The Philippine COVID-19 Living Clinical Practice Guidelines (CPG) is a set of guidelines that provides up-to-date evidence-based recommendations on COVID-19 treatment, diagnosis, infection prevention and control. This living guideline follows the Department of Health’s Manual for Clinical Practice Guideline Development1 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach.2 The diagram below is a summary of the treatment regimens gathered from the Philippine COVID-19 Living Recommendations website. The recommendation for each drug regimen is based on the assessment and literature review done by the Living CPG Task Force (LCTF).3 The LCTF follows the classification of quality of evidence enumerated and described in Box 1.
COVID-19

In the Philippines, the coronavirus disease 2019 (COVID-19) pandemic has accorded a tremendous challenge to health care in terms of protecting frontline staff from contracting the virus and providing optimal medical management to patients with or without COVID-19. Across the globe, even countries with well-developed healthcare systems are battling COVID-19 with great difficulty. In terms of local response, on March 15, 2020, Davao City was placed under community quarantine1 to limit the movement of people and curb the spread of SARS-CoV-2, the virus that causes COVID-19. Further restrictions on work, businesses, transportation, and other daily activities were imposed during an enhanced community quarantine (ECQ) from April 4, 2020 to May 15, 2020,2 3 4 5 followed by a 15-day general community quarantine (GCQ).6 7 Patients from Davao City who are suspected of having COVID-19 began to be referred to the Southern Philippines Medical Center (SPMC) starting in early March 2020. The SPMC Laboratory Unit also started processing reverse transcription polymerase chain reaction (RT-PCR) tests for the diagnosis of COVID-19 as a subnational laboratory late in March. Being the only subnational laboratory in the southern Philippines during the first few weeks of community quarantine, SPMC processed most of Mindanao's COVID-19 RT-PCR tests.
COVID-19

When communities were forced into lockdown due to the COVID-19 pandemic, governments across different countries globally also started to impose new social restrictions. In order to comply with these new rules and to meet the demands of an emerging disease, health facilities modified the structures and processes of health care services. 1 Teleconsultations—or medical consultations wherein patients and health care practitioners are away from each other, connected only by telecommunication devices —took the place of the traditional face-toface (FTF) consultations, especially in the outpatient clinics. The provision of remote clinical services or telemedicine—which frequently involves teleconsultations—has been practiced since the early 1960’s, 2 but its utilization has grown exponentially ever since this pandemic started. 3-5 A few studies have demonstrated a significant reduction, from to 60 to 80%, in in-person outpatient visits and a four-fold increase in telehealth outpatient visits in the United States during the early days of the pandemic. 6 7 Similarly, across Asia-Pacific countries, there has been a surge of activity in telemedicine platforms since the identification of the COVID-19 virus in January 2020. 8 In the Philippines, for example, a subscription-based teleconsultation service called KonsultaMD registered a 450% increase in the number of teleconsultations in April 2020. 9 Medgate, one of the country’s leading international telemedicine providers, reported a 170% increase in teleconsultations in 2020. 10 11 The aim of this article is to recommend policies for the delivery and reporting of outpatient care using telemedicine in a tertiary hospital.
Remote Consultation ; COVID-19

Retinoblastoma (RB), the most common intraocular malignancy in infants and young children,1 2 may lead to the loss of one or two eyes, central nervous system involvement, or even death, if treatment is delayed.3 However, if RB is diagnosed and treated early, patients with the malignancy have a survival rate of almost 100%.4 Delay in diagnosis of RB affects treatment outcomes and prognosis of patients with the disease. With the significant number of RB referrals that result in delays in receiving specialized care in low- and middle-income countries (LMICs)5—where most cases occur—global disparities in the outcomes of RB are evident, such that children with RB in LMICs often have poor prognosis.6 Difficulty of caregivers and primary health care providers in recognizing the earliest presenting signs of RB also contributes to the delay and can increase the risk of local tumor invasion.7 At present, the Department of Health (DOH) has included in its Philippine Cancer Control Program the Cancer in Children Awareness Month, as one of its health advocacies aimed to increase the public’s knowledge and understanding of childhood cancer.8 In September 2021, the first ever DOH-WHO Cancer Control Stakeholders Virtual Summit was held, with special focus given on childhood cancer.9 The DOH program has given emphasis on eight childhood cancers, including RB, that are common in Filipino children.10 In 2011, the Southern Philippines Medical Center (SPMC) and the National University Hospital in Singapore, in collaboration with the Dana Farber Children’s Hospital Cancer Center in Boston and St. Jude Children’s Research Hospital in Memphis, joined together to establish the RB Early Detection Campaign Program. This collaborative project started to educate the public on the early signs of RB, established a referral system across Davao City and other regions in Mindanao (Tagum City, General Santos City, Zamboanga City, and Cagayan de Oro City), and developed a multidisciplinary RB management team at SPMC.11 With the opening of a dedicated RB center at SPMC in 2012 as part of the program, the hospital’s RB census increased, and the majority of the cases detected were still at the early (intraocular) stage.12 However, despite the stringent implementation of the program in SPMC, the time interval between onset of symptoms and initiation of therapy among patients with RB has remained protracted.13 The aim of this article is to recommend health care policies based on the results of a study on the clinical profile and health care timeline of patients seen in a tertiary hospital in Davao City.
Retinoblastoma

Congenital disorders cause a global estimate of 240,000 deaths in newborns and 170,000 deaths in children ages 1 month up to 5 years every year. 1 In order to detect metabolic, hematologic, or endocrine disorders in newborns, newborn screening (NBS) is conducted in many countries around the world. In the Philippines, NBS was introduced by the Newborn Screening Study Group in 1996, with the aim of establishing the incidence of six metabolic conditions, namely, congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, homocystinuria, and glucose-6-phosphate dehydrogenase deficiency, and creating recommendations for the adoption of NBS nationwide.2 The Republic Act No. 9288, otherwise known as the Newborn Screening Act of 2004, requires that the Department of Health shall ensure the establishment and accreditation of newborn screening centers (NSCs) in strategically located areas across the Philippines.3 At present, there are seven operational NSCs in the country,4 with the Newborn Screening Center-Mindanao (NSC-Mindanao) in Southern Philippines Medical Center (SPMC) as the only center catering to all NBS facilities all over Mindanao.5 NSC-Mindanao initially performed screening tests for five disorders, but now tests for a panel of 29 metabolic and other congenital disorders.
Neonatal Screening ; Adrenal Hyperplasia, Congenital ; Glucosephosphate Dehydrogenase Deficiency ; Congenital Hypothyroidism

Accessing health care services can lead to a significant financial burden on patients, especially when an episode of illness necessitates out-of-pocket (OOP) expenditures.1 Apart from health improvement, an essential function of health care systems is to provide financial protection for individuals against the costs associated with illness.2 The establishment of the Philippine Health Insurance Corporation (PhilHealth) has emerged as a crucial step towards achieving the goal of universal health care for individuals in need of medical services.3 Since the passage of the Universal Health Care Act in 2019, all Filipinos have been automatically enrolled in PhilHealth for social health risk protection. In 2021, PhilHealth covered health care utilization claims amounting to over Php 88 billion.4 PhilHealth coverage is usually not sufficient to fund the entire hospital expense in a single episode of illness. Meanwhile, the creation of other government health care financing schemes helps alleviate the financial burden of patients. Through the enactment of the Republic Act (RA) 11463, also known as the Malasakit Centers Act, patients may now seek financial aid from a unified assistance hub to settle outstanding health care expenses not covered by PhilHealth. The Malasakit Centers Act mandates the establishment of one-stop shops for medical and financial assistance. This one-stop shop consists of representatives from the Department of Health (DOH), PhilHealth, the Philippine Charity Sweepstakes Office (PCSO), and Department of Social Welfare and Development (DSWD).5 This article aims to recommend health care policies to improve the existing health financing mechanisms currently sought by patients to cover their medical expenses during an episode of illness.
Financial Stress ; Universal Health Care ; Health Expenditures