Professional Documents
Culture Documents
Department of Health
Subject:
Plan
I.
RATIONALE
The main obstacles to attaining universal health care are the following: 1) The two national healthcare financing mechanisms of direct govemment subsidy through DOH and LGU budgets, and the National Health Insurance Program (NHIP) have not been able to adequately provide financial risk protection for the poor; 2) As a result, poor households have inadequate access to quality outpatient and inpatient care from health care facilities. Rural Health Units (RHUs) and City Health Units in municipalities and cities, district and provincial hospitals, and even DOH-retained regional hospitals and medical centers do not have the necessary provisions to meet the needs of poor families; and 3) Owing to the failure of the financing and health care delivery systems to address the needs of poor Filipinos, it is unlikely that the Philippines will meet its MDG commitments by 2015. This is especially problematic for our targets to reduce maternal and infant mortality.
Administrative Order No. 2010-0036 entitled, "The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos" provided for three strategic thrusts to achieve universal health care or Kalusugan Pangkalahatan (Y-P):1) Rapid expansion in NHIP enrollment and benefit delivery using national subsidies for the poorest families; 2) Improved access to quality hospitals and health care facilities through accelerated upgrading of public health facilities; and 3) Attainment of the health-related MDGs by applying additional effort and resources in localities with high concentration of families who are unable to receive critical public health
services.
Implementation of KP will also involve aligning the DOH budget behind these aforementioned three strategic thrusts. Furthermore, KP execution shall use welldefined and area-specific deliverables as performance targets to be pursued by DOH managers within a set timeframe and with clearly defined accountabilities.
II.
OBJECTIVE
This Order provides for guidelines and management arrangements to implement Kalusugan Pangkalahatanby accelerating the accomplishment of specif,rc performance targets. This is intended to streamline the tasks and functions of central office units to provide critical supporl and assistance to field units, who in turn shall be better supervised by Operations ClusterAssistant Secretaries andlor
Building I, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila Trunk Line +63 (2) 651-7800 Direct Line: +63 (2)7ll-9501 Fax: +63 Q)743-1829 URL: http://\$'w.doh.eov.ph I e-mail: osec(0doh.gov.Bh I FB: facebook.com/DOHgovph I Twitter: @DOHgovph
Undersecretaries that have direct accorxilability to the Soststary of Heolth, This 0tdEr also provides for specific accountabilities and performance targets to field units anct their respective Assistant Secretary/Undersecretary supervisors.
III.
SCOPE This Order applies to all DOH offtces and its attached agencies - Buleaus, National Centers, Centers for Health Development, including the Regional Hospitals and Medical centers, specialty Hospitals and Special Hospitals and the Philippine Health Insurance Corporation, Population Commission, National Nutrition Council, philippine National AIDS Council, Philippine Institute of Traditional and Alternative Uealih Care, and the Philippine International Trading Corporation - Pharma'
IV.
A. Launch
By the end of December 2}ll,all 2010 CONAP and20l1 GAA budgets shall have been spent to ensure that at least the 2.3 million beneficiary families of the DSWD's Pantawid Pamilyang Pilipino Program (4Ps) are enrolled into the NHIP, provided information and guidance on NHIP entitlements, and assigned to the n"".rrury public health and outpatient (OP) services (through upgraded rural health uniis with adequate supply of public health commodities and drugs) as well as inpatient (IP) servites (through upgraded hospitals with adequate supply of drugs and supplies).
For the KP thrust on financial risk protection: 1. 4.89 million of the poorest NHTS-PR households, including those who are beneficiaries of the 4Ps, shall be enrolled into the NHIP sponsored program, using PhP 3.0 B from the 2011 GAA subsidy for NHIP premium of indigents; 2. 10,000 RNheals nurses will be trained as trainers and supervisors to capacitate existing community-level workers (e.g. BHWs, BNS, barangay officials) with community health team (CHT) frrnctions , using remaining funds (approximately PhP 177 M) from the PhilHealth Sabado I budget; 3. All unobligated MOOE by September 15, 2011 from the remaining 2010 and2011 budgets shall be used to secure drugs, medicines, and supplies for DOH-retained hospitals serving NHTS-PR families (including 4Ps beneficiaries) for implementation of the "no balance billing" policy; For the KP thrust on health facilities enhancement: 4. Health facilities (20 percent of DOH-retained hospitals, 46 percent of provincial hospitals, 46 percent of district hospitals, and 51 percent of RHUs) shall be upgraded to ensure that the poorest 5.2MNHTS-PR families shall have access to better quality inpatient and outpatient cafe,
5.
using PhP 1.79 B cY 2010 and PhP 7.2 B cY 2011 Heatth Facilities Enhancement Program (HFEP) funds; Treatment packs for hypertension and diabetes shall be procured and then distributed at RHUs for the use of 4Ps beneficiaries, using PhP 500 M from the National Pharmaceutical Policy Development budget;
For the KP thrust on attaining health-related MDGs: 6. Public health commodities will be procured and then distributed to RHUs serving 4Ps beneficiaries, using PhP 4.2 B from various budgets related to the attainment of health-related MDGs; Preparation for the scale-up phase: 7. In preparation for the scale-up phase in20l2, the following have to be ready by the end of December 2011: i. A system of Province- or City-wide agreement for KP where DOH will consolidate its inputs supporting local implementation of KP into one instrument and negotiation process by which to leverage better health performance from Provinces/Independent Cities; ii. Amendment of the National Health Insurance Act (RA 7875, as amended) Implementing Rules and Regulations to define a new sponsored program that provides for a population based nationallocal premium counterpart scheme that maximizes enrollment of poor families by earmarking national subsidies for the NHTS-PR households with LGUs subsidizing both NHTS-poor households and LGU-identified poor; iii. An NHIP membership services program that shall include, among , others, the provision of critical NHIP information to families such as their benefrts and entitlements, their assigned primary providers, and the network of hospitals that can provide them inpatient services; iv. A new NHIP outpatient benefit package with no balance billing (OPB-NBB), based on a review of the implementation of PhilHealth Circular No. 40, s,2000; v. A new NHIP inpatient benefit package with no balance billing (IP NBB) that draws from the experience of DOH and PhilHealth in NBB implementation (e.g. implementation of AO No. 137 s'2002; implementation of case payment for22 conditions); vi. An improved financial management system in PhilHealth that, among others, translates/converts Benefit Delivery Ratio (BDR) parameters into operational terms recognized by PhilHealth operating units and which shall also serve as basis for annual perforrnance evaluation ; vii. A new HFEP that has a) a clear framework, objective criteria and transparent process in determining the necessity for providing assistance; b) a menu of options for the delivery of HFEP assistance, including mechanisms such as grants, central procurement, budget subsidy, etc.; and c) a procurement and logistics cycle synchronized with NG and LG procurement svstems: and
viii. Budget execution plans for 2012 from each CHD, including
operational plans for implomenting the MDG breakrhrough strategy in 12 areas.
B.
Scale-up Phase (2012 to 2013) For CY 2012to2013, the following shall be implemented: 1. Roll-out of a new sponsored program with full national government premium subsidy to 5.2 million poorest families listed in the NHTS-PR at PhP 2,400 per family. Provision of membership services to NHIP members shall also be ensured; 2. New OPB and IP packages with no balance billing, including catastrophic care coverase to be introduced bv 2013: 3. Closure of tire upgrading gap for local health facilities and DOH-retained hospitals to ensure that the 10.8 million poor households in the NHTS-PR shall have access to improved quality of health services by upgrading in 2A12: i. 25 DoH-retained modern medical centers financed through publicprivate partnerships; ii. 27 provincial hospitals; iii. 1 l8 district hospitals; and iv. 973 RHUs accredited to at least provide the new OPB package; 4. An MDG breakthrough strategy by focusing resources and effort in 12 areas with the highest concentration of NHTS poor, women with unmet need for family planning, mothers giving birth outside facilities, children not fully immunized, children not given Vitamin A supplementation, and adults who are TB smear positive; and 5. Mobilization of at least 100,000 Community Health Teams (CHTs) to be trained and supervised by 21,070 RNheals nurses.
C. Sustainability
From 2014 to2016, the execution of KP budgets shall be done in the context of an expenditure framework that sets milestones for KP implementation, which include: 1. Sustained coverage of at least 10.8M NHTS-PR families in the NHIP; 2. Continued enhancement of the OPB and IP packages with no balance
3.
4. 5.
billing;
Sustained provision of quality cate at DOH-retained and local health facilities upgraded through HFEP; Deployment of CHTs and RNheals to serve at least the 10.8 M NHTS-PR families; and Attainment of health-related MDGs by 2015.
The target outputs or deliverables for 20ll-2016 KP implementation can be found in Annex A.
V.
A. KP execution
shall be guided by well-defined performance targets set at the regional, province, and city levels.
B. Performance targets
approach:
1.
2.
3.
4.
5.
implementation. Determine service utilization gaps at provincial, city, and municipal levels using the best available current data on total population needs versus previous utilization pattems. Set performance targets representing the three KP thrusts, including, amons others: i." The number of NHTS-PR families to enroll into the NHIP, inform, and guide on benefits and entitlements; ii. The number, type, and names/locations of facilities to be upgraded to provide quality outpatient and inpatient services to NHTS-PR families; iii. The supply and distribution points of public health commodities and life-saving drugs for use by NHTS-PR families; iv. The number of CHTs to be deployed to the NHTS-PR families; and v. The number of RNheals nurses to be trained as trainers of CHTs. Separate targets shall be issued for areas with high concentrations of families.who have not received healthcare related to MDGs. The KP breakthrough strategy for MDGs is to significantly affect national-level indicators by concentrating efforts and resources in these areas. These areas for CY 2012 are highlighted in Annex F. In order to meet output targets (shown in Annexes B, C, D, E, and F), specific annual performance benchmarks shall be determined by the CHDs and submitted to their respective Operations Cluster Assistant Secretary/Undersecretary for validation and endorsement for approval by the Secretary of Health. Guidelines for developing an operational monitoring scheme for KP implementation that includes incentives for performance shall be issued separately.
W.
B.
Being the frontline managers of KP implementation, CHDs shall: 1. Be responsible for meeting KP performance targets in their respective provinces and cities; 2. Provide technical assistance to provinces and cities as they implement the three KP thrusts:
3.
4.
5. 6.
7.
Manage resource transfers to leverage LGU counterpart and p0d0rmance with respect to KP implementation; Sustain current efforts in the delivery of priority public health services throughout the region while applying increased effort in selected provinces/cities under the MDG breakthrough strategy; Monitor the performance of provinces and cities in the region with respect to KP implementation; Prepare region-wide budget execution plans for subsequent years to be submitted for review and endorsement by the Operations Cluster Assistant Secretary/Undersecretary prior to approval by the Secretary of Health; and Organrze a KP team dedicated to managing KP implementation in the
provinces and cities under the region. The CHD Regional Director shall be accountable to the Secretary of Health, through the Operations Cluster Assistant SecretaryAJndersecretary.
C.
Being the overall managers of KP implementation for a cluster of regions, the Operations Cluster Assistant Secretaries/Undersecretaries shall: 1. Be responsible for meeting cumulative KP targets in their respective areas; 2. Ensure that technical assistance from the technical clusters is available and delivered to the regions in a well-coordinated manner; 3. Facilitate the flow of resources, as well as manage its allocation and transfers among its regions; 4. Review and endorse regional budget execution plans, for approval by the Secretary of Health; 5. Validate and consolidate performance monitoring reports for the Execom;
and
6.
D.
implementation in the Operations Cluster. Technical Clusters based at the Central Office shall provide technical support to KP implementation. Bureaus, offices and units shall be organized around the following clusters with their respective tasks:
i.
The Sector Finance and Policy (SFPTC) Technical Cluster, which shall: i. Consolidate national level performance regarding KP targets on: a) NHIP Benefit Delivery Ratio (BDR); b) Health facilities enhancement; and c) MDGs; ii. Consolidate overall resource requirements to implement KP from all sources, including the General Appropriations Act (GAA), NHIP, and Foreign Assistance Projects (FAPs); iii. Ensure that technical assistance capacities, packages, and tools are available to support the requirements of the Operations Clusters in implementing KP; iv. Develop measures, and a collection, validation, and reporting scheme for monitoring the performance of KP implementation; v. Determine national level targets with area, regional and provincial breakdowns for KP implementation;
of Health with respect to engagements with the Department of Finance (DOF) and Department of Budget and Management (DBM) in matters related to financing KP implementation; and Perform the following with respect to the catch-up and scale-up phases of the KP roadmap: a) Propose changes in the National Health Insurance Act Implementing Rules and Regulations (NHIA IRR) (e.g., LGU sharing, new sponsored program, OPB-NBB, IP NBB, membership services, rules on reserves, use of 12 percent admin cost, operationalize BDR, etc.); b) Develop a new budget preparation cycle and procedures; c) Develop a new HFEP framework and delivery mechanism; d) Build a listing of the universe of public and private OP and IP providers; e) Develop an operations plan for the MDG breakthrough
strategy.
Units in the SFPTC shall be: DOH Units Bureau of International Health Cooperation (BIHC) Health Policy Development and Planning Bureau (HPDPB) National Center for Health Promotion (NCHP)
Attached Aqencies Philippine Health Insurance Corporation (PhilHealth) Philippine National AIDS Council (PNAC)
2.
The Internal Finance and Administration Technical Cluster (IFATC), which shall: i, Consolidate annual budget execution plans; ii. Perform timely and regular monitoring of budget expenditures through the Expenditure Tracking System (ETS); iii. Facilitate the timely release of funds and delivery of commodities to CHDs; iv. Develop guidelines for the engagement and deployment of doctors to the barrios (DTTBs), RNheals nurses, and other personnel in support of KP implementation; v. Represent the Secretary of Health with respect to engagements with the DBM in matters related to budget execution and expenditure tracking; vi. Develop a CHT deployment and training plan; and vii. Perform the following with respect to the catch-up and scale-up phases of the KP roadmap: a) Train RNheals nurses as trainers for CHTs; b) Identify and assign KP implementation tasks for DTTBs;
and
c)
Intensify and expand use of thE ETS as a platform for oll financial transactions frorn csntral officg to CHDo, hospiralo and provinces.
Units in the IFATC shall be: DOH Units Administrative Service (AS) Finance Service (FS) Health Human Resources Development Bureau (HHRDB) Information Management Service (IMS)
i. ii.
iii.
iv.
Delivery Technical Cluster (SSDTC), which shall Assist CHDs in the operationalization of the new HFEP; Develop and assist CHDs in the operationalization of a new approach to province-wide agreements for KP performance; Develop methods and assist CHDs in validating service delivery outcome measures including, among others, modern family planning (MFP) use, facility based deliveries, TB case detection and cure. etc.: and Develop a sustainable approach to secure access to essential lifesavins medicines for NHTS-PR families.
DOH Units Bureau of Health Facilities and Services (BHFS) Bureau of Local Health Development (BLHD) Health Emergency Management Staff (HEMS) National Center for Disease Prevention and Control (NCDPC) National Center for Health Facilities Development QICHFD) National Center for Pharmaceutical Access and Management (NCPAM)
Attached Agencies Commission on Population (POPCOM) National Nutrition Council (NINC)
E.
The Technical Cluster Assistant SecretaryAJndersecretary shall review policy issuances, guidelines, and protocols developed by the offices and bureaus, prior to endorsement to the Execom for discussion and approval by the Secretary of Health.
bureaus, and units in the Technical Clusters shall provide technical assistance related to KP implementation, through the respective Technical Cluster Assistant SecretaryAJndersecretary. Conversely, requests by the CHDs for support related to KP implementation from offices, bureaus and units under the various technioal clusters shall be coursed through their respective Operations Cluster Assistant SecretariesAjndersecretaries.
F. Offices,
c. KP implementation
DOH Units Dangerous Drugs Abuse Prevention Program (DDAPP) Drug Treatment and Rehabilitation Centers (DTRC) Medical Tourism Program (MTP) Sanitaria
2. 3.
DOH Units Bureau of Quarantine (BOQ) Central Office Bids and Awards Committee (COBAC) Internal Audit Service (IAS) Integrity Development Committee (IDC) Legal Service National Epidemiology Center (NEC) Public-Private Partnership Management Office (PPPMO) Procurement Service
Attached Agencies Local Water Utilities Administration (LWUA) Philippine Institute for Traditional and Alternative Health Care (PTTAHC) Philippine Intemational Trading Corporation - Pharma (PITC-Pharma) Philippine Sportd Commission (PSC)
H.
Relations with the Department of Health-Autonomous Region in Muslim Mindanao (DOH-ARMM) shall be handled by the OSEC.
VII.
ANNBXES
The following Annexes are an integral part of this Order:
Annex A - Target Outputs or Deliverables for 2011-2016KP Implementation Annex B - Distribution of NHTS-PR Families; Number of CHTs to be deployed; and Number of RNheals Nurses to Support CHTs Annex C - Indicative Number of Rural Health Units and City Health Units Requiring
Upgrading
Annex D - Indicative Number of District and other Sub-Provincial Hospitals Requiring Upgrading Annex E - Indicative Number of Provincial and City Hospitals Requiring Upgrading Annex F - Distribution of Poor Families or Individuals Lacking MDG-related
Healthcare Services
VIII.
All orders, rules, regulations, and other related issuances inconsistent with or contrary to this Order are hereby repealed, amended, or modified accordingly. All provisions of existing issuances which are not affected by this Order shall remain valid and in effect.
ln the event that any provision or part of this Order is declared unauthorized or rendered invalid by any Court of law or competent authority, those provisions not affected by such declaration shall remain valid and effective.
IX.
EF'FECTIVITY
This Order shall take effect immediately.
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DO No.
z0ll-lJhfu, Annex B
Distribution of NHTS-PR Families; Number of CHTs to be deployed; and Number of RNheals Nurses to Support CHTs:
Technical Notes: 1. The number and distribution of NHTS-PR families was obtained from PhilHealthprocessed DSWD data, as of February 28,2011. 2. The number of CHTs for deployment to cover 10.8 million NHTS-PR families was estimated by using a ratio of 100 families per CHT' 3. The total number of RNheals nurses needed to support CHTs was estimated by using a ratio of 5 CHTs per RNheals nurse. 4. The number of RNheals nurses for 2012 was obtained from assumptions of the proposed 2012budget of the DOH. 5. The total gap for RNheals nurses is the difference between the total requirement and
PHILIPPINES
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t,7!0
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66 66
1.
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148 L47
74,158 73,57L
88,544 300,690 8,945
736
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89
t77
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18
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332
10
269
8
DAGUPAN
2.
CAGAYAN
VALLEY BATANES
411,600
L,537 L49,473 L77.274
SANTIAGO
4.LL6
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823
3
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2
368
1
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ISABELA
1.,495
299
355
165 196
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3.
CENTRAL
LUZON AURORA
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t7
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DO No.2011--010[, Annex B
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1,160 435
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388
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72 78 62
258
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5,6t4
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NAVOTAS PARANAQUE
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1,368
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DO No.
zlll-illL,
Annex B
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692 2,063
110 303
138
76
62
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61
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865
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6.
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NEGROS OCC.6:ENTAL
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7.
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VISAYAS
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CEBU
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LAPU-LAPU CITY
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MANDAUE
NEGROS
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206
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8.
EASTERN
VISAYAS
7,r87
268
L;437
54
794
30
643 24
BILIRAN
26,847
15
DO No.
zDll-JJlL, Annex B
EASTERN SAMAR
LEYTE
81,788
818
L64 503
38 35
90
73
25t,253
TACLOBAN ORMOC
2,513
188
278
2L
19
225
L7 16
18,755
t7,456
tos,o44
70,825
146,685
L75 1,050
708
116 78
94 53 131
L,467
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MINDANAO
2,926,558
591,549 181,550
2,530 s29
9. ZAMBOANGA
PENINSULA:
ZAMBOANGA DEL
NORTE
L62
165
SUR''
,,
L84,296
110.509
22t
230
L:,39L
99
103
ttS,t94
69s,749 220,741
L,152
6,957 2,207
L37 1,131 497
t27
769 244
15
10.
NORTHERN
MINDANAO
BUKIDNON
623
198
L2
441
27
CAMIGUIN
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13.7t6
113,101
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226
99 207 287
103
11101
125
55
101
44
93
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!,o34
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517
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158 57
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L28 46 493
95 101 133
608
118
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191
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1t2,797
L48,927
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165 106
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95,732
86
I6
DO No.
DAVAO ORIENTAL
86,474 583,463
42,O30
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173
96
77
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L,t67
84
368
645
46
522
38 155 76 97 33
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SOUTH
203
94
119
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216
73
36,342
40
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4O5,304 59,561
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4,053 595
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256
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119
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53 35 95 100 79
39,259
106,468 111,666 88,350
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849,2s9 96,626
1,699
193 351
938
760
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MAGUINDANAO
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703
331
315
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598
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54
TAWI-TAWI
L20
66
t7
DO No.
20ll-
010b, Annex C
Indicative Number of Rural Heatth Units and City Health Units Requiring Upgrading:
Technical Notes: 1. The total number of RHUs and city health units was obtained from a compilation done by the USAID-HealthGov project using different sources to produce a master list of RHUs and CHOs. 2. The number of RHUs and city health units identified for upgrading in HFEP 2010, 2011. and2}l2was obtained from official submissions of the DOH to the DBM. 3. The upgrading gap is the difference between the total number of RHUs and city health units and the total number of facilities identified for upgrading under HFEP. Some facilities in the HFEP that do not match with those listed in the master list have not
4.
is larger than the actual need, CHDs need to validate the actual upgrading requirements for their region.
gap
PHILIPPINES
2,3L4
LUZON
374
813 150
o 9
L54
97
L,178 245
135 15 35 19
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s96
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t
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268
8
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51 36
32
2t t4
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CAR
84
67
18
DO No.
20ll- llfil-,
Annex C
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43 31 77
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DO No.
2Ul-AiL,
Annex C
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20ll-!J98, Annex D
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DO No.
20ll-
0)9Lo Annex E
Provincial Hospitals
89
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DO No.
20ll- |lbbn
Annex E
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DO No.
zDll-JJlL,
Annex E
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20ll- llbL,
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