I. Background/Rationale

Foreign Surgical and Medical Missions (FSMM) are activities where surgical and medical care are provided by local and foreign organizations upon the initiative/requests of various local government units and groups. They are primarily undertaken in underserved areas/communities with the goal of providing assistance to the needy or as a professional humanitarian endeavor. They may also serve the purpose of continuing medical education (CME), professional advancement and as a venue for transfer of technology by the missioners to their local counterparts.

II. Objectives

This Joint Administrative Order aims to provide policies/guidelines to:

1. Integrate the efforts of various agencies overseeing the conduct of FSMM.
2. Facilitate the issuance of Special Temporary Permit to Practice for missioners.
3. Ensure proper supervision and monitoring of FSMM in the country.

III. Scope and Coverage

This order shall apply to all government and private institutions, non-governmental organizations, people ™s organizations and other organizations undertaking or facilitating the conduct of FSMM in the country.

IV. Definition of Terms/Acronyms

1. Foreign Surgical and Medical Missions (FSMM) - is a project or an activity in which health care delivery is provided to the poor segments of Filipino society where medicines, ancillary procedures, medical/surgical interventions, and services are given at no cost to the beneficiary. It also employs a team of Filipino/non-Filipino health service providers, who are foreigners but will need to practice their profession in this country.
2. Local counterpart - is a Philippine counterpart organization sponsoring a medical mission. It may be a local medical society of a specialty society or a civic organization or a local government unit in coordination with the local component medical society and/or specialty society of the Philippine Medical Association (PMA). In all cases, it must be a juridical entity properly listed and operating under the Corporation Code of the Philippines.
3. Local Component Medical Society - is a Philippine medical component society of the PMA operating in a given geographical area and is affiliated with the PMA.
4. Missioner - is someone sent on a foreign mission especially a religious or charitable mission.
5. Specialty Society - is an association of Philippine physicians accredited by the PMA as the recognized association of a given specialty in medicine.
6. DOH - Department of Health
7. PRC - Professional Regulation Commission
8. DILG - Department of Interior and Local Government
9. PMA - Philippine Medical Association
10. PNA - Philippine Nurses Association
11. PDA - Philippine Dental Association
12. BIHC - Bureau of International Health Cooperation
13. BHDT - Bureau of Health Devices and Technology
14. FDA - Food and Drug Administration
15. CHD - Center for Health Management
16. CME - Continuing Medical Education

V. Guiding Principles

The guidelines on the conduct of FSMM were developed based on the following principles:

1. Underserved communities shall be prioritized.
2. The sponsors shall establish linkages and networks with other concerned stakeholders in the community.
3. All medicines, supplies, reagents as well as medical and surgical services shall be provided at no cost to the beneficiaries.
4. Only qualified and competent medical and paramedical health workers shall perform the appropriate medical and surgical procedures.

VI. General Guidelines

1. The Department of Health (DOH) shall be the lead agency in overseeing the implementation of any FSMM in the country.
2. The conduct of any FSMM shall be guided by the following policies and guidelines where applicable:

2.1 DOH Administrative Order Number 2007-0017 dated May 28, 2007 shall be the basis for acceptance and processing of foreign and local donations during emergencies and disaster situation; and

2.2 DOH Administrative Order No. 54-A, s. 2003 dated June 6, 2003 shall be the basis for the processing and clearance of importation through donations during normal situations by the Department of Health.

3. The PMA shall maintain a database containing the valid documents of the foreign physicians given Special Temporary Permit to practice medicine in the country. Only a valid license to practice medicine in their country of origin will be required for subsequent application for future missions.
4. Under no circumstances shall a foreigner physician and/or health-related professional practice their profession in the Philippines without a Special Temporary Permit from the PRC.
5. The actual supervision/monitoring of the conduct of the mission shall be undertaken by the local government health unit and local component medical society and/or specialty society of the PMA. Additionally, the DOH CHDs shall oversee the conduct of the mission.

VII. Implementing Mechanism

1. A team composed of representatives from DOH, DILG, PRC and PMA shall be organized to ensure the smooth implementation of the provisions of this issuance.

2. All applications for FSMM shall be submitted to the PMA who shall forward the same to the following professional groups copy furnished DOH. (Application forms can be downloaded from the PMA website - www.pma.com.ph)

2.1 PMA - medical doctors
2.2 PDA - dentists
2.3 PNA - nurses

3. Each member of the foreign medical team must submit the following documents in applying for temporary license to practice during the duration of the mission. All documents must be in English or with English translation:

a. valid/current license from country of origin
b. board certification (specialty)
c. curriculum vitae

^* (letters a to c must be authenticated by the Philippine Consulate Office in the country of origin)

d. passport sized picture in four copies (taken within one year)
e. Application letter addressed to the President of PMA to contain the following information:

1. type of mission (medical, surgical or both)
2. duration of the mission and inclusive dates
3.names and specialties of the mission team members
4. written consent from the host local government executive (governor/mayor) and/or chief of the health facility where the mission will be conducted.

f. The following are additional requirements if the foreign mission team members intend to bring drugs, and/or medicines, medical supplies and medical equipment to be donated or used during the mission:

1. itemized list of the items together with the quantity and the expiration dates for drugs and medicines
2. flight details
3. deed of donation authenticated at the country of origin
4. deed of acceptance from the host hospital/LGU
5. drugs and medicines to be donated should have a shelf life of at least 12 months upon arrival in the country and the said medicine shall be used solely for the scheduled mission
6. application must be submitted 60 days before the date of mission to facilitate clearance/s from DOH and other agencies.

g. Letter of certification from the sponsoring host organization (LGU or NGO) certifying the need and type of mission to be conducted. Cost of post-care mission of morbidities/mortalities arising from the mission will be shouldered as well by the host organization.

h. Proof of juridical entity (certified true copy of the SEC registration must be submitted).

i. Notarized letter of Guarantee from both the medical mission group and the host organization assuming full responsibility for the outcome of the missions.

4. The PMA, upon receipt of all requirements, will forward the application to the concerned specialty societies for evaluation of credentials. The DOH will be informed immediately of the presence of drugs, medical supplies and medical equipment.

5. The DOH shall facilitate issuance of clearance by its FDA and BHDT for the above mentioned goods.

6. After the evaluation of the missioner ™s credentials by the concerned Specialty Society, the PMA shall send a letter of endorsement to DOH.

7. The DOH shall then endorse the documents to PRC.

8. The PRC after final review shall issue the Special Temporary Permit to Practice to concerned foreign missioners.

9. The lead time for the processing of the application are as follows:

a. PMA - 2 weeks before the mission date
b. DOH - 1 week before the mission date
c. PRC - 3 weeks before the mission date

10. Post-mission report shall be submitted by the head of the foreign surgical and/ or medical missions, concurred/noted by the President of the local component society of PMA, and/or specialty society and the LGU concerned, to the oversight agencies (DOH, PMA, PRC) 15 days after the completion of the mission. All records and audio-visual documents must also be submitted in triplicate form. The post mission report should contain the following minimum basic information:

a. no. and age of cases seen
b. diagnosis of patients
c. list of medicines distributed and surgical interventions done
d. endorsements to the necessary health facilities (follow-up, further evaluation and management)
e. morbidities and mortalities if any

11. All materials submitted to the oversight agencies shall be the property of the Philippine counterpart and may not be used for advertisement, solicitation or medical publication without the written and expressed approval of the local medical society and/or specialty society of the PMA and the local counterpart. Any intellectual output as journal or publication must include the local physicians as senior authors.

12. Former Filipino Registered Health Professionals who are part of a Medical/Surgical Mission Team may practice their profession in the Philippines upon presentation of proof of valid and current PRC licenses. Otherwise they have to renew their licenses upon submission of the following requirements (Presidential Decree No. 541):

a. Photocopy of current/valid passport (Page 1 and the page showing the date of arrival in the Philippines)
b. Photocopy of PRC license and valid certificate of registration
c. License/Certificate of Registration in the adopted country or Certification of employment with letterhead indicating the job description within the definition of the applicant ™s profession
d. Four pieces of recent passport size pictures (taken within one year)
e. Payment of prescribe fees at PRC
f. Certificate of training and board certification (for specialists)
g. Application for Temporary Special Permit (PRC form 103-A)

13. Foreign Religious groups/missionaries practicing medicine in the country shall abide by the same requirements and adhere to the guidelines. These missioners who serve for longer period of time shall signify their intention to continue living in the Philippines to pursue missionary works. They shall secure Special Temporary Permit which is to be renewed annually. The following must be submitted:

a. Certification from their congregation that the medical works are purely for charity purposes and with no remuneration involved whatsoever.
b. A certification from the congregation assuming the responsibility for any action of the said physician.
c. The missionary should submit to PMA an annual mission report including a list of patients treated.
d. The missionary is required to attend PMA or component societies ™ CME related activities once a year to update their medical knowledge
e. The missionary who conducted his missionary works in the province must coordinate with the PMA component society for proper identification and monitoring.

14. Foreign SMM conducted in the Philippines without proper permits/licenses must be reported to PRC for investigation of possible illegal practice of medicine and/or unauthorized conduct of FSMM for appropriate sanction and disposition accordingly.

VIII. Sanction/Penalty Clause

Failure to comply with any provision of this Joint Policy will result to the disapproval of the application and/or disqualification from future application.

IX. Repealing Clause

DOH Administrative Order No. 179, s. 2001 and all other issuances inconsistent with this are hereby repealed.

X. Effectivity

This order shall take effect immediately.

Adopted: 22 December 2009

DEPARTMENT OF HEALTH

BY:

(SGD.) HON. FRANCISCO T. DUQUE III, MD
Department Secretary

DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT

BY:

(SGD.) HON. RONALDO V. PUNO
Department Secretary

PROFESSIONAL REGULATION COMMISSION

BY:

(SGD.) HON. NICOLAS LAPE A
Chairperson