implementing guidelines on the organisation of health clubs (doh ao 2016-014)

8/16/2019 Implementing Guidelines on the Organisation of Health Clubs (DOH AO 2016-014)

1/13

Republic of the

Philippines

Department

of

Health

OFFICE

OF

THE SECRETARY

},|AY

2 3

2016

ADMINISTRATIVE

ORDER

No.2016

-

00ll4

SUBJECT:

Implementins Guidelines

on

the

Orsanization

of

Health Clubs

for

Patients

with

Hvpertension

and

Diabetes

in Health

Facilities

I.

RATIONALE

Non-communicable

Diseases

(NCDs)

continue

to

be the

top

causes

of

deaths

among

Filipinos. Of

these,

hypertension

remains

the

leading

illness.

Diabetes

continues

to

be

significantraffecting

around

5Yo

of our

adult

population

(Source:

FNRI -

National

Nutrition

Survey,20l3).

To

address the

call

for

health interventions that

are

cost-effective

and sustainable,

the

focus

is

on the

most

vulnerable

risk

group

using

two most

common

and

easily

detectable

clinical

manifestations

of

NCDs:

hypertension and diabetes.

By

accelerating

case

detection

of

patients

with

risk factors, illnesses will

most

likely

be

found

at

an

early

stage, that

is, before

the onset of any

damage

to

target organs.

Campaigns are

needed to detect as

many

patients as

possible in the

early

stages

of

hypertension

and

diabetes.

Organizing

patients

into

active

Health

Clubs

is

one

of

the

strategies

to

ensure

continuity

ofcare,

raise

the effectiveness

oflifestyle

changes

and

prevent

complications.

The following

guidelines

are

hereby issued

to

strengthen

the

fight against

NCDs

at

the

primary

health

facilities

specifically,

the health

centers

and barangay

health

stations.

These

guidelines

reiterate the

policies

and

thrusts

outlined

in the'National

Policy on

Strengthening

the

Prevention and Control of

Chronic

Lifestyle

Related

Non-Communicable

Diseases

(NCD) (DOH

AO 2011- 003),

and

Implementing

Guidelines

on

the lnstitutionalization

of

Philippine

Package

of

Essential NCD

lnterventions

(PhilPEN)

on the

lntegrated

Management

of

Hypertension and

Diabetes

for Primary

Health

Care

Facilities

(DOH

AO

2012

-

0029).

II.

OBJECTIVES

A.

General objectives

These

guidelines

aim

to

gulde

various stakeholders

in health

care

in

creating

and

sustaining Hypertension-Diabetes Health

Club

s.

B. Specific objectives

l.

Define

the

process

of accelerating

the

identification

of

patients

based

on

the

PhilPEN

protocol,

of

creating

a Patient Registry

and

of

recruiting

these

patients

into

health

clubs.

Building

l,

San

lazaro Compound, Rizal

Avenue,

Sta.

Cruz,

1003

Manila

o

Trunk

Line 651-78-00

Drect

Line: 711-9501

Fax:743-1829;'143-1786

r

URL:

httorl/www.doh.gov.ph;

e-mail:

osecG)doh.gov

4D

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2/13

Define the

services and

activities of

the health

club that

will

ensure

at

least

90Yo

continuity of

care

to hypertensive

and

diabetic

patients

according

to

the

PHIL

PEN

guidelines

on lifestyle

changes

and the

DOH

guidelines

on

conlmunity

activities

especially

patient

education and motivation.

Promote

better

access to maintenance

medications

and

management

of

pharmaceutical supply chain.

Define

the roles

and

responsibilities

of the

different

DOH offices

and

agencies,

the

LGUs and

other

stakeholders

in

organizing

and

sustaining

health clubs.

Create a mechanism

for

conduct

of

patient

clubs

that

can

be

applicable

for other

diseases

entities.

IIL

SCOPE

AND COVERAGE

This

issuance

applies

to all

DOH

units

including

its

attached agencies,

local

government

units

(LGUs),

non-govemment orgarizations,

professional

organizalions,

the

private

sector

and

other relevant

partners

in

the health sector.

Chronic

Lifestyle

Related

NCDs

affect

the

vulnerable

age

groups

in

all

economic

levels.

Case

finding

and treatment

shall no longer be

limited to

priority

areas

identified

through

the

Conditional

Cash

Transfer

(CCT) program

or to

families under

the

National

Household

Targeting

System

(NHTS)

for

Poverty Reduction.

IV. DEFINITION

OF

TERMS

A.

PhilPEN

Protocol

-

is the Philippine

Package

of Essential

Non

Communicable

Disease

Interventions for low-resource

settings

adopted

from WHO

PEN.

This

protocol

consists

of

guidelines

for

the

integrated

management

of

hypertension

and

diabetes

through a

total risk

approach.

The

individual

client/patient

is assessed

and

managed

based

on using

the

risk

prediction chart. The

prediction

charts

can

estimate

the

client/patients

risk of having a

cardiovascular

event

(CV

risk)

in

the

next

ten

years.

This will

be applied

to all

patients

screened

for

and

found to

have

NCDs.

B. Health Facilities

-

these

are facilities

that

provide

screening and

management

of

diseases

like

hypertension and

diabetes.

May

include

but

not limited

to city

health

offices, rural

health

units

(RHUs)

and

barangay

health stations.

C.

DOH Hypertension and Diabetes

Registry

-

a

registry

of

patients

diagnosed

with

hlpertension

and diabetes

in

the health

facilities, linked

to

iClinicSys

of

RHUs

and

Integrated

Chronic

Non

Communicable

Disease

Registry of

hospitals.

D. DOH

Health Clubs

-

an

organ

izationthat

consist of

officers with

rules

and by-laws

and a

common

goal

of

improving

the health

and

wellness

of its

members.

lnitially,

these shall be organized in

health facilities

such

as

RHUs

and expanded

to barangays.

V. GENERAL GUIDELINES

A.

ACCELERATED

CASE

FINDING.

Accelerated case

finding

is applicable

for

persons

40

years

old

and above.

2.

J.

4.

5.

N

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3/13

MANDATORY

REGISTRY.

All

RHus/health

centers

shall

have a registry

of all

hypertensive

and

diabetic

patients

to

closely

monitor

their

health

conditions and

for

provision

of

medications.

VOLUNTARY

ENROLLMENT.

All

diagnosed

patients

with

hypertension andlor

diabetes

in

all

public

and

private health

facilities

shall be

encouraged

to

enroll

in

designated

Hypertension-Diabetes

Health

Clubs

in

their

health

center

but

will

remain

voluntary.

The

list

of health

clubs

shall

be

submitted

to DOH

Central

Office

after

validation

of

the

Provincial

and

Regional

Offices.

SERVICE

DELIVERY

NETWORI(.

Each

health

facility

shall

ensure

that

there

is

a

network

of higher

facilities

and

providers

within

the

province

or

city-wide

health

systems

where

referrals

and

other

health

care

services

can

be

provided.

STANDARDIZING

DIAGNOSTICS.

Fasting

Blood

Sugar/Glucose

(FBS)

with

8

-

10

hours

fasting

shall

be the

standard

of screening

for

diabetes

instead

of

random

blood

sugar

to

promote

efficiency

in

use

of

resources

and

facilitate follow-up.

This

shall

be initially

through

the

capillary

method

(glucometer)

and

confirmed

using

the

venous

FBS.

F.

FOLLOW

-

UP

OF

PATIENTS.

A11 patients

with diagnosed

hypertension

and

diabetes,

regardless

of

membership

into

a

Health

Club,

shall

be scheduled for

regular

follow-up

and re-evaluation

by

a

physician

based

on

philpEN.

G.

ADOPTION

OF PhilPEN

PROTOCOL.

The PhilPEN

protocol

shall be the

basis

for

further

assessment,

screening,

management

and

follow-up

of

patients

seen

in the

facilities.

Risk

assessment

of

persons

betw

een

25

and

39

years

old

apparently healthy,

with

risk

factors

or with

early

manifestation

of

disease

shall

continue

as

defined

in

this protocol.

VI.

SPECIFIC

GUIDELINES

STAGE

1:

Accelerated

case

finding

among

the highest

risk

group

A.

Identifying

patients

with

hypertension

and

diabetes

1.

Case

Finding

shall

be done

during:

a.

Community

campaign,

or

b. Household

visits

2.

Case

Finding

shall

be done

through:

a.

Blood

pressure

(BP)

measurement

of

all

persons

40

years

old

and above measured

twice,

15-30

minutes

apart,

by

a

Barangay

Health

Worker

(BHW).

b. Risk

assessment

of

clients

25

years

old

and above

who

visit

the

health

center for

other

clinical

complaints,

based

on

philpEN.

3.

Those

found

to have

BP

>140190

on both

readings

shall be referred

to the

local

government

staff

(midwife

or

nurse)

who

shall

verify

the

elevated

BP

reading one

week later

B.

C.

D.

E.

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4.

All those

verified

to

have

elevated

BP

>140/90

by

the health center midwife

or

nurse

shall

be:

a. Referred

to

the

physician/Municipal

Health

Officer

(MHO)

to confirm

diagnosis

of

hypertension

and examined

for

any sign or symptom

of

underlying

causes

(eg.

renal

disease) and target organ

damage.

Using

PhilPEN,

risk

prediction

can

be

done

to

estimate

the

cardiovascular

risk

of

the

patient.

b.

Have

their

fasting

blood

sugar/glucose

(FBS)

tested

c.

Started

on the first

line

antihypertensive

medicine

as

prescribed

by

the

doctor and

if

not

contraindicated

based on the available

drugs

provided

by DOH

(Amlodipine

5

mg, 1

tablet, daily)

and test

blood cholesterol

if

available

d. Registered

in

the

health

center

Hypertensive

Patient

Registry

e.

Strongly

encouraged

to enroll in

the


Health Club,

f.

Assessed for

secondary

hypertension

andl or

signs and symptoms

of some

target

organ

damage and then

referred

to

a

hospital

for fuither

evaluation

5. All other

persons

without

hypertension

but

have

a

family

history of

diabetes,

are

obese

and with signs and symptoms

of

possible

diabetes shall

also have their

fasting

blood

sugar/glucose

(FBS)

tested.

6. All

patients

found

to

have high capillary

FBS

(>7.0

mmol/l or

126 mg/dl)

shall

have

their

FBS

retested using venous

blood

done by a

medical technologist either

in

the

health

center

laboratory, local hospital laboratory or

a

private

laboratory

and

shall

be:

a.

Referred to

the

physician/MHO

to confirm diagnosis

of

diabetes

and

examined for

any sign

or

symptom

of

target organ

damage.

Using PhilPEN,

risk

prediction

can

be done

to

estimate the

cardiovascular

risk

of

the

patient.

b.

Started

on the first

line

anti-diabetic drug as

prescribed

by

the doctor

and if not

contraindicated

(Metformin

500 mg daily).

c. Registered

in

the

health

center

Diabetic

Patient

Registry

d.

Strohgly

encouraged

to

enroll

in

the

Hypertension-Diabetes Health Club

e. Assessed for

signs and symptoms

of

target organ

damage

and

then referred

to

a

hospital for further evaluation

B.

Enrollment

to the NCD Registries

1.

Newly

diagnosed

patients

shall be

registered in

the

specific Chronic

Disease

Registry.

2.

A

patient

who

has

both

hypertension

and diabetes

shall

be

registered

in

both

the

Hypertension

and

Diabetes

registries.

3. Deaths

and

geographic

ffansfers in and out

of their

specific

health facility shall

now

be

recorded

in the

Chronic Disease Registries and

reported

to the DOH

Regional

Offices through

the

appropriate LGUs.

4.

National

Chronic

Disease registries

shall

also

be

maintained

by

DOH

through the

Knowledge Management

and

Information

Technology

Service

(KMITS).

C. Health

Education

1.

All

patients

registered in

the

hypertensive

and diabetic

patient

registries

shall have

their first health

education session

given

by the

health

facility nurse

or

midwife.

2. Topics

on

first

health

education

session

shall be composed

of

but not

limited

to the

following:

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5/13

a.

Diet

changes

needed

for their

specific

condition

(e.g.

increase

intake

of fruits

and

vegetables)

Increased

physical

activity

(at

least

30

minutes

brisk walking

three times a week),

Cessation

of

smoking and

reduction

of alcohol

intake, when relevant,

and

Prevention

of

common

infections

3.

Subsequent

health education

sessions

to

reinforce

the

health

messages

may

be

given

by

the

midwife

or

a BHW

specially

trained

for this task.

D. Follow-up

1.

All

patients

with

hypertension

shall

have

their BP taken

by the BHW at

least

once a

week

to verify

that

their

BP

is

under

control. Follow-up of these

patients

with the

physician

shall

be

monthly

until

BP

is

controlled

and 3

-

6 months thereafter. Those

found

to

still

have BP

>T40190

shall

be referred back to the

physician

who

may

decide

to:

a. Increase

the

dose

of

the

current

medication,

OR

b.

Shift

medication

to

the

second

line

drug

if

not

contraindicated (Losartan 50 mg

daily),

OR

c.

Add

Losartan

on top

of

Amlodipine

2.

All

patients

with

diabetes

shall have

repeat

capillary FBS testing

every three

(3)

months.

Those found

to

still

have

FBS

>7.0

mmolll or 126

mg/dl shall be re-evaluated

by

the

health

center physician

or any

physician

who

may

decide to:

a. Increase

the dose

of

the

current

medication,

OR

b.

Shift

to

the

second

line drug (Gliclazide

80

mg

daily),

OR

c. Refer

the

patient

to

a

hospital

for

further

evaluation

3. Patient treatment

booklet

shall be

given to

the

patient

and shall be

used

to monitor

the

dispensing

of

medications

and health promotion

activities. The

booklet

shall

contain

all

the

essential

clinical

information

that

should

be

assessed

and

monitored

on a

regular

basis.

4.

Clients

who

are 40

years

old

and

above

who

still

do

not manifest

any signs

of

hypertension

or

diabetes

but

are known

smokers,

have

a family history

of

diabetes

and/or

are

obese

should

continue

to

be

followed

up

at

least

every 3

to

6 months since

they are

still considered

low

to moderate

risk

or with


6/13

d.

There shall

be only

one club

for

hypertensive and

diabetic

patients

since

many

diabetics are also hypertensive and

the activities

to

promote

lifestyle

changes

are

the same

for both

types

of

patients.

2.

Establishing

Other

Health

Clubs

a.

Other health clubs

for

other types

of chronic

diseases

such

as

Arthritis

Health

Club or Cancer Survivor Health

Club

may

also be

established

as

deemed

necessary

by

the

health

facility.

b.

Each

health club shall

elect

their own officers

and

they

are encouraged

to

meet at

least once

a

month and election every

year.

3. Core

Activities

of

the Hypertension and Diabetes

Health

Club

shall

include:

a.Lifestyle

improvement

activities such as

changes

of diet,

increased

physical

activities, cessation

of smoking, reduction of

alcohol

intake;

b.

Health education

especially

on

prevention of common

infections

and

proper

use

of

medications, among

othersi

c.Periodic

measurement

of

BP

and

FBS including

reminders when

these

have

to

be

repeated, eg.

through

mobile

phones;

d.

Replenishment

of

free medications; and

e.Mental health improvement

activities

to

encourage

bonding

among

members and

to

relieve

stress.

4.

Membership

Number

a.

Each club member

shall

be

given

a unique

chronological

Club

membership

number

in

the following

format:

i. DOH Heath

Facility

Code

(FC)

of

the

National

Health Facility

Registry

System

-

Year

of

enrollment

in

the

club

-particular

health

club and

chronological

number

of

patient

ii. Example for

the first club

member

who is

registered

in

Payatas

B Health

Center, #I7 Bulacan

St.,2nd

District,

Quezon

City.

Enrolled

in

the

Hypertension

and Diabetes

Health Club,

year

2016: FC102

-

2016

-

H/D

Club

-

1

5.

ID

a. Each patient

shall receive

a unique identification

(ID)

card color-coded

according

to their

clinical

classification

as

follows:

i.

YELLOW:

(30%

risk

score)

the

patient

has

hypertension

and I or diabetes

AND

signs

of

target organ

damage.

b. When the

clinical condition of

the

patient

improves or

deteriorates,

he/she

shall

be

given

an adjusted

color

ID.

c.

Red

coded

patients

shall

also be

enrolled

in

hospital-based

health clubs but they

will retain

their unique facility-based Club

membership

number.

They

can

be

active

in

either clubs

but

shall claim

their

free

medications

only

from

their

respective

RHUs.

^r vh'/r

6?d


7/13

6.

Medications

a. Newly diagnosed

hypertensive and

diabetic

patients

shall:

i.

Receive

a

prescription

good

for 3 months

from the City/Municipal

Health

Officer

ii.

Receive

maintenance medications

in the

Rural

Health Units

where

they

are

registered on

a

monthly

basis.

b.

Previously

diagnosed

hypertensive

and/or

diabetic

patients

who

come to the

health facility

just

to ask

for

free medications

shall be:

i. Thoroughly

evaluated:

measure

BP, test

capillary

FBS

(glucometer),

assess

clinical

signs and symptoms

for target

organ

damage

and underlying

causes

(eg.

renal

disease for

hypertensive

patients)

based

on

PhilPEN

ii. Registered

in

the appropriate

Chronic

Disease

Registry in

the

health

facility.

iii.

Strongly

encouraged

to enroll

in a


Health

Club.

iv.

Given

health

education

reiterating

the

lifestyle

messages mentioned

in

First

Health

Education

v.

Maintained

on

their

current medications

until

the next

follow-up

c. Claiming

of DOH

maintenance medications

i.

Patients

shall

personally

claim

their

medicines

in their

respective

RHUs.

Altematively,

other

people

may claim

for

them

as

long as

with authorization

letter

and

patient

booklet.

ii. Club members may collect

their

free

medications

from another

RHU/Hypertension

-

Diabetes

Health

Club

within

the

same region

provided:

a.

Both clubs

are

informed

and

agree

to the

modified

arrangement.

b.

The drug

allocation

for

these selected

patients

shall

be

transferred

to

the

RHU

where the

patient

will obtain

his/her

medicines

to respond

to

the

needs

of

the

patient

and

at

the

same

time avoid

duplication

of

drug

dispensing.

c.

Inter-regional arrangements

will only

be

possible at

a

later

time when

the

national electronic

registry

system

is in

place.

7.

DOII

flealth Clubs

may

engage

in

other

activities,

such

as:

a.

Peer

group

engagement in

health

education,

regular

activities

like

exercises

and

sustained

medication to ensure

continuity

of

care

leading to better

health

outcomes.

b.

Social activities

like

get-togethers

to

further

raise

the

understanding

of

health

messages

(eg.

the

meals

served

should

be

diabetic-friendly

or

hypertensive-

friendly)

c.

Own fund

raising activities to

get

free

or discounted

laboratory

tests

such

as

cholesterol test and ECG, among

others.

d. Involvement

of family members to

encourage

participation especially

health

promotion

activities.

8. Affiliations

a.

Patient-initiated

health

clubs,

such

as

those

organized

in schools,

workplace

or

churches, may be

recognized as affiliated

chapters

in the

Barangay

where the

school,

workplace

or church is

located.

af:#7


8/13

b.

The

health club

may

start

with

a

few members

that

is

health center/RHU

-

based

and over time, with

additional

members,

health

promotion activities

could

be

organizedthrough

a club

in

each

Barangay.

c.

The

Barangay-based

club

shall

maintain

its links

with

the

Main

RHU-based

Club

through

specific

activities

that

need

the

presence

of

physicians

(e.g.

during

follow-

up health

assessment).

VII. MONITORING

AND

EVALUATION

1.

The

Task

Force for Health Clubs

shall

develop

a

monitoring

and

evaluation

mechanism

to

measure

the

inputs,

processes and outcomes

expected

from the

implementation of

this

issuance.

The

monitoring

will

be based

on

existing

mechanism

that

is

currently

used

for

PhilPEN implementation

and for

inventorylutilization

reports

of

medications.

2. The

DOH

Hypertension and

Diabetes

Club

shall

be

measured in

terms

of:

a.

Performance

indicators to

measure attainment

of

targets

in terms

of

patients

identified

and

treated,

health

clubs

organized

and

functional, and

NCD

drug

utilization

b.

Indicators of

the

effectiveness

of

health clubs

in

preventing

adverse

health

outcomes.

3.

Periodic reports

on the

performance

of

various

DOH

offices

and

agencies shall

be

written and

disseminated

through

quarterly

monitoring

and

performance

evaluation

meetings with appropriate

DOH offices

and stakeholders.

4.

Guidelines

for monitoring of

drug

reactions

at

the

RHU level

will

be

developed by

the

Pharmaceutical Division

in

collaboration

with the

Food

and Drug Administration.

VIII.

ROLES

AND FUNCTIONS

Disease

Prevention

and Control

Bureau

(DPCB)

shall:

a. Provide

technical

assistance to various

stakeholders

in clarifuing

the integration

of

this

guideline

with the

policies/guideline mentioned

above

(AO

2012-0029

and

AO 2011-0003).

b.

Assist

the

DOH Regional Offices

in

translating

the

national

DOH

guidelines

into

simple,

locally

useful

field

implementers'

manuals

and

tools

by

providing

samples

and models

of

patient

manuals

for adaptation

to

field conditions.

c. Oversee the

development

of

a

practical

mechanism

to

harmonize

and

monitor

inputs,

processes

and outcomes

related

to

these

chronic

diseases

Bureau

of

Local Health

System Development

(BLHSD)

shall:

a. In

collaboration

with DPCB

and

PD,

provide

technical

assistance

to

the

LGUs,

through

the DOH

Regional Offices,

on

the

formation

and

maintenance

of


Health

Clubs and

other

health

clubs

especially

in

clarifying the

role of

BHWs and

LGUS

and translating

the

national

DOH

guidelines

into simple,

locally useful

field

implementers'

manuals and

tools

through samples and

models

of

well-organizedhealth

clubs.

b. Facilitate the

organization

of

health

clubs

by

assisting

the

DOH

Regional

Offices

in

advocating

for

support

for

health clubs

among

the

Local

Chief

Executives

and

through

the BHW

Federation, and

various

NGOs

working

in the

communities,

amons

others.

l.

2.

4oqf


9/13

J.

c.

Collaborate

with

DPCB

and

other

DOH units

in

developing

a

practical

mechanism

to harmonize

and

monitor

inputs,

processes and

outcomes

related

to

the

organization

and

maintenance

of

health clubs.

Knowledge Management and

Information

Technology Service

(KMITS)

shall:

a. Maintain

the

National

Chronic

Disease Registry

based

on

data

from

the

various

sources especially

the

LGUs.

b.

Facilitate the

submission

of timely

Chronic

Disease

Registry

reports

by

the

DOH

Regional Offices

by

assisting

them

develop

their

recording

system

through

capability

building.

c.

Through

the

Logistics

Managernent

Division,

ensure

the timely

and

secure

distribution

and accounting

of

essential

drugs

and

medicines

purchased by

DOH

for NCDs and

assist

in

developing

efficient

and

secure

mechanisms

for drug

distribution

and monitoring.

Health Promotion

and

Communication

Service (HPCS)

shall:

a. Provide

technical

support

in

the development

of

promotion

and

IEC

materials

and

the conduct

of

advocacy

and

health

education

activities

for


Health Clubs.

b.

Advocate

among

other

govemment

agencies,

non-govemment

organizations,

private

sector,

development

partners

and

other

relevant

stakeholder

towards

a

supportive

environment

for

health clubs.

DOH

Regional

Offices

shall:

a. Provide

technical

assistance to LGUs

and

various

stakeholders

within

their

Region

by

disseminating

and

clariffing

the

i.

Integration

of

this

guideline

with

the

policies/guidelines

mentioned

above

(AO

2012-0029

and

AO

2011-0003).

ii.

Updating

and

maintenance

of

Chronic

Disease

Registries

and

the

importance

of compliance

with

the

Phil

PEN

protocol.

iii. Role

of

BHWs

and

LGUS.

iv.

Adapting

nationally-developed

field

implanenters'

manuals

and

tools

into

local

manuals and

tools.

b. Facilitate

the

formation

of


Health

Clubs

among

the

LGUs

withintheirRegionbyassistingtheminidentif,zingmethods'interventionsand

resources

and

by

providing

a

responsive

and supportive

health

system

c. Oversee

the

monitoring

of

the inputs,

processes

and outcomes

of

the activities

of


Health

Clubs

within

their

Region

based on

the

monitoring,

feedback

and evaluation

mechanism developed

for

health

clubs.

6.

Development

Management

Officer

(DMOyDOII Representatives

shall:

a.

Be the

overall

coordinator

of

the

Hypertension

and

Diabetes

Health

Club

within

his/her catchment

ar ealLGU

b. Ensure

that

guidelines

and

procedures for the

club

are understood

by

the

LCE

and

health

facility

staff/providers

c. Solicit

the active

participation

of

the

LCE

especially

provision

of

support

to the

club

d.

Assist

in monitoring

and

evaluation

of

the

activities

and

operations

of

the club

4.

5.

ft-\'\f


10/13

Pharmaceutical

Division

shall

:

a.

Collaborate

with the

KMITS-LMD

and

the

Procurement

Service

to

ensure

the

timely

purchase and

distribution

of

essential

medicines

for

NCDs.

b.

Collaborate

with DPCB

and BLHSD

in developing

an

efficient

and

secure

drug

distribution

and

monitoring

system

for

drugs

and

medicines

purchased

by

the PD

for NCDs

and

distributed

through


Health

Clubs.

c.

Assist

the

DOH

Regional

Offrces

in

disseminating

important

information

on

the

proper

use, handling

and

utilization

of

drugs

and

medicines.

d.

In collaboration

with

FDA,

develop

guidelines

for monitoring

drug

reactions

at

the

RHU

level

(pharmacovigilance).

Philippine

Health

Insurance

Corporation

(PHIC

or

PhilHealth)

shall:

a. Incorporate

the NCD

medicines

that are

not

yet covered

by

DOH

in

the

primary

care

package

that

would be

reimbursed

to

the

Health

Care

Provider

through

PhilHealth

financing

b.

Develop

other

Diagnostic

Services

in

the

primary

care

package

that will

complement

the

programs

of

DOH

through

Health

Clubs

c.

Facilitate/Assist

the enrollment

of

patients in

the

Chronic

Disease

Registry

in the

PhilHealth

programs

e.g. Sponsored

Program,

Informal

Sector

and

orient

in

their

rights,

privileges

and

how to avail of

PhilHealth

benefits

City

Health Offices/Rural

Health Units

shall:

a. Develop

their facility-based

Hypertension

and

Diabetes

Club

using

this

guideline

b.

Identify

a

point

person

within

the

facility

(e.g.

MHN)

who

will

oversee

the

plans

and

activities

of the

club.

To

guide

club

officers

and

members

in

ensuring

that

plans

are

carried

out

and

provide

assistance

in

coordinating

with

other

RHU

staff

or

stakeholders

ifresource

persons

are

needed during

activities.

c.

Ensure

sustainability

of

health

clubs

through

regular

follow-up

of

patients

and

registry

and

conduct

of

activities

that

promote education/awareness

d. Submit

monitoring

and evaluation

reports

on

a

regular

basis

e.

Ensure close coordination

with the

Regional

and

Provincial

Health

Offices,

LGUs

and other

stakeholders

10. Local Government

Units

shall:

a. Implement

and support

the

formation of

the club

per

primary

health

care

facility

within

their

area.

b.

Provide support

to PHOs/CHOs/MHOs in

the

logistics

needed

by

the club.

IX. FUNDING

The Department of

Health Central

Office

through

DPCB,

BLHSD

and

HPCS

shall

provide

funds

for

technical

assistance, commodities

such

as

glucose

strips,

monitoring,

capacity

building

and

health

promotion

campaigns

to ensure

that

the above-mentioned

activities are

implemented.

Likewise,

the

Regional

Offices

through

counterpart

departments/divisions

of

central

office shall

allocate

funds

for

the same

strategies.

The Pharmaceutical

Division

shall allocate

funds

and

procure

maintenance

medications

needed

for

chronic

diseases.

8.

9.

^ .\ -/r

10w


11/13

Local

government

units

shall

provide

funds

for

health

facility

activities

in

their

respective

communities.

Other

goveflrment

agencies,

non-government

organizations

and

other

stakeholders

and

partners

in

health shall

provide funds

as

appropriate

to

ensure

the

implementation

of this

guideline.

X.

REPEALING

CLAUSE

The

provisions of

Department

of Health

Administrative

Order

2011-0013

(Implementing

Guidelines

on

the

DOH

Treatment Pack)

limiting

the

distribution

of

ComPack

medicines

to

CCT

priority

areas

and NHTS

families

are hereby

repealed.

A11 other

previous Orders

and

other

ielated

issuances

inconsistent

or

contrary

to

the

provisions

of

this

Administrative

Order

are also

hereby

repealed, amended

or

modified

accordingly.

A11

other

provision

of existing

issuances

which

are

not affected bv

this

Order

shall

remain

valid

and

in effect.

XI.

EFFECTIVITY

This

Order

takes

effect

immediatelv.

JANETTE

ARIN,

MD,

MBA.H

ealth

11

\n

're

-r

1--\Nl /

/\-V-

u

/ a

/


12/13

ANNEX

A

HIGH

RISK GROUP

(>

40

years

old)

a.

Those

with BP

2

140/90 taken

twice

by BHW shall

be

referred

to

RHUs

for further

assessment

b.

In

the

RHU,

the

nurse/midwife

will

confirm

if

the

patient has BP

>-

140190

ffir s

xflw

@

.T

ffir+

H

lIW

Initial: capillary

FBS

by

nurse/midwife

Confirm:

venous

blood

FBS

by

medical technologist

['ffi;l fillF:,.F.ltN _-]

I

ru

'y

I

Fl.*t';-::*il ll

,r,*

|

\/iattackorl'

\

+ /

lt''rne'tensionl I

@ I

I cholesterol. if

available)

| \

I

zr26mfldr_

I

I

l'6mgtdr

I

|

140/90

-

referred

to

physician/MHO for diagnosis

and

further

management

o

The

physician/MHO

will

further evaluate

the

patient

(for

target

organ

damage,

secondary

hlpertension,

etc.)

and start

appropriate

medications:

First

line anti-hypertensive.'

Amlodipine

(based

on

drugs

provided

by

DOH)

First

line

anti-diab etic.'

Metformin

o

Monitor

BP and capillary

FBS monthly

until

target

goals

are

met

Diagnosed

patients

with Hypertension

and/or

Diabetes

will

be

registered

in the

specific

chronic

disease

registry

ofthe

health

facility

I

Uypertensive

and

Diabetic

patients

will

be

strongly

encourased

to

I

I

join

the

Health

Ctub

I

12M


13/13

ANNEX

B

a. Sample

application

form

APPLICATION

F'ORM

DOH

ITYPERTENSION

AND

DIABNTES

CLUB

Date:

Name

of

patient:

Birthdate:

LASTNAME

Age:

_

FIRSTNAME

Sex:

MIDDLE

NAME

No. Street

Brgy./City,Municipality

Email

(if

any):

ontact

number:

PhilHealth

Number:

DOH

HYPERTENSION

AND

DIABETES

CLUB

Patient

No.:

Name:

Address:

RHU:

Birthdate:

Sex:

Contact

number:

b.

Sample

ID

FRONT

ln

case

of

emergency:

Name:

Address:

Contact

number:

Signature

of

member

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implementing guidelines on the organisation of health clubs (doh ao 2016-014)

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