Repatriation Assistance Program for OFWs

Policy and purpose

The State must protect and promote the right to health of the people, including the rights of children to survival, full and healthy development, and a better quality of life (Section 2).
The State shall formulate a comprehensive program for the prevention, early detection, and diagnosis of congenital hearing loss among newborns and infants, based on applied research and consultations with concerned sectors (Section 2).
The Act establishes a universal and continuing program to prevent, detect early, diagnose, and provide intervention and support for congenital hearing loss in newborns and infants (Section 3).

Universal Newborn Hearing Screening Program

A Universal Newborn Hearing Screening Program (UNHSP) is established to institutionalize measures for prevention and early diagnosis of congenital hearing loss among newborns, referral follow-up, recall, and early intervention services for infants with hearing loss, and counseling and support services for families (Section 3).
The UNHSP objectives include ensuring that all newborns have access to hearing loss screening (Section 3).
The UNHSP objective includes establishing a network of government and private stakeholders for policy development, implementation, monitoring, and evaluation to promote universal newborn hearing screening in the country (Section 3).
The UNHSP requires continuing capacity building, including training for healthcare practitioners and conduct of applied research for effective implementation (Section 3).
The UNHSP must establish and maintain a newborn hearing screening database (Section 3).
The UNHSP must include linkages to diagnosis and the community system of early intervention services (Section 3).
The UNHSP must develop public policy on early hearing detection, diagnosis, and intervention based on applied research and consultation, recognizing unique language and communication needs of infants, toddlers, and children who are deaf or hard-of-hearing (Section 3).
The UNHSP must develop models ensuring effective screening, referral, and linkage with appropriate diagnostic and early intervention services and providers within the community (Section 3).

Key definitions

“Audiologic diagnostic evaluation” means a service related to diagnosis of hearing loss administered by professionals or by Newborn Hearing Screening Centers (Section 4).
“Congenital hearing loss” means hearing impairment already present at birth (Section 4).
“Follow-up” means monitoring an infant with possible hearing loss to ensure additional diagnostic services and intervention or treatment (Section 4).
“Healthcare practitioner” includes physicians, nurses, midwives, nursing aides, and traditional birth attendants (Section 4).
“Health Institutions” includes hospitals, health infirmaries, health centers, lying-in centers, or puericulture centers with obstetrical and pediatric services, whether public or private (Section 4).
“Intervention” means any service rendered to an infant diagnosed with hearing loss, ranging from counseling, diagnosis, provision of hearing aid, or administration of any medical procedure for correction of hearing loss (Section 4).
“Newborn hearing screening database” means an organized body of information related to newborn hearing screening (Section 4).
“Newborn” means an infant from the time of complete delivery to 30 days old (Section 4).
“Newborn hearing loss screening” means an objective, physiological procedure on a newborn to determine if the newborn has hearing impairment (Section 4).
“Newborn Hearing Screening Reference Center” means the central facility at the National Institutes of Health (NIH) that defines testing and follow-up protocols, maintains an external laboratory proficiency testing program, oversees the national testing database and case registries, assists in training activities, and oversees content of educational materials (Section 4).
“Recall” means locating an infant with a possible hearing loss to provide diagnostic services to confirm hearing condition and, as appropriate, provide intervention or treatment (Section 4).
“Referral” means sending a patient to another service provider within the network for continuation of care (Section 4).
“Universal Newborn Hearing Screening Program” or “UNHSP” means the program developed to carry out hearing screening for all newborns in the Philippines and to provide adequate interventions for infants with congenital hearing loss (Section 4).

Mandatory screening and diagnostic steps

All infants born in hospitals in the Philippines must undergo newborn hearing loss screening before discharge, unless the parents or legal guardians refuse under Section 7 (Section 6).
Infants not born in hospitals must undergo screening within the first three (3) months after birth (Section 6).
If the newborn’s screening is positive, the newborn must undergo audiologic diagnostic evaluation in a timely manner to allow follow-up, recall, and referral for intervention before the age of six (6) months (Section 6).
Audiologic diagnostic evaluation must be performed by Newborn Hearing Screening Centers duly certified by the DOH (Section 6).
Parents or legal guardians and the healthcare practitioner have joint responsibility to ensure hearing screening is performed (Section 6).
The DOH must make an appropriate informational brochure on the role and duties of parents and guardians available to health institutions and available to any healthcare practitioner requesting it for distribution (Section 6).
If the newborn is born at home or outside birthing facilities, the attending healthcare practitioner must refer the newborn to the municipal or city health center of the barangay having jurisdiction for screening and audiologic diagnostic evaluation (Section 6).

Informed consent, refusal, and obligations

Healthcare practitioners who deliver or assist in delivering a newborn in the Philippines must, prior to delivery, inform parents or legal guardians of the availability, nature, and benefits of hearing loss screening among newborns or infants three (3) months old and below (Section 5).
Parents or legal guardians of newborns found to have congenital hearing loss must be informed of the availability, nature, and benefits of diagnostic audiologic evaluation, intervention and treatment options, and counseling regarding hearing loss (Section 5).
The DOH, in coordination with the NIH and other stakeholders, must prepare, produce, and disseminate informational and educational materials on the nature, benefits, and available medical interventions for hearing loss (Section 5).
A parent or legal guardian may refuse hearing loss screening on the grounds of religious and/or cultural beliefs, but must acknowledge in writing that informed of responsibility to perform screening and of risks of underdiagnosed congenital hearing loss if screening is not administered (Section 7).
The written waiver must be made part of the newborn’s medical record and must be entered into the national newborn hearing screening database (Section 7).

Education, lead agency, and advisory structure

The DOH, with assistance from the NIH and other concerned government agencies, professional associations, and civil society organizations, must conduct continuing education, reeducation, and training programs for healthcare practitioners on rationale, benefits, and procedures of hearing loss screening (Section 8).
The DOH must annually prepare, produce, and disseminate information materials on newborn screening to all health personnel involved in maternal and pediatric care (Section 8).
The DOH is the lead agency implementing the Act (Section 9).
The DOH must coordinate with the Department of the Interior and Local Government (DILG), the Department of Education, local government units, and the private sector (including recognized medical associations and professional-based organizations) for policy development and proper implementation, including early hearing detection, diagnosis, and treatment/intervention (Section 9).
The DOH must coordinate with the NIH Newborn Hearing Screening Reference Center for certification of Newborn Hearing Screening Centers and for preparation of defined testing protocols and quality assurance programs (Section 9).
The DOH must coordinate with consumer groups serving individuals who are deaf or hard-of-hearing and their families, qualified professional personnel proficient in deaf or hard-of-hearing children’s language with specialized knowledge and skills, other health and education professionals and organizations, third party payers and managed care organizations, and related commercial industries (Section 9).
The DOH must monitor the extent to which hearing loss screening and audiologic diagnostic evaluation are conducted in health institutions and assist in developing universal newborn hearing loss screening programs for hospitals and non-hospital sites (Section 9).
The DOH must develop a program for the rehabilitation of deaf children through available intervention services, therapies, and other necessary services for a patient diagnosed with hearing disorders (Section 9).
The membership of the Advisory Committee on Newborn Screening created under Section 11 of Republic Act No. 9288 must be expanded to include representatives from the Philippines Society of Otorhinolaryngology and the Philippine Society of Audiology (Section 10).

Hearing screening centers, data systems, research, grants

Newborn Hearing Screening Centers must be established to undertake newborn hearing loss screening, audiologic diagnostic evaluation, recall, follow-up, and referral programs to infants with hearing loss (Section 11).
Newborn Hearing Screening Centers must be certified by the DOH based on standards formulated in collaboration with the NIH (Section 11).
Newborn Screening Centers established under Section 12 of Republic Act No. 9288 must adopt and implement a program to develop capacity to become Newborn Hearing Screening Centers (Section 11).
The DOH must develop incentives to encourage establishment of Newborn Hearing Screening Centers other than those under the Newborn Screening Centers (Section 11).
Hospitals and Newborn Screening Centers must periodically submit copies of screening test results to the NIH Newborn Hearing Screening Reference Center for consolidation of patient databases (Section 12).
The NIH Newborn Hearing Screening Reference Center must maintain a national database of children tested and a separate registry for children diagnosed with hearing loss (Section 12).
The NIH Newborn Hearing Screening Reference Center must submit annual reports to the DOH on the status of and relevant health information derived from the database (Section 12).
A plan for long-term outcome evaluation using case registries must be developed within one (1) year from the effectivity of the Act by the NIH in consultation with stakeholders (Section 12).
The Secretary of Health, in collaboration with the NIH, must make awards of grants or cooperative agreements to provide technical assistance and conduct applied research related to infant hearing detection, diagnosis, and treatment/intervention (Section 12).
The research and technical assistance program must provide technical assistance on data collection and management (Section 12).
It must develop standardized procedures for data management to ensure quality monitoring of infant hearing loss detection, diagnosis, and intervention programs (Section 12).
It must study costs and effectiveness of hearing detection programs to answer issues of importance to policy makers (Section 12).
It must identify causes and risk factors for congenital hearing loss that may lead to development of preventive interventions (Section 12).
It must study effectiveness of early hearing detection, diagnosis, and treatment/intervention by assessing health, developmental, cognitive, and language status at school age (Section 12).
It must promote sharing data regarding early hearing loss with birth defects and development disabilities monitoring programs to identify previously unknown causes of hearing loss (Section 12).

Government intervention and referral pathways

If a newborn is diagnosed with congenital hearing loss, the Newborn Hearing Screening Center or barangay health workers must provide referral for treatment to the provincial hospital of the concerned local government unit (Section 13).
If the provincial hospital cannot handle the treatment beyond its clinical capability, it must refer the newborn to a DOH Tertiary Hospital, the Philippine General Hospital, or other national non-DOH hospitals funded by national government subsidy (Section 13).
Provincial hospitals must have funds for treatment of newborn hearing loss from the internal revenue allotment of the concerned local government unit (Section 13).

Fees, PHIC benefits, and funding

PHIC must include the cost of hearing loss screening in its benefit package (Section 14).
PHIC coverage for screening may include testing costs, registry, follow-up, and reasonable overhead expenses (Section 14).
PHIC must develop a program for gradual coverage of hearing loss screening, audiologic diagnostic evaluation, and intervention services subject to Section 10 of Republic Act No. 7875, as amended by Republic Act No. 9241, the “National Health Insurance of 1995” (Section 14).
The DOH must periodically review and recommend newborn hearing loss screening fees charged by Newborn Screening Centers (Section 14).
No screening fee may be charged to a patient who availed of accredited behavioral tests, such as the Tuning Fork and Penlight method and other indigenous methods (Section 14).
On DOH-accredited methods, upon recommendation by the NIH, those methods are allowed as newborn hearing screening process (Section 14).
The amount necessary to carry out the purposes of the Act must be included in the annual General Appropriations Act (Section 15).

Implementing rules, separability, and repeal

The DOH, in collaboration with relevant government agencies and professional associations, must develop implementing rules and regulations within 30 days from the effectivity of the Act (Section 16).
The DOH must issue a special protocol on the deaf and people with hearing impairment in implementing Section 5 of the Act (Section 16).
All laws, decrees, executive orders, proclamations, and administrative regulations, or any part thereof, contrary to or inconsistent with the Act are repealed or modified accordingly (Section 17).
If any provision is held unconstitutional or invalid, the remaining provisions continue in full force and effect (Section 18).