In early 2024, under its Modernization for Health Equity framework and in line with the Universal Health Care Law—ensuring every Filipino immediate access to preventive, promotive, curative, rehabilitative, and palliative care¹—the Department of Health launched the “28 for 28 by 28” initiative to establish 28 Bagong Urgent Care and Ambulatory Service (BUCAS) centers, aiming to serve 28 million of the poorest Filipinos by 2028.² The BUCAS Program also aligns with the DOH's 8-Point Action Agenda, specifically addressing “Bawat Pilipino ramdam ang kalusugan” and “Ligtas, dekalidad at mapagkalingang serbisyo.”³ BUCAS centers were created to bridge critical gaps in the Philippine health care system, delivering urgent medical, surgical, and dental care to underserved populations. These centers serve as primary care hubs, decongesting hospitals by offering preventive, diagnostic, and curative services, and guiding patients to higher-level facilities when needed.

The first BUCAS center was launched in Santo Tomas, Pampanga, on March 6, 2024.⁴ By December 16, 2024, a total of 41 BUCAS centers are in operation, with 40 registered in the National Health Facility Registry.⁵ The remaining center, the SPMC-City Government of Davao Marilog District Hospital BUCAS Center, is managed by the Southern Philippines Medical Center in partnership with the City Government of Davao Marilog District Hospital and duly supported by the Department of Health Davao Center for Health Development and the Davao City Health Office (see infographic). More BUCAS centers are being developed with increased funding support from Congress.⁶ While some BUCAS centers are located within or near DOH hospitals as an extension of their services, many operate at a considerable distance from DOH hospitals or other health facilities.

The BUCAS centers work with DOH hospitals, local government units (LGUs), state universities, and regional Centers for Health Development.^{7 8 9 10 11} They rely on shared infrastructure and human resources. Funding sources include PhilHealth reimbursements, the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program, Malasakit Centers, other insurers, and quantified free services provided by DOH hospitals.

BUCAS centers are designed to offer accessible, urgent care, giving walk-in patients a less crowded alternative to tertiary hospitals. Services provided include support for emergency rooms through treatment of non-life-threatening cases, outpatient consultations, x-rays, laboratory tests, minor surgeries, dental/oral health services, and continuity of care through follow-up checkups and referrals. Collaborations with DOH hospitals and LGUs further enhance health care accessibility. A well-rounded health care team is essential to deliver effective urgent and ambulatory services, encompassing General Surgery, Obstetrics and Gynecology, Anesthesiology, Radiology, Internal Medicine, Pediatrics, Family Medicine, Emergency Medicine, and Dental Medicine services, to name a few. BUCAS centers also provide an ideal environment for resident physicians to develop their competencies through hands-on experience with first-contact and continuing health care.

Yet, challenges remain. Currently, BUCAS centers are primarily located in accessible areas, leaving gaps in the original objective of reaching the poorest Filipinos in disadvantaged areas. A robust referral and back-referral system with tertiary hospitals is also needed to ensure continuity of care as BUCAS centers expand, preventing fragmentation and improving outcomes. Sustainability is also a significant concern, as these centers often depend on temporary staff and face funding uncertainties. As facility infrastructure improves, it becomes crucial to develop strategies for attracting and retaining skilled health care professionals. Without adequate staffing, even well-equipped facilities cannot provide timely, quality care.

Expanding PhilHealth coverage for primary health care would enhance access to diagnostics and treatment, particularly for underserved populations. It should also include preventive health care costs to support regular care and early intervention. Preventive and educational programs will promote healthier practices and reduce urgent care demands. Proactive health care service adjustments based on community health data and feedback will enable BUCAS to address evolving needs effectively. Research on patient trends, cost-effectiveness, and the overall impact on health care delivery will help refine the BUCAS model. Data on patient load and the impact on host hospitals will be invaluable for evaluating efficiency and scalability. Regular forums for sharing best practices can enhance collaboration and improve service delivery across BUCAS centers.

Maintaining quality standards in the operation of these centers through licensing is also crucial to ensure that all facilities meet established health care benchmarks. Ensuring that geographically isolated and disadvantaged areas benefit from BUCAS services should also remain a priority. Long-term financing, sufficient staffing, and equipping these centers without overburdening host hospitals are critical for sustainability. Empowering local governments to manage these centers could improve their future stability.

The development of BUCAS centers marks a significant step towards accessible and efficient health care. Their strategic locations and range of services have the potential to relieve hospital emergency rooms. However, ongoing improvements—such as developing sustainable funding and staffing strategies, and adapting services based on community health data and research to meet evolving needs—are needed to enhance patient experience. The success of BUCAS centers ultimately depends on their ability to deliver affordable, accessible, high-quality, and responsive care to all Filipinos.