On December 7, 2009, the Department of Health launched the Unang Yakap Campaign.

With this campaign, the DOH aims to cut down infant mortality in the Philippines by at least half. The campaign employs Essential Newborn Care (ENC) Protocol as a strategy to improve the health of the newborn through interventions before conception, during pregnancy, at and soon after birth, and in the postnatal period. The ENC Protocol provides an evidence-based, low cost, low technology package of interventions that will save thousands of lives.

Based on health statistics, the Philippines is one of the 42 countries that account for 90% of under-five mortality worldwide. 82,000 Filipino children under five years old die every year. 37% of them are newborn. Majority of them (3/4) die within the first two days of life. Mostly due to stressful events or conditions during labor, delivery and immediate postpartum period.

The current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country. Thus the need for a paradigm shift from the prevailing standard procedures into the new protocol.

Health Secretary Duque explained that the ENC Protocol involves focusing on the first hours of life of the newborn with the manual guiding health workers in providing evidence-based essential newborn care.

The ENC Time-bound Interventions The guidelines categorize procedures into time-bound, non time-bound and unnecessary procedures:

TIME BOUND PROCEDURES

Time bound procedures should be routinely performed first immediate drying, skin-to-skin contact followed by clamping of the cord after one to three minutes or until pulsations have stopped, non-separation of the newborn from the mother and breastfeeding initiation.

NON TIME-BOUND PROCEDURES

Non time-bound interventionshould only be done after the first full breastfeed. These are immunizations, eye care, Vitamin K administration and weighing. Washing must be postponed by at least 6 hours as this will hinder the crawling reflex.

UNNECESSARY PROCEDURES
The so-called unnecessary procedures include routine suctioning, routine separation of newborns for observations, administration of prelacteals like glucose, water formula and footprinting.

Nurses who will be taking the Philippine Nurse Licensure Examination should be familiar with these protocols, you can download the eBook provided by the DOH via this link.

Project RNHeals II and RHM Placement: Guidelines for the Implementation of the Learning and Deployment of Nurses and Midwives

This is the full text of the DOH Department Order No. 2011-0239 entitled Guidelines for the Implementation of the Learning and Deployment of Nurses and Midwives (Project RNHeals II and RHM Placement). This is the official guidelines for the RNHeals 2.

I. Rationale
The Rural Health Team Placement Program (RHTPP) is a composite of several human resources for health that utilizes learning cum deployment approach designed for unemployed registered health professionals. In February 14, 201 I the Department of Health (DOH) spearheaded the deployment of 10,000 nurses as counterpart to DSWDs Pantawid Pamilyang Pilipino Program (4Ps). One thousand and twenty one (1021) CCT areas benefited with the provision of quality health services mostly to disadvantaged individuals and families. Anent to this, there is also a need to augment the nursing workforce in hospitals and other health facilities. As such, a 2nd batch of nurses shall be deployed with the end in view of creating a pool of registered nurses with enhanced clinical and public health competencies towards the improvement of health care service delivery. Similarly, midwives shall also be deployed to maintain focus on an integrated basic emergency obstetric and neonatal care. This evolutionary step in health delivery expects to improve maternal and neonatal care in far flung areas where labor-related maternal morbidity and mortality rates are biggest. Henceforth, the following guidelines defines are issued and shall apply to all DOH hospitals and other health facilities involved in the implementation of nurses and midwives training and deployment.

II. Objectives

A. General Objective
The nurses and midwives learning and deployment aims to create a pool of registered health professionals with enhanced clinical and public health competencies towards the improvement of health care service delivery.

B. Specific Objectives

Improve access to quality healthcare services; Increase nurses and midwives employability through the provision of learning Foster independence in the communitys health care delivery system Address the inequitable distribution and augment the nursing and midwifery workforce in DOH hospitals and health facilities especially rural, under-served, hardship communities; Improve the current nurse to patient ratio in accordance to DOH standard staffing patterns; Improve local health systems that will support the countrys attainment of universal health care or Kalusugan Pangkalahatan

III. Scope Of Application

This Department Order shall apply to DOH hospitals and other health facilities involved in the implementation of nurses and midwives learning and deployment, and the nurses and midwives under the project.

IV. Definition of Terms V. Implementing Mechanisms

1. Strengthen the nursing and midwifery workforces in DOH hospitals and their catchment areas, Rural Health Units and other health facilities as a form of technical assistance towards the delivery of the DOH thrust in a well-coordinated manner. 2. Create a network of nurse trainers in DOH hospitals and other health facilities to maintain quality and standards of learning and development. 3. Design comprehensive learning and development competency courses that encompass the priority needs of the country. 4. Structured recruitment and matching strategies to decrease attrition rate of nurses and midwives. 5. Develop a monitoring and evaluation system for the project and the competency gained by the nurses and midwives. 6. Provide both competency and deployment recognition to increase employability of the nurses and midwives. 7. Conduct operational research.

VI. Implementing Guidelines

A. General Guidelines
1. The nurses and midwives shall undergo learning and development in clinical and public health competencies during their one (1) year of deployment. 2. Nurses assigned in hospitals shall be provided with competencies through rotations in the different specialty departments of the hospitals as much as possible. Nurses and midwives assigned in the Rural Health Units shall be abreast with public health programs and services. 3. DOH hospitals and other health facilities shall be supplemented with 11,500 nurses and 1,000 midwives to augment their workforce. 4. The Centers for Health Development (CHD) through their respective cluster heads in close collaboration with the Health Human Resource Development Bureau (HHRDB) shall identify recipient DOH hospitals and other health facilities. 5. A distribution list shall be provided by the HHRDB to all CHDs through their cluster heads. The CHD shall validate the list with the recipient hospitals and other health facilities based on the standard staffing requirements. The re-validated list shall be the basis for the allocation of nurses and midwives within their catchment areas and in the respective regions. 6. Nurses will receive an allowance of Php8, 000 per month while midwives will receive Php6, 000 per month. Both will be provided with Philhealth Insurance of Php1, 200 per year, Group Accident Insurance enrolment of Php500 per year and a Certificate of Completion after satisfactory completion of the project. 7. The DOH hospitals shall provide meals for the nurses during their tour of duty. This shall be equivalent to at least Php2, 000 per month. Nurses and midwives assigned in the Rural Health Units shaft follow the provisions of Joint Memorandum Circular No. 2011-0044 dated 4 August,, 2011 specifically the additional allowance of at least Php2, 000 per month. 8. Nurses and midwives with Certificates of Completion shall be considered for priority employment in government health facilities where vacant posts exist.

9. Nurses and midwives shall be evaluated on a regular basis during the one (1) year period. 10. Absences, tardiness or under time shall be deducted from the nurses and midwives monthly allowances. 11. The accomplished daily time records (DTR), duly approved by the Chief Nurse shall be the basis for the allowances.

B. Procedures in the Recruitment, Selection and Deployment of Applicants

1. Recruitment and Selection

Applicants shall apply directly to the recipient DOH hospitals or through the CHDs. The registry of nurse applicants from the Department of Labor and Employment (DOLE) shall also be a source of candidates to the project. Only nurses and midwives with official and validated Professional Regulations Commissions (PRC) license are eligible to apply. Verification shall be done via the internet at www.prc.gov.ph Preference shall be given to nurses and midwives residing in the localities where the recipient DOH hospitals or health facilities are sited. Nurse and midwife volunteers, trainees, or those exposed in the recipient hospitals and other health facilities shall be given priority. Nurses and midwives must be physically and mentally fit. A medical certificate from a government hospital is required.

2. Deployment

An orientation will be conducted by the recipient DOH hospitals or CHDs and health facilities prior to assumption to duty. Schedule of rotations shall be for the various specialty departments of the DOH hospitals as available. Schedules for those assigned at the RHUs shall be done with the respective heads of units. To enhance and provide focus for the clinical and public health rotations, competencies shall be anchored on courses geared towards specialty modules with continuing professional units as required by the PRC. Replacements shall be allowed in case of drop-outs but will only complete remaining period of the project.

VII. Roles and Responsibilities

The following are the roles and responsibilities of stakeholders in the implementation the project:

1. The DOH Central Office through the HHRDB shall:

Lead in the implementation of the teaming, development and deployment of nurses and midwives through its CHDs and DOH hospitals and other health facilities; Sub-allot the funding requirements of the project to the CHDs or DOH hospitals; Collaborate with the Professional Regulation Commission - Board of Nursing, (PRC-BON) and Board of Midwifery for their Continuing Professional Education (CPE) requirements;

Together with the CHDs, identify the recipient DOH hospitals and other health facilities using the staffing requirement gaps as primary consideration; e. Prepare the nurses and midwives distribution list for approval by the Secretary of Health through the Cluster Head; Lead in the conduct of operational research.

2. The Operational Clusters through the Centers for Health Development shall:

Coordinate with DOH hospitals and other health facilities in their respective regions and identify nurses and midwives requirements; Ensure fair and objective competency based recruitment, selection and placement process of the nurses and midwives assigned in the Rural Health Units; further ensure that the process of recruitment and selection by the recipient DOH hospitals are likewise fair and objective; Validate the PRC license of accepted nurses and midwives; Collaborate with DOH hospitals and health facilities in the orientation and exit conference of nurses and midwives; Manage the funds intended for the project; Lead in the monitoring and evaluation of the project; In coordination with the hospitals and health facilities, provide the nurses and midwives the Certificate of Completion after the satisfactory completion of the project. Coordinate with the DOH hospitals and other health facilities and to the process for Philhealth enrollment Prepare the payroll and remit the corresponding allowances to the bank; Brief the Local Chief Executives (i.e., Congressmen, Governors, Mayors) of the project and explore areas of partnerships; Submit reports as requested by the CHDs and/or the Central Office.

3. DOH Hospitals and other health facilities shall:

Ensure a fair and objective competency based recruitment, selection and placement process of nurses and/or midwives; Together with the CHDS, provide the necessary information needed for the prompt and efficient implementation of the project; Manage the funds intended for the project as need be; Implement learning and deployment of nurses and midwives; Provide meals for the nurses during their tour of duty or its equivalent of at least Php2,000; Ensure the safety and security of the nurses and/or midwives; Exercise administrative and technical supervision over the nurse and/or midwives; Provide regular feedback to the CHDs on issues and concerns encountered during project implementation; Conduct periodic competency assessment of the nurses and/or midwives; Prepare the payroll and remit the corresponding allowances to the bank; Submit reports as requested by the CHDs and/or file Central Office Delegate the following functions to their respective Chief Nurses/Public Health Nurses: o Lead in the orientation and exit conferences in the various clinical rotations of the nurses;

o o o

Lead in the training and development of nurses and/or midwives in accordance to the project Training Design Exercise administrative and technical supervision over the nurses and/or midwives and, Conduct periodic competency assessment of the nurses.

4. The Local Government Units (LGU) shall follow the provisions of the Joint Memorandum Circular 2011 - 0044 dated 4 August 2011. For emphasis the LGUs shall:

Participate in the learning and deployment of nurses and midwives; Provide an additional monthly allowance of at least Php2,000 per month; Secure the safety and security of the nurses and midwives; Support the nurses and midwives learning and development activities; Provide regular feedback to the CHDs on issues and concerns encountered during project implementation.

VIII. Effectivity
These guidelines shall take effect immediately. Originally Signed by Enrique T. Ona, MD Source: DOH Department Order 2011-0239