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Department of Health

Programs, Section Articles, Campaigns,

Source: http://www.doh.gov.ph/health_programs_glossary

Table of Contents A Adolescent and Youth Health Program (AYHP) B Botika Ng Barangay (BnB) Breastfeeding TSEK Blood Donation Program C Child Health and Development Strategic Plan Year 2001-2004 CHD Scorecard Committee of Examiners for Undertakers and Embalmers Committee of Examiners for Massage Therapy (CEMT) Chronic Obstructive Pulmonary Disease Program Cardiovascular Disease Program D Dental Health Program Diabetes Mellitus Prevention and Control Program E Emerging and Re-emerging Infectious Disease Program Environmental Health Expanded Program on Immunization Essential Newborn Care F Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program G

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Garantisadong Pambata H Human Resource for Health Network Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control ) Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center Act of the Philippines) Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999)) Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges) Health and Well-being of Older Persons I Infant and Young Child Feeding (IYCF) Iligtas sa Tigdas ang Pinas Inter Local Health Zone Integrated Management of Childhood Illness (IMCI) K Knock Out Tigdas 2007 L Leprosy Control Program LGU Scorecard Licensure Examinations for Paraprofessionals Undertaken by the Department of Health M Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas) N National Tuberculosis Control Program Natural Family Planning National Filariasis Elimination Program
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National Rabies Prevention and Control Program Newborn Screening National HIV/STI Prevention Program National Mental Health Program National Dengue Prevention and Control Program National Prevention of Blindness Program O Occupational Health Program P Persons with Disabilities Pinoy MD Program Philippine Cancer Control Program Province-wide Investment Plan for Health (PIPH) Philippine Medical Tourism Program Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat) R Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP) S Schistosomiasis Control Program Soil Transmitted Helminth Control Program Smoking Cessation Program U Urban Health System Development (UHSD) Program Unang Yakap (Essential Newborn Care: Protocol for New Life) V Violence and Injury Prevention Program W
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Women's Health and Safe Motherhood Project Women and Children Protection Program

Adolescent and Youth Health Program (AYHP)


A Situationer on Adolescents Health Non-communicable diseases account for more than 40% of the deaths in young people (10-24 years old) and injuries are the causes of death in almost one third of people in this age group. Assault and transport accidents are the leading causes of mortality among young people with a mortality rate of 9.7 and 5.8 deaths per 100,000 populations, respectively (Philippine Health Statistics, 2003). Other significant causes of death among the 10-24 years old Filipinos include complications related to pregnancy, labor and puerperium; epilepsy; chronic rheumatic heart disease; intentional self harm; and accidental drowning and submersion (Philippine Health Statistics, 2003).Of the 1.67 M live births registered in 2003, 35.7% (596, 076 LB) were by women 24 years old. Teenage pregnancy accounted for 8% of all births (National Demographic Health Survey, 2003). Of the 1,798 maternal deaths registered for the same year, 22.3% were women 24 years old. The proportion of malnutrition among those 11 19 years of age (underweight and overweight) were noted to increase from 1993 to 2003 (FNRI Survey 1993, 1998 and 2003).About 4% of Filipinos 10 24 years of age have some form of disability. The most common of this are speaking and hearing disabilities.

MOST COMMON CAUSES OF DEATH AMONG 10-24 YEARS OLD PER 10,000 POPULATION. Philippine Health Statistics, 2003
Male Rank 1 2 3 Asssault Transport Accidents Event of undetermined intent Cause of Death No. Female Both Rate 9.7 5.8 3.9 7 Rate No. Rate No.

2,240 17.6 183 1.5 2,423 1,146 9.0 303 2.5 1,449 570 5.3 300 2.5 970

4 5 6 7 8 9 10

Symptoms, signs & abnormal clinical findings not elsewhere classified Pneumonia Tuberculosis of the Respiratory System Chronic Rheumatic Heart Disease Accidental drowning and submersion Nephritis, nephrotic syndrome and nephrosis Other accidents & late effects of transport/other accidents

602 527 537 447 596 385 518

4.7 352 2.9 4.1 355 2.9 4.2 340 2.8 3.5 426 3.5 4.7 215 1.7 3.0 332 2.7 4.1 113 0.9

954 882 877 873 811 717 631

3.8 3.5 3.5 3.5 3.2 2.9 2.5

Leading Threats to Adolescents Health Accidents and other inflicted injuries Among 10- 24 age groups, this threat caused 27% of the total deaths (2003 data). Young males always exclusively succumb to injuries and females have the increasing mortality due to complications of pregnancy, labor delivery and puerperium. These data have been on the uptrend, a challenge to community-based or DOH-led programs. The threat is caused by the adolescents exposure to poorly maintained roads and poorly managed traffic systems. Adolescents increased mobility to urban areas needs a corresponding physical and infrastructure support in their quest for better opportunities and education pursuits. Another is the inability of the state to provide adequate number of police personnel leading to an increasing number of assault and transport accidents among the young males. Tuberculosis, Pneumonia, and Accidental drowning Close to 6% of young Filipinos who died in 2003 died of various forms of tuberculosis, followed by pneumonia that caused 4% of deaths. This health issue among the young has been declining through the years due to sustained nationwide programs that began in 1987 and has somehow caused to keep deaths down, hence efforts to continue sustaining becomes the challenge. The threat of HIV and other sexually related diseases Reported cases increased substantially increased over the past year. Among the 1524 year olds, reported HIV infections nearly tripled between 2007 and 2008 from 41 cases to 110 per year, which is substantial cause for alarm. In 2009, 15-24 year olds make 29% of all new infections; in 2009, the number of new infections among 20-24 equals the number of new infections among 25-29; with 10 cases see July DOH AIDS Registry Report. The substantial increase from the past year can be traced from
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the adolescents early engagement in health risk behavior, due to serious gaps of the knowledge on the dangers of drugs, as well as the cause as well as causes on the transmission of STD and HIV AIDS , dangers of indiscriminate tattooing and body- piercing and inadequate population education. Under this threat, young males are prone to engaging in health risk behavior and more young females are also doing the same without protection and are prone to aggressive or coercive behaviors of others in the community such that it often results to significant number of unwanted pregnancies, septic abortion and poor self-care practices. In addition, there are also other less common but significant causes of disease and deaths namely; Intentional self- harm the 9th leading cause of death among 20-24 years old. In this age group, seven out of 10 who died of suicide were males. In age group of 1024 years old took up 34% of all deaths from suicide in 2003 Substance Abuse - 15-19 years old group has the claim of drug use; more males than females who are drug users and drug rehabilitation centers claim that majority of clients belong to age group of 25-29 years old. According to the SWS survey, 1996- 1.5M youth Filipinos and 1997- grew into 2.1M youth Filipinos are into substance abuse Nutritional Deficiencies there are no specific rates for adolescent and youth, but there is the prevalence of anemia and vitamin A deficiency which may be also high for the adolescents and youth as those known for the younger and pregnant women. Disability Filipinos aged 10-24 years old has an overall disability prevalence of 4%. The most common disability among this age group affected are speaking (35%), hearing (33%) and moving and mobility (22%) There are also vulnerable Filipino adolescents which can be classified in their respective areas of vulnerability VULNERABLE YOUNG FILIPINOS Sub-groups Young among the street-dwellers Out- of- school adolescents and youth Vulnerability areas Common infections, physical abuse or assault, sexual exploitation, drug use, road accidents High risk behavior; smoking, alcohol use, drug abuse, high risk sexual behavior, risky work conditions leading to injuries and diseases

Urban based male High risk behaviour; transport accidents , other youth inflicted injuries Female adolescents Sexual abuse, sexual exploitation , unwanted
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pregranancies, abortion, unsafe pregnancy and insecure motherhood Not living with parents or family Nutritional disorders, substance use and risky sexual behaviour, other inflcited injuries

Factors Causing Threats to Adolescents Health The alarming patterns of health issues affecting adolescents health is caused by the following factors operating in a systemic manner reinforcing further complexities in the health issues affecting adolescents . Socio-Cultural Factors Demographic Factors Continuing Rapid Population Growth The rapid population growth of the youth creates pressure to the state to expand education, health and employment for this age group. The pressure creates an imbalance to the distribution and allocation of resources to various sectors especially the youth. The imbalance reinforces deeper the marginalization and deprivation of some sectors to basic services. A vicious cycle is created and more are having difficulties to access provision on health service delivery. Increased population movement The scarcity of local employment has triggered the participation of the youth in overseas work. The movement of the sector has caused displacement from families and love ones increase youths vulnerability to exploitation, low paying jobs. According to a study in 2001, there were more than 6,000 workers in the teenage group overseas workers and it is most likely that they would land in overseas low paying work. Attitudes, Lifestyles, Sense of Values, Norms and Behaviors of Adolescents Health Risk Behaviors A significant proportion of young people engage in high-risk behaviors 23% ever had pre- marital sex, 57% of first sex experience was unplanned and unplanned. About 70% - 80% of their most recent sexual experiences were unprotected (YAFS, 2002). The 2002 Young Adult Fertility and Sexuality Survey showed that the proportion of 15-24 year olds who were currently smoking, drinking and using drugs were 20.9%, 41.4% and 2.4%, respectively. The proportion is higher among males compared to females. A comparative data (1994 and 2003) showed that among 15 24 year olds, smoking increased by 23%; drinking increased by 10%; drug use increased by 85%; and pre martial sex increased by 30% (YAFSS, 2003). The likelihood of engaging in pre-marital sex is higher among those who smoke, drink alcohol or take drugs. As a consequence of substance and alcohol abuse, some have mental and neurological
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disorders; others spend the productive years of their life behind bars with hardcore lawless adults. Health Seeking Behavior Adolescents are more likely to consult the health center (45%) or government physician (19%) for their health needs (Baseline Survey for the National Objectives for Health, 2000). The most common reasons for not consulting were the lack of money, lack of time, fear of diagnosis, distance and disapproval of parents. Dental examination and BP monitoring were the most common reasons for consultation (62.4% and 37.8%, respectively). Similarly, Conditions relating to pregnancy, childbirth and post partum were among the leading reasons for utilization of inpatient, emergency room and outpatient health services at DOH-Retained Tertiary General Hospitals. Low Contraceptive Use The overall use of contraception among sexually active adolescents is at 20%. Nondesire for pregnancy and high awareness of contraceptive methods were not enough to encourage adolescents to use contraceptives. Among the reasons cited for the low contraceptive use were: Contraceptives were given only to married individuals of reproductive age Even if they were made available to adolescents, the culture says that it is taboo for young unmarried individuals to avail of contraceptive services and commodities. Condom use is perceived mainly for STIs, HIV/AIDS prevention rather than contraception The practice Abortion and Unmet need for Contraception In 2000, induced abortion among adolescents reached 319,000. This is due to the inadequate knowledge on preventing unwanted pregnancies. Consequences of teenage pregnancies among young mothers include not being able to finish school and reduced employment options and opportunities. In addition, the social stigma and fear brought about by unwanted pregnancy pushes the young mother to resort to abortion. Although the disapproval rating for abortion remains to be high, there is an increasing trend among those who approve of it (from 4% to 6% in males and 3.5% to 4% in females).On contraceptive use , adolescents also don't use condoms for prevention of HIV, it's not only that they don't use them for contraception.

Risk of HIV/AIDS due to Unprotected Sex Adolescents including children living in extreme conditions and great exposure to sexual exploitation and abuse belong to high-risk categories threatened by unprotected sex. Latest data on these shows that majority of people engaged in sex work are young and 70 % of HIV infections involve male-to-male sex. The proportion of young people reported to have STDs/HIV and AIDS is increasing. The YAFS survey
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showed that although awareness about STDs is increasing, misconceptions about AIDS appear to have the same trend. The proportion of those who think AIDS is curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents also resort to services of unqualified traditional healers, obtain antibiotics from pharmacies or drug hawkers or resort to advices from friends (e.g. drinking detergent dissolved in water) without proper diagnosis to address problems of STDs. Improper or incomplete treatment may mask the symptoms without curing the disease increasing the risk of transmission and development of complications. The limited use of condoms to protect adolescents from risk of HIV is an issue to reflection for condom use is not only to prevent pregnancy but also preventing sexually transmitted disease. r The YAFS 2002 survey showed that Filipino males and females are at risk of STIs, HIV/AIDS. It was reported that 62 % of sexually transmitted infections affect the adolescents while 29 % of HIV positive Filipino cases are young people. In addition, it was revealed that thirty seven percent (37%) of Filipino males 25 years of age have had sex before they marry with women other than their wives. Some will have paid for sex while others will have had five or more partners. Political and Economic Factors Marginalization and Poverty The disturbing poverty situation of households and families where majority of the adolescents belong brings in difficulties to meet adolescents needs. Poverty is closely link to adolescent health issues. It reinforces to the situation of adolescents vulnerability to health risks due to the lack of access to various services and unsupportive social, political and economic environment. The following are some of the consequences of poverty faced by the youth. Limited Access to Information -among the greatest challenges for Filipino youth is access to correct and meaningful information on sexual and reproductive issues. Limited access to services and commodities-The lack of access to contraceptive services and supplies was among the most frequently articulated concerns with regard to adolescent SRH. Programs such as the AYHDP do recognize adolescents need for access to contraception. Limited awareness of pertinent policies-While the AYHP Administrative order was issued in 2000, few key informants knew of its existence. In fact, many key informants said that no ARH policy existed at the time they were interviewed Technological Factors Rapid Advancement of Communication The value of technological advancement could never be discounted. However, to the curious and adventurous adolescents various modes of communications are oftentimes abused and misused such as the use of internet and mobile phones. Adolescents then become vulnerable to exploitation, in cybersex and pornography exposing them deeper into risky behavior. In addition the digital dependence and addiction causes alienation of adolescents to personal and closer mode of communication resulting to a distorted image of the adolescents relationships to the
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social environment. This also deprives the adolescents from productive activities where they can develop themselves fully grown up and mature e economic and social being Moreover, communication advancement has also produced advertisements and television commercials whose image are not adolescent- friendly are paving the way for so much consumerism, distorted personal and family values THE ADOLESCENTS HEALTH PROGRAM IN THE PHILIPPINES 8. International Policies, Passages and Laws as anchors In International Laws UN Convention on the Rights of Children UN Convention the Action for the Promotion and Protection of the health of adolescents Convention on the Elimination of all forms of discrimination againts women 1994 International Conference on Populaiton and Development ( ICPD) 1995 Fourth World Conference on Women World Programme of Action for Youth 2000 MDG Goals : Goal 2:Achieve Universal Primary Education Goal 3:Promote Gender Equality Goal 4 : Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6:Combat HIV/AIDS, Malaria and other diseases National Laws and Policies o National Objectives for Health o Fourmula One for Health o Adolescent and Youth Health Policy (AYH) o Adolescent and Youth Health and Develoment Program o National Directional Plan for reaching the Un reahced Youth Population o Reproductive Health Program AO#1 s1998 o Local Government Code WHO, together with countries and areas in the Region and partner agencies, are working to promote healthy development of adolescents and reduce mortality and morbidity. In the Western Pacific Region, several technical units are working to implement interventions that improve adolescent health in the Region. The Philippines belong to the Western Pacific Region and is committed to: Recognize adolescents as vulnerable and a group in need o Address Issues that have an evidence base o Socio- Cultural perspectives o Develop Innovative mechanisms to reach out to adolescents. o Encourage collaboration and partnerships o Program implementation is monitored and evaluated. The Adolescent Health Program
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The Adolescents Youth and Heath Development Programs were established in 2001 under the oversight of the Department of Health in partnership with other government agencies with adolescent concerns and other stakeholders. The program is targeting youth ages 1024, and the program provides comprehensive implementation guidelines for youth-friendly comprehensive health care and services on multiple levelsnational, regional, provincial/city, and municipal. The program is solidly anchored on International and laws, passages and polices meant to address adolescents health concerns. It is operating then within the facets and adolescents and youth health that includes disability, mental and environmental health, reproductive and sexuality, violence and injury prevention and among others. It employed strategies to ensure integration of the program into the health care system in addition, broader society such as building a supportive policy environment, intensifying IEC and advocacy particularly among teachers, families, and peers, building the technical capacity of providers of care, and support for youth; improving accessibility and availability of quality health services, strengthening multi-sectoral partnerships, resource mobilization, allocation and improved data collection and management. The program to address sexual and reproductive health issues likewise adopts gender-sensitive approaches. The primary responsibility for implementation of the AYHDP, and its mainstreaming into the health system, falls to regional and provincial/city sectors. Guidelines cover service delivery, IEC, training, research and information collection, monitoring and evaluation, and quality assurance.

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Botika Ng Barangay (BnB)


I. What is Botika ng Barangay? Botika ng Barangay (BnB) - refers to a drug outlet managed by a legitimate community organization (CO) / non-government organization (NGO) and/or the Local Government Unit (LGU), with a trained operator and a supervising pharmacist specifically established in accordance with this Order. The BnB outlet should be initially identified, evaluated and selected by the concerned Center for Health Development (CHD), approved by the PHARMA 50 Project Management Unit (PMU) and specially licensed by the Bureau of Food and Drugs (BFAD) to sell, distribute, offer for sale and/or make available low-priced generic home remedies, over-thecounter (OTC) Drugs and two (2) selected, publicly-known prescription antibiotics drugs (i.e. Amoxicillin and Cotrimoxazole). The establishment of the Botika ng Barangay (BnB) in the communities, including the insurgent areas, ensures accessibility of low-priced generic over-thecounter drugs and eight (8) prescription drugs as recommended by the National Drug Formulary Committee. Under Memorandum # 31 and its amendment, as much as 40 essential medicines that address common diseases can be made available in BnBs depending on the morbidity and mortality profiles of the community. And the policies surrounding the BnB (AO 144) ensure that such can be sustained in the medium term. II. Objectives The objectives of this Order are as follows: 1. To promote equity in health by ensuring the availability and accessibility of affordable, safe and effective, quality essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas. 2. To integrate all related issuances of the DOH that provides rules and regulations in the establishment and operations of BnBs; and 3. To define the roles and responsibilities of the different units of the DOH and other partners from the different sectors in facilitating and regulating the establishment of BnBs. III. Status of the Program Variants of the BnBs include Botika Binhi (funded by the members of the Peso for Health with counterpart from the local government unit), Health Plus (funded by the GTZ), Botika sa Parokya (funded by DOH and Office of the President) and the Botika ng Bayan (BNB) express under PITC/ PITC Pharma Inc. At present, about 16,350 BnB outlets have been established in the country. The initial target was to establish 1 BnB to serve 3 adjacent Barangays. However, due to the immensity of Barangays, and the need for more than 1 BnB in some poor adjacent barangays to better provide for the service, the target were changed to 1:1. Since absorptive capacity for the DOH-CHDs to establish BnBs is also limited due to resource and time constraints, the initial phasing of the target to achieve 1:1 is being
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done. Thus, for the next two (2) years, the target would be initially 1:2 except for select areas that have high poverty incidence, conflict or Geographically isolated areas, and the like where the target would be 1:1. Sourcing of medicines for the initial seed capital of these medicines is done through PITC Pharma Inc. Issuances about Botika ng Barangay Issuances Date Title Moratorium on the Establishment of Botika ng Barangay (BnB) Nationwide Submission of Reports for the Impact Assessment of Maximum Drug Retail Price (MDRP) / Government Amendment to Memorandum No. 31 s. 2003 dated 17 February 2003 re: Drugs to be sold in Botika ng Barangays (BnBs) Utilization of Slow-Moving Pharma 50 Botika ng Barangay (BnB) Drugs and Medicines Supplemental Guidelines to Administrative Order No. 144 series 2004, entitled: "Guidelines for the Establishment and Operations of Botika ng Barangays (BnB) and Pharmaceutical Distribution Network (PDNs)" relative to the inclusion of other drugs which are classified as Prescription Drugs and other related matters

Department Memorandum January No. 2011-0022 26, 2011 Department Memorandum February No. 2010-0033 12, 2010 Department Memorandum February No. 2008-0038 21, 2008 Department Memorandum April 5, No. 2005-0046 2005

Administrative Order No. 2005-0011

April 4, 2005

Botika ng Barangay Performance Department Memorandum November Monitoring Reports and Routine No. 118 s. 2004 22, 2004 Schedule of Submissions Administrative Order No. 144 s. 2004 Memorandum No. 31 s. 2003 April 14, 2004 February 17, 2003 Guidelines for the Establishment and Operations of Botika ng Barangays (BnB) and Pharmaceutical Distribution Network (PDNs) Drugs to be sold in Botika ng Barangays (BnBs)
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Breastfeeding TSEK
On February 23, 2011, the Department of Health (DOH) launched the exclusive breastfeeding campaign dubbed Breastfeeding TSEK: (Tama, Sapat, Eksklusibo). The primary target of this campaign is the new and expectant mothers in urban areas. This campaign encourages mothers to exclusively breastfeed their babies from birth up to 6 months. Exclusive breastfeeding means that for the first six months from birth, nothing except breast milk will be given to babies. Moreover, the campaign aims to establish a supportive community, as well as to promote public consciousness on the health benefits of breastfeeding. Among the many health benefits of breastfeeding are lower risk of diarrhea, pneumonia, and chronic illnesses.

Blood Donation Program


Republic Act No. 7719, also known as the National Blood Services Act of 1994, promotes voluntary blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act aims to inculcate public awareness that blood donation is a humanitarian act. The National Voluntary Blood Services Program (NVBSP) of the Department of Health is targeting the youth as volunteers in its blood donation program this year. In accordance with RA No. 7719, it aims to create public consciousness on the importance of blood donation in saving the lives of millions of Filipinos. Based from the data from the National Voluntary Blood Services Program, a total of 654,763 blood units were collected in 2009. Fifty-eight percent of which was from voluntary blood donation and the remaining from replacement donation. This year, particular provinces have already achieved 100% voluntary blood donation. The DOH is hoping that many individuals will become regular voluntary unpaid donors to guarantee sufficient supply of safe blood and to meet national blood necessities. Mission: Blood Safety Blood Adequacy Rational Blood Use Efficiency of Blood Services Goals: The National Voluntary Blood Services Program (NVBSP) aims to achieve the following: 1. Development of a fully voluntary blood donation system; 2. Strengthening of a nationally coordinated network of BSF to increase efficiency by centralized testing and processing of blood;
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3. Implementation of a quality management system including of Good Manufacturing Practice GMP and Management Information System (MIS); 4. Attainment of maximum utilization of blood through rational use of blood products and component therapy; and 5. Development of a sound, viable sustainable management and funding for the nationally coordinated blood network.

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Child Health and Development Strategic Plan Year 2001-2004


Introduction The Philippine National Strategic Framework for land Development for Children or CHILD 21 is a strategic framework for planning programs and interventions that promote and safeguard the rights of Filipino children. Covering the period 20002005, it paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a roadmap to achieve the vision. Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical and fundamental element in children's welfare. However, health programs cannot be implemented in isolation from the other component that determines the safety and well being of children in society. Children's Health 2025, therefore, should be able to integrate the strategies and interventions into the overall plan for children's development. Children's Health 2025 contains both mid-term strategies, which is targeted towards the year 2004, while long-term strategies are targeted by the year 2025. It utilizes a life cycle approach and weaves in the rights of children. The life cycle approach ensures that the issues, needs and gaps are addressed at the different stages of the child's growth and development. The period year 2002 to 2004 will put emphasis on timely diagnosis and management of common diseases of childhood as well as disease prevention and health promotion, particularly in the fields of immunization, nutrition and the acquisition of health lifestyles. Also critical for effective planning and implementation would be addressing the components of the health infrastructure such as human resource development, quality assurance, monitoring and disease surveillance, and health information and education. The successful implementation of these strategies will require collaborative efforts with the other stakeholders and also implies integration with the other developmental plan of action for children. Vision A healthy Filipino child is: Wanted, planned and conceived by healthy parents carried to term by healthy mother born into a loving, caring, stable family capable of providing for his or her basic needs, delivered safely by a trained attendant Screened for congenital defects shortly after birth; if defects are found, interventions to correct these defects are implemented at the appropriate time Exclusively breastfed for at least six months of age, and continued breastfeeding up to two years, introduced to complementary foods at about six months of age, and gradually to a balanced, nutritious diet, protected from the consequences of protein-calorie and micronutrient deficiencies through good nutrition and access to fortified foods and iodized salt Provided with safe, clean and hygienic surroundings and protected from accident, properly cared for at home when sick and brought timely to a health facility for appropriate management when needed. Offered equal access to good quality
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curative, preventive and promotive health care services and health education as members of the Filipino society Regularly monitored for proper growth and development, and provided with adequate psychosocial and mental stimulation, screened for disabilities and developmental delays in early childhood; if disabilities are found, interventions are implemented to enabled the child to enjoy a life of dignity at the highest level of function attainable Protected from discrimination, exploitation and abuse Empowered and enabled to make decisions regarding healthy lifestyle and behaviors and included in the formulation health policies and programs, afforded the opportunity to reach his or her full potential as adult

Current Situation Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 live births, while neonatal death rate was 18 deaths per 1000 live births. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, and septicemia), nutritional deficiencies and birth-related complications. The probability of dying between birth and five years of age is 48 deaths per 1000 live births. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningitis and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents. The decline in mortality rates may be attributed partly to the Expanded Program of Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable diseases (tuberculosis, diptheria, tetanus, pertusis, poliomyelitis, Hepatitis B and measles). The Philippines has been declared as polio-free during the Kyoto Meeting on Poliomyelitis Eradication in the Western Pacific Region last October 2000. This however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved. Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997.
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Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos. of age (NDHS). Several strategies were utilized to improve child health. The Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common childhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway. The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and seeking behaviors. It operates through health and nutrition posts established throughout the country. Gaps and Challenges Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for childrens health. There is also the need to update and reiterate the policies on children's health particularly on immunization, micronutrient supplementation and IMCI. LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution. Pockets of low immunization coverage are attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization. Goal The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025. Medium-term Objectives for year 2001-2004 Health Status Objectives 1. Reduce infant mortality rate to 17 deaths per 1,000 live births 2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 live births 3. Reduce the mortality rate among adolescents and youths by 50% Risk Reduction Objectives 1. Increase the percentage 2. Increase the percentage 30% 3. Increase the percentage feeding at six months to 70% 4. Increase the percentage

of fully immunized children to 90% of infants exclusively breastfed up to six months to of infants given timely and proper complementary of mothers and caregivers who know and practice
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home management of childhood illness to 80% 5. Reduce the prevalence of protein-energy malnutrition among school-age children 6. Increase the health care-seeking behavior of adolescents to 50% Services and Protection Objectives 1. Ensure 90% of infants and children are provided with essential health care package 2. Increase the percentage of health facilities with available stocks of vaccines and essential drugs and micronutrients to 80% 3. Increase the percentage of schools implementing school-based health and nutrition programs to 80% 4. Increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70% Strategies and Activities Enhance capacity and capability of health facilities in the early recognition, management and prevention of common childhood illness This will entail improvements in the flow of services in the implementing facilities to ensure that every child receive the essential services for survival, growth and development in an organized and efficient manner. Facilities should be equipped with the essential instruments, equipment and supplies to provide the services. Health providers shall have the knowledge and skills to be able to provide quality services for children. Existing child health policies, guidelines and standards shall be reviewed and updated, and new ones formulated and disseminated to guide health providers in the standard of care. Strengthening community-based support systems and interventions for children's health Notable community-based projects and interventions, such as the health and nutrition posts, mother support groups, community financing schemes shall be replicated for nationwide implementation. Model building and dissemination of best practices from pilot sites has proven effective in generating support and adoption in other sites. More of these shall be initiated particularly for developing interventions to increase care-seeking and prevention of malnutrition in children. Fostering linkages with advocacy groups and professional organizations and to promote children's health Collaboration with the nongovernment sector and professional groups shall: Conduct national campaigns on children's health Conduct and support national campaigns for children Initiate and support legislations and researches on children's health and welfare

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Development of comprehensive monitoring and evaluation system for child health programs and projects

CHD Scorecard
CHD Scorecard shall reflect performance of the CHD as extension producers of the DOH in its mandate and function of steering and leading the national health system. Performance indicators shall include extent and quality of goods and services desired by the local health systems in the regional coverage area, and prescribed by DOH management, along the 4 main strategies of F1. Performance indicators shall also include satisfaction of clients with CHD services and products.

Committee of Examiners for Undertakers and Embalmers


Rationale Embalming is the funeral custom of cleaning and disinfecting bodies after death. It has been part of the funeral parlors so with our lives. For the past decades, embalming has been undergoing profound transformational events, not only in the Philippines but worldwide. Today, embalming is also considered an art. It is done to preserve the dead body from natural decomposition and for restoration for a more pleasing appearance. Likewise, the procedure is significant for restoration of evidences such as in medico-legal cases. These changes were made possible by the multitudes of forces converging in the national as well as the local levels, which is impacting on the quality of embalming practice in the country. Embalmers today should therefore, be looked up to, because of the significant manifold tasks they are rendering including the counseling assistance they are providing the bereaved parties. Objective: The Department of Health (DOH) created the CEUE to regulate embalming practice in the country. The creation was made possible by Presidential Decree (PD) No. 856 "Code of Sanitation of the Philippines" Chapter XXI "Disposal of Dead Persons" and Executive Order No. 102 s. 1999 "Rationalization and Streamlining Plan of the DOH". Strategies: To ensure that only qualified individuals enter the regulated profession and that the care and services which the embalmers provide are within the standards of practice, the DOH-CEUE created: 1. CEUE Resolution No. 2011-001 - Three Year Transition Period for Compliance of Administrative Order No. 2010-0033. 2. Memorandum dated August 10, 2010 - to the Centers for Health Development (CHDs) Human Resource Development Units (HRDUs) regarding Updates on the Committee of Examiners for Undertakers and Embalmers (CEUE) Program.
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3. Administrative Order No. 2010-0033 - Revised Implementing Rules and Regulations of PD 856 Chapter XXI Governing Disposal of Dead Persons 4. CEUE Resolution No. 2010-001 - Adoption of the Code of Ethics for Embalmers in the Philippines 5. CEUE Resolution No. 2009-001 - Creation of the Committee for Continuing Embalmers Education Council (CEEC) 6. CEUE Resolution No. 2008-001 - Conduct of Licensure Examination for Embalmers in Centers for Health Development (CHDs) to conduct a simultaneous licensure examination in the Central Office and the CHDs with a minimum of 50 examinees for cost effectiveness. 7. Department Memorandum No. 2008-0009 - Designation of DOH Human Resource Development Units (DOH-HRDUs) as Coordinators for Embalmers Program" to facilitate immediate response to queries and complaints regarding the embalming practice. 8. CEUE Resolution No. 2008-001 - Accredited Training Institutions and Training Providers for Embalmers for CY 2008-2011 to regulate existing and potential training providers and training institutions for embalmers for the enhancement and maintenance of its professional standards. 9. CEUE Resolution No. 2008-002 - Extension of Moratorium as per CEUE Resolution No. 2007-001. 10. CEUE Resolution No. 2007-001 - Moratorium on the Non-renewal of Licenses of Embalmers for the past five (5) years and over with the aim of providing chance to licensed embalmers who were unable tio renew their licenses for the past five years and over. 11. Administrative Order No. 2007-0020 - Policies and Guidelines for the Accreditation of Training Institutions, Training Programs and Training Providers for Embalmers in the Philippines with the aim of institutionalizing the continuing education program for embalmers in the country. Hence, to ensure the maintenance of efficient, ethical and technical, moral and professional standards in its practice, taking into account the quality of care to be rendered to respective clientele. At the same time, the regulation ensures the global competitiveness of the Filipino embalmers. 12. Department Circular No. 2007-0139 - Reiteration on the observance of precautionary measures in the disposal of dead persons. Chapter XXI "Disposal of Dead Persons" mandate the CEUE to monitor and enforce quality standards of embalming practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in its practice, taking into account the quality of care to be rendered to respective clientele. At the same time, the regulations ensure the global competitiveness of the Filipino embalmers. Program Status Nationwide information dissemination of the following: Administrative Order No. 2010 - 0033 (Disposal of Dead Persons)
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1. 2. 3. 4. 5.

Curriculum for licensure examinations Manuals for Licensure Examinations Code of Ethics March 25, 2011 - National Capital Region May 3, 2011 - Visayas Region (Iloilo City) May 13, 2011 - Mindanao Regions (Cagayan de Oro City) June 30, 2011 - Butuan City (upon request) August 25, 2011 - Aklan (upon request)

Committee of Examiners for Massage Therapy (CEMT)


Rationale Traditional medicine throughout the world recognizes the significance of therapeutic massage in managing stress, illness or chronic ailments. Massage therapy is considered the oldest method of healing that applies various techniques like fixed or movable pressure, holding, vibration, rocking, friction, kneading and compression using primarily the hands and other areas of the body such as the forearms, elbows or feet to the mascular structure and soft tissues of the body. Massage therapy can lead to significant biochemical, physical, behavioral and clinical changes in massage as well as the person giving the massage. It contributes to a higher sense of general well-being. Recognizing this, many healthcare professionals have begun to incorporate massage therapy as a complement to their routine clinical care. Efficacy of massage therapy in patient ranges from pretern neonates to senior citizens. Although the country has the training standards and regulations through the Technical Education and Skills Development Authority (TESDA), it lacks control / regulations over the training institutions, thus, anyone who calls himself/herself a massage therapist is one, regardless of training or experience. Objective: The Department of Health created the Committee of Examiners for Massage Therapy (CEMT) to regulate the practice of massage therapy in accordance to the provisions of the Sanitation Code of the Philippines (PD 856) and Executive Order No. 102 s. 1999, Reorganization and Streamlining of the Department of Health. It provides the CEMT the function to ensure that only qualified individuals enter the regulated profession and that the care and services which the massage therapists provide are within the standards of practice.

Strategies: To ensure that only qualified individuals enter the regulated profession and that the care and services which the massage therapists provide are within the standards of practice, the DOH-CEMT created: 1. CEMT Resolution No. 2011-001 - Three-Year Transition Period for Compliance to Administrative Order No. 2010-0034.
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2. Memorandum dated August 10, 2010 - to the Centers of Health Development (CHDs) Human Resource Development Units (HRDUs) regarding Updates on the Committee of Examiners for Massage Therapy (CEMT) Program 3. Administrative Order No. 2010-0034 - Revised Implementing Rules and Regulations of PD 856 Chapter XIII Governing Massage Clinics and Sauna Establishments 4. CEMT Resolution No. 2010-001 - Adoption of the Code of Ethics for Massage Therapists in the Philippines. 5. CEMT Resolution No. 2009-001 - Creation of Committee for Continuing Massage Therapy Education Council (CMTEC) 6. CEMT Resolution No. 2008-001 - Conduct of Licensure Examination for Massage Therapists in Centers for Health Development (CHDs) to conduct a simultaneous licensure examination in the Central Office and the CHDs with a minimum of 50 examinees for cost effectiveness. 7. Department Memorandum No. 2008-0009 - Designation of DOH Human Resource Development Units (DOH-HRDUs) as Coordinators for Massage Therapy Program to facilitate immediate response to queries and complaints regarding the massage therapy practice. 8. CEMT Resolution No. 2008-001 - Accredited training institutions and training providers for massage therapists for CY 2008-2011 to regulate existing and potential training providers and training institutions for massage therapists for the enhancement and maintenance of its professional standards. 9. CEMT Resolution No. 2008-002 - Extension of Moratorium as per CEMT Resolution No. 2008-001 10. CEMT Resolution No. 2008-001 - Moratorium on the Non-Renewal of Licenses for Embalmers for the past five (5) years and over with the aim of providing chance to licensed embalmers who were unable to renew their licenses for the past five years and over 11. Administrative Order No. 2008-0031 - Policies and Guidelines for the Accreditation of Training Institutions, Training Programs and Trainining Providers for Massage Therapists in the Philippines with the aim of institutionalizing the continuing education program for massage therapists in the country. Hence, to ensure the maintenance of efficient, ethical and technical, moral and professional standards in its practice, taking into account the quality of care to be rendered to respective clientele. At the same time, the regulation ensures the global competitiveness of the massage therapists. Chapter XIII "Massage Clinics and Sauna Establishments mandate the CEMT to monitor and enforce quality standards of massage therapy practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in its practice, taking into account the quality of care to be rendered to respective clientele. At the same time, the regulations ensure the global competitiveness of the Filipino massage therapists. Program Status Nationwide information dissemination of the following:
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1. 2. 3. 4. 5.

Administrative Order No. 2010-0034 (Massage Establishments) Curriculum for Licensure Examinations Manuals for Licensure Examinations Code of Ethics March 25, 2011 - National Capital Region May 3, 2011 - Visayas Regions (Iloilo City) May 13, 2011 - Mindanao Region (Cagayan de Oro City) June 30, 2011 - Butuan City (upon request) August 25, 2011 - Aklan (upon request)

Clinics

and

Sauna

Chronic Obstructive Pulmonary Disease Program I. Rationale:

Respiratory conditions impose an enormous burden on society. According to the WHO World Health Report 2000, the top five respiratory diseases account for 17.4% of all deaths and 13.3% of all Disability Adjusted Life Years (DALYs). Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis and lung cancer are among the leading 10 causes of death worldwide. Based partly on demographic changes in the developing world, but also on the changes in health care systems, schooling, income and tobacco use, the burden of communicable diseases is likely to lessen while the burden of chronic respiratory diseases (CRDs) including asthma, COPD, and Lung Cancer will worsen because of tobacco use and population ageing. COPD (CRD) is a major public health problem in the Philippines today. It occupies 7th among the latest list of top 10 causes of mortality. Significantly, the mortality trend in the last 3 decades shows a shift from acute infectious illness to chronic degenerative diseases. This is also true in the etiology of COPD. No large local study has been done to determine the prevalence of COPD in the Philippines. So far, estimates have been based primarily on morality statistics. These provide misleading figures because COPD is underdiagnosed and often not listed either as primary or contributory cause of death. A spirometry based study in 1997 in a rural community found irreversible airway obstruction in 3.7% of the population. Proceeding from an Asia-Pacific regional workshop in 2000 cited the prevalence of COPD in the Philippines as 6.3%. In 1998, International Study of Asthma and allergies in Childhood (ISAAC) survey reported the prevalence of asthma among 13-14 years old in the Philippines at 11.6% this level increased in the recently concluded WHO-funded National Asthma Epidemiology Survey (NAES) where the prevalence of definite asthma was placed at 4.3% in adults and 28.1% and 12.9% in children aged 13-14 and 6-7 years respectively. In all, among the respondents found to have asthma by the expert panel, about 33% of the children aged 6-7 years, 72% of school children and 28% of
28

adults did not report prior knowledge of Doctor-diagnosed asthma to explain their symptoms. Prevalence and occurrence of Chronic respiratory diseases is likely to increase and the extent of mortalities and financial cost necessitates a decisive plan of action-both preventive and therapeutic. A national program supported by the government, the scientific community, non-government organizations and peoples organization is probably the optimal strategic approach to achieve a control of the rising prevalence of CRDs. A. Policy Statement:

The prevention and control of chronic lifestyle related non communicable diseases shall be guided by the following policy statements. 1. The country shall adopt an integrated, comprehensive and community based response for the prevention and control of chronic, lifestyle related NCDs. 2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in mortality and morbidity due to chronic lifestyle related NCDs. 3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation of an integrated, comprehensive and community based response to chronic, lifestyle- related NCDs. B. Objectives:

1. Decrease of morbidity and Mortality 2. Decrease in the economic burden of CVDs to the individual, family and community. Vision: Improved quality of life for all Filipinos.

Mission: To ensure that quality prevention and control and LRD services are accessible to all, especially to the vulnerable and at-risk population. II. A. Scenario Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from COPD, occurred in low- and middle-income countries. Behavioral risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for
29

about 80% of coronary heart disease and cerebrovascular disease. These important behavioral risk factors of heart disease and stroke are discussed in detail later in this chapter. Referenced from: WHO-Global Status Report on Non-Communicable Diseases 2010 B. Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to NonCommunicable Diseases. 1st: 2nd: 3rd: 4th: 7th: 10th: Diseases of the Heart (CAD) Diseases of the Vascular System (Stroke) Malignant Neoplasm (Cancer) Injuries (Accidents) Chronic Obstructive Pulmonary Disease (COPD) Nephritis, Nephrotic Syndrom

Referenced from: NEC, Department of Health III. Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt high risk behaviors and habits that may lead to the development of COPD. Will be implemented by setting: Community-Based School-Based Industry-Based Hospital-Based Training, Research, Environmental support system are important components of the progress. IV. Status of Implementation/Accomplishment

Program is well in place and its implementation is continuous from the community level (IEC) and screening Hospital (Definitive Diagnosis and treatment and rehabilitation. Development of Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD). 1st Public Hearing on the Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD) with CHD-NCR, Government and Private Hospitals and Non-Government Agencies.
30

Trained Hospitals for the Registry System entitled Users training for the Unified Registry System. Trained CHDs for the Registry System entitled Users training for the Unified Registry System (Non-Communicable Diseases). Establishment of Philippine Coalition on the Prevention and Control of NCD. A Training Manual for Health Workers on Promoting Healthy Lifestyle. (NonCommunicable Diseases). Twenty Years of Non-communicable Diseases (NCD) Prevention and Control in the Philippines (1968-2006). Healthy Lifestyle Advocacy Campaign. Manual of Operations on the Prevention and Control Lifestyle-Related NonCommunicable Diseases in the Philippines. Training Manual for Health Workers: WHO/DOH Smoking Cessation Clinic: Helping Smokers Quit. V. Future Plan/Action: Implement the program through the institutionalized integrated program of NCD-Lifestyle related diseases control program. Development of Service Package for Chronic Obstructive Pulmonary Disease (COPD) Development of Clinical Practice Guideline for COPD. Development of Strategic Framework and a five Year Strategic Plan for COPD (2012-2016).

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Cardiovascular Disease Program


I. Rationale:

Cardiovascular diseases (CVD), cancers, chronic respiratory diseases and diabetes (DM) are among the top killers in the Philippines, causing more than half of all deaths annually. Hypertension and diseases of the heart are among the ten leading causes of illnesses each year. These diseases are collectively known as Lifestyle Related Non-Communicable Diseases (NCDs), as defined in the National Objectives for Health 2005-2010, particularly because these diseases have common risk factors which are to a large extent related to unhealthy lifestyle. The risk factors involved are tobacco use, unhealthy diet, physical inactivity and alcohol use. The Food and Nutrition Research Institute (FNRD National Nutrition and Health Surveys in 1998 to 2008 (Acuin and Duante, 2010) showed that there is increasing prevalence in the associated risk factors between 1998 to 2008: hypertension from 2l%o to 25.3 %; diabetes from 3.9%o to 4.8%; among adults who are overweight, there has been a significant increase from 24.2% to 26.60/o; and those with high blood cholesterol levels had increased from 4Yo to 10.2%. Furthermore, the study found out that the following groups are at risk for NCDs: age group from the 40's onwards and those with Body Mass Index (BMI) > 23, dyslipidemia, high waist circumference and waist hip ratios. Moreover, dietary intake trends show increasing consumption of energy dense foods high in fats and sugars, while almost the entire adult population has low levels of physical activity in all domains: occupation, non-occupation, leisure, transportation. Children and adolescents are also exposed to the above-mentioned risks. Latest data from the Global Adult Tobacco Survey in 2009 shows prevalence of tobacco use (current smokers) among population 15 years old and above tobe28.3%o (17.3 million Filipinos); 47.7% of these are men (14.6 million) and 9%o are women (2.8 million). On the other hand, the prevalence of overweight among adolescents 9-11 years old has increased two folds from 2.4oh in 1993 to 4.8%;oin2005. Similarly, the prevalence rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6%o in 2005. (Source: Philippine Nutrition Facts and Figures 2005). About 30Yo of teenage students are physically inactive, spending three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities. (Source: Philippines Global School-based Student Health Survey, 2007). And, data shows that in 2008 hazardous alcohol intake stands at26.90/o (FNRI-NNHeS 2008). The Philippine Renal Disease Registry (PRDR) illustrates that for 2009, diabetic nephropathy, a complication of diabetes remained the most common etiology of end stage renal disease while clinical hypertensive nephrosclerosis, a complication of hypertension ranked as the second most common etiology of end stage renal disease. Unless something is done to control these non-communicable
32

diseases, renal complications will escalate to a degree that will compromise the current capacity to care for these types of patients. The cost of care of lifestyle-related non-communicable diseases may cause people to fall into poverty and create a downward spiral of worsening poverty and illness. They also undermine the country's economic development. In response to the increasing prevalence of lifestyle related diseases in the country, vertical programs on the prevention and control of cardiovascular diseases, cancers and diabetes were put in place in the mid 1990's. The individual programs however, were focused on treatment and management of those who were already sick and thus were competing with each other for resources and for attention upon field implementation. A. Policy Statement:

The prevention and control of chronic lifestyle related non communicable diseases shall be guided by the following policy statements. 1. The country shall adopt an integrated, comprehensive and community based response for the prevention and control of chronic, lifestyle related NCDs. 2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in mortality and morbidity due to chronic lifestyle related NCDs. 3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation of an integrated, comprehensive and community based response to chronic,lifestyle related NCDs. B. Objectives:

1. Decrease of morbidity and Mortality 2. Decrease in the economic burden of CVDs to the individual, family and community. Mission: To ensure that quality prevention and control and LRD services are accessible to all, especially to the vulnerable and at-risk population. Vision: A nation of Filipinos with Healthy Lifestyle and habits, living and working in clean and safe environment and with access to adequate medical care for CVD.

33

II. A.

Scenario Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from COPD, occurred in low- and middle-income countries. Behavioral risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebrovascular disease. These important behavioral risk factors of heart disease and stroke are discussed in detail later in this chapter. Population growth and improved longevity are leading to increasing numbers and proportions of older people, with population ageing emerging as a significant trend in many parts of the world. As populations age, annual NCD deaths are projected to rise substantially, to 52 million in 2030. Whereas annual infectious disease deaths are projected to decline by around 7 million over the next 20 years, annual cardiovascular disease mortality is projected to increase by 6 million and annual cancer deaths by 4 million. In low and middle-income countries, NCDs will be responsible for three times as many disability adjusted life years (DALYs) and nearly five times as many deaths as communicable diseases, maternal, perinatal and nutritional conditions combined, by 2030. B. Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to Non-Communicable Diseases. 1st : 2nd: 3rd: 4th: 7th: 10th: Diseases of the Heart (CAD) Diseases of the Vascular System (Stroke) Malignant Neoplasm (Cancer) Injuries (Accidents) Chronic Obstructive Pulmonary Disease (COPD) Nephritis, Nephrotic Syndrome

Referenced from: NEC, Department of Health

34

III.

Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt high risk behaviors and habits that may lead to the development of cardiovascular disease. Will be implemented by setting: Community-Based School-Based Industry-Based Hospital-Based Training, Research, Environmental support system are important components of the progress. IV. Status of Implementation/Accomplishment

Program is well in place and its implementation is continuous. Locus of implementation is in the community level and other settings. Complicated cases shall be referred to hospitals and rehabilitation can be community and hospital based. Development of Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD). 1st Public Hearing on the Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD) with CHD-NCR, Government and Private Hospitals and Non-Government Agencies. Trained Hospitals for the Registry System entitled Users training for the Unified Registry System. Trained CHDs for the Registry System entitled Users training for the Unified Registry System (Non-Communicable Diseases). Establishment of Philippine Coalition on the Prevention and Control of NCD. A Training Manual for Health Workers on Promoting Healthy Lifestyle. (NonCommunicable Diseases). Twenty Years of Non-communicable Diseases (NCD) Prevention and Control in the Philippines (1968-2006). Healthy Lifestyle Advocacy Campaign. Manual of Operations on the Prevention and Control Lifestyle-Related NonCommunicable Diseases in the Philippines. Training Manual for Health Workers: WHO/DOH Smoking Cessation Clinic: Helping Smokers Quit. IV. Future Plan/Action: Implement the program through the institutionalized integrated program of NCD-Lifestyle related diseases control program. Development of Service Package for Cardiovascular Disease (CVD) Development of Clinical Practice Guideline for Cardiovascular Disease (CVD)
35

Development of Strategic Framework and a five Year Strategic Plan for Cardiovascular Disease (2012-2016).

Dental Health Program


Oral disease continues to be a serious public health problem in the Philippines. The prevalence of dental caries on permanent teeth has generally remained above 90% throughout the years. About 92.4% of Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although preventable, these diseases affect almost every Filipino at one point or another in his or her lifetime. Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines
YEAR 1987 1992 1998 Prevalence Dental Caries 93.9% 96.3% 92.4% Peridontal Disease 65.5% 48.1% 78.3%

The oral health status of Filipino children is alarming. The 2006 National Oral Health Survey (Monse B. et al, NOHS 2006) investigated the oral health status of Philippine public elementary school students. It revealed that 97.1% of six-year-old children suffer from tooth decay. More than four out of every five children of this subgroup manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-year-old children suffer from dental caries and 49.7% of the same age group manifested symptoms of dentinogenic infections. The severity of dental caries, expressed as the average number of decayed teeth indicated for filling/extraction or filled permanent teeth (DMFT) or temporary teeth (dmft), was 8.4 dmft for the sixyear-old age group and 2.9 DMFT for the twelve-year-old age group (NOHS 2006). Table 2 - Dental caries Experience (Mean DMFT/dmft), per age groups, Philippines
Age in Years 6 12 15-19 35-44 14.18 6.39 5.52 8.51 14.82 5.43 8.25 14.42 4.58 6.3 15.04 NMEDS 1982 NMEDS 1987 NMEDS 1992 NMEDS 1998 NMEDS 2006 8.4 dmft 2.9

Filipinos bear the burden of gum diseases early in their childhood. According to NOHS, 74% of twelve-year-old children suffer from gingivitis. If not treated early,
36

these children become susceptible to irreversible periodontal disease as they enter adolescence and approach adulthood. In general, tooth decay and gum diseases do not directly cause disability or death. However, these conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially dangerous systemic diseases and infections. Serious conditions include arthritis, heart disease, endocarditis, gastrointestinal diseases, and ocular-skin-renal diseases. Aside from physical deformity, these two oral diseases may also cause disturbance of speechsignificant enough to affect work performance, nutrition, social interactions, income, and self-esteem. Poor oral health poses detrimental effects on school performance and mars success in later life. In fact, children who suffer from poor oral health are 12 times more likely to have restricted-activity days (USGAO 2000). In the Philippines, toothache is a common ailment among schoolchildren, and is the primary cause of absenteeism from school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent epidemic, placing a heavy burden on Filipino schoolchildren. VISION: Empowered and responsible Filipino citizens taking care of their own personal oral health for an enhanced quality of life MISSION: The state shall ensure quality, affordable, accessible and available oral health care delivery. GOAL: Attainment of improved quality of life through promotion of oral health and quality oral health care. OBJECTIVES AND TARGETS: 1. The prevalence of dental caries is reduce Annual Target: 5% reduction of the prevalence rate every year 2. The prevalence of periodontal disease is reduced Annual Targets : 5% reduction of the prevalence rate every year 3. Dental caries experience is reduced Annual Target : 5% reduction of the mean dmft/DMFT for 5/6 years old and 12 years old children every year 4. The proportion of Orally Fit Children (OFC) 12-71 months old is increased Annual Targets: Increased by 20% yearly The national government is primarily tasked to develop policies and guideline for local government units. In 2007, the Department of Health formulated the Guidelines in the Implementation of Oral Health Program for Public Health Services (AO 2007-0007). The program aims to reduce the prevalence rate of dental caries to 85% and periodontal disease by to 60% by the end of 2016. The program seeks to achieve these objectives by providing preventive, curative, and promotive dental health care to Filipinos through a lifecycle approach. This approach provides a
37

continuum of quality care by establishing a package of essential basic oral health care (BOHC) for every lifecycle stage, starting from infancy to old age. The following are the basic package of essential oral health services/care for every lifecycle group to be provided either in health facilities, schools or at home.
LIFECYCLE

TYPES OF SERVICE (Basic Oral Health Care Package) Oral Examination Oral Prophylaxis (scaling) Permanent fillings Gum treatment Health instruction Dental check-up as soon as the first tooth erupts Health instructions on infant oral health care and advise on exclusive breastfeeding Dental check-up as soon as the first tooth appears and every 6 months thereafter Supervised tooth brushing drills Oral Urgent Treatment (OUT) - removal of unsavable teeth - referral of complicated cases - treatment of post extraction complications - drainage of localized oral abscess Application of Atraumatic Restorative Treatment (ART) Oral Examination Supervising tooth brushing drills Topical fluoride theraphy Pits and Fissure Sealant Application Oral Prophylaxis Permanent Fillings Oral Examination Health promotion and education on oral hygiene, and adverse effect on consumption of sweets and sugary beverages, tobacco and alcohol Oral Examination Emergency dental treatment Health instruction and advice Referrals Oral Examination Extraction of unsavable tooth Gum treatment Relief of Pain Health instruction and advice

Mother(Pregnant Women) **

Neonatal and Infants under 1 year old**

Children 12-71 months old

**

School Children (6-12 years old)

Adolescent and Youth (10-24 years old)**

Other Adults (25-59 years old)

Older Person (60 years old and above)**

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STRATEGIES AND ACTION POINTS: 1. Formulate policy and regulations to ensure the full implementation of OHP a. Establishment of effective networking system (DepEd, DSWD, LGU, PDA, Fit for School, Academe and others) b. Development of policies, standards, guidelines and clinical protocols - Fluoride Use - Tooth brushing - Other Preventive Measures 2. Ensure financial access to essential public and personal oral health services a. Develop an outpatient benefit package for oral health under the NHIP of the government b. Develop financing schemes for oral health applicable to other levels of care ( Fee for service, Cooperatives, Network with HMOS) c. Restoration of oral health budget line item in the GAA of DOH Central Office 3. Provide relevant, timely and accurate information management system for oral Health. a. Improve existing information system/data collection (reporting and recording dental services and accomplishments) - setting of essential indicators - Development of IT system on recording and reporting oral health service accomplishments and indices - Integrate oral health in every family health information tools, recording books/manuals b. Conduct Regular Epidemiological Dental Surveys every 5 years 4. Ensure access and delivery of quality oral health care services. a. Upgrading of facilities, equipment, instruments, supplies

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b. Develop packages of essential care/services for different groups (children, mothers and marginalized groups) -revival of the sealant program for school children - Tooth brushing program for pre-school children - outreach programs for marginalized groups c. Design and implement grant assistance mechanism for high performing LGUs - Awards and incentives - Sub-allotment of funds for priority programs/activities d. Regular conduct of consultation meetings, technical updates and program implementation reviews with stakeholders 5. Build up highly motivated health professionals and trained auxiliaries to manage and provide quality oral health care a. Provision of adequate dental personnel b. Capacity enhancement programs for dental personnel and non-dental personnel Current FHSIS Indicators/parameters: a) Orally Fit Child (OFC) Proportion of children 12-71 months old and are orally fit during a given point of time. Is defined as a child who meets the following conditions upon oral examination and/or completion of treatment a) cariesfree or carious tooth/teeth filled either with temporary or permanent filling materials, b) have healthy gums, c) has no oral debris, and d) No handicapping dento-facial anomaly or no dento-facial anomaly that limits normal function of the oral cavity b) Children 12-71 months old provided with Basic Oral Health Care (BOHC) c) Adolescent and Youth (10-24 years old) provided with Basic Oral Health care (BOHC) d) Pregnant Women provided with Basic oral Health Care (BOHC) e) Older Persons 60 years old and above provided with Basic Oral Health Care (BOHC) Policy/Standards/Guidelines formulated/developed: a. AO. 101 s. 2003 dated Oct. 14, 2003 National Policy on Oral Health b. AO 2007-0007 Dated January 3, 2007 Guidelines In The Implementation Of Oral Health Program For Public Health Services In The Philippines
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c. AO 4-s.1998 Revised Rules and Regulations and Standard Requirements for Private School Dental services in the Philippines d. AO 11-D s. 1998 Revised Standard Requirements for Hospital Dental services in the Philippines e. AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for Occupational Dental services in the Philippines f. AO 4-A s. 1998 Infection Control Measures for Dental Health Services Trainings/Capacity Enhancement Program: Basic Orientation Course on Management of Public Health Dentist The training program was designed with the Public Health Dentists (PHDs) as the main recipients of the Basic Course on the Management of Oral Health Program. The training is expected to provide an in-depth understanding of the different roles and functions of the PHDs in the management and delivery of Public Health Services. A training module was developed for the basic course. Researches: a. National Monitoring Evaluation Dental Survey (NMEDS).

The Department of Health (DOH) has been conducting nationwide surveys every five years (1977, 1982, 1987, 1992, and 1998) to determine the prevalence of oral diseases in the Philippines. Data gathered provide continuous information that enables planners to update data used in planning, implementation and evaluation of existing oral health programs. The latest NMEDS was conducted in 2011. Results will be available on the 1st quarter of 2012. Existing Working Group for Oral Health: National Technical Working Group (TWG) on Oral Health (DPO 2005-1197) Member Agencies: Department of Health (NCDPC, HHRDB, NCHP) DOH- Center for Health Development for CALABARZON Philippine Dental Association Department of Education UP- College of Public Health Department of Interior and Local Government Department of Social Welfare and Development Local Government Units ( Makati, Quezon City)

NCR,

Central

Luzon

and

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Print materials: Leaflets (Malakas ang dating Buo ang Ngipin) for Children, Adolescent, Pregnant Women and Older Person Training Module on Basic Course on Management of Oral Health Program Non-Government Organization Major Partners: Philippine Dental Association Fit for School, Inc.

Diabetes Mellitus Prevention and Control Program


I. Rationale

Diabetes is a global concern that cuts across geographical boundaries regardless of race, sex, status and age. Diabetes and its complications impose a heavy burden to the individual, his family and society in general. Some of its serious effects are disability, poor quality of life and premature death. These impact not only on health care cost but more significantly on national growth and development. In recognition of the current and emerging importance of diabetes, a concerted effort has been organized to commonly address the diverse problems of the disease. The Non-Communicable Disease Control Service (NCDCS), Office for Public Health Services, presently Degenerative Disease Office of the National Center for Disease Prevention and Control Program is mandated and tasked through Executive Order No. 119 s. 1987, to anchor the Diabetes Mellitus Prevention and Control Program (DMPCP). Relative to this, the Administrative Order No. 16-A s. 1995 The Diabetes Mellitus Prevention and Control Program in the Philippines was signed on September 15, 1995. However, with recent evidences showing that diabetes and other chronic lifestyle related non-communicable diseases (cardiovascular diseases, cancers and chronic respiratory diseases) sharing common risk factors (unhealthy diet, physical inactivity, smoking and alcohol use) should be addressed the most cost-effective way through prevention of the emergence of the risk factors in an integrated manner, employing health promotion strategies across the life course and intervening at the level of family and community. This is essential because the causal risk factors causing these illnesses are deeply entrenched in the social and cultural framework of the society. Thus, an integrated comprehensive program for the prevention and control of these noncommunicable lifestyle related diseases has to be put in place, hence, the signing of the Administrative Order No. 2011 0003, National Policy on Strengthening the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases on April 14, 2011.
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Goal: To reduce morbidity, mortality and disability rates due to chronic lifestyle related NCDs through an integrated and comprehensive program on the prevention and control of lifestyle related diseases. Objectives: 1. To develop and promote an integrated and comprehensive program on the prevention and control of lifestyle related diseases in the country. 2. To engage all province-wide or city-wide health systems to adopt an integrated and comprehensive program on the prevention and control of lifestyle related diseases. 3. To achieve improvement in the following Key Performance Indicators from 2011-2016: Common Risk Factors Reduction in prevalence of current smoking among adult males from 56.3 to 40.0 Reduction in prevalence of current smoking among adolescent female from 8.80 to 7.2 Reduction in prevalence of adults with high physical inactivity from 60.5 to 50.8 Increase in per capita total vegetable from 111.0 (g/day) to 133.0 (g/day) Intermediate Risk Factors Reduction in prevalence of hypertension among adult males from 24.2 to 19.6. Reduction in prevalence of adults with high fasting blood sugar from 3.4 to 3.4. Reduction in the prevalence of central obesity (high waist circumference) among adult females from 18.3 to 12.81 Reduction in prevalence of high total serum cholesterol among adults from 8.5 to 8.5 Disease Control Reduction in mortality from non-communicable diseases at 2% per year through the Medium Development Goal max initiative. II. Scenario

The estimated number of adults living with diabetes has soared to 366 million, representing 8.3% of the global adult population. This number is projected to increase to 552 million people by 2030, or 9.9% of adults which equates to
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approximately three more people with diabetes every 10 seconds(Diabetes Atlas 5th Edition, 2011). In the Philippines, the prevalence of diabetes increased from 3.4% in 2003 to 4.8% in 2008 (NNHeS 2008). Diabetes also ranks 8thin the top 10 leading causes of death in the country (DOH- Health Statistics 2006). III. Interventions/Strategies Implemented by DOH

The Action Framework for the National Program on the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases is based on the Causation Pathway Model for Major Chronic Diseases as contained in the World Health Organization Western Pacific Regional Action Plan for Addressing Non-Communicable Diseases, where the underlying determinants, common risk and intermediate risk factors that would lead to lifestyle-related diseases are identified. The Action Framework has seven action areas as follows: (1) Environmental interventions; (2) Lifestyle interventions; (3) Clinical interventions; (4) Advocacy; (5) Research, Surveillance, Monitoring and Evaluation; (6) Networking and Coalition building; and (7) Health System Strengthening. It draws primarily from the WHO Western Pacific Regional Framework for addressing Non-communicable Diseases and emphasizes the requirement for integrated comprehensive approaches that encompass and address the various levels of determinants and risks for non-communicable lifestyle related diseases. The framework clearly identifies areas for intervention according to the causation pathway by utilizing a comprehensive approach that simultaneously seeks to effect change at three levels: 1) Environmental Interventions such as policy and regulatory interventions seek to create a supportive environment for healthier choices. They address the multiple environmental determinants brought about for example, by globalization and urbanization that give rise to the development of unhealthy lifestyles. 2) Lifestyle interventions address the common risk factors and intermediate risk factors by providing population based lifestyle interventions (for example, information and education and behavioral interventions for those who are already at risk). 3) Clinical interventions, palliation and rehabilitation address the capacity of the health system to treat and manage diseases through screening, risk factor modification, clinical management, palliation and rehabilitation. To support change in these three levels of interventions, additional actions are needed in the following areas: advocacy, research, surveillance, monitoring and evaluation; networking and coalition building across all sectors of the government
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and society, and health system strengthening through primary health care to make it more responsive to chronic care. The framework highlights the balance between healthy choices and healthy environments because it recognizes that supportive environments are needed to empower healthy choices. It also redistributes responsibility across the whole of society, with government, the health sector, the private sector, non-governmental organizations, communities, families and individuals all sharing accountability for putting in place the necessary elements that promote healthy lifestyle and quality care for non-communicable lifestyle related diseases. IV. Status of Implementation/Accomplishment

Policy/Standard/Guidelines Development Development of Clinical Practice Guidelines on diabetes and other NCDs are ongoing. Promotion and Advocacy Conduct of HEATHLY LIFESTYLE TO THE MAX Campaign This brings the problem of NCDs including diabetes high in the consciousness of all sectors and the Filipino public. This advocacy focuses on clear health priorities such as consumption of healthy diet, promoting physical activity, curbing the use of tobacco, alcohol, and illegal drugs, proper weight and stress management, early detection and control of hypertension. Promotion of KALUSUGAN PANGKALAHATAN Encourages everyone to practice healthy lifestyle like exercise as physical inactivity increases the risk of non-communicable diseases specifically cardiovascular diseases and diabetes. Coalition Building Together with other partners in the Phil. Coalition for the Prevention and Control of Non-Communicable Diseases, also known as Healthy Lifestyle Coalition, the DOH also encourages the Fast Food Establishments to offer healthier food choices by reducing the fat, sugar and salt content as well as trans-fatty acids in the food they serve. Serving of fresh fruits and vegetables and other sources of fiber are encouraged as well. Development of Guidelines on Healthy Eating/Food Labeling is also being undertaken together with other partners and stakeholders. Surveillance A national and integrated registry system for chronic non-communicable diseases has been developed where health facilities like hospitals can report new cases of diabetes, cancer, stroke and chronic obstructive pulmonary diseases and statistics concerning incidence, mortality and survival can be generated. An
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Administrative Order re: National Implementation of the Integrated Chronic NonCommunicable Disease Registry System has been drafted for approval. V. Future Plan/Action Printing and Dissemination of Clinical Practice Guidelines on Diabetes Orientation/Forum will be conducted among NCD Coordinators in CHDs and hospitals to discuss details of the CPG. Experts from diabetes societies will be invited as speakers. Continue conduct of promotion and advocacy activities and partnership with specialty societies and other stakeholders on NCD prevention and control including diabetes Ensure implementation of diabetes registry Together with the National Center for Health Promotion and other experts on diabetes, develop various information-education materials on the prevention and management of diabetes for dissemination to various clients.

Emerging and Re-emerging Infectious Disease Program


Emerging and re-emerging infections (e.g., SARS, meningococcemia, Avian Influenza or bird flu, A (H1N1) virus infection) threaten countries all over the world. In 2003, SARS affected at least 30 countries with most of the countries from Asia. In response to its sudden and unexpected emergence, quarantine and isolation measures and rapid contract tracing were carried out. The Philippines was able to minimize the impact of SARS through effective information dissemination, risk communication, and efficient conduct of measures. The unexpected and unusual increase in cases of meningococcal disease (meningococcemia as the predominant form) in the Cordillera Autonomous Region resulted to at least 50% of cases in the early stage of occurrence. In 2009, the influenza A (H1N1) virus infection led to global epidemic, or most popularly known as pandemic. On June 11, 2009, a full pandemic alert was declared by the World Health Organization (WHO). However, some local health offices from many provinces were not able to respond effectively and rapidly. With the lack of strong linkages and coordinating mechanisms, the Department of Health (DOH) hopes to further improve the functionality and effectiveness of local response systems. Efforts to prepare for emerging infections with potential for causing high morbidity and mortality are being done by the program. Applicable prevention and control measures are being integrated while the existing systems and organizational structures are further strengthened. Goal: Prevention and control of emerging and re-emerging infectious disease from becoming public health problems. Objectives:
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The program aims to: 1. Reduce public health impact of emerging and re-emerging infectious diseases; and 2. Strengthen surveillance, preparedness, and response to emerging and reemerging infectious diseases. Program Strategies: The DOH, in collaboration with its partner organizations/agencies, employs the key strategies: 1. Development of systems, policies, standards, and guidelines for preparedness and response to emerging diseases; 2. Technical Assistance or Technical Collaboration; 3. Advocacy/Information dissemination; 4. Intersectoral collaborations; 5. Capability building for management, prevention and control of emerging and re-emerging diseases that may pose epidemic/pandemic threat; and 6. Logistical support for drugs and vaccines for meningococcemia and anti-viral drugs and vaccine for Pandemic Influenza Preparedness. Partner Organizations/Agencies: The following organizations/agencies take part in achieving the goal of the program: World Health Organization (WHO) United Nations Childrens Fund (UNICEF) Department of Interior and Local Government (DILG) Department of Education (DepEd) United States Agency for International Development (USAID) Asian Development Bank (ADB) Philippine Health Insurane Corporation (PhilHealth) Department of Agriculture-Bureau of Animal Industry (DA-BAI)

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Environmental Health
Environmental Health is concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury. It is concerned primarily with effects of the environment to the health of the people. Program strategies and activities are focused on environmental sanitation, environmental health impact assessment and occupational health through interagency collaboration. An Inter-Agency Committee on Environmental Health was created by virtue of E.O. 489 to facilitate and improve coordination among concerned agencies. It provides the venue for technical collaboration, effective monitoring and communication, resource mobilization, policy review and development. The Committee has five sectoral task forces on water, solid waste, air, toxic and chemical substances and occupational health. Vision: Mission: Health Settings for All Filipinos Provide leadership in ensuring health settings

Goals: Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion and mitigation of hazards and risks in the environment and workplaces. Strategic Objectives 1. Development of evidence-based policies, guidelines, standards, programs and parameters for specific healthy settings. 2. Provision of technical assistance to implementers and other relevant partners 3. Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and attainment of healthy settings Key Result Areas 1. Appropriate development and regular evaluation of relevant programs, projects, policies and plans on environmental and occupational health 2. Timely provision of technical assistance to Centers for Health Development (CHDs) and other partners 3. Development of responsive/relevant legislative and research agenda on DPC 4. Timely provision of technical inputs to curriculum development and conduct of human resource development 5. Timely provision of technically sound advice to the Secretary and other stakeholders 6. Timely and adequate provision of strategic logistics

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Components Inter- agency Committee on Environmental Health IACEH Task Force on Water IACEH Task Force on Solid Waste IACEH Task Force on Toxic Chemicals IACEH Task Force on Occupational Health Environmental Sanitation Environmental Health Impact Assessment Occupational Health

Expanded Program on Immunization


I. Rationale

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines. Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. In 1986, 21.3% fully immunized children less than fourteen months of age based on the EPI Comprehensive Program review. II. Scenario

Global Situation The burden. In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to diseases that could have been prevented by routine vaccination. This represents 14% of global total mortality in children under 5 years of age. Source: Weekly Epidemiological Record, WHO: No.46,2011,86.509-520) Burden of Diseases The immunization coverage of all individual vaccines has improved as shown in Figure 1: (Demographic Health Survey 2003 and 2008). Fully Immunized Child (FIC) coverage improved by 10% and the Child Protected at Birth (CPAB) against Tetanus improved by 13% compared to any prior period. Thus, the Philippines has now historically the highest coverage for these two major indicators.

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III.

Interventions/ Strategies

Program Objectives/Goals: Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases. Specific Goals: 1. To immunize all infants/children against the most common vaccine-preventable diseases. 2. To sustain the polio-free status of the Philippines. 3. To eliminate measles infection. 4. To eliminate maternal and neonatal tetanus 5. To control diphtheria, pertussis, hepatitis b and German measles. 6. To prevent extra pulmonary tuberculosis among children. Mandates: Republic Act No. 10152 MandatoryInfants and Children Health Immunization Act of 2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health. Strategies: Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay (REB) strategy REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in 2004 aimed to improve the access to routine immunization and reduce drop-outs. There are 5 components of the strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between the community and service, supportive supervision and maximizing resources. Supplemental Immunization Activity (SIA) Supplementary immunization activities are used to reach children who have not been vaccinated or have not developed sufficient immunity after previous vaccinations. It can be conducted either national or sub-national in selected areas. Strengthening Vaccine-Preventable Diseases Surveillance This is critical for the eradication/elimination efforts, especially in identifying true cases of measles and indigenous wild polio virus Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

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IV.

Status of implementation/ Accomplishment

All health facilities (health centers and barangay health stations) have at least one (1) health staff trained on REB. Polio Eradication: The Philippines has sustained its polio-free status since October 2000. Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to 83%. A least 95% OPV3 coverage need to be achieved to produce the required herd immunity for protection. There is an on-going polio mass immunization to all children ages 6 weeks up to 59 months old in the 10 highest risk areas for neonatal tetanus. These areas are the following: Abra, Banguet, Isabela City and Basilan, Lanao Norte, Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu. Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to 1.38 in 2011. Only regions III, V and VIII have achieved the AFP rate of 2/100,000 children below 15 years old. (Source: NEC, DOH). A decreasing AFP rate means we may not be able to find true cases of polio and may experience resurgence of polio cases Measles Elimination Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011. Implemented the 2-dose measles-containing vaccine (MCV) in 2009 MCV1 (monovalent measles) at 9-11 months old MCV2 (MMR) at 12-15 months old. Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood samples are withdrawn from all measles suspect to confirm the case as measles infection. A supplemental immunization campaign for measles and rubella (German measles) was done in 2011. This was dubbed as Iligtas sa Tigdas ang Pinas 15.6 million (84%) out of the 18.5 million children ages 9 months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between April and June 2011. Rapid coverage assessment (RCA) was conducted in selected areas to validate immunization coverage, assess high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9- months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign. The Government of the Philippines spent PhP 635.7M for the successful conduct of the MR campaign.ss high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9- months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above
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that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign. As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5 cases were epidemiologically-linked and 27 clinically confirmed. This means we have at least 60 true measles at present. Measles is said to be eliminated if we have 1 case per million or below 100 cases in a year Maternal and Neonatal Tetanus Elimination 10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the areas categorized as low risk, at risk and highest risk based on the NT surveillance, skilled birth attendants and facility based delivery and the tetanus toxoid 2+ (TT 2+) vaccination. Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk areas. An estimated 1,010,751 women age 15 - 40 year old women regardless of their TT immunization will receive the vaccine during these rounds. This is funded by the Kiwanis International through UNICEF and World Health Organization. Control of other common vaccine-preventable diseases (Diphtheria, Pertussis, Hepatitis B and Meningitis/Encephalitis secondary to H. influenzae type B) Continuous vaccination for infants and children with the DPT or the combination DPT-HepB-HiB Type B. Annex1 EPI Annual Accomplishment Report. DOH procures all the vaccines and needles and syringes for the immunization activities targeted to infants/children/mothers. Hepatitis B Control Republic Act No. 10152 has been signed. It is otherwise known as the Mandatory Infants and Children Health Immunization Act of 2011, which requires that all children under five years old be given basic immunization against vaccine-preventable diseases. Specifically, this bill provides for all infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of birth. One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and Newborn Care Package (EINC). In 2011, 11 tertiary hospitals are already EINC compliant. The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by HBsAg prevalence to less than 1% in five-year-olds born after routine vaccination started 100% Hepatitis B at birth vaccination. Hepatitis B Coverage. Philippines, 2001-2011 Timing of administration/dose <24 hours >24 hours 2009 34% 62% 2010* 38% 55% 2011* 14% 24%
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Hep B 3rd dose *both 2010 and 2011 data are as of October 2011 Vaccines and cold chain management

86%

81%

30%

Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions since 2003. An effective vaccine management assessment was conducted last December 2011 and revealed cold chain capacity gaps from the national up to the implementers level. A total of PhP 267 million is required to address the gaps identified during the assessment. Introduction to New Vaccines For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization program. Immunization will be prioritized among the infants of families listed in the National Housing and Targeting System (NHTS) for Poverty Reduction nationwide. The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2 vaccines. V. Future Plan/ Action Strengthening the Cold Chain to support the Immunization Program Capacity Building for Health Workers for the Introduction of New Vaccines Advocacy for the financial sustainability for the newly introduced vaccines for expansion. Development of the comprehensive multi-year plan for immunization program. VI. Other Significant information worth mentioning One significant milestone is that the budget allocation for the immunization program has continued to increase year by year The Government of the Philippines allocated budget for the immunization of all infants/children/women/older persons nationwide. For 2012, the budget for EPI is PhP1.8 billion and another P1.5 Billion for the immunization for senior citizen and children for the NHTS families. This is great leap towards universal access to quality vaccines for the prevention of the most common vaccinepreventable diseases.

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Essential Newborn Care


Profile/Rationale of the Health Program The Child Survival Strategy published by the Department of Health has emphasized the need to strengthen health services of children throughout the stages. The neonatal period has been identified as one of the most crucial phase in the survival and development of the child. The United Nations Millennium Development Goal Number 4 of reducing under five child mortality can be achieved by the Philippines however if the neonatal mortality rates are not addressed from its nonmoving trend of decline, MDG 4 might not be achieved. Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy and NOH 2011-2016 Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels Objectives: To provide evidence-based practices to ensure survival of the newborn from birth up to the first 28 days of life To deliver time-bound core intervention in the immediate period after the delivery of the newborn To strengthen health facility environment for breastfeeding initiation to take place and for breastfeeding to be continued from discharge up to 2 years of life To provide appropriate and timely emergency newborn care to newborns in need of resuscitation To ensure access of newborns to affordable life-saving medicines to reduce deaths and morbidity from leading causes of newborn conditions To ensure inclusion of newborn care in the overall approach to the Maternal, Newborn, Child Health and Nutrition Strategy Stakeholders: 1. Both public and private sector at all levels of health service delivery providing maternal and newborn services 2. Health Professional Organizations and their member health professionals Pediatricians/neonatalogists of the Philippine Pediatric Society (PPS) and the Philippine Society of Newborn Medicine (PSNbM) Obstetrician-Gynecologists of the Philippine Obstetrical and Gynecological Society (POGS) Perinatologists of the Perinatal Association of the Philippines, Inc., (PAPI) Anesthesiologists and obstetric anesthesiologists of the Philippine Society of Anesthesiologists (PSA) and the Society for Obstetric Anesthesia of the Philippines (SOAP),
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Family medicine specialists of the Philippine Academy of Family Physicians (PAFP) Nurses, Maternal and child nurses, intensive care nurses of the Philippine Nurses Association and its affiliate nursing societies Midwives of the Integrated Midwives of the Philippines (IMAP), Philippine League of Government and Private Midwives, Inc. (PLGPMI), Midwives Foundation of the Philippines (MFP) and Well Family Midwives Clinic 3. Government regulatory bodies e.g. Professional Regulations Commission 4. Academe - professors and instructors from members schools and colleges of: Association of Philippine Medical Colleges (APMC) Association of Deans of Philippine Colleges of Nursing (ADPCN) Association of Philippine Schools of Midwifery 5. Hospital, health care administrator and infection control associations Philippine Hospital Association (PHA) Private Hospitals Association of the Philippines (PHAP) Philippine College of Hospital Administrators Philippine Hospital Infection Control Society

6. Local government units - local chief executives and LGU legislative bodies Beneficiaries: Newborns all over the country Parents Communities Program Strategies: 1. Health Sector Reform A. Policy and Guideline Issuance a) Administrative Order 2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care - December 1, 2009 b) Clinical Pocket Guide on Essential Newborn Care B. Aquino Health Agenda and Achieving Universal Health Care Administrative Order 2010-0036 C. PhilHealth Circular 2011-011 dated August 5, 2011 on Newborn Care Package D. Development of Operationalization of Essential Newborn Care Protocol in Health Facilities 2. Identification of Centers of Excellence
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Adoption of essential newborn care protocol(including intrapartum care and the MNCHN Strategy) 3. Curriculum Reforms Curriculum integration of essential newborn care (including intrapartum care and the MNCHN Strategy) in undergraduate health courses Integration and revision of board exam questions in licensure examinations for physicians, nurses and midwives 4. Social Marketing Development of social marketing tools - Unang Yakap MDG 4 & 5 Major Activities and its Guidelines: Conduct of one-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy) Regional MNCHN Conference for CHDs and LGUs including DOH-retained hospitals and LGU hospitals Current Status of the Program A. What have been achieved/done 1. Policy was issued in December 1, 2009 2. DOH/WHO Scale-up Implementation was done in 11 hospitals 3. Advocacy Partners Forum on essential newborn care (including intrapartum care and the MNCHN Strategy) 4. One-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy) among health workers in different health facilities 5. Inclusion of dexamethasone and surfactant as core medicines in the essential medicines list for children in the Philippine National Formulary B. Statistics 1. Early outcomes of EINC implementation has shown reduction on neonatal deaths in select DOH-retained hospitals including deaths from neonatal sepsis and complications of prematurity

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Partner organizations/agencies: National Nutrition Council Population Commission WHO UNICEF UNFPA AusAID USAID Health professional and academic organizations mentioned above.

Family Planning
Brief Description of Program A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. The program is anchored on the following basic principles. Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper upbringing and education of children so that they grow up to be upright, productive and civic-minded citizens. Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is NOT a FP method: Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It enables women to recover their health improves women's potential to be more productive and to realize their personal aspirations and allows more time to care for children and spouse/husband, and; Informed Choice that is upholding and ensuring the rights of couples to determine the number and spacing of their children according to their life's aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children's and their own lives. Intended Audience: including adolescents Area of Coverage: Mandate: Men and women of reproductive age (15-49) years old) Nationwide EO 119 and EO 102

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Vision: Empowered men and women living healthy, productive and fulfilling lives and exercising the right to regulate their own fertility through legally and acceptable family planning services. Mission: The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the availability of FP information and services to men and women who need them. Program Goals: To provide universal access to FP information, education and services whenever and wherever these are needed. Objectives General To help couples, individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health. Specifically, by the end of 2004: Reduce MMR from 172 deaths 100,000 LB in 1998 to less than 100 deaths/100,000 LB IMR from 35.3 deaths/1000 livebirths in 1998 to less than 30 deaths/1000 live births TFR from 3.7 children per woman in 1998 to 2.7 chidren per woman Increase Contraceptive Prevalence Rate from 45.6% in 1998 to 57% Proportion of modern FP methods use from 28>2% to 50.5% Key Result Areas Policy, guidelines and plans formulation Standard setting Technical assistance to CHDs/LGUs and other partner agencies Advocacy, social mobilization Information, education and counselling Capability building for trainers of CHDs/LGUs Logistics management Monitoring and evaluation Research and development

Strategies Frontline participation of DOH-retained hospitals Family Planning for the urban and rural poor
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Demand Generation through Community-Based Management Information System Mainstreaming Natural Family Planning in the public and NGO health facilities Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM Contraceptive Interdependence Initiative Major Activities I. Frontline participation of DOH-retained hospitals Establishment of FP Itinerant team by each hospital to respond to the unmet needs for permanent FP methods and to bring the FP services nearer to our urban and rural poor communities FP services as part of medical and surgical missions of the hospital Provide budget to support operations of the itenerant teams inclduing the drugs and medical supplies needed for voluntary surgical sterilization (VS) services Partnership with LGU hospitals which serve as the VS site II. Family Planning for the urban and rural poor Expanded role of Volunteer Health Workers (VHWs) in FP provision Partnership of itenerant team and LGU hospitals Provision of FP services III. Demand Generation through Community-Based Management Information System Identification and masterlisting of potential FP clients and users in need of PF services (permanent or temporary methods) Segmentation of potential clients and users as to what method is preferred or used by clients IV. Mainstreaming Natural Family Planning in the public and NGO health facilities Orientation of CHD staff and creation of Regional NFP Management Committee Diacon with stakeholders Information, Education and counseling activities Advocacy and social mobilization efforts Production of NFP IEC materials Monitoring and evaluation activities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM Field of itinerant teams by retained hospitals to provide VS services nearer to the community Installation of COmmunity Based Management Information System Provision of augmentation funds for CBMIS activities

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VI. Contraceptive Interdependence Initiative Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and FP Itenerant Teams Expansion of Philhealth benefit package to include pills, injectables and IUD Social Marketing of contraceptives and FP services by the partner NGOs National Funding/Subsidy VIII. Development /Updating of FP CLinical Standards IX. Formulation of FP related policies/guidelines. E.g. Creation of VS Outreach team by retained hospitals and its operationalization, GUidelines on the Provision of VS services, etc. X. Production and reproduction of FP advocacy and IEC materials XI. Provision of logistics support such as FP commodities and VS drugs and medical supplies Other Partners 1. Funding Agencies United States Agency for International Development (USAID) United Nations Funds for Population Activities (UNFPA) Management Sciences for Health (MSH) Engender Health The Futures Group 2. NGOs Reachout foundation DKT Philippine Federation for Natual Family Planning (PFNFP) John Snow Inc. - Well Family Clinic Phlippine Legislators Committee on Population Development (PLPCD) Remedios Foundation Family Planning Organization of the Philippines (FPOP) Institute of Maternal and Child Health (IMCH) Integrated Maternal and Child Care Services and Development, Inc. Friendly Care Foundation, Inc. Institute of Reproductive Health 3. Other GOs Commission on Population DILG DOLE LGUs

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Food and Waterborne Diseases Prevention and Control Program


The program covers diseases of a parasitic, fungal, viral, and bacteria in nature, usually acquired through the ingestion of contaminated drinking water or food. The more common of these diseases are bacterial in nature, the most common of which are typhoid fever and cholera. These two organisms had been the cause of major outbreaks in the Philippines in the last two years. Parasitic organisms are also an important factor, among them capillariasis, Heterophydiasis, and paragonimiasis, which are endemic in Luzon, Visayas, and Mindanao. Cysticercosis is also a major problem since it has a neurologic component to the illness. The approaches to control and prevention is centered on public health awareness regarding food safety as well as strengthening treatment guidelines. Goal and Objectives: The program aims to: 1. Prevent the occurrence of food and waterborne outbreaks through strategic placement of water purification solutions and tablets at the regional level so that the area coordinators could respond in time if the situation warrants; 2. Procure Intravenous Fluid solutions, venosets and IV cannula for adult and pediatric patients in diarrheal outbreaks and to be stockpiles at the 17 Centers for Health Development (CHD) and the Central Office for emergency response to complement the stocks of HEMS; 3. Place first line and second line antimicrobial and anti-parasitic medicines such as albendazole and praziquantel at selected CHDs for outbreak mitigation as well as emergency stocks at the DOH warehouse located at the Quirino Memorial Medical Center (QMMC) compound; 4. Increase public awareness in preventable food-borne illnesses such as capillaria, which is centered on unsafe cultural practices like eating raw aquatic products; 5. Increase coordination between the National Epidemiology Center (NEC) and Regional epidemiology surveillance Unit (RESU) to adequately respond to outbreaks and provide technical support; 6. Procure Typhidot-M diagnostic kits for the early detection and treatment of typhoid patients; 7. Procure Typhoid vaccine and oral cholera vaccine to reduce the number of cases seen after severe flooding; 8. Provide training to local government unit (LGU) laboratory and allied medical personnel on the Accurate laboratory diagnosis of common parasites and proper culture techniques in the isolation of bacterial food pathogens; and 9. Provide guidance to field medical personnel with regard to the correct treatment protocols vis--vis various parasitic, bacterial, and viral pathogens involved in food and waterborne diseases. Beneficiaries/Target Population:
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The Food and Waterborne Disease Control Program targets individuals, families, and communities residing in affected areas nationwide. For parasitic infections, endemic areas are more common. Strategies/Management: Case monitoring is maintained through the Philippine Integrated Disease Surveillance and Response (PIDSR) framework of NEC and the sentinel sites of the RESU. To add to that, quarterly reports of the regional coordinators supplement the data and the regular updating from NEC Outbreak Surveillance. Outbreaks are being prevented though public education in print and radio stations. The need for safe food and water intake by adequate cooking and boiling of drinking water is inculcated to the public. Multi-drug resistant cases of typhoid are monitored through reports from the hospital sentinel site and the data from the Research Institute of Tropical Medicines Antibiotic Resistance & Surveillance Program. Partner Organizations/Agencies: The following organizations and agencies take part in the achievement of program objectives: University of the Philippines-National Institutes of Health (UP-NIH) Department of Agriculture-National Meat Inspection Service (DA-NMIS) Asia Centric Disease Bureau World Health Organization-Western Pacific Regional Office (WHO-WPRO) World Health Organization-Southeast Asia Regional Office (WHO-SEARO)

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Food Fortification Program


Objectives: To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem To discuss various types of food fortification strategies To provide an update on the current situation of food fortification in the Philippines Fortification as defined by Codex Alimentarius The addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups Vitamin A, Vitamin A Deficiency (VAD) and its Consequences Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence Vitamin A deficiency - a condition characterized by depleted liver stores & low blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor absorption or utilization of vit. A in the body VAD affects childrens proper growth, resistance to infection, and chances of survival (23 to 35% increased child mortality), severe deficiency results to blindness, night blindness and Bitots spot Prevalence of Vitamin A Deficiency: 1993, 1998, 2003, 2008 (DOST FNRI, NNS) Physiological State 1993 1998 2003 6 months - 5 yrs. Pregnant 35.3 16.4 38.0 22.2 40.1 17.5

2008 15.2 9.5

Lactating 16.4 16.5 20.1 6.4 WHO Cut off Point to be considered a public health problem = >15% Iron and Iron Deficiency Anemia (IDA) and its consequences Iron - an essential mineral and is part of hemoglobin, the red protein in red blood cells that carries oxygen from the lungs to the cells

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Iron Deficiency Anemia - condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood IDA results in premature delivery, increased maternal mortality, reduce ability to fight infection and transmittable diseases and low productivity Iodine and Iodine Deficiency Disorders (IDD) Iodine -a mineral and a component of the thyroid hormones Thyroid hormones - needed for the brain and nervous system to develop & function normally Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various conditions (e.g. goiter, cretinism, mental retardation, loss of IQ points) Progress in the Philippines towards the Elimination of IDD, 1998-2008 Achievements Indicator Goal* 1998 2003 2008 Proportion of Households using Iodized Salt, >90 % Median Urinary Iodine, ug/L 6-12 yrs. Lactating Women Pregnant Women Proportion < 50g/L, % 6-12 yrs. Lactating Women Pregnant Women *ICC-IDD 2007 Policy on Food Fortification ASIN LAW Republic Act 8172, An Act Promoting Salt Iodization Nationwide and for other purposes, Signed into law on Dec. 20, 1995 Food Fortification Law
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9.7

56.0 81.1

100200 100200 150249 < 20

71 -

201 111 142

132 81 105

35.8 11.4 19.7 23.7 34.0 18.0 25.8

Republic Act 8976, An Act Establishing the Philippine Food Fortification Program and for other purposes mandating fortification of flour, oil and sugar with Vitamin A and flour and rice with iron by November 7, 2004 and promoting voluntary fortification through the SPSP, Signed into law on November 7, 2000 Status of the Philippine Food Fortification Program Status and Recommendations for the Sangkap Pinoy Seal Program There are 139 processed food products with SangkapPinoySeal with 83% with vitamin A, 29% with iron and 14% with iodine (2008) 37% of the products are snack foods Most of the products FDA analyzed are within the standard Based on 2003 NNS Households awareness of SPS- and FF-products is 11% and 14%, respectively, in 2008 awareness is 11.6% Although awareness is low, usage of SPS-products is 99.2% Recommendations: Review voluntary fortification standards as standards were developed prior to mandatory fortification Conduct in-depth analysis of the coverage of SangkapPinoySeal of the 2008 NNS Update list of Sangkap Pinoy Seal products as some companies have stopped using the seal in their products Intensify promotions of Sangkap Pinoy Seal Status and Recommendation on Flour Fortification with Vitamin A and Iron Status: Based on FDA monitoring all local flour millers are fortifying with vitamin A and iron 94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A and iron respectively while 77% and 99% were fortified with vitamin A and iron respectively. In 2010 decrease in vitamin A due to non-fortified imported and market samples flour. 58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified according to standards. Recommendations: Review fortificants for iron and possible other micronutrients to be added to wheat flour Continue monitoring wheat fortification Assist flour millers to improve quality of fortification Need to show impact of flour fortification
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Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A Status: Non fortification by industry due to the unresolved issue of who will bear the cost of fortification brought about by the quedansystem of transferable certificates of sugar ownership. Lack of premix production Fortification of refined sugar would benefit mainly those in the high income group. Recommendations: Continue discussions with sugar industry to explore a compromise for fortification ie. fortification of washed sugar Review policy on mandatory fortification of refined sugar Status and Recommendations on Rice Fortification with Iron Status: NFA is fortifying 50% of its rice in 2009 and 2010 With the non fortification of NFA rice, private sector has an excuse for non fortification of its rice. There is limited commercial/private sector iron rice premix and iron fortified rice production and distribution mostly in Mindanao (Region XII and XI) with Gen San having the only commercial iron rice premix plant in the Philippines and Davao City implementing mandatory rice fortification in food outlets NFA conducted communications campaign for its iron fortified rice thru the so called I-rice campaign though issues remain on the acceptability of its product Recommendation: Review of mandatory fortification of rice with iron Status and Recommendations on Cooking Oil Fortification with Vitamin A Status: Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in 2009 and 94% in 2010) Samples monitored were labeled and packed FDA is not monitoring "takal" Recommendations:
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To increase frequency of monitoring by FDA and other agencies such as PCA and LGUs, to ensure all oil refiners and repackersare monitored at least once a year Monitoring of takal oil, use of test kit Monitoring imported oil, FDA and BOC to coordinate Review policy of mandatory fortification of oil to possibly limit to those mostly used by at risk population (coconut and palm oil) Status and Recommendations on Salt Iodization Status: Based on the 2008 NNS, 81.1% of households were positive for iodine using Rapid Test Kit (RTK) In the same survey for Region III, 55.7% were positive for RTK but only 34.2% and 24.2% have iodine content >5ppm and >15ppm respectively using WYD Tester For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm FDA started implementing localization of ASIN Law with General Santos City as the 1stto have a MOA with FDA on localization Recommendation: FDA to expand localization of ASIN Law Set up iodine titration for testing iodine in salt Continue to intensify monitoring particularly imported and takal salt Food Fortification Day Theme 2010: EO 382 declares November 7 as the National Food Fortification Day

Garantisadong Pambata

The Mandate: A.O. 36, s2010 Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos Goal

Achievement of better health outcomes, sustained health financing and responsive health system by ensuring that all Filipinos, esp. the disadvantaged group (lowest 2 income quintiles) have equitable access to affordable health care

Universal Health Care Strategies: Financial risk protection.


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Improved access to quality hospitals and facilities Attainment of health-related MDGs by: Deploy CHTs to actively assist families in assessing and acting on their health needs Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC, IPP, GP for 0-14 years old Aggressive promotion of healthy lifestyle change Harness strengths of inter-agency and intersectoralcooperation with DepEd, DSWD and DILG

EXPANDED GARANTISADONG PAMBATA Comprehensive and integrated package of services and communication on health, nutrition and environment for children available everyday at various settings such as home, school, health facilities and communities by government and nongovernment organizations, private sectors and civic groups. Objectives: Contribute to the reduction of infant and child morbidity and mortality towards the attainment of MDG 1 and 4. Ensure that all Filipino children, especially the disadvantaged group (GIDA), have equitable access to affordable health, nutrition and environment care. Partner Agencies: Department of Education Department of Social Welfare & Development Department of Interior and Local Government Department of Health USAID UNICEF World Health Organization Save the Children Fit for School World Vision Plan Foundation Philippine Dental Association

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GP Services Package Age by Year Health Maternal health care Essential newborn care Immunization Immunization Deworming IMCI Deworming Booster immunization (Screening) Deworming Booster immunization (Screening) Physical activity (Healthy lifestyle)

Nutrition Maternalnutrition Iron supplementation Vitamin A Early &exclusive breastfeeding Complementary feeding Breastfeeding Complementaryfeeding Vitamin A Iron supplementation Iodized salt at home Proper nutrition Iodized salt at home

Environment Water Sanitation Hygiene promotion Oral health Child injury prevention Treated bednets Smoke-free homes

0-1

1-5

6-10

11-14

Proper nutrition Iron supplementation Iodized salt at home

Vitamin A Supplementation Policy remains the same for giving Vitamin A capsules: Routine: - every 6 months for 6-59 months preschoolers Therapeutic: - 1 capsule upon diagnosis regardless of when the last dose of VAC for preschoolers with measles - 1 capsule upon diagnosis except when child was given Vitamin A was given less than 4 weeks for preschoolers with severe pneumonia, persistent diarrhea, severely underweight - 1 capsule immediately upon diagnosis, 1 capsule the next day and another capsule after 2 weeks after for preschoolers with xerophthalmia Recording/Reporting: FHSIS Records and Reports GP Forms submitted to NCDPC thru CHDs April preschoolers 6-59 months given VAC from November of past year to April of the current year October preschoolers 6-59 months given VAC from May to October
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Core Messages per Gateway Behavior MAGPASUSO (Newborn to 6 mos) Pasusuhin ng gatas ni Nanay lang (6 mos to 2 years old) Magpasuso at bigyan ng (mga masustansiyang ibatibang pagkain) ibang pagkain (pampamilyang pagkain). Bumili/ Gumamit ng mga produktong may SANGKAP PINOY seal sa pagluluto. MAGPABAKUNA Siguraduhing kumpletoang bakuna ni baby bago siya magdiwang ng unang kaarawan. Pabakunahan ng MMR ang mga batang 1 taon hanggang 1 taon at 3 buwan. Ito ay laban sa tigdas, beke at rubella (German Measles) MAGBITAMINA A Siguraduhing mabigyan (mapatakan) ng Bitamina A kada anim (6) na buwan ang inyong mga anak na edad 6 na buwan hanggang 5 taon MAGPURGA Siguraduhing mapurga ang inyong mga anak na edad 1 hanggang 12 na taong gulang kada anim na buwan. GUMAMIT NG PALIKURAN Gumamit ng kubeta o palikuran sa pagdumi at pagihi. MAGSIPILYO Wastong pagsisipilyo ng ngipin ng dalawang beses sa isang araw, lalo na bago matulog. MAGHUGAS NG KAMAY Maghugas ng kamay bago kumain at matapos gumamit ng kasilyas. Ugaliin din ang paghuhugas ng kamay matapos maglaro o humawak ng maduduming bagay.

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Human Resource for Health Network


The Department of Health (DOH) spearheaded the creation of Human Resource for Health Network (HRHN), which is a multi-sectoral organization composed of government agencies and non-government organizations. The network seeks to address and respond to human resource for health (HRH) concerns and problems. HRHN was formally established during the launching and signing of the Memorandum of Understanding among its member agencies and organizations held on October 25, 2006. This network was grounded on the Human Resources for Health Master Plan (HRHMP) developed by the DOH and the World Health Organization (WHO). The HRHN was conceived to implement programs and activities that require multi-sectoral coordination. Vision: Collaborative partnerships for a better, more responsive and globally competitive HRH. Mission: The HRHN is a multi-sectoral organization working effectively for coordinated and collaborative action in the accomplishment of each member organizations mandate and their common goals for HRH development to address the health service needs of the Philippines, as well as in the global setting. Values: Upholds the quality and quantity of HRH for the provision of quality health care in the Philippines. Objectives: The objectives of the HRHN are as follows: 1. Facilitate implementation of programs of the HRHMP that would entail coordination and linkage of concerned agencies and organizations; 2. Provide policy directions and develop programs that would address and respond to HRH issues and problems; 3. Harmonize existing policies and programs among different government agencies and non-government organizations; 4. Develop and maintain an integrated database containing pertinent information on HRH from production, distribution, utilization up to retirement and migration; and 5. Advocate HRH development and management in the Philippines. Projects: During its first year of implementation, the HRHN has the following priority projects and activities: 1. Review and Harmonization of HRH Related Policies; 2. Development of HRHN Website; 3. Conduct of Capability Building Activities; and 4. Conduct of the National HRH Forum.

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Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control)
Bureau or Office: National Center for Disease Prevention and Control Program Briefer Cognizant of its mandate and crucial role, the Philippine Department of Health (DOH) formulated the Health Care Program for Older Persons (HCPOP) in 1998. The DOH HCPOP (presently renamed Health Development Program for Older Persons) sets the policies, standards and guidelines for local governments to implement the program in collaboration with other government agencies, non-government organizations and the private sector. The program intends to promote and improve the quality of life of older persons through the establishment and provision of basic health services for older persons, formulation of policies and guidelines pertaining to older persons, provision of information and health education to the public, provision of basic and essential training of manpower dedicated to older persons and, the conduct of basic and applied researches. Target Population/Clients A. Older persons (60 years and above) who are: a. Well and free from symptoms b. Sick and frail c. Chronically ill and cognitively impaired d. In need of rehabilitation services B. Health workers and caregivers C. LGU and partner agencies Area of Coverage: Mandate: International: Vienna International Plan of Action on Ageing General Assembly Resolutions Local: Philippine Constitution (Article XIII, Section XI) Republic Act 7876 - Senior Citizens Center Act of the Philippines Republic Act No. 7432 - An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes Proclamation No. 470 - Declaring the 1st week of October every year as "Elderly Filipino Week" Philippine Plan of action for Older Persons (1999-2004)
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Nationwide

Vision: Goal:

Healthy ageing for all Filipinos. A healthy and productive older population is promoted.

Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center Act of the Philippines)
REPUBLIC ACT NO. 7876 AN ACT ESTABLISHING A SENIOR CITIZENS CENTER IN ALL CITIES AND MUNICIPALITIES OF THE PHILIPPINES, AND APPROPRIATING FUNDS THEREFOR. Sec. 1. Title. This Act shall be known as the "Senior Citizens Center Act of the Philippines." Sec. 2. Declaration of Policy. It is the declared policy of the State to provide adequate social services and an improved quality of life for all. For this purpose, the State shall adopt an integrated and comprehensive approach towards health development giving priority to elderly among others.chan robles virtual law library Sec. 3. Definition of Terms. (a) "Senior citizens," as used in this Act, shall refer to any person who is at least sixty (60) years of age. (b) "Center," as used in this Act, refers to the place established by this Act with recreational, educational, health and social programs and facilities designed for the full enjoyment and benefit of the senior citizens in the city or municipality. Sec. 4. Establishment of Centers. There is hereby established a senior citizens center, hereinafter referred to as the Center, in every city and municipality of the Philippines, under direct supervision of the Department of Social Welfare and Development, hereinafter referred to as the Department, in collaboration with the local government unit concerned. Sec. 5. Functions of the Centers. The centers are extensions of the fourteen (14) regional offices of the Department. They shall carry out the following functions: (a) Identify the needs, trainings, and opportunities of senior citizens in the cities and municipalities;chan robles virtual law library (b) Initiate, develop and implement productive activities and work schemes for senior citizens in order to provide income or otherwise supplement their earnings in the local community; (c) Promote and maintain linkages with provincial government units and other instrumentalities of government and the city and municipal councils for the elderly and the Federation of Senior Citizens Association of the Philippines and other nongovernment organizations for the delivery of health care services, facilities,
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professional advice services, volunteer training and community self-help projects; and (d) To exercise such other functions which are necessary to carry out the purpose for which the centers are established. Sec. 6. Center Workers. The Secretary of the Department of Social Welfare and Development (DSWD) may designate social workers from the Department as the workers of the centers: Provided, however, That the Secretary may appoint other personnel who possess the necessary professional qualifications to work efficiently with the elderly of the community. The Secretary may also call upon private volunteers who are responsible members of the community to provide medical, educational and other services and facilities for the senior citizens. Sec. 7. Qualification/Disqualification. A senior citizen who suffers from a contagious disease, or who is mentally unfit or unsound or whose actuations are inimical to other senior citizens as determined by the DSWD on the basis of an appropriate certification by a qualified government or private volunteer physician, may be denied the benefits provided in the Center. However, the center shall refer the senior citizen concerned to the appropriate government agency for the needed medical care or confinement. Sec. 8. Exemptions of the Center. The Center shall be exempted from the payment of customs duties, taxes and tariffs on the importation of equipment and supplies used actually, directly and exclusively by the Center pursuant to this Act, including those donated to the Center. Sec. 9. Rules and Regulations. Within sixty (60) days from the approval of this Act, the DSWD, in coordination with other government agencies concerned, shall issue the rules and regulations to effectively implement the provisions of this Act. Any violation of this section shall render the concerned official(s) liable under Republic Act No. 6713, otherwise known as the "Code of Conduct and Ethical Standards for Public Officials and Employees" and other existing administrative and/or criminal laws. Sec. 10. Coordination of Government Agencies. The DSWD, in coordination with the Department of Health and other government agencies and local government units, shall assist in the effective implementation of this Act and provide the necessary support services. Sec. 11. Appropriations. The amount necessary to carry out the provisions of this Act shall be included in the General Appropriations Act of the year following its enactment into law and every year thereafter. The sum necessary for the continuous operation of the centers shall be subsidized in part by the DSWD and in part by the local government units concerned.
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Sec. 12. Repealing or Amending Clause. All laws, decrees, executive orders, and rules and regulations, which are not consistent with this Act, are hereby modified, amended or repealed accordingly.chan robles virtual law library Sec. 13. This Act shall take effect fifteen (15) days after its publication in two (2) newspapers of general circulation.

Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999))
The Global Movement for Active Ageing, which was conceived by the World Health Organization (WHO), will need the collaboration of many different partners from all over the world. Active ageing is the capacity of the people, as they grow older to lead productive and healthy lives in their families, societies and economies. The Global Movement will be a network for all those interested in moving policies and practice towards Actives Ageing. It will provide models and ideas for programme and projects that promote active ageing. The key messages of the Global Movement are: 1. CELEBRATE Celebrate ageing ; getting older is good; the alternative dying prematurely is not 2. A SOCIETY FOR ALL Active ageing is key for older persons continuing to contribute to society; all dimensions for being active should be taken into account : the physical, mental, social, and spiritual 3. INTEGENERATIONAL SOLIDARITY Older persons should not be marginalized: reflecting the theme of the UN International Year of Older Persons, towards a society for all ages What is the Global Embrace 1999? The Global Embrace, which will mark simultaneously the launching of Global Movement for Active Ageing 1999 International Year for Older Persons, is exactly as the title implies, a series of walk events embracing the globe: in time zone after time zone, ageing will be celebrated in cities around the world, through these walk events. The walk will start in countries in the Pacific, where the date line marks the start of a new day. Thus, the first walk will be in New Zealand .. followed by Australia, then Japan, Korea, China, Thailand, the Philippines, Indonesia and India.. Always at a set time, a group of cities, within the same time zone, will be starting their celebrations. Eventually, they will reach the Middle East, Africa, Europe, the America, until the very last locations will close the day and embrace. The Global embrace is a round the clock around the world party which every country is invited.
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Objectives: 1. To inspire, to inform, to promote health and to provide enjoyment and good company. 2. Moreover, it will link the local project to a global community of similar concerns and people from all over the world. Target date : October 2, 1999 (Saturday) Target Pop. : General population Target venue : Quezon Memorial Circle, Quezon City (Metro Manila) simultaneous with La Union (Luzon), Metro Cebu (Visayas), and Metro Davao (Mindanao) As there are still negative stereotype associated with old age in many societies, a participatory event that promotes a positive image of ageing will assist in dissipating these stereotypes. This is a necessary precondition both for allowing the aged to make a contribution to the world as well as for building a harmonious global community and an intergenerational society. A. 2 The Message Kami ay para sa KSP ( Kalusugan Sa Pagtanda or Healthy Ageing) Ageing is a NORMAL, dynamic process and NOT a DISEASE. It is the inevitable alternative to PREMATURE DEALTH. It can prevent or delay many disabling conditions that often accompany ageing through healthy lifestyle such as proper diet, exercise, avoidance of untoward stress, smoking and alcohol. A.3 The Walk Event The World Health Organization (WHO) Ageing and Health Programme has launched initiatives that encourage healthy ageing globally. To assist in the promotion, an annual celebration on October 2 (Saturday) as designated by the United Nation and mandated by law shall recognize the International Year of Older Persons (IYOP) These celebratory event will be held at the Quezon Memorial Circle, Quezon City, 3 p.m. till midnight A. 4 Target Population Since the walk event promotes healthy ageing there is NO SPECIFIC TARGET POPULATION. Everybody (All ages) are encouraged to participate in the walk. There is NO competitive aspect to the event that people at all levels of physical activity are encouraged to take part. The primary aim is to promote intergenerational exchanges.
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Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges)
AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES. Be it enacted by the Senate and House of Representative of the Philippines in Congress assembled: SECTION 1. Declaration of Policies and Objectives Pursuant to Article XV, Section 4 of the Constitution, it is the duty of the family to take care of its elderly members while the State may design programs of social security for them. In addition to this, Section 10 in the Declaration of Principles and State Policies provides: The State shall provide social justice in all phases of national development. Further, Article XIII, Section II provides: The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women and children. Consonant with these constitutional principles the following are the declared policies of this Act: a) To motivate and encourage the senior citizens to contribute to nation building; b) To encourage their families and communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizens. In accordance with these policies, this act aims to: 1) Establish mechanism whereby the contribution of the senior citizens are maximized; 2) Adopt measures whereby our senior citizens are assisted and appreciated by the community as a whole; 3) Establish a program beneficial to the senior citizens, their families and the rest of the community that they serve. SECTION 2. Definition of Terms. As used in this Act, the term senior citizen shall mean any resident of the Philippines at least sixty (60) years old, including those who have retired from both government offices and private enterprises, and has an income of not more than Sixty thousand pesos (P60,000.00) per annum subject to review by the National Economic and Development Authority (NEDA) every three (3) years.
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The term head of the family shall mean any person so defined in the National Internal Revenue Code. SECTION 3. Contribution to the Community. Any qualified senior citizens as determined by the Office for Senior Citizen Affairs (OSCA) may render his/her services to the community which shall consist of but not limited to any of the following: a) Tutorial and/or consultancy services; b) Actual teaching and demonstration of hobbies and income generating skills; c) Lectures on specialized fields like agriculture, health, environmental protection and the like; d) The transfer of new skills acquired by virtue of their training mentioned in Section 4, paragraph (d) e) Undertaking other appropriate services as determined by the Office for Senior Citizens Affairs (OSCA) such as school traffic guide, tourist aid, pre-school assistant, etc. In consideration of the services rendered by the qualified elderly, the Office for Senior Citizens Affairs (OSCA) may award or grant benefits or privileges to the elderly, in addition to the other privileges provided for under Section 4 hereof. SECTION 4. Privileges for the Senior Citizens. The senior citizens shall be entitled to the following: a) The grant of twenty percent (20%) discount from all establishments relative to utilization of transportation services, hotels and similar lodging establishment, restaurants and recreation centers and purchase of medicines anywhere in the country: Provided, That private establishments may claim the cost as tax credit; b) A minimum of twenty percent (20%) discount on admission fees charged by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure, and amusements; c) Exemption from the payment of individual income taxes: Provided, That their annual taxable income does not exceed the poverty level as determined by the National Economic and Development Authority (NEDA) for that year; d) Exemption from training fees for socioeconomic programs undertaken by the OSCA as part of its work;

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e) Free medical and dental services in government establishment anywhere in the country, subject to guidelines to be issued by the Department of Health, the Government Service Insurance System and the Social Security System; f) To the extent practicable and feasible, the continuance of the same benefits and privileges given by the Government Service Insurance System (GSIS), Social Security System (SSS) and PAG-IBIG, as the case may be, as are enjoyed by those in actual service. SECTION 5. Government Assistance. The Government shall provide the following assistance to those caring for and living with the senior citizen: a) The senior citizen shall be treated as dependents provided for in the National Internal Revenue Code and as such, individual taxpayers caring for them, be they relatives or not shall be accorded the privileges granted by the Code insofar as having dependents are concerned. b) Individuals or non-governmental institutions establishing homes, residential communities or retirement villages solely for the senior citizens shall be accorded the following: 1) Realty tax holiday for the first five (5) years starting from the first year of operations; 2) Priority in the building and/or maintenance of provincial or municipal roads leading to the aforesaid home, residential community or retirement village. SECTION 6. Retirement Benefits. To the extent practicable and feasible retirement benefits from both the Government and the private sectors shall be upgraded to be at par with the current scale enjoyed by those in actual service. SECTION 7. The Office for Senior Citizens Affairs (OSCA). There shall be established in the Office of the Mayor an OSCA to be headed by a Councilor who shall be designated by the Sangguniang Bayan and assisted by the Community Development Officer in coordination with the Department of Social Welfare and Development. The functions of this office are: a) To plan, implement and monitor yearly work programs in pursuance of the objectives of this Act; b) To draw up a list of available and required services which can be provided by the senior citizens; c) To maintain and regularly update on a quarterly basis the list of senior citizens and to issue nationally uniform individual identification cards which shall be valid anywhere in the country;
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d) To serve as a general information and liaison center to serve the needs of the senior citizens. SECTION 8. Municipal Responsibility. It shall be the responsibility of the municipality through the Mayor to ensure that the provisions of this Act are implemented to its fullest. SECTION 9. Penalties. Violation of any provision of this Act for which no penalty is specifically provided under any other law, shall be punished by imprisonment not exceeding one (1) month or a fine not exceeding One thousand pesos (P1,000.00) or both. SECTION 10. Implementing Rules and Regulations. The Secretary of Social Welfare and Development jointly with the Department of Finance, the Department of Tourism, the Department of Health, the Department of Transportation and Communications and the Department of Interior and Local Government shall issue the necessary rules and regulations to carry out the objectives of this Act. SECTION 11. Appropriation. The necessary appropriation for the operation and maintenance of the OSCA shall be appropriated and approved by the local government units concerned. The National Government shall appropriate such amount as may be necessary to carry out the objectives of this Act. SECTION 12. Repealing Clause. All provisions of laws, orders, and decrees, including rules and regulations inconsistent herewith are hereby repealed and/or modified accordingly. SECTION 13. Separability Clause. If any part or provision of this Act shall be held to be unconstitutional or invalid, other provisions hereof which are not affected thereby shall continue to be in full force and effect. SECTION 14. Effectivity. This Act shall take effect fifteen (15 days following its publication in one (1) national newspaper of general circulation. Approved, (SGD.) RAMON V. MITRA Speaker of the House of Representatives

(SGD.) NEPTHALI A. GONZALES President of the Senate

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This bill, which is a consolidation of Senate Bill Nos. 835, 1435 and House Bill No. 35335, was finally passed by the Senate and the House of Representatives on February 7, 1992.

(SGD.) CAMILO L. SABIO Secretary General House of Representatives

(SGD.) ANACLETO D. BADOY, JR. Secretary of the Senate Approved: April 23, 1992

(SGD.) CORAZON C. AQUINO President of the Philippines GUIDELINES ON THE ISSUANCE OF THE NATIONALLY UNIFORM IDs OF SENIOR CITIZENS AS PER R.A. 7432 The national I.D. of Senior Citizens as per provision of RA 7432 is to be provided by the Department of Social Welfare and Development (DSWD) for free. A senior citizen who has an income of P60,000.00 and below per annum shall be granted the benefits per Section 4 of RA 7432. The process of securing the ID is as follows: 1. A Senior Citizen shall enlist at the Office for Senior Citizens Affairs (OSCA) established at the Office of the Mayor in his/her city or municipality; 2. The OSCA shall determine the eligibility of the senior citizen. All eligible senior citizens shall provide OSCA two (2) ID pictures taken within the year of enlisting at OSCA. One ID picture shall be attached to the OSCA registration form to be kept by the said office. The other picture shall be for the ID card; 3. The OSCA shall prepare the list of Senior Citizens to be certified by the local office of the Bureau of Internal Revenue and the local Civil Registrars office; 4. Duplicate copy of the certified list of senior citizens shall be submitted by OSCA to the DSWD filed office; 5. The Bureau of Disabled Persons Welfare, DSWD shall send to the 14 DSWD Field Offices number of IDs needed by the Elderly of the region;
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6. The DSWD Field Office shall release the IDs to the respective local OSCAs; 7. The OSCA shall issue the ID cards duly signed by the municipal/city Mayor to the qualified senior citizens; 8. The OSCA shall issue the nationally uniform ID card without cost to the Senior Citizen. In case the ID is lost, it must be reported to the local OSCA. Replacement shall be issued upon request by OSCA with corresponding cost. The cost per ID shall be determined by DSWD. The payment shall remain at OSCA as part of its funds. No ID cards of senior citizens shall be issued directly by the DSWD Central Office or its field offices. SOCIAL DEVELOPMENT COMMITTEE Resolution No. 1 (Series 1993) Approving the Implementing Rules and Regulations of R.A. 7432 Maximizing the Contribution of Senior Citizens to Nation Building, Grant Benefits and Privileges Whereas, the Philippine Constitution recognizes the duty of the family to take care of its elderly members with the state designing programs of social security for them, and the need for the state to promote social justice in all phases of national development, by making available essential social services to the priority groups such as the sick, elderly, disabled, women and children; Whereas, RA 7432 has been enacted to motivate and encourage senior citizens to contribute to nation building and to mobilize their families and the communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizen; Whereas, the Medium Term Philippine Development Plan (MTPDP) 1993-1998 aims to pursue a better quality of life for all Filipinos particularly the disadvantaged sectors by providing focused basic services to allow them to manage and control their resources, as well as benefit from developmental interventions; Whereas, the draft IR on R.A. 7432 was formulated by an Inter-agency Committee headed by the Department of Social Welfare and Development (DSWD), and participated in by the Department of Interior and Local Government (DILG), Tourism (DOT), Transportation and Communications (DOTC), Health (DOH) and Finance (DOF), including the National Federation of Senior Citizens Association of the Philippines (NFSCAP). NOW, THEREFORE, BE IT RESOLVED, AS IT IS HEREBY RESOLVED, by the Chairman and the members (of the NEDA, Boards Social Development Committee (SPC) Cabinet level, to approve the Implementing Rules and Regulations of R.A. 7432.

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(Sgd.) Honorable Nieves R. Confesor Secretary, Department of Labor and Employment Chairman, Social Development Committee

(Sgd.) Honorable Cielito F. Habito, Jr. Secretary for Socioeconomic Planning Co-Chairman, Social Development Committee

(Sgd.) Hon. Corazon Alma G. De Leon Acting Secretary Department of Social Welfare and Development

(Sgd.) Hon. Roberto S. Sebastian Secretary Department of Agriculture

(Sgd.) Hon. Ernesto D. Garilao Secretary Department of Agrarian Reform

(Sgd.) Hon. Juan M. Flavier Secretary Department of Health

(Sgd.) Hon. Rafael M. Alunan, III Secretary Department of Interior and Local Government

(Sgd.) Hon. Armand V. Fabella Secretary Department of Education, Culture and Sports

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(Sgd.) Hon. Edelmiro A. Amante, Sr. Secretary Office of Executive Secretary

RULES AND REGULATIONS IN THE IMPLEMENTATION OF RA 7432, THE ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES

RULE I TITLE, PURPOSE AND CONSTRUCTION Article 1. Title These Rules shall be known and cited as the Rules and Regulations implementing the Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes. Article 2. Purpose These Rules are promulgated to prescribe the procedures and guidelines for the implementation of the Act to Maximize the Contribution of Senior Citizens to National Building, Grant Benefits and Special Privileges and for Other Purposes in order to facilitate the compliance therewith and to achieve the objectives thereof. Article 3. Construction These Rules shall be construed and applied in accordance with and in furtherance of the policy and objectives of the law. In case of conflict and/or ambiguity, which may arise in the implementation of these rules, the concerned agencies shall issue the necessary clarification. In case of doubt, the same shall be construed liberally and in favor of the beneficiaries. RULE II DECLARATION OF POLICIES AND OBJECTIVES, SCOPE AND APPLICATION Article 4. Declaration of Policies and Objectives Pursuant to Article XV, Section 4 of the Constitution it is the duty of the family to take care to its elderly members while the State may design programs of social security for them. In addition to this, Section 10 in the Declaration of Principles and State Policies provides: The State shall provide social justice in all phases of national development. Further, Article XIII, Section II provides: The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health, and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women and children. Consonant to these constitutional principles, the following are the declared policies of this Act:
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a) To motivate and encourage senior citizens to contribute to nation building; b) To encourage their families and the communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizens; In accordance with these policies, the Act aims to: a) Establish mechanisms whereby the contribution of the senior citizens are maximized; b) Adopt measures whereby our senior citizens are assisted and appreciated by the community as a whole; c) Establish a program beneficial to the senior citizens, their families and the rest of the community that they serve. Article 5. Definition of Terms As used in these rules, the following terms shall be defined as follows: 5.1 Senior Citizen any resident citizen of the Philippines, at least sixty (60) years old, including those who have retired from both government offices and private enterprises and has an income of not more than sixty thousand pesos (P60,000.00) per annum subject to review by the National Statistics Coordination (NSCB) every three (3) years. Senior Citizens earning sixty thousand pesos (P60,000.00) per annum may be tapped as resource persons to provide transfer technology and consultancy services or other services in the community. Those without income are necessarily covered by this definition. 5.2 Resident Citizen refers to Filipino Citizen who establishes to the satisfaction of the Office of the Senior Citizens Affairs (OSCA) the fact of his physical presence in the Philippines for at least 183 days with a definite intention to reside therein. 5.3 Benefactor shall mean any person whether related to the senior citizen or not who takes care of him or her as dependent. 5.4 Head of the Family shall mean an unmarried or legally separated man or woman with one or both parents or with one or more brothers or sisters or with one or more legitimate, recognized, natural or legally adopted children and/or with one or more senior citizen living with and dependent upon him for their chief support where brother/s or sister/s or children are not more than twenty one (21) years of age unmarried and not gainfully employed or where such children, brother/s or sister/s, regardless of age are incapable of self-support because of mental or physical defect.

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5.5 National Identification Cards are the ID cards provided for initially for free by the Department of Social Welfare and Development and issued through the Office for Senior Citizens Affairs (OSCA). 5.6 Office for Senior Citizens Affairs otherwise known, as the OSCA shall be established in the Office of the Mayor as prescribed in the Act. 5.7 Department of Social Welfare and Development otherwise known as DSWD in this rule, shall mean the national office located at Batasan Complex, Quezon City and its field offices in the fourteen regions of the country. 5.8 Municipal/City Federation of Senior Citizens an organization of senior citizens in the locality which is affiliated with the National Federation of Senior Citizens Associations of the Philippines (NFSCAP). In the absence of such organization, any organization of senior citizens in the locality duly accredited by the Sangguniang Bayan/Panglungsod. 5.9 Air Transportation Service shall mean as the carriage of passenger by air. 5.10 Hotel shall mean the building, edifice or premises or a completely independent part thereof, which is used for the regular reception, accommodation, or lodging of travelers and tourists and the provision of services incidental thereto for a fee. 5.11 Lodging Establishment shall mean any of the following: a. Tourist Inn a lodging establishment catering to transients which does not meet the minimum requirement of an economy hotel. b. Apartel any building or edifice containing several independent and furnished or semi-furnished apartments, regularly leased to tourists and travelers for dwelling on a more or less long-term basis and offering basic services to its tenants, similar to hotels. c. Motorist Hotel any structure with several separate units, primarily located along the highway, with individual or common parking space, at which motorists may obtain lodging and in some instances, meals. d. Pension House a private, or family-operated tourist boarding house, tourist guest house or tourist lodging house, employing non-professional domestic helpers, regularly catering to tourist, and/or travelers, containing several independent lettable rooms, providing common facilities such as toilets, bathrooms/showers, living and dining rooms and/or kitchen and where a combination of board and lodging may be provided. The term lodging establishment shall include lodging houses, which shall mean such establishments as are regularly engaged in the hotel business, but which,
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nevertheless, are not registered, classified and licensed as hotels by reason of inadequate essential facilities and services. 5.12 Restaurant shall mean any establishment, duly licensed by the local government units (LGUs ), offering to the public, regular and special meals or menu, cooked food and short orders. Such eating-places may also serve coffee, beverages and drinks. RULE III CREATION OF THE OFFICE FOR SENIOR CITIZENS AFFAIRS Article 6. Office for Senior Citizens Affairs (OSCA) There shall be established in the office of the Mayor and OSCA to be headed by a councilor who shall be designated by the Sangguniang Bayan/Panglungsod in coordination with the Department of Social Welfare and Development (DSWD) and the Municipal/City Federation of Senior Citizens. Article 7. The Functions of OSCA The OSCA shall perform the following functions: a) To plan, implement and monitor yearly work programs in pursuance of the objectives of this Act; b) To mobilize the different local agencies to identify activities within their programs which can be undertaken by the senior citizens; c) To draw up a list of available and required services which can be provided by the senior citizens; d) To maintain a regular update on a quarterly basis a list of senior citizens; The regular quarterly update of the list of senior citizens shall be made on the first week of the first month of every quarter. e) To issue nationally uniform individual identification cards which shall be valid anywhere in the country; It shall the responsibility of the local Social Welfare Development Officer or any other officer performing such functions to review and process all applications f) To serve as a general information and liaison center to respond to the needs of the senior citizens, the OSCA shall: f.1 assist any complainant or aggrieved senior citizen in filing the appropriate action with the Office of the Public Prosecutor or with the concerned Agency/Department until same is finally terminated or resolved, and;
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f. 2 assist the National Government in putting up the necessary appropriate notices of the mandatory elderly discount privileges/benefits under RA 7432, which shall be posted at a conspicuous place in all establishments. This shall be made as a requirement in the renewal of business licenses annually. The Municipal/City Federations of Senior Citizens shall assist OSCA in the foregoing functions: 8.1 to provide the initial nationally uniform identification cards which shall be issued through the OSCA. The nationally uniform individual identification cards shall contain the following information: a) Control Number, Date of Issue b) Name c) Address d) Age, as supported by a certified birth certificate from the Office of Civil Registrar; Birth date e) Annual income, as supported by a certificate of exemption from payment of income tax issued by the local office of the Bureau of internal Revenue (BIR) f) Picture g) Signature of senior citizen A senior citizen whose income is P60,000.00 and below annually shall be issued a national ID card, which contains the mandatory elderly, discount privileges/benefits under RA 7432. This shall be duly signed by the mayor of the senior citizens locality, the Secretary of the Department of Social Welfare and Development (DSWD) and the Secretary of the Department of Interior and Local Government (DILG). This shall be non-transferrable. 8.2. to assist in developing the standards of programs and services of OSCA. 8.3. to provide technical assistance and monitor services and projects to be undertaken by the OSCA. RULE IV
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CONTRIBUTIONS IN THE COMMUNITY Article 9. Contributions of Senior Citizens to the Community. Any qualified senior citizen as determined by the OSCA may render his/her services to the community, which shall consist of, but not limited to any of the following: a. tutorial and/or consultancy services; b. actual teaching and demonstration of hobbies and income generating skills; c. lectures on specialized field like agriculture, health, environmental protection; d. transfer of new skill acquired by virtue of their training mentioned in Section 4 of paragraph (d) of the Act; e. undertake other appropriate services as determined by the OSCA such as school traffic guide, tourist aide, pre-school assistance, etc. In consideration of services rendered by the qualified elderly, the OSCA may award or grant benefits/privileges to the elderly, in addition to the other privileges provided for under Section 4 of the Act. In the absence of resources, OSCA shall mobilize resources of the community to provide awards or incentives. Financially able institutions desiring to acquire services of the elderly shall be mobilized to provide a reasonable compensation e.g. transport, food, etc. for the duration of the senior citizens services. Senior citizens earning above sixty thousand pesos (P60,000.00) annually can be granted some awards or benefits by the OSCA for services rendered to his community e.g. consultancy services, transfer of new technology, etc. RULE V PRIVILEGES AND BENEFITS OF SENIOR CITIZENS A senior citizen shall be granted twenty per cent (20%) discount from all establishments relative to utilization of transportation services, hotels and similar lodging establishments, restaurants and recreation centers and purchases of medicines, anywhere in the country. A. Transportation Benefits A. 1 Public Water Transportation Every senior citizen who is a passenger of any public water transportation service as this term is understood under the Public Service Act, as amended, shall be entitled to a discount in the amount of not less
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than twenty per cent (20%) of the fare charged or authorized, including discount of twenty per cent (20%) on purchases of meals or food items from the restaurant either operated by concessionaire or the carrier and medicines on board vessels. The Maritime Industry Authority (MARINA) is hereby directed to issue corresponding circulars or directives to the shipping industry for the implementation of these guidelines to ensure compliance herewith, as well as requirements to ship operators/ship owners to disseminate, by posters, handbills or pamphlets, the information about senior citizen on board vessels to maximize the benefits of the senior citizens. A senior citizen, unless his/her physical appearance shows that he/she undoubtedly 60 years old or above, may prove his/her age by any of, but not limited, to the following documents or papers: a. Official Identification Card from the OSCA of the LGUs, SSS/GSIS ID (old or new); b. Drivers License or Birth Certificate; c. Voters ID or Voters Affidavit; d. Residence Certificate (old or new); e. And other public/official record or document, from relevant government agencies. A.2 Public Land Transportation every senior citizen who is a passenger of any public land transportation services stated below, shall be entitled to a discount in the amount of not less than twenty per cent (20%) of the fare authorized by the Land Transportation Franchising and Regulatory Board (LTFRB). The public land transportation referred to are the following: a. Bus (pub) b. Jeepney (puj) c. Taxi d. Shuttle Bus e. Tourist Bus f. Other modes of passenger land transportation devoted for public use and for a fee with general or limited clientele. The LTFRB is hereby directed to issue corresponding circular or directives to the public land transport sector for the implementation of these guidelines to ensure compliance herewith, as well as requirements to these operators to disseminate, by
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posters, handbills or pamphlets, the information about senior citizens on board their vehicles to maximize the benefits of the senior citizens. Every senior citizen is entitled to a grant of twenty per cent (20%) discount on the use of Light Rail Transit (LRT) System. Senior citizens who would wish to avail of the discount privileges on LRTC shall be guided by the following procedures/conditions: a) Senior citizens shall personally apply for the issuance of discount tickets (in booklet form) at the Light Rail Transit Authority (LRTC) or METRO, Inc. with office at the Administration Building, LRTA Compound, Aurora Boulevard, Pasay City or at designated outlets at the LRT system by presenting their ID card issued by the OSCA. Discount tickets will be printed with control numbers and will allow a senior citizen to purchase LRT tokens at a twenty per cent (20%) discount. b) A senior citizen shall personally surrender to any LRT token teller on duty at any LRT station/terminal where he/she will board, a discount ticket for every token he/she will purchase. Upon surrender of the discount ticket and presentation of the national ID card by a senior citizen, he/she shall pay for the LRT token at twenty per cent (20%) discount. (A senior citizen is entitled to purchase only one (1) LRT token at discounted price every time he/she avails of the LRT System.) To avoid untoward incidents, senior citizens are discouraged from riding the LRT during peak hours from 7:00 A.M. to 9:00 A.M. and from 5:00 P.M. to 7:00 P.M. due to the volume of rider ship. Twenty per cent (20%) discount for LRT tokens are available only at LRTC stations/terminals. Discounted token are not available from off-station token vendors. A.3. Domestic Air Transportation Every senior citizen who is duly certified by t he OSCA is entitled to twenty per cent (20%) discount from the Civil Aeronautics Board (CAB) approved and published airline rates for domestic air transportation services. This Act shall cover individuals, partnership, or corporations and all other entities engaged in the carriage of passengers by air. The following are the conditions required of a senior citizen to be able to avail of the twenty per cent (20%) discount on air transportation services: a. The senior citizen should present his/her identification card duly issued by OSCA in securing a passage ticket;
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b. He/She should personally secure the passage ticket; c. The passage ticket shall be non-transferable. B. Hotels/Lodging Establishments Benefits the twenty per cent (20%) discount privileges of the senior citizen from hotels/establishments shall be limited to room accommodation only. The DILG shall issue the necessary circulars or directives to tourism establishments for the implementation of these guidelines and to ensure compliance herewith. Likewise the Department of Tourism (DOT) shall issue the corresponding Administrative Order to DOT accredited establishments. v C. Recreation Center Benefits A senior citizen is entitled to a minimum of twenty per cent (20%) discount on all admission fees charged by the theatres, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure and amusement. D. Purchases of Medicine Benefits A senior citizen is entitled to a minimum of twenty per cent (20%) discount in the purchase of medicine for his personal use and according to his personal needs. In the purchase of medicine, a senior citizen or his doctor or the latters duly authorized representative should always present the national identification card duly certified by the OSCA together with the doctors prescription in case of prescription drugs. If over-the-counter, the number of drugs purchased shall be commensurate to the elderly persons needs. These discount privileges shall be limited and exclusive for the benefit of the senior citizen. E. Income Tax Benefits/Tax Credits For purpose of claiming tax credits, private establishments are required to keep a separate record of sales made to senior citizens which shall include the name, identification number, gross sales, discount and date of transaction. A senior citizen whose annual taxable income does not exceed the poverty level as determined by NSCB shall be exempted from payment of individual income tax. Provided that: a) A senior citizen whose annual taxable income exceed the said poverty level shall be liable to the individual income tax for the full amount of his/her taxable income net of personal and additional exemptions; b) Annual taxable income shall refer to the annual gross compensation, business and other incomes as defined in Section 28 of the National Internal Revenue Code (NIRC) other than income subject to tax under paragraphs (b), (c), (d) and (e) of Section 21 of
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the NICR which include certain passive incomes, capital gains from sale of shares of stock and capital gains from sale of real property; c) The senior citizen is a resident citizen; d) NEDA shall inform the Commissioner of Internal Revenue in writing and publish in a newspaper of general circulation the estimated poverty threshold. F. Training Fee Benefits A senior citizen is exempted from training fees for socioeconomic programs undertaken by or in coordination with the OSCA as part of its work. G. Medical/Dental Benefits A senior citizen is entitled to free medical and dental services in government establishments anywhere in the country subject to guidelines to be issued by the Department of Health (DOH), the Government Service Insurance System (GSIS) and the Social Security System (SSS). G.1 The DOH shall direct the government establishments in the entire country to provide free medical and dental services to senior citizens. a. The term free shall mean free of charge on medical/dental services where capability and facility for such services are available, b. The term medical services shall refer to services pertaining to the medical care/attendance and treatment given to senior citizens. It shall include health examinations, medical/surgical procedures within the competence and capability of DOH establishments/hospitals/units and routine/special laboratory examinations and ancillary procedures as required. c. The term dental services shall refer to services pertaining to dental care/attendance and remedy given to senior citizens. It shall include oral examination, curative services like permanent and temporary fillings, extractions and gum treatment. d. Professional services shall refer to services rendered or extended by medical, dental and nursing professionals, which shall also include services rendered by surgeons, EENT practitioners, gynecologists, urologists, neurologists, psychiatrists, psychologists and other allied specialists. e. Counseling services shall refer to advices given by health professional, e.g. psychologists, psychiatrists, nutritionists, nurses and other allied health professionals in support to specific treatment of illnesses. Provision of all of the above-mentioned services shall be subject to availability of appropriate facilities and trained manpower expertise of the receiving establishment.

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f. Government establishments shall refer to and limited to DOH hospitals, which shall include general hospitals, medical centers and regional hospitals directly under the full control and supervision of the DOH. g. The term anywhere in the country shall be construed to mean health privileges senior citizens may avail of from any hospital in the Philippines, as defined in these guidelines, irrespective of their place of residence/locality, subject to availability of facilities and manpower/technical expertise of the receiving establishment. The following are the health services that may be availed of for free in any government establishments, subject to availability of facilities and manpower/technical expertise of the receiving government establishment: a. Medical and dental services b. Out-Patient consultations c. Available medicines in all public health programs d. Available diagnostic and therapeutic procedures e. Use of operating rooms, special units and central supply items f. Accommodations in the charity ward g. Professional and counseling services To be able to avail of the aforementioned services, the following mechanics are stipulated: a. A senior citizen may obtain the benefits from any government establishment. b. He/she shall present his/her national ID card issued by the OSCA to the medical and social services or Medical Social Worker designated who shall determine the validity of his/her ID card. c. Non-presentation of the national ID card shall be sufficient reason for denial of free hospital benefits. d. In case of emergency, the medical benefits shall be accordingly provided by the receiving hospital even if the ID is not available. However, the national ID card should be presented within a reasonable time. Non-presentation of the national ID card shall be sufficient ground for charging the service already given and denial of further availment of the benefits.

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e. Should the senior citizen choose to be admitted to a private room/pay ward or be transferred from a free room to a pay room, the amount equivalent to the rate of a free room should be discounted from that of the pay room/ward. f. As regard referral or transfer of senior citizen-patient to another government establishment, the receiving hospital shall provide the full benefits under this rule. In case of transfer/referral between the DOH hospitals, procedures shall be based on the DOH Network Guidelines. The responsibilities of the government establishment are as follows: a. Provide all available medical and dental services, as defined in these guidelines that may be deemed necessary in the promotion of the health of senior citizens; b. Establish a system by which all senior citizens in dire need of health serve shall be given priority and utmost consideration; c. Establish and maintain a recording/reporting system which data may be used as inputs for program/project planning and evaluation; and d. Strengthen their competence and capability to evaluate and manage geriatic cases through continuing education. The responsibilities of senior citizens who are entitled to health benefits and privileges as indicated and certified by valid national identification cards issued by the OSCA, are as follows: a. Adhere to rules and regulations relative to the implementation of this program; b. Recognize that the government establishments have limitations and constraints in providing health services and not demand for services that are not available and beyond the level of their competence; c. Secure on their own payable services that are not covered by their health benefits and privileges stipulated herein; and d. Safeguard the integrity of their identification card and shall not allow their misuse and abuse. To the extent practicable and feasible, the continuance of the same benefits and privileges shall be given to senior citizens by the GSIS, SSS and PAG-IBIG as the case may be as are enjoyed by those in the actual service. G.2 Benefits extended to senior citizens who are retirees of the GSIS are as follows: a. Life Insurance
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If a retiree opts to maintain his life insurance policy with the System, he may convert his compulsory life insurance into an optional insurance by paying directly to the System the monthly premiums due thereon (personal plus government share), up to its maturity date. Amount of monthly premiums shall be determined by the System. He will be entitled to receive benefits as enumerated below: 1. maturity benefit retiree will receive the total face value of the policy, less any indebtedness thereon. 2. policy loan loanable amount will not exceed 90% of the cash value of his insurance at the time of application. 3. death benefit when the retiree dies while life insurance membership is in force prior to maturity date, the designated beneficiaries double indemnity. b. Retirement 1. Retirees under PD 1146 or RA 660 shall resume receiving their basic monthly pension (BMP) for life after the lapse of the 5-year guaranteed period. 2. Upon death of a pensioner who retired under PD 1146 or RA 660, the primary beneficiaries (legal spouse and minor children) shall receive a basic survivorship pension (BSP) equivalent to 50% of the BMP plus dependents pension (DP) equivalent to 10% of the BMP for every minor child, if any, but not exceeding five. The spouse shall receive the BSP for life until she/he remarries. The minor children shall continue receiving DP until emancipated by marriage, gainful employment or upon reaching 21 years of age. A mentally or physically incapacitated child, however, shall receive DP for life. 3. Funeral Benefit payable upon death of the retirees, pensioner or gratuitant, the latter must have retired with at least 20 years of service to be entitled to the benefit. c. Medicare Coverage:Employees who retired from the service before age 60 may opt to continue their membership within 6 months from date of retirement by contributing both personal and government shares of their Medicare premiums until their 60th birthday. However, a government employee who retires under RA 1616, PD 1146 or PD 1184 at age 60 or above or under RA 660 (regardless of age) are covered without paying contributions pursuant to PD No. 408. Effective January 1, 1992, their legal dependents are also extended Medicare benefits. Legal Dependents: 1. The legal spouse who is not a Medicare member.
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2. The unmarried and unemployed children, including legitimated, acknowledged, legally adopted and step children below 21 years of age; 3. Children 21 years old or above with disability acquired before the age of 21. Benefits under the Medicare Act consist of: 1. Allowance for room and board 2. Allowance for drugs and medicines 3. Allowance for x-ray/laboratory examinations/others (others means items such as syringes, gloves, vaco sets, butterfly, contrast media and other agents used in establishing correct diagnosis). 4. Surgeons fee 5. Medical Practitioners fee 6. Anesthesiologists fee 7. Operating room fee 8. Allowance for sterilization procedures Types of Non-Compensable Treatments 1. Cosmetic surgery or treatment 2. Optometric services 3. Psychiatric services 4. Services which are purely diagnostic d. Employees Compensation (PD 626) Only employment-connected injury or sickness resulting in disability or death is compensable. It therefore presupposes the existence of an employee-employer relationship at the time the contingency occurs. The legal and/or medical evaluation to determine compensability is lodged solely with the System. Type of Disability Benefits Temporary Total Disability (TTD)
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1. daily income benefit of not less than P10,00 nor more than P90.00 for a period not exceeding 120 days and in severe cases up to 240 days. 2. medical and/or related services (for work-connected injury or sickness) consisting of: 2.1 hospitalization room and board supplies, x-ray, medicines, laboratory, professional fee. 2.2 ambulatory/d o miciliary care, services for hospitalization except room and board 2.3 reimbursement of medicines (in case of non-confinement) Permanent Partial Disability (PPD) 1. monthly income benefit (MIB) for the designated number of months of not less than P250.00 or more than P3,240.00. 2. medical and/or related services (for work-connected injury or sickness) (refer to 2.1 2.2 and 2.3) Permanent Total Disability (PTD) 1. monthly income benefit (MIB) of not less than P250.00 nor more than P3,240.00 plus 10% increment for each minor child not exceeding five starting from the youngest without substitution payable for life and guaranteed for 5 years. 2. medical and/or related services (refer to 2.1, 2.2 and 2.3) 3. rehabilitation services consist of medical/surgical management, necessary appliances and supplies such as artificial leg and arm, wheelchair, crutches, etc. and vocational training and assistance for placement. DEATH A. Death of the Employee 1. MIB the same as in PPD (plus 10% thereof for each dependent child, not exceeding five) payable to: a. primary beneficiary/ies for life and/or as long as qualified b. secondary beneficiary/ies (in the absence of primary beneficiary/ies) for a period not ot exceed 60 months B. Death of a PTD Pensioner
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1. MIB due to death (80% of the MIB after the 5-year guaranteed period) payable to: a. primary beneficiary/ies for life and/or as long as qualified b. secondary beneficiary/ies (in the absence of primary beneficiary/ies) MIB excluding dependents pension of the remaining balance of the 5-year guaranteed period. 2. Funeral benefit of P3,000.00 payable upon the death of a covered employee or PTD pensioner to the person who can show incontrovertible proof that he shouldered funeral expenses. G.3 The SSS provides medical and dental services to its retirees and their dependents through the Medicare Program without the need for additional contributions. However, the Medicare Program does not cover the entire cost of hospitalization. The SSS medical staff in the regional offices render free consultation to SSS pensioners. The SSS regularly evaluates the level of pension of the retirees. The SSS involvement in this Act is limited only to its retirees since the SSS funds are held in trust for the exclusive benefits of the private workers and their beneficiaries. Usage of such funds for other purposes is not allowed under SSS charter. G.4 Membership in the PAG-IBIG Fund shall be open to all senior citizens who opt to continue with their provident savings in the Fund, even after their retirement from their employment or upon reaching the age of sixty (60) years. a. Senior citizens who wish to enlist with the PAG-IBIG Fund for the first time may do so upon proof of gainful employment, or of being self employed, or of membership in trade/service cooperative (e.g. farmers cooperatives, fishermens cooperative, loom weavers association, handicraft makers organization, and the like) and upon payment of the monthly minimum contribution rate as may be set up by the PAGIBG Fund from time to time. b. PAG-IBIG members of good standing shall be entitled to avail themselves of PAGIBIG loan privileges subject to the customary guidelines on loan availments. For PAGIBIG housing loans, the loan availments. For PAG-IBIG housing loans, the loan period shall not be more than twenty five (25) years but in no case shall it exceed the difference between the present age reckoned from the borrowers nearest birthday and his seventieth (70th) year; in the case of a joint and several loan, the loan period shall be based on the age of the youngest of the co-borrowers. RULE VI
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GOVERNMENT ASSISTANCE Article 10. Personal Tax Exemption for Benefactor A senior citizen shall be treated as dependent provided for in the NIRC and as such, shall be accorded the privileges granted by the Code insofar as having dependent are concerned. In determining personal exemptions allowable to individuals under Section 29 (k) (l) of the NIRC, a senior citizen may be granted as a dependent. For this purpose, the definition of the term Head of the family under the said Section shall be deemed amended to refer to the condition under Article (5) of this implementing rules and regulations. The OSCA shall require the senior citizen to declare his benefactor who will be granted the exclusive right to claim him as dependent and issue a identification thereof. The said certification shall be presented by the benefactor to the BIR for purposes of determining personal exemptions. The personal tax exemption shall take effect January 1992. Article 11. Property Tax Exemptions and Privileges for Individuals and NonGovernment Institutions. Individuals or non-government institutions establishing homes, residential communities or retirement villages solely for the senior citizen shall be accorded the following: a. One per cent (1%) property tax exemption for the first five years starting first year of operation: b. (1) The exemption is automatically withdrawn effective on the year after the institution ceases its operation before the end of the fifth year of operation. The owners of the properties shall thereafter be liable for the realty taxes applicable thereon. (2) The first year of operation shall be reckoned from the date the institution was granted a mayors permit to operate the establishment. (3) The exemption shall apply prospectively. Establishments which are beyond their fifth year of operation shall not be entitled to refund of their payments or condonation of their realty tax delinquencies during their first five years of operation. However existing establishments which have been operating for less than five years shall be entitled to the exemption in the remaining of the five years. c. Priority in the building and/or maintenance of provincial or municipal roads leading to the aforesaid home residential community or retirement village. Provided that: in both cases, said exemption and priority shall apply only when said homes residential communities or retirement villages are non-stock, no-profit as such which shall be presented to the Assessors Office of the LGUs concerned.
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RULE VII PENALTY PROVISIONS Article 12. Penalties. Any person who willfully refuses to grant the privileges provided for by RA 7432 or violates any provision thereof and for which no penalty is specifically provided for by any existing law, shall be punished by imprisonment not exceeding one (1) month or a fine not exceeding One Thousand Pesos (P1,000.00) or both. Any organization, private government establishment and government department/bureau/agency/institution who willfully refuses to grant the privileges given to senior citizens or violates any provision of RA 7432 shall be administratively dealt with by any of the agency/department concerned including, but not limited to the cancellation of permit/s or franchise/s to operate to a business establishment or institution or public service. RULE VIII FINAL PROVISIONS Article 13. Implementation, Supervision, Monitoring and Technical Assistance. a. Municipal Responsibility. It shall be the responsibility of every municipality, through its chief executive, to ensure that the provisions of RA 7432 are operationalized and implemented to the fullest within its jurisdiction. b. The DILG, having been designated by the President to exercise general supervision over LGUs, by virtue of the Local Code, rule XI, shall ensure the compliance of LGUs with this Act. It shall likewise institute the necessary interventions aimed at enhancing the capacities of the LGUs in implementing the above-mentioned provisions. c. On a national scale, the DSWD, by virtue of its monitoring and technical assistance function shall ensure the viability and standard of the programs and services that are implemented, while the DILG shall ensure compliance of LGUs. Article 14. Appropriation. The municipality, through its Sangguniang Bayan shall appropriate funds on a yearly basis for the maintenance and other operating expenses of the OSCA to incorporate in the annual budget. The concerned provincial/municipal government agency shall likewise mobilize other sources of funds particularly those that are made available for local development activities by the national government, the legislature and the private sector. Article 15. Separatibility Clause, If, for nay reason/s, any part or provision of this Implementing Rules and Regulations shall be held unconstitutional or invalid, other
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parts or provisions hereof which are not affected thereby shall continue to be in full force and effect. Article 16. Effectivity Clause. This Implementing Rules and Regulations shall take effect fifteen (15) days following its publication in one (1) national newspaper of general circulation. ADDENDUM REVENUE REGULATIONS NO. 2-94 (August 23, 1993) SUBJECT: Republic Act No. 7432 otherwise known as an Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes. To: All Internal Revenue Officers and Others Concerned. Section 1. SCOPE Pursuant to Section 245 of the National Internal Revenue Code (NIRC) as amended, in relation to Section 10 of Republic Act No. 7432, these regulations are hereby promulgated to (1) implement the provisions of Section 4 and 5 (a) of the said Act granting tax exemption and other privileges to senior citizens, and (2) prescribe the guidelines for the availment thereof. SECTION 2. DEFINITIONS. For purposes of these regulations: a. Act refers to Republic Act No. 7432. b. Senior citizen means any resident citizen of the Philippines at least sixty (60) years old, including those who have retired from both government offices and private enterprises, and has an income of not more than sixty thousand pesos (P60,000.00) per annum subject to review by the National Economic and Development Authority (NEDA) every three (3) years. The term qualified senior citizen shall refer to a resident Filipino citizen who meets the statutory requirements of Section 2 of the Act and Section 2(b) of these regulations. c. Resident citizen refers to a Filipino citizen with permanent/legal residence in the Philippines, and shall include those, who, having migrated to a foreign country, have returned to the Philippines with a definite intention to side therein, and whose immigrant visa has been surrendered to the foreign government. d. Dependent a qualified senior citizen whether or not related to a benefactor with whom he lives and who takes care of him/her. e. Head of the Family an unmarried or legally separated man or woman, with one or both parents, or with one or more brothers or sisters, or with one or more legitimate,
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recognized natural or legally adopted children, living with and dependent upon him/her for their chief support, where such brothers or sisters or children are not more than twenty-one (21) years of age, unmarried and not gainfully employed or where such children, brothers or sisters, regardless of age are incapable of selfsupport because of mental or physical defect. The term head of family includes an unmarried or legally separated man or woman who is the benefactor of a qualified senior citizen as defined in Section 2 of the Act and these regulations. The term qualified senior citizen shall refer to a resident Filipino citizen who meets the statutory requirements of Section 2 of the Act and Section 2(b) of these regulations. f. Benefactor any person whether or not related to the senior citizen who takes care of the latter as a dependent. g. OSCA refers to the Office for Senior Citizens Affairs. h. Income/Annual Taxable Income of a resident Senior Citizen shall refer to the annual gross compensation, business and other income received during each taxable year from all sources as defined in Section 28 of the NIRC, which shall not exceed the poverty level of P60, 000 or such amount as may thereafter be determined by the NEDA. However, income derived by a qualified senior citizen from the following sources: 1. Interest income from Philippine currency bank deposits, yield and other monetary benefit from deposit substitutes, trust fund and similar arrangements; royalties, prizes and winnings (Sec. 21 (c), NIRC); 2. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC); and 3. Capital gains from sales of real property (Sec.21(e), NIRC). shall not be included in the determination of his income/annual taxable income which should not exceed the poverty level of P60,000 or such amount as may thereafter be determined by the NEDA for a certain taxable year inasmuch as income from such sources shall be subject to the corresponding income tax rates prescribed under Section 21 (c), (d) and (e) of the NIRC as amended. i. Tax Credit refers to the amount representing the 20% discount granted to a qualified senior citizen by all establishments relative to their utilization of transportation services, hotels and similar lodging establishments, restaurants, drugstores, recreation centers, theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture, leisure and amusement, which discount
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shall be deducted by the said establishments from their gross income for income tax purposes and from their gross sales for value-added tax or other percentage tax purposes. Sec. 3. INCOME TAX BENEFIT AND PRIVILEGES FOR THE SENIOR CITIZENS. Senior citizens qualified as such by the Commissioner of Internal Revenue or his duly authorized representative who, for purposes of these regulations, is the Regional Director of the Revenue Region having jurisdiction of the city or municipality where they are permanent residents shall be entitled to the following tax benefit and privileges: a. Exemption from the payment of individual income tax provided that their annual taxable income does not exceed the poverty level of P60,000.00 or such amount as may be determined bt the NEDA for a certain taxable year. b. A 20% discount from all establishements relative to utilization of transportation services, hotels and similar lodging establishments, restaurants and recreation center, and on purchases of medicine anywhere in the country. c. A minimum of twenty perecent (20%) discount on admission fees charged by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure, and amusement. Sec. 4. RECORDING/BOOKKEEPING REQUIREMENTS FOR PRIVATE ESTABLISHMENTS. Private establishments, i.e., transport services, hotels and similar lodging establishments, restaurants, recreation centers, drugstores, theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture leisure and amusement, giving 20% discounts to qualified senior citizens are required to keep separate and accurate record of sales made to senior citizens, which shall include the name, identification number, gross sales/receipts, discounts, dates of transactions and invoice number for every transaction. The amount of 20% discount shall be deducted from the gross income for income tax purposes and from gross sales of the business enterprise concerned for purposes of the VAT and other percentage taxes. Sec. 5. AVAILMENT OF INCOME TAX EXEMPTION. Asenior citizen who shall avail of the exemption from income tax is required to submit the following documents to the Revenue District Officer (RDO) of the place where he is a permanent resident, who shall make the necessary verification and report for purposes of the income tax exemption to be issued by the Commissioner of Internal Revenue or his duly authorized representative: A. Certified true copy of his Birth Certificate/Baptismal Certificate or in the absence thereof, a certification from the National Statistics and Census Bureau or an affidavit by two (2) disinterested credible persons who know personally the senior citizen.
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B. If he has a benefactor as defined in Section 2 (f) of these Regulations, Certification as to the name, address, occupation, Office or business address (office/business) and TIN of his benefactor; C. If employed, a copy of his withholding tax statement (BIR Form W-2) for the preceding taxable year; c. 1 A senior citizen who derives taxable (fixed) compensation income from only one employer in an amount not exceeding P60,000 per annum shall be exempt from income tax and consequently from the withholding tax prescribed under Section 72 Chapter 10, Title II of the National Internal Code, as amended. D. If self-employed, (i.e., practice of profession, or in business as single proprietorship) a copy of his income tax return (ITR) for the preceding taxable year together with the annual license or permit issued by the city or municipality where he has his principal place of business, supported by a copy of his declaration of sales or income. d.1 A senior citizen who derives taxable compensation income from two (2) or more employers, or who receives mixed income from employment and from business shall still file an income tax return. The RDO concerned shall transmit his verification report/recommendation to the said Regional Director, as duly authorized representative of the Commissioner, for issuance of the certificate of income tax exemption to the senior citizen. For purposes of applying for the OSCA ID Card, the duly stamped income tax return and or the BIR Certification shall be honored. Sec. 6. TAXABILITY OF SENIOR CITIZENS TO OTHER INTERNAL REVENUE TAXES. a. A senior citizen whose annual taxable income exceeds the poverty level of P60,000 or such amount as may thereafter be determined by the NEDA for a certain taxable year shall be liable to the individual income tax in the full amount thereof on his taxable income net of allowable deductions. b. Regardless of the amount of taxable income, a senior citizen who derives income from self-employment, business and practice of profession shall be subject to other internal revenue taxes which include but are not limited to the value added tax, caterers tax, documentary stamp tax, overseas communications tax, excise taxes, and other percentage taxes. He shall therefore, file the corresponding business tax returns in accordance with existing laws, rules and regulations. c. He shall be subject to the 20% final withholding tax on, interest income from Philippine Currency bank deposit, yield and other monetary benefit from deposit substitutes, trust fund and similar arrangements; royalties, prizes (except prizes amounting to P3,000 or less which shall be subject to income tax at the rates
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prescribed under Section 21, paragraph (a) or (f), NIRC) as the case may be, and winnings (except Philippine Charity Sweeptakes winnings). d. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC). e. Capital gains from sales of real property (Sec. 21 (e), NIRC). Sec. 7. BASIC PERSONAL EXEMPTION ONLY FOR BENEFACTOR -. A qualified senior citizen living with and taken cared of by a benefactor whether related to him or not, shall be treated as a dependent and his benefactor shall be entitled to the basic personal exemption of P12,000 as head of the family, as defined in Section 2 (e) of these regulations. For purposes of claiming personal exemptions as head of family with dependent senior citizen, the identification card number issued by the OSCA shall be indicated in the ITR to be filed by the benefactor. The senior citizen shall indicate in a certification to be submitted to the RDO and the OSCA his benefactor who will be granted the exclusive right to claim him as dependent for income tax purposes. Caring for a dependent senior citizen shall not, however, entitle the benefactor to claim the additional exemption allowable to a married individual or head of family with qualified dependent children under Sec. 29 (1) (2) of the NIRC, as amended. Sec. 8. REPEALING CLAUSE. All existing rules, regulations and other issuances or portions thereof inconsistent with the provisions of these regulations are hereby modified, repealed or revoked accordingly. Sec. 9. EFFECTIVITY. These regulations shall take effect fifteen (15) days after publication in the Official Gazette or newspaper of general circulation whichever comes first and shall apply to income earned beginning January 1, 1992.

(Sgd.) ERNESTO LEUNG Acting Secretary of Finance RECOMMENDED BY: (Sgd.) LIWAYWAY VINZONS-CHATO Commissioner of Internal Revenue

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Health and Well-being of Older Persons


Rationale The proportion of older persons is expected to rise worldwide. In the 1998 World Health Report, there were 390 million older people and this figure is expected to increase further (WHO). This growth will certainly pose a challenge to country governments, particularly to the developing countries, in caring for their aging population. In the Philippines, the population of 60 years or older was 3.7 million in 1995 or 5.4% of total population. In the CY 2000 census, this has increased to about 4.8 million or almost 6% (NSCB). At present there are 7M senior citizens (6.9% of the total population), 1.3M of which are indigents. With the rise of the aging population is the increase in the demand for health services by the elderly. A study done by Racelis et al (2003) on the share of health expenditure of Filipino elderly on the National Health Account, the elderly are relatively heavy consumers of personal health care (22%) and relatively light consumers of public health care (5%). From out-of-pocket costs, the aged are heavy users of care provided by medical centers, hospitals, non-hospital health facilities and traditional care facilities. Cognizant of the growing concerns of the older population, laws and policies were developed which would provide them with enabling mechanisms for them to have quality life. RA 9257 or the Expanded Senior Citizens Act of 2003 (predecessor of RA 9994) provided for the expansion of coverage of benefits and privileges that the elderly may acquire, including medically necessary services. Parallel to this objective is the Departments desire to provide affordable and quality health services to the marginalized population, especially the elderly, without impeding currently pursued objectives and alongside health systems reform. One of the provisions of RA 9994 or the Expanded Senior Citizens act of 2010 is for the DOH to administer free vaccination against the influenza virus and pneumococcal diseases for indigent senior citizens. The DOH in coordination with local government units (LGUs), NGOs and POs for senior citizens shall institute a national health program and shall provide an integrated health service for senior citizens. It shall train community based health workers among senior citizens health personnel to specialize in the geriatric care and health problems of senior citizens. Interventions/Strategies Implemented by DOH 1. Creation of a National Technical Working Group on the Health and Wellbeing of Older Persons (DPO. No. 2011- 3578 dated June 29, 2011 Chaired by NCDPC- Director III. 2. Planning Meeting for the Senior Citizens Immunization Program 3. Consultative Planning and Finalization of Immunization Guidelines for Indigent Senior Citizens 4. Provision of Pneumococcal and Flu Vaccines to Indigent Senior Citizens aged 60 years old and above using the NHTS of the DSWD including GO NGO shelter homes in 2011 5. Conduct annual Summer Camp ni Lolo at Lola 6. Support the annual Walk for Life for the elderly every October
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Status of Implementation / Accomplishment 1. The total pneumococcal and influenza vaccines delivered to all CHDs for the CY 2011 were 197,000 and 173,000 respectively including the sub-allotment per region for HWOP activities. 2. Training and Orientation of Pneumo and Flu Vaccines for HWOP Coordinators 3. Signed Guidelines to Implement the Provisions Relevant to Health of RA 9994 or the Expanded Senior Citizens Act of 2010. 4. Summer Camp ni Lolo at Lola 2012 held at Davao, City. 5. Support World Health Day April 12, 2012 with the theme Ageing and Health in coordination with NCHP and WHO Future 1. 2. 3. Plan / Action Pneumococcal and Influenza Vaccines for CY 2012 still with COBAC Support to Walk for Life Activity on October 2012. Summer Camp nina Lolo at Lola 2013

Infant and Young Child Feeding (IYCF)


I. Profile/Rationale of the Health Program

A global strategy for Infant and Young Child Feeding (IYCF) was issued jointly by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) in 2002, to reverse the disturbing trends in infant and young child feeding practices. This global strategy was endorsed by the 55th World Health Assembly in May 2002 and by the UNICEF Executive Board in September 2002 respectively. In 2004, infant and young child feeding practices were assessed using the WHO assessment protocol and rated poor to fair. Findings showed four out of ten newborns were initiated to breastfeeding within an hour after birth, three out of ten infants less than six months were exclusively breastfed and the median duration of breastfeeding was only thirteen months. The complementary feeding indicator was also rated as poor since only 57.9 percent of 6-9 months children received complementary foods while continuing to breastfed. The assessment also found out that complementary foods were introduced too early, at the age of less than two months. These poor practices needed urgent action and aggressive sustained interventions. To address these problems on infant and young child feeding practices, the first National IYCF Plan of Action was formulated. It aimed to improve the nutritional status and health of children especially the under-three and consequently reduce infant and under-five mortality. Specifically, its objectives were to improve, protect and promote infant and young child feeding practices, increase political commitment at all levels, provide a supportive environment and ensure its sustainability. Figure 1 shows the identified key objectives, supportive strategies and key interventions to guide the overall implementation and evaluation of the 2005-2010 Plan of Action. The
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main efforts were directed towards creating a supportive environment for appropriate IYCF practices. The approval of the National Plan of Action in 2005 helped the Department of Health (DOH) and its partners, in the development of the first (1st) National Policy on Infant and Young Child Feeding. Thus on May 23, 2005, Administrative Order (AO) 2005-0014: National Policies on IYCF was signed and endorsed by the Secretary of Health. The policy was intended to guide health workers and other concerned parties in ensuring the protection, promotion and support of exclusive breastfeeding and adequate and appropriate complementary feeding with continued breastfeeding. (1) GUIDING PRINCIPLES The IYCF Strategic Plan of Action upholds the following guiding principles: 1. Children have the right to adequate nutrition and access to safe and nutritious food, and both are essential for fulfilling their right to the highest attainable standard of health. (5) 2. Mothers and Infants form a biological and social unit and improved IYCF begins with ensuring the health and nutritional status of women. (5) 3. Almost every woman can breastfeed provided they have accurate information and support from their families, communities and responsible health and non-health related institutions during critical settings and various circumstances including special and emergency situations.(5) 4. The national and local government, development partners, nongovernment organizations, business sectors, professional groups, academe and other stakeholders acknowledges their responsibilities and form alliances and partnerships for improving IYCF with no conflict of interest. 5. Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community empowerment. GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS GOAL: Reduction of child mortality and morbidity through optimal feeding of infants and young children MAIN OBJECTIVE: To ensure and accelerate the promotion, protection and support of good IYCF practice
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OUTCOMES: By 2016: 90 percent of newborns are initiated to breastfeeding within one hour after birth; 70 percent of infants are exclusively breastfeed for the first 6 months of life; and 95 percent of infants are given timely adequate and safe complementary food starting at 6 months of age. TARGETS: By 2016: 50 percent of hospitals providing maternity and child health services are certified MBFHI; 60 percent of municipalities/cities have at least one functional IYCF support group; 50 percent of workplaces have lactation units and/or implementing nursing/lactation breaks; 100 percent of reported alleged Milk Code violations are acted upon and sanctions are implemented as appropriate; 100 percent of elementary, high school and tertiary schools are using the updated IYCF curricula including the inclusion of IYCF into the prescribed textbooks and teaching materials; and 100 percent of IYCF related emergency/disaster response and evacuation are compliant to the IFE guidelines. II. Target beneficiaries of the program are infants (0-11 months) and young children (12 to 36 months years old or 1 to 3 years old) III. Action/Work Plan

KEY INTERVENTION SETTINGS AND SERVICES STRATEGIES, PILLARS AND ACTION POINTS

STRATEGY1: Partnerships with NGOsand GOs in the coordination and implementation of the IYCF Program 1.1 Formalize partnerships with GOs and NGOs working on IYCF program coordination and implementation a. Strengthen the TWG to allow it to effectively coordinate the GOs and NGOs working for the IYCF Program The national TWG will remain but will be strengthened. It shall be constituted by: NCDPC as Chair, FHO as secretariat and representatives from NCDPC,FHO, NCHP, FDA, DJFMH, DSWD,CWC, NNC, ILO, WHO and UNICEF. This time, members
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of theTWG will be tasked to focus participation to the intervention setting where it ismost relevant. The TWG shall be reporting regularly to the Service Delivery Cluster Head. At the Regional level, the Regional Coordinators from the above offices shall collaborate in the implementation of the IYCF Program. To ensure that GO and NGO IYCF partners work together, the composition of the TWGs and AD Hoc committees shall be made up of representatives from the government and non-government sectors and the Ad Hoc Committees shall be chaired by the relevant agency where the intervention setting belongs. At the provincial, municipal and barangay levels the existing Coordinating Committees which has an interagency composition shall be the coordinating arm of the IYCF Program. This is where the participation of non-government entities will be facilitated. Mechanisms for coordination shall be devised to build a strong foundation for partnership between the LGU, the Coordinating Committees and local NGOs or private entities. A memorandum of agreement (MOA) shall be executed between DOH and other agencies invited to become members of the TWG. b. Organize functional Intervention Setting Committees (this is the same as the adhoc committee) The years covered by this action plan will be marked with many developmental activities in all the intervention settings. The TWG shall create a committee for each of the intervention setting. The committees shall be chaired by the relevant agency/ office. Other government and non-government agencies will be invited to the committees relevant to their mandate. c. Return the MBFHI responsibility from NCHFD to NCDPC The National Policy on IYCF created in 2005 has affirmed the MBFHI responsibility to NCHFD. Since MBFHI is now under the umbrella of the IYCF Program, it is in a better position to consolidate efforts towards MBFHI compliance. Thus the return of the MBFHI responsibility from NCHFD to NCDPC shall be pursued. The collaboration of NCHFD is still needed though as it has a direct hand on health facility development. At NCDPC the integration of IYCF in the MNCHN Action Plan shall be worked out in all aspects of the program and at the different levels of implementation. d. Augment human resource complement of NCDPC- FHO, IYCF program NCDPC-FHO as the secretariat of the TWG and supervising and supporting the IYCF Program will not be able to effectively carry out the technical, management and administrative roles and responsibilities without additional human resource. Funds shall be allotted for job orders for this purpose. e. Programmed contracting out of activities to organizations outside of DOH
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To achieve the objectives and targets of the IYCF program, it shall be implemented simultaneously in the different intervention settings and at a faster pace. This is a gargantuan task considering the extent of the developmental work, the management requirements, and the mobilization of the IYCF network and the sourcing of funds for implementation. Organizations and consultants that possess the expertise and the commitment to the IYCF program will be contracted out for complex activities that require time and effort beyond the capacity of the TWG and the Ad Hoc committees. These contracts shall be arranged based on need and awarded based on merit. STRATEGY 2: Integration of key IYCF action points in the MNCHN Plan of Action/Strategy 2.1 Institutionalize the IYCF monitoring and tracking system for national, regional and LGU levels a. Institutionalize the collection of PIR Data and generate annual performance report The established IYCF data set that are being collected during PIRs shall be further reviewed, revised as appropriate and institutionalized through a Department Circular and in collaboration with the other programs in the FHO. An IYCF Program annual performance report shall be generated at the end of every year based on the PIR data, the consolidated data from the unified monitoring and related data coming from research and studies as appropriate. Reports on the performance of developmental activities shall be collected as part of the data base and to be reported as needed to the Service Delivery Cluster Head. b. Maximize the use of the unified monitoring tool The CHDs through its Regional Coordinators shall be required to use and consolidate the unified monitoring tool. A simple data management program shall be developed to facilitate the consolidation of data extracted from monitoring. Reports shall be required two weeks after the end of every quarter. c. Collaborate with the National Epidemiology Center (NEC) and Information Management Service (IMS) regarding IYCF data The current records and reports being collected by the DOH Field Health Information System will remain as the main source of data from health facilities. However, collaboration with NEC and IMS to improve data quality and include data on complementary feeding is essential. 2.2 Participation of the IYCF Focal person in MNCHN planning and monitoring activities
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a. Designate the IYCF Focal Person as a regular member of the team working for the development and implementation of the MNCHN Strategy The IYCF Focal Person shall ensure that the IYCF action points become an agenda of the MNCHN Strategy and thus ultimately the IYCF services forms a part of the integrated services for mothers and children. In the MNCHN planning and monitoring, the IYCF Focal Person shall help ensure that in the multitude of activities, critical IYCF action points and indicators are not overlooked. STRATEGY 3: Harnessing the executive arm of government to implement and enforce the IYCF related legislations and regulations (EO 51, RA 7200 and RA 10028) 3.1 Consultation mechanism with the IAC and DOJ for the enforcement of the Milk Code and with other relevant GOs for other IYCF related legislations and regulations a. Devise and implement a consultation mechanism to bring together the IAC, DOJ and other relevant GOs for IYCF related legislations and regulations The Committee for Industry Regulation shall devise and implement a consultation mechanism to facilitate the implementation and enforcement of IYCF related laws and regulations. This will require participation of higher levels of authority in the GOs. The goal of the consultation mechanisms is to develop activities that will focus on facilitating the process of monitoring of compliance and enforcement of IYCF related laws and regulations not only at the national level but also at regional and local levels and in the five IYCF intervention settings. 3.2 Support Civil Society in the implementation and enforcement of IYCF related laws and regulations a. Institutionalize enforcement of MBFHI compliance in the regulatory function of the DOH The inclusion of the MBFHI requirements in the unified licensing/accreditation benchmarks of the BHFS and the Licensing Offices shall be pursued more vigorously in collaboration with BHFS and the Licensing offices of the CHDs. These offices are in a better position to enforce compliance in relation to their regulatory function and in their power to promulgate penalties for violations. b. Review and improve the processing of reports on violations on the Milk Code The handling of reports on violations shall be reviewed for thoroughness and timeliness from the time a report is submitted up to the final decision rendered on a case. Problematic areas and bottlenecks shall be identified and threshed out. Measures to ensure that all reports on violations are acted upon shall be devised.
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To ensure speedy resolution of cases, it is necessary to set deadlines on the processing of reports on violations. c. Invite the Professional Regulatory Board as a resource agency of the IAC Apart from companies who are actively marketing breastmilk substitutes, health professionals who have direct access and influence on pregnant and postpartum women are also among the most common violators of the law. The PRC as the legal authority that regulates the practice of the medical and allied professions can contribute to the development and enforcement of the IACs regulatory function. d. Augment human resource of FDA as secretariat of the IAC The current load of violations cases being processed and the fulfillment of other responsibilities with regards to the Milk Code at FDA require a full time legal officer who will also assist the CHDs. Furthermore, the strengthened monitoring of compliance to the Milk Code will result in a surge on violation reports. FDA should be prepared to process such reports. An additional full time legal officer and an administrative/ clerical staff is required to facilitate and help speed up the process. e. Engage professional societies to come-up with measures for self monitoring and regulation Monitoring of overt advertisements and marketing of breast milk substitutes is a persistent challenge. Monitoring of compliance to the Milk Code among health workers and medical and allied professional organizations is much more difficult. Promotion of breast milk substitutes is more personal and concealed. The medical and allied professional societies are strong and active bodies that foster organizational development and discipline among its members. An advocating stance over a punitive approach may be the more prudent initial approach in this environment. There will be dialogue, negotiations and forging of agreements to push the Milk Code and other policies on IYCF. The professional societies will be engaged to participate in the development of the monitoring scheme within their ranks and in health facilities. They are a good resource in the development of schemes for MBFHI and related technical matters. Working arrangements/contracts may be forged to seal responsibilities and partnerships. Representatives from the professional societies will constitute the Speakers Bureau which will be organized for the information dissemination/awareness campaign on the Milk Code, the Expanded Breastfeeding Promotion Act and the Policies on IYCF. STRATEGY 4: Intensified focused supportive to IYCF practices activities to create an environment

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4.1 Modeling the MBF system in the key intervention settings in selected regions a. Set up Models of MBFHI and MNCHN implementation in key strategic hospitals and referral networks Regional Hospitals and selected private hospitals shall be developed as models of MBFHI and MNCHN implementation to help create an impact and to serve as showcases for other health facilities. If these hospitals are currently training facilities for obstetrics and pediatrics residency program, the MBFHI environment will certainly add value to the training. An itinerant team will facilitate the development of the hospital models. The team will be composed of an Obstetrician with training/background on MNCHN, Pediatrician with training/background on Lactation Management/Essential Newborn Care, Nurse trainer for breastfeeding counseling, Senior IYCF Program person with administrative background who can deal with arrangements and coordination with hospitals and local governments and who can be a trainer and an administrative assistant who will facilitate administrative matters. The team will facilitate the activities leading to the organization and maintenance of the MBFHI in the hospitals. This shall include planning, setting up of operational details and physical structures when needed, training/coaching of personnel, keeping records and completing reports and self assessment. Regional hospitals shall be developed for IYCF capacity building. Trainings at Regional Hospitals shall be conducted in collaboration with the CHDs. This is so that training is de-centralized and monitoring and evaluation can be done more frequently at the provincial and municipal levels. b. Establish protocols/standards on how to set-up and maintain MBF workplaces and integrated in the standards for healthy workplace The IYCF Program shall focus on the enforcement of the Expanded Breastfeeding Promotion Act of 2009 which mandates workplaces to establish lactation stations and/or grant breastfeeding breaks. Guidelines for the establishment and maintenance of MBF workplace shall be developed. It will learn from lessons of already established and successful MBF workplace. In as much as standards for the healthy workplace are already established, the MBF guidelines shall be integrated into those standards. The establishment of MBF workplaces initiated in factories shall be scaled up and efforts shall be expanded to include government and private offices in line with Expanded Breasfeeding Act. The current collaboration partners in the workplace setting may also need to be expanded to promote the establishment of the MBF workplace in government and private offices. With the multitude of workplaces
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scattered throughout the country, the expansion may require outsourcing of organizations to continue the MBF workplace efforts. c. Enhance the primary, secondary and tertiary education curricula on IYCF The enhancement of the primary, IYCF shall be pursued. If necessary, the enhancement. Apart from the books and teachers guide shall also secondary and tertiary education curricula on a review of the curriculum will be done prior to curriculum enhancement, training materials, be updated.

The initial collaboration for the enhancement of the primary, secondary and tertiary education curricula shall take place at the central office of DepEd (Bureau of Elementary Education and Bureau of Secondary Education) and TESDA. The enhanced curriculum, training materials, books and teachers guide shall be field tested province-wide in three selected provinces, evaluated and further enhanced before a national implementation. d. Develop policy on IYCF in emergencies (IFE) and guidelines on the management of malnutrition, and IYCF in special medical conditions for the community A clear policy on IYCF is necessary to allow the program to define the guidelines that can be easily followed by GOs, NGOs and LGUs once such situations arise. The policy/guidelines shall address among others the issue of milk donations. Guidelines on the Community Management of Malnutrition, IYCF in special medical conditions such as errors of metabolism or HIV positive mothers shall also be developed for implementation. Camp managers and organized local nutrition clusters shall be oriented on the IFE guidelines. Disaster prone areas will be prioritized in the orientation. Training/orientation shall be a collaborative effort between the IYCF Program, HEMS and the NDCC. 4.2 Creation of a Regional and National incentive and awarding systems for the most outstanding IYCF champions in the different sectors of society a. Review and update the existing awarding system The current awarding system shall be reviewed. The search protocol shall be further refined to allow a wider search. The organization of the search committees in the local and national levels shall be formalized. Funds for the awards shall be ensured. b. Establish a recognition system for health facilities complying with EO51, RA10028 and the MBFHI National Policy

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Set up an annual recognition system for facilities, establishments complying with relevant IYCF legislations and regulations. The benefits provided for by the Milk Code to compliant health facilities shall be reviewed and improved/established parallel with the development of the incentive scheme for the Expanded Breastfeeding Promotion Act. Procedures for claiming benefits shall be established and made accessible in collaboration with PhilHealth, BIR and other relevant government offices. 4.3 Allocate/Raise /Seek resources for IYCF Research activities that document best practices in the Philippines a. Carry out an inventory of best practices on IYCF Identify best IYCF practices by allowing every province in the country to identify exemplary or creative activities on IYCF that boosted program services/performance. Validate the reports through CHDs and select the best practices for documentation and publication. b. Allocate resources and conduct IYCF related researches focusing on the documentation and measure of impact of noble experiences and interventions The documentation of IYCF best practices is considered a critical area that allows the development of models/ references for appropriate IYCF protocols and guidelines for implementation. Field personnel who are able to establish and provide successful models of IYCF services are often deficient in resources and skills to document the efforts. Resources to conduct IYCF related researchers, focusing on the documentation and measure of impact of noble experiences and interventions, will have to be allocated. STRATEGY 5: Engaging the Private Sector and International Organizations to raise funds for the scaling up and support of the IYCF program 5.2 Setting up of a fund raising mechanism for IYCF with the participation of International Organizations and the Private Sector a. Set-up the fund raising mechanism The development and sustainability of IYCF activities partly depends on the availability of resources. At the national level, where many developmental activities will take place, the regular sources of funds are not sufficient. At the local levels, the poorer more problematic areas have the least resources to promote, protect and support good IYCF practices. It is critical for the IYCF Program to determine and actively source budgetary and other resource requirements. The availability of resources will guide the scale and prioritization of IYCF activities in the annual operational planning.
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To augment the funds for the IYCF program, a funding mechanism/body that will serve as a fund raising arm for the elimination of child malnutrition shall be established. The effort should be able to explore and proceed with the development of a funding mechanism that can encourage public-private partnership and ensure resources to initiate and sustain critical interventions nationwide. The arena of fund raising is not within the expertise of DOH, and it will be important to discuss with the international and national partners on the most suitable mechanism that can help attain such important goal. PILLAR 1: Capacity Building Capacity building shall take different forms and intensity in accordance to the requirement of the intervention settings. In health facilities, training on Lactation Management and Counseling shall continue. A system for regular in- service or refresher training to address the fast turnover of health staff in hospitals and to provide necessary program updates shall be put in place. Staggered training and self- enforcing programs may also be devised to improve access to training when warranted. Periodic evaluation shall be incorporated into the system to ensure effectiveness and efficiency of the trainings. The Milk Code monitors at FDA, CHDs and local levels shall be trained on the latest guidelines to help ensure that provisions on regulation and enforcement in the RIRR of the Milk Code are closely adhered to. The monitors should be prepared to handle incidents of actual violation of the code during inspection/monitoring. The local monitors shall be equipped with user friendly monitoring tools. The competencies of teachers and administrators to teach the new IYCF updated curriculum and to appreciate the importance of MBF environment shall be enhanced. A training/seminar program on IYCF for teachers/ administrators will be developed. A core of teacher trainers in every region will be developed and organized to conduct the training/seminars nationwide. IV. Status of the Program A REVIEW FROM 2005 TO 2010 Objectives and Targets set in 2005-2010 OBJECTIVE 1: TO IMPROVE, PROTECT AND PROMOTE APPROPRIATE INFANT AND YOUNG CHILD FEEDING
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Status of Achievement

Remarks

PRACTICES CHILD FEEDING PRACTICES - 70% of newborns initiated to breastfeeding within 30 minutes - 80% of 0-6 months infants are exclusively breastfed - 50% of infants are exclusively breastfed for 6 months

53.5% (NDHS 08) 34% (NDHS 2008) 22.2% (NDHS 2008)

40.7%(NDHS 1998) 33.5%(NDHS 2003) 16.1%(NDHS 2003) 13 months (NDHS 1998) 57.9%(NDHS 2003)

- median duration of breastfeeding 15.1months (NDHS 2008) is 18 months - 90% of 6- <10 months infants are given timely, adequate and safe 58% (NDHS 2008) complementary foods

- 95% of children 6 months to 59 months received Vitamin A

75.9% (NDHS 2008)

76% (NDHS 2003) NDHS 2008 and 2003 data refers to those that received vitamin A in the past 6 months from the interview

- 70% of low birth weight babies and iron deficient 6 months to less than 5 years received complete 78.3% of children 6-59 dose of iron supplements months consumed foods rich in iron in the past 24 hours from the time of the survey - 80% of pregnant women have at least 4 prenatal visits - 80% of pregnant women received complete dose of iron supplements - 80% of lactating women received vitamin A capsule 77.8% (NDHS 2008) 82.4% (NDHS 2008)

37% of children age 6-59 months received iron supplements in the seven days before the survey (NDHS 2008)

72.8% of 6-59 months received iron drops / syrup (not specified if complete dose, MCHS 2002)

67.5% (MCHS 2002) 82% (not specified if complete dose, MCHS 2002) 44.6% (NDHS 2003) NDHS 2003 and 2008 data represents the %
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45.6% (NDHS 2008)

of women that received Vitamin A dose during postpartum - 80% of household using iodized salt OBJECTIVE 2: TO INCREASE POLITICAL COMMITMENT AT DIFFERENT LEVELS OF GOVERNMENT, INTERNATIONAL ORGANIZATIONS, NONGOVERNMENT ORGANIZATIONS, PRIVATE SECTOR, PROFESSIONAL GROUPS , CIVIL SOCIETY, COMMUNITIES AND FAMILIES - Approved and widely disseminated National Infant and Young Child Feeding Policy - Approved multi-sectoral National IYCF Plan of Action IYCF Policy approved May 25, 2005 and disseminated to all Regions and LGUs. IYCF Plan of Action 20052010 approved. AO 2007-0017: Guidelines on the Acceptance and Processing of Local and Foreign Donations During Emergency and Disaster Situations was signed May 28, 2007. New groups were active in supporting activities on IFE mostly during the post-Ondoy interventions and in relation to breastfeeding support. Active organizations include Latch, La Leche League, Save the Children, Plan International and Arugaan. 41.9% (NDHS 2008) 81.1% household positive for iodine in salt (NDHS 2008) 38%, household using iodized salt and 56.4% household positive for iodine in salt (NNS 2003)

- IYCF policy enhancement for emerging issues

- Increase number of organizations actively involved in IYCF

- Increase budget for IYCF

From 1 million pesos in 2005 Additional funds for to 20 million pesos in 2010. IYCF were secured since April 2007, the start of the AHMP Additional funds were with intensive IYCF
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secured by the Joint program on MDG-F, wherein UN Agencies (Unicef, FAO, ILO and WHO) with NNC and DOH, started implementing key IYCF interventions.

training. September 2009, signing of the JP for Ensuring Food Security and Nutrition for Children 0-24 months in the Philippines, funded by the Government of Spain through the MDG Achievement Fund.

OBJECTIVE 3: PROVIDE SUPPORTIVE ENVIRONMENT THAT WILL ENABLE PARENTS, MOTHER, CAREGIVERS, FAMILIES AND COMMUNITIES TO IMPLEMENT OPTIMAL FEEDING PRACTICES FOR INFANTS AND YOUNG CHILD PROGRAMME MANAGEMENT National TWG active and 11/12 Regions confirmed having established a TWG. - Functional IYCF Program authority and responsibility flow at the national, regional and LGU level At the LGU level 7/80 provinces, 9/120 cities and 175/1425 municipalities have passed a resolution/ordinance in support of IYCF.

Data as of Dec 2009. Although the national TWG is considered active, the collaboration between agencies can be considered deficient.

- Existing local committees functioning as IYCF committees INSTITUTIONAL SUPPORT AO 2007-0026: Revitalization of the MBFHI in Health Facilities with Maternity Services was signed and endorsed on July 10, 2007.

No available data

- 1,426 currently certified MBF hospitals sustained 10 steps

Within 2 years after the issuance of COC, 0/47 hospitals applied for accreditation to become MBF based on the new standards
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PhilHealth Circular No. 26 S2005: Requirement for Accredited Hospitals to be Mother- Baby Friendly was issued on October 11, 2005. Only 47/1487 have received - 300 additional hospitals/lying-in a COC certified as MBF since 2007 - 100% of hospitals roomingin their newborns RA 10028: Expanded - All offices of government agencies Breastfeeding Promotion Act who are members of the IYCF IAC of 2009 was enacted on will be MBF March 16, 2010. - At least one model workplace per province/city certified as MBF 6/16 Regions reported that there are at least 88 breastfeeding friendly workplaces.

and requirements.

No available data RA 10028 set the standards to becoming MBF.

- At least one model IYCF resource No resource center center 1 province and 1 city in each established region - At least 3 IYCF model barangay/ municipality per province and city 10/16 Regions reported that there are at least 2159 breastfeeding support groups at the barangay level. Milk bank is functional in 3 Medical Centers: PGH, DJFMH and PCMC RA 10028 encourages other Medical Centers to set up their own milk bank.

- Functional milk bank in all medical centers IMPROVING SYSTEMS - 100% of national, regional and LGU health facilities have integrated IEC on IYCF into regular MCH services with clearly stated protocols on how to provide key IYCF - Functional and effective Milk Code Monitoring system

Based on monitoring visits and reports from CHDs, public health facilities have ensured the integration. Only 4/13 Regions reported some sort of Milk Code monitoring activities. At the FDA, from 2007 to

No available data on private health facilities.

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2009, there were 67 reports of violations and only 3/13 Regions reported filing a complaint for the alleged violations. - Institutionalize facility IYCF MIS system in place by end of 2009 -Improving skills of health manpower - Available national / regional IYCF trainers - Active IYCF Speakers Bureau 28,063/34,298 staff were - Available IYCF counselors in 50% trained on of health facilities IYCF Counseling. - At least 10 Filipino health professionals internationally accredited as breastfeeding counselors by the International Board of Lactation Consultants Examiners Draft tool developed and used in two key instances. No institutionalization yet. 28,063/34,298 staff were trained on IYCF Counseling. 16/17 Regions reported conduct of training on IYCF. No available data NCDPC and NNC combined report. NCDPC and NNC combined report

DOH focused on capacitating health workers on With the support of Counseling and Lactation NNC. Management. 9/13 Regions reported having trained a total of 1485 hospital based health No denominator workers on Lactation available. Management with the support of DJFMH, NCDPC,CHDs and NNC. In June 2010 a workshop on integration/updating of good IYCF practice into the medical, nursing, midwifery and nutrition curricula was conducted. RA 10028: Expanded Breastfeeding Promotion Act of 2009 mandates the integration. 10/16 Regions reported that The process of integration is ongoing. RA 10028 was enacted on March 16, 2010. The IRR is yet to be signed. As of Dec 2009.
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- A lactation specialist is available in tertiary hospitals

- Improved curricula for IYCF of medical / nursing / midwifery schools

- Inclusion of breastfeeding in elementary education - Community level support

systems and services

there are at least 2,159 barangay level BF support groups and more than 40 BF friendly public places.

RA 10028 will help boost the number of breastfeeding friendly public places. No available data

- 100% of target communities with functional community level monitoring system of IYCF practices and changes - At least 50% of city and poblacion municipalities with adequate number of trained IYCF peer counselors - At least one functional BF / IYCF support group in poblacions and selected communities OBJECTIVE 4: ENSURE SUSTAINABILITY OF INTERVENTIONS TO IMPROVE, PROTECT AND PROMOTE INFANT AND YOUNG CHILD FEEDING - Functional self assessment health facility tools for IYCF in certified MBFH and main health centers Tool Drafted. Not yet institutionalized. 10/16 Regions reported that there are at least 2,159 BF support groups at the barangay level. 10/16 Regions reported that there are at least 2,159 BF support groups at the barangay level.

- Annual progress reports of status of implementation of Milk 1st IYCF PIR: 2007 Code, Rooming In and Breastfeeding Act, ASIN Law, Food 2nd IYCF PIR: 2009 Fortification and ECCD Law / IYCF Policy - IYCF integrated into Philippine Plan of Action for Nutrition and annual planning and health monitoring systems at all levels - Periodic feedback of IYCF status during annual conventions of health professionals/Leagues of Provinces/ Cities/Municipalities IYCF integrated in PPAN 2005-2010. PIR was conducted last quarter of 2010. Regular Presentations are offered by DOH on IYCF status (2005: 1st presentation during
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Key result of integration was the intensive training on IYCF Counseling in AHMP target areas.

and Barangays

National Convention Liga Ng Barangay)

V. Program Manager VICENTA E. BORJA, RN, MPH Supervising Health Program Officer Family Health Office National Center for Disease Prevention and Control Department of Health Telephone no. 7329956 E-mail Add: vicentaborja@hotmail.com Partner Organizations/agencies NGO Partners: Local: Employers Confederation of the Philippines Trade Union Congress of the Philippines Beauty, Brains and Breastfeeding ARUGAAN Action for Economic Reforms Save Baby e-group Philippine Pediatric Society Philippine Obstetrics and Gynecology Society Philippine Academy of Family Physicians Inc. Philippine Society of Newborn Medicine Philippine Society of Pediatric Gastroenterology Philippine Neonatology Society Philippine Society of Obstetric Anesthesiologist Philippine Academy of Lactation Consultant Perinatal Association of the Philippines Philippine Medical Association Integrated Midwives Association of the Philippines Maternal and Child Nurses Association of the Philippines Philippine Nurses Association National League of Philippine Government Nurses Inc. Malls: SM , NCCC Union of Local Authorities of the Philippines CODHEND Government Partners: Department of Labor and Employment Department of Social Welfare and Development Department of Justice Department of Trade and Industry
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Department of Local Government Food and Drug Administration National Nutrition Council Council for the Welfare of Children Department of Education Commission on Higher Education Nutrition Council of the Philippines

International Organizations: World Health Organization UNICEF PLAN International Helen Keller International Save the Children-US World Vision

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Iligtas sa Tigdas ang Pinas

A Door-to-Door Measles-Rubella (MR) Immunization Campaign Vaccinating All Children, 9 months to below 8 years old From April 4 to May 4, 2011 The Philippines has committed to eliminate measles in 2012, the target year agreed upon with the other countries in the Western Pacific Region. Three (3) mass measles immunization campaigns were conducted in 1998, 2004 and 2007, achieving 95% coverage in each round. In contrast, the annual coverage for routine measles vaccination given to infants ages 9-11 months never reached the target of at least 95%. The highest coverage ever attained is 92% and the lowest coverage was 67% (1987 DOH EPI Report). The lower the coverage, the faster is the accumulation of unimmunized susceptible infants, resulting in measles outbreaks in different areas of the Philippines. Laboratory confirmed measles cases continued to be reported all over the country, which indicates uninterrupted circulation of measles virus transmission resulting to illness and deaths among children. Mass measles immunization campaigns provide a second opportunity to catch missed children, but these are done every 2-3 years interval and therefore not enough to prevent seasonal outbreaks from occurring in areas with low immunization coverage. The administration of a 2nd dose of measles containing vaccines on a routine schedule will provide this second opportunity at an earlier time and ensure the protection against measles of infants/children who failed to be protected during the first dose. As a response to interrupt the transmission of the measles virus and prevent a potential large measles outbreak to occur, there is an urgent need to conduct a measles supplemental immunization activity this April 2011. All children ages 9-95 months old nationwide should be given a dose of measles-rubella vaccine through a door-to-door vaccination campaign. Unlike previous campaign, a measles-free certification will be issued to city/province meeting all the criteria of (1) all barangays passed the RCA with no missed child and 95% and above house marking accuracy; (2) there are no measles cases for the next 3 months after the campaign and (3) measles surveillance indicators have met the national standards.

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Inter Local Health Zone


An ILHZ is defined to be any form or organized arrangement for coordinating the operations of an array and hierarchy of health providers and facilities, which typically includes primary health providers, core referral hospital and end-referral hospital, jointly serving a common population within a local geographic area under the jurisdictions of more than one local government. ILHZ, as a form of inter-LGU cooperation is established in order to better protect the public or collective health of their community, assure the constituents access to a range of services necessary to meet health care needs of individuals, and to manage their limited resources for health more efficiently and equitably. For these to happen, existing ILHZs in the country must strengthen their operations and sustain their functionality. Regardless of the organizational nature of each ILHZ, whether these are formally organized, informally organized or DOHinitiated, the overall aim is to make each ILHZ functional in order to perform its abovementioned purposes and tasks. It must be recognized that a good inter-LGU coordination in health is one that secures health benefits for the people living in LGUs that are coordinating with one another. A functional ILHZ therefore is to be viewed as one that provides health benefits to its individual residents and to the zone population as a whole. The ILHZ functionality is defined mainly by observable zone-wide health sector performance results in terms of: improved health status and coverage of public health intervention of the zone population; access by everyone in the zone to quality care; and efficiency in the operations of the inter-local health services. Replication of Exemplary Replication: Sharing Good Practices and Practical Solutions to Common Problems By virtue of Administrative Order No. 2008-0006, dated January 22, 2008, the DOH has adopted the integration of replication strategies in its operation. Replication is learning from and sharing with others exemplary practices that are proven and effective solutions to common and similar problems encountered by local government units, with the least possible costs and effort. The underlying principle of replication is to avoid reinventing the wheel and benefiting from already tested solutions. LGUs can share lessons learned from practices that work, as well as share experiences systematically. A structured organized process of replicating, including proper dissemination of validated exemplary practices and making Lakbay Arals more meaningful and useful, help ensure the chances of achieving best results. Replication makes learning more interesting and exciting as one gets to see the model and its benefits firsthand.
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Criteria for Selecting Exemplary Health Practices 1. LGU-initiated solutions initiated to address one or more health issues or problems encountered. 2. High level of sustainability Consistent with existing health policies LGU support Had been in place for more than three ears Widely participated and supported by the communities Adopted as a permanent structure or program with regular budgetary support Adopted as a permanent structure or program with regular budgetary support Community representation in decision making bodies and committee 3. Simple and doable so that they can be replicated within one year and a half or less. 4. Cost effective and cost efficient Mobilization and utilization of indigenous resources Minimal support from external sources 5. Positive results on the beneficiaries and communities. 6. Other important factors to consider: Consistency with the thrusts or priorities of the Department of Health Willingness of the Host LGU to share its practice to others Demand for the practice from other LGUs

Integrated Management of Childhood Illness (IMCI)


One million children under five years old die each year in less developed countries. Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and malnutrition is often the underlying condition. Effective and affordable interventions to address these common conditions exist but they do not yet reach the populations most in need, the young and impoverish. The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and development and is based on the combined delivery of essential interventions at community, health facility and health systems levels. IMCI includes elements of prevention as well as curative and addresses the most common conditions that affect young children. The strategy was
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developed by the World Health Organization (WHO) and United Nations Childrens Fund (UNICEF). In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital staff were capacitated to implement the strategy at the frontline level. Objectives of IMCI Reduce death and frequency and severity of illness and disability, and Contribute to improved growth and development Components of IMCI Improving case management skills of health workers 11-day Basic Course for RHMs, PHNs and MOHs 5 - day Facilitators course 5 day Follow-up course for IMCI Supervisors Improving over-all health systems Improving family and community health practices Rationale for an integrated approach in the management of sick children Majority of these deaths are caused by 5 preventable and treatable conditions namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood illness are caused by these five conditions Most children have more than one illness at one time. This overlap means that a single diagnosis may not be possible or appropriate. Who are the children covered by the IMCI protocol? Sick children birth up to 2 months (Sick Young Infant) Sick children 2 months up to 5 years old (Sick child) Strategies/Principles of IMCI

All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital The children and infants are then assessed for main symptoms. For sick children, the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional, immunization and deworming status and for other problems Only a limited number of clinical signs are used A combination of individual signs leads to a childs classification within one or more symptom groups rather than a diagnosis. IMCI management procedures use limited number of essential drugs and encourage active participation of caretakers in the treatment of children
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Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILDS ILLNESS (please see enclosed portion of the IMCI Chartbooklet) The childs illness is classified based on a color-coded triage system: PINKindicates urgent hospital referral or admission YELLOW- indicates initiation of specific Outpatient Treatment GREEN indicates supportive home care Steps of the IMCI Case management Process The following is the flow of the iMCI process. At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and other processes indicated in the chart below. Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. Once admitted, the hospital protocol is used in the management of the sick child.

Knock Out Tigdas 2007

Knock-out Tigdas Logo Knock-out Tigdas 2007 is a sequel to the 1998 and 2004 Ligtas Tigdas mass measles immunization campaign. All children 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated against measles from October 15 - November 15, 2007 , door-to-door. All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball court, town plazas and other identified public places will also offer FREE vaccination services during the campaign period.
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Other services to be given include Vitamin A Capsule and deworming tablet. Knockout Tigdas for the period of the Barangay and SK Elections

Executive Order No. 663 Promotional materials What is Knock-out Tigdas (KOT) 2007? Knock-out Tigdas 2007 is a sequel to the 1998 and 2004 Ligtas Tigdas mass measles immunization campaigns. This is the second follow-up measles campaign to eliminate measles infection as a public health problem. What is the over-all objective of the Knock-out Tigdas? The Knock-out Tigdas is a strategy to reduce the number or pool of children at risk of getting measles or being susceptible to measles and achieve 95% measles immunization coverage. Ultimately, the objective of KOT is to eliminate measles circulation in all communities by 2008. What does measles elimination mean? Measles elimination means: 1. Less than one (1) measles case is confirmed measles per one million population. 2. Detects and extracts blood for laboratory confirmation from at least 2 suspect measles cases per 100,000 populations. 3. No secondary transmission of measles. This means that when a measles case occurs, measles is not transmitted to others. Who should be vaccinated? All children between 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated against measles. When will it be done? Immunization among these children will be done on October 15-November 15, 2007. How will it be done? Vaccination teams go from door-to-door of every house or every building in search of the targeted children who needs to be vaccinated with a dose of measles vaccines, Vitamin A capsule and deworming drug. All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball court, town plazas and other identified public places will also offer FREE vaccination services during the campaign period. My child has been vaccinated against measles. Is she exempted from this vaccination campaign? No, she is not. A previously vaccinated child is not exempted from the vaccination campaign because we cannot be sure if her previous vaccination was 100% effective.

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Chances are a vaccinated child is already protected, but no one can really be sure. There is 15% vaccine failure when the vaccine is given to 9 months old children. We want to be 100% sure of their protection.

What strategy will be used during the campaign? It is a door-to-door strategy. The team goes from one-household to another in all areas nationwide. My child had measles previously, is he exempted in this campaign? There are many measles-like diseases. We cannot be sure exactly what the child had, especially if the illness occurred years ago. Anyway, the vaccination will not harm a child who already had measles. The effect will also be like a booster vaccination. The previously received measles immunization has formed antibodies, with the booster shot it will strengthened the said antibodies. Is there any overdose, if my child receives this booster immunization? Antibodies in the blood which provide protection against disease decrease as the child grows older. Booster vaccinations are needed to raise protection again. Measles vaccination during the said campaign will be a booster vaccination for a previously vaccinated child. The childs waning internal protection will increase. The child will not harm because there is no vaccine overdose for the measles vaccine. The measles vaccine is even known to enhance overall immunity against other diseases. What will happen to my child after receiving the measles immunization? Normally, the child will have slight fever. The fever is a sign that the childs vaccine is working and is helping the body develop antibodies against measles. The best thing to do when the child has fever is to give him paracetamol every four (4) hours. Give him plenty of fluids and breastfeed the child. Ensure that the child has enough rest and sleep. What will happen after the Knock-out Tigdas 2007? To interrupt measles circulation by 2008, ALL children ages 9 months will continue to routinely receive one dose of the measles vaccine together with the vaccines the other disease of the childhood like polio, diphtheria, pertussis, etc. All children with fever and rashes have to be listed and tested to verify the cause of the infection. ALL 18 months old children will be given a second dose of measles immunization to really ensure that these children are protected against measles infection. What other services will be given? Vitamin A capsule will be given to all children 6 months to 71 month old and deworming tablet to 12 months to 71 months old nationwide. Additional messages: Once the child is vaccinated, the posterior upper left earlobe will be marked with gentian violet, so do not try to remove for the purpose of validation.
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Houses will also be marked, so do not erase. I heard that there are cases where the child who was vaccinated who became seriously ill or died. Is this true? Measles vaccine is very safe. Minor reactions may occur such as fever but in an already immunizes child, this may not occur. The most serious and RARE adverse event following immunization is anaphylaxis which is inherent on the child, not on the vaccines.

Leprosy Control Program

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Vision: Empowered primary stakeholders in leprosy and eliminated leprosy as a public health problem by 2020 Mission: To ensure the provision of a comprehensive, integrated quality leprosy services at all levels of health care Goal: To maintain and sustain the elimination status Objectives: The National Leprosy Control Program aims to:

Ensure the availability of adequate anti-leprosy drugs or multiple drug therapy (MDT). Prevent and reduce disabilities from leprosy by 35% through Rehabilitation and Prevention of Impairments and Disabilities (RPIOD) and SelfCare. Improve case detection and post-elimination surveillance system using the WHO protocol in selected LGUs. Integration of leprosy control with other health services at the local level. Active participation of person affected by leprosy in leprosy control and human dignity program in collaboration with the National Program for Persons with Disability. Strengthen the collaboration with partners and other stakeholders in the provision of quality leprosy services for socio-economic mobilization and advocacy activities for leprosy.

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Beneficiaries: The NLCP targets individuals, families, and communities living in hyperendemic areas and those with history of previous cases.
NLCP Strategy (2011-2016) MDG& NOH

Global Strategy (2006-2010)

Universal Health Care (Kalusugang Pangkalahatan)

Sustain leprosy control in all endemic countries Strengthen routine & referral service Ensure high quality diagnosis, case management, recording & reporting in all endemic communities Establish the Sentinel Surveillance System to monitor Drug Resistance Develop procedures/ tools that are home/communitybased, integrated and locally appropriate for Self Care/POD, rehabilitation services (CBR)

Provision of Quality Leprosy services at all levels

Governance for Health Service Delivery Policy, Standards & Regulations Human Resources for Health

Health System Strengthening Capability building of an efficient, effective, accessible human and facility resources Develop policies/ guidelines/ sentinel sites/referral centers (Luzon,Visayas & Mindanao) Collaborate with NEC/RESU/ PESU / MESU

Health Information

NLAB, NCCL RA 7277- Rights of PWD & Caregivers BP 34- Accessibility & Human Rights Law PhilHealth Insurance Package

Health Financing

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LGU Scorecard
The performance indicators in the LGU Scorecard are a subset of the Performance Indicator Framework (PIF) of the ME3. The performance indicators measure basic intermediate outcomes and major outputs of health reform programs, projects and activities (PPAs). There are 46 performance indicators in the LGU Scorecard categorized in two sets (Set I and Set II). The two sets of performance indicators are the following: Set I is composed of 27 outcome indicators mostly representing intermediate outcomes that can be assessed every year (See Annex 1: Data Definitions for Set I Indicators in LGU Scorecard). Set II is composed of 27 output indicators representing major thrusts and key interventions for the four reform components of service delivery, regulation, financing, and governance. They are mostly composed of health system reform outputs. These indicators are assessed only every 3-5 years, since these require more time and more resources to set up. The equity dimensions of these indicators are not measured (See Annex 2: Data Definitions for Set II Indicators in LGU Scorecard). Set I performance indicators of the LGU Scorecard are standardized as to numerators, denominators, multipliers and data sources. The definition of performance indicators is consistent with the Department of Health FHSIS data dictionary. The other references used in defining performance indicators in the LGU Scorecard are PhilHealth data definitions and WHO definitions of indicators. The standardization of performance indicators guarantees consistency of data across various LGUs and across years of implementation. It also facilitates the automation of the LGU Scorecard collection and publication of results. The sources of data utilized for the LGU Scorecard are the institutional data sources in the Department of Health. The availability of data on an annual basis was an important consideration for inclusion of Set I performance indicators in the LGU Scorecard.
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Licensure Examinations for Paraprofessionals Undertaken by the Department of Health I. Mandates Presidential Decree No. 856 Code of Sanitation of the Philippines Massage Therapists Administrative Order No. 2010-0034 Revised Implementing Rules and Regulations Governing Massage Clinics and Sauna Bath Establishments Embalmers Administrative Order No. 2010-0033 Revised Implementing Rules and Regulations Governing Disposal of Dead Persons Committees The Committee of Examiners for Massage Therapy (CEMT) and the Committee of Examiners for Undertakers and Embalmers (CEUE) were created by the DOH to regulate the practice of massage therapy and embalming to ensure that only qualified individuals enter the profession and that the care and services to be provided are within the standards of practice. II. Application Procedure A. Who can apply Any high school graduate At least 18 years old at the time of the examination B. How to apply Application Requirements: a. Certified True Copy of Birth Certificate (at least 18 years old at the time of the examination) b. Certificate of Good Moral Character from barangay captain of the community where the applicant resides c. Certification or clearance from the National Bureau of Investigation (NBI) or provincial fiscal that he/she is not convicted by the court in any case involving moral turpitude. d. Medical Certificate from a government physician e. Certified True Copy of Diploma or Transcript of Record (at least high school graduate) f. Submit Marriage Contract for female married applicant g. Certification from any DOH accredited training institution/ provider that he/she has received basic instructions in five (5) subjects based on Program Curriculum h. Certification from any DOH accredited training institution/provider that he/she has skillfully embalmed at least 10 cadavers within one year period under his/her supervision
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i. Filled up application form (1 copy) j. 1 X 1 size photograph taken within the last 6 months (3 copies) When is the licensure examination? Massage Therapist every 1st week of June and December Embalmers every 1st week of March and September III. Accredited Training Institutions Training Institutions Office Address Contact Number

2nd Floor ABN Bldg. Mc Massage Therapy Arthur Highway del (045) 861-2493 Central Luzon Alternative Rosario, City of San 09159970969 Health & Development, Inc. Fernando, Pampanga Unit 5 2nd Floor VMCC Centre de Centre International Bldg. Santolan Rd. cor. (02) 750-0442 Wellness Institute Inc. Granada St., Valencia, Quezon City Early Divine School Forever 59-A Escarilla Subd., 09305886037 Alternative Medicine Rehab Mandurriao, Iloilo City (033) 500-6529 and Training Center (02) 341-6674 1443 M. Hizon St. cor. EMPRIZ Massage Therapy Sun09325337262/ Alvarez St. Sta. Cruz, Review & Training Center 0922-8576674 Manila Smart 09292551959 Hand-Med Healthcare Center Integrative Osmena Avenue, Kalibo, (036) 268-2810 Aklan 09297350080

3rd Floor Crispina Bldg. 1589 Quezon Avenue, (02) 473-7369 Brgy West Triangle 0917-5117744 HIMAS- Asian Wellness and Quezon City Spa Academy Door 2 Sazon Bldg. (082) 305-1013 Ponciano Reyes St., Davao City HILOT at HILOM Pilipinas 33 Bakersfield St. (049) 544-0704 Laguna Bel Air 1, Don 09175457494 Jose, Sta. Rosa, Laguna Unit D ProVita Bldg. 26 (02) 473-5115 Columbia cor. Yale St. 09189199140 Cubao, Quezon City (032) 238-8744 Dona Luisa Bldg. Fuente 09189199149 Osmena, Cebu City
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International NKYR Academy

Le Petit Paradis Academy NMA Center for Therapy & Massage Potters Hand Training Center Aquatic

Suite 708 Cattleya Bldg. (02) 401-1242 235 Salcedo St. Legaspi 09228576674 Village, Makati City #2 Brgy. Court Villa 09298062688 Angela Subd., Angeles 09196133621 City (045) 888-3458 55-B Malac St. (02) 359-3985 Masambong, Quezon Fax #: (02) 413-3296 City

Review

and

Remnant Institute Alternative Medicine SPA @ WORK

of #26 Huervana St. Lapaz, 09209513589 Iloilo City (033) 329-1916 2205 Cityland Tower 2, 154 H.V. dela Costa St. (02)840-0242/ 840-1239 cor. Valerosts Makati City 0927-5004167 09175989897 (02) 400-4741

Ventura College of Natural Therapeutic Health and Tagum, Davao City Science Embalmers 1623 Quezon F&M Embalmers Review and Quezon City Training Center, Inc. Avenue,

Paz Review Center

and

Valgosong Bldg., CM 0922-8187622 Recto cor. Bonifacio St., 0922-8210797 Training Davao City 0917-8240409 143 G Araneta Ave. cor. (02) 743-6520 loc. 140 Kaliraya St. Quezon City 2139 T. Mapua St. Sta. (02) 254-0885 and Cruz, Manila (033) 775-8212 Miag-ao, Iloilo City 0918-9395984

Ongchangco Review Training Center

Nivel Hills, Lahug, Cebu (032) 232-2282 City Pacific Center for Advanced (032) 231-7542 Studies Cebu Branch Abad Santos St. Camus 0918-4334695 Ext., Davao City Philippine Embalmers & 794-2232 2070 E. Pascua St. Brgy. Undertakers Review and 0921-5401107 Kasilawan Makati City Training Center 0917-8312244 GSP Training Center and Review LT Building 815 EDSA (02) 895-4266 Avenue, Brgy. 144, 0917-8436276 Pasay City
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Malaria Control Program

Malaria is a parasite-caused disease that is usually acquired through the bite of a female Anopheles mosquito. It can be transmitted in the following ways: (1) blood transfusion from an infected individual; (2) sharing of IV needles; and (3) transplacenta (transfer of malaria parasites from an infected mother to its unborn child). This parasite-caused disease is the 9th leading cause of morbidity in the country. As of this year, there are 58 out of 81 provinces that are malaria endemic and 14 million people are at risk. In response to this health problem, the Department of Health (DOH) coordinated with its partner organizations and agencies to employ key interventions with regard to malaria control. Vision: Malaria-free Philippines Mission: To empower health workers, the population at risk and all others concerned to eliminate malaria in the country. Goal: To significantly reduce malaria burden so that it will no longer affect the socioeconomic development of individuals and families in endemic areas. Objectives: Based on the 2011-2016 Malaria Program Medium Term Plan, it aims to: 1. Ensure universal access to reliable diagnosis, highly effective, and appropriate treatment and preventive measures; 2. Capacitate local government units (LGUs) to own, manage, and sustain the Malaria Program in their respective localities; 3. Sustain financing of anti-malaria efforts at all levels of operation; and 4. Ensure a functioning quality assurance system for malaria operations. Beneficiaries: The Malaria Control Program targets the meager-resourced municipalities in endemic provinces, rural poor residing near breeding areas, farmers relying on forest products, indigenous people with limited access to quality health care services, communities affected by armed conflicts, as well as pregnant women and children aged five years old and below. Program Strategies: The DOH, in coordination with its key partners and the LGUs, implements the following interventions:
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1.Early diagnosis and prompt treatment Diagnostic Centers were established and strengthened to achieve this strategy. The utilization of these diagnostic centers is promoted to sustain its functionality. 2. Vector control The use of insecticide-treated mosquito nets, complemented with indoor residual spraying, prevents malaria transmission. 3. Enhancement of local capacity LGUs are capacitated to manage and implement community-based malaria control through social mobilization. Program Accomplishments: For the development of health policies, the Malaria Medium Term Plan (20112016) is already in its final draft while the Malaria Monitoring and Evaluation Framework and Plan is being drafted. The Malaria Program is being monitored in six provinces as the Philippine Malaria Information System is being reviewed and enhanced. In strengthening the capabilities of the LGUs, trainings are conducted. These include: series of Basic and Advance Malaria Microscopy Training; Malaria Program Management Orientation and Training for the rural health unit (RHU) staff; and Data Utilization Training. Also, there are the Clinical Management for Uncomplicated and Severe Malaria and the Malaria Epidemic Management. Lastly, health services are leveraged through the provision of anti-malaria commodities. Partner Organization/Agencies: The following organizations/agencies take part in achieving the goals of Malaria Control Program: Pilipinas Shell Foundation, Inc, (PSFI) Roll Back Malaria (RBM); World Health Organization (WHO) Act Malaria Foundation, Inc Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI) Research Institute of Tropical Medicine (RITM) University of the Philippines-College of Public Health (UP-CPH) Philippine Malaria Network Australian Agency for International Development (AusAID) Asia Pacific Malaria Elimination Network (APMEN) Malaria Elimination Group (MEG) Local Government Units (LGUs)

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National Tuberculosis Control Program


Tuberculosis is a disease caused by a bacterium called Mycobeacterium tuberculosis that is mainly acquired by inhalation of infectious droplets containing viable tubercle bacilli. Infectious droplets can be produced by coughing, sneezing, talking and singing. Coughing is generally considered as the most efficient way of producing infectious droplets. In 2007, there are 9.27 million incident cases of TB worldwide and Asia accounts for 55% of the cases. Through the National TB Program (NTP), the Philippines achieved the global targets of 70% case detection for new smear positive TB cases and 89% of these became successfully treated. The various initiatives undertaken by the Program, in partnership with critical stakeholders, enabled the NTP to sustain these targets. Nonetheless, emerging concerns like drug resistance and co-morbidities need to be addressed to prevent rapid transmission and future generation of such threats. Coverage should also be broadened to capture the marginalized populations and the vulnerable groups namely, urban and rural poor, captive populations (inmates/prisoners), elderly and indigenous groups. Last 2009, the National Center for Disease Prevention and Control of the Department of Health led the process of formulating the 2010-2016 Philippine Plan of Action to Control TB (PhilPACT) that serves as the guiding direction for the attainment of the Millenium Development Goals (MDGs). Learning from the Directly-Observed Treatment Shortcourse (DOTS) strategy, the eight (8) strategies of PhilPACT are anchored on this TB control framework. Moreover, these strategies are also attuned with the Governments health reform agenda known as Kalusugang Pangkalahatan (KP) to ensure sustainability and risk protection. Vision: TB-free Philippines Goal: To reduce by half TB prevalence and mortality compared to 1990 figures by 2015 Objectives: The NTP aims to: 1. Reduce local variations in TB control program performance 2. Scale-up and sustain coverage of DOTS implementation 3. Ensure provision of quality TB services 4. Reduce out-of-pocket expenses related to TB care Strategies: Under PhilPACT, there are 8 strategies to be implemented, namely: 1. Localize implementation of TB control 2. Monitor health system performance 3. Engage all health care providers, public and private 4. Promote and strengthen positive behavior of communities 5. Address MDR-TB,TB-HIV and needs of vulnerable populations 6. Regulate and make quality TB diagnostic tests and drugs 7. Certify and accredit TB care providers
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8. Secure adequate funding and improve allocation and efficiency of fund utilization Program Accomplishments: Significant progress has been achieved since the Philippines adopted the DOTS strategy in 1996 and at the end of 2002-2003, all public health centers are enabled to deliver DOTS services. Because of the Governments efforts to continuously improve health care delivery, there have been progressive increases in the detection and treatment success. While a strong groundwork has been installed, acceleration of efforts is entailed to expand and sustain successful TB control. All stakeholders are called upon to achieve the TB targets linked to the MDGs set to be attained by 2015. However, with the emergence of other TB threats, more has to be done. Likewise, with the ongoing global developments and new technologies in the pipeline, constraints will hopefully be addressed. The 2010-2016 PhilPACT as defined by multi-sector partners, through broadbased collective technical inputs, underlines the key strategic approaches towards achieving these targets at both national and local levels. The Plan aims for universal access to DOTS including strategic responses to vulnerable groups and emerging TB threats. Nationwide, a wide array of health facilities are installed and equipped to provide quality TB care to the general population. This involves participation of private facilities (clinics, hospitals), other health-related agencies or NGOs and other Government organizations. Coverage for DOTS services, at least in the public primary care network has reached nearly 100% in late 2002. Ever since, diagnosis through sputum smear microscopy and treatment with a complete set of anti-TB drugs are given free through the support of the Government. Training on TB care for different types of health workers is being conducted through the regional and local NTP Coordinators. The conclusions during the program implementation review (PIR) done by the DOH of selected public health programs on January 2008 reveal the following: Extent and quality of nationwide TB-DOTS coverage have reached levels necessary for eventual control since 2004 up to present NTP continues to add enhancements and improvements to TB care providers for better delivery of services Partner Organizations/Agencies: The following are the organizations/agencies that take part in achieving the objectives of the National TB Control Program: Philippine Business for Social Progress Philippine Coalition Against TB Holistic Community Development Initiatives (HCDI) National TB Ref Laboratory Lung Center of the Philippines Bureau of Jail Management and Penology (BJMP) Bureau of Corrections Department of Interior and Local Government (DILG) Department of Education (DepEd) Armed Forces of the Philippines-Office of the Surgeon General (AFP-OTSG) PhilHealth
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Research Institute of Tuberculosis/ Japan Anti-Tuberculosis Association Philippines, Inc. (RIT/JATA) Philippine Tuberculosis Society Inc. (PTSI) Kabalikat sa Kalusugan Samahang Lusog Baga National Commission for Indigenous Peoples Department of National Defense-Veterans Memorial Medical Center (DNDVMMC) Occupational Health and Safety (OSHC); Bureau of Working Conditions (BWC) World Vision Development Foundation (WVDF) International Committee of Red Cross Korea Foundation for International Health Care (KOFIH) World Health Organization (WHO) United States Agency for International Development (USAID) Committee of German Doctors for Developing Countries

Natural Family Planning


Population/Family Planning Issue Senate Bill No. 1546: "Reproductive Health Act of 2004" House Bill No. 16: "Reproductive Health Act of 2004" The Truth About the P50M CFC Contract with DOH CFC-DOH Partnership Letter to the Editor: Philippine Daily Inquirer Family Planning Brief Description of Program A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. The program is anchored on the following basic principles. * Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper upbringing and education of children so that they grow up to be upright, productive and civic-minded citizens.

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National Filariasis Elimination Program


Filariasis is a major parasitic infection, which continues to be a public health problem in the Philippines. It was first discovered in the Philippines in 1907 by foreign workers. Consolidated field reports showed a prevalence rate of 9.7% per 1000 population in 1998. It is the second leading cause of permanent and long-term disability. The disease affects mostly the poorest municipalities in the country about 71% of the case live in the 4th-6th class type of municipalities. The World Health Assembly in 1997 declared Filariasis Elimination as a priority and followed by WHOs call for global elimination. A sign of the DOHs commitment to eliminate the disease, the programs official shift from control to elimination strategies was evident in an Administrative Order #25-A,s 1998 disseminated to endemic regions. A major strategy of the Elimination Plan was the Mass Annual Treatment using the combination drug, Diethylcarbamazine Citrate and Albendazole for a minimum of 2 years & above living in established endemic areas after the issuance from WHO of the safety data on the use of the drugs. The Philippine Plan was approved by WHO which gave the government free supply of the Albendazole (donated b y GSK thru WHO) for filariasis elimination. In support to the program, an Administrative Order declaring November as Filariasis Mass Treatment Month was signed by the Secretary of Health last July 2004 and was disseminated to all endemic regions. Vision: Healthy Philippines and productive individuals and families for Filariasis-free

Mission: Elimination of Filariasis as a public health problem thru a comprehensive approach and universal access to quality health services Goal: To eliminate Lymphatic Filariasis as a public health problem in the Philippines by year 2017 General Objectives: To decrease Prevalence Rate of filariasis in endemic municipalities to <1/1000 population. Specific Objectives: The National Filariasis Elimination Program specifically aims to: 1. Reduce the Prevalence Rate to elimination level of <1%; 2. Perform Mass treatment in all established endemic areas; 3. Develop a Filariasis disability prevention program in established endemic areas; and 4. Continue surveillance of established endemic areas 5 years after mass treatment. Baseline Data: Prevalence Rate (1997): 9.7% per 1,000 pop. Endemic in 43 provinces in 11 regions with a total population at risk of 30,000,000
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Target Population/Clients/Beneficiaries: The program targets individuals, families and communities living in endemic municipalities in 44 provinces in 12 regions (30 million targeted for mass treatment or 1/3 of the total population of the country). However, 9 provinces have reached elimination level namely: Southern Leyte; Sorsogon; Biliran; Bukidnon; Romblon; Agusan Sur; Dinagat Islands; Cotabato Province; and COMVAL. Program Strategies: STRATEGY 1. Endemic Mapping STRATEGY 2. Capability Building STRATEGY 3. Mass Treatment (integrated with other existing parasitic programs) STRATEGY 4. Support Control STRATEGY 5. Monitoring and Supervision STRATEGY 6. Evaluation STRATEGY 7. National Certification STRATEGY 8. International Certification Management Being Used: 1. Selective Treatment treating individuals found to be positive for microfilariae in nocturnal blood examination. Drug: Diethylcarbamazine Citrate Dosage: 6 mg/kg body weight in 3 divided doses for 12 consecutive days (usually given after meals) 2. Mass Treatment giving the drugs to all population from aged 2 years and above in all established endemic areas. Drug: Diethlcarbamazine Citrate (single dose based on 6 mg/kg body wt) plus Albendazole 400mg given single dose given once annually to people 2 yrs & above living in established endemic areas 3. Disability Prevention thru home-based or community-based care for lymphedema & elephantiasis cases. Surgical management for hydrocele patients. Status of the Program: PROVINCES THAT REACHED ELIMINATION STAGE: Southern Leyte, Sorsogon, Biliran, Bukidnon, Romblon, Agusan Sur, Dinagat island, Cotabato Province and COMVAL Partner Organizations/Agencies: The following are the organizations/agencies that take part in achieving the objectives of the National Filariasis Elimination Program: Coalition for the Elimination of Lymphatic Filariasis Culion Foundation, Inc. Peace and Equity Foundation, Inc. (PEF) Iloilo Caucus of Development NGOs, Inc. Iloilo (ICODE) Marinducare Foundation, Inc. Lingap Para sa Kalusugan ng Sambayanan, Inc. (LIKAS) Del Monte Foundation, Inc. Ang-Hortaleza Foundation (Splash Foundation)
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Belo Medical Group GlaxoSmitheKline Foundation Center for Social Concern and Action (COSCA) with Theology Religious Education Department (TREDTWO) De La Salle University-Manila UP Open University-Manila UP Manila National Institutes of Health (UP Manila-NIH) UP-College of Public Health

National Rabies Prevention and Control Program


Rabies is a human infection that occurs after a transdermal bite or scratch by an infected animal, like dogs and cats. It can be transmitted when infectious material, usually saliva, comes into direct contact with a victims fresh skin lesions. Rabies may also occur, though in very rare cases, through inhalation of viruscontaining spray or through organ transplants. Rabies is considered to be a neglected disease, which is 100% fatal though 100% preventable. It is not among the leading causes of mortality and morbidity in the country but it is regarded as a significant public health problem because (1) it is one of the most acutely fatal infections and (2) it is responsible for the death of 200300 Filipinos annually. Vision: To Declare Philippines Rabies-Free by year 2020

Goal: To eliminate human rabies by the year 2020 Program Strategies: To attain its goal, the program employs the following strategies: 1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite Treatment Centers (ABTCs) 2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk individuals and school children in high incidence zones 3. Health Education Public awareness will be strengthened through the Information, Education, and Communication (IEC) campaign. The rabies program shall be integrated into the elementary curriculum and the Responsible Pet Ownership (RPO) shall be promoted. In coordination with the Department of Agriculture, the DOH shall intensify the promotion of dog vaccination, dog population control, as well as the control of stray animals. In accordance with RA 9482 or The Rabies Act of 2007, rabies control ordinances shall be strictly implemented. In the same manner, the public shall be informed on the proper management of animal bites and/or rabies exposures. 4. Advocacy The rabies awareness and advocacy campaign is a year-round activity highlighted on two occasions March as the Rabies Awareness Month and September 28 as the World Rabies Day. 5. Training/Capability Building Medical doctors and Registered Nurses are to be trained on the guidelines on managing a victim.
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6. Establishment of ABTCs by Inter-Local Health Zone 7. DOH-DA joint evaluation and declaration of Rabies-free islands Program Achievements: The DOH, together with the partner organizations/agencies, has already developed the guidelines for managing rabies exposures. With the implementation of the program strategies, five islands were already declared to be rabies-free. In 2010, 257 rabies cases and 266,200 animal bites or rabies exposures were reported. A total of 365 ABTCs were established and strategically located all over the country. Post Exposure Prophylaxis against rabies was provided in all the 365 ABTCs. Partner Organizations/Agencies: The following organizations/agencies take part in attaining the goal of the National Rabies Prevention and Control Program: Department of Agriculture (DA) Department of Education (DepEd) Department of Interior and Local Government (DILG) World Health Organization (WHO) Animal Welfare Coalition (AWC) BMGF Foundation WHO/BMGF Rabies Elimination Project 1. Bill and Melinda Gates Foundation 2. World Society for the Protection of Animals (WSPA) 3. Medical Research Council (MRC)

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Newborn Screening
Republic Act 9288 Newborn screening (NBS) is a public health program aimed at the early identification of infants who are affected by certain genetic/metabolic/infectious conditions. Early identification and timely intervention can lead to significant reduction of morbidity, mortality, and associated disabilities in affected infants. NBS in the Philippines started in June 1996 and was integrated into the public health delivery system with the enactment of the Newborn Screening Act of 2004 (Republic Act 9288). From 1996 to December 2010, the program has saved 45 283 patients. Five conditions are currently screened: Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Phenylketonuria, Galactosemia, and Glucose-6-Phosphate Dehydrogenase Deficiency. Current Status of NBS Implementation in the Philippines Newborn Screening Legislation NBS was integrated into the public health delivery system with the enactment of Republic Act 9288 or Newborn Screening Act of 2004 as it institutionalized the National NBS System, which shall ensure the following: [a] that every baby born in the Philippines is offered NBS; [b] the establishment and integration of a sustainable NBS System within the public health delivery system; [c] that all health practitioners are aware of the benefits of NBS and of their responsibilities in offering it; and [d] that all parents are aware of NBS and their responsibility in protecting their child from any of the disorders. The highlights of the law and its implementing rules and regulations are: 1. DOH is the lead agency tasked with implementing this law; 2. Any health practitioner who delivers or assists in the delivery of a newborn in the Philippines shall prior to delivery, inform parents or legal guardians of the newborns the availability, nature and benefits of NBS; 3. Health facilities shall integrate NBS in its delivery of health services; 4. Creation of the Newborn Screening Reference Center at the National Institutes of Health and establishment and accreditation of NSCs equipped with a NBS laboratory and recall/follow up program;
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5. Provision of NBS services as a requirement for licensing and accreditation, the DOH and the Philippine Health Insurance Corporation (PHIC) 6. Inclusion of cost of NBS in insurance benefits Currently, there are four Newborn Screening Centers (NSCs) in the country: NSCNational Institutes of Health in Manila; NSC- Visayas in Iloilo City; NSC-Mindanao in Davao City; and NSC-Central Luzon in Angeles City. The four NSCs provide laboratory and follow up services for more than 3000+ health facilities. DOH, its partners and major stakeholders remain aggressive in identifying strategies to intensify awareness in the communities and increase coverage among home deliveries. Among the recent efforts to increase the newborn screening coverage are appointment of full-time Regional NBS Coordinators; opening more G6PD Confirmatory Laboratories; partnership with midwives organizations; and production of information materials targeting different groups of health workers and professionals. Key Players in the Implementation Organizational chart for the national implementation of Newborn Screening Newborn Screening Statistics As of December 2010, there are 2,389,959 babies that have undergone NBS and based on these data, the incidences of the following disorders are: CH (1: 3,324); CAH (1: 9,446); PKU (1: 149,372); Gal (1: 108,635) and G6PD deficiency (1: 52). The program has saved the following numbers of newborns from complications and/or death: 719 from CH, 253 from CAH, 22 from Gal, 16 from PKU and 44 273 from G6PD deficiency. Coverage As of December 2010, the coverage of NBS is at 35%. DIRECTORY OF PROGRAM IMPLEMENTERS National Center for Disease Prevention and Control Family Health Office Program Manager Dr. Juanita A. Basilio Dr. Anthony P. Calibo National Newborn Screening Coordinator: Ms. Lita Orbillo San Lazaro Compound, Sta. Cruz, Manila Telephone: (02) 7359956 litaorbillo_rn@yahoo.com

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Newborn Screening Reference Center Director: Dr. Carmencita D. Padilla National Institutes of Health Building H, UP Ayala Land Technohub Complex,Commonwealth Avenue, Brgy. UP Campus Diliman, Quezon City Email: info@newbornscreening.ph www.newbornscreening.ph Newborn Screening Centers For Regions I, II, III & CAR Unit Head: Dr. Florencio Dizon Newborn Screening Center Central Luzon Angeles City University Foundation Medical Center MacArthur Highway, Barangay Salapungan, Angeles City Telephone: (045) 6246502-03; Email: nsc@aufmc.org For Regions IV, V & NCR Newborn Screening Center National Institutes of Health Unit Head: Ms. Ma. Elouisa Reyes Building H, UP Ayala Land Technohub Complex,Commonwealth Avenue, Brgy. UP Campus Diliman, Quezon City Email: nbsadmin.ihg@gmail.com For Visayas Newborn Screening Center Visayas Unit Head: Dr. J Winston Edgar Posecion West Visayas State University Medical Center E. Lopez St., Jaro, Iloilo City Telefax: (033) 329-3744; Email: wvsumc_nsc@info.com.ph For Mindanao Newborn Screening Center Mindanao Unit Head: Dr. Conchita Abarquez Southern Philippines Medical Center J.P. Laurel Avenue, Davao City Telephone: (082) 226-4595 / 224-0337 Telefax (082) 227-4152; Email:nscmindanao@gmail.com

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Centers for Health Development CHD CHD 1 - Ilocos Mailing Address San Fernando, La Union Business Phone NBS Regional Coordinator

(072) 2425315; (072) Clarita B. Lewis, 2424773 RN (078) 3046585; (078) Leticia 8446585; (078) Cabrera, 8446523 MPA (045) 4552324; (045) Adelina 9617649; (045) RN 9617654 T. MD, Cabrera, M.

CHD 2 Tuguegarao City Cagayan Valley CHD 3 San Fernando, Pampanga Central Luzon

CHD 4-A QMMC Compound, Project 4, (02) 4403372 Calabarzon Quezon City CHD Mimaropa 4-B Quirino Hospital Compound, (02) 9134650; Quezon City 9115025 First Park Subdidivion, Daraga, Albay -

Maria Luisa Malana, RN

(02) Ma. Teresa Castillo, MD

CHD 5- Bicol CHD 6 Western Visayas

Carla A. Orozco, (052) 4830840 MD, MPH loc 517/516 MS III Renilyn P. Reyes, MD Nayda Bautista,MD, MPH P.

Q. Abeto St., Mandurriao, Iloilo (033)3210364 City (032) 4187633

CHD 7 Osmea Blvd., Cebu City Central Visayas CHD Eastern Visayas CHD 9 Zamboanga Peninsula CHD 10 Northern Mindanao 8Candahug, Palo , Leyte Upper City Calarian, Zamboanga

(053)3235025

Lilibeth Andrade, MD Nerissa Gutierrez, RN B.

(062)9830314-15

J.V. Seria St., Cagayan de Oro City

Carmen,

088-22- 727400

Ellenietta HMV N. Gamolo, MD, MPH

Ma. Clarose M. CHD 11 (082) 3051907; (082) J.P. Laurel Avenue, Davao City Mascardo, RN, Davao Region 2214011 MPH CHD 12 Central Mindanao ARMM Compound, Gov. (064) 4217436; (064) Lucy Decio, RN Guttierez Ave, Cotabato City 4218053
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CHD CARAGA CHD CAR CHD NCR CHD ARMM

Pizarro St. cor. Butuan City BGHMC City

Narra

Rd.

(085) 3411452

Glynna B. Andoy, MD, MPH

Compound,

Baguio (074) 4428096; (074) Nicolas R. Gordo, 4445255 Jr, MD (02) Ma. Paz Corrales, MD Dayan Sangcopan, MD P.

Welfareville Compound, Brgy. (02) 7183097; Addition Hills, Mandaluyong 5354521 City ORG Compound, Cotabato City (064) 4217703

Reunion of Saved Babies, October 10, 2010 at the UP Bahay ng Alumni, Quezon City

Continuing Education for Health Professionals, October 4, 2011 in La Union


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The Heel Prick Method

NBS Awarding Ceremony October 3, 2011 Traders Hotel

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National HIV/STI Prevention Program


Objective: Reduce the transmission of HIV and STI among the Most At Risk Population and General Population and mitigate its impact at the individual, family, and community level. Program Activities: With regard to the prevention and fight against stigma and discrimination, the following are the strategies and interventions: 1. Availability of free voluntary HIV Counseling and Testing Service; 2. 100% Condom Use Program (CUP) especially for entertainment establishments; 3. Peer education and outreach; 4. Multi-sectoral coordination through Philippine National AIDS Council (PNAC); 5. Empowerment of communities; 6. Community assemblies and for a to reduce stigma; 7. Augmentation of resources of social Hygiene Clinics; and 8. Procured male condoms distributed as education materials during outreach. Program Accomplishments: As of the first quarter of 2011, the program has attained particular targets for the three major final outputs: health policy and program development; capability building of local government units (LGUs) and other stakeholders; and leveraging services for priority health programs. For the health policy and program development, the Manual of Procedures/ Standards/ Guidelines is already finalized and disseminated. The ARV Resistance surveillance among People Living with HIV (PLHIV) on Treatment is being implemented through the Research Institute for Tropical Medicine (RITM). Moreover, both the Strategic Plan 2012-2016 for Prevention of Mother to Child Transmission and the Strategic Plan 2012-2016 for Most at Risk Young People and HIV Prevention and Treatment are being drafted. With regard to capability building, the Training Curriculum for HIV Counseling and Testing is already revised. Twenty five priority LGUs provided support in strengthening Local AIDS councils. as of March 2011, there were already 17 Treatment Hubs nationwide. Lastly, for the leveraging services, baseline laboratory testing is being provided while male condoms are being distributed through social Hygiene Clinics. A total of 1,250 PLHIV were provided with treatment and 4,000 STI were treated. Partner Organizations/Agencies: The following organizations/agencies take part in achieving the goal of the National HIV/STI Prevention Program: Department of Interior and Local Government (DILG) Philippine National AIDS Council (PNAC) Research Institute for Tropical Medicine (RITM) STI/AIDS Cooperative Central Laboratory (SCCL) World Health Organization (WHO)
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United States Agency for International Development (USAID) Pinoy Plus Association AIDS Society of the Philippines (ASP) Positive Action Foundation Philippines, Inc. (PAFPI) Action for Health Initiatives (ACHIEVES) Affiliation Against AIDS in Mindanao (ALAGAD-Mindanao) AIDS Watch Council (AWAC) Family Planning Organization of the Philippines (FPOP) Free Rehabilitation, Economic, Education, and Legal Assistance Volunteers Association, Inc. (FREELAVA) Philippine NGO council on Population, Health, and Welfare, Inc. (PNGOC) Leyte Family Development Organization (LEFADO) Remedios AIDS Foundation (RAF) Social Development Research Institute (SDRI) TLF share Collectives, Inc. Trade Union Congress of the Philippines (TUCP) Katipunang Manggagawang Pilipino Health Action Information Network (HAIN) Hope Volunteers Foundation, Inc. KANLUNGAN Center Foundation, Inc. (KCFI) Kabataang Gabay sa Positibong Pamumuhay, Inc. (KGPP)

National Mental Health Program


I. Rationale:

Background of the Program Vision: Better Quality of Life through Total Health Care for all Filipinos. Mission: A Rational and Unified Response to Mental Health. Goal: Quality Mental Health Care. Objective: Implementation of a Mental Health Program strategy The National Mental Health Policy shall be pursued through a Mental Health Program strategy prioritizing the promotion of mental health, protection of the rights and freedoms of persons with mental diseases and the reduction of the burden and consequences of mental ill-health, mental and brain disorders and disabilities. State International Support and Policies, Mandates Stakeholders: To ensure the sustainability and effectiveness of the National Mental Health Program, certain committees and teams were organized. 1. National Program Management Committee (NPMC) The NPMC is chaired by the Undersecretary of Health of the Policy and Standards Development Team for Service Delivery and co-chaired by the
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Director IV of the National Center for Disease Prevention and Control (NCDPC). Its functions are as follows: Oversee the development of mental health measures for sub-programs and components; Integrate the various programs, project and activities from the various program development and management groups for each sub-program; Manage the various sub-programs and components of the National Mental Health Program; Oversee the implementation of prevention and control measures for mental health issues and concerns; and Recommended to the Secretary of Health a master plan for mental health aligned with the mandates and thrusts of various government agencies. 2. Program Development and Management Teams (PDMT)

Under the NPMC, PDMT shall be established corresponding to the four sub-programs of the National Mental Health Program. A PDMT shall oversee the operations of a sub-program of the National Mental Health Program. The functions of PDMT are: Formulate and recommend policies, standards, guidelines approaches on each specifics sub-programs on mental health; Develop a plan of action for each specific sub-program in consultation with mental health advocates and stakeholders Develop operating guidelines, procedures, protocols for the mental health subprogram. Ensure the implementation of the program among all stakeholders; and Provide technical assistance to other mental health teams according to subprograms thrusts. 3. Regional Mental Health Teams (RMHT) To ensure an efficient and effective multi-sectoral implementation of the National Mental Health Program at the regional level, a RMHT shall be established in each of the Centers for Health Development (CHD). The functions are as follows: Oversee the planning and operation of the National Mental Health Program at the regional level; Provide technical assistance on the issues and concerns pertaining to the implementation of the different subprograms of the National Mental Health Program;
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Strengthen technical and managerial capability at the local level to ensure LGU participation on the implementation of the National Mental Health Program; Ensure establishment of LGU teams for mental health; Ensure the conduct of monitoring and evaluation of the implementation of the National Mental Health Program at the regional level; and Regularly update the PDMT on the status of the regional implementation of the National Mental Health Program. 4. Local Government Unit Mental Health Teams (LGUMHT)

The suggested members of the LGUMHT are the local health board members, technical health staff, civil society groups, non-government organizations and other stakeholders. Primarily, the LGUMHT enacts necessary legislative issuances and promotes and advocates the implementation of Community-based Mental Health Program among their respective localities and constituents. 5. Other Partners and Stakeholders

Other stakeholders who may or may not belong to the above-mentioned committees or teams may contribute to the implementation of the National Mental Health Program by: Ensuring the availability of competent, efficient, culturally and gender-sensitive health care professionals who provide mental health services; Identifying mental health needs of the population and refer findings to the appropriate mental care provider; and Promoting and advocating for the implementation of the program within their respective areas of responsibility. II. Scenario Global Situation: Many people with mental health conditions, as well as their families and caregiver, experience the consequences of vulnerability on a daily basis. Stigma, abuse, and exclusion are all-too-common. Although their vulnerability is not inevitable, but rather brought about their social environments, over time it leads to a range of adverse outcomes, including poverty, poor health, and premature death. Because they are highly vulnerable and are barely noticed- expert to be stigmatized and deprive of their rights- it is crucial that people with mental health conditions are recognized and targeted for development interventions. The case for their inclusion is compelling. People with mental health conditions meet vulnerability criteria: they experience severe stigma and discrimination; they are more likely to be subjected to abuse and violence than the general population; they encounter barriers to exercising their civil and political rights, and participating fully in society; they lack access to
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health and social services, and services during emergencies; they encounter restriction to education; and they excluded from income-generating and employment opportunities. As a cumulative result of these factors, people with mental conditions are at heightened risk for premature death and disability. Mental health conditions also are highly prevalent among people living in poverty, prisoners, people living with HIV/AIDS, people in emergency settings, and other vulnerable groups. Attention from development stakeholders is needed urgently so that the down-wardspiral of even-greater vulnerability and marginalization is stopped, and instead, people with mental health conditions can contribute meaningfully to their countries development. As a starting point, development stakeholders can consider carefully the general principles for action outlined in this report, and decided how best to incorporate them into their specific areas of work. Targeted policies, strategies, and interventions for reaching people with mental conditions then should be developed, and mental health interventions should be mainstreamed into broader national development and poverty reduction policies, strategies, and interventions. To make implementation a reality, adequate funds must be dedicated to mental health interventions, and recipients of development aid should be encouraged to address the needs of people with mental health conditions as a part of their development work. At country level, people with mental health conditions should be sought and supported to participate in development opportunities in their communities. Specific areas for action address the social and economic factors leading to vulnerability. Mental health services should be provided in primary care settings and integrated with general health services. To that end, mental health issues should be mainstreamed on countries broader health policies, plans, and human resource development, as well as recognized as an important issue to consider in global and multisectoral efforts, such as the International Health Partnership, the Gloring Health Workforce Alliance, and the Health Metrics Network. During and after emergencies, development stakeholders should promote the (re)construction of community-based mental health services, which can serve the population long beyond the immediate aftermath of the emergency. Development strategies and plans should encourage strong links between health/mental health services, housing, and other social services. Access to education for people with mental conditions, as well as early childhood programmes for vulnerable groups should be supported by development stakeholders in order to achieve better development outcomes. People with mental health conditions should be included in employment and income generating programmes to assist with poverty alleviation, improve autonomy and mental health. Throughout their different areas of work, development stakeholders can and should support human rights protections for people with mental conditions and built their capacity to participate in public affairs. This report provides a number of recommendation and specifics areas of action that need to be integrated into policy, planning, and implementation by development stakeholders according to their role and strategic advantage. To achieve this aim
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development stakeholders need to recognize people with mental health conditions as a vulnerable group requiring support from development programmes. (World Health Organization and Mental Health and Poverty Project, 2010) Local Situation In a local baseline survey in 1964-67 in Sta. Cruz, Lubao, Pampanga, Manapsal of the DOH Division of Mental Hygiene, Bureau of Disease Control, found that the prevalence of mental health was 36% per 1,000 adults, children and adolescents. The 1980 WHO Collaborative Studies for Extending Mental Health Care in General Health Care Services (involving seven countries) showed that 17% for adults and 16% of children who consulted at three health centers in Sampaloc, Manila have mental disorders. Depressive reactions in adults and adaptation reaction in children were most frequently found. In Sapang Palay, San Jose Del Monte, Bulacan, the prevalence of adult schizophrenia was 12 cases per 1,000 population in 1988-1989 (Manalang et al). In Region 6 (Iloilo, Negros Occidental and Antique), Perlas et al. im 1993-94 showed that the prevalence of the following mental illness in the adult population were: psychosis (4.3%), anxiety (14.3%), panic (5.6%). For the children and adolescent, the top five most prevalent psychiatric conditions were: enuresis (9.3%), speech and language disorder (3.9%), mental subnormality (3.7%), adaption reaction (2.4%) and neurotic disorder (1.1%). The current DOH bed capacity for mental disorder is 5,465. Of these, 4,200 beds are in the NCR (at the National Center for Mental Health). The rest of the country share the remaining 1,265 beds (CAR-40 beds, Region 2-200 beds, Region3-500 beds, Region 11-200 beds). Regions 1, 4, 10, 12, CARAGA and ARMM do not have inpatient psychiatric facilities. Only 27 DOH medical centers and regional hospitals have mental health services. Cavite is the only province with a psychiatric facility. These situations have hampered the delivery of basic services, aborted the national development, and reduced quality of life of the Filipino. Life has become severely stressful to most, whether rich or poor, young or old. The resiliency of the Filipino people to adapt to his present life situation is being stretched too far. Warning signs of restlessness abound such as increasing reports of suicides and substance abuse. Decline in the socio-economic condition may translate into mental-ill health and therefore mental health disorders and mental disabilities. However, the provision of mental health services in the country, has remained illness-oriented, institution-based, fragmented, inadequate, inequitable, inaccessible, prohibitive, and neglected. The Department of Health (DOH), the national lead agency for health recognizes the magnitude of the mental health problem as contained in the National Objectives for Health (NOH) 1999-2004. Among the objectives are set the following:
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Reduction of morbidity, mortality, disability and complications from mental disorder Promotion of healthy lifestyle through the promotion of mental health and less stressful life. However, the DOH has constraints in attaining these objectives given the limited government resources. Within the health sector, mental health has to compare for resources against other equally important health objectives. Concomitant reforms are therefore being pursued in hospitals, public health, local health systems, regulation as well as financing with the end-view of improving the health of all Filipinos as embodied in the Health Sector Reform Agenda. Statistics/Local data about the disease program
Disorder Specific Phobias Alcohol Abuse Depression Number of Diagnosis One Diagnosis Multiple Diagnosis 2 Diagnoses 3 Diagnoses >/=4 Diagnoses Total Number of Cases 93 31 14 % 19 6 3 95% CI 15.98, 23.1 4.56, 8.96 1.74, 4.8 % 12 15

No. of Respondents 56 66 32 7 27 122

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*Department of Health (DOH) and Field Epidemiology Training Program Alumni Foundation Incorporated (FETPAFI) III. Interventions/ Strategies employed or implemented by DOH

The National Mental Health Program has the following program strategies: 1. Health Promotion and Advocacy

Enrichment of advocacy and multimedia information, education and community (IEC) strategies targeting the general public, mental health patients and their families, and service providers shall be done through the promulgation of observances issued by the Office of the President.
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2.

Service Provision

Enhancement of service delivery at the national and local levels will enable the early recognition and treatment of mental health problems. To ensure continuity of care, mental health services for people with persistent disabilities shall be established close to home and the workplace. 3. Policy and Legislation

The formulation and institutionalization of national legislation, policies, program standards and guidelines shall emphasize the development of efficient and effective structures, systems, and mechanisms that will ensure equitable, accessible, affordable and appropriate health services for the mentally ill patients, victims of disaster, and other vulnerable groups. 4. Encouraging the development of a research culture and capacity

The program shall support researches and studies relevant to mental health, with focus on the following areas: clinical behavior, epidemiology, public health treatment options, and knowledge management. It aims to acquire evidence-based information that will contribute to the public health information and education, policy formulation, planning, and implementation. 5. Capability Building

The capability of national, regional and local health workers in delivering efficient, effective and appropriate mental health services shall be strengthen. Training shall be conducted on psychosocial care, the detection and management of specific psychiatric morbidity, and the establishment of mental health facilities. 6. Public-Private Partnership

Inter-sectoral approaches and networking with other government agencies, nongovernment organizations, academe and private service providers and other stakeholders at the locals, regional and national levels shall be pursued to develop partnership and expand the involvement of stakeholders in: a.) advocacy, promotion and provision of mental health services; b.) conduct of relevant studies, researches and surveys; c.) training of mental health workers; d.) sharing of researches, data and other information on mental issues and concerns; and e.) sharing of resources. 7. Establishment of data base and information system

This is needed to determine the magnitude of the problem, its epidemiological characteristics and knowledge and practices to serve as basis for shifting the program for being institutional and treatment focused to being preventive, family focused and community oriented.
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8.

Development of model programs

Best practices/models for prevention of substance abuse and risk reduction for mental illness can be replicated in different LGUs in coordination with other agencies involved in mental health and substance abuse prevention programs. 9. Monitoring and Evaluation

A regular review process shall be conducted. Results of program monitoring and evaluation shall be used in formulating and modifying policies, program objectives and action plans to sustain the mental health initiatives and ensure continuing improvement in the delivery of mental health care. Program Direction Micro Point of View Major Activities/Celebrations: Celebration Autism Consciousness Week National Mental Retardation Week National Epilepsy Awareness Week National Mental Health Week

Date Every 3rd Week of January February 14 to 19 Every 1st Week of September Every 2nd Week of October

National Attention Deficit/Hyperactivity Every 3rd Week of October Disorder Awareness Week Substance Abuse Prevention & Control Week Every 3rd Week of November

V.

Future Plan/ Action 2 Batches of Training on Promotion Mental Health in the Communities 1 Batch of Training on Psychosocial Intervention Series of lecture on Suicide prevention in different Schools & Colleges Mental Health Summit in celebration of World Mental Health Day

Partner Organizations/Agencies: The following organizations/agencies partake in achieving the vision of the program: Philippine Psychiatric Association (PPA) Suite 1007, 10th flr. Medical Plaza Ortigas Condominium San Miguel Ave. Ortigas Center Pasig City # (632) 635-98-58.
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Dr. Constantine Della President Contact no. 0922-8537949 Email Add.: constantine.della@dlsu.edu.ph Dr. Romeo Enriquez Vice President Contact no. 0933-5794140/ 0920-9053041 Email add: pnasop@yahoo.com National Center for Mental Health (NCMH) Nuevo de Pebrero St. Mauway, Madaluyong City # (632) 531-90-01 Dr. Bernardino Vicente Medical Center Chief Philippine Mental Health Association (PMHA) No. 18 East Avenue, Quezon City 1100 #(632) 921-49-58; (632) 921-49-59 Ms. Regina De Jesus National Executive Director Christoffel Blindenmission (CBM) Unit 604, Alabang Business Tower 1216 Acacia Avenue, Madrigal Business Park Alabang, Muntinlupa City 178 # (632) 807-85-86; (632) 807-85-87 Mr. Willy Reyes Contact no. 0905-4142608

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National Dengue Prevention and Control Program


The National Dengue Prevention and Control Program was first initiated by the Department of Health (DOH) in 1993. Region VII and the National Capital Region served as the pilot sites. It was not until 1998 when the program was implemented nationwide. The target populations of the program are the general population, the local government units, and the local health workers. Vision: Dengue Risk-Free Philippines Mission: To improve the quality of health of Filipinos by adopting an integrated dengue control approach in the prevention and control of dengue infection. Goal: Reduce morbidity and mortality from dengue infection by preventing the transmission of the virus from the mosquito vector human. Objectives: The objectives of the program are categorized into three: health status objectives; risk reduction objectives; and services & protection objectives. Health Status Objectives: Reduce incidence from 32 cases/100,000 population to 20 cases/100,000 population; Reduce case fatality rate by <1%; and Detect and contain all epidemics. Risk Reduction Objectives: Reduce the risk of human exposure to aedes bite by House index of <5 and Breteau index of 20; Increase % of HH practicing removal of mosquito breeding places to 80%; and Increase awareness on DF/DHF to 100%. Services & Protection Objectives: Establish a Dengue Reference Laboratory capable of performing IgM capture ELISA for Dengue Surveillance; Increase the % of 1 and 2 government hospitals with laboratory capable of platelet count and hematocrit; and Ensure surveillance and investigation of all epidemics. Partner Organizations/Agencies: The following organizations/agencies take part in the achievement of the programs objectives: World Health Organization (WHO) United Nations childrens Fund (UNICEF) Department of Interior and Local Government (DILG) Department of Education (DepEd) United States Agency for International Development (USAID) Asian Development Bank (ADB) Philippine Health Insurance Corporation (PhilHealth)
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National Prevention of Blindness Program


Government Mandates and Policies: Administrative Order No. 179 s.2004: Guidelines for the Implementation of the National Prevention of Blindness Program Department Personnel Order No. 2005-0547: Creation of Program Management Committee for the National Prevention of Blindness Program Subcommittees: Refractive Error/Low Vision, Childhood Blindness, Cataract Proclamation No. 40 declaring the month of August every year as Sight Saving Month Vision: All Filipinos enjoy the right to sight by year 2020 Mission: The DOH, Local Health Unit (LGU) partners and stakeholders commit to: 1. Strengthen partnership among and with stakeholder to eliminate avoidable blindness in the Philippines; 2. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness; 3. Provide access to quality eye care services for all; and 4. Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos. Goal: Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care. The program has the following objectives: General Objective No. 1: Increase Cataract Surgical Rate from 730 to 2,500 by the year 2010 Specific: 1. Conduct 74,000 good outcome cataract surgeries by 2010; 2. Ensure that all health centers are actively linked to a cataract referral center by 2008; 3. Advocate for the full coverage of cataract surgeries by Philhealth; 4. Establish provincial sight preservation committees in at least 80% of provinces by 2010; 5. Mobilize and train at least one primary eye care worker per barangay by 2010; 6. Mobilize and train at least one mid-level eye care health personnel per municipality by 2010; 7. Improve capabilities of at least 500 ophthalmologists in appropriate techniques and technology for cataract surgery; 8. Develop quality assurance system for all ophthalmology service facilities by 2008; and 9. Ensure that 76 provincial,16 regional and 56 DOH retained hospitals are equipped for appropriate technology for cataract surgery.

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General objective no 2: Reduce visual impairment due to refractive errors by 10% by the year 2010 1. Institutionalize visual acuity screening for all sectors by 2010; 2. Ensure that all health centers are actively linked to a referral center by 2008; 3. Distribute 125,000 eye glasses by 2010; 4. Ensure that the hospitals and of health centers have professional eye health care providers by 2010; 5. Ensure establishment of equipped refraction centers in municipalities by 2008; and 6. Establish and maintain an eyeglass bank by 2007. General objective no 3: Reduce the prevalence of visual disability in children from 0.3% to 0.20% by the 2010 1. Identify children with visual disability in the community for timely intervention; 2. Improve capability of 90% of health worker to identify and treat visual disability in children by 2010; and 3. Establish a completely equipped primary eye care facility in municipalities by 2008. Burden of Blindness and Visual Impairment : Global Facts The Philippines is a signatory in the Global Elimination of Avoidable Blindness: Vision 2020 The Right to Sight. The Vision 2020 was initiated by the International Agency for Prevention of Blindness (IAPB), World Health Organization (WHO), and the Christian Blind Mission (CBM), Vision 2020 aims to develop sustainable comprehensive health care system to ensure the nest possible vision for all people and thereby improve the quality of life. According to WHO estimates: Approximately 314 million people worldwide live with low vision and blindness Of these, 45 million people are blind and 269 million have low vision 145 million people's low vision is due to uncorrected refractive errors (nearsightedness, far-sightedness or astigmatism). In most cases, normal vision could be restored with eyeglasses Yet 80% of blindness is avoidable - i.e. readily treatable and/or preventable 90% of blind people live in low-income countries Restorations of sight, and blindness prevention strategies are among the most cost-effective interventions in health care Infectious causes of blindness are decreasing as a result of public health interventions and socio-economic development. Blinding trachoma now affects fewer than 80 million people, compared to 360 million in 1985 Aging populations and lifestyle changes mean that chronic blinding conditions such as diabetic retinopathy are projected to rise exponentially Women face a significantly greater risk of vision loss than men Without effective, major intervention, the number of blind people worldwide has been projected to increase to 76 million by 2020
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Burden of Blindness and Visual Impairment : Local Facts Number of blind people: 592,000 (based on 2011 estimated population of 102M & 2002 blindness prevalence of 0.58%) Number of persons with moderate or severe visual impairment: 2 million (2011 popn. & 2002 prevalence of 2.04%) Number of blind due to cataract: 367,000 (62%) Number of blind due to EOR: 59,000 (10%) Number of blind from cataract below poverty line: 92,000 (25%, NSCB 2009 figures]; figure est. doubled to include first & second quintiles RP Prevalence of Blindness (%), 2002 Caraga National Capital Region Cordillera Autonomous Region Central Mindanao Ilocos Region Western Visayas Eastern Visayas Southern Luzon National Figure Northern Mindanao Central Visayas Bicol Region Western Mindanao Central Luzon Autonomous Region of Mislim Mindanao Cagayan Valley Southern Mindanao

0.16 0.19 0.2 0.4 0.5 0.51 0.53 0.56 0.58 0.61 0.62 0.71 0.74 0.79 0.8 0.87 1.08

RP Prevalence of Low Vision (%), 2002 Caraga National Capital Region Cordillera Autonomous Region Central Luzon

0.6 0.81 0.87 1.21


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Central Mindanao Western Mindanao Southern Mindanao Central Visayas Western Visayas National Figure Northern Mindanao Ilocos Region Autonomous Region of Muslim Mindanao Bicol Region Eastern Visayas Southern Luzon Cagayan Valley RP Prevalence of Visual Impairment (%) , 2002 Caraga National Capital Region Cordillera Autonomous Region Central Mindanao Central Luzon Western Mindanao Central Visayas Western Visayas National Figure Northern Mindanao Southern Mindanao (blindness) Ilocos Region (Low Vision) Eastern Visayas (Low Vision) Autonomous Region of Muslim Mindanao Bicol Region Southern Luzon (Low Vision) Cagayan Valley

1.53 1.59 1.71 1.76 1.91 1.98 2.17 2.43 2.43 2.52 2.56 3.71 4.07

0.76 1 1.07 1.93 2 2.33 2.38 2.42 2.56 2.78 2.79 2.93 3.18 3.23 3.23 4.27 4.94

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Interventions/Strategies employed or Implementation by the DOH 1. Advocacy and Health Education This includes patient information and education, public information and education and intersectoral collaboration on eye health promotion and the nature and extent of visual impairments particularly its risk factors and complications and the need/urgency of early diagnosis and management. 2. Capability Building This component shall focus on ensuring the capability of national and local government health facilities in delivering the appropriate eye health care services especially to the indigent sector of the population. Program shall provide training for coordinators at regional and provincial levels; will ensure the availability of and access to training programs by program implementers. It shall include strengthening treatment/management capabilities of existing personnel and operating capabilities of facilities conducting cataract operations etc., taking into outmost consideration basic quality assurance and standardization of procedures and techniques appropriate to each facility/locality. 3. Information Management The program shall develop an information management system for purposes of reporting and recording. As far as practicable, this system shall consider and will build on any existing mechanism. The system shall be national in scope, although the mechanism shall consider the regional and local needs and capabilities. 4. Networking, Partnership Building and Resource Mobilization An important component of the program is networking and partnership building to ensure that services are available at the local level. This shall include publicprivate and public-public partnership aimed at building coalition and networks for the delivery of appropriate eye health care services at affordable cost especially to the indigent sector. This component shall also focus on ensuring that the highest appropriate quality services are made available and accessible to the people. 5. Supervision, Monitoring and Evaluation The Program shall be coordinated by a national program coordinator from the Degenerative Disease Office of the National Center for Disease Prevention and Control, Department of Health. The national program coordinator shall oversee the implementation of program plans and activities with the assistance of the regional coordinators from the Centers for Health Development. A system of monitoring program plans and activities shall be developed and implemented taking into consideration the provision of the local government code as well as the organic act of Muslim Mindanao, and any similar issuances/laws that will be passed in the future. A program review shall be conducted as needed. Result of program evaluation shall be used in formulating policies, program objectives and action plans.

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Research and Development The program shall encourage the conduct of researches for purposes of developing local competence in eye health care and for other purposes that may be necessary. The development and dissemination of clinical practice guidelines for eye health shall form part of the research agenda of the program. The program shall support researches/studies in the clinical behavior (KAP) and epidemiological (trends) areas. It also aims to acquire information that is utilized for continuing public health information and education, policy formulation, planning and implementation. 7. Service Delivery Service delivery for the prevention of Blindness Program shall be covered by the principle of best practice. In collaboration with the local government units and stakeholders, the program shall develop systems and procedures for the integration and provision of services at the community level. This means primary eye prevention concentrating on health education, advocacy and primary eye interventions; Secondary prevention; screening/early detection/basic management/ counseling, referral and/or definitive care and tertiary prevention: management of complications, continuing care and follow up including rehabilitation. The following areas will be the priority areas for services to be provided by the National Prevention of Blindness Program: a. b. c. Cataract Surgeries Errors of Refraction Childhood Blindness

6.

Activities for the Vitamin A Deficiency Disorder, for practical purposes, shall be led by the Family Health Office also of the NCDPC. A Referral System shall form part of services delivered by the program. This is to ensure that all patients receive quality eye health care at appropriate levels of health care delivery system. All rural health units should be linked to an eye care referral center. Cataract Cataract, the opacification of the normally clear lens of the eye, is the most common cause of blindness worldwide. It is the cause in 62% of all blindness in the Philippines and is found mostly in the older age groups. The only cure for cataract blindness is surgery. This is available in almost all provinces of the country; however there are barriers in accessing such services. Interventions will therefore consist of increasing awareness about cataract and cataract surgery; as well as improving the delivery of cataract services. The parameter used worldwide to monitor cataract service delivery is the Cataract Surgical Rate. Errors of Refraction Errors of refraction is the most common cause of visual impairment in the country (prevalence is 2.06% in the population). Errors of refraction are corrected either with spectacle glasses, contact lenses or surgery. The services to address the problem of
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EOR are provided mainly by optometrists. However, the provision of the eyeglasses or lenses (who should provide, how is it provided, etc.) has to be addressed. Childhood Blindness The prevalence of blindness among children (up to age 19) is 0.06% while the prevalence of visual impairment in the same age group is 0.43%. The problem of childhood blindness is the highly specialized services that are needed to diagnose and treat it. However, screening of children for any sign of visual impairment can be done by pediatricians, school clinics and health workers. Future Plan/Action: Development of Service Package for Prevention Blindness Program Development of Clinical Practice Guidelines for Prevention Blindness Program Development of Strategic Framework and a Five Year Strategic Plan for Prevention Blindness Program (2012-2016) Continue conduct of promotion and advocacy activities and partnership with National Committee for Sight Preservation, Specialty Societies and other stakeholders on PBP Creation of PBP Registry System Ensure the implementation of the National Prevention of Blindness Program

Status of Implementation/Accomplishment: Department of Health supports prevention of blindness and vision impairment Signatory of all World Health Assembly resolution on Vision 2020 and blindness prevention. National Prevention on Blindness Program under Non-Communicable Disease Cluster. Funded 3 national surveys of blindness 1987, 1955 and 2002. Planning workshop 2004 crafted 5 year development plan for eye care 2005-2010 assisted by IAPB / ICEH. AO 179 issued on Nov. 2004 by Sec. Dayrit creating Guidelines for Implementation of the National Prevention Blindness Program (NPBP) which set-up the Program Management Committee (PMC) Blindness prevention and rehabilitation of persons with irreversible blindness are incorporated in the health program for persons with disability of DOH The following programs/projects are included in the Maternal and Child Care Program of DOH: Expanded Program for Immunization (includes vaccination for diseases that causes blindness) Vitamin A provision for pregnant mothers and children to prevent vitamin A deficiency Comprehensive newborn care includes prophylaxis for ophthalmia neonatorum
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Newborn screening includes screening for galactosemia which cause congenital cataract Several activities in the PBP Consultative and Planning Workshop on PBP, October 2011 National Eye Summit, Manila Grand Opera Hotel, Manila last October 2009 Strategic Planning Workshop on the National Sight Preservation and Blindness Program 2008 Training of Trainors of Primary Eye Care conducted 2007 Other Significant information: Available Human Resources: Ophthalmologists 1,573 registered PAO members as of January 27, 2011 95% is in private practice Optometrists 10,266 registered with Philippine Board of Optometry as of July 2010

Financial Resources DOH provides funds largely for technical assistance for training, capacity building activities, and augmentation of funds for local program implementation. Philippine Health Insurance Corporation covering personal eye care services (hospital based) Partner Organizations: Aside from the collaborating divisions in the DOH, the following institutions partake in the program: Local Government Units (LGUs) National Committee for Sight Preservation (NCSP) Philippine Academy of Ophthalmology Philippine Information Agency Optometric Association of the Philippines Rotary International Integrated Philippine Association of Optometrists Foundation for Sight Helen Keller International Lions Club International Tanggal Katarata Foundation UP - Institute of Ophthalmology Christian Blind Mission
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Resources for the Blind SentroOfthalmologico Jose Rizal World Health Organization Sources: Files and Links: Administrative Order No. 179 s. 2004 World Health Organization

Occupational Health Program


Vision/Mission Statement Health for all occupations in partnership with the workers, employers, local government authorities and other sectors in promoting self-sustaining programs and improvement of workers' health and working environment.

Program Objectives and Targets To promote and protect the health and well being of the working population thru improved health, better working conditions and workers' environment.

Persons with Disabilities


I. Profile / Rationale of the Health Program

Republic Act No. 7277, An Act Providing for the Rehabilitation, and SelfReliance of Disabled Persons and Their Integration into the Mainstream of Society and for Other Purposes, and otherwise known as The Magna Carta for Disabled Persons. was passed in July 19, 1991. This specifically required the Department of Health (DOH) to. (1) Institute a national health program for PWDs, (2) establish medical rehabilitation centers in provincial hospitals, and (3) adopt an integrated and comprehensive to the Health Development of PWD which shall make essential health services available to them at affordable cost. Rule IV, Section 4. Paragraph B of the implementing rules and regulations (IRRI) of this act required the Department of Health to address the health concerns of seven (7) different categories of this ability, which includes the following: (1) Psychosocial and behavioral disabilities, (2) Chronic illnesses with disabilities, (3) Learning (cognitive or intellectual) disabilities, (4) Mental disabilities, (5) Visual/ seeing disabilities, (6) Orthopedic/ moving, and; (7) Communications deficits. In compliance thereof, the DOH piloted in 1995 a community based rehabilitation program in 112 (7.5%) out of 1,492 towns nationwide. Between 1992 and 2004 it had upgraded DOH hospital facilities to include rehabilitation and allied medical services for PWDs. Today there are about 21 DOH hospitals that have rehabilitation program/units/centers representing 22% of all DOH hospitals. It had registered 508,270 PWDs in 2004 or about 12% of the target PWD population. (Source: DOH report 2004). The turnout was influenced by the presence, absence or inadequacy of health services for PWDs at the local regional level and in DOH health
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facilities. A Social Weather (SWS) survey commissioned by DOH last 2004 revealed that around 7% of the households under the study have at least one family member who is disabled. (Source SWS Survey 2004). With the frontline services of the Department of Health developed to the local government units, the final implementation of this Act now rests with the Local Government Units (LGUs). This Order prescribes the guidelines in the formulation, implementation, and evaluation of health programs for PWDs. Vision: Improve the total well-being of Person with Disabilities (PWD) Mission: The Department of Health, as the focal organization, shall ensure the development, implementation, and monitoring of relevant and efficient health programs and systems for PWDs that are available, affordable, and acceptable. Goals and Objectives: This Order defines and establishes the strategic and operational framework for the development, implementation and monitoring of an effective, and efficient, promotive, preventive, curative, rehabilitative and palliative health services from conception, birth, growth, maturity and in terminal phase in the life of PWDs Strategic Goals: International Development Organizations (INGOs) American Leprosy Missions World Health Organization Australian Agency for International Development (AusAID) Christoffel Blindenmission (CBM) JICA Expert Unicef II. SCENARIO

Global Situation Key facts Over a billion people, about 15% of the worlds population, have some form of disability. Between 110 million and 190 million people have significant difficulties in functioning. Rates of disability are increasing due to population ageing and increases in chronic health conditions, among other causes. People with disabilities have less access to health care services and therefore experience unmet health care needs. HOW ARE THE LIVES OF PEOPLE WITH DISABILITIES AFFECTED? People with disabilities are particularly vulnerable to deficiencies in health care services. Depending on the group and setting, persons with disabilities may experience greater vulnerability to secondary conditions, co-morbid conditions, age181

related conditions, engaging in health risk behaviors and higher rates of premature death. Secondary conditions Co-morbid conditions Age-related conditions Engaging in health risk behaviors Higher rates of premature death BARRIERS TO HEALTH CARE People with disabilities encounter a range of barriers when they attempt to access health care including the following.

Prohibitive costs Limited availability of service Physical barriers Inadequate skills and knowledge of health workers

ADDRESSING BARRIERS TO HEALTH CARE Governments can improve health outcomes for people with disabilities by improving access to quality, affordable health care services, which make the best use of available resources. As several factors interact to inhibit access to health care, reforms in all the interacting components of the health care system are required. Policy and legislation Financing Service delivery Human resources Data and research Local Situation The results of the 1995 Census showed that the total population of persons with various disabilities was 919,332. Considering that the total population of the country at that time was 68,617,000, the disabled population was 1.3%. The male population was comprised of 0.6% while female, also, 0.6%. The low vision had the highest prevalence rate of 4.0%. The recently conducted 2000 National Census of Population is expected to provide a better and reliable statistics of persons with disability in as much as its preparation for the conduct gave much consideration to observe limitations, weaknesses and errors of the previous censuses and surveys as well as the criticisms and recommendations of experts and users. However, the result of the Census only registered 1.23 percent PWDs which is way below the prevalence rate estimated by the World health Organization. III. Interventions/ Strategies employed or implemented by DOH

The program goals are: 1. Reduce the prevalence of all types of disabilities; and
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2. Promote, and protect the human rights and dignity of PWDs and their caregivers. Strategic Objectives: The strategic objectives of the program are as follows: 1. Develop an integrated national health and human rights program and local models to serve the special health needs; 2. Pursue the implementation and monitoring of laws and policies for PWD such as the accessibility law, human rights, and other related laws; 3. Ensure that the health facilities and services are equitable, available, accessible, acceptable, and affordable to PWD through the development and implementation of essential health package that is suitable to their special needs and enrollment of into the National Health Insurance Program; 4. Initiate and strengthen collaboration and partnership among stakeholders to improve the facilities devoted to the management and rehabilitation of PWD and upgrade the capabilities of health professional and frontline workers to cater to their special needs; and 5. Continue and fast-track the registration of PWD in order to generate data for accurate planning and implementation of programs. The Philippine Registry for Persons with Disability will be continued, monitored, and evaluated and developed into an information system that will be incorporated into currently used health service information system. Program Strategies/Program Components: A Health program shall be developed for each type of disability and special population which must contain all of the following essential components: 1. Health Promotion This concept shall include patient and caregiver information and education, public information and education and intersectoral collaboration on disability health promotion on the nature and extent of impairments particularly its risk factors, complications and the need/urgency of early diagnosis and management. This component shall ensure the advocacy for the following promulgated observances on the following specified time each year as per issuances from the Office of the President: Celebration Autism National Downs Syndrome Retarded Childrens Week Time Every 3rd week of January Every February February 14 to 19
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Leprosy Week Women with disabilities Day

Last week of February Last Monday of March

National disability Prevention and Rehabilitation Every 3rd week of July Week NDPR Week to Culminate on the Birthdate of the July 23 Sublime Paralytic: Apolinario Mabini White Cane Safety Day in the Philippines Brain attack awareness Cerebral Palsy Awareness Week National Epilepsy Awareness Week National Mental Health Week August 1 3rd Week of August September 16 to 22 1st Week of September 2nd Week of October

Bone and Joint (Musculo-Skeletal) Awareness Week 3rd Week of October National Attention Deficit / Hyperactivity Disorder rd 3 week of October (ADHD) Awareness Week National Skin Disease Detection and Prevention nd 2 Week of November Week Deaf Awareness Week Drug Abuse Prevention and Control November 10 to 16 3rd Week of November

Future related observances promulgated by the office of the President shall also become part of this component. 2. Capability Building

3. Philippine Registry for Persons with Disabilities (PRPWD) 4. Networking, Inter-organizational linkages, and Resource Mobilization 5. Monitoring and Evaluation 6. Accreditations and Equitable Health Financing Packages 7. Research and Development 8. Service Delivery The following areas for services to be developed for implementing facilities, localities or organizations: 1. Community based and institution-based rehabilitation program 2. Clinical assessment of functioning, health and disability 3. Medical assistive devices

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IV.

Status of Implementation/ Accomplishment Capability Building on Community Rehabilitation of Barangay Health Workers in Pilot areas-Done. Web enabled online Registration implemented. Expansion of coverage of Newborn Screening. Implementation of PWD Health Benefits as provided for RA 3994(20% discount). Support to activities of PWD groups given.

V.

Future/ Action Conduct Sensitivity training to Health workers at all levels. Formulate PWD Health service packages. Formulate mechanism to provide specialty society services on detection diagnosis and care of non-apparent PWDs in all region.

Program Managers: Dr. Frank Diza Department of Health-National Center for Disease Prevention and Control (DOHNCDPC) Contact Number: 651-78-00 local 1750-1752 Files and Links: Administrative Order No. 2006-003 World Health Organization The Philippine Disability Data Situation(UNESCAP Website

Pinoy MD Program
"Gusto kong Maging Doktor" A Medical Scholarship Grant for Indigenous People, Local Health Workers, Barangay Health Workers, Department of Health Employees or their children. This is a jJoint program of the Department of Health (DOH), Philippine Charity Sweepstakes Office (PCSO), and several State Universities and Medical Schools. For interested applicants see the PinoyMD flyer for the qualification and scholarship package details.

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Philippine Cancer Control Program


I. Rationale Cancer is predicted to be an increasingly important cause of morbidity and mortality in the next few decades, in all regions of the world. The challenges of tackling cancer are enormous and when combined with population ageing increases in cancer prevalence are inevitable, regardless of current or future actions or levels of investment. In recognition of current and emerging importance of non-communicable diseases like cancer, E.O 119 reorganizing the Department of Health, had revised a Non-Communicable Disease Control Service whose mandate includes planning and management of Cancer Control activities. This order provides for guidelines on the Philippine Cancer Control Program (PCCP) to be organized and managed by the NonCommunicable Disease Service. Vision : Improve quality of life for all Filipinos Mission : To provide quality, effective and accessible services for the prevention and control of cancer Goal : Reduce morbidity, mortality and disability due to common preventable cancers Objectives: 1. To reduce the exposure of population to risk related factors primarily smoking, unhealthy diet, physical inactivity, and harmful use of alcohol, cancer related infections, chemical and ultra violet rays exposure. 2. To increase the number of patient given appropriate screening, diagnosis and treatment on cancer 3. To increase the number of patient given appropriate pain relief and support care services with cancer Mandates: A. Program Policies AO 89-A s. 1990 Establishment of Phil. Cancer Control Program dated April 18, 1990 AO 2005-0006 Establishment of Cervical Cancer Screening Program dated February 10, 2005 RA 7846 Compulsory Hepatitis B Immunization AO 122 s 2003 on Smoking Cessation Program AO 2007-2004 National Tobacco Prevention and Control Program AO 2011-0003 National Policy on Strengthening the Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases B. Policies on HL Promotion-Healthy Diet & Nutrition
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RA7394 or Consumer Act of Phils. to enforce compulsory labeling to enable consumer obtain accurate information as to the content of the products AO 88-B s. 1984 Rules & regulations on labeling of pre-Packaged Food Products to ensure labels are not fake, misleading and deceptive DepEd Memo 373 s. 1998 encouraging sale and consumption of healthy foods in school. Bureau Circular 2007-002 Guidelines in the Use of Nutrition and Health Claims in Food C. Policies HL Promotion-Smoking/Alcohol RA 9334 An Act Increasing the Excise Tax Rated Imposed on Alcohol & Tobacco Products RA 9211 Act Regulating Use, Sale and Distribution and Advertisements of Tobacco Products RA 8749 Phil. Clean Air Act-prohibits smoking in public places or outdoors Policy on HL Promotion-Physical Activity Civil Service Memo Circular enjoining all government institution to implement physical and Mental fitness program Policy on Awareness Campaign PD 1349 s. 1974 mandated DOH/PCS & other organization to observe National Cancer Consciousness Week. Department Circular #2009-0019 Launching of HL to the Max dated Jan 21, 2000 promoting the 7 healthy lifestyle practices Policy on Cancer Screening/ Diagnosis and Treatment RA 4921 Act extending the scope of cancer detection and diagnostic center of JRMMC to include cancer treatment & research AO 19 s. 1987 transferring of functions for Cancer Control Center to JRMMC & to the Non-Communicable Control Services under Office of Public Health Service & Cancer Control Center shall be converted into Dept of Radiotherapy AO 3-B s. 1997 DOH Guidelines on Papanicolaou Smear Procedure dated March 27, 1997 AO 19-A s.1998 National Policy on Cyto-Screening in the Cervical Cancer Control Program

D.

E.

F.

G. Policy on Strengthening Cancer Registry AO 188-A s. 1973 Authority & Functions of National Center for Disease Prevention and Control responsible for Cancer Epidemiology in the Phils. & to collect data & statistics to establish reliable cancer registry of nationwide scope. H. Policy on Management & Planning DPO # 2010-2976 on the Creation of TWG on Cervical Cancer Prevention and Control dated July 13, 2010
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International Support, Policies and Mandates International Policies and Mandates WHA58.22 cancer prevention and control WHA57.12 on the reproductive health strategy, including control of cervical cancer screening WHA57.16 on health promotion and healthy lifestyles; WHA57.17 on the Global Strategy on Diet, Physical Activity and Health, WHA56.1 on tobacco control
International Support In 2011, the UNFPA had donated three (3) units of cryotherapy machines for use in the treatment of pre cancerous lesion in the cervix. This partner also provided funds in the development of the Training Module on Cervical Cancer Prevention and Control together with the support of Womens Health and Safe Motherhood Project II.

II.

Scenario

Global Cancer is the major public health problem worldwide. It ranks second in the leading cause of death in developed countries and is the third leading cause of deaths in the developing countries. About 7.6 million deaths occurred per day worldwide, by 2030; around 27 million new cases are expected to occur if the government will not act on it. The forecasted changes in population demographics in the next two decades mean that even if current global cancer rates remain unchanged, the estimated incidence of 12.7 million new cancer cases in 2008 (5) will rise to 21.4 million by 2030, with nearly two thirds of all cancer diagnoses occurring in low- and middleincome countries (6). Large variations in both cancer frequency and case fatality are observed, even in relation to the major forms of cancer, in different regions of the world. The geographical variation in cancer distribution and patterns is mirrored on examination of cancer morbidity and mortality data in relation to the World Bank income groups of countries. Within upper-middle-income and high-income countries, prostate and breast cancers are the most commonly diagnosed in males and females respectively, with lung and colorectal cancers representing the next most common types in both sexes. These cancers also represent the most frequent types of cancerrelated deaths in these countries although lung cancer is the most common cause of cancer death in both sexes. Within low-income countries, the absolute burden of cancer is much lower, and while lung and breast cancers remain among the most common diagnoses and types of cancer-related deaths, cancers of the cervix, stomach and liver are also among the leading types all of which are cancers with infectionrelated etiology. Middle-income countries are intermediate with respect to their patterns of cancer burden. Within the lower-middle-income countries, the three most common types of cancer are lung, stomach and liver cancers in males, and breast, cervix and
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lung cancer in females, i.e. a similar pattern to the low-income countries (although liver, colorectal and esophageal cancers are also of importance). The lower middleincome group contains some of the most populous countries in the world, including China and India; hence the absolute numbers of cancers and cancer-related deaths are notably high in this group. Future planning of service provision is an integral part of cancer control programmes. Considering the projected growth in cancer morbidity, important differences can be observed in relation to World Bank income groups. The estimated percentage increase in cancer incidence by 2030 (compared with 2008) will be greater in low- (82%) and lower-middle-income countries (70%) compared with the uppermiddle- (58%) and high-income countries (40%). Without any changes in underlying risk factors (i.e. based only on anticipated demographic changes), between 10 and 11 million cancers will be diagnosed annually in 2030 in the low- and lower-middleincome countries. Local In the Philippines, cancer ranks third in the ten leading causes of mortality. Cancer is common in both sexes with the highest deaths in males. The common cancer deaths in both sexes are lung, liver, breast, colon/rectum and cervix. While the top 5 cancer cases in both sexes are lung, breast, colon/rectum, liver and cervix. The Non Communicable Disease Service is tasked to operationalize programs towards prevention and control of cancer that is accessible and affordable giving priority to the disadvantaged population. This was started in 1970 when the National Cancer Control Center was created and considered as autonomous unit. The Rizal and Manila Cancer Registries were established during this period. In 1973 the Community Cancer Control Program was started. Pursuant to the issuance of Executive Order 119 in 1986, the National Cancer Control was abolished. The Office of Public Health Services was created where Non-Communicable Disease Control was lodge. In May 1987 the Cancer Core Group was created to assist the Secretary of Health in developing a framework of cancer control. Orientation Training of Core of Trainers was done in 1988. In 1990 the Philippine Cancer Control Program was created as per Administrative Order # 89-A, s.1990. A year later the Cancer Core Group was reconstituted as an Advisory Council. In 1999, the Degenerative Disease Office was established as per EO 102 Redirecting the Functions and Operations of the Department of Health. The intervention was focused in the control measures to promote healthy lifestyle and avoid exposure to risk factors contributing to the development of cancer. Cancer in particular was not given priority attention to manage patient comprehensively. Screening for early detection and treatment intervention were not foreseen as highly needed by population at risk of getting cancer. Funds for the operationalization of the program were not included to address the problem. In mid 2007, the Cervical Cancer Control Program was transferred by the Family Health Office to the Degenerative Disease Office where the said program was originated. The Cervical Cancer Control Program had provided Free Cervical Cancer Screening among women 30 to 45 years of age to respond to the issuance of the Guidelines in the Establishment of Cervical Cancer Screening Program in 2005.

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The creation of the National Center for Pharmaceutical Access and Management contributed much in the provision of intervention on cancer. These are : 1) Free Adjuvant Chemotherapy provided to breast cancer patient newly diagnosed stage I to Stage IIIa piloted in Jose Reyes Memorial Medical Center, East Avenue Medical Center, Rizal Medical Center and Philippine General Hospital, 2). Free Chemotherapy for Acute Lymphatic Leukemia among children (ALL) in selected DOH hospital. Due to the limited resources, the Phil Cancer Control Program is moving slowly geared towards the improvement of health and prolonging the life of cancer patient.

Statistics/Local Data about the Disease Program Global Data on Cancer Top Five Cancer Deaths in 2011 Type of Cancer Cases Lung Stomach Liver Colorectoral Breast 1.4 Million 740,000 700,000 610,000 460,000

Philippine Data on Cancer, 2010 Cancer Facts and Estimates Number of Cases, Both Sexes 2010 Cancer Number of Cases Breast Lung Liver Colon/Rectum Cervix Leukemia Stomach Prostate Brain/Nervous System Ovary 12,262 11,458 7,331 5,787 4,812 3,153 3,129 2,712 2,236 2,165 Number of Deaths, Both Sexes, 2010 Number of Deaths 9,184 6,819 4,371
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Cancer Lung Liver Breast

Colon/Rectum Leukemia Stomach Cervix Brain/Nervous System Prostate Ovary

3,060 2,609 2,274 1,984 1,855 1,410 1,016 Number of New Cases, 2010, Males Cases 8,772 5,522 3,208 2,712 1,920 1,669 1,236 1,145 982 848 Number of Deaths, 2010, Males Cases 6,987 5,102 1,690 1,410 1,340 1,381 1,069 804 598 389 10 Most Common Cancer Cases in 2010, Females
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Cancer Lung Liver Colon/Rectum Prostate Stomach Leukemia Brain/Nervous System Other Pharynx

Non-Non-Hodgkin Lymphoma Kidney

Cancer Lung Liver Colon/Rectum Prostate Stomach Leukemia

Brain/Nervous System Other Pharynx Non-Hodgkin Leukemia Kidney

Type of Cancer Breast Cervix Uteri Lung Colon/Rectum Ovary Liver Corpus Uteri Leukemia Thyroid Stomach

Cases 12,262 4,812 2,686 2,579 2,165 1,809 1,760 1,484 1,474 1,209

10 Most Common Cancer Deaths in 2010, Females Type of Cancer Cases Breast Cervix Uteri Lung Colon/Rectum Ovary Liver Corpus Uteri Leukemia Thyroid Stomach III. 4,371 1,984 2,197 1,370 1,016 1,717 796 1,228 450 934

Interventions/Strategies employed or implemented by DOH

Packages of Services Free Cervical Cancer Screeningprovided every year in 58 DOH Hospitals done during the month of May to screen women ages 30-45 years of age Free Adjuvant Chemotherapy for women diagnosed stage 1 to IIIa breast cancer in 4 pilot hospitals (Jose Reyes Memorial Medical Hospital, East Avenue Medical Center, Rizal medical Center, UP-PGH) funded by NCPAM Free Chemotherapy for Acute Lymphatic Leukemia (ALL) among children with cancer funded by NCPAM Strategies Promotion of Healthy Lifestyle
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Increase avoidance of the risk factors done in coordination with the National Center for Health Promotion Vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV) not in nationwide scope but done by professional societies among children who can afford HPV vaccination Control occupational hazards done in coordination with the Environmental and Occupational Health Office Reduce exposure to sunlight Improve Screening/Diagnosis and Treatment Improve Rehabilitation and Palliative Care Improve Cancer Registry

IV. Status of implementation/Accomplishment The status of the implementation on the different types of cancer varies due to the limited resources in the operationalization of the program. A.

Cervical Cancer Conducted Free Cervical Cancer Screening in DOH Hospitals from 2009 to 2011 Conducted Cervical Cancer Awareness Month during the month of May from 2009 to 2011 Drafted Training Module on Cervical Cancer Prevention and Control in 2010 Provided 3 units of cryotherapy machine in Bicol Regional & Teaching Hospital, Jose Reyes Memorial Medical Center, Cotabato Regional Hospital from UNFPA in 2011 Provided supplies (acetic acid, cotton swab ) for cervical cancer screening in 58 DOH Hospitals in 2011 Conducted the 1st National Symposium on Cervical Cancer Prevention and Control in 2010 Conducted Catching Cancer : A Forum on Cervical Cancer Prevention and Control in 2011 Conducted Press Conference on Cervical Cancer in 2009 to 2011 Created Technical Working Group on Cervical Cancer in 2010

B.

Cancer Registry Provided funds for the Population-Based Cancer Registry in Rizal and Manila Develop Cancer Registry Forms for the Establishment of an Integrated ChronicNon-Communicable Disease Registry System in 2010 Conducted Training on Integrated Chronic NCD Registry in pilot hospital in 2010 Conducted 1st Batch of Integrated NCD Registry Training last April 4-5, 2011 Conducted 2nd Batch of Integrated NCD Registry dated Sept 22-30, 2011

C.

Breast Cancer Reviewed Guidelines on Patient Navigator Program for the Provision of Free Chemotherapy on Breast Cancer with Stage I-IIIa initiated by NCPAM
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IV.

Future Plan/Action 1. Strengthen the implementation of an Integrated Lifestyle Related Disease Control Program for the promotion of healthy lifestyle and avoid population risk exposure 2. Maintain the operation of an Integrated Chronic Non-Communicable Disease Registry System in all health facilities 3. Development of Service Package for Cancer Control Program 4. Development of Clinical Practice Guidelines for Cancer Control Program 5. Development of Strategic Framework and a Five Year Strategic Plan for Cancer Control Program 6. Improvement of Hospital Facilities through upgrading of HWs capability and equipment necessary for screening, diagnosis and treatment of cancer

Province-wide Investment Plan for Health (PIPH)


A five year medium term plan prepared by F1 convergence provinces using the Fourmula One for Health framework to improve the highly decentralized system; financing, regulation, good governance and service delivery The five year province-wide investment plan for health is an important evidencebased platform for local health system management and a milestone in DoH engagement at the local level. PIPH was adopted on a pilot basis by 16 provinces in 2007, followed by 21 more in 2008, including six provinces from the Autonomous Region of Muslim Mindanao (ARMM). In 2009, 44 provinces and eqight cities have completed their own five year plans.

Philippine Medical Tourism Program


Vision: "The global leader in providing quality health care for all through universal health care" Mission: To ensure that the Philippines is globally competitive through implementation of quality standards in both public and private sector. Goal: 1. The local Global Health Care industry will contribute a noticeable and quantifiable amount to the Philippine economy and improvement in the quality of life. 2. Increase the number of institutions offering advanced medical services suitable for Global HealthCare, the generation of jobs in the Medical Services industry and other
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related industries, thereby increasing the productivity of the workforce and enabling it to expand and upgrade. 3. Attract increased numbers of visitors from other countries availing of medical services and at the same time ensure that quality of those currently offering services suitable for Global Health Care is on the same level as with globally-recognized standards, and making these services equitably available for both Medical Travellers and local patients. Objectives: 1. To increase competitiveness by compliance to recognized bodies that implement national and international healthcare organization accreditation 2. Institutionalize policies and enact legislation for high level quality healthcare and patient safety standards in all health facilities 3. Continue collaboration with national government agencies, LGUs, private sector organizations and academe involved in quality healthcare and patient safety, international medical travel and wellness services, retirement, trade and tourism 4. Continue advocacy in all regions of the country on quality healthcare and patient safety, international medical travel and wellness services, retirement, trade and tourism through quad media approach, capacity building activities and collaborative participation in international forum and conferences Stakeholders/Beneficiaries: Private clinics/centers, Public and Private Hospitals, National Government Agencies, Private Specialty Clinics/Centers providing Dermatology, plastic surgery, ophthalmology and dental medicine, Geriatric and Treatment and Rehabilitation Centers for substance abuse Partner Organizations/Agencies: Department of Tourism (DOT) Department of Foreign Affairs (DFA) Department of Trade and Industry (DTI) Department of Public Works and Highways (DPWH) Department of Interior Local Governments (DILG) Department of Justice (DOJ) Department of Finance (DFA) Department of Science and Technology (DOST) Department of Labor and Employment (DOLE) DTI - Board of Investments (BOI) DTI - Philippine Export Zone Authority (PEZA) DOT - Tourism Infrastructure Enterpise Zone Authority (TIEZA) DOJ - Bureau of Immigration (BI) DOF - Bureau of Customs (BoC) Subic Bay Metropolitan Authority (SBMA) Clark Development Corporation (CDC) Philippine Health Insurance Corporation (PhilHealth) Philippine Retirement Authority (PRA) Cebu Health and Wellness Council (CHWC)
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Development Academy of the Philippines (DAP) National Economic Development Authority (NEDA) Technical Education and Skills Development Authority (TESDA) Commission on Higher Education Development (CHED) Philippine Information Agency (PIA) Public Private Partnership Center (PPPC) Joint Foreign Chambers of Commerce in the Philippines European Chamber of Commerce in the Philippines (ECCP) American Chamber of Commerce in the Philippines (ACCP) Canadian Chamber of Commerce (CCC) Australian New Zealand Chamber of Commerce in the Philippines (ANZCHAM) Japanese Chamber of Commerce in the Philippines (JCCP) Korean Chamber of Commerce in the Philippines (KCCP) Philippine Association of Multinational Companies Regional Headquarters, Inc. (PAMURI) Professional Regulations Commission (PRC) Philippine Medical Association (PMA) Philippine Nurses Association (PNA) Philippine Hospital Association (PHA) Philippine Council for the Accreditation of Health Care Organizations (PCAHO) International Society for Quality in Healthcare (ISQUA) Joint Commission International (JCI) National Accrediting Body for Hospitals (NABH - India) TUV Rheinland Private Sector Health and Wellness Alliance of the Philippines (HEAL Philippines) Health Core and HIM Communications Retirement and Healthcare Coalition (RHC) Spas and Wellness Association of the Philippines (SAPI) Philippine Dental Association (PDA)

Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases


I. BACKGROUND AND RATIONALE Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are among the top killers in the Philippines, causing more than half of all deaths annually. Hypertension and diseases of the heart are among the ten leading causes of illnesses each year. These diseases are collectively known as Lifestyle Related NonCommunicable Diseases (NCDs), as defined in the National Objectives for Health 2005-2010, particularly because these diseases have common risk factors which are to a large extent related to unhealthy lifestyle.
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The risk factors involved are tobacco use, unhealthy diet, physical inactivity and alcohol use.A study conducted by Food and Nutrition Research Institute (FNRI) in 2003 revealed that 90% of Filipinos have one or more of the following risk factors: physical inactivity, smoking, obesity, hypertension, diabetes and abnormal cholesterol. Among adults, 20% are overweight and 5% are obese, 22.5% are hypertensive, 60.5% are physically inactive, and a significant number have high levels of blood cholesterol and sugar. More than half (56%) of adult males and 12% of adult females are current smokers. Alcohol use has also risen steadily since the 1960s. Children and adolescents are also exposed to the above-mentioned risks. The prevalence of overweight among adolescents 9-11 years old had increased two folds from 2.4% in 1993 to 4.8% in 2005. Similarly, the prevalence rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6% in 2005. (Source: Philippine Nutrition Facts and Figures 2005) Twenty two (22) per cent of teenagers currently smoke cigarettes. (Source: Philippines Global Youth Tobacco Survey, 2007). About 30% of teenage students are physically inactive, spending three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities. (Source: Philippines Global School-based Student Health Survey, 2007) The cost of care of lifestyle-related diseases may cause people to fall into poverty and create a downward spiral of worsening poverty and illness. They also undermine the country's economic development. In response to the increasing prevalence of lifestyle related diseases in the country, vertical programs on the prevention and control of cardiovascular diseases, cancers, and diabetes were put in place in the mid 1990s. The individual programs however, were focused on treatment and management of those who were already sick and thus were competing with each other for resources and for attention upon field implementation. Recent evidence shows that the most cost-effective way of controlling these noncommunicable lifestyle related diseases is by the prevention of the emergence of the risk factors in an integrated manner, employing health promotion strategies across the life course and intervening at the level of family and community. This is essential because the causal risk factors causing these illnesses are deeply entrenched in the social and cultural framework of the society. Thus, an integrated comprehensive program for the prevention and control of these non-communicable lifestyle related diseases has to be put in place. II. GOALS AND OBJECTIVES

Goals: To reduce morbidity, mortality and disability rates due to chronic lifestyle related NCDs through an integrated and comprehensive program on the prevention and control of lifestyle related diseases. Objectives:
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1. To develop and promote an integrated and comprehensive program on the prevention and control of lifestyle related diseases in the country. 2. To engage all province-wide or city-wide health systems to adopt an integrated and comprehensive program on the prevention and control of lifestyle related diseases. 3. To achieve improvement in the following Key Performance Indicators from 2011 to 2016: Common Risk Factors 1. Reduction in prevalence of current smoking among adult males from 56.3 to 40.0. 2. Reduction in prevalence of current smoking among adolescent female from 8.80 to 7.2 3. Reduction in prevalence of adults with high physical inactivity from 60.5 to 50.8 4. Increase in per capita total vegetable from 111.0 (g/day) to 133.0 (g/day) Intermediate Risk Factors A. Reduction in prevalence of hypertension among adult males from 24.2 to 19.6. B. Reduction in prevalence of adults with high fasting blood sugar from 3.4. C. Reduction in the prevalence of central obesity (high waist circumference) among adult females from 18.3 to 12.81 D.Reduction in prevalence of high total serum cholesterol among adults from 8.5. Disease a. Reduction in mortality from non-communicable diseases at 2% through the MDG max initiative. per year

III. ACTION FRAMEWORK FOR THE PREVENTION AND CONTROL OF CHRONIC LIFESTYLE RELATED NON-COMMUNICABLE DISEASES: The Action Framework for the National Program on the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases is based on the Causation Pathway Model for Major Chronic Diseases as contained in the WHO Western Pacific Regional Action Plan for Addressing Non-Communicable Diseases, where the underlying determinants, common risk and intermediate risk factors that would lead to lifestyle-related diseases are identified (Figure 1).

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The action framework (Figure 2) has seven action areas as follows: (1) Environmental interventions; (2) Lifestyle interventions; (3) Clinical interventions; (4) Advocacy; (5) Research, surveillance, monitoring, and evaluation; (6) Networking and coalition building; and (7) Health system strengthening. It draws primarily from the WHO Western Pacific Regional Framework for Addressing Non-communicable Diseases and emphasizes the requirement for integrated comprehensive approaches that encompass and address the various levels of determinants and risks for noncommunicable lifestyle related diseases (Figure 2).

Figure 2: Action Framework for the Prevention and Control of Chronic LifestyleRelated Non-communicable Diseases The framework clearly identifies areas for intervention according to the causation pathway shown in Figure 1 by utilizing a comprehensive approach that simultaneously seeks to effect change at three levels: 1) Environment Interventions
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such as policy and regulatory interventions seek to create a supportive environment for healthier choices. They address the multiple environmental determinants brought about, for example, by globalization and urbanization that give rise to the development of unhealthy lifestyles. 2) Lifestyle Interventions address the common risk factors and intermediate risk factors by providing population-based lifestyle interventions (for example, information and education and behavioural interventions for those who are already at risk). 3) Clinical Interventions, palliation and rehabilitation address the capacity of the health system to treat and manage diseases through screening, risk factor modification, clinical management, palliation and rehabilitation. To support change in these three levels of interventions, additional actions are needed in the following areas: advocacy; research, surveillance, monitoring and evaluation; networking and coalition building across all sectors of the government and society, and health system strengthening through primary health care to make it more responsive to chronic care. The framework highlights the balance between "healthy choices" and "healthy environments" because it recognizes that supportive environments are needed to empower healthy choices. It also redistributes responsibility across the whole of society, with government, the health sector, the private sector, nongovernmental organizations, communities, families and individuals all sharing accountability for putting in place the necessary elements that promote healthy lifestyles and quality care for non-communicable lifestyle related diseases. IV: PROGRAM INTERVENTIONS

A. Environmental interventions Aimed at providing and encouraging healthy choices for all to be implemented in three (3) major health promotion settings: community, school and workplace. As the underlying determinants of non-communicable diseases often lie outside the health sector, multi-sectoral actions shall be implemented involving both public and private sectors. B. Population based lifestyle interventions Preventive strategies using the life course perspective and focused on major risk factors particularly tobacco use, unhealthy diet, physical inactivity, and alcohol use, and, include other relevant risk factors such as but not limited to the following: hypertension, high blood sugar, overweight and obesity, and impaired lung function. Strategies shall be integrated in other health programs and health-related initiatives to effectively address lifestyle-related non-communicable diseases and their social and economic determinants. Service packages for clinical interventions of diabetes, cardiovascular diseases, cancers and chronic respiratory diseases addressing the following unique features of NCDs such as: 1. The limitation of definitive treatment, the lifelong duration of management and the extensive self management involved must be addressed by service delivery providers. 2. The multidrug regimens, drug interactions and drug cost that has to be regulated.
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3. The acute attacks and exacerbations from failed prevention, financial barriers in access to acute care and financial risk that must be addressed by adequate financing. 4. The co-morbidities requiring coordination by various providers and teams that must be managed by proper governance infrastructure. V. ROLES OF STAKEHOLDERS The National Center for Disease Prevention and Control (NCDPC) shall: 1. Oversee the implementation of the national policy and program on the Prevention and Control of Lifestyle-Related Diseases. 2. Establish standards and package of services on lifestyle-related diseases and ensure their quality, access, and availability at all levels of the health system. 3. Provide technical assistance to the LGUs and other partners on clinical interventions for lifestyle-related diseases. 4. Support the design of health financing of personal care related to lifestyle related diseases in collaboration with PhilHealth and other partners. 5. Conduct regular monitoring and evaluation of the burden of disease related to lifestyle related diseases. 6. Ensure participation of other DOH offices and bureaus and coordinate with partners within and outside the health sector for the effective implementation of the national program. The National Center for Health Promotion (NCHP: 1. Lead in the development and implementation of the National Healthy Lifestyle Program as a major strategy for the prevention and control of lifestyle-related diseases. 2. Advocate with other government agencies, non-government organizations, private sector, development partners, and other relevant stakeholders for support in policy development and resource generation towards the creation of supportive environments for lifestyle modification. 3. Provide technical assistance to ensure environmental interventions at the 3 health promotion settings: community, school and workplace. 4. Facilitate organization and development of a multi-sectoral coalition for the prevention and control of lifestyle related diseases. The Health Policy Development and Planning Bureau (HPDPB): 1. Support the development of relevant policies on NCD prevention and control. 2. Assist in securing adequate funding for Prevention and Control of LifestyleRelated Diseases. 3. Facilitate and support program evaluation studies and researches. The National Epidemiology Center (NEC) and the Information Management Service (IMS) 1. Establish and sustain public health and hospital surveillance systems including registries, for lifestyle-related diseases and other non-communicable diseases. 2. Facilitate collection, analysis, and dissemination of data on mortality, morbidity and risks on lifestyle-related diseases.
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3. Support conduct of population-based surveys on risk factors and lifestylerelated diseases. The Health Human Resource Development Bureau (HHRDB): 1. Develop, update as necessary and implement training and development plan of health professionals, particularly those in primary health care facilities and hospitals on the prevention and management of lifestyle-related diseases. 2. Facilitate integration of prevention and control of lifestyle-related diseases in the academic curriculum of health professionals. The National Center for Health Facility Development (NCHFD: 1. Ensure access and availability to quality hospital and facility-based services on lifestyle-related diseases. 2. Establish standards for an efficient hospital referral system. 3. Facilitate development and implementation of hospital-based information and surveillance system to gather data particularly on mortality and morbidity from lifestyle-related diseases. The National Center for Pharmaceutical Access and Management (NCPAM) shall develop guidelines and standards and provide mechanisms to ensure that affordable, but quality medicines for lifestyle-related diseases are always available, especially to the poor. The Bureau of International Health Cooperation (BIHC) shall coordinate with international development partners and other countries for technical and resource assistance on prevention and control of lifestyle-related diseases. The Philippine Health Insurance Corporation (PHIC) shall develop and implement health insurance package for clients at risk and afflicted with lifestyle-related diseases to reduce financial burden and impoverishment of individuals and families resulting from said diseases. The National Nutrition Council (NNC) shall provide technical assistance and contribute to the advocacy on healthy lifestyle, particularly on healthy diet. The Philippine Coalition for the Prevention and Control of Non-Communicable Diseases (PCPCNCD) shall provide support to the advocacy on healthy lifestyle. The Centers for Health Development (CHDs) shall provide technical assistance and lead the regions to ensure local implementation of the National Program on Prevention and Control of Lifestyle-Related Diseases. DOH hospitals shall ensure provision of quality promotive, preventive, curative, rehabilitative, and palliative care for patients with lifestyle related diseases;
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The Local Government Units (LGUs) shall adopt and implement the National Program on Prevention and Control of Lifestyle-Related Diseases and provide services and products in primary health care facilities and hospitals in their localities. Non-government organizations, professional groups, other government organizations, private sector, the Academe, and Civil Societies shall assist in the implementation of the National Program on Lifestyle-Related Diseases.

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Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat)

I.

PROFILE/ RATIONALE OF THE HEALTH PROGRAM

Provision of safe water supply is one of the basic social services that improve health and well-being by preventing transmission of waterborne diseases. However, about 455 municipalities nationwide have been identified by NAPC as waterless areas that are having households with access to safe water of less 50% only. As a result, diarrhea and other waterborne diseases still rank among the leading causes of morbidity and mortality in the Philippines. The incidence rate for these diseases is high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 populations. The Sagana at Ligtas na Tubig sa Lahat Program (SALINTUBIG) is one of the governments main actions in addressing the plight of Filipino households in such areas. The program aims to contribute to the attainment of the goal of providing potable water to the entire country and the targets defined in the Philippine Development Plan 2011-2016 Millennium Development Goals (MDG), and the Philippine Water Supply Sector Roadmap and the Philippine Sustainable Sanitation Roadmap. To attain this objective, One Billion and Five Hundred Million Pesos (Php 1,500,000,000) is appropriated to the DOH through Item B.I.a of the 2011 General Appropriations Act (GAA). The appropriation is a grant facility for LGU to develop infrastructure for the provision of potable water supply. A. OBJECTIVES 1. To increase water service for the waterless population 2. To reduce incidence of water-borne and sanitation related diseases 3. To improved access of the poor to sanitation services TARGETS 1. Increased water service for the waterless population by 50% 2. Reduced incidence of water-borne and sanitation related diseases by 20% 3. Improved access of the poor to sanitation services by at least 10% 4. Sustainable operation of all water supply and sanitation projects constructed, organized and supported by the Program by 80%. ABOUT THE STAKEHOLDERS/ BENEFICIARIES

B.

II.

The program is designed to be implemented by DOH, NAPC and DILG. The NAPC will perform as the lead coordinating agency, the DOH will provide the funding and ensure the implementation of various water supply projects and the DILG will be in-charge of the capacity building of LGUs. The implementing guidelines define the specific roles of each agency.
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The DOH, NAPC and DILG used the data from the National Household Targeting System for Poverty Reduction for identification of the target municipalities which compose of the following: 115 Waterless Municipalities Waterless Areas based on the following thematic concerns: Poorest waterless barangays with high incidence of water borne diseases Resettlement areas in Bulacan, Rizal, Cavite, Laguna, Batangas and Albay Health Centers without access to safe water III. PROGRAM COMPONENT/ACTIVITIES A. Rehabilitation/expansion/upgrading of Level III water supply systems including appropriate water treatment systems. B. Construction/rehabilitation/expansion/upgrading of Level II water supply systems. C. Construction/rehabilitation of Level I water supply systems in areas, where such facilities are only applicable. D.Provision of training for existing or newly organized water users associations/ community-based organizations. E. Support for new and innovative technologies for water supply delivery and sanitation systems. F. Training, mentoring, coaching and other capacity development assistance to LGU on planning, implementation and management of water supply and sanitation projects. IV. STATUS OF THE PROGRAM Summary of Physical and Financial Status Report January 2012 February 2012 March 2012 April 2012 Monthly Status Report per Site October 2011 January 2012 February 2012 March 2012 April 2012 Administrative Issuances Department Order # 2011-0090 Department Order # 2011-0091 Department Order # 2011-0091-A Department Order # 2011-0091-B Memorandum of Agreement of the National Poverty Commission, Department of Health and Department of Interior and Local Government Implementing Guidelines of the Salintubig Program
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V. A.

PROGRAM MANAGER(S) FULL NAME(S) OF PROGRAM MANAGERS 1. ENGR. JOSELITO M. RIEGO DE DIOS 2. ENGR. MA. SONABEL S. ANARNA 3. ENGR. LUIS F. CRUZ 4. ENGR. GERARDO S. MOGOL 5. ENGR. ROLANDO I. SANTIAGO 6. ENGR. CATHERINE J. OLAVIDES PARTNER ORGANIZATION/ AGENCIES AND THEIR CONTACT DETAILS

B.

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT (DILG) Francisco Gold Condominium II, EDSA cor. Mapagmahal St, Diliman, Quezon City, Philippines 1100 Contact No.: Tel. No. 925-0330 / 925-0331; Fax No. 925-0332 NATIONAL ANTI-POVERTY COMMISSION (NAPC) 3rd Floor, Agricultural Training Institute Building, Elliptical Road, Diliman, Quezon City, Philippines1101 Trunklines: 426-5028 / 426-5019 / 426-4956 / 426-4965 Facsimile: 927-9796 / 426-5249 Email: napc.gov@gmail.com DEPARTMENT OF HEALTH Environmental and Occupational Health Office Division Bldg. 14, San Lazaro Coumpound, Rizal Ave., Sta. Cruz, Manila 1003 Tel.: 732-9966 local 2324 to 2326 Fax: 711-7846 Email: litoriego@yahoo.com, masonabel@yahoo.com, louiedpogi@yahoo.com, roilayas antiago@yahoo.com

Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP)
Rationale: The Philippines maternal and infant morbidity and mortality rates have been marked despite its efforts to assist local government units for the past decade. An important factor identified was the lack of trained healthcare providers particularly, in the far flung areas of the country. This hinders the recognition of basic obstetric needs and delivery of quality health service to the community.
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To intensify the countrys capacity in the provision of quality health service to the people, the Department of Health (DOH) has adopted the facility-based basic emergency obstetric care strategy. The midwives, being the frontline healthcare providers, have been identified by the DOH to serve as the link between health service delivery and the community in the reduction of maternal and neonatal morbidity and mortality. The RHMPP aims to provide competent midwives to areas that have not performed well in terms of facility-based deliveries, fully immunized child and contraceptive prevalence rates, hence, improve facility-based health services. By augmenting health staff to selected government units, the DOH may improve maternal and child health and attain the Millennium Development Goals (MDGs). In order to ensure a constant supply of competent midwives and to deliver their services to the people in dire need, the DOH created the MSPP that aims to produce competent midwives from qualified residents of priority areas. Program Description: The World Health Organization (WHO) affirms that approximately 15% of all pregnant women develop a potentially life-threatening complication that calls for either skilled care or major obstetrical interventions to survive. Readily accessible Emergency Obstetric Care may thus reduce maternal and perinatal morbidity and mortality. The DOH is restating its commitment towards a health nation through more aggressive safe motherhood initiatives, hence, the upgrading of obstetric deliveries to strategic facility-based Basic Emergency Obstetric Care (BEmONC), where these facilities are manned by a team composed of a licensed physician, public health nurse, and a rural health midwife at the primary level. Since the rural health midwives are considered as the frontline health workers in the rural areas and have progressed to become multi-task personnel in the delivery of healthcare services, amidst migration of other healthcare professionals, the DOH created the Rural Health Midwife Placement Program (RHMPP) to address the inequitable distribution of midwives and equip them for facility-based BEmONC practice. In support to the RHMPP, thus, ensure constant supply of competent midwives, the DOH created the Midwifery Scholarship Program of the Philippines (MSPP). Career Track/ Return Service Obligation Upon completion of the MSPP and obtaining the midwifes Certificate of Registration and license, the scholars shall render two (2) years of service to the DOH for every year of scholarship granted as form of return service.
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Expected Output: The MSPP aims to produce and ensure constant supply of competent midwives who are ready to serve the DOH identified priority areas of the country. The RHMPP addresses the inequitable distribution of midwives and equip them for facility-based BEmONC practice. Likewise, it provides competent midwives to areas that have not performed well in terms of facility-based deliveries, fully immunized child and contraceptive prevalence rates, hence, improve facility-based health services. The DOH ultimately aims in the attainment of the Millennium Development Goals (MDGs). Program Status: For the MSPP, a hundred scholars are currently pursuing the Midwifery Course. On April of this year, 11 scholars graduated and passed the Board Examination by the Professional Regulation Commission (PRC). These scholars were deployed to DOH identified priority areas starting July 2011. This coming November, 37 other scholars will take the Board Examination. For the RHMPP, 23 Registered Midwives were already deployed for the first batch (2008-2010). In addition to that, 175 Registered Midwives (batch 2, 2010-2012) and 11 scholars (batch 3, 2011-2013) are currently being deployed in the DOH (BEmONC/CCT) identified priority areas. Partner Schools: Currently, the MSPP has four partner schools: Area Partner School Total # of Scholars Batch 1: 16 scholars (2008-2010) Batch 2: 11 scholars (June 2009-May 2011) Batch 3: 21 scholars (June 2010-May 2012) Batch 4: 17 scholars (June 2011-May 2013)

National Capital Region

Dr. Jose Fabella Memorial Hospital, School of Midwifery

Luzon Visayas

Batch 1: 19 scholars Naga College Foundation, Naga (June 2011-May City 2013) University of the Philippines, Batch 1: 37 scholars School of Health Science, Palo, (June 2009-May
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Leyte

2011) Batch 2: 29 scholars (June 2010-May 2012) Batch 1: 14 scholars (June 2011-May 2013)

Mindanao

Tecarro College Foundation, Inc., Davao City

The RHMPP has deployed midwives in the different DOH identified priority areas of the country: Batch/ Year Total Number of Midwives Batch 1 2008-2010 Batch 2 2010-2012 Batch 3 2011-2013 23 RHMs 175 RHMs (to include the 16 scholars from MSPP for Return Service) 11 RHMs Return service of scholars

III. Career Track / Return Service Obligation Upon completion of the MSPP and obtaining the midwife's Certificate of Registration and license, the scholars shall render two (2) years of service to the DOH for every year of scholarship granted as form of return service. IV. Expected Output The MSPP aims to produce and ensure constant supply of competent midwives who are ready to serve the DOH identified priority areas of the country. The RHMPP addresses the inequitable distribution of midwives and equip them for facility-based BEmONC practice. Likewise, it provides competent midwives to areas that haver not performed well in terms of facility based deliveries, fully immunized child and contraceptive prevalence rates, improve facility-based health services. The DOH ultimately aims in the attainment of the Millenium Development Goals (MDGs). V. Program Status: A. MSPP

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11 scholars graduated on April 2011 and passed the Board Examination by the Professional Regulation Commission will be deployed starting July 2011 to DOH identified priority areas. 37 scholars will take the November 2011 Board Examination by the Professional Regulation Commission 100 scholars pursuing the Midwifery Course B. RHMPP 175 Registered Midwives are currently deployed in the DOH (BEmONC/CCT) identified priority areas Deployment of 11 scholars

Schistosomiasis Control Program


Schistosomiasis is an infection caused by blood fluke, specifically Schistosoma japonicum. An individual may acquire the infection from fresh water contaminated with larval cercariae, which develop in snails. Infected yet untreated individuals could transmit the disease through discharging schistosome eggs in feces into bodies of water. Long term infections can result to severe development of lesions, which can lead to blockage of blood flow. The infection can also cause portal hypertension, which can make collateral circulation, hence, redirecting the eggs to other parts of the body. Schistosomiasis is still endemic in 12 regions with 28 provinces, 190 municipalities, and 2,230 barangays. Approximately 12 million people are affected and about 2.5 million are directly exposed. Goal: To reduce the disease prevalence by 50% with a vision of eliminating the disease eventually in all endemic areas Objectives: The Schistosomiasis control Program has the following objectives: 1. Reduce the Prevalence Rate by 50% in endemic provinces; and 2. Increase the coverage of mass treatment of population in endemic provinces. Program Strategies: The Schistosomiasis Control Program employs the following key interventions: 1. Morbidity control: Mass Treatment 2. Infection control: Active Surveillance 3. Surveillance of School Children 4. Transmission Control 5. Advocacy and Promotion

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Its enabling activities include; linkaging and networking; policy guidelines and CPGs; institutional capacity building; competency enhancement of frontline service provider; and monitoring and supervision.

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Soil Transmitted Helminth Control Program


Profile/Rationale of the Health Program Given the relatively high prevalence rate of STH infections in the country and the existing issues confronting the implementation of the STHCP nationwide, there is a need to integrate all related efforts and strengthen coordination of those involved to ensure better complementation of resource, obtain higher coverage and generate better health outcomes. Within the Department of Health (DOH), several programs exist which are viable mechanisms to operationalize an integrated approach in preventing and controlling STH infections more effectively and efficiently. This needs to expand to the other national and local agencies and organizations engaged in the same endeavor. The IHCP envisions healthy and productive Filipinos. It aims to reduce the deaths and diseases due to STH infections by reducing the prevalence of the infection among population groups found most at risk. Helminth infections adversely affect the health of the children and women. Program interventions and related measures have to be focused on them. Children are classified into preschoolers and school children while women include adolescent females and pregnant women. In addition, there are also special groups, which by the nature of their work and situation, are gravely exposed to helminthes infection. These include the soldiers, farmers, food handlers and operators as well as indigenous people. They also require the necessary attention. The IHCP interventions consist primarily of chemotherapy, WASH and several behavior changing approaches. Chemotherapy remains as the core package in helminth infection control. The IHCP identifies the corresponding approach of deworming that must be applied for each identified population group. Water, sanitation and hygiene (WASH) serves as the cornerstone in reducing the prevalence of worm infection. The expansion of these measures reduces more effectively the transmission of worm infection. The promotion of desired behaviors ensures that these efforts on chemotheraphy and WASH are translated into actual healthy practices and better utilization of these facilities. These interventions only become viable and effective if they are carried out in a supportive environment. Enabling mechanisms must therefore be established to support their implementation. An enabling environment entails good governance of the IHCP at all levels of operations. The political will and support of national and local leaders are essential to propel the cause of the IHCP. Quality of deworming services and expansion of service outlet to increase access must be given due to consideration. Financing reforms must likewise introduce. The LGUs must begin to allocate budget for their own deworming program. A more equitable or rationalized allocation of deworming assistance from the DOH must be established. Local financing mechanisms to sustain the delivery of STHCP services need to be explored and established. Strict monitoring of LGUs compliance to national laws and policies must be undertaken while several program support systems (e.g., procurement and logistics management, information management system, surveillance and research) have to be installed.
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Central to the achievement of the IHCP vision is the commitment and participation of all sectors concerned considering that helminth infection is a multifaceted problem. While the LGUs are expected to be primarily responsible for the controlling helminth infection, the support of DOH, DepEd and other national government agencies including the private sector, civil society and the community is very critical to the success of IHCP. Vision: Mission: Healthy and Productive Filipinos in the 21st Century To reduce the morbidity and mortality due to STH infections.

Goals/Objectives The program aims to reduce the prevalence of STH infection to below 50.0% among the 1-12 years old children by 2010 and lower STH infection among adolescent females, pregnant women and other special population group. Stakeholders/Beneficiaries: The DOH is the lead agency in the deworming of children while the Department of Education (DepEd) is in charge of deworming all children aged 6-12 years old enrolled in public schools (Grade 1-VI). Deworming is done by teachers under the supervision of school nurses or any health personnel. Program Strategies: 1. Improve governance through: a. Policies/resolutions; b. Securing budget for STH prevention and control; c. Mobilization and coordination of sectoral support; and Improve service quality and scale-up coverage. a. Capacity building 1. Areas for training Epidemiology, life cycle etc. Proficiency training on lab diagnosis for med techs/lab techs Annual/biannual updates on current technology in lab diagnosis Training on drug administration, side effects, etc 2. Target participants 3. Training mechanisms b. Development and issuance of protocols and guidelines c. Expansion of service delivery points d. Availability and affordability of deworming drugs Institute financing reforms a. Efficiency in program implementation b. Mobilization of resources c. Strengthening LGU financing schemes
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2.

3.

4. 5.

Strengthen regulations Installation of management support systems a. Drug procurement b. Research c. Surveillance

Targets and Doses 1. Children aged 1 year to 12 years old For children 12 24 months old Albendazole - 200 mg, single dose every 6 months. Since the preparation is 400mg, the tablet is halve and can be chewed by the child or taken with a glass of water or Mebendazole - 500 mg, single dose every 6 months For children 24 months old and above Albendazole - 400 mg, single dose every 6 months Or Mebendazole - 500 mg, single dose every 6 months Note: If Vitamin A and deworming drug are given simultaneously during the GP activity, either drug can be given first. 2. Adolescent females It is recommended that all adolescent females who consult the health be given anthelminthic drug Albendazole 400 mg once a year or Mebendazole 500 mg once a year 3. Pregnant women It is recommended that all pregnant women who consult the health be given anthelminthic drug once in the 2nd trimester of pregnancy. In areas where hookworm is endemic: Where hookworm prevalence is 20 30% Albendazole 400 mg once in the 2nd trimester or Mebendazole 500 mg once in the 2nd trimester Where hookworm prevalence is > 50%, repeat treatment in the 3rd trimester

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4. Special groups, e.g., food handlers and operators, soldiers, farmers and indigenous people Selective deworming is the giving of anthelminthic drug to an individual based on the diagnosis of current infection. However, certain groups of people should be given deworming drugs regardless of their status once they consult the health center. Special groups like soldiers, farmers, food handlers and operators, and indigenous people are at risk of morbidity because of their exposure to different intestinal parasites in relation to their occupation or cultural practices. For the clients who will be dewormed selectively, treatment shall given be anytime at the health centers. Guidelines/Administrative Orders AO No. 2010-0023 guidelines on deworming drug administration and the management of adverse events following deworming (AEFD) AO No.2006-0028 Strategic and operational framework for establishing integrated helminth control program (IHCP) Status of the program Deworming of target population during: 1-5 years old during Garantisadong Pambata (GP) April and October 6-12 years old (school children Grade 1-6 enrolled in public schools) every January and July Partner Organizations/Agencies: World Health Organization (WHO) University of the Philippines-National Institutes of Health (UP-NIH) United Nations Childrens Fund (UNICEF) World Vision Feed the Children International Helen Keller International (HKI) Council for the Welfare of Children Department of Science and Technology-Food and Nutrition Institute (DOST -FNRI) Department of Education (DepEd) Plan International Save the Children

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Smoking Cessation Program


Rationale: The use of tobacco continues to be a major cause of health problems worldwide. There is currently an estimated 1.3 billion smokers in the world, with 4.9 million people dying because of tobacco use in a year. If this trend continues, the number of deaths will increase to 10 million by the year 2020, 70% of which will be coming from countries like the Philippines. (The Role of Health Professionals in Tobacco Control, WHO, 2005) The World Health Organization released a document in 2003 entitled Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence. This document very clearly stated that as current statistics indicate, it will not be possible to reduce tobacco related deaths over the next 30-50 years unless adult smokers are encouraged to quit. Also, because of the addictiveness of tobacco products, many tobacco users will need support in quitting. Population survey reports showed that approximately one third of smokers attempt to quit each year and that majority of these attempts are undertaken without help. However, only a small percentage of cigarette smokers (1-3%) achieve lasting abstinence, which is at least 12 months of abstinence from smoking, using will power alone (Fiore et al 2000) as cited by the above policy paper. The policy paper also stated that support for smoking cessation or treatment of tobacco dependence refers to a range of techniques including motivation, advise and guidance, counseling, telephone and internet support, and appropriate pharmaceutical aids all of which aim to encourage and help tobacco users to stop using tobacco and to avoid subsequent relapse. Evidence has shown that cessation is the only intervention with the potential to reduce tobacco-related mortality in the short and medium term and therefore should be part of an overall comprehensive tobacco-control policy of any country. The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH, Philippines GATS Country Report, March 16, 2010) revealed that 28.3% (17.3 million) of the population aged 15 years old and over currently smoke tobacco, 47.7% (14.6 million) of whom are men, while 9.0% (2.8 million) are women. Eighty percent of these current smokers are daily smokers with men and women smoking an average of 11.3 and 7 sticks of cigarettes per day respectively. The survey also revealed that among ever daily smokers, 21.5% have quit smoking. Among those who smoked in the last 12 months, 47.8% made a quit attempt, 12.3% stated they used counseling and or advise as their cessation method, but only 4.5% successfully quit. Among current cigarette smokers, 60.6% stated they are interested in quitting, translating to around 10 million Filipinos needing help to quit smoking as of the moment. The above scenario dictates the great need to build the capacity of health workers to help smokers quit smoking, thus the need for the Department of Health to set up a national infrastructure to help smokers quit smoking. The national smoking infrastructure is mandated by the Tobacco Regulations Act which orders the Department of Health to set up withdrawal clinics. As such DOH Administrative Order No. 122 s. 2003 titled The Smoking Cessation Program to
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support the National Tobacco Control and Healthy Lifestyle Program allowed the setting up of the National Smoking Cessation Program. Vision: health risks. Mission: Reduced prevalence of smoking and minimizing smoking-related To establish a national smoking cessation program (NSCP).

Objectives: The program aims to: 1. Promote and advocate smoking cessation in the Philippines; and 2. Provide smoking cessation services to current smokers interested in quitting the habit. Program Components: The NSCP shall have the following components: 1. Training The NSCP training committee shall define, review, and regularly recommend training programs that are consistent with the good clinical practices approved by specialty associations and the in line with the rules and regulations of the DOH. All DOH health personnel, local government units (LGUs), selected schools, industrial and other government health practitioners must be trained on the policies and guidelines on smoking cessation. 2. Advocacy A smoke-free environment (SFE) shall be maintained in DOH and participating nonDOH facilities, offices, attached agencies, and retained hospitals. DOH officials, staff, and employees, together with the officials of participating non-DOH offices, shall participate in the observance and celebration of the World No Tobacco Day (WNTD) every 31st of May and the World No Tobacco Month every June. 3. Health Education Through health education, smokers shall be assisted to quit their habit and their immediate family members shall be empowered to assist and facilitate the smoking cessation process. 4. Smoking Cessation Services Below is the National Smoking Cessation Framework detailing Smoking Cessation services at different levels of care: LEVEL OF CARE STAFFING Intervention Package

DRUGS/MEDS EQUIPMENTS Risk Assessment Tool Quit Contract Referral Form

PRIMARY LEVEL BHW I. Barangay RM Health Station

Risk assessment/ Risk None screening (Note: Use

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Risk Assessment Form) Assess for Tobacco Use If smoker, do Brief Intervension Advice (5 A's) See Attached Protocol If nonsmoker, Congratulate and advice continue Healthy Lifestyle activity Above Plus Quit Clinic (Use DOH Protocol or other suggested protocols e.g. Motivational Interview, SDA Protocol, etc. as available) PRIMARY DOH Protocol LEVEL provides: II. RHU Assessment of Above Plus client's Nurses Doctor SECONDAR Smoking s and other Y LEVEL History, health Current personnel Smoking TERTIARY Status and LEVEL Readiness to stop smoking Planning for clients Readiness to stop smoking Quit day: Pharmacologi c, Psychological Patient Assessment Tool: Stages of change WHO Mental Health Checklist Use of Motivation Nicotine and Replace Confidence ment to quit therapy Smoking particula History and rly Current Nicotine Smoking patch Status and Self-test for Nicotine reason for Gum is smoking advocate (Horn's d Smoker's Selt-test) Fagerstrom Nicotine Dependencet est Self-test on Readiness to
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and Behavioral Interventions - Identifying and address triggers for going back into smoking - Dealing with cravings to smoke - Managing withdrawal syndromes Monitoring and Prevention of Relapse Quit Lines

stop smoking Previous attempts to stop smoking Form: Quit Contract

5. Research and Development Research and development activities are to be conducted to better understand the nature of nicotine dependence among Filipinos and to undertake new pharmacological approaches. Partner Organizations: The following institutions take part in achieving the goals of the program:

LUNG CENTER OF THE PHILIPPINES Contact Number: 924-9204

PHILIPPINE COLLEGE OF CHEST PHYSICIAN Contact Number:924-6101 to 20

PHILIPPINE GENERAL HOSPITAL Contact Number: 554-8400


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WORLD HEALTH ORGANIZATION Contact Number: 338-7478/ 338-7479

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS Contact Number: 844-2135 / 889-8053

PHILIPPINE MEDICAL ASSOCIATION Contact Number: 929-6366

FRAMEWORK CONVENTION ON TOBACCO CONTROL Contact Number: 468- 7222

PSYCHOLOGICAL ASSOCIATION OF THE PHILIPPINES Contact Number: 453-8257

SEVENTH DAY ADVENTIST Contact Number: 526-9870/ 526-9871/ 536-1080

PHILIPPINE AMBULATORY PEDIATRIC ASSOCIATION Contact Number:525-1797

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PHILIPPINE PSYCHIATRIC ASSOCIATION Contact Number: 635-9858

METROPOLITAN MANILA DEVELOPMENT AUTHORITY Contact Number: 882-4151 Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC) DEGENERATIVE DISEASE OFFICE Contact Number: 651-78-00 local 1750-1751 and 732-2493

Urban Health System Development (UHSD) Program


(As contained in Administrative Order No. 2011-0008 dated July 12, 2011) I. RATIONALE

In developing countries, the rapid rate of urbanization has outpaced the ability of governments to build essential infrastructure for health and social services. Among many features of urbanization in developing countries include greater population densities and more congestion, concentrated poverty and slum formation, and greater exposure to risks, hazards and vulnerabilities to health (eg. violence, traffic injuries, obesity, and settlement in unsafe areas). The concentration of risks is seen in the poorest neighborhoods resulting to health inequities. From the above, it will require more than the provision and use of health services to improve the health of urban populations. UHSD must help cities address the challenges of rapid urbanization brought about by the interplay of different social determinants of health. II. A. UHSD GOALS AND OBJECTIVES Goals

1. To improve Health System Outcomes Urban Health Systems shall be directed towards achieving the following goals: (i) Better Health Outcomes; (ii) More equitable healthcare financing; and (iii) Improved responsiveness and client satisfaction.
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2. To influence social determinants of health The DOH must help influence social determinants of health in urban settings, with focused application on urban poor populations particularly those living in slums. 3. To reduce health inequities Urban Health Systems Development seeks to narrow the disparity of health outcome indicators between the rich and the poor. B. C. 1. 2. 3. General objective: To address the Urban Health challenge Specific objectives: To establish awareness on the challenges of Urban Health; To initiate inter-sectoral approach to Urban Health Systems Development; and To guide LGUs to develop sustainable responses to the Urban Health challenge

III. Components The following are the developmental components of the UHSD Program: 1. Programs and Strategies Healthy Cities Initiative (HCI): the approach of continuously improving health and social determinants of health, and continually creating and improving physical and social environments shall be continued and further strengthened. Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a strategy of going to every depressed barangay to reach the urban poor, vulnerable groups and hidden slums to increase access to health services. Environmentally Sustainable and Healthy Urban Transport (ESHUT) initiatives which include the development or enhancement of existing projects that improve the policy, design and practice of an urban transport system and lead to improvement of health and safety of urban population. Planning Tools and Framework Urban Health Equity Assessment and Response Tool (Urban HEART): a tool to facilitate identification of and response to health equity concerns. It is used as a situational assessment, monitoring and planning tool particularly for Highly Urbanized Cities, in tandem with the Local Government Unit (LGU) Scorecard. City-wide Investment Planning for Health (CIPH): a framework for the development of public investment plans in health covering the utilization, mobilization and rationalization of the citys relatively abundant resources, more extensive capabilities and stronger institutions to attain health system goals. Capability Building Short Course on Urban Health Equity (SCUHE) is a 6-month course offered to cities and urban stakeholders that aims to improve the knowledge, practice and skills of health practitioners, policy and decision-makers at the national, regional and city levels to identify and address urban health inequities and challenges, particularly in relation to social determinants of health.
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2.

3.

IV.

General Principles

1. Healthy urbanization. Urban Health Systems (UHS) must promote healthy urbanization so that cities develop in ways that achieve better health and avoid risks to ill health under conditions of rapid urbanization. 2. Inter-sectoral action. UHS must be designed through inter-sectoral collaboration with people and institutions from outside the health sector to influence a broad range of health determinants and generate responses producing sustainable health outcomes. 3. Inter-city coordination. Inter-city coordination between contiguous cities is important because a city, particularly if it is not a Highly Urbanized City may not have all the resources, institutions and capacities to be able to respond to the entire health needs of its constituents, and may thus benefit from resources, institutions and capacities of other cities through inter-city or inter-LGU coordination. 4. Social cohesion. Social cohesion is action through core groups.

5. Community participation. Community participation must be integrated in all aspects of the intervention process, including planning, designing, implementing, and sustaining any project/program. 6. Empowerment. Empowerment is enabling individuals and communities to have ultimate control over key decisions involving their wellbeing through strategies such as building knowledge and purchasing power, and mechanisms to increase client accountability. The DOH approach in the reform of urban health systems is the management of social determinants of health in urban settings, with focused application on poor populations, particularly those living in slum communities/settlements to address equity concerns. Briefer on the Urban Health Equity Assessment and Response Tool (Urban HEART) I. Rationale:

Rapid unplanned urbanization gives rise to urban poverty, health problems, and health inequities in the cities. Disparities in health system outcomes between the affluent and the poor are becoming more prominent in highly urbanized areas as government sectors find it hard to cope with the increasing demands of the fast growing population of urban poor.

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To address the above concerns, the Urban HEART or the Urban Health Equity Assessment and Response Tool was developed by the WHO Centre for Health Development in Kobe, Japan to assist Ministries of Health of countries in systematically generating evidence to assess and respond to unfair health conditions and inequity in the urban setting. It was initially launched in Tehran, Iran on April 2008, and the Philippines along with Iran, Zambia, and Brazil were the pilot sites to test the Urban HEART in each country. Seven cities initiated the use of the Urban HEART in the Philippines in 20082009, namely: Paranaque City, Taguig City, Olongapo City, Naga City, Tacloban City, Zamboanga City, and Davao City. The cities helped develop the tool for applicability in varied urban settings in the country. Urban Health Systems need to establish evidence on the status of the disadvantaged population in the highly urbanized areas in order to develop objective interventions to address inequities. Department Memorandum No. 2010-0207 dated August 20, 2010 on the Use of the Urban Health Equity Assessment and Response Tool in Highly Urbanized Cities is intended to help Highly Urbanized Cities (HUCs) generate systematic data on health inequities to guide effective interventions.

Unang Yakap (Essential Newborn Care: Protocol for New Life)


Many initiatives, globally and locally, help save lives of pregnant women and children. Essential Newborn Care (ENC) is one. ENC is a simple cost-effective newborn care intervention that can improve neonatal as well as maternal care. IT is an evidence-based intervention that Emphasizes a core sequence of actions, performed methodically (step -by-step); Is organized so that essential time bound interventions are not interrupted; and Fills a gap for a package of bundled interventions in a guideline format.

Violence and Injury Prevention Program


Accidents consistently remain one of the leading causes of morbidity and mortality in the country. The Philippine Health Statistics from 1975 to 2002 revealed that there has been increasing trend of mortality due to accidents per 100,000 populations. Mortality rate increased from 19.1/100,000 population in 1975 to 42.3/100,000 populations in 2002 corresponding to 33,617 deaths, majority of which is caused by assaults (13,276); transport accidents (6,131); accidental drowning and submersion (2,871); and accidental falls (1,536). Accidents ranked 8th in 1975, 7th in 1985 and 6th in 1995 and 5th in 2002 among the 10 leading causes of death.
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The Department of Health (DOH) shall serve as the focal agency with respect to violence and injury prevention. As such, it shall design, coordinate and integrate activities, plans, and programs of various stakeholders into an effective and efficient system. The Violence and Injury Prevention Program is hereby institutionalized as one of the programs of the National Center for Disease Prevention and Control (NCDPC). To ensure coordination and sustainability of the program, a Program Management Committee (PMC) shall be organized. The Committee shall then be subdivided into Sub-Committees according to the areas of concern: road traffic injuries, thermal injuries (burns and scalds), drowning, physical injuries (fall, violence), and chemical injuries (poisoning, etc.). For a comprehensive approach, the Program shall coordinate with other programs like the Maternal and Child Health and other DOH Offices such as the National Center for Health Facility Development, Health Emergency and Management Services, among others, solicit active representation from public and private stakeholders that are involved in violence and injury prevention. The 4 Es. Strategies shall utilize the concept of the 4 Es, Education, Enforcement (in addition to Enactment), Engineering, and Economic incentives, in the prevention and control of injuries. Education entails dissemination of information related to injury prevention. Strategies and programs can be targeted at the risk group indentified in the populations. Enforcement and enactment of strategies indentify opportunities for injury prevention policy development and implementation. Engineering provides and effective way of reducing the impact of injury causes through application of energy transmission designs. Economic incentives can be instrumental in pursuing injury prevention policies. Goals and Objectives: To establish a national policy and strategic framework for injury prevention activities for DOH and other government agencies, local government units (LGUs), nongovernment organizations (NGOs), communities, and individuals. Program Strategies: The program and action plan that are to be developed for each classification of injuries shall consider the following principles: 1. Health Promotion DOH, in collaboration with other stakeholders, shall undertake advocacy, information and education, political support, and inter-sectoral collaboration on accidents/injury
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prevention and patterns and factors associated with incidence of accidents/injury to policy makers, government agencies, civil societies, peoples organizations, the general public and other stakeholders. 2. Developing Institutional Arrangement and Capacity DOH, and partnership with other stakeholders, shall develop and enhance the violence and injury prevention capabilities of a wide range of sectors and stakeholders at the local and national levels. Training programs shall be made available and accessible to policy implementers at the national, regional, and local levels. 3. Injury Surveillance System DOH shall establish and institutionalize a system of data recording, reporting, analysis at the national, regional and local levels. An information system shall be developed for this purpose. The system shall record injuries, patterns and factors that may have cause the injury as well as the available services, health status needs and circumstances of injured person. DOH shall advocate to various stakeholders involved in the management of different types of injuries through cooperated reporting, archiving and linking of new and existing databases for a more comprehensive picture. 4. Networking and Resource Mobilization DOH shall promote partnership with among various stakeholders to build coalitions and networks and generate resources for activities related to violence and injury prevention. In the process, the department shall initiate coalition building through formal and informal instruments with stakeholders in order to ascertain their commitment in implementing defined action plans and programs and in mobilizing all available resources. Sharing of responsibilities and allocation of resources to address the problem to achieve maximum results shall be explored. 5. Monitoring and Evaluation DOH, in consultation with various stakeholders, shall identify indicators and targets for program monitoring and evaluation purposes. 6. Equitable Health Financing Package DOH in collaboration with various stakeholders, shall advocate to health financing institutions and financial intermediaries, insurance companies, the development and implementation of policies that would be beneficial to victims of violence and injury. 7. Research and Development DOH shall promote the conduct of multi-disciplinary and multi-sectoral solutions and researches for purposes of developing national and local competence in injury prevention, health care services and for other purposes that may be necessary. 8. Service Delivery In collaboration with stakeholders, DOH shall institutionalize systems and procedures for the integration and provisions of services at the community level.
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Information shall be utilized for continued public health information and education, planning and implementation, and policy revision. Appropriate primary prevention, care and rehabilitation of injured people shall also be crucially provided. 9. Community Participation DOH shall aim for a successful community based violence and injury prevention to anchor upon a community-wide sense of ownership and empowerment to accomplish tasks. This is to ensure that all patients receive quality services at the appropriate levels of health care delivery system. Successful community-based programs also revolve around the formation of new partnerships between a diverse group of constituents who have vested interest in violence and injury control, including representatives of public safety, law enforcement, fire, local governments, schools, business, community groups, and health care provider. All rural health units should be linked to a referral center specific and appropriate to the type of injury sustained. 10. Policy Advocacy DOH shall advocate for the necessary policy instruments, such as laws, executive orders, administrative orders, and ordinances to the Congress, other national agencies and LGUs, respectively. This approach shall ensure sectoral and community-based interventions to propel action on violence ad injury. Major Activities and its Guidelines: In line with the effort to reduce the incidence of firecracker - related injuries during the Holiday Season and in consonance with its present strategy, the Department of Health embarks on the project, Kontra Paputok which promotes information and awareness on the dangers of firecrackers and the prevention of firecrackers and fireworks- related injuries. In this regard, all Center for Health Development Directors and Chiefs of DOH Hospitals are hereby directed to mobilize their respective offices and hospitals to undertake the following activities: 1. Public Information Campaign

All Centers for Health Development should take the lead and shall implement a public information campaign in their respective Region or catchments area for Kontra Paputok Activities. They should coordinate with their local radio and TV Network and assign a pool of speakers to promote the prevention of firecracker injuries, especially informing the public on the dangers of using prohibited firecrackers and watusi. As per Memorandum of the Firearms and Explosives Division-Philippine National Police (FED-PNP) dated 17 January 2002, WATUSI IS ALREADY BANNED FROM THE MARKET and no longer authorized the sale of the said firecracker. Streamers and posters should be posted in strategic and public places. The slogan for this year's campaign is "Walang Batang Magpapaputok" See the Prototypes of the streamer and poster at the DOH website.

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2.

Emergency Room Preparedness and Responsiveness

All DOH Hospitals are hereby declared on CODE WHITE ALERT on December 24, 25, 31, 2010 and January 1, 2011 to prepare their emergency units and ensure the provision of prompt emergency services to injured patients during the Holiday. 3. Nationwide Registry Injuries

All DOH Sentinel Hospitals shall report to the Online National Electronic Surveillance System Registry (ONEISS) of the Department of Health. The surveillance period for fireworks related injuries, stray bullets and watusi ingestion victims shall commence at 6:00 am of December 21, 2010 and will end at 5:59 am of January 5, 2011. Reporting should be done daily and strict observance of time is required. 4. Tetanus Surveillance

The surveillance period for fireworks-related tetanus victim shall commence on December 21, 2010 and shall end on January 21, 2011. Fireworks related tetanus cases hospitalized even after the surveillance period must be reported. Availability/stocks of Tetanus Toxoid/Vaccine in hospitals should be ensured. 5. Networking with Other Government Agencies

The strategy for this year's campaign is advocating the use of safe and alternative ways of celebrating the New Year with a Healthy Bang such as street parties, concerts, amateur contests, Ati-Atihan, designation of identified area for fireworks display and other ways of noise-making like using pots and pans and torotot. And in the light of the devolution, provision of technical assistance and close coordination with the Local Government Units (LGUs) should be enhanced wherein the Local Government Executives (LGEs) should enforce strictly the Republic Act 7183 (Firecracker Law) and spread the safe and alternative celebration of the New Year in their respective areas. Coordination among the Regional Offices of various Agencies Philippine National Police, Armed Forces of the Philippines, Department of Education, Department of Trade and Industry, Department of Interior and Local Government, Department of Labor and Employment, Philippine Information Agency, Bureau of Fire Protection, National Police Commission, Department of Environment and Natural Resources, Department of Science and Technology, different Leagues of the Philippines (Provincial, Cities, Municipalities, and Barangay) and non-government agencies strengthen public information campaign and other advocacy activities especially against the use of Watusi and illegal Firecrackers, which is prohibited under Republic Act 7183 or the Firecracker Law. 6. Firecracker Ban on all DOH Facilities

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All offices, hospitals of the DOH and its attached agencies are hereby declared a FIRECRACKER FREE ZONE. Moreover, SELLING OF FIRECRACKERS IS STRICTLY PROHIBITED within the premises of the Department of Health Facilities. All Heads of Agencies are hereby instructed to disseminate these guidelines to their respective personnel. Status of the Program: As a nationwide undertaking, the NCDPC requires health facilities to adhere to all national policies and guidelines on injury reporting. The NCDPC is the central coordinating body for the evaluation, processing, monitoring, and dissemination of data or information. Each health facility is required to report on a daily basis all injury related cases through the Online National Electronic Injury Surveillance System. While the NCDPC has no regulatory power over the health facilities, it does have indirect power thru the Bureau of Health Facilities and Services. The NCDPC as the highest policy making body can make recommendations to the BHFS for appropriate actions on erring health facilities. The general objective of National Electronic Injury Surveillance System (NEISSE) is to make efficient and effective the current systems and procedures of reporting injury-related data. Specifically, NEISS aims to: 1. Promote efficiency to maximize time and effort in data collection, processing, validation, analysis and dissemination of injury-related data; 2. Improve accuracy, reliability, integrity and timeliness of injury-related data; 3. Implement the most reliable and effective technology solution to interconnect with the different agencies and/or beneficiaries/stakeholders of the injury related data; and 4. Enforce standards on inputs, processes and outputs on injury-related data collection, analysis, report generation and feedback. ONEISS shall be the standard reporting system for the collection, storage, analysis and reporting of data pertaining to injury. ONEISS is the information system being implemented by the DOH in support of the Injury Program. The PNIDMS The Philippine Network for Injury Data Management System (PNIDMS) is a multi-sectoral organization composed of the World Health Organization, United Nations Children's Fund, Department of Health, Department of Transportation and Communication, Department of Public Works and Highway, Philippine National Police - Highway Patrol Group, Metro Manila Development Authority, Land Transportation Office and Safe Kids Philippines, which aims to establish and
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maintain a coordinated data management system that can link, integrate, or combine injury data from various sources or systems to provide an overall picture for policy makers and decision makers at the national, regional and local levels. Partner Organizations/Agencies: The program management committee (PMC) shall be chaired by the director IV of the National Center for Disease Prevention and Control with the following as members: Division chief of the Degenerative Disease Program: National focal person (Program Manager) for violence and injury prevention program; and representatives from DOTC, DPWH, DILG/League of municipalities. Specialty Societies and other agencies/organizations are to be identified by the committee itself. Experts in the various aspects of violence and injury prevention shall also be involved to ensure a comprehensive program approach. The following institutions/agencies partake in the achievement of the program goals:

Department of Transportation and Communication (DOTC) Philippine National Police (PNP) Department of Interior and Local Government (DILG) Department of Public Works and Highways (DPWH) Department of Education (DepEd) Metro Manila Development Authority (MMDA) Department of Social Welfare and Development (DSWD) Bureau of Fire Protection (BFP) Safe Kids Philippines, Inc. Automobile Association of the Philippines Safety Organization of the Philippines, Inc. Philippine National Red Cross Motorcycle Development Participants Association Ford Road Safety Youth Council Project CARES Trauma Centers: o Philippine Orthopedic Hospital o East Avenue Medical Center o Las Pias General Hospital and Satellite Trauma Center o UP-Philippine General Hospital o Vicente Sotto Memorial Medical Center

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Women's Health and Safe Motherhood Project


I. RATIONALE The Philippines has committed to the United Nation millennium declaration that translated into a roadmap a set of goals that targets reduction of poverty, hunger and ill health. In the light of this government commitment, the Department of Health is faced with a challenge: to champion the cause of women and children towards achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6(combat HIV/AIDS, malaria and other diseases). Pregnancy and child birth are among the leading causes of death, disease and disability in women of reproductive age in developing countries. The Philippine government commitment to the MDGs is, among others, a commitment to work towards the reduction of maternal mortality ratios by three-quarters and under-five mortality by two-thirds by 2015 at all cost. Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal mortality ratio, increasing neonatal deaths particularly on the first week after birth, unmet need for reproductive health services and weak maternal care delivery system, in addition to identifying the technical interventions to address these problems, the DOH with support from the World Bank decided to focus on making pregnancy and childbirth safer and sought to change fundamental societal dynamics that influence decision making on matters related to pregnancy and childbirth while it tries to bring quality emergency obstetrics and newborn care to facilities nearest to homes. This moves ensures that those most in need of quality health care by competent doctors, nurses and midwives have easy access to such care. Project Development Objectives and Indicators The Project contributes to the national goal of improving womens health by: 1. Demonstrating in selected sites a sustainable, cost-effective model of delivering health services access of disadvantaged women to acceptable and high quality reproductive health services and enables them to safely attain their desired number of children. 2. Establishing the core knowledge base and support systems that can facilitate countrywide replication of project experience as part of mainstream approaches to reproductive health care within the Kalusugan Pangkalahatan framework. Project Components Component A: Local Delivery of the WHSM Service Package This component supports LGUs in mobilizing networks of public and private providers to deliver the integrated WHSM-SP. In such project site, the following are currently being undertaken: 1. Establishment of Critical Capabilities to Provide Quality WHSM Services through the organization and operation of a network of Service Delivery Teams consisting of:
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a. Womens Health Teams b. BEmONC Teams c. CEmONC Teams d. Itinerant Teams 2. Establishment of Reliable Sustainable Support Systems for WHSM Service Delivery: a. Drug and Contraceptive Security b. Safe Blood Supply c. Behavior Change Interventions d. Sustainable financing of local WHSM services and commodities Component B: National Capacity 1. Operational and Regulatory Guidelines (Manual of Operations) 2. Network of Training Providers 3. Monitoring, Evaluation, Research and Dissemination II. INTERVENTIONS AND STRATEGIES EMPLOYED The Department of Health through the Womens Health and Safe Motherhood Project 2 introduces new strategies to address critical reproductive health concerns while confronting both demand and supply side obstacles to access for disadvantaged women of reproductive age. Among the changes that the Project introduced and has systematically mainstreamed into the current National Safe Motherhood Program are the following:

Strategic Change in the Design of Womens Health and Safe Motherhood Services

WHSMP2 brought about strategic changes in the way services are delivered to clients particularly the disadvantaged and underserved. These changes involve (1) a shift in emphasis from the risk approach that identifies high-risk pregnancies during the prenatal period to an approach that prepares all pregnant for the complications at childbirth this change brought about the establishment of the BEmONC CEmONC network, which is now part of the MNCHN service delivery network; (2) improved quality of FP counseling and expanded service availability, including the organization of more Itinerant Teams providing permanent methods and IUD insertion on an outreach basis and (3) the integration of STI screening into the maternal care and family planning protocols.

An Integrated Package to Womens Health Services

The above changes in service delivery will likewise involve a shift from centrally controlled national programs (MC, FP, STI and AH) operating separately and governed independently at various levels of the health system to an LGU governed system that delivers an integrated womens health and safe motherhood service package. This
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service delivery strategy is focused on maximizing synergies among key services and on ensuring a continuum of care across levels of the referral system. At the ground level, this implies that a woman, whatever her age and specially if she is disadvantaged, who seeks care from a public health provider for reproductive health concerns, could expect to be given a comprehensive array of services that addresses her most critical reproductive health needs.

Reliable Sustainable Support Systems

Support Systems for WHSM service delivery include systems for (1) drug and contraceptive security, through a strategy of contraceptive self reliance; (2) safe blood supply; (3) stakeholder behavior change, through a combination of performance based grants and advocacy and communication; (4) sustainable financing, through a diversification of funding sources, principally given by the development of client classification scheme so that the poor gets public subsidies and the non-poor are charged user fees.

Stronger Stewardship and Guidance from the DOH

DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on WHSM services, (2) a system for accrediting providers of integrated WHSM service package training program; and (3) monitoring, evaluation and research on the new WHSM strategies. The Project is implemented in LGUs in 2 phases: Phase 1 (2006-2012): Sorsogon in the Bicol region and Surigao del Sur in the Caraga Region Phase 2 (2009-2012): Albay, Catanduanes and Masbate III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS As of December 2011, the project accomplishments via-a-vis its life of project work plan is 71%. Among the operations issues that delays accomplishments of critical inputs relates to procurement and other external factors such as LGU organizational structures. The following summarizes the over-all accomplishment of the project. Results Matrix: 2011 Baseline (2010) Target Accomplishments Values 67% 80% 80% 2011 Accomplishments 77% 100%
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Outcome Indicators 80% Facility-based Births

80% of the Women who gave 99% birth have birth plans

75% of facility deliveries are 17% financed by PHIC Increase CPR percentage points by 10 36%

55%

27%

5% points 3% points increase increase 39% 100% 50% 75% 70% 52% 100%

100% of LGUs have passed an ordinance on the 47% Contraceptive Self Reliance 100% of BEmONC have MCP 45% accreditation Universal Social Insurance Coverage Health 72%

Relative to the physical targets, the Project has accomplished the following in the Project sites: Year Project Milestones Status

2009

Social Preparation of Batch 2 Sites Organization of Service Delivery Done Teams Done Regional Blood Centers equipment Done upgrade 73% Ongoing: Albay: 90% Infrastructure Masbate: 80% Catanduanes: 60% Surigao del Sur: 53% Sorsogon: 84%

2009-2011

Facility upgrade: and Equipment

2009-2010

Currently undergoing procurement Training Centers Insfrastructure 13 Training Centers already and equipment enhancement provided with equipment and other training logistics Ensuring environmental Safeguards Organization of EMU in CEmONCs Done Designation of Waste Management Focal Persons in BEmONCs Capability Enhancement: BEmONC Skills: 60% Women's Health Teams Sorsogon: 73%
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2009-2010

2008-2012

Albay: 103% Catanduanes: 55% Masbate: 73% Surigao del Sur: 63% 2008-2010 2008-2010 2011-2012 2010 BEmONC Teams Midwives on BEmONC Skills Provincial Review Teams Behavior Change Interventions Performance-based Grants: Facility based Deliveries Universal Social Health Insurance Coverage Essential Drugs and Contraceptive Security Advocacy for Positive Change TV Infomercials Behavior 4 Infomercials produced and aired in 2011; another 4 being produced for airing in 2012. 52% Albay: 31% (5/16) MCP Catanduanes: 17% (1/6) Masbate: 62% (13.21) Sorsogon: 82% (14/17) Surigao del Sur: 16% (3/19) Module currently being finalized Done CEmONC Doctors (non-specialists) Module currently being finalized

2009-2013

2010-2013

2009-2013

BEmONC Accreditation

Facility

IV. PLANS FOR 2012 The Project intends to propose for an extension of another year to enable it to accomplish important activities as provided for by the design and loan agreement with the World Bank. These are: 1. Pilot test of an Adolescent Health Program model for the Philippines. This requires 2 years. 2. Study on the Impact of the WHSMP2 Performance Based Grant on Facility Based Deliveries is a one-year study. 3. Assessment of BEmONC Functionality is nationwide in scope and requires 1 year. If the extension is not granted, the Project implementation ends by December 2012. The activities therefore will be focused on accomplishing the remaining tasks with no new activities, except the conduct of the end of Project survey to determine its impact at the Project LGUs and its contribution to the attainment of national goals. Writing of end of project reports will be done in January to June of 2013. The project also supported the BEmONC Skills Training Program of the National Safe Motherhood Program and was instrumental in the
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1. Establishment of 30 Training Centers in the country for the BEmONC Skills Training Course. Three of these training centers have efficiently partnered with academic institutions. 2. Development of training guidelines. 3. Passage of the Department Order allowing for the collection of training fees for the operation of the Training Centers. 4. Engagement of Technical Assistance (UP-Manila College of Public Health) for the development of the CEmONC Training Curriculum and Module. 5. Development of the Harmonized Module for BEmONC for Midwives in cooperation with UNICEF and UNFPA. 6. Training of BEmONC Teams nationwide; the current accomplishment is 48%. 7. Development and maintenance of a database on BEmONC Training. V. Other Significant Information Worth Mentioning 1. The Project provided assistance in the development of the Maternal Health Reporting and Review Protocol in cooperation with the National Safe Motherhood Program and WHO. 2. Publication of the Project Experience (in Sorsogon) in the November 2011 issue of the WHO Bulletin. Program Manager: Ms. Zenaida D. Recidoro National Center for Disease Prevention and Control - Family Health Office Telephone Number: 651-7800 locals 1726-1730 (As stated in the Womens Health and Safe Motherhood Project 2 Implementation Plan) Women's Health Safe Motherhood Program 2 Safe Motherhood and Women's Health Project

Women and Children Protection Program


I. BACKGROUND AND RATIONALE The Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos embodied in Administrative Order No. 2010-0036, dated December 16, 2010 states that poor Filipino families have yet to experience equity and access to critical health services. A.0. 2010-0036 further recognizes that the public hospitals and health facilities have suffered neglect due to the inadequacy of health budgets in terms of support for upgrading to expand capacity and improve quality of services.
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AHA also states the poorest of the population are the main users of government health facilities. This means that the deterioration and poor quality of many government health facilities is particularly disadvantageous to the poor who needs the services the most. In 1997, Administrative Order 1-B or the Establishment of a Women and Children Protection Unit in All Department of Health (DOH) Hospitals was promulgated in response to the increasing number of women and children who consult due to violence, rape, incest, and other related cases. Since A.O. 1-B was issued, the partnership among the Department of Health (DOH), University of the Philippines Manila, the Child Protection Network Foundation, several local government units, development partners and other agencies resulted in the establishment of women and child protection units (WCPUs) in DOHretained and Local Government Unit (LGU) -supported hospitals. As of 2011, there are 38 working WCPUs in 25 provinces of the country. For the past years, there have been attempts to increase the number of WCPUs especially in DOH-retained hospitals but they have been unsuccessful for many reasons. The experience of these 38 women and children protection units reflect that: 1. Over the last 7 years from 2004 to 2010, all these WCPUs handled an average of 6,224 new cases with a mean increase of 156 percent. The 2010 statistics presented a record high of 12,787 new cases and an average of 79.86 percent increase from 2009. More than 59 percent were cases of sexual abuse; more than 37 percent were physical abuse and the rest on neglect, combined sexual and physical abuse and minor perpetrators. More than 50 percent of these new cases were obtained from WCPUs based in highly urbanized areas across the country. Figures show there is a need to continue to raise awareness on domestic violence to have more accurate recording and reporting; 2. The National Demographic and Health Survey of 2008 reveals that one in five women aged 15-49 are physically abused and one out of 10 of the same age group are sexually abused. This figure runs into millions of abused women nationwide who do not seek any help or assistance; 3. A consistent and adequate budget is necessary to sustain a women and children protection unit once it is established; 4. The source of budget cited in A.O. 1-B is subjected to multiple interpretations and is dependent on the priorities of the local chief executive and/or the healthcare facility management; 5. There is no standard quality of service; 6. Doctors and social workers are reluctant to take on the task due to heavy workload of women and child protection work, lack of training and feeling of inadequacy, and the nature of work, which among others requires responding to subpoenas and appearing in court;
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7. All the WCPUs are being managed by part-time personnel who are given add-on responsibilities and their appointments are not classified as regular plantilla positions; 8. Women and child protection work is a new field and a pool of professionals must be recruited and trained to sustain the work; and 9. Women and children protection work has gone beyond being a health advocacy to becoming an essential health service addressing the needs of victims of violence against women and children. The strategies espoused by the AHA, specifically the service delivery network (SDN) and public-private partnership (PPP), will be utilized in the institutionalization of the women and children protection program nationwide. A health SDN is composed of a network of health service providers at different levels of care from levels 1: health centers or women and childrens desks offering primary services, 2: district health facilities offering secondary care and 3: regional and national hospitals with tertiary care. An SDN can be as small as an Inter-Local Health Zone or as large as a regional SDN with a regional hospital serving as the end-referral hospital. The most efficient system for women and child protection facilities follows the SDN model where a complete and integrated women and child protection unit is located in a strategic hospital. The primary goal is to identify where the women and children protection units will be located across the country and to ensure that there will be at least one in each province. Hospitals, whether public or private, which do not have a women and child protection unit may be trained to refer the victims to women and children protection coordinators (WCPCs) and WCPUs in other hospitals where the staff is trained in recognizing, recording, reporting and referring abuse cases. This will ensure that all women and children victims of violence who seek medical care have access to health services provided by trained, competent, and caring health personnel. II. GOALS AND OBJECTIVES GOAL: To institutionalize and standardize the quality of service and training of all women and children protection units. GENERAL OBJECTIVES: 1. Establish at least one women and children protection unit in every province; 2. Ensure that all health facilities have competent and trained gender-responsive professionals who will coordinate the services needed by women and children victims of violence; 3. Standardize and maintain the quality of health care services rendered by all women and children protection units;
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4. Ensure the sustainability of women and childrens protection unit programs through appropriate organizational and budgetary support; 5. Create and maintain a centralized and harmonized database for all reports submitted by the different women and children protection units. III. SCOPE AND COVERAGE This issuance shall apply to the entire health sector, including the DOH hospitals, LGU-supported health facilities, private hospitals, and other attached agencies involved in the implementation of the AHA. Health professionals from private hospitals seeing patients who they suspect are victims of abuse are duty-bound to refer the said individuals to concerned government agencies for appropriate response in accord with either Republic Act Nos. 7610[1] or 9262[2]. IV. DECLARATION OF POLICY This issuance supports the Government Health Reform Agenda, the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination Against Women, the Beijing Platform for Action, the Child Protection Law,[3] the Anti-Violence Against Women and Their Childrens Act of 2004,[4] AntiRape Act of 1998,[5] the Rape Victim Assistance and Protection Act of 1998[6], and the Magna Carta of Women (2009).[7] The DOH shall there by contribute to the realization of the countrys goal of eliminating all forms of gender-based violence and promoting social justice.[8] V. GUIDING PRINCIPLES This issuance is governed by the following principles: 1. Rights-based approach. Identification and treatment of violence against women and children is anchored on respect for and recognition of the rights of women and children as mandated by the Philippine Constitution, the Convention on the Elimination of All Forms of Discrimination Against Women, the Convention on the Rights of the Child, and the Beijing Platform for Action. 2. Best interest of the child. All actions concerning victims of abuse, neglect, and maltreatment shall take full account of the childrens best interests. All decisions regarding children shall be based upon the needs of individual children, taking into account their development and evolving capacities so that their welfare is of paramount importance. This necessitates careful consideration of the childrens physical, emotional/psychological, developmental and spiritual needs. Adequate care shall be provided by multidisciplinary child protection teams when the parents
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and/or guardians fail to do so. In cases whether there is doubt or conflict, the principle of the best interest of the child shall prevail. 3. Holistic service delivery. Care focused on the whole person addressing the biomedical, psycho-social, and legal concerns. 4. Respect for diversity and non-discrimination. Holistic and appropriate health care delivered shall be coupled with respect for cultural, religious, developmental (including special needs), gender and sexual orientation, and socio-economic diversity. All women and children victims of violence shall have a right to receive medical treatment, care, and psycho-social interventions. 5. Evidence-based interventions and approaches. Policies and guidelines shall be developed in accordance with recent data gathered through prevalence surveys, efficacy studies, and other research done locally and internationally. Recommendations from international organizations may also be utilized when appropriate. 6. Multidisciplinary approach. Recognition, reporting, and care management of cases involving violence against women and children are be best achieved through medical, psycho-social, and legal teamwork including the mental health intervention and local government unit response and cooperation, whenever necessary. VI. IMPLEMENTING RULES AND GUIDELINES 1. Committee on Women and Children Protection Program. The Committee on Women and Children Protection Program, hereinafter referred to as the Committee, shall be primarily responsible for policymaking, coordinating, monitoring, and overseeing the implementation of this revised issuance. 2. Composition. - The Committee shall be composed of the following: a. Undersecretary of Health Service Delivery as ex officio Chairperson; b. Undersecretary for the Local Affairs of the Department of the Interior and Local Government or his/her authorized representative; c. Undersecretary for Policy of the Department of Social Welfare and Development or his/her authorized representative; d. A regional director of the Department of Health; e. A hospital director of a DOH-retained hospital; f. Executive Director of the Philippine Commission for Women; g. Executive Director of the Council for the Welfare of Children; h. Executive Director of the Child Protection Network Foundation; i. One representative each from the Philippine Pediatrics Society, the Philippine Obstetrics and Gynecological Society, Inc., the Philippine Psychiatric Association, the Philippine Psychological Association, the Philippine College of Emergency Medicine, the Philippine College of Surgeons, and the Philippine Academy of Family Physicians, Inc.
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The Chairperson shall appoint a Vice-Chair from among the Committee members who shall preside over the meeting in the formers absence. The Committee shall designate from among its members a program manager who will be given appointment by the Undersecretary of Health through a Department Personnel Order. The Committee may create a technical working group, as the need arises, to help it in the performance of its functions. 3. Term. The Committee shall hold office for three (3) years and may be reappointed or until their successors shall have been appointed. 4. Functions. The Committee shall have the following functions: 1. Identify and recommend strategically-located DOH-retained and LGU-supported hospitals for WCPU establishment using geographical and population ratio criteria; 2. Formulate standard protocols and procedures and the manual of operations for multidisciplinary care for women and children victims of abuse and violence; 3. Set the policy for criteria and procedure for accreditation of women and children protection units to be forwarded to the Bureau of Standards and Regulation for appropriate action by the Department of Health (DOH); 4. Lay down the policy for minimum requirements for training programs that are gender responsive, such as the Certificates for Women and Child Protection Specialty Program and other relevant residency programs; 5. Monitor and evaluate the efficacy, effectiveness and sustainability of creation, operations, and maintenance of WCPUs; 6. Recommend policy reforms and new guidelines anchored on evidence-based interventions and approaches; 7. Harmonize existing databases and create a central databank for women and children protection cases; and 8. Perform other functions as may be necessary for the implementation of the revised issuance. 5. Reportorial Functions. The Committee shall submit to the Office of the Secretary of Health its annual report on policies, plans, programs and activities on or before the last working day of February. 6. Meetings. The Committee shall meet regularly at least once every quarter. The venue shall be agreed upon by the members. Special meetings may be requested by the Chairperson or any Committee member, as the need arises. The Committee members and program manager shall be entitled to an honorarium for every meeting.

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VIII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES A. Department of Health at the National Level 1. The Committee shall be under the direct supervision of the Office of the Undersecretary for Health Services Delivery. 2. The specific office/s to be designated by the Undersecretary for Health Services Delivery shall be primarily responsible for: a. The overall execution of the revised policy and manual of operations on Women and Children Protection Program; b. Accreditation of WCPUs; c. Generation mobilization of resources for the operations of WCPUs. B. Philippine Health Insurance Office (PhilHealth) The PhilHealth shall develop a service package for all WCPU patients that will facilitate the provision of inpatient and outpatient services. C. Centers for Health Development 1. Disseminate the policy for adoption and implementation by LGU health systems in the different localities within their respective regions; 2. Provide technical assistance to LGUs in organizing WCPU activities and developing relevant technical references and information, education and communication (IEC) materials; 3. Generate resources to strengthen the implementation of the policy and manual of operations for WCPUs; 4. Formulate and implement advocacy plans to generate stakeholders support, particularly the local officials; 5. Monitor the implementation of the policy and guidelines in both public and private hospitals, and in different localities in their respective regions; 6. Undertake regular review with LGUs on the progress of the WCPU policy and guidelines. D. Local Government Units 1. Provincial / City Health Office a. Train private and public health workers on the women and children protection program; b. Advocate with municipalities/cities and other concerned agencies and stakeholders to adopt and implement the revised policy on the women and children protection program; c. Generate and allocate resources in support of WCPU provision (e.g., counterpart funds for training, procurement of additional WCPUs, etc); d. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols. 2. Regional and provincial hospitals a. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols; Allocate budget sufficient for the operations of WCPUs; Conduct training and orientation on 4Rs;
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Maintain an accurate and complete database on WCPU clients.

E. Child Protection Network Foundation, Inc. 1. Provide expertise and technical support for the establishment of WCPUs and the central database on childrens cases; 2. Extend guidance to the trained physicians and social workers in WCPUs; 3. Coordinate with the Philippine Commission for Women, Council for the Welfare of Children and non-government organizations (NGOs) regarding matters related to womens and childrens health and gender concerns; 4. Participate in the implementation of the WCPU policy including its manual of operations. F. Philippine Commission on Women 1. Provide expertise and technical assistance on gender-responsive delivery of services by the WCPU service providers and the central database on womens cases; 2. Assist the DOH in monitoring the implementation of the WCPU using the Performance Standards and Assessment Tools for Services Addressing VAW in the Philippines; 3. Require all hospitals to allocate from their gender and development (GAD) budget the funds required to create, operate, and maintain WCPUs and to report the use of their GAD funds to PCW. IX. REQUIREMENTS FOR THE ESTABLISHMENT OF WOMEN AND CHILDREN PROTECTION UNITS The Committee shall ensure that all present and future WCPUs comply with the criteria mandated in this revised policy and its Manual of Operations. All WCPUS, depending on the number of their personnel, range of services rendered, and annual budget shall be classified as Levels I, II and III facilities. Minimum criteria for each of these units are enumerated in the Manual of Operations of this policy. MANUAL OF OPERATIONS The Committee on Women and Children Protection Program shall regulate the establishment and operations of all WCPUs in the Philippines. I. MINIMUM REQUIREMENTS FOR ALL HOSPITALS

A. Training. The Committee shall require that all hospital personnel undergo training on the recognition, reporting, recording and referral (4Rs) of cases of violence against women and children. B. Women and Children Protection Coordinator. Hospitals without a women and children protection unit shall have a women and children protection coordinator (WCPC) responsible for coordinating the management and referral of all violence against women and children cases in the hospital.
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II. The minimum standard criteria shall be maintained by all WCPUs. A. Organizational Structure - The WCPU shall: 1. Be an integral part of the hospital; 2. Be under the Office of the Chief of Clinics; 3. Be supervised by a WCPU head who shall have the following responsibilities: a. Integrate and operationalize the multidisciplinary functions of the WCPU b. Prepare the annual work and financial plan, including budget preparation, 4. Submit quarterly reports to the Office of the Undersecretary for Health Services Delivery. 5. Have the following minimum staff, preferably with regular plantilla positions, who shall be primarily responsible to the WCPU: a. a trained physician and b. a trained social worker. B. Facilities - The WCPU shall: 1. Be permanently situated in a designated area, preferably near the emergency room of the hospital; 2. Be spacious enough to accommodate all the services provided by the facility, such as: a. A separate room for interviews and crisis counselling b. A separate room for medical examination; c. A reception area to accommodate those waiting to be served, including their companions. The reception area must have culture- and gender-sensitive information materials on violence against women and children (VAWC) d. Filing cabinets and other furniture/equipment that will ensure the security and confidentiality of files and records; 3. Have its own toilet or comfort room; 4. Have the following fixtures: a. Examination table b. Desk and chairs c. Washing facilities with clean running water d. Light source, and e. Telephone line f. Computer and printer g. Office supplies 5. Have readily available supplies and equipment for medical examination, including: a. Digital camera b. Rape kit c. Speculum of different sizes d. Blood tubes
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e. Syringes, needles and sterile swabs f. Examination gloves g. Pregnancy testing kits h. Microscope slides i. Measuring devices like rulers and calipers j. Urine specimen containers k. Refrigerator for storage of specimens l. Analgesics, medicines for STI prophylaxis, and emergency contraceptives m. Labels n. Medical forms including consent forms and anatomical diagrams o. Colposcope (Optional) p. Video camera for recording the forensic interview (optional) q. Tape recorder (optional) III. LEVELS OF CARE DELIVERED BY WCPUs

a. Level I WCPU 1. Personnel A trained physician, and A trained and registered social worker. 2. Services. A level I WCPU provides Minimum medical services in the form of medico-legal examination, acute medical treatment, minor surgical treatment, monitoring & follow-up In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations A full coverage, 24/7 Minimum social work intervention such as safety (and risk) assessment, coordination with other disciplines (i.e., Department of Social Welfare and Development (DSWD) or the local social welfare and development office (SWDO), police, legal, NGOs) Peer review of cases Proper documentation and record-keeping Expert testimony in court Networks with other disciplines and agencies 3. 4. Training Capability Training on 4Rs Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement

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b. Level II WCPU 1. Personnel A trained physician; A trained and registered social worker, also with full-time coverage of duties at the WCPU; and A trained police officer or a trained mental health professional. 2. Services Medical services similar to a Level I WCPU including rape kits and surgical intervention. In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations Full coverage, 24/7 Social work intervention similar to that of a Level I WCPU plus case management and case conferences Additional services in the form of police investigation or mental health care Proper documentation and record-keeping using the Child Protection Management Information System (CPMIS) Expert testimony in court Peer review of cases Availability of specialty consultations (ENT, ophthalmology, surgery, OBGyne, pathology) Networks with other disciplines and agencies. 3. Training Capability Training on 4Rs Residency training 4. Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement c. Level III WCPU 1. Personnel At least two (2) trained physicians; At least two (2) trained and registered social workers; A registered nurse; A trained police officer; and A mental health professional 2. Services Medical services of a Level 2 WCPU

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In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations Full coverage, 24/7 Social work intervention of a Level 2 WCPU capacity plus long-term case management Mental health care Police investigation Nursing services Peer review of cases Death review Proper documentation and record-keeping using the CPMIS Expert testimony in court Availability of specialty consultations (i.e., ENT, ophthalmology, surgery, OB-gyne, pathology) Other support services (i.e., livelihood, educational) Networks with other discipline and agencies Availability of subspecialty consultations (e.g., child development, forensic psychiatry, forensic pathology)

3. Training Capability Training on 4Rs Competence and facility to run residency training and specialty trainings 4. Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement; Conduct of empirical investigations on women and children protection work; Publication of such research studies in reputable journals and/or presentation in scientific conferences or meetings. IV. TRAINING AND EDUCATION IN WOMEN AND CHILDREN PROTECTION

A multi-disciplinary training program will address human resource needs of women and child protection units and womens and childrens desk as well as create and sustain a woman- and child-sensitive hospital environment. The women and children protection program in the central office will set directions and define a career path for medical and paramedical graduates who might be interested in professionally pursuing this line of work. This will be made available not only to hospital personnel but to community and interested organizations that would like to avail of the training. Training areas may focus on the following: 1. For trainees to acquire/enhance attitudes necessary in the management of acute and chronic causes of crisis such as sensitivity, compassion, confidentiality and empathy.
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2. For the trainees to develop/strengthen their skills in early detection, screening, interviewing, physical examination, use of appropriate diagnostic procedures, management, counseling and referral. 3. For the trainees to have additional knowledge on understanding of conditions leading to crisis, recognition of early sign of crisis identification, analysis of aggravating/contributory factors including family factors/stresses, understanding of the impact of crisis on the individual the family and the community management of patients and their families networking, linkage development and referral. V. MINIMUM REQUIREMENTS OF A TRAINED WOMEN AND CHILDREN PROTECTION SPECIALIST 1. Physician Six (6)-week Child Protection Specialist Training for Physicians of the Child Protection Network Foundation or its equivalent 2. Social Worker Four (4) -week Child Protection Specialist Training for Social Workers of the Child Protection Network Foundation or its equivalent 3. Police Officer Four (4)-week Child Protection Specialist Training for Police Officers of the Child Protection Network Foundation or its equivalent [1] Republic Act 7610: Anti-Child Abuse Law [2] Republic Act 9262: Anti-Violence Against Women and their Children Act [3] Republic Act No. 7610 [4] Republic Act No. 9262 [5] Republic Act No. 8353 [6] Republic Act No. 8505 [7] Republic Act 9710 [8] DOH Performance Standards and Assessment Tools for Services Addressing Violence against Women in the Philippines, 2008 (ed), at p.9.

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