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Republic of the Philippin
Department of Health
OFFICE OF THE SECRETARY
JUN 1 3 2016
ADMINISTRATIVE ORDER
No. 2016 -
SUBJECT: Standardization of Per a ita Bud et for Meal Provision of Patients
1. BACKGROUND AND RATIONALE
According to the Hospital Licensure Act (RA 4226) of 1971, the Nutrition and
Dietetics Service is one of the six (6) major services of a hospital and is integral to total
patient care. As such, the Nutrition and Dietetics Service of each hospital plays a crucial
role in quality patient care which includes provision of nutritious meals tailored to the
patient's specific health condition.
Studies show that malnutrition cases among hospital patients are at an alarming rate,
which may be starvation-related, chronic-disease related, or hospital-related. A I O-year
study conducted by St. Luke's Medical Center revealed that 45.6% of their patients were
malnourished while admitted in the hospital. Moreover, the Philippine Society for
Parenteral and Enteral Nutrition states that the rate of malnutrition in Philippine hospitals
is 35 to 50 0/0. This malnutrition rates are in fact reflective of undernutrition.
An analysis of the one-week cycle menu presented bv five
(S) (10) DOH Hospitals in Visayas and Mindanao regions that
kilocalorie daily allowance is met while fòr the macronutrient Intake, carbohydrates IS met
at 63%, prote:n at 70% and fats at 53% with the mean daily cost of the diet at Php 74.39
per patient. The cost of meal ranged from Php 45.20 to Php 61.68/ patient meal / day in
LGUfunded level I to 3 hospitals, while in DOH-funded Medical Centers and Regional
Hospitals the range was Php 61.63 to Php 68.79. (Evaluation ofDietary Services ofSelected
Hospitals, Philippines, 2014).
It is therefore imperative for government hospitals to be allocated with increased
per capita budget for meals to enable the Nutrition and Dietetics Service to achieve its goal
of providing patient-centered dietetics services which are focused on the quantity and
quality of meals served to inpatients.
11. OBJECTIVES
General Objective:
To prescribe and implement a standardized per capita budget fòr meals of Inpatients in
DOH and I-GU Hospitals.
and
2
OFFICE OF THE CHIEF
Specific Objectives:
l. To provide guidance to Hospital Administrators and Nutritionist-Dietitians on the
planning and implementation of interventions appropriate for hospital inpatients
within the recommended per capita budget.
2. To sucport budgetary increase and standardization for inpatient meals.
111. GUIDING PRINCIPLES
This Order is governed by the following principles:
1. Rights-based Approach. The provision of diet based on the disease condition of each patient
is anchored on respect for the rights to nutritionally adequate and sate "l stipulated in the
Philippine Constitution.
2. Systems Approach. Sustained provision of nutritionally adequate and appropriate
diet is contingent on the adoption of a systems approach that initiates fundamental
reforms in health and nutrition service delivery management.
3. Life-cycle Based Interventions. The health and nutritional care must be aligned with
the requirements and conditions of individuals at various stages of the life-cycle.
4. Equity. Population groups confined in DOH and LGU Hospitals with the least
access to quality health and nutritional care must be given top priority for provision
of meals and special dietary needs.
5. Comvlement of Interventions. Health and nutritional care must be complemented with
other dietetics services including nutrition counselling. case rcfQltal fc,ilow-up.
6. Evidence-based Interventions and Approach. This policy guideline was developed
based on 2013 Evaluation of Dietary Services of Selected Hospitals gathered by the
Food and Nutrition Research Institute-Department of Science and Technology and
from other relevant researches and studies.
Dietary Diversification. Meeting the prescribed energy and nutrient requirements of
in-patients can be facilitated through offerings of variety of food sources at minimal
cost. This is attainable through increased food production in the hospital and
establishment of sustainable food networks.
Iv. SCOPE AND COVERAGE
This Order shall apply to all Government Hospitals under the DOI l. National
Government Agencies (NGA) Hospitals, and the IX)cal Govetmment I those
under Government Owned and Controlled Corporations. The allocated per capita meal
budget covers both Regular and Special Diets as prescribed for inpatients.
Received
.l)ate:
3
V. DEFINITION OF TERMS
I. Adequate Nutrition - also known as good nutrition, attained through the right balance
of macronutrients and micronutrients to deliver the appropriate Recommended Energy
Nutrient Intake (REM) and Total Energy Requirement (TER) for the patient fast
recovery and reduced length of hospital stay.
2. Budgetary Meal Allowance - an estimated cost of meal/day which serves as basis for
comparison and control Of food expenses especially for expenditures at the Nutrition
and Dietetics Service.
3. Continuum of Care - is a concept involving an integrated system of care that guides
and tracks patients over time through a comprehensive array of health and nutrition
services spanning all levels of care.
4. Diet — a measured regimen of food and beverages a person eats and prescribed
period of time. This includes special or therapeutic dlets for inpatients.
5. Dietetic Intervention — refers to a plan of action designed with the intent of changing
dietary-related behaviours, risk factors, environmental condition and other aspects Of
nutrition and health affecting the status of an individual, group or population.
6. Food Quality and Safety Standards are tools/parameters/guidelines to food processing
and preparation, food labelling, food hygiene, food additives and pesticide iTRidues.
Policies on biotechnology and food for the management of governmental import and
export inspection and certification systems for foods are also covered.
7. Hospital Food Service — a section in the health care facility that plans, prepares, serves
meals according to acceptable standards of management such as aesthetics appeal, taste
sanitation, nutrition, budget and the Pac Illttes
8. Nutrition and Dietetics Service - is a section in the health care facility headed by a
permanent licensed Nutritionist —Dietitian that primarily provides quality and
nutritionally adequate diet for optimal nutrition among inpatients.
9. Recommended Energy and Nutrient Intake (REM) — is the daily requirement for
energy, protein, carbohydrates, fat, vitamins, electrolytes, minerals, and water.
10. Special Dietary Requirement — refers to the minimum amount of specific nutrients
needed by the body to attain a specified state of health. (See Annex A)
I l . Therapeutic Diet — is a meal plan which is a modification of regular diet prescribed
by a physician and planned by a Nutritionist-Dietitian that is tailored to fit the nutrition
need of a particular person based on his/her medical condition
4
G NERAL GUIDELINES
The following guidelines should be observed In all Hospi la:
1. Nutrition and Dietetics Service shall ensure delivery of health and nutrition care of
utmost quality that will provide patient's meals, especially those dietary
requirements and/or prescribed therapeutic diets to achieve the best possible
outcome.
2. Hospitals shall provide adequate budget appropriation based on the following:
a) Chiefs of Hospitals shall strictly enforce 1,800 kcalories as prescribed by the
physician for a normal and regular diet of an adult person using actual number
Of inpatients or an equivalent of at least the Php150 pesos/day meal allowance
for inpatient. Basis of computation is shown in Annex B and Annex C.
b) DOH and all other government hospitals shall earmark a per capita meal budget of at
least Php 150.00/day sourced from hospital Income, Philhealth general
appropriations (MOOE) and other possible sources.
c) This minimum rate shall apply to all patients regardless of capacity to pay or
income classification.
d) Adjustment of the per capita meal budget allowance shall be based on the
inflation rate of every three years.
e) Unless otherwise prescribed by the attending physician, DOH and government
hospitals shall serve inpatient meals of at least 1,800 kcalories per day of the
patient's energy requirement provided by the following major nutrients:
carbohydrates (60%), protein (15%) and fats (25%).
Q//IMPLEMENTING MECHANISMS
The oversight for the implementation of this policy shall rest 'A lth the Ilealth
Development Bureau under DOH Cluster Head of Office fòr Technical Services-B.
Recognized stakeholders based on their mandates shall assist in the implementation of the
policy nationwide.
In order to institutionalize the implementation of this Standardized Meal Allowance
Initiative, the DOH Central Office and attached agencies, DOH Regional Offices, DOH
Hospitals, Local Government Unit (LGU) Hospitals, and National Government Agencies
Hospitals (NGA) shall:
1. sseminate and inform staff about the Standardized Meal Allowance initiatives.
2. Ensure that the Hospital Finance Officer implements at least Php 150.00 pesos per patient per
day the policy for budget and procurement purposes. Other computation for the Total Energy
Requirement shall emanate from the or Recommende.l Energy Nutrient Intake (RENI) or based
from the prescribe diet ot the pli', a specific individual.
3. The amount of one hundred fifty pesos (Php 1 50.00) for 1,800 calories/dav as
prescribed by the physician is applicable to all diets, whether Regular Therapeutic,
and even for Tube feeding preparation in all kinds ot patients. c or paying.
4. Ensure that the Hospital Food Service shall serve meals to patients based on
guidelines prescribed by this Administrative Order.
5. Ensure that patient's adequacy of intake shall be monitored through plate food
waste, patients' satisfaction survey regularly done and analyzed by the
Nutritionist- Dietitian.
6. Ensure that the Chief Nutritionist-Dietitian of the hospital submits an annual
report to the Chief of Hospital concerning compliance with the Administrative
Order, copy furnished the Department of Health - Health Facility Development
Bureau.
VIll d(Roles and Responsibilities
A. Department of Health
I. Health Facility Development Bureau (HFDB)
The DOH- HFDB shall oversee the implementation of this Order. It will undertake
the following tasks:
a. Lead in the advocacy and dissemination of the policy in the DOH-Retained and
LGU Hospitals.
b. Coordinate and provide nutrition technical inputs for the operationalization of the
policy and other relevant initiatives.
c. Lead in the monitoring and evaluation of the policy implementation.
d. Lead in the periodic conduct of research and development strategies relative to the
policy implementation.
2. DOH -Regional Offices
a. Guide the implementation of the policy in all DOH and I-GU hospitals
within its
catchment areas.
b. Support the dissemination of the policy at the regional level.
c. Advocate for the adoption of the policy to LGUs.
d. ide technical assistance to LGUs on the provisions of the policy.
c. Support monitoring and evaluation of policy implementation.
f. Facilitate submission of reports from DOH Retained Hospitals and LGUs.
3. DOH Hospitals
a. Ensure the adoption and implementation of the policy.
b. Build capacities for the implementation of the policy.
e. Monitor the prescribed menu through the Chief Nutritionist-Dietitian of 1,800
kcalories with the equivalent of at least Php 150.00/day meal of a patient or as
prescribed by the physician or any other computation of Total Energy Requirements
(TER) of a patient.
d. Earmark appropriate budget for the policy operationalization
e. Monitor and evaluate the outcome and impact of the policy implementation.
f. Provide feedback for policy review and updating.
g. Prepare and submit reports of accomplishments.
4. Local Government Unit Hospitals
a. Ensure the adoption and implementation of the policy.
b. Advocate for the adoption of the policy through the issuance of Executive
Orders, ordinances, etc. to Local Chief Executives (LCEs).
c. Earmark appropriate budget for the policy operationalization.
d. Build capacities for the implementation of the policy.
e. Monitor and evaluate the outcome and impact of the policy implementation.
f. Provide feedback for policy review and updating.
g. Prepare and submit reports of accomplishments.
5. Philippine Health Insurance Corporation (PhilHealth)
a. Integrate the budget for the Nutrition and Dietetics Service in the computation
of rates and diagnosis- related groups (DRG).
b. Monitor the compliance of hospitals in the breakdown of budget allocation.
rx. REPEALING CLAUSE
All issuances inconsistent with this policy are hereby revised, modified, or rescinded
accordingly.
X. EFFECTIVITY DATE
This policy shall take effect immediately after publication in the DOH Intranet and in a
newspaper of general circulation.
JANETT1f P. LARIN, MD, MBA-H
ealth
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Annex B
JUSTIFICATION ON THE COMPUTATION OF MEAL ALLOWANCE AT THE
NUTRITION AND DIETETICS SERVICE FOR TIIE P150.OO/DAY/PATIENT
Breakfast Lunch Su er
Day
1
Day
2
Day
3
Day
4
Day
1
Day
2
Day
3
Day
4
Day
1
Day
2
Day
3
Day
4
37.21 52.62 44.93 53.42 52.46 48.82 49.72 44.22 57.71 43.91 52.07 47.41
Average cost: P47.50 Average cost: P48.81 Average cost: P50.27
Average cost: P 146.58/patient/dŽn
13-1
JUSTIFICATION ON THE COMPUTATION OF MEAL ALLOWANCE AT THE
NUT1eTION AND DIETETICS SERVICE FOR THE P150.OO/DAY/PATIENT
Day 1
BREAKFAST LUNCH SUPPER
1 .5 1
Cost of Raw Food 24.64 89
Cost of LPG 1.51 1.51
Cost of Water .14 .14 .14
Cost of Electricity 1.24 1.24 1.24
Cost of Labor 8.6 8.6 8.6
Others
Food Wrap .90 .90 .90
Liquid Soap .10 .10 .10
Annex B
Powdered Soap .04 04
02 Sodium Hypochlorite 02
Disposable hand gloves .02 .02 .02
37.21 52.46 57.71
TOTAL 147.38
13-2
Day 2
BREAKFAST LUNCH SUPPER
Cost of Raw
Food
40.05 36.25 31.34
Cost of LPG 1.51 1.51 1.51
Cost of Water .14
1.24
Cost of
Electricity
I .24
Cost of Labor 8.6 8.6 8.6
Otlærs
Food wrap .90 .90 .90
Liquid Soap 10 .10 .10
Powdered
Soap
.04 .04 .04
02 Sodium
Hypochlorite
.02 02
Disposable
hand gloves
.02 .02 .02
52.62 48.82 43.91
TOTAL 145.35
Day 3
02
Annex B
BREAKFAST LUNCH SUPPER
Cost of Raw
Food
32.36 37.15 39.5
Cost of LPG 1.51 1.51 1.51
Cost of Water .14 .14 14
Cost of
Electricity
I .24 1 24
Cost of Labor 8.6 8.6 8.6
Others
Food wrap .90 .90 .90
Liquid Soap .10 .10 .10
Powdered
Soap
.04 .04
Sodium
Hypochlorite
.02 .02 .02
Disposable
hand gloves
.02 02
44.93 49.72 52.07
TOTAL 146.72
Day 4
BREAKFAST LUNCH SUPPER
Cost of Raw
Food
40.85 31.65 34.84
Cost ofLPG 1.51 1.51 1.51
Cost of Water .14 .14 14
Cost of
ziectricity
1.24 1.24 1.24
Annex B
Cost of Labor 8.6 8.6
Others
Food Wrap .90 .90 .90
Liquid Soap .10 .10 .10
Powdered
Soap
.04
Sodium
Hypochlorite
.02 .02 .02
Disposable
hand gloves
.02 .02
.02
53.42
TOTAL 145.05
COST OF LPG
Ave. Consumption : Cylinders (50kg) in 3 days
• P2730/50kg cylinder
• P2730.OO X 2 cylinder = P5,460.OO
• P5460.OQ
3 days
• PI 820.00 400 pts.
• P4.55/2t
3 meals
Cost of LPG/Patient/Meal.• P 1.51 /Dt/meal
COST OF ELECTRICITY
Average Consumption:6 269.61 KwHR,/Month — P44 514.23/month
P44 514.23/month 30
days
P1483.81/day
3 meals
p494.6()
400 patients
Annex B
Cost of Electricity/Patient/Meal: = PI .24
COST OF WATER
Average Consumption:90 cu.m/month (P4.884.4())
P4 884.40
30 days
P 162.81/day
3 meals p 54.27
400 patients
Cost of Water /Patient/Meal. • —- PO.14
13-6
COST OF LABOR
Personnel No. of
Personnel
Rate /day Total
NutritionistDietitian
Il
3 I I R I
.00
NutritionistDietitian
-
Contractual
1 355.00 355.00
Cook 11 4 546.27 2185.08
Cook-Contractual 1 275.00 275.00
Office Aide 1 275.00 275.00
Food
ServerContractual
13 275.00
27500
3575.00
Encoder-
Contractual
10,333.80
Cost of Labor/Day/Patient
= 10,333.80
400 patients
Annex B
= 25.83/patient/dav
3 meals
Cost of Labor/Patient/Meal: P 8.61/patient/meal COST OF OTHER SUPPLIES
Cling Wrap
Average Consumption: 1 roll/meal
400 patients
Cost of other supplies/Patient/Meal: = PO.9()
Liquid Soap
Average Consumption: 1 pack (600mI)
P128.OO/pack
3 meals
P42.66
400 patients
Cost of Liquid soap (Patient/Meal: = PO.IO
Powdered Soap
Average Consumption: I bag (2000g) in 4 days
PI 69.00/bag
4 days
P42.25/bag
3 meals
p14.08
400 patients
Cost of powdered soap /Patient/Meal: = PO.04
Sodium Hypochlorite
Average Consumption: I gallon (4 liters) in 7 days
7 days
P22.43/day
3 meals
Annex B
P7.48/meal
400 patients
Cost of Sodium Hypochlorite / Patient/Meal: = po.02
Disposable Hand gloves
Average Consumption: I pack (100pcs) in 2 days
P45.00/ pack
2 days
3 meals
P7.50/mea1
400 meals
Cost of Disposable Hand Gloves /Patient/Meal: =
Annex
C
SAMPLE REGULAR MEAL PLAN (1800 KCAL)
Menu Exchange Kilocalorie ( osttng
BREAKFAST
Banana 40 4.3
Sliced Bread 2 slices bread 90 100 2.7
Arrozcaldo with I cu Lu aw 66.6 2
Hard cooked e I CE -medium 122 5
30 Chicken Breast 41 5.6
1 ts Oil 45 .5
Garlic, Onion, .5
Pe er, atis, salt .5
Coffee Mix I sachet Ko iko black 3 in I 90 4.15
Mar arine 90 2.19
p24.64
12.6
594.6 kcal
123 LUNCH
Ban s Sini an 2 1/2 NIBS Ban -El))
1/4 cu Radish & Kan on 8 2.00
Onion, Tomatoes, Sam alok I .00
Bihon Guisado 1/2 cu Bihon 50 2.16
10 s Chicken breast 13.6 1.23
1/4 cu of Cabba e, Sa Ote, Carrot 8 2.50
Onion, arlic, e er .50
1 ts Oil 45 .50
Rice 250 9.90
Tro ical Fruit Salad Watermelon, a a a, banana 40 4.5
4 ts Condensed milk 20 2
I tbs All Pu ose cream 45
19
602.6 kcal
DINNER
Bistek Tagalo 2 1/2 MBS Beef laman
123
Su ar, Pinea le Juice 12 3
2 ts . Oil 90 .5
Habitsuelas .5
Cornstarch 2.5 .3
Calamansi .5
Pe er, Garlic, Onion 2
To e-Carrots Guisado 1/2 cu To e 25 ) &carrot(20 16 4
5 Shrim s 500 : 100 ts 8.2 1.5
Su ar (60 : 100 ts 2.4 1
I ts .0il 45 .5
Patis .5
Onion, arlic
Rice I 1/4 cu
40
589. I kcal p45.14
Pa a a I slice 120 -AP)
Total 1786.3kcal PI 09.67
Annex C
SAMPLE REGULAR MEAL PLAN (1800 KCAL)
Day 2
Menu Exchan e Kilocalorie Costin
BREAKFAST
Watermelon 1 slice 226 -AP 40
153.5
4.5
1 1.15
Rice 1 1/4 cu
Hotdo 2 cs Hotdo
I ts Oil
Milk with Su ar I sachet Bearbrand Swak, 33 s
1 sachet Brown su ar 20 2
643.8 kcal P40.05
LUNCH
Chicken Estofado 2 MBS Chicken 82 10
20 Saba 20 .5
20 Camote 16 .5
2 ts Oil 90 .50
Garlic, onion, bell er, laurel 1.5
So sauce ,Tomato sauce 1
Cornstarch 2.5 .5
Su ar 5
5 Pecha Guisado with 1/2 cu Pecha 16
45
Beef 15 Beef
I ts Oil
Garlic, Onion,tomatoes,bell e er 1.5
Patis .5
Rice 1 1/4 cu s 250 9.9
Pinea le I slice 40 4
587 kcal P36.25
DINNER
Breaded Fish 2 1/2 MBS Matambaka 102.5 12.5
2 ts Oil 90
10 s Flour (1k : 100 ts 4.5 .5
Cornstarch 2.5 .5
Banana heart with 1/2 cu Banana Heart 16 2
O ster sauce 1 ts Oil 45
Garlic, onion. bell e
Su yar
So sauce
c-2
Annex C
SAMPLE REGULAR MEAL PLAN (1800 KCAL)
Menu Exchan e Kilocalorie Costin
BREAKFAST
Pa a a 1 slice 120 40 1.44
Rice 1 1/4 cu 250 9.9
Corned beef Guisado 45 s Corned Beef 129 10
1 ts Oil 45
Onion , arlic, salt
Boiled E
93 Chocolate drink I sachet Milo,22 rms
679 kcal P 32.36
LUNCH
Chicken Afritada 2 MBS Chicken 82 14
1/4 cu Carrots ,
otato,
een eas 8 1
Onion ,salt .5
Su ar 2.5 .5
Catsu ,tomato sauce 1
I ts Oil 90 .5
Ginataan Kamansi 1/3 cu kamansi 16 2
2 ts Coconut milk 45
Dilis 1/4 kl:lOO ts
1/2 ts oil
Garlic, Onion, Ginger, Green
onions
Salt, su ar .5
Kalawa wder .5
Rice 250 9.90
Banana 40 4.3
563.95 kcal P37.15
DINNER
Fish Tausi 2 1/2 MBS Barileson 102.5 14
E 10 cs:lOO ts 12.2 .5
Su ar 1/4 cu : 100 ts 2.4 .1
Cornstarch 1k : 100 ts 2.5 .3
Flou 1k :100 ts 4.5
2 ts Oil 90
S uash-alu bati uisado 1/2 cu S uash and alu bati 16 1
1/2 ts Oil 22.5 .5
Garlic, onion
5
P39.5
Salt
Rice 1 1/4 cu
Ponkan
545.1 kcal
Total 1788.05kcal P109.01
Annex C
SAMPLE REGULAR MEAL PLAN (1800 KCAL)
Da 4
Menu Exchan e Kilocalorie Costin
BREAKFAST
Banana 40 4.3
Rice 1 1/4 cu Rice
250 9.9
Chicken Adobo 2 1/2 MBS Chicken 102.5 12
1 ts oil 45
.5
50 Potatoes 2 64
So sauce, Vine 'ar
Salt, Onion, Garlic, Pe er
Milk with su ar I ack Bearbrand swak, 33 s 150.15 11.15
1 sachet Sugar 20 1
633.29 kcal
LUNCH
Paksiw na Tulin an 2 1/2 MBS Tulin an 102.5 12.5
1 ts oil 45 .5
Vine ar, onion, P er .5
Squash-Stringbeans
Guisado
1/2 cup Squash & stringbeans 16 1
I ts oil 45 .5
9.9
Su ar 2.5
Onion, arlic, salt
Patis
Rice 1 1/4 cu Rice 250
Potato Salad 40 Potato, 20 carrots 28 2
10 Pinea le tidbits, 5 raisins 4+13.317.3
1 ts ma onnaise, 45 .5
1/2 tbs All Pu ose cream 22.5 1
10 Cheese 15 .5
2 ts Condensed Milk 20 .5
608.8 kcal P 31.65
DINNER
Beef Patties 75 Beeflaman 2 1/2 exch 123 19
Su ar 2.5 .5
2 ts . Oil 90 .5
Onion, arlic, er