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 Female Both

Ran Rat No Rat Rat
Cause of Death No. No.
k e . e e
2,24 18 2,42
1 Asssault 17.6 1.5 9.7
0 3 3
1,14 30 1,44
2 Transport Accidents 9.0 2.5 5.8
6 3 9
30
3 Event of undetermined intent 570 5.3 2.5 970 3.9
0
Symptoms, signs & abnormal clinical findings not elsewhere 35
4 602 4.7 2.9 954 3.8
classified 2
35
5 Pneumonia 527 4.1 2.9 882 3.5
5
34
6 Tuberculosis of the Respiratory System 537 4.2 2.8 877 3.5
0
42
7 Chronic Rheumatic Heart Disease 447 3.5 3.5 873 3.5
6
21
8 Accidental drowning and submersion 596 4.7 1.7 811 3.2
5
33
9 Nephritis, nephrotic syndrome and nephrosis 385 3.0 2.7 717 2.9
2

11
10 Other accidents & late effects of transport/other accidents 518 4.1 0.9 631 2.5
3

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 exlusively succumb to injuries and females have
the increasing mortality due to complications of pregrancy, 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
correspondidng physical and infrastructre 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.

Tubercolusis, 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 15-24 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 the adolescents early
engagement in health risk behaviour, 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 behaviour and
more young fermales are also doing the same without protection and are
prone to aggressive or coercive behaviours of others in the community
such that it often results to significant number of unwanted
pregrancies,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 9 leading cause of death among 20-24 years
th

old. In this age group, seven out of 10 who died of suicide were males. In
age group of 10-24 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 rehabilitaiton 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 Vulnerability areas
Young among the street- Common infections, physical abuse or assault, sexual exploitation, drug
dwellers use, road accidents
Out- of- school adolescents High risk behaviour; smoking, alcohol use, drug abuse, high risk sexual
and youth behaviour, risky work conditions leading to injuries and diseases
Urban based male youth High risk behaviour; transport accidents , other inflicted injuries
Sexual abuse, sexual exploitation , unwanted pregranancies, abortion,
Female adolescents
unsafe pregnancy and insecure motherhood
Not living with parents or Nutritional disorders, substance use and risky sexual behaviour, other
family 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 FO rhtis 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 viscious
cycle is created and more are having difficulties to access provision on health
service delivery.

Increased population movement

The scarctiy of local employment has triggered the participation of the
youth in overseas work. The movemente 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
tha 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 Behaviours 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 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).Similalry, Conditions relating to pregnancy, childbirth and post
partum were among the leading reasons for utilization of in-patient,
emergency room and out patient health services at DOH-Retained Tertiary
General Hospitals.

Low Contraceptive Use

The overall use of contraception among sexually active adolescents is at

20%. Non- desire 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 teen-age pregnancies among young mothers include not
being able to finish school and reduced employment options and
opportunities. In addtion, the social stigma and fear brought about by
unwanted pregrancy 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 exteme conditons 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 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
pregranancy but also preventing sexually transmitetd 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
behaviour. In addtion the digital dependence and addiction causes alienation
of adolescetns to personal and closer mode of communciation resulting to
a distorted image of the adoelscents relationships to the social environment.
This also deprives the adolescents from productive activities where they
can develop themselves fully grown up and mature e conomic and socail
being Moreover, communcation advantcement has also produced
adverstisements and television commercials whose image are not
adoelsent- 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

The Adolescents Youth and Heath Development Programs was established

in 2001 under the oversight of the Department of Health in partnership
with other government agencies with adolescent concerns and other
stakeholdres. 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 achored 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 intothe 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.