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Adolescent and Youth Health Program (AYHP) Male Rank 1 2 3 4 5 6 7 8 9 10 Asssault Transport Accidents Event of undetermined intent 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 Cause of Death No. Female Both Rate

Rate No. Rate No.

2,240 17.6 183 1.5 2,423 9.7 1,146 9.0 303 2.5 1,449 5.8 570 602 527 537 447 596 385 518 5.3 300 2.5 970 954 882 877 873 811 717 631 3.9 3.8 3.5 3.5 3.5 3.2 2.9 2.5

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

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

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

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

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 bodypiercing and inadequate population education. Under this threat, young males are

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 2529 years old. According to the SWS survey, 19961.5M 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

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 selfcare 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 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
th

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 and youth Urban based male youth Female adolescents Not living with parents or family High risk behaviour; smoking, alcohol use, drug abuse, high risk sexual behaviour, risky work conditions leading to injuries and diseases High risk behaviour; transport accidents , other inflicted injuries Sexual abuse, sexual exploitation , unwanted pregranancies, abortion, unsafe pregnancy and insecure motherhood 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 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 increase youths low paying jobs. movemente of the sector has caused displacement from families and love ones vulnerability to exploitation,

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%, relating to respectively).Similalry, Conditions

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.

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.

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). 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

(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 of proper diagnosis or to address problems STDs. Improper 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.

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

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.

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

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

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

Technological Factors Rapid Advancement of Communication The value of adventurous technological adolescents advancement various modes could of

adoelsent- friendly are paving the way for so much consumerism, distorted personal and family values

never be discounted. However, to the curious and

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 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. first six months from birth, nothing except breast milk will be given to babies.

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-the-counter (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-the-counter 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.

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 Mission: 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.


Goals:

Blood Safety Blood Adequacy Rational Blood Use Efficiency of Blood Services

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;

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

3. Implementation of a quality management system including of Good

sustainable management and funding for the nationally coordinated blood network

Child Health and Development Strategic Plan Year 2001-2004


The Philippine National Strategic Framework for lan Development for CHildren or CHILD 21 is a strategic framework for planning programs and interventions that promote and safegurad the rights of Filipino children. Covering the period 2000-2005, 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 determine 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 midterm 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 acquisisiton of health lifestyles. Also critical for effective pallning 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 stakeholdres 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 parentsCarried to term by healthy motherBorn into a loving, caring. stable family capable of providing for his or her basic needsDelivered safely by a trained attendant

Screened for congenital defects shortly after birth; if defects are found, interventions to corrrect these defects are implemented at the appropriate time

Exclusively breastfed for at least six months of age, and continued breasfeeding up to two yearsIntroduced to compementary foods at about six months of age, and gradually to a balanced, nutritious dietProtected from the consequences of protein-calorie and micronutirent deficiencies through good nutrition and access to fortified foods and iodized salt

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, septicemia), nutritional deficiencies and birth-realted complications. The probability of dying between birth and five years of age is 48 deaths per 1000 livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, malnutrition. diarrhea, About measles, 6% die of meningities accidents and i.e.

Provided with safe, clean and hygienic surroundings and protected from accidentsProperly cared for at home when sick and brought timely to a health facility for appropriate management when needed.Offered equal access to good quality curative, preventive and promotive health care services and health education as members of the Filipino society

submersion, foreign bodies, and vehicular accidents. The decline in mortality rates may be attributed partly mortality due to to the Expanded seven Program of diseases pertussis, Immunization (EPI), aimed to reduce infant and child immunizable tetanus, (tuberculosis, diptheria,

Regularly monitored for proper growth and development, and provided with adequate psychosocial and mental stimulationScreened 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

poliomyelities, Hepatitis B and measles). The Philippines has been declared as poliofree druing the Kyoto Meeting on Poliomyelities 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 urrgent 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.

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 programsAfforded 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 livebirths, while neonatal death rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central

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. 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 omprove child health. THe Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common chldhood 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 is 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 livebirths 3. Reduce the mortality rate among adolescents and youths by 50% Risk Reduction Objectives 1. Increse the percentage of fully immunized children to 90% 2. Increase the percentage of infants exclusively breastfed up to six months to 30% 3. Increase the percentage of infants given timely and proper complementary feeding at six months to 70% 4. Increase the percentage of mothers and caregivers who know and practice 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 esential 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%

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


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: 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. 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".

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

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

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 -

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.

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.

Committee of Examiners for Massage Therapy (CEMT)


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 Massage therapy can lead to significant biochemical, physical, behavioral and clinical changes in massage as well as the person giving the massage. It areas of the body such as the forearms, elbows or feet to the mascular structure and soft tissues of the body.

contributes to a higher sense of general well-being. Recognizing this, many healthcare professionals have begun to incorporate massage therapy as a 3. 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 5. himself/herself a massage therapist is one, regardless of training or experience. 6. 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 2. Period for Compliance to Administrative Order No. 2010-0034. Memorandum dated August 10, 2010 - to the Centers of Health Development (CHDs) Human Resource regarding Development Updates on Units the (HRDUs) of Committee 9. 8. 7. 4.

Examiners Program

for

Massage

Therapy

(CEMT)

Administrative Order No. 2010-0034 - Revised Implementing Rules and Regulations of PD 856 Chapter XIII Governing Massage Clinics and Sauna Establishments CEMT Resolution No. 2010-001 - Adoption of the Code of Ethics for Massage Therapists in the Philippines. CEMT Resolution No. 2009-001 - Creation of Committee for Continuing Massage Therapy Education Council (CMTEC) 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. Department Memorandum No. 2008-0009 Designation Development of DOH Units Human Resource as (DOH-HRDUs)

Coordinators for Massage Therapy Program to facilitate immediate response to queries and complaints regarding the massage therapy practice. 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. CEMT Resolution No. 2008-002 - Extension of Moratorium as per CEMT Resolution No. 2008001 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 enforce XIII quality "Massage standards Clinics of and Sauna therapy

Establishments mandate the CEMT to monitor and massage 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.

Climate Change
Ang climate change ay ang pagbabago ng klima o panahon dahil sa pagtaas ng mg greenhouse gases na nagpapainit sa mundo. Nagdudulot ito ng mga sakuna kagaya ng heatwave, baha at tagtuyot na maaaring magdulot ng pagkakasakit o pagkamatay. Kapag tumaas ang temperatura ng mundo, dadami ang mga sakit kagaya ng dengue, diarrhea, malnutrisyon at iba pa. Sanhi ng CLIMATE CHANGE Ayon sa pag-aaral, ang dalawang sanhi ng climate change ay ang: Epektong Pangkalusugan ng CLIMATE CHANGE sa mundo. Ang pagbuga ng carbon dioxide ng mga sasakyang gumagamit ng gasolina, ang pagputol ng mga puno na siya sanang mag-aalis ng carbon dioxide sa hangin, at pagkabulok ng mga bagay na organic na nagbubunga ng methane (isa pang uri ng GHGs) ay ilan sa mga dahilan ng climate change.

Mga epekto sa tao ng matinding init, tagtuyot at bagyo. Pagtaas ng bilang ng kaso ng mga sakit na: - Dala ng tubig o pagkain tulad ng choler at iba pang sakit na may pagtatae. - Dala ng insekto tulad ng lamok )malaria at dengue) at ng daga (Leptospirosis). Dulot ng polusyon (allergy)

1. Natural na pagbabago ng klima ng buong mundo nitong mga nagdaang matagal na panahon. Ito ay sama-samang epekto ng enerhiya mula sa araw, sa pag-ikot ng mundo, at sa init na nagmumula sa ilalim ng lupa na nagpapataas ng temperatura o init sa hangin na bumabalot sa mundo. 2. Mga gawain ng tao na nagbubunga ng pagdami o pagtaas ng carbon dioxide at iba pang greenhouse gases )GHGs). ANg GHGs ang nagkukulong ng init

Malnutrisyon at epektong panglipunan dulot ng pagkasira ng mga komunidad at pangkabuhayan nito.

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.

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 sixyear-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 six-year-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

NMEDS 1982
6.39

NMEDS 1987
5.52 8.51

NMEDS 1992
5.43 8.25 14.42

NMEDS 1998
4.58 6.3 15.04

NMEDS 2006
8.4 dmft 2.9

14.18

14.82

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, 103110). 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

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.

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

LIFECYCLE
Children 12-71 months old **

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 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 (ART)

Mother(Pregnant Women) **

Neonatal and Infants under 1 year old**

School Children (6-12 years old)

Adolescent and Youth

(10-24 years old)**

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 - 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

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

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) c) (BOHC) d) e) (BOHC)

Children 12-71 months old Adolescent and Youth (10-24 years

provided with Basic Oral Health Care (BOHC) old) provided with Basic Oral Health care Pregnant Women provided with Older Persons 60 years old and

Basic oral Health Care (BOHC) above provided with Basic Oral Health Care

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). Objectives: The program aims to: 1. Reduce public health impact of emerging and re-emerging infectious diseases; and 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 reHowever, 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.

emerging infectious disease from becoming public health problems.

2. Strengthen surveillance, preparedness, and response to emerging and re-emerging 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 reemerging 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.

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 virute 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 Health Settings for All Filipinos Mission 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 worksplaces. 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

Expanded Program on Immunization


I . Rationale Figure 1: Comparison of the 2003 and 2008 EPI indicators, Source: NDHS 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 pertussis were and initially measles. included In 1986, in the EPI: fully tuberculosis, poliomyelitis, diphtheria, tetanus,

21.3%

immunized children less than fourteen months of age based on the EPI Comprehensive Program review.

II.

Scenario III. Interventions/ Strategies

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.

Program Objectives/Goals: Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases. Specific Goals:

Burden of Diseases 1. To immunize all infants/children against the most 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 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. common vaccine-preventable diseases.

coverage for these two major indicators.

6. To prevent extra pulmonary tuberculosis among children. Mandates: Republic Act No. 10152MandatoryInfants and

Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

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:

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:

Conduct of Routine Immunization for Infants/Children/Women through the Reaching

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 protection. the required herd immunity for

Every Barangay (REB) strategy


REB strategy, an adaptation of the WHOUNICEF 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.

Figure 2 OPV1 and OPV3 Coverage, Philippines, 2005-2010

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

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.

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.

Rapid

coverage in

assessment areas

(RCA) to

were validate every

conducted

selected

immunization coverage, assess high quality and that there are NO missed child in 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.

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

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

Measles Elimination

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.

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

As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5 cases were epidemiologicallylinked 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

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

Maternal and Neonatal Tetanus Elimination

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.

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.

One

strategy

to

strengthen and

Hepatitis

coverage is to integrate birth dose in the Essential Intrapartum 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 fiveyear-olds born after routine vaccination started 100% Hepatitis B at birth vaccination.

Figure 4

Hepatitis B Coverage. Philippines, 2001-2011

Timing of administration/dose <24 hours >24 hours Hep B 3rd dose

2009 34% 62% 86%

2010* 38% 55% 81%

2011* 14% 24% 30%

*both 2010 and 2011 data are as of October 2011

Vaccines and cold chain management

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.

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 VI. Other Significant information worth mentioning assessment.

Introduction to New Vaccines

One significant milestone is that the budget allocation for the immunization program has continued to increase year by year

For

2012,

Rotavirus

and

Pneumococcal

The Government of the Philippines allocated budget for the immunization of all infants/children/women/older persons

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.

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.

The

Government

of

the

Philippines

has

allocated PhP 1.6 billion for the procurement of these 2 vaccines. V. Future Plan/ Action

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 non-moving trend of decline, MDG 4 might not be achieved. 2. Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy and NOH 20112016 Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels Objectives: 1. 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

3.

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

e. Family medicine specialists of the Philippine Academy of Family Physicians (PAFP) f. Nurses, Maternal and child nurses, intensive care nurses of the Philippine Nurses Association and its affiliate nursing societies g. 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: a. Association of Philippine Medical Colleges (APMC) b. Association of Deans of Philippine Colleges of Nursing (ADPCN) c. Association of Philippine Schools of Midwifery 5. Hospital, health care administrator and infection control associations a. Philippine Hospital Association (PHA) b. Private Hospitals Association of the Philippines (PHAP) c. Philippine College of Hospital Administrators

4.

To provide appropriate and timely emergency newborn care to newborns in need of resuscitation

5.

To ensure access of newborns to affordable life-saving medicines to reduce deaths and morbidity from leading causes of newborn conditions

6.

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 a. Pediatricians/neonatalogists of the Philippine Pediatric Society (PPS) and the Philippine Society of Newborn Medicine (PSNbM) b. Obstetrician-Gynecologists of the Philippine Obstetrical and Gynecological Society (POGS) c. Perinatologists of the Perinatal Association of the Philippines, Inc., (PAPI) d. Anesthesiologists and obstetric anesthesiologists of the Philippine Society of Anesthesiologists (PSA) and the Society for Obstetric Anesthesia of the Philippines (SOAP),

d. Philippine Hospital Infection Control Society 6. Local government units - local chief executives and LGU legislative bodies Beneficiaries: a. Newborns all over the country b. Parents c. communities Program Strategies: 1. Health Sector Reform a. Policy and Guideline Issuance i) Administrative Order 20090025 - Adopting Policies and Guidelines on Essential Newborn Care - December 1, 2009 ii) 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

- 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 midives 4. Social Marketing - Development of social marketing tools - Unang Yakap MDG 4 & 5

Major Activities and its Guidelines: a. Conduct of one-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy) b. 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

Family Planning
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.

Informed Choice that is upholding and ensuring the rights of couples to determin 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:
Men and women of reproductive age (15-49) years old) including adolescents

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 ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens.


Vision:

Mandate: EO 119 and EO 102

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.

Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is NOT a FP method: 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.

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;

Program Goals: To provide universal access to FP information, education and services whenever and wherever these are needed.

Key Result Areas 1. 2. 3.

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

4.

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:

5. 6.

7. 8. 9.

Research and development

Reduce
MMR from 172 deaths 100,000 LB in 1998 to less than 100 deaths/100,000 LB

Strategies 1. Frontline participation of DOH-retained hospitals


2. 3. 4. 5. Family Planning for the urban and rural poor 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 6. Contraceptive Interdependence Initiative

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%

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.

(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

Goal and Objectives: The program aims to:

vaccine to reduce the number of cases seen after severe flooding; 8. Provide training to local government unit

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;

(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

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;

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: 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 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. 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.

Outbreaks

are

being

prevented

though

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 Program. Antibiotic Resistance Surveillance

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.

Food Fortification Program


Objectives: 1. To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem 2. To discuss various types of food fortification strategies 3. 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 deficiencyof 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 6 months - 5 yrs. Pregnant Lactating Iron and Iron Deficiency Anemia (IDA) and its consequences

1993 35.3 16.4 16.4

1998 38.0 22.2 16.5

2003 40.1 17.5 20.1

2008 15.2 9.5 6.4

Iron Deficiency Anemia - condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood

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

IDA results in premature delivery, increased maternal mortality, reduce ability to fight

infection and transmittable diseases and low productivity

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 condition e.g. goiter, cretinism, mental retardation, loss of IQ points

Iodine and Iodine Deficiency Disorders (IDD)

Iodine -a mineral and a component of the thyroid hormones

Progress in the Philippines towards the Elimination of IDD, 1998-2008 Achievements 1998 9.7 2003 56.0 2008 81.1

Indicator Proportion of Households using Iodized Salt, % 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

Goal* >90

100-200 100-200 150-249 < 20

71 -

201 111 142

132 81 105

35.8 -

11.4 23.7 18.0

19.7 34.0 25.8

2004 and promoting voluntary fortification through the SPSP, Signed into law on November 7, 2000

ASIN LAW

Republic Act 8172, An Act Promoting Salt Iodization Nationwide and for other purposes, Signed into law on Dec. 20, 1995 Status and Recommendations for the Sangkap Pinoy Status of the Philippine Food Fortification Program

Food Fortification Law

Seal Program

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,

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%

Assist flour millers to improve quality of fortification Need to show impact of flour fortification Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A

Although awareness is low, usage of SPSproducts is 99.2%

Status:

Recommendations:

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.

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

Lack of premix production Fortification of refined sugar would benefit mainly those in the high income group.

Recommendations:

Intensify promotions of Sangkap Pinoy Seal

Continue discussions with sugar industry to explore a compromise for fortification ie. fortification of washed sugar

Status and Recommendation on Flour Fortification with Vitamin A and Iron Status:

Review policy on mandatory fortification of refined sugar

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.

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.

58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified according to standards.

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

Recommendations:

Review fortificantsfor iron and possible other micronutrients to be added to wheat flour Continue monitoring wheat fortification

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

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

Recommendation: Status:

Review of mandatory fortification of rice with iron Status and Recommendations on Cooking Oil Fortification with Vitamin A

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

Status:

Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in 2009 and 94% in 2010)

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

Samples monitored were labeled and packed FDA is not monitoring "takal"

Recommendations:

Recommendation:

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

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

Monitoring of takal oil, use of test kit Monitoring imported oil, FDA and BOC to coordinate

Food Fortification Day Theme 2010: EO 382 declares November 7 as the National Food Fortification Day

Garantisadong Pambata
Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos Goal Universal Health Care the disadvantaged group (lowest 2 income quintiles) have equitable access to affordable health care

Achievement of better health outcomes, sustained health financing and responsive health system by ensuring that all Filipinos, esp. Strategies:

Financial risk protection.

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

environment for children available everyday at various settings such as home, school, health facilities and communities by government and non-government 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.

Aggressive promotion of healthy lifestyle change Harness strengths of inter-agency and intersectoralcooperation with DepEd, DSWD and DILG EXPANDED GARANTISADONG PAMBATA

Ensure that all Filipino children, especially the disadvantaged group (GIDA), have equitable access to affordable health, nutrition and environment care. Rationale for the New

Comprehensive and integrated package of services and communication on health, nutrition and GP Design GP Services Package

Age by Year

Health

Nutrition

Environment

Maternalnutrition Iron supplementation Vitamin A Early &exclusive breastfeeding Complementary feeding Water Sanitation Hygiene promotion Oral health Child injury prevention Immunization 1-5 Deworming IMCI Breastfeeding Complementaryfeeding Vitamin A Treated bednets Smoke-free homes

Maternal health care 0-1 Essential newborn care Immunization

Iron supplementation Iodized salt at home

Deworming 6-10 Booster immunization (Screening)

Proper nutrition Iodized salt at home

Deworming Booster immunization (Screening) Physical activity (Healthy lifestyle)

Proper nutrition Iron supplementation Iodized salt at home

11-14

Vitamin A Supplementation Policy remains the same for giving Vitamin A capsules:

( Please refer to your MOP for other target groups) Recording/Reporting:

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

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 months given October preschoolers 6-59

VAC from May to October

Core Messages per Gateway Behavior MAGPASUSO (Newborn to 6 mos) Pasusuhin ng gatas ni Nanay

- 1 capsule immediately upon diagnosis, 1 capsule the next day and another capsule after 2 weeks after for preschoolers with xerophthalmia

lang

(6 mos to 2 years old) Magpasuso at bigyan ng (mga masustansiyang ibat-ibang 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.

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 nongovernment 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 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. Vision: Collaborative partnerships for a better, more responsive and globally competitive HRH. require multi-sectoral coordination.

Objectives: The objectives of the HRHN are as follows:

HRH from production, distribution, utilization up to retirement and migration; and 5. Advocate HRH development and

1. Facilitate implementation of programs of the HRHMP that would entail coordination and linkage of concerned agencies and organizations;

management in the Philippines. Projects: During its first year of implementation, the HRHN has

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

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.

Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control )
Cognizant of its mandate and crucial role, the Philippine Department of Heallth (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 of through policies the Area of Coverage Nationwide and establishment and provision of basic health services for older persons, formulation 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 1. 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 2. Health workers and caregivers 3. LGU and partner agencies

Mandate International:

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"


Local:

Vienna International Plan of Action on Ageing General Assembly Resolutions

Philippine Plan of action for Older Persons (1999-2004)

Vision Philippine Constitution (Article XIII, Section Healthy ageing for all Filipinos. Goal A healthy and productive older population is promoted.

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

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 (b) Initiate, develop and implement productive activities and work schemes for senior citizens in (a) Identify the needs, trainings, and opportunities of senior citizens in the cities and municipalities;chan robles virtual law library 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:

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, 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. Withinsixty (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. 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. 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.

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 In accordance with these policies, this act aims to: 1) Establish mechanism whereby the contribution of the senior citizens are maximized; b) To encourage their families and communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizens. a) To motivate and encourage the senior citizens to contribute to nation building; 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:

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.

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%)

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, preschool assistant, etc.

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; 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.

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

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.

quarterly basis the list of senior citizens and to issue nationally uniform individual identification cards which shall be valid anywhere in the country; 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

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;

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.

Health and Well-being of Older Persons


The proportion of older persons is expected to rise worldwide. 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, nonhospital health facilities and traditional care facilities. Cognizant of the growing concerns of the older population, laws and policies were developed which In the 1998 World Health Report, there

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 affordable necessary and services. health Parallel services the to to this the objective is the Departments desire to provide quality marginalized population, especially 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.

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 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, non-government 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 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 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 from NCDPC,FHO, NCHP, FDA, DJFMH, DSWD,CWC, NNC, ILO, WHO and UNICEF. This time, members of theTWG will be tasked to focus participation to the intervention setting where it

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 ad-hoc 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 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 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. 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 activities to create an environment supportive to IYCF practices 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, 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 the MBFHI

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 This is so that training is de-centralized and monitoring and

conducted in collaboration with the CHDs.

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 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, secondary and tertiary education curricula on IYCF shall be pursued. If

necessary, a review of the curriculum will be done prior to the enhancement. Apart from the curriculum enhancement, training materials, books and teachers guide shall also 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 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 the annual operational planning. to determine and actively source budgetary and other resource requirements. The availability of resources will guide the scale and prioritization of IYCF activities in

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

Status of Achievement

Remarks

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

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

- 50% of infants are 22.2% (NDHS 2008) exclusively breastfed for 6 months - 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 75.9% (NDHS 2008) A

76% (NDHS 2003) NDHS 2008 and 2003 data refers to those that received vitamin A in the

past 6 months from the interview 37% of children age 6-59 months received iron supplements in the seven 72.8% of 6-59 days before the survey - 70% of low birth weight babies months received (NDHS 2008) and iron deficient 6 months to less iron drops / than 5 years received complete syrup (not specified 78.3% of children 6-59 dose of iron supplements if complete dose, months consumed foods MCHS 2002) rich in iron in the past 24 hours from the time of the survey - 80% of pregnant women have 77.8% (NDHS 2008) at least 4 prenatal visits - 80% of pregnant women received complete dose of iron supplements 82.4% (NDHS 2008) 67.5% (MCHS 2002) 82% (not specified if complete dose, MCHS 2002) 44.6% (NDHS 2003) NDHS 2003 and 2008 data represents the % of women that received Vitamin A dose during post-partum 38%, household using iodized salt and 56.4% household positive for iodine in salt (NNS 2003)

- 80% of lactating women received vitamin A capsule

45.6% (NDHS 2008)

41.9% (NDHS 2008) - 80% of household using iodized salt 81.1% household positive for iodine in salt (NDHS 2008)

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 IYCF Policy approved May disseminated National Infant and 25, 2005 and disseminated Young Child Feeding Policy to all Regions and LGUs. - Approved multi-sectoral National IYCF Plan of Action IYCF Plan of Action 20052010 approved.

AO 2007-0017: Guidelines on the Acceptance and Processing of Local and - IYCF policy enhancement for Foreign Donations During emerging issues Emergency and Disaster Situations was signed May 28, 2007. New groups were active in supporting activities on IFE Increase number of mostly during the postorganizations actively involved in Ondoy interventions and in IYCF relation to breastfeeding support. Active organizations include Latch, La Leche League, Save the Children, Plan International and Arugaan.

Additional funds for IYCF were secured since April 2007, the start of the From 1 million pesos in AHMP with 2005 to 20 million pesos in intensive IYCF 2010. training. Additional funds were 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. 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.

- Increase budget for IYCF

OBJECTIVE 3: SUPPORTIVE

PROVIDE

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 Data as of Dec established a TWG. 2009. Although the - Functional IYCF Program national TWG is authority and responsibility flow considered active, at the national, regional and LGU At the LGU level 7/80 the collaboration level provinces, between agencies 9/120 cities and 175/1425 can be considered municipalities have passed deficient. a resolution/ordinance in support of IYCF. - Existing local committees functioning as IYCF committees INSTITUTIONAL SUPPORT AO 2007-0026: Revitalization of the MBFHI in Health Facilities Within 2 years after with Maternity Services the issuance of was signed and endorsed COC, 0/47 hospitals on July 10, 2007. applied for - 1,426 currently certified accreditation to MBF hospitals sustained 10 steps become MBF based PhilHealth Circular No. 26 on the new S-2005: Requirement for standards and Accredited Hospitals to be requirements. Mother- Baby Friendly was issued on October 11, 2005. Only 47/1487 have - 300 additional hospitals/lying-in received a COC certified as MBF since 2007 No available data

- 100% of hospitals roomingin their newborns

No available data

RA 10028: Expanded - All offices of government RA 10028 set the Breastfeeding Promotion agencies who are members of the standards to Act of 2009 was enacted on IYCF IAC will be MBF becoming MBF. March 16, 2010. 6/16 Regions reported that - At least one model workplace there are at least 88 per province/city certified as MBF breastfeeding friendly workplaces. - At least one model IYCF No resource center resource center 1 province and 1 established city in each region 10/16 Regions reported that - At least 3 IYCF model there are at least 2159 barangay/ breastfeeding support municipality per province and city groups at the barangay level. RA 10028 Milk bank is functional in 3 encourages other - Functional milk bank in all Medical Medical medical centers Centers: PGH, DJFMH and Centers to set up PCMC their own milk bank. 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 Based on monitoring visits No available data on and reports from CHDs, private health public health facilities have facilities. ensured the integration. Only 4/13 Regions reported some sort of Milk Code monitoring activities. - Functional and effective Milk At the FDA, from 2007 to Code 2009, there were 67 reports Monitoring system of violations and only 3/13 Regions reported filing a complaint for the alleged violations. - Institutionalize MIS facility IYCF Draft tool developed and used in two key instances.

system in place by end of 2009 -Improving manpower skills of health

No institutionalization yet. 28,063/34,298 staff were trained on IYCF Counseling. NCDPC and NNC combined report

- Available national / regional 16/17 Regions reported IYCF conduct of training on trainers IYCF. - Active IYCF Speakers Bureau - Available IYCF counselors in 28,063/34,298 staff were 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 No available data NCDPC and NNC combined report.

DOH focused on capacitating health With the support of workers on Counseling and NNC. Lactation Management.

9/13 Regions reported having trained a total of 1485 hospital based health - A lactation specialist is available No denominator workers on Lactation in tertiary hospitals available. Management with the support of DJFMH, NCDPC,CHDs and NNC. In June 2010 a workshop on integration/updating of - Improved curricula for IYCF good IYCF practice into of medical / nursing / midwifery the medical, nursing, schools midwifery and nutrition curricula was conducted. RA 10028: Expanded - Inclusion of breastfeeding in Breastfeeding Promotion elementary education Act of 2009 mandates the integration. 10/16 Regions reported that there are at least 2,159 barangay level BF support groups and more than 40 BF friendly public places. 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. - Community level systems and services support RA 10028 will help boost the number of breastfeeding friendly public places.

- 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 10/16 Regions reported that there are at least 2,159 BF support groups at the barangay level.

No available data

10/16 Regions reported that - At least one functional BF / there are at least 2,159 BF IYCF support group in poblacions support groups at the and selected communities barangay level. 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 Tool Drafted. Not yet certified MBFH and main health institutionalized. centers - Annual progress reports of status of implementation of Milk 1st IYCF PIR: 2007 Code, Rooming In and Breastfeeding Act, ASIN Law, 2nd IYCF PIR: 2009 Food 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 and Barangays 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 National Convention Liga Ng Barangay) Key result of integration was the intensive training on IYCF Counseling in AHMP target areas.

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, 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.

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.

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.

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 It must be recognized that a good inter-LGU coordination in health is one that secures health 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 DOH-initiated, the overall aim is to make each ILHZ functional in order to perform its abovementioned purposes and tasks. to meet health care needs of individuals, and to manage their limited resources for health more efficiently and equitably.

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: (i) improved health status and coverage of public

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.

health intervention of the zone population; (ii) and access by everyone in the zone to quality care;

LGUs can share lessons learned from practices that work, as well as share experiences systematically. A structured organized process of replicating, including

(iii)

efficiency in the operations of the inter-local

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.

health services.

Replication of Exemplary Replication: Sharing Good Practices and Practical Solutions to Common Problems

Criteria for Selecting Exemplary Health Practices 3. 1. LGU-initiated solutions initiated to address one or more health issues or problems encountered. 4. 2. High level of sustainability Cost effective and cost efficient Mobilization and utilization of indigenous resources Minimal support from external sources Positive results on the beneficiaries and communities. Simple and doable so that they can be replicated within one year and a half or less.


5.

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 committees

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 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.

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, (3) out malaria, of four measles and malnutrition. Three 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.

(4) episodes of childhood illness are caused by these

Objectives of IMCI

Reduce death and frequency and severity of illness and disability, and Contribute to improved growth and development

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)

Components of IMCI

Strategies/Principles 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: PINKadmission YELLOW- indicates initiation of specific Outpatient Treatment GREEN indicates supportive home care indicates urgent hospital referral or

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 AND for VERY SEVERE DISEASE 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

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.

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

Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI

Knock Out Tigdas 2007


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.

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

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. 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.

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 Knockout 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.

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. 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 imm

Leprosy Control Program


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

Ensure the availability of adequate antileprosy 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.

program in collaboration with the National Program for Persons with Disability.

Improve case detection and postelimination surveillance system using the WHO protocol in selected LGUs.

Strengthen the collaboration with partners and other stakeholders in the provision of quality leprosy services for socio-economic mobilization and advocacy activities for leprosy.

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

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.

Licensure Examinations for Paraprofessionals Undertaken by the Department of Health


I. Mandates Administrative Order No. 2010-0034 Revised Presidential Decree No. 856 Code of Sanitation of the Philippines Implementing Rules and Regulations Governing Massage Clinics and Sauna Bath Establishments

Massage Therapists

Embalmers

Administrative Order No. 2010-0033 Revised Implementing Rules and Regulations Governing Disposal of Dead Persons

not convicted by the court in any case involving moral turpitude. d. Medical Certificate from a government physician

Committees e. Certified True Copy of Diploma or Transcript of 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 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 i. Filled up application form (1 copy) j. 1 X 1 size photograph taken within the last 6 months (3 copies) 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 When is the licensure examination? Massage Therapist every 1st week of June and December Embalmers every 1st week of March and September Record (at least high school graduate)

Any high school graduate At least 18 years old at the time of the examination

B. How to apply

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 In 2007, there are 9.27 million incident cases of TB worldwide and Asia accounts for 55% of the cases. singing. Coughing is generally considered as the most efficient way of producing infectious droplets.

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. 4.

Ensure provision of quality TB services Reduce out-of-pocket expenses related to TB care

Strategies: Under PhilPACT, there are 8 strategies to be implemented, namely: 1. 2. 3. Localize implementation of TB control Monitor health system performance 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. 8. Certify and accredit TB care providers 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 multisector partners, through broad-based 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. Eversince, 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 revealed 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

Natural Family Planning


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 ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens.

National Filariasis Elimination Program

Filariasis is

major parasitic infection,

which

Philippines. It was first discovered in the Philippines in 1907 by foreign workers. Consolidated field reports

continues to be a public health problem in the

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 Secretary of Order Health declaring last July November 2004 and as was Filariasis Mass Treatment Month was signed by the disseminated to all endemic regions.

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.

Vision: Healthy and productive individuals and families for Filariasis-free Philippines

Baseline Data: Prevalence Rate (1997): 9.7% per 1,000 pop. Endemic in 43 provinces in 11 regions with a total

Mission: Elimination of Filariasis as a public health problem thru a comprehensive approach and universal access to quality health services

population at risk of 30,000,000

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

Management Being Used: 1. Selective Treatment treating individuals found to be positive for microfilariae in nocturnal blood examination. Drug: Diethylcarbamazine Citrate

elimination level namely: Southern Leyte; Sorsogon; Biliran; Bukidnon; Romblon; Agusan Sur; Dinagat Islands; Cotabato Province; and COMVAL.

Program Strategies: STRATEGY 1. Endemic Mapping

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

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

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.

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 Vision: To Declare Philippines Rabies-Free by year 2020 morbidity in the country but it is regarded as a significant public health problem because (1) it is one of the most acutely fatal infection and (2) it is responsible for the death of 200-300 Filipinos annually.

Goal: To eliminate human rabies by the year 2020

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. 6. Establishment of ABTCs by InterLocal Health Zone 7. DOH-DA joint evaluation and declaration of Rabies-free islands

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.

Newborn Screening
Republic Act 9288 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 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 Act of 2004 (Republic Act 9288). From 1996 to December 2010, the program has saved 45 283 patients. Congenital Five conditions are currently screened: Hypothyroidism, Congenital Adrenal

Hyperplasia, Phenylketonuria, Galactosemia, and Glucose-6-Phosphate Dehydrogenase Deficiency.

3. 4.

Health facilities shall integrate NBS in its delivery of health services; 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;

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. 2. DOH is the lead agency tasked with implementing this law; 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;

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: NSC-National Institutes of Health in Manila; NSC- Visayas in Iloilo City; NSCMindanao 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.

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.

National Mental Health Program


I. Rationale: Vision: Better Quality of Life through

Background of the Program

Total Health Care for all Filipinos.

Mission:

A Rational and Unified

Manage the various sub-programs and components of the National Mental Health Program;

Response to Mental Health. Goal: Objective: Quality Mental Health Care. Implementation of a Mental

Oversee the implementation of prevention and control measures for mental health issues and concerns; and

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.

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:

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

Formulate and recommend policies, standards, guidelines approaches on each specifics sub-programs on mental health;

(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 Director IV of the National Center for Disease Prevention and Control (NCDPC).

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 sub-program. Ensure the implementation of the program among all stakeholders; and

Its functions are as follows:

Provide technical assistance to other mental health teams according to sub-programs thrusts.

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;

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:

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 Communitybased Mental Health Program among their respective localities and constituents. 5. Other Partners and Stakeholders

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;

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:

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

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

Regularly update the PDMT on the status of the regional implementation of the National Mental Health Program.

Promoting and advocating for the implementation of the program within their respective areas of responsibility.

4.

Local Government Unit Mental Health Teams

(LGUMHT)

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: Mission: Dengue Risk-Free Philippines 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

Reduce the risk of human exposure to aedes bite by House index of <5 and Breteau index of 20;

from dengue infection by preventing the transmission of the virus from the mosquito vector human.

Increase % of HH practicing removal of mosquito breeding places to 80%; and Increase awareness on DF/DHF to 100%.

Objectives: The objectives of the program are categorized into three: health status objectives; risk reduction objectives; and services & protection objectives.

Services & Protection Objectives:

Establish a Dengue Reference Laboratory capable of performing IgM capture ELISA for Dengue Surveillance;

Health Status Objectives:

Increase the % of 1 and 2 government hospitals with laboratory capable of platelet count and hematocrit; and

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.

Ensure surveillance and investigation of all epidemics.

Risk Reduction Objectives:

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 Society and for Other Purposes, and otherwise known as The Magna Carta for Disabled Persons. was passed in July 19, 1991. This specifically

Republic Act No. 7277, An Act Providing for the Rehabilitation, and Self-Reliance of Disabled Persons and Their Integration into the Mainstream of

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 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

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.

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 evidence-based 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 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 globallyrecognized 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

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 Progr am (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. 2. 3. To increase water service for the waterless population To reduce incidence of water-borne and sanitation related diseases To improved access of the poor to sanitation services

B. TARGETS

1. 2. 3. 4.

Increased water service for the waterless population by 50% Reduced incidence of water-borne and sanitation related diseases by 20% Improved access of the poor to sanitation services by at least 10% Sustainable operation of all water supply and sanitation projects constructed, organized and supported by the

Program by 80%.

II. ABOUT THE STAKEHOLDERS/ BENEFICIARIES 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. 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.

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. 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. 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.

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: endemic areas To reduce the disease prevalence by 50% with a vision of eliminating the disease eventually in all

Objectives: The Schistosomiasis control Program has the following objectives: 1. 2. Reduce the Prevalence Rate by 50% in endemic provinces; and Increase the coverage of mass treatment of population in endemic provinces.

Program Strategies: The Schistosomiasis Control Program employs the following key interventions: 1. 2. 3. 4. 5. Morbidity control: Mass Treatment Infection control: Active Surveillance Surveillance of School Children Transmission Control Advocacy and Promotion

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

Soil Transmitted Helminth Control 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. Central to the achievement of the IHCP vision is the commitment and participation of all sectors concerned considering that helminth infection is a multi-faceted 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:

Healthy and Productive Filipinos in the 21st Century

Mission:

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. a. b. c. 2. Improve governance through: Policies/resolutions; Securing budget for STH prevention and control; Mobilization and coordination of sectoral support; and Improve service quality and scale-up coverage. a. Capacity building 1. Areas for training 2. 3. b. c. d. 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

Target participants Training mechanisms

Development and issuance of protocols and guidelines Expansion of service delivery points Availability and affordability of deworming drugs

3.

Institute financing reforms a. b. c. Efficiency in program implementation Mobilization of resources Strengthening LGU financing schemes Strengthen regulations Installation of management support systems a. b. c. Drug procurement Research Surveillance

4. 5.

Smoking Cessation Program


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 support the National Tobacco Control and Healthy Lifestyle Program allowed the setting up of the National Smoking Cessation Program. Vision: Mission: Reduced prevalence of smoking and minimizing smoking-related health risks. To establish a national smoking cessation program (NSCP).

Urban Health System Development (UHSD) Program


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. 1. UHSD GOALS AND OBJECTIVES Goals 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. 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. III. 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 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, Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a strategy of going to every

and continually creating and improving physical and social environments shall be continued and further strengthened. 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. 2. 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. 3. 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. IV. 1. 2. General Principles Healthy urbanization. Urban Health Systems (UHS) must promote healthy urbanization so that cities develop in Inter-sectoral action. UHS must be designed through inter-sectoral collaboration with people and institutions from

ways that achieve better health and avoid risks to ill health under conditions of rapid urbanization. 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. 5. 6. Social cohesion. Social cohesion is action through core groups. Community participation. Community participation must be integrated in all aspects of the intervention process, Empowerment. Empowerment is enabling individuals and communities to have ultimate control over key

including planning, designing, implementing, and sustaining any project/program. 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.

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 intervintion 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.

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), non-government 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 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. 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.


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

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.

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: 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 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:

Outcome Indicators 80% Facility-based Births 80% of the Women who gave birth have birth plans 75% of facility deliveries are financed by PHIC Increase CPR by 10 percentage points 100% of LGUs have passed an ordinance on the Contraceptive Self Reliance 100% of BEmONC have MCP accreditation Universal Social Health Insurance Coverage

Baseline (2010) Accomplishments 67% 99% 17% 36% 47% 45% 72%

2011 Target Values 80% 80% 55%

2011 Accomplishments 77% 100% 27%

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

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

Social Preparation of Batch 2 Sites 2009 Organization of Service Delivery Teams Regional Blood Centers equipment upgrade

Done Done Done

73% Ongoing: Albay: 90% 20092011 Facility upgrade: Infrastructure and Equipment Masbate: 80% Catanduanes: 60% Surigao del Sur: 53% Sorsogon: 84%

Currently undergoing procurement 20092010 Training Centers Insfrastructure and equipment enhancement 13 Training Centers already provided with equipment and other training logistics

Ensuring environmental Safeguards 20092010

Organization of EMU in CEmONCs Designation of Waste Management Focal Persons in BEmONCs

Done

BEmONC Skills: 60% 20082012 Capability Enhancement: Women's Health Teams Sorsogon: 73% Albay: 103% Catanduanes: 55%

Masbate: 73% Surigao del Sur: 63% 20082010 20082010 20112012 2010

BEmONC Teams

Midwives on BEmONC Skills

Module currently being finalized

CEmONC Doctors (non-specialists) Provincial Review Teams Behavior Change Interventions Performance-based Grants:

Module currently being finalized Done

20092013

Facility based Deliveries Universal Social Health Insurance Coverage Essential Drugs and Contraceptive Security

20102013

Advocacy for Positive Behavior Change

4 Infomercials produced and aired in 2011; another 4 being produced for airing in 2012.

TV Infomercials 52% Albay: 31% (5/16)

20092013

Catanduanes: 17% (1/6) BEmONC Facility MCP Accreditation Masbate: 62% (13.21) Sorsogon: 82% (14/17) Surigao del Sur: 16% (3/19)

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 oneyear 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 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.

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. 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 DOH-retained 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. 4. 5. A consistent and adequate budget is necessary to sustain a women and children protection unit once it is established; 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; 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;

7. 8. 9.

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; Women and child protection work is a new field and a pool of professionals must be recruited and trained to sustain the work; and 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 s econdary 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; 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 dutybound 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] Anti-Rape 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 thereby 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/psychologic al, developmental and spiritual needs. Adequate care shall be provided by multidisciplinary child protection teams when the parents 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 bio-medical, 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. 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. 2. 3. Identify and recommend strategically-located DOH-retained and LGU-supported hospitals for WCPU establishment using geographical and population ratio criteria; Formulate standard protocols and procedures and the manual of operations for multidisciplinary care for women and children victims of abuse and violence; 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. 5. 6. 7. 8. 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; Monitor and evaluate the efficacy, effectiveness and sustainability of creation, operations, and maintenance of WCPUs; Recommend policy reforms and new guidelines anchored on evidence-based interventions and approaches; Harmonize existing databases and create a central databank for women and children protection cases; and 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. VIII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES A. Department of Health at the National Level 1. 2. The Committee shall be under the direct supervision of the Office of the Undersecretary for Health Services Delivery. 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. 2. 3. 4. 5. 6. Disseminate the policy for adoption and implementation by LGU health systems in the different localities within their respective regions; Provide technical assistance to LGUs in organizing WCPU activities and developing relevant technical references and information, education and communication (IEC) materials; Generate resources to strengthen the implementation of the policy and manual of operations for WCPUs; Formulate and implement advocacy plans to generate stakeholders support, particularly the local officials; Monitor the implementation of the policy and guidelines in both public and private hospitals, and in different localities in their respective regions; 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;

a. b. c.

Allocate budget sufficient for the operations of WCPUs; Conduct training and orientation on 4Rs; Maintain an accurate and complete database on WCPU clients.

D. Child Protection Network Foundation, Inc. 1. 2. 3. Provide expertise and technical support for the establishment of WCPUs and the central database on childrens cases; Extend guidance to the trained physicians and social workers in WCPUs; Coordinate with the Philippine Commission for Women, Council for the Welfare of Children and nongovernment 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.

E. Philippine Commission on Women 1. 2. 3. Provide expertise and technical assistance on gender-responsive delivery of services by the WCPU service providers and the central database on womens cases; Assist the DOH in monitoring the implementation of the WCPU using the Performance Standards and Assessment Tools for Services Addressing VAW in the Philippines; 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. II. The minimum standard criteria shall be maintained by all WCPUs. A. Organizational Structure - The WCPU shall: 1. 2. 3. Be an integral part of the hospital; Be under the Office of the Chief of Clinics; 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. 2. Be permanently situated in a designated area, preferably near the emergency room of the hospital; 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. 4. Have its own toilet or comfort room; 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 e. Syringes, needles and sterile swabs f. Examination gloves g. Pregnancy testing kits h. Microscope slides i. j. l. Measuring devices like rulers and calipers Urine specimen containers Analgesics, medicines for STI prophylaxis, and emergency contraceptives

k. Refrigerator for storage of specimens 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 2. Personnel

A trained physician, and A trained and registered social worker.

3. 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

4.

Training Capability Training on 4Rs

5.

Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement

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


6.

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, OB-Gyne, pathology) Networks with other disciplines and agencies. Training Capability Training on 4Rs Residency training Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement


7.

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 Services Medical services of a Level 2 WCPU 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) Training Capability Training on 4Rs Competence and facility to run residency training and specialty trainings 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.


2.


3.


4.

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. 2. 3. For trainees to acquire/enhance attitudes necessary in the management of acute and chronic causes of crisis such as sensitivity, compassion, confidentiality and empathy. For the trainees to develop/strengthen their skills in early detection, screening, interviewing, physical examination, use of appropriate diagnostic procedures, management, counseling and referral. 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