1. Establishment of PuroKalusugan
    1. PuroKalusugan is envisioned to be applied and organized in all barangays and their puroks for the continuous provision of primary health care services as aligned with the strategies in this Department Memorandum and future expansion of implementation sites as resources may allow.
    2. For its initial implementation, at least three (3) barangays (with their respective puroks) per municipality/city shall be identified as priority implementation sites, the selection of which shall be guided using the criteria in Annex A. These priority implementation sites shall be provided with enhanced provision of health services and additional assistance/logistics support. These sites are encouraged to prioritize health services based on the criteria on Annex B, as may be appropriate.
  2. Responsive Health Service Delivery to Address the Specific Needs of each Barangay and its Puroks

    1. Targeted Interventions: The priority implementation sites shall focus on health promotion, wellness, and nutrition at the primary level and shall be empowered to implement primary health care services aligned with the DOH’s 8 Priority Health Outcomes, namely:

      1. Immunization;
      2. Nutrition;
      3. Maternal Health;
      4. Water, Sanitation, and Hygiene (WASH);
      5. Tuberculosis and Human Immunodeficiency Virus (HIV) and AIDS Management and Control;
      6. Road Safety;
      7. Non-communicable diseases (NCDs), especially Hypertension and Diabetes Control, and Mental Health;
      8. Cancer Prevention and Control, and Hepatitis B Management;

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      Anchored on these priority health outcomes, the priority implementation sites may focus on at least three (3) programs identified to be in urgent need of enhanced delivery of services and assistance. This may be expanded depending on the result of the implementation and the resources available. The criteria for the selection of priority programs is attached as Annex B.

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    2. PuroKalusugan Health Teams (PKTs):

      1. The PKTs shall be composed of the following core members:
        1. At least one nurse or midwife from the NHWSS;
        2. Other DOH-deployed Human Resource for Health (HRH) under the National Health Workforce Support System (NHWSS) and other HRH hired by DOH Offices, such as those hired by the CHDs, Disease Prevention and Control Bureau (DPCB), Health Promotion Bureau (HPB) and DOH Hospitals deployed at the LGU level;
        3. The assigned nurse or midwife from the LGU;
        4. Barangay Health Workers (BHWs).
      2. The PKTs of a municipality/city shall be directly supervised by a DOH Representative.
      3. There shall be at least one PKT to facilitate the PuroKalusugan implementation in each barangay, i.e. priority implementation site. The nurse or midwife from the DOH-deployed HRH (either from NHWSS or hired by DOH Offices) shall lead one PKT, and shall directly report to the DOH Representative assigned.
      4. This composition may be expanded by tapping other community health volunteer workers and other health champions depending on the community’s needs.
      5. The PKTs shall deliver health services at the priority implementation sites at least twice (2x) a week. While all health programs will continue to be provided, the programs identified as priorities will receive focused monitoring and evaluation.

    3. Other Potential healthcare workers (HCWs) and stakeholders to participate in the implementation of PuroKalusugan:

      1. Through the CHDs’ and LGUs’ strategic and operational planning, different cadres of healthcare workers may potentially be deployed to deliver health services in the puroks. The specific cadres will depend on the identified needs and strategies to be implemented.
      2. Health and non-health workers are essential in delivering or assisting in the delivery of specific health services in the purok/barangays. The following may be tapped:
        1. Barangay Nutrition Scholars (BNS), Barangay Voluntary Sanitary Inspectors (BVSI), Barangay Health Emergency Response Teams (BHERTs) of identified priority barangays/puroks;
        2. Outsourced HRH from State Universities and Colleges (SUCs), including their allied medical students;
        3. Private sector health providers;
        4. Other volunteer HRH cadres from both private and public organizations;
        5. Other personnel deployed by other National Government Agencies (e.g. Department of Education, Department of Social Welfare and Development, National Commission on Indigenous Peoples, Philippine Commission on Women, PhilHealth, and National Nutrition Council, among others);
        6. Other stakeholders (e.g., civil society organizations, academe, faith/cultural leaders).
      3. Other potential healthcare workers and stakeholders who would like to participate in the implementation of PuroKalusugan may directly coordinate with the CHDs or the LGUs. Their plans and activities shall be aligned and coordinated with the implementation and activities designed and planned by the PKTs.

    4. Resource Assessment and Gap Analysis: Conduct of a community participative comprehensive assessment, profiling, and mapping of resources to identify gaps in commodities, HRH, and service delivery within the puroks shall be done. This should also include evaluating existing efforts, developing a problem tree and solution matrix, and formulating long-term action plans, particularly for issues that cannot be resolved through short-term or direct service delivery.

    5. Structured Health Services: Health service delivery will be done using a strategic and structured mechanism based on the microplanning done by the LGUs and CHDs.

      1. The services may be provided through existing healthcare facilities, deployment of mobile clinics, or direct house-to-house service delivery to ensure they reach the most vulnerable.
      2. Primary health care services may be provided at designated sites in the barangay or purok.
      3. The PKTs shall refer clients to the Rural Health Units (RHUs) and other higher-level facilities, as needed.

    6. Health Promotion: Technical assistance may be provided to enhance health literacy, community awareness, and support for health initiatives.

    7. Patient Registration: Advocacy shall be carried out for first patient encounters to ensure registration or updating of registrations to a primary care provider, thereby enhancing continuity of care.

  3. Enhanced Digital Information Systems for Health Service Delivery and Monitoring of Implementation
    1. Toolkit Adaptation: A PuroKalusugan Manual/Toolkit shall be developed for the DOH Representatives, PKTs, and BHWs.
    2. PuroKalusugan Dashboard (PK Dash): The DOH shall implement an innovative approach to monitor and evaluate the performance and impact of the PuroKalusugan initiative. A digital platform shall be utilized by the PKTs and other stakeholders involved in the implementation of the PuroKalusugan to input timely updates, monitor the progress, and enable stakeholders to visualize the contributions of PuroKalusugan to the DOH’s 8 Priority Health Outcomes. The Knowledge Management and Information Technology Services (KMITS), in collaboration with all relevant offices, shall develop this dashboard and ensure that it will be functional and user-friendly for all stakeholders.
    3. Data Digitalization: Digitalization of health data should be done for easier tracking, faster data collection, and more efficient analysis. The DOH shall provide further guidance in a subsequent guideline on the equipment and information system to be used for this purpose, as well as support that may be provided to facilitate effective and efficient data digitalization.
    4. Digital Health Integration: Technological advancements will be maximized by integrating telemedicine in platforms appropriate to the community’s local connectivity setting and other digital health tools into service delivery.
  4. Financing Strategies for the Implementation and Sustainability of PuroKalusugan
    1. Fund Review Allocation: The DOH Central Office and DOH-CHDs shall review fund sources, such as budgetary allocations from DOH Central Office, and identify potential areas for reallocation to effectively implement PuroKalusugan. The DOH shall also endeavor to ensure allocation of funds for the succeeding years.
    2. Partnerships and Collaboration: The DOH, through the CHDs, shall explore partnerships with the private sector, development partners, and civil society organizations to support relevant health services.
    3. Maximizing Patient Benefits: The DOH and PhilHealth shall endeavor to improve the Konsulta Packages and existing benefit packages. The CHDs and LGUs shall maximize and utilize existing benefit packages to enhance service provision.
    4. Cost Projection: CHDs shall closely coordinate with LGUs in identifying financial needs and implementation costs for potential funding from the LGUs, Central Office, and other investments in health. This will include financial plans for the succeeding years and possible expansion of areas covered by PuroKalusugan.
  5. Leadership and Governance
    1. Creation of PuroKalusugan Steering Committee: A Steering Committee shall be created to provide overall oversight in the implementation of PuroKalusugan. The Steering Committee shall be supported by a Technical Working Group and a Technical Secretariat. A Department Personnel Order shall be drafted subsequently.
    2. Direct Oversight of PuroKalusugan Implementation through the CHDs: The CHDs shall lead and oversee the implementation of the PuroKalusugan initiative in their respective regions. With the guidance of the CHD, the Provincial/City Department of Health Offices (P/CDOHOs) through the DOH Representatives and in coordination with the Provincial/City Health Offices, shall directly supervise the LGU’s implementation, provide technical assistance, and monitor and evaluate the performance of the PKTs, particularly the DOH-hired HRH.
    3. Community Leadership and Engagement: The LGUs and the P/CDOHOs may engage formal and informal community leaders as Health Champions through collaborations in planning and implementing PuroKalusugan. Health Stakeholders may be engaged in the implementation of the PuroKalusugan in the provision of logistics, equipment, transportation and communication, service delivery, and monitoring and evaluation, among others.
  6. Monitoring and Evaluation
    1. The performance monitoring and evaluation of DOH Bureaus, Services, Offices, and Centers for Health Development relating to the PuroKalusugan initiative shall be reflected in their respective Office/Individual Performance Committee and Review (O/IPCRs).
    2. Further, the performance of DOH-hired HRH, whether under the NHWSS or those directly hired by DOH Offices / CHDs, deployed for the implementation of the PuroKalusugan or as members of PKTs, shall be monitored and evaluated based on indicators aligned with the DOH’s 8 Priority Health Outcomes as reflected in their respective IPCRs.