What is FOURmula ONE for Health?

Defining the Road Map for Reforms FOURmula ONE for Health is the implementation framework for health sector reforms in the
Philippines for the medium term covering 2005-2010. It is designed to implement critical health interventions as a single package,
backed by effective management infrastructure and financing arrangements.
This document provides the road map towards achieving the strategic health sector reform goals and objectives of FOURmula ONE
for Health from the national down to the local levels.
FOURmula ONE for Health engages the entire health sector, including the public and private sectors, national agencies and local
government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an
invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and
the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a
brighter future for generations to come.
Starting the Race with the End in Mind:
Fourmula One for Health Goals and Objectives
Over-all Goals:
The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the
health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine
Development Plan:
* Better health outcomes;
* More responsive health system; and
* More equitable healthcare financing.
General Objective:
FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination directed at improving
the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos,
especially the poor.
Specific Objectives:
Fourmula One for Health will strive, within the medium term, to:
*
*
*
*

Secure more, better and sustained financing for health;

Assure the quality and affordability of health goods and services;
Ensure access to and availability of essential and basic health packages; and
Improve performance of the health system

Pharma 50
GMA 50 is the name of the Department of Health (DoH) undertaking to effect the SONA pledge of President Gloria MacapagalArroyo. The primary goal of the project is to ensure that affordable, high quality, safe and effective drugs and medicines are always
available, especially to the poor.
Health care is central to the concept of development and that a health policy of conscious intervention through public agencies is
required in order to reach certain basic health objectives. In order to achieve these health objectives provisions for the basic
requirement of preventive, promotive and curative health care services must be top priority.
An essential component of a health policy includes measures to promote the rational use of drugs and ensure the availability of
medicines of adequate quality at a reasonable price. To date the cost of medicines in the Philippines remains hign and is even higher
by 40% to 70% compared to other ASEAN countries. Moreover, our budget for drugs and medicines is too small to procure sufficient
quantities of low-cost, essential drugs for the population in need.
In 23 July 2001, H.E. President Gloria Macapagal-Arroyo made a commitment to lower the prices of drugs and medicines frequently
bought by the poor by 50%.
What is GMA 50%?
GMA 50 is the name of the Department of Health (DoH) undertaking to effect the SONA pledge of President Gloria Macapagal-Arroyo.
The primary goal of the project is to ensure that affordable, high quality, safe and effective drugs and medicines are always available,
especially to the poor.
How does GMA 50 intend to attain its objective?
The strategies that GMA 50 will employ are:
A. Short-term (2001 SONA - 2002 SONA)
1. Continue the importation of high quality, safe, effective and affordable drugs and medicines for as long as the prices in the country
remain high.
2. Expand, as appropriate the list of drugs and medicines for importation. The list will contain essential drugs needed to treat the
prevailing causes of morbidity and mortality.
3. Increase the number of outlets. Initially, the outlets will be limited to public health facilities i.e., DoH and LGU retained hospitals,
Botika ng Barangay, and NFA rolling stores. However, initial meetings with private retail outlets are being conducted to draw up the
guidelines for their involvement.

B. Medium and Long-term (SONA 2002 and beyond)

1. Promote the use of Generic drugs and medicines. Basically, generic counterparts of branded drugs are far lower in prices.
However, generic product in the country has very low acceptability to the medical practitioners and general public, as reflected in the
sales and use. There is a need to ensure the quality, safety and efficacy of these products through regulations and other measures.
2. Ensure continuous supply of high quality, safe, effective and affordable drugs and medicines, whether imported or locally
manufactured. (i.e.Toll Manufacturing for selected drugs and medicines, the PITC to procure for government health facilities,
encourage local production, etc).
3. Develop reimbursement scheme for medicines with PhilHealth (Reference price for 100 most commonly needed/claimed drugs and
medicines, PHIC to reimburse Generic drugs, etc).
4. Work with the pharmaceutical industry/organization/companies for them to reduce significantly the prices of drugs and medicines.
5. Work with the local retail industry for them to pass on to the consumers the low price of drugs and medicines, and
6. Wage war versus substandard drugs.
Who are involved?
Reducing the prices of drugs and medicines requires the cooperation and collaboration of many organizations, both private and
public. As of today, the major players are:
A. Public
1. Department of Health
a) Bureau of Food and Drugs
b) Philippine Health Insurance Corporations
2. Department of Trade and Industry
a) Philippine International Trade Corporation
b) Philippine Health Insurance Corporation
3. Philippine Charity Sweepstakes
4. National Food Authority
5. Local Government Units
B. Private
1. Association of Drug Industries in the Philippines
2. Philippine Healthcare Association of the Philippines
3. Chamber of Filipino Pharmaceutical Manufacturers and Distributors
4. Filipino Drug Association
5. Generics Association of the Philippines
6. United Laboratories, Inc.
7. Drugstore Association of the Philippines
What have we accomplished so far?
1. Undertaken 2 importation of 8 drugs and medicines and distributed in 30 DOH retained hospitals.
2. Third shipment of about 40 drugs and medicines in transit to be distributed in 73 DOH retained hospitals
3. Approval of a Special License to Operate for the Botika ng Barangay and National Food Authority Rolling Stores to sell over-thecounter drugs and medicines.
4. Lagundi and Sambong are sold in NFA rolling stores in Metro Manila. 5. Develop the operational guidelines for establishing Botika
ng Barangay.

What needs to be done?

Agency

Expectation

Department of Health

Promote rational drug use

Strengthen the capability of the Bureau of Food and Drugs
Intensify the promotion of generic drugs and medicines

Philippine International Trade

Import drugs and medicines at affordable prices

Philippine Charity Sweepstakes

Source of funds

Local Government Units

Increase enrollment to PHIC

Procure, use and sell affordable high quality drugs and medicines
Practice rational drug use

Philippine Health Insurance Corporation

Price reference
Drug reimbursement scheme for generic drugs and medicines
Health practices

Board of Investments

Incentives to pharmaceutical firms

List of Drugs | Participating Hospitals | Comprarative Price

Inventory Report of Pharma50 | Botika ng Barangay Initiative
Drug Consignment System | Botika ng Barangay Monitoring System
ARSP Progress Report 2005 | Drug Price Reference Index (DPRI)
Comparative Price of Drugs of GMA 50 Project

Type of Disease

Generic
Name/Brand
Name

Price in
Private
Drug
Outlets

Price in
30 DOH
Hospitals

Price
Difference

% Savings

294.75

197.60

97.15

49.16%

831.00

532.50

298.50

56.06%

17.75

9.05

8.70

96.13%

34.15

5.75

28.40

493.91%

24.10

5.10

19.00

372.55%

13.50

2.80

10.70

382.14%

82.68

67.60

15.08

22.31%

7.75

3.10

4.65

150.00%

Salbutamol
(Ventolin/Ventorlin)
1. Asthma

100 mcg/dose x 200

doses MDI

Beclomethasone
(Becloforte/Becoride)
2. Asthma
250 mcg inhaler

Atenolol (Tenormin)
3. Hypertension

4. Hypertension

5. Bronchitis/
Pneumonia/
UTI

50 mg tablet

Nifedipine (Adalat
Retard) 20 mg capsule

Cotrimoxazole
(Bactrim) 800 mg
SMZ +
160 mg TMP tablet

6. Bronchitis/
Pneumonia/
UTI

Cotrimoxazole
(Bactrim) 400 mg
SMZ +
80 mg TMP tablet

7. Bronchitis/
Pneumonia/
UTI

8. Diabetes mellitus

Cotrimoxazole
(Septrin/Septran)
200 mg
SMZ + 40 mg TMP/5
ml susp. 50 mL bot.

Glibenclamide
(Daonil) 5 mg tablet

No Tobacco
The tobacco plant, scientifically known as Nicotiana tabacum, is a plant grown for its leaves, which are smoked, chewed, or sniffed
for a variety of effects. Tobacco is considered addicting because it contains the chemical nicotine. Sniffing and chewing tobacco
originated in North America and Europe.
It was Christopher Columbus who introduced tobacco into Europe.

It then became very popular with the Portugese, Spanish, French, British, and Scandinavians.

Why is cigarette smoking dangerous?

In 1960s, medical research on tobacco showed smoking to be strongly linked to heart and lung diseases. Smoking may be even
more dangerous now than 30 years ago because the lower levels of tar and nicotine in cigarette brands make smokers inhale more
deeply. In the US . . . .
Only 42 of male lifelong smokers reach the age of 73 compared to 78% of non-smokers
25.7% of the adult population (47 million people) continue to smoke despite repeated warnings on the hazards of cigarette smoking.
28% of the male population and 23% of women smoke
Despite the known dangers of smoking, television, radio, and print ads continue to promote a number of cigarette brands
What are the chemicals in tobacco smoke?
Tobacco contains nicotine, as well as tar. Both substances get deposited in the bronchi and the lungs. The other chemicals found in
tobacco are:
Acetone
Ammonia
Carbon Monoxide
Carbon Dioxide
Hydrogen Cyanide
Methane
Benzopyrene
These chemicals are the major factors responsible for smoking related diseases like coronary heart disease, atherosclerosis, stroke,
emphysema, acute bronchitis and cancers of the nose, pharynx, larynx (voice box), and lungs
What are the effects of nicotine on the body?
Nicotine gives the so-called positive effects which include:
Enhancement of memory and alertness
Improvement of skills and work performance
Alteration of mood, reduced stress, improvement in sociability and even euphoria
However, these effects are fleeting and are far outweighted by negative effects. These include:
Shortness of breath
Chronic cough
Increased heart rate and blood pressure
Ulcer-like stomach pains (hunger pains), nausea and diarrhea
Reduction of fertility
Early onset of menopause in women
Tremors, especially in the inexperienced user
Sweating with the smell of nicotine
Others related to gastro-intestinal effects:
Appetite suppression specifically for simple carbohydrates (sweets)
Inability to taste food
Decreased efficiency of food digestion and metabolism
What is second-hand smoke?
Second-hand smoke is smoke exhaled by a smoker and inhaled by other people. Non-smokers who are exposed to second-hand
smoke are more at risk because the particles in the exhaled smoke are smaller. They reach deeper into the lungs of the passive
smokers.
The unfortunate non-smoker exposed regularly to second-hand smoke, is prone to specific health risks which include:
Increased risk of heart disease
Increased risk of lung cancer
Increase frequency of respiratory infections and asthmatic bronchitis in infants and children
Chronic irritation of the eyes, nose and throat especially among children
What are the long-term effects of cigarette smoking?

Long-term smoking can contribute significantly to the acceleration of the following health problems:
Nicotine addiction
Coronary artery disease at least 20% of deaths are smoking-related
Heart disease - Smokers in their 30s and 40s have a heart attack rate that is five times their non-smoking peers
Hardening of the arteries and complication of blocked arteries, hypertension, blood clots
Stoke People who smoke a pack a day have almost two and a half times the risk of getting a stroke
Peptic ulcer disease
Lung diseases chronic obstructive pulmonary diseases such as chronic bronchitis and emphysema; smoking caused nearly 85,000
deaths in 1990 due to these diseases.
Cancers oral, especially of the respiratory tract and the oral cavity, nose, pharynx, larynx, lung, cervical, urinary bladder, kidney,
and pancreas; smoking accounts for 85% of all lung cancers
Disease of the oral cavity, e.g., irritation and infection of the gums and teeth
Delayed wound healing

Smoking can cause the following problems in women:

Reproductive disturbances (such as, infertility)
Problems during pregnancy include:
a. Fetal abnormalities and even death
b. Low-birth weight infants
Why is very hard to quit smoking?
Withdrawal is a difficult process. About 70% of smokers want to quit. In one study of women smokers who wanted to quit, 80% of
them were unable to. This is because nicotine increases the activity of dopamine, a chemical in the brain that elicits pleasurable
sensations. Even after years of non-smoking, about 20% of ex-smokers still have occasional cravings for cigarettes.
What are the signs and symptoms of nicotine withdrawal?
Withdrawal symptoms begin as soon as 4 hours after one decides to quit smoking or after the last cigarette, generally peak in
intensity at three to five days, and disappear after two weeks. These symptoms start with headache, anxiety, irritability, tremors,
poor concentration, and hunger pains. Other signs and symptoms include insomnia and depression, sweating, constipation and
diarrhea.
What are the benefits of quitting smoking?
Chronologically, these are the benefits when one decides to quit smoking:
1. Within 20 minutes, the blood pressure and pulse rate drop to normal, the body temperature of the hands and feet returns to
normal.
2. Within 8 hours, the carbon monoxide level in blood drops to normal and the oxygen level I blood increases to normal.
3. Within 24 hours, the risk of a sudden heart attack decreases.
4. Within 48 hours, the nerve endings begin to regenerate and a persons ability to smell and taste begins to return to normal.
5. Within 2 weeks to 3 months, blood circulation improves and lung function increases up to 30%.
6. Within 1 to 9 months, overall energy increases, signs and symptoms of coughing, nasal congestion, fatigue, and shortness of
breath are markedly reduced. Natural cleansing mechanisms of the respiratory tract returns to normal, so that the body is able to
handle mucus, clean the respiratory tract, and prevent respiratory infections.
7. Within 1 year, risk of coronary heart disease is reduced by 50%.
8. Within 5 years, the risk of dying from lung cancer is reduced by 50%. The risk of cancer of the mouth is half that of a tobacco
user.
9. Within 10 years, the risk of dying lung cancer, stroke and heart attack is the same as that of a non-smokers.
When is the best time to quit smoking?
The sooner a smoker quits smoking, the better. It is never too late to quit. No one is too old too quit. Because the first two weeks are
critical success, smokers should seek all the help they can during this period.
Here is a tip to help smoker decide when to quit smoking:
A smoker should choose a particular date to quit when his level of stress is lowest.
Example: Women should not start during the premenstrual period when stress is high.
What are ways to quit smoking?

Scheduled reduction the process of slowly reducing the number of cigarettes per day until one has stopped completely.
Nicotine Replacement Therapy (NRT) a smoker who stops smoking is given small amounts of nicotine over a period of six weeks or
more to reduce withdrawal signs. The nicotine is given either as chewing gum. patch, nasal spray or cigarette-like inhaler. Consult
your physician about NRT.
Totally quitting smoking without any outside help.
What should smokers do while they are quitting?
Exercise. Take deep breaths, dance, run, wall jump up and down, stretch.
Drink plenty of water and eat fruits and vegetables. Take plenty of vitamins and minerals. Carrots, apples, singkamas, chewing gum,
and candies are good munching foods to replace the feel of a cigarette in the mouth.
Take naps, warm baths or showers during intensive cravings to smoke.
Tell friends and family that you have stopped smoking. This will make you feel embarrassed when they catch you smoking.
Change activities or habits that are associated with smoking. For instance, find other ways to finish a meal without smoking. Go out
for a walk, go to a place where smoking is prohibited, doodle instead of smoking while talking on the phone.
Advice to smokers:
While is was once a fad to smoke, it has now become dangerous to health. Smoking is abnormal. It is very addicting and very hard
to stop. Smoking not only affects other people who inhaled second-hand smoke. Smoking contributes significantly to diseases that
shortens life and is leading cause of death like heart attack, stroke, respiratory diseases which make smokers pulmonary cripples
as in asthma, emphysema, bronchitis, recurrent infections, and cancer.
The Food Fortification Program
The Food Fortification program is the government's response to the growing micronutrient malnutrition, which have been prevalent
in the Philippines for the past several years.
Food Fortification is the addition of Sangkap Pinoy or micronutrients such as Vitamin A, Iron and/or Iodine to food, whether or not
they are normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency with one or more
nutrients in the population or specific population groups.
Sangkap Pinoy or micronutrients are vitamins and minerals required by the body in very small quantities. These are essential in
maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children.
Past studies have shown that worldwide, the problem of malnutrition has been the cause of death of 60% of children less than 5
years old.
Ligtas Tigdas
Ligtas Tigdas 2004 is a special nationwide vaccination month for children who are at high risk of getting measles. The Department
of Health identified these children to be those between the ages of 9 months to less than 8 years old.
During the Ligtas Tigdas 2004, 100% of the children in this age group will be vaccinated. Other children are not classified as high
risk.
The Philippine Measles Elimination Campaign of which the Ligtas Tigdas 2004 is only one component. PMEC includes continuing
routine vaccination of infants at 9 months old after Ligtas Tigdas 2004; the catch-up mass vaccination done in 1998; continuing
monitoring or disease surveillance and Follow-up campaign such as Ligtas Tigdas 2004 which may have to be repeated every 4 or 5
years.Vitamin A capsules will also be given to children 9 months to below 6 years of age.
The LIGTAS TIGDAS should be done to rapidly reduce the number of children at risk of getting measles infection which has
accumulated in the past years. This nationwide campaign supports the routine vaccination given on a regular basis at the health
centers.
It is a Door-to-Door campaign. BakunaDOORS (Vaccination Teams) led by doctors, nurses and midwives will visit every home and
school to vaccinate children against measles which will be done in the whole month of February 2004