Implementing Guidelines on the Institutionalization of Philippine Package of Essential NCD Interventions (Phil PEN) on the Integrated Management of Hypertension and Diabetes for Primary Health Care Facilities

Objectives

The policy institutionalises the Philippine Package of Essential Noncommunicable Disease Interventions (Phil PEN) as a nationwide, integrated primary healthcare response to hypertension and diabetes within the broader prevention and control of lifestyle-related non-communicable diseases. It combines environmental, lifestyle and clinical interventions with advocacy, research, surveillance, monitoring, evaluation, cross-sector collaboration and primary healthcare strengthening.[1][2]Phil PEN adapts the World Health Organization Package of Essential Noncommunicable Disease Interventions to deliver feasible essential services in low-resource settings through primary care physicians and non-physician health workers.[2][3]

• Reduce non-communicable disease mortality, contributing to the national commitment to reduce mortality by 2% annually and the global target of a 25% reduction by 2025.[2]
• Provide quality, integrated clinical interventions for hypertension and diabetes, using a total-risk approach that treats hypertension, diabetes and tobacco use as key entry points for addressing common cardiovascular, cancer, diabetes and chronic respiratory disease risk factors.[2][3]
• Identify and manage cardiovascular risk by estimating an individual’s 10-year risk of fatal or non-fatal cardiovascular events and directing lifestyle support, drug treatment, follow-up and referral according to risk.[3][4]
• Detect risk factors and disease early through assessment and screening, while recognising that screening is preliminary and does not establish a diagnosis.[5]
• Target assessment at people aged 25 years and above without established cardiovascular, cerebrovascular or peripheral vascular disease, with particular screening attention for people over 40 and those with tobacco exposure, central adiposity, raised blood pressure, diabetes or relevant family history.[6][5]
• Improve equitable access for people at high risk of, or living with, non-communicable diseases to essential technologies, affordable quality generic medicines and sustained primary-care services.[1][7]
• Promote healthy lifestyles, including reduced dietary salt consumption, regular monitoring of blood glucose, blood pressure and urine, prevention of diabetes complications and foot-health protection.[7][8][9]

Implementation

Implementation shifts care from a predominantly hospital-centred acute-care model towards early detection, chronic long-term management and integrated referral through barangay health stations, rural health units or centres, community health centres and higher-level facilities.[1][3][6]Primary healthcare facilities use Phil PEN risk assessment, screening and management protocols, supported by referral centres for patients with complications or higher clinical risk.[6][4]

• Apply the Non-Communicable Disease Risk Assessment and Screening Form to record demographic and family history, tobacco and alcohol use, diet, physical activity, body mass index, waist circumference, blood pressure, blood glucose, cholesterol and urine-test findings.[5][9][10]
• Use World Health Organization and International Society of Hypertension risk-prediction charts for the Western Pacific Region to classify risk and guide risk reduction, regular follow-up and referral for people who do not require immediate higher-level assessment.[3][4]
• Provide intensive lifestyle interventions and appropriate medicines for people with established cardiovascular disease, very high risk, significant renal disease or persistent severe hypertension.[4]
• Establish coordination with the next referral level, equip higher-level facilities to receive referrals, and reorganise primary healthcare services around chronic-care patient load, logistics, recording and reporting requirements.[6][4]
• Ensure availability of essential equipment, supplies and medicines, including blood-pressure and glucose measurement devices, weighing and height-measurement tools, urine-testing supplies, antihypertensive medicines, aspirin, glucose-lowering medicines and simvastatin.[6]
• Train relevant providers through the Department of Health Non-Communicable Disease Prevention and Control Cluster, coordinated with the National Center for Pharmaceutical Access Management and the Philippine Health Insurance Corporation.[3]
• Provide complete treatment packs through Department of Health arrangements until Philippine Health Insurance Corporation benefit packages are fully established, with those packages intended as longer-term support.[3]

Governance is led by the Department of Health, with Phil PEN oversight assigned to the National Center for Disease Prevention and Control’s Degenerative Disease Office in collaboration with the National Center for Pharmaceutical Access Management and the Philippine Health Insurance Corporation.[7]The Department of Health provides national leadership, partnerships, technical and logistical support, financial assistance to local government units and nationwide monitoring.[7]Centres for Health Development coordinate regional support, coalition building, technical assistance and access to grants, while local government units implement services, fund community products and services, and develop personnel capacity.[11]Higher-level referral facilities manage referrals and support lower-level providers.[11]

Monitoring includes recording screening results, applying risk stratification, repeating protocol actions, checking referral criteria at each visit and maintaining follow-up according to assessed risk.[6][8]For the specified 20% to less-than-30% cardiovascular-risk category, follow-up occurs every three months, with reassessment after three to six months of interventions where indicated.[8]The National Center for Disease Prevention and Control is to develop reporting and monitoring arrangements with the National Epidemiology Center, which supports indicator and data-source development, while the Health Policy Development and Planning Bureau facilitates evaluation studies and research.[7][11]Specific final indicators, reporting frequencies, performance targets and accountability sanctions are not specified in the supplied text.[7][11]

Monitoring & Evaluation

Monitoring and accountability combine nationwide implementation oversight with facility-level risk assessment, clinical follow-up, recording and referral. The Department of Health monitors implementation nationwide, while the National Center for Disease Prevention and Control, working with the National Epidemiology Center, is to develop reporting and monitoring arrangements.[7]The National Epidemiology Center supports development of indicators and potential data sources, and the Health Policy Development and Planning Bureau facilitates programme evaluation studies and research.[11]

• Record non-communicable disease risk assessments and screening results using the prescribed Non-Communicable Disease Risk Assessment and Screening Form, including demographic information, family history, tobacco and alcohol use, diet, physical activity, anthropometric measures, blood pressure, blood glucose, cholesterol and urine-test results.[5][9][10]
• Screen people aged 25 years and above for relevant risk factors, with particular attention to those over 40 years, tobacco users or those exposed to tobacco, people with central adiposity, raised blood pressure, diabetes or relevant family history.[5]
• Stratify cardiovascular risk using World Health Organization and International Society of Hypertension risk-prediction charts, estimating the 10-year probability of fatal or non-fatal cardiovascular events to guide lifestyle support, treatment, referral and follow-up.[3][4]
• Classify estimated 10-year cardiovascular risk as low, mild, medium, high or very high, corresponding respectively to less than 10%, 10% to less than 20%, 20% to less than 30%, 30% to less than 40%, and at least 40%.[4]
• Maintain recording and reporting responsibilities as primary healthcare facilities are reorganised to provide chronic long-term care, and coordinate referrals with higher-level facilities.[6]
• Continue risk-based follow-up, including three-monthly follow-up for the specified 20% to less-than-30% risk group and reassessment after three to six months of interventions where required.[8]
• Monitor patients through regular blood glucose, blood-pressure and urine checks; the patient advice also includes annual eye checks where feasible and daily foot inspection, with referral to a health worker for injury or other foot problems.[8][9]
• Apply symptom screening for possible angina, heart attack, stroke or transient ischaemic attack, and direct people with relevant positive responses to seek medical attention.[10][12]

Complementary accountability is intended across Department of Health offices, the Philippine Health Insurance Corporation, local government units, referral facilities and other partners.[2]Specific performance targets, a complete indicator set, reporting frequency, surveillance tools, evaluation design and accountability sanctions are not specified in the supplied text.[1][3][7][11]

Costing & Financing

Financing is framed around sustaining integrated primary-care management of hypertension and diabetes, ensuring access to medicines, technologies and treatment support, and mobilising contributions from national and local institutions. Early primary-healthcare intervention is presented as low-cost and cost-effective compared with late treatment and care for advanced disease.[1]

• Provide complete treatment packs for lifestyle-related diseases through the National Center for Pharmaceutical Access Management under Department of Health arrangements until Philippine Health Insurance Corporation benefit packages are fully instituted.[3]
• Use Philippine Health Insurance Corporation benefit packages as the intended long-term financing mechanism for implementation of the integrated hypertension and diabetes protocol.[3]
• Develop an insurance package for people at risk of, or affected by, lifestyle-related disease, with financial incentives linked to adoption of the Philippine Package of Essential Noncommunicable Disease Interventions in health facilities.[11]
• Fund technical assistance, monitoring and health-promotion campaigns through the Department of Health central office and Centres for Health Development.[11]
• Fund community-level products and services through local government units, while other government agencies, non-government organisations and stakeholders may provide counterpart funding and technical assistance where appropriate.[11]
• Resource primary care with essential equipment, testing supplies, medicines, provider training, referral-centre capacity and facility reorganisation for chronic long-term care.[6]

No total budget, monetary allocation, unit cost, expenditure schedule, funding-gap estimate, cost-effectiveness estimate, or detailed economic assumption is specified in the supplied text.[3][6][5][11]