influences the design,
organization, operation, and monitoring of a PC facility (PCF). PC Managers should
understand how these PCFs relate to the larger care organizations, such as the HCPN and
the Province or City-wide Health Systems (P/CWHS).
through
The formation of HCPNs
the provision of
is part of the UHC Act's strategy to address fragmentation
continuous, coordinated, and comprehensive care within an
integrated set up. HCPNs may be composed of integrated local health systems
(municipalities, cities, provinces), networks of private providers, or a mix of both. Each HCPN
must be linked to an apex or end-referral hospital and must have organized PCPNs. Each
HCPN, once formed, is tasked to streamline its operations towards integration, rationalize
multiple payers of care, and link the participation of public and private providers to serve a
well-defined catchment population. P/CWHS are public-led HCPNs composed of integrated
local health systems, consisting of a province or city and its component local health units,
public and private providers. The DOH, Philhealth and the Department
Government (DILG) shall facilitate and incentivize their integration and aid
of Interior and Local
in the formulation
of cooperative undertakings between LGUs. The P/CWHS must then have a commitment
manage health system costs, maintain quality and safety, and equitably improve the health of
to
their population (AO 2020-0021).
According to the UHC Act, DOH and LGUs shall endeavor to
provide every Filipino a
primary care provider within a PCPN. Registration of Filipinos to their PCPN of choice must
be in consideration of the proximity and ease of travel, absorptive capacity and capability of
the network. As discussed earlier, PCPNs provide 1) initial contact and navigation, 2) guide
patient decision-making for cost-efficient and appropriate care, 3) coordinate two-way
referral, 4) removes or manage barriers, 5) enable patient records, and 6) implement public
health services such as health promotion, disease surveillance, and disaster risk reduction
and management for health.
EO 138: Mandanas-Garcia Ruling: The re-devolution of services

PC Managers are in charge of programs and the management and procurement of
commodities for their facilities. To fulfill this role, PC Managers should understand the
implication of the Supreme Court Ruling on the Mandanas-Garcia case that led to the EO
138 of 2021 or the “Full Devolution of Certain Functions of the Executive Branch to Local
Governments.” EO 138 increased the National Tax Allocation to LGUs and redevolved some
national functions to local units. In particular, public PCFs (e.g. RHU, Health Centers) shall be
in charge of procurement for and delivery of: (1) services or commodities available within
their local market; (2) services for existing Philhealth benefits packages; and (3)
population-based services that are within the LGU’s capacity to implement.

Additional national functions that are re-devolved

storage, and distribution of commodities to component
to local units include warehousing,
LGUs. National agencies (DOH) shall
maintain responsibility over services that have significant costs or spillovers (externalities)
such as vaccines and selected family planning commodities. Currently, Devolution Transition
Plans are being formulated and the LGUs are expected to start implementation by Fiscal
year 2022. (Department of Health - Health Policy Development and Planning Bureau, 2021)
The operating models of HCPNs
(
It is imperative that
PC Managers have a clear understanding of the operating models
for HCPNs i.e. public-led HCPN (P/CWHS), purely private HCPN, mixed public-private
HCPN)
to be and
able to identify the contexts of operations, decision-making, service pathways,
agreements, accountability. Both HCPNs and P/CWHS plan and organize integrated
delivery of health care on a scale larger than its component PCPNs. P/CWHS have the
geo-political boundary of a city or province. Hence, public PCFs and PCPNs will likely cover
smaller geo-political territories (i.e. municipality, city, barangay). PCFs and PCPNs are
responsible for the care of that particular population and are within the auspices of a Local
Chief Executive or a Local Health Board. HCPNs may be composed of private health care
providers or mixed public-private service providers. They do not necessarily cover a province
or city hence, may report under a “network board.”
Contracting Mechanisms: (AO 2020-018)

DOH
in
shall contract P/CWHS the delivery of population-based services through a
Terms of Partnership (TOP) (DM 2021-0453)(Appendix D) ensuring shared responsibilities
and accountabilities among actors of its health systems. While individual-based services
shall be contracted by Philhealth to HCPNs through a service level agreement (SLA). PCFs
and PCPNs may not be directly contracted by DOH or Philhealth but may be subcontracted
as part of an established HCPN.
HCPNs have a minimum components of:(1) a PCPN linked to secondary and tertiary
providers; (2) assured patient access to all levels of services; (3) patient navigation and
coordination system; (4) records management system; (5) defined provider payment
mechanism; (6) proof of legal personality; (7) a fund pooling mechanism (AO 2020-0019).
Based on this AO, PCPNs_ are the foundational units of an HCPN and can likewise be
composed of public, private, or mixed PCs.
The leadership and management structure supporting PCPNs
PCFs and PCPNs must establish a robust and appropriate governance structure in
order to effectively deliver primary care services. Such governance structures should
ascertain how a facility or a network wishes to operate and carry-out decisions on a
day-to-day basis. A PCF can have a PC Manager, while PCPNs may have a “Board” (i.e. Local
Health Board). Either PC Managers or the Board should be able to understand the country's
basic policy process, development and adoption. This includes knowing how to form legal
agreements with other LGUs, health facilities, and relevant partners and recognize its
reporting relationship within a larger HCPN. Public PCPNs essentially will be under a
P/CWHS.
Department of Health, Philippines 17

According to AO 2020-0021, the management structure of the P/CWHS. shall be It

composed of: 1) the Provincial/ City Health Board; 2) Provincial/ City Health Office; and a 3)
Management Support Unit. Provincial and City Health Boards play a role in the overall policy
direction, coordination and oversight of integration, financial management, administrative
and technical supervision of P/-CWHS, and by extension, the public PCPNs. Municipal PCPNs
and PCFs are likely to be under their respective Mayors and managed by a Municipal Health
Officer or Rural Health Physician (Figure 2, Chapter 2).
Building conditions for good management
Strategic Alignments
priorities
For PCFs and PCPNs
and perspectives
to
to
operate smoothly, it is imperative for them to align to broader
allow support, complementation, budget appropriation, and
facilitation of their actions. Both DOH and DILG provide important health planning tools such
as the LIPH Handbook to check national alignment and consistency of programs. PC
Managers for public facilities must also develop skills in policy and program advocacy.
Using these tools would be helpful in communicating high-level support from the Local
Health Board and the Local Development Council.
Strategic Directions: Guiding Local Health Systems Integration (AO 2020-0037)

PC Managers must also be cognizant that local health systems must mature their level
of managerial and financial integration as part of a PIPCWHS. AO 2020-0037 defines the
concept of maturity levels, its building blocks, characteristics, levels of progression and key
result areas. It provides the mechanisms in
the implementation of the maturity levels as one
of the monitoring tools for the P/CWHS and guides the prioritization of resources and
support to facilitate the integration of the local health systems. A harmonized monitoring
matrix was made using WHO's Six Building Blocks of the health system. PC Managers will
find it useful to plan strategies around the more important integrative directions for each
pillar:
Table 1. Integrative Directions for the Six Building Blocks of Health Systems
Governance e LGU cooperation in creating PCPNs and P/CWHS, strategic

investments
Financing e Setting up and utilization of the Special Health Fund
Human Resource e Baseline gaps assessment for HRH requirements
e Management and development of human resources for health
e Attainment of desired staffing patterns, primary care worker
certification
Health Information e Baseline gaps assessment on health information systems
System .e Validated electronic medical records linking members to PCPs
Local emergency surveillance units_and reporting quidelines
Medicinal Products, e Baseline gaps assessment for procurement and supplies and info.
Vaccines and Technology| system
e Warehousing and transport network, availability of essential
medicines
Service Delivery e Baseline gaps assessment on health care provider
e Functional PCPN-led referral pathways; Fully registered population
e Self sufficient Health Emergency Response Team (HERT)& DRRM-H
system
e Local health promotion and Health impact assessment
Human resource management and staff competence

PC Managers and providers should be selected based on competencies. They should
have the knowledge, skills, and official DOH certification to participate as PCPs. They should
fully understand their role, tasks, and purpose. Managing PCPNs needs the balanced
involvement of people (leadership, health staff and community) in making sound decisions
and managing patient relations to achieve patient satisfaction apart from health outcomes
(British Medical Association). PC Managers must have the required tools and the correct
understanding of the Primary Health Care philosophy and DOH'’s Primary Care framework to
manage the networks well. These requirements for the human resource for health will be
further discussed in Chapter 5.
Coordination and collaboration with partners and stakeholders
Multi-stakeholder participation is an essential element of PHC and the framework for
implementing primary care. PC Managers have a catalytic role in knowing and mapping
potential partners to jumpstart engagement. Certain legal agreements with other LGUs,
health facilities and relevant partners cannot happen without skillful engagement. It is also
within the remit of PC Managers to
anticipate and manage possible conflicts of interest: All
actors that will be sought for involvement in programs and policy-determining activities and
even service delivery should be required to declare COI when they are engaged to serve the
public’s interest. AO 2020-0061 provides guidelines on the review of public health ethics.
Similarly, AO 2021-0011 also expounds section 35 of the UHC Act that mandates the
commitment of stakeholders to abide by ethical principles in public health practice through
(1) a Conflict of Interest (COI) declaration and management policy; (2) tracking of financial
relationships between health and health-related commodity manufacturers, healthcare
providers and health professionals; and (3) the constitution of a Public Health Ethics
Committee.
Systems for performance accountability

PCFs and PCPNs should apply a uniform framework for monitoring and evaluation that
will reinforce their accountability to desired health outcomes. Itis important as well to
ascribe to a framework of accountability for continuously improving quality of services,
safeguarding standards of care, and creating an environment for excellence in clinical care
(Baker et al. ). It would be helpful for PC Managers to make use of recognized mechanisms
such as the LGU Health Scorecard (AO 2019-0003) and for those participating as P/CWHS,
the Local Health System Maturation Level (LHS ML) in AO 2020-0037 provides a good
9.
basis. Further discussion on this topic is found in Chapter

Chapter 2
The Formation of a Primary Care Provider Network

Chapter 2: The formation of a primary care provider network

(Managed care instruments: MOA and other legal agreements,
decision-making protocols)
Gathering commitment and enabling sustainable primary care provider networks
PCPs that endeavor to form PCPNs should establish structure and governance
arrangements before they can move towards setting up their service guarantees and acquire
the necessary workforce commensurate for their respective catchment population (Baker et
al. ). PCPs that already have collaborative arrangements (i.e. Memorandum of Agreement)
through formed Inter-Local Health Zones (ILHZ), Inter-Barangay Health Zones, or Service
Delivery Networks (SDN) must also seek further advice on forming agreements and meeting
legal imperatives to establish their linkage within a larger HCPN and P/CWHS (AO
2020-0021). In doing so, they could gain access to the financial stimulus and technical
assistance from the national government and cooperating agencies for integrating their
operations.
Establishing the juridical entity (AO 2020-0021)
This is a particular concern for PCPs that hope

provider within an HCPN. Establishment of the
to participate as a Philhealth-accredited
juridical entity is part of Philhealth’s
requirement for HCPN accreditation. This serves as proof and assurance that participating
providers shall abide by its legal duties especially concerning fundholding capacities. While
provinces, cities, and municipalities already hold as a legal entity that forms the local health
system, P/CWHS still has to legally organize its Province-wide/City-wide Health Board
(P/CHB). Doing so explicitly designates them to manage an inter-LGU or inter-facility shared
Special Health Fund (SHF) where allocations from DOH and other payers will be placed.
Both HCPNs and P/CWHS alsohave to establish the legal entity for their component PCPNs.
Developing the system for internal governance and decision-making
All PCPs need leadership, management and administrative support structures. These
structures should incorporate and describe the authority that the PC Manager or a PC
“Management Board” may have. Decision-making protocols such as frequency of meetings,
mechanisms for deliberations, and documentation of processes, among others, need to be
put in place. AO 2020-0021 provides the required management structure for the P/CWHS
which other HCPNs may emulate (Figure 2).
Firstly, it designates the establishment of the “Health Board” or the P/CHB which shall
consist of the local chief executive (e.g. Provincial Governor or City Mayor) as the Chair, the
Province or City Health Officer as the Vice Chair, and other members representing the
legislative branch, non-government/private sector/people’s organizations, the DOH, and
other relevant groups such as the Indigenous Cultural Communities/Indigenous Peoples

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Figure 2. The Integrated Management Structure of the Provincial/City Wide Health System
(ICC/IP). The P/CHB shall serve as stewards and provide strategic directions for the
integrated LHS. They shall be assisted by a Management Support Unit that functions as
administrative secretariat, and two other technical divisions: the Health Service Delivery
Division, and the Health Systems Support Division.
Meanwhile, stand-alone PCFs shall need an individual facility manager or a

management unit that can provide operational oversight in its primary care activities. Both
Philhealth shall provide primary care licensing and accreditation standards that PC
Managers could refer to (AO 2020-047; PHIC Circ. 2020-0021).
It is also important to check the appropriateness of representation within
decision-making bodies. The DILG-DOH-NCIP JAO 2013-0001 supported by AO
2020-0023, highlights the importance of indigenous people (IP) mandatory representation. It
stipulates that this mandatory seat in decision-making is a manifestation of a real partnership
with the indigenous groups for their health development.

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Chapter 3
Shaping Investments and Financial Management

for Primary Care
Chapter 3: Shaping investments and financial management for Primary

Care
(Managed care instruments: investment planning, Special Health Fund,
prospective & performance-based payments)
Following the establishment of the structure of governance and administration, PCFs
and PCPNs should be able to deliver a guaranteed set of primary care services. This will
entail certain expansions or delineation of existing services to fit the needs of an assigned
to
population. A prerequisite, of course, is for the PCFs and PCPNs plan investments around
profiled needs and the expected costs of primary care operations. Good financial
management should be able to account for various funding streams and carry out sound
financial allocations for procurement, operations, and provider payments. Investment plans
for health should be realistic and expenditure should be adequately monitored and compared
et
across time (Baker al.; British Medical Association).
Policies on public financial management for health
Financial plan matrices of the local governments

PC Managers that deal with publicly-owned and managed facilities need to be
thoroughly familiar with the Philippine government's national plans and planning tools. As
mentioned before, there is a range of local planning instruments that the DILG employs
including Comprehensive Development Plan (Province), Local Development Plan
(City/Municipality), Annual Operation Plan, and Annual Investment Plan. Guidance is
provided to also ensure various lenses and principles are applied in the context of planning
(i.e. gender-sensitivity, indigenous people’s health, women’s rights) and for the local
investment plans for health to be non-duplicative, complementary, aligned and contribute to
the broader provincial, regional, and national agenda (LIPH Handbook).
The UHC Special Health Fund and allocations for PCPN (DOH-DBM-DOF JMC 2021-001)
The UHC Special Health Fund is a financial pooling set up that PCFs within a
P/CWHS must understand and participate in. The SHF was put forth by the UHC Act to
facilitate a more strategic and efficient management of health finances. It aims to reduce
fragmentation in financing, harmonize and streamline allocation, ensure efficient pooling,
provide appropriate incentives, and ensure transparency and accountability on the use of
health resources. PC Managers under component LGUs are tasked to enjoin LGU
administrators specifically the Treasurer, Budget Officer, Accountant, the Local Chief
Executive and their respective funding partners to abide by the provisions of the
DOH-DBM-DOF JMC 2021-001 in managing the SHF. This includes participation in
planning, allocation, and execution of budgets. The SHF includes the income generated from
Philhealth payments. In the wider context, participating in the HCPN in order to deliver
Philhealth-contracted individual-based services entails the execution of a prospective
provider payment mechanism that is performance-driven, closed end, and based on
Diagnosis-Related Groups (DRG). Both the DOH and Philhealth, through the SHF, shall also
employ differential payment schemes that incentivizes quality, efficiency, equity, and
effective attainment of public health outcomes.

Transitioning financing and procurement for primary care commodities (EO 138)
National health programs and services currently being funded by DOH which
eventually will be classified as local functions shall be partially or fully devolved to the
LGUs. PC Managers who
are
provincial, city, and municipal health officers should keep track
of the new expenditure assignments under EO 138. Its implications are that funding for local
health facility enhancement, epidemiology and surveillance, nurse and midwife
placements,
family health, communicable and non-communicable disease control shall generally be
appropriated responsibilities of the LGUs. Procurement, warehousing, and storage of related
supplies for public health programs are likewise transferred to LGUs (See Chapter 1).
Delineation of financing for primary care services
As earlier described, the DOH shall contract the P/CWHS for

the delivery of
population-based services. Meanwhile, should the P/CWHS decide to harness financing from
Philhealth, it then needs to establish its HCPN beginning with the smaller component
PCPNs. Financing for individual-based primary care services shall be provided by Philhealth.
As these services require different financing mechanisms, PC Managers should be able to
properly categorize services. The table below should further familiarize the PC Managers on
the general classifications for primary care services (AO 2020-0040).
Table 2. Examples of primary care services per category

Classification Population-based Individual-based
Funding source National Government and LGU Philhealth, HMO, Private
(Payer) Insurance, Patients and
Households
Examples of
Primary Care
e Mass interventions (community
vaccination, vector control, Water and
e
e
Counseling
Screening and diagnostic
Services Sanitation) e Outpatient treatment
e Health Promotion and communication e Rehabilitation
Epidemiologic Surveillance e Palliation
° Disease Risk Reduction and
Management
e Program Management
Development
Handbook)
of Local Investment Plan for Health (AO 2020-022; DM 2021-0434; LIPH
As this manual focuses on guiding PCFs and PCPNs within the public sector, an
understanding of the Local Investment Planning for Health process would be useful.
Private sector actors may also benefit from an understanding of the LIPH process since it
would allow them to easily participate in harmonized resource sharing with the local health
system. The LIPH is essentially the medium-term (3 years), costed strategic plan of the
P/CWHS for the implementation of the UHC harmonizing resource allocation from various
funding streams. PC Managers should understand this process to ensure that their primary
care strategies and actions will be fully-supported by the local and national government and
have line item budgets that are attributable within broader planning schemes.

The following are the steps of the LIPH process (LIPH Handbook):
a. After establishing the care network entity, the

P/CWHS must set the mission, vision, and
goals for the integrated LHS. This guides local
units/ facilities towards joint attainment of
better health outcomes.
b. Map. strategies and estimate needs for
essential interventions for population-based
and individual-based health services,
improving health service delivery,
strengthening health system operations and
addressing social determinants.
c. Map actions and commitments of different
stakeholders, including the private sector.
d. Develop the local investment plan for health
and proceed with appraisal activities.
Eflectweness,
Ethic
e. Check against prerequisite alignments and Equity,
inclusions (National Development Plan or

Ambisyon Natin 2040, Provincial
Comprehensive Development Plan, the LGU’s
Executive Legislative Agenda, Local
Development Plans, Ancestral Domain
Investment Plan for Health for Indigenous
People, DOH Program Plans such as the
DRMM-H plan, Health Facility Development Figure 3. Flowchart of investment
Plan, HRH Masterplan, ICT Plan) plan development and appraisal
d. Convert the LIPH to corresponding Annual activities
Operational Plans (AOP) to become the basis
for financial and non-financial grants from the
National Government, particularly DOH, and
other health partners.
e. Integrate the health AOP into the LGU’s
yearly Annual Investment Plans.
Harnessing financing potential from sources other than government

The private sector is deemed as a highly viable partner of the public sector in the
management and delivery of primary care services. The members of the private sector can
augment gaps such as pharmaceutical access, delivery of higher level care, diagnostics, and
referral transport. Public-private partnerships can support health financing through
mechanisms such as agreements, grants, sponsorships, etc.

Chapter 4
Integrating Service Delivery and Care Pathways

for better access
Chapter 4: Integrating service delivery and care pathways for better access
(Managed care instruments: gatekeeping, referral pathways, disease
management, case management)
Integrated service delivery improves care experience by improving access, lessening
missed opportunities for care, unifying practice standards, and reducing overall system cost
and patient expenditures (Baker et al.). The guiding principle of integration is that it is
centered on the health needs of the people. Every point of patient contact must be used as
an opportunity to provide or direct towards appropriate care. Every discrete health care event
should also be seen as part of an overall continuum of care experience meant to ensure the
health and well-being of a patient. It also means that no person or condition should be left
uncared for because of care discontinuities (financial, physical, socio-cultural barriers) (Pan
American Health Organization; Amelung).
The Philippines has made various efforts to reduce fragmentation of care and improve
service delivery. This includes setting up cooperative arrangements such as ILHZs where
contiguous LGUs cooperate to ensure care for constituents. Other examples include care
networks like the Public-Private Mixed DOTS, the Maternal Care Service Delivery Networks
(SDN), and the Provincial SDNs, all of which employ tools such as gatekeeping or triage,
referral agreements and pathways, and disease management standards (AO 2020-0021).
All PCPs should be able to recognize and employ these tools in order to effectively
participate within care network settings.
Linking the people to primary care providers
Gatekeeping ensures a coordinated and an inter-sectoral treatment process.The

gatekeeper acts as a first access point and the clearing house that deals with the disease
panorama of the population, then links or contracts the people to other providers or
specialists (Amelung; Garrido et al. ). To be an effective gatekeeper, the PC Manager needs to
assume the responsibility of ensuring that PCPs make themselves accessible, are able to
manage and provide quality care, and protect the health system from excessive use. This has
been done in the Philippines through processes like patient profiling, diagnostic screening
and assessment, triage, and some alternative routes like Barangay Health Emergency
Response Teams (BHERT), medical missions, referral from Botika ng Barangay, and
house-to-house visits. To properly instigate the gatekeeping process, Section 6 of the UHC
Act IRR and the DOH-PHIC JAO 2020-001 gives guidance that every Filipino must be
registered with a licensed public or private PCP of choice. These providers need to be near,
likely within territorial jurisdiction, and are able to accommodate their care. The process of
registration should be overseen by the LGU, assisted by the DOH and Philhealth. PC
Managers should collaborate closely with their respective LGUs to ensure all Filipinos are
registered.

Integrating clinical, logistical, and administrative care management
PCPs provide care for most presenting conditions and have a great variety of patients.
Providers in PCFs must provide guideline-based individual care and population-level
interventions (Finley et al.). DOH’s primary care guarantees consist of all of the agency’s
health programs and interventions that address 48 health conditions or 80% of local disease
burden lifted from the study by Wong et al (2015). All these which are provided in an
integrated manner are meant
and
to
reduce
facilitate the patient to the appropriate care, improve health
costs (AO 2017-0012; AO 2020-0040).
system experience,
Guidelines and referral pathways enable the PC Managers to make sense of

diagnosis and forms of therapy, regulate clinical decisions and reduce degree of compulsion
(can be obligatory to recommendatory algorithms), define scope of care, and direct transfer
to recognized providers that adhere to similar standards (Amelung). PC Managers should aid
in consolidating various guidelines, establish the continuum of clinical presentations, and
train providers in delivering the disease-agnostic set of services. These must also be
accounted for when forming referral agreements between the PCPN and higher-level
facilities. Healthcare providers must know what presentations would be considered
manageable at the primary care leveland what conditions would necessitate referral for
specialized care. The DOH continues to develop its set of national practice guidelines for
adoption and dissemination (AO 2021-0020), which will greatly aid in the development
standardized services and referral protocols.
of
Patient navigation differs from referral pathways
or managing barriers and helping patients gain
as
confidence
it primarily deals with removing
on how and where to get the
appropriate care. This involves accounting for social, cultural, and geographic factors
(Freeman and Rodriguez). PCPNs have to map the geographic location of patients, services,
providers, and existing roads, and communication lines to effectively manage patient
transfers. It is especially important to make sure that geographic isolation and disadvantages
are addressed. GIDAs essentially entail higher support in terms of human resource
availability, transportation, communication, and sharing of health information that are
important in patient navigation. Social factors affecting navigation apart from costs include
lack of information and fear or distrust in the providers or the services being offered. Within
the Philippines, a number of innovative navigation designs arose during the establishment
Service Delivery Networks. This included community initiatives such as Sea Ambulances
of
aided by community boat operators, referral by (motorcycle) habal-habal, and partnership
with hilots, local healers, women’s groups, Barangay Nutrition Scholars and the Barangay
Health Workers serving as patient navigators. PC Managers should be able to maximize the
potential of the community to activate all possible entry and navigation points for care.

Essential services and Primary Care Disease Management (AO 2020-0040)

to
Individual based services are services that can be traced back an individual recipient
with limited effect on population-level health determinants. Components include: history
taking, physical examination, nutritional assessment, developmental/mental health
evaluation, screening, basic laboratory examination, vaccination, counseling and health
promotion, normal birthing services, and family planning services. This includes care for the
primary presentation of most common illnesses of Filipinos where clinical or disease
management are distinguished by DOH according to life-stages:(a) maternal care services
(b) newborn and child care services; (c) adolescent care services (d) adult care; and (e) elderly
care. A more exhaustive discussion of the clinical standards and approaches per life-stage
condition will be provided in the Primary Care Manual Part 2: Manual on the Standards
and Procedures of Primary Care Service Delivery. Population-based services are services
aimed to promote health, survey and control disease and vectors, and are administered at a
population level. These services can be clustered together as those considered as: (1) mass
interventions (e.g. bed net distribution); (2) health promotion and communication (e.g.
Behavior Change Campaigns); and (3) program management (e.g. Epidemic surveillance/RA
11332, Disaster Risk Reduction, Infection Control). PCPs essentially integrate primary clinical
care with essential public health functions as a complete continuum of services that every
Filipino must have.
Apart from these, Basic Health Services for Indigenous Communities must carefully be
examined so that they are adequate and appropriately culture-sensitive. Developing health
service standards like culture-sensitive birthing and essential health packages with safe and
effective indigenous knowledge, systems, and practices (IKSP) is expected among facilities
covering areas with IP populations. (DOH-DILG-NCIP JMC 2013-01; AO 2020-003).
PCPs must also see to it that ancillary services integrated in primary care are also
provided (AO 2020-0047). These include: clinical laboratory, diagnostic radiologic services,
pharmacy, birthing services, oral/dental services, and ambulance service (Type 1),
medico-legal and autopsy (for Local Health units). These services may be outsourced and
located outside the PCF. While attending to all the integrated services previously mentioned,
the PC Manager must also integrate other administrative responsibilities on supply chain
management (e.g. pharmaceutical management information system) and medical waste
management (DOH HCWM Manual), and procurement of standard medical equipment and
medicines in health facilities. These standards are overseen by the Health Facilities and
Services Regulatory Bureau (HFSRB). It would be useful for PC Managers to keep abreast of
any developments.
Utilizing telemedicine for remote care access
Especially in the light of the COVID-19 Pandemic, using digital technologies such as
Telemedicine for the remote access and delivery of individual-based health services has been
integral to modern consultations. As prescribed by DOH-DILG-PHIC 2021-001, provinces,
highly urbanized cities, independent component cities that commit to integrate their local
health systems shall adopt and implement telemedicine technologies in the delivery of
individual-based health services. This is also part of the requirements for all HCPNs.

Applying good practices
can
Other good practices that have emerged
still be continued. This includes
in
using the
the earlier integration efforts of the country
PC facility to link patients to other services
such as social welfare support, as a portal for Philhealth enlistment, and a provider of
pre-marital counseling. When a collaborative process in managing patients arises, where
more comprehensive concerns are planned, assessed, implemented, and coordinated, then
this is termed case management (Amelung). Case management is
multi-sectoral integration
in care, allows ease of doing business, and expands the influence of PC providers in
managing other determinants of health.

Chapter 5
Requirements, Competencies, and Cooperation of

Human Resources for Health
Chapter 5: Requirements, competencies, and cooperation of human

resources for health
(Managed care instruments: selective contracting; competency certification)
When
should also bea PCF
or PCPN
able to
is ready
to begin or redefine its set of primary care services,
according to the expected workload and assign a
reorganize
it
corresponding workforce. PC Managers have this complex task of ensuring the adequacy of
staffing and appropriateness of task-shifting, providing training, mentoring and supervision,
and fostering a safe work environment that also raises motivation and retention.
The Requirements for and competencies of Primary Care HRH
A primary care provider refers to a health care worker, who may be a health
professional or a community health worker or volunteer that has been certified by DOH to
provide primary care services (RA 11223 IRR). PCPs may come from the cadre of: (1)
physicians (2) nurses (3) midwives (4) nutritionist-dietitians, (5) dentists, among others. A
single PC facility should have a duly licensed physician as the head of the facility and its
providers, referred to in this manual as the Primary Care Manager, whose task is to manage
the clinical and administrative operations of the PCPs. PCFs that are rural health units or
urban health centers have to oversee clinical and administrative operations of barangay
health stations within their jurisdiction. Minimum staffing standards within PCFs in terms of
composition and ratio are set by the DOH, adjusted according to workload and services
provided or contracted (AO 2020-0047). According to the DOH Health Human Resource and
Development Bureau, there are 7 domains of competencies a PC provider/worker must be
able to demonstrate: (1) providing first contact care; (2) providing comprehensive primary
care; (3) providing continuing care; (4) coordinating care; (5) managing patient records; (6)
promoting health; and (7) implementing public health functions. More specific competencies
for each domain can be found in Appendix A (HHRDB Competency Assessment Tool; AO
2020-0038).
All these domains of competencies should be demonstrated by a PC Manager, but

must additionally hone skills that would be necessary for their oversight role. A PC Manager
can be a Municipal/City Health Officer, a Provincial Health Officer, or a chief of a stand alone
PCF. Additional competencies that can be expected of a PC Manager are provided in
Appendix B: evidence-based decision-making, financial management, HR development,
strategy development, network collaboration, health promotion, and performance
management. In addition to PCP and Managers, there are also the PC support staff that
would be needed to run a fully functional PCF. This can include: sanitation officer,
information technology officer, records officer, administrative officer, and utility worker (AO
2020-0047). All personnel, whether a manager, provider, or support staff should also
conform to a professional code of conduct, moral and cultural sensitivity (Nontapet et al.)

* Certification of Primary Care (CPC) Workers for UHC (DOH-PRC JAO 2020-01) is the
procedure for assessment of PC providers in the delivery of services. This is based on the
competency
care. The
tois
CPC
deliver initial-contact, accessible, continuous, comprehensive and coordinated
a prerequisite for accreditation and licensing of PCFs by DOH and Philhealth
and in essence, for selective contracting. DOH is also working with the Commission on
Health Education and the Professional Regulations Commission on the inclusion of PC
competencies in the curricula and reorientation of health workers. This has also been
considered within the National Health Human Resource Masterplan 2020-2040 (DC
2021-0253).
Managing human resource (CSC MC 2012-03)
The Civil Service Commission has provided guidance to national agencies and local
government units to espouse a systematic, well-defined, and meritocratic path for human
resource management. The CSC recognizes five system domains in HR management: (1)
recruitment, selection, and placement, (2) learning and development (3) performance
management (4) rewards and recognition; (5) health and safety. The HR system domains,
when applied, can also be seen as a sequence of HR
activities that can be categorized into 4
phases: (1) Pre-hiring Phase: conducting job analysis, planning for labor needs and
recruitment; (2) Hiring Phase: selecting job candidates, orienting new hires; (3) Post-hiring
Phase: managing salaries, providing incentives and benefits, appraising performance; (4)
Development Phase: communicating, training and developing managers, building employee
commitment. Understanding the system domains and the chronology of HR management
allows PC Managers to recognize opportunities for their useful application.
Harnessing cooperation of community health allies
PC Managers should also be able to manage and link PCPs with interprofessional
teams. They can also be involved in HR development plans to ensure the participation and
cooperation of non-professional health care workers. This is especially true for Barangay
Health Workers (BHW) and Barangay Nutrition Scholars (BNS) who are
the largest cadre
and the most spread out frontline health workers in the country. Apart from the PCP
Certification, they can be updated with their competencies through a National Certification
Training from the Technological Education and Skills Development Authority (TESDA BHS
NC II for BHWs 2015). The DOH-DILG-NCIP JAO 2013-01 also encourages a mixed culture
workforce. Included among the PC staff are trained and culture-sensitive health workers who
provide locally-adapted care such /P health leaders, hilots and traditional birth attendants to
assume an alternative/complementary role in a safe, effective, and culturally-sensitive
primary care system.

Chapter 6
Applying Standards and Policies to

Regulate Quality and Costs
Chapter 6: Applying standards and policies to regulate quality and costs

(Managed care instruments: licensing, accreditation, formularies, Price
Referencing)
As the workforce expands and primary care services reconfigure to become more
comprehensive, PCFs and PCPNs_ would need to maintain costs without compromising
quality. Standards and guidelines are set within the premises of guaranteed quality, safety,
and cost-efficiency of services of a PCF and would be useful to consider for this purpose. Itis
also expected of the PC Manager to foster and maintain an organizational culture for quality
by keeping quality in the agenda of PCFs and PCPNs and amply structuring workplace
protocols (British Medical Association). Meanwhile, various policies play a role in regulating
costs within the primary care setting, using tools such as selective contracting of licensed
and accredited facilities that enforce No Balance Billing, applying drug formularies and
price references also make sure costs are contained for the patients and the PCP.
Quality Planning, Assurance, Quality Control
Quality care should be safe, effective, timely, equitable, and people-centered (World
Health Organization and United Nations Children's Fund). Managing the quality of integrated
primary care may be done through assessment of the patient status along the care pathway,
appropriateness of care, timeliness of referrals, attainment of health outcomes (individual
and population), and ease of care experience and patient satisfaction. Quality planning and
controlling can begin with PCFs determining their own standards and protocols or ascribing
to expert-derived or national standards of care. Putting these within a single framework or a
standards manual will allow PCFs to place certain controls should deviations happen.
Clinical quality monitoring and improvement can also be done through a process called
utilization review and utilization management which will be discussed in Chapter 9
(Amelung).
Accreditation and Licensing of PCFs and HRH
As mentioned, PCFs refer to the institutions licensed or registered in DOH that mainly
deliver primary care services. The rules and regulations for the licensure of PCFs can be
found in AO 2020-0047. Infrastructural considerations include water and sanitation,
occupational and environmental safety, visual and auditory privacy, infection prevention and
control, communication infrastructure and transport, health care waste management,
laboratory and pharmacy. Because of COVID-19, ventilation and space have increasingly
become pertinent infrastructural concerns. Other licensing requirements include clinical
standards/guidebook, HR management (see Chapter 5), service capabilities, equipment and
supplies, leadership and management, and organizational ethics. PC Managers should know
that only licensed or accredited PCPs are selectively contracted by DOH and Philhealth to
provide primary care. A single DOH License to Operate (LTO) valid for 3 years is issued to a
PCF and later re-assessed by the DOH Centers for Health Development. PCFs must have a
Manual of Procedures and must only use drugs registered under the Food and Drugs
Administration (FDA)and listed under the Philippine National Formulary, a list of quality
essential drugs that are available, accessible, efficacious, safe and affordable.

The Accreditation of PC Providers for Philhealth Konsultasyong Sulit at Tama

(Konsulta) Package or PHIC Circular 2020-021 provides the same requirements as DOH but
additionally requires adherence to Philhealth-prescribed guidelines, abidance by a
prospective provider payer mechanisms, and the use of an interoperable electronic medical
records system. They are also expected to provide certain packages in addition to the base
primary care services, namely: Maternal Care Package, Newborn Care Package, TB-DOTS
package, Outpatient HIV Antiviral Treatment Package, and Animal Bite Treatment Package.
Being PHlIC-accredited also allows the PC facility to participate within a
Philhealth-accredited HCPN.
Cost containment
It is important that PC Managers recognize and understand various cost containment

measures being employed to make sure that financial risk protection is afforded to both the
patients and the payers of services, and that overall health system costs are kept reasonably
low without compromising quality of care. According to the UHC Act, DOH shall require the
availability of fairly-priced generic equivalents of all drugs in the DOH-licensed PCFs. These
drugs are placed within the Philippine National Formulary which also provides a review of
the guidelines on proper prescription writing, adequate patient counseling, and a timely
report on the emerging problems due to Antimicrobial Resistance (PNF, 2021). Those drugs
within the PNF are also given a Drug Price Reference Index or DPRI which serves as a basis
to pricing medicines for governmental procurements and intended to prevent undue
increases in drug pricing. The Government Procurement and Reform Act (RA 9184) which
provides guidance in the procurement activities of the government abides by the PNF and the
DPRI.
Apart from these measures, as described in Chapter 3, the LIPH process allows for
pooling of financial activities. It makes use of the Project Procurement Management Plan
(PPMP) and the Annual Procurement Plans (AOP) to anticipate the needs of the LGU in the
coming year. It
costs (DOH-DBM-DOF JMC 2021-001).
to
is a tool of local governments pool similar requests to reduce procurement

OF yo) <=) af
Making use of eHealth Systems

for Primary Care
Chapter 7: Making use of eHealth systems for primary care

(Managed care instruments: eHealth systems, eHealth standards
The DOH gears to standardize mandatory health data for information and
)
communication technology systems (ICT) that shall be adopted by the entire health sector.
Part of this is to develop standards for interoperable electronic management systems such as
but not limited to electronic health records, e-prescription, and enterprise resource planning
systems that shall be basic requirements for PCPNs to ensure continuity and coordination of
care (AO 2020-0024). Some of the major eHealth systems and applications for PCFs
include the integrated disease reporting systems, electronic medical records (eMR),
Telemedicine, mHealth (Mobile Health), eHealth Devices and Equipment, and various other
emerging eHealth technologies and platforms.
PC Managers and providers, by and large, should already be familiar with the two
main epidemiologic surveillance information systems being used by the country: the Field
Health Service Information System (FHSIS) and the Philippine Integrated Disease
Surveillance Response (PIDSR). It is also important to learn and make use of the
DOH-developed eMR system, the iClinicSys. This eMR feeds into various health reporting
systems and inter-operate as well with the Philhealth information systems (DOH-PHIC JAO
2021-0019). Done properly, these eHealth systems are very useful tools to assess individual
and population health status, determine needs, gauge health system performance and even
assess the quality of primary care. Based on the guidelines on Local Health System Maturity
Level (LHS ML), a functional P/CWHS should have a validated eMR system that links the
PCPN
to higher levels of care and has a capacity for reporting data security incidents.
also expected that FHSIS and PIDSR are fully implemented and are supported through
It is
legislation (AO 2020-0037).

Some localities in the country have chosen to adopt their own eHealth innovations
such as the Community Health Information Tracking System (CHITS), an open source eMR.
DOH permits these innovations but they must conform to the following recognized eHealth
standards and principles, namely: (a) must serve the needs of the client or person; (b) must
be aligned or harmonized, without controlling health care providers to implement local
eHealth solutions; (c) human resource can be made available by building capability; (d)
require minimum eHealth Investments; and (e) aid in the progressive realization & monitoring
of the LHS ML characteristics. The DOH-DICT-PHIC JAO 2021-001 has set the Standard
Conformance and Interoperability Validation (SCIV) to enable different health information
systems and other eHealth solutions of health care providers, insurers, and health-related
data and reports at the local and national levels. All HIS and other eHealth solutions that are
being implemented shall be required to undergo and pass SCIV and also adapt to the
DOH-PHIC JAO 2021-002 National Health Data standards, including data security
measures. All of these are being monitored and implemented by the DOH Knowledge
Management and Information Technology Service (KMITS).

Chapter 8
Mobilizing the Community for

Primary Care and Public Health
Chapter 8: Mobilizing the community for primary care and public health
(Managed care instruments: patient coaching, demand management)
To fulfill the aspirations of the UHC Act, primary care providers in the country must
take on a more proactive role to “make every contact count.” Every opportunity to promote
and protect health and prevent disease should be identified and utilized. To effectively carry
this out, the more personal and family-oriented primary clinical care must seamlessly be
integrated with population-based public health interventions. This allows PC providers to
develop strategies in individual care that will also seek to address broader social
determinants of health (e.g. smoking cessation). Likewise, population-based actions can be
motivated by the desire to improve the health of individuals (e.g. food safety seals) (RA
11223; World Health Organization).
Community roles in health promotion
The Health Promotion Framework Strategy described in AO 2020-0042 inscribes that

P/CWHS must provide policies and programs that (a) considers all life-stages; (b) targets
behavior of individuals to make healthy choices and curb risk factors; and (c) considers the
environment in which the individual lives, studies, and works in. To do this, the province/ city
health boards must form a Health Promotion Committee, composed of different sectors
(education, budget, social welfare, etc.) to guide local health boards. The P/CHB shall also
form a Health Promotion Unit under the P/CWHS Health Service Delivery Division.
More locally, this may include municipal PCPNs or PCPs developing partnerships,
supporting school measures such as a ban on smoking, harmful use of alcohol and illicit
drugs, joining community promotion of good dietary practices and proper nutrition and
actions on infection control and environmental measures against vectors, and encouraging
pooling of multi-sectoral resources for health promotion. The Department of Education, for
example, has been a staunch partner of the Department of Health in the promotion of
Healthy School Settings (DOH-DSWD- DepEd-CHED-LEB-TESDA-DILG JAO/DEpED OUA
Memo 00-0621-0160). Broadcast media and social media networks also play a role in health
promotion through behavior-modifying commercials, announcements, or media programs
that talk about health.
Community roles in patient coaching, demand management and care
The community can also play an important role in care. Health and non-health actors
could work with PCPs to raise health awareness, disseminate information, reduce stigma,
assist in triage, coordinate care, mobilize resources, and improve treatment outcomes
through patient support (World Health Organization and United Nations Children's Fund).
Below are some examples:

Participatory consultation and family/community sessions

Participatory methods are tools to allow greater communication and discovery of
health issues between the primary care providers and their assigned community. Community
assemblies, like the Usapan Series of USAID, as an example, may take some time and
resources but could ensure better working relations and catalyze lasting partnerships in care
(World Health Organization and United Nations Children's Fund). The Family Development
Sessions of the Department of Social Welfare Development provide avenues for demand
management by learning about self-care and convincing families to properly utilize primary
care services.
Peer support groups

There have also been several efforts in forming peer assistance in treatment and
health literacy such as the Hypertension Clubs and Diabetes Clubs. When peer support
groups particularly know a patient well or are specifically trained, they could also help in
patient follow visits or assist in mental and psychosocial care.
up
Barangay Health Workers as case managers

BHWs and BNS in the country have performed a myriad of functions and continue to
be a formidable ally of health professionals in delivering care. BHWs, in essence, have
performed the role of a case manager (see Chapter 4) combining multiple tasks for the
various needs of patients acting as: navigators, care planners, first points of contact, health
educators, and links to home-based support.

Chapter 9
Monitoring and Evaluating Performance &

Responsiveness of Primary Care
Chapter 9: Monitoring and evaluating performance & responsiveness of

Primary Care
(Managed care instruments: utilization review/ management, Strategic
Performance Management System, scorecards, data quality checks)
PCFs and PCPNs that implement both individual-based and population-based
interventions would need to monitor information on the individual, facility, and network level
(if part of a PCPN). Patient monitoring can be done through the use of routine information
and compilation and analysis of individual patient information. Patient management includes
aggregating and sharing these individual information with a whole clinical team, which may
be in the form of longitudinal patient monitoring looking at the patient record across time and
along a referral path. Program monitoring, on the other hand, is another monitoring
function that can be done through routine tracking of priority information on programs and
outputs of the primary care system (i.e. number of patients served) (World Health
Organization & United Nations Children's Fund, 2020).
Evaluating quality of clinical care

As
earlier described, PCFs and PCPN’s should have quality as part of their primary
care agenda. This means committing to continuously improve the quality of services,
safeguard standards of care, and create an environment for excellence in clinical care.
Various integrated care provider networks in other countries have made use of three
perspectives for care quality monitoring summarized by the three inquiries below (Baker et
al., 1999) :
(1) did patients receive needed care ?
(2) was care delivered consistent to standards
at the least possible cost?
(3) did care deliver the desired effect on the patient’s health and well-being?
These can form the assessment protocol for what can be referred to as primary care
clinical utilization review where individual patient experiences are evaluated. When taken
altogether, PCFs and PCPN can then perform aggregate assessments (eg. % of
inappropriate and failed referrals per year, per facility, per network) to look at their overall
performance in primary care provision. This process is referred to as utilization
management (Amelung).
Evaluating facility-level or network-level performance
Monitoring and evaluation of PCFs and PCPNs shall be in accordance with the national
directions and goals currently presented within the Fourmula 1 Plus for Health (AO
2018-0014). In assessing facility and network performance, PCPs, whether from public,
private, or mixed networks must be able to utilize the F1 Plus M&E framework (AO
2019-0003) and the LGU Health Scorecard (AO 2021-0002) as these conform to desired
outcomes and targets of the country which all providers must contribute to. PC providers
could also refer to the functionality targets set by the LHS ML (AO 2020-0037). Primary care
policy framework (AO 2020-0024) highlights that key performance indicators must provide
focus on accessibility, comprehensiveness, continuity, coordination, quality, efficiency, and
equity of primary care.

It is also important for PC Managers to make sure that targets are transformed into
accountabilities. For public PC providers, a system for setting up performance accountabilities
was outlined by the Civil Service Commission as the Strategic Performance Management
System (CSC Res. 1200481). This process focuses on linking individual performance
vis-a-vis the agency’s (in this case, the RHU or PCPN and the P/CWHS) organizational vision,
mission, and strategic goals. PC Managers would benefit in knowing and employing the four
stages of the SPMS cycle: (1) performance planning and commitment — where individual
performance commitment records (IPCR) and the organizational performance commitment
records (OPCR) are developed and aligned; (2) performance monitoring and coaching; (3)
performance review and evaluation; and (4) performance rewarding and development
planning. Typically, reviews are done by a performance management team that can be
established by the organization or care network.
Validating and utilizing the performance evaluation information
Performing Data Quality Checks (DQC) is essential in ensuring that the information
which serves as the basis of organizational decisions are correct, up-to-date, and valid. PC
Managers should be prompted to perform DQCs in instances wherein there are "zero
reporting" and accomplishments exceeding a 100% target. DOH’s Development
Management Officers and Program Managers are duly trained in the performance of DQCs
and can aid the PCFs and PCPNs in carrying this out.
Utilizing data for responsiveness is about analyzing data and information and
assessing whether the desired outcomes and impact have been achieved. Itis also about
revisiting consultations with patients and the community to see whether their expectations
have been met. PC Managers could facilitate this process and analyze other performance
information to be able to unpack a range of issues and solutions for Continuous Quality
Improvements. Multiple factors affect quality and quality improvements can be more
methodical if evaluations focus on the evolving and actual needs of a patient, determining
what primary care intervention needs improvement, testing solutions, then applying the
change. Making quality improvement part of the tasks of PCFs and networks can raise
organizational morale because the staff and patients can see that barriers to care are
constantly being addressed. Having a vision for quality would be necessary. Building staff
capacity and motivation is another intervention for quality improvement (World Health
Organization & United Nations Children's Fund, 2020). A similar methodology can go as well
with the conduct of Program Implementation Reviews. Apart from these, data from the
various information systems and sources of the PC providers and PCPN can also be used for
research and development. In particular, certain useful studies that can aid decision-making
and legislation surrounding primary and public health are Health Technology Assessments,
Health Economic Evaluations, and Health Impact Assessment.

Summary Note
All in all, this manual has provided an exhaustive discussion of the country’s
framework for a more responsive Primary Care. Through research and consultations, nine
domains of operation were identified and presented in the hopes that Primary Care Managers
and other knowledge-informed users would review and utilize them to develop their
respective systems for delivering primary care. Competencies for assessing Primary Care
workers were further enhanced to include professional ethics and management
competencies and a wide range of recent and relevant policies have been reviewed. Three
to
appendices have been supplied at the end of this manual aid checking and recall.
Department of Health, Philippines 55

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Appendix A. Competency Checklist for Primary Care Workers

Providing first
|. QO
ability to communicate with patients during consultation
contact Care a ability to take relevant health information
a ability to provide initial treatment within primary care
QO
ability to recognize patients needing higher level care
Il.Providing QO
ability to apply biopsychosocial approach in care management
Comprehensive Oo ability to provide individual, family and community health care
Primary Care Q ability to provide counseling services
Providing
Ill. QO
ability to sustain continuing relationship with patients
Continuing Care Qa ability to formulate plans with patients requiring continuing care
IV. Coordinating a ability to refer to higher-level or specialty care

Care Q ability to assist patients during referrals
oO ability to participate in interprofessional care
oO ability to navigate through other agencies and resources
V.Managing Patient O ability to ensure quality patient records
Records Oo ability to maintain data privacy
Oo ability to demonstrate familiarity with local HIS
VI. Promoting QO
ability to understand and explain the fundamental concepts of
Health health promotion
oO ability to effectively communicate with families and communities to
promote better health
a ability to implement strategies that promote inclusivity to identified
vulnerable groups
VII.Implementing Qo ability to apply the basic concepts of public health surveillance
Integrated Public a ability to implement and monitor public health programs
Health Function Q ability to engage community leaders and stakeholders in the
implementation of health programs
Professional
VIII. Qo abidance bya professional code of ethics and respect for patient
accountability * rights
a
able to apply cultural and moral sensitivity along with interpersonal
skills
IX.Managing capable of utilizing evidence and insight in sound leadership and

Primary Care OD
decision-making
Facilities and effectively plans facility or network finances and able to manage
Networks ** costs
oO provide strategic leadership in workforce development and task
shifting
oo develop initiatives that ensure access to comprehensive,
continuous primary care
support care network standards, agreements, and strategy
development
ooo fosters people collaboration for effective community health
promotion
fosters excellent performance and continuing quality improvement
Items I-IV refer to the four core functions of primary care providers.
Items I-VIl were derived from the DOH-HHRDB Self-Assessment Tool for Primary Care Workers.
*Item VIlLis added taking into consideration the insights from a Thai study (Nontapet
** Item IX
et
al. 2008). ,
are additional competencies specific for Primary Care Providers that perform management roles.

Appendix B. Policy Reference Checklist for

Primary Care Managers
(AO 2020-0024) Primary care policy framework and sectoral strategies
(EO 138) Full Devolution of Executive Branch to LGU (Mandanas Ruling)
coooo
(AO 2020-037) Guidelines on the Implementation of the LHS Maturity Level
(AO 2020-0023) Guidelines on Identifying GIDA and Strengthening Health System
(AO 2020-0040) Guidelines on the Classification of Individual-based and Population-based Primary Care Service
Packages
(RA 11332) Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern
cooo
(AO 2021-002) Revised guidelines on the LGU Health scorecard
(AO 2020-018) Contracting P/CWHS
(DM 2021-0453) Template for 2022 Terms of Partnership between the DOH-CHD and the Province/HUC/ICC for the
Implementation of 2022 Annual Operation Plan
(AO 2020-0019) Guidelines on service delivery design of HCPNs
cooo
(AO 2020-021) Guidelines on integration of Local Health Systems in to P/-CWHS
(AO 2020-061) Guidelines on Public Health Ethics Review
(AO 2021-0011) Implementing Guidelines of Section 35 of the Republic Act No. 11223, otherwise known as the
“Universal Health Care Act’, on Standards on Receipt, Assessment, and Management of Conflict of Interest
o (DOH-DBM-DOF JMC 2021-001) Guidelines on the Allocation, Utilization, and Monitoring of and Accountability for
the Special Health Fund
(DM 2021-0434) Directions for the Development of 2023-2025 LIPH and 2023 AOP
(AO 2020-022) Developing LIPH
(AO 2019-0003) The F1Plus For Health M&E System for the Health Sector
oooocoocoO
(AO 2020-0047)Rules and Regulation Governing Licensure of Primary Care Facilities in the Philippines
(Philhealth Circular no. 2020-0021) Accreditation of Health Care Providers for Konsulta Package
(DOH-PHIC JAO 2020-001) Guidelines on the Registration of Filipinos to a Primary Care Provider
(DOH-NCIP-DILG JMC 2013-01) Guidelines on the Delivery of Basic Health Services for Indigenous Cultural
Communities/Indigenous Peoples (ICCs/IPs)
(DOH-PRC JAO: 2020-01) Certification of Primary Care workers for UHC
ooo
(CSC MC 2012-03) Program to Institutionalize Meritocracy and Excellence in HR Management (PRIME-HRM)
(DOH-PRC JAO 2021-001) Guidelines on the Establishment, Utilization and Maintenance of the National Health
Workforce Registry
(RA 7883 and IRR) BHW Benefits and Incentives Act of 1995 and its Implementing Rules and Regulations
ocooocoo
(TESDA) BHS NC
IIfor BHWs 2015 BHW Reference Manual (with ongoing revisions)
(AO 2017-0012) Guidelines on the Adoption of Primary Health Care Guarantees for all Filipinos
(DC 2013-0435) Implementation of Service Capabilities of Laboratory at Various Levels
(DC 2021- 0455) Dissemination and Utilization of the Philippine National Formulary (PNF) Manual for Primary Care
Providers 9th Edition
oOo
(AO 2020-0038) Guidelines on the Deployment of Human Resources for Health under the National Health
Workforce Support System
Co
(DC 2021-0253) Dissemination of the National Human Resource for Health Masterplan 2020-2040
(DOH-PHIC JAO 2021-0019) Guidelines on the Implementation and Maintenance of an Integrated Health
Information System
O (DOH-DILG-PHIC JAO 2021-001) Guidelines on the implementation of Telemedicine in the Delivery of
Individual-based Health Services
0 (DOH-DICT-PHIC JAO 2021-001) Guidelines on the Implementation of the Standards of Conformance and
Interoperability Validation
OO
(DOH-PHIC JAO 2021-002) Mandatory Adoption and Use of National Health Data Standards for Interoperability
(DOH-PHIC JAO 2020-019) Implementing Guidelines of Section 31 of RA 11223 on the Processing and Submission
of Health and Health-related Data
00
(AO 2020-0042) Health Promotion Framework Strategy in P/CWHS
(DOH-DSWD-DepEd-CHED-LEB-TESDA-DILG JAO/ DEpED OUA Memo 00-0621-0160) Guidelines on Health
setting framework in learning institutions
(AO 2020-0036) Guidelines on the Institutionalization of DRRM-H in P/CWHS
(AO 2019-0003)F1 Plus for Health Monitoring and Evaluation Framework
(AO 2019-0027/AO 2021-0002) LGU Health Scorecard
(RA 9184) Government Procurement Reform Act
(RA 7160) Local Government Code of 1991
Oooooo0000co0
(RA 7305) Magna Carta for BHWs

(PD 1569) Strengthening Barangay Nutrition Program
(RA 11223) Universal Health Care Law
(PD 856) Sanitation Code of the Philippines
(RA 9502) Cheaper Medicines Act of 2008
(CSC MC 2012-06/ CSC Res. 1200481) Guidelines in the establishment and implementation of Agency Strategic
Performance Management Systems

=
Appendix C. Operations Checklist for Primary Care Managers

Domain Items
Leadership and Setting up an internal governance and decision-making system

Governance ooo
Deciding on the operational model for the network (public, private, mixed)
Setting up a system for performance accountability and an organizational culture for
quality
Primary Care (4 Establishment of legal and juridical entity of the PCPN or the whole HCPN
Network (4. Mapping of service availability and linking with facilities through service agreements
formation 4 Entering into contract with DOH under an assigned P/CWHS and Philhealth under an
HCPN
Financing (4 Delineation of financing for health services (through DOH and PhilHealth contracting)
4 ~=Accomplishment and validation of Local Investment Plans for Health
‘4 Transitioning financing for primary care commodities
4 Streamlining procurement of commodities through pooling
Access & 4 Setting-up of mechanism for registration of every Filipino to a primary care provider of
|
Integrated choice
Service Delivery Profiling of patients and families and linking to primary care providers
(4 Integrated provision of individual-based and population-based health services
4 Effective, timely, and appropriate patient navigation and bi-directional referral systems
Human Resources} “1
‘4.
Ensuring adequacy ofstaffing and effectiveness of task-shifting
Enhancement of primary care competencies through training and certification
‘4 Mentoring and supportive supervision to foster motivation, retention, anda safe
working environment
Regulation of Attain licensing or accreditation as PC facility from DOH and Philhealth

Quality and Costs ooo
Adherenceto national practice guidelines and standards in primary care
Adherence to national formularies and price references to ensure affordable access
{4 Process for monitoring and maintaining quality and standards
Health 4 Setting-up of accurate, sensitive and timely epidemiologic surveillance system

Information 4 Setting up technology-enabled records management (and telemedicine)
System
Community 4 Implementation of proactive, effective and evidence-based health promotion program

Health and {4 Communication plan to promote positive social and behavioral change
Health Promotion| “Programs and strategies to ensure delivery of population-based services
4 Setting up mechanisms for people participation and multi-stakeholder collaboration
Performance 4 Set up KPls to address accessibility, comprehensiveness, continuity, coordination,

Monitoring quality, efficient, and equity of primary care utilizing available M&E mechanisms
4 Setting up data quality checks
4 Setting up mechanism of communication and learning from performance

Appendix D. DOH Template for

Terms of Partnership
P/CWHS in entering into
2022 TOP Template ver 28Sept2021
TERMS OF PARTNERSHIP
(Annual Operational Plan CY 2022)
KNOW ALL MEN BY THIS PRESE

This Terms of Partnership (TOP) is made and entered by and benveen:
CHD
The Department of Health — Center for Health Development
ee
ney crea nd existing under the laws of the Republic of the Philippines
wi
regional government
Accountant,
principal office address at herein represented

by the Director IV, and hereinafter referred to
»
as the *DOH-CHD™;
CHO
and
The Province/City of . a Local Government Unit established and existing

Officer
under the laws and re: ions of the Republic of the Philippines, with principal o: address at
represented by HON.
Health
, in his/her capacity as the Provincial Governor/City
Mayor.
jz
an/Panlungsod under Resolution No.
Provincial/City
__
lated
dated
a » herein,
. and (for UHC-IS) Province/City
er referredto as the “PROVINCE/CITY™:

Health Board Resolution No.
WITNESSETH
WHEREAS, Section 11, Article XI of
the 1987 Philippine Constitution provides, among others, that
the State shall adopt an integrated and comprehensive approach to health development, which shall
endeavor to make essential goods, health and social servic able to all people at affordable cost;
WHEREAS, Republic Act 7160 otherwise known he 1991 Local Government Code mandated the
devolution of
the delivery of health services and fa
of all Local Government Units (LGUs) at all levels;
Sas one of the basic functions and responsibilities.
|
CHD
WHEREAS, Section 22 of Republic Act 11223 otherwise known as

the Universal Health Care (UHC)
Act 2019 mandated the National Government to make available commensurate financial and non-financial
Director
matching grants, including ¢ outlay, human resources for health and health commodities, to improve
the functionality of province-wide and ¢ ide health systems, provided that the grants shall be in
accordance with the approved province-wid city-wide health investment plans.
dd
WHEREAS, the Fourmula One Plus for Health with its tagline “Boosting Universal Health Care” is the
stratey! mework tor Health Sector Reform to attain the vo: ppine Government
the Philippine Development Plan, the Sustainable Development Goals, and The Ambisyon Natin 2040,
in
spe ally for the health sector, goals of better health outcomes, more equitable health care financing, and
more responsive health system;
CHD
IV, the Province/City of |

—
has agreed to implement health sector
reforms cons: ent with the Universal Health Care Act and the Fourmula One Plus for Health and has
proven its capacity to utilize investment and sustain the reform process, among others:
Director
WHEREAS, the Local Investment Plan for Health (LIPH) is the key instrument in forging the
Department of Health (DOH) and Local Government Unit (LGU) partnership to carry out the Fourmula
One Plus for Health, and techn: ce from the DOH shall be consolidated and matched with the
needs outlined in the Local Investment Plans for Health; and whereas the implementation of the LIPH
translated through the Annual Operation Plat
is
WHEREAS, the Province/City, partnership with their component LGUs, have agreed to fund and
in
implement the programs, projects and activities under their respective LIPHs/AOPs through their own
financing soure nd through available funds and resources from the DOH, and
development partners,
Provincial
coordinated with the DOH;
WHEREAS,
2022
the
Province/City of
Annual Operational I
a
has prepared 2020-2022 LIPH, and
=
(AOP), which have been revi ed by the Provinee/City and DOH-CHD
its
Appraisal Committee, and modified as nec ary following the recommendations of the above;
Page 1
of 6
—
WHEREAS, the
Year 2022 is a milestone year as it ushers in a new era in health sector
development, with the implementation of Executive Order No. 138 on full devolution of functions
to the LGU, enshrined in Sections 3 and 17 of Republic Act 7160 or the Local Government
as
Code (LGC) of 1991, and the execution of the Supreme Court Mandanas-Gareia ruling increasing
__
CHD the share of LGUs in

national taxes;
NOW THEREFORE, in
consideration of the foregoing premis and by way of formalizing and
Accountant,
confirming the commitment of

the Province/City and the DOH-CHD, the parties hereby agree to enter into
agreement in accordance with the terms and conditions hereunder set forth:
CHD
ARTICLE I
IMPL. ME ATION ARRANGEMENT
1.1 Program Coverage

: This agreement shall cover the management and implementation of the approved 2022 AOP (Annex), and
s shall focus on the achievement of improved local health system performance consistent with the UHC Act
g
and Fourmula One Plus For Health.
1.2 Roles and Responsibilities
A. The Province/City shall:
The Province/City hereby adheres to an integrated and phased implementation of the UHC Act and
2020-2022 LIPH, as embodied in the approved 2022 AOP, and commits to the principles and
conditions set forth and to this end, shall:
ue executive instrume: or local legislations, whenever nec ry, for the effective
implementation of the UIC Act and 2020-2022 LIPH, through the approved 2022 AOP;
ie) Secure the participation and cooperation of itscomponent LGUs in carrying out local initiatives or
activities pursuant to a province/city-wide implementation of the UHC Act and 2020-2022 LIPH,
through the approved 2022 AOP, to
include but not limited to:
2.1 Secure increased, better and sustained financing for health from DOH, PhilHealth and LGU
appropriation
2.2 Assure the quality and affordability of health goods and services through DOH licensing and
PhilHealth accreditation;
2.3 Ensure access to and availability of essential and basic health packages by matching its
catchment population to appropriate Primary Care Provider Network and through effective
referral systems;
2.4 Ensure delivery of population-based health services
CHD
IV,
2.4.1 Improve performance of
the health system, measured through accurate, sensitive and
timely epidemiologic surveillance systems and other monitoring and evaluation
system:
Director
2.4.2 Proactive, effective and evidence-based health promotion programs or campaigns;

2.4.3 Timely, effective and efficient preparedness and response to public health emergencies
and disasters;
2.44 Environment health s rVvil
Mayor
24.5 Services tor di elimination
5 Improve human resources for health management and development;
wt 6 Improve information managemen/VEMR;
Mitigate public health threats and pandemic such as COVID19,
Governor/City
Allocate, release and utilize, together with its component LGUs, funds that are necessary for the
nce/city-wide implementation of the approved 2022 AOP:
Jed by the approved 2022 AOP in the disbursement of funds
Provincial
na “Trust Fund Account for Health” in a government depository bank,

od
for the funds releases, provided that separate ledgers and/or sub-ledgers shall be maintained by
the Province/City for each and every type of fund trans
3.3 For UHC-IS, establish and maintain a Special Health Fund account, in a government
depository bank for the funds releases, provided that separate book of accounts, ledgers and/or
sub-ledgers shall be maintained by the Province/City for each and every type of fund transfer
subject to the provisions of Joint Memorandum Circular 2021-0001 on Special Health Fund;
Page 2 of 6

3.4 Ensure all funds, including grants proceeds and counterpart, shall flow directly to the
Provinee/City Trust Fund Account for Health or the Special Health Fund Account, as
appropriate, and/or shall be automatically appropriated for the implementation of the approved
2022 AOP;
3.3.1 Assure that adequate funds shall be made avail: able to support/enable the progressive
realization of UHC;
CHD
3.4 Ensure compliance with existing COA rules and regulations.
4. Take all steps in meeting the technical requirements and operational conditions that are pre-
requisites for the release of grants for specific programs, which include but not limited to;
Accountant,
4.1 Prepare and submit, in a timely manner/within the deadline set/agreed, to the DOH-CHD
CHD Monitoring Reports and Fund Utlization/Liquidation Reports;
4.2 Upgrade/enhance the administrative and operational capabilit
conform to
the
4.3 Be responsible for the comp!
ion and licensing standards;
environmental and zoning law nd regulations, and that all nece:

obtained prior to the commencement ofcivil works;
Officer
ve the program resources and ensure the delivery of inputs (e.g.

Health
equipment, Human Resource for Health deployment, commodities, capacity building, ete.) to the
lower levels of local government to produce required outputs;
Provincial/City
6. Contribute to and facilitate monitoring, evaluation, and conduct of internal audit activities in the
course of the program, that shall be conducted in the course of the program;
6.1 Submit the accomplishmentmonitoring reports required by the DOH in a timely
manner/within the deadline seVagreed.
B. ‘The Department of Health — Center for Health Development (DOH-CHD) shall:

1. Coordinate/facilitate the support from National Government: Agencies (NGAs) and their
g instrumentalit and development partners, to the Province/City for the implementation of the
approved 2022 AOP;
5= 1.1 Maintain stewardship function over DOH funds provided to the Provincee/ City to support
g attainment of goals and objectives of the approved 2022 AOP;
a
2. Issue the nec ry policies to mobilize its offices to assist’ in the province/city-wide
implementation of the approved 2022 AOP:
3. Advocate for the issuance of local executive policies or legislative enactments by the LGUs that
are necessary for the implementation of the approved 2022 AOP;
4. Deliver the necessary technical assistance (TA) to the Province/City;

2 4.1 Provide logistical and technical support to the Provinee/City for the overall planning,
& management, coordination and implementation of priority activities and progrant
= 4.2 Assist in building the capacity of the Province! City:
E $. Undertake monitoring of the implementation of the approved 2022 AOP;
6. Facilitate and rrange the provision and release of grants within the DOH-CHD Director's authority
and control:
Mayor
6.1 Ensure the timely release of DOH-CHD funds to
the Province/City nd/or to component LGUs
when necessary, based on the verified physical, finance: al, and technical accomplishment
reports;
1/City
6.2. Release the funds and commodities to the Province/City based on the guidelines issued by the
DOH or as
by joint agencies such the Joint Memorandum Circular 2021-0001 on Special Health
63
Fund; as applicable;
Authorize the Province/City to manage the DOH-CHD fund transterred and commodities in
Provincial the implementation of the approved 2022 AOP for the deliverables and outputs indicated in
this Agreement, cash transle nd support in kind (commodities) it implements the approved
as
2022 AOP to produce the deliverables and outputs indicated in

this Agreement;
insure compliance with e ng COA rules and regula
Page 3 of 6

3.4 Ensure all including grants proceeds and counterpart, shall flow directly to the
funds,
Province/City Trust Fund Account for Health or the Special Health Fund Account, as
appropriate, and/or shall be automatically appropriated for the implementation of the approved
2022 AOP;
3.3.1 Assure that adequate funds shall be made available to support/enable the progre sive
realization of UHC;
CHD
3.4 Ens ure compliance with
e
sting COA rules and regulations.
Accountant,
4. Take
all steps in meeting the technical requirements and operational conditions that are pre-
requisites for the release of grants for specific programs, which include but not limited to;
4.1 Prepare and submit, in a timely manner/within the deadline seVagreed, to the DOH-CHD
Monitoring Reports and Fund Utilization/Liquidation Reports;
its
CHD
4.2 Upgrade/enhance the administrative and operational capabiliti of local health facilities to
conform to
the creditation and licen
4.3 Be responsible for the compliance with all applicable procedures, rules and regulations,
Officer
environmental and zoning laws and regulations, ary licenses and permii
obtained prior to the commence
Manage the program resources and ensure the delivery of inputs (e.g. rehabilitation works,
Health
5S.
equipment, Human Resource for Health deployment, commodities, capacity building, etc.) to the
lower levels of local government to produce required outputs;
Provincial/City
6. Contribute to and ilitate monitoring, eval and conduct of internal audit activiti sin the
course of the program. that shall be conducted in the course of the program;
6.1 Submit the accomplishment/monitoring reports required by the DOH
manner/within the deadline set/agreed.
timely in a_
B. The Department of Health —- Center for Health Development (DOH-CHD) shall:

1. Coordinate/ te the support from National Government: Agencies (NGAs) and their
CHD instrumentalities, and
development partners, to the Province/City for the implementation of the
|,
approved 2022 AOP;
1.1 Maintain stewardship function over DOH funds provided to the Province/ City to support
Director
attainment of
goals and objectives of the approved 2022 AOP;
nN
Issue the necessary policies to mobilize its offi es to assist. in the province/city-wide
implementation of the approved 2022 AOP;
3. Advocate for the issuance of local executive policies or legislative enactments by the LGUs that
are necessary for the implementation of the approved 2022 AOP;
4. Deliver the necessary tech ance (TA) to

the Provinee/City;
o 4.1 Provide logistical and technical support to the Province/City for the overall planning,
& management, coordination and implementation of priority activities and program:
= 4.2 Assist in building the capacity of the Province/ Cit
i 5. Undertake monitoring of the implementation of the approved 2022 AOP:;
6. Facilitate and arrange the provision and release of grants within the DOH-CHD Director's authority
and control:
=
gs
6.1 Ensure the timely release of DOH-CHD funds
when necessary, based on the verified phys
to
the Province/City and/or to component LGUs
financial, and technical accomplishment
.
reports;
6.2 Release the funds and commodities to the Province/City based on the guidelines issued by the
DOH or
by joint agence such as the Joint Memorandum Circular 2021-0001 on Special Health
Governor/Ci
Fund. applicable;
63 Authorize the Province/City to manage the DOH-CHD fund transferred and commod
Provincial
the implementation of the approved 2022 AOP for the deliverables and outputs in
this Ag nent, transfers and support in kind (commodities) it implements the approved
cash as
2022 AOP to produce the deliverables and outputs indicated in this Agreement;
6.4 Ensure compliance with existing COA rules and tions.
Page 3 of 6

ARTICLE IL
RESOURCES AND FINANCIAL ARRANGEMENTS
2.1 Resources from National Government and Local Government Unit

__
2.1.1 The Provin receive an estimated allocation of PhP_
I
support (financial and
non-finan 's) from the National Government-DOH for the implementation of the approved
CHD
2022 AOP, details of which is shown in Table 1.
Accountant,
2.1.2 Program Funding
The implementation of the approved 2022 AOP shall be funded by various sources which may
CHD include the following: 1) Local Government Unit Funds, 2) Fund transfers from the DOH-CHD, 3)
Support in kind or commodities from the DOH regular budget of the Central Office, coursed
Mayor
through the DOH-CHD, 4) Philllealth payments, and 5) Other funds identified by DOH-CHD and
LGU, including funds from development partners, and other stakeholders.
|
= ‘Table 1. Resources from DOH and LGU
to support implementation of the approved 2022 AOP.
eur
s Total
Nee
Fund Allocations
ee
A. Local Government Unit (Amounts
to be filled up by
ee
pHocnoy
1 —
1!
:
Province HUG ICC LGU POW.
Component City Barangay LGU
a
2.
Municipal
Total _
DOH (Cent Mice and CHD) (Amounts to be filled
- up by DOH-CHD)
1 Fixed Tranche
2 Health Facilities Enhancement Pr oxram (HPEP)
a Infrastructure
6 Equipment
3
© Motor vehicle
Human Resource for Health (HRH) Deployment
4 Commodities
S Other technical assistance

6 Cash transfers (from programs/projects), ifany
(Ann
C. Development Partner, specify if any up by (DOH-CHD.
PHO C!
2 2.2 Financial Arrangements

3
= 2.2.1 Uses of ‘Tranche: <d
s Assistance to Provinces/ primarily for the development, planning, encoding and

8 monitoring of their Local Investment Plans for Health (LIPH)/Annual Operational Plans (AOP)
a and integration of local health systems into Province-wide and City-wide Health Systems
(P/CWHIS)
Other use
Geographically Isolated and Disadvantaged Ar (GIDAY Indigenous Cultural Communities’
Indigenous Peoples (ICC/IPs)/ Urban Poor activities’ projects to improve availability and access to
Governor/City
health care through the Health Care Provider Network;
For HUCs/ICCs: Data collection for equity ass essmenl/ measurement;
ween
LGU
Health Scorecard implementation
Activities in support of identification, documen ion and replication of Good Practices
Support interventions to strengthen the ystems, operations and capacity of the Local Health Board
(c.g. capacity building of LHB membe: mentoring and coaching ons, support for leadership
Provincial
and governance for health meeting: ties);
Page 4 of 6

—
6. Barangay Health Workers (BIW) capacity development (e. S, Orientations, TESDA

applicati creditation as applicable, cte.), logistics (c.g. face masks, gloves, face shield,
alcohol, first aid kit, thermometer, sphygmomanometer, etc.), financial support (c.g.
incentives, allowance for trainings), and recognition (e.g. awarding); and
7. COVID-19 and Emerging and Re-emerging Infectious Diseases (EREID)
response/control/interventions.
2.2.2. The LGU counterpart shall be based on the approved 2022 AOP which is included by the
~—
__
Provinee/City & its component LGUs in

their Annual Investment Plans (AIP), as per DILG, NEDA,
CHD
DBM and DOF Joint Memorandum Circular No. 1, Series of 2016: Updated Guidelines on the
Harmonization of Local Planning, Investment Programming, Resource Mobilization, Budgeting,
Accountant,
Expenditure Management, and Performance Monitoring and Coordination in Fiscal Oversight;
Transfer/use of funds or commodities shall adhere to the DOH guidelines for the Work and
CHD
Finan Plan, Joint Memorandum Circular 2021-0001 on Special Health Fund and technical
guidelines on the release and transfer of resources from the National Government to
Province/City/Municipal Local Government Units, and specify the sources and uses of the
resources including the expected outputs/deliverables;
the
event that additional financial grants shall be provided but were not indicated in the AOP
Officer
2.2.4 In
and TOP, the PHO/CHO shall submit a Work and Financial Plan or a supplemental AOP for
approval of the CHD Director, provided that the WFP has been reviewed by the concerned CHD
Health
program manager following the appropriate DOH Guidelines issued. Said WFP/supplemental AOP
Provincial/City
shall be attached to the TOP for
the release of grants.
2.2.5 The shall submit a copy of “Certification by the Accountant that funds previously transferred
LGU
to the Implementing Agency (IA) has been liquidated and accounted for in the books” (per COA
Circular 2016-002 dated 31 May 2016) to the DOH-CHD before the end of Quarter 2 of the
succeeding year and to refund expenditures disallowed by audit;
2.2.6 In the event that the LGU fails to liquidate the previously transferred DOH funds within the
prescribed timelines, the DOH-CHD shall manage or co-manage the funds based on the approved
AOP orWork and Financial Plan for FT funds or return the same to the National Treasury in
accordance with existing accounting and auditing rules and regulations. Moreover, fund utilization
9
&
of the LGU may be one of the bases for the increase/decrease in the computation
Tranche for the succeeding years.
of
its Fixed
3 2.2.7 All fund transfers, disbursements, utilization and accounting of resources shall strictly adhere to all
é government budgeting, accounting and auditing rules and regulations.
ARTICLE
Ill
Miscellaneous
3.1 Mutual Obligations
The DOH-CHD and the
Province/City agree to perform, fulf and submit to any and all of
the provisions and requirements and all
matters related, contained or expressed or reasonably inferred
from this Agreement. All unobligated amounts from DOH support funds shall be applied according to
2 modalities determined by the DOH-CHD and Province/City subject to existing budgeting, accounting,
7 and auditing rules. The Province/City shall abide by the decisions of the DOH-CHD in this regard.
3 3.2 Duration and Effectivity

6 The DOH-CHD and the Province/City agree that the provisions herein described shall cover activities
from January to December 2022.
This Agreement shall be terminated upon satisfactory fulfillment of all the terms and conditions
Mayor
embodied herein but not later than June 30, . Any modi ion or amendments to this Agreement
as proposed by cither party mutually be agreed upon in writing byall the parties hereto.
shall
3.3 Notices
of
Governor/City
All notices called for by the terms this Agreement shall become effective only at the time of receipt
thereof and only when received by the parties to whom theyare addressed:
Provincial
For the DOH-CHD: Director IV
For the Province/City:
Page 5 of 6

3.4 Integration
a
The DOH-CHD and
the Province/City agree that this Agreement exp nd integra
agreements, promises, and covenants of the parties and supersedes prior negotiat ns understan all
and agreements, whether written or oral and that no modification or alteration of this Agreement shall
be valid or binding on either party unless expressed in writing and in agreement both parties. of
IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be signed in their respective
names in , Republic ofthe Philippines:
For the Department of Health — For

.
the Province/City
7
a
os
Center for Health Development

=
_
Signature
_
Printed Name
7
Position Director DOH-CHD 7

Mayor
__
1V,
Date ____ Governor/City
Signed in the Presence of:
Director HI, DOH-CHD Provincial/City Health Officer
CHD Accountant, DOH-CHD ___
ACKNOWLEDGEMENT
Republic of the Philippines

City of
Before me, this

Philippines, personally appeared:
day of + 20__ in the City of
— 7 ;
ID Number
:
Director IV, DOH-CHD
known tobefreetheandsame
to their
me
ee
Provincial Governor/City Mayor
ID Number
persons who executed the foregoing instrument, and they acknowledge that
the same is voluntary act and deed.
(6) pages including this page on which the acknowledgement

‘This instrument consisting of seven
has been signed on each and every page thereof by the parties and their instrumental witnes
is written
WITNESS MY HAND AND § SAL,
at the place on the date first written above
Doc.:
Page No.
Book No.
Series of
Page 6 of 6


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of the Philippines

December 29, 2021

TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

BANGSAMORO AUTONOMOUS REGION MUSLIM. _IN__

MINDANAO; LOCAL GOVERNMENT UNITS; PRIVATE

SUBJECT: Dissemination of the Manual for Primary Care Managers

Attached is the Manual for reference.

MARIA ROSARIO VERGEIRE, MD, MPH, CESO

Primary Cave Managers

One crucial element the success of the UHC Act

Further, the DOH recognizes the importance of the

However, effective management of

Through this manual, we hope to be a step

Department of Health, Philippines

We would also like to acknowledge and reiterate

Technical Working Group Technical Reviewers

nt of Healt Otite atin

User’s Guide to the Manual

Department of Health, Philippines

Department of Health, Philippines

Primary Care -refers to initial-contact, accessible, continuous, comprehensive, and

Primary Care Manager

Primary Care Provider Network - refers to a coordinated group of

Department of Health, Philippines

User’s Guide to the Manual 6

Department of Health, Philippines

The Department of Health (DOH)

Department of Health, Philippines

e Strategic financing: this is about streamlining investments towards cost-effective primary

Department of Health, Philippines

Apart from PHC, other guiding principles prescribed within AO 2020-0024's

HE More Responsive Primary Care

Delineation of Financing and Health

Transitioning of financing for primary

of Care facilities access to medicines

Figure 1. Policy Framework for Primary Care (AO 2020-0024)

Department of Health, Philippines

From Governance to Leadership to Managing

Chapter 1: FromGovernance to Leadership to Managing the

EO 138: Mandanas-Garcia Ruling: The re-devolution of services

Department of Health, Philippines

Additional national functions that are re-devolved

Contracting Mechanisms: (AO 2020-018)

The leadership and management structure supporting PCPNs

Department of Health, Philippines 17

According to AO 2020-0021, the management structure of the P/CWHS. shall be It

Building conditions for good management

Strategic Directions: Guiding Local Health Systems Integration (AO 2020-0037)

Governance e LGU cooperation in creating PCPNs and P/CWHS, strategic

Human resource management and staff competence

Systems for performance accountability

Department of Health, Philippines

The Formation of a Primary Care Provider Network

Chapter 2: The formation of a primary care provider network

Establishing the juridical entity (AO 2020-0021)

This is a particular concern for PCPs that hope

Developing the system for internal governance and decision-making

Department of Health, Philippines