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 noncommunicable 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 non-communicable 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. 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 20112016: common risk factors, intermediate risk factors and disease control.

Common Risk Factors a. 7.2 b. 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

c. d.

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 a. b. 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.

c. Reduction in the prevalence of central obesity (high waist circumference) among adult females from 18.3 to 12.81 8.5 d. Reduction in prevalence of high total serum cholesterol among adults from 8.5 to

Disease Control a. 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 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 Noncommunicable 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. 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 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 on-going.

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 are 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 Administrative Order re: National Implementation of the Integrated Chronic Non-Communicable 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.

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. 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-yearold 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 six-year-old age group and 2.9 DMFT for the twelve-year-old age group (NOHS 2006). 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, 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, gastro-intestinal 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 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. TYPES OF SERVICE LIFECYCLE (Basic Oral Health Care Package)

Mother(Pregnant Women) **

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

Neonatal and Infants under 1 year old**

Children 12-71 months old **

- referral of complicated cases - treatment of post extraction complications - drainage of localized oral abscess

Application of Atraumatic Restorative

Treatment

(ART)

School Children (6-12 years old)

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

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

Other Adults (25-59 years old)

Older Person (60 years old and above)**

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 - Toothbrushing - 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 servicesa. a. Upgrading of facilities, equipment, instruments, supplies b. Develop packages of essential care/services for different groups (children, mothers and marginalized groups) -revival of the sealant program for school children - toothbrushing 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 auxilliaries 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) caries- free 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) (BOHC) c) d) (BOHC) e) Children 12-71 months old provided with Basic Oral Health Care (BOHC) Adolescent and Youth (10-24 years old) provided with Basic Oral Health care Pregnant Women provided with Basic oral Health Care (BOHC) Older Persons 60 years old and above provided with Basic Oral Health Care

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 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:

a.

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.

What is the objective of the program? a. To ensure quality health care service to depressed, marginalized and underserved areas through the deployment of competent and community-oriented doctors. b. To effect changes in the approach to health care delivery by the stakeholders in health top How can the LGU avail of the program? The Center for Health Development (CHDs), through the Human Resource Development Unit (HRDU) shall submit to the HHRDB a list of areas qualified to be recipients of a DTTB. This shall be supported with the written request in the form of a resolution passed by the Local Health Board and the Sanguniang Bayan approved by the Local Chief Executive. top What are the qualifications of a DTTB volunteer. The minimum requirements for applicants to the program shall be the following: a. Licensed Doctor of Medicine b. Bonafide Filipino citizen c. Physically and mentally fit d. Certified to be of good moral character e. Willing to work in depressed and hard to reach areas for two (2) years f. Interested in community health g. Not more than 50 years old top What are the available areas for deployment? What is the category of this areas? The following areas will be given priority: a. Depressed, unserved/underserved, hard to reach and critical 5th and 6th class municipalities without doctors for at least two(2) years. b. Depressed, unserved/underserved, hard to reach and critical 5th and 6th class municipalities with MHO/RHP on study leave. c. 3rd and 4th class municipalities needing additional doctors to achieve the doctor to population. (1:20,000) top What are the benefits of a DTTB volunteer? The DTTB shall receive the following: a. Receive a salary equivalent of salary grade 24 (P24,000.00+++) b. Representation Allowance c. Magna Carta for Health Workers d. Continuing Medical Education e. Opportunity to travel f. Opportunity to Postgraduate studies

What is the scope of the program.? How can the hospitals avail of the program? The program is for all government hospitals, national or local , which are requesting for augmentation of their Medical Specialist II cadre and replacement of their Medical Officer III items undergoing training. What is the objective of the program? The general objective is to provide the country with competent Medical Human Resource who will render quality medical care to patients. The specific objectives are: a. To provide Medical Officer III replacements for provincial and district hospitals who are sending their service residents for training. b. To augment the Medical Specialist human resource needed in government/public hospitals. c. To provide items for residency training to identified physicians who have rendered government service. Who are qualified to avail of physicians items under the program? a. For the Medical Officer III items, Local Government Hospitals who are sending their permanent medical staff for training, other government physicians who have rendered substantial services for the country and those government representatives endorsed by public officials for meritorious accomplishments. b. For Medical Specialist that will augment the medical specialty needs of a government hospitals, they must be Filipino Citizen, Fellow/Diplomate of the relevant accredited specialty society or board eligible as endorsed by the accredited specialty society. What is the basis for distributing/allocating and re-allocating of Medical Pool item? a. On geographical location : far-flung or hard to reach areas in the catchment of the DOH hospitals as determined by the CHDs and approved by the Undersecretary of Health. b. On Hospital Development Plan: Hospital Development Plan of the health facility concerned in consonance with the National Hospital Development Plan. How many years can a hospital avail of DOH medical pool items? a. For Medical Specialist II, it is renewable yearly for a maximum of three(3) years. The renewal shall be based on satisfactory performance. Within the period of three(3) years the recipient hospitals shall device measures on how to provide a regular hospital item for possible absorption of the medical specialist after its termination. b. For Medical Officer III, that is being used for replacing LGU physicians, it is renewable yearly corresponding to the length of the residency training program of the doctor being replaced. For specialty training , it is renewable yearly corresponding to the specified training program requirements where the trainee is undergoing training.