ZAMBOANGA PENINSULA

REGIONAL REFERRAL SYSTEM

Produced by
Health Facility Development Unit (HFDU)
Department of Health – Zamboanga Peninsula Center for Health
Development
2023
TABLE OF CONTENTS
FOREWORD

ACKNOWLEDGMENT

MESSAGE FROM [IMPORTANT PERSON HERE]

INTRODUCTION

Background

Legal Mandates

General Objective

Specific Objectives

DEFINITION OF TERMS

REFERRAL SYSTEM FRAMEWORK AND CONCEPTS

Framework

Categorization of Referrals

Referral Procedure

THE WEB-BASED ZAMBOANGA PENINSULA REFERRAL SYSTEM

Background

Guiding Principles

General Objective

Specific Objectives

Specific Guidelines

Roles and Responsibilities of Stakeholders

Instructional Guide

MONITORING AND EVALUATION

The TWG is composed of:

Chairperson :

Vice Chairperson :

Technical Writers : Khalid Bin Walid E. Epping, RN (Development Management Officer II)
 INTRODUCTION
BACKGROUND
The Department of Health Zamboanga Peninsula Center for Health Development, hereinafter
referred to as DOH-ZPCHD, is continuing its pursuit in bringing about health reforms in the region
through the Universal Health Care Act of 2019 (Republic Act 11223). This integrated and
comprehensive approach in harmonizing our health systems ensures quality care, healthy living
conditions, and protection from health hazards will be provided for all patients, families, and
communities in the region.

One of the salient features of the Universal Health Care Act of 2019 is the creation of an equitable,
primary-care oriented, and integrated healthcare system in the form of province or city-wide
Health Care Provider Networks (HCPN) as stipulated in Section 18 of the UHC Act. As such, the
DOH-ZPCHD together with the different hospitals and health care facilities in the region have
endeavored in the establishment of a functional HCPN per province in the region and integration
of both public and private health facilities to provide coordinated and comprehensive health care
following the Administrative Order No. 2020-0019, otherwise known as the Guidelines on the
Service Delivery Design of Health Care Provider Networks.

Additionally, the establishment of a functional referral system is further emphasized in the Local
Health Systems Maturity Levels (AO 2020-0037) as one of its key reform areas to make sure that
the Local Government Units are in line with the vision of HCPN.

Furthermore, this referral system is consistent with the goals of the Republic Act 11463, otherwise
known as the Malasakit Centers Act of 2019. This program was signed into law by former President
Rodrigo Duterte to provide medical and financial assistance for indigent Filipinos. With this, the
DOH-ZPCHD also aims to incorporate the Malasakit Center program into this health system to
strengthen the thrust of this project that is to provide equitable and affordable access to quality
health care to the people of Zamboanga Peninsula. This will be helpful especially to the
marginalized members of our community.

Currently, the majority of the referral systems in the region are fragmented and disorganized.
Oftentimes, health facilities have a hard time navigating their patients throughout the referral
process because of the lack of a harmonious referral system, vague roles and responsibilities of the
health facilities, poor communication and coordination among health facilities, and/or knowledge
deficit. In turn, the referral process becomes unnecessarily long thereby decreasing the quality of
care, jeopardizing patient safety, and wasting the health care resources.

To improve the health system performance in the region, the DOH ZPCHD, in consultation with
other stakeholders involved, has established the guidelines found herewith.

LEGAL MANDATES
The Zamboanga Peninsula Regional Patient Referral System is grounded on the following policy
issuances:

 Republic Act No. 11223: The Universal Health Care (UHC) Act and its Implementing Rules
and Regulations (IRR)
  Administrative Order No. 2020-0019: Guidelines on the Service Delivery Design of Health
Care Provider Networks
 Administrative Order No. 2020-0021: Guidelines on Integration of the Local Health Systems
(LHS) into Province-wide and City-wide Health Systems (P/C WHS)
 Administrative Order No. 2020-0003: Strategic Framework on the Adoption of Integrated
People-Centered Health Services in All Health Facilities
 Administrative Order No. 2020-0018: Guidelines on Contracting Province-wide and /or City-
wide Health Systems
 Administrative Order No. 2020-0024: Primary Care Policy Framework and Sectoral Strategies
 Administrative Order No. 2020-0047: Rules and Regulations Governing the Licensure of
Primary Care Facilities in the Philippines
 Administrative Order No. 2020-0037: Guidelines on Implementation of the Local Health
Systems Maturity Level (LHS ML)
 Administrative Order No. 2020-0026: Monitoring and Evaluation Framework for RA 11223,
Otherwise known as the Universal Health Care Act
 Administrative Order No. 2017-0014: Framework for Redefining Service Delivery Networks
(SDN)
 Administrative Order Number 2014-0046: Defining the Service Delivery Networks (SDNs) for
Universal Health Care or Kalusugan Pangkalahatan
 Department Memorandum 2014-03 13: Adoption of the Guidelines in Establishing Service
Delivery Network
 Republic Act No. 10354: The Responsible Parenthood and Reproductive Health
Implementing Rules and Regulations

GENERAL OBJECTIVE
The Zamboanga Peninsula Patient Referral System Guidelines shall set the standards for patient
referral, patient navigation, and coordination system among all hospitals and other health facilities
in Zamboanga Peninsula.

SPECIFIC OBJECTIVES
Specifically, the Zamboanga Peninsula Patient Referral System Guidelines aim to:

1. Ensure effective referral processes from the community to the hospitals and other health
facilities to save lives and ensure high quality and continuity of care;
2. Avoid overlapping of stakeholder roles through proper delineation of roles and
responsibilities;
3. Minimize patient congestions in higher level facilities;
4. Foster a well-coordinated relationship among all health care organizations in the health
system and streamline communication among health service providers; and
5. Integrate referral management within the existing clinical workflow to ensure strict
compliance to the established referral protocols outlined in this Manual.
 DEFINITION OF TERMS
 Apex hospital – is an end-referral hospital that has full complement of health services,
including manpower and equipment. In Region IX, the Apex Hospital is Zamboanga City
Medical Center.
 Contracting - Refers to a process where providers and networks are engaged to commit and
deliver quality health services at agreed cost, cost sharing and quantity in compliance with
prescribed standards.
 Emergency - Refers to a condition or state of a patient wherein based on the objective findings
of a prudent medical officer on duty, there is immediate danger and where delay in initial
support and treatment may cause loss of life or permanent disability to the patient, or in the
case of a pregnant woman, permanent injury or loss of her unborn child, or a non-institutional
delivery.
 Healthcare Facility – is any licensed institution that provides treatment of diseases and/or
injuries, specifically referring to the Primary Care Provider Network (health stations,
CHOs/RHUs, clinics); Health Care Provider Network (hospitals – Level 1, 2, and 3) and the Apex
hospital (Single Specialty Hospital / General Hospitals with Multi-specialty centers)
 Health Care Provider Network (HCPN) – refers to a group of primary to tertiary care
providers, whether public or private, organized to follow a pathway in referring the patient with
the primary care provider acting as the navigator of health care within the network ensuring
continuum of care.
 Individual-based Health Services - refer to services which can be accessed within a health
facility or remotely that can be definitively traced back to one (1) recipient, has limited effect at
a population level and does not alter the underlying cause of illness such as ambulatory and
inpatient care, medicines, laboratory tests and procedures, among others (RA 11223).
 Population-based Health Services - Refer to interventions such as health promotion, disease
surveillance, and vector control, which have population groups as recipients.
 Primary Care - Refers to initial-contact, accessible, continuous, comprehensive, and
coordinated care that is accessible at the time of need including a range of services for all
presenting conditions, and the ability to coordinate referrals to other health care providers in
the health care delivery system, when necessary.
 Primary Care Provider Network - refers to a coordinated group of public, private, or mixed
primary care providers, as the foundation of the HCPN.
 Primary Care Facility – is a private or public institution that primarily delivers primary care
services which shall be licensed or registered by the DOH with the prescribed service capability.
 Primary Health Care - Refers to a whole-of-society approach that aims to ensure the highest
possible level of health and well-being through equitable delivery of quality health services.
 Referral - the process in which a health facility officially and appropriately transfers the
management of a patient to a better or differently resourced facility and refers the patient back
to the assigned primary care provider.
 Referral Facility – is the receiving hospital facility where the patient is electronically referred by
the referring facility for an immediate intervention of a critical illness or injury where the latter
facility could not intervene.
 Referring Facility – is the health facility (CHO/RHU, birthing clinic, infirmaries, and hospitals)
where the patient is initially managed and treated.
 REFERRAL SYSTEM FRAMEWORK AND CONCEPTS
The Universal Health Care Act provides for the formation of Health

TYPES OF REFERRAL
Patient referrals are typically classified based on its directions whether it is to: a) another facility; b)
within the same facility; or c) a specific level of facility.

Internal Referral – refers to patient referrals that take place within the same facility, usually from
one department to another (e.g., Male Medical Ward refers a patient with nosocomial pneumonia
to the Isolation Ward) or from one health service provider/physician to another.

External Referral – refers to when a patient is referred to another health facility or institution.