Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

bet 15 2020

ADMINISTRATIVE ORDER
No. 2020-0053

SUBJECT: Operational Guidelines in the Delivery of Essential Health

Service Packages (EHSPs) for Medical and Public Health
Services During Emergencies and Disasters

I. RATIONALE/ BACKGROUND
The Department of Health (DOH), as the nation’s leader in health is committed to
guarantee equitable, accessible and quality health services, and to ensure that essential
health services are not disrupted even during emergencies and disasters. In line with
Republic Act (RA) No. 11223, or the “Universal Health Care (UHC) Act of 2019”, and
Administrative Order (AO) No. 2020-0036, “Guidelines on the Institutionalization of
Disaster Risk Reduction and Management in Health (DRRM-H) in Province-wide and
City-wide Health Systems”, the DOH shall continue to lead and provide guidance for
aligning response mechanisms, and ensuring delivery of essential health services, including
medical and public health interventions.

With recent events such as the COVID-19 pandemic and other health threats,
for medical and
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health
it
necessary to develop the operational guidelines providing public
services , and for identifying the responsibilities of different stakeholders involved. This
policy seeks to complement AO 2017-0007, “Guidelines in the Provision of the Essential
Health Service Packages (EHSPs) in Emergencies and Disasters” which identifies the list
of EHSPs fer
medical and public health services, and Department Circular (DC) No. 2020-
0167, “Provision of Essential Health Services during the COVID-19 Epidemic”, which
reiterates directives on the continuous provision of essential health services under the Code
Red Alert.

Furthermore, this Order shall strengthen the health dimension of RA 7160, or the
“Local Government Code of 1991”, which places Local Government Units (LGUs)
responsible for delivering primary health care services, ensuring access to secondary and
tertiary health care services, and serving as first responders during emergencies and
disasters

Wl. OBJECTIVE
To provide guidance on the delivery of EHSPs for medical and public health
services during emergencies and disasters.

Il. SCOPE OF APPLICATION

This Order shall apply to all offices and attached agencies of the DOH, Centers for
Health Development (CHDs), LGUs, and to the Ministry of Health - Bangsamoro
_Autonomous Region in Muslim Mindanao (MOH-BARMM) subject
to the applicable
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. provisions of RA 11054 or the “Bangsamoro Organic Act” and subsequent rules and
policies issued by the Bangsamoro government, and to both government and private
national and local health facilities, health care providers, and stakeholders.

IV. DEFINITION OF TERMS

1. Essential Health Service Packages (EHSPs) — consists of essential health services

under the four (4) key sub-clusters namely: Medical and Public Health, Water
Sanitation and Hygiene (WASH), Nutrition, and Mental Health and Psychosocial
Support (MHPSS). |
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2. Cluster Approach — is a system where a group of agencies gather to work together

-
towards common objectives within a particular sector of emergency response.
3. Health Emergency Alert Reporting System (HEARS) — a reporting system to
alert the DOH at every level to the possible need for implementing emergency
response measures.

V. GENERAL GUIDELINES
1. LGUs through their local health offices, barangay health stations (BHS), rural
health units (RHUs), local hospitals (government and private), and Barangay Health
Emergency Response Teams (BHERTs) shall provide the EHSPs for Medical and
Public Health Services as enumerated in AO 2017-0007 (see Annex A).
2. During the evacuation and displacement of
the affected population, EHSPs shall be
provided through the mobilization of health workers, allied health service providers,
and stakeholders.
3. LGUs shall coordinate with the next higher level of governance for their resource
requirements when needed. RA 7160 Section 17(b)(2)(iii), enumerates the
responsibilities of LGUs which include the implementation of programs and
projects on primary health care, maternal and child care, and communicable and
non-communicable disease control services; access to secondary and tertiary health
care services; and purchase of medicines, medical supplies, and equipment needed
to carry out the services.
4. The Health Emergency Management Unit (HEMU)/City Health Office
(CHO)/Municipal Health Office (MHO) shall establish a Public Health Emergency
Operations Center (PH EOC) for the coordination of health response operations.
5. Activities and interventions shall be financed using any available funds allocated
for emergency and disasters, and from the Quick Response Fund (QRF) ofagencies.

VI. SPECIFIC GUIDELINES

A. Provision of EHSPs
1. All LGUs through their local chief executives shall implement the delivery of
EHSPs during the different phases of a disaster as indicated in the National
Disaster Response Plan (NDRP), as a specific task of the Health Cluster under
the operations section of the IMT.
2. Evacuation centers used during emergencies and disasters shall provide for a
working space where EHSPs can be provided.
3. Delivery of EHSPs under the sub-clusters Medical and Public Health, WASH,
Nutrition, and MHPSS shall be through deployment of Health Emergency
Response Teams (HERTs), Emergency Medical Teams (EMTs), and technical
experts. This will be supported by the mobilization of logistics, financial

part,
assistance through QRF, and other resources in support of the local health

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system and health facilities infrastructure (e.g. BHS, RHU, clinics, sanitaria,
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LGUs shall ensure the availability of adequate logistics and human resources
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Department of Health _
 5. DC 2020-0167 shall provide the guidelines for the delivery of EHSPs during
the occurrence of outbreaks (epidemic or pandemic).

B. Coordination
1. All LGUs and operating units shall coordinate and obtain directives from the
Incident Management Team (IMT)/ Emergency Operations Center (EOC)
established for the response.
LGUs using the cluster approach based on the Section IV of AO 2017-0007
shall work jointly in providing EHSPs during emergencies and disasters.
The National Government or the next higher level of LGU may provide or
augment the basic services and facilities assigned to a lower level of LGU when
such services or facilities are not made available or, if made available, are
inadequate to meet the requirements of its inhabitants (RA 7160).
The DOH through its CHDs shall provide the appropriate technical assistance
and logistics support when needed or requested.
In an event of a large-scale disaster, the primary responsibility to manage the
incident shall be in accordance with the provisions of RA 10121 or the
“Philippine Disaster Risk Reduction and Management Act of 2010”.

C. Reporting
l. In the immediate post-impact phase of the emergency or disaster, conditions
permitting, Rapid Assessment Teams (RATs) shall be deployed to gather
information regarding the extent of damage sustained and other issues
necessitating appropriate action by the decision makers and the IMT.
2. Documentations and reports shall be submitted to the Provincial Health Office
(PHO) and to the CHD daily during the duration of the response.
3. All responders shall submit activity reports to the EOC for consolidation,
evaluation, and analysis. A final report shall be submitted to the IMT for
appropriate action.

VII. ROLES AND RESPONSIBILITIES

A. Department of Health — Central Office (DOH-CO)

1. Health Emergency Management Bureau (HEMB)

a. Monitor ongoing response operations;
b. Coordinate the mobilization of HERTs and technical experts as needed;
c. Coordinate the mobilization of medicines, medical supplies, materials;
and equipment requested, and,
d. Submit a daily report to the office of the Secretary of Health.

2. Disease Prevention and Control Bureau (DPCB)

a. Provide technical assistance and guidance for the continuity of health
programs such as maternity and child care, mental health services,
prevention and control of infectious diseases, WASH, and Minimum
Initial Service Package (MISP); and
b. Mobilize technical experts as needed.

3. Epidemiology Bureau (EB)

a. Conduct disease surveillance and response; and,

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war ctr. b. Mobilize technical experts as needed.

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4. Supply Chain Management Service (SCMS)
a. Package and ensure the delivery of logistics mobilized;
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arrival and acceptance the end user; and,
C. Submit reports on the logistics mobilized to HEMB-Logistics Unit.

5. Bureau of International Health Cooperation (BIHC)

a. Facilitate the call and receiving of international aid and donations.

B. DOH-Centers for Health Development (CHDs)

a. The CHD - Health Emergency Management Unit (HEMU) through its
different health sub-cluster focal points shall ensure the delivery of
EHSPs in
close coordination with the affected LGUs;
b. Establish a CHD - Public Health Emergency Operations Center (PH
EOC) to monitor ongoing response operations in
the affected LGU;
Cc. The Disaster Risk Reduction and Management in Health (DRRM-H)
Manager shall convene its health cluster and sub-cluster members to
ensure the uninterrupted delivery of EHSPs during the response; and,
Submit daily reports to the DOH-HEMB Operation Center following
existing reporting guidelines.

C. Local Government Units (LGUs)

a. Perform functions as defined in RA 7160.
b. Deliver the expected DRRM-H functions and EHSPs in all
phases of an
emergency or disaster together with the local DRRM Council/Office,
Public Health Units, Epidemiological Surveillance Units, and Health
Units
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VIII. REPEALING CLAUSE

All other provisions of existing issuances which are not affected by this Order shall
remain valid and in effect.

IX. EFFECTIVITY CLAUSE

This Order shall take effect fifteen (15) days following its publication in the Official
Gazette or a newspaper of
general circulation.

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 ANNEX A: ESSENTIAL HEALTH SERVICE PACKAGES (EHSPs) FOR |

MEDICAL AND PUBLIC HEALTH SERVICES

AS MANDATED BY
ADMINISTRATIVE ORDER (AQ) NO. 2017-0007, “(GUIDELINES IN THE
PROVISION OF THE EHSPS IN
EMERGENCIES AND DISASTERS” THE FOLLOWING EHSPS
FOR MEDICAL AND PUBLIC HEALTH SERVICES SHALL BE PROVIDED DURING EMERGENCIES
AND DISASTERS:

1. Health services for saving lives including those that are needed for search and rescue
right after disaster strikes such as Basic Life Support (BLS), Standard First Aid
(SFA), and prehospital care. These also include prepositioned _first-
aid/survival/family health kits and breastfeeding kits.

1. Health services to prevent and control disaster-related morbidities e.g.

communicable diseases and vaccine-preventable diseases which involve the
following:
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a. Provision of effective injury and proper wound care

b. Provision of prophylaxis for flood-borne diseases such as leptospirosis and
acute watery diarrhea, and
c. Provision of tetanus toxoid to those with dirty wounds and those involved in
rescue or clean-up operations

2. Early treatment and continuation of essential therapies for acute or chronic

conditions/exacerbations such as the following:
a. Trauma and injuries
b. Skin infections
c. Non-communicable diseases (NCDs) e.g. lifestyle-related diseases,
degenerative diseases, bronchial asthma, pulmonary tuberculosis (PTB),
cardiovascular diseases (CVD), diabetes mellitus (DM), and other endemic
diseases

3. Maternal, Newborn and Child Health (MNCH), Essential Intrapartum and Newborn
Care (EINC), Basic Emergency Obstetric and Newborn Care (BEmONC) which
involve the following:
a. Ensuring clean and safe deliveries
b. Infant and young child feeding counseling
c. Measles and oral poliovirus vaccine (OPV) immunization for children aged
six (6) months to 15 years old
d. Vitamin A supplementation for children aged six (6) months to under-five
(5) years old
and
e. Iron and folic acid supplementation for pregnant and lactating women,
f. Feeding support to children under-five (5) years old

4. Provision of safe havens e.g. child-friendly and women-friendly spaces

5. Sexual and Reproductive Health (SRH) services which involve the following:
a. Treatment, prevention, and support services for sexually-transmitted
diseases (STDs) in accordance to AO 2016-0005, “National Policy on the
Minimum Initial Service Package (MISP) for Sexual and Reproductive
Health (SRH) in Health Emergencies and Disasters”
b. Breastfeeding support and counseling to mothers living with STDs,
particularly HIV/AIDS
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2. Essential services to support vulnerable groups such the following:
a. Health and social services for the elderly, persons with disabilities (PWDs),
persons with special needs (PWSNs), and persons with pre-existing mental
illness
a. Clinical and legal assistance to survivors of domestic and sexual violence
b. Systems of referral, communication, safe transport and prehospital care of
patients requiring definitive care.