Republic Act No. 11332 | Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act
The 2020 Revised Implementing Rules and Regulations of Republic Act No. 11332, or the Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act
RULE I GENERAL PROVISIONS
Section 1. Title. – These rules and regulations shall be known as the 2020 Revised Implementing Rules and Regulations (IRR) of Republic Act No. 11332, or the “Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act” (hereinafter referred to as the Act).
Section 2. Declaration of Policy. – It is hereby declared the policy of the State to protect and promote the right to health of the people and instill health consciousness among them. It shall endeavor to protect the people from public health threats through the efficient and effective disease surveillance of notifiable diseases including emerging and reemerging infectious
diseases, diseases for elimination and eradication, epidemics, and health events including chemical, biological, radioactive, nuclear and environmental agents of public health concern and provide an effective response system in compliance with the 2005 International Health Regulations (IHR) of the World Health Organization (WHO), and its amendments.
The State recognizes epidemics and other public health emergencies as threats to public health and national security, which can undermine the social, economic, and political functions of the State.
The State also recognizes disease surveillance and response systems of the Department of Health (DOH) and its local counterparts as the first line of defense to epidemics and health events of public health concern that pose risk to public health and security.
Section 3. Objectives. – This IRR shall have the following objectives:
- To continuously develop and upgrade the list of nationally notifiable diseases and health events of public health concern with their corresponding case definitions and laboratory confirmation;
- To ensure the establishment and maintenance of relevant, efficient and effective disease surveillance and response system at the national and local levels;
- To expand collaborations beyond traditional public health partners to include others who may be involved in the disease surveillance and response such as, but not limited to, agricultural agencies, veterinarian, environmental agencies, law enforcement entities, the hotel industry and other accommodation establishments, transportation (road, rail, maritime and aviation sectors), population and development agencies and information and communication technology companies, and other private establishments;
- To provide accurate and timely health information about notifiable diseases, and health-related events and conditions to citizens and health providers as an integral part of response to public health emergencies;
- To establish effective mechanisms for strong collaboration with national and local government health agencies to ensure proper procedures are in place to promptly respond to reports of notifiable diseases and health events of public health concern, including case investigations, treatment, and control and containment, including follow-up activities;
- To ensure that public health authorities have the statutory and regulatory authority to ensure the following:
- Mandatory reporting of reportable diseases and health events of public health concern;
- Epidemic/outbreaks and/or epidemiologic investigation, case investigations, patient interviews, review of medical records, contact tracing, specimen collection and testing, risk assessments, laboratory investigation, population surveys, and environmental investigation;
- Implement quarantine and isolation procedures; and
- Rapid containment and implementation of measures for disease prevention and control;
- To provide sufficient funding to support operation requirements to establish and maintain Epidemiology and Surveillance Units (ESU) at the DOH, health facilities, Local Government Units (LGUs), offices and/or agencies; efficiently and effectively investigate epidemics and health events of public health concern; validate, collect, analyze and disseminate disease surveillance information to relevant agencies or organizations; and implement appropriate epidemiologic response;
- To require public and private physicians, allied medical personnel, professional societies, hospitals, clinics, health facilities, laboratories, pharmaceutical companies, private companies and institutions, workplaces, schools, prisons, jails, and detention centers, ports, airports, establishments, communities, other government agencies, and non-governmental organizations (NGOs) to actively participate in disease surveillance and response; and
- To respect to the fullest extent possible, the rights of people to liberty, bodily integrity, and privacy while maintaining and preserving public health and security.
Section 4. Definition of Terms. – For the purposes of this IRR, the following terms are defined as such:
- Confirmed case refers to a case that is classified as confirmed for reporting purposes, as may be defined by the DOH specific to a disease. Case definitions for this case , classification are commonly based on clinical, laboratory, and other epidemiological criteria but may only be based on current/existing recommendations as to confirming laboratory test;
- Contact tracing refers to the process of identification, listing, assessment, and monitoring of persons who may have come into contact with an infected person and subsequent collection of further information about these contacts. It is a major public health intervention to interrupt ongoing transmission and reduce spread of an infection;
- Disease refers to an illness due to a specific toxic substance, occupational exposure or infectious agent, which affects a susceptible individual, either directly or indirectly, as from an infected animal or person, or indirectly through an intermediate host, vector, or the environment;
- Disease control refers to the reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts and continued intervention measures to maintain the reduction;
- Disease response refers to the implementation of specific activities to control further spread of infection, outbreaks or epidemics and to prevent reoccurrence. It includes verification, contact tracing, rapid risk assessment, case measures, treatment of patients, risk communication, conduct of prevention activities, and rehabilitation and reintegration. Disease response activities shall include the imposition of minimum public health standards including, but not limited to, movement restrictions, partial or complete closure of schools and businesses, imposition of quarantine in specific geographic areas and international or domestic travel restrictions, construction of facilities for the quarantine of health and emergency front liners, and the prepositioning and distribution of personal protective equipment for health workers;
- Disease surveillance refers to the ongoing systematic collection, analysis, interpretation, and dissemination of outcome-specific data for use in the planning, implementation, and evaluation of public health practice in terms of epidemics, emergencies, and disasters. A disease surveillance system includes the functional capacity for data analysis as well as the timely dissemination of these data to persons who can undertake effective prevention and control activities;
- Emerging or re-emerging infectious diseases refer to diseases that:
- Have not occurred in humans before;
- Have occurred previously but affected only small numbers of people in isolated areas;
- Have occurred throughout human history but have only recently been recognized as a distant disease due to an infectious agent;
- Are caused by previously undetected or unknown infectious agents;
- Are due to mutant or resistant strains of a causative organism; or
- Once were major health problems in the country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population;
- Epidemic or outbreak refers to an occurrence of more cases of disease than normally expected within a specific place or group of people over a given period of time;
- Epidemiologic investigation refers to an inquiry to the incidence, prevalence, extent, source, mode of transmission, causation of, and other information pertinent to a disease occurrence;
- Health event of public health concern refers to either a public health emergency or a public health threat due to biological, chemical, radio-nuclear, and environmental agents;
- Infectious disease refers to a clinically manifested disease of humans or animals resulting from an infection;
- Isolation refers to the separation of ill or contaminated persons or affected baggage, containers, conveyances, goods or postal parcels from others in such a manner as to prevent the spread of infection or contamination;
- Local counterparts of the DOH refer to government offices and agencies performing the same purposes, mandates, and/or functions as the DOH within the provinces, cities, or municipalities;
- Mandatory reporting refers to the obligatory reporting to the DOH Epidemiology Bureau (EB) ortheir local counterparts, as required for notifiable diseases, epidemics or health events of public health concern;
- Non-cooperation refers to the failure to fully comply with a duty required under the provisions of the Act and this IRR, or to abide by guidelines, orders, issuances, or ordinances issued pursuant to, and to implement the provisions of, the Act or this IRR;
- Notifiable disease refers to a disease enumerated or may be listed pursuant to Rule II herein, which must be reported to public health authorities in accordance with Rule VI, Section 4 of this IRR;
- Probable case refers to a case that is classified as probable for reporting purposes, as may be defined by the DOH specific to a disease. Case definitions for this case classification are commonly based on clinical, laboratory, and/or other epidemiological criteria;
- Public health authorities refers to the DOH, specifically, the EB, Disease Prevention and Control Bureau (DPCB), Bureau of Quarantine and International Health Surveillance, Health Emergency Management Bureau (HEMB), Food and Drug Administration (FDA), Government hospitals, Research Institute for Tropical Medicine (RITM) and other National Reference Laboratories, and Centers for Health Development (CHD) or DOH Regional Offices, the local health offices (provincial, city or municipality), or any person directly authorized to act on behalf of the DOH and/or the local health offices. For this purpose, Local Chief Executives shall be considered public health authorities;
- Public health emergency refers to an occurrence or imminent threat of an illness or health condition that:
- Is caused by any of the following: (1) Bioterrorism; (2) Appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; (3) A natural disaster; (4) A chemical attack or accidental release; (5) A nuclear attack or accident; or (6) An attack or accidental release of radioactive materials; and
- Poses a high probability of any of the following: (1) A large number of deaths in the affected population; (2) A large number of serious injuries or long-term disabilities in the affected population; (3) Widespread exposure to an infectious or toxic agent that poses a significant risk of substantial harm to a large number of people in the affected population; (4) International exposure to an infectious or toxic agent that poses a significant risk to the health of citizens of other countries; or (5) Trade and travel restrictions;
- Public health threat refers to any situation or factor that may represent a danger to the health of the people;
- Quarantine refers to the restriction of activities and/or separation from others of suspect persons whoare not ill, or of suspect baggage, containers, conveyances, or goods, in such a manner as to prevent the possible spread of infection or contamination; and
- Suspect case refers to a case that is classified as suspect for reporting purposes, as may be defined by the DOH specific to a disease. Case definitions for this case classification are commonly based on clinical and other epidemiological criteria.
Section 5. Acronyms. – As used in this IRR, the following terms shall mean:
- “BOQ” – Bureau of Quarantine of the DOH;
- “CESU” – City Epidemiology and Surveillance Unit;
- “CHD” – Center for Health Development or Regional Offices of the DOH;
- “CIF” – Case Investigation Form;
- “COVID-19” – Coronavirus Disease-2019;
- “CRF” – Case Report Form;
- “DOH” – Department of Health;
- “EB” – Epidemiology Bureau of the DOH;
- “ESU” – Epidemiology and Surveillance Unit;
- “FHSIS”- Field Health Services Information System;
- “HSSS” – Hospital Sentinel Surveillance System;
- “IATA” – International Air Transport Association;
- “IATF-MEID” – Inter-Agency Task Force for the Management of Emerging or Re-Emerging Infectious Diseases;
- “THR” – 2005 International Health Regulations, and its amendments;
- “IRR” – The 2020 Revised Implementing Rules and Regulations of Republic Act No. 11332;
- “KMITS” – Knowledge Management and Information Technology Service of the DOH;
- “LESU”- Local Epidemiology and Surveillance Unit;
- “LGU” – Local Government Units;
- “MERS”- Middle East Respiratory Syndrome;
- “MESU”- Municipal Epidemiology and Surveillance Unit;
- “NDEPH” – List of Notifiable Diseases, Syndromes and Health Events of Public Health Concern;
- “NGO” – Non-Government Organization;
- “PESU”- Provincial Epidemiology and Surveillance Unit;
- “PHEIC” – Public Health Emergency of International Concern;
- “PIDSR” – Philippine Integrated Disease Surveillance and Response;
- “RESU”- Regional Epidemiology and Surveillance Unit;
- “SARS” – Severe Acute Respiratory Syndrome; and
- “WHO” – World Health Organization.
RULE II NOTIFIABLE DISEASES AND HEALTH EVENTS OF PUBLIC HEALTH CONCERN
Section 1. Priority Diseases/Syndromes/Conditions Targeted for Surveillance. – The EB shall regularly update and issue a list of nationally notifiable diseases and health events of public health concern with their corresponding case definitions. For purposes of the Act and this IRR, the priority diseases/syndromes/conditions targeted for surveillance shall be selected based on the following categories:
- Diseases spread by droplet:
- Bacterial meningitis;
- Haemophilus influenzae type b (Hib)
- Streptococcus pneumoniae
- Coronavirus disease 2019 (COVID-19);
- Severe acute respiratory syndrome (SARS)-associated coronavirus 2 (SARS-CoV 2)
- Diphtheria;
- Corynebacterium diphtheriae
- Hand Foot and Mouth Disease;
- Human Avian Influenza;
- Influenza-like Illness (ILI);
- Severe acute respiratory syndrome (SARS);
- SARS-associated coronavirus
- Measles;
- Measles morbillivirus
- Meningococcal Disease;
- Neisseria meningitidis
- Middle East Respiratory Syndrome (MERS);
- Middle East respiratory syndrome coronavirus (MERS-CoV); and
- Pertussis (Whooping cough)
- Bordetella pertussis
- Bacterial meningitis;
- Airborne diseases:
- Anthrax;
- Bacillus anthracis
- Human Avian Influenza;
- Influenza-like Illness (ILD; and
- Measles
- Measles morbillivirus
- Anthrax;
- Diseases spread by direct contact:
- Acute Viral Hepatitis;
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis D virus (HDV)
- Anthrax;
- Bacillus anthracis
- Bacterial meningitis;
- Group B Streptococcus
- Escherichia coli
- Neisseria meningitidis
- Diphtheria;
- Corynebacterium diphtheriae
- Hand-Foot-and-Mouth Disease
- Leptospirosis;
- Leptospira
- Meningococcal Disease; and
- Neisseria meningitidis
- Rabies
- Rabies virus (RV)
- Acute Viral Hepatitis;
- Vehicle-borne diseases:
- Acute Bloody Diarrhea
- Campylobacter bacteria
- Salmonella bacteria
- Shigella species (bacillary dysentery)
- Entamoeba histolytica (amoebic dysentery)
- Enterohaemorrhagic E. coli (EHEC)
- Acute Viral Hepatitis;
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Hepatitis E virus (HEV)
- Anthrax;
- Bacillus anthracis
- Bacterial meningitis;
- E. coli
- Listeria monocytogenes
- Cholera;
- Vibrio cholerae
- Neonatal tetanus
- Clostridium tetani
- Paralytic Shellfish Poisoning;
- Typhoid and Paratyphoid Fever; and
- Salmonella enterica serotype Typhi
- Salmonella enterica serotypes Paratyphi A, B (tartrate negative), and C (S. Paratyphi)
- Poliomyelitis (Acute Flaccid Paralysis)
- Poliovirus
- Acute Bloody Diarrhea
- Vector-borne diseases:
- Dengue;
- Dengue viruses (DENV-1, -2, -3, and -4)
- Acute Encephalitis Syndrome/Japanese Encephalitis; and
- Japanese Encephalitis Virus
- Malaria
- Plasmodium parasites (P. falciparum, P. malariae, P. ovale, and P. vivax)
- Dengue;
Section 2. Basis for Inclusion and Exclusion. – The selection and the deletion of diseases and health events of public health concern, including the procedure to be followed, shall be governed by DOH Administrative Order No. 2018 – 0028 or the “Guidelines for the Inclusion and Delisting of Diseases, Syndromes, and Health Events in the List of Notifiable Diseases, Syndromes and Health Events of Public Health Concern (NDEPH)”, or any subsequent amendments or revisions thereto. The DOH may classify notifiable diseases under those which should be immediately notifiable (Category I) or weekly notifiable (Category II). The listing and delisting of diseases of zoonotic origins, such as those being observed by the Department of Agriculture – Bureau of Animal Industry, shall be upon the recommendations of the Philippine Inter-Agency Committee on Zoonoses created pursuant to Administrative Order No. 10, s. 2011;
Provided, that the reference on notifiable diseases shall likewise include Volume 2, Section 10 of the latest Manual of Procedures of the Philippine Integrated Disease Surveillance and Response (PIDSR) and Event-based Surveillance and Response”
Section 3. Criteria for Inclusion. – The criteria for inclusion, recommendation, and issuance of the List of Notifiable Diseases and Health Events of Public Health Concern for mandatory reporting are any one or more of the following:
- Disease is of international or national concern;
- Disease has epidemic or outbreak potential;
- Disease is being eliminated;
- Disease is included in the top ten (10) leading cause of morbidity and/or mortality in the Philippines;
- Disease with large number of serious or long term disabilities in the affected population;
- Disease with large number of deaths in the affected population;
- Disease characteristics, prevalence, incidence and/or mortality is changing and would likely impact public health;
- Disease is a priority of the DOH; or
- Disease or health event that fulfills either one of the following surveillance goals:
- To monitor and control the spread of disease; and
- To monitor the trends of a disease over time.
Section 4. Criteria for Exclusion. – The followingarethe criteria for exclusion (de-listing) in the List of Notifiable Diseases and Health Events of Public Health Concern:
- Disease is not considered a public health risk or threat;
- Disease has no epidemic or outbreak potential;
- Disease has been eliminated or controlled;
- Disease is no longer included in the top 10 leading cause of morbidity and/or mortality;
- Disease has low or no incidence of disability or residual complication;
- Disease has low risk for mortality; or
- Disease characteristics, prevalence, incidence and/or mortality is consistently low or has no impact to public health
RULE III DECLARATION OF PUBLIC HEALTH EMERGENCY
Section 1. Authority of the Secretary of Health. – Subject to Section 2 of this Rule, the Secretary of Health shall have the authority to declare epidemics of national and/or international concern, which shall include but are not limited to:
- Epidemic linked with nationally or internationally distributed pandemic;
- Case/s of exotic disease acquired locally;
- Diseases linked with pathogenicity;
- Diseases with significant risks of international spread;
- Epidemics associated with health service failure; and
- Epidemics in tourist facilities, among foreign travelers or at national/international events,
No declaration by any LGU of an epidemic that constitutes national and international concern shall be valid and effective without the written affirmation/approval of the Secretary of Health.
Pursuant to Section 105 of the Local Government Code, in cases of epidemics, pestilence, and other widespread public health dangers, the Secretary of Health, upon the direction of the President of the Republic of the Philippines and in consultation with the LGU concerned, may temporarily assume direct supervision and control over the health operations of the LGU for the duration of the emergency, but in no case exceeding a cumulative period of six (6) months; Provided, that the period for such direct national control and supervision may be further extended upon the concurrence of the LGU concerned.
The Secretary of Health may convene the Inter-Agency Task Force for the Management of Emerging or Re-emerging Infectious Diseases (IATF-MEID) created under Executive Order No. 168, s. 2014, the Inter-Agency Committee on Environmental Health created under Executive Order No. 489, s. 1991, or such inter-agency bodies or task forces as
may be created and assigned, for appropriate response (e.g. de-escalation or escalation of response). Regional counterparts of the IATF-MEID or other relevant inter-agency bodies, task forces, or committees may likewise be called upon to ensure the alignment of national directives with local actions.
The Secretary of Health shall have the authority to declare if an epidemic or outbreak has ended.
Section 2. Declaration by the President. – In the event of an epidemic of national and/or international concern that threatens national security, the President of the Republic of the Philippines shall declare a State of Public Health Emergency and mobilize governmental and non-governmental agencies to respond to the threat.
Section 3. Declaration by Provincial, City, or Municipal Health Offices. – Provincial, city or municipal health offices shall only declare a disease outbreak within their respective localities; Provided, that the declaration is supported by sufficient scientific evidence-based on disease surveillance data, epidemiologic investigation, environmental investigation, and laboratory investigation.
Provided, further, that the Secretary of Health shall have the authority to affirm or reverse any declaration of a disease outbreak by any provincial, city, and municipal health office.
RULE IV GRANT OF STATUTORY AND REGULATORY AUTHORITY
Section 1. Powers and Functions. – To perform their disease surveillance and response functions, authorized personnel from the DOH and its local counterparts are granted the statutory and regulatory authority to enforce the following, subject to the guidelines as may be issued by the DOH:
- Establishment of public health information systems and disease surveillance and response systems in private and public health facilities deemed necessary to protect the health of the population;
- Mandatory reporting of notifiable diseases and health events of public health concern;
- Conduct of epidemic/outbreak and epidemiologic investigations; case investigations, patient interviews; review of medical records; contact tracing; collection, storage, transport and testing of samples and specimen; risk assessments; laboratory investigation; population surveys; and environmental investigation;
- Rapid containment, quarantine and isolation, disease prevention and control measures, and product recall; and
- Response activities for events of public health concern.
RULE V PUBLIC HEALTH INFORMATION AND DISEASE SURVEILLANCE AND RESPONSE SYSTEMS
Section 1. Official List of Institutionalized Systems. – The official public health information and disease surveillance and response systems shall be as follows:
- Hospital Sentinel Surveillance System (HSSS);
- Field Health Services Information System (FHSIS);
- Philippine Integrated Disease Surveillance Response (PIDSR) System, with its Case-based Surveillance and Event-based Surveillance;
- Community-Based Disease Surveillance System;
- Laboratory Surveillance System;
- Quarantine Health Services and Information System of the BOQ; and
- Other duly institutionalized public health disease surveillance and response systems as may be issued by the DOH (e.g. COVID KAYA for COVID-19, Health Facility Capacity Monitoring, among others).
The DOH EB shall be responsible in giving the specifications of health information systems and disease surveillance and response systems if there will be new systems created aside from the ones listed in the official institutionalized system to ensure that the data collected from various local units can be collated in a central database for future analysis and decision-making processes.
Section 2. Operations. – The DOH and its local counterparts shall establish and maintain functional disease surveillance and response systems, which include coordination mechanisms, implementation protocols for reporting and response, measures for data security and confidentiality, and procedures and provision to ensure safety of personnel conducting disease surveillance and response activities.
The DOH and its local counterparts shall ensure that all surveillance and response officers have adequate capacity for mandatory reporting of notifiable diseases, risk assessment, epidemiology, disease surveillance, and response to epidemics and health events of public health concern. They shall also ensure that the safety and protection of all personnel directly involved in surveillance and response activities are upheld.
Section 3. Digitization. — The DOH, in close coordination with its local counterparts and other government agencies and stakeholders, shall endeavor to develop digitized public health information and disease surveillance and response systems to maximize the identification, detection, testing, quarantine and isolation, treatment, and other activities aimed at preventing, mitigating, containing, or addressing notifiable diseases and health events of public health concern.
Section 4. Respect for Human Rights. – All personnel of the DOH andits local counterparts, and all other individuals or entities involved in conducting disease surveillance and response activities shall respect, to the fullest extent possible, the rights of people to liberty, bodily integrity, and privacy while maintaining and preserving public health and security.
RULE VI MANDATORY REPORTING OF NOTIFIABLE DISEASES AND HEALTH EVENTS OF PUBLIC HEALTH CONCERN
Section 1. Implementation. – The DOH, in close coordination with its local counterparts, is mandated to implement the mandatory reporting of notifiable diseases and health events of public health concern.
Section 2. Persons and Entities Required to do Mandatory Reporting. – Subject to the procedure laid down under this Rule, all of the following, whether public or private, are required to accurately and immediately report notifiable diseases and health events of public health concern provided for under Rule II of this IRR or as may be issued by the DOH:
- Licensed public and private medical and allied health professionals;
- Health facilities and offices as defined under the DOH Administrative Order No. 2019-0060 or the Guidelines on the Implementation of the National Health Facility Registry (Annex “A’’), or subsequent amendments or revisions thereto;
- Workplaces including those in special economic and/or free port zones;
- Public and private educational institutions providing basic education, higher education, or technical-vocational education and/or training;
- Prisons, jails, or detention centers;
- Major transportation passenger terminals, seaports, and airports;
- Dining and hotel and other accommodation establishments, including other establishments as may be required by public health authorities;
- Communities, including household members, the punong barangay, barangay health emergency response teams, homeowners’ associations, indigenous people communities, cooperatives, and community-based organizations;
- Other government agencies providing health and emergency frontline services, border control, and other critical services; and
- Professional societies, civic organizations, and other NGOs.
Section 3. Categories of Notifiable Diseases and Health Events of Public Health Concern. All persons or entities under Section 2 of this Rule shall report notifiable diseases and health events of public health concern in accordance with the PIDSR and their categorization or disease surveillance guidelines or manual of procedures that may be later developed. The diseases/syndromes enumerated under Rule III, or listed as a notifiable disease or health event of public health concern pursuant thereto, shall be categorized as immediately notifiable (Category I) or weekly notifiable (Category II):
For the purpose of this IRR, the following diseases/syndromes shall be categorized as immediately notifiable (Category I):
- Acute Flaccid Paralysis;
- Adverse Event Following Immunization;
- Anthrax;
- COVID-19;
- Hand-Foot-and-Mouth Disease;
- Human Avian Influenza;
- Measles;
- Meningococcal Disease;
- Middle East Respiratory Syndrome (MERS);
- Neonatal Tetanus;
- Paralytic Shellfish Poisoning;
- Rabies; and
- Severe Acute Respiratory Syndrome (SARS).
On the other hand, the following diseases/syndromes shall be categorized as weekly notifiable (Category II):
- Acute Bloody Diarrhea;
- Acute Encephalitis Syndrome;
- Acute Hemorrhagic Fever Syndrome;
- Acute Viral Hepatitis;
- Bacterial Meningitis;
- Cholera;
- Dengue;
- Diphtheria;
- Influenza-like IIness;
- Leptospirosis;
- Malaria;
- Non-neonatal Tetanus;
- Pertussis; and
- Typhoid and Paratyphoid Fever.
Section 4. Submission of Report to the Local Epidemiology and Surveillance Units. – Mandatory reporting of notifiable diseases or health events of public health concern shall be done by submitting the Case Investigation Form (CIF) for diseases/syndromes under Category I diseases/syndromes), or the Case Report Form (CRF) for diseases/syndromes under Category II, to the local epidemiology and surveillance unit (LESU) mandated to be established or maintained under Rule VII of this IRR. The DOH may prescribe such other official forms as appropriate.
In localities where no LESU is in place, the report shall be submitted to the local health office.
Upon receipt of reports, the LESU or the local health office shall then timely submit reports in accordance with reporting procedures mandated under the PIDSR or in disease surveillance guidelines or manual of procedures that may be later developed” as may be directed by the DOH.
In instances where the suspect case involves a foreign national, immediate coordination with the Department of Foreign Affairs and the Bureau of Immigration shall likewise be made for their appropriate action.
Section 5. Deadline for Reporting. – Diseases or syndromes included under Category I are considered immediately notifiable and should be reported to the LESU, RESU, and EB within twenty-four (24) hours from detection. Diseases or syndromes included under Category II shall be reported every Friday of the week.
Section 6. Minimum Data Needed for Mandatory Reporting. – The necessary data for collection in the prescribed official forms under the DOH Manual of Procedures such as the CIF (Annex “B”) or the CRF (Annex “C”), shall be the following:
- Name of disease reporting unit;
- Name of interviewer at first point of contact;
- Name of the person subject of the interview;
- Age;
- Sex;
- Civil status;
- Date of birth;
- Permanent residential address (from the smallest identifiable geographical unit such as street, purok or barangay);
- Current residential address (from the smallest identifiable geographical unit such as street, purok or barangay);
- Date of onset of illness or symptoms; and
- Contact details such as mobile or landline phone number, or email address.
In addition to the aforementioned details, the reporting entities must, as far as practicable, likewise obtain the following data as part of the CIF:
- History of travel (places/countries visited, date of travel to places/countries visited, date of arrival to residence/the Philippines, as well as places recently visited in the Philippines) in the last thirty (30) days; and
- Other health conditions such as comorbidities, medical history, last menstrual period if applicable, among others.
The aforementioned details are crucial and indispensable for the formulation of appropriate policies and disease response activities. Hence, health professionals conducting the interview at point of first contact shall obtain such details from a suspect case, properly informing the data subject that the information sought to be obtained is being processed in accordance with Republic Act No. 10173, or the “Data Privacy Act of 2012,” and that deliberately providing false or misleading personal information on the part of person, or the next of kin in case of person’s incapacity, may constitute as non-cooperation punishable under the Act or this IRR.
Section 7. Furnishing of Information as Prerequisite to Availing of Health Services. – For notifiable diseases and health events of public health concern, patients are obliged to provide complete and accurate data required in Section 6 of this Rule to the interviewer at point of first contact prior to availing of health care services. In emergency cases, the next of kin shall provide the necessary data while the patient is being treated.
RULE VII EPIDEMIOLOGY AND SURVEILLANCE UNITS
Section 1. Establishment of ESUs. – It is hereby directed that all local health offices in every province, city and municipality nationwide, including all the persons and entities required to do mandatory reporting under Rule VI, Section 2, of this IRR shall establish or designate ESUs and submit such designation to the CHD/Regional Office of the DOH in their respective regions not later than fifteen (15) days from the effectivity of this IRR.
The ESU shall capture and verify all reported notifiable diseases and health events of public health concern; provide timely, accurate, and reliable epidemiologic information to appropriate agencies; conduct disease surveillance and epidemiologic response activities including contact tracing; recommend needed response; and facilitate capacity building in applied field epidemiology, disease surveillance and response as organized and provided by the EB.
All ESUs shall be required to have a trained human resource complement and provision of adequate resources, including equipment, logistics, communication, transportation, laboratory supplies and reagents, personal protective equipment and health insurance,to effectively perform their disease surveillance and response functions.
Section 2. Organizational Structure at the Local Level. – The EB together with the RESU shall provide technical assistance to the Provincial/City/Municipal Epidemiology and Surveillance Unit (PESU/CESU/MESVU) in determining appropriate organizational structure to ensure efficient and effective operation of an ESU. Once created, the budgetary requirement for the operation of the ESUs shall be drawn from the annual budgetary allocation of their respective mother offices.
The Office of the Provincial/City/Municipal Health Officer, as approved by the Provincial/City/Municipal Health Office Board, shall determine the establishment and composition of an ESU, in accordance with the organization of the respective Province/City/Municipality-Wide Health System of the said LGU.
Each ESU shall have at least one (1) disease surveillance officer duly trained on applied/field epidemiology, surveillance, and response, and one (1) epidemiology assistant of an allied health profession.
Pending the formal creation or establishment of plantilla positions of ESUs in LGUs, the Local Health Board may temporarily designate personnel capable of performing tasks as stated herein, and be provided with essential resources, to serve as members of the ESU.
Section 3. Functional Relationship. – The RESUs shall be an office directly under the Office of the DOH Regional Director. Resources, such as appropriate number ofplantilla positions and budgetary requirements, shall be distinct and separate from the health emergency units. The functionality of the RESU shall be regularly monitored by the EB, while the PESU/CESU/MESU shall be monitored by the RESU.
Section 4. Functions. – The ESUs at the city and municipal level, as the case may be, shall have the following functions:
- Organize data collection and gather epidemiological data from their health facilities (Rural Health Units, Health Centers, Barangay Health Stations, satellite clinics, etc.);
- Prepare and periodically update graphs, tables and charts to describe time, place and person for Notifiable / Reportable diseases and conditions;
- Analyze data and provide feedback to health facilities and local leaders;
- Identify and inform concerned personnel (Rural Health Physicians, Public Health Nurses, Rural Health Midwives, and Barangay Health Workers) immediately of any disease or condition in their expected areas that: exceeds an epidemic threshold, occurs in locations where it was previously absent, occurs more often in a population group than previously, and presents unusual trends or patterns;
- Carry out outbreak investigations;
- Coordinate with appropriate laboratory for collection and transport of specimens;
- Liaise with other agencies such as Department of Agriculture or Department of Environment and Natural Resources whose assistance is needed to complete outbreak investigation;
- Implement preliminary control measures immediately, if required;
- Forward epidemiological data to the next level on a regular basis and in accordance with the national surveillance protocol; and
- Use epidemiological data to plan and implement communicable disease control activities at the municipal and city level.
ESUs at the provincial level shall perform the following:
- Organize data collection and gather epidemiological data from their sentinel sites (Provincial Hospital, District Hospitals, etc.);
- Prepare and periodically update graphs, tables, and charts to describe time, place and person for Notifiable / Reportable diseases and conditions;
- Analyze data and provide feedback to health facilities and provincial leaders;
- Identify and inform city/municipal health offices immediately of any disease or condition in their expected areas that: exceeds an epidemic threshold, occurs in locations where it was previously absent, occurs more often in a population group than previously, and presents unusual trends or patterns;
- Confirm the status of reported events from the municipalities and cities and to support or implement additional control measures if necessary;
- Assess reported events immediately and, if found urgent, to report all essential information to the CHD/DOH Regional Office and DOH central office. Urgent events are those with serious public health impact and/or unusual or unexpected nature with high potential for spread;
- Provide on-site assistance (e.g., technical, logistics, laboratory analysis of samples) as required to supplement local investigations at the municipal and city level;
- Establish, operate, and maintain a public health epidemic preparedness and response plan, including the creation of multi-sectoral teams to respond to events that may constitute a public health emergency of local and international concern;
- Notify the DOH central office of all reported urgent events within twenty-four (24) hours as required in the IHR;
- Forward epidemiological data to the next level as identified in the PIDSR Manual or disease surveillance guidelines or manual of procedures that may be later developed on a regular basis and in accordance with the national surveillance protocol;
- Use epidemiological data to plan and implement communicable disease control activities at the provincial level; and
- Support municipal and city surveillance teams in strengthening surveillance and epidemic response through training and supervision.
The functions of ESUsin entities required to do mandatory reporting of notifiable diseases and health events of public health concern shall be governed under Rule X, Section 1 of this IRR.
The aforementioned functions are subject to changes in accordance with subsequent amendments to the PIDSR Manual, if any, or as prescribed by EB, as necessary.
RULE VIII DISEASE SURVEILLANCE
Section 1. Processing of Information. — Data collection, analysis, dissemination of information, from official disease surveillance and response systems shall be done by authorized personnel from the DOH and its local counterparts, and shall be used for public health concern purposes only. Subject to the foregoing conditions and consistent with the provisions of the Data Privacy Act of 2012, the personnel authorized to process personal data and information, which shall include the checking of completeness of the data entries in the required forms, and consistency of data in the summary sheets and prescribed official forms such as the CIFs, and CRFs, shall be as follows:
- The Municipal Health Officer of the Rural Health Unit/Municipal Health Office, the City Health Officer of the City Health Office; or the Provincial Health Officer of the Provincial Health Office, as applicable;
- The Regional Epidemiology and Surveillance Unit Head of the CHDs/Regional Offices of the DOH; and
- The Public Health Surveillance Division of the DOH EB.
Section 2. Disease Surveillance Duty of DOH Offices. – The DOH shall ensure that epidemiology and surveillance capacity is treated as an essential service capability across all health systems and health facilities, and provide enabling policies, regulations, capacity building, capital outlay, operating expenses, and personnel to fulfill such.
The DOH, through the following offices, shall perform the following disease surveillance functions:
- The EB shall:
- Assess all reported epidemics within forty-eight (48) hours; and
- Notify the WHO when the assessment indicates that the event is a public health emergency of international concern (PHEIC); and
- Coordinate with other DOH offices in establishing a laboratory network.
- The BOQ shall:
- Develop and ensure compliance to protocols and field operation guidelines on entry or exit management of persons, conveyances, and goods in coordination with airport and port authorities;
- Be in charge of quarantine as deemed necessary;
- Conduct surveillance in ports and airports of entry and sub-ports as well as the airports and ports of origin of international flights and vessels;
- Monitor public health threats in other countries; and
- Provide effective networking and collaboration among the BOQ stakeholders.
- The CHDs/Regional Offices of the DOH shall:
- Assess reported epidemics immediately and report all essential information to the DOH central office;
- Provide direct liaison with other regional government agencies;
- Provide a direct operational link with senior health and other officials at the regional level; and
- Facilitate submission of weekly notifiable disease surveillance reports from public and private hospitals.
- The RESUsshall:
- Provide on-site assistance (e.g., technical, logistics, and laboratory analysis of samples) as requested through any means of communication to supplement local epidemic investigations and control;
- Coordinate with appropriate laboratory for collection and transport of specimens especially if specialized laboratory testing is necessary;
- Establish, operate, and maintain a regional epidemic preparedness and response plan, including the creation of multidisciplinary/multi-sectoral teams to respond to events that may constitute a public health emergency of local and international concern;
- Assess reported epidemics immediately and report all essential information to the DOH central office;
- Provide direct liaison with other regional government agencies;
- Provide a direct operational link with senior health and other officials at the regional level;
- Facilitate submission of weekly notifiable disease surveillance reports from public and private hospitals; and
- Advocate to the LGUs and the persons and entities required to do mandatory reporting under Rule VI of this IRR, to ensure functionality of their ESUs and to actively participate in disease surveillance and response by having information drive and having systems in place for mandatory reporting and response to health events.
RULE IX QUARANTINE AND ISOLATION
Section 1. Quarantine and Isolation Measures. – In the performance of surveillance and response activities, authorized personnel of DOH and its local counterparts are empowered to determine if a person exhibits symptoms of infection of, or is a close contact of a person found to have been infected with, a notifiable disease or a health event of public health
concern, and accordingly issue a quarantine/isolation order or directive to compulsorily confine the person inside a facility or in his/her home residence for an indicated period. A person subject to such order or directive is bound to stay therein until the expiration of said period. Failure to comply with the quarantine/isolation order, as well as violation of the terms or conditions of the quarantine or isolation, shall constitute non-cooperation.
No home quarantine/isolation shall be permitted in instances where the nature of the notifiable disease or health event of public health concern requires a more stringent form of quarantine or isolation.
Home and/or facility-based quarantine or isolation shall be in accordance with the protocols as may be issued by the DOH taking into account humane and dignified treatment and living conditions during the course of the quarantine. Compliance with the protocols on quarantine and isolation such as provision of necessary basic facilities shall be subject to
regular ocular inspection or visit of quarantine/isolation facilities by the public health authorities, both home and facility-based.
The DOH or its local counterparts may mobilize other government offices, such as officials at the barangay level and personnel of law enforcement agencies to accompany them in enforcing quarantine or isolation measures; Provided, that the participation of local law enforcement agencies should only be limited to assisting the DOH and local counterparts in the enforcement of quarantine/isolation orders.
RULE X DISEASE RESPONSE
Section 1. Persons or Entities Required to Participate in Disease Response Activities, and Specific Responsibilities. – Pursuant to Rule I, Section 3(h) of this IRR, the following are required to participate in disease response activities as may be enforced by the DOH or its local counterparts. At the minimum, they are required to perform the following acts:
- Licensed public and private medical and allied health professionals shall:
- For those employed in health facilities, notify the respective reporting or surveillance unit of their facilities of notifiable disease or health event of public health concern; and
- For private practitioners, report the same directly to the local health office.
- Health facilities and offices as defined under Annex “A” shall:
- Establish or designate their ESUs within the period provided under this IRR;
- Comply with the appropriate surveillance system (verification, validation, quality check of CIF/CRF, encoding, and reporting to a higher level of ESU);
- Report cases of notifiable diseases or health events of public health concern to the appropriate public health authorities using the CIF or CRF, as the case may be;
- Allocate hospital beds in such number or percentage as may be deemed necessary by the DOH, or corresponding to the peak day critical care capacity based on updated projections from a DOH-recognized epidemiological projection model for a particular epidemic, to accommodate and service patients affected by the notifiable disease or health event of public health concern. Provided, that compliance with this rule shall not constitute a violation of relevant warranty made before the Philippine Health Corporation (PhilHealth) or the Health Facilities and Services Regulatory Bureau of the DOH;
- Coordinate the transfer of patients who are classified as mild cases to a different facility, in instances where there is a need to prioritize severe and critical cases and/or once the surge capacity has been reached;
- Report health system data as required by the DOH, such as but not limited to, the number of hospital beds available;
- Participate in unified hospital command systems as may be organized by the DOH, its local counterparts, or other public health authorities; and
- Adhere to the Philippine Epidemic Preparedness and Response Plan issued by the DOH.
- Private companies and institutions; workplaces including those in special economic and/or freeport zones; public and private educational institutions providing basic education, higher education, technical vocational education and/or training; major transportation passenger terminals, seaports and airports; dining, hotel and other accommodation establishments, including other establishments as may be required by the DOH; other government agencies providing health and emergency frontline services, border control, and other critical services; and prisons, jails, or detention centers shall:
- Establish or designate a unit that will perform the functions of an ESU within their respective premises;
- Participate in disease response activities by reporting health events to their local health office using the event-based surveillance form (Annex “D”) within twenty-four (24) hours from identification; and
- AS appropriate, provide adequate support for their workforce in terms of transportation, lodging, food allowance, and other appropriate assistance.
- Private companies in the transportation sector (aviation, maritime, road, rail) shall comply with the duty to transport samples, specimens, or hot boxes following the guidelines of the International Air Transport Association (IATA) on transporting infectious and hazardous materials, or such other similar guidelines, including mission-critical personal protective equipment, medicines, medical equipment, and other commodities.
- Communities, including household members, the punong barangay, barangay health emergency response teams, homeowners’ associations, indigenous people communities, cooperatives, and community-based organizations shall:
- Report any health event of public health concern to the local health office within twenty-four (24) hours from occurrence thereof; and
- Perform such other functions to respond to the notifiable disease or health event of public health concern.
- Professional societies, civic and faith-based organizations, civil society organizations, and other non-government organizations shall:
- Designate a unit or person/s that shall perform the event-based surveillance of any notifiable disease or health event of public health concern in any activity that may be organized by them; and
- Report any health event of public health concern that takes place to the local health office where such activity is held within twenty-four (24) hours from occurrence thereof.
For all of the foregoing, failure to comply with the disease response systems indicated herein shall constitute non-cooperation. Further, all of the foregoing surveillance and response activities shall be without prejudice to the guidelines/rules/regulations that may be issued by other national government agencies in close coordination with the DOH.
Section 2. Disease Response Activities Required of Communities and the General Public.– Communities and the general public shall comply with minimum public health standards and/or non-pharmaceutical interventions as may be enforced by the DOH and its local counterparts may as part of their duty to participate in response activities to notifiable diseases and health events of public health concern, which shall include the following:
- For diseases spread by droplets enumerated in, or may be classified as such, under Rule II:
- Regular and thorough washing of hands with soap and water, and if unavailable, regular disinfection of hands by using a sanitizer with at least 60% alcohol component;
- Covering the nose and mouth with a tissue when coughing or sneezing. Properly disposing of used tissue, and washing of hands thereafter;
- Cleaning with soap and water or a bleach-and-water solution or disinfectant of surfaces and objects that are touched frequently;
- Limited transport and movement of patients (e.g. use of portable diagnostic equipment and tools to limit the movement of patients from one place to another within the health facility); and
- Wearing of masks, or other personal protective equipment (PPE) as may be prescribed by the DOH orits local counterparts.
- For airborne diseases enumerated in, or may be classified as such, under Rule II;
- Regular and thorough washing hands with soap and water, and if unavailable, regular disinfection of hands by using a sanitizer with at least 60% alcohol component;
- Covering the nose and mouth with a tissue when coughing or sneezing. Properly disposing of used tissue, and washing of hands thereafter;
- Cleaning with soap and water or a bleach-and-water solution or disinfectant of surfaces and objects that are touched frequently;
- Increasing ventilation in all settings to reduce airborne transmission;
- Limited transport and movement of patients (e.g. use of portable diagnostic equipment and tools to limit the movement of patients from one place to another within the health facility);
- To do home quarantine or home isolation as advised by a medical professional or by the DOH’s advisories;
- Avoidance of close contact with people who have symptoms of the disease; and
- Wearing of masks, or other personal protective equipment (PPE) as may be prescribed by the DOH or its local counterparts.
- For diseases spread by direct contact enumerated in, or may be classified as such, under Rule II:
- Regular and thorough washing hands with soap and water, and if unavailable, regular disinfection of hands by using a sanitizer with at least 60% alcohol component;
- Cleaning with soap and water or a bleach-and-water solution or disinfectant of surfaces and objects that are touched frequently;
- avoiding close contact with sick persons; and
- Isolating contagious persons.
- For vehicle-borne diseases enumerated in, or may be classified as such, under Rule II:
- Using barrier contraception when engaging in sexual intercourse if currently infectious due to sexually transmitted infection;
- Non Sharing of needles when administering drugs;
- Avoiding use of an infected person’s personal items; and
- Taking precautions when undergoing tattooing or body-piercing procedures.
- For vector-borne diseases enumerated in, or may be classified as such, under Rule II:
- Removing stagnant water in receptacles at least once a week;
- Using screens on windows and doors to keep mosquitoes outside homes; and
- Using mosquito bed nets, if screened rooms are not available when sleeping outside of an enclosed space.
The aforementioned shall be without prejudice to the authority of the DOH or its local counterparts to require additional minimum public health standards and non-pharmaceutical interventions should the same be warranted, and to disease-specific minimum public health standards and/or nin-pharmaceutical interventions stated under Annex “E”.
In addition, communities, as part of their response activities, shall extend the necessary assistance to ensure that no acts of discrimination shall be inflicted upon persons identified as having the notifiable disease or health events of public health concern whether confirmed, recovered, or undergoing treatment, as well as suspect and probable cases, including health care workers and personnel providing health and emergency frontline services. Discrimination refers to any distinction, exclusion or restriction which has the purpose of effect of nullifying the recognition, enjoyment or exercise, on an equal basis with others, of all human rights and fundamental freedoms. In includes all forms of discrimination,
including denial of reasonable accommodation.
Failure to comply with the foregoing shall constitute non-cooperation.
Section 3. Disease Response Activities Required of the DOH. – The DOH, through the following offices shall perform the following response activities:
- The Epidemiology Bureau shall:
- Rapidly determine the control measures required to prevent domestic and international spread of disease;
- Provide support through specialized staff and logistical assistance during epidemic investigation and response;
- Establish effective networking with other relevant government agencies at the national local level;
- Provide direct operational link with senior health and other officials at the national and local levels to approve rapidly and implement containment and control measures;
- Provide timely and relevant data to the public;
- Facilitate the dissemination of information and recommendations from DOH Central office and WHO regarding local and international public health events to the concerned agencies and institutions; and
- Facilitate the budget allocation for surveillance and response at the CHDs/Regional Offices of the DOH;
- The DOH representatives to the LGUs shall ensure that the roles and functions of the CHDs/Regional Offices of the DOH are being implemented at their assigned LGUs, as follows:
- Plan and advocate the implementation of functional ESU to the Local Health Board;
- Provide technical assistance in terms of hospital development, formation of functional unit of surveillance, outbreak, emergency and disaster response;
- Provide regular feedback to the CHD/Regional Office of the DOH thestatus of ESU functionality, and regulatory issues;
- Mobilize resources;
- Evaluation; and
- Inter-agency and inter-sectoral collaborator;
- The Disease Prevention and Control Bureau shall:
- Provide updates, technical advice, and recommendations on the recognition, prevention, and control of diseases;
- Organize the DOH Management Committee for the Prevention and Control of Emerging and Re-emerging Infectious Diseases;
- Prepare, and lead in the implementation of, the Philippine Preparedness and Response Plan for Emerging and Re-emerging Infectious Diseases; and
- Timely update the Philippine Preparedness and Response Plan for emerging and re-emerging infectious diseases as the need arises. For this purpose, other agencies and offices of the government may be called upon to participate in the formulation of the response plan as well as for simulation exercises;
- The CHDs/Regional Offices shall:
- Provide on-site assistance (e.g., technical, logistics, and laboratory analysis of samples) as requested to supplement local epidemic investigations and control;
- Establish, operate and maintain a regional epidemic preparedness and response plan, including the creation of multidisciplinary/multisectoral teams to respond to events that may constitute a public health emergency of local and international concern;
- Provide technical and logistical assistance in the establishment of ESUs at the provincial/city/municipal health offices;
- Ensure the functionality of the regional disease surveillance and response system;
- The Hospital Licensing Team at the CHDs/Regional Offices shall track and monitor the compliance of public and private hospitals in the implementation of PIDSR orother disease surveillance systems and their guidelines or manual of procedures that may be later developed as part of the requirements for renewal of license to operate. The team shall inform the CHDs/PHOs/LGUs of activities taken against non-complying hospital institutions. Likewise, provincial/city/municipal health offices shall report to the CHDs/ Regional Offices hospitals and related facilities that fail to comply with the reporting requirements of PIDSR or other disease surveillance systems and their guidelines or manual of procedures that may be later developed. The regional director shall issue a regional order to enforce compliance; and
- Create an Epidemic Management Committee at the regional level;
- The RESUs shall:
- Provide on-site assistance (e.g., technical, logistics, and laboratory analysis of samples) as requested to supplement local epidemic investigations and control;
- Establish, operate, and maintain a regional epidemic preparedness and response plan, including the creation of multidisciplinary/multi-sectoral teams to respond to events that may constitute a public health emergency of local and international concern;
- Provide technical and logistical assistance in the establishment of ESUs at the provincial/city/municipal health offices; and
- Ensure the functionality of the regional disease surveillance and response system;
- The Health Emergency Management Bureau shall act as the DOH coordinating unit and operations center for all health emergencies, disasters, and incidents with potential of becoming an emergency;
- The Health Promotion Bureau shall develop and implement strategic risk and response communications plan to empower all stakeholders in observing recommended and evidence-based measures, upon the Secretary of Health’s declaration of an epidemic;
- The Knowledge Management and Information Technology Service (KMITS), under the technical advice and in close collaboration with the EB, shall develop, establish, and maintain a harmonized electronic functional public health information system to support the disease surveillance and response systems, which shall include, but shall not be limited to, coordination mechanisms, data compatibility and interoperability, implementation protocols for reporting and response, and measures for data security and confidentiality;
- The Health Facility Development Bureau shall! lead, in close collaboration with the EB, the development of facility standards in the establishment and maintenance of functional ESUs, which include, but not limited to, infrastructure and equipment;
- The Health Facilities Enhancement Program shall ensure that appropriate funding is provided for the development of government ESUs in terms of infrastructure, equipment, and surveillance and response vehicles;
- The Health Human Resource Development Bureau and Personnel Administration Division shall lead in ensuring that appropriate staffing is provided in the national and regional ESUs; Provided, that the EB shall provide the appropriate staffing standards for ESUs at each level; and
- The Health Facilities and Services Regulatory Bureau shall include an ESU as part of its minimum standards for the regulation of health facilities and services.
Section 4. Disease Response Activities Required of Local Counterparts. – Local health offices shall perform the following response activities:
- The Provincial Health Office (and CHOs of Highly Urbanized Cities and Chartered Cities) shall:
- Setup and maintain a functional provincial disease surveillance system equipped with the necessary resources and adequate local financial support. Financial support may come from the disaster, calamity, or other appropriate funding sources as determined by the provincial government officials;
- Collect, organize, analyze, and interpret surveillance data in their respective areas;
- Report all available essential information (e.g., clinical description, laboratory results, numbers of human cases and deaths, sources and type of risk) immediately to the regional level;
- Assess reported epidemics immediately and report all essential information to CHDs/Regional Offices of the DOH and DOH Central office;
- Provide on-site assistance (e.g., technical, logistical, and laboratory analysis of samples) as requested to supplement local epidemic investigations and control;
- Facilitate submission of weekly notifiable disease surveillance reports from public and private hospitals; and
- Establish, operate, and maintain a provincial epidemic preparedness and response plan, including the creation of multidisciplinary/multi-sectoral teams to respond to events that may constitute a public health emergency of local and international concern.
- The Municipal/City Health Office shall:
- Setup and maintain a functional municipal/city/community disease surveillance system equipped with the necessary resources and adequate local financial support. Financial support may come from the disaster, calamity, or other appropriate funding sources as determined by the municipal/city government officials;
- Collect, organize, analyze, and interpret surveillance data in their respective areas;
- Report all available essential information (e.g., clinical description, laboratory results, numbers of human cases and deaths, sources and type of risk) immediately to the provincial level;
- Implement appropriate epidemic control measures immediately;
- Establish, operate, and maintain a municipal/city epidemic preparedness and response plan, including the creation of multidisciplinary/multi-sectoral teams to respond to events that may constitute a public health emergency; and
- Facilitate submission of weekly notifiable disease surveillance reports from public and private hospitals.
Section 5. Disease Response Activities Required of Philippine Health Insurance Corporation (PhilHealth). – The PhilHealth shall support the implementation of disease surveillance and response in hospitals and private practitioners by using its accreditation authority and reimbursement of claims as a leverage to encourage compliance.
Section 6. Response Activities Based on Guidelines Issued by Authorized Entities. – Response activities set forth by the IATF-MEID or such other relevant authorities as may be authorized by the DOH or its local counterparts shall be mandatory over persons orentities mentioned under Rule I, Section 3(h) of this IRR. Guidelines may include, but are not limited to:
- Where appropriate, using governmental authorities to limit non-essential movement of people, goods, services into and out of areas where an outbreak occurs;
- Providing guidance to all levels of government on the range of options for infection control and containment, including those circumstances where social distancing measures, limitations on gatherings or quarantine authority may be an appropriate public health intervention;
- Emphasizing the roles and responsibilities of the individual in preventing the spread of an outbreak and the risk to others if infection-control practices are not followed; and
- Providing guidance for LGUs, and industries to prevent the spread of disease.
Section 7. Other Disease Response Activities. – The aforementioned provisions notwithstanding, public health authorities may enforce other response activities as may be called for to address notifiable diseases or health events of public health concern, in accordance with the following criteria:
- The response required shall be in the form of activities aimed to control the further spread of infection, outbreaks or epidemics and prevent reoccurrence. It includes verification, contact tracing, rapid risk assessment, case measures, treatment of patients, risk communication, conduct of prevention activities, and rehabilitation;
- The response is mandated by a public health authority; and
- The response is required of persons or entities mandated to participate in response activities pursuant to Rule I, Section 3(h) of this IRR.
RULE XI PROHIBITED ACTS AND PENALTIES
Section 1. Prohibited Acts. – The following shall be prohibited under this IRR:
- Unauthorized disclosure of private and confidential information pertaining to a patient’s medical condition or to any advice or treatment given to a patient considered privileged communication in accordance with existing laws, rules and regulations.
Consistent with the Data Privacy Act of 2012, the reporting of information to public health authorities by the persons or entities mandated to notify under Rule VI of this IRR shall not be considered a violation of this provision. Relévant issuances as may be promulgated by the DOH and other relevant agencies in coordination with the National Privacy Commission shall be applicable. Neither shall the disclosure of private and confidential information upon order issued by a court of competent jurisdiction be considered a violation thereof. - Tampering of records relating to notifiable diseases or health events of public health concern, which includes identification documents or passes and other similar documents for the movement of cargoes and passage of persons, official medical test results or medical certificates, or such other documents and records issued by public health authorities in connection therewith.
- Intentionally providing misinformation by:
- Deliberately providing false or misleading information/details in the required official forms such as but not limited to the CIF, CRF, or Events-Based Surveillance Form; or
- Creating, perpetrating, or spreading false information about the notifiable disease or health event of public health concern in any form of media, such as information having no valid or beneficial effect on the population, and are clearly geared to promote chaos, panic, anarchy, fear, or confusion.
- Non-operation of the disease surveillance and response systems by responsible persons or entities mentioned under this IRR shall be considered a violation of this provision.
- Non-cooperation of persons and entities that should report notifiable diseases or health events of public concern, which can be any of the following acts:
- Failure of persons and entities mentioned in Rule VI, Section 2 of this IRR to comply with mandatory reporting of notifiable diseases or health events of public concern; or
- Failure of persons and entities mentioned in Rule VI, Section 2 of this IRR to grant public health authorities timely access to information of persons infected with or suspected of having notifiable disease or health events of public health concern.
- Non-cooperation of persons and entities that should respond to notifiable diseases or health events of public concern, which can be any of the following acts:
- Failure on the part of entities required to establish ESUs under Rule VII of this IRR to comply with the duty to establish the same;
- Failure on the part of entities identified under Rule X of this IRR to perform specific disease response activities listed therein;
- Failure to abide by minimum public health standards and/or non-pharmaceutical interventions as enforced by public health authorities pursuant to Rule X of this IRR; or
- Failure to abide by other disease response activities as enforced by public health authorities pursuant to Rule X of this IRR.
- Non-cooperation of the person or entities identified as having the notifiable disease, which can be any of the following acts:
- Refusal of the person identified by a public health authority as suspect or probable case to submit for physical examination and/or provision of clinical samples as required for the investigation;
- Failure or refusal of the person or entity identified by a public health authority identified as suspect, probable or confirmed case to provide the required information necessary for disease surveillance or response, including for contact tracing activities;
- Failure to comply with a quarantine/ isolation order or directive duly issued by a public health authority;
- Violation of any terms or conditions of the quarantine or isolation order or directive issued by a public health authority; or
- Knowingly or willfully infecting another with a contagious or communicable disease classified as notifiable or a health event of public health concern, or aids in the spreading of the same.
- Non-cooperation of the person or entities affected by a notifiable disease or a health event of public health concern, which can be any of the following acts:
- Failure by close contacts to cooperate/submit to public health authorities doing contact tracing activities upon being notified of their status as such;
- Violation of community quarantine or stay-at-home order or directive issued by public health authorities; or
- Commission of the acts of discrimination against an individual on account of having a notifiable disease whether probable, suspect, or confirmed, whether undergoing treatment or recovered; on account of being a health worker (e.g. doctors, nurses, and other allied health workers) or being a personnel providing health and emergency frontline service.
Section 2. Inter-Agency Arrangement. – The DOH may coordinate with law enforcement agencies on the appropriate arrangement to implement the filing of the criminal charges against the erring persons or entities for violation of the Act and this IRR.
Section 3. Penalties. – Any person or entity found to have committed any of the prohibited acts referred to in Section 1 of this Rule shall be penalized with a fine of not less than Twenty Thousand Pesos (P20,000.00) but not more than Fifty Thousand Pesos (P50,000.00) or imprisonment of not less than one (1) month but not more than six (6) months, or both such fine and imprisonment, at the discretion of the proper court.
If the offender is a foreign national, the case shall be referred to the Bureau of Immigration for the institution of summary deportation proceedings after service of sentence.
If the offender is a professional with a license issued by the Professional Regulation Commission, the case shall be referred to the said commission for the institution of appropriate proceeding to suspend or revoke the license to practice for any violation of the Act and this IRR.
If the offender is a civil servant, the case shall be referred to the Civil Service Commission for the institution of appropriate proceeding to suspend or revoke the civil service eligibility for violation of the Act and this IRR.
If the offense is committed by a public or private health facility, institution, agency, corporation, school, or other juridical entity duly organized in accordance with law, the chief executive officer, president, general manager, or such other officer in charge shall be held liable. In addition, the business permit and license to operate of the concerned facility, institution, agency, corporation, school, or legal entity shall be canceled.
RULE XII FINAL PROVISIONS
Section 1. Appropriations. – The amount needed for the initial implementation of this IRR shall be charged against the current year’s appropriations of the DOH. Thereafter, such sums as may be necessary for the continued implementation of this IRR shall be included in the annual General Appropriations Act.
Section 2. Construction and Interpretation. – These rules shall be given a liberal construction in favor of measures instituted by public health authorities in the exercise of the statutory and regulatory authority vested by the Act and this IRR to protect public health.
Section 3. Separability Clause. – If any part, section or provision of this IRR is held invalid or unconstitutional, other provisions not affected thereby shall remain in full force and effect.
Section 4. Repealing Clause. – The Implementing Rules and Regulations of Republic Act No. 11332, or the “Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern” issued by the DOH on 23 March 2020 is hereby repealed. All orders, issuances, and rules and regulations or parts thereof inconsistent with the provisions of this IRR are hereby repealed or modified accordingly.
Section 5. Effectivity. – This IRR shall take effect immediately upon its publication in the Official Gazette or in a newspaper of general circulation. Let copies of this IRR be submitted to the Office of the National Administrative Register of the University of the Philippines Law Center.
Approved (Signed) Francisco T. Duque III, MD, MSc – Secretary of Health
Links
Official Gazette Link – https://www.officialgazette.gov.ph/2019/04/26/republic-act-no-11332/
DOH Link – https://doh.gov.ph/sites/default/files/health-update/revised-IRR-RA11332.pdf
List of Annexes – http://bit.ly/RA11332annexes