Republic of the Philippines Department of Health OFFICE OF THE SECRETARY ‘San Lezaro Compound Rial Avenue, Sta. Cz 1003 Menita, Philippines ‘Trunk Line 743-82-01 Diteet Line 711-95-02 to 03 Line 743-1828, e-mail: csse@doh.gov-ph September 9, 2004 ADMINISTRATIVE ORDER No. _}6g 3.2004 SUBJECT: National Policy on Health Emergencies and Disasters 1, BACKGROUND AND RATIONALE In an emergency, the health sector is always called-and relied upon to resporid, It is expected to take the lead in dealing with disease outbreaks or epidemics and, oftentimes, to provide essential back up support during rescue operations, like after an earthquake. The responsibility for dealing with disaster rests primarily on the national and local government since efficient disaster management requires the optimum uflization of existing resources, majority of which tend to be under government ownership and control. in 1978, P.D. 1566 “Strengthening the Philippine Disaster Control Capabilty and Establishing the National Program in Community Disaster Preparedness” paved the way for the institutionalization of the disaster management structure from the national government down to the ‘barangay level. The Department of Health is mandated to lead the proviston of medical services in collaboration with other stakeholders in the health sector. Its role in health ‘emergency management is to lead in Health Sector preparedness and response. It follows, therefore, that the organizational set-up needed for dealing with disasters is best based on existing government structures. Failure on the part ofthe health sector to respond adequately ‘and appropriately can be quite costly, not only health-wise, in terms of ensuing disabilities and tost lives, but also socially, technically and poiticaly Reports from the United Nations Office for Coordination of Humanitarian Affairs (OCHA) showed that 145 or 23 percent of the 617 major disasters caused by natural hazarés in the world occurred in the Wester Pacific Region. Moreover, the total world figures from World Health Organization (WHO) data revealed that 8.1 percent were kiled in the disaster, 48.8 percent injured, 89.2 percent homeless, and 65.2 percent were affected in the Region The Philippines is among the top five counties in terms of the number of natural disasters occurring in the Region, with no less than 4f events or 28 percent hitting the country. ‘Another growing concern is the steady increase in the number of major disasters caused by man-made and technological hazards, in adcition to the global concern on terrorism as well as the threat of new and re-emerging diseases such as SARS and the Avian Flu. Around 1,500 people are kiled by major technological disasters every year in the Region since 1893. th fact, the Philippines ranks second in terms of the number of mass casualty events due to industrial accidents. ‘The WHO's Emergency and Humanitarian Action Programme, (EHA) has identified five regional issues that have parlly hampered the realization of regional objectives to support capacity building for emergency health management. To wit. i) increasing natural and technological hazards; ii) insufficient readiness; ii) insufficient public health information on ‘emergency situation; iv) weak institutional capacity for emergency management, and v) lack of collaboration among partner agencies prior to emergency.To enhance the capacity of the health sector in emergency management, two National ‘Conventions on Heaith Emergency Management for the Health Sector have been conducted, Which resulted in the forging of a Memorandum of Agreement among 12 national agencies and the development of a Strategic Plan for the Health Sector. The main objective of the MOA is to establish a comprehensive, integrated and coordinated health sector response to emergencies and disasters. Given these concems, this guideline is hereby formulated to define the rules of engagement, procedures, coordination and sharing of resources and responsibilities, 10 include the varying levels of state of preparedness and the desired response to emergencies and disasters in the health sector. DEFINITIONS. @. HAZARD — any phenomenon which has the potential to cause disruption or damage to people, their property, their services or their environment, ie. their communities. b. EMERGENCY — any actual threat to public safety. ©. MAJOR EMERGENCY — any emergency where response is constrained by insufficient resources to meet immediate needs. d. EMERGENCY MANAGEMENT ~ a management process that is applied to deal with the actual or implied effects of hazards. @. MASS CASUALTY EVENT ~ an event in which the number of dead and injured is of ‘sufficient magnitude as to overwhelm the available resources; e.g. a plane crash or an ‘epidemic, t DISASTER — an event, in which local emergency management measures were insufficient to cope with a hazard, whether due to lack of time, capacity or resources, resulting in unacceptable levels of damage or numbers of casualties. 9. PREPAREDNESS — measures taken to strengthen the capacity of the emergency services to respond in an emergency. Emergency preparedness is done at all levels while disaster preparedness is focused mostly at the national level. h. RISK ~ the level of loss or damage that can be predicted to result from a particular hazard affecting a particular place ata particular time. RISK MANAGEMENT ~ a comprehensive strategy for reducing risks to public safety by preventing hazards, reducing vulnerabillies and enhancing preparedness ie response capacities. i HEALTH EMERGENCY MANAGEMENT HEALTH SECTOR — is an organization of ‘agencies each with a health unit primarily devoted to and united to provide state of the ‘art, appropriate and acceptable technical assistance andior direct services on health ‘emergency preparedness and response to any entity ~ international or national. OBJECTIVES: A. General To formulate and implement a national policy framework for emergencies and isasters for the Health Sector in order to decrease mortality and morbidity, promote physical and mental health as well as prevent injury and disability on the part of both victims and responders.Nv. Specific 4. To develop goals, strategies, plans and policies for ensuring an efficient and effective system for managing emergencies and disasters in the Health Sector, 2. To improve the effectiveness of DOH systems, structures, capacities and mechanisms for managing emergencies and disasters; 3. To build up the preparedness and response activities of both the public and private health facilities for administering mass casualty events during emergencies and disasters; and 4. To strengthen links between partner agencies and stakeholders in responding to emergencies and disasters in the country. ‘SCOPE AND COVERAGE ‘This Order shall apply to all Department of Health offices, hospitals and its attached agencies. It shall likewise apply to all disciplines and institutions, whether government, non-govemmment or private entities whose functions and activities contribute to health ‘emergency preparedness and response. FRAMEWORK OF HEALTH EMERGENCY MANAGEMENT Vision ‘To be Asia's prime mover in health emergency and disaster preparedness and response. Mission To lead in the formulation of a comprehensive, integrated and coordinated health sector response to emergencies and disasters. To ensure the development of competent, dynamic, committed and compassionate health professionals equipped with the most modern and state-of-the-art facilities at par with global standards. To be the center of all health and health-related information on emergencies and disasters. Goals/Objectives 1. General To ensure health emergency preparedness and response among the general public and to strengthen the health sector's capability to respond to emergencies and disasters2. Specific a. To establish an integrated system —_for__health emergency preparedness/response and management within the Department of Health, b. To enhance the capabilities of the Health Sector in effective and efficient health emergency and disaster response c. To promote health emergency preparedness through networking, inter- sectoral collaboration, fechnical assistance, training and development, public information and advocacy. d. To support researches on health emergency preparedness and management and response @, To develop a tisk reduction framework for health emergency preparedness as well as @ policy framework in support of this initiative. D. Strategies Capacity Building and Facilities Enhancement — this includes ‘training on health ‘emergency preparedness at al! levels of the Health Sector, from the community to the tertiary level as well as enhancing necessary facities to improve the capacities of involved institutions. ‘Service Delivery — this should aim at providing timely, holistic and appropriate responses in emergency situations. Likewise, competent, compassionate and dedicated personnel should provide the service. Health Information and Advocacy — this activity aims at informing the public on prevention and preparedness for emergencies and disasters, basic first aid in managing emergencies at home, at the work place, schools and other public places. Efforts shall be done to empower the community through health education and promotion. Health Policy — efforts should be done with policy makers at all levels, both in the ‘executive and legislative departments, other concemed agencies to pass laws related to preparedness and secure their public commitment and support. Networking and Social Mobilization — this aims to network and collaborate with various sectors from the government and private organizations for advocating and implementing the objectives and activities of HEM. Inter-sectoral response and ‘community participation shall be encouraged in all phases of the disaster. Research and Development — the importance of research cannot be overemphasized ‘as this serves as inputs and feedback mechanism for policy and program development. Resource Mobilization — this aims at mobilizing all resources of the health sector with ‘the sim of maximization and equitable distribution. Furthermore, it encourages ‘generating the appropriate resources needed and prevents wastage and unnecessary utilization. Information Management System and Surveillance — this emphasizes the importance ‘managing health emergency situations and assisting decision ‘Standards and Regulation ~ to put in order all the different aspects in management, efforts will be done to improve preparedness and response to health emergencies. In10, so doing, standards will be set, regulations willbe reinforced and accreditation will be ‘complied with Monitoring and Evaluation ~ Emphasis will be done on documenting events, lessons teamed, postmortem analysis, sharing of good practices in special forums and conventions. All events shall be documented in the form of final reports that will erve a8 inputs for policy making and improvement in response. POLICY STATEMENTS: ‘Organizational Structure: All health facilities should have an-Emergency Preparedness and Response Pian and ‘a Health Emergency Management Office / Unit / Program, Such offices, units or programs shall be under the supervision of the highest officer such as the Regional Director, Chief of Hospitel and its equivalent officer so as to ensure faster decision- making in times of emergencies and disasters. ‘All health facilities shall establish a crisis and consequence management committee to handle major emergencies. and disasters, consisting of people from operations, planning, logistics, and finance group. ‘An emergency coordinator shall be designated in all heaith facilties. He/she should be ‘an integral member of any crisis or consequence management in his/her respective facility or institution. As such, he/she shall coordinate directly to higher officials for technical aspects during emergencies, and administratively, shall be answerable to hisfher mother unit, He/she shall be given proper authority and support (personnel and material) by the management during operations. ‘An official spokesperson who is accessible and available to the media shall also be designated. He shall be responsible for disseminating information that is accurate and updated. Human Resource Development ‘All health workers should receive basic training on health emergency management as part of their educational preparation as it is expected that everyone should participate in preparedness, response, rehablitation, and mitigation activities at various levels. ‘The safetysecurity of the health worker is of prime importance In any health emergency operation. Before deployment, they should be provided with proper ‘identification, proper uniform and the necessary personal protective equipment Furthermore, they should be properly oriented and given proper guidance on the risks ‘and hazards involved in such an operation ‘A system for rewards, incentives and recognition for outstanding performance should be put in place to develop a culture of excellence in health emergency management. “The physical and psychological integrity of health workers is an important factor in the success of health emergency management. Physical and psychological fitness of personnel shall be maintained through drillssimulation exercises, stress management, debriefing sessions and respite care in long-term operation. A mental health program for disasters should be developed and integrated in the training for health personnel,5. A mechanism for certifying, updating, and conducting refresher courses shall be “organized to ensure that all personnel involved in health emergency management are Knowledgeable in current trends and state-of-the-art techniques and technology related to their area of expertise. 6. Core and functional competencies required of heaith emergency personnel at various levels shall be identified to develop an integrated national human resource ‘development program addressing various types of health emergencies. Selection of health personnel for training shall be based on their roles and responsibilities. Personnel trained and developed shail be retained in areas where their expertise can ‘be maximally utilized e.g. emergency rooms. In the event that they are rotated there ‘should be a system wherein they could readily be recalled for emergency operations. 7. An inventory of the available human resources based on their expertise should be developed at each level G. Support Systems 4. Logistics Management shall be developed for heath emergency with the aim of providing the right requirement, with the right amount, at the right time and the right place. A system for procurement and delivery shall be developed wherein the logistical needs are identified at the different leve's of health facies. Resource pooling/sharing of resources (including manpower and materials) among the various stakeholders in the health sector shall be institutionalized. 3. Media management and public information shall be made readily accessible in such Situations. As such, there shall be 2 designated spokesperson in all health facities and institutions to respond to inquiries related to health emergencies. Such person Should be trained and be readily available/accessible to the media. A system for managing information during emergencies shall be developed anc ‘stitutionalized for the health sector to ensure that appropriate, timely and relevent formation are disseminated to the target stakeholders. Furthermore, flow of formation and proper way of documentation should be established. 6. Communication system should be developed at all levels to improve monitoring and response to emergencies and disasters. 6. Crisis management and consequence management be institutionalized at all health facilties and at all levels. /. Hospital Emergency Preparedness and Response Plan, Code Alert System and Hospital Emergency Incident Command System (HEICS) should be a requirement in hospital licensing. & A Mase Casually Management System should be institutionalized for the Health Sector. 9. Other protocols, guidelines, flow charts and manual/s of operation needed to improve response should be developed and coordinated with all members of the Health Sector responding to emergencies and disasters. 40, There should be @ system for documentation of lessons teamed from all health ‘emergency incidents.D. Program Development ‘All health facilities should develop an emergency preparedness and response plan which should be holistic, to include amongst others the following: Emergency Planning Committee; Hazard and Vulnerability Assessment; Identification of Resources and Gaps; Response to respective Hazards; Organizational and implementing Structure; Training and Drills; Information Dissemination and Advocacy; Networking and Coordination; Research and Development. This should be disseminated and tested for the functionality of the plan and its inter-operability with other health facilities and institutions in their respective area. ‘The community should be involved in all phases of disaster management and programs. ‘The Department of Health shall provide technical assistance on health emergency ‘management to LGUs. [All local government units are encouraged to establish a health emergency management tesm and coordination mechanism to ink up with the DOH-HEMS and NGOs for technical support and assistance during health emergencies. Program Components Components of the health emergency preparedness and response should be holistic ‘and should cover all phases of the disaster: pre-disester phase, disaster phase and post-disaster phase. There should be a focus on the Community Risk Reduction Strategy in the Program. “This should include decreasing the hazard, decreasing vulnerability and increasing health preparedness, The coverage should be comprehensive and should inciude all types of disasters, natural, man-made and technological. Likewise, it should cover Mass Casualty Management, Public Health, Mental Heath and all types of emergencies with a potential to be a disaster. Mental Health in Disaster should be a mejor component and should be institutionalized in all phases of disaster. Likewise, mental health services should be provided to the victims, relatives of victims as well as the responders. Lastly, Health Emergency Management should be integrated in health programs of the community, the local government and the stale. Networking and Coltaboration Response to emergencies and disasters is not a monopoly of any institution. Hence, there should be an active desire to coordinate with all agencies, other government agencies, non-government organizations, private organization and also intemstional organizations, . Collaboration with the Health Sector responding to emergencies and disasters will ‘ensure a more comprehensive, integrated and coordinated response to emergencies in addition to maximization of resources. Hence, a system for coordination/collaboration should be developed.G. Finance vw 4. All health facilities, institutions and agencies should allot a certain percentage of their ‘annual budget for preparedness activites, training and drills, advocacy activities for health emergency. In the event of emergencies and disasters, all DOH facilities are authorized to tap clher resources in their respective agencies/offices to respond to the emergency Likewise, all members of the Health Sector may adept this policy. IMPLEMENTING MECHANISM ROLES AND RESPONSIBILITIES 4, DEPARTMENT OF HEALTH a. Serves as the leader and the policy making body of the Health Sector b. In coordination with the Health Sector, formulates protocols, guidelines, standards, etc,, in relation to emergencies and disasters. Serves @s the Operation Center (HEMS) monitoring all health emergencies and disasters and events that might arise to emergencies 4. Informs the public of health emergency events. 2. Provides technical assistance to LGUs, health facilities, NGOs, and other stakeholders. f __Enforces standards and regulate facilities in the implementation of health ‘emergency procedures. 9. Provides technical advice to and coordinates with the National Disaster Coordinating Council and international agencies. fh. Monitors, evaluates existing policies and formulates new policies and ‘guidelines pertaining to medical emergencies and disasters, 2. HOSPITALS a. Observe all the requirements and standards (hospital emergency plan, HEICS, Code Alert etc.) needed to respond to emergencies and disasters, b. Ensure enhancement of their facilities to respond to the neads of the ‘communities especially during emergencies. c. Network with other hospitals in the area to optimize resources and coordinate transferring of vietims to the appropriate facil. Report all health emergencies to the Operation Center; document all Incident responded, 3. CENTERS FOR HEALTH DEVELOPMENT (CHD'S) Serve as the DOH Coordinating Body in their region. Maintain an’ updated hazard and vulnerabilty assessment of their ‘catchment areas,c. . Observe all the requirements and standards (regional emergency plan etc.) needed to respond fo emergencies and disasters. d. Organize the health sector in the region and provide a mechanism for coordination and collaboration, Provide advice to the RDCC for health ‘emergency concerns, €. Maintain an operation center to serve as the regional repository of events for the Health Sector. Identify an official spokesperson to answer concems by the public and the media. £ Provide technical assistance and empower all LGUs in the area on health ‘emergency management. @. Report to thé Central OOH (HEMS) for all emergencies and disasters and any incident with the potential of becoming an emergency. fh. Document all health emergency events and conduct researches to ‘support policies and program development. . 4, OTHER GOVERNMENT AGENCIES a. Observe all requirements: and standards needed to respond to emergencies and disasters in accordance to the thrust of the Department of Health, b: Coordinate with the Department of Health all health emergencies responded c. Participate in inter-agency activities of the Department of Health, Coordinate with the Deparment of Health during emergencies and disasters. 5. NON- GOVERNMENT ORGANIZATIONS: a. Organize preparedness and response activities in accordance with the national thrust of the Department of Health b. Provide logistical support for health service delivery. Coordinate and participate in interagency activities, d. Advocate for emergency preparedness and mitigation. 6. DOH -CENTRAL OFFICE: A. HEALTH EMERGENCY MANAGEMENT STAFF a. Act as the DOH coordinating unit and Operations Center for all health emergencies and disasters and incidents with the potential of becoming an ‘emergency and coordinates mobilization and sharing of resources, b. Provide the communications linkage among DOH Central Office and other concemed agencies including the hospitals and the regions during ‘emergencies and disasters.Maintain updated information of all heath emergencies and disasters (except epidemiological investigation report) and provide such information to other offices and agencies in accordance with existing protocols. d. Maintain 2 database of all health emergency personnel, technical experts, ‘and resource speakers. Together with NCHFD maintain a database of ‘capabilities of health feces. @. Lead in the development of National Health Emérgency Preparedness and Response Plan, development of protocols, guidelines and standards for health emergency management. f. Provide technical assistance in the development of programs, planning ‘activities for HEM for other Government and Non- government organizations. g. Lead advocacy activities including simulation exercises. fh. Develop and implement an integrated Human Resource training agenda for the Health Sector for emergencies and disasters. i. Leads in the networking of hospitals and organization of the Health Sector responding to emergencies and disasters. j. Monitor and evaluate the enforcement and compliance of -polcies, recommend policy formulation and amendment related to health emergency management. 2, NATIONAL EPIDEMIOLOGY CENTER a. Serves as the overall coordinating unit in the surveillance and detection of diseases that have the potential to become an epidernic. b. Ensures the establishment of disease surveillance system during health ‘emergencies and disasters in coordination with the Regional Surveillance Units (RESUs) e.g. in evacuation centers. * c Coordinates with DOH offices and with the Health Sector in disease outoreak investigation and recommends appropriate response. 4. Provides technical assistance to LGUs/health facilities/gavernment facilities in staft development, setting of surveillance system and monitoring of such activities during emergencies and disasters. 2. Maintains a documentatior’ of all reported epidemic-related events. f. Conducts epidemiological studies, as needed, during emergencies. 3. NATIONAL CENTER FOR DISEASE PREVENTION AND CONTROL. ‘a. Develops protocols and field operation guidelines in coordination with the Health Sector on case definition, identification and management of diseases during emergencies, which should cover but not limited to the following: diseases in evacuation centers; infectious diseases and those related to Biological and Chemical Weapons of Mass Destruction; water and sanitation; food and nutrition; mental health in disasters and ensures compliance to protocols. b. Provides technical inputs in the development of training for these particular diseases as well as in the ‘development of prototype IEC materials and identifies experts as needed.&. Provides updates, technical advice and recommendations on the recogrition, prevention and control of chemical events and infectious diseases with potential for outbreaks. 4. Assists in the development of health emergency preparedness pians. 4, BUREAU OF QUARANTINE AND INTERNATIONAL HEALTH SURVEILLANCE ‘a. Develops and ensures compliance to protocols and field operation guidelines ‘on entry — exit management of persons, conveyances and goods in coordination with airport and port authorities. b. Conducts health surveillance on the country’s ports and airports of entry and sub-ports as well as the airports and ports of origin of international fights and vessels c. Provides technical inputs in the development of alert level systems, training design and materials on quarantine measures for public health emergencies. d. Assists in the Health Sector's preparedness and response plan on public health emergencies at airports and ports of entry and sub ports. fe. Monitors public threats occurring in other countries. f Provides effective networking and collaboration among the Bureau of Quarantine stakeholders (aimort / port authorities, security, airine!shipping ‘companies and other concerned government agencies). 5. NATIONAL CENTER FOR HEALTH FACILITY DEVELOPMENT ‘a. Maintains a database of all DOH health facilities, (hospitals, laboratories, clinics, institutions etc.) to include their capabilities and resources. b. Regularly assesses existing DOH health facilities and recommends the required development works that would assure preparedness and response to health emergencies. c. Provides technical assistance and recommendations needed in relation to hospital planning, resource procurement and facility enhancement. d. Develops standard designs for specialized area such as decontamination areas, negative pressure rooms etc. @. Develops policies on the availability and accessibiliy to all blood components during emergencies and disasters. In coordination with HEMS, develops an Emergency Room Manual to include appropriate room design, needed essential equipment, flow of operations, required number and type (type 1.1L.) of ambulance. Furthermore, develop other relevant policies and protocols related to Emergency Room Preparedness. 6. NATIONAL CENTER FOR HEALTH PROMOTION ‘a Develops and implements communication and mobilization plan for all types of health emergencies. b. Leads in the formulation and development of prototype materials, advisories and posters in relation to health emergencies. ‘c. Leads in public information campaigns using the tri-media,HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU ‘a. Together with HEMS, develops a training agenda for health emergency ‘managers and responders. b. Assists in the development of training programs, designs and manuals for various stakeholders on health emergency. c. Identifies and coordinates with institutions that provide capability building on health emergency management. @. BUREAU OF INTERNATIONAL HEALTH GOOPERATION a. Facilitates activities on Health Emergencies that require international collaboration and cooperation. b. Identifies external sources of funds for health emergency training, preparedness and response activities, 4. Together with the Bureau of Food and Drugs (BEAD), develops protocols and guidelines on the entry of emergency drugs needed during disasters, in addition to donations. fe. Together with the Professional Regulation Commission (PRC), develops guidelines and facilitates entry of medical volunteers to the couniry during disasters, 9. BUREAU OF HEALTH DEVICES AND TECHNOLOGY a. Develops protocols and field operation guidelines on definition, identification, ‘and management of cases of nuclear and radiological incidents. b. Provides technical inputs in the development of the health sector's plan in preparedness and response for nuclear/radiological incidents. 40. INFORMATION MANAGEMENT SERVICE ‘a. Assists the concemed Offices in the Department of Health in formulating information systems and procedures. b. Provides technical assistance in developing the database. 44. PROCUREMENT AND LOGISTIC SERVICE a. Develops guidelines, systems and procedures for emergency purchase and distribution during emergency situations. Maintains a database of available medicines, supplies and suppliers. Develops a system of pooling all vehicles that can be used for emergencies. 42. FINANCE SERVICE 2, Identifies sources of funds (including contingency funds) for heelth emergency preparedness and response.‘locates and releases funds for emergency preparedness and response activities. Develops guidelines, systems and procedures for emergency release and disbursement of funds (e.g. petty cash) 43, BUREAU OF FOOD AND DRUGS Provides information on the availability of antidotes, reagents, drugs, vaccines, supplies needed in emergencies. Maintains a database of the pharmaceutical stockpiling specifically for ines needed during emergencies mentioned above end mechanism to access these requirements. Together with BHIC, develops guidelines and procedures on the enty of emergency and donated drugs, medicines and medical supplies. 44, BUREAU OF LOCAL HEALTH DEVELOPMENT Assists concemed offices in establishing network with Local Government Units in developing plan, systems and procedures for health emergency preparedness and response. 45. BUREAU OF HEALTH FACILITIES AND SERVICES a Ensures that all hospitals have a health emergency preparedness plan as a requirement for licensing, Includes in the accreditation requirements, standards development and quality assurance policies for health facilites in relation to health emergency preparedness and response. 46. HEALTH POLICY DEVELOPMENT AND PLANNING BUREAU a ‘Assists in the development of health emergency policies, standards, ‘protocols, and guidelines. Facilitates the inclusion of health emergency bills in the legislative agenda. ‘Advocates researches on health emergencies for policy development. Ensures the inclusion of health emergency activities in health planning. 47.MEDIA RELATIONS UNIT In coordination with the different concerned offices, prepares press briefings during emergencies and disasters. Conducts orientation sessions to health reporters with regards emergencies and. disasters. Anticipates media concerns during emergencies and coordinates with proper office for technical inputs. Develops a pool of spokespersons to respond to queries and requests from media.vi. vi vi ‘SEPARABILITY CLAUSE ‘Should any of the provisions herein be declared invalid or unconstitutional by the appropriate authority or courts of laws respectively, the same shail not affect the other provisions validity unless otherwise so specified, REPEALING CLAUSE: ‘The provisions from previous issuances and other related orders that are inconsistent ‘or contrary to this Order are amended and modified accordingly. EFFECTIVITY This Order shall take effect immediately well Boy Secretary of Health