Administrative Order No. 9-C series 1997

27 May 1997

ADMINISTRATIVE ORDER

No. 9–C series 1997

IMPLEMENTING RULES AND REGULATION OF ADMINISTRATIVE ORDER No. 5–A SERIES 1996

One of the retained functions of the Department of Health over the developed set–up of the health care delivering system is standard setting and regulation. This is to safeguard compliance to quality health care as the DOH primary responsibility is to maintain the accessibility and dependability of health facilities in terms of health care.

These Implementing Rules and Regulations are designed to facilitate clear understanding of the users to avoid discrepancy in its implementation. It is also made in such manner that it will address issues/problems regarding affiliation and training of students involving the use of government facilities.

I.     TITLE

This Order shall be known as the Implementing Rules and Regulations Governing the Affiliation and Training of Students in Government Hospitals and other Health Facilities.

II.    COVERAGE

These rules and regulations shall govern affiliation activities in the following facilities accredited by NCATS/RCATS for affiliation and training of students:

1. Hospitals

1.1.Specialized Hospitals

1.2.Medical Centers

1.3.Regional Hospitals

1.4.Provincial Hospitals

1.5.District Hospitals

1.6.City Hospitals

1.7.Armed Forces of the Philippine Hospitals

1.8.Community or Municipal or Medicare Hospitals

1.9.Government Laboratories

1.10.  Sanitaria

2. Field Health Units

2.1.Rural Health Units/Barangay Health Stations

2.2.City Health Office or Centers

District/City Hospitals with bed capacity of 25 and above but less than 100 and occupancy rate of 100% will be considered for accreditation of health facilities for affiliation. However, training of students in these types of facilities shall be considered an exposure to public or community health.

District/City Hospitals with bed capacity of 100 or more and occupancy rate of not lower than 80% may be utilized for hospital experience.

III.  NATIONAL COMMITTEE ON AFFILIATION AND TRAINING OF STUDENTS (NCATS)

1. COMPOSITION

Chairman              :           Director III, Health Manpower and Training Service

                                          (HMDTS)

Vice – Chairman   :           Director III/Representative, Hospital Operations and

                                          Management Service

Members              :           Representative, Internal Planning Service

                                          Representative, Dental Health Service

                                          Representative, Finance Service

                                          Representative, Bureau of Licensing and Regulation

                                          Representative, Bureau of Research and Laboratories

                                          Representative, HMDTS

                                          Representative, Jose Fabella Memorial Hospital

                                          Representative, National Center for Mental Health

Executive Secretary:         HMDTS

Secretariat                        :           HMDTS

Advisers                :           Undersecretary, Office for Hospital Facilities, Standards

                                          and Regulations

                                          Undersecretary, Office of the Chief of Staff

2. FUNCTIONS

2.1.Hold regular meetings to discuss/deliberate on issues or other

concerns relative to the training and affiliation of students.

2.2.Conduct National Consultative Workshops to review/revise/formulate

Or develop policies and standards on affiliation and training of students.

2.3.Meet annually for planning and evaluation.

2.4.Monitor each health facility within their area of coverage at least once

a year.

2.5.Conduct supervisory visits to Regional Committee on Affiliation and

Training of Students (RCATS) and Hospital Committee on Affiliation and Training of Students (HCATS) utilizing tools developed for the purpose.

2.6.Create a National Advisory Council (NAC) and conduct regular

meetings related to training and affiliation.

2.7.Conduct assessment for accreditation with the National Advisory

Council (NAC) members of government health facilities such as hospitals, laboratories, and health centers that is capable of providing the necessary resources for the student learning.

2.8.Prepare resolution recommending approval of contract of affiliation

to the Secretary of Health.

2.9.Maintain a file of contracts of affiliation, list of accredited health

Facilities, schools offering health and other health–related courses, quarterly reports, minutes of meetings and be responsible in the publication of accredited health facilities.

2.10.                 Provide technical assistance to government health facilities on

accreditation and other health related matters.

2.11.                 Keep records and reports in relation to the implementation of the

program.

3. HONORARIUM

Each committee member shall be given a rate of FIVE HUNDRED PESOS (P500) per meeting attended, while the Executive Secretary and Secretariat shall be entitled to a monthly honorarium not to exceed 50% of their monthly salary.

In the absence of any member of NCATS/RCATS/HCATS or RHUCATS, only responsible and knowledgeable designated should be allowed to attend meetings and at the same time, authorized to claim remuneration for his/her degree of participation in relation to affiliation activities. Designates shall be determined by the NCATS/RCATS/HCATS or RHUCATS members concerned.

IV.   REGIONAL COMMITTEE ON AFFILIATION AND TRAINING OF STUDENTS (RCATS)

1. COMPOSITION

Chairman              :           Chief, Health Manpower Development and Training

                                          Division (HMDTD)

Vice–Chairman     :           Training Officer, Medical Center or Regional Hospital

Executive

      Secretary         :           Regional Training Nurse, HMDTD

Members              :           Chief, Technical Division

                                          Chief, Finance or Accounting or Budget

                                          Representative from Provincial Health Office (PHO II /

                                          Designated Permanent Representative)

                                          Local Health Board Representative

                                                            (preferably one coming from the province with the

                                                            most number of accredited facilities for affiliation and

                                                            Training of students and accessible to the region)

                                                            Chief Nurse of the Medical Center or Regional Hospital

                                                            Chief, Regional Hospital Laboratory

            Approving Officer       :           Regional Health Director

            Technical Support

                        Group (TSG)    :           Members of the TSG could constitute from among the                                                      following:

                                                            2 – Nurse Instructor/Regional Training Nurse

                                                            1 – Medical Training Officer/Dental Training Officer

                                                            1 – Clerk /Computer Operator

                                                            1 – Management and Audit Analyst

                                                            1 – Supply Officer

                                                            1 – Accountant

                                                            1 – Cashier

                                                            1 – Bookkeeper

2. FUNCTIONS

2.1.RCATS

2.1.1.     Hold regular meetings to discuss/deliberate on issues or concerns relative to training and affiliation of students.

2.1.2.     Meet annually for planning and evaluation.

2.1.3.     Conduct Regional Consultative Workshops to review/revise/formulate or develop policies and standards based on A.O. No. 5–A s. 1996.

2.1.4.     Conduct regular dialogue with the Academe, Commission on Higher Education (CHED), Association of Deans and Hospitals.

2.1.5.     Conduct pre–assessment visits to health facilities prior to final accreditation.

2.1.6.     Review application for affiliation and validate if necessary.

2.1.7.     Prepare resolution recommending approval of contract of affiliation to the Regional Health Director.

2.1.8.     Maintain a file of contracts of affiliation, list of accredited health facilities, schools offering health and other health–related course, quarterly reports, minutes of meetings, and be responsible in the publication of accredited health facilities.

2.1.9.     Conduct supervisory visits to Hospital Committee on Affiliation and Training of Students (HCATS)/Rural Health Unit Committee on Affiliation and Training of Students (RHUCATS) utilizing tools developed for the purpose.

2.1.10.  Provide technical assistance to government health facilities on accreditation and other related matters.

2.1.11.  Monitor each health facility within their area of coverage at least once a year.

2.1.12.  Monitor compliance to standards on training and affiliation.

2.1.13.  Create Technical Support Group (TSG) who will provide technical and administrative assistance in the discharge of its function.

2.1.14.  Submit annual reports to NCATS using the attached Report Form.

2.2.TSG

2.2.1.     Nurse Instructor/Regional Training Nurse – assists RCATS in making reports, monitoring, processing of contracts, etc.

2.2.2.     Medical Training Officer/Dental Training Officer – assists in RCATS in training and affiliation activities involving medical and other affiliating students.

2.2.3.     Clerk/Computer Operator – processes contracts, types hand outs and prepares payroll.

2.2.4.     Management and Audit Analyst II – checks legality of supporting documents for vouchers, payroll for training and affiliation of students.

2.2.5.     Cashier – receives, deposits and disburses training and affiliation finds.

2.2.6.     Bookkeeper – keeps records of training and affiliation finds.

2.2.7.     Supply officer – facilitates purchase of materials, supplies and equipment for training and affiliation.

2.2.8.     Accountant – checks completeness and correctness of supporting documents for vouchers, payroll for training and affiliation and certifies availability of training and affiliation funds.

3. HONORARIUM

An honorarium of TWO HUNDRED PESOS (P250) will be given to all RCATS members and invited resource persons per meeting attended.

Honoraria shall be prorated to the RCATS and TSG members at the end of the year to be taken from the 2% balance allocated for the purpose in the following manner:

From the balance of 2%

      75% – RCATS

      25% – TSG

Of the 75% from RCTS

      20% – Chairperson

      20% – Executive Secretary

      20% – Approving Officer

      60% – Total

      5% – Training Officer, Medical Center or Regional Hospital

      5% – Chief, Technical

      5% – Chief, Finance/Accounting/Budget

      5% – Administrative Officer

      5% – Local Health Board (LHB) Representative

      5% – Representative from Provincial Health Office

      5% – Chief Nurse, Medical Center or Regional Hospital

      5% – Chief Regional Hospital Laboratory

      40% – Total

The 25% shall be prorated equally to the TSGH members.

Meetings will be conducted quarterly or whenever necessary and only responsible and knowledgeable designates should be allowed to attend meetings and at the same time, authorized to claim remuneration for his/her degree of participation in relation to affiliation activities. Designates shall be determined by the RCATS members concerned.

Those RCATS members receiving honorarium from other affiliation (hospital/RHU) funds shall be given an honorarium of P250 when attending RCATS meeting. A staff shall collect an honorarium only once and in the event that he qualifies to share in more than one committee, then, he shall be included in the committee where he gets a bigger share (A.O. 123 s. 1992). This shall be certified by the Chairman, RCATS.

V.     HOSPITAL COMMITTEE ON AFFILIATION AND TRAINING OF STUDENTS (HCATS)

1. COMPOSITION

Chairman              :           Chief of Hospital

Vice Chairman      :           Chief of Medical Training Officer

Members              :           Chief of Clinics (medical center/regional hospital)

                                                Trainers from each department/section accepting

                                                            Affiliates

                                                Administrative Officer

                                                Budget Officer

                                                Accountant

                                                Representative from each position group/discipline

                                                            Existing in the institution

2. FUNCTIONS

2.1.Screen and approve affiliation of applicants as per A.O. No. 5–A s. 1996 for endorsement to RCATS. The following requirements shall be

complied:

2.1.1.     Certificate to offer the course from CHED

2.1.2.     License to Operate of base hospital

2.1.3.     Proposed training program

2.1.4.     List of students and areas of rotation

2.2.Ensure compliance to:

2.2.1.     Guidelines and standards per discipline

2.2.2.     Statement on the delineation of the roles and functions of hospital staff and clinical instructors/coordinators/preceptors in relation to affiliation and training of students as specified by the concerned parties.

2.3.Set standard operating procedure in relation to affiliation and training

of students.

2.4.Devise mechanism that will ensure on time and full payment of

Affiliation fees, validity of affiliation contracts, fair and just distribution of affiliation fees.

2.5.Monitor and evaluate all aspects of the affiliation program in the

Hospital

2.5.1.     Training Program

2.5.2.     Training staff

2.5.3.     Training Procedure/Policies

2.5.4.     Training Facilities

2.6.Determine proration of affiliation fees based on the degree of

participation or involvement in the training of students.

2.7.Prepare an annual plan for training and affiliation

2.7.1.     Requisition for the purchase of equipment, supplies, materials, journal and other needed paraphernalia for affiliation and training.

2.7.2.     Ensure the availability of equipment, supplies, materials, journals, etc., by preparing an allocation and distribution plan specific for affiliation and training.

2.8.Update and maintain a list of schools/universities/colleges affiliating

In the hospital.

2.9.Submit quarterly reports to RCATS of all affiliation activities taking

Place in the hospital. The following data shall be reflected.

2.9.1.     Schools affiliating

2.9.1.1.Category and number of affiliating students

2.9.1.2.Area of rotation

2.9.1.3.Duration of training

2.9.2.     Affiliation fees

2.9.2.1.Amount collected

2.9.2.2.Amount disbursed

2.9.2.3.Amount remitted to RCATS

2.10.                 Conduct regular dialogue with the schools affiliating with the hospitals

2.11.                 Conduct/hold regular meetings to discuss/deliberate on issues and

other concerns relative to training and affiliation activities.

3. HONORARIUM

HCATS shall determine proration of honorarium depending on the degree of involvement which may be categorized as follows:

3.1.Directly involved – hospital staff who are acting as trainers to

affiliates. These are hospital staff members who exactly belong to closely allied to the profession orientation or educational preparation of the student affiliating.

3.2.Indirectly involved – hospital staff who in one way facilitate affiliation

and training in the facility.

VI.   RURAL HEALTH UNIT COMMITTEE ON AFFILIATION AND TRAINING OF STUDENTS (RHUCATS)

1. COMPOSITION

Chairperson          :           Municipality Health Officer (MHO/Rural Health

                                          Physician in areas where there is no MHO

Secretary               :           Public Health Nurse

Members              :           Public Health Dentist/Public Health Midwife

                                          Treasurer of the Local Government

Adviser                  :           Municipal Mayor

2. FUNCTIONS

2.1.Provides contract of affiliation as per A.O. No. 5–A s. 1996

2.2.Enters into a contract with the concerned affiliating party

2.3.Requires affiliating schools to submit the following requirements

Together with the accomplished contract of affiliation for

Endorsement to RCATS:

2.3.1.     Certificate to offer the course from CHED

2.3.2.     Proposed training program

2.3.3.     Schedule of affiliation

2.3.4.     List of affiliating students

2.4.Ensure compliance to:

2.4.1.     Guidelines and standards per discipline

2.4.2.     Statement on the delineation of the roles and functions of the RHU staff and the school’s Community Health Coordinators in relation to affiliation and training of students as specified by the concerned parties.

2.5.Observe standard operating procedures developed in relation to

affiliation and training of students as specified by the concerned parties.

2.6.Devise mechanism that will ensure on time and full payment of

Affiliation fees, validity of affiliation contracts, fair and just distribution of affiliation fees.

2.7.Monitor and evaluate all aspects of the affiliation program in the RHU:

2.7.1.     Training program

2.7.2.     Training staff

2.7.3.     Training procedure/policies

2.7.4.     Training facilities

2.8.Determine proration of affiliation fees based on the degree of

participation or involvement in the training of students.

2.9.Prepare an annual procurement plan for training and affiliation

2.9.1.     Requisition purchase of equipment, supplies, materials, journals, and other needed paraphernalia for affiliation and training.

2.9.2.     Distribute materials/equipment/supplies based on allocation list. The list of allocation must be properly evaluated and determined by the committee according to immediate priorities.

2.10.                 Update and maintain a list of schools/universities/colleges affiliating

in the RHU.

2.11.                 Submit quarterly reports to RCATS of all affiliation activities taking

place in the RHU. The following data shall be reflected:

2.11.1.  Schools affiliating

2.11.1.1.       Category and number of affiliating students

2.11.1.2.       Areas of rotation

2.11.1.3.       Duration of training

2.11.2.  Affiliation fees

2.11.2.1.       Amount collected

2.11.2.2.       Amount disbursed

2.11.2.3.       Amount remitted to RCATS

2.12.                 Conduct regular dialogue with the schools affiliating with the RHU.

2.13.                 Conduct/hold regular meetings to discuss/deliberate on issues and

other concerns relative to affiliation and training.

3. HONORARIUM

RHUCATS shall determine proration of honorarium depending on the degree of involvement which may be categorized as follows:

3.1.Directly involved – RHU staff who are acting as trainers to affiliates

3.2.Indirectly involved – RHU staff who in one way facilitated affiliation

and training in the facility.

VII.  APPROVAL OF CONTRACTS

1. For health facilities directly under the Central Office, DOH, the Secretary of Health or his duly authorized representative shall approve contracts based on the recommendation of the NCATS Chairman. Contract signatories shall be the following:

First Party :           Hospital Chief

Witness     :           Chief Training Officer/Training Officer of the Department

                              Concerned

Second

Party   :           President of the University or Dean of College

Witness     :           Clinical Instructor / Course Coordinator

Recommending

      Approval:        Secretary of Health/Undersecretary, Office for Hospital

                              Facilities, Standards and Regulations

2. At the regional level, the Regional Health Director shall approve contracts of affiliation with the accredited facilities in the region based on the recommendation of RCATS.

For retained DOH hospitals, contract signatories shall be the following:

First Party             :           Hospital Chief

Witness                 :           Chief Training Officer/Training Officer of the

                                          Department concerned

Second Party        :           President of the University or Dean of College

Witness                 :           Clinical Instructor/Course Coordinator

Recommending

      Approval         :           Chairman, RCATS

Approving Officer :           Regional Health Director – DIRFO

3. For Local Government Unit health facilities, contract signatories shall be the following:

3.1.District Hospital / City Hospital

First Party       :           Hospital Chief

Witness           :           Chief Training Officer of the Department/

                                    Section

Concurred       :           Governor/City Mayor

Second Party  :           President of the University or Dean of College

Witness           :           Clinical Instructor /Course Coordinator

Recommending

Approval         :           Chairman, RCATS

Approving

            Officer :           Regional Health Director – DIRFO

3.2.Rural health Unit (RHU)

First Party       :           Municipal Health Officer / Rural Health

                                    Physician

Witness           :           Public Health Nurse/Public Health Dentist

Concurred       :           Municipal Mayor

Second Party  :           President of the University or Dean of College

Witness           :           Clinical Instructor / Course Coordinator

Recommending

Approval         :           Chairman, RCATS

Approving

            Officer :           Regional Health Director – DIRFO

VIII. PROCEDURES IN APPLYING FOR AFFILIATION

1. Steps

1.1  Hospitals / RHUs shall make available copies of affiliation contracts to schools, colleges and universities.

1.2  All contracts of affiliation shall be duly accomplished and signed by both parties (Chief of Hospital /MHO or RHP and President of the University/College Dean)

1.3  For newly established schools, colleges and universities with Medical, Nursing and Midwifery courses, their course curriculum should pass through the Innovative Health Sciences Education Partnership (IHSEP) Program prior to recommendation for approval by NCATS/RCATS to the Secretary of Health or his duly representative. In the absence of the Regional IHSEP Coordinator, course curriculum may be submitted to the Innovative Health Sciences Education Partnership Council at the national level through NCATS for review.

1.4  All duly accomplished affiliation contracts for hospital under the Department of Health shall be forwarded to the NCATS for evaluation prior to recommendation for approval to the Secretary of Health or his duly authorized representative.

1.5  For Hospitals/RHUs in the region, all duly accomplished contracts shall be submitted to the RCATS for evaluation prior to the recommendation by the Chairman for approval by the Regional Health Director or his duly authorized representative

1.6  Application for affiliation shall be filed two (2) months before the start of the actual affiliation.

1.7  Affiliation contracts shall be renewed yearly for the first two (2) years and every two (2) years subsequently.

1.8  For inter–regional affiliation, affiliating institution should submit a Certificate of Approval for Cross Regional Affiliation from the RCATS of the home region to the RCATS where they intend to affiliate.

2.     Validity of the Contract:

2.1  New contract – every year for the first two (2) years and every two (2) years thereafter

2.2  Old contract – every two (2) years

3.     Cross–regional affiliation shall be approved by local RCATS if learning areas of affiliation are not available or cannot be accommodated in the home region.

IX.   PROCEDURES IN APPLYING FOR ACCREDITATION

1. The hospital submits a letter of intent to be accredited for affiliation and training to RCATS if at the regional level and/or to NCATS if at Metro Manila level.

2. NCATS/RCATS will send an Application Form.

3. The applicant will return the accomplished application form to NCATS/RCATS.

4. NCATS/RCATS conducts pre–assessment.

5. Applicants which do not show evidence of fulfilling the minimum requirements for accreditation will be notified.

6. Applicants which show evidence of fulfilling the minimum requirements will be visited by an Assessment Team composed of members of the NCATS, RCATS and the National Advisory Council.

7. The Assessment Team will meet, deliberate, evaluate and make recommendation to the NCATS.

8. RCATS issues Certificate of Accreditation to the health facility after NCATS returns documents with concurrence of approval.

9. For Metro Manila based facilities/or hospital facilities directly under the Department of Health, NCATS issues Certificate of Accreditation

X.    PROCEDURES IN ACCREDITING HEALTH FACILITIES FOR AFFILIATION

Please refer to

Form No. 5–A, Appendix 9 for Metro Manila

        Form No. 5–B, Appendix 10 for Regional level

XI.   AFFILIATION FEES

1. Standard Affiliation Fees Rates shall conform to the rates stipulated under A.O. No. 5–A s. 1996.

2. Affiliation fees for IHSEP Program participants shall be referred to the mother contract of partnership with DOH. Non–stipulation of agreements on the affiliation fee shall mean payment of the standard fees based on A.O. No. 5–A s. 1996.

3. In accordance with Executive Order No. 338 dated 17 May 1996 affiliation fees collected by health facilities under the Department of Health or the National Government shall be remitted to the National Treasury and will be disbursed as stipulated therein.

4. For hospitals/facilities under the LGU, affiliation fees shall be treated as trust receipts in the books of collecting agencies, deposited in an authorized government depository bank. At the RHU level, affiliation fees shall be remitted to the Municipal Treasurer and treated as a Trust Fund to be utilized in accordance with A.O. No. 5–A s. 1996, section 10.

5. HCATS/RHUCATS shall remit semi–annually 5% of their collection from the affiliation fees in the name of RCATS.

5.1.The 5% shall be utilized in accordance with Section 10.2.1., A.O. No. 5

–A s. 1996

6. Forty percent (40%) of the affiliation fee shall be utilized for the following purpose:

6.1.Attendance of HCATS/RHUCATS members to human resource

Development activities related to affiliation and training.

6.2.Procurement of supplies and equipment needed to upgrade training

and affiliation of students.

6.3.Research related to affiliation and training.

7. Fifty five percent (55%) intended for honoraria or incentives to personnel shall be prorated as follows:

7.1.60% - trainers/coordinators/preceptors directly involved

7.2.40% - hospital/RHU staff indirectly involved

In order to come up with a fair distribution of the 60% honoraria/incentive for personnel in the training service/department concerned or RHU, the HCATS/RHUCATS shall prepare a list of personnel with direct involvement and the corresponding activities in relation to training and affiliation of a specific category of students to be contained in the Hospital Order. This Order shall be updated as the need arises. This also applies to RHUCATS.

The HCATS/RHUCATS shall determine proration of the remaining 40% intended for the honoraria of indirectly involved personnel.

8. All disbursements of affiliation fees shall pass through the Training Office which shall identify items for purchase and procurement, bad on the training and affiliation needs of the students. A regular quarterly affiliation financial report shall be prepared by the Finance Office to be submitted to the training office copy furnished NCATS/RCATS.

9.  Flow of remittance shall be:

9.1.Facilities directly under the Office of the Secretary of Health Affiliating

School ---> Health Facility -----> NCATS

9.2.Retained DOH Facilities

Affiliating School ---> Retained DOH Facility ---> RCATS/NCATS

9.3.Local Government Unit (LGU) Health Facilities Affiliating School --->

LGU Health Facility ----> LGU Treasurer ----> RCATS/NCATS

XII. SANCTION

All health facilities accredited by the NCATS/RCATS/NAC are hereby enjoined to comply with the provisions embodied in A.O. No. 5–A s. 1996 and its Implementing Rules and Regulations. Any violation herewith will mean revocation of accreditation of health facility to accept affiliation and training of students.

Prior to the formal revocation, the NCATS/RCATS/NAC shall issue a written notice stating valid reasons of such decision made. A thirty (30) days grace period after the effectivity of notice shall be granted to those facilities which choose to re–appeal their case or when the cause for withdrawal is proven to have corrected.

XIII. REPEALING CLAUSE

All department orders and issuance inconsistent therewith are hereby repealed or modified accordingly

XIV.  EFFECTIVITY

These Rules and Regulations shall be effective upon its approval, subject to review or revision by the National Committee on Affiliation and Training Students and the National Advisory Council.

CARMENCITA N. REODICA, MD, MPH, CESO II

Secretary of Health