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Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
APR 08 2027

DEPARTMENT ORDER
No. 2022- AIL

SUBJECT: idelin for th trengthenin f the ational Patient

Navigation and Referral System (NPNRS)

I. RATIONALE

One of the critical components of Republic Act (RA) No. 11223, otherwise
known as the Universal Health Care (UHC) Act, is
to ensure that patients have timely
access to appropriate health care services through effective and efficient navigation,
coordination, and referral. The occurrence of the Coronavirus Disease 2019
(COVID-19) pandemic highlighted the importance of a mechanism to refer patients
amidst the fragmented health system. In response, the Department of Health (DOH)
established the One Hospital Command System (OHCS). It is a gatekeeping and
navigation system that bridges the gap between the community and access to the
healthcare system. It serves as the venue for navigation and referral of all patients to
health care institutions from the Primary level to the specialized care through various
modes of communication such as mobile phones, landlines, hotlines, and social media
where patients, their families, and health facilities may request for assistance.

The OHCS, through its 24/7 command center, the National One Hospital
Command Center (NOHCC), has proven to be an effective solution in ensuring that
patients from the community going to primary, intermediate, tertiary, and specialized
levels of care are coordinated effectively and efficiently. This system also provides an
alternative point of contact with patients other than primary care. A focused and
systematic patient navigation ensures that health services and resources are optimized
and appropriately utilized by preventing unnecessary self-referral to higher levels of
care and vice versa, as envisioned in the UHC Act.

In its effort to improve its access to the public, the OHCS opened its regional
counterparts known as the Regional One Hospital Command Center (ROHCC). Aside
2/r7 from COVID-19 related services, the national and regional OHCCs extended their
telehealth services to blood product requisition, financial health assistance, transport
02 24.
202
services, diagnostics, as well as provision of teleconsultation services, all to respond
to the existing needs of the general public with emphasis to those marginalized and
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underprivileged. Advancement in technology played a vital role in easing the
coordination between the community and health facilities. The digital platform
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MAY

AMENDED.

023. adapted by the NOHCC, facilitated institutional referrals of clients based on their
onioy:
healthcare service needs.

With tangible and discernible benefits aligned with the UHC, the OHCS shall
Posiad
Date,
No,

be strengthened and refined as it transitions to become the National Patie

Navigation and Referral System (NPNRS), along with the reinforc

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ® Trunk Line 651-7800 local 1108, 1111, 112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ® URL: http://www.doh.gov.ph; e-mail: ftduque@doh.goy.ph
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 expansion of the Regional Patient Navigation and Referral Units (RPNRU) under the
supervision of Centers for Health Development (CHDs), and the establishment of
service hotlines in all DOH health facilities for continuous, streamlined and
systematic operations. The strengthening of the NPNRS shall ensure that all
interventions provided are consistent with the goal of the UHC by maximizing the
provisions of specific and targeted health care intervention that is accessible and
equitable through an efficient system in partnership with the established Health Care
Provider Network (HCPN) at the local level.

In view of this, the DOH hereby issues this Order to guide the strengthening of
the NPNRS.

II. OBJECTIVE

To provide guidance in strengthening patient navigation and referral as the

operational policies, procedures, and protocols are expanded to the CHDs and DOH
health facilities to ensure alignment of all NPNRS Units.

HHI. SCOPE

This Order shall apply to DOH Central Office Bureaus, Services and attached
agencies, CHDs and the Bangsamoro Autonomous Region in Muslim Mindanao
(BARMM), DOH hospitals, sanitaria, medical centers, Treatment and Rehabilitation
Centers (TRCs), and other concerned DOH offices.

IV. DEFINITION OF TERMS

A. DOH Health Facility - refers to any DOH duly-licensed or accredited public or

private hospitals, Temporary Treatment and Monitoring Facilities (TTMFs) or
quarantine/isolation facilities, molecular laboratories, diagnostic facilities,
ambulatory surgical clinics, dialysis clinic, sanitaria, infirmaries, treatment and
rehabilitation centers, birthing facilities, OR vaccination sites, health centers, rural
health units (RHU), barangay health stations (BHS), including the Department of
Health Central Office, Centers for Health Development,
Provincial/City/Municipal Health Office, and Local Government Health Offices,
who are engaged in COVID-19 response as reflected in the National Action Plan
Against COVID-19 Phase IV (NAP-4). .

B. Health Care Provider Networks (HCPN) - refer to the primary to tertiary health
care providers, whether public, private or mixed, offering people-centered and
comprehensive care in an integrated and coordinated manner with the primary
care provider acting as a navigator and coordinator of health care within the
network.

C. National Call Center (NCC) - refers to the Emergency 911 National Hotline
Public Safety Answering Center. It is a unit under the direction and control of the
Department of the Interior and Local Government that coordinates emergency
services for deployment. During the pandemic response, the NCC

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 assistance by coordinating ambulance service to aid the transport needed prior to
the admission of the patient.

. National Patient Navigation and Referral System (NPNRS) - refers to the

integrated patient navigation and referral system that shall provide coherent and
seamless linkages among relevant health facilities and agencies throughout the
country. It shall support, strengthen, and facilitate the access to health care
services.

. National Patient Navigation and Referral Center (NPNRC) - refers to the

implementing arm of the NPNRS that shall serve as the centralized unit to
manage, coordinate and monitor patient referrals for medical assistance,
telemedicine, and provide support to government and private hospitals, medical
centers and isolation facilities. During the pandemic, it shall serve as the
command center of all hospital referrals for all patients who need information,
assistance and referrals for their medical needs and hospital admission. It shall
also cater referrals through the help of Malasakit Center, LGUs and other
government agencies that can provide medical and financial assistance.

One Hospital Command System (OHCS) - refers to the system to interconnect

the services of hospitals and call centers to other health facilities, such as
temporary treatment and monitoring facilities (TTMFs), hotel isolation facilities
and DOH licensed COVID-19 testing laboratories. It likewise covers HCPNs for
COVID-19 response facilities and LGUs. The DOH teams and bureaus, consistent
with their current mandates, shall participate in the policy-making and planning,
operations, logistics and supplies management, and information and
communications technology (ICT) and data analytics of the OHCS.

. One Hospital Command Center (OHCC) - refers to the operations base for the
Operations Manager and the teams for data analytics, medical dispatch and
navigation, and communication, where emergency calls and referral requests are
responded and facilitated.

. Public Health Unit (PHU) - refers to the unit in the hospital facilitating the
provision of population-based services, implementation of national public health
programs, coordination with primary care provider networks, and provision of a
one-stop shop patient navigation system within the hospital.

Referral Mechanism - refers to the process of coordination in which a health

worker at one level of the health system, having insufficient resources (drugs,
equipment, skills) to manage a clinical condition, seeks the assistance of a better
or differently resourced facility at the same or higher level to assist in, or takeover
the management of the patient.

Regional One Hospital Command Center (ROHCC) - refers to the regional

coordinating body of the NOHCC on patient referral, medical emergencies, and
information sharing and reporting.
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 Regional Patient Navigation and Referral Unit (RPNRU) - refers to the
implementing arm of the NPNRC that shall be established in all the regions of the
country. It is a referral unit that shall support the general public in the provision of
effective health care services in coordination and partnership with the HCPN.

Telehealth - refers to delivery of health care services, where patients and

providers are separated by distance using information and communication
technology.

GENERAL GUIDELINES

A. The NOHCC shall now be known as the NPNRC and shall assist in policy
development, planning, data analysis, monitoring and evaluation, in partnership
with the Health Facility Development Bureau (HFDB) and in coordination with
the HCPN in all levels of governance for patients including but not limited to
health facility referral, transport, telemedicine, and other healthcare-related needs
(e.g. financial health assistance, blood product requisition, diagnostic procedures,
contact tracing, etc.).

The NPNRS shall facilitate linkages and optimize coordination among the HCPNs
from the primary care facilities to the national specialty centers which include but
are not limited to hospitals, infirmaries, other health facilities (i.e. rural health
units, urban health centers, stand-alone hemodialysis), telehealth service
providers, and local and national government agencies, to maximize the use of
limited health resources and to improve access to quality health services for
patients.

The NPNRS shall complement the functions and services of the National Call
Center (NCC), and other emergency hotlines, specifically on medical and
health-related assistance. It shall closely coordinate with the NCC in terms of
emergency medical services provided by its Primary Service Providers.

The ROHCC services shall, likewise, transition to RPNRU. The Unit shall be
under the supervision of the CHDs and shall provide technical assistance to the
LGUs while providing navigation and referral services to include patient transport
coordination, telemedicine, and coordination of other health-related requests.

All DOH health facilities including hospitals, sanitaria, medical centers, and TRCs
shall establish their respective service hotlines and shall identify their focal person
for transferring and receiving patients. These facilities shall continuously provide
data to the National Office on service capability such as available beds,
specialties, schedule, and other pertinent data for navigation and referral.

The DOH Central Office Bureaus, Services and attached agencies, pursuant to
their respective mandates, shall provide assistance in the implementation of this
issuance.
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VL SPECIFIC GUIDELINES

A. Components of the NPNRS

The NPNRS shall be composed of the following:

1. Functional and fully-equipped command center with dedicated working space

and sufficient human resource to cater the respective areas of responsibility at
the national and regional level as well as DOH health facilities through the
Emergency Department (ED) and/or Public Health Unit (PHU);

2. State of the art ICT capacities that enable interoperability of all NPNRS units
by identifying appropriate communication facilities, functional equipment and
services with redundancy and contingency of resources;

3. Comprehensive and extensive network of partners and stakeholders as part of

the HCPN with up-to-date directory of service hotlines and health service
capacities; and,

4. Standardized, integrated, and regular monitoring and evaluation mechanisms

for referral and navigation in order to enhance and update policies, procedures,
and protocols.

VII. ROLES AND RESPONSIBILITIES

Toprovide efficient, effective, and uninterrupted operations of all NPNRS

Units including NPNRC, RPNRUs, and DOH health facilities, the following roles and
responsibilities shall be observed:

A. The NPNRC shall:

1. Oversee the overall operations of the NPNRS;
2. Develop standardized guidelines and protocols that shall be implemented to
all NPNRS units in observance of the whole-of-government approach;
3. Identify performance parameters for assessment, monitoring and evaluation of
all NPNRS Units annually conducted;
4. Provide evidence-based strategies and interventions to the RPNRUs and PHUs
through technical assistance such as, but not limited to, learning and
development interventions, field visits, as well as monitoring and evaluation in
line with patient navigation and referral in consultation with the Health
Human Resource Development Bureau (HHRDB);
5. Integrate a comprehensive, up-to-date, and secure ICT system in coordination
with the Knowledge Management and Information Technology Service
(KMITS) in accordance with the Data Privacy Act and other government
issuances that shall affect the NPNRS operations;
6. Provide technical assistance (i.e. training, follow-through training, updating,
and troubleshooting) in establishing and maintaining service hotlines at the
RPNRUSs and DOH health facilities lodged at the EDs for emergency referrals

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and PHUs for non-urgent referrals in coordination with KMITS;

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 Ensure availability of health facility service hotlines optimizing current ICT
systems that shall guarantee that all calls are properly handled and all patients
are properly catered with expansion as contact point centers for patient
navigation and referral;
Lead in identifying, consolidating and recommending solutions to identified
issues and concerns encountered by the entire NPNRS,;
Provide quality data products on service capability, including but not limited
to, availability and utilization of beds in different levels of hospitals and
number of patients waiting for admission at the ED, and accomplishment
reports, on a regular basis based on the set timeline and performance
indicators;
10. Generate regular updates of the NPNRS capacities and services, such as, but
not limited to, service database, directory, telemedicine providers, and
emergency transport providers by enhancing existing information systems
(e.g. DOH Data Collect) and advancing current related innovations in systems
and technology;
11. Utilize available data for navigation and referral to ensure provision of
appropriate management of patients;
12. Provide telemedicine services that shall provide consultations using different
communication platforms and initiate appropriate referrals to health facilities
as deemed fit;
13. Identify and collaborate with relevant partners and stakeholders that may
assist in navigation and referral of patients as well as providing appropriate,
timely, and cost efficient health care service delivery;
14. Coordinate with the Health Promotion Bureau (HPB) for the publication and
posting in conspicuous places and/or in the official social media pages of the
DOH the nationwide referral hotlines gathered from all RPNRUs; and
15. Conduct bi-annual and quarterly implementation review to recalibrate,
improve, and monitor strategies and interventions, and likewise secure
additional resources for the RPNRUs and PHUs. Furthermore, lead monthly
meetings via preferred platform for feedback and consultation with partners
and stakeholders to ensure congruence and systematic operations.

. The RPNRU through the CHD shall:

1. Operate as a section lodged in the regional Disaster Risk Reduction and
Management in Health (DRRM-H) Units with adequate human resources, and
other relevant resources necessary to support its operations;
Adopt the NPNRS policies, plans, guidelines, and ICT system;
Operate 24 hours a day, seven (7) days a week to provide navigation and
referral services and data on coordination of patients, transport, telemedicine,
and other health-related services to include financial assistance through the
Field Implementation and Coordination Team (FICT);
Initiate, update and maintain healthcare service delivery resource mapping
within its scope of jurisdiction and report to the NPNRC;
Initiate, update and maintain referral pathways and networks within its scope
of jurisdiction considering existing HCPNs and referral pathways, and its
geographical limitations;
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 6. Provide guidance, support and technical assistance to all the members of the
HCPN through establishment of linkages and partnerships for ease in health
service navigation and referral;
Maintain interoperability among HCPNs through an organized line of
communication and established referral networks;
Coordinate with its Health Promotion Units (HPUs) for the publication and
posting in conspicuous areas and/or in the official social media pages of the
CHD the regional referral hotlines. Updates shall be communicated to all
members of the NPNRS;
Maximize the referral to the appropriate health facilities that can cater to the
patient’s needs taking into consideration the geographical location of the
patient;
10. Escalate inter-regional, specialized inter-facility, and other needs-based
referrals to the NPNRC;
11. Ensure equitable health service delivery to its partners and stakeholders; and
12. Report to the NPNRC the key performance indicators (KPIs), issues, concerns,
and recommendations on a regular basis.

. The DOH health facilities shall;

1. Designate the EDs as the receiver of emergency referrals while the PHUs as
the coordinating office for referral of non-emergency cases as well as
providing reportorial requirements to the NPNRC;
Provide a service hotline accessible 24/7 using available PNRS ICT system
with an identified focal person, and interoperable with the ICT system of the
NPNRC;
Allocate and communicate the number of dedicated beds for all patients
especially those with emerging/re-emerging infectious disease (EREID) in
terms of isolation beds based on approved bed capacity;
Coordinate with the HCPN for transferring and receiving patients and
logistics;
. Ensure proper and standardized endorsement of patients between health
facilities;
Standardize regularly and update case definitions;
Update regularly the list of services and schedule, available beds, and other
pertinent data in the PNRS health facilities database to the NPNRC via the
existing ICT system; and
Report to the NPNRC the KPIs, issues, concerns, and recommendations on a
regular basis.

. The following bureaus, offices, services, units, and attached agencies of the
Department of Health (DOH) shall provide guidance and full support to the
NPNRS operations, to wit:
1. The Administrative Service (AS) shall:
a. Provide assistance in augmenting logistics to DOH health facilities as
referred by the NPNRC.
b. Coordinate with the NPNRC in providing human resource complement

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and emergency hiring.
. The Bureau of International Health Cooperation (BIHC) shall provide
policy direction and technical assistance in the delivery of specific services to
returning overseas Filipinos (ROFs), including foreign nationals, with critical
health needs, such as medical repatriation assistance and medical assistance.

. The Bureau of Quarantine (BOQ) shall:

a. Provide technical assistance in issuing the certificate of approval on the
requests from ROFs and foreign nationals for exemption to the
mandatory facility-based quarantine.
b. Provide isolation facilities for ROFs and foreign nationals that test positive
of any infectious disease warranting facility-based isolation or quarantine.

. The Disease Prevention and Control Bureau (DPCB) shall:

a. Provide technical assistance in the development of policies and plans on
integrated disease prevention and control services at all levels of care in
relation to the operations of the NPNRS and PHUs.
b. Provide references on the standards of care across the continuum of care
for all life-stages on key population-based and individual-based health
services, with priority on the diseases or conditions posing the highest
burden, in order to guide health care providers, including NPNRS Units,
on services needed to be delivered based on the assessed condition of the
patient being referred to.

. The Field Implementation and Coordination Team (FICT) shall:

a. Provide oversight to the CHDs and support for the RPNRUs as
counterparts of the NPNRC.
b. Oversee the implementation of public health programs in all DOH
Hospitals, in coordination with concerned teams, through the
establishment, strengthening and operationalization of PHUs in all DOH
hospitals to facilitate the provision of population-based health services,
such as but not limited to health education and promotion, disease
prevention and control, and disease surveillance; and patient navigation
within their respective HCPNs.

. The Health Emergency Management Bureau (HEMB) shall:

a. Facilitate Disaster Risk Reduction Management in Health (DRRM-H)
related referrals.
b. Provide technical and logistical assistance for the strengthening of
operations of the NPNRS.

. The Health Facility Enhancement Program (HFEP) shall provide technical

and financial assistance in aligning investment strategies in improving health
facilities in support of the NPNRS.

. The Health Facility Development Bureau (HFDB) shall provide data

analysis on COVID-19 dedicated beds, health facility capacities, monitoring
of demand for oxygen, and issue policies and guidance on Infection
Prevention and Control.
 9. The Health Human Resource Development Bureau (HHRDB) shall
provide guidance on the implementation of the learning and development
management system to the NPRNC.

10. The Knowledge Management and Information Technology Service

(KMITS) shall:
a. Provide technical assistance in setting up integrated health information
systems and telemedicine services at the RPNRUSs.
b. Provide technical guidance and recommendation on the ICT system
currently utilized in accordance with existing standards, such as data
privacy, data security and other ICT-related issuance.

11. The Malasakit Program Office (MPO) shall:

a. Receive and update referral of patients for financial and health service
assistance from the NPNRC and relay regional assistance to the
appropriate offices.
b. Coordinate with appropriate government agencies (e.g. Department of
Social Welfare and Development and Philippine Charity Sweepstakes
Office) the request for medical assistance not covered by the assistance
provided by the MPO and PhilHealth.

12. The Office of the Chief of Staff (OCS) shall:

a. Oversee the operations and provide strategic direction of all NPNRS units
for an efficient and effective service delivery.
b. Provide oversight to all DOH hospitals to ensure efficient coordination
between health facilities towards the effective implementation of the
NPNRS. It shall coordinate directly with the DOH hospitals in the
execution of its oversight functions.

13. The Procurement Service (PS) shall cosurc that the cquipment and supplics
requested by the NPNRC for operations are included in the Annual
Procurement Plan and are timely provided.

14. The Philippine Health Insurance Corporation (PhilHealth) shall:

a. Provide technical assistance in ensuring interoperability of current systems
to enhance NPNRC operations.
b. Provide necessary policies and coverage for telemedicine services through
accredited facilities including all NPNRS Units.

VIII. FUNDING

The NPNRC costs and expenses, including the operations for RPNRUs, will
be charged to the appropriations available in the annual General Appropriations Act
of the Department of Health.
IX. SEPARABILITY CLAUSE

If any clause, sentence, or provision of this Order shall be declared invalid or

unconstitutional, the other provisions not affected thereby shall remain valid and
effective.

REPEALING CLAUSE

The Department Order No. 2020-0653 or the “Guidelines on the Creation of

the One Hospital Command Center” and other related issuances, rules, and
regulations inconsistent with or contrary to this Department Order shall be repealed,
amended, or modified accordingly.

XL EFFECTIVITY

This Order shall take effect immediately.

O/T. DUQUE III, MD, MSc

ecretary of Health

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