Department of Health

Programs A-z, Monthly Health Events, Top 10 Causes of mortality and morbidity in the Philippines

RESPECTFULLY SUBMITTED TO:

DR. AILEEN O. CAMANGEG, R.Ph.
PCARE 101 INSTRUCTOR

SUBMITTED BY:
JOYCE P. DELA CRUZ
BS-PHARMACY I-B

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

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Table of Contents

A
Adolescent and Youth Health Program (AYHP) 6
B
Botika Ng Barangay (BnB) 14
Breastfeeding TSEK 16
Blood Donation Program 16
C
Child Health and Development Strategic Plan Year 2001-2004 18
CHD Scorecard 22
Committee of Examiners for Undertakers and Embalmers 22
Committee of Examiners for Massage Therapy (CEMT) 24
Chronic Obstructive Pulmonary Disease Program 26
Cardiovascular Disease Program 30
D
Dental Health Program 34
Diabetes Mellitus Prevention and Control Program 40
E
Emerging and Re-emerging Infectious Disease Program 44
Environmental Health 46
Expanded Program on Immunization 47
Essential Newborn Care 52
F
Family Planning 55

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Food and Waterborne Diseases Prevention and Control Program 59
Food Fortification Program 61

G
Garantisadong Pambata 65
H
Human Resource for Health Network
Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and
Control )
Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center Act of the Philippines)
Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999))
Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to
Nation Building, Grant Benefits and Special Privileges)
Health and Well-being of Older Persons
Healthy Lifestyle Program
I
Infant and Young Child Feeding (IYCF)
Iligtas sa Tigdas ang Pinas
Inter Local Health Zone
Integrated Management of Childhood Illness (IMCI)
K
Knock Out Tigdas 2007
L
Leprosy Control Program
LGU Scorecard

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Licensure Examinations for Paraprofessionals Undertaken by the Department of Health
M
Malaria Control Program
Measles Elimination Campaign (Ligtas Tigdas)
N
National Tuberculosis Control Program
Natural Family Planning
National Filariasis Elimination Program
National Rabies Prevention and Control Program
Newborn Screening
National HIV/STI Prevention Program
National Mental Health Program
National Dengue Prevention and Control Program
National Prevention of Blindness Program
O
Occupational Health Program
P
Persons with Disabilities
Pinoy MD Program
Philippine Cancer Control Program
Province-wide Investment Plan for Health (PIPH)
Philippine Medical Tourism Program
Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases
Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat)
R

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Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP)
S
Schistosomiasis Control Program
Soil Transmitted Helminth Control Program
Smoking Cessation Program
U
Urban Health System Development (UHSD) Program
Unang Yakap (Essential Newborn Care: Protocol for New Life)

V
Violence and Injury Prevention Program
W
Women's Health and Safe Motherhood Project
Women and Children Protection Program

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 Adolescent and Youth Health Program (AYHP)

A Situationer on Adolescents Health                 

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

MOST COMMON CAUSES OF DEATH AMONG 10-24 YEARS OLD

PER 10,000 POPULATION. Philippine Health Statistics, 2003
    Male Female Both
Rat
Rank Cause of Death No. Rate No. No. Rate
e
2,24
1 Asssault 17.6 183 1.5 2,423 9.7
0
2 Transport Accidents 1,14 9.0 303 2.5 1,449 5.8
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3 Event of undetermined intent 570 5.3 300 2.5 970 3.9
Symptoms, signs & abnormal
4 clinical findings not elsewhere 602 4.7 352 2.9 954 3.8
classified
5 Pneumonia 527 4.1 355 2.9 882 3.5
Tuberculosis of the Respiratory
6 537 4.2 340 2.8 877 3.5
System
7 Chronic Rheumatic Heart Disease 447 3.5 426 3.5 873 3.5
Accidental drowning and
8 596 4.7 215 1.7 811 3.2
submersion
Nephritis, nephrotic syndrome
9 385 3.0 332 2.7 717 2.9
and nephrosis
Other accidents & late effects of
10 518 4.1 113 0.9 631 2.5
transport/other accidents

Leading Threats to Adolescents Health

Accidents and other inflicted    injuries

Among 10- 24 age groups, this threat caused 27% of the total deaths (2003 data).
Young males always exclusively succumb to injuries and females have the increasing
mortality due to complications of pregnancy, labor delivery and puerperium. These
data have been on the uptrend, a challenge to community-based or DOH-led
programs.  The threat is caused by the adolescent’s exposure to poorly maintained
roads and poorly managed traffic systems. Adolescents’ increased mobility to urban
areas needs a corresponding physical and infrastructure support in their quest for
better opportunities and education pursuits. Another is the inability   of the state to
provide adequate number of police personnel leading to an increasing number of
assault and transport accidents among the young males.   
 
Tuberculosis, Pneumonia, and Accidental  drowning
Close to 6% of young Filipinos who died in 2003 died of various forms of
tuberculosis, followed by pneumonia that caused 4% of deaths. This health issue
among the  young  has  been declining  through the years  due  to sustained 
nationwide  programs   that began in  1987  and  has somehow caused  to keep
deaths  down, hence  efforts to continue  sustaining  becomes the challenge.  
 
The threat of HIV and other sexually – related diseases   
Reported cases increased substantially increased over the past year. Among the 15-
24 year olds, reported HIV infections nearly tripled between 2007 and 2008 from 41

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cases to 110 per year, which is substantial cause for alarm. In 2009, 15-24 year olds
make 29% of all new infections; in 2009, the number of new infections among 20-24
equals the number of new infections among 25-29; with 10 cases see July DOH AIDS
Registry Report.  The substantial  increase  from the  past year can be  traced  from 
the   adolescents’   early engagement in health risk behavior, due to  serious gaps  of 
the knowledge on  the  dangers  of drugs, as well as  the  cause  as well as causes 
on  the   transmission of  STD and HIV AIDS ,  dangers  of indiscriminate  tattooing
and body- piercing  and    inadequate population  education.  Under this   threat,
young males  are prone to engaging  in health risk behavior  and more  young
females  are also doing  the same  without  protection  and are  prone to  aggressive
or coercive  behaviors  of others  in the community such that  it often results   to
significant  number  of unwanted pregnancies,septic abortion and poor self-care
practices.
In addition, there are also other   less common but significant causes of disease and
deaths namely;

Intentional self- harm –the 9th leading cause of death among 20-24 years old. In
this age group, seven out of 10 who died of suicide   were males. In age group of 10-
24 years old took up 34% of all deaths from suicide in 2003

Substance Abuse  -  15-19 years  old  group has  the  claim  of  drug use; more
males than females who are drug users and  drug rehabilitation centers claim  that
majority  of clients   belong to age group of 25-29 years  old.  According to the SWS
survey, 1996- 1.5M youth Filipinos and 1997-   grew into 2.1M youth Filipinos are
into substance abuse    

Nutritional Deficiencies   –there are no specific rates for adolescent and youth, but
there is  the prevalence  of anemia and vitamin A deficiency  which may be also 
high  for the adolescents and youth  as those known for the  younger and  pregnant
women.   

Disability – Filipinos aged 10-24 years old has an overall disability prevalence of 4%.
The most common disability among this age group affected are speaking (35%),
hearing (33%) and moving and mobility (22%)  
There are also vulnerable Filipino adolescents which can be classified in
their respective areas of vulnerability 

VULNERABLE YOUNG FILIPINOS

Sub-groups Vulnerability areas
Young among the  Common infections, physical abuse or assault,
street-dwellers   sexual  exploitation, drug use, road  accidents 
Out- of- school  High risk behavior; smoking, alcohol use, drug
adolescents and  abuse, high  risk sexual  behavior, risky work
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 youth  conditions leading to injuries  and diseases 
Urban –based male High risk behaviour; transport accidents , other 
youth   inflicted  injuries 
Sexual abuse, sexual exploitation , unwanted 
Female
pregranancies, abortion, unsafe pregnancy  and
adolescents 
insecure  motherhood 
Not living  with Nutritional disorders, substance use and risky
parents or family  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 forthis age group. The pressure creates an
imbalance to the distribution and allocation of resources to various sectors especially
the youth. The imbalance reinforces deeper the marginalization and deprivation of
some sectors to basic services. A vicious cycle is created and more are having
difficulties to access provision on health service delivery.  
 
Increased population movement    
The scarcity   of local employment has triggered   the participation of   the youth in
overseas work.  The movement   of the sector has   caused displacement from families
and love ones    increase youth’s vulnerability to exploitation, low paying jobs. 
According to a study in 2001, there were more than 6,000 workers in the teenage
group overseas workers and it is most likely that   they would land in overseas   low
paying work.  

Attitudes, Lifestyles, Sense of Values, Norms and Behaviors of Adolescents

Health Risk Behaviors

A significant proportion of young people engage in high-risk behaviors – 23% ever
had pre- marital sex, 57% of first sex experience was unplanned and unplanned.
About 70% - 80% of their most recent sexual experiences were unprotected (YAFS,
2002). 
The 2002 Young Adult Fertility and Sexuality Survey showed that the proportion of
15-24 year olds who were currently smoking, drinking and using drugs were 20.9%,
41.4% and 2.4%, respectively. The proportion is higher among males compared to
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females. A comparative data (1994 and 2003) showed that among 15 – 24 year olds,
smoking increased by 23%; drinking increased by 10%; drug use increased by 85%;
and pre martial sex increased by 30% (YAFSS, 2003). The likelihood of engaging in
pre-marital sex is higher among those who smoke, drink alcohol or take drugs. As a
consequence of substance and alcohol abuse, some have mental and neurological
disorders; others spend the productive years of their life behind bars with hardcore
lawless adults.  

Health Seeking Behavior

Adolescents are more likely to consult the health center (45%) or government
physician (19%) for their health needs (Baseline Survey for the National Objectives for
Health, 2000). The most common reasons for not consulting were the lack of money,
lack of time, fear of diagnosis, distance and disapproval of parents. Dental
examination and BP monitoring were the most common reasons for consultation
(62.4% and 37.8%, respectively). Similarly, Conditions relating to pregnancy,
childbirth and post partum were among the leading reasons for utilization of in-
patient, emergency room and outpatient health services at DOH-Retained Tertiary
General Hospitals. 

Low Contraceptive Use

The overall use of contraception among sexually active adolescents is at 20%.  Non-
desire for pregnancy and high awareness of contraceptive methods were not enough
to encourage adolescents to use contraceptives. Among the reasons cited for the low
contraceptive use were:
    Contraceptives were given only to married individuals of reproductive age
    Even if they were made available to adolescents, the culture says that it is
taboo for young unmarried individuals to avail of contraceptive services and
commodities.
    Condom use is perceived mainly for STIs, HIV/AIDS prevention rather than
contraception
 
The practice Abortion and Unmet need for Contraception
In 2000, induced abortion among adolescents reached 319,000. This is due to the
inadequate knowledge on preventing unwanted pregnancies. Consequences of teen-
age pregnancies among young mothers include not being able to finish school and
reduced employment options and opportunities. In addition, the social stigma and
fear brought about by unwanted pregnancy pushes the young mother to resort to
abortion. Although the disapproval rating for abortion remains to be high,  there is
an increasing trend among those who approve of it (from 4% to 6% in males and
3.5% to 4% in females).On contraceptive use , adolescents also don't use condoms for
prevention of HIV,it's not only that they don't use them for  contraception.
 

Risk of HIV/AIDS due to Unprotected Sex

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  Adolescents including children living in extreme conditions and great exposure to
sexual exploitation and abuse    belong to high-risk categories threatened by
unprotected sex.   Latest data on these shows that majority of people engaged in sex
work are young and 70 % of HIV infections involve male-to-male sex.   The proportion
of young people reported to have STDs/HIV and AIDS is increasing. The YAFS survey
showed that although awareness about STDs is increasing, misconceptions about
AIDS appear to have the same trend. The proportion of those who think AIDS is
curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents
also resort to services of unqualified traditional healers, obtain antibiotics from
pharmacies or drug hawkers or resort to advices from friends (e.g. drinking detergent
dissolved in water) without proper diagnosis to address problems of STDs. Improper
or incomplete treatment may mask the symptoms without curing the disease
increasing the risk of transmission and development of complications. The limited
use    of condoms to protect adolescents from risk of HIV is an issue to reflection for
condom use is not only to prevent pregnancy but also preventing sexually
transmitted disease. r The YAFS 2002 survey showed that Filipino males and females
are at risk of STIs, HIV/AIDS.  It was reported that 62 % of sexually transmitted
infections affect the adolescents while 29 % of HIV positive Filipino cases are young
people. In addition, it was   revealed that thirty seven percent (37%) of Filipino males
25 years of age have had sex before they marry with women other than their wives.
Some will have paid for sex while others will have had five or more partners.
 
Political and Economic Factors
Marginalization and Poverty
The disturbing poverty situation of households and families where majority of the
adolescents belong   brings in difficulties to meet adolescents’needs.  Poverty   is
closely link to adolescent health   issues.  It reinforces to the situation of adolescents
vulnerability to health risks due to the lack of access to various services and
unsupportive social, political and economic environment.  The following are some of
the consequences of poverty faced by the youth.    
 Limited Access to Information -among the greatest challenges for Filipino
youth is access to correct and meaningful information on sexual and reproductive
issues. 
 Limited access to services and commodities-The lack of access to
contraceptive services and supplies was among the most frequently articulated
concerns with regard to adolescent SRH. Programs such as the AYHDP do
recognize adolescents’ need for access to contraception.
 Limited awareness of pertinent policies-While the AYHP Administrative
order was issued in 2000, few key informants knew of its existence. In fact, many
key informants said that no ARH policy existed at the time they were interviewed
 
Technological Factors 
Rapid   Advancement of Communication
The value of   technological    advancement   could   never be discounted. However, to
the curious and adventurous adolescents various modes of communications are
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 oftentimes abused and misused such as   the use of internet and mobile phones. 
Adolescents then become vulnerable to exploitation, in cybersex   and pornography
exposing them deeper into risky behavior. In addition the digital dependence and
addiction causes alienation of   adolescents to   personal and closer mode of
communication resulting to a distorted image of the adolescents relationships to the
social environment. This  also  deprives the  adolescents  from   productive activities 
where they can  develop  themselves fully grown up and mature e economic and social
being  Moreover,  communicationadvancement has also produced  advertisements and
television  commercials whose image are not adolescent- friendly  are paving the way
for  so much consumerism,  distorted personal and family values
 
THE ADOLESCENTS HEALTH PROGRAM IN THE PHILIPPINES

8. International Policies, Passages and Laws as anchors 

In   International Laws
    UN   Convention on the  Rights of  Children
    UN Convention  the Action for the Promotion and Protection of the health  of
adolescents
    Convention  on the Elimination of  all forms  of discrimination  againts 
women
    1994  International Conference  on Populaiton and Development  ( ICPD)
    1995  Fourth World  Conference  on  Women
    World  Programme of Action for Youth  2000
    MDG  Goals :
    Goal 2:Achieve Universal Primary Education 
    Goal 3:Promote Gender Equality
    Goal 4 :  Reduce Child Mortality
    Goal 5:  Improve Maternal Health
    Goal 6:Combat HIV/AIDS, Malaria and other diseases
National Laws and Policies
o   National Objectives  for Health
o   Fourmula One for Health
o   Adolescent and Youth Health  Policy (AYH)
o   Adolescent and   Youth  Health    and Develoment  Program 
o   National  Directional  Plan   for  reaching the Un reahced Youth
Population
o   Reproductive Health Program AO#1 s1998
o   Local Government  Code 
WHO, together with countries and areas in the Region and partner agencies,
are working to promote healthy development of adolescents and reduce mortality
and morbidity.  In the Western Pacific Region, several technical units are working to
implement interventions that improve adolescent health in the Region.  The  
Philippines   belong to the Western Pacific Region and is committed to:
   Recognize adolescents as ‘vulnerable and a ‘group in need’
o   Address Issues that have an evidence base
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 o   Socio- Cultural perspectives
o   Develop Innovative mechanisms to reach out to adolescents.
o   Encourage collaboration and partnerships
o   Program implementation is monitored and evaluated.
The Adolescent Health Program
The Adolescents Youth and Heath Development Programs   were established
in 2001 under the oversight of the Department   of Health in partnership with other
government agencies with adolescent concerns   and other stakeholders. The 
program  is targeting youth ages 10–24,  and the program  provides comprehensive
implementation guidelines for youth-friendly comprehensive health care and services
on multiple levels—national, regional, provincial/city, and municipal.
The program is solidly anchored on International and laws, passages
and polices meant to address adolescent’s health concerns. It is operating then  
within the facets and adolescents and youth health that includes disability, mental
and environmental health, reproductive and sexuality, violence and injury prevention
and among others.
It employed strategies to ensure integration of the program into the health
care system in addition, broader society such as building a supportive policy
environment, intensifying IEC and advocacy particularly among teachers, families,
and peers, building the technical capacity of providers of care, and support for youth;
improving accessibility and availability of quality health services, strengthening
multi-sectoral partnerships, resource mobilization, allocation and improved data
collection and management.
The program to address sexual and reproductive health issues likewise
adopts gender-sensitive approaches. The primary responsibility for implementation of
the AYHDP, and its mainstreaming into the health system, falls to regional and
provincial/city sectors. Guidelines cover service delivery, IEC, training, research and
information collection, monitoring and evaluation, and quality assurance. 

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 Botika Ng Barangay (BnB)

I. What is Botika ng Barangay?

            Botika ng Barangay (BnB) - refers to a drug outlet managed by a legitimate
community organization (CO) / non-government organization (NGO) and/or the Local
Government Unit (LGU), with a trained operator and a supervising pharmacist
specifically established in accordance with this Order. The BnB outlet should be
initially identified, evaluated and selected by the concerned Center for Health
Development (CHD), approved by the PHARMA 50 Project Management Unit (PMU)
and specially licensed by the Bureau of Food and Drugs (BFAD) to sell, distribute,
offer for sale and/or make available low-priced generic home remedies, over-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.

III. Status of the Program

Variants of the BnBs include Botika Binhi (funded by the members of the Peso
for Health with counterpart from the local government unit), Health Plus (funded by
the GTZ), Botika sa Parokya (funded by DOH and Office of the President) and the
Botika ng Bayan (BNB) express under PITC/ PITC Pharma Inc. At present, about
16,350 BnB outlets have been established in the country.
The initial target was to establish 1 BnB to serve 3 adjacent Barangays. However, due
to the immensity of Barangays, and the need for more than 1 BnB in some poor
adjacent barangays to better provide for the service, the target were changed to 1:1.
Since absorptive capacity for the DOH-CHDs to establish BnBs is also limited due to
resource and time constraints, the initial phasing of the target to achieve 1:1 is being
done. Thus, for the next two (2) years, the target would be initially 1:2 except for
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select areas that have high poverty incidence, conflict or Geographically isolated
areas, and the like where the target would be 1:1.
Sourcing of medicines for the initial seed capital of these medicines is done through
PITC Pharma Inc.

Issuances about Botika ng Barangay

Issuances Date Title

Department Memorandum January Moratorium on the Establishment of
No. 2011-0022 26, 2011 Botika ng Barangay (BnB) Nationwide
Submission of Reports for the Impact
Department Memorandum February
Assessment of Maximum Drug Retail
No. 2010-0033 12, 2010
Price (MDRP) / Government 
Amendment to Memorandum No. 31 s.
Department Memorandum February 2003 dated 17 February 2003 re: Drugs
No. 2008-0038 21, 2008 to be sold in Botika ng Barangays
(BnBs)
Utilization of Slow-Moving Pharma 50
Department Memorandum April 5,
Botika ng Barangay (BnB) Drugs and
No. 2005-0046 2005
Medicines
Supplemental Guidelines to
Administrative Order No. 144 series
2004, entitled: "Guidelines for the
Establishment and Operations of Botika
Administrative Order No. April 4, ng Barangays (BnB) and
2005-0011 2005 Pharmaceutical Distribution Network
(PDNs)" relative to the inclusion of other
drugs which are classified as
Prescription Drugs and other related
matters
Botika ng Barangay Performance
Department Memorandum November
Monitoring Reports and Routine
No. 118 s. 2004 22, 2004
Schedule of Submissions
Guidelines for the Establishment and
Administrative Order No. April 14, Operations of Botika ng Barangays
144 s. 2004 2004 (BnB) and Pharmaceutical Distribution
Network (PDNs)
Memorandum No. 31 s. February Drugs to be sold in Botika ng
2003 17, 2003 Barangays (BnBs)

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17
 Breastfeeding TSEK

  On February 23, 2011, the Department of Health (DOH) launched the exclusive
breastfeeding campaign dubbed “Breastfeeding TSEK: (Tama, Sapat, Eksklusibo)”.
The primary target of this campaign is the new and expectant mothers in urban
areas.
          This campaign encourages mothers to exclusively breastfeed their babies from
birth up to 6 months. Exclusive breastfeeding means that for the first six months
from birth, nothing except breast milk will be given to babies.
               Moreover, the campaign aims to establish a supportive community, as well
as to promote public consciousness on the health benefits of breastfeeding. Among
the many health benefits of breastfeeding are lower risk of diarrhea, pneumonia, and
chronic illnesses. 

Blood Donation Program

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

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3. Implementation of a quality management system including of Good
Manufacturing Practice GMP and Management Information System (MIS);
4. Attainment of maximum utilization of blood through rational use of blood
products and component therapy; and
5. Development of a sound, viable sustainable management and funding for
the nationally coordinated blood network.

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 Child Health and Development Strategic Plan Year 2001-2004

Introduction
The Philippine National Strategic Framework for land Development for Children or
CHILD 21 is a strategic framework for planning programs and interventions that
promote and safeguard the rights of Filipino children. Covering the period 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 determines the
safety and well being of children in society. Children's Health 2025, therefore, should
be able to integrate the strategies and interventions into the overall plan for
children's development.
             Children's Health 2025 contains both mid-term strategies, which is targeted
towards the year 2004, while long-term strategies are targeted by the year 2025. It
utilizes a life cycle approach and weaves in the rights of children. The life cycle
approach ensures that the issues, needs and gaps are addressed at the different
stages of the child's growth and development.
                The period year 2002 to 2004 will put emphasis on timely diagnosis and
management of common diseases of childhood as well as disease prevention and
health promotion, particularly in the fields of immunization, nutrition and the
acquisition of health lifestyles. Also critical for effective planning and implementation
would be addressing the components of the health infrastructure such as human
resource development, quality assurance, monitoring and disease surveillance, and
health information and education.
               The successful implementation of these strategies will require collaborative
efforts with the other stakeholders and also implies integration with the other
developmental plan of action for children.
 
Vision
A healthy Filipino child is:
 Wanted, planned and conceived by healthy parents carried to term by healthy
mother born into a loving, caring, stable family capable of providing for his or her
basic needs, delivered safely by a trained attendant
 Screened for congenital defects shortly after birth; if defects are found,
interventions to correct these defects are implemented at the appropriate time
 Exclusively breastfed for at least six months of age, and continued
breastfeeding up to two years, introduced to complementary foods at about six
months of age, and gradually to a balanced, nutritious diet, protected from the
consequences of protein-calorie and micronutrient deficiencies through good
nutrition and access to fortified foods and iodized salt
 Provided with safe, clean and hygienic surroundings and protected from
accident, properly cared for at home when sick and brought timely to a health
facility for appropriate management when needed. Offered equal access to good

20
 quality curative, preventive and promotive health care services and health
education as members of the Filipino society
 Regularly monitored for proper growth and development, and provided with
adequate psychosocial and mental stimulation, screened for disabilities and
developmental delays in early childhood; if disabilities are found, interventions
are implemented to enabled the child to enjoy a life of dignity at the highest level
of function attainable
 Protected from discrimination, exploitation and abuse
 Empowered and enabled to make decisions regarding healthy lifestyle and
behaviors and included in the formulation health policies and programs, afforded
the opportunity to reach his or her full potential as adult
 
Current Situation
           Deaths among children have significantly decreased from previous years. In
the 1998 NDHS, the infant mortality rate was 35 per 1000 live births, while neonatal
death rate was 18 deaths per 1000 live births. Among regions IMR is highest in
Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much
higher among infants whose mothers had no antenatal care or medical assistance at
the time of delivery. Top causes of illness among infants are infectious diseases
(pneumonia, measles, diarrhea, meningitis, and septicemia), nutritional deficiencies
and birth-related complications.
             The probability of dying between birth and five years of age is 48 deaths per
1000 live births. The top five leading causes of deaths (which make up about 70%) of
deaths in this age group) are pneumonia, diarrhea, measles, meningitis and
malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and
vehicular accidents.
             The decline in mortality rates may be attributed partly to the Expanded
Program of Immunization (EPI), aimed to reduce infant and child mortality due to
seven immunizable diseases (tuberculosis, diptheria, tetanus, pertusis, poliomyelitis,
Hepatitis B and measles).
           The Philippines has been declared as polio-free during the Kyoto Meeting on
Poliomyelitis Eradication in the Western Pacific Region last October 2000. This
however, is not a reason to be complacent. The risk of importing the poliovirus from
neighboring countries remains high until global certification of polio eradication.
There is an urgent need for sustained vigilance, which includes strengthening the
surveillance system, the capacity for rapid response to importation of wild poliovirus,
adequate laboratory containment of wild poliovirus materials, and maintaining high
routine immunization until global certification has been achieved.
               Malnutrition is common among children. The 1998 FNRI survey show that
three to four out of ten children 0-10 years old are underweight and stunted. The
prevalence of low vitamin A serum levels and vitamin A deficiency even increased in
1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation
coverage reached to more than 90%, however, a downward trend was evident in the
succeeding years from as high as 97% in 1993 to 78% in 1997.

21
             Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher
in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased
from 13.2% to 20% among children 4-5 mos. of age (NDHS).
             Several strategies were utilized to improve child health. The Integrated
Management of Childhood Illness aims at reducing morbidity and deaths due to
common childhood illness. The IMCI strategy has been adopted nationwide and the
process of integration into the medical, nursing, and midwifery curriculum is now
underway.
             The Enhanced Child Growth strategy is a community-based intervention
that aims to improve the health and nutritional status of children through improved
caring and seeking behaviors. It operates through health and nutrition posts
established throughout the country.
 
Gaps and Challenges 
        Many Local Health Units were not adequately informed about the Framework
for Children's Health as well as the policies. There is a need to disseminate the two
documents, CHILD 21 and Children's Health 2025 to serve as the template for local
planning for children’s health. There is also the need to update and reiterate the
policies on children's health particularly on immunization, micronutrient
supplementation and IMCI.
         LGUs experienced problems in the availability of vaccines and essential drugs
and micronutrients due to weakness in the procurement, allocation and distribution.
       Pockets of low immunization coverage are attributed largely to the irregular
supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the
promotion of immunization.

Goal
The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino
children by the year 2025.
 
Medium-term Objectives for year 2001-2004
Health Status Objectives
          1. Reduce infant mortality rate to 17 deaths per 1,000 live births
          2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 live
births
          3. Reduce the mortality rate among adolescents and youths by 50%
 
Risk Reduction Objectives
         1. Increase the percentage 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

22
home management of childhood illness to 80%
        5. Reduce the prevalence of protein-energy malnutrition among school-age
children
        6. Increase the health care-seeking behavior of adolescents to 50%
 
Services and Protection Objectives
       1. Ensure 90% of infants and children are provided with essential health care
package
       2. Increase the percentage of health facilities with available stocks of vaccines
and essential drugs and micronutrients to 80%
       3. Increase the percentage of schools implementing school-based health and
nutrition programs to 80%
       4. Increase the percentage of health facilities providing basic health services
including counseling for adolescents and youth to 70%
 
Strategies and Activities

 Enhance capacity and capability of health facilities in the early recognition,

management and prevention of common childhood illness
 This will entail improvements in the flow of services in the implementing
facilities to ensure that every child receive the essential services for survival,
growth and development in an organized and efficient manner. Facilities
should be equipped with the essential instruments, equipment and supplies to
provide the services. Health providers shall have the knowledge and skills to be
able to provide quality services for children. Existing child health policies,
guidelines and standards shall be reviewed and updated, and new ones
formulated and disseminated to guide health providers in the standard of care.
 Strengthening community-based support systems and interventions for
children's health
Notable community-based projects and interventions, such as the health and
nutrition posts, mother support groups, community financing schemes shall be
replicated for nationwide implementation. Model building and dissemination of
best practices from pilot sites has proven effective in generating support and
adoption in other sites. More of these shall be initiated particularly for
developing interventions to increase care-seeking and prevention of
malnutrition in children.
 Fostering linkages with advocacy groups and professional organizations and to
promote children's health
 Collaboration with the nongovernment sector and professional groups shall:
 Conduct national campaigns on children's health
 Conduct and support national campaigns for children
 Initiate and support legislations and researches on children's health and
welfare

23
  Development of comprehensive monitoring and evaluation system for child
health programs and projects

CHD Scorecard

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

Committee of Examiners for Undertakers and Embalmers

Rationale
Embalming is the funeral custom of cleaning and disinfecting bodies after death. It
has been part of the funeral parlors so with our lives. For the past decades,
embalming has been undergoing profound transformational events, not only in the
Philippines but worldwide. Today, embalming is also considered an art. It is done to
preserve the dead body from natural decomposition and for restoration for a more
pleasing appearance. Likewise, the procedure is significant for restoration of
evidences such as in medico-legal cases.
These changes were made possible by the multitudes of forces converging in the
national as well as the local levels, which is impacting on the quality of embalming
practice in the country. Embalmers today should therefore, be looked up to, because
of the significant manifold tasks they are rendering including the counseling
assistance they are providing the bereaved parties.

Objective:
The Department of Health (DOH) created the CEUE to regulate embalming practice
in the country. The creation was made possible by Presidential Decree (PD) No. 856
"Code of Sanitation of the Philippines" Chapter XXI "Disposal of Dead Persons" and
Executive Order No. 102 s. 1999 "Rationalization and Streamlining Plan of the DOH".

Strategies:
To ensure that only qualified individuals enter the regulated profession and that the
care and services which the embalmers provide are within the standards of practice,
the DOH-CEUE created:
1. CEUE Resolution No. 2011-001 - Three Year Transition Period for Compliance of
Administrative Order No. 2010-0033.
2. Memorandum dated August 10, 2010 - to the Centers for Health Development
(CHDs) Human Resource Development Units (HRDUs) regarding Updates on the
Committee of Examiners for Undertakers and Embalmers (CEUE) Program.

24
3. Administrative Order No. 2010-0033 - Revised Implementing Rules and
Regulations of PD 856 Chapter XXI Governing Disposal of Dead Persons
4. CEUE Resolution No. 2010-001 - Adoption of the Code of Ethics for Embalmers in
the Philippines
5.  CEUE Resolution No. 2009-001 - Creation of the Committee for Continuing
Embalmers Education Council (CEEC)
6. CEUE Resolution No. 2008-001 - Conduct of Licensure Examination for
Embalmers in Centers for Health Development (CHDs) to conduct a simultaneous
licensure examination in the Central Office and the CHDs with a minimum of 50
examinees for cost effectiveness.
7. Department Memorandum No. 2008-0009 - Designation of DOH Human Resource
Development Units (DOH-HRDUs) as Coordinators for Embalmers Program" to
facilitate immediate response to queries and complaints regarding the embalming
practice. 
8. CEUE Resolution No. 2008-001 - Accredited Training Institutions and Training
Providers for Embalmers for CY 2008-2011 to regulate existing and potential training
providers and training institutions for embalmers for the enhancement and
maintenance of its professional standards.
9. CEUE Resolution No. 2008-002 - Extension of Moratorium as per CEUE
Resolution No. 2007-001.
10. CEUE Resolution No. 2007-001 - Moratorium on the Non-renewal of Licenses of
Embalmers for the past five (5) years and over with the aim of providing chance to
licensed embalmers who were unable tio renew their licenses for the past five years
and over.
11. Administrative Order No. 2007-0020 - Policies and Guidelines for the
Accreditation of Training Institutions, Training Programs and Training Providers for
Embalmers in the Philippines with the aim of institutionalizing the continuing
education program for embalmers in the country. Hence, to ensure the maintenance
of efficient, ethical and technical, moral and professional standards in its practice,
taking into account the quality of care to be rendered to respective clientele. At the
same time, the regulation ensures the global competitiveness of the Filipino
embalmers.
12. Department Circular No. 2007-0139 - Reiteration on the observance of
precautionary measures in the disposal of dead persons.

Chapter XXI "Disposal of Dead Persons" mandate the CEUE to monitor and
enforce quality standards of embalming practice in the Philippines and exercise the
powers necessary to ensure the maintenance of efficient, ethical and technical, moral
and professional standards in its practice, taking into account the quality of care to
be rendered to respective clientele. At the same time, the regulations ensure the
global competitiveness of the Filipino embalmers.

Program Status
Nationwide information dissemination of the following:
 Administrative Order No. 2010 - 0033 (Disposal of Dead Persons)
25
  Curriculum for licensure examinations
 Manuals for Licensure Examinations
 Code of Ethics
1.  March 25, 2011 - National Capital Region
2. May 3, 2011 - Visayas Region (Iloilo City)
3. May 13, 2011 - Mindanao Regions (Cagayan de Oro City)
4. June 30, 2011 - Butuan City (upon request)
5. August 25, 2011 - Aklan (upon request)

Committee of Examiners for Massage Therapy (CEMT)

Rationale
Traditional medicine throughout the world recognizes the significance of therapeutic
massage in managing stress, illness or chronic ailments. Massage therapy is
considered the oldest method of healing that applies various techniques like fixed or
movable pressure, holding, vibration, rocking, friction, kneading and compression
using primarily the hands and other areas of the body such as the forearms, elbows
or feet to the mascular structure and soft tissues of the body. 
Massage therapy can lead to significant biochemical, physical, behavioral and clinical
changes in massage as well as the person giving the massage. It contributes to a
higher sense of general well-being. Recognizing this, many healthcare professionals
have begun to incorporate massage therapy as a complement to their routine clinical
care. Efficacy of massage therapy in patient ranges from pretern neonates to senior
citizens. Although the country has the training standards and regulations through
the Technical Education and Skills Development Authority (TESDA), it lacks control /
regulations over the training institutions, thus, anyone who calls himself/herself a
massage therapist is one, regardless of training or experience.

Objective:
The Department of Health created the Committee of Examiners for Massage Therapy
(CEMT) to regulate the practice of massage therapy in accordance to the provisions of
the Sanitation Code of the Philippines (PD 856) and Executive Order No. 102 s. 1999,
Reorganization and Streamlining of the Department of Health. It provides the CEMT
the function to ensure that only qualified individuals enter the regulated profession
and that the care and services which the massage therapists provide are within the
standards of practice.

Strategies:
To ensure that only qualified individuals enter the regulated profession and that the
care and services which the massage therapists provide are within the standards of
practice, the DOH-CEMT created:
1. CEMT Resolution No. 2011-001 - Three-Year Transition Period for
Compliance to Administrative Order No. 2010-0034.

26
 2. Memorandum dated August 10, 2010 - to the Centers of Health Development
(CHDs) Human Resource Development Units (HRDUs) regarding Updates on the
Committee of Examiners for Massage Therapy (CEMT) Program
3. Administrative Order No. 2010-0034 - Revised Implementing Rules and
Regulations of PD 856 Chapter XIII Governing Massage Clinics and Sauna
Establishments
4. CEMT Resolution No. 2010-001 - Adoption of the Code of Ethics for Massage
Therapists in the Philippines. 
5. CEMT Resolution No. 2009-001 - Creation of Committee for Continuing
Massage Therapy Education Council (CMTEC)
6. CEMT Resolution No. 2008-001 - Conduct of Licensure Examination for
Massage Therapists in Centers for Health Development (CHDs) to conduct a
simultaneous licensure examination in the Central Office and the CHDs with a
minimum of 50 examinees for cost effectiveness.
7. Department Memorandum No. 2008-0009 - Designation of DOH Human
Resource Development Units (DOH-HRDUs) as Coordinators for Massage Therapy
Program to facilitate immediate response to queries and complaints regarding the
massage therapy practice.
8. CEMT Resolution No. 2008-001 - Accredited training institutions and
training providers for massage therapists for CY 2008-2011 to regulate existing
and potential training providers and training institutions for massage therapists
for the enhancement and maintenance of its professional standards.
9. CEMT Resolution No. 2008-002 - Extension of Moratorium as per CEMT
Resolution No. 2008-001 
10. CEMT Resolution No. 2008-001 - Moratorium on the Non-Renewal of
Licenses for Embalmers for the past five (5) years and over with the aim of
providing chance to licensed embalmers who were unable to renew their licenses
for the past five years and over
11. Administrative Order No. 2008-0031 - Policies and Guidelines for the
Accreditation of Training Institutions, Training Programs and Trainining
Providers for Massage Therapists in the Philippines with the aim of
institutionalizing the continuing education program for massage therapists in the
country. Hence, to ensure the maintenance of efficient, ethical and technical,
moral and professional standards in its practice, taking into account the quality
of care to be rendered to respective clientele. At the same time, the regulation
ensures the global competitiveness of the massage therapists.

Chapter XIII "Massage Clinics and Sauna Establishments mandate the CEMT to
monitor and enforce quality standards of massage therapy practice in the Philippines
and exercise the powers necessary to ensure the maintenance of efficient, ethical and
technical, moral and professional standards in its practice, taking into account the
quality of care to be rendered to respective clientele. At the same time, the
regulations ensure the global competitiveness of the Filipino massage therapists.

Program Status
Nationwide information dissemination of the following:

27
  Administrative Order No. 2010-0034 (Massage Clinics and Sauna
Establishments)
 Curriculum for Licensure Examinations
 Manuals for Licensure Examinations
 Code of Ethics
1. March 25, 2011 - National Capital Region
2. May 3, 2011 - Visayas Regions (Iloilo City)
3. May 13, 2011 - Mindanao Region (Cagayan de Oro City)
4. June 30, 2011 - Butuan City(upon request)
5. August 25, 2011 - Aklan (upon request)

Chronic Obstructive Pulmonary Disease Program

I. Rationale:

Respiratory conditions impose an enormous burden on society. According to

the WHO World Health Report 2000, the top five respiratory diseases account for
17.4% of all deaths and 13.3% of all Disability Adjusted Life Years (DALYs). Lower
respiratory tract infections, chronic obstructive pulmonary disease (COPD),
tuberculosis and lung cancer are among the leading 10 causes of death worldwide.
Based partly on demographic changes in the developing world, but also on the
changes in health care systems, schooling, income and tobacco use, the burden of
communicable diseases is likely to lessen while the burden of chronic respiratory
diseases (CRDs) including asthma, COPD, and Lung Cancer will worsen because of
tobacco use and population ageing.

COPD (CRD) is a major public health problem in the Philippines today. It

occupies 7th among the latest list of top 10 causes of mortality. Significantly, the
mortality trend in the last 3 decades shows a shift from acute infectious illness to
chronic degenerative diseases. This is also true in the etiology of COPD.

No large local study has been done to determine the prevalence of COPD in the
Philippines. So far, estimates have been based primarily on morality statistics. These
provide misleading figures because COPD is underdiagnosed and often not listed
either as primary or contributory cause of death. A spirometry based study in 1997
in a rural community found irreversible airway obstruction in 3.7% of the population.
Proceeding from an Asia-Pacific regional workshop in 2000 cited the prevalence of
COPD in the Philippines as 6.3%.

In 1998, International Study of Asthma and allergies in Childhood (ISAAC)

survey reported the prevalence of asthma among 13-14 years old in the Philippines at
11.6% this level increased in the recently concluded WHO-funded National Asthma
Epidemiology Survey (NAES) where the prevalence of definite asthma was placed at
4.3% in adults and 28.1% and 12.9% in children aged 13-14 and 6-7 years
respectively. In all, among the respondents found to have asthma by the expert
panel, about 33% of the children aged 6-7 years, 72% of school children and 28% of

28
adults did not report prior knowledge of Doctor-diagnosed asthma to explain their
symptoms. Prevalence and occurrence of Chronic respiratory diseases is likely to
increase and the extent of mortalities and financial cost necessitates a decisive plan
of action-both preventive and therapeutic. A national program supported by the
government, the scientific community, non-government organizations and people’s
organization is probably the optimal strategic approach to achieve a control of the
rising prevalence of CRDs.

A. Policy Statement:

The prevention and control of chronic lifestyle related non communicable diseases
shall be guided by the following policy statements.

1. The country shall adopt an integrated, comprehensive and community based

response for the prevention and control of chronic, lifestyle related NCDs.

2. Health promotion strategies shall be intensified to effect changes that would

lead to a significant reduction in mortality and morbidity due to chronic lifestyle
related NCDs.

3. Complementary accountabilities of all stakeholders must be ensured and

actively pursued in the implementation of an integrated, comprehensive and
community based response to chronic, lifestyle- related NCDs.

B. Objectives:

1. Decrease of morbidity and Mortality

2. Decrease in the economic burden of CVDs to the individual, family and
community.

Vision: Improved quality of life for all Filipinos.

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

II. Scenario

A. Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17
million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths);
and respiratory diseases, including asthma and chronic obstructive pulmonary
disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths.

Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths
from COPD, occurred in low- and middle-income countries. Behavioral risk factors,
including tobacco use, physical inactivity, and unhealthy diet, are responsible for

29
about 80% of coronary heart disease and cerebrovascular disease. These important
behavioral risk factors of heart disease and stroke are discussed in detail later in this
chapter.

Referenced from: WHO-Global Status Report on Non-Communicable Diseases 2010

B. Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to Non-

Communicable Diseases.

1st: Diseases of the Heart (CAD)

2nd: Diseases of the Vascular System (Stroke)
3rd: Malignant Neoplasm (Cancer)
4th: Injuries (Accidents)
7th: Chronic Obstructive Pulmonary Disease (COPD)
10th: Nephritis, Nephrotic Syndrom

Referenced from: NEC, Department of Health

III. Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of the
targeted population to adopt high risk behaviors and habits that may lead to the
development of COPD.

Will be implemented by setting:

 Community-Based
 School-Based
 Industry-Based
 Hospital-Based
 Training, Research, Environmental support system are important components
of the progress.

IV. Status of Implementation/Accomplishment

Program is well in place and its implementation is continuous from the

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

30
  Trained Hospitals for the Registry System entitled “Users’ training for the
Unified Registry System”.
 Trained CHDs for the Registry System entitled “Users’ training for the Unified
Registry System” (Non-Communicable Diseases).
 Establishment of Philippine Coalition on the Prevention and Control of NCD.
 A Training Manual for Health Workers on Promoting Healthy Lifestyle. (Non-
Communicable Diseases).
 Twenty Years of Non-communicable Diseases (NCD) Prevention and Control in
the Philippines (1968-2006).
 Healthy Lifestyle Advocacy Campaign.
 Manual of Operations on the Prevention and Control Lifestyle-Related Non-
Communicable Diseases in the Philippines.
 Training Manual for Health Workers: WHO/DOH Smoking Cessation Clinic:
Helping Smokers Quit.

V. Future Plan/Action:

 Implement the program through the institutionalized integrated program of

NCD-Lifestyle related diseases control program.
 Development of Service Package for Chronic Obstructive Pulmonary Disease
(COPD)
 Development of Clinical Practice Guideline for COPD.
 Development of Strategic Framework and a five Year Strategic Plan for COPD
(2012-2016).

31
 Cardiovascular Disease Program

I. Rationale:

Cardiovascular diseases (CVD),cancers, chronic respiratory diseases and

diabetes (DM) are among the top killers in the Philippines, causing more than half of
all deaths annually. Hypertension and diseases of the heart are among the ten
leading causes of illnesses each year. These diseases are collectively known as
Lifestyle Related Non-Communicable Diseases (NCDs), as defined in the National
Objectives for Health 2005-2010, particularly because these diseases have common
risk factors which are to a large extent related to unhealthy lifestyle.

The risk factors involved are tobacco use, unhealthy diet, physical inactivity
and alcohol use. The Food and Nutrition Research Institute (FNRD National
Nutrition and Health Surveys in 1998 to 2008 (Acuin and Duante, 2010) showed
that there is increasing prevalence in the associated risk factors between 1998 to
2008: hypertension from 2l%o to 25.3 %; diabetes from 3.9%o to 4.8%; among adults
who are overweight, there has been a significant increase from 24.2% to 26.60/o;
and those with high blood cholesterol levels had increased from 4Yo to 10.2%.
Furthermore, the study found out that the following groups are at risk for NCDs: age
group from the 40's onwards and those with Body Mass Index (BMI) > 23,
dyslipidemia, high waist circumference and waist hip ratios. Moreover, dietary intake
trends show increasing consumption of energy dense foods high in fats and sugars,
while almost the entire adult population has low levels of physical activity in all
domains: occupation, non-occupation, leisure, transportation.

Children and adolescents are also exposed to the above-mentioned risks. Latest
data from the Global Adult Tobacco Survey in 2009 shows prevalence of tobacco use
(current smokers) among population 15 years old and above tobe28.3%o (17.3 million
Filipinos); 47.7% of these are men (14.6 million) and 9%o are women (2.8 million). On
the other hand, the prevalence of overweight among adolescents 9-11 years old has
increased two folds from 2.4oh in 1993 to 4.8%;oin2005. Similarly, the prevalence
rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6%o in
2005. (Source: Philippine Nutrition Facts and Figures 2005). About 30Yo of teenage
students are physically inactive, spending three or more hours per day sitting and
watching television, playing computer games, talking with friends, or doing other
sitting activities. (Source: Philippines Global School-based Student Health Survey,
2007). And, data shows that in 2008 hazardous alcohol intake stands at26.90/o
(FNRI-NNHeS 2008).

The Philippine Renal Disease Registry (PRDR) illustrates that for 2009,
diabetic nephropathy, a complication of diabetes remained the most common
etiology of end stage renal disease while clinical hypertensive nephrosclerosis, a
complication of hypertension ranked as the second most common etiology of end
stage renal disease. Unless something is done to control these non-communicable
diseases, renal complications will escalate to a degree that will compromise the
current capacity to care for these types of patients.
32
 The cost of care of lifestyle-related non-communicable diseases may cause
people to fall into poverty and create a downward spiral of worsening poverty and
illness. They also undermine the country's economic development. In response to the
increasing prevalence of lifestyle related diseases in the country, vertical programs on
the prevention and control of cardiovascular diseases, cancers and diabetes were put
in place in the mid 1990's. The individual programs however, were focused on
treatment and management of those who were already sick and thus were competing
with each other for resources and for attention upon field implementation.

A. Policy Statement:

The prevention and control of chronic lifestyle related non communicable

diseases shall be guided by the following policy statements.

1. The country shall adopt an integrated, comprehensive and community based

response for the prevention and control of chronic, lifestyle related NCDs.

2. Health promotion strategies shall be intensified to effect changes that would

lead to a significant reduction in mortality and morbidity due to chronic lifestyle
related NCDs.

3. Complementary accountabilities of all stakeholders must be ensured and

actively pursued in the implementation of an integrated, comprehensive and
community based response to chronic,lifestyle related NCDs.

B. Objectives:

1. Decrease of morbidity and Mortality

2. Decrease in the economic burden of CVDs to the individual, family and
community.

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

Vision: A nation of Filipinos with Healthy Lifestyle and habits, living and working
in clean and safe environment and with access to adequate medical care for CVD.

33
II. Scenario

A. Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17
million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths);
and respiratory diseases, including asthma and chronic obstructive pulmonary
disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths.

Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths
from COPD, occurred in low- and middle-income countries. Behavioral risk factors,
including tobacco use, physical inactivity, and unhealthy diet, are responsible for
about 80% of coronary heart disease and cerebrovascular disease. These important
behavioral risk factors of heart disease and stroke are discussed in detail later in this
chapter.

Population growth and improved longevity are leading to increasing numbers

and proportions of older people, with population ageing emerging as a significant
trend in many parts of the world. As populations age, annual NCD deaths are
projected to rise substantially, to 52 million in 2030. Whereas annual infectious
disease deaths are projected to decline by around 7 million over the next 20 years,
annual cardiovascular disease mortality is projected to increase by 6 million and
annual cancer deaths by 4 million. In low and middle-income countries, NCDs will be
responsible for three times as many disability adjusted life years (DALYs) and nearly
five times as many deaths as communicable diseases, maternal, perinatal and
nutritional conditions combined, by 2030.

B. Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to Non-Communicable

Diseases.

1st : Diseases of the Heart (CAD)

2nd: Diseases of the Vascular System (Stroke)
3rd: Malignant Neoplasm (Cancer)
4th: Injuries (Accidents)
7th: Chronic Obstructive Pulmonary Disease (COPD)
10th: Nephritis, Nephrotic Syndrome

Referenced from: NEC, Department of Health

34
III. Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of

the targeted population to adopt high risk behaviors and habits that may lead to the
development of cardiovascular disease.

Will be implemented by setting:

 Community-Based
 School-Based
 Industry-Based
 Hospital-Based
 Training, Research, Environmental support system are important components
of the progress.

IV. Status of Implementation/Accomplishment

Program is well in place and its implementation is continuous. Locus of

implementation is in the community level and other settings. Complicated cases shall
be referred to hospitals and rehabilitation can be community and hospital based.
 Development of Administrative Order on the National Policy on the Integrated
Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and
COPD).
 1st Public Hearing on the Administrative Order on the National Policy on the
Integrated Chronic Non-Communicable Disease Registry System (Cancer,
Stroke, DM, and COPD) with CHD-NCR, Government and Private Hospitals and
Non-Government Agencies.
 Trained Hospitals for the Registry System entitled “Users’ training for the
Unified Registry System”.
 Trained CHDs for the Registry System entitled “Users’ training for the Unified
Registry System” (Non-Communicable Diseases).
 Establishment of Philippine Coalition on the Prevention and Control of NCD.
 A Training Manual for Health Workers on Promoting Healthy Lifestyle. (Non-
Communicable Diseases). Twenty Years of Non-communicable Diseases
(NCD) Prevention and Control in the Philippines (1968-2006).
 Healthy Lifestyle Advocacy Campaign.
 Manual of Operations on the Prevention and Control Lifestyle-Related Non-
Communicable Diseases in the Philippines.
 Training Manual for Health Workers: WHO/DOH Smoking Cessation Clinic:
Helping Smokers Quit.

IV. Future Plan/Action:

 Implement the program through the institutionalized integrated program of

NCD-Lifestyle related diseases control program.
 Development of Service Package for Cardiovascular Disease (CVD)
 Development of Clinical Practice Guideline for Cardiovascular Disease (CVD)

35
  Development of Strategic Framework and a five Year Strategic Plan for
Cardiovascular Disease (2012-2016).

Dental Health Program

Oral disease continues to be a serious public health problem in the Philippines.

The prevalence of dental caries on permanent teeth has generally remained above
90% throughout the years. About 92.4% of Filipinos have tooth decay (dental caries)
and 78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although
preventable, these diseases affect almost every Filipino at one point or another in his
or her lifetime.

Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines
Prevalence
YEAR
Dental Caries Peridontal Disease
1987 93.9% 65.5%
1992 96.3% 48.1%
1998 92.4% 78.3%

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

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

36
these children become susceptible to irreversible periodontal disease as they enter
adolescence and approach adulthood.

In general, tooth decay and gum diseases do not directly cause disability or
death. However, these conditions can weaken bodily defenses and serve as portals of
entry to other more serious and potentially dangerous systemic diseases and
infections. Serious conditions include arthritis, heart disease, endocarditis, gastro-
intestinal diseases, and ocular-skin-renal diseases. Aside from physical deformity,
these two oral diseases may also cause disturbance of speechsignificant enough to
affect work performance, nutrition, social interactions, income, and self-esteem.
Poor oral health poses detrimental effects on school performance and mars success
in later life. In fact, children who suffer from poor oral health are 12 times more likely
to have restricted-activity days (USGAO 2000). In the Philippines, toothache is a
common ailment among schoolchildren, and is the primary cause of absenteeism
from school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent
epidemic, placing a heavy burden on Filipino schoolchildren.

VISION: Empowered and responsible Filipino citizens taking care of their own
personal oral health for anenhanced quality of life
MISSION: The state shall ensure quality, affordable, accessible and available oral
health care delivery.
GOAL: Attainment of improved quality of life through promotion of oral health
and quality oral health care.

OBJECTIVES AND TARGETS:

1. The prevalence of dental caries is reduce

Annual Target: 5% reduction of the prevalence rate every year

2. The prevalence of periodontal disease is reduced

Annual Targets : 5% reduction of the prevalence rate every year

3. Dental caries experience is reduced

Annual Target : 5% reduction of the mean dmft/DMFT for 5/6 years old and
12 years old children every year

4. The proportion of Orally Fit Children (OFC) 12-71 months old is

increased
Annual Targets: Increased by 20% yearly

The national government is primarily tasked to develop policies and guideline

for local government units. In 2007, the Department of Health formulated the
Guidelines in the Implementation of Oral Health Program for Public Health Services
(AO 2007-0007). The program aims to reduce the prevalence rate of dental caries to
85% and periodontal disease by to 60% by the end of 2016. The program seeks to
achieve these objectives by providing preventive, curative, and promotive dental
health care to Filipinos through a lifecycle approach. This approach provides a

37
continuum of quality care by establishing a package of essential basic oral health
care (BOHC) for every lifecycle stage, starting from infancy to old age.

The following are the basic package of essential oral health services/care for
every lifecycle group to be provided either in health facilities, schools or at home.
TYPES OF SERVICE
LIFECYCLE
(Basic Oral Health Care Package)
 Oral Examination
 Oral Prophylaxis (scaling)
Mother(Pregnant Women) **  Permanent fillings
 Gum treatment
 Health instruction
 Dental check-up as soon as the first tooth erupts
Neonatal and Infants under 1
 Health instructions on infant oral health care
year old** 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
Children 12-71 months old     **
              - referral of complicated cases
              - treatment of post extraction complications
              - drainage of localized oral abscess
 Application of Atraumatic Restorative
Treatment    (ART)
 Oral Examination
 Supervising tooth brushing drills
 Topical fluoride theraphy
School Children (6-12 years old)
 Pits and Fissure Sealant Application
 Oral Prophylaxis
 Permanent Fillings
 Oral Examination
Adolescent and Youth (10-24  Health promotion and education on oral hygiene,
years old)** and adverse effect on consumption of sweets and
sugary beverages, tobacco and alcohol
 Oral Examination
 Emergency dental treatment
Other Adults (25-59 years old)
 Health instruction and advice
 Referrals
 Oral Examination
 Extraction of unsavable tooth
Older Person (60 years old and
 Gum treatment
above)**  Relief of Pain
 Health instruction and advice

38
STRATEGIES AND ACTION POINTS:

1. Formulate policy and regulations to ensure the full implementation of OHP

a. Establishment of effective networking system (DepEd, DSWD, LGU, PDA, Fit for
School, Academe and others)

b. Development of policies, standards, guidelines and clinical protocols

- Fluoride Use

- Tooth brushing

- Other Preventive Measures

2. Ensure financial access to essential public and personal oral health services

a. Develop an outpatient benefit package for oral health under the NHIP of the
government

b. Develop financing schemes for oral health applicable to other levels of care
( Fee for service, Cooperatives, Network with HMOS)

c. Restoration of oral health budget line item in the GAA of DOH Central Office

3. Provide relevant, timely and accurate information management system for oral
Health.

a. Improve existing information system/data collection (reporting and recording

dental services and accomplishments)

- setting of essential indicators

- Development of IT system on recording and reporting oral health service

accomplishments and indices

- Integrate oral health in every family health information tools, recording

books/manuals

b. Conduct Regular Epidemiological Dental Surveys – every 5 years

4. Ensure access and delivery of quality oral health care services.

a. Upgrading of facilities, equipment, instruments, supplies

39
 b. Develop packages of essential care/services for different groups (children,
mothers and marginalized groups)

-revival of the sealant program for school children

- Tooth brushing program for pre-school children

- outreach programs for marginalized groups

c. Design and implement grant assistance mechanism for high performing LGUs

- Awards and incentives

- Sub-allotment of funds for priority programs/activities

d. Regular conduct of consultation meetings, technical updates and program

implementation reviews with stakeholders

5. Build up highly motivated health professionals and trained auxiliaries to manage

and provide quality oral health care

a. Provision of adequate dental personnel

b. Capacity enhancement programs for dental personnel and non-dental

personnel

Current FHSIS Indicators/parameters:

a) Orally Fit Child (OFC)– Proportion of children 12-71 months old and are orally
fit during a given point of time. Is defined as a child who meets the following
conditions upon oral examination and/or completion of treatment a) 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) Children 12-71 months old provided with Basic Oral Health Care (BOHC)
c) Adolescent and Youth (10-24 years old) provided with Basic Oral Health care
(BOHC)
d) Pregnant Women provided with Basic oral Health Care (BOHC)
e) Older Persons 60 years old and above provided with Basic Oral Health Care
(BOHC)

Policy/Standards/Guidelines formulated/developed:

a. AO. 101 s. 2003 dated Oct. 14, 2003 – National Policy on Oral Health
b. AO 2007-0007 – Dated January 3, 2007 Guidelines In The Implementation Of
Oral Health Program For Public Health Services In The Philippines

40
 c. AO 4-s.1998 – Revised Rules and Regulations and Standard Requirements for
Private School Dental services in the Philippines
d. AO 11-D s. 1998 – Revised Standard Requirements for Hospital Dental
services in the Philippines
e. AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for
Occupational Dental services in the Philippines
f. AO 4-A s. 1998 – Infection Control Measures for Dental Health Services

Trainings/Capacity Enhancement Program:

Basic Orientation Course on Management of Public Health Dentist

The training program was designed with the Public Health Dentists (PHDs) as the
main recipients of the Basic Course on the Management of Oral Health Program. The
training is expected to provide an in-depth understanding of the different roles and
functions of the PHDs in the management and delivery of Public Health Services. A
training module was developed for the basic course.

Researches:

a. National Monitoring Evaluation Dental Survey (NMEDS).

The Department of Health (DOH) has been conducting nationwide surveys

every five years (1977, 1982, 1987, 1992, and 1998) to determine the prevalence of
oral diseases in the Philippines. Data gathered provide continuous information that
enables planners to update data used in planning, implementation and evaluation of
existing oral health programs. The latest NMEDS was conducted in 2011. Results will
be available on the 1st quarter of 2012.

Existing Working Group for Oral Health:

National Technical Working Group (TWG) on Oral Health (DPO 2005-1197)

Member Agencies:
 Department of Health (NCDPC, HHRDB, NCHP)
 DOH- Center for Health Development for NCR, Central Luzon and
CALABARZON
 Philippine Dental Association
 Department of Education
 UP- College of Public Health
 Department of Interior and Local Government

 Department of Social Welfare and Development

 Local Government Units ( Makati, Quezon City)

41
Print materials:

 Leaflets (Malakas ang dating Buo ang Ngipin) for Children, Adolescent,
Pregnant Women and Older Person
 Training Module on Basic Course on Management of Oral Health Program

Non-Government Organization Major Partners:

 Philippine Dental Association

 Fit for School, Inc.

Diabetes Mellitus Prevention and Control Program

I. Rationale

Diabetes is a global concern that cuts across geographical boundaries

regardless of race, sex, status and age. Diabetes and its complications impose a
heavy burden to the individual, his family and society in general. Some of its serious
effects are disability, poor quality of life and premature death. These impact not only
on health care cost but more significantly on national growth and development.

In recognition of the current and emerging importance of diabetes, a concerted

effort has been organized to commonly address the diverse problems of the disease.
The Non-Communicable Disease Control Service (NCDCS), Office for Public Health
Services, presently Degenerative Disease Office of the National Center for Disease
Prevention and Control Program is mandated and tasked through Executive Order
No. 119 s. 1987, to anchor the Diabetes Mellitus Prevention and Control Program
(DMPCP). Relative to this, the Administrative Order No. 16-A s. 1995 – The Diabetes
Mellitus Prevention and Control Program in the Philippines was signed on September
15, 1995.

However, with recent evidences showing that diabetes and other chronic
lifestyle related non-communicable diseases (cardiovascular diseases, cancers and
chronic respiratory diseases) sharing common risk factors (unhealthy diet, physical
inactivity, smoking and alcohol use) should be addressed the most cost-effective way
through prevention of the emergence of the risk factors in an integrated manner,
employing health promotion strategies across the life course and intervening at the
level of family and community.

This is essential because the causal risk factors causing these illnesses are
deeply entrenched in the social and cultural framework of the society. Thus, an
integrated comprehensive program for the prevention and control of these non-
communicable lifestyle related diseases has to be put in place, hence, the signing of
the Administrative Order No. 2011 – 0003, National Policy on Strengthening the
Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases on
April 14, 2011.
42
Goal:

To reduce morbidity, mortality and disability rates due to chronic lifestyle

related NCDs through an integrated and comprehensive program on the prevention
and control of lifestyle related diseases.

Objectives:
1. To develop and promote an integrated and comprehensive program on the
prevention and control of lifestyle related diseases in the country.
2. To engage all province-wide or city-wide health systems to adopt an integrated
and comprehensive program on the prevention and control of lifestyle related
diseases.
3. To achieve improvement in the following Key Performance Indicators from
2011-2016:

Common Risk Factors

 Reduction in prevalence of current smoking among adult males from 56.3 to

40.0
 Reduction in prevalence of current smoking among adolescent female from
8.80 to 7.2
 Reduction in prevalence of adults with high physical inactivity from 60.5 to
50.8
 Increase in per capita total vegetable from 111.0 (g/day) to 133.0 (g/day)

Intermediate Risk Factors

 Reduction in prevalence of hypertension among adult males from 24.2 to 19.6.

 Reduction in prevalence of adults with high fasting blood sugar from 3.4 to 3.4.
 Reduction in the prevalence of central obesity (high waist circumference)
among adult females from 18.3 to 12.81
 Reduction in prevalence of high total serum cholesterol among adults from 8.5
to 8.5

Disease Control

Reduction in mortality from non-communicable diseases at 2% per year

through the Medium Development Goal max initiative.

II. Scenario

The estimated number of adults living with diabetes has soared to 366 million,
representing 8.3% of the global adult population. This number is projected to
increase to 552 million people by 2030, or 9.9% of adults which equates to

43
approximately three more people with diabetes every 10 seconds(Diabetes Atlas 5th
Edition, 2011).

In the Philippines, the prevalence of diabetes increased from 3.4% in 2003 to

4.8% in 2008 (NNHeS 2008). Diabetes also ranks 8thin the top 10 leading causes of
death in the country (DOH- Health Statistics 2006).

III. Interventions/Strategies Implemented by DOH

The Action Framework for the National Program on the Prevention and Control
of Chronic Lifestyle Related Non-Communicable Diseases is based on the Causation
Pathway Model for Major Chronic Diseases as contained in the World Health
Organization Western Pacific Regional Action Plan for Addressing Non-Communicable
Diseases, where the underlying determinants, common risk and intermediate risk
factors that would lead to lifestyle-related diseases are identified.

The Action Framework has seven action areas as follows: (1) Environmental
interventions; (2) Lifestyle interventions; (3) Clinical interventions; (4) Advocacy; (5)
Research, Surveillance, Monitoring and Evaluation; (6) Networking and Coalition
building; and (7) Health System Strengthening.

It draws primarily from the WHO Western Pacific Regional Framework for
addressing Non-communicable Diseases and emphasizes the requirement for
integrated comprehensive approaches that encompass and address the various levels
of determinants and risks for non-communicable lifestyle related diseases.

The framework clearly identifies areas for intervention according to the

causation pathway by utilizing a comprehensive approach that simultaneously seeks
to effect change at three levels:

1) Environmental Interventions such as policy and regulatory interventions seek to

create a supportive environment for healthier choices. They address the multiple
environmental determinants brought about for example, by globalization and
urbanization that give rise to the development of unhealthy lifestyles.

2) Lifestyle interventions address the common risk factors and intermediate risk
factors by providing population based lifestyle interventions (for example, information
and education and behavioral interventions for those who are already at risk).

3) Clinical interventions, palliation and rehabilitation address the capacity of the

health system to treat and manage diseases through screening, risk factor
modification, clinical management, palliation and rehabilitation.

To support change in these three levels of interventions, additional actions are

needed in the following areas: advocacy, research, surveillance, monitoring and
evaluation; networking and coalition building across all sectors of the government

44
and society, and health system strengthening through primary health care to make it
more responsive to chronic care.

The framework highlights the balance between “healthy choices” and “healthy
environments” because it recognizes that supportive environments are needed to
empower healthy choices. It also redistributes responsibility across the whole of
society, with government, the health sector, the private sector, non-governmental
organizations, communities, families and individuals all sharing accountability for
putting in place the necessary elements that promote healthy lifestyle and quality
care for non-communicable lifestyle related diseases.

IV. Status of Implementation/Accomplishment

 Policy/Standard/Guidelines Development
Development of Clinical Practice Guidelines on diabetes and other NCDs are on-
going.

 Promotion and Advocacy

Conduct of HEATHLY LIFESTYLE TO THE MAX Campaign

This brings the problem of NCDs including diabetes high in the consciousness of
all sectors and the Filipino public. This advocacy focuses on clear health priorities
such as consumption of healthy diet, promoting physical activity, curbing the use of
tobacco, alcohol, and illegal drugs, proper weight and stress management, early
detection and control of hypertension.

 Promotion of KALUSUGAN PANGKALAHATAN

Encourages everyone to practice healthy lifestyle like exercise as physical inactivity
increases the risk of non-communicable diseases specifically cardiovascular diseases
and diabetes.

 Coalition Building
Together with other partners in the Phil. Coalition for the Prevention and Control
of Non-Communicable Diseases, also known as Healthy Lifestyle Coalition, the
DOH also encourages the Fast Food Establishments to offer healthier food choices by
reducing the fat, sugar and salt content as well as trans-fatty acids in the food they
serve. Serving of fresh fruits and vegetables and other sources of fiber are encouraged
as well.

Development of Guidelines on Healthy Eating/Food Labeling is also being

undertaken together with other partners and stakeholders.

 Surveillance
A national and integrated registry system for chronic non-communicable
diseases has been developed where health facilities like hospitals can report new
cases of diabetes, cancer, stroke and chronic obstructive pulmonary diseases and
statistics concerning incidence, mortality and survival can be generated. An

45
Administrative Order re: National Implementation of the Integrated Chronic Non-
Communicable Disease Registry System has been drafted for approval.

V. Future Plan/Action

 Printing and Dissemination of Clinical Practice Guidelines on Diabetes

 Orientation/Forum will be conducted among NCD Coordinators in CHDs and
hospitals to discuss details of the CPG. Experts from diabetes societies will be
invited as speakers.
 Continue conduct of promotion and advocacy activities and partnership with
specialty societies and other stakeholders on NCD prevention and control
including diabetes
 Ensure implementation of diabetes registry
 Together with the National Center for Health Promotion and other experts on
diabetes, develop various information-education materials on the prevention
and management of diabetes for dissemination to various clients.

Emerging and Re-emerging Infectious Disease Program

Emerging and re-emerging infections (e.g., SARS, meningococcemia, Avian

Influenza or bird flu, A (H1N1) virus infection) threaten countries all over the world.
In 2003, SARS affected at least 30 countries with most of the countries from
Asia. In response to its sudden and unexpected emergence, quarantine and isolation
measures and rapid contract tracing were carried out. The Philippines was able to
minimize the impact of SARS through effective information dissemination, risk
communication, and efficient conduct of measures.
The unexpected and unusual increase in cases of meningococcal disease
(meningococcemia as the predominant form) in the Cordillera Autonomous Region
resulted to at least 50% of cases in the early stage of occurrence.
In 2009, the influenza A (H1N1) virus infection led to global epidemic, or most
popularly known as pandemic. On June 11, 2009, a full pandemic alert was declared
by the World Health Organization (WHO).
However, some local health offices from many provinces were not able to
respond effectively and rapidly. With the lack of strong linkages and coordinating
mechanisms, the Department of Health (DOH) hopes to further improve the
functionality and effectiveness of local response systems.
Efforts to prepare for emerging infections with potential for causing high
morbidity and mortality are being done by the program. Applicable prevention and
control measures are being integrated while the existing systems and organizational
structures are further strengthened.

Goal: Prevention and control of emerging and re-emerging infectious disease from
becoming public health problems.

Objectives:

46
The program aims to:
1. Reduce public health impact of emerging and re-emerging infectious diseases;
and
2. Strengthen surveillance, preparedness, and response to emerging and 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
re-emerging diseases that may pose epidemic/pandemic threat; and
6. Logistical support for drugs and vaccines for meningococcemia and anti-viral
drugs and vaccine for Pandemic Influenza Preparedness.

Partner Organizations/Agencies:

The following organizations/agencies take part in achieving the goal of the program:

 World Health Organization (WHO)

 United Nations Children’s Fund (UNICEF)
 Department of Interior and Local Government (DILG)
 Department of Education (DepEd)
 United States Agency for International Development (USAID)
 Asian Development Bank (ADB)
 Philippine Health Insurane Corporation (PhilHealth)
 Department of Agriculture-Bureau of Animal Industry (DA-BAI)

47
 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 inter-
agency collaboration. An Inter-Agency Committee on Environmental Health was
created by virtue of E.O. 489 to facilitate and improve coordination among concerned
agencies. It provides the venue for technical collaboration, effective monitoring and
communication, resource mobilization, policy review and development. The
Committee has five sectoral task forces on water, solid waste, air, toxic and chemical
substances and occupational health.

Vision: 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 workplaces.

Strategic Objectives

1. Development of evidence-based policies, guidelines, standards, programs and

parameters for specific healthy settings.
2. Provision of technical assistance to implementers and other relevant partners
3. Strengthening inter-sectoral collaboration and broad based mass participation
for the promotion and attainment of healthy settings

Key Result Areas

1. Appropriate development and regular evaluation of relevant programs, projects,

policies and plans on environmental and occupational health
2. Timely provision of technical assistance to Centers for Health Development
(CHDs) and other partners
3. Development of responsive/relevant legislative and research agenda on DPC
4. Timely provision of technical inputs to curriculum development and conduct of
human resource development
5. Timely provision of technically sound advice to the Secretary and other
stakeholders
6. Timely and adequate provision of strategic logistics

48
Components

 Inter- agency Committee on Environmental Health

 IACEH Task Force on Water
 IACEH Task Force on Solid Waste
 IACEH Task Force on Toxic Chemicals
 IACEH Task Force on Occupational Health
 Environmental Sanitation
 Environmental Health Impact Assessment
 Occupational Health

Expanded Program on Immunization

I. Rationale

The Expanded Program on Immunization (EPI) was established in 1976 to

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

II. Scenario

Global Situation

The burden.
In 2002, WHO estimated that 1.4 million of deaths among children under 5
years due to diseases that could have been prevented by routine vaccination. This
represents 14% of global total mortality in children under 5 years of age.

Source: Weekly Epidemiological Record, WHO: No.46,2011,86.509-520)

Burden of Diseases
The immunization coverage of all individual vaccines has improved as shown in
Figure 1: (Demographic Health Survey 2003 and 2008). Fully Immunized Child (FIC)
coverage improved by 10% and the Child Protected at Birth (CPAB) against Tetanus
improved by 13% compared to any prior period. Thus, the Philippines has now
historically the highest coverage for these two major indicators.

49
III. Interventions/ Strategies

Program Objectives/Goals:

Over-all Goal:

To reduce the morbidity and mortality among children against the most common
vaccine-preventable diseases.

Specific Goals:

1. To immunize all infants/children against the most common vaccine-preventable

diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.

Mandates:

Republic Act No. 10152“MandatoryInfants and Children Health Immunization Act

of 2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory
includes basic immunization for children under 5 including other types that will be
determined by the Secretary of Health.

Strategies:

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

Reaching Every Barangay (REB) strategy
REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was
introduced in 2004 aimed to improve the access to routine immunization and reduce
drop-outs. There are 5 components of the strategy, namely: data analysis for action,
re-establish outreach services, , strengthen links between the community and
service, supportive supervision and maximizing resources.
 Supplemental Immunization Activity (SIA)
Supplementary immunization activities are used to reach children who have not
been vaccinated or have not developed sufficient immunity after previous
vaccinations. It can be conducted either national or sub-national –in selected areas.
 Strengthening Vaccine-Preventable Diseases Surveillance
This is critical for the eradication/elimination efforts, especially in identifying
true cases of measles and indigenous wild polio virus
Procurement of adequate and potent vaccines and needles and syringes to all
health facilities nationwide

50
IV. Status of implementation/ Accomplishment

All health facilities (health centers and barangay health stations) have at least one
(1) health staff trained on REB.

Polio Eradication:
 The Philippines has sustained its polio-free status since October 2000.
 Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to
83%. A least 95% OPV3 coverage need to be achieved to produce the required
herd immunity for protection.
 There is an on-going polio mass immunization to all children ages 6 weeks up to
59 months old in the 10 highest risk areas for neonatal tetanus. These areas
are the following: Abra, Banguet, Isabela City and Basilan, Lanao Norte,
Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.
 Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to
1.38 in 2011. Only regions III, V and VIII have achieved the AFP rate of
2/100,000 children below 15 years old. (Source: NEC, DOH). A decreasing AFP
rate means we may not be able to find true cases of polio and may experience
resurgence of polio cases

Measles Elimination

 Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.
 Implemented the 2-dose measles-containing vaccine (MCV) in 2009
 MCV1 (monovalent measles) at 9-11 months old
 MCV2 (MMR) at 12-15 months old.

 Implemented and strengthened the laboratory surveillance for confirmation of

measles. Blood samples are withdrawn from all measles suspect to confirm the
case as measles infection.
 A supplemental immunization campaign for measles and rubella (German
measles) was done in 2011. This was dubbed as “Iligtas sa Tigdas ang Pinas”
15.6 million (84%) out of the 18.5 million children ages 9 months to 8 years old
were given 1 dose of the measles-rubella (MR) vaccine between April and June
2011.
 Rapid coverage assessment (RCA) was conducted in selected areas to validate
immunization coverage, assess high quality and that there are NO missed child
in every barangay. Overall RCA results showed that 70,594 (97.6%) out of
72,353 9- months to 8 years old living in the randomly selected barangays were
vaccinated. There are 3,494 barangays with a population of 1000 and above
that were randomly selected. 97.6% of all eligible children were given the MR
vaccine during the immunization campaign.
 The Government of the Philippines spent PhP 635.7M for the successful
conduct of the MR campaign.ss high quality and that there are NO missed
child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of
72,353 9- months to 8 years old living in the randomly selected barangays were
vaccinated. There are 3,494 barangays with a population of 1000 and above
51
 that were randomly selected. 97.6% of all eligible children were given the MR
vaccine during the immunization campaign.
 As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were
laboratory confirmed, 5 cases were epidemiologically-linked and 27 clinically
confirmed. This means we have at least 60 “true” measles at present. Measles
is said to be eliminated if we have 1 case per million or below 100 cases in a
year

Maternal and Neonatal Tetanus Elimination

 10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3
shows the areas categorized as low risk, at risk and highest risk based on the
NT surveillance, skilled birth attendants and facility based delivery and the
tetanus toxoid 2+ (TT 2+) vaccination.
 Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk
areas. An estimated 1,010,751 women age 15 - 40 year old women regardless
of their TT immunization will receive the vaccine during these rounds. This is
funded by the Kiwanis International through UNICEF and World Health
Organization.
 Control of other common vaccine-preventable diseases (Diphtheria, Pertussis,
Hepatitis B and Meningitis/Encephalitis secondary to H. influenzae type B)
 Continuous vaccination for infants and children with the DPT or the
combination DPT-HepB-HiB Type B. Annex1 EPI Annual Accomplishment
Report. DOH procures all the vaccines and needles and syringes for the
immunization activities targeted to infants/children/mothers.

Hepatitis B Control

 Republic Act No. 10152 has been signed. It is otherwise known as the
“Mandatory Infants and Children Health Immunization Act of 2011, which
requires that all children under five years old be given basic immunization
against vaccine-preventable diseases. Specifically, this bill provides for all
infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of
birth.
 One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the
Essential Intrapartum and Newborn Care Package (EINC). In 2011, 11 tertiary
hospitals are already EINC compliant.
 The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate
as measured by HBsAg prevalence to less than 1% in five-year-olds born after
routine vaccination started 100% Hepatitis B at birth vaccination.

Hepatitis B Coverage. Philippines, 2001-2011

Timing of administration/dose 2009 2010* 2011*

<24 hours 34% 38% 14%

52
 >24 hours 62% 55% 24%
Hep B 3rd dose 86% 81% 30%
*both 2010 and 2011 data are as of October 2011

Vaccines and cold chain management

 Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16

regions since 2003.
 An effective vaccine management assessment was conducted last December
2011 and revealed cold chain capacity gaps from the national up to the
implementers level.
 A total of PhP 267 million is required to address the gaps identified during the
assessment.

Introduction to New Vaccines

 For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the

national immunization program. Immunization will be prioritized among the
infants of families listed in the National Housing and Targeting System (NHTS)
for Poverty Reduction nationwide.
 The Government of the Philippines has allocated PhP 1.6 billion for the
procurement of these 2 vaccines.

V. Future Plan/ Action

 Strengthening the Cold Chain to support the Immunization Program

 Capacity Building for Health Workers for the Introduction of New Vaccines
 Advocacy for the financial sustainability for the newly introduced vaccines for
expansion.
 Development of the comprehensive multi-year plan for immunization program.

VI. Other Significant information worth mentioning

 One significant milestone is that the budget allocation for the immunization
program has continued to increase year by year
 The Government of the Philippines allocated budget for the immunization of all
infants/children/women/older persons nationwide. For 2012, the budget for
EPI is PhP1.8 billion and another P1.5 Billion for the immunization for senior
citizen and children for the NHTS families. This is great leap towards universal
access to quality vaccines for the prevention of the most common vaccine-
preventable diseases.

53
 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.

Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy
and NOH 2011-2016

Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels

Objectives:

 To provide evidence-based practices to ensure survival of the newborn from

birth up to the first 28 days of life
 To deliver time-bound core intervention in the immediate period after the
delivery of the newborn
 To strengthen health facility environment for breastfeeding initiation to take
place and for breastfeeding to be continued from discharge up to 2 years of life
 To provide appropriate and timely emergency newborn care to newborns in need
of resuscitation
 To ensure access of newborns to affordable life-saving medicines to reduce
deaths and morbidity from leading causes of newborn conditions
 To ensure inclusion of newborn care in the overall approach to the Maternal,
Newborn, Child Health and Nutrition Strategy

Stakeholders:

1. Both public and private sector at all levels of health service delivery providing
maternal and newborn services
2. Health Professional Organizations and their member health professionals

 Pediatricians/neonatalogists of the Philippine Pediatric Society (PPS) and

the Philippine Society of Newborn Medicine (PSNbM)
 Obstetrician-Gynecologists of the Philippine Obstetrical and Gynecological
Society (POGS)
 Perinatologists of the Perinatal Association of the Philippines, Inc., (PAPI)
 Anesthesiologists and obstetric anesthesiologists of the Philippine Society of
Anesthesiologists (PSA) and the Society for Obstetric Anesthesia of the
Philippines (SOAP),

54
  Family medicine specialists of the Philippine Academy of Family Physicians
(PAFP)
 Nurses, Maternal and child nurses, intensive care nurses of the Philippine
Nurses Association and its affiliate nursing societies
 Midwives of the Integrated Midwives of the Philippines (IMAP), Philippine
League of Government and Private Midwives, Inc. (PLGPMI), Midwives
Foundation of the Philippines (MFP) and Well Family Midwives Clinic

3. Government regulatory bodies e.g. Professional Regulations Commission

4. Academe - professors and instructors from members schools and colleges of:

 Association of Philippine Medical Colleges (APMC)

 Association of Deans of Philippine Colleges of Nursing (ADPCN)
 Association of Philippine Schools of Midwifery

5. Hospital, health care administrator and infection control associations

 Philippine Hospital Association (PHA)

 Private Hospitals Association of the Philippines (PHAP)
 Philippine College of Hospital Administrators
 Philippine Hospital Infection Control Society

6. Local government units - local chief executives and LGU legislative bodies

Beneficiaries:

 Newborns all over the country

 Parents
 Communities

Program Strategies:

1. Health Sector Reform

A. Policy and Guideline Issuance
a) Administrative Order 2009-0025 - Adopting Policies and Guidelines on
Essential Newborn Care - December 1, 2009
b) Clinical Pocket Guide on Essential Newborn Care
B. Aquino Health Agenda and Achieving Universal Health Care -
Administrative Order 2010-0036

C. PhilHealth Circular 2011-011 dated August 5, 2011 on Newborn Care

Package
D. Development of Operationalization of Essential Newborn Care Protocol in
Health Facilities
2. Identification of Centers of Excellence

55
  Adoption of essential newborn care protocol(including intrapartum care and
the MNCHN Strategy)
3. Curriculum Reforms
 Curriculum integration of essential newborn care (including intrapartum
care and the MNCHN Strategy) in undergraduate health courses
 Integration and revision of board exam questions in licensure examinations
for physicians, nurses and midwives
4. Social Marketing
 Development of social marketing tools - Unang Yakap MDG 4 & 5

Major Activities and its Guidelines:

 Conduct of one-day orientation-workshop on essential newborn care (including

intrapartum care and the MNCHN Strategy)
 Regional MNCHN Conference for CHDs and LGUs including DOH-retained
hospitals and LGU hospitals

Current Status of the Program

A. What have been achieved/done

1. Policy was issued in December 1, 2009

2. DOH/WHO Scale-up Implementation was done in 11 hospitals
3. Advocacy Partners Forum on essential newborn care (including intrapartum
care and the MNCHN Strategy)
4. One-day orientation-workshop on essential newborn care (including
intrapartum care and the MNCHN Strategy) among health workers in different
health facilities
5. Inclusion of dexamethasone and surfactant as core medicines in the essential
medicines list for children in the Philippine National Formulary

B.Statistics

1. Early outcomes of EINC implementation has shown reduction on neonatal

deaths in select DOH-retained hospitals including deaths from neonatal sepsis
and complications of prematurity

56
Partner organizations/agencies:

 National Nutrition Council

 Population Commission
 WHO
 UNICEF
 UNFPA
 AusAID
 USAID
 Health professional and academic organizations mentioned above.

Family Planning

Brief Description of Program

A national mandated priority public health program to attain the country's

national health development: a health intervention program and an important tool for
the improvement of the health and welfare of mothers, children and other members
of the family. It also provides information and services for the couples of reproductive
age to plan their family according to their beliefs and circumstances through legally
and medically acceptable family planning methods.

The program is anchored on the following basic principles.

 Responsible Parenthood which means that each family has the right and duty to
determine the desired number of children they might have and when they
might have them. And beyond responsible parenthood is Responsible Parenting
which is the proper upbringing and education of children so that they grow up
to be upright, productive and civic-minded citizens.
 Respect for Life. The 1987 Constitution states that the government protects the
sanctity of life. Abortion is NOT a FP method:
 Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It
enables women to recover their health improves women's potential to be more
productive and to realize their personal aspirations and allows more time to
care for children and spouse/husband, and;
 Informed Choice that is upholding and ensuring the rights of couples to
determine the number and spacing of their children according to their life's
aspirations and reminding couples that planning size of their families have a
direct bearing on the quality of their children's and their own lives.

Intended Audience: Men and women of reproductive age (15-49) years old)
including adolescents
Area of Coverage: Nationwide
Mandate: EO 119 and EO 102

57
Vision: Empowered men and women living healthy, productive and
fulfilling lives and exercising the right to regulate their own fertility through legally
and acceptable family planning services.
Mission: The DOH in partnership with LGUs, NGOs, the private sectors and
communities ensures the availability of FP information and services to men and
women who need them.

Program Goals:

 To provide universal access to FP information, education and services whenever

and wherever these are needed.

Objectives

General

 To help couples, individuals achieve their desired family size within the context
of responsible parenthood and improve their reproductive health. Specifically,
by the end of 2004:

Reduce
 MMR from 172 deaths 100,000 LB in 1998 to less than 100 deaths/100,000 LB
 IMR from 35.3 deaths/1000 livebirths in 1998 to less than 30 deaths/1000 live
births
 TFR from 3.7 children per woman in 1998 to 2.7 chidren per woman

Increase
 Contraceptive Prevalence Rate from 45.6% in 1998 to 57%
 Proportion of modern FP methods use from 28>2% to 50.5%

Key Result Areas

 Policy, guidelines and plans formulation

 Standard setting
 Technical assistance to CHDs/LGUs and other partner agencies
 Advocacy, social mobilization
 Information, education and counselling
 Capability building for trainers of CHDs/LGUs
 Logistics management
 Monitoring and evaluation
 Research and development

Strategies

 Frontline participation of DOH-retained hospitals

 Family Planning for the urban and rural poor

58
  Demand Generation through Community-Based Management Information
System
 Mainstreaming Natural Family Planning in the public and NGO health facilities
 Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8,
NCR, ARMM
 Contraceptive Interdependence Initiative

Major Activities

I. Frontline participation of DOH-retained hospitals

 Establishment of FP Itinerant team by each hospital to respond to the unmet
needs for permanent FP methods and to bring the FP services nearer to our
urban and rural poor communities
 FP services as part of medical and surgical missions of the hospital
 Provide budget to support operations of the itenerant teams inclduing the drugs
and medical supplies needed for voluntary surgical sterilization (VS) services
 Partnership with LGU hospitals which serve as the VS site

II. Family Planning for the urban and rural poor

 Expanded role of Volunteer Health Workers (VHWs) in FP provision
 Partnership of itenerant team and LGU hospitals
 Provision of FP services

III. Demand Generation through Community-Based Management Information System

 Identification and masterlisting of potential FP clients and users in need of PF
services (permanent or temporary methods)
 Segmentation of potential clients and users as to what method is preferred or
used by clients

IV. Mainstreaming Natural Family Planning in the public and NGO health facilities
 Orientation of CHD staff and creation of Regional NFP Management Committee
 Diacon with stakeholders
 Information, Education and counseling activities
 Advocacy and social mobilization efforts
 Production of NFP IEC materials
 Monitoring and evaluation activities

V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR,
ARMM
 Field of itinerant teams by retained hospitals to provide VS services nearer to
the community
 Installation of COmmunity Based Management Information System
 Provision of augmentation funds for CBMIS activities

59
VI. Contraceptive Interdependence Initiative
 Expansion of PhilHealth coverage to include health centers providing No Scalpel
Vasectomy and FP Itenerant Teams
 Expansion of Philhealth benefit package to include pills, injectables and IUD
 Social Marketing of contraceptives and FP services by the partner NGOs
 National Funding/Subsidy

VIII. Development /Updating of FP CLinical Standards

IX. Formulation of FP related policies/guidelines. E.g. Creation of VS Outreach team by

retained hospitals and its operationalization, GUidelines on the Provision of VS
services, etc.

X. Production and reproduction of FP advocacy and IEC materials

XI. Provision of logistics support such as FP commodities and VS drugs and medical
supplies

Other Partners

1. Funding Agencies
 United States Agency for International Development (USAID)
 United Nations Funds for Population Activities (UNFPA)
 Management Sciences for Health (MSH)
 Engender Health
 The Futures Group

2. NGOs
 Reachout foundation
 DKT
 Philippine Federation for Natual Family Planning (PFNFP)
 John Snow Inc. - Well Family Clinic
 Phlippine Legislators Committee on Population Development (PLPCD)
 Remedios Foundation
 Family Planning Organization of the Philippines (FPOP)
 Institute of Maternal and Child Health (IMCH)
 Integrated Maternal and Child Care Services and Development, Inc.
 Friendly Care Foundation, Inc.
 Institute of Reproductive Health

3. Other GOs
 Commission on Population
 DILG
 DOLE
 LGUs

60
 Food and Waterborne Diseases Prevention and Control Program

The program covers diseases of a parasitic, fungal, viral, and bacteria in nature,
usually acquired through the ingestion of contaminated drinking water or food. The
more common of these diseases are bacterial in nature, the most common of which
are typhoid fever and cholera. These two organisms had been the cause of major
outbreaks in the Philippines in the last two years. Parasitic organisms are also an
important factor, among them capillariasis, Heterophydiasis, and paragonimiasis,
which are endemic in Luzon, Visayas, and Mindanao. Cysticercosis is also a major
problem since it has a neurologic component to the illness. The approaches to control
and prevention is centered on public health awareness regarding food safety as well
as strengthening treatment guidelines.

Goal and Objectives:

The program aims to:

1. Prevent the occurrence of food and waterborne outbreaks through strategic

placement of water purification solutions and tablets at the regional level so
that the area coordinators could respond in time if the situation warrants;
2. Procure Intravenous Fluid solutions, venosets and IV cannula for adult and
pediatric patients in diarrheal outbreaks and to be stockpiles at the 17 Centers
for Health Development (CHD) and the Central Office for emergency response
to complement the stocks of HEMS;
3. Place first line and second line antimicrobial and anti-parasitic medicines such
as albendazole and praziquantel at selected CHDs for outbreak mitigation as
well as emergency stocks at the DOH warehouse located at the Quirino
Memorial Medical Center (QMMC) compound;
4. Increase public awareness in preventable food-borne illnesses such as
capillaria, which is centered on unsafe cultural practices like eating raw
aquatic products;
5. Increase coordination between the National Epidemiology Center (NEC) and
Regional epidemiology surveillance Unit (RESU) to adequately respond to
outbreaks and provide technical support;
6. Procure Typhidot-M diagnostic kits for the early detection and treatment of
typhoid patients;
7. Procure Typhoid vaccine and oral cholera vaccine to reduce the number of cases
seen after severe flooding;
8. Provide training to local government unit (LGU) laboratory and allied medical
personnel on the Accurate laboratory diagnosis of common parasites and
proper culture techniques in the isolation of bacterial food pathogens; and
9. Provide guidance to field medical personnel with regard to the correct treatment
protocols vis-à-vis various parasitic, bacterial, and viral pathogens involved in
food and waterborne diseases.

Beneficiaries/Target Population:
61
  The Food and Waterborne Disease Control Program targets individuals, families,
and communities residing in affected areas nationwide. For parasitic infections,
endemic areas are more common.

Strategies/Management:

 Case monitoring is maintained through the Philippine Integrated Disease

Surveillance and Response (PIDSR) framework of NEC and the sentinel sites of
the RESU. To add to that, quarterly reports of the regional coordinators
supplement the data and the regular updating from NEC Outbreak
Surveillance.
 Outbreaks are being prevented though public education in print and radio
stations. The need for safe food and water intake by adequate cooking and
boiling of drinking water is inculcated to the public.
 Multi-drug resistant cases of typhoid are monitored through reports from the
hospital sentinel site and the data from the Research Institute of Tropical
Medicine’s Antibiotic Resistance & Surveillance Program.

Partner Organizations/Agencies:

The following organizations and agencies take part in the achievement of program
objectives:

 University of the Philippines-National Institutes of Health (UP-NIH)

 Department of Agriculture-National Meat Inspection Service (DA-NMIS)
 Asia Centric Disease Bureau
 World Health Organization-Western Pacific Regional Office (WHO-WPRO)
 World Health Organization-Southeast Asia Regional Office (WHO-SEARO)

62
 Food Fortification Program

Objectives:

 To provide the basis for the need for a food fortification program in the
Philippines: The Micronutrient Malnutrition Problem
 To discuss various types of food fortification strategies
 To provide an update on the current situation of food fortification in the
Philippines

Fortification as defined by Codex Alimentarius

“The addition of one or more essential nutrients to food, whether or not it is normally
contained in the food, for the purpose of preventing or correcting a demonstrated
deficiency of one or more nutrients in the population or specific population groups”

Vitamin A, Vitamin A Deficiency (VAD) and its Consequences

Vitamin A - an essential nutrient as retinol needed by the body for normal sight,
growth, reproduction and immune competence

Vitamin A deficiency - a condition characterized by depleted liver stores & low

blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed
by poor absorption or utilization of vit. A in the body

VAD affects children’s proper growth, resistance to infection, and chances of

survival (23 to 35% increased child mortality), severe deficiency results to blindness,
night blindness and Bitot’s spot

Prevalence of Vitamin A Deficiency:

1993, 1998, 2003, 2008
(DOST – FNRI, NNS)
Physiological State 1993 1998 2003 2008
6 months - 5 yrs. 35.3 38.0 40.1 15.2
Pregnant 16.4 22.2 17.5 9.5
Lactating 16.4 16.5 20.1 6.4
WHO Cut – off Point to be considered a public health problem = >15%

Iron and Iron Deficiency Anemia (IDA) and its consequences

Iron - an essential mineral and is part of hemoglobin, the red protein in red
blood cells that carries oxygen from the lungs to the cells

63
 Iron Deficiency Anemia - condition where there is lack of iron in the body
resulting to low hemoglobin concentration of the blood

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

to fight infection and transmittable diseases and low productivity

Iodine and Iodine Deficiency Disorders (IDD)

Iodine -a mineral and a component of the thyroid hormones

Thyroid hormones - needed for the brain and nervous system to develop &
function normally

Iodine Deficiency Disorders refers to a group of clinical entities caused by

inadequacy of dietary iodine for the thyroid hormone resulting into various conditions
(e.g. goiter, cretinism, mental retardation, loss of IQ points)

Progress in the Philippines towards the Elimination of IDD, 1998-2008

Achievements
Indicator Goal* 200
1998 2008
3
Proportion of Households using Iodized Salt,
>90 9.7  56.0 81.1
%
Median Urinary Iodine, ug/L        
100-
6-12 yrs. 71 201 132
200
100-
Lactating Women - 111 81
200
150-
Pregnant Women - 142 105
249
Proportion < 50µg/L, % < 20      
6-12 yrs.    35.8 11.4 19.7
Lactating Women   - 23.7 34.0
Pregnant Women   - 18.0 25.8
*ICC-IDD 2007

Policy on Food Fortification

ASIN LAW
Republic Act 8172, “An Act Promoting Salt Iodization Nationwide and for other
purposes”, Signed into law on Dec. 20, 1995

64
Food Fortification Law
Republic Act 8976, “An Act Establishing the Philippine Food Fortification Program
and for other purposes” mandating fortification of flour, oil and sugar with Vitamin A
and flour and rice with iron by November 7, 2004 and promoting voluntary
fortification through the SPSP, Signed into law on November 7, 2000

Status of the Philippine Food Fortification Program

Status and Recommendations for the Sangkap Pinoy Seal Program

 There are 139 processed food products with SangkapPinoySeal with 83% with
vitamin A, 29% with iron and 14% with iodine (2008)
 37% of the products are snack foods
 Most of the products FDA analyzed are within the standard
 Based on 2003 NNS Households’ awareness of SPS- and FF-products is 11%
and 14%, respectively, in 2008 awareness is 11.6%
 Although awareness is low, usage of SPS-products is 99.2%

Recommendations:

 Review voluntary fortification standards as standards were developed prior to

mandatory fortification
 Conduct in-depth analysis of the coverage of SangkapPinoySeal of the 2008
NNS
 Update list of Sangkap Pinoy Seal products as some companies have stopped
using the seal in their products
 Intensify promotions of Sangkap Pinoy Seal
 Status and Recommendation on Flour Fortification with Vitamin A and Iron

Status:

 Based on FDA monitoring all local flour millers are fortifying with vitamin A and
iron
 94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A
and iron respectively while 77% and 99% were fortified with vitamin A and iron
respectively. In 2010 decrease in vitamin A due to non-fortified imported and
market samples flour.
 58% of samples from local mills for vitamin A and 67% of imported flour for iron
were fortified according to standards.

Recommendations:

 Review fortificantsfor iron and possible other micronutrients to be added to

wheat flour
 Continue monitoring wheat fortification
 Assist flour millers to improve quality of fortification

65
  Need to show impact of flour fortification
 Status and Recommendations on Mandatory Fortification of Refined Sugar with
Vitamin A

Status:

 Non – fortification by industry due to the unresolved issue of who will bear the
cost of fortification brought about by the quedansystem of transferable
certificates of sugar ownership.
 Lack of premix production
 Fortification of refined sugar would benefit mainly those in the high income
group.

Recommendations:

 Continue discussions with sugar industry to explore a compromise for

fortification ie. fortification of washed sugar
 Review policy on mandatory fortification of refined sugar

Status and Recommendations on Rice Fortification with Iron

Status:

 NFA is fortifying 50% of its rice in 2009 and 2010

 With the non – fortification of NFA rice, private sector has an excuse for non –
fortification of its rice.
 There is limited commercial/private sector iron rice premix and iron fortified
rice production and distribution mostly in Mindanao (Region XII and XI) with
Gen San having the only commercial iron rice premix plant in the Philippines
and Davao City implementing mandatory rice fortification in food outlets
 NFA conducted communications campaign for its iron fortified rice thru the so
called “I-rice” campaign though issues remain on the acceptability of its
product

Recommendation:

 Review of mandatory fortification of rice with iron

Status and Recommendations on Cooking Oil Fortification with Vitamin A

Status:

 Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are
fortified (91% in 2009 and 94% in 2010)
 Samples monitored were labeled and packed
 FDA is not monitoring "takal"
Recommendations:

66
  To increase frequency of monitoring by FDA and other agencies such as PCA
and LGU’s, to ensure all oil refiners and repackersare monitored at least once a
year
 Monitoring of “takal” oil, use of test kit
 Monitoring imported oil, FDA and BOC to coordinate
 Review policy of mandatory fortification of oil to possibly limit to those mostly
used by at risk population (coconut and palm oil)
 Status and Recommendations on Salt Iodization

Status:

 Based on the 2008 NNS, 81.1% of households were positive for iodine using
Rapid Test Kit (RTK)
 In the same survey for Region III, 55.7% were positive for RTK but only 34.2%
and 24.2% have iodine content >5ppm and >15ppm respectively using WYD
Tester
 For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm
 FDA started implementing localization of ASIN Law with General Santos City as
the 1stto have a MOA with FDA on localization

Recommendation:

 FDA to expand localization of ASIN Law

 Set – up iodine titration for testing iodine in salt
 Continue to intensify monitoring particularly imported and takal salt

Food Fortification Day Theme 2010:

EO 382 declares November 7 as the National Food Fortification Day

Garantisadong Pambata

The Mandate: A.O. 36, s2010

Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos

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

Universal Health Care

Strategies:
 Financial risk protection.
67
  Improved access to quality hospitals and facilities
 Attainment of health-related MDGs by:
 Deploy CHTs to actively assist families in assessing and acting on their health
needs
 Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC,
IPP, GP for 0-14 years old
 Aggressive promotion of healthy lifestyle change
 Harness strengths of inter-agency and intersectoralcooperation with DepEd,
DSWD and DILG

EXPANDED GARANTISADONG PAMBATA

Comprehensive and integrated  package of services and communication on

health, nutrition and environment for children available everyday at various settings
such as home, school, health facilities and communities by government and 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.
 ›Ensure that all Filipino children, especially the disadvantaged group (GIDA),
have equitable access to affordable health, nutrition and environment care. 

Partner Agencies:
 Department of Education
 Department of Social Welfare & Development
 Department of Interior and Local Government
 Department of Health
 USAID
 UNICEF
 World Health Organization
 Save the Children
 Fit for School
 World Vision
 Plan Foundation
 Philippine Dental Association

68
GP Services Package
Age by Year Health  Nutrition Environment
Maternalnutrition
Maternal health
Iron supplementation
care Water
Vitamin A
0-1 Essential newborn Sanitation
Early &exclusive
care Hygiene promotion
breastfeeding
Immunization Oral health
Complementary feeding
Child injury
Breastfeeding prevention
Immunization Complementaryfeeding Treated bednets
1-5 Deworming Vitamin A Smoke-free homes
IMCI Iron supplementation
Iodized salt at home
Deworming
Booster Proper nutrition
6-10
immunization  Iodized salt at home
(Screening)
Deworming  
Booster
Proper nutrition
immunization
11-14 Iron supplementation
(Screening)
Iodized salt at home
Physical activity
(Healthy lifestyle)
 
Vitamin A Supplementation
›Policy remains the same for giving Vitamin A capsules:

Routine:
           - every 6 months for 6-59 months preschoolers

Therapeutic:
         - 1 capsule upon diagnosis  regardless of when the last dose of  VAC for
preschoolers with measles
         - 1 capsule upon diagnosis except when child was given Vitamin A was given
less than 4 weeks for               preschoolers with severe pneumonia,
persistent diarrhea, severely underweight    
- 1 capsule immediately upon diagnosis, 1 capsule the next day and another capsule
after 2 weeks after for preschoolers with xerophthalmia 

Recording/Reporting:
 FHSIS Records and Reports
 GP Forms – submitted to NCDPC thru CHDs
 April – preschoolers 6-59 months given   VAC from November of past year to
 April of the current year     October – preschoolers 6-59 months given
 VAC from May to October 
69
 
Core Messages per Gateway Behavior

MAGPASUSO
 (Newborn to 6 mos)  Pasusuhin ng gatas ni Nanay lang
 (6 mos to 2 years old)  Magpasuso  at bigyan ng (mga masustansiyang 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. 

70
 Human Resource for Health Network
 
The Department of Health (DOH) spearheaded the creation of Human Resource
for Health Network (HRHN), which is a multi-sectoral organization composed of
government agencies and non-government organizations. The network seeks to
address and respond to human resource for health (HRH) concerns and problems.
HRHN was formally established during the launching and signing of the
Memorandum of Understanding among its member agencies and organizations held
on October 25, 2006. This network was grounded on the Human Resources for
Health Master Plan (HRHMP) developed by the DOH and the World Health
Organization (WHO). The HRHN was conceived to implement programs and activities
that require multi-sectoral coordination.
 
Vision: Collaborative partnerships for a better, more responsive and globally
competitive HRH.
 
Mission:  The HRHN is a multi-sectoral organization working effectively for
coordinated and collaborative action in the accomplishment of each member
organization’s mandate and their common goals for HRH development to address the
health service needs of the Philippines, as well as in the global setting.
 
Values:  Upholds the quality and quantity of HRH for the provision of quality health
care in the Philippines.
 
Objectives:
The objectives of the HRHN are as follows:

1.  Facilitate implementation of programs of the HRHMP that would entail

coordination and linkage of concerned agencies and organizations;
2.  Provide policy directions and develop programs that would address and respond
to HRH issues and problems;
3.  Harmonize existing policies and programs among different government agencies
and non-government organizations;
4.  Develop and maintain an integrated database containing pertinent information on
HRH from production, distribution, utilization up to retirement and migration; and
5.  Advocate HRH development and management in the Philippines.
 
Projects:
During its first year of implementation, the HRHN has the following priority projects
and activities:
1. Review and Harmonization of HRH Related Policies;
2. Development of HRHN Website;
3. Conduct of Capability Building Activities; and
4. Conduct of the National HRH Forum.

71
 Health Development Program for Older Persons - (Bureau or Office: National
Center for Disease Prevention and Control)

Bureau or Office: National Center for Disease Prevention and Control

Program Briefer

Cognizant of its mandate and crucial role, the Philippine Department of Health
(DOH) formulated the Health Care Program for Older Persons (HCPOP) in 1998. The
DOH HCPOP (presently renamed Health Development Program for Older Persons)
sets the policies, standards and guidelines for local governments to implement the
program in collaboration with other government agencies, non-government
organizations and the private sector.

The program intends to promote and improve the quality of life of older persons
through the establishment and provision of basic health services for older persons,
formulation of policies and guidelines pertaining to older persons, provision of
information and health education to the public, provision of basic and essential
training of manpower dedicated to older persons and, the conduct of basic and
applied researches.

Target Population/Clients
A. Older persons (60 years and above) who are:
a. Well and free from symptoms
b. Sick and frail
c. Chronically ill and cognitively impaired
d. In need of rehabilitation services
B.Health workers and caregivers
C.LGU and partner agencies

Area of Coverage: Nationwide

Mandate:

International:
          Vienna International Plan of Action on Ageing
         General Assembly Resolutions
Local:
         Philippine Constitution (Article XIII, Section XI)
         Republic Act 7876 - Senior Citizens Center Act of the Philippines
         Republic Act No. 7432 - An Act to Maximize the Contribution of Senior
Citizens to Nation Building, Grant Benefits and Special Privileges and for Other
Purposes
         Proclamation No. 470 - Declaring the 1st week of October every year as
"Elderly Filipino Week"
         Philippine Plan of action for Older Persons (1999-2004)
Vision: Healthy ageing for all Filipinos.
72
Goal: A healthy and productive older population is promoted.

Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center
Act of the Philippines)

REPUBLIC ACT NO. 7876

AN ACT ESTABLISHING A SENIOR CITIZENS CENTER IN ALL CITIES AND

MUNICIPALITIES OF THE PHILIPPINES, AND APPROPRIATING FUNDS THEREFOR.

Sec. 1.Title. — This Act shall be known as the "Senior Citizens Center Act of the
Philippines."

Sec. 2.Declaration of Policy. — It is the declared policy of the State to provide

adequate social services and an improved quality of life for all. For this purpose, the
State shall adopt an integrated and comprehensive approach towards health
development giving priority to elderly among others.chan robles virtual law library

Sec. 3.Definition of Terms. — (a) "Senior citizens," as used in this Act, shall refer to
any person who is at least sixty (60) years of age.
(b) "Center," as used in this Act, refers to the place established by this Act with
recreational, educational, health and social programs and facilities designed for the
full enjoyment and benefit of the senior citizens in the city or municipality.

Sec. 4.Establishment of Centers. — There is hereby established a senior citizens

center, hereinafter referred to as the Center, in every city and municipality of the
Philippines, under direct supervision of the Department of Social Welfare and
Development, hereinafter referred to as the Department, in collaboration with the
local government unit concerned.

Sec. 5.Functions of the Centers. — The centers are extensions of the fourteen (14)
regional offices of the Department. They shall carry out the following functions:
(a) Identify the needs, trainings, and opportunities of senior citizens in the cities and
municipalities;chan robles virtual law library

(b) Initiate, develop and implement productive activities and work schemes for senior
citizens in order to provide income or otherwise supplement their earnings in the
local community;

(c) Promote and maintain linkages with provincial government units and other
instrumentalities of government and the city and municipal councils for the elderly
and the Federation of Senior Citizens Association of the Philippines and other non-
government organizations for the delivery of health care services, facilities,
professional advice services, volunteer training and community self-help projects;
and

73
(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

74
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.

75
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.

76
 Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the
Contribution of Senior Citizens to Nation Building, Grant Benefits and Special
Privileges)

AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION

BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER
PURPOSES.

Be it enacted by the Senate and House of Representative of the Philippines in

Congress assembled:

SECTION 1. Declaration of Policies and Objectives – Pursuant to Article XV,

Section 4 of the Constitution, it is the duty of the family to take care of its elderly
members while the State may design programs of social security for them. In addition
to this, Section 10 in the Declaration of Principles and State Policies provides: “The
State shall provide social justice in all phases of national development”. Further,
Article XIII, Section II provides: “The State shall adopt an integrated and
comprehensive approach to health development which shall endeavor to make
essential goods, health and other social services available to all the people at
affordable cost. There shall be priority for the needs of the underprivileged, sick,
elderly, disabled, women and children.” Consonant with these constitutional
principles the following are the declared policies of this Act:

a) To motivate and encourage the senior citizens to contribute to nation

building;

b) To encourage their families and communities they live with to reaffirm the
valued Filipino tradition of caring for the senior citizens.

In accordance with these policies, this act aims to:

1) Establish mechanism whereby the contribution of the senior citizens are

maximized;

2) Adopt measures whereby our senior citizens are assisted and appreciated
by the community as a whole;

3) Establish a program beneficial to the senior citizens, their families and the
rest of the community that they serve.

SECTION 2.Definition of Terms. – As used in this Act, the term “senior citizen”
shall mean any resident of the Philippines at least sixty (60) years old, including
those who have retired from both government offices and private enterprises, and has
an income of not more than Sixty thousand pesos (P60,000.00) per annum subject to
review by the National Economic and Development Authority (NEDA) every three (3)
years.

77
The term “head of the family” shall mean any person so defined in the National
Internal Revenue Code.

SECTION 3.Contribution to the Community. – Any qualified senior citizens as

determined by the Office for Senior Citizen Affairs (OSCA) may render his/her
services to the community which shall consist of but not limited to any of the
following:

a) Tutorial and/or consultancy services;

b) Actual teaching and demonstration of hobbies and income generating skills;

c) Lectures on specialized fields like agriculture, health, environmental

protection and the like;

d) The transfer of new skills acquired by virtue of their training mentioned in

Section 4, paragraph (d)

e) Undertaking other appropriate services as determined by the Office for

Senior Citizens Affairs (OSCA) such as school traffic guide, tourist aid, pre-school
assistant, etc.

In consideration of the services rendered by the qualified elderly, the Office for Senior
Citizens Affairs (OSCA) may award or grant benefits or privileges to the elderly, in
addition to the other privileges provided for under Section 4 hereof.

SECTION 4.Privileges for the Senior Citizens. – The senior citizens shall be
entitled to the following:

a) The grant of twenty percent (20%) discount from all establishments relative
to utilization of transportation services, hotels and similar lodging establishment,
restaurants and recreation centers and purchase of medicines anywhere in the
country: Provided, That private establishments may claim the cost as tax credit;

b) A minimum of twenty percent (20%) discount on admission fees charged by

theaters, cinema houses and concert halls, circuses, carnivals and other similar
places of culture, leisure, and amusements;

c) Exemption from the payment of individual income taxes: Provided, That

their annual taxable income does not exceed the poverty level as determined by the
National Economic and Development Authority (NEDA) for that year;

d) Exemption from training fees for socioeconomic programs undertaken by the

OSCA as part of its work;

78
e) Free medical and dental services in government establishment anywhere in the
country, subject to guidelines to be issued by the Department of Health, the
Government Service Insurance System and the Social Security System;

f) To the extent practicable and feasible, the continuance of the same benefits and
privileges given by the Government Service Insurance System (GSIS), Social Security
System (SSS) and PAG-IBIG, as the case may be, as are enjoyed by those in actual
service.

SECTION 5.Government Assistance. – The Government shall provide the following

assistance to those caring for and living with the senior citizen:

a) The senior citizen shall be treated as dependents provided for in the National
Internal Revenue Code and as such, individual taxpayers caring for them, be they
relatives or not shall be accorded the privileges granted by the Code insofar as having
dependents are concerned.

b) Individuals or non-governmental institutions establishing homes, residential

communities or retirement villages solely for the senior citizens shall be accorded the
following:

1) Realty tax holiday for the first five (5) years starting from the first year of
operations;

2) Priority in the building and/or maintenance of provincial or municipal roads

leading to the aforesaid home, residential community or retirement village.

SECTION 6.Retirement Benefits. – To the extent practicable and feasible retirement

benefits from both the Government and the private sectors shall be upgraded to be at
par with the current scale enjoyed by those in actual service.

SECTION 7.The Office for Senior Citizens Affairs (OSCA). – There shall be
established in the Office of the Mayor an OSCA to be headed by a Councilor who
shall be designated by the Sangguniang Bayan and assisted by the Community
Development Officer in coordination with the Department of Social Welfare and
Development. The functions of this office are:

a) To plan, implement and monitor yearly work programs in pursuance of the

objectives of this Act;

b) To draw up a list of available and required services which can be provided by

the senior citizens;

c) To maintain and regularly update on a quarterly basis the list of senior

citizens and to issue nationally uniform individual identification cards which shall be
valid anywhere in the country;

79
 d) To serve as a general information and liaison center to serve the needs of the
senior citizens.

SECTION 8.Municipal Responsibility. – It shall be the responsibility of the

municipality through the Mayor to ensure that the provisions of this Act are
implemented to its fullest.

SECTION 9.Penalties. – Violation of any provision of this Act for which no penalty is
specifically provided under any other law, shall be punished by imprisonment not
exceeding one (1) month or a fine not exceeding One thousand pesos (P1,000.00) or
both.

SECTION 10.Implementing Rules and Regulations. – The Secretary of Social

Welfare and Development jointly with the Department of Finance, the Department of
Tourism, the Department of Health, the Department of Transportation and
Communications and the Department of Interior and Local Government shall issue
the necessary rules and regulations to carry out the objectives of this Act.

SECTION 11.Appropriation. – The necessary appropriation for the operation and

maintenance of the OSCA shall be appropriated and approved by the local
government units concerned. The National Government shall appropriate such
amount as may be necessary to carry out the objectives of this Act.

SECTION 12.Repealing Clause. – All provisions of laws, orders, and decrees,

including rules and regulations inconsistent herewith are hereby repealed and/or
modified accordingly.

SECTION 13.Separability Clause. – If any part or provision of this Act shall be held
to be unconstitutional or invalid, other provisions hereof which are not affected
thereby shall continue to be in full force and effect.

SECTION 14.Effectivity. – This Act shall take effect fifteen (15 days following its
publication in one (1) national newspaper of general circulation.

Approved,

(SGD.) RAMON V. MITRA

Speaker of the House of Representatives

(SGD.) NEPTHALI A. GONZALES

President of the Senate

80
This bill, which is a consolidation of Senate Bill Nos. 835, 1435 and House Bill No.
35335, was finally passed by the Senate and the House of Representatives on
February 7, 1992.

(SGD.) CAMILO L. SABIO

Secretary General
House of Representatives

(SGD.)ANACLETO D. BADOY, JR.

Secretary of the Senate

Approved: April 23, 1992

(SGD.) CORAZON C. AQUINO

President of the Philippines

GUIDELINES ON THE ISSUANCE OF THE NATIONALLY UNIFORM IDs OF

SENIOR CITIZENS AS PER R.A. 7432

The national I.D. of Senior Citizens as per provision of RA 7432 is to be provided by

the Department of Social Welfare and Development (DSWD) for free. A senior citizen
who has an income of P60,000.00 and below per annum shall be granted the benefits
per Section 4 of RA 7432. The process of securing the ID is as follows:

1. A Senior Citizen shall enlist at the Office for Senior Citizens Affairs (OSCA)
established at the Office of the Mayor in his/her city or municipality;

2. The OSCA shall determine the eligibility of the senior citizen. All eligible senior
citizens shall provide OSCA two (2) ID pictures taken within the year of enlisting at
OSCA. One ID picture shall be attached to the OSCA registration form to be kept by
the said office. The other picture shall be for the ID card;

3. The OSCA shall prepare the list of Senior Citizens to be certified by the local office
of the Bureau of Internal Revenue and the local Civil Registrar’s office;

4. Duplicate copy of the certified list of senior citizens shall be submitted by OSCA to
the DSWD filed office;

5. The Bureau of Disabled Persons Welfare, DSWD shall send to the 14 DSWD Field
Offices number of IDs needed by the Elderly of the region;

81
6. The DSWD Field Office shall release the IDs to the respective local OSCAs;

7. The OSCA shall issue the ID cards duly signed by the municipal/city Mayor to the
qualified senior citizens;

8. The OSCA shall issue the nationally uniform ID card without cost to the Senior
Citizen.

In case the ID is lost, it must be reported to the local OSCA. Replacement shall be
issued upon request by OSCA with corresponding cost. The cost per ID shall be
determined by DSWD. The payment shall remain at OSCA as part of its funds. No ID
cards of senior citizens shall be issued directly by the DSWD Central Office or its field
offices.

SOCIAL DEVELOPMENT COMMITTEE Resolution No. 1 (Series 1993)

Approving the Implementing Rules and Regulations of R.A. 7432 Maximizing the
Contribution of Senior Citizens to Nation Building, Grant Benefits and Privileges

Whereas, the Philippine Constitution recognizes the duty of the family to take care of
its elderly members with the state designing programs of social security for them,
and the need for the state to promote social justice in all phases of national
development, by making available essential social services to the priority groups such
as the sick, elderly, disabled, women and children;

Whereas, RA 7432 has been enacted to motivate and encourage senior citizens to
contribute to nation building and to mobilize their families and the communities they
live with to reaffirm the valued Filipino tradition of caring for the senior citizen;

Whereas, the Medium Term Philippine Development Plan (MTPDP) 1993-1998 aims
to pursue a better quality of life for all Filipinos particularly the disadvantaged
sectors by providing focused basic services to allow them to manage and control their
resources, as well as benefit from developmental interventions;

Whereas, the draft IR on R.A. 7432 was formulated by an Inter-agency Committee

headed by the Department of Social Welfare and Development (DSWD), and
participated in by the Department of Interior and Local Government (DILG), Tourism
(DOT), Transportation and Communications (DOTC), Health (DOH) and Finance
(DOF), including the National Federation of Senior Citizens Association of the
Philippines (NFSCAP).

NOW, THEREFORE, BE IT RESOLVED, AS IT IS HEREBY RESOLVED, by the

Chairman and the members (of the NEDA, Board’s Social Development Committee
(SPC) Cabinet level, to approve the Implementing Rules and Regulations of R.A. 7432.

82
(Sgd.) Honorable Nieves R. Confesor
Secretary, Department of Labor and Employment
Chairman, Social Development Committee

(Sgd.)Honorable Cielito F. Habito, Jr.

Secretary for Socioeconomic Planning
Co-Chairman, Social Development Committee

(Sgd.) Hon. Corazon Alma G. De Leon

Acting Secretary
Department of Social Welfare and Development

(Sgd.) Hon. Roberto S. Sebastian

Secretary
Department of Agriculture

(Sgd.) Hon. Ernesto D. Garilao

Secretary
Department of Agrarian Reform

(Sgd.) Hon. Juan M. Flavier

Secretary
Department of Health

(Sgd.) Hon. Rafael M. Alunan, III

Secretary
Department of Interior and Local Government

(Sgd.) Hon. Armand V. Fabella

Secretary
Department of Education, Culture and Sports

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

RULES AND REGULATIONS IN THE IMPLEMENTATION OF RA 7432,

THE ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS
TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES
AND FOR OTHER PURPOSES

RULE I

TITLE, PURPOSE AND CONSTRUCTION

Article 1. Title – These Rules shall be known and cited as the Rules and Regulations
implementing the Act to Maximize the Contribution of Senior Citizens to Nation
Building, Grant Benefits and Special Privileges and for Other Purposes.

Article 2. Purpose – These Rules are promulgated to prescribe the procedures and
guidelines for the implementation of the Act to Maximize the Contribution of Senior
Citizens to National Building, Grant Benefits and Special Privileges and for Other
Purposes in order to facilitate the compliance therewith and to achieve the objectives
thereof.

Article 3. Construction – These Rules shall be construed and applied in accordance

with and in furtherance of the policy and objectives of the law. In case of conflict
and/or ambiguity, which may arise in the implementation of these rules, the
concerned agencies shall issue the necessary clarification. In case of doubt, the same
shall be construed liberally and in favor of the beneficiaries.

RULE II

DECLARATION OF POLICIES AND OBJECTIVES, SCOPE AND APPLICATION

Article 4. Declaration of Policies and Objectives – Pursuant to Article XV, Section 4

of the Constitution it is the duty of the family to take care to its elderly members
while the State may design programs of social security for them. In addition to this,
Section 10 in the Declaration of Principles and State Policies provides: “The State
shall provide social justice in all phases of national development.” Further, Article
XIII, Section II provides: “The State shall adopt an integrated and comprehensive
approach to health development which shall endeavor to make essential goods,
health, and other social services available to all the people at affordable cost. There
shall be priority for the needs of the underprivileged, sick, elderly, disabled, women
and children.” Consonant to these constitutional principles, the following are the
declared policies of this Act:

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 a) To motivate and encourage senior citizens to contribute to nation building;

b) To encourage their families and the communities they live with to reaffirm
the valued Filipino tradition of caring for the senior citizens;

In accordance with these policies, the Act aims to:

a) Establish mechanisms whereby the contribution of the senior citizens are

maximized;

b) Adopt measures whereby our senior citizens are assisted and appreciated
by the community as a whole;

c) Establish a program beneficial to the senior citizens, their families and the
rest of the community that they serve.

Article 5. Definition of Terms – As used in these rules, the following terms shall be
defined as follows:

5.1 Senior Citizen – any resident citizen of the Philippines, at least sixty (60)
years old, including those who have retired from both government offices and private
enterprises and has an income of not more than sixty thousand pesos (P60,000.00)
per annum subject to review by the National Statistics Coordination (NSCB) every
three (3) years.

Senior Citizens earning sixty thousand pesos (P60,000.00) per annum may be tapped
as resource persons to provide transfer technology and consultancy services or other
services in the community. Those without income are necessarily covered by this
definition.

5.2 Resident Citizen – refers to Filipino Citizen who establishes to the

satisfaction of the Office of the Senior Citizens Affairs (OSCA) the fact of his physical
presence in the Philippines for at least 183 days with a definite intention to reside
therein.

5.3 Benefactor – shall mean any person whether related to the senior citizen or
not who takes care of him or her as dependent.

5.4 Head of the Family – shall mean an unmarried or legally separated man or
woman with one or both parents or with one or more brothers or sisters or with one
or more legitimate, recognized, natural or legally adopted children and/or with one or
more senior citizen living with and dependent upon him for their chief support where
brother/s or sister/s or children are not more than twenty one (21) years of age
unmarried and not gainfully employed or where such children, brother/s or sister/s,
regardless of age are incapable of self-support because of mental or physical defect.

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 5.5 National Identification Cards – are the ID cards provided for initially for free
by the Department of Social Welfare and Development and issued through the Office
for Senior Citizens Affairs (OSCA).

5.6 Office for Senior Citizens Affairs – otherwise known, as the OSCA shall be
established in the Office of the Mayor as prescribed in the Act.

5.7 Department of Social Welfare and Development – otherwise known as

DSWD in this rule, shall mean the national office located at Batasan Complex,
Quezon City and its field offices in the fourteen regions of the country.

5.8 Municipal/City Federation of Senior Citizens – an organization of senior

citizens in the locality which is affiliated with the National Federation of Senior
Citizens’ Associations of the Philippines (NFSCAP). In the absence of such
organization, any organization of senior citizens in the locality duly accredited by the
Sangguniang Bayan/Panglungsod.

5.9 Air Transportation Service – shall mean as the carriage of passenger by air.

5.10 Hotel – shall mean the building, edifice or premises or a completely

independent part thereof, which is used for the regular reception, accommodation, or
lodging of travelers and tourists and the provision of services incidental thereto for a
fee.

5.11 Lodging Establishment – shall mean any of the following:

a. Tourist Inn – a lodging establishment catering to transients which does not meet
the minimum requirement of an economy hotel.

b. Apartel – any building or edifice containing several independent and

furnished or semi-furnished apartments, regularly leased to tourists and travelers for
dwelling on a more or less long-term basis and offering basic services to its tenants,
similar to hotels.

c. Motorist Hotel – any structure with several separate units, primarily located along
the highway, with individual or common parking space, at which motorists may
obtain lodging and in some instances, meals.

d. Pension House – a private, or family-operated tourist boarding house, tourist guest

house or tourist lodging house, employing non-professional domestic helpers,
regularly catering to tourist, and/or travelers, containing several independent lettable
rooms, providing common facilities such as toilets, bathrooms/showers, living and
dining rooms and/or kitchen and where a combination of board and lodging may be
provided.

The term lodging establishment shall include lodging houses, which shall mean such
establishments as are regularly engaged in the hotel business, but which,

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nevertheless, are not registered, classified and licensed as hotels by reason of
inadequate essential facilities and services.

5.12 Restaurant – shall mean any establishment, duly licensed by the local
government units (LGUs ), offering to the public, regular and special meals or menu,
cooked food and short orders. Such eating-places may also serve coffee, beverages
and drinks.

RULE III

CREATION OF THE OFFICE FOR SENIOR CITIZENS AFFAIRS

Article 6. Office for Senior Citizens Affairs (OSCA) – There shall be established in the
office of the Mayor and OSCA to be headed by a councilor who shall be designated by
the Sangguniang Bayan/Panglungsod in coordination with the Department of Social
Welfare and Development (DSWD) and the Municipal/City Federation of Senior
Citizens.

Article 7.The Functions of OSCA – The OSCA shall perform the following functions:

a) To plan, implement and monitor yearly work programs in pursuance of the

objectives of this Act;

b) To mobilize the different local agencies to identify activities within their programs
which can be undertaken by the senior citizens;

c) To draw up a list of available and required services which can be provided by the
senior citizens;

d) To maintain a regular update on a quarterly basis a list of senior citizens;

The regular quarterly update of the list of senior citizens shall be made on the first
week of the first month of every quarter.

e) To issue nationally uniform individual identification cards which shall be valid

anywhere in the country;

It shall the responsibility of the local Social Welfare Development Officer or any other
officer performing such functions to review and process all applications

f) To serve as a general information and liaison center to respond to the needs of the
senior citizens, the OSCA shall:

f.1 assist any complainant or aggrieved senior citizen in filing the appropriate action
with the Office of the Public Prosecutor or with the concerned Agency/Department
until same is finally terminated or resolved, and;

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f. 2 assist the National Government in putting up the necessary appropriate notices
of the mandatory elderly discount privileges/benefits under RA 7432, which shall be
posted at a conspicuous place in all establishments.

This shall be made as a requirement in the renewal of business licenses annually.

The Municipal/City Federations of Senior Citizens shall assist OSCA in the foregoing
functions:

8.1 to provide the initial nationally uniform identification cards which shall be issued
through the OSCA.

The nationally uniform individual identification cards shall contain the following
information:

a) Control Number, Date of Issue

b) Name

c) Address

d) Age, as supported by a certified birth certificate from the Office of Civil Registrar;
Birth date

e) Annual income, as supported by a certificate of exemption from payment of income

tax issued by the local office of the Bureau of internal Revenue (BIR)

f) Picture

g) Signature of senior citizen

A senior citizen whose income is P60,000.00 and below annually shall be issued a
national ID card, which contains the mandatory elderly, discount privileges/benefits
under RA 7432.

This shall be duly signed by the mayor of the senior citizen’s locality, the Secretary of
the Department of Social Welfare and Development (DSWD) and the Secretary of the
Department of Interior and Local Government (DILG). This shall be non-transferrable.

8.2. to assist in developing the standards of programs and services of OSCA.

8.3. to provide technical assistance and monitor services and projects to be

undertaken by the OSCA.

RULE IV

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CONTRIBUTIONS IN THE COMMUNITY
Article 9.Contributions of Senior Citizens to the Community. Any qualified senior
citizen as determined by the OSCA may render his/her services to the community,
which shall consist of, but not limited to any of the following:

a. tutorial and/or consultancy services;

b. actual teaching and demonstration of hobbies and income generating skills;

c. lectures on specialized field like agriculture, health, environmental protection;

d. transfer of new skill acquired by virtue of their training mentioned in Section 4 of

paragraph (d) of the Act;

e. undertake other appropriate services as determined by the OSCA such as school

traffic guide, tourist aide, pre-school assistance, etc.

In consideration of services rendered by the qualified elderly, the OSCA may award or
grant benefits/privileges to the elderly, in addition to the other privileges provided for
under Section 4 of the Act.

In the absence of resources, OSCA shall mobilize resources of the community to

provide awards or incentives.

Financially able institutions desiring to acquire services of the elderly shall be

mobilized to provide a reasonable compensation e.g. transport, food, etc. for the
duration of the senior citizen’s services.

Senior citizens earning above sixty thousand pesos (P60,000.00) annually can be
granted some awards or benefits by the OSCA for services rendered to his community
e.g. consultancy services, transfer of new technology, etc.

RULE V

PRIVILEGES AND BENEFITS OF SENIOR CITIZENS

A senior citizen shall be granted twenty per cent (20%) discount from all
establishments relative to utilization of transportation services, hotels and similar
lodging establishments, restaurants and recreation centers and purchases of
medicines, anywhere in the country.

A. Transportation Benefits

A. 1 Public Water Transportation – Every senior citizen who is a passenger of any

public water transportation service as this term is understood under the Public
Service Act, as amended, shall be entitled to a discount in the amount of not less

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than twenty per cent (20%) of the fare charged or authorized, including discount of
twenty per cent (20%) on purchases of meals or food items from the restaurant either
operated by concessionaire or the carrier and medicines on board vessels.

The Maritime Industry Authority (MARINA) is hereby directed to issue corresponding

circulars or directives to the shipping industry for the implementation of these
guidelines to ensure compliance herewith, as well as requirements to ship
operators/ship owners to disseminate, by posters, handbills or pamphlets, the
information about senior citizen on board vessels to maximize the benefits of the
senior citizens.

A senior citizen, unless his/her physical appearance shows that he/she undoubtedly
60 years old or above, may prove his/her age by any of, but not limited, to the
following documents or papers:

a. Official Identification Card from the OSCA of the LGUs, SSS/GSIS ID (old or new);

b. Driver’s License or Birth Certificate;

c. Voter’s ID or Voter’s Affidavit;

d. Residence Certificate (old or new);

e. And other public/official record or document, from relevant government agencies.

A.2 Public Land Transportation – every senior citizen who is a passenger of any
public land transportation services stated below, shall be entitled to a discount in the
amount of not less than twenty per cent (20%) of the fare authorized by the Land
Transportation Franchising and Regulatory Board (LTFRB).

The public land transportation referred to are the following:

a. Bus (pub) b. Jeepney (puj)

c. Taxi

d. Shuttle Bus

e. Tourist Bus

f. Other modes of passenger land transportation devoted for public use and for a fee
with general or limited clientele.

The LTFRB is hereby directed to issue corresponding circular or directives to the

public land transport sector for the implementation of these guidelines to ensure
compliance herewith, as well as requirements to these operators to disseminate, by

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posters, handbills or pamphlets, the information about senior citizens on board their
vehicles to maximize the benefits of the senior citizens.

Every senior citizen is entitled to a grant of twenty per cent (20%) discount on the use
of Light Rail Transit (LRT) System.

Senior citizens who would wish to avail of the discount privileges on LRTC shall be
guided by the following procedures/conditions:

a) Senior citizens shall personally apply for the issuance of discount tickets (in
booklet form) at the Light Rail Transit Authority (LRTC) or METRO, Inc. with office at
the Administration Building, LRTA Compound, Aurora Boulevard, Pasay City or at
designated outlets at the LRT system by presenting their ID card issued by the OSCA.

Discount tickets will be printed with control numbers and will allow a senior citizen
to purchase LRT tokens at a twenty per cent (20%) discount.

b) A senior citizen shall personally surrender to any LRT token teller on duty at any
LRT station/terminal where he/she will board, a discount ticket for every token
he/she will purchase.

Upon surrender of the discount ticket and presentation of the national ID card by a
senior citizen, he/she shall pay for the LRT token at twenty per cent (20%) discount.
(A senior citizen is entitled to purchase only one (1) LRT token at discounted price
every time he/she avails of the LRT System.)

To avoid untoward incidents, senior citizens are discouraged from riding the LRT
during peak hours from 7:00 A.M. to 9:00 A.M. and from 5:00 P.M. to 7:00 P.M. due
to the volume of rider ship.

Twenty per cent (20%) discount for LRT tokens are available only at LRTC
stations/terminals. Discounted token are not available from off-station token
vendors.

A.3. Domestic Air Transportation – Every senior citizen who is duly certified by t he
OSCA is entitled to twenty per cent (20%) discount from the Civil Aeronautics Board
(CAB) approved and published airline rates for domestic air transportation services.

This Act shall cover individuals, partnership, or corporations and all other entities
engaged in the carriage of passengers by air.

The following are the conditions required of a senior citizen to be able to avail of the
twenty per cent (20%) discount on air transportation services:

a. The senior citizen should present his/her identification card duly issued by OSCA
in securing a passage ticket;

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b. He/She should personally secure the passage ticket;

c. The passage ticket shall be non-transferable.

B. Hotels/Lodging Establishments Benefits – the twenty per cent (20%) discount

privileges of the senior citizen from hotels/establishments shall be limited to room
accommodation only.

The DILG shall issue the necessary circulars or directives to tourism establishments
for the implementation of these guidelines and to ensure compliance herewith.

Likewise the Department of Tourism (DOT) shall issue the corresponding

Administrative Order to DOT accredited establishments. v C. Recreation Center
Benefits – A senior citizen is entitled to a minimum of twenty per cent (20%) discount
on all admission fees charged by the theatres, cinema houses and concert halls,
circuses, carnivals and other similar places of culture, leisure and amusement.

D. Purchases of Medicine Benefits – A senior citizen is entitled to a minimum of

twenty per cent (20%) discount in the purchase of medicine for his personal use and
according to his personal needs.

In the purchase of medicine, a senior citizen or his doctor or the latter’s duly
authorized representative should always present the national identification card duly
certified by the OSCA together with the doctor’s prescription in case of prescription
drugs. If over-the-counter, the number of drugs purchased shall be commensurate to
the elderly person’s needs.

These discount privileges shall be limited and exclusive for the benefit of the senior
citizen.

E. Income Tax Benefits/Tax Credits – For purpose of claiming tax credits, private
establishments are required to keep a separate record of sales made to senior citizens
which shall include the name, identification number, gross sales, discount and date
of transaction.

A senior citizen whose annual taxable income does not exceed the poverty level as
determined by NSCB shall be exempted from payment of individual income tax.
Provided that:

a) A senior citizen whose annual taxable income exceed the said poverty level shall be
liable to the individual income tax for the full amount of his/her taxable income net
of personal and additional exemptions;

b) Annual taxable income shall refer to the annual gross compensation, business and
other incomes as defined in Section 28 of the National Internal Revenue Code (NIRC)
other than income subject to tax under paragraphs (b), (c), (d) and (e) of Section 21 of

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the NICR which include certain passive incomes, capital gains from sale of shares of
stock and capital gains from sale of real property;

c) The senior citizen is a resident citizen;

d) NEDA shall inform the Commissioner of Internal Revenue in writing and publish in
a newspaper of general circulation the estimated poverty threshold.

F. Training Fee Benefits – A senior citizen is exempted from training fees for socio-
economic programs undertaken by or in coordination with the OSCA as part of its
work.

G. Medical/Dental Benefits – A senior citizen is entitled to free medical and dental

services in government establishments anywhere in the country subject to guidelines
to be issued by the Department of Health (DOH), the Government Service Insurance
System (GSIS) and the Social Security System (SSS).

G.1 The DOH shall direct the government establishments in the entire country to
provide free medical and dental services to senior citizens.

a. The term “free” shall mean free of charge on medical/dental services where
capability and facility for such services are available,

b. The term “medical services” shall refer to services pertaining to the medical
care/attendance and treatment given to senior citizens. It shall include health
examinations, medical/surgical procedures within the competence and capability of
DOH establishments/hospitals/units and routine/special laboratory examinations
and ancillary procedures as required.

c. The term “dental services” shall refer to services pertaining to dental

care/attendance and remedy given to senior citizens. It shall include oral
examination, curative services like permanent and temporary fillings, extractions and
gum treatment.

d. Professional services – shall refer to services rendered or extended by medical,

dental and nursing professionals, which shall also include services rendered by
surgeons, EENT practitioners, gynecologists, urologists, neurologists, psychiatrists,
psychologists and other allied specialists.

e. Counseling services – shall refer to advices given by health professional, e.g.

psychologists, psychiatrists, nutritionists, nurses and other allied health
professionals in support to specific treatment of illnesses.

Provision of all of the above-mentioned services shall be subject to availability of

appropriate facilities and trained manpower expertise of the receiving establishment.

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f. Government establishments shall refer to and limited to DOH hospitals, which
shall include general hospitals, medical centers and regional hospitals directly under
the full control and supervision of the DOH.

g. The term “anywhere in the country” shall be construed to mean health privileges
senior citizens may avail of from any hospital in the Philippines, as defined in these
guidelines, irrespective of their place of residence/locality, subject to availability of
facilities and manpower/technical expertise of the receiving establishment.

The following are the health services that may be availed of for free in any
government establishments, subject to availability of facilities and
manpower/technical expertise of the receiving government establishment:

a. Medical and dental services

b. Out-Patient consultations

c. Available medicines in all public health programs

d. Available diagnostic and therapeutic procedures

e. Use of operating rooms, special units and central supply items

f. Accommodations in the charity ward

g. Professional and counseling services

To be able to avail of the aforementioned services, the following mechanics are

stipulated:

a. A senior citizen may obtain the benefits from any government establishment.

b. He/she shall present his/her national ID card issued by the OSCA to the medical
and social services or Medical Social Worker designated who shall determine the
validity of his/her ID card.

c. Non-presentation of the national ID card shall be sufficient reason for denial of free
hospital benefits.

d. In case of emergency, the medical benefits shall be accordingly provided by the

receiving hospital even if the ID is not available. However, the national ID card should
be presented within a reasonable time. Non-presentation of the national ID card shall
be sufficient ground for charging the service already given and denial of further
availment of the benefits.

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e. Should the senior citizen choose to be admitted to a private room/pay ward or be
transferred from a free room to a pay room, the amount equivalent to the rate of a
free room should be discounted from that of the pay room/ward.

f. As regard referral or transfer of senior citizen-patient to another government

establishment, the receiving hospital shall provide the full benefits under this rule. In
case of transfer/referral between the DOH hospitals, procedures shall be based on
the DOH Network Guidelines.

The responsibilities of the government establishment are as follows:

a. Provide all available medical and dental services, as defined in these guidelines
that may be deemed necessary in the promotion of the health of senior citizens;

b. Establish a system by which all senior citizens in dire need of health serve shall be
given priority and utmost consideration;

c. Establish and maintain a recording/reporting system which data may be used as

inputs for program/project planning and evaluation; and

d. Strengthen their competence and capability to evaluate and manage geriatic cases
through continuing education.

The responsibilities of senior citizens who are entitled to health benefits and
privileges as indicated and certified by valid national identification cards issued by
the OSCA, are as follows:

a. Adhere to rules and regulations relative to the implementation of this program;

b. Recognize that the government establishments have limitations and constraints in

providing health services and not demand for services that are not available and
beyond the level of their competence;

c. Secure on their own payable services that are not covered by their health benefits
and privileges stipulated herein; and

d. Safeguard the integrity of their identification card and shall not allow their misuse
and abuse.

To the extent practicable and feasible, the continuance of the same benefits and
privileges shall be given to senior citizens by the GSIS, SSS and PAG-IBIG as the case
may be as are enjoyed by those in the actual service.

G.2 Benefits extended to senior citizens who are retirees of the GSIS are as follows:

a. Life Insurance

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If a retiree opts to maintain his life insurance policy with the System, he may convert
his compulsory life insurance into an optional insurance by paying directly to the
System the monthly premiums due thereon (personal plus government share), up to
its maturity date. Amount of monthly premiums shall be determined by the System.
He will be entitled to receive benefits as enumerated below:

1. maturity benefit – retiree will receive the total face value of the policy, less any
indebtedness thereon.

2. policy loan – loanable amount will not exceed 90% of the cash value of his
insurance at the time of application.

3. death benefit – when the retiree dies while life insurance membership is in force
prior to maturity date, the designated beneficiaries double indemnity.

b. Retirement

1. Retirees under PD 1146 or RA 660 shall resume receiving their basic monthly
pension (BMP) for life after the lapse of the 5-year guaranteed period.

2. Upon death of a pensioner who retired under PD 1146 or RA 660, the primary
beneficiaries (legal spouse and minor children) shall receive a basic survivorship
pension (BSP) equivalent to 50% of the BMP plus dependent’s pension (DP)
equivalent to 10% of the BMP for every minor child, if any, but not exceeding five. The
spouse shall receive the BSP for life until she/he remarries. The minor children shall
continue receiving DP until emancipated by marriage, gainful employment or upon
reaching 21 years of age. A mentally or physically incapacitated child, however, shall
receive DP for life.

3. Funeral Benefit – payable upon death of the retirees, pensioner or gratuitant, the
latter must have retired with at least 20 years of service to be entitled to the benefit.

c. Medicare

Coverage:Employees who retired from the service before age 60 may opt to continue
their membership within 6 months from date of retirement by contributing both
personal and government shares of their Medicare premiums until their 60th
birthday.

However, a government employee who retires under RA 1616, PD 1146 or PD 1184 at

age 60 or above or under RA 660 (regardless of age) are covered without paying
contributions pursuant to PD No. 408. Effective January 1, 1992, their legal
dependents are also extended Medicare benefits.

Legal Dependents:

1. The legal spouse who is not a Medicare member.

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2. The unmarried and unemployed children, including legitimated, acknowledged,
legally adopted and step children below 21 years of age;

3. Children 21 years old or above with disability acquired before the age of 21.

Benefits under the Medicare Act consist of:

1. Allowance for room and board

2. Allowance for drugs and medicines

3. Allowance for x-ray/laboratory examinations/others (“others” means items such as

syringes, gloves, vaco sets, butterfly, contrast media and other agents used in
establishing correct diagnosis).

4. Surgeon’s fee

5. Medical Practitioner’s fee

6. Anesthesiologist’s fee

7. Operating room fee

8. Allowance for sterilization procedures

Types of Non-Compensable Treatments

1. Cosmetic surgery or treatment

2. Optometric services

3. Psychiatric services

4. Services which are purely diagnostic

d. Employees Compensation (PD 626)

Only employment-connected injury or sickness resulting in disability or death is

compensable. It therefore presupposes the existence of an employee-employer
relationship at the time the contingency occurs. The legal and/or medical evaluation
to determine compensability is lodged solely with the System.

Type of Disability Benefits

Temporary Total Disability (TTD)

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1. daily income benefit of not less than P10,00 nor more than P90.00 for a period not
exceeding 120 days and in severe cases up to 240 days.

2. medical and/or related services (for work-connected injury or sickness) consisting

of:

2.1 hospitalization room and board supplies, x-ray, medicines, laboratory,

professional fee.

2.2 ambulatory/d o miciliary care, services for hospitalization except room and board

2.3 reimbursement of medicines (in case of non-confinement)

Permanent Partial Disability (PPD)

1. monthly income benefit (MIB) for the designated number of months of not less
than P250.00 or more than P3,240.00.

2. medical and/or related services (for work-connected injury or sickness) (refer to

2.1 2.2 and 2.3)

Permanent Total Disability (PTD)

1. monthly income benefit (MIB) of not less than P250.00 nor more than P3,240.00
plus 10% increment for each minor child not exceeding five starting from the
youngest without substitution payable for life and guaranteed for 5 years.

2. medical and/or related services (refer to 2.1, 2.2 and 2.3)

3. rehabilitation services – consist of medical/surgical management, necessary

appliances and supplies such as artificial leg and arm, wheelchair, crutches, etc. and
vocational training and assistance for placement.

DEATH

A. Death of the Employee

1. MIB the same as in PPD (plus 10% thereof for each dependent child, not exceeding
five) payable to:

a. primary beneficiary/ies for life and/or as long as qualified

b. secondary beneficiary/ies (in the absence of primary beneficiary/ies) for a period

not ot exceed 60 months

B. Death of a PTD Pensioner

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1. MIB due to death (80% of the MIB after the 5-year guaranteed period) payable to:

a. primary beneficiary/ies for life and/or as long as qualified

b. secondary beneficiary/ies (in the absence of primary beneficiary/ies)

MIB excluding dependent’s pension of the remaining balance of the 5-year

guaranteed period.

2. Funeral benefit of P3,000.00 payable upon the death of a covered employee or PTD
pensioner to the person who can show incontrovertible proof that he shouldered
funeral expenses.

G.3 The SSS provides medical and dental services to its retirees and their dependents
through the Medicare Program without the need for additional contributions.
However, the Medicare Program does not cover the entire cost of hospitalization.

The SSS medical staff in the regional offices render free consultation to SSS
pensioners.

The SSS regularly evaluates the level of pension of the retirees.

The SSS involvement in this Act is limited only to its retirees since the SSS funds are
held in trust for the exclusive benefits of the private workers and their beneficiaries.
Usage of such funds for other purposes is not allowed under SSS charter.

G.4 Membership in the PAG-IBIG Fund shall be open to all senior citizens who opt to
continue with their provident savings in the Fund, even after their retirement from
their employment or upon reaching the age of sixty (60) years.

a. Senior citizens who wish to enlist with the PAG-IBIG Fund for the first time may do
so upon proof of gainful employment, or of being self employed, or of membership in
trade/service cooperative (e.g. farmers cooperatives, fishermen’s cooperative, loom
weavers association, handicraft maker’s organization, and the like) and upon
payment of the monthly minimum contribution rate as may be set up by the PAG-
IBG Fund from time to time.

b. PAG-IBIG members of good standing shall be entitled to avail themselves of PAG-

IBIG loan privileges subject to the customary guidelines on loan availments. For PAG-
IBIG housing loans, the loan availments. For PAG-IBIG housing loans, the loan
period shall not be more than twenty five (25) years but in no case shall it exceed the
difference between the present age reckoned from the borrower’s nearest birthday
and his seventieth (70th) year; in the case of a joint and several loan, the loan period
shall be based on the age of the youngest of the co-borrowers.

RULE VI

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GOVERNMENT ASSISTANCE

Article 10. Personal Tax Exemption for Benefactor – A senior citizen shall be treated
as dependent provided for in the NIRC and as such, shall be accorded the privileges
granted by the Code insofar as having dependent are concerned. In determining
personal exemptions allowable to individuals under Section 29 (k) (l) of the NIRC, a
senior citizen may be granted as a dependent. For this purpose, the definition of the
term Head of the family under the said Section shall be deemed amended to refer to
the condition under Article (5) of this implementing rules and regulations. The OSCA
shall require the senior citizen to declare his benefactor who will be granted the
exclusive right to claim him as dependent and issue a identification thereof. The said
certification shall be presented by the benefactor to the BIR for purposes of
determining personal exemptions.

The personal tax exemption shall take effect January 1992.

Article 11.Property Tax Exemptions and Privileges for Individuals and Non-
Government Institutions. Individuals or non-government institutions establishing
homes, residential communities or retirement villages solely for the senior citizen
shall be accorded the following:

a. One per cent (1%) property tax exemption for the first five years starting first year
of operation:

b.

(1) The exemption is automatically withdrawn effective on the year after the
institution ceases its operation before the end of the fifth year of operation. The
owners of the properties shall thereafter be liable for the realty taxes applicable
thereon.

(2) The first year of operation shall be reckoned from the date the institution was
granted a mayor’s permit to operate the establishment.

(3) The exemption shall apply prospectively. Establishments which are beyond their
fifth year of operation shall not be entitled to refund of their payments or
condonation of their realty tax delinquencies during their first five years of operation.
However existing establishments which have been operating for less than five years
shall be entitled to the exemption in the remaining of the five years.

c. Priority in the building and/or maintenance of provincial or municipal roads

leading to the aforesaid home residential community or retirement village.

Provided that: in both cases, said exemption and priority shall apply only when said
homes residential communities or retirement villages are non-stock, no-profit as
such which shall be presented to the Assessor’s Office of the LGUs concerned.

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RULE VII

PENALTY PROVISIONS

Article 12.Penalties. Any person who willfully refuses to grant the privileges provided
for by RA 7432 or violates any provision thereof and for which no penalty is
specifically provided for by any existing law, shall be punished by imprisonment not
exceeding one (1) month or a fine not exceeding One Thousand Pesos (P1,000.00) or
both.

Any organization, private government establishment and government

department/bureau/agency/institution who willfully refuses to grant the privileges
given to senior citizens or violates any provision of RA 7432 shall be administratively
dealt with by any of the agency/department concerned including, but not limited to
the cancellation of permit/s or franchise/s to operate to a business establishment or
institution or public service.

RULE VIII

FINAL PROVISIONS

Article 13.Implementation, Supervision, Monitoring and Technical Assistance.

a. Municipal Responsibility. It shall be the responsibility of every municipality,

through its chief executive, to ensure that the provisions of RA 7432 are
operationalized and implemented to the fullest within its jurisdiction.

b. The DILG, having been designated by the President to exercise general supervision
over LGUs, by virtue of the Local Code, rule XI, shall ensure the compliance of LGUs
with this Act. It shall likewise institute the necessary interventions aimed at
enhancing the capacities of the LGUs in implementing the above-mentioned
provisions.

c. On a national scale, the DSWD, by virtue of its monitoring and technical

assistance function shall ensure the viability and standard of the programs and
services that are implemented, while the DILG shall ensure compliance of LGUs.

Article 14.Appropriation. The municipality, through its Sangguniang Bayan shall

appropriate funds on a yearly basis for the maintenance and other operating
expenses of the OSCA to incorporate in the annual budget.

The concerned provincial/municipal government agency shall likewise mobilize other

sources of funds particularly those that are made available for local development
activities by the national government, the legislature and the private sector.

Article 15. Separatibility Clause, If, for nay reason/s, any part or provision of this
Implementing Rules and Regulations shall be held unconstitutional or invalid, other

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parts or provisions hereof which are not affected thereby shall continue to be in full
force and effect.

Article 16.Effectivity Clause. This Implementing Rules and Regulations shall take
effect fifteen (15) days following its publication in one (1) national newspaper of
general circulation.
ADDENDUM
REVENUE REGULATIONS NO. 2-94
(August 23, 1993)

SUBJECT:
Republic Act No. 7432 otherwise known as an Act to Maximize the Contribution of
Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for
Other Purposes.

To: All Internal Revenue Officers and Others Concerned.

Section 1. SCOPE – Pursuant to Section 245 of the National Internal Revenue Code
(NIRC) as amended, in relation to Section 10 of Republic Act No. 7432, these
regulations are hereby promulgated to (1) implement the provisions of Section 4 and
5 (a) of the said Act granting tax exemption and other privileges to senior citizens,
and (2) prescribe the guidelines for the availment thereof.

SECTION 2.DEFINITIONS. – For purposes of these regulations:

a. Act – refers to Republic Act No. 7432.

b. Senior citizen – means any resident citizen of the Philippines at least sixty (60)
years old, including those who have retired from both government offices and private
enterprises, and has an income of not more than sixty thousand pesos (P60,000.00)
per annum subject to review by the National Economic and Development Authority
(NEDA) every three (3) years.

The term “qualified senior citizen” shall refer to a resident Filipino citizen who meets
the statutory requirements of Section 2 of the Act and Section 2(b) of these
regulations.

c. Resident citizen – refers to a Filipino citizen with permanent/legal residence in the

Philippines, and shall include those, who, having migrated to a foreign country, have
returned to the Philippines with a definite intention to side therein, and whose
immigrant visa has been surrendered to the foreign government.

d. Dependent – a qualified senior citizen whether or not related to a benefactor with

whom he lives and who takes care of him/her.

e. Head of the Family – an unmarried or legally separated man or woman, with one or
both parents, or with one or more brothers or sisters, or with one or more legitimate,

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recognized natural or legally adopted children, living with and dependent upon
him/her for their chief support, where such brothers or sisters or children are not
more than twenty-one (21) years of age, unmarried and not gainfully employed or
where such children, brothers or sisters, regardless of age are incapable of self-
support because of mental or physical defect.

The term ‘head of family’ includes an unmarried or legally separated man or woman
who is the benefactor of a qualified senior citizen as defined in Section 2 of the Act
and these regulations.

The term “qualified senior citizen” shall refer to a resident Filipino citizen who meets
the statutory requirements of Section 2 of the Act and Section 2(b) of these
regulations.

f. Benefactor – any person whether or not related to the senior citizen who takes care
of the latter as a dependent.

g. OSCA – refers to the Office for Senior Citizens Affairs.

h. Income/Annual Taxable Income of a resident Senior Citizen shall refer to the

annual gross compensation, business and other income received during each taxable
year from all sources as defined in Section 28 of the NIRC, which shall not exceed the
poverty level of P60, 000 or such amount as may thereafter be determined by the
NEDA.

However, income derived by a qualified senior citizen from the following

sources:

1. Interest income from Philippine currency bank deposits, yield and other
monetary benefit from deposit substitutes, trust fund and similar arrangements;
royalties, prizes and winnings (Sec. 21 (c), NIRC);

2. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC); and

3. Capital gains from sales of real property (Sec.21(e), NIRC).

shall not be included in the determination of his income/annual taxable income’

which should not exceed the poverty level of P60,000 or such amount as may
thereafter be determined by the NEDA for a certain taxable year inasmuch as income
from such sources shall be subject to the corresponding income tax rates prescribed
under Section 21 (c), (d) and (e) of the NIRC as amended.

i. Tax Credit – refers to the amount representing the 20% discount granted to a
qualified senior citizen by all establishments relative to their utilization of
transportation services, hotels and similar lodging establishments, restaurants,
drugstores, recreation centers, theaters, cinema houses, concert halls, circuses,
carnivals and other similar places of culture, leisure and amusement, which discount

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shall be deducted by the said establishments from their gross income for income tax
purposes and from their gross sales for value-added tax or other percentage tax
purposes.

Sec. 3.INCOME TAX BENEFIT AND PRIVILEGES FOR THE SENIOR CITIZENS. –
Senior citizens qualified as such by the Commissioner of Internal Revenue or his duly
authorized representative who, for purposes of these regulations, is the Regional
Director of the Revenue Region having jurisdiction of the city or municipality where
they are permanent residents shall be entitled to the following tax benefit and
privileges:

a. Exemption from the payment of individual income tax provided that their annual
taxable income does not exceed the poverty level of P60,000.00 or such amount as
may be determined bt the NEDA for a certain taxable year.

b. A 20% discount from all establishements relative to utilization of transportation

services, hotels and similar lodging establishments, restaurants and recreation
center, and on purchases of medicine anywhere in the country.

c. A minimum of twenty perecent (20%) discount on admission fees charged by

theaters, cinema houses and concert halls, circuses, carnivals and other similar
places of culture, leisure, and amusement.

Sec. 4.RECORDING/BOOKKEEPING REQUIREMENTS FOR PRIVATE

ESTABLISHMENTS. – Private establishments, i.e., transport services, hotels and
similar lodging establishments, restaurants, recreation centers, drugstores, theaters,
cinema houses, concert halls, circuses, carnivals and other similar places of culture
leisure and amusement, giving 20% discounts to qualified senior citizens are required
to keep separate and accurate record of sales made to senior citizens, which shall
include the name, identification number, gross sales/receipts, discounts, dates of
transactions and invoice number for every transaction.

The amount of 20% discount shall be deducted from the gross income for income tax
purposes and from gross sales of the business enterprise concerned for purposes of
the VAT and other percentage taxes.

Sec. 5.AVAILMENT OF INCOME TAX EXEMPTION. – Asenior citizen who shall avail
of the exemption from income tax is required to submit the following documents to
the Revenue District Officer (RDO) of the place where he is a permanent resident,
who shall make the necessary verification and report for purposes of the income tax
exemption to be issued by the Commissioner of Internal Revenue or his duly
authorized representative:

A. Certified true copy of his Birth Certificate/Baptismal Certificate or in the absence

thereof, a certification from the National Statistics and Census Bureau or an affidavit
by two (2) disinterested credible persons who know personally the senior citizen.

104
B. If he has a benefactor as defined in Section 2 (f) of these Regulations, Certification
as to the name, address, occupation, Office or business address (office/business) and
TIN of his benefactor;

C. If employed, a copy of his withholding tax statement (BIR Form W-2) for the
preceding taxable year;

c. 1 A senior citizen who derives taxable (fixed) compensation income from only one
employer in an amount not exceeding P60,000 per annum shall be exempt from
income tax and consequently from the withholding tax prescribed under Section 72
Chapter 10, Title II of the National Internal Code, as amended.

D. If self-employed, (i.e., practice of profession, or in business as single

proprietorship) a copy of his income tax return (ITR) for the preceding taxable year
together with the annual license or permit issued by the city or municipality where
he has his principal place of business, supported by a copy of his declaration of sales
or income.

d.1 A senior citizen who derives taxable compensation income from two (2) or more
employers, or who receives mixed income from employment and from business shall
still file an income tax return.

The RDO concerned shall transmit his verification report/recommendation to the

said Regional Director, as duly authorized representative of the Commissioner, for
issuance of the certificate of income tax exemption to the senior citizen.

For purposes of applying for the OSCA ID Card, the duly stamped income tax return
and or the BIR Certification shall be honored.

Sec. 6.TAXABILITY OF SENIOR CITIZENS TO OTHER INTERNAL REVENUE TAXES.

a. A senior citizen whose annual taxable income exceeds the poverty level of P60,000
or such amount as may thereafter be determined by the NEDA for a certain taxable
year shall be liable to the individual income tax in the full amount thereof on his
taxable income net of allowable deductions.

b. Regardless of the amount of taxable income, a senior citizen who derives income
from self-employment, business and practice of profession shall be subject to other
internal revenue taxes which include but are not limited to the value added tax,
caterer’s tax, documentary stamp tax, overseas communications tax, excise taxes,
and other percentage taxes. He shall therefore, file the corresponding business tax
returns in accordance with existing laws, rules and regulations.

c. He shall be subject to the 20% final withholding tax on, interest income from
Philippine Currency bank deposit, yield and other monetary benefit from deposit
substitutes, trust fund and similar arrangements; royalties, prizes (except prizes
amounting to P3,000 or less which shall be subject to income tax at the rates

105
prescribed under Section 21, paragraph (a) or (f), NIRC) as the case may be, and
winnings (except Philippine Charity Sweeptakes winnings).

d. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC).

e. Capital gains from sales of real property (Sec. 21 (e), NIRC).

Sec. 7.BASIC PERSONAL EXEMPTION ONLY FOR BENEFACTOR -.

A qualified senior citizen living with and taken cared of by a benefactor whether
related to him or not, shall be treated as a dependent and his benefactor shall be
entitled to the basic personal exemption of P12,000 as head of the family, as defined
in Section 2 (e) of these regulations.

For purposes of claiming personal exemptions as head of family with dependent

senior citizen, the identification card number issued by the OSCA shall be indicated
in the ITR to be filed by the benefactor. The senior citizen shall indicate in a
certification to be submitted to the RDO and the OSCA his benefactor who will be
granted the exclusive right to claim him as dependent for income tax purposes.

Caring for a dependent senior citizen shall not, however, entitle the benefactor to
claim the additional exemption allowable to a married individual or head of family
with qualified dependent children under Sec. 29 (1) (2) of the NIRC, as amended.

Sec. 8.REPEALING CLAUSE. – All existing rules, regulations and other issuances or
portions thereof inconsistent with the provisions of these regulations are hereby
modified, repealed or revoked accordingly.

Sec. 9.EFFECTIVITY. – These regulations shall take effect fifteen (15) days after
publication in the Official Gazette or newspaper of general circulation whichever
comes first and shall apply to income earned beginning January 1, 1992.

(Sgd.) ERNESTO LEUNG

Acting Secretary of Finance

RECOMMENDED BY:

(Sgd.) LIWAYWAY VINZONS-CHATO

Commissioner of Internal Revenue

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 Health and Well-being of Older Persons
Rationale         

The proportion of older persons is expected to rise worldwide.  In the 1998

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

HEALTHY LIFESTYLE PROGRAM

"MAG HL TAYO"
NATIONAL HEALTHY LIFESTYLE CAMPAIGN

RATIONALE:

     The Department of Health, cognizant of the increasing prevalence of lifestyle

related diseases, has taken as one of its priorities for the year 2003, the Promotion of
Healthy Lifestyles. The promotion of healthy lifestyles emphasizes the anti-smoking
campaign, regular physical activity and weight control. It also includes healthy diet
and nutrition, stress management and regular health check up.

THE NATIONAL HEALTHY LIFESTYLE CAMPAIGN

     The National Healthy Lifestyle Campaign is being undertaken in collaboration

with the Philippine Heart Association and a Coalition of Stakeholders composed of
various medical societies, professional organizations, academe and other government
agencies.
     
As a year round advocacy and IEC campaign it aims to:
1. Raise the awareness of the Filipinos on the need to practice healthier lifestyles.
2. Raise the consciousness of policy makers on the need to provide the Filipinos with
an environment supportive of healthy lifestyle.
Healthy lifestyle in this context is defined as a way of life which promotes and
protects one’s health and well-being. The campaign promotes the following
messages: 
1. Don't  smoke 
2. Regular exercise 
3. Eat a healthy diet everyday
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 4. Watch your weight/Weight control
5. Manage stress
6. Regular health check up

TARGET AUDIENCES:

     Primary Audience:

1. All family members - grandparents, parents, sons and daughters belonging to

the C-D-E economic classes in urban areas.
2. Each of the 5 healthy messages will specifically prioritize the following target
audiences:
 Adults to elderly for exercise
 Schoolchildren for healthy diet
 Mothers and daughters for watch your weight
 Teenagers for Don't smoke
 Working adults for manage stress
3. For purposes of this campaign, the profile of the family members are as follows:
 Grandparents: 60 years old and above
 Father: 40-45 years old
 Mother 30-35 years old
 Teenage son: 13-15 years old
 Preteen daughter: 9-12 years old
     
Secondary Audience:

1. Executives and employees of local government units

2. Legislators/politicians
3. Media

COMMUNICATION HANDLE/ACTION TAGLINE

 MAG HL TAYO!

COMMUNICATION STRATEGIES

The process of behavioral changes that will lead to the adoption of a healthy
lifestyle in individuals is long and tedious. Thus, the healthy lifestyle campaign
should be continuous, sustained and integrated. Because of limited resources, the
DOH needs to start small but intense and hope that various sectors of society jump
in the bandwagon. For the first year of implementation, the following strategies were
adopted:
1. Convened the National Healthy Lifestyle Coalition composed of stakeholders
from various sectors who formulated the health promotion and communication
plan and implement them in their various capacities.
2. Developed, produced and disseminated the various IEC materials to be used
for the campaign.

109
 3. Highlight and schedule one Healthy Lifestyle message at certain times of the
year in connection with other more popular health campaign or traditional or
cultural celebrations of the country.
4. Mobilize politicians, legislators, media practitioners, and members of various
government and non-government agencies and organizations to push laws,
ordinances and activities to create supportive environments in communities
and places where most people are congregating.
    
Various activities lines up to drum up awareness are:

1. Tri-Media Campaign with a communication handle:

                       "MAG HL TAYO"
a. Exposure on TV and Radio of infomercials developed
b. Press releases
c. Articles/write ups on various publications/magazines
d. Rounds of TV and Radio visits to talk about healthy lifestyle
e. Postings of posters on strategic places: buses/LRT/MRT
f. Distribution of flyers to target population
g. Distribution of journalist's manuals to various media outlets

2. High Profile Launching of the Campaign on February 16, 2003

3. conduct of Periodic "MAG HL TAYO" Campaign to celebrate various awareness

weeks highlighting the following messages:
a. February- - - Hearth Month- - - Exercise Regularly
b. May 31/June- - - World No Tobacco Day/Month- - - Don't Smoke
c. July- - - Nutrition Month- - - Eat a healthy Diet Everyday
d. October- - - Mental Health Week- - - Manage Stress
e. December - - - - - - - - - - - - - - - - - -  Watch Your Weight   
The messages on regular health check up underlines all the other messages.

REGIONAL ACTIVITIES

The regions are given a free hand in implementing regional Mag HL Tayo
Campaign based on their own needs and resources. They are also enjoined to observe
the conduct of the scheduled periodic thematic Mag HL Tayo Campaign.
Reports of various activities conducted should be submitted.   .

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 Children’s Fund
(UNICEF) in 2002, to reverse the disturbing trends in infant and young child feeding
110
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,

111
 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.
 

112
II.      Target beneficiaries of the program are infants (0-11 months) and young
children (12 to 36 months years old or 1 to 3 years old)

III.    Action/Work Plan

KEY INTERVENTION SETTINGS AND SERVICES

STRATEGIES,   PILLARS AND ACTION POINTS

STRATEGY1:  Partnerships   with  NGOsand  GOs in  the coordination and

implementation of the IYCF Program

1.1   Formalize partnerships with GOs and NGOs working on IYCF program
coordination and implementation
a.   Strengthen  the TWG to allow it to effectively coordinate the GOs and NGOs
working for the IYCF Program
The national TWG will remain but will be strengthened. It shall be constituted by:
NCDPC as Chair, FHO as secretariat and  representatives   from  NCDPC,FHO,
NCHP, FDA, DJFMH, DSWD,CWC, NNC, ILO, WHO and UNICEF. This time, members
of theTWG will be tasked to focus participation  to the intervention setting where it
ismost relevant.
The TWG shall be reporting  regularly  to the Service Delivery Cluster  Head.  At  the
Regional  level,  the Regional Coordinators from the above offices shall collaborate    
in   the   implementation   of   the   IYCF Program.  To ensure that  GO and NGO
IYCF partners work together,  the composition of  the TWGs and AD Hoc committees
shall be made up of representatives from the government and non-government
sectors and the Ad Hoc Committees shall be chaired by the relevant agency where the
intervention setting belongs.
At the   provincial,   municipal   and   barangay   levels the  existing  Coordinating
Committees  which has  an interagency composition shall be the coordinating arm of
the IYCF Program.  This is where the participation of non-government  entities  will
be facilitated. Mechanisms for coordination shall be devised to build a strong
foundation for partnership  between the LGU, the Coordinating Committees and local
NGOs or private entities.
 
A memorandum of agreement (MOA) shall be executed between DOH and  other
agencies  invited to  become members of the TWG.
 
b. Organize functional Intervention Setting Committees (this is the same as the 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.
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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

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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

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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 IAC’s 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
 

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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 Speaker’s 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,    the MBFHI  environment will certainly  add  value to  the
training.
 
An itinerant  team  will facilitate  the  development of the hospital models. The team
will be composed of an Obstetrician with training/background on MNCHN,
Pediatrician  with training/background on Lactation Management/Essential
Newborn Care,  Nurse  trainer for  breastfeeding  counseling,  Senior  IYCF Program
person with administrative  background  who can deal with  arrangements   and
coordination  with  hospitals and  local  governments  and  who  can  be  a  trainer
and an administrative  assistant  who will facilitate administrative   matters.  The
team  will facilitate  the activities leading to the organization  and maintenance of the
MBFHI in the hospitals. This shall include planning,   setting   up   of   operational    
details   and physical structures  when needed, training/coaching  of personnel,
keeping records and completing reports and self assessment.

117
 
Regional   hospitals   shall   be   developed  for   IYCF capacity building. Trainings at
Regional Hospitals shall be conducted  in collaboration  with the  CHDs.   This is  so
that  training  is  de-centralized  and  monitoring and  evaluation  can  be  done
more  frequently  at  the provincial and municipal levels.
 
b.  Establish  protocols/standards   on  how to  set-up  and maintain MBF
workplaces and integrated in the standards  for healthy workplace
 
The IYCF Program shall focus on the enforcement of the Expanded Breastfeeding
Promotion Act of 2009 which mandates workplaces to establish lactation stations
and/or grant  breastfeeding  breaks.  Guidelines for the establishment   and
maintenance  of  MBF  workplace shall be developed. It will learn from lessons of
already established and successful MBF workplace. In as much as standards for the
healthy workplace are already established,  the  MBF  guidelines  shall  be
integrated into those standards.
 
The establishment of MBF workplaces initiated in factories shall be scaled up and
efforts shall be expanded to include government and private offices in line with
Expanded Breasfeeding Act. The current collaboration partners  in the workplace
setting may also need to be expanded  to  promote  the  establishment  of the  MBF
workplace  in  government  and  private  offices.  With the multitude  of workplaces
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 teacher’s 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

118
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

119
the  documentation and measure of impact of noble experiences and interventions,
will have to be allocated.
 

STRATEGY 5:  Engaging  the  Private  Sector  and International  Organizations

to raise  funds for the scaling up and support of the IYCF program
 
 
5.2  Setting up of a fund raising mechanism for IYCF with the  participation  of
International   Organizations  and the Private Sector
 
a.  Set-up the fund raising mechanism
 
The development and sustainability of IYCF activities partly depends on the
availability of resources. At the national  level, where  many  developmental  activities
will  take  place,  the  regular   sources  of  funds  are not sufficient. At the local
levels, the poorer more problematic areas have the least resources to promote, protect
and support good IYCF practices.  It is critical for  the  IYCF  Program   to  determine
and  actively source  budgetary  and  other  resource  requirements. The  availability
of  resources   will  guide  the  scale and prioritization of IYCF activities in the annual
operational planning.
 
To augment the funds for the IYCF program, a funding mechanism/body that will
serve as a fund raising arm for the elimination of child malnutrition shall be
established.
 
The  effort  should  be  able  to  explore  and  proceed with  the  development of a
funding mechanism  that can encourage public-private partnership and ensure
resources to initiate  and sustain critical  interventions nationwide.  The arena of
fund raising is not within the expertise of DOH, and it will be important  to discuss
with  the  international  and  national  partners  on the most suitable mechanism
that can help attain such important goal.
 
 
PILLAR 1: Capacity Building
 
Capacity building shall take different forms and intensity in accordance to the
requirement of the intervention settings.
 
In health facilities, training on Lactation Management and  Counseling shall
continue.  A system for  regular  in- service or refresher training to address the fast
turnover of health staff in hospitals and to provide necessary program updates shall
be put in place. Staggered  training and self- enforcing programs may also be devised
to improve access to training  when warranted.  Periodic  evaluation  shall be
incorporated  into  the  system to  ensure  effectiveness and efficiency of the
trainings.
 

120
 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
Status of Achievement Remarks
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   53.5% (NDHS 08) 40.7%(NDHS 1998)
minutes
- 80%   of  0-6   months   infants  
34% (NDHS 2008) 33.5%(NDHS 2003)
are exclusively breastfed
- 50%  of  infants   are  
22.2% (NDHS 2008) 16.1%(NDHS 2003)
exclusively breastfed for 6 months
- median duration  of breastfeeding 13 months (NDHS
15.1months (NDHS 2008)
is 18 months 1998)
- 90% of 6- <10 months infants are
given timely, adequate and safe 58% (NDHS 2008) 57.9%(NDHS 2003)
complementary foods
- 95%    of   children   6   months   75.9% (NDHS 2008)  
to 59   months   received   Vitamin 76% (NDHS 2003)
A NDHS 2008 and 2003
data refers to those
that received vitamin
A in the past 6
months from the
121
 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 iron
(NDHS 2008)
and iron deficient 6 months to less drops /
 
than 5 years received complete syrup (not specified if
78.3% of children 6-59
dose of iron supplements complete dose, MCHS
months consumed foods rich
2002)
in iron in the past
24 hours from the time of the
survey
- 80%  of  pregnant  women  have
77.8% (NDHS 2008) 67.5% (MCHS 2002)
at least 4 prenatal  visits
- 80%  of  pregnant  women 82% (not specified if
received complete dose of iron 82.4% (NDHS 2008) complete dose, MCHS
supplements 2002)
44.6% (NDHS 2003)
NDHS 2003 and 2008
data represents the %
- 80%  of  lactating   women
45.6% (NDHS 2008) of women that
received vitamin A capsule
received Vitamin A
dose during post-
partum
38%, household
41.9% (NDHS 2008) using iodized salt and
- 80% of household using iodized
81.1% household positive for 56.4% household
salt
iodine in salt (NDHS 2008) positive for iodine in
salt (NNS 2003)
OBJECTIVE 2: TO INCREASE
POLITICAL COMMITMENT 
AT DIFFERENT LEVELS OF
GOVERNMENT, INTERNATIONAL
ORGANIZATIONS, NON-
   
GOVERNMENT ORGANIZATIONS,
PRIVATE SECTOR,
PROFESSIONAL GROUPS , CIVIL
SOCIETY, COMMUNITIES AND
FAMILIES
- Approved and  widely IYCF Policy approved May 25,
disseminated National Infant and 2005 and disseminated to all  
Young Child Feeding Policy Regions and LGUs.

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- Approved   multi-sectoral  
IYCF Plan of Action 2005-
National  
2010 approved.
IYCF Plan of Action
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.
Active organizations
New groups were active in
include Latch, La
- Increase   number  of supporting activities on IFE
Leche League, Save
organizations actively involved in mostly during the post-Ondoy
the Children, Plan
IYCF interventions and in relation
International  and
to breastfeeding support.
Arugaan.
Additional funds for
IYCF were secured
since April 2007, the
From 1 million pesos in 2005 start of the AHMP
to 20 million pesos in 2010. with intensive IYCF
  training.
   
Additional funds were September 2009,
secured by the Joint program signing of the JP for
- Increase budget for IYCF
on MDG-F, wherein UN Ensuring Food
Agencies (Unicef, FAO, ILO Security and
and WHO) with NNC and Nutrition for Children
DOH, started implementing 0-24 months in the
key IYCF interventions. Philippines, funded
  by the
Government of Spain
through the MDG
Achievement Fund.
OBJECTIVE 3: PROVIDE
SUPPORTIVE ENVIRONMENT
THAT WILL ENABLE PARENTS,
MOTHER, CAREGIVERS,
   
FAMILIES AND COMMUNITIES
TO IMPLEMENT OPTIMAL
FEEDING PRACTICES FOR
INFANTS AND YOUNG CHILD
PROGRAMME MANAGEMENT    

123
 National TWG active and
11/12
Regions confirmed having
Data as of Dec 2009.
established a TWG.
Although the national
- Functional IYCF Program  
TWG is
authority and  responsibility flow  
considered active, the
at  the national, regional and LGU At the LGU level 7/80
collaboration between
level provinces,
agencies can be
9/120 cities and 175/1425
considered deficient.
municipalities have passed a
resolution/ordinance in
support of IYCF.
- Existing local committees
  No available data
functioning as IYCF committees
INSTITUTIONAL SUPPORT    
AO 2007-0026: Revitalization
of the MBFHI in Health
Facilities with Maternity Within 2 years after
Services was signed and the issuance of COC,
endorsed on July 10, 2007. 0/47 hospitals
- 1,426  currently certified   applied for
MBF hospitals sustained 10 steps   accreditation  to
PhilHealth Circular No. 26 S- become MBF based
2005: Requirement for on the new standards
Accredited Hospitals to be and requirements.
“Mother- Baby Friendly” was
issued on October 11, 2005.
Only 47/1487 have received
- 300  additional  hospitals/lying-in
a COC  
certified as MBF
since 2007
- 100%  of hospitals rooming–in
  No available data
their newborns
RA 10028:  Expanded
- All offices of government  agencies RA 10028  set the
Breastfeeding Promotion Act
who are members of the IYCF IAC standards  to
of 2009 was enacted on
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 resource No resource center  
center 1 province and 1 city in each established

124
region
10/16 Regions reported that
- At  least  3  IYCF model
there are at least 2159
barangay/  
breastfeeding support groups
municipality per province and city
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 Based on monitoring visits
No available data on
integrated IEC on IYCF into regular and reports from CHDs,
private health
MCH services with clearly stated public health facilities have
facilities.
protocols on how to provide key ensured the integration.
IYCF
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   facility  IYCF Draft tool developed and used
MIS in two  key instances. No  
system in place by end of 2009 institutionalization  yet.
28,063/34,298 staff were
-Improving skills of health NCDPC and NNC
trained on
manpower combined report
IYCF Counseling.
- Available national  / regional
16/17 Regions reported
IYCF  
conduct of training on IYCF.
trainers
- Active IYCF Speakers’ Bureau   No available data
28,063/34,298 staff were
- Available IYCF counselors in 50% NCDPC and NNC
trained on
of health facilities combined report.
IYCF Counseling.
- At least 10 Filipino health DOH focused on capacitating With the support of
125
professionals internationally
accredited as breastfeeding
health workers on Counseling
counselors by the International NNC.
and Lactation Management.
Board of Lactation Consultants
Examiners
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 good
- Improved   curricula   for   IYCF The process of
IYCF practice into the
of medical / nursing / midwifery integration is on-
medical, nursing, midwifery
schools going.
and nutrition curricula was
conducted.
RA 10028:  Expanded RA 10028  was
- Inclusion  of  breastfeeding  in Breastfeeding Promotion Act enacted on March 16,
elementary education of 2009 mandates the 2010.  The IRR is yet
integration. to be signed.
As of Dec 2009.
10/16 Regions reported that
 
there are at least 2,159
- Community  level  support   RA 10028  will help
barangay level BF support
systems and services boost the number of
groups and more than 40 BF
breastfeeding friendly
friendly public places.
public places.
- 100%  of target  communities
with functional community level
  No available data
monitoring system of IYCF
practices and changes
- At least 50%  of city and 10/16 Regions reported that
poblacion municipalities with there are at least 2,159  BF
 
adequate number of trained IYCF support groups at the
peer counselors barangay level.
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    

126
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, Food
2nd IYCF PIR: 2009
Fortification  and ECCD Law /
IYCF Policy
Key result of
- IYCF integrated into Philippine IYCF integrated in PPAN
integration was the
Plan of Action for Nutrition  and 2005-2010.  PIR was
intensive training on
annual planning and health conducted last quarter of
IYCF Counseling in
monitoring systems at all levels 2010.
AHMP target areas.
Regular Presentations  are
- Periodic  feedback  of  IYCF offered by DOH on IYCF
status during annual conventions status (2005:
of health professionals/Leagues  of 1st presentation during  
Provinces/ Cities/Municipalities National
and Barangays Convention Liga Ng
Barangay)
 
V. Program Manager

VICENTA E. BORJA, RN, MPH

Supervising Health Program Officer
Family Health Office
National Center for Disease Prevention and Control
Department of Health
Telephone no. 7329956
E-mail Add: [email protected]
 
Partner Organizations/agencies
 
 NGO Partners:
Local:
          Employers Confederation of the Philippines
          Trade Union Congress of the Philippines

127
           Beauty, Brains and Breastfeeding
          ARUGAAN
          Action for Economic Reforms
          Save Baby e-group
          Philippine Pediatric Society
          Philippine Obstetrics and Gynecology Society
          Philippine Academy of Family Physicians Inc.
          Philippine Society of Newborn Medicine
          Philippine Society of Pediatric Gastroenterology
          Philippine Neonatology Society
          Philippine Society of Obstetric Anesthesiologist
          Philippine Academy of Lactation Consultant
          Perinatal Association of the Philippines
          Philippine Medical Association
          Integrated Midwives Association of the Philippines
          Maternal and Child Nurses Association of the Philippines
          Philippine Nurses Association
          National League of Philippine Government Nurses Inc.
          Malls: SM , NCCC
          Union of Local Authorities of the Philippines
          CODHEND
 
Government Partners:
 Department of Labor and Employment
 Department of Social Welfare and Development
 Department of Justice
 Department of Trade and Industry
 Department of Local Government
 Food and Drug Administration
 National Nutrition Council
 Council for the Welfare of Children
 Department of Education
 Commission on Higher Education
 Nutrition Council of the Philippines

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

128
 Iligtas sa Tigdas ang Pinas

A Door-to-Door Measles-Rubella (MR) Immunization Campaign Vaccinating All

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

129
 Inter Local Health Zone

An ILHZ is defined to be any form or organized arrangement for coordinating the

operations of an array and hierarchy of health providers and facilities, which typically
includes primary health providers, core referral hospital and end-referral hospital,
jointly serving a common population within a local geographic area under the
jurisdictions of more than one local government.
ILHZ, as a form of inter-LGU cooperation is established in order to better
protect the public or collective health of their community, assure the constituents
access to a range of services necessary to meet health care needs of individuals, and
to manage their limited resources for health more efficiently and equitably.
For these to happen, existing ILHZs in the country must strengthen their
operations and sustain their functionality. Regardless of the organizational nature of
each ILHZ, whether these are formally organized, informally organized or DOH-
initiated, the overall aim is to make each ILHZ functional in order to perform its
abovementioned purposes and tasks.
It must be recognized that a good inter-LGU coordination in health is one that
secures health benefits for the people living in LGUs that are coordinating with one
another.   A functional ILHZ therefore is to be viewed as one that provides health
benefits to its individual residents and to the zone population as a whole. The ILHZ
functionality is defined mainly by observable zone-wide health sector performance
results in terms of:

 improved health status and coverage of public health intervention of the zone

population;
 access by everyone in the zone to quality care; and
efficiency in the operations of the inter-local health services.
 
Replication of Exemplary

Replication:  Sharing Good Practices and Practical Solutions to Common Problems

By virtue of Administrative Order No. 2008-0006, dated January 22, 2008, the

DOH has adopted the integration of replication strategies in its operation.
Replication is learning from and sharing with others exemplary practices that are
proven and effective solutions to common and similar problems encountered by local
government units, with the least possible costs and effort.  The underlying principle
of replication is to avoid reinventing the wheel and benefiting from already tested
solutions.
LGUs can share lessons learned from practices that work, as well as share
experiences systematically.  A structured organized process of replicating, including
proper dissemination of  validated exemplary practices and making Lakbay Arals
more meaningful and useful, help ensure the chances of achieving best results. 
Replication makes  learning  more  interesting and exciting as one gets to see 
the model and its benefits firsthand.

130
Criteria for Selecting Exemplary Health Practices

1. LGU-initiated solutions initiated to address one or more health issues or

problems encountered.

2. High level of sustainability

 Consistent with existing health policies
 LGU support
 Had been in place for more than three ears
 Widely participated and supported by the communities
 Adopted as a permanent structure or  program with regular budgetary
support
 Adopted as a permanent structure or program with regular budgetary
support
 Community representation in decision making bodies and committee

3. Simple and doable so that they can be replicated within one year and a half or
less.

4. Cost effective and cost efficient

 Mobilization and utilization of indigenous resources
 Minimal support from external sources

5. Positive results on the beneficiaries and communities. 

6. Other important factors to consider:

 Consistency with the thrusts or priorities of the Department of Health
 Willingness of the Host LGU  to share its practice to others
 Demand for the practice from other LGUs

Integrated Management of Childhood Illness (IMCI)

One million children under five years old die each year in less developed
countries. Just five diseases (pneumonia, diarrhea, malaria, measles and dengue
hemorrhagic fever) account for nearly half of these deaths and malnutrition is often
the underlying condition. Effective and affordable interventions to address these
common conditions exist but they do not yet reach the populations most in need, the
young and impoverish.
The Integrated Management of Childhood Illness strategy has been introduced
in an increasing number of countries in the region since 1995.  IMCI is a major
strategy for child survival, healthy growth and development and is based on the
combined delivery of essential interventions at community, health facility and health
systems levels. IMCI includes elements of prevention as well as curative and
addresses the most common conditions that affect young children. The strategy was

131
developed by the World Health Organization (WHO) and United Nations Children’s
Fund (UNICEF).
In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more
health workers and hospital staff were capacitated to implement the strategy at the
frontline level.
 
Objectives of IMCI
 Reduce death and frequency and severity of illness and disability, and
 Contribute to improved growth and development

Components of IMCI
 Improving case management skills of health workers
                  11-day Basic Course for RHMs, PHNs and MOHs
                  5 - day Facilitators course
                  5 – day Follow-up course for IMCI Supervisors
 Improving  over-all health systems
 Improving family and community health practices
 
Rationale for an integrated approach in the management of sick children

Majority of these deaths are caused by 5 preventable and treatable conditions

namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out
of four (4) episodes of childhood illness are caused by these five conditions
Most children have more than one illness at one time. This overlap means that a
single diagnosis may not be possible or appropriate.
 
Who are the children covered by the IMCI protocol? 
 Sick children birth up to 2 months (Sick Young Infant)
 Sick children 2 months up to 5 years old (Sick child)
 
Strategies/Principles of IMCI

 All sick children aged 2 months up to 5 years are examined for GENERAL

DANGER signs and all Sick Young Infants Birth up to 2 months are examined
for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These
signs indicate immediate referral or admission to hospital
 The children and infants are then assessed for main symptoms. For sick
children, the main symptoms include: cough or difficulty breathing, diarrhea,
fever and ear infection. For sick young infants, local bacterial infection,
diarrhea and jaundice. All sick children are routinely assessed for
nutritional, immunization and deworming status and for other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’s 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

132
  Counseling of caretakers on home care, correct feeding and giving of fluids, and
when to return to clinic is an essential component of IMCI
 
BASIS FOR CLASSIFYING THE CHILD’S ILLNESS 
(please see enclosed portion of the IMCI Chartbooklet)
The child’s illness is classified based on a color-coded triage system:
PINK-         indicates urgent hospital referral or admission
YELLOW- indicates initiation of specific Outpatient Treatment
GREEN –   indicates supportive home care
 
Steps of the IMCI Case management Process

The following is the flow of the iMCI process. At the out-patient health facility,
the health worker should routinely do basic demographic data collection, vital signs
taking, and asking the mother about the child's problems. Determine whether this is
an initial or a follow-up visit. The health worker then proceeds with the IMCI process
by checking for general danger signs, assessing the main symptoms and other
processes indicated in the chart below.
Take note that for the pink box, referral facility includes district, provincial and
tertiary hospitals. Once admitted, the hospital protocol is used in the management of
the sick child.

Knock Out Tigdas 2007

Knock-out Tigdas Logo

“Knock-out Tigdas 2007” is a sequel to the 1998 and 2004 “Ligtas Tigdas” mass
measles immunization campaign. All children 9 months to 48 months old ( born
October 1, 2003 – January 1,2007) should be vaccinated against measles from
October 15 - November 15, 2007 , door-to-door. All health centers, barangay health
stations, hospitals and other temporary immunization sites such as basketball court,
town plazas and other identified public places will also offer FREE vaccination
services during the campaign period.
Other services to be given include Vitamin A Capsule and deworming tablet.
133
Knockout Tigdas for the period of the Barangay and SK Elections

Executive Order No. 663 

Promotional materials

What is “Knock-out Tigdas (KOT) 2007?

“Knock-out Tigdas 2007” is a sequel to the 1998 and 2004 “Ligtas Tigdas” mass
measles immunization campaigns. This is the second follow-up measles campaign to
eliminate measles infection as a public health problem.

What is the over-all objective of the Knock-out Tigdas?

The Knock-out Tigdas is a strategy to reduce the number or pool of children at risk of
getting measles or being susceptible to measles and achieve 95% measles
immunization coverage. Ultimately, the objective of KOT is to eliminate measles
circulation in all communities by 2008.

What does measles elimination mean?

Measles elimination means:
1. Less than one (1) measles case is confirmed measles per one million population.
2. Detects and extracts blood for laboratory confirmation from at least 2 suspect
measles cases per 100,000 populations.
3. No secondary transmission of measles. This means that when a measles case
occurs, measles is not transmitted to others.
Who should be vaccinated?
All children between 9 months to 48 months old ( born October 1, 2003 – January
1,2007) should be vaccinated against measles.

When will it be done?

Immunization among these children will be done on October 15-November 15, 2007.

How will it be done?

Vaccination teams go from door-to-door of every house or every building in search of
the targeted children who needs to be vaccinated with a dose of measles vaccines,
Vitamin A capsule and deworming drug.
All health centers, barangay health stations, hospitals and other temporary
immunization sites such as basketball court, town plazas and other identified public
places will also offer FREE vaccination services during the campaign period.

My child has been vaccinated against measles. Is she exempted from this
vaccination campaign?
No, she is not. A previously vaccinated child is not exempted from the vaccination
campaign because we cannot be sure if her previous vaccination was 100% effective.
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.

134
What strategy will be used during the campaign?
It is a door-to-door strategy. The team goes from one-household to another in all
areas nationwide.

My child had measles previously, is he exempted in this campaign?

There are many measles-like diseases. We cannot be sure exactly what the child had,
especially if the illness occurred years ago. Anyway, the vaccination will not harm a
child who already had measles. The effect will also be like a booster vaccination. The
previously received measles immunization has formed antibodies, with the booster
shot it will strengthened the said antibodies.

Is there any overdose, if my child receives this booster immunization?

Antibodies in the blood which provide protection against disease decrease as the
child grows older. Booster vaccinations are needed to raise protection again. Measles
vaccination during the said campaign will be a booster vaccination for a previously
vaccinated child. The child’s 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 child’s 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?

135
Measles vaccine is very safe. Minor reactions may occur such as fever but in an
already immunizes child, this may not occur. The most serious and RARE adverse
event following immunization is anaphylaxis which is inherent on the child, not on
the vaccines.

Leprosy Control Program

136
137
  

Vision:    Empowered primary stakeholders in leprosy and eliminated leprosy as a

public health problem by 2020

Mission:  To ensure the provision of a comprehensive, integrated quality leprosy

services at all levels of health care

Goal:  To maintain and sustain the elimination status

Objectives:

The National
Leprosy
Control
Program
aims to:

138
           Ensure the availability of adequate anti-leprosy drugs or multiple drug
therapy (MDT).
           Prevent and reduce disabilities from leprosy by 35% through
Rehabilitation and Prevention of Impairments and Disabilities (RPIOD) and
SelfCare.
           Improve case detection and post-elimination surveillance system using
the WHO protocol in selected LGUs.
           Integration of leprosy control with other health services at the local level.
           Active participation of person affected by leprosy in leprosy control and
human dignity program in collaboration with the National Program for Persons
with Disability.   
           Strengthen the collaboration with partners and other stakeholders in the
provision of quality leprosy services for socio-economic mobilization and
advocacy activities for leprosy.           

139
Beneficiaries:

The NLCP targets individuals, families, and communities living in hyperendemic

areas and those with history of previous cases.

NLCP Strategy Universal Health

Global Strategy Care
(2011-2016)  
(2006-2010) (Kalusugang
MDG& NOH Pangkalahatan)

 Provision of
 Sustain leprosy control in Quality Leprosy  Governance
all endemic countries services at all for Health
levels        
  Strengthen routine &  Health System  Service
referral service Strengthening Delivery
 Ensure high quality  Capability building
 Policy,
diagnosis, case management, of an efficient, effective,
Standards &
recording & reporting in all accessible human and
Regulations
endemic communities facility resources
 Develop policies/
 Establish the guidelines/ sentinel  Human
Sentinel Surveillance System sites/referral centers Resources for
to monitor Drug Resistance (Luzon,Visayas & Health 
Mindanao)
 Develop procedures/ tools
that are home/community-
 Collaborate with
based, integrated and locally  Health
NEC/RESU/ PESU /
appropriate for Self Information
MESU
Care/POD, rehabilitation
services (CBR)
   Health
 NLAB, NCCL
Financing
   RA 7277- Rights of  
PWD & Caregivers
   BP 34- Accessibility  
& Human Rights Law
   PhilHealth Insurance  
Package

140
  

141
 

LGU Scorecard

The performance indicators in the LGU Scorecard are a subset of the

Performance Indicator Framework (PIF) of the ME3. The performance indicators
measure basic intermediate outcomes and major outputs of health reform programs,
projects and activities (PPAs).
There are 46 performance indicators in the LGU Scorecard categorized in two
sets (Set I and Set II). The two sets of performance indicators are the following:
Set I is composed of 27 outcome indicators mostly representing intermediate
outcomes that can be assessed every year (See Annex 1: Data Definitions for Set I
Indicators in LGU Scorecard). Set II is composed of 27 output indicators representing
major thrusts and key interventions for the four reform components of service
delivery, regulation, financing, and governance. They are mostly composed of health
system reform outputs. These indicators are assessed only every 3-5 years, since
these require more time and more resources to set up. The equity dimensions of
these indicators are not measured (See Annex 2: Data Definitions for Set II Indicators
in LGU Scorecard).
Set I performance indicators of the LGU Scorecard are standardized as to
numerators, denominators, multipliers and data sources. The definition of
performance indicators is consistent with the Department of Health FHSIS data
dictionary. The other references used in defining performance indicators in the LGU
Scorecard are PhilHealth data definitions and WHO definitions of indicators. The
standardization of performance indicators guarantees consistency of data across
various LGUs and across years of implementation. It also facilitates the automation
of the LGU Scorecard collection and publication of results.
The sources of data utilized for the LGU Scorecard are the institutional data
sources in the Department of Health. The availability of data on an annual basis was
an important consideration for inclusion of Set I performance indicators in the LGU
Scorecard.

142
Licensure Examinations for Paraprofessionals Undertaken by the Department of
Health

I. Mandates

Presidential Decree No. 856 “Code of Sanitation of the Philippines”

 
Massage Therapists
Administrative Order No. 2010-0034 – “Revised Implementing Rules and Regulations
Governing Massage Clinics and Sauna Bath Establishments”

Embalmers
Administrative Order No. 2010-0033 “Revised Implementing Rules and Regulations
Governing Disposal of Dead Persons”
 
Committees
The Committee of Examiners for Massage Therapy (CEMT) and the Committee of
Examiners for Undertakers and Embalmers (CEUE) were created by the DOH to
regulate the practice of massage therapy and embalming to ensure that only qualified
individuals enter the profession and that the care and services to be provided are
within the standards of practice.
 
II. Application Procedure

A. Who can apply

         Any high school graduate
         At least 18 years old at the time of the examination
 
B. How to apply

Application Requirements:
a. Certified True Copy of Birth Certificate (at least 18 years old at the time of the
examination)
b. Certificate of Good Moral Character from barangay captain of the community
where the applicant resides
c. Certification or clearance from the National Bureau of Investigation (NBI) or
provincial fiscal that he/she is not convicted by the court in any case involving moral
turpitude.
d. Medical Certificate from a government physician
e. Certified True Copy of Diploma or Transcript of Record (at least high school
graduate)
f. Submit Marriage Contract for female married applicant
g. Certification from any DOH accredited training institution/ provider that he/she
has received basic instructions in five (5) subjects based on Program Curriculum
h. Certification from any DOH accredited training institution/provider that he/she
has skillfully embalmed at least 10 cadavers within one year period under his/her
supervision

143
i. Filled up application form (1 copy)
j. 1 ½ X 1 ½ size photograph taken within the last 6 months (3 copies)
 
When is the licensure examination?
Massage Therapist – every 1st week of June and December
Embalmers – every 1st week of March and September
 
 III. Accredited Training Institutions
 
Training Institutions Office Address Contact Number
2nd Floor ABN Bldg. Mc
Massage Therapy
Arthur Highway del (045) 861-2493
Central Luzon Alternative
Rosario, City of San 09159970969
Health & Development, Inc.
Fernando, Pampanga
Unit 5 2nd Floor VMCC
Centre de Centre International Bldg. Santolan Rd. cor.
(02) 750-0442
Wellness Institute Inc. Granada St., Valencia,
Quezon City
Early Divine School Forever
59-A Escarilla  Subd., 09305886037
Alternative Medicine Rehab
Mandurriao, Iloilo City (033) 500-6529
and Training Center
(02) 341-6674
1443 M. Hizon St. cor.
EMPRIZ Massage Therapy Sun- 09325337262/
Alvarez St. Sta. Cruz,
Review & Training Center 0922-8576674
Manila
Smart – 09292551959
Hand-Med Integrative Osmena Avenue, Kalibo, (036) 268-2810
Healthcare Center Aklan 09297350080
3rd Floor Crispina Bldg.
1589 Quezon Avenue,
(02) 473-7369
Brgy West Triangle
0917-5117744
HIMAS- Asian Wellness and Quezon City
 
Spa Academy  
 
Door 2 Sazon Bldg.
(082) 305-1013
Ponciano Reyes St.,
Davao City
33 Bakersfield St.
(049) 544-0704
HILOT at HILOM Pilipinas Laguna Bel Air 1, Don
09175457494
Jose, Sta. Rosa, Laguna
International NKYR Academy Unit D ProVita Bldg. 26 (02) 473-5115
Columbia cor. Yale St. 09189199140
Cubao, Quezon City  
  (032) 238-8744
Dona Luisa Bldg. Fuente 09189199149

144
 Osmena, Cebu City
Suite 708 Cattleya Bldg.
(02) 401-1242
Le Petit Paradis Academy 235 Salcedo St. Legaspi
09228576674
Village, Makati City
#2 Brgy. Court Villa 09298062688
NMA Center for Aquatic
Angela Subd., Angeles 09196133621
Therapy & Massage
City (045) 888-3458
55-B Malac St.
Potter’s Hand Review and (02) 359-3985
Masambong, Quezon
Training Center Fax #: (02) 413-3296
City
Remnant Institute of #26 Huervana St. Lapaz, 09209513589
Alternative Medicine Iloilo City (033) 329-1916
2205 Cityland Tower 2,
154 H.V. dela Costa St.
SPA @ WORK  (02)840-0242/ 840-1239
cor. Valerosts Makati
City
Ventura College of Natural
Therapeutic Health and Tagum, Davao City 0927-5004167
Science
Embalmers 09175989897
1623 Quezon Avenue,
F&M Embalmers Review and (02) 400-4741
Quezon City
Training Center, Inc.  
Valgosong Bldg., CM
0922-8187622
Recto cor. Bonifacio St.,
0922-8210797
Paz Review and Training Davao City
 
Center  
0917-8240409
143 G Araneta Ave. cor.
(02) 743-6520 loc. 140
Kaliraya St. Quezon City
2139 T. Mapua St. Sta. (02) 254-0885
Ongchangco Review and Cruz, Manila (033) 775-8212
Training Center    
Miag-ao, Iloilo City 0918-9395984
Nivel Hills, Lahug, Cebu
(032) 232-2282
City
Pacific Center for Advanced (032) 231-7542
 
Studies Cebu Branch  
Abad Santos St. Camus
0918-4334695
Ext., Davao City
Philippine Embalmers & 794-2232
2070 E. Pascua St. Brgy.
Undertakers Review and 0921-5401107
Kasilawan Makati City
Training Center 0917-8312244
GSP Training and Review LT Building 815 EDSA (02) 895-4266

145
 Avenue, Brgy. 144,
Center 0917-8436276
Pasay City
Malaria Control Program

Malaria is a parasite-caused disease that is usually acquired through the bite of

a female Anopheles mosquito. It can be transmitted in the following ways: (1) blood
transfusion from an infected individual; (2) sharing of IV needles; and (3)
transplacenta (transfer of malaria parasites from an infected mother to its unborn
child).
This parasite-caused disease is the 9 th leading cause of morbidity in the
country. As of this year, there are 58 out of 81 provinces that are malaria endemic
and 14 million people are at risk. In response to this health problem, the Department
of Health (DOH) coordinated with its partner organizations and agencies to employ
key interventions with regard to malaria control.
 
Vision:  Malaria-free Philippines
 
Mission:  To empower health workers, the population at risk and all others
concerned to eliminate malaria in the country.
 
Goal:  To significantly reduce malaria burden so that it will no longer affect the socio-
economic development of individuals and families in endemic areas.
 
Objectives:
Based on the 2011-2016 Malaria Program Medium Term Plan, it aims to:
1. Ensure universal access to reliable diagnosis, highly effective, and appropriate
treatment and preventive measures;
2. Capacitate local government units (LGUs) to own, manage, and sustain the Malaria
Program in their respective localities;
3. Sustain financing of anti-malaria efforts at all levels of operation; and
4. Ensure a functioning quality assurance system for malaria operations.
Beneficiaries:
The Malaria Control Program targets the meager-resourced municipalities in
endemic provinces, rural poor residing near breeding areas, farmers relying on forest
products, indigenous people with limited access to quality health care services,
communities affected by armed conflicts, as well as pregnant women and children
aged five years old and below.
 
Program Strategies:

146
The DOH, in coordination with its key partners and the LGUs, implements the
following interventions:

1.Early diagnosis and prompt treatment

          Diagnostic Centers were established and strengthened to achieve this strategy.
The utilization of these diagnostic centers is promoted to sustain its functionality.
2. Vector control
           The use of insecticide-treated mosquito nets, complemented with indoor
residual spraying, prevents malaria transmission.
3. Enhancement of local capacity
           LGUs are capacitated to manage and implement community-based malaria
control through social mobilization.
 
Program Accomplishments:
For the development of health policies, the Malaria Medium Term Plan (2011-
2016) is already in its final draft while the Malaria Monitoring and Evaluation
Framework and Plan is being drafted. The Malaria Program is being monitored in six
provinces as the Philippine Malaria Information System is being reviewed and
enhanced.
In strengthening the capabilities of the LGUs, trainings are conducted. These
include: series of Basic and Advance Malaria Microscopy Training; Malaria Program
Management Orientation and Training for the rural health unit (RHU) staff; and Data
Utilization Training. Also, there are the Clinical Management for Uncomplicated and
Severe Malaria and the Malaria Epidemic Management.
Lastly, health services are leveraged through the provision of anti-malaria
commodities.
 
Partner Organization/Agencies:
The following organizations/agencies take part in achieving the goals of Malaria
Control Program:
  Pilipinas Shell Foundation, Inc, (PSFI)
  Roll Back Malaria (RBM); World Health Organization (WHO)
  Act Malaria Foundation, Inc
  Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI)
  Research Institute of Tropical Medicine (RITM)
  University of the Philippines-College of Public Health (UP-CPH)
  Philippine Malaria Network
  Australian Agency for International Development (AusAID)
  Asia Pacific Malaria Elimination Network (APMEN)
  Malaria Elimination Group (MEG)
  Local Government Units (LGUs)

147
 National Tuberculosis Control Program

Tuberculosis is a disease caused by a bacterium called Mycobeacterium

tuberculosis that is mainly acquired by inhalation of infectious droplets containing
viable tubercle bacilli. Infectious droplets can be produced by coughing, sneezing,
talking and singing. Coughing is generally considered as the most efficient way of
producing infectious droplets.
In 2007, there are 9.27 million incident cases of TB worldwide and Asia
accounts for 55% of the cases. Through the National TB Program (NTP), the
Philippines achieved the global targets of 70% case detection for new smear positive
TB cases and 89% of these became successfully treated. The various initiatives
undertaken by the Program, in partnership with critical stakeholders, enabled the
NTP to sustain these targets. Nonetheless, emerging concerns like drug resistance
and co-morbidities need to be addressed to prevent rapid transmission and future
generation of such threats. Coverage should also be broadened to capture the
marginalized populations and the vulnerable groups namely, urban and rural poor,
captive populations (inmates/prisoners), elderly and indigenous groups.
Last 2009, the National Center for Disease Prevention and Control of the
Department of Health led the process of formulating the 2010-2016 Philippine Plan of
Action to Control TB (PhilPACT) that serves as the guiding direction for the attainment
of the Millenium Development Goals (MDGs). Learning from the Directly-Observed
Treatment Shortcourse (DOTS) strategy, the eight (8) strategies of PhilPACT are
anchored on this TB control framework. Moreover, these strategies are also attuned
with the Government’s health reform agenda known as Kalusugang Pangkalahatan
(KP) to ensure sustainability and risk protection.
 
Vision: TB-free Philippines
Goal: To reduce by half TB prevalence and mortality compared to 1990 figures by
2015

Objectives:
The NTP aims to:
1. Reduce local variations in TB control program performance
2. Scale-up and sustain coverage of DOTS implementation
3. Ensure provision of quality TB services
4. Reduce out-of-pocket expenses related to TB care
 
Strategies:
Under PhilPACT, there are 8 strategies to be implemented, namely:
1. Localize implementation of TB control
2. Monitor health system performance
3. Engage all health care providers, public and private
4. Promote and strengthen positive behavior of communities
5. Address MDR-TB,TB-HIV and needs of vulnerable populations
6. Regulate and make quality TB diagnostic tests and drugs
7. Certify and accredit TB care providers

148
 8. Secure adequate funding and improve allocation and efficiency of fund
utilization
 
Program Accomplishments:
Significant progress has been achieved since the Philippines adopted the DOTS
strategy in 1996 and at the end of 2002-2003, all public health centers are enabled
to deliver DOTS services. Because of the Government’s efforts to continuously
improve health care delivery, there have been progressive increases in the detection
and treatment success. While a strong groundwork has been installed, acceleration of
efforts is entailed to expand and sustain successful TB control. All stakeholders are
called upon to achieve the TB targets linked to the MDGs set to be attained by 2015.
However, with the emergence of other TB threats, more has to be done. Likewise, with
the ongoing global developments and new technologies in the pipeline, constraints
will hopefully be addressed.
The 2010-2016 PhilPACT as defined by multi-sector partners, through 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. Ever since, diagnosis through
sputum smear microscopy and treatment with a complete set of anti-TB drugs are
given free through the support of the Government. Training on TB care for different
types of health workers is being conducted through the regional and local NTP
Coordinators. The conclusions during the program implementation review (PIR) done
by the DOH of selected public health programs on January 2008 reveal the following:
 Extent and quality of nationwide TB-DOTS coverage have reached levels
necessary for eventual control since 2004 up to present
 NTP continues to add enhancements and improvements to TB care providers for
better delivery of services
 
Partner Organizations/Agencies:
The following are the organizations/agencies that take part in achieving the
objectives of the National TB Control Program:
 Philippine Business for Social Progress         
 Philippine Coalition Against TB
 Holistic Community Development Initiatives (HCDI)
 National TB Ref Laboratory
 Lung Center of the Philippines
 Bureau of Jail Management and Penology (BJMP)
 Bureau of Corrections
 Department of Interior and Local Government (DILG)
 Department of Education (DepEd)
 Armed Forces of the Philippines-Office of the Surgeon General (AFP-OTSG)
 PhilHealth
149
  Research Institute of Tuberculosis/ Japan Anti-Tuberculosis
Association Philippines, Inc. (RIT/JATA)
 Philippine Tuberculosis Society Inc. (PTSI)
 Kabalikat sa Kalusugan
 Samahang Lusog Baga
 National Commission for Indigenous Peoples
 Department of National Defense-Veterans Memorial Medical Center (DND-
VMMC)
 Occupational Health and Safety (OSHC); Bureau of Working Conditions (BWC)
 World Vision Development Foundation (WVDF)
 International Committee of Red Cross
 Korea Foundation for International Health Care (KOFIH)
 World Health Organization (WHO)
 United States Agency for International Development (USAID)
 Committee of German Doctors for Developing Countries

Natural Family Planning

Population/Family Planning Issue

Senate Bill No. 1546: "Reproductive Health Act of 2004"
House Bill No. 16: "Reproductive Health Act of 2004"
The Truth About the P50M CFC Contract with DOH
CFC-DOH Partnership
Letter to the Editor: Philippine Daily Inquirer

Family Planning

Brief Description of Program

A national mandated priority public health program to attain the country's

national health development: a health intervention program and an important tool for
the improvement of the health and welfare of mothers, children and other members
of the family. It also provides information and services for the couples of reproductive
age to plan their family according to their beliefs and circumstances through legally
and medically acceptable family planning methods.
The program is anchored on the following basic principles.
* Responsible Parenthood which means that each family has the right and duty
to determine the desired number of children they might have and when they might
have them. And beyond responsible parenthood is Responsible Parenting which is the
proper upbringing and education of children so that they grow up to be upright,
productive and civic-minded citizens.

150
 National Filariasis Elimination Program

Filariasis is a major parasitic infection, which continues to be a public health

problem in the Philippines.  It was first discovered in the Philippines in 1907 by
foreign workers.  Consolidated field reports showed a prevalence rate of 9.7% per
1000 population in 1998. It is the second leading cause of permanent and long-term
disability. The disease affects mostly the poorest municipalities in the country about
71% of the case live in the 4th-6th class type of municipalities.
The World Health Assembly in 1997 declared “Filariasis Elimination as a
priority” and followed by WHO’s call for global elimination. A sign of the DOH’s
commitment to eliminate the disease, the program’s official  shift from control to
elimination strategies was evident in an Administrative Order #25-A,s 1998
disseminated to endemic regions. A major strategy of the Elimination Plan was the
Mass Annual Treatment using the combination drug, Diethylcarbamazine Citrate and
Albendazole for a minimum of 2 years & above living in established endemic areas
after the issuance from WHO of the safety data on the use of the drugs.  The
Philippine Plan was approved by WHO which gave the government free supply of the
Albendazole (donated b y GSK thru WHO) for filariasis elimination. In support to the
program, an Administrative Order declaring “November as Filariasis Mass Treatment
Month was signed by the Secretary of Health last July 2004 and was disseminated to
all endemic regions. 
 
Vision:  Healthy and productive individuals and families for Filariasis-free
Philippines
 
Mission:   Elimination of Filariasis as a public health problem thru a comprehensive
approach and universal access to quality health services
 
Goal:  To eliminate Lymphatic Filariasis as a public health problem in the Philippines
by year 2017
 
General Objectives:   To decrease Prevalence Rate of filariasis in endemic
municipalities to <1/1000 population.
 
Specific Objectives:
The National Filariasis Elimination Program specifically aims to:
1. Reduce the Prevalence Rate to elimination level of <1%;
2. Perform Mass treatment in all established endemic areas;
3. Develop a Filariasis disability prevention program in established endemic areas;
and
4. Continue surveillance of established endemic areas 5 years after mass treatment.
 
Baseline Data:
Prevalence Rate (1997): 9.7% per 1,000 pop.
Endemic in 43 provinces in 11 regions with a total population at risk of 30,000,000
 
Target Population/Clients/Beneficiaries:
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The program targets individuals, families and communities living in endemic
municipalities in 44 provinces in 12 regions (30 million targeted for mass treatment
or 1/3 of the total population of the country).  However, 9 provinces have reached
elimination level namely: Southern Leyte; Sorsogon; Biliran; Bukidnon; Romblon;
Agusan Sur; Dinagat Islands; Cotabato Province; and COMVAL.
 
Program Strategies:
STRATEGY 1. Endemic Mapping                       
STRATEGY 2. Capability Building
STRATEGY 3. Mass Treatment (integrated with other existing parasitic programs)
STRATEGY 4. Support Control
STRATEGY 5. Monitoring and   Supervision
STRATEGY 6. Evaluation
STRATEGY 7. National Certification
STRATEGY 8. International Certification
 
Management Being Used:
1. Selective Treatment – treating individuals found to be positive for microfilariae in
nocturnal blood examination.
Drug: Diethylcarbamazine Citrate
Dosage: 6 mg/kg body weight in 3 divided doses for 12 consecutive days (usually
given after meals)
2. Mass Treatment – giving the drugs to all population from aged 2 years and above
in all established endemic areas.
Drug: Diethlcarbamazine Citrate (single dose based on 6 mg/kg body wt)
plus Albendazole 400mg given single dose given once annually to people 2 yrs &
above living in established endemic areas
3.  Disability Prevention thru home-based or community-based care for lymphedema
& elephantiasis cases.  Surgical management for hydrocele patients.
 
Status of the Program:
PROVINCES THAT REACHED ELIMINATION STAGE: Southern Leyte, Sorsogon,
Biliran, Bukidnon, Romblon, Agusan Sur, Dinagat island, Cotabato Province and
COMVAL
 
Partner Organizations/Agencies:
The following are the organizations/agencies that take part in achieving the
objectives of the National Filariasis Elimination Program:
 Coalition for the Elimination of Lymphatic Filariasis
 Culion Foundation, Inc.
 Peace and Equity Foundation, Inc. (PEF)
 Iloilo Caucus of Development NGOs, Inc. Iloilo (ICODE)
 Marinducare Foundation, Inc.
 Lingap Para sa Kalusugan ng Sambayanan, Inc. (LIKAS)
 Del Monte Foundation, Inc.
  Ang-Hortaleza Foundation (Splash Foundation)
  Belo Medical Group
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   GlaxoSmitheKline Foundation
  Center for Social Concern and Action (COSCA) with Theology Religious
Education Department (TREDTWO) – De La Salle University-Manila
  UP Open University-Manila
  UP Manila – National Institutes of Health (UP Manila-NIH)
  UP-College of Public Health
National Rabies Prevention and Control Program

Rabies is a human infection that occurs after a transdermal bite or scratch by

an infected animal, like dogs and cats. It can be transmitted when infectious
material, usually saliva, comes into direct contact with a victim’s fresh skin lesions.
Rabies may also occur, though in very rare cases, through inhalation of virus-
containing spray or through organ transplants.
Rabies is considered to be a neglected disease, which is 100% fatal though
100% preventable. It is not among the leading causes of mortality and morbidity in
the country but it is regarded as a significant public health problem because (1) it is
one of the most acutely fatal infections and (2) it is responsible for the death of 200-
300 Filipinos annually.
 
Vision:   To Declare Philippines Rabies-Free by year 2020
 
Goal:  To eliminate human rabies by the year 2020
 
Program Strategies:
To attain its goal, the program employs the following strategies:
         1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite Treatment
Centers (ABTCs)
         2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk individuals and
school children in high incidence zones
         3.  Health Education
              Public awareness will be strengthened through the Information, Education,
and Communication (IEC) campaign. The rabies program shall be integrated into the
elementary curriculum and the Responsible Pet Ownership (RPO) shall be promoted.
In coordination with the Department of Agriculture, the DOH shall intensify the
promotion of dog vaccination, dog population control, as well as the control of stray
animals.
              In accordance with RA 9482 or “The Rabies Act of 2007”, rabies control
ordinances shall be strictly implemented. In the same manner, the public shall be
informed on the proper management of animal bites and/or rabies exposures.
         4.  Advocacy
              The rabies awareness and advocacy campaign is a year-round activity
highlighted on two occasions – March as the Rabies Awareness Month and
September 28 as the World Rabies Day.
         5. Training/Capability Building
              Medical doctors and Registered Nurses are to be trained on the guidelines
on managing a victim.
         6. Establishment of ABTCs by Inter-Local Health Zone
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         7. DOH-DA joint evaluation and declaration of Rabies-free islands
 
Program Achievements:

The DOH, together with the partner organizations/agencies, has already

developed the guidelines for managing rabies exposures. With the implementation of
the program strategies, five islands were already declared to be rabies-free.
In 2010, 257 rabies cases and 266,200 animal bites or rabies exposures were
reported.  A total of 365 ABTCs were established and strategically located all over the
country. Post Exposure Prophylaxis against rabies was provided in all the 365
ABTCs.
 
Partner Organizations/Agencies:
The following organizations/agencies take part in attaining the goal of the National
Rabies Prevention and Control Program:
 Department of Agriculture (DA)
 Department of Education (DepEd)
 Department of Interior and Local Government (DILG)
 World Health Organization (WHO)
 Animal Welfare Coalition (AWC)
 BMGF Foundation
 WHO/BMGF Rabies Elimination Project
1. Bill and Melinda Gates Foundation
2. World Society for the Protection of Animals (WSPA)
3. Medical Research Council (MRC)

154
 Newborn Screening
 

Republic Act 9288

 
Newborn screening (NBS) is a public health
program aimed at the early identification of
infants who are affected by certain
genetic/metabolic/infectious conditions. Early
identification and timely intervention can lead
to significant reduction of morbidity, mortality,
and associated disabilities in affected infants.
NBS in the Philippines started in June 1996
and was integrated into the public health
delivery system with the enactment of the
Newborn Screening Act of 2004 (Republic Act
9288). From 1996 to December 2010, the
program has saved 45 283 patients.   Five
conditions are currently screened: Congenital
Hypothyroidism, Congenital Adrenal
Hyperplasia, Phenylketonuria, Galactosemia,
and Glucose-6-Phosphate Dehydrogenase
Deficiency.  
 
 
Current Status of NBS Implementation in the Philippines
 
Newborn Screening Legislation
NBS was integrated into the public health delivery system with the enactment of
Republic Act 9288 or Newborn Screening Act of 2004   as it institutionalized the
‘National NBS System’, which shall ensure the following: [a] that every baby born in
the Philippines is offered NBS; [b] the establishment and integration of a sustainable
NBS System within the public health delivery system; [c] that all health practitioners
are aware of  the benefits of NBS and of their responsibilities in offering it; and [d]
that all parents are aware of NBS and their responsibility in protecting their child
from any of the disorders. The highlights of the law and its implementing rules and
regulations are:
 
1. DOH is the lead agency tasked with implementing this law;
2. Any health practitioner who delivers or assists in the delivery of a newborn in
the Philippines shall prior to delivery, inform parents or legal guardians of the
newborns the availability, nature and benefits of NBS;
3. Health facilities shall integrate NBS in its delivery of health services;
4. Creation of the Newborn Screening Reference Center at the National Institutes
of Health and establishment and accreditation of NSCs equipped with a NBS
laboratory and recall/follow up program;

155
 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; NSC-Mindanao in
Davao City; and NSC-Central Luzon in Angeles City. The four NSCs provide
laboratory and follow up services for more than 3000+ health facilities.
 
DOH, its partners and major stakeholders remain aggressive in identifying strategies
to intensify awareness in the communities and increase coverage among home
deliveries.  Among the recent efforts to increase the newborn screening coverage are
appointment of full-time Regional NBS Coordinators; opening more G6PD
Confirmatory Laboratories; partnership with midwives organizations; and production
of information materials targeting different groups of health workers and
professionals.
 
Key Players in the Implementation
 
Organizational chart for the national implementation of Newborn Screening
 
Newborn Screening Statistics 
As of December 2010, there are 2,389,959 babies that have undergone NBS and
based on these data, the incidences of the following disorders are: CH (1: 3,324); CAH
(1: 9,446); PKU (1: 149,372); Gal (1: 108,635) and G6PD deficiency (1: 52).  The
program has saved the following numbers of newborns from complications and/or
death:  719 from CH, 253 from CAH, 22 from Gal, 16 from PKU and 44 273 from
G6PD deficiency.
 
Coverage
As of December 2010, the coverage of NBS is at 35%.  
 
DIRECTORY OF PROGRAM IMPLEMENTERS
 
National Center for Disease Prevention and Control –Family Health Office
Program Manager
Dr. Juanita A. Basilio
Dr. Anthony P. Calibo
 
National Newborn Screening Coordinator:
Ms. Lita Orbillo
San Lazaro Compound, Sta. Cruz, Manila
Telephone: (02) 7359956 
[email protected]  
 

156
Newborn Screening Reference Center
Director: Dr. Carmencita D. Padilla 
National Institutes of Health
Building H, UP Ayala Land Technohub
Complex,Commonwealth Avenue, Brgy. UP Campus
Diliman, Quezon City
Email: [email protected]
www.newbornscreening.ph 
 
Newborn Screening Centers
 
For Regions I, II, III & CAR 
Unit Head: Dr. Florencio Dizon
Newborn Screening Center – Central Luzon
Angeles City University Foundation Medical Center 
MacArthur Highway, Barangay Salapungan, Angeles City
Telephone: (045) 6246502-03; Email: [email protected]
 
For Regions IV, V & NCR 
Newborn Screening Center– National Institutes of Health 
Unit Head: Ms. Ma. Elouisa Reyes
Building H, UP Ayala Land Technohub
Complex,Commonwealth Avenue, Brgy. UP Campus
Diliman, Quezon City
Email: [email protected]
 
For Visayas  
Newborn Screening Center– Visayas
Unit Head: Dr. J Winston Edgar Posecion
West Visayas State University Medical Center
E. Lopez St., Jaro, Iloilo City
Telefax: (033) 329-3744; Email: [email protected]
 
For Mindanao  
Newborn Screening Center– Mindanao
Unit Head: Dr. Conchita Abarquez
Southern Philippines Medical Center
J.P. Laurel Avenue, Davao City
Telephone: (082) 226-4595 / 224-0337 
Telefax (082) 227-4152; Email:[email protected]
 

157
 Centers for Health Development
 
NBS Regional
CHD Mailing Address Business Phone
Coordinator
(072) 2425315; (072) Clarita B. Lewis,
CHD 1 - Ilocos San Fernando, La Union
2424773 RN
(078) 3046585; (078) Leticia T.
CHD 2 -
Tuguegarao City 8446585; (078) Cabrera, MD,
Cagayan Valley
8446523 MPA
(045) 4552324; (045)
CHD 3 - Adelina Cabrera,
San Fernando, Pampanga 9617649; (045)
Central Luzon RN
9617654
CHD 4-A QMMC Compound, Project 4, Maria Luisa M.
(02) 4403372
Calabarzon Quezon City Malana, RN
CHD 4-B Quirino Hospital Compound, (02) 9134650; (02) Ma. Teresa
Mimaropa Quezon City 9115025 Castillo, MD
Carla A. Orozco,
First Park Subdidivion, (052) 4830840
CHD 5- Bicol MD, MPH
Daraga, Albay loc 517/516
MS III
CHD 6 -
Q. Abeto St., Mandurriao, Iloilo Renilyn P. Reyes,
Western (033)3210364
City MD
Visayas
Nayda P.
CHD 7 -
Osmeña Blvd., Cebu City (032) 4187633 Bautista,MD,
Central Visayas
MPH
CHD 8-
Lilibeth Andrade,
Eastern Candahug, Palo , Leyte (053)3235025
MD
Visayas
CHD 9 -
Upper Calarian, Zamboanga Nerissa B.
Zamboanga (062)9830314-15
City Gutierrez, RN
Peninsula
CHD 10 - Ellenietta HMV N.
J.V. Seriña St., Carmen,
Northern 088-22- 727400 Gamolo, MD,
Cagayan de Oro City
Mindanao MPH
Ma. Clarose M.
CHD 11 - (082) 3051907; (082)
J.P. Laurel Avenue, Davao City Mascardo, RN,
Davao Region 2214011
MPH
CHD 12 - ARMM Compound, Gov. (064) 4217436; (064) Lucy Decio, RN
Central Guttierez Ave, Cotabato City 4218053

158
Mindanao
Pizarro St. cor. Narra Rd. Glynna B. Andoy,
CHD CARAGA (085) 3411452
Butuan City MD, MPH
BGHMC Compound, Baguio (074) 4428096; (074) Nicolas R. Gordo,
CHD CAR
City 4445255 Jr, MD
Welfareville Compound, Brgy.
(02) 7183097; (02) Ma. Paz P.
CHD NCR Addition Hills, Mandaluyong
5354521 Corrales, MD
City
Dayan
CHD ARMM ORG Compound, Cotabato City (064) 4217703
Sangcopan, MD

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

159
 
Continuing Education for Health Professionals, October 4, 2011 in La Union
 

 
The Heel Prick Method
 

 
NBS Awarding Ceremony
October 3, 2011
Traders Hotel

160
 National HIV/STI Prevention Program
 
Objective:
Reduce the transmission of HIV and STI among the Most At Risk Population and
General Population and mitigate its impact at the individual, family, and community
level.
 
Program Activities:
 With regard to the prevention and fight against stigma and discrimination, the
following are the strategies and interventions:
1. Availability of free voluntary HIV Counseling and Testing Service;
2. 100% Condom Use Program (CUP) especially for entertainment establishments;
3.  Peer education and outreach;
4.  Multi-sectoral coordination through Philippine National AIDS Council (PNAC);
5.  Empowerment of communities;
6. Community assemblies and for a to reduce stigma;
7.  Augmentation of resources of social Hygiene Clinics; and
8. Procured male condoms distributed as education materials during outreach.
 
Program Accomplishments:
As of the first quarter of 2011, the program has attained particular targets for
the three major final outputs: health policy and program development; capability
building of local government units (LGUs) and other stakeholders; and leveraging
services for priority health programs.
For the health policy and program development, the Manual of Procedures/
Standards/ Guidelines is already finalized and disseminated. The ARV Resistance
surveillance among People Living with HIV (PLHIV) on Treatment is being
implemented through the Research Institute for Tropical Medicine (RITM). Moreover,
both the Strategic Plan 2012-2016 for Prevention of Mother to Child Transmission
and the Strategic Plan 2012-2016 for Most at Risk Young People and HIV Prevention
and Treatment are being drafted.
With regard to capability building, the Training Curriculum for HIV Counseling
and Testing is already revised. Twenty five priority LGUs provided support in
strengthening Local AIDS councils. as of March 2011, there were already 17
Treatment Hubs nationwide.
Lastly, for the leveraging services, baseline laboratory testing is being provided
while male condoms are being distributed through social Hygiene Clinics. A total of
1,250 PLHIV were provided with treatment and 4,000 STI were treated.
 
Partner Organizations/Agencies:
The following organizations/agencies take part in achieving the goal of the National
HIV/STI Prevention Program:
 Department of Interior and Local Government (DILG)
 Philippine National AIDS Council (PNAC)
 Research Institute for Tropical Medicine (RITM)
 STI/AIDS Cooperative Central Laboratory (SCCL)
 World Health Organization (WHO)
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  United States Agency for International Development (USAID)
 Pinoy Plus Association
 AIDS Society of the Philippines (ASP)
 Positive Action Foundation Philippines, Inc. (PAFPI)
 Action for Health Initiatives (ACHIEVES)
 Affiliation Against AIDS in Mindanao (ALAGAD-Mindanao)
 AIDS Watch Council (AWAC)
 Family Planning Organization of the Philippines (FPOP)
 Free Rehabilitation, Economic, Education, and Legal Assistance Volunteers
Association, Inc. (FREELAVA)
 Philippine NGO council on Population, Health, and Welfare, Inc. (PNGOC)
 Leyte Family Development Organization (LEFADO)
 Remedios AIDS Foundation (RAF)
 Social Development Research Institute (SDRI)
 TLF share Collectives, Inc.
 Trade Union Congress of the Philippines (TUCP) Katipunang Manggagawang
Pilipino
 Health Action Information Network (HAIN)
 Hope Volunteers Foundation, Inc.
 KANLUNGAN Center Foundation, Inc. (KCFI)
 Kabataang Gabay sa Positibong Pamumuhay, Inc. (KGPP)

National Mental Health Program

I. Rationale:

Background of the Program

Vision: Better Quality of Life through Total Health Care for all Filipinos.
Mission: A Rational and Unified Response to Mental Health.
Goal: Quality Mental Health Care.
Objective: Implementation of a Mental Health Program strategy

The National Mental Health Policy shall be pursued through a Mental Health
Program strategy prioritizing the promotion of mental health, protection of the rights
and freedoms of persons with mental diseases and the reduction of the burden and
consequences of mental ill-health, mental and brain disorders and disabilities.

State International Support and Policies, Mandates

Stakeholders:

To ensure the sustainability and effectiveness of the National Mental Health Program,
certain committees and teams were organized.
1. National Program Management Committee (NPMC)

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 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).

Its functions are as follows:

 Oversee the development of mental health measures for sub-programs and

components;
 Integrate the various programs, project and activities from the various program
development and management groups for each sub-program;
 Manage the various sub-programs and components of the National Mental
Health Program;
 Oversee the implementation of prevention and control measures for mental
health issues and concerns; and
 Recommended to the Secretary of Health a master plan for mental health
aligned with the mandates and thrusts of various government agencies.

2. Program Development and Management Teams (PDMT)

Under the NPMC, PDMT shall be established corresponding to the four sub-programs
of the National Mental Health Program. A PDMT shall oversee the operations of a
sub-program of the National Mental Health Program.

The functions of PDMT are:

 Formulate and recommend policies, standards, guidelines approaches on each

specifics sub-programs on mental health;
 Develop a plan of action for each specific sub-program in consultation with
mental health advocates and stakeholders
 Develop operating guidelines, procedures, protocols for the mental health sub-
program. Ensure the implementation of the program among all stakeholders;
and
 Provide technical assistance to other mental health teams according to sub-
programs thrusts.

3. Regional Mental Health Teams (RMHT)

To ensure an efficient and effective multi-sectoral implementation of the National

Mental Health Program at the regional level, a RMHT shall be established in each of
the Centers for Health Development (CHD).

The functions are as follows:

 Oversee the planning and operation of the National Mental Health Program at
the regional level;

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  Provide technical assistance on the issues and concerns pertaining to the
implementation of the different subprograms of the National Mental Health
Program;
 Strengthen technical and managerial capability at the local level to ensure LGU
participation on the implementation of the National Mental Health Program;
 Ensure establishment of LGU teams for mental health;
 Ensure the conduct of monitoring and evaluation of the implementation of the
National Mental Health Program at the regional level; and
 Regularly update the PDMT on the status of the regional implementation of the
National Mental Health Program.

4. Local Government Unit Mental Health Teams (LGUMHT)

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

5. Other Partners and Stakeholders

Other stakeholders who may or may not belong to the above-mentioned committees
or teams may contribute to the implementation of the National Mental Health
Program by:

 Ensuring the availability of competent, efficient, culturally and gender-sensitive

health care professionals who provide mental health services;
 Identifying mental health needs of the population and refer findings to the
appropriate mental care provider; and
 Promoting and advocating for the implementation of the program within their
respective areas of responsibility.

II. Scenario

Global Situation:

Many people with mental health conditions, as well as their families and caregiver,
experience the consequences of vulnerability on a daily basis. Stigma, abuse, and
exclusion are all-too-common. Although their vulnerability is not inevitable, but
rather brought about their social environments, over time it leads to a range of
adverse outcomes, including poverty, poor health, and premature death.

Because they are highly vulnerable and are barely noticed- expert to be stigmatized
and deprive of their rights- it is crucial that people with mental health conditions are
recognized and targeted for development interventions. The case for their inclusion is
compelling. People with mental health conditions meet vulnerability criteria: they
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experience severe stigma and discrimination; they are more likely to be subjected to
abuse and violence than the general population; they encounter barriers to exercising
their civil and political rights, and participating fully in society; they lack access to
health and social services, and services during emergencies; they encounter
restriction to education; and they excluded from income-generating and employment
opportunities. As a cumulative result of these factors, people with mental conditions
are at heightened risk for premature death and disability. Mental health conditions
also are highly prevalent among people living in poverty, prisoners, people living with
HIV/AIDS, people in emergency settings, and other vulnerable groups.

Attention from development stakeholders is needed urgently so that the down-ward-

spiral of even-greater vulnerability and marginalization is stopped, and instead,
people with mental health conditions can contribute meaningfully to their countries’
development.

As a starting point, development stakeholders can consider carefully the general

principles for action outlined in this report, and decided how best to incorporate
them into their specific areas of work. Targeted policies, strategies, and interventions
for reaching people with mental conditions then should be developed, and mental
health interventions should be mainstreamed into broader national development and
poverty reduction policies, strategies, and interventions. To make implementation a
reality, adequate funds must be dedicated to mental health interventions, and
recipients of development aid should be encouraged to address the needs of people
with mental health conditions as a part of their development work. At country level,
people with mental health conditions should be sought and supported to participate
in development opportunities in their communities.

Specific areas for action address the social and economic factors leading to
vulnerability. Mental health services should be provided in primary care settings and
integrated with general health services. To that end, mental health issues should be
mainstreamed on countries’ broader health policies, plans, and human resource
development, as well as recognized as an important issue to consider in global and
multisectoral efforts, such as the International Health Partnership, the Gloring
Health Workforce Alliance, and the Health Metrics Network. During and after
emergencies, development stakeholders should promote the (re)construction of
community-based mental health services, which can serve the population long
beyond the immediate aftermath of the emergency. Development strategies and plans
should encourage strong links between health/mental health services, housing, and
other social services. Access to education for people with mental conditions, as well
as early childhood programmes for vulnerable groups should be supported by
development stakeholders in order to achieve better development outcomes. People
with mental health conditions should be included in employment and income
generating programmes to assist with poverty alleviation, improve autonomy and
mental health. Throughout their different areas of work, development stakeholders
can and should support human rights protections for people with mental conditions
and built their capacity to participate in public affairs.

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This report provides a number of recommendation and specifics areas of action that
need to be integrated into policy, planning, and implementation by development
stakeholders according to their role and strategic advantage. To achieve this aim
development stakeholders need to recognize people with mental health conditions as
a vulnerable group requiring support from development programmes.

(World Health Organization and Mental Health and Poverty Project, 2010)

Local Situation
In a local baseline survey in 1964-67 in Sta. Cruz, Lubao, Pampanga, Manapsal of
the DOH Division of Mental Hygiene, Bureau of Disease Control, found that the
prevalence of mental health was 36% per 1,000 adults, children and adolescents. The
1980 WHO Collaborative Studies for Extending Mental Health Care in General Health
Care Services (involving seven countries) showed that 17% for adults and 16% of
children who consulted at three health centers in Sampaloc, Manila have mental
disorders. Depressive reactions in adults and adaptation reaction in children were
most frequently found. In Sapang Palay, San Jose Del Monte, Bulacan, the
prevalence of adult schizophrenia was 12 cases per 1,000 population in 1988-1989
(Manalang et al).

In Region 6 (Iloilo, Negros Occidental and Antique), Perlas et al. im 1993-94 showed
that the prevalence of the following mental illness in the adult population were:
psychosis (4.3%), anxiety (14.3%), panic (5.6%). For the children and adolescent, the
top five most prevalent psychiatric conditions were: enuresis (9.3%), speech and
language disorder (3.9%), mental subnormality (3.7%), adaption reaction (2.4%) and
neurotic disorder (1.1%).

The current DOH bed capacity for mental disorder is 5,465. Of these, 4,200 beds are
in the NCR (at the National Center for Mental Health). The rest of the country share
the remaining 1,265 beds (CAR-40 beds, Region 2-200 beds, Region3-500 beds,
Region 11-200 beds). Regions 1,4,10,12, CARAGA and ARMM do not have inpatient
psychiatric facilities. Only 27 DOH medical centers and regional hospitals have
mental health services. Cavite is the only province with a psychiatric facility.

These situations have hampered the delivery of basic services, aborted the national
development, and reduced quality of life of the Filipino. Life has become severely
stressful to most, whether rich or poor, young or old. The resiliency of the Filipino
people to adapt to his present life situation is being stretched too far. Warning signs
of restlessness abound such as increasing reports of suicides and substance abuse.
Decline in the socio-economic condition may translate into mental-ill health and
therefore mental health disorders and mental disabilities.

However, the provision of mental health services in the country, has remained
illness-oriented, institution-based, fragmented, inadequate, inequitable, inaccessible,
prohibitive, and neglected.

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The Department of Health (DOH), the national lead agency for health recognizes the
magnitude of the mental health problem as contained in the National Objectives for
Health (NOH) 1999-2004. Among the objectives are set the following:

- Reduction of morbidity, mortality, disability and complications from

mental disorder

- Promotion of healthy lifestyle through the promotion of mental health

and less stressful life.

However, the DOH has constraints in attaining these objectives given the limited
government resources. Within the health sector, mental health has to compare for
resources against other equally important health objectives. Concomitant reforms are
therefore being pursued in hospitals, public health, local health systems, regulation
as well as financing with the end-view of improving the health of all Filipinos as
embodied in the Health Sector Reform Agenda.

Statistics/Local data about the disease program

Disorder Number of Cases % 95% CI

Specific Phobias 93 19 15.98, 23.1
Alcohol Abuse 31 6 4.56, 8.96
Depression 14 3 1.74, 4.8
 

Number of Diagnosis No. of Respondents %

One Diagnosis 56 12
Multiple Diagnosis 66 15
                  2 Diagnoses 32  
                  3 Diagnoses 7  
                  >/=4 Diagnoses 27  
Total 122 27

*Department of Health (DOH) and Field Epidemiology Training Program Alumni

Foundation Incorporated (FETPAFI)

III. Interventions/ Strategies employed or implemented by DOH

The National Mental Health Program has the following program strategies:

1. Health Promotion and Advocacy

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

2. Service Provision

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

3. Policy and Legislation

The formulation and institutionalization of national legislation, policies, program

standards and guidelines shall emphasize the development of efficient and effective
structures, systems, and mechanisms that will ensure equitable, accessible,
affordable and appropriate health services for the mentally ill patients, victims of
disaster, and other vulnerable groups.

4. Encouraging the development of a research culture and capacity

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

5. Capability Building

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

6. Public-Private Partnership

Inter-sectoral approaches and networking with other government agencies, non-

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

7. Establishment of data base and information system

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

8. Development of model programs

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

9. Monitoring and Evaluation

A regular review process shall be conducted. Results of program monitoring and

evaluation shall be used in formulating and modifying policies, program objectives
and action plans to sustain the mental health initiatives and ensure continuing
improvement in the delivery of mental health care.

Program Direction
Micro Point of View

Major Activities/Celebrations:
Celebration Date
Autism Consciousness Week Every 3rd Week of January
National Mental Retardation Week February 14 to 19
National Epilepsy Awareness Week Every 1st Week of September
National Mental Health Week Every 2nd Week of October
National Attention Deficit/Hyperactivity
Every 3rd Week of October
Disorder Awareness Week
Substance Abuse Prevention & Control Week Every 3rd Week of November

V. Future Plan/ Action

 2 Batches of Training on Promotion Mental Health in the Communities

 1 Batch of Training on Psychosocial Intervention
 Series of lecture on Suicide prevention in different Schools & Colleges
 Mental Health Summit in celebration of World Mental Health Day

Partner Organizations/Agencies:

The following organizations/agencies partake in achieving the vision of the program:

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Philippine Psychiatric Association (PPA)
Suite 1007, 10th flr. Medical Plaza Ortigas Condominium
San Miguel Ave. Ortigas Center Pasig City
# (632) 635-98-58.

Dr. Constantine Della

President
Contact no. 0922-8537949
Email Add.: [email protected]

Dr. Romeo Enriquez

Vice President
Contact no. 0933-5794140/ 0920-9053041
Email add: [email protected]

National Center for Mental Health (NCMH)

Nuevo de Pebrero St. Mauway, Madaluyong City
# (632) 531-90-01

Dr. Bernardino Vicente

Medical Center Chief

Philippine Mental Health Association (PMHA)

No. 18 East Avenue, Quezon City 1100
#(632) 921-49-58; (632) 921-49-59

Ms. Regina De Jesus

National Executive Director

Christoffel Blindenmission (CBM)

Unit 604, Alabang Business Tower
1216 Acacia Avenue, Madrigal Business Park
Alabang, Muntinlupa City 178
# (632) 807-85-86; (632) 807-85-87

Mr. Willy Reyes

Contact no. 0905-4142608

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 National Dengue Prevention and Control Program
 
The National Dengue Prevention and Control Program was first initiated by the
Department of Health (DOH) in 1993. Region VII and the National Capital Region
served as the pilot sites. It was not until 1998 when the program was implemented
nationwide. The target populations of the program are the general population, the
local government units, and the local health workers.
 
Vision: Dengue Risk-Free Philippines
Mission: To improve the quality of health of Filipinos by adopting an integrated
dengue control approach in the prevention and control of dengue infection.
Goal: Reduce morbidity and mortality from dengue infection by preventing the
transmission of the virus from the mosquito vector human.
 
Objectives:
The objectives of the program are categorized into three: health status objectives; risk
reduction objectives; and services & protection objectives.
 
Health Status Objectives:
 Reduce incidence from 32 cases/100,000 population to 20 cases/100,000
population;
 Reduce case fatality rate by <1%; and
 Detect and contain all epidemics.

Risk Reduction Objectives:

 Reduce the risk of human exposure to aedes bite by House index of <5 and
Breteau index of 20;
 Increase % of HH practicing removal of mosquito breeding places to 80%; and
 Increase awareness on DF/DHF to 100%.
 
Services & Protection Objectives:
 Establish a Dengue Reference Laboratory capable of performing IgM capture
ELISA for Dengue Surveillance;
 Increase the % of 1° and 2° government hospitals with laboratory capable of
platelet count and hematocrit; and
 Ensure surveillance and investigation of all epidemics. 
  
Partner Organizations/Agencies:
The following organizations/agencies take part in the achievement of the program’s
objectives:
 World Health Organization (WHO)
 United Nations children’s Fund (UNICEF)
 Department of Interior and Local Government (DILG)
 Department of Education (DepEd)
 United States Agency for International Development (USAID)
 Asian Development Bank (ADB)

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  Philippine Health Insurance Corporation (PhilHealth)
National Prevention of Blindness Program

Government Mandates and Policies:

 Administrative Order No. 179 s.2004: Guidelines for the Implementation of the
National Prevention of Blindness Program
 Department Personnel Order No. 2005-0547: Creation of Program Management
Committee for the National Prevention of Blindness Program

Subcommittees: Refractive Error/Low Vision, Childhood Blindness, Cataract

 Proclamation No. 40 declaring the month of August every year as “Sight Saving
Month”

Vision:All Filipinos enjoy the right to sight by year 2020

Mission: The DOH, Local Health Unit (LGU) partners and stakeholders commit  to:
1. Strengthen partnership among and with stakeholder to eliminate avoidable
blindness in the Philippines;
2. Empower communities to take proactive roles in the promotion of eye health
and prevention of blindness;
3. Provide access to quality eye care services for all; and
4. Work towards poverty alleviation through preservation and restoration of sight
to indigent Filipinos.

Goal:         Reduce the prevalence of avoidable blindness in the Philippines through

the provision of quality eye care.
            The program has the following objectives:
 
General Objective No. 1:
Increase Cataract Surgical Rate from 730 to 2,500 by the year 2010
Specific:
1. Conduct 74,000 good outcome cataract surgeries by 2010;
2. Ensure that all health centers are actively linked to a cataract referral center by
2008;
3. Advocate for the full coverage of cataract surgeries by Philhealth;
4. Establish provincial sight preservation committees in at least 80% of provinces
by 2010;
5. Mobilize and train at least one primary eye care worker per barangay by 2010;
6. Mobilize and train at least one mid-level eye care health personnel per
municipality by 2010;
7. Improve capabilities of at least 500 ophthalmologists in appropriate techniques
and technology for cataract               surgery;
8. Develop quality assurance system for all ophthalmology  service facilities by
2008; and
9. Ensure that 76 provincial,16 regional and 56 DOH retained hospitals are
equipped for appropriate technology for cataract surgery.
 
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General objective no 2:
Reduce visual impairment due to refractive errors by 10% by the year 2010   
1. Institutionalize visual acuity screening for all sectors by 2010;
2. Ensure that all health centers are actively linked to a referral center by 2008;
3. Distribute 125,000 eye glasses by 2010;
4. Ensure that the hospitals and of health centers have professional eye health
care providers by 2010;
5. Ensure establishment of equipped refraction centers in municipalities by 2008;
and
6. Establish and maintain an eyeglass bank by 2007.
 
General objective no 3:
Reduce the prevalence of visual disability in children from 0.3% to 0.20% by
the 2010
1. Identify children with visual disability in the community for timely intervention;
2. Improve capability of 90% of health worker to identify and treat visual disability
in children by 2010; and
3. Establish a completely equipped primary eye care facility in municipalities by
2008.
 
Burden of Blindness and Visual Impairment :       

Global Facts
The Philippines is a signatory in the Global Elimination of Avoidable Blindness:
Vision 2020 – The Right to Sight. The Vision 2020 was initiated by the International
Agency for Prevention of Blindness (IAPB), World Health Organization (WHO), and the
Christian Blind Mission (CBM), Vision 2020 aims to develop sustainable
comprehensive health care system to ensure the nest possible vision for all people
and thereby improve the quality of life.
According to WHO estimates:
 Approximately 314 million people worldwide live with low vision and blindness
 Of these, 45 million people are blind and 269 million have low vision
 145 million people's low vision is due to uncorrected refractive errors (near-
sightedness, far-sightedness or astigmatism). In most cases, normal vision
could be restored with eyeglasses
 Yet 80% of blindness is avoidable - i.e. readily treatable and/or preventable
 90% of blind people live in low-income countries
 Restorations of sight, and blindness prevention strategies are among the most
cost-effective interventions in health care
 Infectious causes of blindness are decreasing as a result of public health
interventions and socio-economic development. Blinding trachoma now affects
fewer than 80 million people, compared to 360 million in 1985
 Aging populations and lifestyle changes mean that chronic blinding conditions
such as diabetic retinopathy are projected to rise exponentially
 Women face a significantly greater risk of vision loss than men

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  Without effective, major intervention, the number of blind people worldwide has
been projected to increase to 76 million by 2020
 
Burden of Blindness and Visual Impairment :       

Local Facts
 Number of blind people:  592,000 (based on 2011 estimated population of 102M
& 2002 blindness prevalence of 0.58%)
 Number of persons with moderate or severe visual impairment:  2 million (2011
popn. &  2002 prevalence of 2.04%)
 Number of blind due to cataract:  367,000 (62%)
 Number of blind due to EOR:  59,000 (10%)
 Number of blind from cataract below poverty line:  92,000 (25%, NSCB 2009
figures]; figure est. doubled to include first & second quintiles
 
RP Prevalence of Blindness (%), 2002
Caraga 0.16
National Capital Region 0.19
Cordillera Autonomous Region 0.2
Central Mindanao 0.4
Ilocos Region 0.5
Western Visayas 0.51
Eastern Visayas 0.53
Southern Luzon 0.56
National Figure 0.58

Northern Mindanao 0.61

Central Visayas 0.62
Bicol Region 0.71
Western Mindanao 0.74
Central Luzon 0.79
Autonomous Region of Mislim Mindanao 0.8
Cagayan Valley 0.87
Southern Mindanao 1.08
 
 
RP Prevalence of Low Vision (%), 2002
Caraga 0.6

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 National Capital Region 0.81
Cordillera Autonomous Region 0.87
Central Luzon 1.21
Central Mindanao 1.53
Western Mindanao 1.59
Southern Mindanao 1.71
Central Visayas 1.76
Western Visayas 1.91
 National Figure                                                                          1.98

Northern Mindanao 2.17

Ilocos Region 2.43
Autonomous Region of Muslim Mindanao 2.43
Bicol Region 2.52
Eastern Visayas 2.56
Southern Luzon 3.71
Cagayan Valley 4.07
 
RP Prevalence of Visual Impairment (%) , 2002
Caraga 0.76
National Capital Region 1
Cordillera Autonomous Region 1.07
Central Mindanao 1.93
Central Luzon 2
Western Mindanao 2.33
Central Visayas 2.38
Western Visayas 2.42
National Figure                                                      2.56 

Northern Mindanao 2.78

Southern Mindanao (blindness) 2.79
Ilocos Region (Low Vision) 2.93
Eastern Visayas (Low Vision) 3.18
Autonomous Region of Muslim Mindanao 3.23
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 Bicol Region 3.23
Southern Luzon (Low Vision) 4.27
Cagayan Valley 4.94
 

Interventions/Strategies employed or Implementation by the DOH

       1.     Advocacy and Health Education

   This includes patient information and education, public information and education
and intersectoral collaboration on eye health promotion and the nature and extent of
visual impairments particularly its risk factors and complications and the
need/urgency of early diagnosis and management.       
       2.    Capability Building
     This component shall focus on ensuring the capability of national and local
government health facilities in delivering the appropriate eye health care services
especially to the indigent sector of the population. Program shall provide training for
coordinators at regional and provincial levels; will ensure the availability of and
access to training programs by program implementers. It shall include strengthening
treatment/management capabilities of existing personnel and operating capabilities
of facilities conducting cataract operations etc., taking into outmost consideration
basic quality assurance and standardization of procedures and techniques
appropriate to each facility/locality.

      3.      Information Management

      The program shall develop an information management system for purposes of
reporting and recording. As far as practicable, this system shall consider and will
build on any existing mechanism. The system shall be national in scope, although
the mechanism shall consider the regional and local needs and capabilities.

      4.      Networking, Partnership Building and Resource Mobilization

      An important component of the program is networking and partnership building
to ensure that services are available at the local level. This shall include public-
private and public-public partnership aimed at building coalition and networks for
the delivery of appropriate eye health care services at affordable cost especially to the
indigent sector. This component shall also focus on ensuring that the highest
appropriate quality services are made available and accessible to the people.

     5.      Supervision, Monitoring and Evaluation

      The Program shall be coordinated by a national program coordinator from the
Degenerative Disease Office of the National Center for Disease Prevention and
Control, Department of Health. The national program coordinator shall oversee the
implementation of program plans and activities with the assistance of the regional
coordinators from the Centers for Health Development.
    A system of monitoring program plans and activities shall be developed and
implemented taking into consideration the provision of the local government code as
176
well as the organic act of Muslim Mindanao, and any similar issuances/laws that will
be passed in the future.
      A program review shall be conducted as needed. Result of program evaluation
shall be used in formulating policies, program objectives and action plans.

    6.      Research and Development

      The program shall encourage the conduct of researches for purposes of
developing local competence in eye health care and for other purposes that may be
necessary. The development and dissemination of clinical practice guidelines for eye
health shall form part of the research agenda of the program.
      The program shall support researches/studies in the clinical behavior (KAP) and
epidemiological (trends) areas. It also aims to acquire information that is utilized for
continuing public health information and education, policy formulation, planning
and implementation.

    7.      Service Delivery

      Service delivery for the prevention of Blindness Program shall be covered by the
principle of best practice. In collaboration with the local government units and
stakeholders, the program shall develop systems and procedures for the integration
and provision of services at the community level. This means primary eye prevention
concentrating on health education, advocacy and primary eye interventions;
Secondary prevention; screening/early detection/basic management/ counseling,
referral and/or definitive care and tertiary prevention: management of complications,
continuing care and follow up including rehabilitation. The following areas will be the
priority areas for services to be provided by the National Prevention of Blindness
Program:

a.       Cataract Surgeries

b.      Errors of Refraction
c.       Childhood Blindness

Activities for the Vitamin A Deficiency Disorder, for practical purposes, shall be led by
the Family Health Office also of the NCDPC.
A Referral System shall form part of services delivered by the program. This is to
ensure that all patients receive quality eye health care at appropriate levels of health
care delivery system. All rural health units should be linked to an eye care referral
center.

Cataract
Cataract, the opacification of the normally clear lens of the eye, is the most common
cause of blindness worldwide. It is the cause in 62% of all blindness in the
Philippines and is found mostly in the older age groups. The only cure for cataract
blindness is surgery. This is available in almost all provinces of the country; however
there are barriers in accessing such services. Interventions will therefore consist of
increasing awareness about cataract and cataract surgery; as well as improving the

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delivery of cataract services. The parameter used worldwide to monitor cataract
service delivery is the Cataract Surgical Rate.

Errors of Refraction
Errors of refraction is the most common cause of visual impairment in the country
(prevalence is 2.06% in the population). Errors of refraction are corrected either with
spectacle glasses, contact lenses or surgery. The services to address the problem of
EOR are provided mainly by optometrists. However, the provision of the eyeglasses or
lenses (who should provide, how is it provided, etc.) has to be addressed.

Childhood Blindness
The prevalence of blindness among children (up to age 19) is 0.06% while the
prevalence of visual impairment in the same age group is 0.43%. The problem of
childhood blindness is the highly specialized services that are needed to diagnose and
treat it. However, screening of children for any sign of visual impairment can be done
by pediatricians, school clinics and health workers.   
 
Future Plan/Action:

 Development of Service Package for Prevention Blindness Program

 Development of Clinical Practice Guidelines for  Prevention Blindness Program
 Development of Strategic Framework and a Five Year Strategic Plan for
Prevention Blindness Program (2012-2016)
 Continue conduct of promotion and advocacy activities and partnership with
National Committee for Sight Preservation, Specialty Societies and other
stakeholders on PBP
 Creation of PBP Registry System
 Ensure the implementation of the National Prevention of Blindness Program
 
Status of Implementation/Accomplishment:

 Department of Health supports prevention of blindness and vision impairment

 Signatory of all World Health Assembly resolution on Vision 2020 and
blindness prevention.
 National Prevention on Blindness Program under Non-Communicable
Disease Cluster.
 Funded 3 national surveys of blindness 1987, 1955 and 2002.
 Planning workshop 2004 crafted 5 year development plan for eye care
2005-2010 assisted by IAPB /    ICEH.
 AO 179 issued on Nov. 2004 by Sec. Dayrit creating “Guidelines for
Implementation of the National Prevention Blindness Program (NPBP)”
which set-up the Program Management Committee (PMC)
 Blindness prevention and rehabilitation of persons with irreversible
blindness are incorporated in the health program for persons with
disability of DOH
 

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  The following programs/projects are included in the Maternal and Child Care
Program of  DOH:                                 
 Expanded Program for Immunization (includes vaccination for diseases
that causes blindness)
 Vitamin A provision for pregnant mothers and children to prevent vitamin
A deficiency
 Comprehensive newborn care includes prophylaxis for ophthalmia
neonatorum
 Newborn screening includes screening for galactosemia which cause
congenital cataract 
 
 Several activities in the PBP
 Consultative and Planning Workshop on PBP, October 2011
 National Eye Summit, Manila Grand Opera Hotel, Manila last October
2009
 Strategic Planning Workshop on the National Sight Preservation and
Blindness Program 2008
 Training of Trainors of Primary Eye Care conducted 2007
 
Other Significant information:

Available Human Resources:

Ophthalmologists       
 1,573 registered PAO members as of January 27, 2011
 95% is in private practice

Optometrists
 10,266 registered with Philippine Board of Optometry as of  July 2010                        
 

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

Occupational Health Program

Vision/Mission Statement
 Health for all occupations in partnership with the workers, employers, local
government authorities and other sectors in promoting self-sustaining
programs and improvement of workers' health and working environment.

Program Objectives and Targets
To promote and protect the health and well being of the working population thru
improved health, better working conditions and workers' environment.

Persons with Disabilities

I.     Profile / Rationale of the Health Program

Republic Act No. 7277, “An Act Providing for the Rehabilitation, and Self-
Reliance of Disabled  Persons and Their Integration into the Mainstream of Society
and for Other Purposes,” and otherwise known as “The Magna Carta for Disabled
Persons.”  was passed in July 19, 1991. This specifically required the Department of
Health (DOH) to. (1) Institute a national health program for PWDs, (2) establish
medical rehabilitation centers in provincial hospitals, and (3) adopt an integrated and
comprehensive to the Health Development of PWD which shall make essential health
services available to them at affordable cost.
Rule IV, Section 4. Paragraph B of the implementing rules and regulations
(IRRI) of this act required the Department of Health to address the health concerns of
seven (7) different categories of this ability, which includes the following: (1)
Psychosocial and behavioral disabilities, (2) Chronic illnesses with disabilities, (3)
Learning (cognitive or intellectual) disabilities, (4) Mental disabilities, (5) Visual/
seeing disabilities, (6) Orthopedic/ moving, and; (7) Communications deficits.

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 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 PWD’s
 
Strategic Goals: International Development Organizations (INGOs)
 American Leprosy Missions
 World Health Organization
 Australian Agency for International Development (AusAID)
 Christoffel Blindenmission  (CBM)
 JICA Expert
 Unicef
 
II.    SCENARIO

Global Situation
Key facts
          Over a billion people, about 15% of the world’s population, have some
form of disability.
          Between 110 million and 190 million people have significant difficulties in
functioning.

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           Rates of disability are increasing due to population ageing and increases
in chronic health conditions, among other causes.
          People with disabilities have less access to health care services and
therefore experience unmet health care needs.

HOW ARE THE LIVES OF PEOPLE WITH DISABILITIES AFFECTED?

             People with disabilities are particularly vulnerable to deficiencies in health
care services. Depending on the group and setting, persons with disabilities may
experience greater vulnerability to secondary conditions, co-morbid conditions, age-
related conditions, engaging in health risk behaviors and higher rates of premature
death.
 Secondary conditions
 Co-morbid conditions
 Age-related conditions
 Engaging in health risk behaviors
 Higher rates of premature death
 

BARRIERS TO HEALTH CARE

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

The program goals are:

1. Reduce the prevalence of all types of disabilities; and
2. Promote, and protect the human rights and dignity of PWDs and their
caregivers.
 
Strategic Objectives:
The strategic objectives of the program are as follows:

1.       Develop an integrated national health and human rights program and local
models to serve the special health needs;

2.       Pursue the implementation and monitoring of laws and policies for PWD such
as the accessibility law, human rights, and other related laws;

3.       Ensure that the health facilities and services are equitable, available,
accessible, acceptable, and affordable to PWD through the development and
implementation of essential health package that is suitable to their special needs and
enrollment of into the National Health Insurance Program;

4.       Initiate and strengthen collaboration and partnership among stakeholders to

improve the facilities devoted to the management and rehabilitation of PWD and
upgrade the capabilities of health professional and frontline workers to cater to their
special needs; and

5.       Continue and fast-track the registration of PWD in order to generate data for
accurate planning and implementation of programs. The Philippine Registry for
Persons with Disability will be continued, monitored, and evaluated and developed
into an information system that will be incorporated into currently used health
service information system.
 
Program Strategies/Program Components:

A Health program shall be developed for each type of disability and special population
which must contain all of the following essential components:

1.       Health Promotion

This concept shall include patient and caregiver information and education,
public information and education and intersectoral collaboration on disability health
promotion on the nature and extent of impairments particularly its risk factors,
complications and the need/urgency of early diagnosis and management.

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 This component shall ensure the advocacy for the following promulgated
observances on the following specified time each year as per issuances from the
Office of the President:

Celebration Time
Autism Every 3rd week of January
National Down’s Syndrome Every February
Retarded Children’s Week February 14 to 19
Leprosy Week Last week of February
Women with disabilities Day Last Monday of March 
National disability Prevention and Rehabilitation
Every 3rd week of July 
Week
NDPR Week to Culminate on the Birthdate of the
July 23
Sublime Paralytic: Apolinario Mabini  
White Cane Safety Day in the Philippines August 1
Brain attack awareness  3rd Week of August
Cerebral Palsy Awareness Week  September 16 to 22
National  Epilepsy  Awareness Week 1st Week of September 
National Mental Health Week 2nd Week of October
Bone and Joint (Musculo-Skeletal) Awareness  Week 3rd Week of October
National  Attention Deficit / Hyperactivity Disorder rd
3  week of October
(ADHD) Awareness Week
National Skin Disease Detection and Prevention nd
2  Week of November
Week
Deaf Awareness Week November 10 to 16
Drug Abuse Prevention and Control 3rd Week of November
 
Future related observances promulgated by the office of the President shall also
become part of this component.

2.    Capability Building

3. Philippine Registry for Persons with Disabilities (PRPWD)

4. Networking, Inter-organizational linkages, and Resource Mobilization

5. Monitoring and Evaluation

6. Accreditations and Equitable Health Financing Packages

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7. Research and Development

8. Service Delivery
The following areas for services to be developed for implementing facilities, localities
or organizations:
1.        Community based and institution-based rehabilitation program
2.        Clinical assessment of functioning, health and disability
3.        Medical assistive devices
 

IV.      Status of Implementation/ Accomplishment

 Capability Building on Community Rehabilitation of Barangay Health Workers

in Pilot areas-Done.
 Web enabled online Registration implemented.
 Expansion of coverage of Newborn Screening.
 Implementation of PWD Health Benefits as provided for RA 3994(20%
discount). 
 Support to activities of PWD groups given.
 
V.    Future/ Action

 Conduct Sensitivity training to Health workers at all levels.

 Formulate PWD Health service packages.
 Formulate mechanism to provide specialty society services on detection
diagnosis and care of non-apparent PWDs in all region.
 
Program Managers:

Dr. Frank Diza

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

Pinoy MD Program

"Gusto kong Maging Doktor"

A Medical Scholarship Grant for Indigenous People, Local Health Workers,
Barangay Health Workers, Department of Health Employees or their children. This is
a jJoint program of the Department of Health (DOH), Philippine Charity Sweepstakes
185
Office (PCSO), and several State Universities and Medical Schools. For interested
applicants see the PinoyMD flyer for the qualification and scholarship package
details.

186
 Philippine Cancer Control Program

I.    Rationale
Cancer is predicted to be an increasingly important cause of morbidity and
mortality in the next few decades, in all regions of the world. The challenges of
tackling cancer are enormous and – when combined with population ageing –
increases in cancer prevalence are inevitable, regardless of current or future actions
or levels of investment.
In recognition of current and emerging importance of non-communicable
diseases like cancer, E.O 119 reorganizing the Department of Health, had revised a
Non-Communicable Disease Control Service whose mandate includes planning and
management of Cancer Control activities. This order provides for guidelines on the
Philippine Cancer Control Program (PCCP) to be organized and managed by the Non-
Communicable Disease Service.
 
Vision :
Improve quality of life for all Filipinos    
Mission :
To provide quality, effective and accessible services for the prevention and control of
cancer
Goal :
Reduce morbidity, mortality and disability due to common preventable cancers

Objectives:
1. To reduce the exposure of population to risk  related   factors primarily
smoking,  unhealthy diet, physical inactivity, and harmful use of alcohol, 
cancer related infections, chemical and ultra violet rays exposure.
2. To increase the number of patient given appropriate screening, diagnosis and
treatment on cancer
3. To increase the number of patient given appropriate pain relief  and support
care services  with cancer
 
Mandates:
A.    Program Policies
 AO 89-A s. 1990 Establishment of Phil. Cancer Control Program dated April 18,
1990
 AO 2005-0006 Establishment of Cervical Cancer Screening Program dated
February 10, 2005
 RA 7846 Compulsory Hepatitis B Immunization
 AO 122 s 2003 on Smoking Cessation Program
 AO 2007-2004 National Tobacco Prevention and Control Program
 AO 2011-0003 National Policy on Strengthening the Prevention and Control of
Chronic Lifestyle Related Non Communicable Diseases
 
B.     Policies on HL Promotion-Healthy Diet & Nutrition
 RA7394 or Consumer Act of Phils. to enforce compulsory labeling to enable 
consumer obtain accurate information as to the content of the products
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  AO 88-B s. 1984 Rules & regulations on labeling of pre-Packaged Food Products
to ensure labels are not fake, misleading and deceptive
 DepEd Memo 373 s. 1998 encouraging sale and consumption of healthy foods
in school.
 Bureau Circular 2007-002 Guidelines in the Use of Nutrition and Health Claims
in Food
 
C.    Policies HL Promotion-Smoking/Alcohol
 RA 9334 An Act Increasing the Excise Tax Rated Imposed on Alcohol & Tobacco
Products
 RA 9211 Act Regulating Use, Sale and Distribution and Advertisements of
Tobacco Products
 RA 8749 Phil. Clean Air Act-prohibits smoking in public places or outdoors

D.    Policy on HL Promotion-Physical Activity

 Civil Service Memo Circular enjoining  all government institution to implement
physical and Mental fitness program

E.     Policy on Awareness Campaign

 PD 1349 s. 1974 mandated DOH/PCS & other organization to observe National
Cancer Consciousness Week.
 Department Circular #2009-0019 Launching of HL to the Max dated Jan 21,
2000 promoting the 7 healthy lifestyle practices

F.      Policy  on Cancer Screening/ Diagnosis and Treatment

 RA 4921 Act extending the scope of cancer detection and diagnostic center of
JRMMC to include cancer treatment & research
 AO 19 s. 1987 transferring of functions for Cancer Control Center to JRMMC & 
to the Non-Communicable Control Services under Office of Public Health
Service & Cancer Control Center shall be converted into Dept of Radiotherapy
 AO 3-B s. 1997 DOH Guidelines on Papanicolaou Smear Procedure  dated
March 27, 1997
 AO 19-A s.1998 National Policy on Cyto-Screening in the Cervical Cancer
Control Program

G. Policy on Strengthening Cancer Registry

 AO 188-A s. 1973 Authority & Functions of National Center for Disease
Prevention and Control responsible for Cancer Epidemiology in the Phils. & to
collect data & statistics to establish reliable cancer registry of nationwide
scope.

H.    Policy on Management & Planning

 DPO # 2010-2976 on the Creation of TWG on Cervical Cancer Prevention and
Control dated July 13, 2010 
 

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International Support, Policies and Mandates
 International Policies and Mandates
 WHA58.22 cancer prevention and control
 WHA57.12 on the reproductive health strategy, including control of cervical
cancer screening
 WHA57.16 on health promotion and healthy lifestyles;
 WHA57.17 on the Global Strategy on Diet, Physical Activity and Health,
 WHA56.1 on tobacco control

 International Support
In 2011, the UNFPA had donated three (3) units of cryotherapy machines for use in
the treatment of pre – cancerous lesion in the cervix. This partner also provided
funds in the development of the Training Module on Cervical Cancer Prevention and
Control together with the support of Women’s Health and Safe Motherhood Project II.
 
II.      Scenario

 Global
        Cancer is the major public health problem worldwide. It ranks second in the
leading cause of death in developed countries and is the third leading cause of deaths
in the developing countries. About 7.6 million deaths occurred per day worldwide, by
2030; around 27 million new cases are expected to occur if the government will not
act on it.
        The forecasted changes in population demographics in the next two decades
mean that even if current global cancer rates remain unchanged, the estimated
incidence of 12.7 million new cancer cases in 2008 (5) will rise to 21.4 million by
2030, with nearly two thirds of all cancer diagnoses occurring in low- and middle-
income countries (6).
          Large variations in both cancer frequency and case fatality are observed, even
in relation to the major forms of cancer, in different regions of the world.
        The geographical variation in cancer distribution and patterns is mirrored on
examination of cancer morbidity and mortality data in relation to the World Bank
income groups of countries. Within upper-middle-income and high-income countries,
prostate and breast cancers are the most commonly diagnosed in males and females
respectively, with lung and colorectal cancers representing the next most common
types in both sexes. These cancers also represent the most frequent types of cancer-
related deaths in these countries although lung cancer is the most common cause of
cancer death in both sexes. Within low-income countries, the absolute burden of
cancer is much lower, and while lung and breast cancers remain among the most
common diagnoses and types of cancer-related deaths, cancers of the cervix, stomach
and liver are also among the leading types – all of which are cancers with infection-
related etiology.
        Middle-income countries are intermediate with respect to their patterns of
cancer burden. Within the lower-middle-income countries, the three most common
types of cancer are lung, stomach and liver cancers in males, and breast, cervix and
lung cancer in females, i.e. a similar pattern to the low-income countries (although
liver, colorectal and esophageal cancers are also of importance). The lower middle-
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income group contains some of the most populous countries in the world, including
China and India; hence the absolute numbers of cancers and cancer-related deaths
are notably high in this group.
      Future planning of service provision is an integral part of cancer control
programmes. Considering the projected growth in cancer morbidity, important
differences can be observed in relation to World Bank income groups. The estimated
percentage increase in cancer incidence by 2030 (compared with 2008) will be greater
in low- (82%) and lower-middle-income countries (70%) compared with the upper-
middle- (58%) and high-income countries (40%). Without any changes in underlying
risk factors (i.e. based only on anticipated demographic changes), between 10 and 11
million cancers will be diagnosed annually in 2030 in the low- and lower-middle-
income countries.

  Local
         In the Philippines, cancer ranks third in the ten leading causes of mortality.
Cancer is common in both sexes with the highest deaths in males. The common
cancer deaths in both sexes are lung, liver, breast, colon/rectum and cervix. While
the top 5 cancer cases in both sexes are lung, breast, colon/rectum, liver and cervix.
        The Non Communicable Disease Service is tasked to operationalize programs
towards prevention and control of cancer that is accessible and affordable giving
priority to the disadvantaged population.  This was started in 1970 when the
National Cancer Control Center was created and considered as autonomous unit. The
Rizal and Manila Cancer Registries were established during this period. In 1973 the
Community Cancer Control Program was started. Pursuant to the issuance of
Executive Order 119 in 1986, the National Cancer Control was abolished. The Office
of Public Health Services was created where Non-Communicable Disease Control was
lodge. In May 1987 the Cancer Core Group was created to assist the Secretary of
Health in developing a framework of cancer control. Orientation Training of Core of
Trainers was done in 1988.  In 1990 the Philippine Cancer Control Program was
created as per Administrative Order # 89-A, s.1990.   A year later the Cancer Core
Group was reconstituted as an Advisory Council.
       In 1999, the Degenerative Disease Office was established as per EO 102
“Redirecting the Functions and Operations of the Department of Health”. The
intervention was focused in the control measures to promote healthy lifestyle and
avoid exposure to risk factors contributing to the development of cancer. Cancer in
particular was not given priority attention to manage patient comprehensively.
Screening for early detection and treatment intervention were not foreseen as highly
needed by population at risk of getting cancer.  Funds for the operationalization of
the program were not included to address the problem.
     In mid 2007, the Cervical Cancer Control Program was transferred by the Family
Health Office to the Degenerative Disease Office where the said program was
originated. The Cervical Cancer Control Program had provided Free Cervical Cancer
Screening among women 30 to 45 years of age to respond to the issuance of the
Guidelines in the Establishment of Cervical Cancer Screening Program in 2005. 
     The creation of the National Center for Pharmaceutical Access and Management
contributed much in the provision of intervention on cancer. These are : 1) Free
Adjuvant Chemotherapy provided to breast cancer patient newly diagnosed stage I to

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Stage IIIa piloted in Jose Reyes Memorial Medical Center, East Avenue Medical
Center, Rizal Medical Center and Philippine General Hospital, 2). Free Chemotherapy
for Acute Lymphatic Leukemia among children (ALL) in selected DOH hospital.
      Due to the limited resources, the Phil Cancer Control Program is moving slowly
geared towards the improvement of health and prolonging the life of cancer patient.
 
 Statistics/Local Data about the Disease Program
                Global Data on Cancer
                Top Five Cancer Deaths in 2011                            
Type of Cancer Cases
Lung 1.4 Million
Stomach 740,000
Liver 700,000
Colorectoral 610,000
Breast 460,000
       
            Philippine Data on Cancer, 2010 Cancer Facts and Estimates
                                               Number of Cases, Both Sexes 2010                        
Cancer Number of Cases
Breast 12,262
Lung 11,458
Liver 7,331
Colon/Rectum 5,787
Cervix 4,812
Leukemia 3,153
Stomach 3,129
Prostate 2,712
Brain/Nervous System 2,236
Ovary 2,165
 
                                          Number of Deaths, Both Sexes, 2010
Cancer Number of Deaths
Lung 9,184
Liver 6,819
Breast 4,371
Colon/Rectum 3,060

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 Leukemia 2,609
Stomach 2,274
Cervix 1,984
Brain/Nervous System 1,855
Prostate 1,410
Ovary 1,016
 
                                            Number of New Cases, 2010, Males
Cancer Cases
Lung 8,772
Liver 5,522
Colon/Rectum 3,208
Prostate 2,712
Stomach 1,920
Leukemia 1,669
Brain/Nervous System 1,236
Other Pharynx 1,145
Non-Non-Hodgkin Lymphoma 982
Kidney 848
 
                                          Number of Deaths, 2010, Males
Cancer Cases
Lung 6,987
Liver 5,102
Colon/Rectum 1,690
Prostate 1,410
Stomach 1,340
Leukemia  1,381
Brain/Nervous System 1,069
Other Pharynx 804
Non-Hodgkin Leukemia 598
Kidney 389
 
                                       10 Most Common Cancer Cases in 2010, Females
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 Type of Cancer Cases
Breast 12,262
Cervix Uteri 4,812
Lung 2,686
Colon/Rectum 2,579
Ovary 2,165
Liver 1,809
Corpus Uteri 1,760
Leukemia 1,484
Thyroid 1,474
Stomach 1,209
                   
                                   10 Most Common Cancer Deaths in 2010, Females
Type of Cancer Cases
Breast 4,371
Cervix Uteri 1,984
Lung 2,197
Colon/Rectum 1,370
Ovary 1,016
Liver 1,717
Corpus Uteri 796
Leukemia 1,228
Thyroid 450
Stomach 934
 
III.      Interventions/Strategies employed or implemented by DOH
 
Packages of Services
 Free Cervical Cancer Screeningprovided every year in 58 DOH Hospitals done
during the month of May to screen women ages 30-45 years of age
 Free Adjuvant Chemotherapy for women diagnosed stage 1 to IIIa breast cancer
in 4 pilot hospitals (Jose Reyes Memorial Medical Hospital, East Avenue
Medical Center, Rizal medical Center, UP-PGH) funded by NCPAM
 Free Chemotherapy for Acute Lymphatic Leukemia (ALL) among children with
cancer funded by NCPAM

Strategies
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  Promotion of Healthy Lifestyle
 Increase avoidance of the risk factors done in coordination with the National
Center for Health Promotion
 Vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV)
not in nationwide scope but done by professional societies among children
who can afford HPV vaccination
 Control occupational hazards done in coordination with the Environmental
and Occupational Health  Office
 Reduce exposure to sunlight
   Improve Screening/Diagnosis and Treatment
   Improve Rehabilitation and Palliative Care
   Improve Cancer Registry
 
IV. Status of implementation/Accomplishment

The status of the implementation on the different types of cancer varies due to the
limited resources in the operationalization of the program.

A.    Cervical Cancer
 Conducted Free Cervical Cancer Screening in DOH Hospitals from 2009 to 2011
 Conducted Cervical Cancer Awareness Month during the month of May from
2009 to 2011
 Drafted Training Module on Cervical Cancer Prevention and Control in 2010
 Provided 3 units of cryotherapy machine in Bicol Regional & Teaching Hospital,
Jose Reyes Memorial Medical Center, Cotabato Regional Hospital from UNFPA
in 2011
 Provided supplies (acetic acid, cotton swab ) for cervical cancer screening in 58
DOH Hospitals in 2011
 Conducted the 1st National Symposium on Cervical Cancer Prevention and
Control in 2010
 Conducted Catching Cancer : A Forum on Cervical Cancer Prevention and
Control in 2011
 Conducted Press Conference on Cervical Cancer in 2009 to 2011
 Created Technical Working Group on Cervical Cancer in 2010
 
B.     Cancer Registry
 Provided funds for the Population-Based Cancer Registry in Rizal and Manila
 Develop Cancer Registry Forms for the Establishment of an Integrated Chronic- 
Non-Communicable Disease Registry System in 2010
 Conducted Training on Integrated Chronic NCD Registry in pilot hospital in
2010
 Conducted 1st Batch of Integrated NCD Registry Training last April 4-5, 2011
 Conducted 2nd Batch of Integrated NCD Registry dated Sept 22-30, 2011
 
C.    Breast Cancer

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

IV.   Future Plan/Action

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

Province-wide Investment Plan for Health (PIPH)

A five year medium term plan prepared by F1 convergence provinces using the
Fourmula One for Health framework to improve the highly decentralized system;
financing, regulation, good governance and service delivery
The five year province-wide investment plan for health is an important 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.

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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 globally-recognized
standards, and making these services equitably available for both Medical Travellers
and local patients.
 
Objectives:
1. To increase competitiveness by compliance to recognized bodies that implement
national and international healthcare organization accreditation
2. Institutionalize policies and enact legislation for high level quality healthcare and
patient safety standards in all health facilities
3. Continue collaboration with national government agencies, LGUs, private sector
organizations and academe involved in quality healthcare and patient safety,
international medical travel and wellness services, retirement, trade and tourism
4. Continue advocacy in all regions of the country on quality healthcare and patient
safety, international medical travel and wellness services, retirement, trade and
tourism through quad media approach, capacity building activities and collaborative
participation in international forum and conferences
 
Stakeholders/Beneficiaries:
Private clinics/centers, Public and Private Hospitals, National Government Agencies,
Private Specialty Clinics/Centers providing Dermatology, plastic surgery,
ophthalmology and dental medicine, Geriatric and Treatment and Rehabilitation
Centers for substance abuse
 
Partner Organizations/Agencies:
 Department of Tourism (DOT)
 Department of Foreign Affairs (DFA)
 Department of Trade and Industry (DTI)
 Department of Public Works and Highways (DPWH)
 Department of Interior Local Governments (DILG)
 Department of Justice (DOJ)
 Department of Finance (DFA)
 Department of Science and Technology (DOST)
 Department of Labor and Employment (DOLE)
 DTI - Board of Investments (BOI)
 DTI - Philippine Export Zone Authority (PEZA)
 DOT - Tourism Infrastructure Enterpise Zone Authority (TIEZA)
 DOJ - Bureau of Immigration (BI)
 DOF - Bureau of Customs (BoC)
 Subic Bay Metropolitan Authority (SBMA)
 Clark Development Corporation (CDC)

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  Philippine Health Insurance Corporation (PhilHealth)
 Philippine Retirement Authority  (PRA)
 Cebu Health and Wellness Council (CHWC)
 Development Academy of the Philippines (DAP)
 National Economic Development Authority (NEDA) 
 Technical Education and Skills Development Authority (TESDA)
 Commission on Higher Education Development (CHED)
 Philippine Information Agency (PIA)
 Public Private Partnership Center (PPPC)
 Joint Foreign Chambers of Commerce in the Philippines 
 European Chamber of Commerce in the Philippines (ECCP)
 American Chamber of Commerce in the Philippines (ACCP)
 Canadian Chamber of Commerce (CCC)
 Australian New Zealand Chamber of Commerce in the Philippines (ANZCHAM)
 Japanese Chamber of Commerce in the Philippines (JCCP)
 Korean Chamber of Commerce in the Philippines (KCCP)
 Philippine Association of Multinational Companies Regional Headquarters, Inc.
(PAMURI)
 Professional Regulations Commission (PRC)
 Philippine Medical Association (PMA)
 Philippine Nurses Association (PNA)
 Philippine Hospital Association (PHA)
 Philippine Council for the Accreditation of Health Care Organizations (PCAHO)
 International Society for Quality in Healthcare (ISQUA)
 Joint Commission International (JCI)
 National Accrediting Body for Hospitals (NABH - India)
 TUV Rheinland 
 Private Sector
 Health and Wellness Alliance of the Philippines (HEAL Philippines)
 Health Core and HIM Communications 
 Retirement and Healthcare Coalition (RHC)
 Spas and Wellness Association of the Philippines (SAPI)
 Philippine Dental Association (PDA)

Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases

I. BACKGROUND AND RATIONALE

 
Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are
among the top killers in the Philippines, causing more than half of all deaths
annually. Hypertension and diseases of the heart are among the ten leading causes of
illnesses each year.  These diseases are collectively known as Lifestyle Related Non-
Communicable Diseases (NCDs), as defined in the National Objectives for Health

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

II. GOALS AND OBJECTIVES

Goals: 
To reduce morbidity, mortality and disability rates due to chronic lifestyle related
NCDs through an integrated and comprehensive program on the prevention and
control of lifestyle related
diseases.                                                                                                              

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Objectives:
1. To develop and promote an integrated and comprehensive program on the
prevention and control of lifestyle related diseases in the country.
2. To engage all province-wide or city-wide health systems to adopt an integrated
and comprehensive program on the prevention and control of lifestyle related
diseases.                                                                                                      
      
3. To achieve improvement in the following Key Performance Indicators  from 2011
to 2016:    
 

Common Risk Factors               

1. Reduction in prevalence of current smoking among adult males from 56.3 to
40.0.
2. Reduction in prevalence of current smoking among adolescent female from 8.80
to 7.2
3. Reduction in prevalence of adults with high physical inactivity from 60.5 to 50.8
4. Increase in per capita total vegetable  from 111.0 (g/day)  to 133.0 (g/day)
 
Intermediate Risk Factors
A. Reduction in prevalence of hypertension among adult males from 24.2 to 19.6.
B.Reduction in prevalence of adults with high fasting blood sugar from 3.4.
C.Reduction in the prevalence of central obesity (high waist circumference) among
adult females from 18.3 to 12.81
D.Reduction in prevalence of high total serum cholesterol among adults from 8.5.

Disease
a. Reduction in mortality from non-communicable diseases at 2%  per year
through   the  MDG max initiative.

III. ACTION FRAMEWORK FOR THE PREVENTION AND CONTROL  OF CHRONIC

LIFESTYLE RELATED NON-COMMUNICABLE DISEASES:

            The Action Framework for the National Program on the Prevention and
Control of Chronic Lifestyle Related Non-Communicable Diseases is based on the
Causation Pathway Model for Major Chronic Diseases as contained in the WHO
Western Pacific Regional Action Plan for Addressing Non-Communicable Diseases,
where the underlying determinants, common risk and intermediate risk factors that
would lead to lifestyle-related diseases are identified (Figure 1). 

199
 
The action framework (Figure 2) has seven action areas as follows: (1)
Environmental interventions; (2) Lifestyle interventions; (3) Clinical interventions; (4)
Advocacy; (5) Research, surveillance, monitoring, and evaluation; (6) Networking and
coalition building; and (7) Health system strengthening. It draws primarily from the
WHO Western Pacific Regional Framework for Addressing Non-communicable
Diseases and emphasizes the requirement for integrated comprehensive approaches
that encompass and address the various levels of determinants and risks for non-
communicable lifestyle related diseases (Figure 2).         
 
                                                     

            
Figure 2:  Action Framework for the Prevention and Control of Chronic Lifestyle-
Related Non-communicable Diseases                                

The framework clearly identifies areas for intervention according to the

causation pathway shown in Figure 1 by utilizing a comprehensive approach that
simultaneously seeks to effect change at three levels: 1) Environment Interventions
200
such as policy and regulatory interventions seek to create a supportive environment
for healthier choices. They address the multiple environmental determinants brought
about, for example, by globalization and urbanization that give rise to the
development of unhealthy lifestyles.  2) Lifestyle Interventions address the common
risk factors and intermediate risk factors by providing population-based lifestyle
interventions (for example, information and education and behavioural interventions
for those who are already at risk).  3) Clinical Interventions, palliation and
rehabilitation address the capacity of the health system to treat and manage diseases
through screening, risk factor modification, clinical management, palliation and
rehabilitation.  To support change in these three levels of interventions, additional
actions are needed in the following areas: advocacy; research, surveillance,
monitoring and evaluation; networking and coalition building across all sectors of the
government and society, and health system strengthening through primary health
care to make it more responsive to chronic care.    
 The framework highlights the balance between "healthy choices" and "healthy
environments" because it recognizes that supportive environments are needed to
empower healthy choices. It also redistributes responsibility across the whole of
society, with government, the health sector, the private sector, nongovernmental
organizations, communities, families and individuals all sharing accountability for
putting in place the necessary elements that promote healthy lifestyles and quality
care for non-communicable lifestyle related diseases.
                                                                   
IV:   PROGRAM INTERVENTIONS 

A.   Environmental interventions

Aimed at providing and encouraging healthy choices for all to be implemented in
three (3) major health promotion settings: community, school and workplace. As the
underlying determinants of non-communicable diseases often lie outside the health
sector, multi-sectoral actions shall be implemented involving both public and private
sectors.

B.  Population based lifestyle interventions

Preventive strategies using the life course perspective and focused on major risk
factors particularly tobacco use, unhealthy diet, physical inactivity, and alcohol use,
and, include other relevant risk factors such as but not limited to the following:
hypertension, high blood sugar, overweight and obesity, and impaired lung function.
Strategies shall be integrated in other health programs and health-related initiatives
to effectively address lifestyle-related non-communicable diseases and their social
and economic determinants.
Service packages for clinical interventions of diabetes, cardiovascular diseases,
cancers and chronic respiratory diseases addressing the following unique features of
NCDs such as:
1. The limitation of definitive treatment, the lifelong duration of management and
the extensive self management involved must be addressed by service delivery
providers.
2. The multidrug regimens, drug interactions and drug cost that has to be
regulated.

201
 3. The acute attacks and exacerbations from failed prevention, financial barriers in
access to acute care and financial risk that must be addressed by adequate
financing.
4. The co-morbidities requiring coordination by various providers and teams that
must be managed by proper governance infrastructure.
                              
V. ROLES OF STAKEHOLDERS
            The National Center for Disease Prevention and Control (NCDPC) shall:
1.  Oversee the implementation of the national policy and program on the
Prevention and Control of Lifestyle-Related Diseases.
2. Establish standards and package of services on lifestyle-related diseases and
ensure their quality, access, and availability at all levels of the health system.
3. Provide technical assistance to the LGUs and other partners on clinical
interventions for   lifestyle-related diseases.
4. Support the design of health financing of personal care related to lifestyle
related diseases in collaboration with PhilHealth and other partners.
5. Conduct regular monitoring and evaluation of the burden of disease related to
lifestyle related diseases.
6. Ensure participation of other DOH offices and bureaus and coordinate with
partners within and outside the health sector for the effective implementation
of the national program.
                                                                                            
 The National Center for Health Promotion (NCHP:
1. Lead in the development and implementation of the National Healthy Lifestyle
Program as a major strategy for the prevention and control of lifestyle-related
diseases.
2. Advocate with other government agencies, non-government organizations,
private sector, development partners, and other relevant stakeholders for
support in policy development and resource generation towards the creation of
supportive environments for lifestyle modification.
3. Provide technical assistance to ensure environmental interventions at the 3
health promotion settings: community, school and workplace.
4. Facilitate organization and development of a multi-sectoral coalition for the
prevention and control of lifestyle related diseases.

The Health Policy Development and Planning Bureau (HPDPB): 

1. Support the development of relevant policies on NCD prevention and control.
2. Assist in securing adequate funding for Prevention and Control of Lifestyle-
Related Diseases.
3. Facilitate and support program evaluation studies and researches.

The National Epidemiology Center (NEC) and the Information

Management Service (IMS)
1. Establish and sustain public health and hospital surveillance systems including
registries, for lifestyle-related diseases and other non-communicable diseases.
2. Facilitate collection, analysis, and dissemination of data on mortality, morbidity
and risks on lifestyle-related diseases.

202
 3. Support conduct of population-based surveys on risk factors and lifestyle-
related diseases.

The Health Human Resource Development Bureau (HHRDB):

1. Develop, update as necessary and implement training and development plan of
health professionals, particularly those in primary health care facilities and
hospitals on the prevention and management of lifestyle-related diseases.
2. Facilitate integration of prevention and control of lifestyle-related diseases in the
academic curriculum of health
professionals.                                                                                               
                                    
The National Center for Health Facility Development (NCHFD:
1.  Ensure access and availability to quality hospital and facility-based services on
lifestyle-related diseases.
2. Establish standards for an efficient hospital referral system. 
3. Facilitate development and implementation of hospital-based information and
surveillance system to gather data particularly on mortality and morbidity from
lifestyle-related
diseases.                                                                                  

The National Center for Pharmaceutical Access and Management (NCPAM)  shall

develop guidelines and standards and provide mechanisms to ensure that affordable,
but quality medicines for lifestyle-related diseases are always available, especially to
the poor.

The Bureau of International Health Cooperation (BIHC) shall coordinate with

international development partners and other countries for technical and resource
assistance on prevention and control of lifestyle-related diseases. 

The Philippine Health Insurance Corporation (PHIC) shall develop and implement
health   insurance package for clients at risk and afflicted with lifestyle-related
diseases to reduce financial burden and impoverishment of individuals and families
resulting from said diseases.

The National Nutrition Council (NNC) shall provide technical assistance and

contribute to the advocacy on healthy lifestyle, particularly on healthy diet.

The Philippine Coalition for the Prevention and Control of Non-Communicable

Diseases (PCPCNCD) shall provide support to the advocacy on healthy lifestyle.

The Centers for Health Development (CHDs) shall provide technical assistance and
lead the regions to ensure local implementation of the National Program on
Prevention and Control of Lifestyle-Related
Diseases.                                                                                                              
                                                                   
DOH hospitals shall ensure provision of quality promotive, preventive, curative,
rehabilitative, and palliative care for patients with lifestyle related diseases;

203
The Local Government Units (LGUs) shall adopt and implement the National
Program on Prevention and Control of Lifestyle-Related Diseases and provide services
and products in primary health care facilities and hospitals in their localities.

Non-government organizations, professional groups, other government

organizations, private sector, the Academe, and Civil Societies  shall assist in
the implementation of the National Program on Lifestyle-Related Diseases.

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

I. PROFILE/ RATIONALE OF THE HEALTH PROGRAM

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

B.   TARGETS
1. Increased water service for the waterless population by 50%
2. Reduced incidence of water-borne and sanitation related diseases by 20%
3. Improved access of the poor to sanitation services by at least 10%
4. Sustainable operation of all water supply and sanitation projects constructed,
organized and supported by the Program by 80%.
 
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:
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  115 Waterless Municipalities
 Waterless Areas based on the following thematic concerns:
              Poorest waterless barangays with high incidence of water borne diseases 
              Resettlement areas in Bulacan, Rizal, Cavite, Laguna, Batangas and Albay
              Health Centers without access to safe water
 
III. PROGRAM COMPONENT/ACTIVITIES
A. Rehabilitation/expansion/upgrading of Level III water supply systems including
appropriate water treatment systems.
B.Construction/rehabilitation/expansion/upgrading of Level II water supply
systems.
C.Construction/rehabilitation of Level I water supply systems in areas, where
such facilities are only applicable.
D.Provision of training for existing or newly organized water users associations/
community-based organizations.
E.Support for new and innovative technologies for water supply delivery and
sanitation systems.
F. Training, mentoring, coaching and other capacity development assistance to
LGU on planning, implementation and management of water supply and
sanitation projects.
 
IV. STATUS OF THE PROGRAM

Summary of Physical and Financial Status Report

 January 2012
 February 2012
 March 2012
 April 2012

Monthly Status Report per Site

 October 2011
 January 2012
 February 2012
 March 2012
 April 2012

Administrative Issuances
 Department Order # 2011-0090
 Department Order # 2011-0091
 Department Order # 2011-0091-A
 Department Order # 2011-0091-B
 Memorandum of Agreement of the National Poverty Commission, Department of
Health and Department of Interior and Local Government
 Implementing Guidelines of the Salintubig Program
 

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V.     PROGRAM MANAGER(S)

A.   FULL NAME(S) OF PROGRAM MANAGERS

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

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT (DILG)

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

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 country’s capacity in the provision of quality health service to

the people, the Department of Health (DOH) has adopted the facility-based basic
207
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 midwife’s Certificate of

Registration and license, the scholars shall render two (2) years of service to the DOH
for every year of scholarship granted as form of return service.

Expected Output:

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 The MSPP aims to produce and ensure constant supply of competent midwives
who are ready to serve the DOH identified priority areas of the country.

The RHMPP addresses the inequitable distribution of midwives and equip them
for facility-based BEmONC practice. Likewise, it provides competent midwives to
areas that have not performed well in terms of facility-based deliveries, fully
immunized child and contraceptive prevalence rates, hence, improve facility-based
health services. The DOH ultimately aims in the attainment of the Millennium
Development Goals (MDGs).

Program Status:

For the MSPP, a hundred scholars are currently pursuing the Midwifery Course.
On April of this year, 11 scholars graduated and passed the Board Examination by
the Professional Regulation Commission (PRC). These scholars were deployed to DOH
identified priority areas starting July 2011. This coming November, 37 other scholars
will take the Board Examination.

For the RHMPP, 23 Registered Midwives were already deployed for the first
batch (2008-2010). In addition to that, 175 Registered Midwives (batch 2, 2010-2012)
and 11 scholars (batch 3, 2011-2013) are currently being deployed in the DOH
(BEmONC/CCT) identified priority areas.

Partner Schools:

Currently, the MSPP has four partner schools:

Area Partner School Total # of Scholars

Batch 1: 16 scholars
(2008-2010)
Batch 2: 11 scholars
(June 2009-May
2011)
Dr. Jose Fabella Memorial
National Capital Region Batch 3: 21 scholars
Hospital, School of Midwifery
(June 2010-May
2012)
Batch 4: 17 scholars
(June 2011-May
2013) 
Batch 1: 19 scholars
Naga College Foundation, Naga
Luzon (June 2011-May
City
2013)
Visayas  University of the Philippines, Batch 1: 37 scholars
School of Health Science, Palo, (June 2009-May
Leyte 2011)

209
 Batch 2: 29 scholars
(June 2010-May
2012)
Batch 1: 14 scholars
Tecarro College Foundation,
Mindanao (June 2011-May
Inc., Davao City
2013)

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

III. Career Track / Return Service Obligation

Upon completion of the MSPP and obtaining the midwife's Certificate of

Registration and license, the scholars shall render two (2) years of service to the DOH
for every year of scholarship granted as form of return service.

IV. Expected Output

The MSPP aims to produce and ensure constant supply of competent midwives
who are ready to serve the DOH identified priority areas of the country.

The RHMPP addresses the inequitable distribution of midwives and equip them
for facility-based BEmONC practice. Likewise, it provides competent midwives to
areas that haver not performed well in terms of facility based deliveries, fully
immunized child and contraceptive prevalence rates, improve facility-based health
services. The DOH ultimately aims in the attainment of the Millenium Development
Goals (MDGs).

V. Program Status:

A. MSPP

210
  11 scholars graduated on April 2011 and passed the Board Examination by the
Professional Regulation Commission will be deployed starting July 2011 to
DOH identified priority areas.
 37 scholars will take the November 2011 Board Examination by the Professional
Regulation Commission
 100 scholars pursuing the Midwifery Course
B. RHMPP

 175 Registered Midwives are currently deployed in the DOH (BEmONC/CCT)

identified priority areas
 Deployment of 11 scholars

Schistosomiasis Control Program

Schistosomiasis is an infection caused by blood fluke, specifically Schistosoma

japonicum. An individual may acquire the infection from fresh water contaminated
with larval cercariae, which develop in snails. Infected yet untreated individuals
could transmit the disease through discharging schistosome eggs in feces into bodies
of water.
Long term infections can result to severe development of lesions, which can lead
to blockage of blood flow. The infection can also cause portal hypertension, which
can make collateral circulation, hence, redirecting the eggs to other parts of the body.
Schistosomiasis is still endemic in 12 regions with 28 provinces, 190
municipalities, and 2,230 barangays. Approximately 12 million people are affected
and about 2.5 million are directly exposed.

Goal:
To reduce the disease prevalence by 50% with a vision of eliminating the disease
eventually in all endemic areas
 
Objectives:
The Schistosomiasis control Program has the following objectives:
1.       Reduce the Prevalence Rate by 50% in endemic provinces; and
2.       Increase the coverage of mass treatment of population in endemic provinces.
 
Program Strategies:
The Schistosomiasis Control Program employs the following key interventions:
1.       Morbidity control: Mass Treatment
2.       Infection control: Active Surveillance
3.       Surveillance of School Children
4.       Transmission Control
5.       Advocacy and Promotion
 
Its enabling activities include; linkaging and networking; policy guidelines and
CPGs; institutional capacity building; competency enhancement of frontline service
provider; and monitoring and supervision.
211
212
 Soil Transmitted Helminth Control Program
 
Profile/Rationale of the Health Program

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

213
 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.       Improve governance through:

a.       Policies/resolutions;
b.      Securing budget for STH prevention and control;
c.       Mobilization and coordination of sectoral support; and

2.       Improve service quality and scale-up coverage.

a.       Capacity building
1.       Areas for training
 Epidemiology, life cycle etc.
 Proficiency training on lab diagnosis for med techs/lab techs
 Annual/biannual updates on current technology in lab
diagnosis
 Training on drug administration, side effects, etc
2.       Target participants
3.       Training mechanisms
b.      Development and issuance of protocols and guidelines
c.       Expansion of service delivery points
d.      Availability and affordability of deworming drugs

3.       Institute financing reforms

a.       Efficiency in program implementation
b.      Mobilization of resources
c.       Strengthening LGU financing schemes

214
4.       Strengthen regulations
5.       Installation of management support systems
a.       Drug procurement
b.      Research
c.       Surveillance
 
Targets and Doses

1. Children aged 1 year to 12 years old

For children 12 – 24  months old

Albendazole       -  200 mg, single dose every 6 months.  Since the preparation is
400mg, the tablet is halve and can be chewed by the child or taken with a glass of
water or
Mebendazole    -  500 mg, single dose every 6 months
For children 24  months old and above
Albendazole    -  400 mg, single dose every 6 months
Or
Mebendazole    -  500 mg, single dose every 6 months
Note: If Vitamin A and deworming drug are given simultaneously during the GP
activity, either drug can be given first. 

2.  Adolescent females

It is recommended that all adolescent females who consult the health be given

anthelminthic drug

Albendazole  400 mg  once a year or

Mebendazole 500 mg once a year

3.  Pregnant women

It is recommended that all pregnant women who consult the health be given

anthelminthic drug once in the 2nd trimester of pregnancy.
In areas where hookworm is endemic:

Where hookworm prevalence is 20 – 30%

Albendazole  400 mg once in the 2nd trimester or

Mebendazole 500 mg once in the 2nd trimester

Where hookworm prevalence is > 50%, repeat treatment in the 3rd trimester

215
4.   Special groups, e.g., food handlers and operators, soldiers, farmers and
indigenous people

Selective deworming is the giving of anthelminthic drug to an individual based

on the diagnosis of current infection. However, certain groups of people should be
given deworming drugs regardless of their status once they consult the health center.
Special groups like soldiers, farmers, food handlers and operators, and indigenous
people are at risk of morbidity because of their exposure to different intestinal
parasites in relation to their occupation or cultural practices.
For the clients who will be dewormed selectively, treatment shall given be
anytime at the health centers.
 
Guidelines/Administrative Orders

AO No. 2010-0023 – guidelines on deworming drug administration and the

management of adverse events following deworming (AEFD)
 
AO No.2006-0028 – Strategic and operational framework for establishing integrated
helminth control program (IHCP)
 
Status of the program

Deworming of target population during:

 1-5 years old – during Garantisadong Pambata (GP)  April and October
 6-12 years old (school children Grade 1-6 enrolled in public schools) every
January and July

Partner Organizations/Agencies:
          World Health Organization (WHO)
          University of the Philippines-National Institutes of Health (UP-NIH)
          United Nations Children’s Fund (UNICEF)
          World Vision
          Feed the Children International
          Helen Keller International (HKI)
          Council for the Welfare of Children
          Department of Science and Technology-Food and Nutrition Institute
(DOST -FNRI)
          Department of Education (DepEd)
          Plan International
          Save the Children

216
 Smoking Cessation Program
 
Rationale:

The use of tobacco continues to be a major cause of health problems worldwide.

There is currently an estimated 1.3 billion smokers in the world, with 4.9 million
people dying because of tobacco use in a year.  If this trend continues, the number of
deaths will increase to 10 million by the year 2020, 70% of which will be coming from
countries like the Philippines. (The Role of Health Professionals in Tobacco Control,
WHO, 2005)
The World Health Organization released a document in 2003 entitled Policy
Recommendations for Smoking Cessation and Treatment of Tobacco Dependence.
This document very clearly stated that as current statistics indicate, it will not be
possible to reduce tobacco related deaths over the next 30-50 years unless adult
smokers are encouraged to quit.  Also, because of the addictiveness of tobacco
products, many tobacco users will need support in quitting.  Population survey
reports showed that approximately one third of smokers attempt to quit each year
and that majority of these attempts are undertaken without help.  However, only a
small percentage of cigarette smokers (1-3%) achieve lasting abstinence, which is at
least 12 months of abstinence from smoking, using will power alone  (Fiore et al
2000) as cited by the above policy paper.
The policy paper also stated that support for smoking cessation or “treatment of
tobacco dependence” refers to a range of techniques including motivation, advise and
guidance, counseling, telephone and internet support, and appropriate
pharmaceutical aids all of which aim to encourage and help tobacco users to stop
using tobacco and to avoid subsequent relapse.  Evidence has shown that cessation
is the only intervention with the potential to reduce tobacco-related mortality in the
short and medium term and therefore should be part of an overall comprehensive
tobacco-control policy of any country.
The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH,
Philippines GATS Country Report, March 16, 2010) revealed that 28.3% (17.3 million)
of the population aged 15 years old and over currently smoke tobacco, 47.7% (14.6
million) of whom are men, while 9.0% (2.8 million) are women.  Eighty percent of
these current smokers are daily smokers with men and women smoking an average
of 11.3 and 7 sticks of cigarettes per day respectively.
The survey also revealed that among ever daily smokers, 21.5% have quit
smoking.  Among those who smoked in the last 12 months, 47.8% made a quit
attempt, 12.3% stated they used counseling and or advise as their cessation method,
but only 4.5% successfully quit.  Among current cigarette smokers, 60.6% stated
they are interested in quitting, translating to around 10 million Filipinos needing help
to quit smoking as of the moment. The above scenario dictates the great need to
build the capacity of health workers to help smokers quit smoking, thus the need for
the Department of Health to set up a national infrastructure to help smokers quit
smoking.
The national smoking infrastructure is mandated by the Tobacco Regulations
Act which orders the Department of Health to set up withdrawal clinics. As such
DOH Administrative Order No. 122 s. 2003 titled The Smoking Cessation Program to
217
support the National Tobacco Control and Healthy Lifestyle Program allowed the
setting up of the National Smoking Cessation Program.

Vision:                 Reduced prevalence of smoking and minimizing smoking-related

health risks.
Mission:            To establish a national smoking cessation program (NSCP).
 
Objectives:
The program aims to:
1.       Promote and advocate smoking cessation in the Philippines; and
2.       Provide smoking cessation services to current smokers interested in quitting
the habit.
 
Program Components:
The NSCP shall have the following components:

1.       Training
The NSCP training committee shall define, review, and regularly recommend training
programs that are consistent with the good clinical practices approved by specialty
associations and the in line with the rules and regulations of the DOH.
All DOH health personnel, local government units (LGUs), selected schools, industrial
and other government health practitioners must be trained on the policies and
guidelines on smoking cessation.
 
2.       Advocacy
A smoke-free environment (SFE) shall be maintained in DOH and participating non-
DOH facilities, offices, attached agencies, and retained hospitals. DOH officials, staff,
and employees, together with the officials of participating non-DOH offices, shall
participate in the observance and celebration of the World No Tobacco Day (WNTD)
every 31st of May and the World No Tobacco Month every June.

3.       Health Education
Through health education, smokers shall be assisted to quit their habit and their
immediate family members shall be empowered to assist and facilitate the smoking
cessation process.

4.       Smoking Cessation Services

Below is the National Smoking Cessation Framework detailing Smoking Cessation
services at different levels of care:

LEVEL Intervention DRUGS/ME

STAFFING EQUIPMENTS
OF CARE Package DS
PRIMARY BHW  Risk None  Risk
LEVEL RM assessme Assessm
I. nt/ Risk ent Tool
Barangay screening  Quit

218
 (Note:
Use Risk
Assessme
nt Form)
 Assess for
Tobacco
Use
 If smoker,
do Brief
Intervens
ion
Contract
Health Advice (5
 Referral
Station  A's) See
Form
Attached
Protocol
 If non-
smoker,
Congratu
late and
advice
continue
Healthy
Lifestyle
activity
PRIMARY Above Plus Above Plus  Use of Patient
LEVEL Nurses Doc  Quit Nicoti Assessment
II. RHU tors and Clinic ne Tool:
  other (Use DOH Repla  Stages of
SECONDA health Protocol or ceme change
RY personnel other suggested nt  WHO
LEVEL protocols e.g. thera Mental
  Motivational py Health
  Interview, SDA partic Checklist
TERTIAR Protocol, etc. as ularly  Motivatio
Y LEVEL available) Nicoti n and
 DOH ne Confiden
Protocol patch ce to quit
provides: and  Smoking
 Assessme Nicoti History
nt of ne and
client's Gum Current
Smoking is Smoking
History, advoc Status
Current ated  Self-test
Smoking for
Status reason
219
 and for
Readiness smoking
to stop (Horn's
smoking Smoker's
 Planning Selt-test)
for clients  Fagerstro
Readiness m
to stop Nicotine
smoking Depende
 Quit day: ncetest
Pharmaco  Self-test
logic, on
Psycholog Readines
ical and s to stop
Behaviora smoking
l  Previous
Interventi attempts
ons to stop
 
5. Research and Development
Research and development activities are to be conducted to better understand the
nature of nicotine dependence among Filipinos and to undertake new
pharmacological approaches. 
 
 
Partner Organizations:
The following institutions take part in achieving the goals of the program:

220
LUNG CENTER OF THE PHILIPPINES
Contact Number: 924-9204
 

PHILIPPINE COLLEGE OF CHEST PHYSICIAN

Contact Number:924-6101 to 20
 

PHILIPPINE GENERAL HOSPITAL               

Contact Number:  554-8400 
 

WORLD HEALTH ORGANIZATION

Contact Number: 338-7478/ 338-7479
 

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS 

Contact Number: 844-2135 / 889-8053
 

PHILIPPINE MEDICAL ASSOCIATION

Contact Number: 929-6366
 

FRAMEWORK CONVENTION ON TOBACCO CONTROL     

Contact Number: 468- 7222
 

221
PSYCHOLOGICAL ASSOCIATION OF THE PHILIPPINES
Contact Number: 453-8257
 

SEVENTH DAY ADVENTIST

Contact Number: 526-9870/ 526-9871/  536-1080
 

PHILIPPINE AMBULATORY PEDIATRIC ASSOCIATION          

Contact Number:525-1797
 

  PHILIPPINE PSYCHIATRIC ASSOCIATION 

 Contact Number: 635-9858
 

METROPOLITAN MANILA DEVELOPMENT AUTHORITY

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

Urban Health System Development (UHSD) Program

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

I. RATIONALE

222
 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. UHSD GOALS AND OBJECTIVES

A. Goals

1. To improve Health System Outcomes Urban Health Systems shall be directed

towards achieving the following goals: (i) Better Health Outcomes; (ii) More equitable
healthcare financing; and (iii) Improved responsiveness and client satisfaction.
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. General objective: To address the Urban Health challenge

C. Specific objectives:

1. To establish awareness on the challenges of Urban Health;

2. To initiate inter-sectoral approach to Urban Health Systems Development; and
3. To guide LGUs to develop sustainable responses to the Urban Health challenge

III. Components
The following are the developmental components of the UHSD Program:

1. Programs and Strategies

 Healthy Cities Initiative (HCI): the approach of continuously improving health
and social determinants of health, and continually creating and improving
physical and social environments shall be continued and further strengthened.
 Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a
strategy of going to every depressed barangay to reach the urban poor,
vulnerable groups and hidden slums to increase access to health services.
 Environmentally Sustainable and Healthy Urban Transport (ESHUT) initiatives
which include the development or enhancement of existing projects that

223
 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 city’s 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. General Principles

1. Healthy urbanization. Urban Health Systems (UHS) must promote healthy

urbanization so that cities develop in ways that achieve better health and avoid risks
to ill health under conditions of rapid urbanization.

2. Inter-sectoral action. UHS must be designed through inter-sectoral collaboration

with people and institutions from outside the health sector to influence a broad range
of health determinants and generate responses producing sustainable health
outcomes.

3. Inter-city coordination. Inter-city coordination between contiguous cities is

important because a city, particularly if it is not a Highly Urbanized City may not
have all the resources, institutions and capacities to be able to respond to the entire
health needs of its constituents, and may thus benefit from resources, institutions
and capacities of other cities through inter-city or inter-LGU coordination.

4. Social cohesion. Social cohesion is action through core groups.

5. Community participation. Community participation must be integrated in all

aspects of the intervention process, including planning, designing, implementing, and
sustaining any project/program.

6. Empowerment. Empowerment is enabling individuals and communities to have

ultimate control over key decisions involving their wellbeing through strategies such

224
as building knowledge and purchasing power, and mechanisms to increase client
accountability.

The DOH approach in the reform of urban health systems is the management of
social determinants of health in urban settings, with focused application on poor
populations, particularly those living in slum communities/settlements to address
equity concerns.

Briefer on the Urban Health Equity Assessment and Response Tool (Urban
HEART)

I. Rationale:

Rapid unplanned urbanization gives rise to urban poverty, health problems,

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

To address the above concerns, the Urban HEART or the Urban Health Equity
Assessment and Response Tool was developed by the WHO Centre for Health
Development in Kobe, Japan to assist Ministries of Health of countries in
systematically generating evidence to assess and respond to unfair health conditions
and inequity in the urban setting. It was initially launched in Tehran, Iran on April
2008, and the Philippines along with Iran, Zambia, and Brazil were the pilot sites to
test the Urban HEART in each country.

Seven cities initiated the use of the Urban HEART in the Philippines in 2008-
2009, namely: Paranaque City, Taguig City, Olongapo City, Naga City, Tacloban City,
Zamboanga City, and Davao City. The cities helped develop the tool for applicability
in varied urban settings in the country.

Urban Health Systems need to establish evidence on the status of the

disadvantaged population in the highly urbanized areas in order to develop objective
interventions to address inequities. Department Memorandum No. 2010-0207 dated
August 20, 2010 on the “Use of the Urban Health Equity Assessment and Response
Tool in Highly Urbanized Cities” is intended to help Highly Urbanized Cities (HUCs)
generate systematic data on health inequities to guide effective interventions.

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

Many initiatives, globally and locally, help save lives of pregnant women and
children. Essential Newborn Care (ENC) is one.

225
 ENC is a simple cost-effective newborn care intervention that can improve
neonatal as well as maternal care. IT is an evidence-based intervention that

 Emphasizes a core sequence of actions, performed methodically (step -by-step);

 Is organized so that essential time bound interventions are not interrupted; and
 Fills a gap for a package of bundled interventions in a guideline format.

Violence and Injury Prevention Program

 
Accidents consistently remain one of the leading causes of morbidity and
mortality in the country. The Philippine Health Statistics from 1975 to 2002 revealed
that there has been increasing trend of mortality due to accidents per 100,000
populations. Mortality  rate increased from 19.1/100,000 population in 1975 to
42.3/100,000 populations in 2002 corresponding to 33,617 deaths, majority of
which is caused by assaults (13,276); transport accidents (6,131); accidental
drowning and submersion (2,871); and accidental falls (1,536). Accidents ranked
8th in 1975, 7th in 1985 and 6th in 1995 and 5th in 2002 among the 10 leading causes
of death.
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 “E’s”, 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.

226
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, people’s
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

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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

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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

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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.
 
 
Status of the Program:

As a nationwide undertaking, the NCDPC requires health facilities to adhere to

all national policies and guidelines on injury reporting. The NCDPC is the central
coordinating body for the evaluation, processing, monitoring, and dissemination of
data or information. Each health facility is required to report on a daily basis all
injury related cases through the Online National Electronic Injury Surveillance
System. While the NCDPC has no regulatory power over the health facilities, it does
have indirect power thru the Bureau of Health Facilities and Services. The NCDPC as
the highest policy making body can make recommendations to the BHFS for
appropriate actions on erring health facilities.

The general objective of National Electronic Injury Surveillance System (NEISSE)

is to make efficient and effective the current systems and procedures of reporting
injury-related data. Specifically, NEISS aims to:

1. Promote efficiency to maximize time and effort in data collection, processing,

validation, analysis and dissemination of injury-related data;

2. Improve accuracy, reliability, integrity and timeliness of injury-related data;

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 3. Implement the most reliable and effective technology solution to interconnect
with the different agencies and/or beneficiaries/stakeholders of the injury
related data; and

4. Enforce standards on inputs, processes and outputs on injury-related data

collection, analysis, report generation and feedback.

ONEISS shall be the standard reporting system for the collection, storage,
analysis and reporting of data pertaining to injury. ONEISS is the information system
being implemented by the DOH in support of the Injury Program.
 
The PNIDMS

The Philippine Network for Injury Data Management System (PNIDMS) is a

multi-sectoral organization composed of the World Health Organization, United
Nations Children's Fund, Department of Health, Department of Transportation and
Communication, Department of Public Works and Highway, Philippine National
Police - Highway Patrol Group, Metro Manila Development Authority, Land
Transportation Office and Safe Kids Philippines, which aims to establish and
maintain a coordinated data management system that can link, integrate, or combine
injury data from various sources or systems to provide an overall picture for policy
makers and decision makers at the national, regional and local levels.
 
Partner Organizations/Agencies:

The program management committee (PMC) shall be chaired by the director IV

of the National Center for Disease Prevention and Control with the following as
members: Division chief of the Degenerative Disease Program: National focal person
(Program Manager) for violence and injury prevention program; and representatives
from DOTC, DPWH, DILG/League of municipalities. Specialty Societies and other
agencies/organizations are to be identified by the committee itself. Experts in the
various aspects of violence and injury prevention shall also be involved to ensure a
comprehensive program approach.
The following institutions/agencies partake in the achievement of the program
goals:
 
 Department of Transportation and Communication (DOTC)
 Philippine National Police (PNP)
 Department of Interior and Local Government (DILG)
 Department of Public Works and Highways (DPWH)
 Department of Education (DepEd)
 Metro Manila Development Authority (MMDA)
 Department of Social Welfare and Development (DSWD)
 Bureau of Fire Protection (BFP)
 Safe Kids Philippines, Inc.
 Automobile Association of the Philippines
 Safety Organization of the Philippines, Inc.
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 Philippine National Red Cross
 Motorcycle Development Participants Association
 Ford Road Safety Youth Council
 Project CARES
 Trauma Centers:
o   Philippine Orthopedic Hospital
o   East Avenue Medical Center
o   Las Piňas General Hospital and Satellite Trauma Center
o   UP-Philippine General Hospital
o   Vicente Sotto Memorial Medical Center

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 Women's Health and Safe Motherhood Project

I. RATIONALE

The Philippines has committed to the United Nation millennium declaration

that translated into a roadmap a set of goals that targets reduction of poverty, hunger
and ill health. In the light of this government commitment, the Department of Health
is faced with a challenge: to champion the cause of women and children towards
achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6(combat
HIV/AIDS, malaria and other diseases). Pregnancy and child birth are among the
leading causes of death, disease and disability in women of reproductive age in
developing countries. The Philippine government commitment to the MDGs is, among
others, a commitment to work towards the reduction of maternal mortality ratios by
three-quarters and under-five mortality by two-thirds by 2015 at all cost.
Confronted with the challenge of MDG 5 and the multi-faceted challenges of
high maternal mortality ratio, increasing neonatal deaths particularly on the first
week after birth, unmet need for reproductive health services and weak maternal care
delivery system, in addition to identifying the technical interventions to address these
problems, the DOH with support from the World Bank decided to focus on making
pregnancy and childbirth safer and sought to change fundamental societal dynamics
that influence decision making on matters related to pregnancy and childbirth while
it tries to bring quality emergency obstetrics and newborn care to facilities nearest to
homes. This moves ensures that those most in need of quality health care by
competent doctors, nurses and midwives have easy access to such care.
 
Project Development Objectives and Indicators

The Project contributes to the national goal of improving women’s health by:

1. Demonstrating in selected sites a sustainable, cost-effective model of delivering

health services access of disadvantaged women to acceptable and high quality
reproductive health services and enables them to safely attain their desired number
of children.

2. Establishing the core knowledge base and support systems that can facilitate
countrywide replication of project experience as part of mainstream approaches to
reproductive health care within the Kalusugan Pangkalahatan framework.
 
Project Components

Component A: Local Delivery of the WHSM – Service Package

This component supports LGUs in mobilizing networks of public and private
providers to deliver the integrated WHSM-SP. In such project site, the following are
currently being undertaken:

1. Establishment of Critical Capabilities to Provide Quality WHSM Services through

the organization and operation of a network of Service Delivery Teams consisting of:

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            a. Women’s 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 Women’s 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 Women’s 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 Women’s 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 women’s health and safe motherhood service

234
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:

2011
Baseline (2010) 2011
Outcome Indicators Target
Accomplishments Accomplishments
Values
80% Facility-based Births 67% 80% 77%
80% of the Women who gave
99% 80% 100%
birth have birth plans
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75% of facility deliveries are
17% 55% 27%
financed by PHIC
Increase CPR by 10 5% points 3% points increase
36%
percentage points increase 39%
100% of LGUs have passed
an ordinance on the 47% 100% 70%
Contraceptive Self Reliance
100% of BEmONC have MCP
45% 50% 52%
accreditation
Universal Social Health
72% 75% 100%
Insurance Coverage

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
Organization of Service Delivery Done
2009 Teams Done
Regional Blood Centers equipment Done
upgrade
73%
Ongoing:
Albay: 90%
Facility upgrade: Infrastructure
2009-2011 Masbate: 80%
and Equipment
Catanduanes: 60%
Surigao del Sur: 53%
Sorsogon: 84%
Currently undergoing
procurement
Training Centers Insfrastructure
2009-2010 13 Training Centers already
and equipment enhancement
provided with equipment and
other training logistics
Ensuring environmental
Safeguards
 Organization of EMU in
2009-2010 CEmONCs Done
 Designation of Waste
Management Focal Persons
in BEmONCs
2008-2012 Capability Enhancement: BEmONC Skills: 60%

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 Sorsogon: 73%
Albay: 103%
Women's Health Teams Catanduanes: 55%
Masbate: 73%
Surigao del Sur: 63%
2008-2010 BEmONC Teams  
2008-2010 Midwives on BEmONC Skills Module currently being finalized
2011-2012 CEmONC Doctors (non-specialists) Module currently being finalized
2010  Provincial Review Teams Done
Behavior Change Interventions
Performance-based Grants:
 Facility based Deliveries
2009-2013   Universal Social Health  
Insurance Coverage
 Essential Drugs and
Contraceptive Security
Advocacy for Positive Behavior 4 Infomercials produced and aired
2010-2013 Change in 2011; another 4 being
 TV Infomercials produced for airing in 2012.
52%
Albay: 31% (5/16)
BEmONC Facility MCP Catanduanes: 17% (1/6)
2009-2013
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 one-year study.
3. Assessment of BEmONC Functionality is nationwide in scope and requires 1
year.
If the extension is not granted, the Project implementation ends by December
2012. The activities therefore will be focused on accomplishing the remaining tasks
with no new activities, except the conduct of the end of Project survey to determine
its impact at the Project LGUs and its contribution to the attainment of national
goals. Writing of end of project reports will be done in January to June of 2013.

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 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.
 
Program Manager:

Ms. Zenaida D. Recidoro

National Center for Disease Prevention and Control - Family Health Office
Telephone Number: 651-7800 locals 1726-1730
 
(As stated in the Women’s Health and Safe Motherhood Project 2 Implementation
Plan)

Women's Health Safe Motherhood Program 2

Safe Motherhood and Women's Health Project

Women and Children Protection Program

I. BACKGROUND AND RATIONALE

The Aquino Health Agenda (AHA): Achieving Universal Health Care for All
Filipinos embodied in Administrative Order No. 2010-0036, dated December 16, 2010
states that poor Filipino families “have yet to experience equity and access to critical
health services.” A.0. 2010-0036 further recognizes that the public hospitals and

238
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. A consistent and adequate budget is necessary to sustain a women and children

protection unit once it is established;

4. The source of budget cited in A.O. 1-B is subjected to multiple interpretations

and is dependent on the priorities of the local chief executive and/or the
healthcare facility management;

5. There is no standard quality of service;

6. Doctors and social workers are reluctant to take on the task due to heavy
workload of women and child protection work, lack of training and feeling of

239
 inadequacy, and the nature of work, which among others requires responding
to subpoenas and appearing in court;

7. All the WCPUs are being managed by part-time personnel who are given add-on
responsibilities and their appointments are not classified as regular plantilla
positions;

8. Women and child protection work is a new field and a pool of professionals
must be recruited and trained to sustain the work; and

9. Women and children protection work has gone beyond being a health advocacy
to becoming an essential health service addressing the needs of victims of
violence against women and children.

           The strategies espoused by the AHA, specifically the service delivery network
(SDN) and public-private partnership (PPP), will be utilized in the institutionalization
of the women and children protection program nationwide. A health SDN is
composed of a network of health service providers at different levels of care from
levels 1: health centers or women and children’s desks offering primary services, 2:
district health facilities offering secondary care and 3: regional and national hospitals
with tertiary care. An SDN can be as small as an Inter-Local Health Zone or as large
as a regional SDN with a regional hospital serving as the end-referral hospital.  The
most efficient system for women and child protection facilities follows the SDN model
where a complete and integrated women and child protection unit is located in a
strategic hospital.
         The primary goal is to identify where the women and children protection units
will be located across the country and to ensure that there will be at least one in each
province. Hospitals, whether public or private, which do not have a women and child
protection unit may be trained to refer the victims to women and children protection
coordinators (WCPCs) and WCPUs in other hospitals where the staff is trained in
recognizing, recording, reporting and referring abuse cases. This will ensure that all
women and children victims of violence who seek medical care have access to health
services provided by trained, competent, and caring health personnel.

II. GOALS AND OBJECTIVES       

GOAL: To institutionalize and standardize the quality of service and training of all
women and children protection units. 

GENERAL OBJECTIVES:

1.   Establish at least one women and children protection unit in every province;

2.   Ensure that all health facilities have competent and trained gender-responsive
professionals who will coordinate the services needed by women and children victims
of violence;

240
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 children’s protection unit programs
through appropriate organizational and budgetary support;

5.   Create and maintain a centralized and harmonized database for all reports
submitted by the different women and children protection units.

III.  SCOPE AND COVERAGE

      This issuance shall apply to the entire health sector, including the DOH
hospitals, LGU-supported health facilities, private hospitals, and other attached
agencies involved in the implementation of the AHA.

        Health professionals from private hospitals seeing patients who they suspect are
victims of abuse are duty-bound to refer the said individuals to concerned
government agencies for appropriate response in accord with either Republic Act Nos.
7610[1] or 9262[2].

IV. DECLARATION OF POLICY

        This issuance supports the Government Health Reform Agenda, the Convention
on the Rights of the Child, the Convention on the Elimination of All Forms of
Discrimination Against Women, the Beijing Platform for Action, the Child Protection
Law,[3] the Anti-Violence Against Women and Their Children’s 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 there by contribute to the realization of the country’s 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 children’s 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 children’s

241
physical, emotional/psychological, 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

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 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 former’s absence.
        The Committee shall designate from among its members a program manager
who will be given appointment by the Undersecretary of Health through a
Department Personnel Order.
        The Committee may create a technical working group, as the need arises, to
help it in the performance of its functions.

3.   Term. – The Committee shall hold office for three (3) years and may be
reappointed or until their successors shall have been appointed.

4.   Functions. The Committee shall have the following functions:

1. Identify and recommend strategically-located DOH-retained and LGU-supported
hospitals for WCPU establishment using geographical and population ratio
criteria;
2. Formulate standard protocols and procedures and the manual of operations for
multidisciplinary care for women and children victims of abuse and  violence;
3. Set the policy for criteria and procedure for accreditation of women and children
protection units to be forwarded to the Bureau of Standards and Regulation for
appropriate action by the Department of Health (DOH);
4. Lay down the policy for minimum requirements for training programs that are
gender responsive, such as the Certificates for Women and Child Protection
Specialty Program and other relevant residency programs;
5. Monitor and evaluate the efficacy, effectiveness and sustainability of creation,
operations, and maintenance of WCPUs;
6. Recommend policy reforms and new guidelines anchored on evidence-based
interventions and approaches;
7. Harmonize existing databases and create a central databank for women and
children protection cases; and
8. Perform other functions as may be necessary for the implementation of the
revised issuance.

5.   Reportorial Functions. – The Committee shall submit to the Office of the
Secretary of Health its annual report on policies, plans, programs and activities on or
before the last working day of February.

6.   Meetings. – The Committee shall meet regularly at least once every quarter. The
venue shall be agreed upon by the members. Special meetings may be requested by
the Chairperson or any Committee member, as the need arises.

        The Committee members and program manager shall be entitled to an

honorarium for every meeting.

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VIII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES

A.  Department of Health at the National Level

1. The Committee shall be under the direct supervision of the Office of the
Undersecretary for Health Services Delivery.
2. The specific office/s to be designated by the Undersecretary for Health Services
Delivery shall be primarily responsible for:
a.   The overall execution of the revised policy and manual of operations on
Women and Children Protection Program; 
b.   Accreditation of WCPUs;
c.   Generation mobilization of resources for the operations of WCPUs.

B.   Philippine Health Insurance Office (PhilHealth)

The PhilHealth shall develop a service package for all WCPU patients that will
facilitate the provision of inpatient and outpatient services.

C.  Centers for Health Development

1. Disseminate the policy for adoption and implementation by LGU health systems
in the different localities within their respective regions;
2. Provide technical assistance to LGUs in organizing WCPU activities and
developing relevant technical references and information, education and
communication (IEC) materials;
3. Generate resources to strengthen the implementation of the policy and manual
of operations for WCPUs;
4. Formulate and implement advocacy plans to generate stakeholders’ support,
particularly the local officials;
5. Monitor the implementation of the policy and guidelines in both public and
private hospitals, and in different localities in their respective regions;
6. Undertake regular review with LGUs on the progress of the WCPU policy and
guidelines.

D.  Local Government Units

1.   Provincial / City Health Office
a.   Train private and public health workers on the women and children
protection program;
b.   Advocate with municipalities/cities and other concerned agencies and
stakeholders to adopt and implement the revised policy on the women and
children protection program;
c.   Generate and allocate resources in support of WCPU provision (e.g.,
counterpart funds for training, procurement of additional WCPUs, etc);
d.   Require all hospitals to implement the revised policy and its manual of
operation as an integral part of their treatment and care protocols.
2.   Regional and provincial hospitals
a.   Require all hospitals to implement the revised policy and its manual of
operation as an integral part of their treatment and care protocols;
 Allocate budget sufficient for the operations of WCPUs;
 Conduct training and orientation on 4Rs;

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  Maintain an accurate and complete database on WCPU clients.

E. Child Protection Network Foundation, Inc.

1. Provide expertise and technical support for the establishment of WCPUs and the
central database on children’s cases;
2. Extend guidance to the trained physicians and social workers in WCPUs;
3. Coordinate with the Philippine Commission for Women, Council for the Welfare
of Children and non-government organizations (NGOs) regarding matters
related to women’s and children’s health and gender concerns;
4. Participate in the implementation of the WCPU policy including its manual of
operations.

F. Philippine Commission on Women

1. Provide expertise and technical assistance on gender-responsive delivery of
services by the WCPU service providers and the central database on women’s
cases;
2. Assist the DOH in monitoring the implementation of the WCPU using the 
Performance Standards and Assessment Tools for Services Addressing VAW in
the Philippines;
3. Require all hospitals to allocate from their gender and development (GAD)
budget the funds required to create, operate, and maintain WCPUs and to
report the use of their GAD funds to PCW.

IX.  REQUIREMENTS FOR THE ESTABLISHMENT OF WOMEN AND CHILDREN

PROTECTION UNITS
       
     The Committee shall ensure that all present and future WCPUs comply with the
criteria mandated in this revised policy and its Manual of Operations.
All WCPUS, depending on the number of their personnel, range of services rendered,
and annual budget shall be classified as Levels I, II and III facilities. Minimum
criteria for each of these units are enumerated in the Manual of Operations of this
policy.                              

MANUAL OF OPERATIONS
         The Committee on Women and Children Protection Program shall regulate the
establishment and operations of all WCPUs in the Philippines.

I.   MINIMUM REQUIREMENTS FOR ALL HOSPITALS

A. Training. – The Committee shall require that all hospital personnel undergo
training on the recognition, reporting, recording and referral (4R’s) of cases of
violence against women and children.

B.   Women and Children Protection Coordinator. – Hospitals without a women and
children protection unit shall have a women and children protection coordinator
(WCPC) responsible for coordinating the management and referral of all violence
against women and children cases in the hospital.

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II. The minimum standard criteria shall be maintained by all WCPUs.

A.  Organizational Structure - The WCPU shall:

1. Be an integral part of the hospital;
2. Be under the Office of the Chief of Clinics;
3. Be supervised by a WCPU head who shall have the following responsibilities: 
 a.   Integrate and operationalize the multidisciplinary functions of the WCPU 
 b.   Prepare the annual work and financial plan, including  budget
preparation,
4. Submit quarterly reports to the Office of the Undersecretary for Health Services
Delivery.
5. Have the following minimum staff, preferably with regular plantilla positions,
who shall be primarily responsible to the WCPU:    
              a.   a trained physician and
              b.   a trained social worker. 

B.  Facilities - The WCPU shall:

1. Be permanently situated in a designated area, preferably near the emergency
room of the hospital;
2. Be spacious enough to accommodate all the services provided by the facility,
such as:
a. A separate room for interviews and crisis counselling
b. A separate room for medical examination;
c. A reception area to accommodate those waiting to be served, including their
companions. The reception area must have culture- and gender-sensitive
information materials on violence against women and children (VAWC)
d. Filing cabinets and other furniture/equipment that will ensure the security and
confidentiality of files and records;

3. Have its own toilet or comfort room;

4. Have the following fixtures:    

a.   Examination table
b.   Desk and chairs 
c.   Washing facilities with clean running water
d.   Light source, and
e.   Telephone line
f.    Computer and printer
g.   Office supplies
 
5. Have readily available supplies and equipment for medical examination,
including:
             a.   Digital camera 
             b.   Rape kit
             c.   Speculum of different sizes
             d.   Blood tubes

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             e.   Syringes, needles and sterile swabs 
             f.    Examination gloves
             g.   Pregnancy testing kits
             h.   Microscope slides
             i.    Measuring devices like rulers and calipers
             j.    Urine specimen containers
             k.   Refrigerator for storage of specimens
             l.     Analgesics, medicines for STI prophylaxis, and emergency
contraceptives
            m.   Labels
            n.   Medical forms including consent forms and anatomical diagrams 
            o.   Colposcope (Optional)
            p.   Video camera for recording the forensic interview (optional)
            q.   Tape recorder (optional)

III.     LEVELS OF CARE DELIVERED BY WCPUs

a.   Level I WCPU

1.   Personnel
 A trained physician, and
 A trained and registered social worker.

2.   Services. – A level I WCPU provides

 Minimum medical services in the form of medico-legal examination, acute
medical treatment, minor surgical treatment, monitoring & follow-up
 In the preparation of the medico-legal certificate and report, the WCPU
shall utilize the terminology and the form attached as Annexes “A” and
“B,” respectively, to this Manual of Operations
 A full coverage, 24/7
 Minimum social work intervention such as safety (and risk) assessment,
coordination with other disciplines (i.e., Department of Social Welfare and
Development (DSWD) or the local social welfare and development office
(SWDO), police, legal, NGOs)
 Peer review of cases
 Proper documentation and record-keeping
 Expert testimony in court
 Networks with other disciplines and agencies

3.      Training Capability

 Training on 4Rs

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

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b.   Level II WCPU

1. Personnel
 A trained physician;
 A trained and registered social worker, also with full-time coverage of
duties at the WCPU; and
 A trained police officer or a trained mental health professional.

2. Services
 Medical services similar to a Level I WCPU including rape kits and surgical
intervention.
 In the preparation of the medico-legal certificate and report, the WCPU
shall utilize the terminology and the form attached as Annexes “A” and
“B,” respectively, to this Manual of Operations
 Full coverage, 24/7
 Social work intervention similar to that of a Level I WCPU plus case
management and case conferences
 Additional services in the form of police investigation or mental health care
 Proper documentation and record-keeping using the Child Protection
Management Information System (CPMIS)
 Expert testimony in court
 Peer review of cases
 Availability of specialty consultations (ENT, ophthalmology, surgery, OB-
Gyne, pathology)
 Networks with other disciplines and agencies.

3. Training Capability
 Training on 4Rs
 Residency training

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

c. Level III WCPU

1. Personnel
 At least two (2) trained physicians;
 At least two (2) trained and registered social workers;
 A registered nurse;
 A trained police officer; and
 A mental health professional

2. Services
 Medical services of a Level 2 WCPU

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

3. Training Capability
 Training on 4Rs
 Competence and facility to run residency training and specialty trainings

4. Research
 Proper documentation of experiences which will serve as inputs for policy
research, formulation and program improvement;
 Conduct of empirical investigations on women and children protection
work;
 Publication of such research studies in reputable journals and/or
presentation in scientific conferences or meetings.
 
IV.       TRAINING AND EDUCATION IN WOMEN AND CHILDREN PROTECTION

            A multi-disciplinary training program will address human resource needs of

women and child protection units and women’s and children’s desk as well as create
and sustain a woman- and child-sensitive hospital environment. The women and
children protection program in the central office will set directions and define a
career path for medical and paramedical graduates who might be interested in
professionally pursuing this line of work. This will be made available not only to
hospital personnel but to community and interested organizations that would like to
avail of the training.  Training areas may focus on the following:

1.  For trainees to acquire/enhance attitudes necessary in the management of

acute and chronic causes of crisis such as sensitivity, compassion,
confidentiality and empathy.

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 2. For the trainees to develop/strengthen their skills in early detection, screening,
interviewing, physical examination, use of appropriate diagnostic procedures,
management, counseling and referral.

3. For the trainees to have additional knowledge on understanding of conditions

leading to crisis, recognition of early sign of crisis identification, analysis of
aggravating/contributory factors including family factors/stresses,
understanding of the impact of crisis on the individual the family and the
community management of patients and their families networking, linkage
development and referral.

V.  MINIMUM REQUIREMENTS OF A TRAINED WOMEN AND CHILDREN

PROTECTION SPECIALIST

1.   Physician
 Six (6)-week Child Protection Specialist Training for Physicians of the Child
Protection Network Foundation or its equivalent

2.   Social Worker

 Four (4) -week Child Protection Specialist Training for Social Workers of the
Child Protection Network Foundation or its equivalent

3.   Police Officer

 Four (4)-week Child Protection Specialist Training for Police Officers of the Child
Protection Network Foundation or its equivalent

[1] Republic Act 7610: Anti-Child Abuse Law

[2] Republic Act 9262: Anti-Violence Against Women and their Children Act
[3] Republic Act No. 7610
[4] Republic Act No. 9262
[5] Republic Act No. 8353
[6] Republic Act No. 8505
[7] Republic Act 9710
[8] DOH Performance Standards and Assessment Tools for Services Addressing
Violence against Women in the Philippines, 2008 (ed), at p.9.

joyshe

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