DOH STRUCTURAL AND DEVELOPMENT STANDARDS FOR MEDICAL OUT-PATIENT CLINICS Rationale: Currently, the country s health care system involves the national, local government units (LGUs) and the private sector. With the devolution of health services to the LGUs in 1992, the city and municipal government manages the rural health units and health center facilities. As such, the health care system involving this type of health service and facility is quite extensive. In 1999, the Department of Health s (DOH) Sentrong Sigla Movement was launched to promote the availability of quality health service in health centers and hospitals. In July 2000, the Revised Implementing Rules and Regulations of the National Health Insurance Act of 1995 was approved with specific provisions for benefits, payment of claims, quality assurance and accreditation of health professionals, out-patient facilities and services. These significant events and undertakings created a demand making therefore imperative for the Department of Health through the Bureau of Health Facilities and Services (BHFS) to recommend structural and development standards for both government and private medical out-patient clinics. The following aims to provide specific guidelines pertaining to the structure of medical out-patient clinics that will hopefully promote quality services in these facilities. QUESTION: Are they envisioning that the MOPC will be the venue where the comprehensive package for outpatient component of the NHIP will be provided? Is it a facility where majority of the health problems of the total population can be addressed? Are they envisioning that a certain segment of the population like those enrolled in the sponsored program of the NHIP shall have the MOPC as the entry point in health care? Coverage: Medical Out-Patient Clinics (MOPC) for the purpose of this guideline is defined as health facilities where patients can avail of medical consultations or treatments on an outpatient basis. These standards shall cover MOPCs that are established: a) within commercial establishments b) within residences c) within hospital premises d) attached to ancillary facilities such as laboratories, radiology and pharmacies e) within factories and other workplaces f) school clinics g) health centers/ rural health units The list above are so varied. There are prepaid facilities in commercial establishment like Health way, Clinica Manila etc which can not be compared with those within residences which are more often solo practices.
Other similar facilities such as birthing homes, infirmaries, dental clinics, physical therapy/rehabilitation facilities, aesthetic/ dermatology clinics, alternative health care facilities, dialysis clinics, out-patient center for drug treatment, rehabilitation and after care, out-patient clinics providing pre-employment examination for overseas workers and out-patient clinics providing surgical ambulatory services are covered by a different set of implementing rules and regulations for purposes of licensing and accreditation. MOPCs are also classified as follows: 1 Ownership 1.1 Government operated and maintained partially or wholly by the national, provincial, city or municipal government, or other political unit or by any department, division, board or agency thereof. 1.2 Private privately owned, established and operated with funds through donation, principal, investment or other means, by any industry, corporation, association or organization. 2 Institutional Character 2.1 Free standing a health facility that is located outside the premises of an institution and operates independently. 2.2 Institution-based a health facility that is located within the premises and operates as part of an institution. Does 2.2. include the OPD of hospitals? Guiding Principles, Standards and Criteria: 1. The standards of excellence and quality for structure and services shall not be different from that of the government and private facilities. 2. Access to care must be a function of a person s health needs rather than ability to pay. 3. Regardless of the nature or purpose of the clinic, the highest priority shall be to achieve the best quality service that can be offered to a high coverage of the population served. 4. Services provided in each category shall be cognizant of their appropriate roles and respective strengths, ever mindful however, of its complementary and supportive roles in the overall health care delivery system.
In order to promote and enhance the acceptability of performance and structure of these facilities to a certain degree of quality, the standards and criteria were developed in consideration of the following: STANDARDS CRITERIA I. Physical Plant: a) MOPCs shall be designed to observe appropriate architectural practice to meet the prescribed functional program in conformity with but not limited to the following codes: PD 1096 National Building Code of the Philippines PD 1185 Fire Code of the Philippines PD 856 Code of Sanitation of the Philippines BP 344 Accessibility Law RA 1378 National Plumbing Code of the Philippines RA184 Philippine Electrical Code RA 9003 Ecological Solid Waste Management Act b) MOPCs shall reflect holistic and healthy atmosphere of wellness and wholesomeness. Functional and spatial relationships shall be observed to ensure accessibility, efficiency, orderliness and safety for the patients, personnel and the public in general. Provision of adequate space for people, activity, furniture, equipment and utility assigned to the area or room shall be observed. Consultation and treatment rooms shall be situated with provisions for visual and auditory privacy as a foremost concern. Observance of beneficial housekeeping and sanitation practices II. Human Resource: a) All health care providers of the facility shall be qualified to do their responsibility and accountable in all their dealings with their clients and patients. b) MOPC services shall promote patient/ client satisfaction, improvement of services and efficiency at all times. The facility shall be headed by a licensed or certified professional who shall take responsibility for the various activities in the health facility. Similarly, the personnel shall have clinical expertise earned through education, specialization, training and experience. There shall be a written description of the staff s duties, functions and responsibilities, which they are familiar with and copies of which are readily available. The number and kind of personnel shall adequately complement the average number of clients/ patients seen, the type of activities conducted and the corresponding schedule of activities. There shall be opportunities for staff development and continuing education that will ensure improvement of service, updated knowledge and skills, and promote job satisfaction and quality performance. There shall be mechanisms to gather patient s feedback in place. Observance of good inter-intra personal rapport.
STANDARDS CRITERIA III. Equipment: a) There shall be provisions for appropriate and adequate equipment to effectively carryout the services of these facilities. b) Use of equipment shall be according to acceptable medical and health practices and applicable guidelines and laws. The necessary functional clinical equipment shall be available to provide the expected service in the facility. The personnel using the equipment shall be qualified and trained. There shall be provisions for its maintenance and repair. Under no circumstances should clinical trials and sampling of drugs and medicines be done among private or government patients unless the proper ethical procedures and protocol are strictly followed. Use of equipment shall be based on the Manual of Operations consistent with the DOH-Bureau of Health Devices and Technology standards and guidelines. IV. Recording and Reporting: a) There shall be a system and mechanism for proper and efficient documentation of care and interventions done. Individual patient records shall properly be filled-up and filed for easy retrieval and referred to when needed. Recording of diagnosis shall be in accordance with the International Classification of Diseases (ICD-10). A statistical record of the leading causes for consultation and cases seen shall be maintained on a monthly, quarterly and yearly basis, while cases of communicable disease should be reported to the nearest government health station as provided by law. b) Health records, statistics and other facility-generated data shall be utilized for planning and decision- making purposes to improve services. Individual patient records shall be kept in confidentiality, maintaining and following patient-physician privileged information at all times c) Confidentiality of information shall be observed at all times.
STANDARDS CRITERIA V. Services and Referrals: a) Performance of medical procedures shall be according to established and acceptable protocol and practices. Standard disease management protocol shall be consistent with national health policies and guidelines. There shall be a written manual of procedures readily available for quick reference Preventive and promotive programs shall be made available through health teachings, counseling and use of IEC materials. MOPCs shall incorporate and institutionalize programs for quality assurance/ quality improvement (internal and external) with the satisfaction of the community, clients, patients and the personnel as a determinant of the quality of service. Available services, schedules and identity of facility personnel shall be known to clients/patients through posted schedules, signage and other visual information. Recording of diagnosis shall be in accordance with the International Classification of Diseases (ICD-10). The facility should be supported by a referral system with procedures and forms. Referral facilities shall be pre-identified, taking into consideration accessibility and availability of services and amenities. b) Establishment of a network of health facilities for services and amenities corresponding to the level of care and services required in the geographic location.
Guidelines in the Planning and Design of Medical Out-Patient Clinics: MOPCs shall be planned and designed to observe appropriate architectural practices, to meet prescribed functional programs, and to conform to applicable codes as part of normal professional practice. 1. Safety: MOPCs shall provide and maintain a safe environment for clients/ patients, personnel and the public. The facility shall be of such construction so that no hazards to the life and safety of clients/ patients, personnel and public exist. It shall be capable of withstanding weight and elements to which they may be subjected. 1.1 Exits shall be restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair. 1.2 A minimum of two (2) exits, remote from each other, shall be provided for each floor of the building. 1.3 Exits shall terminate directly at an open space to the outside of the building. 2. Patient Movement: Spaces shall be wide enough for free movement of clients/ patients, personnel and other guests. 3. Lighting: All areas in a MOPC-HCF shall be provided with sufficient illumination to enable personnel to properly perform procedures and tasks. 4. Ventilation: Adequate ventilation shall be provided to ensure comfort of clients/ patients, personnel and public. 5. Water Supply: All MOPCs shall use an approved public water supply system whenever available. The water supply shall be adequate and shall be brought into the building free of cross connections. 6. Waste Segregation and Disposal: Liquid waste shall be discharged into an approved public sewerage system whenever available. Solid waste shall be collected, treated and disposed of in accordance with applicable codes, laws or ordinances. 7. Sanitation: Utilities for the maintenance of sanitary system, including approved water supply and sewerage system, shall be provided through the buildings and premises for insuring cleanliness. 8. Maintenance: The building/ facility and equipment shall be kept in a state of good repair. Proper maintenance shall be provided to correct or prevent leaking roofs, loose plaster, uneven flooring, faulty equipment, or other undesirable conditions. 9. Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow ease of cleaning. 10. Fire Protection: There shall be measures for detecting fire such as fire alarms in walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas. 11. Space: Adequate area shall be provided for the people, activity, furniture, equipment and utility.
Service Capability: 1. General Administrative Service 2. Clinical Service and/or any of the following as deemed appropriate with the specialty concerned: a) General Pediatrics e) ENT b) General Obstetrics and Gynecology f) Ophthalmology c) General Surgery g) Family Medicine d) Internal Medicine h) Minor Surgery (when applicable) 3. Health Education Personnel: 1. General administrative service a) Administrator and/or physician-administrator (1) 2. Clinical service a) Physician (1) b) Nurse or any other allied or health trained personnel c) Support staff as necessary Equipment/Instrument: 1. General Administrative Service a) Bench (1) e) Desk (1/staff) b) Cabinet or open shelf (1) f) Fire extinguisher (1) c) Calculator (1) g) Color coded trash container d) Chair (1/staff) 2. Clinical Service a) Clinical weighing scale (1) h) Stethoscope (1) b) Examining table (if applicable) (1) i) Suturing set (if applicable) (1) c) Gooseneck lamp/examining light (1) j) EENT diagnostic set (if applicable) (1) d) Instrument table (1) k) Nebulizer (if applicable) (1) e) Minor surgery instrument set (if applicable) (1) l) Thermometer
f) Sphygmomanometer (1) m) Emergency medicine cabinet and corresponding medicine g) Sterilizer (if applicable) (1) n) Consumable clinic supplies Physical Facility: 1. General Administrative Service a) Waiting area b) Information and receiving area c) Access to toilet 2. Clinical Service a) Consultation area d) Sterilizing area (if applicable) b) Examination and treatment area with lavatory/sink e) Minor operating room area ( if applicable) c) Equipment and supply storage area/ appropriate cabinets