Mandatory Reporting of Notifiable Diseases Act

Policy, purpose, and governing principles

Republic Act No. 11332 declares it State policy to protect and promote the right to health of the people and instill health consciousness (Section 2).
The State must protect the people from public health threats through efficient and effective disease surveillance of notifiable diseases, including emerging and re-emerging infectious diseases, and also diseases for elimination and eradication, epidemics, and health events involving chemical, radio-nuclear, and environmental agents of public health concern (Section 2).
The State must provide an effective response system in compliance with the 2005 International Health Regulations (IHR) of the World Health Organization (WHO) (Section 2).
The State recognizes epidemics and other public health emergencies as threats to public health and national security, capable of undermining the State’s social, economic, and political functions (Section 2).
Disease surveillance and response systems of the Department of Health (DOH) and its local counterparts are recognized as the first line of defense against epidemics and health events of public health concern (Section 2).
The law’s objectives include continuously updating the list of nationally notifiable diseases and health events with case definitions and laboratory confirmation (Section 4(a)).

Key definitions and coverage concepts

“Disease” refers to an illness due to a specific toxic substance, occupational exposure, or infectious agent affecting a susceptible individual, directly or indirectly (including via infected animals or persons, or indirectly through an intermediate host, vector, or the environment) (Section 3(a)).
“Disease surveillance” means ongoing systematic collection, analysis, interpretation, and dissemination of outcome-specific data for planning, implementation, and evaluation of public health practice, including timely dissemination to those who can undertake prevention and control (Section 3(c)).
“Emerging or re-emerging infections diseases” include diseases that fit any of the enumerated situations such as newly appearing in humans, previously isolated with small numbers, newly recognized due to an infectious agent, caused by previously undetected/unknown infectious agents, caused by mutant or resistant strains, or declining then becoming major problems again (Section 3(d)).
“Epidemic/outbreak” means occurrence of more cases of disease than normally expected within a specific place or group of people over a given period of time (Section 3(e)).
“Health event of public health concern” refers to either a public health emergency or a public health threat due to biological, chemical, radio-nuclear and environmental agents (Section 3(g)).
“Mandatory reporting” is the obligatory reporting of a condition to local or state health authorities as required for notifiable diseases, epidemics, or health events of public health concern (Section 3(i)).
“Notifiable disease” is a disease that, by legal requirements, must be reported to public health authorities (Section 3(j)).
“Public health authority” includes the DOH (specifically named bureaus and units and DOH Regional Offices), the local health office (provincial, city, or municipality), or any person directly authorized to act on behalf of the DOH or the local health office (Section 3(k)).
“Public health emergency” includes occurrences or imminent threats caused by specified agents/incidents (including bio-terrorism, novel/previously controlled or eradicated infectious agent or toxin, natural disaster, chemical attack or accidental release, nuclear attack or accident, and attacks or accidental release of radioactive materials) and posing a high probability of specified consequences including large numbers of deaths, serious injuries or long-term disabilities, widespread exposure posing significant risk, international exposure posing risk to citizens of other countries, and trade and travel restrictions (Section 3(l)).
“Response” includes verification, contact tracing, rapid risk assessment, case measures, treatment of patients, risk communication, prevention activities, and rehabilitation (Section 3(n)).

Objectives and mandated public-health functions

Republic Act No. 11332 requires the DOH to continuously develop and upgrade the list of nationally notifiable diseases and health events of public health concern with corresponding case definitions and laboratory confirmation (Section 4(a)).
The law ensures establishment and maintenance of relevant, efficient, and effective disease surveillance and response systems at national and local levels (Section 4(b)).
The law expands collaborations beyond traditional public health partners to include agencies such as agricultural agencies, veterinarians, environmental agencies, law enforcement entities, and transportation and communication agencies (Section 4(c)).
The law requires accurate and timely health information about notifiable diseases and health-related events and conditions to citizens and health providers as an integral part of response to public health emergencies (Section 4(d)).
The law establishes mechanisms for strong collaboration with national and local government health agencies to ensure proper procedures for prompt response, including case investigations, treatment, and control and containment, including follow-up activities (Section 4(e)).
The law ensures public health authorities have statutory and regulatory authority for:
- Mandatory reporting of importable diseases and health events of public health concern (Section 4(f)(1));
- Epidemic/outbreak and epidemiologic investigation, case investigations, patient interviews, review of medical records, contact tracing, specimen collection and testing, risk assessments, laboratory investigation, population surveys, and environmental investigation (Section 4(f)(2));
- Quarantine and isolation (Section 4(f)(3));
- Rapid containment and implementation of measures for disease prevention and control (Section 4(f)(4)).
Funding must support operations to establish and maintain epidemiology and surveillance units at the DOH, health facilities, and LGUs; investigate outbreaks and health events; validate, collect, analyze, and disseminate surveillance information; and implement appropriate response (Section 4(g)).
The law requires participation in surveillance and response by a broad set of stakeholders including public and private physicians and allied medical personnel, hospitals, clinics, health facilities, laboratories, pharmaceutical and private companies and institutions, workplaces, schools, prisons, ports, airports, establishments, communities, other government agencies, and NGOs (Section 4(h)).
The law mandates respect for the rights of people to liberty, bodily integrity, and privacy while maintaining public health and security (Section 4(i)).

Notifiable diseases list and surveillance systems

The Epidemiology Bureau under the DOH must regularly update and issue a list of nationally notifiable diseases and health events of public health concern with their corresponding case definitions (Section 5).
The selection and deletion of diseases and health events are based on criteria established by the DOH (Section 5).
The DOH, through the Epidemiology Bureau, must issue the official list of institutionalized public health information system, disease surveillance and response systems for mandatory reporting under Section 5 (Section 6).
The official list includes Field Health Service Information System (FHSIS), the Philippine Integrated Disease Surveillance Response (PIDSE) System with Case-based Surveillance and Event-based Surveillance, and other duly institutionalized DOH surveillance and response systems (Section 6).
The DOH and its local counterparts must implement mandatory reporting of notifiable diseases and health events of public health concern (Section 6(a)).
The DOH and local counterparts must establish and maintain functional disease surveillance and response systems including coordination mechanisms, reporting and response protocols, data security and confidentiality, and procedures to ensure safety of personnel conducting surveillance and response activities (Section 6(b)).
The law restricts data collection, analysis, and dissemination from official surveillance and response systems to authorized DOH and local counterpart personnel, and limits use to public health concern purposes only (Section 6(d)).

Mandatory reporting duties and authority to act

All public and private physicians, allied medical personnel, professional societies, hospitals, clinics, health facilities, laboratories, institutions, workplaces, schools, prisons, ports, airports, establishments, communities, other government agencies, and NGOs must accurately and immediately report notifiable diseases and health events of public health concern as issued by the DOH (Section 6(c)).
Authorized health personnel from the DOH and its local counterparts have statutory and regulatory authority to enforce public health information and surveillance systems and to conduct the full range of surveillance and response actions, including:
- Establishment of public health information systems and disease surveillance and response systems in private and public facilities needed to protect population health in coordination with DOH–Epidemiology Bureau (Section 6(e)(1));
- Mandatory reporting (Section 6(e)(2));
- Epidemic/outbreak and epidemiologic investigations, case investigations, patient interviews, review of medical records, contact tracing, collection/storage/transport/testing of samples and specimens, risk assessments, laboratory investigation, population surveys, and environmental investigation (Section 6(e)(3));
- Rapid containment, quarantine and isolation, disease prevention and control measures, and product recall (Section 6(e)(4));
- Response activities for events of public health concern (Section 6(e)(5)).
The DOH and local counterparts must ensure surveillance and response officers have adequate capacity for mandatory reporting, risk assessment, epidemiology, surveillance, and response to epidemics and public health events of public concern (Section 6(f)).
The DOH and local counterparts must uphold safety and protection of personnel directly involved in surveillance and response activities (Section 6(f)).
All personnel of the DOH and local counterparts, and all other individuals or entities conducting surveillance and response activities, must respect the rights to liberty, bodily integrity, and privacy while preserving public health and security (Section 6(g)).

Declaration of epidemics and emergencies; ESUs

The Secretary of Health may declare epidemics of national and/or international concern except when the epidemic threatens national security (Section 7).
When an epidemic threatens national security, the President of the Philippines declares a State of Public Health Emergency and mobilizes governmental and nongovernmental agencies to respond (Section 7).
Provincial, city, or municipal health offices may declare a disease outbreak within their localities only if the declaration is supported by sufficient scientific evidence based on:
- disease surveillance/data,
- epidemiologic investigation,
- environmental investigation, and
- laboratory investigation (Section 7).
The DOH, in coordination with LGUs, must ensure Epidemiology and Surveillance Units (ESUs) are established and functional:
- at all levels of the DOH and its local counterparts,
- in public and private health facilities and laboratories, and
- in ports and airports in all provinces, cities, and municipalities throughout the country (Section 8).
ESUs must capture and verify all reported notifiable diseases and health events of public health concern, provide timely accurate epidemiologic information to appropriate agencies, conduct surveillance and response activities, coordinate needed response, and facilitate capacity building in epidemiology, surveillance, and response (Section 8).
ESUs must have trained required human resources and adequate resources including equipment, logistics, communication, transportation, laboratory supplies and reagents, personal protective equipment, and health insurance to perform surveillance and response functions (Section 8).

Prohibited acts and penalties

Section 9 prohibits unauthorized disclosure of private and confidential information pertaining to a patient’s medical condition or treatment.
Section 9 prohibits tampering of records or intentionally providing misinformation.
Section 9 prohibits non-operation of the disease surveillance and response systems.
Section 9 prohibits non-cooperation of persons and entities that should report and/or respond to notifiable diseases or health events of public concern.
Section 9 prohibits non-cooperation of the person or entities identified as having the notifiable disease or affected by the health event of public concern.
Unauthorized disclosure of confidential information is not a violation when disclosure is made to comply with a legal order issued by a court of law with competent jurisdiction (Section 9).
Section 10 imposes penalties for violations of Section 9: a fine of not less than Twenty thousand pesos (P20,000.00) but not more than Fifty thousand pesos (P50,000.00), or imprisonment of not less than one (1) month but not more than six (6) months, or both, at the discretion of the proper court.
The Professional Regulation Commission may suspend or revoke the license to practice of a medical professional for any violation of the Act (Section 10).
The Civil Service Commission may suspend or revoke the civil service eligibility of a public servant who violates the Act (Section 10).
If the offense is committed by a public or private health facility, institution, agency, corporation, school, or other juridical entity, the chief executive officer, president, general manager, or such other officer in charge shall be held liable (Section 10).
If the offense is committed by a juridical entity, the business permit and license to operate of the concerned facility, institution, agency, corporation, school, or legal entity shall be cancelled (Section 10).

Implementing rules, appropriations, and repeal

Initial implementation costs are charged against the current year’s appropriations of the DOH (Section 11).
Subsequent sums needed for continued implementation are included in the annual General Appropriations Act (Section 11).
The DOH must issue the implementing rules and regulations within one hundred twenty (120) days after approval of the Act (Section 12).
Section 13 provides a separability rule: invalid or unconstitutional parts do not affect the validity of other provisions.
Section 14 repeals Act No. 3573, titled “Law on Reporting of Communicable Diseases”, for purposes covered by this Act.
Section 14 also repeals or modifies all inconsistent laws, decrees, orders, issuances, rules, and regulations or parts thereof.

Procedural lifecycle for declarations and reporting system

The DOH’s disease surveillance and response systems are structured around institutionalized public health information systems including FHSIS and the PIDSE system’s case-based and event-based surveillance components (Section 6).
The Secretary of Health uses epidemic declarations at the national and/or international level, while the President declares a State of Public Health Emergency when national security is threatened (Section 7).
ESUs operate nationwide across DOH levels, health facilities, laboratories, and ports and airports, capturing and verifying reports and enabling timely epidemiologic information and response coordination (Section 8).