Republic of the Philippines TANGGAPAN NG SANGGUNIANG PANLUNGSOD Lungsod ng Butuan 14" Sangguniang Panlungsod 15 Regular Session Series of 2017 AN ORDINANCE ADOPTED BY THE HONORABLE SANGGUNIANG PANLUNGSOD OF THE CITY OF BUTUAN IN ITS REGULAR SESSION HELD AT THE SP SESSION HALL ON APRIL 20, 2017 PRESENT: Honorable Jose S. Aquino II - City Vice Mayor Presiding Officer Honorable Glenn C. Carampatana - Member Honorable Ferdinand E. Nalcot - Member Honorable Rema E, Burdeos - Member Honorable Derrick A. Plaza - Member Honorable Cromwell P. Nortega - Member Honorable Cherry May G. Busa - Member Honorable Vincent Rizal C. Rosario - Member Honorable Ehrnest John C. Sanchez - Member ABSENT: Honorable Joseph Omar O. Andaya - Member (on Vacation Leave) Honorable John Gil S. Unay, Sr. - Member (on Special Leave) The meeting was called to order at exactly 10:55in the morning. SP ORDINANCE NO. 5254-2017 AN ORDINANCE PRESCRIBING GUIDELINES ON THE OPERATION OF THE BIRTHING CLINICS AND BEmONC FACILITIES OF BUTUAN, DEFINING ITS FUNCTIONS, OPERATIONS AND FEES THEREOF, AND FOR OTHER PURPOSES Be it ordained by the Honorable SangguniangPanlungsod of Butuan City in session assembled and by authority of the same th SECTION 1. TITLE. This ordinance shall be known as “Prescribing Guidelines on the Operation of the BEmONC and Birthing Clinies of Butuan, Defining its Functions, Operations and Fees”. SECTION 2. PURPOSE. To provide pregnant mothers with adequate and affordable basic and or emergency obstetric and newborn care and encourage mothers to deliver their babies in the birthing facilities.SECTION 3. DEFINITION OF TERMS. As used in this Ordinance the following. shall mean: 3.1 Age of gestation — number of weeks of the baby inside the mother’s womb based on the first day of the last menstrual period. 32 asic Emergency Obstetrics and Newborn Care (BEmONC) ~ is a capable private health facility or an appropriately upgraded public health facility that is either a Rural Health Unit (RHU) and/or its satellite Barangay Health Station (BHS) or Hospital capable of performing emergency obstetrics functions 3.3 Birthing Clinic — any health facility, place or institution which is not a hospital or in a hospital where births are planned to occur away from the mother’s residence following normal, uncomplicated pregnancy. 3.4 User’s Fee — an amount paid by the mother for the services incurred in the BEmONC or Birthing Facility whom is a Non-Philhealth member. 3.5 Full term Pregnaney — pregnancy with age of gestation from 37 to 41 weeks. 3.6 Supplies — pertains to items needed in the Maternal and Newborn services. 3.7 Newborn Care — care for newborn baby which includes cord care, thermal care, eye prophylaxis, initiation to breastfeeding, Bacillus Calmette Guerin (BCG) and Hepatitis B immunization and newborn screening. 3.8 Normal Spontaneous Delivery (NSD) ~ spontaneous expulsion of full-term baby in presentation through vaginal opening 3.9 Antenatal/Prenatal care — care for pregnant women having monthly prenatal visits from the first week to the seventh month of gestation, twice a month at cight month and weekly during the ninth month of gestation. 3.10 Post partum care — care for the mother who has newly delivered a newborn baby. 3.11Skilled birth attendant ~ refers to licensed physicians, nurses or midwives handling maternal deliveries. 3.12 Traditional birth attendants (TBA) — are independent, non-formally trained ‘and community based providers of care during pregnancy, childbirth and neonatal period. Under MNCHN strategy, they are made part of the formal health system as members of the Community Health Teams and serve as advocates of skilled health professional care. 3.13 Registered Midwife - a health professional duly licensed by the Board of Midwifery who handle and assist child birth. 3.14 PHIC — Philippine Health Insurance Corporation, 3.15 Acereditation — process which all government-owned health units that are certified as Basic Emergency Obstetrics and Neonatal Care (BEmONC), Birthing Clinics and Newborn Screening Facility by the Department of Health need to comply in the certification that the facility met the quality standards set by PhilHealth. This accreditation will allow the Philhealth members to enjoy thebenefits of the Maternity Care Package (MCP), Normal Spontaneous Delivery (NSD), Antenatal Care Package (ACP) and Newborn Care Package (NCP) wherein the facility will be reimbursed with the cost of services rendered for the patients, 3.16 Staff Compensation — Thi provided in the Birthing Cli Professional Fee. is the amount given equivalent to the service/s ic or BeMONC facility. This may also refer to the 3.17 Facility Fee-the fees help to offset costs to operate and improve the Birthing Clinic and BeMONC facilities. This may also refer to Operational Expenses. 3.18 Indigent — a person identified in the barangay as someone without permanent source of ineome who cannot provide for his basic needs and not receiving support from relatives. SECTION 4. COVERAGE. The Birthing Clinics and BEmONC Facilities will serve those who have regular prenatal records in the health center within the territorial jurisdiction of the City of Butuan. It may cater also to residents and non-residents of the City without prenatal records in extreme and emergency cases only. SECTION 5. REGULATORY CLAUSE, 5.1 All pregnant mothers with or without Philhealth coverage are encouraged to deliver their babies at any birthing clinic or other health care facility in or outside the city which has the capability of handling baby deliveries. 5.2 Traditional Birth Attendants (TBAs) are prohibited to perform home deliveries but may only assist in bringing the pregnant mother to the nearest facilities capable of handling maternal deliveries and may also assist during childbirth with the presence of the skilled birth attendants, 5.3 Maternal Delivery and postpartum care shall be handled and assisted by an Accredited Registered Midwife. SECTION 6. OPERATIONS, SUPERVISION AND CONTROL OF THE FACILITY. 6.1 The operations of the birthing clinic shall be 24 hours daily which shall be managed by employed accredited registered midwives under the supervision and control of the City Health Officer (CHO). 6.2 The City Health Office (CHO) shall assign regular personnel such as medical doctors, nurses, medical technicians, dentists and accredited registered midwives fo attend to the pregnant mothers who will undergo antenatal/prenatal and ‘maternal deliveries. Proper sanitation and cleanliness of the facility shall be well maintained. 6.3 Those who have undergone regular prenatal check-ups and those who will undergo normal spontaneous vaginal delivery, in cephalic presentation shall be admitted to the facility. 6.4 Those with identified medical and obstetrical problems shall be referred to the hospital.Page four SP Ord. No. 5254-2017. cont'd. 6.5 All newborn delivered babies shall undergo newbom screening SECTION 7. STAFFING AND MANAGEMENT. The Birthing Clinie shall be administered and operated by the City Health Office personnel namely: 7.1 City Health Officer shall act as the overall officer-in-charge of the said facility The City Health Office (CHO) shall see to it that the midwives assigned to different barangays shall not leave their area of responsibility or they may leave their Barangay Health Station (BHS) and render services in a facility but not to exceed the 40 hours in a week, to ensure execution of other health services to the people and also the daily operation of other health services at the Health Center rendered to the people shall not be interrupted. 7.2 Medical Doctors who serve as consultants to assess the condition of the patient for further management. 7.3 Accredited Registered Midwife who go on duty to handle and or assist maternal deliveries. 7.4 Registered Nurse who serve as senior staff or team leader of the birthing staff and personnel who is on duty. 7.5 Laboratory Medical Technologist is an allied health professional who conduct tests on body fluids and tissues. 7.6 Dentist is another allied health professional who is responsible to ascertain that the pregnant mother is free of any oral infections. 7.5 Barangay Health Worker (BHW) who serve as staff of the facility to attend to patient and ensure the facility's sanitation and cleanliness. 7.6 Clerk and/or Messenger who serve as staff of the facility to assist in processing the documentary requirements for accreditation, registration, and other administrative tasks related to the operation of the facility. SECTION 8. QUALIFICATIONS. The following are the qualifications for pregnant mothers who want to avail the services of Birthing Clinics and BEmONC facilities: 8.1 Age: 19 to 35 years old without any complications 8.2 Gravida 2 and 4 without any complications from previous delivery 8.3 Below 10 years gap from previous delivery 8.4 Age of Gestation: 36 to 41 weeks 8.5 Single pregnancy 8.6 Cephalic presentation 8.7 Fundal height: 29 to 34 em. SECTION 9. FEES AND CHARGES. The following fees and charges shall be imposed;Page five SP Ord. No. 5254-2017, cont’ 1. PHILHEALTH MEMBERS (Philhealth Circular 22-2014, VI. Benefits Package for Women About to Give Birth) 9.1 Maternity Care Package (MCP) Package-This package covers the essential health services during antenatal/prenatal period, entire stages of labor, normal delivery and immediate post-partum period including follow-up visits within the first 72 hours and 1 week after delivery. ‘The pregnant women are encouraged to have the first pre-natal check-up during the first trimester of pregnancy with at least 4 pre-natal visits throughout the course of pregnancy with the same birthing clinic or BEMONC PHIC will reimburse the amount of Php8, 000.00 (per case) which shall be divided as follows: Staff Compensation 40% share - Php3,200.00 Facility Fees / OPEX 60% share Php 4.80 TOTAL 100% share = Php8,000.00 Breakdown of Php3, 200.00 for Staff Compensation (per case) with corresponding percentages of share: PERCENT STAFF SHARE _| AMOUNT Medical Doctor 35% | 1,120.00 ‘Accredited Registered Midwife — Handle 20%| 640.00 ‘Accredited Registered Midwife — Assist 15% | 480.00 Registered Nurse 10% | 320.00 Medical Technologist 3% |__ 160.00 Dentist 5% 160.00 Barangay Health Worker 5% | 160.00 Clerk and Messenger 5% | 160.00 100% | 3,200.00 Facility Fees / Operational Expenses shall include, but not limited, to the following expenses: a. Utility Expenses Electric Bill ii, Water Bill iii, Communication Expenses (Telephone and Internet) b. Medical Supplies i. Drugs and Medicines ii, Supplies (necessary for the delivery of maternal and child care services) c. Other Administrative Costs i, Database Recording and Reporting, to include Birth RegistryPage six SP Ord. No. 5254-2017, cont’d. ii, Office Supplies (items necessary to maintain the administrative function of the birthing facility operation) iii, Laundry Labor Service Fee and Supplies iv. Maintenance/Utility Services v. Security Service vi. Improvement of Facilities (Purchase of Ambulance, nursery beds, recovery beds, and other capitalization needed for the enhancement of the birthing clinic operation) vii. Licensing and Accreditation fees, and other administrative fees 9.2 Normal Spontaneous Delivery (NSD) Package - This package covers essential health services for normal low risk vaginal deliveries and post-partum period within the first 72 hours and 7 days after delivery. Under this package are those pregnant women who received pre-natal care from another facility, the facility where pre-natal care is rendered may claim for Antenatal Care Package. PHIC will reimburse the amount of Php6, 500.00 (per case) which shall be divided as follows: Staff Compensation 40% share - Php 2,600.00 Facility Fees (Operational Expenses 60% share Php 3.90.00 TOTAL 100% share - Php 6,500.00 Breakdown of Php 2,600.00 for Staff Compensation with corresponding percentages of the share: PERCENT STAFF SHARE _| AMOUNT Medical Doctor 35% | 910.00 ‘Accredited Registered Midwife — Handle 20% | __ 520.00 ‘Accredited Registered Midwife — Assist 15% |__390.00 Registered Nurse 10% | _ 260.00 Medical Technologist 5% |__ 130.00 Dentist, 5% |__ 130.00 Barangay Health Worker 5% | __130.00 Clerk and Messenger 5% | __ 130.00 100% | 2,600.00 Facility Fees / Operational Expenses shall refer to the following expenses: a. Utility Expenses i, Electric Bill Water Bill ‘ommunication Expenses (Telephone and Internet) b. Medical Supplies i, Drugs and Medicines ii, Supplies (necessary for the delivery of maternal and child care services)Page seven SP Ord. No. 5254-2017, cont'd. c. Other Administrative Costs i, Database Recording and Reporting, to include Birth Registry ii, Office Supplies (items necessary to maintain the administrative function of the birthing facility operation) iii, Laundry Labor Service Fee and Supplies iv. Maintenance/Utility Services v. Security Service vi. Improvement of Facilities (Purchase of Ambulance, nursery beds, recovery beds, and other capitalization needed for the enhancement of the birthing clinic operation) vii. Licensing and Accreditation fees, and other administrative fees 9.3 Antenatal/Prenatal Care Package - This package covers essential health services that pregnant mothers during antenatal/prenatal period. PHIC will reimburse the amount of Php1, 500.00 (per case) which shall be divided as follows: Staff Compensation (40%) - Php 600.00 Laboratory, Vaccines, and Medicines (60 TOTAL 100% Breakdown of Php 600.00 for Staff Compensation: PERCENT STAFF SHARE | AMOUNT Medical Doctor 35% | 210.00 “Accredited Registered Midwife - Handle 20% | _ 120.00 ‘Accredited Registered Midwife - Assist 15% 90.00 Registered Nurse 10% 60.00 Medical Technologist 5% 30.00 Dentist 5% 30.00 Barangay Health Worker 3% 30.00 Clerk and Messenger 5% 30.00 100% | 600.00 9.4 User's Fee (residents or non-residents of Butuan City) — utilized for the functionality of Birthing Clinics and BeMONC Facilities to provide better maternal and child health services under the care of a trained and competent professional and also provide efficient 24-hour service for emergency cases and improve protective measures for mothers during delivery. ‘The User’s Fee for the Birthing and BeMONC facilities shall be as follows: ‘The amount of Php1,500.00 will be divided to the following: Staff Compensation (60%) - Php 900.00 Operational Expenses (40%) Php 64 TOTAL (100%) - Php 1,500.00Page eight SP Ord, No, 5254-2017, cont'd. Breakdown of Php 900.00 for Staff Compensation: PERCENT STAFF SHARE _| AMOUNT Medical Doctor 20% 180.00 Accredited Registered Midwife - Handle 25%. 225.00 Accredited Registered Midwife - Assist 20% 180.00 Registered Nurse 15% 135.00 Medical Technologist 5% 45.00 Dentist 5% 45.00 Barangay Health Worker 5% 45.00 Clerk and Messenger 5% 45.00 100% 900.00 Il. NEW BORN PACKAGE (NBP) 9.5 New Born Package (NBP) ~ PHIC will reimburse the amount of P1, 550.00 which will be divided as follows: Essential New Born Care - Php 500.00 Newborn Screening - Php 550.00 Staff Compensation - Php _ 500.00 TOTAL - Php 1,550.00 Distribution Breakdown of Php 500.00 for Staff Compensation: PERCENT STAFF SHARE _| AMOUNT Medical Doctor 20% | 100.00 ‘Accredited Registered Midwife - Handle 25% | 125.00 ‘Accredited Registered Midwife - Assist 20% | 100.00 Registered Nurse 15% 75.00 Barangay Health Worker 10% 50.00 Clerk and Messenger 10% 50.00 100% | 00.00 9.6 No fee will be collected from the patient when she is to be referred to the nearest hospital. The service fee is exclusive of newborn screening and other charges. SECTION 10. SPECIAL PROVISION. The attending regular health personnel shall not be given overtime pay, night shift differential for his extra working hours, however, she/he shall receive incentives per case attended. SECTION 11. EXEMPTION. The following are exempted from paying the fees: 11.1 Philheallth member patient and qualified beneficiary who gives birth up to her 4" child.Page nine SP Ord. No. 5254-2017. cont'd. 11.2 Exceptional and meritorious cases as determined and approved by the Local Chief Executive (LCE). Non-Philhealth member who is indigent, who must secure a certification from the Barangay official and City Social Welfare and Development Office and should be submitted for consideration of the Local Chief Executive (LCE). SECTION12. PAYMENT EXECUTION. All service fee/charges payments will be paid directly to the City Treasurer's Office or to duly authorized personnel designated by the City Treasurer to accept payments which in turn will be issued an official receipt for every transaction made. SECTIONI3. CREATION OF TRUST FUND. A trust fund account will be created by the City Government of Butuan where all service fees collected will be deposited in this account SECTION14. DISPOSITION OF TRUST FUND. The management and disposition of the trust fund shall be governed by City Government of Butuan. 14,1 The disbursement and liquidation of the trust fund shall be in accordance with the pertinent government accounting and auditing rules and regulations. 14.2 A separate ledger shall be maintained by the City for this purpose. SECTION 15, DISBURSEMENT OF FUND COVERED UNDER FACILITY SHARE. The City Health Office regular personnel assigned in the Birthing Clinic and BEmONC facilities will create a Workplan in coordination with the Barangay (Punong Barangay) where the Birthing facilities are being operated. The Workplan will reflect its operating expenses as provided: The following shall be charged to the Birthing/BEmONC FacilitiesTrust Fund: 15.1 Utility Expenses 15.1.1 Electric Bill 15.1.2 Water Bill 15.1.3 Communication Expenses (Telephone and Internet) 15.2 Medical Supplies 15.2.1 Drugs and Medicines 15.2.2 Supplies (necessary for the delivery of maternal and child care services) 19.3 Other Administrative Costs 15.3.1 Database Recording and Reporting, to include Birth Registry 153.2 Office Supplies (items necessary to maintain the administrative function of the birthing facility operation) 15.3.3 Laundry Labor Service Fee and Supplies 15.3.4 Maintenance/Utility Services 15.3.5 Security Service 15.3.6 Improvement of Facilities (Purchase of Ambulance, nursery beds, recovery beds, and other capitalization needed for the enhancement of the birthing clinic operation)Page ten SP Ord. No. 5254-2017. cont'd, 15.3.7 Licensing and Accreditation fees, and other administrative fees SECTIONI6. PENAL CLAUSE. Any person who violates any provision of this Ordinance shall be duly sanctioned according to Civil Service Commission regulations and policies, in the case of a civil service-recognized government employee, or according to contract terms, in the case of a non-permanent employee. Any Traditional Birth Attendant (TBA) who violates any regulatory provision of this Ordinance shall be duly sanctioned according to SP Ordinance 3871-2012. SECTION17. SEPARABILITY CLAUSE. If, any provision of this Ordinance or any part thereof be declared unconstitutional or invalid, other provisions or any part thereof not affected shall continue to be in full force and effect. SECTIONI8. REPEALING CLAUSE. Any existing ordinance or any provision thereof inconsistent with the provisions of this ordinance is hereby repealed. SECTION19. EFFECTIVITY. This Ordinance shall take effect fifteen (15) days after the approval of the Implementing Rules and Regulations (IRR). Unanimously Approved Date Enacted: April 20, 2017 APPROVED: nage JOSE S. AQUINO II City Vice Mayor PresidingOfficer ATTESTED: Colm B. CABALLES,/ City Government Department Head If City SecretaryPage eleven SP Ord, No. 5254-2017, cont'd. Authors: Hon. Cherry May G. Busa Hon. John Gil S. Unay, Sr. Hon, Glenn C. Carampatana Hon. Ferdinand E. Nalcot Hon. Rema E. Burdeos Hon. Derrick A. Plaza Hon. Vincent Rizal C. Rosario :Hon. Cromwell P. Nortega Hon. Joseph Omar O. Andaya Hon. Ehrnest John C. Sanchez Movant: Hon. Cherry May G. Busa Seconders — : Hon. Vincent Rizal C. Rosario : Hon. Ehrnest John C. Sanchez Co-Authors