Human ; Infant, Newborn ; Mass Screening ; Neonatal Screening ; Censuses

Out-of-hospital Cardiac Arrest ; Heart Arrest ; Policy ; Covid-19 ; Pandemics

Client feedback is an integral part of the health care system’s quality and effectiveness. In health care operations, it is paramount as it serves as a vital tool for continuous improvement, ensuring patient-centric care delivery, and fostering trust and accountability within the health care system. Client feedback helps shape up new and existing policies and is, therefore, highly valued, considered, and acted upon. In health care institutions such as the Southern Philippines Medical Center (SPMC), incorporating client feedback into policy-making enhances health care operations and aligns services with patient needs and institutional goals. In SPMC, the Hospital Client Experience Survey is the primary feedback mechanism by which clients, both internal and external, can voice their opinions, concerns, and suggestions regarding its personnel, processes, and structure. Through directives from the Anti-Red Tape Authority (ARTA)1 and the Department of Health (DOH),2 SPMC uses the Hospital Client Experience Survey Tool (HCES) to enhance service delivery. Public Assistance and Complaints Desk (PACD) Officers conduct monthly surveys across 200 hospital areas. Each area expects 5 to 30 responses, based on a calculation by the HCES Online Report Generator (ORG). PACD officers actively engage staff within their designated areas, encouraging their participation in survey distribution per transaction and motivating clients to provide feedback during specified survey days. Highlighting the significance of these surveys, PACD Officers emphasize the invaluable insights gained from diverse client responses, which ultimately shape and validate the impact of service delivery initiatives within the hospital. At the end of each quarter, PACD officers analyze data using the HCES-ORG, collate comments and commendations, verify the accuracy of HCES results, and then post them for viewing by the different departments within the institution. Exceptional staff commendations are documented in the quarterly HCES results publication, prominently displayed within the hospital. These commendations contribute to individual performance evaluations. If a staff member receives negative feedback on the HCES form, their unit manager receives a photocopy of the form and may implement disciplinary action or enroll the staff in customer service seminars hosted by the Professional Education and Training Department (PETD). Consistent negative feedback over three consecutive months may trigger appropriate improvement plans or corrective actions among individual staff or even entire departments. The infographic displays the reports from the HCES for the first to the fourth quarters of 2023. Clients’ feedback comprises three domains: personnel, processes, and structures. Personnel covers attitude and character, processes involve system and organization, and structures include facilities and equipment. The feedback includes both positive and negative comments, with recommendations also identified. The HCES consists of statements rated on a scale from 1 (strongly disagree) to 5 (strongly agree). For this infographic, we computed the mean satisfaction scores for each domain and the proportion of clients who reported satisfaction with the service and timeliness of service they received. To summarize the recommendations from the HCES, we utilized the artificial intelligence (AI) chatbot-powered search engine Perplexity AI. We uploaded the recommendations in spreadsheet format and prompted Perplexity AI to "Summarize, in bullets, the recommendations into three categories: personnel, process, and structure," and then to "Count the times each of those summarized comments were mentioned in the file." We used the response of Perplexity AI to illustrate the results as a word cloud, with the sizes of the words in the cloud proportional to the frequency of mentions. In the HCES, the most frequently mentioned suggestion was to provide additional staff. Other suggestions included maintaining clean and functional restrooms, and improving overall cleanliness and sanitation. Infrastructure-related suggestions focused on better ventilation, air conditioning or fans, expanding wards and watchers’ areas, adding more hospital beds and chairs, ensuring a consistent water supply, and providing necessary diagnostic and therapeutic equipment and medicines. Process-related recommendations focused on reducing service delivery turnaround time, prioritizing senior citizens, PWD, and pregnant patients, improving billing and laboratory services, optimizing operation scheduling, and enhancing staff communication and coordination between and among offices. Personnel-related suggestions included improving staff interaction with patients, providing staff training, ensuring staff safety, and performing diligent patient checks. Client feedback helps SPMC retain positive responses, optimize health care delivery, and serve clients better through ongoing renovations, reorganizations, and transformations, affirming its vision of quality service.
Feedback ; Patient-Centered Care

A burn mass casualty incident (BMCI), an incident that involves at least three burn victims with severe injuries,1 presents several unique challenges. In a mass casualty event, between 25 and 30 percent of those injured can sustain moderate-to-severe burn injuries.2 Management of burn patients necessitates a significant amount of health resources and logistical support, along with prompt and high-quality care to optimize the functional and cosmetic outcomes of severely injured patients. While some developed countries have sound disaster management plans, many countries where most BMCIs occur lack such well-established plans.3 The effective management of BMCIs is crucial for positive patient outcomes. Given resource scarcity, especially in geographically isolated and disadvantaged areas, comprehensive mitigation and preparedness strategies are essential. These strategies must address worst-case scenarios that may challenge the existing internal protocols, especially at the local level.4 The surge in health care facility capacity during BMCIs can quickly overwhelm local and regional resources, from prehospital care to specialized burn centers. In the Philippines, disaster response levels and adequacy may vary widely among different regions and local government units (LGU). While the Department of Health has issued guidelines for health emergency and disaster response management,5 there are currently no policies or guides on specifically addressing preincident planning for BMCIs. The aim of this article is to recommend policies that will potentially improve the current health care approach to BMCIs.
Mass Casualty Incidents ; Burns

Medical assistance programs are government-funded programs that provide financial assistance to low-income individuals and families. These programs aim to reduce financial burdens and improve health care access. Coverage may include outpatient visits, hospital care, mental health services, diagnostic work-ups, prescriptions, and other services. This increases the detection of health conditions and improves drug utilization.1 2 3 Even though government health schemes and compulsory contributory health care financing schemes (e.g., PhilHealth) accounted for the majority of health expenditures in the Philippines, household out-of-pocket (OOP) payment still remains high. In 2022, the country’s total health expenditure (THE) was Php 1.12 trillion, with government health schemes and compulsory contributory health care financing schemes accounting for 44.8% of the THE and household OOP payment accounting for 44.7%. Thus, every Filipino spent an average amount of Php 10,059.49 for health care goods and services in 2022
Medical Assistance ; Health Services Accessibility ; Mental Health Services

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

In accordance with the Republic Act (RA) 11036, also known as the Mental Health Act of 2017, the Department of Health (DOH) was tasked to "establish a balanced system of community-based and hospital-based mental health services at all levels of the public health care system from the barangay, municipal, city, provincial, regional to the national level." It is also expected that the Local Government Units (LGUs) "promote deinstitutionalization and other recovery-based approaches to the delivery of mental health care services."1 Even before RA 11036 was enacted, the Davao Center for Health Development (DCHD) had already facilitated the establishment of several Community-Based Mental Health Programs (CBMHPs) in rural health units (RHUs) within the region since 2015. These programs are guided by six principles–coordinated level of referral system for better patient care, optimizing the expertise of the regional mental hub to guarantee rational use of drugs, community-based patient care for a more cost-effective treatment, capitalizing family and patient's support groups for better patient outcomes, optimizing innovative long-acting injections for better compliance and decreased relapse, and neutralizing the stigma against schizophrenia to improve mental health.2 The aim of this article is to recommend health care policies based on the report on observations and lessons learned from the implementation of the CBMHPs by the DCHD in four municipalities in Davao Region.
Community Health Services ; Mental Health Services

Before the COVID-19 pandemic, almost all outpatient consultation services in Southern Philippines Medical Center (SPMC)一from triaging up to the actual consultations with doctors一were done face-to-face (FTF). Seeking medical care during the pandemic became more difficult. Since the start of the community quarantine last March 2020,1 all stakeholders in health care一health care workers, and patients alike一have had to comply with infection control measures like FTF interactions and travel restrictions to reduce COVID-19 transmission. When Davao City was placed under enhanced community quarantine (ECQ) last April 4, 20202, SPMC became the primary government tertiary care institution tasked to handle patients with COVID-19.3 Since then, most of the outpatient services, conducted by clinical departments, were limited to teleconsultations. SPMC created a set of procedures for doing teleconsultations in the Outpatient Department (OPD) to screen patients who need either urgent or routine care, and to either connect these patients to their physicians in the OPD or direct them to an SPMC department/unit outside of the OPD. A patient seeking outpatient consultation should send a private message via the SPMC Virtual Consultation Facebook page. A nurse moderator inquires about the patient’s concern or chief complaint through an online messaging platform and obtains a written informed consent by requesting the patient to reply with “Yes, I give consent” if, after reading the information form, they agree to the terms of the teleconsultation. New patients need to fill up a pre-formatted information sheet and download an app into their communication device. Returning patients are required to send their hospital numbers for record retrieval. The nurse then triages the patient to their designated clinical department. Through phone or online calls via the downloaded app, the resident-on-duty (ROD) contacts the patient, takes the patient’s medical history, requests diagnostic examinations, prescribes medications, and discusses diagnostic examination results and therapeutic plans with the patient, as appropriate. If the need for a physical examination in order to further assess the patient’s condition arises, the ROD obtains another informed consent for an FTF consultation. Before scheduling the patient for an FTF consultation, the ROD determines the patient’s risk of exposure to COVID-19 and directs them to the COVID-19 hotline if their risk is considered to be high. Low-risk patients, on the other hand, are given an appointment schedule and a checklist of requirements needed prior to FTF consultation. On the scheduled date of FTF consultation, the patient is reassessed for the risk of exposure to COVID-19. High-risk patients are redirected to the SPMC COVID-19 isolation area. All patients who physically walk in for outpatient consultation receive instructions from the outpatient triage nurses to follow this teleconsultation process. This report includes data from June 2020 to March 2021. Although the system for teleconsultation was immediately established in SPMC after the city was placed under ECQ,1 the procedures were only refined and strictly implemented in June 2020. Data in this report does not include appointments or consultations directly done in other departments such as SPMC Cancer Institute, Mindanao Heart Center, and Institute of Psychiatry and Behavioral Medicine. With the exception of some patients seen by the Family Medicine (FM) department, all patients who had FTF consultations in this report initially underwent the teleconsultation process, but were subsequently advised to show up for physical examination for further assessment of their conditions. The FM department sees both patients from the general public and those who come to the Personnel Health Services (PHS) of SPMC一including SPMC employees and their dependents. PHS patients, especially those who are already physically within the hospital vicinity when they decide to look for medical attention, have been allowed to seek outpatient care directly by FTF consultations, without the need for prior appointments arranged by teleconsultations. In this report, the FM census is presented as two graphs一the graph for the general public, and that for PHS patients. In general, there was a gradual increase in the frequency of teleconsultations across all departments over the months following June 2020. During the start of 2021, the frequencies of FTF consultations significantly rose in the Internal Medicine and Obstetrics-Gynecology departments. The FTF consultation frequencies also increased, albeit to a lesser degree, in the Dermatology, Ophthalmology, General Surgery, Urology, and ENT-HNS departments. The Orthopedics and Pediatrics departments had very minimal FTF consultations. The Dental Medicine department had no FTF consultations at all from June 2020 to March 2021. We calculated the OPD consultation ratio by dividing the number of FTF consultations with the number of teleconsultations. A higher ratio, expressed in decimals, would imply a higher number of FTF consultations done after teleconsultation. Excluding PHS data, the overall OPD consultation ratio for all departments from June 2020 to March 2021 was 0.17 (i.e., there were 2,557 FTF consultations done after 15,264 initial teleconsultations). The three departments who had the highest OPD consultation ratios for the entire report duration were the Urology (0.38), Internal Medicine (0.34), and Obstetrics and Gynecology (0.25) departments. On the other hand, the three departments with the lowest OPD consultation ratios for the entire report duration were the Orthopedics (0.01), Pediatrics (0.01), and General Surgery (0.10) departments. Data on specific morbidities/diagnoses and dispositions of patients after the teleconsultations or the FTF consultations are not included in this report.

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

The Republic Act No. 11494, also known as the "Bayanihan to Recover as One Act," mandates the allocation of funds and provides guidance for the procurement of COVID-19 vaccines.1 However, with the limited availability of COVID-19 vaccines, the Department of Health (DOH) established different policies and guidelines for the selection, access, and deployment of these vaccines throughout the country.2 3 4 5 To date, the Philippine Food and Drugs Authority (FDA) has granted emergency use authorizations for eight COVID-19 vaccines, namely: Pfizer-BioNTech COVID-19 Vaccine, COVID-19 Vaccine AstraZeneca, CoronaVac, Sputnik V, Janssen COVID-19 Vaccine, Covaxin, COVID-19 Vaccine Moderna, and COVID-19 Vaccine BIBP/Sinopharm.6 One of the guidelines established by the DOH is the implementation of a prioritization scheme, wherein citizens are categorized into different prioritization groups based on risk of exposure to the virus and risk of mortality from COVID-19.4 In Davao City, the COVID-19 vaccination roll out started last 5 March 2021 among health care workers at Southern Philippines Medical Center. 7 Aiming to vaccinate 1,200,000 individuals in Davao City,8 the City Government of Davao, DOH Davao Region, and other participating sectors established 59 vaccination sites throughout the city.9 We gathered online data posted in the official facebook pages of DOH Davao Region and the City Government of Davao. According to the DOH Davao Region reports, as of 27 July 2021, a total of 742,710 doses of COVID-19 vaccines were allotted for Davao City. From the total allotted doses, the City Government of Davao City has successfully administered a total of 330,954 first doses, and 149,122 second doses of COVID-19 vaccines.10 According to the City Government of Davao, as of 25 July 2021, Davao City has administered a total of 85,260 doses (1st dose - 47,332 doses, 2nd dose - 37,928 doses) of COVID-19 vaccine among individuals in the A1 prioritization group, 103,837 doses (1st dose - 76,472 doses, 2nd dose - 27,365 doses) among those in the A2 prioritization group, 179,479 (1st dose - 101,833 doses, 2nd dose - 77,646 doses) among those in the A3 prioritization group, 98,502 doses (1st dose - 97,446 doses, 2nd dose - 1,056 doses) among those in the A4 prioritization group, and 12,998 doses (1st dose - 7,871 doses, 2nd dose - 5,127 doses) among those in the A5 prioritization group.11 All in all, as of 27 July 2021, 149,122 individuals out of Davao City's target of 1,200,000 individuals (12.43%) have received complete COVID-19 vaccination. In addition, 181,832 individuals have already received the first dose of a two-dose COVID-19 vaccine.8
COVID-19