Philippines Toolkit: Self Reliance
Digitalization and PhilHealth Accreditation for Family Planning
PhilHealth Accreditation is the process through which the Philippine Health Insurance Corporation (PhilHealth) acknowledges Health Care Providers, both facilities and individuals, as qualified to deliver health consultations and procedures, thereby offering services to the general population.
The Philippine National Health Insurance Program (PhilHealth) is designed to provide universal health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines. Administered by the government corporation of the same name, PhilHealth aims to offer universal health insurance coverage for the entire Filipino population. It covers the costs of specific health services for health beneficiaries through designated health service packages.
To ensure sustainable health financing on the provider side, PhilHealth reimburses service providers who have undergone the appropriate accreditation and have delivered services covered under specific packages.
For Family Planning (FP) services, PhilHealth offers three distinct packages:
- Konsulta package accreditation is tailored for Public Health Centers/Clinics;
- Free-standing FP Package is available for Private FP Clinics, and,
- Maternal Care Package is designated for lying-in clinics and hospitals.
In addition to facility accreditation, each establishment must ensure that at least one healthcare provider is accredited with PhilHealth and holds a training certification for the specific FP package. This ensures that the facility is eligible to receive reimbursement for services rendered.
What are the benefits of PhilHealth Accreditation?
- Reimbursement Opportunities: Accredited health facilities can claim reimbursements from PhilHealth for each FP intervention or procedure conducted.
- Additional Income Generation: Reimbursements serve as an additional source of income for local health facilities. This extra revenue can be utilized to enhance health service delivery and infrastructure.
- Financial Protection: PhilHealth accreditation offers financial protection for FP services provided to PhilHealth members. This ensures that individuals can access necessary FP services without facing financial burdens.
PhilHealth Accreditation as a High-Impact Intervention (HII) for Universal Health Care (UHC)
The PhilHealth Accreditation HII approach aims to enhance the self-reliance of health services by integrating PhilHealth as a potential funding source to reimburse FP services provided by the Service Delivery Network (SDN).
To ensure sustainable FP supply and reimbursement, the system must include:
- Health Services: Fully-equipped and adequately staffed Service Delivery Points (SDPs) i.e., clinics, health centers, hospitals with Department of Health (DOH) License to Operate (LTO), PhilHealth Institutional Partner accreditation, and accreditation in either the Konsulta, Free-standing FP, or Maternal Care Package (MCP).
- Human Resources for Health: Each facility must have at least 1-2 trained service providers with PhilHealth professional accreditation and certification in their respective Family Planning Competency-Based Training (FPCBT) program.
- Health Information System: All SDPs must be connected to an Electronic Medical Record (EMR) system accredited with PhilHealth to ensure accurate documentation and reporting.
- Health Governance: The Local Government Unit (LGU) City Health Office must establish a robust system for accounting services provided, managing medical records, tracking PhilHealth reimbursement, and monitoring FP inventory and stock-out situations.
How to implement
Step 1: Orient the LGU and develop a strategy for PhilHealth Accreditation
- Gather and orient key stakeholders: Bring together policy stakeholders, service providers, technical experts, and beneficiaries to orient them on PhilHealth accreditation. This orientation typically includes representatives from:
- PhilHealth Local Health Insurance Office (LHIO)
- DOH-Center for Health Development (CHD)
- City Mayor (as overseer and co-signatory for MOU and LGU bank account)
- City Councilor for Health (to facilitate the passage of policies, MOU, legislation)
- City Health Officer
- City Treasurer (facilitate SHF)
- CHO focal in-charge of Health Management Information system
- CHO focal for Health operations, Human resources
- Representatives from hospitals (LGU, DOH-retained, Private)
- Representatives from private FP clinics
- EMR partner (if external)
- Develop an Action Plan: Lay out an action plan to address systems-level requirements. This includes:
- Development of Electronic Medical Records (EMR)
- Establishment of a Primary Care Providers Network
- Creation of a Special Health Fund
- Implementation of a monitoring system
Ensure the action plan covers aspects such as professional accreditations, facility accreditation, creation of an LGU account, and mechanisms for networking with referral hospitals and private facilities.
PhilHealth Systemic Requirements
1. Set up the Primary Care Provider Network (PCPN)
The PCPN is a group of healthcare providers tasked with delivering Konsulta-covered services, including FP. These providers can fall into various categories: purely public, purely private, mixed public-led, or mixed private-led. However, this document focuses specifically on establishing a purely public (LGU-led) PCPN. Other PCPN types can be further referred to the Implementation Guidelines for PCPN.
In a public-led system, the LGU, represented by its City Health Office, serves as the overseer of the network. Ideally, all LGU-owned health facilities, such as Barangay Health Stations, Health Centers, Rural Health Units, Infirmaries, Lying-in Clinics, and LGU-owned hospitals, are included in the network.
In forming a PCPN, the following actions shall be undertaken:
Establish the entire network as a Legal Entity through the enactment of an Ordinance.
- Develop a manual or policy outlining the organizational structure of the PCPN, including the composition of the Technical Working Group (TWG) or City Leadership Team (CLT), and delineate the responsibilities of each unit.
Conduct a mapping exercise of all SDPs to identify the level of FP coverage they can offer.
- For facilities unable to provide certain commodities, determine their nearest referral point for seamless access to services.
Develop a manual of operations encompassing the following areas:
- Administrative/Management
- Organizational chart detailing composition of PCPN
- Protocols for resource inventory, acquisition, and distribution
- Human Resources
- Directory of providers detailing geographic catchment, services provided, Philhealth accreditation licenses
- Protocol for patient navigation and referral from primary care facilities to secondary and tertiary or apex facilities
- Policy (MOA/MOU/MOI) among facilities to facilitate the referral process
- Internal Monitoring Mechanism via Electronic Medical Records (EMR) partners
- Mechanism to monitor individual provider performance
- Patient Medical Records secured with appropriate privacy protocols and EMR security features, with accompanying patient consent
- Monitoring mechanism for referral system including first patient encounter, list of patients provided with services, referral practice
- Patient satisfaction survey
- Inventory of supplies and medicines
- Able to generate forms for claims reimbursement
Tip: PhilHealth mandates the use of a fully-digital EMR for PCPNs. Ensure that all facilities have the necessary hardware (at least one computer for patient records and additional units for patient entry) and software (operating system, supported browsers). LGUs can consider partnering with PhilHealth-accredited third-party EMR providers. While this may entail initial operational and partnership costs, these providers offer hardware and software compatible with PhilHealth standards and typically have direct liaison with PhilHealth for efficient troubleshooting and third-party monitoring. Third-party EMRs also reduce the need for LGUs to hire additional technical IT staff or develop new EMRs from scratch.
Refer to Annex A for a detailed list of documents outlining the PCPN Contracting Standard.
2. Create the Special Health Fund (SHF)
The responsibility for creating and disbursing the SHF lies with the Local Health Board (LHB). Management of the fund entails the following key roles:
- City Mayor: Primary executor responsible for overseeing fund management and execution.
- City Treasurer: Ensures compliance with budgetary requirements and manages financial transactions related to the SHF.
- City Health Officer: Oversees the budget plan through the Local Investment Plan for Health (LIPH) and ensures alignment with health priorities.
- Other LHB members: Assist in fund management, execution of utilization, and auditing processes.
The budgeting framework for the SHF involves several stages: fund creation, planning and preparation, authorization, execution, and accounting. These stages are detailed further in the table below:
| Planning-Budgeting Framework | Specific Activities | Timeline |
| a. Establishment of SHF | Call for City-wide Health System (CWHS) to open SHF depository bank account with authorized government depository banks. | |
| CHB to issue a resolution on opening the SHF account. | ||
| City accountant to create a separate book of accounts for SHF. | ||
| b. Planning for SHF | CHB through CHO shall facilitate the formulation of AOP of CWHS which shall serve a basis for the planning of the SHF. | Q4, 2 years prior to the budget year covered by AOP |
| Copies of AOP shall be furnished to DOH and PhilHealth. | Q3 of the year preceding the budget year covered by AOP | |
| c. Budget Preparations | CHB to convene and prepare estimates of income from PHIC payments Specific training modules/workshops are available that can capacitate service providers, equip them with the proper knowledge and boost their confidence.
For Healthcare Workers:
For CHVs and non-health workers:
Peer educator’s training – for peer educators and navigators indicative amounts from DOH among others, that will form part of the SHF and expenditure items that will be sourced from the SHF. This shall include the percentage of the SHF that shall be retained at the city level and those that shall be downloaded to the component LGUs |
Q3 of preceding year
|
| Transfer of funds to CWHS upon signing of TOP with DOH and PHIC contract | Q1 of current year | |
| d. Budget Authorization | CHB to issue resolutions to authorize and approve SHF budget and utilization of funds. The CHB shall furnish the DOH & PHIC copies of approved SHF budget. | Q1 of current year |
| e. Budget Execution | Copy of approved Board Resolution be furnished to City Budget Officer, Treasurer, and Accountant as basis for certification of availability of funds, disbursement and for recording purposes. | Q1 of current year |
| Copy of certification of availability of funds for the SHF from the City Accountant. | Q1 of current year | |
| Copy of approved Board Resolution be furnished to component LGUs, hospitals and/or LEE for recording purposes. | Q1 of current year | |
| f. Budget Accountability | Submission of required quarterly and annual reports using the SHF budget accountability form No. 1 and 2 on SHF utilization (Annex C and D) and other prescribed forms to DOH and PHIC, copy furnished the component LGU, CHO and hospitals. | Quarterly reports (not later than 20th day after the end of quarter
Annual report (not later than 15th Feb of following year) |
| Submission of liquidation reports of case advances and other supporting documents. | End of current year or not later than 20th Jan of following year | |
| Post the utilization report of the SHF budget in the website of the CWS and/or 3 conspicuous public places in compliance with the Full Disclosure Policy of DILG. | Q1 of succeeding year |
Step 2: Map out an inventory of facilities
- Identify all health centers/stations, clinics, lying-in clinics, hospitals, etc., that offer FP services.
- Develop a directory of these facilities indicating their location, the range of FP services provided, head of the facility, and healthcare staff along with their accreditation and training certificates.
- While ideally, all facilities should be equipped to provide counseling for FP methods and dispense short-term FP commodities, it is important to note that the PhilHealth only accredits the provision of Long-Acting Reversible Contraceptives (LARCs), such as Progestin Subdermal Implants (PSI) and Intrauterine Devices (Interval and Postpartum IUD). The type of accreditation and its respective requirements may vary depending on the facility.
| For Accreditation of the Following: | Type of Accreditation and Requirement for FP Reimbursement | Requirements for FP Reimbursement |
All health professionals |
Professional Accreditation |
Documents needed:
|
All health facilities |
Facility Accreditation |
Documents needed:
Facility:
|
Public Health centers/ Rural health units/ clinics |
Konsulta Package |
Documents needed:
Facility:
|
Private/ Free-standing clinics |
Free-standing FP Package |
Documents needed:
Facility:
|
Lying-in/ Birthing clinics |
Maternal Care Package |
Documents needed:
Facility:
|
Hospital |
Maternal Care Package |
Documents needed:
Facility
|
Step 3: Accomplish PhilHealth Accreditation requirements
- Develop individual facilities. Each facility must be equipped with the following:
- Relevant signage, documents, and necessary office equipment.
- Staffing: One health facility director and at least one nurse/midwife trained and certified in Family Planning Competency-Based Training-1 (FPCBT-1), along with FPCBT-2 for Progestin Subdermal Implants (PSI) or Postpartum/Interval Intrauterine Devices (PPIUD/Int IUD).
- Adequate room or facility: This includes minor surgical suites or corners for PSI insertion, delivery rooms for PPIUD insertion, or separate operating rooms for Bilateral Tubal Ligation (BTL-MLLA) and Non-Scalpel Vasectomy (NSV).
- Computer with Digital EMR software for efficient processing of forms and inventory data
See table below Steps for the document requirements for training accreditation of healthcare professionals as indicated in the PhilHealth Circ 2022-0029.
- Engage each facility for proper filing of PhilHealth claims and timely submission of requirements.
- Conduct an orientation with clinic/facility heads regarding administrative processes, required forms, EMR utilization, and inventory management.
- Train and accredit healthcare workers in FPCBT-1, FPCBT-2 PSI & PPIUD.
- Provide continuous coaching to facility staff to ensure efficient completion of all filing processes.
- Facilitate reimbursement. Subdermal implants can be reimbursed at PhP 3,900 each, while each provided IUD is reimbursed at PhP 2,000.
- Develop the Health Information System by uploading patient files, claims forms, inventory data, and health statistics into an EMR. EMRs should not only serve as data archives but also serve as the foundation for identifying gaps and allocating commodity supply and budget.
Tip: Consider utilizing Wireless Access for Health (WAH), an EMR provider. WAH, in partnership with select TCI cities, offers a fully-digital EMR service capable of facilitating patient data collection, aggregation and analysis, inventory and funding monitoring, and automated PhilHealth claims reimbursement. Real-time data accessibility from health centers to the City Health Office (CHO) streamlines targeted planning efforts for the CHO.
Step 4: Expand the delivery of FP services
A fully-digitized and accredited PCPN creates a positive feedback loop: increased provision of FP commodities leads to higher FP claims, resulting in greater financial reimbursement. These funds can then be reinvested to enhance infrastructure, expand staff training in FP provision, procure additional commodities, and/or improve FP services overall.
- Mobilize Community Health Volunteers (CHVs) to conduct house-to-house activities and identify individuals interested in FP services. Provide CHVs with information and instructions to guide interested individuals to their respective health centers to access FP commodities.
- Organize outreach activities and targeted demand-generation activities to identify and register more individuals interested in FP services.
- Monitor accreditation progress through a Quality Implementation Checklist for PhilHealth Accreditation.
Document Requirements for Training Accreditation of Healthcare Professionals
Physicians
Midwives and Nurses
Physicians
1. Certificate of Good Standing from PMA
2. Certificate of Completed Residency Training
1. Certificate of Good Standing from PMA
2. Specialty Board Certificate
3. Certificate of Good Standing from Specialty/Subspecialty Society
Midwives and Nurses
1. Certificate of Training from a program accredited by CPE Council of the PRC
2. Training Certificate from accredited DOH-PRC training provider/institution
3. Certificate of apprenticeship (1 or more years) with PHIC-accredited Ob-Gyne or a accredited midwife done in an accredited facility
1. Certificate of Training on BEmONC from DOH-recognized training center
2. Certificate of work experience (at least 2 years) in the labor and delivery room of at least level 1 hospital
Physicians
1. Certificate of Good Standing from PMA
2. Certificate of Good Standing from Specialty/Subspecialty Society
Midwives and Nurses
1. Certificate of Training from a program accredited by CPE Council of the PRC
2. Training Certificate from accredited DOH-PRC training provider/institution
3. Certificate of apprenticeship (1 or more years) with PHIC-accredited Ob-Gyne or a accredited midwife done in an accredited facility
1. Certificate of Training on BEmONC from DOH-recognized training center
2. Certificate of work experience (at least 2 years) in the labor and delivery room of at least level 1 hospital
Physicians
GP to GPT
1. Certificate of Good Standing from PMA
2. Certificate of Completed Residency Training
GP to MS
1. Certificate of Good Standing from PMA
2. Specialty Board Certificate
3. Certificate of Good Standing from Specialty/Subspecialty Society
1. Certificate of Good Standing from PMA
2. Specialty Board Certificate
3. Certificate of Good Standing from Specialty/Subspecialty Society
Midwives and Nurses
1. Certificate of Training from a program accredited by CPE Council of the PRC
2. Training Certificate from accredited DOH-PRC training provider/institution
3. Certificate of apprenticeship (1 or more years) with PHIC-accredited Ob-Gyne or a accredited midwife done in an accredited facility
1. Certificate of Training on BEmONC from DOH-recognized training center
2. Certificate of work experience (at least 2 years) in the labor and delivery room of at least level 1 hospital
Indicators for success
Vertical Indicators
- Inclusion of HLG into the Program Design
- Inclusion of HLG in the Work & Financial Plan, Annual Operational Plan, Annual Investment Plan
- Incorporation of master coaches into the development plan
Horizontal Indicators
- # of master coaches trained
- # of coaching meetings conducted
What evidence supports the strengthening of family planning through PhilHealth Accreditation?
- Offering FP services free of charge or at discounted rates entices adolescents and Women of Reproductive Age (WRA) to seek out services, particularly Long-Acting contraceptives like implants, BTL, and NSV.
- Health workers are motivated to encourage men and women to utilize FP services due to the incentives received from PhilHealth reimbursements.
- Additional income generated for LGU through PhilHealth reimbursements for FP claims can supplement budgets for procuring contraceptives and other essential medicines.
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Challenges
- Utilization of EMR for PhilHealth claims processing:
- Ensuring effective integration and utilization of EMR systems to streamline the processing of claims with PhilHealth.
- Addressing technical issues and ensuring compatibility between EMR platforms and PhilHealth systems to facilitate seamless data transmission.
- Proficiency of healthcare workers, particularly PhilHealth Liaison Officers, in preparing FP claims for reimbursement and payment:
- Providing training and ongoing support to healthcare workers, especially designated PhilHealth Liaison Officers, to enhance their proficiency in preparing accurate and complete FP claims.
- Ensuring healthcare workers are knowledgeable about PhilHealth policies, procedures, and documentation requirements to facilitate smooth claims processing.
External Resources
- Mandate and Functions: About Us | PhilHealth
- Accreditation process: Institutional health care providers | PhilHealth
- Health IT Partners: Corporate Partners | PhilHealth
- Regional Offices: About us | PhilHealth
- Case rates search | Philippine Health Insurance Corporation
- Wireless Access for Health. About us
Philippines Program Areas
Service Delivery
Demand Generation
Self-Reliance
Advocacy
