Doh Programs A-z i332d

DOH Programs A-Z A Adolescent and Youth Health Program (AYHP) A Situationer on Adolescents Health

Non-communicable diseases 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 ed in 2003, 35.7% (596, 076 LB) were by women £24 years old. Teenage pregnancy ed for 8% of all births (National Demographic Health Survey, 2003). Of the 1,798 maternal deaths ed 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. B Botika Ng Barangay (BnB) 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 lowpriced 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 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

ces

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.

Program Manager: Fernando E. Depano Health Education Promotion Officer IV

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 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 Date

Title

National Center for Pharmaceutical Access and Management (NAM) Number: 651-7800 local 2554/2555

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.

ent January dum 26, Moratorium on the Establishment of Botika ng Barangay (BnB) Nationwide 0022 2011

ent Februar dum y 12, 0033 2010

This campaign encourages mothers to exclusively breastfeed their babies from birth up to 6 months. Exclusive breastfeeding means that Submission of Reports for the Impact Assessment of Maximum Drug forRetail the first six months from birth, nothing except Price (MDRP) / Government breast milk will be given to babies.

ent Februar Amendment to Memorandum No. 31 s. 2003 dated 17 February 2003 re: Moreover, the campaign aims to establish a dum y 21, Drugs to be sold in Botika ng Barangays (BnBs) ive community, as well as to promote 0038 2008

ent dum April 5, -0046 2005

ative

1

ent dum .

ative 144

dum 2003

public consciousness on the health benefits of breastfeeding. Among the many health benefits Utilization of Slow-Moving Pharma 50 Botika ng Barangay (BnB) Drugs of and breastfeeding are lower risk of diarrhea, Medicines pneumonia, and chronic illnesses.

Supplemental Guidelines to istrative Order No. 144 series 2004, entitled: "Guidelines for the Establishment and Operations of Botika ng Blood Donation Program April 4, Barangays (BnB) and Pharmaceutical Distribution Network (PDNs)" relative 2005 Republic to the inclusion of other drugs which are classified as Prescription Drugs Act No. 7719, also known as Blood Services Act of 1994, promotes and other related matters

the National voluntary blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act aims Novemb to inculcate public awareness that blood donation Botika ng Barangay Performance Monitoring Reports and Routine Schedule er 22, is a humanitarian act. of Submissions 2004

The National Voluntary Blood Services Program (NVBSP) of the Department of Health is April 14, Guidelines for the Establishment and Operations of Botika ng Barangays targeting the youth as volunteers in its blood 2004 (BnB) and Pharmaceutical Distribution Network (PDNs) donation program this year. In accordance with RA No. 7719, it aims to create public consciousness on the importance of blood Februar donation in saving the lives of millions of Filipinos. y 17, Drugs to be sold in Botika ng Barangays (BnBs) 2003

Based from the data from the National Voluntary Blood Services Program, a total of

654,763 blood units were collected in 2009. Fiftyeight 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; 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. Program Manager:Dr. Ponciano Limcangco Mr. Salvador Avdante, Jr. C

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 acquisisiton of health lifestyles. Also critical for effective pallning and implementation would be addressing the components of the health infrastructure such as human resource development, quality assurance, monitoring and disease surveillance, and health information and education. The successful implementation of these strategies will require collaborative efforts with the other stakeholdres and also implies integration with the other developmental plan of action for children. Vision A healthy Filipino child is: 

Child Health and Development Strategic Plan Year 2001-2004 INTRODUCTION The Philippine National Strategic Framework for lan Development for CHildren or CHILD 21 is a strategic framework for planning programs and interventions that promote and safegurad the rights of Filipino children. Covering the period 2000-2005, it paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a roap to achieve the vision. Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical and fundamental element in children's welfare. However, health programs cannot be implemented in isolation from the other component that determine the safety and well being of children in society. Children's Health 2025, therefore, should be able to integrate the







Wanted, planned and conceived by healthy parentsCarried to term by healthy motherBorn into a loving, caring. stable family capable of providing for his or her basic needsDelivered safely by a trained attendant Screened for congenital defects shortly after birth; if defects are found, interventions to corrrect these defects are implemented at the appropriate time Exclusively breastfed for at least six months of age, and continued breasfeeding up to two yearsIntroduced to compementary foods at about six months of age, and gradually to a balanced, nutritious dietProtected from the consequences of protein-calorie and micronutirent deficiencies through good nutrition and access to fortified foods and iodized salt Provided with safe, clean and hygienic surroundings and protected



 

from accidentsProperly cared for at home when sick and brought timely to a health facility for appropriate management when needed.Offered equal access to good quality curative, preventive and promotive health care services and health education as of the Filipino society Regularly monitored for proper growth and development, and provided with adequate psychosocial and mental stimulationScreened for disabilities and developmental delays in early childhood; if disabilities are found, interventions are implemented to enabled the child to enjoy a life of dignity at the highest level of function attainable Protected from discrimination, exploitation and abuse Empowered and enabled to make decisions regarding healthy lifestyle and behaviors and included in the formulation health policies and programsAfforded the opportunity to reach his or her full potential as adult

Current Situation Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, septicemia), nutritional deficiencies and birth-realted complications. The probability of dying between birth and five years of age is 48 deaths per 1000 livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningities and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents.

The Philippines has been declared as poliofree druing the Kyoto Meeting on Poliomyelities Eradication in the Western Pacific Region last October 2000. This. however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urrgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved. Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997. Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos of age (NDHS). Several strategies were utilized to omprove child health. THe Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common chldhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway. The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and seeking behaviors. It operates through health and nutrition posts established throughout the country. Gaps and Challenges

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, pertussis, poliomyelities, Hepatitis B and measles).

Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for childrens health. There is also the need to update and reiterate the

policies on children's health particularly on immunization, micronutrient supplementation and IMCI. LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution. Pockets of low immunization coverage is attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization. Goal The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025. Medium-term Objectives for year 2001-2004 Health Status Objectives 1. Reduce infant mortality rate to 17 deaths per 1,000 live births 2. Reduce mortality rate among children 14 years old to 33.6% per 1000 livebirths 3. Reduce the mortality rate among adolescents and youths by 50% Risk Reduction Objectives 1. Increse the percentage of fully immunized children to 90% 2. Increase the percentage of infants exclusively breastfed up to six months to 30% 3. Increase the percentage of infants given timely and proper complementary feeding at six months to 70% 4. Increase the percentage of mothers and caregivers who know and practice home management of childhood illness to 80% 5. Reduce the prevalence of protein-energy malnutrition among school-age children 6. Increase the health care-seeking behavior of adolescents to 50% Services and Protection Objectives 1. Ensure 90% of infants and children are provided with essential health care package 2. Increase the percentage of health facilities with available stocks of vaccines and esential drugs and micronutrients to 80% 3. Increase the percentage of schools implementing school-based health and nutrition

programs to 80% 4. Increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70% 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 faciities 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 systems and interventions for children's health Notable community-based projects and interventions, such as the health and nutrition posts, mother 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 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 national campaigns for children * Initiate and legislations and researches on children's health and welfare * 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

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 - ThreeYear Transition Period for Compliance to istrative Order No. 2010-0034. 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. istrative 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. 20080009 - Designation of DOH Human Resource Development Units (DOHHRDUs) 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. istrative 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 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 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.

enerhiya mula sa araw, sa pag-ikot ng mundo, at sa init na nagmumula sa ilalim ng lupa na nagpapataas ng temperatura o init sa hangin na bumabalot sa mundo. 2. Mga gawain ng tao na nagbubunga ng pagdami o pagtaas ng carbon dioxide at iba pang greenhouse gases )GHGs). ANg GHGs ang nagkukulong ng init sa mundo. Ang pagbuga ng carbon dioxide ng mga sasakyang gumagamit ng gasolina, ang pagputol ng mga puno na siya sanang mag-aalis ng carbon dioxide sa hangin, at pagkabulok ng mga bagay na organic na nagbubunga ng methane (isa pang uri ng GHGs) ay ilan sa mga dahilan ng climate change. Epektong Pangkalusugan ng CLIMATE CHANGE Mga epekto sa tao ng matinding init, tagtuyot at bagyo. 

Climate Change Ano ang CLIMATE CHANGE? Ang climate change ay ang pagbabago ng klima o panahon dahil sa pagtaas ng mg greenhouse gases na nagpapainit sa mundo. Nagdudulot ito ng mga sakuna kagaya ng heatwave, baha at tagtuyot na maaaring magdulot ng pagkakasakit o pagkamatay. Kapag tumaas ang temperatura ng mundo, dadami ang mga sakit kagaya ng dengue, diarrhea, malnutrisyon at iba pa.



Sanhi ng CLIMATE CHANGE



Ayon sa pagaaral, ang dalawang sanhi ng climate change ay ang:

  

Pagtaas ng bilang ng kaso ng mga sakit na: - Dala ng tubig o pagkain tulad ng choler at iba pang sakit na may pagtatae. - Dala ng insekto tulad ng lamok ) malaria at dengue) at ng daga (Leptospirosis). Dulot ng polusyon (allergy) Malnutrisyon at epektong panglipunan dulot ng pagkasira ng mga komunidad at pangkabuhayan nito. Video Presentation on Green for Health: Plant a Tree "Protecting Health from Climate Change" Climate Change Policy Manual Climate Change WHO Reference Manual Climate Change Newsletter

Prevalence YEAR Dental Caries

Peridontal Disease

1987

93.9%

65.5%

1992

96.3%

48.1%

1998

92.4%

78.3%

D Dental Health

Program 1. Natural na pagbabago ng klima ng buong mundo nitong mga nagdaang matagal na panahon. Ito ay sama-samang epekto ng

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.

3544

Table 2 - Dental caries Experience (Mean DMFT/dmft), per age groups, Philippines

NMEDS 1992

NMEDS 1998

1519

15.04

NMEDS VISION: Empowered and 2006 responsible Filipino citizens taking care of their own personal oral health for an 8.4 dmftenhanced quality of life

6 12

14.42

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.

The oral health status of Filipino children is alarming. The 2006 National Oral Health Survey (Monse B. et al, NOHS 2006) investigated the oral health status of Philippine public elementary school students. It revealed that 97.1% of sixyear-old children suffer from tooth decay. More than four out of every five children of this subgroup manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-year-old children suffer from dental caries and 49.7% of the same age group manifested symptoms of dentinogenic infections. The severity of dental caries, expressed as the average number of decayed teeth indicated for filling/extraction or filled permanent teeth (DMFT) or temporary teeth (dmft), was 8.4 dmft for the six-year-old age group and 2.9 DMFT for the twelve-year-old age group (NOHS 2006).

NMEDS 1987

14.82

Filipinos bear the burden of gum diseases early in their childhood. According to NOHS, 74% of twelve-year-old children suffer from gingivitis. If not treated early, these children become susceptible to irreversible periodontal disease as they enter adolescence and approach adulthood.

Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines

Age in NMEDS Yea 1982 rs

14.18

6.39

5.52

5.43

4.58

8.51

8.25

6.3

2.9

MISSION: The state shall ensure quality, affordable, accessible and available oral health care delivery.

GOAL: Attainment of improved quality of life through promotion of oral health and quality oral health care. OBJECTIVES AND TARGETS: 1. The prevalence of dental caries is reduce Annual Target : 5% reduction of the prevalence rate every year 2. The prevalence of periodontal disease is reduced Annual Targets : 5% reduction of the prevalence rate every year 3.

Dental caries experience is reduced

Annual Target : 5% reduction of the mean dmft/DMFT for 5/6 years old and 12 years old children every year 4. The proportion of Orally Fit Children (OFC) 12-71 months old is increased Annual Targets : Increased by 20% yearly The national government is primarily tasked to develop policies and guideline for local government units. In 2007, the Department of Health formulated the Guidelines in the Implementation of Oral Health Program for Public Health Services (AO 2007-0007). The program aims to reduce the prevalence rate of dental caries to 85% and periodontal disease by to 60% by the end of 2016. The program seeks to achieve these objectives by providing preventive, curative, and promotive dental health care to Filipinos through a lifecycle approach. This approach provides a continuum of quality care by establishing a package of essential basic oral health care (BOHC) for every lifecycle stage, starting from infancy to old age. The following are the basic package of essential oral health services/care for every

lifecycle group to be provided either in health facilities, schools or at home.

TYPES OF SERVICE

STRATEGIES AND ACTION POINTS:

LIFECYCLE

(Basic Oral Health Care

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

Package)

Mother(Pregnant Women) **

Neonatal and Infants under 1 year old**

    

Oral Examination



Dental check-up as soon



Oral Prophylaxis (scaling) Permanent fillings Gum treatment

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

Health instruction

as the first tooth erupts Health instructions on infant oral health care and

b. Development of policies, standards, guidelines and clinical protocols - Fluoride Use

advise on exclusive

- Toothbrushing

breastfeeding



Dental check-up as soon

- Other Preventive Measures

as the first tooth appears and every 6 months thereafter



Supervised tooth brushing drills



Oral Urgent Treatment (OUT)

Children 12-71 months old

**

- removal of unsavable teeth - referral of complicated cases

extraction complications - drainage of localized oral abscess Application of Atraumatic Restorative Treatment

  School Children (6-12 years old)

     

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

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.

- treatment of post



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

(ART)

a. Improve existing information system/data collection (reporting and recording dental services and accomplishments ) - setting of essential indicators

Oral Examination Supervising tooth brushing drills Topical fluoride theraphy Pits and Fissure Sealant Application Oral Prophylaxis Permanent Fillings Oral Examination Health promotion and education on oral hygiene, and adverse effect on consumption of sweets and

- development of IT system on recording and reporting oral health service accomplishments and indices - Integrate oral health in every family health information tools, recording books/manuals

b. Conduct Regular Epidemiological Dental Surveys – every 5 years 4. Ensure access and delivery of quality oral health care servicesa. a. Upgrading of facilities, equipment, instruments, supplies

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)

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

c) Adolescent and Youth (10-24 years old) provided with Basic Oral Health care (BOHC)

-revival of the sealant program for school children

d) Pregnant Women provided with Basic oral Health Care (BOHC)

- toothbrushing program for pre-school children

e) Older Persons 60 years old and above provided with Basic Oral Health Care (BOHC)

- outreach programs for marginalized groups c. Design and implement grant assistance mechanism for high performing LGUs

Policy/Standards/Guidelines formulated/developed: a. AO. 101 s. 2003 dated Oct. 14, 2003 – National Policy on Oral Health

- Awards and incentives - Sub-allotment of funds for priority programs/activities d. Regular conduct of consultation meetings, technical updates and program implementation reviews with stakeholders 5. Build up highly motivated health professionals and trained auxilliaries to manage and provide quality oral health care

b. AO 2007-0007 – Dated January 3, 2007 Guidelines In The Implementation Of Oral Health Program For Public Health Services In The Philippines c. AO 4-s.1998 – Revised Rules and Regulations and Standard Requirements for Private School Dental services in the Philippines d. AO 11-D s. 1998 – Revised Standard Requirements for Hospital Dental services in the Philippines

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)

e. AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for Occupational Dental services in the Philippines f. AO 4-A s. 1998 – Infection Control Measures for Dental Health Services Trainings/Capacity Enhancement Program:

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

1. Leaflets (Malakas ang dating Buo ang Ngipin) for Children, Adolescent, Pregnant Women and Older Person 2. Training Module on Basic Course on Management of Oral Health Program Non-Government Organization Major Partners: Philippine Dental Association Fit for School, Inc. Program Managers/Coordinators:

Existing Working Group for Oral Health: Dr. Manuel F. Calonge National Technical Working Group (TWG) on Oral Health (DPO 2005-1197)

Chief Health Program Officer

Member Agencies: Department of Health (NCDPC, HHRDB, NCHP)

National Oral Health Program Coordinator

DOH- Center for Health Development for NCR, Central Luzon and Calabarzon

National Center for Disease Prevention and Control Department of Health

Philippine Dental Manila, Philippines

Association Department of Education

(632) 651-7800 loc. 1726-1730

Up- College of Public

E-Mail : [email protected]

Health Department of Interior and Local Government Department of Social Welfare and Development

REGIONAL DENTAL COORDINATORS

REGION

CHD DENTAL COORDINA

Local Government Units ( Makati, Quezon City)

Print materials:

CHD FOR CORDILLERA

Dr. Flora B. Pelingen

BGMC Compound, Baguio City

[email protected]

OR ILOCOS

nando, La Union

n 1)

OR CAGAYAN VALLEY

(Region 5)

CHD FOR WESTERN VISAYAS Dr. Artemio R. Licos Mandurriao, Iloilo City [email protected] (Region 6)

Dr. Clodualdo B. Divinagrac [email protected]

CHD FOR CENTRAL VISAYAS Dr. Josefino Flores

Dr. Expedito Medalla/Dr. Ph Yray Jr.

[email protected]

arao, Cagayan

n 2)

(Region 7)

OR CENTRAL LUZON Dr. BlessildaCHD Sanchez FOR EASTERN VISAYAS

nando, Pampanga

Dr. Ma. Vilma Estorba [email protected] Tacloban City

n 3)

[email protected] (Region 8)

OR SOUTHERN TAGALOG

arzon-A)

4, Quezon City

CHD FOR ZAMBOANGA PENINSULA Dr. Edwina Go Zamboanga City [email protected] (Region 9)

Dr. Manuel Isagan 09172063878

n 4) CHD FOR NORTHERN MINDANAO

OR SOUTHERN TAGALOG

Dr. Fe Paler Dr. Maria Gracia S. Gabriel Carmen, Cagayan de Oro City

ropa-B)

[email protected] (Region 10)

4, Quezon City

OR BICOL

i City, Albay

CHD FOR DAVAO REGION Dr. Elena Cortez Bajada, Davao [email protected] (Region 11)

Dr. Memory Padua [email protected] Ms. Ma. Theresa Ronquillo

were carried out. The Philippines was able to [email protected] minimize the impact of SARS through effective information dissemination, risk communication, and efficient conduct of measures.

OCCKSARGEN Dr. Anna Liza Alo

to City [email protected]

n 12)

OR CARAGA City

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 Dr. Ma. Carmela Mary Beltran alert was declared by the World Health Organization (WHO). [email protected]

GA)

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.

OR METRO MANILA

Dr. Alexander Alberto

eville Subd., Mandaluyong City

09158801332

NOMOUS REGION FOR MUSLIM ANAO

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 Dr. Shalmalynne Ampatuanintegrated while the existing systems and [email protected] organizational structures are further strengthened.

)

to City

E 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

Goal: Prevention and control of emerging and re-emerging infectious disease from becoming public health problems. Objectives: 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 reemerging diseases that may pose epidemic/pandemic threat; and 6. Logistical for drugs and vaccines for meningococcemia and antiviral 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)

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 nonbiological 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 virute of E.O. 489 to facilitate and improve coordination among concerned agencies. It provides the venue for technical collaboration, effective monitoring and communication, resource mobilization, policy review and development. The Committee has five sectoral task forces on water, solid waste, air, toxic and chemical substances and occupational health. Vision Health Settings for All Filipinos Mission Provide leadership in ensuring health settings Goals Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion and mitigation of hazards and risks in the environment and worksplaces. Strategic Objectives 1. Development of evidence-based policies, guidelines, standards, programs and parameters for specific healthy settings. 2. Provision of technical assistance to implementers and other relevant partners 3. Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and attainment of healthy settings Key Result Areas  Appropriate development and regular evaluation of relevant programs, projects, policies and plans on environmental and occupational health  Timely provision of technical assistance to Centers for Health Development (CHDs) and other partners  Development of responsive/relevant legislative and research agenda on DPC  Timely provision of technical inputs to curriculum development and conduct of human resource development  Timely provision of technically sound advice to the Secretary and other stakeholders  Timely and adequate provision of strategic logistics 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. 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 (AB) against Tetanus improved by 13% compared to any prior period. Thus, the Philippines has now historically the highest coverage for these two major indicators. Figure 1: Comparison of the 2003 and 2008 EPI indicators, Source: NDHS

III. Interventions/ Strategies Program Objectives/Goals: Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccinepreventable 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 WHOUNICEF Reaching Every District (RED), was introduced in 2004 aimed to improve the access

to routine immunization and reduce drop-outs. There are 5 components of the strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between the community and service, ive 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

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 measlescontaining 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) were 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 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

Control of other common vaccinepreventable 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 

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. Figure 3: Level of Risk for NT, Philippines





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. Figure 4



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.

Hepatitis B Coverage. Philippines, 2001-2011

Timing of istration /dose

2009

2010*

2011*

<24 hours

34%

38%

14%

>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 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 multiyear 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.

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: 1. To provide evidence-based practices to ensure survival of the newborn from birth up to the first 28 days of life 2. To deliver time-bound core intervention in the immediate period after the delivery of the newborn 3. To strengthen health facility environment for breastfeeding initiation to take place and for breastfeeding to be continued from discharge up to 2 years of life 4. To provide appropriate and timely emergency newborn care to newborns in need of resuscitation 5. To ensure access of newborns to affordable life-saving medicines to reduce deaths and morbidity from leading causes of newborn conditions 6. To ensure inclusion of newborn care in the overall approach to the Maternal, Newborn, Child Health and Nutrition Strategy Stakeholders: 1. Both public and private sector at all levels of health service delivery providing maternal and newborn services 2. Health Professional Organizations and their member health professionals a. Pediatricians/neonatalogists of the Philippine Pediatric Society (PPS) and the Philippine Society of Newborn Medicine (PSNbM)

b. Obstetrician-Gynecologists of the Philippine Obstetrical and Gynecological Society (POGS) c. Perinatologists of the Perinatal Association of the Philippines, Inc., (PAPI) d. Anesthesiologists and obstetric anesthesiologists of the Philippine Society of Anesthesiologists (PSA) and the Society for Obstetric Anesthesia of the Philippines (SOAP), e. Family medicine specialists of the Philippine Academy of Family Physicians (PAFP) f. Nurses, Maternal and child nurses, intensive care nurses of the Philippine Nurses Association and its nursing societies g. Midwives of the Integrated Midwives of the Philippines (IMAP), Philippine League of Government and Private Midwives, Inc. (PLGPMI), Midwives Foundation of the Philippines (MFP) and Well Family Midwives Clinic 3. Government regulatory bodies e.g. Professional Regulations Commission 4. Academe - professors and instructors from schools and colleges of: a. Association of Philippine Medical Colleges (APMC) b. Association of Deans of Philippine Colleges of Nursing (ADPCN) c. Association of Philippine Schools of Midwifery 5. Hospital, health care and infection control associations a. Philippine Hospital Association (PHA) b. Private Hospitals Association of the Philippines (PHAP) c. Philippine College of Hospital s d. Philippine Hospital Infection Control Society 6. Local government units - local chief executives and LGU legislative bodies Beneficiaries:

a. Newborns all over the country b. Parents c. communities Program Strategies: 1. Health Sector Reform a. Policy and Guideline Issuance i) istrative Order 20090025 - Adopting Policies and Guidelines on Essential Newborn Care - December 1, 2009 ii) Clinical Pocket Guide on Essential Newborn Care b. Aquino Health Agenda and Achieving Universal Health Care istrative Order 2010-0036 c. PhilHealth Circular 2011-011 dated August 5, 2011 on Newborn Care Package d. Development of Operationalization of Essential Newborn Care Protocol in Health Facilities 2 Identification of Centers of Excellence - Adoption of essential newborn care protocol(including intrapartum care and the MNCHN Strategy) 3. Curriculum Reforms - Curriculum integration of essential newborn care (including intrapartum care and the MNCHN Strategy) in undergraduate health courses - Integration and revision of board exam questions in licensure examinations for physicians, nurses and midives 4. Social Marketing - Development of social marketing tools - Unang Yakap MDG 4 & 5 Major Activities and its Guidelines: a. Conduct of one-day orientationworkshop on essential newborn care (including intrapartum care and the MNCHN Strategy) b. Regional MNCHN Conference for CHDs

and LGUs including DOH-retained hospitals and LGU hospitals Current Status of the Program A. What have been achieved/done 1. Policy was issued in December 1, 2009 2. DOH/WHO Scale-up Implementation was done in 11 hospitals 3. Advocacy Partners Forum on essential newborn care (including intrapartum care and the MNCHN Strategy) 4. One-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy) among health workers in different health facilities 5. Inclusion of dexamethasone and surfactant as core medicines in the essential medicines list for children in the Philippine National Formulary B. Statistics Early outcomes of EINC implementation has shown reduction on neonatal deaths in select DOH-retained hospitals including deaths from neonatal sepsis and complicatons of prematurity Partner organizations/agencies:  National Nutrition Council  Population Commission  WHO  UNICEF  UNFPA  AusAID  USAID  health professional and academic organizations mentioned above. F 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 of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally

and medically acceptable family planning methods. The program is anchored on the following basic principles. 

Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens.



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 determin the number and spacing of their children according to their life's aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children's and their own lives.

Intended Audience: Men and women of reproductive age (15-49) years old) including adolescents

Area of Coverage: Nationwide Mandate:EO 119 and EO 102 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 1. Policy, guidelines and plans formulation 2. Standard setting 3. Technical assistance to CHDs/LGUs and other partner agencies 4. Advocacy, social mobilization 5. Information, education and counselling 6. Capability building for trainers of CHDs/LGUs 7. Logistics management 8. Monitoring and evaluation 9. Research and development Strategies 1. Frontline participation of DOH-retained hospitals 2. Family Planning for the urban and rural poor 3. Demand Generation through CommunityBased Management Information System 4. Mainstreaming Natural Family Planning in the public and NGO health facilities 5. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM 6. 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 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 CommunityBased Management Information System  Identification and masterlisting of potential FP clients and s in need of PF services (permanent or temporary methods)  Segmentation of potential clients and s 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 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 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 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 ; 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: 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 Physiolo education in print and radio gical 1993 stations. The need for safe State food and water intake by 6 months adequate cooking and 35.3 - 5 yrs. boiling of drinking water is inculcated to the public. Pregnant 16.4 Multi-drug resistant cases of Lactating 16.4 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)

Food Fortification Program Objectives: 1. To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem 2. To discuss various types of food fortification strategies 3. To provide an update on the current situation of food fortification in the Philippines Fortification as defined by Codex Alimentarius “the addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiencyof one or more nutrients in the population or specific population groups” Vitamin A, Vitamin A Deficiency (VAD) and its Consequences  ›Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence  ›Vitamin A deficiency - a 1998 2003 2008 condition characterized by depleted liver stores & 38.0 40.1 15.2 low blood levels of vitamin A 22.2 17.5 9.5 due to prolonged 16.5 20.1 6.4 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) 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  ›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 Prevalence of anemia by age, sex and physiologic state: Philippines, 2008

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›Thyroid hormones - needed for the brain and nervous system to develop & function normally ›Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various condition e.g. goiter, cretinism, mental retardation, loss of IQ points

Progress in the Philippines towards the Elimination of IDD, 1998-2008 *ICC-IDD 2007

Iodine and Iodine Deficiency Disorders (IDD) 

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Republic Act 8172, “An Act Promoting Salt Iodization Nationwide and for other purposes”, Signed into law on Dec. 20, 1995  Food Fortification Law

›Iodine -a mineral and a component of the thyroid hormones

Indicator

Achievemen ts Goal * 19 20 20 98

Proportion of Households using Iodized Salt, %

>90

9.7

03

08

56. 81. 0 1

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

Median Urinary Iodine, ug/L 6-12 yrs.

100200

Lactating Women

100200

-

111 81

Pregnant Women

150249

-

142 105

Proportion < 50µg/L, %

< 20

6-12 yrs.

Policy on Food Fortification ASIN LAW

Status and Recommendations for the Sangkap Pinoy Seal Program

71 201 132 

  

35. 11. 19. 8 4 7

Lactating Women

-

23. 34. 7 0

Pregnant Women

-

18. 25. 0 8

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›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 SPSproducts is 99.2%

Recommendations: 

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›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:  

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›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: 

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›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 ›Need to show impact of flour fortification

Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A Status: 

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›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

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›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:  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)

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Status and Recommendations on Salt Iodization

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

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Status: 

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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

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: 

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



›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. Rationale for the New GP Design

GP Services Package Age

G 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.  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

by

Health

Nutrition

Year

0-1

Environmen t

Maternalnutrition

Water

Maternal health care

Iron supplementation

Sanitation

Essential newborn

Vitamin A

Hygiene promotion

care Early &exclusive Immunization

breastfeeding

Oral health

Complementary feeding

Child injury prevention

1-5 Immunization

Breastfeeding

Deworming

Complementaryfeeding

IMCI

Vitamin A Iron supplementation

Treated bednets Smoke-free homes

Iodized salt at home

Deworming 6-10

Booster immunization (Screening)

Proper nutrition Iodized salt at home

Deworming Proper nutrition 1114

Booster immunization (Screening)

Iron supplementation

Physical activity

Iodized salt at home

(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 ( Please refer to your MOP for other target groups) 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

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.

H 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 g 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.

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:

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.

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.

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

Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control ) Program Briefer Cognizant of its mandate and crucial role, the Philippine Department of Heallth (DOH) formulated the Health Care Program for Older Persons (HOP) in 1998. The DOH HOP (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 1. Older persons (60 years and above) who are: a. Well and free from symptoms b. Sick and frail c. Chronically ill and cognitively impaired d. In need of rehabilitation services 2. Health workers and caregivers 3. LGU and partner agencies 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. 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 . — (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 selfhelp projects; and

(d) To exercise such other functions which are necessary to carry out the purpose for which the centers are established. Sec. 6. Center Workers. — The Secretary of the Department of Social Welfare and Development (DSWD) may designate social workers from the Department as the workers of the centers: Provided, however, That the Secretary may appoint other personnel who possess the necessary professional qualifications to work efficiently with the elderly of the community. The Secretary may also call upon private volunteers who are responsible 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 istrative 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 services. Sec. 11. Appropriations. — The amount necessary to carry out the provisions of this Act shall be included in the General Appropriations Act of the year following its enactment into law and every year thereafter. The sum necessary for the continuous operation of the centers shall be subsidized in part by the DSWD and in part by the local government units concerned. Sec. 12. Repealing or Amending Clause. — All laws, decrees, executive orders, and rules and regulations, which are not consistent with this Act, are hereby modified, amended or repealed accordingly.chan robles virtual law library Sec. 13. This Act shall take effect fifteen (15) days after its publication in two (2) newspapers of general circulation. Approved: February 14, 1995

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 : 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”

(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.

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.

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.

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.

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

Objectives:

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.

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

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)

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

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

SECTION 2. Definition of . – 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.

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 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;

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 ission fees charged by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure, and amusements; c) Exemption from the payment of individual income taxes: Provided, That their annual taxable income does not exceed the poverty level as determined by the National Economic and Development Authority (NEDA) for that year; d) Exemption from training fees for socioeconomic programs undertaken by the OSCA as part of its work; e) Free medical and dental services in government establishment anywhere in the country, subject to guidelines to be issued by the Department of Health, the Government Service Insurance System and the Social Security System; f) To the extent practicable and feasible, the continuance of the same benefits and privileges given by the Government Service Insurance System (GSIS), Social Security System (SSS) and PAG-IBIG, as the case may be, as are enjoyed by those in actual service. 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;

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.

Approved, (SGD.) RAMON V. MITRA Speaker of the House of Representatives (SGD.) NEPTHALI A. GONZALES President of the Senate

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.

This bill, which is a consolidation of Senate Bill Nos. 835, 1435 and House Bill No. 35335, was finally ed by the Senate and the House of Representatives on February 7, 1992. (SGD.) CAMILO L. SABIO

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

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

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

Acting Secretary Department of Social Welfare and Development RULE I (Sgd.) Hon. Roberto S. Sebastian TITLE, PURPOSE AND CONSTRUCTION Secretary Department of Agriculture (Sgd.) Hon. Ernesto D. Garilao

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.

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

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

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 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: 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 – As used in these rules, the following 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 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- because of mental or physical defect. 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 d 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 enger 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, nevertheless, are not ed, 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.

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

e) To issue nationally uniform individual identification cards which shall be valid anywhere in the country;

e) Annual income, as ed by a certificate of exemption from payment of income tax issued by the local office of the Bureau of internal Revenue (BIR)

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; 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:

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 CONTRIBUTIONS IN THE COMMUNITY

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:

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) Control Number, Date of Issue

a. tutorial and/or consultancy services;

b) Name

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

c) Address 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.

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);

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 enger 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

e. And other public/official record or document, from relevant government agencies. A.2 Public Land Transportation – every senior citizen who is a enger 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 enger 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 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 istration Building, LRTA Compound, Aurora Boulevard, Pasay City or at designated outlets at the LRT system by presenting their ID card issued by the OSCA.

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 offstation 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 engers 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 age ticket;

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. He/She should personally secure the age ticket;

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.

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.

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

c. The age ticket shall be non-transferable.

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 istrative 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 ission 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:

Revenue Code (NIRC) other than income subject to tax under paragraphs (b), (c), (d) and (e) of Section 21 of the NICR which include certain ive 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,

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. 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.

b) Annual taxable income shall refer to the annual gross compensation, business and other incomes as defined in Section 28 of the National Internal

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.

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

e. Counseling services – shall refer to advices given by health professional, e.g. psychologists, psychiatrists, nutritionists, nurses and other allied health professionals in 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. 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

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. e. Should the senior citizen choose to be itted 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 citizenpatient 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.

and PAG-IBIG as the case may be as are enjoyed by those in the actual service.

The responsibilities of the government establishment are as follows:

G.2 Benefits extended to senior citizens who are retirees of the GSIS 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;

a. Life Insurance

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;

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 s due thereon (personal plus government share), up to its maturity date. Amount of monthly s 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 hip is in force prior to maturity date, the designated beneficiaries double indemnity. b. Retirement

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

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.

5. Medical Practitioner’s fee 6. Anesthesiologist’s fee

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.

7. Operating room fee 8. Allowance for sterilization procedures

c. Medicare

Types of Non-Compensable Treatments

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

1. Cosmetic surgery or treatment 2. Optometric services 3. Psychiatric services 4. Services which are purely diagnostic

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.

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

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:

Temporary Total Disability (TTD) 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 workconnected injury or sickness) consisting 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

2.1 hospitalization room and board supplies, xray, 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 nonconfinement)

Permanent Partial Disability (PPD)

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

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

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

2. medical and/or related services (for workconnected injury or sickness) (refer to 2.1 2.2 and 2.3)

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

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

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 hip 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 PAGIBIG Fund for the first time may do so upon proof of gainful employment, or of being self employed, or of hip 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 PAGIBG Fund from time to time.

b. PAG-IBIG 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 t and several loan, the loan period shall be based on the age of the youngest of the co-borrowers. RULE VI 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. 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 istratively 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

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 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.

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

REVENUE REGULATIONS NO. 2-94 (August 23, 1993) SUBJECT:

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 abovementioned 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

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, recognized natural or legally adopted children, living with and dependent upon him/her for their chief , 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- 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 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 ission 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. 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, ed 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 selfemployment, 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 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.

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 , 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 s 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 ister 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 DOH

Implemented

by

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. the annual “Walk for Life” for the elderly every October

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. 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. to Walk for Life Activity on October 2012. 3.

Summer Camp nina Lolo at Lola 2013

Program Manager: Ms. Remedios Guerrero Department of Health-Non Communicable Disease Office (DOH NCDPC-DDO) Number: 651-78-00 local 1750-1752

I 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 tly 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 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 ive environment and ensure its sustainability. Figure 1 shows the identified key objectives, ive

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 ive 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, istrative 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 of exclusive breastfeeding and adequate and appropriate complementary feeding with continued breastfeeding. (1)

4. The national and local government, development partners, non-government

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 from their families, communities and responsible health and non-health related institutions during critical settings and various circumstances including special and emergency situations.(5)

organizations, business sectors, professional groups, academe and other stakeholders acknowledges their responsibilities and form alliances and partnerships for improving IYCF with no conflict of interest. 5. Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community empowerment.

GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS GOAL: Reduction of child mortality and morbidity through optimal feeding of infants and young children MAIN OBJECTIVE: To ensure and accelerate the promotion, protection and of good IYCF practice

OUTCOMES:

STRATEGY1: Partnerships with NGOsand GOs in the coordination and implementation of the IYCF Program

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 group; 50 percent of workplaces have lactation units and/or implementing nursing/lactation breaks; 100 percent of reported alleged Milk Code violations are acted upon and sanctions are implemented as appropriate; 100 percent of elementary, high school and tertiary schools are using the updated IYCF curricula including the inclusion of IYCF into the prescribed textbooks and teaching materials; and 100 percent of IYCF related emergency/disaster response and evacuation are compliant to the IFE guidelines.

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

Action/Work Plan

KEY INTERVENTION SETTINGS AND SERVICES STRATEGIES,

PILLARS AND ACTION POINTS

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, 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 nongovernment 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 of the TWG.

b. Organize functional Intervention Setting Committees (this is the same as the ad-hoc committee) The years covered by this action plan will be marked with many developmental activities in all the intervention settings. The TWG shall create a committee for each of the intervention setting. The committees shall be chaired by the relevant agency/ office. Other government and non-government agencies will be invited to the committees relevant to their mandate. c. Return the MBFHI responsibility from NCHFD to NCDPC The National Policy on IYCF created in 2005 has affirmed the MBFHI responsibility to NCHFD. Since MBFHI is now under the umbrella of the IYCF Program, it is in a better position to consolidate efforts towards MBFHI compliance. Thus the return of the MBFHI responsibility from NCHFD to NCDPC shall be pursued. The collaboration of NCHFD is still needed though as it has a direct hand on health facility development. At NCDPC the integration of IYCF in the MNCHN Action Plan shall be worked out in all aspects of the program and at the different levels of implementation. d. Augment human resource complement of NCDPC- FHO, IYCF program NCDPC-FHO as the secretariat of the TWG and supervising and ing the IYCF Program will not be able to effectively carry out the technical, management and istrative roles and responsibilities without additional human resource. Funds shall be allotted for job orders for this purpose. e. Programmed contracting out of activities to organizations outside of DOH To achieve the objectives and targets of the IYCF program, it shall be implemented simultaneously in the different intervention settings and at a faster pace. This is a gargantuan task considering the extent of the developmental work, the management requirements, and the mobilization of the IYCF

network and the sourcing of funds for implementation. Organizations and consultants that possess the expertise and the commitment to the IYCF program will be contracted out for complex activities that require time and effort beyond the capacity of the TWG and the Ad Hoc committees. These contracts shall be arranged based on need and awarded based on merit.

STRATEGY 2: Integration of key IYCF action points in the MNCHN Plan of Action/Strategy 2.1 Institutionalize the IYCF monitoring and tracking system for national, regional and LGU levels a. Institutionalize the collection of PIR Data and generate annual performance report The established IYCF data set that are being collected during PIRs shall be further reviewed, revised as appropriate and institutionalized through a Department Circular and in collaboration with the other programs in the FHO. An IYCF Program annual performance report shall be generated at the end of every year based on the PIR data, the consolidated data from the unified monitoring and related data coming from research and studies as appropriate. Reports on the performance of developmental activities shall be collected as part of the data base and to be reported as needed to the Service Delivery Cluster Head. b. Maximize the use of the unified monitoring tool The CHDs through its Regional Coordinators shall be required to use and consolidate the unified monitoring tool. A simple data management program shall be developed to facilitate the consolidation of data extracted from monitoring. Reports shall be required two weeks after the end of every quarter.

c. Collaborate with the National Epidemiology Center (NEC) and Information Management Service (IMS) regarding IYCF data

The current records and reports being collected by the DOH Field Health Information System will remain as the main source of data from health facilities. However, collaboration with NEC and IMS to improve data quality and include data on complementary feeding is essential. 2.2 Participation of the IYCF Focal person in MNCHN planning and monitoring activities a. Designate the IYCF Focal Person as a regular member of the team working for the development and implementation of the MNCHN Strategy The IYCF Focal Person shall ensure that the IYCF action points become an agenda of the MNCHN Strategy and thus ultimately the IYCF services forms a part of the integrated services for mothers and children. In the MNCHN planning and monitoring, the IYCF Focal Person shall help ensure that in the multitude of activities, critical IYCF action points and indicators are not overlooked. STRATEGY 3: Harnessing the executive arm of government to implement and enforce the IYCF related legislations and regulations (EO 51, RA 7200 and RA 10028) 3.1 Consultation mechanism with the IAC and DOJ for the enforcement of the Milk Code and with other relevant GOs for other IYCF related legislations and regulations a. Devise and implement a consultation mechanism to bring together the IAC, DOJ and other relevant GOs for IYCF related legislations and regulations The Committee for Industry Regulation shall devise and implement a consultation mechanism to facilitate the implementation and enforcement of IYCF related laws and regulations. This will require participation of higher levels of authority in the GOs.

The goal of the consultation mechanisms is to develop activities that will focus on facilitating the process of monitoring of compliance and enforcement of IYCF related laws and regulations not only at the national level but also at regional and local levels and in the five IYCF intervention settings. 3.2 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 istrative/ clerical staff is required to facilitate and help speed up the process. e. Engage professional societies to come-up with measures for self monitoring and regulation Monitoring of overt ments 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 . 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 ive 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 istrative background who can deal with arrangements and coordination with hospitals and local governments and who can be a trainer and an istrative assistant who will facilitate istrative matters. The team will facilitate the activities leading to the organization and maintenance of the MBFHI in the hospitals. This shall include planning, setting up of operational details and physical structures when needed, training/coaching of personnel, keeping records and completing reports and self assessment.

Regional hospitals shall be developed for IYCF capacity building. Trainings at Regional Hospitals shall be conducted in collaboration with the CHDs. This is so that training is decentralized and monitoring and evaluation can be done more frequently at the provincial and municipal levels.

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.

b. Establish protocols/standards on how to set-up and maintain MBF workplaces and integrated in the standards for healthy workplace

d. Develop policy on IYCF in emergencies (IFE) and guidelines on the management of malnutrition, and IYCF in special medical conditions for the community

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

A clear policy on IYCF is necessary to allow the program to define the guidelines that can be easily followed by GOs, NGOs and LGUs once such situations arise. The policy/guidelines shall address among others the issue of milk donations. Guidelines on the Community Management of Malnutrition, IYCF in special medical conditions such as errors of metabolism or HIV positive mothers shall also be developed for implementation. Camp managers and organized local nutrition clusters shall be oriented on the IFE guidelines. Disaster prone areas will be prioritized in the orientation. Training/orientation shall be a collaborative effort between the IYCF Program, HEMS and the NDCC. 4.2 Creation of a Regional and National incentive and awarding systems for the most outstanding IYCF champions in the different sectors of society a. Review and update the existing awarding system The current awarding system shall be reviewed. The search protocol shall be further refined to allow a wider search. The organization of the search committees in the local and national levels shall be formalized. Funds for the awards shall be ensured. b. Establish a recognition system for health facilities complying with EO51, RA10028 and the MBFHI National Policy Set up an annual recognition system for facilities, establishments complying with relevant IYCF

legislations and regulations. The benefits provided for by the Milk Code to compliant health facilities shall be reviewed and improved/established parallel with the development of the incentive scheme for the Expanded Breastfeeding Promotion Act. Procedures for claiming benefits shall be established and made accessible in collaboration with PhilHealth, BIR and other relevant government offices. 4.3 Allocate/Raise /Seek resources for IYCF Research activities that document best practices in the Philippines a. Carry out an inventory of best practices on IYCF Identify best IYCF practices by allowing every province in the country to identify exemplary or creative activities on IYCF that boosted program services/performance. Validate the reports through CHDs and select the best practices for documentation and publication. b. Allocate resources and conduct IYCF related researches focusing on the documentation and measure of impact of noble experiences and interventions The documentation of IYCF best practices is considered a critical area that allows the development of models/ references for appropriate IYCF protocols and guidelines for implementation. Field personnel who are able to establish and provide successful models of IYCF services are often deficient in resources and skills to document the efforts. Resources to conduct IYCF related researchers, focusing on the documentation and measure of impact of noble experiences and interventions, will have to be allocated. STRATEGY 5: Engaging the Private Sector and International Organizations to raise funds for the scaling up and 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 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. 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 friendly monitoring tools.

The competencies of teachers and s 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/ s 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 2005Status of Achievement 2010

Remarks

OBJECTIVE 1: TO IMPROVE, PROTECT AND PROMOTE APPROPRIATE INFANT AND YOUNG CHILD FEEDING PRACTICES CHILD FEEDING PRACTICES - 70% of newborns initiated to breastfeeding within 30 minutes

53.5% (NDHS 08)

40.7%(NDHS 1998)

- 80% of 0-6 months infants are exclusively breastfed

34% (NDHS 2008)

33.5%(NDHS 2003)

- 50% of infants are exclusively breastfed for 6 months

22.2% (NDHS 2008)

16.1%(NDHS 2003)

- median duration of breastfeeding is 18 months

15.1months (NDHS 2008)

13 months (NDHS 1998)

- 90% of 6- <10 months infants are given timely, adequate and safe complementary foods

58% (NDHS 2008)

57.9%(NDHS 2003)

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

75.9% (NDHS 2008)

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

- 70% of low birth weight babies and iron deficient 6 months to less than 5 years received complete dose of iron supplements

37% of children age 6-59 72.8% of 6-59 months received iron drops / months received iron supplements in the seven syrup (not specified if complete dose, MCHS 2002) days before the survey (NDHS 2008)

78.3% of children 6-59 months consumed foods

rich in iron in the past 24 hours from the time of the survey - 80% of pregnant women have at 77.8% (NDHS 2008) least 4 prenatal visits

67.5% (MCHS 2002)

- 80% of pregnant women received complete dose of iron supplements

82.4% (NDHS 2008)

82% (not specified if complete dose, MCHS 2002)

- 80% of lactating women received 45.6% (NDHS 2008) vitamin A capsule

44.6% (NDHS 2003) NDHS 2003 and 2008 data represents the % of women that received Vitamin A dose during post-partum

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

38%, household using iodized salt and 56.4% household positive for iodine in salt (NNS 2003)

OBJECTIVE 2: TO INCREASE POLITICAL COMMITMENT AT DIFFERENT LEVELS OF GOVERNMENT, INTERNATIONAL ORGANIZATIONS, NONGOVERNMENT ORGANIZATIONS, PRIVATE SECTOR, PROFESSIONAL GROUPS , CIVIL SOCIETY, COMMUNITIES AND FAMILIES - Approved and widely disseminated IYCF Policy approved May National Infant and Young Child 25, 2005 and disseminated Feeding Policy to all Regions and LGUs. - Approved multi-sectoral

National

IYCF Plan of Action

- IYCF policy emerging issues

enhancement

IYCF Plan of Action 20052010 approved.

AO 2007-0017: Guidelines on the Acceptance and Processing of Local and for Foreign Donations During Emergency and Disaster Situations was signed May 28, 2007.

New groups were active in ing activities on IFE Active organizations include Latch, La - Increase number of organizations mostly during the postLeche League, Save the Children, Plan actively involved in IYCF Ondoy interventions and in International and Arugaan. relation to breastfeeding . - Increase budget for IYCF

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

2010.

intensive IYCF training.

Additional funds were secured by the t program on MDG-F, wherein UN Agencies (Unicef, FAO, ILO

September 2009, g of the JP for Ensuring Food Security and Nutrition for Children 0-24 months in the Philippines, funded by the

and WHO) with NNC and Government of Spain through the MDG DOH, started implementing Achievement Fund. key IYCF interventions.

OBJECTIVE 3: PROVIDE IVE ENVIRONMENT THAT WILL ENABLE PARENTS, MOTHER, CAREGIVERS, FAMILIES AND COMMUNITIES TO IMPLEMENT OPTIMAL FEEDING PRACTICES FOR INFANTS AND YOUNG CHILD PROGRAMME MANAGEMENT National TWG active and 11/12 Regions confirmed having established a TWG.

- Functional IYCF Program authority and responsibility flow at the national, regional and LGU level

Data as of Dec 2009. Although the national TWG is considered active, the collaboration between agencies can be considered At the LGU level 7/80 deficient. provinces, 9/120 cities and 175/1425 municipalities have ed a resolution/ordinance in of IYCF.

Existing local committees functioning as IYCF committees

No available data

INSTITUTIONAL 1,426 currently certified AO 2007-0026: MBF hospitals sustained 10 steps Revitalization of the MBFHI in Health Facilities with Maternity Services was signed and endorsed on July 10, 2007.

Within 2 years after the issuance of COC, 0/47 hospitals applied for accreditation to become MBF based on the new standards and requirements.

PhilHealth Circular No. 26 S-2005: Requirement for Accredited Hospitals to be “Mother- Baby Friendly” was issued on October 11, 2005.

- 300 additional certified as MBF

Only 47/1487 have hospitals/lying-in received a COC since 2007

- 100% of hospitals rooming–in their newborns

No available data

RA 10028: Expanded - All offices of government agencies Breastfeeding Promotion who are of the IYCF IAC Act of 2009 was enacted will be MBF on March 16, 2010.

RA 10028 set the standards to becoming MBF.

6/16 Regions reported that - At least one model workplace per there are at least 88 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 region

- At least 3 IYCF model barangay/ municipality per province and city

- Functional milk bank in all medical centers

10/16 Regions reported that there are at least 2159 breastfeeding groups at the barangay level. Milk bank is functional in 3 Medical

RA 10028 encourages other Medical

Centers: PGH, DJFMH and Centers to set up their own milk bank. PCMC

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

Based on monitoring visits and reports from CHDs, public health facilities have ensured the integration.

Only 4/13 Regions reported some sort of Milk Code monitoring activities.

At the FDA, from 2007 to 2009, there were 67 reports of violations and only 3/13 Regions reported filing a complaint for the alleged

No available data on private health facilities.

violations. Draft tool developed and used in two key instances. No institutionalization yet.

- Institutionalize facility IYCF MIS system in place by end of 2009

-Improving skills of health manpower

28,063/34,298 staff were trained on

NCDPC and NNC combined report

IYCF Counseling. - Available national / regional IYCF

16/17 Regions reported conduct of training on IYCF.

trainers - Active IYCF Speakers’ Bureau

No available data 28,063/34,298 staff were trained on

- Available IYCF counselors in 50% of health facilities

NCDPC and NNC combined report.

IYCF Counseling.

- At least 10 Filipino health professionals internationally accredited as breastfeeding counselors by the International Board of Lactation Consultants Examiners

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

9/13 Regions reported having trained a total of 1485 hospital based health - A lactation specialist is available in workers on Lactation No denominator available. tertiary hospitals Management with the of DJFMH, NCDPC,CHDs and NNC. In June 2010 a workshop on integration/updating of - Improved curricula for IYCF of good IYCF practice into the The process of integration is on-going. medical / nursing / midwifery schools medical, nursing, midwifery and nutrition curricula was conducted.

- Inclusion of breastfeeding elementary education

RA 10028: Expanded in Breastfeeding Promotion Act of 2009 mandates the integration.

RA 10028 was enacted on March 16, 2010. The IRR is yet to be signed.

As of Dec 2009. 10/16 Regions reported that there are at least 2,159 - Community level systems barangay level BF and services groups and more than 40 RA 10028 will help boost the number of BF friendly public places. breastfeeding friendly public places. - 100% of target communities with functional community level monitoring system of IYCF practices and changes

No available data

10/16 Regions reported - At least 50% of city and poblacion that there are at least 2,159 municipalities with adequate number BF groups at the of trained IYCF peer counselors barangay level. 10/16 Regions reported that there are at least 2,159 - At least one functional BF / IYCF BF groups at the group in poblacions and barangay level. selected communities

OBJECTIVE 4: ENSURE SUSTAINABILITY OF INTERVENTIONS TO IMPROVE, PROTECT AND PROMOTE INFANT AND YOUNG CHILD FEEDING - Functional self assessment health facility tools for IYCF in Tool Drafted. Not yet certified MBFH and main health institutionalized. centers - Annual progress reports of status 1st IYCF PIR: 2007 of implementation of Milk Code, Rooming In and Breastfeeding Act, ASIN Law, Food Fortification and 2nd IYCF PIR: 2009 ECCD Law / IYCF Policy - IYCF integrated into Philippine Plan of Action for Nutrition and annual planning and health monitoring systems at all levels

IYCF integrated in PPAN 2005-2010. PIR was conducted last quarter of 2010.

Key result of integration was the intensive training on IYCF Counseling in AHMP target areas.

Regular Presentations are offered by DOH on IYCF status (2005:

- Periodic of IYCF status during annual conventions of health 1st presentation during professionals/Leagues of Provinces/ National Cities/Municipalities and Barangays Convention Liga Ng Barangay)

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 V. Program Manager

E-mail Add: [email protected]

Partner Organizations/agencies NGO Partners:

                     

Employers Confederation of the Philippines Trade Union Congress of the Philippines Beauty, Brains and Breastfeeding ARUGAAN Action for Economic Reforms Save Baby e-group Philippine Pediatric Society Philippine Obstetric 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 Trade and Industry Department of Local Government Food and Drug istration National Nutrition Council Council for the Welfare of Children Department of Education Commission on Higher Education Nutrition Council of the Philippines

International Organizations:

Local: 

       

Department of Labor and Employment Department of Social Welfare and Development Department of Justice

     

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

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 istration 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 measlesrubella vaccine through a door-todoor vaccination campaign. Unlike previous campaign, a measles-free certification will be issued to city/province meeting all the criteria of (1) all barangays ed the RCA with no missed child and 95% and above house marking

Criteria for Selecting Exemplary Health Practices

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.

1. LGUinitiated solutions initiated to address one or more health issues or problems encountered.

Inter Local Health Zone

2. High level of sustainability 

 







Consist ent with existing health policies LGU Had been in place for more than three ears Widely participat ed and ed by the communit ies Adopte d as a permanen t structure or program with regular budgetary Adopte d as a permanen t structure or program with regular budgetary

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 from external sources

5. Positive results on the beneficiaries and communities. 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

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, tly 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 of: (i) improved health status and coverage of public health intervention of the zone population; (ii) access by everyone in the zone to quality care; and (iii) efficiency in the operations of the interlocal health services.

Replication of Exemplary Replication: Sharing Good Practices and Practical Solutions to Common Problems By virtue of istrative 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.

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) for nearly half of these deaths and malnutrition is often the underlying condition. Effective and affordable interventions to address these common conditions exist but they do not yet reach the populations most in need, the young and impoverish. The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and development and is based on the combined delivery of essential interventions at community, health facility and health systems levels. IMCI includes elements of prevention as well as curative and addresses the most common conditions that affect young children. The strategy was developed by the World Health Organization (WHO) and United Nations 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, measlesand 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 ission 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  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: PINKindicates urgent hospital referral or ission YELLOW- indicates initiation of specific Outpatient Treatment GREEN – indicates ive 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 itted, the hospital protocol is used in the management of the sick child. K Knock Out Tigdas 2007 “Knock-out Tigdas 2007” is a sequel to the 1998 and 2004 “Ligtas Tigdas” mass measles immunization campaign. All children 9 months to 48 months old ( born October 1, 2003 – January 1,2007) should be vaccinated against measles from October 15 - November 15, 2007 , door-todoor. 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.

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

Knockout Tigdas for the period of the Barangay and SK Elections Executive Order No. 663 Promotional materials

How will it be done?

What is “Knock-out Tigdas (KOT) 2007? “Knock-out Tigdas 2007” is a sequel to the 1998 and 2004 “Ligtas Tigdas” mass measles immunization campaigns. This is the second follow-up measles campaign to eliminate measles infection as a public health problem. What is the over-all objective of the Knockout Tigdas? The Knock-out Tigdas is a strategy to reduce the number or pool of children at risk of getting measles or being susceptible to measles and achieve 95% measles immunization coverage. Ultimately, the objective of KOT is to eliminate measles circulation in all communities by 2008. What does measles elimination mean? Measles elimination means: 1. Less than one (1) measles case is confirmed measles per one million population. 2. Detects and extracts blood for laboratory confirmation from at least 2 suspect measles cases per 100,000 populations. 3. No secondary transmission of measles. This means that when a measles case occurs, measles is not transmitted to others. Who should be vaccinated? All children between 9 months to 48 months old ( born October 1, 2003 – January 1,2007) should be vaccinated against measles. When will it be done?

Vaccination teams go from door-to-door of every house or every building in search of the targeted children who needs to be vaccinated with a dose of measles vaccines, Vitamin A capsule and deworming drug. All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball court, town plazas and other identified public places will also offer FREE vaccination services during the campaign period. My child has been vaccinated against measles. Is she exempted from this vaccination campaign? No, she is not. A previously vaccinated child is not exempted from the vaccination campaign because we cannot be sure if her previous vaccination was 100% effective. Chances are a vaccinated child is already protected, but no one can really be sure. There is 15% vaccine failure when the vaccine is given to 9 months old children. We want to be 100% sure of their protection. What strategy will be used during the campaign? It is a door-to-door strategy. The team goes from one-household to another in all areas nationwide. My child had measles previously, is he exempted in this campaign? There are many measles-like diseases. We cannot be sure exactly what the child had, especially if the illness occurred years ago. Anyway, the vaccination will not harm a child who already had measles. The effect will also be like a booster vaccination. The previously received measles immunization has formed antibodies, with the

booster shot it will strengthened the said antibodies.

Antibodies in the blood which provide protection against disease decrease as the child grows older. Booster vaccinations are needed to raise Is there any overdose, if my child receives protection again. Measles vaccination during the this booster immunization? 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 NL Strategy Universal Health Care overdose for the measles vaccine. The Global Strategy measles vaccine is even known to enhance (2011-2016) (Kalusugang overall immunity against other diseases. (2006-2010) Pangkalahatan)

MDG& NOH

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Sustain

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Strengthen routine & referral service

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Establish the Sentinel Surveil lance System to monitor Drug Resistance

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Health System Strengthening

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Governance for Health

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Capability building of an efficient, effective, accessible human and facility resources

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Policy, Standards & Regulations

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Human Resources for Health

Develop procedures/ tools that are home/communi ty- based, integrated and locally appropriate for Self Care/POD, rehabilitation services (CBR)

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Collaborate with NEC/RESU/ PESU / MESU

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Health Information

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NLAB, NCCL

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Health Financing

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RA 7277- Rights of PWD & Caregivers

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BP 34- Accessibility & Human Rights Law

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PhilHealth Insurance Package

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”?

Develop policies/ guidelines/ sentinel sites/referral centers (Luzon,Visayas & Mindanao)

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.

Service Delivery

Ensure high quality diagnosis, case management, recording & reporting in all endemic communities



Provision of Quality Leprosy services at all levels

leprosy control in all endemic countries

What will happen to my child after receiving the measles immunization?

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 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: 

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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?

Improve case detection and postelimination 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.

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.

Beneficiaries:

L

Program Manager:

Leprosy Control Program

Dr. sca C. Gajete

Vision: Empowered primary stakeholders in leprosy and eliminated leprosy as a public health problem by 2020

Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC)

The NL targets individuals, families, and communities living in hyperendemic areas and those with history of previous cases.

Number: 651-78-00 local 2353 Mission: To ensure the provision of a comprehensive, integrated quality leprosy services at all levels of health care Goal: To maintain and sustain the elimination status

Objectives: The National Leprosy Control Program aims to:  

Ensure the availability of adequate anti-leprosy drugs or multiple drug therapy (MDT). Prevent and reduce disabilities from leprosy by 35% through Rehabilitation and Prevention of Impairments and Disabilities (RPIOD) and SelfCare.

Email: [email protected]

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.

Licensure Examinations for Paraprofessionals Undertaken by the Department of Health I. Mandates Presidential Decree No. 856 “Code of Sanitation of the Philippines” 

Massage Therapists

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

Embalmers

istrative 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 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. Persons: Dr. Josephine H. Hipolito Mr. Ryan B. Dordas

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:

M Malaria Control Program Malaria is a parasite-caused disease that is usually acquired through the bite of a female Anopheles mosquito. It can be transmitted in the following ways: (1) blood transfusion from an infected individual; (2) sharing of IV needles; and (3) transplacenta (transfer of malaria parasites from an infected mother to its unborn child). This parasite-caused disease is the 9th leading cause of morbidity in the country. As of this year, there are 58 out of 81 provinces that are malaria endemic and 14 million people are at risk. In response to this health problem, the Department of Health (DOH) coordinated with its partner organizations and agencies to employ key interventions with regard to malaria control. Vision: Malaria-free Philippines Mission: To empower health workers, the population at risk and all others concerned to eliminate malaria in the country. Goal: To significantly reduce malaria burden so that it will no longer affect the 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;

The Malaria Control Program targets the meagerresourced municipalities in endemic provinces, rural poor residing near breeding areas, farmers relying on forest products, indigenous people with limited access to quality health care services, communities affected by armed conflicts, as well as pregnant women and children aged five years old and below. Program Strategies: The DOH, in coordination with its key partners and the LGUs, implements the following interventions: 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-H)  Philippine Malaria Network  Australian Agency for International Development (AusAID)  Asia Pacific Malaria Elimination Network (APMEN)  Malaria Elimination Group (MEG)  Local Government Units (LGUs) Measles Elimination Campaign (Ligtas Tigdas) N 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 s 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 20102016 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 DirectlyObserved 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

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 multisector partners, through broad-based collective

technical inputs, underlines the key strategic approaches towards achieving these targets at both national and local levels. The Plan aims for universal access to DOTS including strategic responses to vulnerable groups and emerging TB threats. Nationwide, a wide array of health facilities are installed and equipped to provide quality TB care to the general population. This involves participation of private facilities (clinics, hospitals), other health-related agencies or NGOs and other Government organizations. Coverage for DOTS services, at least in the public primary care network has reached nearly 100% in late 2002. Eversince, diagnosis through sputum smear microscopy and treatment with a complete set of anti-TB drugs are given free through the of the Government. Training on TB care for different types of health workers is being conducted through the regional and local NTP Coordinators. The conclusions during the program implementation review (PIR) done by the DOH of selected public health programs on January 2008 revealed the following: 

Extent and quality of nationwide TB-DOTS coverage have reached levels necessary for eventual control since 2004 up to present



NTP continues to add enhancements and improvements to TB care providers for better delivery of services

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

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Philippine Coalition Against TB

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Holistic Community Development Initiatives (HCDI)

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National TB Ref Laboratory

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Lung Center of the Philippines

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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 Research Institute of Tuberculosis/ Japan Anti-Tuberculosis Association Philippines, Inc. (RIT/JATA)

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

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National Commission for Indigenous Peoples

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Department of National Defense-Veterans Memorial Medical Center (DND-VMMC)

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 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.

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Occupational Health and Safety (OSHC); Bureau of Working Conditions (BWC)

The program is anchored on the following basic principles.

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World Vision Development Foundation (WVDF)

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Philippine Tuberculosis Society Inc. (PTSI)

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Kabalikat sa Kalusugan

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Samahang Lusog Baga

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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

* Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens. National Filariasis Elimination Program Filariasis is 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 4 th-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 istrative 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 to the program, an istrative 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: 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. 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 homebased 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  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 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 infection 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.

    

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)

4. Advocacy Newborn Screening 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 ed Nurses are to be trained on the guidelines on managing a victim. 6. Establishment of ABTCs by InterLocal Health Zone 7. DOH-DA t 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)

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. Newborn Screening Legislation NBS was integrated into the public health delivery system with the enactment of Republic Act 9288 or Newborn Screening Act of 2004 as it institutionalized the ‘National NBS System’, which shall ensure the following: [a] that every baby born in the Philippines is offered NBS; [b] the establishment and integration of a sustainable NBS System within the public health delivery system; [c] that all health practitioners are aware of the benefits of NBS and of their responsibilities in offering it; and [d] that all parents are aware of NBS and their responsibility in protecting their child from any of the disorders. The highlights of the law and its implementing rules and regulations are:

1. 2.

3. 4.

5.

6.

DOH is the lead agency tasked with implementing this law; Any health practitioner who delivers or assists in the delivery of a newborn in the Philippines shall prior to delivery, inform parents or legal guardians of the newborns the availability, nature and benefits of NBS; Health facilities shall integrate NBS in its delivery of health services; Creation of the Newborn Screening Reference Center at the National Institutes of Health and establishment and accreditation of NSCs equipped with a NBS laboratory and recall/follow up program; Provision of NBS services as a requirement for licensing and accreditation, the DOH and the Philippine Health Insurance Corporation (PHIC) 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 NSCCentral 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. 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] 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]

Centers for Health Development

CHD

Mailing Address

Business Phone

NBS Regional Coordinator

CHD 1 Ilocos

San Fernando, La Union

(072) 2425315; (072) 2424773

Clarita B. Lewis, RN

CHD 2 Cagayan Valley

Tuguegarao City

(078) 3046585; (078) 8446585; (078) 8446523

Leticia T. Cabrera, MD, MPA

CHD 3 Central Luzon

(045) 4552324; San Fernando, Pampanga (045) 9617649; (045) 9617654

Adelina Cabrera, RN

CHD 4-A Calabarzon

QMMC Compound, Project (02) 4403372 4, Quezon City

Maria Luisa M. Malana, RN

CHD 4-B Mimaropa

Quirino Hospital Compound, Quezon City

(02) 9134650; (02) 9115025

Ma. Teresa Castillo, MD

(052) 4830840 loc 517/516

Carla A. Orozco, MD, MPH MS III

First Park Subdidivion, CHD 5- Bicol Daraga, Albay

CHD 6 Western Visayas CHD 7 Central Visayas

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

Renilyn P. Reyes, MD

Osmeña Blvd., Cebu City

Nayda P. Bautista,MD, MPH

(032) 4187633

CHD 8Eastern Visayas

Candahug, Palo , Leyte

(053)3235025

Lilibeth Andrade, MD

CHD 9 Zamboanga Peninsula

Upper Calarian, Zamboanga City

(062)9830314-15

Nerissa B. Gutierrez, RN

CHD 10 Northern Mindanao

J.V. Seriña St., Carmen, Cagayan de Oro City

088-22- 727400

Ellenietta HMV N. Gamolo, MD, MPH

CHD 11 Davao Region

J.P. Laurel Avenue, Davao (082) 3051907; City (082) 2214011

Ma. Clarose M. Mascardo, RN, MPH

CHD 12 Central Mindanao

ARMM Compound, Gov. Guttierez Ave, Cotabato City

(064) 4217436; (064) 4218053

Lucy Decio, RN

CHD CARAGA

Pizarro St. cor. Narra Rd. Butuan City

(085) 3411452

Glynna B. Andoy, MD, MPH

CHD CAR

BGHMC Compound, Baguio City

(074) 4428096; (074) 4445255

Nicolas R. Gordo, Jr, MD

CHD NCR

Welfareville Compound, Brgy. Addition Hills, Mandaluyong City

(02) 7183097; (02) 5354521

Ma. Paz P. Corrales, MD

CHD ARMM

ORG Compound, Cotabato City

(064) 4217703

Dayan Sangcopan, MD

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 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) 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 (TU) 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 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.

Partner Organizations/Agencies: The following organizations/agencies take part in the achievement of the program’s objectives:

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.

      

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 Insurance Corporation (PhilHealth)

Program Manager: Dr. Lyndon L. Lee Suy

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

Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC) Number: 651-78-00 local 2353 Email: [email protected]

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:   

 

Government Mandates and Policies : 



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: 

National Prevention of Blindness Program

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.

istrative Order No. 179 s.2004: Guidelines for the Implementation of the National Prevention of Blindness Program Department Personnel Order No. 20050547: 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

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. 2010;

Distribute 125,000 eye glasses by

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.

Specific: 1. 2.

3. 4.

5. 6.

7.

8.

9.

Conduct 74,000 good outcome cataract surgeries by 2010; Ensure that all health centers are actively linked to a cataract referral center by 2008; Advocate for the full coverage of cataract surgeries by Philhealth; Establish provincial sight preservation committees in at least 80% of provinces by 2010; Mobilize and train at least one primary eye care worker per barangay by 2010; Mobilize and train at least one midlevel eye care health personnel per municipality by 2010; Improve capabilities of at least 500 ophthalmologists in appropriate techniques and technology for cataract surgery; Develop quality assurance system for all ophthalmology service facilities by 2008; and Ensure that 76 provincial,16 regional and 56 DOH retained hospitals are equipped for appropriate technology for cataract surgery.

General objective no 3: Reduce the prevalence of visual disability in children from 0.3% to 0.20% by the 2010 1. Identify children with visual disability in the community for timely intervention; 2. Improve capability of 90% of health worker to identify and treat visual disability in children by 2010; and 3. Establish a completely equipped primary eye care facility in municipalities by 2008.

Burden of Blindness and Visual Impairment : Global Facts The Philippines is a signatory in the Global Elimination of Avoidable Blindness: Vision 2020 – The Right to Sight. The Vision 2020 was initiated by the International Agency for Prevention of Blindness (IAPB), World Health

Organization (WHO), and the Christian Blind Mission (CBM), Vision 2020 aims to develop sustainable comprehensive health care system to ensure the nest possible vision for all people and thereby improve the quality of life. According to WHO estimates :   

  





 

Approximately 314 million people worldwide live with low vision and blindness Of these, 45 million people are blind and 269 million have low vision 145 million people's low vision is due to uncorrected refractive errors (nearsightedness, far-sightedness or astigmatism). In most cases, normal vision could be restored with eyeglasses Yet 80% of blindness is avoidable - i.e. readily treatable and/or preventable 90% of blind people live in low-income countries Restorations of sight, and blindness prevention strategies are among the most cost-effective interventions in health care Infectious causes of blindness are decreasing as a result of public health interventions and socio-economic development. Blinding trachoma now affects fewer than 80 million people, compared to 360 million in 1985 Aging populations and lifestyle changes mean that chronic blinding conditions such as diabetic retinopathy are projected to rise exponentially Women face a significantly greater risk of vision loss than men Without effective, major intervention, the number of blind people worldwide has been projected to increase to 76 million by 2020



Number of blind from cataract below poverty line: 92,000 (25%, NSCB 2009 figures]; figure est. doubled to include first & second quintiles

Interventions/Strategies employed or Implementation by the DOH 1.

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.



 

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%)

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.

Burden of Blindness and Visual Impairment : Local Facts 

Advocacy and Health Education

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 capabilities.

and

local

needs

and

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.

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 well as the organic act of Muslim Mindanao, and any similar issuances/laws that will be ed 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 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.

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: Cataract Cataract, the opacification of the normally clear lens of the eye, is the most common cause of blindness worldwide. It is the cause in 62% of all blindness in the Philippines and is found mostly in the older age groups. The only cure for cataract blindness is surgery. This is available in almost all provinces of the country; however there are barriers in accessing such services. Interventions will therefore consist of increasing awareness about cataract and cataract surgery; as well as improving the delivery of cataract services. The parameter used worldwide to monitor cataract service delivery is the Cataract Surgical Rate. Errors of Refraction Errors of refraction is the most common cause of visual impairment in the country (prevalence is 2.06% in the population). Errors of refraction are corrected either with spectacle glasses, 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

  



 

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 s prevention of blindness and vision impairment o Signatory of all World Health Assembly resolution on Vision 2020 and blindness prevention. o National Prevention on Blindness Program under Non-Communicable Disease Cluster. o Funded 3 national surveys of blindness 1987, 1955 and 2002. o Planning workshop 2004 crafted 5 year development plan for eye care 20052010 assisted by IAPB / ICEH. o 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)

o Blindness prevention and rehabilitation of persons with irreversible blindness are incorporated in the health program for persons with disability of DOH



The following programs/projects are included in the Maternal and Child Care Program of DOH: o Expanded Program for Immunization (includes vaccination for diseases that causes blindness) o Vitamin A provision for pregnant mothers and children to prevent vitamin A deficiency o Comprehensive newborn care includes prophylaxis for ophthalmia neonatorum o Newborn screening includes screening for galactosemia which cause congenital cataract



Several activities in the PBP o Consultative and Planning Workshop on PBP, October 2011 o National Eye Summit, Manila Grand Opera Hotel, Manila last October 2009 o Strategic Planning Workshop on the National Sight Preservation and Blindness Program 2008 o Training of Trainors of Primary Eye Care conducted 2007

O 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. P 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 ed in July 19, 1991. This specifically required the Department of Health (DOH) to. (1) Institute a national health program for PWDs, (2) establish medical rehabilitation centers in provincial hospitals, and (3) adopt an integrated and comprehensive to the Health Development of PWD which shall make essential health services available to them at affordable cost. Rule IV, Section 4. Paragraph B of the implementing rules and regulations (IRRI) of this act required the Department of Health to address the health concerns of seven (7) different categories of this ability, which includes the following: (1) Psychosocial and behavioral disabilities, (2) Chronic illnesses with disabilities, (3) Learning (cognitive or intellectual) disabilities, (4) Mental disabilities, (5) Visual/ seeing disabilities, (6) Orthopedic/ moving, and; (7) Communications deficits. In compliance thereof, the DOH piloted in 1995 a community based rehabilitation program in 112 (7.5%) out of 1,492 towns nationwide. Between 1992 and 2004 it had upgraded DOH hospital facilities to include rehabilitation and allied medical services for PWDs. Today there are about 21 DOH hospitals that have rehabilitation program/units/centers representing 22% of all DOH hospitals. It had ed 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

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.  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 Strategic Goals: International Development Organizations (INGOs)      

II.

American Leprosy Missions World Health Organization Australian Agency for International Development (AusAID) Christoffel Blindenmission (CBM) JICA Expert Unicef

SCENARIO

People with disabilities encounter a range of barriers when they attempt to access health care including the following.

   

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

ADDRESSING BARRIERS TO HEALTH CARE Governments can improve health outcomes for people with disabilities by improving access to quality, affordable health care services, which make the best use of available resources. As several factors interact to inhibit access to health care, reforms in all the interacting components of the health care system are required.     

Policy and legislation Financing Service delivery Human resources Data and research

Local Situation The results of the 1995 Census showed that the total population of persons with various disabilities was 919,332. Considering that the total population of the country at that time was 68,617,000, the disabled population was 1.3%. The male population was comprised of 0.6% while female, also, 0.6%. The low vision had the highest prevalence rate of 4.0%. The recently conducted 2000 National Census of Population is expected to provide a better and reliable statistics of persons with disability in as much as its preparation for the conduct gave much consideration to observe limitations, weaknesses and errors of the previous censuses and surveys as well as the criticisms and recommendations of experts and s. However, the result of the Census only ed 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. This component shall ensure the advocacy for then 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 Week

Every 3rd week of July

NDPR Week to Culminate on the Birthdate of the Sublime Paralytic: Apolinario Mabini

July 23

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 t (Musculo-Skeletal) Awareness Week

3rd Week of October

National Attention Deficit / Hyperactivity Disorder (ADHD) Awareness Week

3rd week of October

National Skin Disease Detection and Prevention Week

2nd Week of November

Deaf Awareness Week

November 10 to

16 3rd Week of November

Drug Abuse Prevention and Control

Expansion of coverage of Newborn Screening. Future related observances promulgated by the office of the President shall also become part of this component. 2.

Capability Building

3. Philippine Registry Disabilities (PRPWD)

given.

to activities of PWD groups

for Persons with

4. Networking, Inter-organizational linkages, and Resource Mobilization

Equitable

V.

Future/ Action

Conduct Sensitivity training to Health workers at all levels.

5. Monitoring and Evaluation 6. Accreditations and Financing Packages

Implementation of PWD Health Benefits as provided for RA 3994(20% discount).

Health

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 institutionbased 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.

packages.

Formulate PWD Health service

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

Philippine Medical Tourism Program Vision: "The global leader in providing quality health care for all through universal health care" Mission: To ensure that the Philippines is globally competitive through implementation of quality standards in both public and private sector. Goal: 1. The local Global Health Care industry will contribute a noticeable and quantifiable amount to the Philippine economy and improvement in the quality of life. 2. Increase the number of institutions offering advanced medical services suitable for Global HealthCare, the generation of jobs in the Medical Services industry and other related industries, thereby increasing the productivity of the workforce and enabling it to expand and upgrade. 3. Attract increased numbers of visitors from other countries availing of medical services and at the same time ensure that quality of those currently offering services suitable for Global Health Care is on the same level as with globallyrecognized standards, and making these services equitably available for both Medical Travellers and local patients.

Objectives: 1. To increase competitiveness by compliance to recognized bodies that implement national and international healthcare organization accreditation 2. Institutionalize policies and enact legislation for high level quality healthcare and patient safety standards in all health facilities 3. Continue collaboration with national government agencies, LGUs, private sector organizations and academe involved in quality healthcare and patient safety, international medical travel and wellness services, retirement, trade and tourism

4. Continue advocacy in all regions of the country on quality healthcare and patient safety, international medical travel and wellness services, retirement, trade and tourism through quad media approach, capacity building activities and collaborative participation in international forum and conferences Stakeholders/Beneficiaries: Private clinics/centers, Public and Private Hospitals, National Government Agencies, Private Specialty Clinics/Centers providing Dermatology, plastic surgery, ophthalmology and dental medicine, Geriatric and Treatment and Rehabilitation Centers for substance abuse Partner Organizations/Agencies:  Department of Tourism (DOT)  Department of Foreign Affairs (DFA)  Department of Trade and Industry (DTI)  Department of Public Works and Highways (DPWH)  Department of Interior Local Governments (DILG)  Department of Justice (DOJ)  Department of Finance (DFA)  Department of Science and Technology (DOST)  Department of Labor and Employment (DOLE)  DTI - Board of Investments (BOI)  DTI - Philippine Export Zone Authority (PEZA)  DOT - Tourism Infrastructure Enterpise Zone Authority (TIEZA)  DOJ - Bureau of Immigration (BI)  DOF - Bureau of Customs (BoC)  Subic Bay Metropolitan Authority (SBMA)  Clark Development Corporation (CDC)  Philippine Health Insurance Corporation (PhilHealth)  Philippine Retirement Authority (PRA)  Cebu Health and Wellness Council (CHWC)  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)  t Foreign Chambers of Commerce in the Philippines

      

              

European Chamber of Commerce in the Philippines (EC) American Chamber of Commerce in the Philippines (AC) Canadian Chamber of Commerce (CCC) Australian New Zealand Chamber of Commerce in the Philippines (ANZCHAM) Japanese Chamber of Commerce in the Philippines (JC) Korean Chamber of Commerce in the Philippines (KC) 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) t 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)

Program Manager: Emmanuel A. Tiongson, MD 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 Roap and the Philippine Sustainable Sanitation Roap. 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 ed by the Program by 80%.

II. ABOUT BENEFICIARIES

THE

STAKEHOLDERS/

The program is designed to be implemented by DOH, NAPC and DILG. The NAPC will perform as the lead coordinating agency, the DOH will provide the funding and ensure the implementation of various water supply projects and the DILG will be in-charge of the capacity building of LGUs. The implementing guidelines define the specific roles of each agency. The DOH, NAPC and DILG used the data from the National Household Targeting System for Poverty Reduction for identification of the target municipalities which compose of the following:  

115 Waterless Municipalities Waterless Areas based on the following thematic concerns:

F. Training, mentoring, coaching and other capacity development assistance to LGU on planning, implementation and management of water supply and sanitation projects. V. A.

PROGRAM MANAGER(S) FULL NAME(S) OF PROGRAM MANAGERS 1.

ENGR. JOSELITO M. RIEGO DE DIOS

2.

ENGR. MA. SONABEL S. ANARNA

3.

ENGR. LUIS F. CRUZ

4.

ENGR. GERARDO S. MOGOL

5.

ENGR. ROLANDO I. SANTIAGO

6.

ENGR. CATHERINE J. OLAVIDES

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 s associations/ communitybased organizations. E. for new and innovative technologies for water supply delivery and sanitation systems.

B. PARTNER ORGANIZATION/ AGENCIES AND THEIR DETAILS 1. DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT (DILG) Francisco Gold Condominium II, EDSA cor. Mapagmahal St, Diliman, Quezon City, Philippines 1100 No.: Tel. No. 925-0330 / 9250331; Fax No. 925-0332

2. NATIONAL ANTI-POVERTY COMMISSION (NAPC) 3rd Floor, Agricultural Training Institute Building, Elliptical Road, Diliman, Quezon City, Philippines1101 Trunklines: 426-5028 / 426-5019 / 4264956 / 426-4965 Facsimile: 927-9796 / 426-5249 Email: [email protected]

3.

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

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:

Email: [email protected], roilayasantiago@ya hoo.com

Q R 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 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 of facility-based deliveries, fully immunized child

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 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: 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 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 ed 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 ed Midwives were already deployed for the first batch (2008-2010). In addition to that, 175 ed 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)

National Dr. Jose Fabella Memorial Hospital, Capital Region School of Midwifery

Batch 2: 11 scholars (June 2009-May 2011) Batch 3: 21 scholars (June 2010-May 2012) Batch 4: 17 scholars (June 2011-May 2013)

Luzon

Visayas

Mindanao

Naga College Foundation, Naga City

University of the Philippines, School of Health Science, Palo, Leyte

Tecarro College Foundation, Inc., Davao City

The RHMPP has deployed midwives in the different DOH identified priority areas of the country:

Batch 1: 19 scholars (June 2011-May 2013) Batch 1: 37 scholars (June 2009-May 2011) Batch 2: 29 scholars (June 2010-May 2012) Batch 1: 14 scholars (June 2011-May 2013)

Batch/ Year

Total Number of Midwives

Batch 1 23 RHMs 2008-2010

Batch 2

175 RHMs

2010-2012

(to include the 16 scholars from MSPP for Return 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 of facility based deliveries, fully immunized child and contraceptive prevalence rates, improve facilitybased health services. The DOH ultimately aims in the attainment of the Millenium Development Goals (MDGs). V. Program Status: A. MSPP



11 scholars graduated on April 2011 and ed 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 ed Midwives are currently deployed in the DOH (BEmONC/CCT) identified priority areas Deployment of 11 scholars

Program Manager: Dr. Josephine H. Hipolito / Ms. Winselle Joy C. Manalo S 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.

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

Program Manager: Ms. Ruth M. Martinez

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

Soil Transmitted Helminth Control Program Profile/Rationale of the Health Program

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

Given the relatively high prevalence rate of STH infections in the country and the existing issues confronting the implementation of the STH 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 IH 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 IH interventions consist primarily of chemotherapy, WASH and several behavior changing approaches. Chemotherapy remains as the core package in helminth infection control. The IH 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 ive environment. Enabling mechanisms must therefore be established to their implementation. An enabling environment entails good governance of the IH at all levels of operations. The political will and of national and local leaders are essential to propel the cause of the IH. 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 STH services need to be explored and established. Strict monitoring of LGUs compliance to national laws and policies must be undertaken while several program systems (e.g., procurement and logistics management, information management system, surveillance and research) have to be installed. Central to the achievement of the IH 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 of DOH, DepEd and other national government agencies including the private sector, civil society and the community is very critical to the success of IH.

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 ; and 2. Improve service quality and scaleup 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 istration, 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 4. Strengthen regulations 5. Installation of management 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 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/istrative Orders

AO No. 2010-0023 – guidelines on deworming drug istration and the management of adverse events following deworming (AEFD) AO No.2006-0028 – Strategic and operational framework for establishing integrated helminth control program (IH)

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

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 s will need 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 (13%) 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 for smoking cessation or “treatment of tobacco dependence” refers to a range of techniques including motivation, advise and guidance, counseling, telephone and internet , and appropriate pharmaceutical aids all of which aim to encourage and help tobacco s to stop using tobacco and to avoid subsequent relapse. Evidence has shown that cessation is the only intervention with the potential to reduce tobaccorelated 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.

2. Provide smoking cessation services to current smokers interested in quitting the habit.

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 NS shall have the following components:

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 istrative Order No. 122 s. 2003 titled The Smoking Cessation Program to 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 (NS).

Objectives: The program aims to: 1. Promote and advocate smoking cessation in the Philippines; and

Program Components:

1.

Training

The NS 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 nonDOH 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 shall be empowered to assist and facilitate the smoking cessation process. 4.

Smoking Cessation Services

Below is the National Smoking Cessation Framework detailing Smoking Cessation services at different levels of care:

LEVEL OF CARE

Intervention Package

STAFFING



PRIMARY LEVEL I. Barangay Health Station

 BHW RM





DRUGS/MEDS

Risk assessment/ Risk screening (Note: Use Risk Assessment Form) Assess for Tobacco Use If smoker, do Brief Intervension Advice (5 A's) See Attached Protocol If nonsmoker, Congratulate and advice continue Healthy Lifestyle activity

 None

II. RHU

SECOND ARY LEVEL

Above Plus

Above Plus

Quit Clinic Nurses Docto  rs and other (Use DOH Protocol health personnel or other suggested protocols e.g. Motivational Interview, SDA Protocol, etc. as available) 

TERTIARY LEVEL



DOH Protocol provides: Assessmen t of client's Smoking History, Current Smoking Status and Readiness to stop smoking

 

 PRIMARY LEVEL

EQUIPMENTS

Risk Assessment Tool Quit Contract Referral Form

Use of Nicotine Patient Replacem Assessment Tool: ent therapy  Stages of particularl change y Nicotine  WHO patch and Mental Nicotine Health Gum is Checklist advocated  Motivatio n and Confidence to quit  Smoking History and Current Smoking Status  Self-test for reason for smoking (Horn's Smoker's Selt-test)  Fagerstro





Planning for clients Readiness to stop smoking Quit day: Pharmacologi c, Psychological and Behavioral Interventions

- Identifying and address triggers for going back into smoking





m Nicotine Dependence test Self-test on Readiness to stop smoking Previous attempts to stop smoking

Form: 

Quit Contract

- Dealing with

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. U Urban Health System Development (UHSD) Program (As contained in istrative Order No. 20110008 dated July 12, 2011)

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

cities address the challenges of rapid urbanization brought about by the interplay of different social determinants of health. II. 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 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, deg, implementing, and sustaining any project/program. 6. Empowerment. Empowerment is enabling individuals and communities to have ultimate control over key decisions involving their wellbeing through strategies such as building knowledge and purchasing power, and mechanisms to increase client ability. 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. ENC is a simple cost-effective newborn care intervention that can improve neonatal as well as maternal care. IT is an evidence-based intervintion that  emphasizes a core sequence of actions, performed methodically (step -by-step);  is organized so that essential time bound interventions are not interrupted; and  fills a gap for a package of bundled interventions in a guideline format. V Violence and Injury Prevention Program Background The first global study on premature deaths in 2009 (WHO Report) revealed that road crashes,

suicide and violence were among the main causes of death worldwide for people aged 10 to 24 years. In 2011 (WHO Report), injuries were reported to be responsible for 9% of all deaths with road traffic injuries claiming nearly 3,500 lives each day, making it among the 10 leading causes of mortality globally. In response to the foregoing, WHO called upon Member States to develop measures to prevent road traffic injuries and violence. WHO recommended that such policies, strategies and plans of action be concrete and contain objectives, priorities, timetables and mechanisms for evaluation. In the Western Pacific, WHO called on its Member States to take firmer action to reduce the region's more than 600 suicides per day. At the September 2011 Fifth Milestones in a Global Campaign for Violence Prevention (GCVP) Meeting in South Africa, the Violence Prevention Alliance (VPA) developed the plan of action geared towards increasing the priority of evidence-informed violence prevention, building the foundations for violence prevention, and implementing violence prevention strategies. Likewise, the United Nations General Assembly adopted Resolution 64/255 proclaiming 2011– 2020 to be a Decade of Action for Road Safety to stabilize and reduce global road traffic fatalities by 2020. The Global Burden of Diseases, Injuries, and Risk Factors Study conducted in 2010 showed that interpersonal violence, road injury, drowning, and self-harm (suicide) ranked sixth, 11th, 17th, and 27th, respectively, on the leading causes of premature deaths in the Philippines. Accidents are the fifth leading cause of mortality for the period of 2005-2010 as reported in the Philippine Health Statistics of the National Epidemiology Center. The Online National Electronic Injury Surveillance System (ONEISS) Fact Sheet for 2010-2012 revealed that transport or vehicular crash was the leading cause of unintentional injuries and interpersonal violence (mauling/assault, with sharp objects, and gunshot) was the leading cause of intentional injuries. 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 plans, projects and

activities of various stakeholders into a more effective and efficient system geared towards violence and injury prevention. The Violence and Injury Prevention Program has been institutionalized as one of the programs of the Disease Prevention and Control Bureau (DPCB) formerly, National Center for Disease Prevention and Control (NCDPC). The program was the offshoot of istrative Order No. 2007-0010 National Policy on Violence and Injury Prevention which was issued in 2007. After seven years in January 2014, said AO was further enhanced thru the issuance of AO 20140002 Revised National Policy on Violence and Injury Prevention which serves as the overarching istrative Order of different policies concerning violence and injuries and shall include the service delivery mechanism and the welldefined roles and responsibilities of the Department of Health and other major players. The program aims to reduce mortality, morbidity and disability due to the following intentional and unintentional injuries: 1)

road traffic injuries

2) interpersonal violence including bullying, torture and violence against women and children 3)

falls

4)

occupational and work-related injuries

5)

burns and fireworks-related injuries

6)

drowning

7)

poisoning and drug toxicity

8)

animal bites and stings

9)

self-harm / suicide

10)

sports and recreational injuries

For a comprehensive approach, the program shall coordinate with other programs like the Child Injury Prevention Program, Violence Against Women and Children Program and other DOH Offices such as the Health Facility Development

Bureau, Health Emergency and Management Bureau, among others, solicit active representation from public and private stakeholders that are involved in violence and injury prevention.

that is, Online National Electronic Injury Surveillance System (ONEISS) and Philippine Network for Injury Data Management System (PNIDMS), shall be fully operationalized for this purpose.

VIP Program Objectives

B. Networking and Alliance Building – DOH shall promote partnerships with and among stakeholders to build alliance and networks and to generate resources for activities related to VIPP.

1. To reduce the number of deaths from violence and injuries 2. To reduce disability caused by violence and injury 3. To enhance capacity of CHDs and other stakeholders in the prevention of violence and injury 4. To develop & implement evidence-based policies, standards and guidelines in the prevention of violence and injury 5. To strengthen collaboration with stakeholders in the prevention violence and injury 6. To ensure reliable, timely, and complete data and researches on violence and injury 7. To advocate for alternative health financing schemes for trauma care

VIPP Program Strategies A. Evidence-Based Research and Electronic Surveillance System – Multidisciplinary and multi-sectoral interventions shall be developed based on evidence-based research. DOH shall establish and institutionalize a system of data reporting, recording, collection, management and analysis at the national, regional, and local levels. An information system,

C. Capacity Building and Community Participation - DOH shall develop and enhance the violence and injury prevention capabilities of a wide range of sectors and stakeholders at the national, regional and local levels. D. Advocacy – DOH shall advocate to LGUs for ordinance development and lobby to Congress for enactment of laws. E. Equitable Health Financing Package – DOH, in collaboration with various stakeholders, shall advocate to health financing institutions and financial intermediaries, i.e. the Philippine Health Insurance Corporation (PHIC) and insurance companies, the development and implementation of policies that would be beneficial for the victims of all forms of violence and injury. F. Service Delivery – In collaboration with stakeholders, DOH shall institutionalize systems and procedures for the integration and provision of services at the community level. In collaboration with various stakeholders, DOH shall undertake advocacy, information and education, political , and multi-sectoral action on violence and injury prevention. Appropriate interventions at all levels of prevention shall be crucially provided. G. Six (6) E’s. Strategies shall utilize the concept of the six E’s (Education, Enactment / Enforcement, Empowerment, Engineering, Emergency Medical Service, and Engagement in surveillance and research) in the prevention of violence and injuries. 1. Education entails wide dissemination of information and communication related to violence and injury prevention;

2. Enactment / Enforcement of laws and policies related to violence and injury prevention; 3. Empowerment of all stakeholders in the implementation of VIPP. This also covers the provision of psychosocial to the victims of violence and injury to help them recover from the psychological trauma; 4. Engineering control provides the most effective way of reducing the cause and impact of violence and injuries. This involves the improvement of facilities and infrastructures to promote safe environments; 5. Emergency Medical Services prior to hospital care. This is vital in providing prehospital trauma life to the injured on site at the soonest possible time so as to prevent needless mortality or long-term morbidity or permanent disability; and 6. Engagement in surveillance and research to promote evidence-based, substantial, scientific, and systematic approach to VIPP. H. Monitoring and Evaluation – DOH, together with various stakeholders, shall identify indicators, targets and milestones for program monitoring and evaluation purposes. There shall be a regular audit and mechanism of all VIPP-related strategies and activities. ONEISS As a nationwide undertaking, the DOH requires all health facilities to adhere to all national policies and guidelines on injury reporting. The DPCB 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 DPCB has no regulatory power over the health facilities, it does have indirect power thru the Health Facilities and Services Regulatory Bureau (HFSRB). The DPCB as the highest policy making body can make recommendations to the HFSRB for appropriate actions on erring health facilities.

The general objective of Online National Electronic Injury Surveillance System (ONEISS) is to make efficient and effective the current systems and procedures of reporting injuryrelated data. Specifically, ONEISS aims to: 1. Promote efficiency to maximize time and effort in data collection, processing, validation, analysis and dissemination of injury-related data; 2. Improve accuracy, reliability, integrity and timeliness of injury-related data; 3. Implement the most reliable and effective technology solution to interconnect with the different agencies and/or beneficiaries/stakeholders of the injury related data; and 4. Enforce standards on inputs, processes and outputs on injury-related data collection, analysis, report generation and . ONEISS shall be the standard reporting system for the collection, storage, analysis and reporting of data pertaining to violence and injury. ONEISS is the information system being implemented by the DOH in of the Injury Program. PNIDMS The Philippine Network for Injury Data Management System (PNIDMS) is a multi-sectoral organization 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. Presently, its include more than twenty inter-agencies and multi-sectoral organizations. Program Management Committee (PMC) The PMC shall provide direction and technical on policies and plans pertaining to the prevention of violence and injury. It shall also provide the forum for coordinating all aspects of the implementation of the program. It shall be chaired by the Director IV of the Disease

Prevention and Control Bureau (DPCB) with the following :

b) Ensure the implementation of integrated, comprehensive, sustainable and gender-

a) Chief of the Essential Non-Communicable Disease Division

responsive communitybased VIPP

b) National Focal Person (Program Manager) of VIPP

c) Ensure the collection and analysis of violence- and injuryrelated data

c) Representatives from CHED, DepEd, DOTC, DPWH, DOLE, DSWD, DILG, MMDA, and

d) Empower and engage all the stakeholders to participate in the VIPP thru Violence and

Philippine National Police.

Injury Prevention Alliance (VIPA)

d) Representatives from specialty societies and other agencies / organizations which can

e) Monitor and evaluate the VIPP regularly through program implementation review

greatly contribute to the various aspects of violence and injury prevention.

f) Initiate and undertake inter-agency collaboration through formal and informal modes

PMC shall be nominated by the agency / organization that they represent. Their hip to the PMC shall be on annual basis. Renewal or replacement of hip shall be the exclusive prerogative of the represented agency / organization.

g) Endorse of researches in the clinical, epidemiological, public health and

PMC shall be subdivided into Sub-Committees to undertake more specific policy interventions and activities in relation to each area of concern. Each Sub-Committee shall have an inter-disciplinary composition. The composition of PMC shall be provided in pertinent Department issuances in addition to written agreements such as Memorandum of Agreement (MOA) or Memorandum of Understanding (MOU) with the involved agencies and stakeholders.

knowledge management areas as well as evaluate them h) Others that may be identified and approved by the Secretary of Health

National Focal Person / Program Manager Dr. Clarito U. Cairo, Jr.

PMC shall have the following functions: a) Recommend to the Secretary of Health VIPP-related plans, programs, strategies and activities

W Women's Health and Safe Motherhood Project I. RATIONALE

The Philippines has committed to the United Nation millennium declaration that translated into a roap 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 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 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 s LGUs in mobilizing networks of public and private providers to deliver the integrated WHSM-SP. In such project site, the following are currently being undertaken: 1. Establishment of Critical Capabilities to Provide Quality WHSM Services through the organization and operation of a network of Service Delivery Teams consisting of: a. Women’s Health Teams b. BEmONC Teams c. CEmONC Teams d. Itinerant Teams 2. Establishment of Reliable Sustainable 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 anintegrated women’s health and safe motherhood service package. This service delivery strategy is focused on maximizing synergies among key services and on ensuring a continuum of care across levels of the referral system. At the ground level, this implies that a woman, whatever her age and specially if she is disadvantaged, who seeks care from a public health provider for reproductive health concerns, could expect to be given a comprehensive array of services that addresses her most critical reproductive health needs. 

Reliable Sustainable Systems

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 fees. 

Stronger Stewardship and Guidance from the DOH

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

Outcome Indicators

Baseline (2010) Accomplishment s

2011 Target Values

2011 Accomplishme nts

80% Facility-based Births

67%

80%

77%

80% of the Women who gave birth have birth plans

99%

80%

100%

75% of facility deliveries are financed by PHIC Increase R by 10 percentage points

17%Relative to the 55%physical targets, 27% the Project has accomplished the following in the Project sites: 5% points 3% points 36% increase increase 39%

100% of LGUs have ed an ordinance on the Contraceptive Self Reliance

47%

100%

70%

100% of BEmONC have M accreditation

45%

50%

52%

Universal Social Health Insurance Coverage

72%

75%

100%

Year

Project Milestones

Status

Social Preparation of Batch 2 Sites 2009

Done

Organization of Service Delivery Teams

Done Done

Regional Blood Centers equipment upgrade

73% Ongoing: Albay: 90% 2009- Facility upgrade: Infrastructure 2011 and Equipment

Masbate: 80% Catanduanes: 60% Surigao del Sur: 53% Sorsogon: 84%

Currently undergoing procurement 2009- Training Centers Insfrastructure 2010 and equipment enhancement

13 Training Centers already provided with equipment and other training logistics

Ensuring environmental Safeguards 20092010

 

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

2008- Capability Enhancement: 2012 Women's Health Teams

Done

BEmONC Skills: 60% Sorsogon: 73% Albay: 103%

Catanduanes: 55% Masbate: 73% Surigao del Sur: 63% 2008BEmONC Teams 2010 2008Midwives on BEmONC Skills 2010

Module currently being finalized

2011- CEmONC Doctors (non2012 specialists)

Module currently being finalized

2010

Done

Provincial Review Teams Behavior Change Interventions Performance-based Grants:

20092013

  

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

Advocacy for Positive Behavior 2010Change 2013 

TV Infomercials

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

52% Albay: 31% (5/16) 2009- BEmONC Facility M 2013 Accreditation

Catanduanes: 17% (1/6) 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. The project also ed 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. age 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 Women and Children Protection Program I. BACKGROUND AND RATIONALE The Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos embodied in istrative Order No. 2010-0036, dated December 16, 2010 states that poor Filipino families “have yet to experience equity and access to critical health services.” A.0. 2010-0036 further recognizes that the public hospitals and health facilities have suffered neglect due to the inadequacy of health budgets in of for upgrading to expand capacity and improve quality of services. AHA also states “the poorest of the population are the main s 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, istrative 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 (WUs) in DOH-retained and Local Government Unit (LGU) -ed hospitals. As of 2011, there are 38

working WUs in 25 provinces of the country. For the past years, there have been attempts to increase the number of WUs especially in DOHretained hospitals but they have been unsuccessful for many reasons. The experience of these 38 women and children protection units reflect that: 1.

2.

3.

4.

5. 6.

7.

8.

Over the last 7 years from 2004 to 2010, all these WUs 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 WUs 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; 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; A consistent and adequate budget is necessary to sustain a women and children protection unit once it is established; The source of budget cited in A.O. 1-B is subjected to multiple interpretations and is dependent on the priorities of the local chief executive and/or the healthcare facility management; There is no standard quality of service; Doctors and social workers are reluctant to take on the task due to heavy workload of women and child protection work, lack of training and feeling of inadequacy, and the nature of work, which among others requires responding to subpoenas and appearing in court; All the WUs are being managed by parttime personnel who are given add-on responsibilities and their appointments are not classified as regular plantilla positions; Women and child protection work is a new field and a pool of professionals must be

recruited and trained to sustain the work; and 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 (WCs) and WUs in other hospitals where the staff is trained in recognizing, recording, reporting and referring abuse cases. This will ensure that all women and children victims of violence who seek medical care have access to health services provided by trained, competent, and caring health personnel. II. GOALS AND OBJECTIVES GOAL: To institutionalize and standardize the quality of service and training of all women and children protection units. GENERAL OBJECTIVES:

1. Establish at least one women and children protection unit in every province; 2. Ensure that all health facilities have competent and trained gender-responsive professionals who will coordinate the services needed by women and children victims of violence; 3. Standardize and maintain the quality of health care services rendered by all women and children protection units; 4. Ensure the sustainability of women and children’s protection unit programs through appropriate organizational and budgetary ; 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, LGUed 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 s 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] AntiRape Act of 1998,[5] the Rape Victim Assistance and Protection Act of 1998[6], and the Magna Carta of Women (2009).[7] The DOH shall thereby 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 of the children’s best interests. All decisions regarding children shall be based upon the needs of individual children, taking into their development and evolving capacities so that their welfare is of paramount importance. This necessitates careful consideration of the children’s 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, psychosocial, and legal concerns.

b. Undersecretary for the Local Affairs of the Department of the Interior and Local Government or his/her authorized representative;

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 socioeconomic diversity. All women and children victims of violence shall have a right to receive medical treatment, care, and psycho-social interventions.

c. Undersecretary for Policy of the Department of Social Welfare and Development or his/her authorized representative;

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, psychosocial, 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;

d. A regional director of the Department of Health; e. A hospital director of a DOH-retained hospital; f. Executive Director of the Philippine Commission for Women; g. Executive Director of the Council for the Welfare of Children; h. Executive Director of the Child Protection Network Foundation; i. One representative each from the Philippine Pediatrics Society, the Philippine Obstetrics and Gynecological Society, Inc., the Philippine Psychiatric Association, the Philippine Psychological Association, the Philippine College of Emergency Medicine, the Philippine College of Surgeons, and the Philippine Academy of Family Physicians, Inc. The Chairperson shall appoint a Vice-Chair from among the Committee who shall preside over the meeting in the former’s absence. The Committee shall designate from among its a program manager who will be given appointment by the Undersecretary of Health through a Department Personnel Order. The Committee may create a technical working group, as the need arises, to help it in the performance of its functions. 3. Term. – The Committee shall hold office for three (3) years and may be reappointed or until their successors shall have been appointed.

4. Functions. The Committee shall have the following functions: 1.

2.

3.

4.

5.

6.

7.

8.

Identify and recommend strategicallylocated DOH-retained and LGU-ed hospitals for WU establishment using geographical and population ratio criteria; Formulate standard protocols and procedures and the manual of operations for multidisciplinary care for women and children victims of abuse and violence; Set the policy for criteria and procedure for accreditation of women and children protection units to be forwarded to the Bureau of Standards and Regulation for appropriate action by the Department of Health (DOH); Lay down the policy for minimum requirements for training programs that are gender responsive, such as the Certificates for Women and Child Protection Specialty Program and other relevant residency programs; Monitor and evaluate the efficacy, effectiveness and sustainability of creation, operations, and maintenance of WUs; Recommend policy reforms and new guidelines anchored on evidence-based interventions and approaches; Harmonize existing databases and create a central databank for women and children protection cases; and Perform other functions as may be necessary for the implementation of the revised issuance.

5. Reportorial Functions. – The Committee shall submit to the Office of the Secretary of Health its annual report on policies, plans, programs and activities on or before the last working day of February. 6. Meetings. – The Committee shall meet regularly at least once every quarter. The venue shall be agreed upon by the . Special meetings may be requested by the Chairperson or any Committee member, as the need arises. The Committee and program manager shall be entitled to an honorarium for every meeting.

VIII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES A. Department of Health at the National Level 1.

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 WUs; c. Generation mobilization of resources for the operations of WUs. B. Philippine Health Insurance Office (PhilHealth) The PhilHealth shall develop a service package for all WU patients that will facilitate the provision of inpatient and outpatient services. C. Centers for Health Development 1.

2.

3.

4.

5.

6.

Disseminate the policy for adoption and implementation by LGU health systems in the different localities within their respective regions; Provide technical assistance to LGUs in organizing WU activities and developing relevant technical references and information, education and communication (IEC) materials; Generate resources to strengthen the implementation of the policy and manual of operations for WUs; Formulate and implement advocacy plans to generate stakeholders’ , particularly the local officials; Monitor the implementation of the policy and guidelines in both public and private hospitals, and in different localities in their respective regions; Undertake regular review with LGUs on the progress of the WU 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 of WU provision (e.g., counterpart funds for training, procurement of additional WUs, etc); d. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols. 2. Regional and provincial hospitals a. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols; a. Allocate budget sufficient for the operations of WUs; b.

Conduct training and orientation on 4Rs;

c. Maintain an accurate and complete database on WU clients. D. Child Protection Network Foundation, Inc. 1.

Provide expertise and technical for the establishment of WUs and the central database on children’s cases; 2. Extend guidance to the trained physicians and social workers in WUs; 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 WU policy including its manual of operations. E. Philippine Commission on Women

1.

Provide expertise and technical assistance on gender-responsive delivery of services by the WU service providers and the central database on women’s cases; 2. Assist the DOH in monitoring the implementation of the WU 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 WUs 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 WUs comply with the criteria mandated in this revised policy and its Manual of Operations. All WUS, 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 WUs 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 (WC) responsible for coordinating the management and referral of all

water d. Light source, and e. Telephone line f. Computer and printer g. Office supplies

violence against women and children cases in the hospital. II. The minimum standard criteria shall be maintained by all WUs. A. Organizational Structure - The WU shall: 1. 2. 3.

Have readily available supplies and equipment for medical examination, including:

Be an integral part of the hospital; Be under the Office of the Chief of Clinics; Be supervised by a WU head who shall have the following responsibilities: a. Integrate and operationalize the multidisciplinary functions of the WU 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 WU: a. a trained physician and b. a trained social worker. B. Facilities - The WU 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. 4.

5.

Have its own toilet or comfort room; Have the following fixtures: a. Examination table b. Desk and chairs c. Washing facilities with clean running

a. b. c. d. e. f. g. h. i.

Digital camera Rape kit Speculum of different sizes Blood tubes Syringes, needles and sterile swabs Examination gloves Pregnancy testing kits Microscope slides 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 WUs a. Level I WU 2. Personnel  

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

3. Services. – A level I WU 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 WU shall utilize the terminology and the form attached as

 

   

4.

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 Training Capability

  



6.   7. 

Training on 4Rs 5. 

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

b. Level II WU 1. Personnel  



A trained physician; A trained and ed social worker, also with full-time coverage of duties at the WU; and A trained police officer or a trained mental health professional.



 

 

Medical services similar to a Level I WU including rape kits and surgical intervention. In the preparation of the medico-legal certificate and report, the WU 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 WU 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 (MIS)

Training Capability Training on 4Rs Residency training Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement

c. Level III WU 1.      2.  

2. Services 

Expert testimony in court Peer review of cases Availability of specialty consultations (ENT, ophthalmology, surgery, OB-Gyne, pathology) Networks with other disciplines and agencies.

         



Personnel At least two (2) trained physicians; At least two (2) trained and ed social workers; A ed nurse; A trained police officer; and A mental health professional Services Medical services of a Level 2 WU In the preparation of the medico-legal certificate and report, the WU 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 WU 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 MIS Expert testimony in court Availability of specialty consultations (i.e., ENT, ophthalmology, surgery, OB-gyne, pathology) Other services (i.e., livelihood, educational)

 

3.  

4. 

 

Networks with other discipline and agencies Availability of subspecialty consultations (e.g., child development, forensic psychiatry, forensic pathology) Training Capability Training on 4Rs Competence and facility to run residency training and specialty trainings Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement; Conduct of empirical investigations on women and children protection work; Publication of such research studies in reputable journals and/or presentation in scientific conferences or meetings.

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  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, comion, confidentiality and empathy. 2. For the trainees to develop/strengthen their skills in early detection, screening, interviewing, physical examination, use of

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. Z