DOH Reengineering Monograph

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  • 8/19/2019 DOH Reengineering Monograph



    T H E N E E D F O R

    H E A L T H R E F O R M S


    Historical Background

    The Philippine Department of Health (DOH) has a long and distinguished history.

    It began as the Board of Health on June 23, 1898 by virtue of a decree by the

    new republic under President Emilio Aguinaldo. It has since evolved into one of

    the major departments of government with a budget and personnel that has kept it

    among the top five agencies of the executive branch. In 1999, under Republic Act (RA)

    8745, it had an appropriation of about P12 Billion and a nationally paid workforce of

    27,410 employees.

    The past twenty years were marked with changes. In

    1982, President Ferdinand E. Marcos reorganized the DOH

    under Executive Order (EO) 851. This was done to

    synchronize health structures and operations with th

    shift to a parliamentary form of government. Instead

    being referred to as DOH, it became known as the Minist

    of Health (MOH)





    The Office of the President had control of the ministry,

    with supervision provided by the Prime Minister. It wasalso accountable to the Batasang Pambansa or the parliament and to the cabinet to

    ensure harmonization of health programs with the rest of the programs of government.

    It was during this period that a State Minister for Health with the rank of deputy

    minister was appointed from elected members of Parliament. However, its organic

    structure remained basically unchanged. There was one line bureau, five staff bureaus,

    seven project or technical offices, which focused on diseases or special concerns. They

    were later renamed into technical services.

    June 23, 1898 – Boardof Health

    Pres. Emilio Aguinaldo

     EO 851/1982 – Ministryof Health

    Pres. Ferdinand E. Marcos

     EO 119/1986 –Department of Health

    Pres. Corazon C. Aquino



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    The Minister of Health at the same time

    supervised a number of medical centers,

    hospitals including those with research

    functions and attached agencies such as

    the Dangerous Drugs Board, the

    Philippine Medical Care Commission and

    the Schistosomiasis Control Council. For

    service delivery, the hierarchy began

    with the regional health offices under

    which operated provincial health offices

    and city or municipal health offices. The

    MOH through the Regional Health Offices

    administratively and technically

    supervised local health services.

    The next major change came in 1986

    with EO 119, “Reorganizing the Ministryof Health”, by President Corazon C.

    Aquino. It was promulgated under the

    Freedom Constitution. EO 119 clustered

    agencies and programs under the Office

    for Public Health Services, Office for

    Hospital and Facilities Services, Office

    for Standards and Regulations and Office

    for Management Services.

    An Executive Committee for National

    Field Operations was also established

    headed by the Minister with a secretariat

    headed by the Deputy Minister serving as

    Chief of Staff. The Field Offices were

    composed of the Regional Health Offices

    and National Health Facilities. The latter

    was composed of the National Medical

    Centers, the Special Research Centers

    and Hospitals. Five Deputy Minister

    positions were created and a number of

    DOH personnel were relieved.

    EO 292 known as the Administrative Code

    was promulgated under the new

    Constitution. It maintained the

    organizational structures under EO 119.

    The only difference was that the

    ministries were now reverted to

    departments as the country returned to

    the presidential form of government

    from the short-lived parliamentary


    In 1988, RA 6675, otherwise known as

    the Generics Act was passed to promote,

    require and ensure the production of

    adequate supply, timely distribution,

    rational use and acceptance of drugs and

    medicines identified by their generic

    name. This Act serves as the legal

    framework of the Philippine National

    Drug Policy Program.

    A major shift

    took place in

    1991 with the

    passage of the



    Code also known

    as Republic Act

    (RA) 7160.

    Under this law,

    all structures,

    personnel and

    budgetary allocations from the provincial

    health level down to the barangays were

    devolved to the local government units

    to facilitate health service delivery.

    Surprisingly, this did not result in an

    immediate restructuring of the affected

    departments, including the DOH.

     1988  Generics Act – RA 6675

     1991  Local Government Code

    – RA 7180

     1992  MO 27 to improve andstreamline operationsof national agencies


    Magna Carta for Public

    Health Workers – RA7305

    On August 13, 1992, Memorandum Order

    (MO) 27 was issued by President Fidel V.

    Ramos, which mandated all

    instrumentalities and agencies of the

    national government to streamline and

    improve their operations and


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    organizations. The restructuring of the

    DOH did not push through in spite of

    attempts to reconfigure its vision,

    mandate, functions and activities in

    keeping with a devolved set-up.

    On March 26, 1992, a Magna Carta for

    Public Health Workers (RA 7305) was

    passed providing for social and economic

    benefits for public health workers and

    called for a corresponding Code of

    Conduct for Public Health Workers.

    However, it was not fully implemented

    that year due to insufficient funds.

    To date, only four types of financial

    benefits are being given to governmentworkers, namely: subsistence allowance,

    clothing allowance, salary differentials;

    and for Rural Health Physicians,

    representation and transportation

    allowance (RATA). Other devolved health

    workers were not paid the benefits

    mandated under the Act due to

    insufficient funds from local government

    units. Given the funding problem, the

    implementation of RA 7305, had to

    proceed in stages. This situation has

    demoralized local health officials and

    devolved health workers prompting calls

    for a re-nationalization of devolved

    health services.

    Efforts to promote community-based,

    primary health care system were

    strengthened through the Barangay

    Health Worker’s Benefits and Incentives

    Act of 1995 (RA 7883). RA 7883 led to

    the registration and accreditation of

    some 174,569 Barangay Health Workers

    (BHWs) by the city and municipal health

    boards in 1997.

    The national government appropriated

    55 Million as subsidy to the fourth, fifth

    and sixth class local government units

    (LGUs) to provide for the subsistence

    allowance of accredited BHWs. However,

    the law has encountered several

    implementation problems, including the

    following: 1) some BHWs have not been

    able to avail of the benefits and

    incentives due them after being removed

    from the BHW list by local chief

    executives (LCEs); 2) some LCE-

    accredited BHWs have not undergone the

    basic training required under the law;

    and 3) the need to sustain the subsidy

    from the national government has not

    been met.

    In the interim, there were other policy

    developments that impinged on the

    health care system. Laws were passed in

    support of the

    major policy

    thrusts of the

    DOH as

    stipulated in the

    National HealthPlan (1995-2020)

    and its


    document, the

    10-year public

    investment plan entitled “Investing in

    Equity in Health”.


     BHW Benefits(RA 7883)


     NHI Act(RA7875)


     ASIN Law (RA 8172)

    The National Health Insurance Act (RA

    7875) providing for health insurance

    coverage to all Filipinos was passed into

    law in 1995. A National Health Insurance

    Program (NHIP) was institutionalized

    giving emphasis on indigents and is

    administered by the Philippine Health


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    Insurance Corporation (PhilHealth). Since

    then, PhilHealth has instituted a number

    of measures relative to increasing

    membership, claims processing and

    benefit packages.

    In the field of nutrition, notable

    developments included the formulation

    and adoption of the Philippine Plan of

    Action for Nutrition (PPAN) and the

    implementation of an Act Promoting Salt

    Iodization Nationwide, or the ASIN Law

    (RA 8172). The ASIN Law and its

    implementing Rules and Regulations (IRR)

    were disseminated nationwide in 1996

    and 1997.

    Despite these gains, some issues continueto hamper the effective the effective

    implementation of the law, such as low

    utilization of iodized salt, lack of supply

    of iodized salt in the market, absence of

    sanctions for violators, absence of a

    monitoring system, high prices and high

    standard requirement.


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    ◘The State of the Nation’s Health

    While all these developments over the

    years have given rise to opportunities

    that led to better health care services

    and improved state of health for all

    Filipinos - there are still many challenges

    that the whole health sector has to


    Infant Mortality Rate (IMR) and Maternal

    Mortality Rate (MMR) have declined, but

    the rate of decline has slowed down

    since 1992. Over the past years, there

    has been no significant change in thesevital health indices.

    The health status of the Philippines is

    typical of developing countries in

    “transition”. With the rapid demographic

    changes today, the country faces threats

    from infectious diseases and from the

    ever-rising tide of degenerative chronic

    conditions. Emerging health problems

    brought about by environmental andwork-related risks factors have remained

    largely unattended. These are diseases

    that are usually found in urban

    population brought about by

    industrialization and development. Over

    all, the country suffers from what is

    called the double burden of disease

    patterns common in developing


    Improvement in the quality of health

    care remains wanting in most areas and

    yet the cost of such care has become

    exorbitantly high and is beyond the reach

    of ordinary people. Added to this is the

    prohibitive cost of drugs and medicines.

    It has become common for some people

    to die without seeing a doctor or without

    taking medicines. There are indications

    that we are not effectively allocating our

    health resources. Likewise, our sourcing

    of funds remains inefficient.

    The health sector in the Philippines falls

    short in meeting these problems due to

    several reasons:

    Inappropriate health delivery system

    such as, poor hospital facilities,

    fragmented primary health system,

    ineffective delivery mechanism for

    public health program, misdistribution

    of health human resources and


    Inadequate health regulatory

    mechanisms such as gaps in

    regulatory mandates, lengthy and

    laborious regulatory systems andprocesses and inadequate human

    resources and facilities resulting in

    poor quality of health care, high cost

    of privately provided health services,

    high cost of drugs and others.

    Poor health care financing such as,

    inadequate funding, inefficient

    sourcing and ineffective allocation.

    To be able to transform the health system

    into one that would ensure the delivery of

    cost effective services, universal access

    to essential services and adequate and

    efficient financing, major reforms must be



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    ◘  The National Objectives for Health

    Major Health Developments inthe Past Decade

     Devolution of health services

     Passage of the National HealthInsurance Act

     Epidemiological, demographic and

    environmental shifts affectinghealth patterns 

    Pursuing the needed improvement in the

    health care system is in line with the

    administration’s thrust to prioritize

    delivery of services to the masses and

    improve the quality of life of all Filipinos,

    especially the poor. The differences in

    health status among various groups and

    regions in the country have widened

    through the years. These disparities

    indicate deficient economic and social

    policies and the need to reprioritize

    interventions to promote equity, fairnessand immediate action.

    Revitalizing the health care system must

    be seen within the broader context of

    several forces affecting the delivery of

    basic health services in the past two

    decades. These factors are: devolution of

    health services to local government units,

    passage of the National Health Insurance

    Law, the epidemiological, demographicand environmental shifts that resulted in

    the emergence of new diseases and

    reversals of past initiatives or successes in

    disease prevention and control.

    Under these realities, the health sector

    must work to attain a common goal. The

    DOH as the lead agency on health sets the

    vision for the nation’s health, “Health

     for All Filipinos”. 

    The mission for the entire health sector

    is, “To ensure accessibility and quality

    of health care to improve the quality of

    life of all Filipinos, especially the poor”. 

    The DOH, in partnership with all agencies

    and organization in the health sector aims

    to achieve for communities, families and

    individuals the following medium term


    General health status of the population

    is improved.

    Morbidity, mortality, disability and

    complications from specific diseases

    and disorders are reduced.

    Some diseases (e.g., schistosomiasis,

    malaria, filariasis, leprosy, rabies,

    poliomyelitis, measles and others) are

    eliminated or eradicated as public

    health problems.

    Healthy lifestyle is promoted.

    Health and nutrition of families and

    special populations are promoted.

    Environmental health and sustainable

    development are pursued.


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    ◘The Health Secto r Reform Agenda


     Efficient and effective health delivery


     Well-established and strong healthregulatory system

     Sustainable health care financing


    To bring the country towards the

    attainment of this vision, the DOH,

    health professionals, healthorganizations and other stakeholders in

    health, put together the Health Sector

    Reform Agenda (HSRA). The agenda

    outlines the problems and reforms

    needed to bring about an efficient and

    effective health delivery system, a well

    established and strong health regulatory

    system and sustainable health care

    financing mechanisms. The HSRA

    prescribes the adoption of the followingstrategies:

    On Health Service Delivery

    Promoting fiscal autonomy to

    government hospitals

    Secure funding for priority public

    health programs

    Developing and strengthening of local

    health systems capacities

    On Health Regulation

    Strengthening capacities of health

    regulatory agencies

    On Health Financing

    Expanding the coverage and benefit

    spending of the National Health

    Insurance Program (NHIP)

    Reforms in these areas are

    interconnected and interrelated. Health

    financing reforms through the NHIP will

    make hospital fiscal autonomy viable;

    hospital reforms in turn will free

    resources for investments in public

    health and in health regulation at both

    the national and local levels; and goodpublic health programs will relieve the

    NHIP from the burden of having to pay

    for increasing number of curative

    services and be able to address those

    diseases which are preventable.

    To get the reforms going, the DOH has to

    take the lead role in providing the

    direction of the health sector and in

    undertaking several initiatives to

    implement the reform strategies. These


    Formulation of the investment

    packages for health

    Formulation of new laws and

    issuance of new policy directives

    Pursuing organizational changes in

    the DOH, PhilHealth and LGUs

    Improvement of finance andprocurement management systems

    The DOH should pursue the

    organizational restructuring it had

    already initiated several years ago.


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    The organizational change in the DOH stems both from the realities within andoutside of the health sector. A movement towards “reinventing” government

    has swept bureaucracies all over the world. With greater demand for specific

    services and meager resources, government simply cannot provide for all the

    needs of its various constituencies.

    Governance is no longer an exclusive function of governments but it has to be

    distributed rationally to other concerned sectors of society. The paradigm postulates

    that what the private sector does better, it should do without undue competition from

    government. In addition, non-government organizations should be allowed to

    accomplish what they can accomplish on their own or in partnership with government

    and other service providers.

    Governments must do what only government can do. The Local Government Code of

    1991 already laid out the proper role of local governments. The national government

    must therefore follow suit. The rethinking of government’s role began with President

    Fidel Ramos’ Reengineering the Bureaucracy for Better Governance. This was

    reinforced by the guidelines issued by President Joseph Estrada under EO 165, which

    directed the formulation of an institutional strengthening program for the Executive

    Branch under the Presidential Committee on Effective Governance (PCEG).

    There were a number of studies already done on organizational efficiency, as a resultof the devolution of health services. For a number of reasons however, the identified

    necessary changes did not materialize.

    Between 1992 and 1998, the DOH management undertook three major reorganization

    attempts. The first one was during the term of Secretary Juan M. Flavier; the second

    began under Secretary Jaime Galvez-Tan and continued under Secretary Hilarion

    Ramiro; and the third by Secretary Carmencita N. Reodica. The reorganization under

    EO 102 initiated by Secretary Alberto G. Romualdez, Jr. was the fourth major effort at

    rationalizing and streamlining the DOH after the devolution of health services to the

    local governments.


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    ◘  Review of Past Studies On DOH


    1994 Study - The reorganization studyof 1994 proposed a number of significantchanges. Among these are:

    1. Reduction of the number of

    undersecretaries from five to

    three to take care of the Office

    of the Chief of Staff, the Public

    Health Group and the Health

    Regulation Group; and the

    reduction of Assistant Secretaries

    from four to two to take care of

    Administrative and Technical

    Services, respectively.

    2. Consolidation of the disease-

    specific programs into a Bureau

    of Disease Control; the

    consolidation of targeted sector

    services (such as nutrition,

    dental service, family planning

    and others) into a Bureau ofPromotive and Preventive

    Health, and the setting up of aBureau of Preventive and

    Promotive Education.

    3. Creation of a Bureau of Hospitals

    and Health Facilities, a Bureau of

    Research and Laboratories, a

    Bureau of Food and Drugs and a

    Bureau of Quarantine.

    4. Consolidation of the 14

    administrative regions into eight

    territorial field offices.

    It is clear that these changes would have

    satisfied some of the requirements of

    devolution and the government’s need

    for a more streamlined and rationalized

    DOH structure. Unfortunately, no

    enabling authority was issued, either in

    the form of an executive order or a law.

    Thus, the proposed reorganizationstructure shown in Figure 1 did not push



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    1995 Study - The efforts of Secretary

    Jaime Galvez-Tan and Secretary

    Hilarion Ramiro differed in the

    proposed structure. The Galvez-Tan

    organization and management study

    focused more on the processes of the

    DOH than on its structure.

    Among others, it recommended the

    adoption of Daily Situationer Briefs,

    which will enable the Secretary, Chief

    of Staff and other key DOH officers to

    quickly address health problems and


    Figure 1

    Proposed DOH Organizational Structure(1994 Study)

    Office of

    Public Health 



    ManagementServices Group 

    Office of the

    Chief of Staff


    Health FieldTeams 



    Health Office

    RegionalMedical Centers


    Office forHealth

    Re ulation 

    It also recommended the fine-tuning of

    the existing planning-budget-change

    process, the definition of the functions

    of the Management Committee,

    Executive Committee and the Expanded

    Management Committee and the

    adoption of a proposed organizational

    structure that essentially picks up from

    EO 119.


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    Following this study, there will be four undersecretaries and an equal number of

    assistant secretaries. The undersecretaries will take on the roles of chief of staff,

    public health services, hospital and facility services and management services

    respectively. Before any of these initiatives could be undertaken, Congressman Hilarion

    Ramiro, formerly a public health doctor, was appointed as Secretary of Health. The

    corresponding organizational structure for this proposal is shown in Figure 2. 

    Office of the Chief of StaffUndersecretaryAssistant Secretary


    Support Services

    Office of PublicHealth ServiceUndersecretary

    Asst. Secretary

    Office for Hospitaland Facility ServicesUndersecretary Asst. Secretary


    Service Programs/




    Office for ManagementServicesUndersecretary Asst. Secretary




    Figure 2

    Proposed DOH Organizational Structure(1995 Study)


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    The Ramiro organizational analysis

    proposed a continuance of the existing

    structure with the addition of sub-

    committees headed by assistant

    secretaries to handle LGUs and Health

    Systems, resource generation and

    mobilization and health information and

    monitoring. There seemed to have been

    a consensus at that time that in the

    absence of an enabling law from

    Congress, no restructuring or

    reengineering could be legally


    What appeared to be a major insight of

    the Ramiro study is the fact that DOH

    programs and activities suffer from afunnel effect. There are 2000 staff

    coordinating 62 programs at the national

    level; 80 to 100 staff coordinating the

    same program at the regional level; 30

    personnel implementing programs at the

    provincial level; and 10 staff actually

    executing these programs at the

    municipal level. Clearly, these defy

    administrative logic and the very

    principles of devolution. Clearly too,these also presented opportunities for


    1997 Study. The 1997 study

    conducted under Secretary Carmencita

    Reodica recognized that there were

    unmet health care needs due to

    underprovision on the supply side and

    underutilization on the demand side. It

    also specified that the attainment of

    quality health care and high standard of

    staffing, facilities and working

    relationships would be a major goal of a

    reengineered DOH. This study identified

    the following as areas for improvement

    within DOH:

    1. Weak health policy process

    2. No strategic planning

    3. Poor health program management

    4. Inefficient and fragmented

    enabling processes and systems

    5. Inadequate health advocacy

    6. Lack of efficient and effective

    health and management

    information system

    7. Lack of accountability of

    management systems

    8. Reliance on old work habits

    9. Weak networking with health

    partners and stakeholders

    10. Lack of reward and incentive


    11. Structural flaws

    12. Too much bureaucratic red tape

    The following are the salient features of

    the 1997 DOH reengineering proposal:

    1. Streamline the DOH topmanagement from four

    undersecretaries to one


    2. Develop a scientist and specialist

    track for technical personnel.

    3. Create non-permanent Cluster on

    Health Policy and Program


    4. Shift from disease-specific toprocess management teams.

    5. Establish two separate offices for

    licensing and regulation.


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    6. Create advisory boards to the

    Office of the Secretary.

    7. Create a single office for support


    8. Privatize production plants.

    9. Strengthen DOH liaisoning


    10. Place retained hospitals under an

    Office for Hospital Development.

    The proposed DOH organizational

    structure under the Reodica

    proposal is shown in Figure 3.

    FFiigguurree 33 

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    Office forHealth





    Office of theUndersecretary Advisory





    Office forPharmaceuticalsand Radiation


    Office forPublicHealth



    Office forPolicy andProgram Support 

    Office forHospitalDevelop-





    Cluster for Health Policy and P


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    Executive Order 102 issued in May 1999 “Redirecting the Functions and

    Operations of the Department of Health” gave it the mandate to institute the

    necessary organizational changes. The issuance and implementation of EO 102 is

    based on Sections 77 (Organizational Changes), 78 (Implementation of

    Reorganization) and Section 79 (Scaling Down and Phasing Out of Activities of Agencies

    within the Executive Branch) of the General Provisions of the General Appropriations

    Act (GAA) for 1999. The same provisions were also included in the GAAs of 1995 to

    1998, which is in keeping with Section 42, Chapter 5 and Book VI of the Administrative

    Code of 1987.

    EO 102 mandates the DOH to provide assistance to LGUs, people’s organizations (PO)

    and other members of civil society in effectively implementing programs, projects and

    services that:

    1. Promote the health and well being of every Filipino.

    2. Prevent and control diseases among populations at risks.

    3. Protect individuals, families and communities exposed to health hazards and


    4. Treat, manage and rehabilitate individuals affected by disease and disability.

    Among others, EO 102 stipulates the preparation of a Rationalization and Streamlining

    Plan (RSP) for the DOH.

    Phase1 of the RSP shall contain all the proposed structures, functions and staffing

    pattern of the different offices in the Central Office (CO), including the Bureau of Food

    and Drugs (BFAD) and the National Quarantine Office (NQO). Phase 2 shall deal with

    streamlining the functions and staffing pattern of the regional offices and retained

    hospitals, while Phase 3 shall deal with the DOH attached agencies.

    EO 102 is complemented by a later issuance affecting the health care service deliverysystem. EO 205 dated January 31, 2000 provides for the creation of a National Health

    Planning Committee (NHPC) and the establishment of Inter-Local Health Zones (ILHZs)

    throughout the Philippines. In tandem with EO 102, EO 205 is expected to accelerate

    service delivery under a decentralized mode.


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    ◘Guiding Principles and Parameters

    In the formulation of the RSP, the DOH considered the governance framework

    formulated by the Presidential Committee on Streamlining the Bureaucracy (PCSB)

    under the DBM in August 1995 and reinforced by the PCEG in October 1999. The guidingprinciples of this framework were:

    Principle of Frugality and

    Prioritization - The scope ofgovernment shall be within available

    resources and its activities accordingly

    prioritized. Government should have a

    conscious and deliberate effort to define

    what it will do, must do, can do 

    and wants to do given the call of the

    times, its legal mandate, resources and

    constraints. All these shall be defined in

    the government’s plans and policy


    Principle of Steering - The role ofthe national government in the sectors

    shall be to steer rather than row the

    boat. The focus of its sectoral functions

    therefore shall be on the following:

    1. Policy setting, monitoring and


    2. Promotion and advocacy.

    3. Provision of information and

    linkages or access to markets,

    services and production inputs and


    4. Provision of assistance and

    incentives that will equalize and

    level the playing field.

    5. Enforcement of appropriate rules

    and regulations.

    6. Ensuring the provision of safety

    nets for adversely affected


    This principle also laid down therelationship of the government to the

    private sector. It is government’s role to:

    1. Promote a stable policy

    environment; set minimum and

    appropriate rules; provide

    information and give support to the

    production of goods rather be

    directly engaged in it.

    2. Encourage sharing of resources and


    3. Assume primary responsibility in

    the production of public goods and


    Principle of Vertical

    Compartmentalization –Government should reduce duplication of

    effort and maximize the use of allresources to achieve socioeconomic and

    political goals. Sectoral activities shall

    be properly compartmentalized and

    accordingly appropriated between the

     government and the private sector.


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    Government activities shall be properly

    distributed among levels of government

    - central government, government

    corporations and local government units.

    Principle of Devolution - Thenational government and local

    government units shall be partners in the

    pursuit of the development process. The

     proper role of the national government

    is to set national policy and standards;

    and assist, oversee and, monitor local

     government units complementary to the

    stronger implementing role that local

     governments shall assume.

    Parameters - The organizational change in the DOH took into consideration

    the following basic policy framework.

    1. Leaner and Better Central Office

    (CO). Enhancing the central office

    function particularly on policy

    formulation and on establishingtechnical leadership in health.

    2. Stronger and More Responsive

    Field Offices and Facilities.

    Strengthening of field offices

    including hospitals and attached

    agencies to support direct service

    provision and technical leadership

    in health.

    3. Technical Leadership Over Health

    Programs and Increased Technical

    Assistance to Local Health

    Systems. Strengthening of DOH’s

    advocacy role; emphasizing the

    need for stronger external

    networking and linkaging.

    4. Integration of Public Health

    Concepts in the Hospital System.

    Ensuring that preventive and

    promotive health concepts are alsooperational in hospitals.

    5. Stronger Regulatory Systems for

    Quality Assurance in Health.

    Ensuring enforcement of health

    standards by reinforcing standard-

    setting activities, focusing on

    quality assurance and deploying

    more enforcement officers in the


    6. Stronger National Health

    Insurance System. Strengthening

    the national health insurance

    system to ensure more access to

    health by the less privileged,

    especially the indigents.

    Guidelines - In addition, the reengineering efforts of DOH were guided by the

    following specific guidelines and rules:

    1. No person will be laid-off or

    demoted in keeping with existing

    Civil Service Commission (CSC)

    rules on reorganization. The worst

    scenario is deployment to the

    various hospitals or field officeswhere a person’s security of tenure

    is assured unless he or she chooses

    to resign, retire or seek voluntary

    separation. A six-month period was

    provided during which time


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    employees may choose which

    offices they wish to be deployed


    2. CO will attempt to diminish the

    number of its personnel by half in

    keeping with the realignment of

    functions envisioned in the RSP.

    3. The grouping of functions will

    reflect the DOH’s major reform

    areas for the next ten years.

    4. The reengineered DOH will have a

    personnel budget that does not

    exceed its present Personal Service


    5. A system of incentives will be

    developed for relocating personnel

    including relocation allowances,

    assurance of security of tenure and

    equal consideration for career

    movement within the DOH,

    whether at CO, the field offices,

    the hospitals and the attached



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    ◘  Procedures and Processes

    At the start of the reorganization

    process, the DOH Oversight Committee

    on Reengineering  directed all heads of

    offices to undertake a review of their

    existing functions. They were also

    advised to propose the corresponding

    changes in staffing complement

    according to new defined functions and

    according to the foundational principles

    from the Civil Service Commission (CSC)

    and the DBM.

    The various offices, bureaus and servicessubmitted draft proposals that were

    further deliberated and reviewed both by

    the concerned offices and the

    Reengineering Secretariat before these

    were endorsed to the DOH Oversight

    Committee for approval. After the DOH

    Oversight Committee has approved the

    RSP, this was presented to the DBM,

    which reviewed the plan and

    recommended some revisions. The DBM

    Secretary approved the RSP with the

    issuance of the Notice of Organizational

    Staffing and Compensation Action

    (NOSCA). The plan was then forwarded

    to the PCEG, which was headed by the

    Executive Secretary. The PCEG through

    Memorandum Circular (MC) No. 62 finally

    approved the implementation of the RSPon July 17, 2000.

    The DOH reorganization proceeded from

    the prescribed procedures and steps

    shown in Table 1.



    1. Mandate Review 1. EO 102; Health SectorReform Agenda; Pertinentlegislation; and otheradministrative issuances

    1.Hierarchy of Functions(Indicate if function isprimary, secondary ortertiary, or if shift in functionis contemplated)

    Guide Questions:

    a. What will we do now thatwe were not doing before?What activities should westop doing?

    b. What cluster of activities

    should I belong to:regulation, program, policy,management support andothers

    c. Who or which offices shouldbe in which cluster?


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    2. Drawing Up the OrganizationalStructure

    2. Output No.1 2. Table of Organization

    Guide Questions:

    a. What kind of organization do we needto fulfill our functions (bureau, service,unit)?

    b. What level or rank should our highestofficial be?

    c. What units should we have and whatkind of function should these unitsexercise?

    3. Staffing Review 3. Output No. 2 3. Staffing pattern ofunit

    Guide Questions:

    a. How many people do we need toimplement the functions?

    b. What kinds of skills, titles and otherqualifications should they carry?

    4. Cost Review 4. Output No. 3; and present costallocation per unit

    4. Total personnel costs

    Guide Questions:

    a. How much will it cost in terms ofhuman resource to pursue thefunctions we will now exercise?

    b. Will this represent an increase ordecrease in present costs?

    5. Integration of outputs across the DOH 5. Outputs No. 1 to 4 5. Rationalization andStreamlining Plan (RSP)

    Guide Questions:

    a. Will this RSP meet the intentions ofstrengthening the Region as a technicaland resource center for LGUs?

    b.Will this result in eliminatingfunctional/ supervisory overlaps at CO?

    c.Will this meet the DOH’s HSRA?

    d. What kind of retraining and retoolingwill this require of the DOH personnel?


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    As the aforementioned processes were

    undertaken, supplemental activities

    were on going:

    1. Review of pertinent laws such asEO 851 (Reorganizing the Ministry

    of Health, 1982), EO 119

    (Reorganizing the Ministry of

    Health, 1987), EO 292 (Instituting

    the Administrative Code, 1987),

    EO 102 (Redirecting the Functions

    and Operations of the

    Department of Health), and the

    Magna Carta for Public Health

    Workers and other relevant DOHdocuments.

    2. Interviews with selected officials

    and personnel from DOH CO, field

    offices and attached agencies.

    3. Interviews with significant DOH

    constituencies: Congressmen,

    Senators, LGUs and NGOs.

    4. Conduct of group meetings with

    DOH management.

    5. Conduct of orientation workshops

    participated by personnel from

    all ranks.


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    DD OO HH   RR aa tt ii oo nn aa ll ii zz aa tt ii oo nn  Part3 AA nn dd   SS tt rr ee aa mm ll ii nn ii nn g g   PP ll aa nn  

    The DOH Rationalization and Streamlining Plan (RSP) for Phase 1 focusing on

    Central Office reorganization was formulated. This was approved by the DBM

    through its issuance of the NOSCA with the approved staffing complement and

    positions in all offices of the reengineered DOH. The NOSCA was posted in all

    offices for guidance and information of all DOH officials and personnel and the

    Placement and Selection Committees. The issuance of Memorandum Circular (MC) No.

    62, through the PCEG sets into motion the DOH reengineering process.

    Memorandum Circular 62 among other things highlighted that the rationalization and

    streamlining process in the DOH was in keeping with the health sector reform program.It also called for a more in-depth organizational restructuring at all levels and offices

    of the DOH, such that the Centers for Health Development (CHD), retained hospitals

    and other attached agencies of the DOH shall follow suit.

    Components of the RSP - The RSP shall detail the following shifts:

    1. The shifts in policy directions, functions, programs, strategies and activities.

    2. The structural and organizational shift, stating the specific functions and

    activities by organizational units; and the relationship of each unit.

    3. The staffing shift, highlighting and itemizing the existing filled and unfilled


    4. The resource allocation shift, specifying the effects of the streamlined set-up on

    the agency budgetary allocation and possible savings.


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    ◘  Policy and Functional Shifts

    The shift in policy directions, functions, programs, strategies and activities of the DOH

    are summarized below in Table 2.


    Area From To

    Policy Direction Planner, formulator andimplementer of public healthpolicies, programs and standards 

    National technical authority onhealth; providing technical andother resource assistance toconcerned groups

    Function Direct provision of service Policy formulation, advocacy,program development,standard setting, regulationand monitoring


    Establishment, operation andmaintenance of health units downto the barangay level

    Technical and financialassistance to DOHintermediaries through thefield offices

    Approach Individual Health Sector

    Constituency Individuals DOH partners, intermediaries,LGUs, NGOs, POs, privatesector

    DOH Roles  - These shifts are

    amplified in the following roles of

    the DOH as prescribed in EO 102: 

    1. Lead agency in articulating national

    objectives for health to guide the

    development of local health systems,

    programs and services. 

    3. Lead agency in health emergency

    preparedness and response

    services, including referral and

    networking systems for trauma,

    injuries and catastrophic events.

    4. Technical authority in disease

    control and prevention. 

    2. Direct service provider for specific

    programs that affect large segments

    of the population, such astuberculosis, malaria,

    schistosomiasis, HIV-AIDS and other

    emerging infections and

    micronutrients deficiencies. 

    5. Lead agency in ensuring equity,

    access and quality of health care

    services through policy formulation,standards development and



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    13. Protector of standards of excellence

    in the training and education of

    health care providers at all levels of

    the health care system.

    14. Implementer of the National HealthInsurance Law, providing

    administrative and technical

    leadership in health care financing. 

    6. Technical oversight agency in charge

    of monitoring and evaluating the

    implementation of health programs,

    projects, research, training and


    7. Administrator of selected health

    facilities at sub-national levels that

    act as referral centers for local

    health system (i.e., tertiary and

    special hospitals, reference

    laboratories, training centers, center

    for health promotion; centers for

    disease prevention and control,

    regulatory offices among others). 

    8. Innovator of new strategies for

    responding to emerging health needs.

    9. Advocate for health promotion and

    healthy lifestyles for the general


    10. Capacity-builder of LGUs, the private

    sector, NGOs, people’s organizations,

    national government agencies in

    implementing health programs andservices through technical

    collaborations, logistical support,

    provision of grants and allocation and

    other partnership mechanism.

    11. Lead agency in health and medical


    12. Facilitator of the development of

    health industrial complex in

    partnership with the private sector to

    ensure self-sufficiency in the

    production of biologicals, vaccines

    drugs and medicines. 

    DOH Functions - Given these

    roles, the DOH has the following

    functions under EO 102:

    1. Formulate national policies and

    standards for health.

    2. Prevent and control leading causes

    of death and disability.

    3. Develop disease surveillance and

    health information systems.

    4. Maintain national health facilities

    and hospitals with modern and

    advanced capabilities to support

    local services.

    5. Promote health and well being

    through public information; and to

    provide the public with timely and

    relevant information on health risks

    and hazards.

    6. Develop and implement strategies

    to achieve appropriate

    expenditures patterns in health asrecommended by international



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    7. Develop sub-national centers and

    facilities for health promotion,

    disease prevention and control,

    standards and regulations and

    technical assistance.

    8. Promote and maintain international

    linkages for technical collaboration.

    9. Create the environment for

    development of a health industrial


    11. Ensure quality of training and

    health human resource

    development at all levels of the

    health care system.

    12. Oversee financing of the health

    sector and ensure equity and

    accessibility to health services.

    13. Articulate the national health

    research agenda and ensure the

    provision of sufficient resource and

    logistics to attain excellence in

    evidenced-based interventions for


    10. Assume leadership in health in

    times of emergencies, calamities,

    disasters and systems failures.

    All these indicate a de-emphasis on direct

    service provision and program

    implementation in keeping with

    devolution, to an emphasis on policy-

    formulation, standard setting and quality

    assurance and shift to technical

    leadership and resource assistance. 


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    ◘   Structural and Organizational Shifts

    With the shift in policy directions,

    functions and programs, the structure

    and organizational composition of the

    DOH were likewise modified. The

    principles that guided this shift are:

    1. Enhance the CO function

    particularly on policy formulation

    and on establishing technical

    leadership in health.

    2. Strengthen the DOH’s advocacy

    role, emphasizing the need forstronger external networking and

    developing linkages.

    3. Strengthen the field offices

    including hospitals and attached

    agencies to support direct service

    provision and technical leadership

    in health.

    4. Ensure enforcement of health

    standards by reinforcing standard-

    setting activities, focusing on

    quality assurance and deploying

    more enforcement officers to the


    5. Strengthen the national health

    insurance system to ensure more

    access to health by the less


    The structural framework for

    organizational reforms and reengineering

    efforts undertaken by the DOH under EO

    102 is shown in Figure 4.

    The organizational structure

    encompasses the various DOH units as

    well as its attached agencies. The

    attached agencies are the Philippine

    Health Insurance Corporation (PHIC),

    which used to be the Philippine Medical

    Care Commission; the Dangerous Drugs

    Board ; the two new agencies created by

    specific laws - the Philippine Institute

     for Traditional and Alternative Health

    Care (PITAHC) through RA 8423 and the

    Philippine National AIDS Council (PNAC)through RA 8504; and the corporate

    hospitals (Philippine Heart Center, Lung

    Center of the Philippines, National

    Kidney and Transplant Institute and the

    Philippine Children’s Medical Center),

    collectively called the National Centers

     for Specialized Health Care.

    There are three major office clusters

    under the Office of the Secretary in thenew DOH structure. These are:

    Health Regulation Cluster, which

    shall initiate standard-setting and policy

    formulation for the licensing, regulation

    and monitoring of health facilities and

    services, food and drugs and health

    devices and health-related technology.

    Regulation officers in the Centers for

    Health Development will enforce these


    External Affairs Cluster, which shall

    be responsible for the formulation of

    policies and standards pertaining to

    international health surveillance,


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    linkages of the DOH with the

    international community as well as local

    government units, non-government

    organizations and the private sector.

    Health Program Development

    Cluster, which shall be the technical

    authority for public health surveillance,

    disease prevention and control, health

    promotion and health facility


    These three major office clusters are

    composed of bureaus and centers.

    Two staff bureaus directly report and

    provide support to the Secretary of

    Health, the Health Human Resource

    Development Bureau and the Health

    Policy Development and Planning

    Bureau. While these bureaus serve the

    internal requirements of the DOH as an

    organization, the extent of their work

    includes the wider health sector as

    policies, plans and human resource

    development programs are promulgated

    with and for sector-wide constituents

    and therefore cannot be limited to

    organic DOH staff. To complement these,

    a staff unit, the Health Emergency

    Management Staff  also reporting directly

    to the Secretary of Health, was

    organized to provide sector-wide

    coordination and development on health

    emergency preparedness and response.

    Internal management support services

    are provided by four services namely:

    Administrative Service, Information

    Management Service, Finance Service

    and Procurement and Logistics Service.

    The Secretary of Health exercises overall

    direction and control over the operations

    of the Centers for Health Development 

    (CHDs). These

    CHDs oversee



    on of policies

    and programs

    at the

    regional level

    and in the



    facilities within the region.

    Four CHD Divisions

     ManagementSupport Division

    Health OperationsDivision

    Health RegulationDivision

    There are four divisions under the CHDs,

    similar to the number of divisions of the

    former Regional Health Offices but with

    shift in functions. The Administrative and

    Finance Divisions were merged into the

    Management Support Division. The

    Technical and Training Divisions were

    merged into Health Operations Division.However, two new divisions were

    created: Health Regulation Division 

    which will handle enforcement of

    regulatory policies and Local Health

     Assistance Division which will directly

    relate to LGUs, NGOs, POs and the

    private sector in the development of

    local health systems, extension of

    technical and other kinds of assistance in

    the field of health.


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    Table 3 lists the number of major offices and units within the DOH and its attached

    agencies. Overall, there is a net decrease of 30 units.




    Existing under

    EO 119


    Created under

    EO 102




    1. Executive Offices

    1.1 Office of the Secretary 1 1 0

    1.2 Office of the Undersecretary 5 3 (2)

    1.3 Office of the Asst. Secretary 4 4 0

    2. Central Office

    2.1 Offices headed by Director IV(Bureaus and National Centers)

    4 12 8

    2.2 Offices headed by Director III(Services and Staff Offices)

    25 5 (20)

    2.3 Divisions headed by Positionsat SG 25

    37 29 (8)

    2.4 Divisions headed by Positionsat SG 24

    34 26 (8)

    3. Centers for Health Development*

    3.1 Office of the Director 15 15 0

    3.2 Divisions headed by Positions at SG25

    30 30 0

    3.3 Divisions headed by Positions at SG24

    30 30 0

    4. Hospitals *

    4.1 Special Hospitals 12 12 0

    4.2 Regional Hospitals and MedicalCenters

    31 31 0

    4.3.Provincial Hospitals 4 4 0

    4.4 District Hospitals 5 5 0

    4.5.Municipal Hospitals 2 2 0

    4.6 Sanitaria 8 8 0

    4.7.Research Hospitals 2 2 0

    5. Attached Agencies**

    5.1 Corporations/Council/Board 2 4 2

    5.2 Specialty Hospitals 4 4 0Net Increase / (Decrease) (30)

    * For further organizational review under Phase 2 of the reengineering process.** For further organizational review under Phase 3 of the reengineering process.


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    Offices of the Undersecretary were

    reduced from five to three. One office

    for Undersecretary (which is vacant) was

    abolished while another office will be

    abolished after the Undersecretary

    position, which is considered a co-

    terminus position, is vacated.

    While there is an increase of eight

    bureaus headed by Director IV,

    significant reductions are realized in the

    number of staff services headed by

    Director III and divisions headed by

    Division Chief occupying positions with

    salary grade 25 and salary grade 24.

    Table 4 details the 12 newly createdbureau level offices including the

    national centers. It will be noted that

    three regulatory bureaus are retained,

    the functions of the former Bureau of

    Research and Laboratories are now

    integrated into the National Center for

    Health Facility Development, for non-

    regulatory functions and the Bureau of

    Health Facilities and Services (formerly

    the Bureau of Licensing and Regulation)

    for regulatory functions. A Bureau of

    Health Devices and Technology  has been

    created with the former Radiation Health

    Service as the core with an expanded

    function to regulate and determine the

    health hazards posed by a myriad of new

    health and health-related technology and

    devices that have entered the market.


    Offices Headed by Director IVCentral Office 

    Existing Under EO 119 Created Under EO 102

    1. Bureau of Licensing andRegulation

    2. Bureau of Food and Drugs3. Bureau of Research and


    4. National Quarantine Office

    1. Bureau of Health Facilities and Services

    2. Bureau of Food and Drugs

    3. Bureau of Health Devices and Technology

    4. Bureau of Quarantine and International HealthSurveillance

    5. Bureau of International Health Cooperation

    6. Bureau of Local Health Development

    7. National Epidemiology Center

    8. National Center for Disease Prevention andControl

    9. National Center for Health Promotion

    10. National Center for Health Facility Development

    11. Health Policy Development and Planning Bureau

    12. Health Human Resource Development Bureau


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    The following Table 5 identifies the five new services headed by a Director III. All the

    previous 25 services and staff offices are deemed abolished or integrated into the

    newly created bureaus, national centers and services.


    Offices Headed by Director III - Central Office

    Existing Under EO 119 Created Under EO 102

    1. Maternal and Child Health Service 1. Administrative Service

    2. Tuberculosis Control Service 2. Information Management Service

    3. Family Planning Service 3. Finance Service

    4. Environmental Health Service 4. Procurement and Logistics Service

    5. Nutrition Service 5. Health Emergency Management Staff

    6. Dental Health Service

    7. Malaria Control Service

    8. Schistosomiasis Control Service

    9. Communicable Disease Control Service

    10. Non-communicable Disease ControlService

    11. Hospital Operations and ManagementService

    12. Radiation Health Service

    13. Hospital Maintenance Service

    14. Health Infrastructure Service

    15. Community Health Service

    16. Public Information and Health EducationService

    17. Health Intelligence Service

    18. Internal Planning Service

    19. Foreign Assistance Coordination Service

    20. Administrative Service

    21. Finance Service

    22. Management Advisory Service

    23. Health Manpower Development andTraining Service

    24. Procurement and Logistics Service

    25. Biologicals Production Service


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    ◘  Staff ing Shift

    The changes in the structure and the

    organizational composition of the DOH

    necessitate corresponding changes in


    Guiding Principles - The

    determination of staffing requirements,

    position allocation and classification

    under the proposed set-up considered

    the following factors:

    1. Adopt standard staffing pattern as

    much as possible for similar units

    or posts.

    2. Emphasize technical over non-

    technical positions consistent with

    the redirected functions of the


    3. Expand the number of positions

    charged with substantive functions

    and compress positions performing

    activities that may be purchasedfrom the private sector.

    4. Adopt generic nomenclatures for

    positions to accommodate more

    professions and disciplines in the

    roster of personnel.

    Staffing Scheme - The

    preparation of the staffing pattern

    involved careful deliberations and

    selection of the appropriate number and

    competencies of the positions proposed.

    The proposal assumed a phased

    implementation scheme as follows:

    1. Stage 1 proposed staffing pattern

    includes co-terminus (CT) positions

    (i.e., CT/co-terminus with

    incumbent (CTI) positions). This

    will be the operational staffing

    pattern in the course of RSP


    2. Stage 2 proposed staffing pattern

    excludes co-terminus positions

    (i.e., without CT/CTI). This will be

    the staffing pattern upon full

    implementation of the RSP.

    In effect, Stage 1 shall serve, as the

    interim or transition stage while Stage 2

    will be the final stage when RSP is fully


    For Stage 1, proposed positions were

    matched with existing positions with the

    same or higher salary grades. This

    resulted in the transitory provision of co-

    terminus positions in the interim stage.

    Also, this meant that the implementation

    of the ideal or full staffing pattern (i.e.,

    with proposed needed positions) would

    be deferred until such time that certain

    posts are vacated and resources

    generated to fund the desired staffing


    This scheme was resorted to in order to

    reconcile two conflicting objectives: (1)limiting funding to existing personnel

    services appropriations and (2) providing

    a long-term view of the staffing

    requirements of a reengineered DOH.


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    Moreover, the two-stage implementation

    takes into consideration that this

    reengineering may have uncovered

    redundancies which, for humanitarian

    reason will simply be the subject of

    deployment with abolition to take place

    upon retirement, transfer or promotion,

    or resignation of the incumbent,

    whichever comes first.

    It will also be noted that while around

    half of central office staff would be

    deployed, these numbers in fact went to

    field offices as well as hospitals, which

    suffer from chronic personnel shortage.

    Also, bureaus and attached corporations

    that have been given additionalmandates of new laws were recipients of

    deployed positions, mitigating in the

    meantime, the creation of new positions.

    To minimize staffing problems, the DOH

    has chosen to implement its RSP using a

    number of interventions. At the onset, it

    asked its employees to register for

    voluntary deployment to any of its

    regions, hospitals or attached agencies

    that have sought Department of Budget

    and Management (DBM) approval for the

    creation of new positions.

    In the meantime, it met with central

    office staff and other constituencies to

    configure the ideal CO structure. Those

    who did not volunteer for deployment to

    any agency of their choice would

    eventually be subject to mandatory

    deployment to offices that are in need of

    personnel. In any case, there would be

    no instance of any demotion in rank,

    salary or emoluments subject to existing

    CSC guidelines and standards.

    Staffing Modification - Some

    proposals called for a reclassification of

    existing position titles to conform to the

    new functions of the DOH. Some

    positions were also identified as co-terminus with the incumbents and will

    either be abolished or downgraded to its

    appropriate rank when the incumbents

    retire, resign, transfer or get promotion. 

    Standard Staffing Pattern - Standard staffing patterns were adopted

    for the offices of the Undersecretary,

    Assistant Secretary, Bureau Director or

    equivalent and Service Director or

    equivalent. A standard staff complement

    adapted for specific offices are as


    Office of the Undersecretary

    1. Undersecretary

    2. Executive Assistant IV

    3. Administrative Officer II

    4. Private Secretary II

    5. Computer Operator IV

    6. Clerk III

    7. Chauffeur I

    8. Utility Worker I 

    Office of the Assistant Secretary

    1. Assistant Secretary

    2. Executive Assistant III

    3. Computer Operator III

    4. Private Secretary I

    5. Clerk II

    6. Driver II

    7. Utility Worker I


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    The staff complement for the Offices of the Director IV and the Offices of the Director

    III at the central office were also standardized as follows:

    Office of the Bureau Director

    1. Director IV

    2. Administrative Officer II

    3. Computer Operator II

    4. Driver II 

    Office of the Service Director

    1. Director III

    2. Administrative Officer I

    3. Computer Operator II

    4. Driver I 

    Salary Grade Structure - The

    staffing pattern improved the quality of

    positions in the DOH towards higherand more substantive posts compared

    to administrative/routinary posts in

    keeping with the leadership role of

    DOH in the health sector. Table 6

    shows that there is more technical staffcompared to administrative staff.




    Technical Staff

    (SG 11 & Above)

    Administrative Staff

    (SG 10 & Below)

    TOTAL 850 449 1299

    Office of the Secretary 78 42 120

    OSEC Proper 25 13 38

    Office of the Undersecretaries 18 12 30

    Office of the Asst. Secretaries 16 12 28

    Health Emergency Management Staff 13 3 16

    Phil. National AIDS Council 6 2 8

    Health Regulation Cluster 355 184 539

    Bureau of Health Facilities & Services 56 20 76

    Bureau of Food and Drugs 249 147 396

    Bureau of Health Devices & Technology 50 17 67

    External Affairs Cluster 91 100 191

    Bureau of Quarantine & Int’l Health


    45 93 138

    Bureau of Int’l Health Cooperation 25 3 28

    Bureau of Local Health Development 21 4 25


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    Technical Staff

    (SG 11 & Above)

    Administrative Staff

    (SG 10 & Below)

    Health Program Development Cluster 179 41 220

    National Epidemiology Center 30 8 38

    National Center for Disease Prevention

    & Control

    73 11 84

    National Center for Health Promotion 31 17 48

    National Center for Health Facility


    45 5 50

    Sectoral Support Cluster 53 18 71

    Health Human Resource Development


    23 9 32

    Health Policy Development and

    Planning Bureau

    30 9 39

    Management Support Cluster 94 64 158

    Administrative Service 20 19 39

    Information Management Service 38 11 49

    Finance Service 22 13 35

    Procurement and Logistics Service 14 21 35


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    ◘  Resource Allocation Shift

    The changes in the structure and staffing

    pattern of the DOH effected

    corresponding changes in resourceallocation particularly for Personal

    Services (PS). Guided by the principle

    that the reengineered DOH shall have a

    personnel budget that does not exceed

    the existing PS allocation, the estimated

    PS cost (which only covers basic salary)under the EO 119 and the EO 102

    organizational structures are compared

    in Table 7.



    EO 119 EO 102(Transition stage) *

    EO 102(Final stage)**

    Offices Required No. of Staff Required No. of Staff RequiredNo. ofStaff

    PS under EO102(a)

    PS under EO102(a)


    Office of the Secretary  309 44,945,376 38 4,013,002 37 3,874,185

    Executive Offices  99 13,640,652 58 7,763,256 52 6,849,791

    Sectoral Support Cluster 82 9,023,868 87 9,720,648 88 9,809,317

    Management SupportCluster

    637 66,605,599 159 19,119,021 158 19,030,352

    Health Regulation Cluster 509 64,526,800 539 44,644,198 539 44,644,198

    External Affairs Cluster 350 32,879,640 191 19,012,176 191 19,012,176

    Health ProgramDevelopment Cluster

    964 128,926,320 220 23,789,024 218 23,494,058

    TOTAL 2,950 360,548,255 1,292 128,061,325 1,283 126,557,928

    * Stage I – staffing pattern includes positions, which are co-terminus with incumbent holderof positions (CTI)

    ** Stage II – staffing pattern upon full implementation of RSP Stage 1, which excludes CTIpositions

    (a) Excludes staff of Philippine National AIDS Council


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    As shown in Table 7, the PS requirement of the staffing complement of the DOH central

    office under EO 119 amounts to P360.5M. Under the transition phase of Stage 1, PS

    requirement amounts to P128M. This reduces PS allocation by about 64 percent. In the

    final phase of Stage 1, when all the CTI positions have been vacated, an additional

    savings amounting to P1, 5M shall be generated.

    Phase 1 of the reengineering process immediately generated an estimated savings of

    about P56, 754,132. This is broken down as follows:

    Direct savings from abolition of vacancies - P15, 000,000

    Indirect savings from the deployment of

    positions to units created by

    special laws

    Renationalized hospitals P15, 908,562

    PITAHC 17, 514,390

    PNAC 1, 233,648

    BFAD Satellite Labs

    CHD VII 3, 617,356

    CHD XI 3, 480,176

    TOTAL P56, 754,132

    As a result of the proposed staffing changes, there is also a corresponding change in the

    budget format and in the program/project/activity (P/P/A) language in the General

    Appropriations Act. This simplifies account/item entries in the GAA in consonance with

    the HSR objectives.


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    M A N A G I N G T H ER E F O R M P R O C E S S



    ◘  Management of Change and Expectations

    Managing change at the DOH is a daunting proposition. While any kind of

    change is expected to meet some measure of resistance, the situation at the

    DOH was aggravated by a number of factors.

    The first one had to do with RA 7160 or the Local Government Code (LGC).

    Implemented in 1992 after its passage in 1991. RA 7160 succeeded in shifting almost

    46,000 DOH personnel to LGUs all over the country. This left a still substantial number

    of over 27,262 personnel under the DOH national payroll as of December 31, 1999. This

    was an awkward situation considering that direct service delivery, which is supposed to

    be the more people-intensive part of the DOH functions had already been devolved.

    The DOH pre-devolution structure remained untouched, perpetuating practices and

    procedures that should have changed with the downloading of the DOH’s service

    delivery function. Since form usually defines function, the unchanged DOH structure

    continued to operate on old premises. The remaining employees have been led tobelieve that the status quo would remain and that, for the most part, their respective

    assignments and responsibilities would not change significantly. This mindset resulted

    from failed attempts to restructure the DOH after the enactment of the LGC.

    The second factor had to do with the enactment of the Magna Carta for Public Health

    Workers or RA 7305. Among others, this law mandates that health workers cannot be

    transferred to another station or place of work without their consent. This further

    solidified the perception that reorganization would no longer take place, even if the

    bureaucracy at the national level remained at levels that were difficult to justify.

    The previous experience of devolved employees constitute another source of resistance

    by the remaining employees to any form of movement, even if this is merely de-

    concentration or movement within the same organization.


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    There are more than enough stories of

    health workers who, under devolution,

    were designated to do jobs other than

    what they were trained for; who were

    demoted in pay or rank even if this was

    explicitly prohibited by existing laws;

    who experienced difficulties in the

    payment of retirement benefits and who

    had to work with local officials whose

    priorities did not include health care in

    the volume and value attributed to the

    earlier national health service delivery

    system. Those who thought themselves

    lucky to have stayed with the national

    government swore that they would not

    allow themselves to be caught in a

    similar situation in the future.

    The growing militancy of government

    workers has not spared the DOH. Some of

    its employees are allied with the more

    militant labor federation and are not

    beyond using their network to lobby and

    advocate for the maintenance of existing

    rights or to protest perceived diminution

    of benefits. They are joined by a group

    of middle managers and seniorexecutives whose positions may be

    deactivated with the shift to a function-

    focused CO as opposed to the existing

    disease-specific and sector-based


    What was also being questioned is the

    authority of the President to effect a

    reorganization of specific executive

    departments in the absence of any

    legislation from Congress. It is held by

    some that the authority to reorganize is

    an inherent function of Congress and may

    not be exercised by any other. Thus, a

    reorganization covered by an executive

    order may not be carried out without the

    risk of being declared void by the proper


    Any change management plan must

    address these factors if it is to achieve

    some measure of success. It must be

    pointed out that while there may be

    hindering factors to the change process

    that accompanies a reorganization or

    reengineering effort at the DOH, there

    are also assisting factors that could be

    put to work. For instance, the senior

    management levels of the DOH are all

    “old hands”, so to speak.

    Three of the undersecretaries are CareerExecutive Service Officers (CESOs) who

    are unlikely to be dislocated by any

    reengineering effort. The other

    undersecretary and the Secretary of

    Health himself were former DOH

    officials, serving as Head Executive

    Assistant and Assistant Secretary,

    respectively during an earlier period. In

    terms of understanding the functions,

    the structures and the needs of the

    organization, they are considered

    knowledgeable insofar as the needed

    internal reforms are concerned.

    There was also some realization that the

    previous structure was not working very

    well for the immediate as well as the

    ultimate clients of the DOH are

    concerned. A proposed bill in Congress

    seeks the abolition of the DOH regional

    units on the perception that these DOH

    field offices presently do not serve the

    LGUs as well as they should. Seen in this

    light, the reengineering of the DOH

    became a matter of institutional



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    A number of laws recently passed also

    provided for the staffing of new agencies

    such as the Voluntary Blood Donation

    Program, the Philippine National AIDS

    Council, the Philippine Institute of

    Traditional and Alternative Health Care,

    as well as the increased staffing

    requirement of the PhilHealth and the

    newly renationalized hospitals.

    Since the major shift in the DOH

    reengineering is in the thinning out of CO

    and building organizational muscle in the

    field and operating units such as the

    retained as well as the special and

    specialty hospitals, dislocations were

    minimized by deploying CO personnel to

    the new agencies, the field offices and

    the operating units.

    What also became imminent and

    necessary is the retooling and retraining

    program, given the new or additional

    skills that are required at CO as well as

    in the field and the operating units. The

    DOH management recognized this and

    has in fact allocated funds for this



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    RR SS PP   II mm pp ll ee mm ee nn tt aa tt ii oo nn ::  Part1 TT hh ee   DD OO HH   EE xx pp ee rr ii ee nn cc ee  

    V arious working groups and committees were created through Department OrderNo. 380-D s. 1999 to affect a unified, smooth process of facilitating the

    formulation of the RSP and of implementing change. These groups and

    committees were:

    Oversight Committee – Provided the

    overall direction of the change program.

    This committee was composed of the

    Health Secretary, Undersecretaries and

    Assistant Secretaries.

    Reengineering Secretariat –

    Provided the staff support to the

    Oversight Committee and was

    responsible for facilitation, coordination

    and provision of technical assistance in

    the change program and activities of all

    offices in the CO, including the BFAD and

    the NQO. A full-time Director under the

    Office of the Secretary and a select staff

    from the Health Policy Development

    Staff and the Administrative Service

    composed this group. A major

    consideration in the selection of

    membership to this group was their

    commitment and willingness to work for


    Task Force on Personnel

    Deployment and Budgetary

    Requirements – This group was

    organized on account of the inevitabledeployment of some CO personnel. This

    group was tasked with the processing of

    requests for voluntary deployment,

    retirement and separation from office of

    those affected by the reengineering

    program. Aside from determining the

    cost requirements and ensuring financial

    resource, it was also responsible for the

    development of integration programs for

    the deployed personnel in the other DOHoffices.

    Task Force on Information and

    Communication – This group

    developed helpful messages and

    information to facilitate the wide

    acceptance of the change process; and

    disseminated information relative to

    activities and programs of the different

    committees involved in the DOH


    Task Force on Retooling and

    Counseling – This group conducted

    orientation programs on the rationale

    and need for change in the early stages

    of the change process. The group

    provided emotional support to those who

    suffered from the stress brought about

    by the organizational change. Prior to

    the actual implementation of the neworganizational structure, this group

    formulated a retooling/retraining

    program that ensured that newly

    organized offices and staff measure up to

    the expectations of the new roles and


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    functions of the DOH. The training

    programs were designed for building

    capacities for leadership in the health

    sector and in support of the HSRA


    The Reengineering Desk – This washeaded by an Assistant Secretary and

    was created primarily for “quick

    response” to most of the commonly

    asked questions about reengineering.

    The group also helped in facilitating

    several types of requests from affected

    employees such as deployment and

    transfer, counseling, retraining among


    Three consultants were hired for the

    duration of the reengineering exercise in

    the CO. They played a significant role in

    the formulation and implementation of

    the DOH Rationalization and Streamlining

    Plan. They acted as a technical resource

    in the day-to-day management of

    change. In the process, some problems

    cropped up with no answers from the

    book, but were drawn from experience

    and practice. The consultants provided

    insights and direction during the change



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    The Change Management Process

    To support the reengineering process,

    the DOH Reengineering Technical

    Committees and Secretariat carefullystudied and reviewed other guidelines

    issued by the CSC and those enacted by

    law, such as RA 6656 or An Act to Protect

    the Security of Tenure of Civil Service

    Officers and Employees in the

    Implementation of Government

    Reorganization (1988).

    The basis of action and decision made by

    the Selection and Placement and Appeals

    committees for the implementation of

    the approved reengineered DOH was

    grounded on these rules and provisions.

    The appeals made by protesting

    employees also found strength and

    support from these provisions.

    The following were the activities and

    mechanisms that facilitated or mitigated

    the effects of the organizational change


    1. The Secretary of Health clarified

    intentions and directions to the

    undersecretaries and assistant

    secretaries who acted as the

    Oversight Committee and as team

    leaders for their respective groups.

    2. The Undersecretaries explained

    intention and direction of

    reorganization to units, agencies,

    or bureaus in her/his cluster;

    reviewed mandate given under EO

    102 and the HSRA; and

    documented frequently asked

    questions for discussion and

    feedback to the Executive

    Committee (Execom) or Oversight


    3. The Secretary of Health

    established the Reengineering Desk

    headed by an Assistant Secretary

    and backstopped by a Technical

    Working Group or Secretariat

    headed by a Director and

    consultants coordinating with

    several Task Forces which, sought

    clearance from Execom or

    Oversight Committee.

    4. The Secretary of Health issued

    guidelines for reengineering and

    retooling. These are:

    a. All DOH employees are

    expected to be computer

    literate thus minimizing the

    need for clerical and

    secretarial support.

    b. CO staff must be retooled for

    policy analysis, program

    development, resource

    coordination, mobilization and

    technical supervision.

    c. Field Unit staff must be

    retooled for networking,

    developing linkage, political

    sensitivity, grassroots planning,grants administration and

    technical assistance.

    d. Hospital staff must be retooled

    towards integrating public


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    health concepts and issues

    with clinical care.

    e. DOH representatives to LGUs

    must be retooled to respond to

    LGU needs and not merely to

    attend Local Health Board

    meetings. They must also be

    retooled as local health

    advisors on all matters relating

    to health.

    5. The Secretary of Health issued

    guidelines on managing the

    reengineering process. These are:

    a. DOH managers and senior

    officials must present

    themselves at all times to

    answer all questions about

    reorganization honestly and

    without equivocation. Those

    issues about which officials

    were unsure or unhappy about

    were brought to the

    Execom/Oversight Committee

    for quick resolution.

    b. The central message was that

    even with redeployment, the

    DOH remains a family.

    Whether one is in the CO, the

    regions or any of the hospitals,

    one continues to be part of

    DOH whose services can be

    counted towards retirement

    and where security of tenure,

    given adequate behavior andperformance, remains assured.

    c. Success stories on

    redeployment should be

    documented and disseminated.

    Problems encountered should

    similarly be documented and

    addressed operationally. An

    example was the inability of

    the redeployed person to get

    his salary as soon as possible.

    Another problem was the

    unwillingness of the regions to

    advance the salary despite

    order from the Secretary.

    d. Frequently asked questions

    should be documented and the

    answers to these questions

    should be consistent and

    widely distributed.

    e. Unresolved issues such as

    staffing numbers or position

    titles were not disseminated

    until approved by the

    Secretary to prevent

    unwarranted speculation. The

    only certain thing about the

    reengineering exercise is that

    nobody will lose his/her job.

    f. Alternatives to redeployment

    were clearly presented.

    Among these are:

    Employment in DOH-attached

    agencies where additional

    staffs are mandated by law but

    has not been approved or

    confirmed by DBM. Examples

    of these are PNAC, PITAHC and


    Redeployment was also made to

    special, specialty and retained

    hospitals in Metro Manila during

    the voluntary deployment


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    period. When the staffing

    pattern is approved, the

    Secretary reserves the right to

    re-deploy personnel where they

    are most needed.

    Retirement or separation

    benefits (for those not yet

    qualified to retire) were made

    available under existing laws.

    The reengineering team

    deployed available personnel

    who computed the amount of

    these benefits for specific


    The assistance of DOLE and CSCwere sought relative to job

    hunts, both within government

    itself (in case employees want to

    transfer to other government

    agencies) and outside the

    country. A job fair put together

    overseas, government and

    within-DOH jobs that highlighted

    other options available to

    employees who did not wis