Text by Jennifer Manongdo and Dr. Carmelo Alfiler
Photos by Dr. Carmelo Alfiler, Dr. Jimmy Dumlao II
The University of the Philippines – Philippine General Hospital (UP-PGH) is set to fully implement its pioneering Transition Program, Lipat Kalinga (LK), this year, marking a major milestone in adolescent to adult healthcare in the country.
Launched in 2008 as the first of its kind in both PGH and the Philippines, LK aims to provide a structured and coordinated system that supports adolescents as they move from pediatric care to adult health services, ensuring continuity of care and better health outcomes for this vulnerable population.
Owing to its success, LK has already been replicated by other medical institutions and subspecialty societies in the Philippines and the Asian region. Hospitals with Philippine Society of Nephrology-accredited pediatric nephrology and adult nephrology fellowship training programs have dedicated transition sessions in their 2-year curricula.
Singapore’s National University Hospital (Pediatric Nephrology Department) has also taken steps to start a similar program in coordination with PGH.
The LK Chronicle
LK was the brainchild of former PGH Director and Pediatric Nephrology expert Dr. Carmelo Alfiler. Conceived during his term as chairman of the Department of Pediatrics (1998 to 2003), LK drew inspiration from a health care transition model introduced by Adolescent Medicine specialist, Dr. Emma Llanto, following her medical fellowship in Australia. Dr. Alfiler and Dr. Llanto saw the need to have a structured program that would arm chronically-ill adolescents with kidney and urinary tract diseases with self-management skills before their transfer to adult health services.
The first phase of LK, aptly named LK1, was formally launched in 2008 during the celebration of UP Centennial Year. The first 51 patients were aged 10 to 18 years and were enrolled in a three-step Transition Map. They were diagnosed with chronic kidney disease with or without deteriorating kidney function for at least three months. The patients were under the care of a multidisciplinary team composed of pediatric and adult nephrologists, adolescent medicine specialists, nurses, social workers, dietitians, and school teachers.
The second step involves the dedicated Adolescent Renal Transition Clinic (ARTC), which serves as the central hub for transition activities involving patients, their families, and a multidisciplinary healthcare team.
At the ARTC, patients undergo assessment through a transition readiness score that measures their ability to understand and apply information from health education modules. An active transition checklist also tracks attendance and participation in clinic activities, ensuring consistent engagement throughout the program. The patient’s score and checklist are reviewed as part of activities leading to the patient’s graduation from the clinic, which also marks their formal endorsement and transfer to the adult nephrology team.
In 2014, LK1 segued into LK2, marking a significant evolution of the program. The age of entry into the ARTC was adjusted to 15 years, and additional eligible chronic illnesses were included. On September 7, 2015, a joint Memorandum of Understanding (MOU) was signed between the Departments of Pediatrics and Medicine, formally encouraging other subspecialties managing chronic illnesses to participate in the program. The age of entry to ARTC was raised to 17 years, and the transition period was set between six and 24 months. LK2 was eventually renamed LK3. This phase saw the inclusion of three more subspecialties: Endocrinology, Rheumatology, and Neurology.
Classroom within the Clinic
Aside from medical interventions, LK also entails a one-on-one education system with the Silahis ng Kalusugan school for chronically ill children. Housed within the Pediatrics section of PGH, this unique school has two teachers employed by the national government through the Division of City Schools. They teach age-appropriate subjects, allowing the students to continue their studies even while undergoing treatment for their illnesses under the LK program.
“When they finish their stay here, they can join mainstream [level]. Walang nasisirang panahon,” Dr. Alfiler emphasized. “We are the only hospital with Silahis ng Kalusugan established in 1964 by Dr. Perla Santos Ocampo. Some of our patients finished high school, pursued college degrees, and engaged in blue-collar jobs. Some came back to give positive testimonies of how the PGH LK program gave them sufficient self-management/adult skills, better control of their disease, and improvement of their quality of life.”
LK3 Facility
Currently operating at the outpatient department of PGH, pediatric and adult subspecialty experts have proposed the establishment of a dedicated common transitioning facility for all participating LK3 subspecialties within the 16-story Pediatric and Adult Specialty Center currently under construction in PGH, or at any vacated area within the outpatient department where LK3 clinics currently operate.
“Having our own facility is expected to significantly enhance the delivery of seamless, integrated care, improve the overall patient experience, and strengthen the program’s contributions to tertiary-level preventive and promotive health care in alignment with the Universal Health Care Law,” Dr. Alfiler said.
To deepen the scope of LK3 in PGH, officials from the Department of Pediatrics, Neurosciences, Dermatology, Obstetrics and Gynecology, and Psychiatry held a meeting on July 25, 2025, to incorporate their services and address mental health concerns, teenage pregnancies, sexually transmitted infections, body image and care issues, and other health challenges affecting today’s adolescents and young adults, especially those with chronic illnesses.#
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