The Philippine System of

Medical Examinations

for Seafarers

Department of Health Bureau of Health Facilities and Services (BHFS)

Manila, Philippines Presenter: Cynthia R. Rosuman, MD

27 August 2014, Bergen, Norway

OBJECTIVE

To present the system of

medical examinations for

seafarers in the Philippines

Migrant Workers Act

RA No. 10022 IRR Rule XI Role of DOH

Section 16. (c) Department

of Health (DOH).

The DOH shall regulate the

activities and operations of

all clinics which conduct

medical, physical, optical,

dental, psychological and

other similar examinations,

hereinafter referred to as

medical examinations, on

Filipino migrant workers as

requirement for their

overseas employment.

Section 1. Regulation of Medical

Clinics. The DOH shall regulate the

activities and operations of all clinics

which conduct medical, physical,

optical, dental, psychological and other

similar examinations, hereinafter

referred to as medical examinations on

Filipino migrant workers as requirement

for their overseas employment. Pre-

Employment Medical Examinations

(PEME) for overseas work applicants

shall be performed only in DOH-

accredited medical clinics and

health facilities utilizing the

standards set forth by the DOH.

Migrant Workers Act

RA No. 10022 IRR Rule XI Role of DOH

Section 16. (c) Department

of Health

(c.1) The fees for the health

examinations are regulated,

regularly monitored and duly

published to ensure that the

said fees are reasonable

and not exorbitant.

Section 1. Regulation of Medical Clinics.

(a) The fees for the health examinations

are regulated, regularly monitored and

duly published to ensure that the said fees

are reasonable and not exorbitant. The

DOH shall set a minimum and

maximum range of fees for the different

examinations to be conducted, based

on a thorough and periodic review of

the cost of health examinations and

after consultation with concerned

stakeholders. The applicant-worker

shall pay directly to the DOH-accredited

medical clinic or health facility where

PEME is to be conducted.

Administrative Order No. 2013-0006 “Guidelines to Rule XI: Role

of DOH in the Omnibus Rules and Regulations Implementing

the MWA of 1995, as Amended by RA No. 10022”

2 Mar 2013: date of effectivity

7 Feb 2013: Approved

by the Secretary of

Health

25 May 2011: Notice of Public

Hearing Published at PDI

15 Feb 2013: A.O. No. 2013-0006

Published at The Philippine Star

ANNEX SUBJECT

A Planning and Design Guidelines for OFW Clinics

B Reference Floor Plan for OFW Clinics

C DOH PEME Certificate and MER for Land Based Overseas Workers

D DOH PEME Certificate and MER for Seafarers

E Statistical Report on the Pre-Employment Medical Examination (PEME)

F Statistical Report on Selected Laboratory Tests

G Tabulated Psychological Assessment Form

H Cases of Repatriation

I Non-Reactive HIV Screening Test Certificate

J DOH Master Logbook

K Basic DOH PEME Package

L ILO/ IMO Guidelines on the Medical Examinations of Seafarers

M Peer Review Committee pursuant to DOH D.O. No. 185-N s. 1996

A. O. No. 2013 – 0006 ANNEXES

HIGHLIGHTS OF REQUIREMENTS OLD NEW

Rationale: New Law R. A. No. 10022 X ✓

New Definitions: Fitness Date, STCW, Seafarer X ✓

General Guidelines:

a. QSS Certification

b. Set range of prices (minimum – maximum)

c. Decking practice is prohibited

✓

X

X

✓

✓

✓

Personnel: Registered nurse on full time basis X ✓

Physical Facilities: minimum ___ sq. m. 50 200

Establish an electronic uploading system X ✓

Level up basic DOH PEME Package: digital x-ray,

serum PT, semi-automated urinalysis and stool exam X ✓

Validity of Pre-Employment Medical Exam (PEME):

a. 90 days prior to deployment

b. 2 years for seafarers

✓

X

✓

✓

Guidelines on Repatriation X ✓

DOH Peer Review Committee D.O. No. 185-N s.1996 ✓ ✓

Transitory Provision (30 June 2014) X 2014

DOH Process of Accreditation

PROCESS

STANDARDS

Legislative Acts

Rules & Regulations

Technical Requirements

Administrative SOPs

Manuals

INPUT

Manpower

Forms / Checklists

Office/ furniture

Clerical support

Travel fund

Application

Payment of fees

Processing

Inspection

Evaluation

Action

Education

OUTPUT

Accomplished forms (application,

inspection, evaluation forms)

Approved Permit to Construct

Certificate of Accreditation

List of DOH Accredited Clinics

Review of accomplished

forms (application,

inspection, evaluation)

Monitoring reports

Monthly clinic reports

Peer Review Committee

Complaints

Consultation meetings

FEEDBACK

Clients/

Clinics

DOH

Process Flow

BHFS Director

receives the

complaint

LICENSING Peer

Review

Committee

Referral

DOH Accredited

Medical Clinic

YES

Referral to Peer Review Committee

Documentary

requirements

Recommendations

Heads of Medical/

Surgical Departments,

Government

Specialists

Decision

is final.

DOH DO No. 185-N s. 1996

Mapping of DOH Accredited Medical

Clinics for Migrant Workers

DOH A.O. No. 2013 – 0006

List and distribution of DOH accredited medical clinics.

Empowers DOH in planning activities which would improve access to medical services in line with the “Aquino Health Agenda: Achieving Universal Health Care for All Filipinos”.

http://maps.doh.gov.ph/nec_afp.html

Figure 1. Number of Medical Facilities for

Overseas Workers and Seafarers

n = 179 2%

3%

95%

Special Sea-Based

Special Land-Based

Regular

DOH-BHFS 2014

DOH Accredited Medical Clinics

(as of 30 April 2014) n = 179

REGION RLS SLF

(Landbased)

SSF

(Seabased)

NCR 137 1 2

CAR 1 2 -

I 3 1 -

II - 1 -

IV-A 3 - -

VI 9 - 1

VII 9 - 1

IX 1 - -

X 2 - -

XI 3 - -

XII 2 - -

TOTAL 170 5 4

RLS – Regular Land- and Sea-Based Facility;

SLF- Special Landbased Facility; SSF – Special Seabased Facility

Findings on Licensing and

Monitoring of Medical Clinics

for Seafarer and Overseas

Work Applicants

Partial Data as of December 2013

67

9 Inspected and was not

issued a Certificate of

Accreditation

Inspected and was

issued a Certificate

of Accreditation

Fig. 2. Number of Clinics Inspected

Year 2013, n = 76

FINDINGS “LICENSING”

SERVICE CAPABILITY PERSONNEL

Absence of documented policies /

procedures on proper disposal of

wastes and hazardous substances

Contract of employment not notarized;

Physician’s license not updated;

Professional Tax Receipt not updated.

Absence of flow chart of activities Absence of specialty board certificates

of affiliate consultants

Absence of MOA with board

certified consultants (retainers)

Absence of medical certificate and drug

test report of drug test lab personnel

PHYSICAL FACILITIES EQUIPMENT/ INSTRUMENT/

SUPPLIES

Inadequate space Absence of non-mercurial thermometer

Absence of FECT for stool exam

Inadequate handwashing facilities Absence of ELISA Machine

FINDINGS “MONITORING”

SERVICE CAPABILITY PERSONNEL

Inadequate training on HIV

proficiency Physician’s license is not updated.

No certificate of participation in the

National External Quality

Assessment Scheme (NEQAS)

No examining physician

Sending out of hematology and/or

chemistry services No registered medical technologist

PHYSICAL FACILITIES EQUIPMENT/ INSTRUMENT/

SUPPLIES

Floor to ceiling walls in specific

areas for security / confidentiality

No schedule of maintenance and

calibration of equipment

Sound-proofing of audiometric

facilities

No inventory of reagents / expired

reagents

REGULATORY POLICIES DOH COURSE

OF ACTION

TRANSITORY PROVISION:

Full implementation of new

requirements

30 June 2014

Strict enforcement of

period of transition

On-going monitoring

of the conduct of

PEME for seafarers

Posting and

publication of the

prices of health

examinations for

Filipino migrant

workers

REGULATORY POLICIES DOH COURSE

OF ACTION

VALIDITY OF CERTIFICATE OF

ACCREDITATION (COA):

Three (3) years

Strict enforcement of

validity

VIOLATION:

Stakeholders found violating any

provision of these guidelines and its

related issuances, INCLUDING FAILURE

of the clinic TO HONOR THE DECISION

OF THE PEER REVIEW COMMITTEE

and/or commission / omission of acts by

personnel operating the facility shall

constitute a violation and shall be

penalized and/or its COA suspended or

revoked.

1. Regardless of the

nature of the Offense:

1st Offense 50th

2nd Offense 100th

3rd Offense

Revocation of COA

2. Preventive suspension

< 60 days

STRATEGY /

INTERVENTION

Key Performance

Indicator (KPI)

PERSON

RESPONSIBLE

TIME

FRAME

Cost /

Resources

1. Develop policies in the

regulation of health

facilities and services:

2 Approved

Policies

DOH-BHFS with

active

participation of

stakeholders

31 Dec 2016 ~ Php 2.0 M

a. Prices Charged by

DOH Accredited

Medical Clinics on

Health Exams for

Overseas Workers/

Seafarers

Approved policy

(draft ready)

Post Prices

Publication of

Prices

DOH-BHFS 30 June 2014

DONE

Php 500,000

(Office supplies,

meals for public

consult,

publication of

Notice / Prices)

b. Formulate a module

on training in

maritime medicine

Approved Training

Module

DOH-BHFS,

MARINA 30 Sept 2015 Php 1.5 M

2. Establish and maintain

an integrated MIS

Approved MOA “i-

Clinicalab Project”

DOH-BHFS,

contractor, clinic

owners

Full

implementation

Sept 2014

No cost to DOH,

clinic owners and

clients

ACTION PLAN 2014 – 2016 (Short Term Plan)

Develop policies and systems in the regulation of health facilities

and services in accordance with D.M. No. 2013-0320 re: Health

Policy Agenda by 31 Dec 2016.

STRATEGY / INTERVENTION Key Performance

Indicator (KPI)

PERSON

RESPONSIBLE

TIME

FRAME

Cost /

Resources

1. Improve public service

access and delivery of

information through the

DOH / BHFS portal

Continual Access

(based on Customer

Satisfaction Survey)

DOH-BHFS 31 Dec

2020 c/o IMS

a. Online portal to view and

comment on pending

regulations

BHFS Portal / website

with data field on

‘Pending Regulations’

DOH-BHFS DONE c/o IMS

b. Provide compliance data

on-line on prices of

health exams charged

by medical clinics

Prices encoded in e-form,

posted on-line and

regularly updated

DOH-BHFS,

Admin, IMS,

Clinic Owners

Work in

progress

2014

c/o IMS

2. Initiate funding

opportunities through

collaborative partnership

among stakeholders

Project Proposal

“Mirror Website of BHFS”

DOH-BHFS,

Contractor

2015 –

2018 Php 1.0 M

3. Strengthen interface with

other Divisions and DOH

Regional Offices for the

timely submission of data

Interconnection of DOH –

BHFS and Regional

Licensing Offices

BHFS, Regional

Offices, IMS,

Contractor

2015 –

2020 Php 25 M

ACTION PLAN 2014 – 2020 (Long Term Plan)

Reform government website of the Regulatory Bureau to promote

transparency and to improve customer service by 31 Dec 2020.

DOH / BHFS Website

bhfs.doh.gov.ph

Licensing / Accreditation Requirements

and Issuances

Medical Facilities for Overseas Workers

and Seafarers

or go to

Pending Regulations for Comments

Thank you.

Approved and authorized by the DOH and the Maritime Industry Authority

(MARINA) of the Republic of the Philippines, issued in Compliance with STCW

Convention 1978, as amended Section A-I/9 Paragraph 7 and the MLC 2006.

I. Seafarer’s Information

II. Declaration of the Authorized Physician

III. Mug Shot Photo of Seafarer / Issuing Authority

IV. Seafarer’s Signature: “I have read and understood and was informed of the

contents of the Certificate and of the right to a review in accordance with Paragraph

6 of Section A-I/9 of the STCW Code.”

V. Validity of Medical Certificate (Date of Issuance and Date of Expiration)

VI. Important Integral Notes (Back of Certificate)

MEDICAL CERTIFICATE FOR

SERVICE AT SEA

PHOTO

Examining Physician: ________________

License Number:____________________

Date of Medical Examination: __________

Approved and authorized by the DOH and the Maritime Industry Authority

(MARINA) of the Republic of the Philippines, issued in Compliance with STCW

Convention 1978, as amended Section A-I/9 Paragraph 7 and the MLC 2006.

I. Personal Information of the Seafarer

II. Medical History

III. Medical Examination

IV. Results of Ancillary Exams

V. Summary of MER

VI. Assessment of Fitness for Service at Sea (With / Without Restrictions)

VII. Seafarer’s Signature: “I hereby certify that the personal declaration above is true to

the best of my knowledge. I fully understand the above results of my medical

examination as explained to me by the examining / authorized physician.”

I hereby authorize the release of all my medical records to the DOH / MARINA /

POEA, the examining/authorized physician and my employer/manning agency.

MEDICAL EXAM REPORT (MER)

FOR SEAFARERS

Examining Physician: ________________

License Number:____________________

Date of Medical Examination: __________

PHOTO

REPORT “Unfitness”

REASONS FOR UNFITNESS NUMBER

TOTAL UNFIT

Name of

Worker/

Age/Sex

Date

of

PEME

Position

Applied

For

Company

Vessel

Type

(Cruise,

Cargo,

Tanker,

Seismic)

Sea Trade

(Offshore,

Coastal)

Date of

Deployment

Date of

Repatriation

Cause /

Reason for

Repatriation

Total Number of FIT PEME Certificates issued to seafarer applicants = __________

REPORT “Repatriations”

Non-Reactive Human Immunodeficiency Virus (HIV) Screening Test Certificate

This is to certify that Mr. / Ms. ____________________ has undergone screening test for

HIV and was found to be NON-REACTIVE based on laboratory test (HIV-1 / HIV-2).

Name: ______________________________ Age: _____ Sex: _____ Civil Status: ________

Address: ______________________________________ Date of Report: _______________

Screening Test Used (Equipment-Based ELISA):

Immunoassay: EIA / CMIA / ELFA

Non-Reactive HIV Screening

Test Certificate

PHOTO

Examining Physician: ________________

License Number:____________________

Date of Medical Examination: __________

MANDATORY EXAMS MINIMUM REQUIREMENTS

Color Perception Ishihara 24-Plates

Audiometry Pure Tone (Air Conduction)

Chest X-Ray Digital

ECG Routine 12-Lead

Blood Typing (ABO and Rh

Typing)

For new applicants: Tube Method, direct and reverse

For re-hires: Slide Test

CBC Automated with 3-Part Differential Count

Syphilis Test RPR and/or TPHA

Pregnancy Test (for females) Serum

Urinalysis Microscopy and urine strip reader for urine chemistry

Stool Exam (for food handlers) FECT and/or equivalent

OPTIONAL EXAMS MINIMUM REQUIREMENTS

Basic Blood Chemistries Automated and/or semi-automated

Blood Borne Diseases (HIV,

HBV, HCV) Equipment-Based ELISA

Other lab and diagnostic

procedures

Subject to Physician’s Recommendations and/or

Company Set Policies / Principal’s Requirements

Type in the url “doh.iclinicalab.com.ph” Home page will appear. Click CLINICAL LABORATORY

Input Username and Password.

“Prices Charged by DOH Medical Clinics

on Health Exams for Migrant Workers” (Sample Matrix)

Name of Clinic

Address

Contact number

Prices

Updated as of

dd/mm/yyy

DOH

Package

Male

DOH

Package

Female

Chest

X-Ray ECG BT CBC

Stool

Exam

Urine

Analysis

Minimum Price

Maximum Price

Average Price

A 27/08/2014 - - - - - - - -

B 27/08/2014 - - - - - - - -

C 27/08/2014 - - - - - - - -

Etc 27/08/2014 - - - - - - - -

Website: bhfs.doh.gov.ph

‘Pending Regulations for Comments’