MISSION AND VISION

Vision by 2030
A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable
health financing.

Mission
To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for
excellence in health.

ADOLESCENT AND YOUTH HEALTH PROGRAM (AYHP)

A Situationer on Adolescents Health

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

MOST COMMON CAUSES OF DEATH AMONG 10-24 YEARS OLD

PER 10,000 POPULATION. Philippine Health Statistics, 2003

Rank Cause of Death

1 Asssault
2 Transport Accidents
3 Event of undetermined intent
4 Symptoms, signs & abnormal clinical findings not elsewhere classified
5 Pneumonia
6 Tuberculosis of the Respiratory System
7 Chronic Rheumatic Heart Disease
8 Accidental drowning and submersion
9 Nephritis, nephrotic syndrome and nephrosis
10 Other accidents & late effects of transport/other accidents

Leading Threats to Adolescents Health

Accidents and other inflicted injuries

Among 10- 24 age groups, this threat caused 27% of the total deaths (2003 data). Young males always exlusively succumb to injuries
and females have the increasing mortality due to complications of pregrancy, labor delivery and puerperium. These data have been on
the uptrend, a challenge to community-based or DOH-led programs. The threat is caused by the adolescents exposure to poorly
maintained roads and poorly managed traffic systems. Adolescents increased mobility to urban areas needs a correspondidng physical

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 and infrastructre support in their quest for better opportunities and education pursuits. Another is the inability of the state to provide
adequate number of police personnel leading to an increasing number of assault and transport accidents among the young males.

Tubercolusis, Pneumonia, and Accidental drowning

Close to 6% of young Filipinos who died in 2003 died of various forms of tuberculosis, followed by pneumonia that caused 4% of
deaths. This health issue among the young has been declining through the years due to sustained nationwide programs that
began in 1987 and has somehow caused to keep deaths down, hence efforts to continue sustaining becomes the challenge.

The threat of HIV and other sexually related diseases

Reported cases increased substantially increased over the past year.Among the 15-24 year olds, reported HIV infections nearly tripled
between 2007 and 2008 from 41 cases to 110 per year, which is substantial cause for alarm. In 2009, 15-24 year olds make 29% of all
new infections; in 2009, the number of new infections among 20-24 equals the number of new infections among 25-29; with 10 cases
see July DoH AIDS Registry Report. The substantial increase from the past year can be traced from the adolescents early
engagement in health risk behaviour, due to serious gaps of the knowledge on the dangers of drugs, as well as the cause as well
as causes on the transmission of STD and HIV AIDS , dangers of indiscriminate tattooing and body- piercing and inadequate
population education. Under this threat, young males are prone to engaging in health risk behaviour and more young fermales
are also doing the same without protection and are prone to aggressive or coercive behaviours of others in the community such
that it often results to significant number of unwanted pregrancies,septic abortion and poor self-care practices.

In addition, there are also other less common but significant causes of disease and deaths namely;

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

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

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

Disability Filipinos aged 10-24 years old has an overall disability prevalence of 4%. The most common disability among this age
group affected are speaking (35%), hearing (33%) and moving and mobility (22%)

There are also vulnerable Filipino adolescents which can be classified in their respective areas of vulnerability

VULNERABLE YOUNG FILIPINOS

Sub-groups Vulnerability areas
Young among the street-dwellers
Common infections, physical abuse or assault, sexual exploitation, drug use, road accidents
Out- of- school adolescents
High riskand
behaviour; smoking, alcohol use, drug abuse, high risk sexual behaviour, risky work conditions leading to injuries
and diseases
Urban based male youth
High risk behaviour; transport accidents , other inflicted injuries
Female adolescents Sexual abuse, sexual exploitation , unwanted pregranancies, abortion, unsafe pregnancy and insecure motherhood
Not living with parents
Nutritional
or family
disorders, substance use and risky sexual behaviour, other inflcited injuries

Factors Causing Threats to Adolescents Health

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 The alarming patterns of health issues affecting adolescents health is caused by the following factors operating in a systemic manner
reinforcing further complexities in the health issues affecting adolescents .

Socio-Cultural Factors

Demographic Factors

Continuing Rapid Population Growth

The rapid population growth of the youth creates pressure to the state to expand education, health and employment FO rhtis age
group. The pressure creates an imbalance to the distribution and allocation of resources to various sectors especially the youth. The
imbalance reinforces deeper the marginalization and deprivation of some sectors to basic services. A viscious cycle is created and
more are having difficulties to access provision on health service delivery.

Increased population movement

The scarctiy of local employment has triggered the participation of the youth in overseas work. The movemente of the sector
has caused displacement from families and love ones increase youths vulnerability to exploitation, low paying jobs. According to
a study in 2001, there were more tha 6,000 workers in the teenage group overseas workers and it is most likely that they would land
in overseas low paying work.

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

Health Risk Behaviors

A significant proportion of young people engage in high-risk behaviors 23% ever had pre- marital sex, 57% of first sex experience
was unplanned and unplanned. About 70% - 80% of their most recent sexual experiences were unprotected (YAFS, 2002).

The 2002 Young Adult Fertility and Sexuality Survey showed that the proportion of 15-24 year olds who were currently smoking,
drinking and using drugs were 20.9%, 41.4% and 2.4%, respectively. The proportion is higher among males compared to females. A
comparative data (1994 and 2003) showed that among 15 24 year olds, smoking increased by 23%; drinking increased by 10%; drug
use increased by 85%; and pre martial sex increased by 30% (YAFSS, 2003). The likelihood of engaging in pre-marital sex is higher
among those who smoke, drink alcohol or take drugs. As a consequence of substance and alcohol abuse, some have mental and
neurological disorders; others spend the productive years of their life behind bars with hardcore lawless adults.

Health Seeking Behavior

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

Low Contraceptive Use

The overall use of contraception among sexually active adolescents is at 20%. Non- desire for pregnancy and high awareness of
contraceptive methods were not enough to encourage adolescents to use contraceptives. Among the reasons cited for the low
contraceptive use were:

Contraceptives were given only to married individuals of reproductive age

Even if they were made available to adolescents, the culture says that it is taboo for young unmarried individuals
to avail of contraceptive services and commodities.
Condom use is perceived mainly for STIs, HIV/AIDS prevention rather than contraception

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 The practice Abortion and Unmet need for Contraception

In 2000, induced abortion among adolescents reached 319,000. This is due to the inadequate knowledge on preventing unwanted
pregnancies. Consequences of teen-age pregnancies among young mothers include not being able to finish school and reduced
employment options and opportunities. In addtion, the social stigma and fear brought about by unwanted pregrancy pushes the young
mother to resort to abortion. Although the disapproval rating for abortion remains to be high, there is an increasing trend among those
who approve of it (from 4% to 6% in males and 3.5% to 4% in females).On contraceptive use , adolescents also don't use condoms for
prevention of HIV,it's not only that they don't use them for contraception.

Risk of HIV/AIDS due to Unprotected Sex

Adolescents including children living in exteme conditons and great exposure to sexual exploitation and abuse belong to high-risk
categories threatened by unprotected sex. Latest data on these shows that majority of people engaged in sex work are young and 70
% of HIV infections involve male-to-male sex. The proportion of young people reported to have STDs/HIV and AIDS is increasing.
The YAFS survey showed that although awareness about STDs is increasing, misconceptions about AIDS appear to have the same
trend. The proportion of those who think AIDS is curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents
also resort to services of unqualified traditional healers, obtain antibiotics from pharmacies or drug hawkers or resort to advices from
friends (e.g. drinking detergent dissolved in water) without proper diagnosis to address problems of STDs. Improper or incomplete
treatment may mask the symptoms without curing the disease increasing the risk of transmission and development of complications.
The limited use of condoms to protect adolescents from risk of HIV is an issue to reflection for condom use is not only to prevent
pregranancy but also preventing sexually transmitetd disease. r The YAFS 2002 survey showed that Filipino males and females are at
risk of STIs, HIV/AIDS. It was reported that 62 % of sexually transmitted infections affect the adolescents while 29 % of HIV
positive Filipino cases are young people. In addition, it was revealed that thirty seven percent (37%) of Filipino males 25 years of
age have had sex before they marry with women other than their wives. Some will have paid for sex while others will have had five or
more partners.

Political and Economic Factors

Marginalization and Poverty

The disturbing poverty situation of households and families where majority of the adolescents belong brings in difficulties to meet
adolescents.needs. Poverty is closely link to adolescent health issues. It reinforces to the situation of adolescents vulnerability to
health risks due to the lack of access to various services and unsupportive social, political and economic environment. The following
are some of the consequences of poverty faced by the youth.

Limited Access to Information -among the greatest challenges for Filipino youth is access to correct and
meaningful information on sexual and reproductive issues.
Limited access to services and commodities-The lack of access to contraceptive services and supplies was among
the most frequently articulated concerns with regard to adolescent SRH. Programs such as the AYHDP do recognize adolescents need
for access to contraception.
Limited awareness of pertinent policies-While the AYHP Administrative order was issued in 2000, few key
informants knew of its existence. In fact, many key informants said that no ARH policy existed at the time they were interviewed

Technological Factors

Rapid Advancement of Communication

The value of technological advancement could never be discounted. However, to the curious and adventurous adolescents
various modes of communications are oftentimes abused and misused such as the use of internet and mobile phones. Adolescents
then become vulnerable to exploitation, in cybersex and pornography exposing them deeper into risky behaviour. In addtion the
digital dependence and addiction causes alienation of adolescetns to personal and closer mode of communciation resulting to a
distorted image of the adoelscents relationships to the social environment. This also deprives the adolescents from productive
activities where they can develop themselves fully grown up and mature e conomic and socail being Moreover, communcation

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 advantcement has also produced adverstisements and television commercials whose image are not adoelsent- friendly are paving the
way for so much consumerism, distorted personal and family values

THE ADOLESCENTS HEALTH PROGRAM IN THE PHILIPPINES

8. International Policies, Passages and Laws as anchors

In International Laws

UN Convention on the Rights of Children

UN Convention the Action for the Promotion and Protection of the health of adolescents
Convention on the Elimination of all forms of discrimination againts women
1994 International Conference on Populaiton and Development ( ICPD)
1995 Fourth World Conference on Women
World Programme of Action for Youth 2000
MDG Goals :
Goal 2:Achieve Universal Primary Education
Goal 3:Promote Gender Equality
Goal 4 : Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6:Combat HIV/AIDS, Malaria and other diseases

National Laws and Policies

o National Objectives for Health

o Fourmula One for Health

o Adolescent and Youth Health Policy (AYH)

o Adolescent and Youth Health and Develoment Program

o National Directional Plan for reaching the Un reahced Youth Population

o Reproductive Health Program AO#1 s1998

o Local Government Code

WHO, together with countries and areas in the Region and partner agencies, are working to promote healthy development of
adolescents and reduce mortality and morbidity. In the Western Pacific Region, several technical units are working to implement
interventions that improve adolescent health in the Region. The Philippines belong to the Western Pacific Region and is committed
to:

Recognize adolescents as vulnerable and a group in need

o Address Issues that have an evidence base

o Socio- Cultural perspectives

o Develop Innovative mechanisms to reach out to adolescents.

o Encourage collaboration and partnerships

o Program implementation is monitored and evaluated.

The Adolescent Health Program

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 The Adolescents Youth and Heath Development Programs was established in 2001 under the oversight of the Department of Health
in partnership with other government agencies with adolescent concerns and other stakeholdres. The program is targeting youth
ages 1024, and the program provides comprehensive implementation guidelines for youth-friendly comprehensive health care and
services on multiple levelsnational, regional, provincial/city, and municipal.

The program is solidly achored on International and laws, passages and polices meant to address adolescents health concerns. It is
operating then within the facets and adolescents and youth health that includes disability, mental and environmental health,
reproductive and sexuality, violence and injury prevention and among others.

It employed strategies to ensure integration of the program intothe health care system in addition, broader society such as building a
supportive policy environment, intensifying IEC and advocacy particularly among teachers, families, and peers, building the technical
capacity of providers of care, and support for youth; improving accessibility and availability of quality health services, strengthening
multi-sectoral partnerships, resource mobilization, allocation and improved data collection and management.

The program to address sexual and reproductive health issues likewise adopts gender-sensitive approaches. The primary
responsibility for implementation of the AYHDP, and its mainstreaming into the health system, falls to regional and provincial/city
sectors. Guidelines cover service delivery, IEC, training, research and information collection, monitoring and evaluation, and quality
assurance.

BOTIKA NG BARANGAY (BNB)

Botika ng Barangay

I. What is Botika ng Barangay?

Botika ng Barangay (BnB) - refers to a drug outlet managed by a legitimate community organization (CO) /
non-government organization (NGO) and/or the Local Government Unit (LGU), with a trained operator and a
supervising pharmacist specifically established in accordance with this Order. The BnB outlet should be initially
identified, evaluated and selected by the concerned Center for Health Development (CHD), approved by the
PHARMA 50 Project Management Unit (PMU) and specially licensed by the Bureau of Food and Drugs (BFAD) to
sell, distribute, offer for sale and/or make available low-priced generic home remedies, over-the-counter (OTC)
Drugs and two (2) selected, publicly-known prescription antibiotics drugs (i.e. Amoxicillin and Cotrimoxazole).

The establishment of the Botika ng Barangay (BnB) in the communities, including the insurgent areas,
ensures accessibility of low-priced generic over-the-counter drugs and eight (8) prescription drugs as recommended
by the National Drug Formulary Committee. Under Memorandum # 31 and its amendment, as much as 40 essential
medicines that address common diseases can be made available in BnBs depending on the morbidity and mortality
profiles of the community. And the policies surrounding the BnB (AO 144) ensure that such can be sustained in the
medium term.

II. Objectives

The objectives of this Order are as follows:

1. To promote equity in health by ensuring the availability and accessibility of affordable, safe and effective,
quality essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas.
2. To integrate all related issuances of the DOH that provides rules and regulations in the establishment and
operations of BnBs; and

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 3. To define the roles and responsibilities of the different units of the DOH and other partners from the
different sectors in facilitating and regulating the establishment of BnBs.

III. Status of the Program

Variants of the BnBs include Botika Binhi (funded by the members of the Peso for Health with counterpart from
the local government unit), Health Plus (funded by the GTZ), Botika sa Parokya (funded by DOH and Office of the
President) and the Botika ng Bayan (BNB) express under PITC/ PITC Pharma Inc. At present, about 16,350 BnB
outlets have been established in the country.

The initial target was to establish 1 BnB to serve 3 adjacent Barangays. However, due to the immensity of
Barangays, and the need for more than 1 BnB in some poor adjacent barangays to better provide for the service, the
target were changed to 1:1.

Since absorptive capacity for the DOH-CHDs to establish BnBs is also limited due to resource and time constraints,
the initial phasing of the target to achieve 1:1 is being done. Thus, for the next two (2) years, the target would be
initially 1:2 except for select areas that have high poverty incidence, conflict or Geographically isolated areas, and
the like where the target would be 1:1.

Sourcing of medicines for the initial seed capital of these medicines is done through PITC Pharma Inc.

Issuances about Botika ng Barangay

Issuances Date Title

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

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.

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 This campaign encourages mothers to exclusively breastfeed their babies from birth up to 6 months.
Exclusive breastfeeding means that for the first six months from birth, nothing except breast milk will be given to
babies.

Moreover, the campaign aims to establish a supportive community, as well as to promote public
consciousness on the health benefits of breastfeeding. Among the many health benefits of breastfeeding are lower
risk of diarrhea, pneumonia, and chronic illnesses.

BLOOD DONATION PROGRAM

Republic Act No. 7719, also known as the National Blood Services Act of 1994, promotes voluntary
blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act aims to inculcate
public awareness that blood donation is a humanitarian act.

The National Voluntary Blood Services Program (NVBSP) of the Department of Health is targeting the
youth as volunteers in its blood donation program this year. In accordance with RA No. 7719, it aims to create
public consciousness on the importance of blood donation in saving the lives of millions of Filipinos.

Based from the data from the National Voluntary Blood Services Program, a total of 654,763 blood units
were collected in 2009. Fifty-eight percent of which was from voluntary blood donation and the remaining from
replacement donation. This year, particular provinces have already achieved 100% voluntary blood donation. The
DOH is hoping that many individuals will become regular voluntary unpaid donors to guarantee sufficient supply
of safe blood and to meet national blood necessities.

Mission:

Blood Safety
Blood Adequacy
Rational Blood Use
Efficiency of Blood Services

Goals:

The National Voluntary Blood Services Program (NVBSP) aims to achieve the following:

1. Development of a fully voluntary blood donation system;

2. Strengthening of a nationally coordinated network of BSF to increase efficiency by centralized testing and
processing of blood;

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.

BELLY GUD FOR HEALTH

Contact Person:
Rosemarie Holandes
Telephone Nos.:
651-7800 loc. 1750-1754

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 Overnutrition such as overweight and obesity is a serious health concern especially in the light of its strong
association with the development of non-communicable diseases which are among the leading causes of mortality,
morbidity and disability in the country today. These NCDs include cardiovascular diseases, cancer, diabetes
mellitus, hypertension, renal diseases, and degenerative arthritis, gout and gallbladder diseases. With the various
medical consequences associated with overnutrition, this weight problem contributes to decreased productivity and
economic growth retardation.

In the Department of Health Office, from a total of 779 personnel taken waist circumference in 2012 prior to the
conduct of Belly Gud for Health, 362 or 46.5% have waist circumference above desirable levels. Waist
circumference (WC) is a simple and easy measure of central obesity among adults and a significant indicator of risk
for non-communicable diseases particularly heart disease and stroke.

In the effort to promote and protect the health of the DOH personnel, the National Center for Disease Prevention
and Control, Degenerative Disease Office in partnership with the National Center for Health promotion will repeat
the conduct of Belly Gud for Health (BG for Health) 2012 as an advocacy strategy for healthy lifestyle this 2013.
This time , it will challenge the executives namely Secretary, Undersecretaries, Assistant Secretaries and Directors
and employees of the Department of Health Central Office with high waist circumference (HCW), to be fit by
attaining and maintaining a desirable waist circumference (DWC) of <80 cms for females and <90cms for males.

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 roadmap to achieve the vision.

Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical and fundamental
element in children's welfare. However, health programs cannot be implemented in isolation from the other
component that determine the safety and well being of children in society. Children's Health 2025, therefore, should
be able to integrate the strategies and interventions into the overall plan for children's development.

Children's Health 2025 contains both 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:

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

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 needed.Offered equal access to good quality curative, preventive and promotive health care services
and health education as members of the Filipino society
Regularly monitored for proper growth and development, and provided with adequate psychosocial
and mental 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 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).

The Philippines has been declared as polio-free 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

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.

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 Pockets of low immunization coverage is attributed largely to the irregular supply of vaccines due to
inadequate funds. Moreover, there is a need to revitalize the promotion of immunization.

Goal

The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025.

Medium-term Objectives for year 2001-2004

Health Status Objectives

1. Reduce infant mortality rate to 17 deaths per 1,000 live births

2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 livebirths
3. Reduce the mortality rate among adolescents and youths by 50%

Risk Reduction Objectives

1. Increse the percentage of fully immunized children to 90%

2. Increase the percentage of infants exclusively breastfed up to six months to 30%
3. Increase the percentage of infants given timely and proper complementary feeding at six months to 70%
4. Increase the percentage of mothers and caregivers who know and practice home management of childhood
illness to 80%
5. Reduce the prevalence of protein-energy malnutrition among school-age children
6. Increase the health care-seeking behavior of adolescents to 50%

Services and Protection Objectives

1. Ensure 90% of infants and children are provided with essential health care package
2. Increase the percentage of health facilities with available stocks of vaccines and esential drugs and
micronutrients to 80%
3. Increase the percentage of schools implementing school-based health and nutrition programs to 80%
4. Increase the percentage of health facilities providing basic health services including counseling for
adolescents and youth to 70%

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 support systems and interventions for children's health

Notable community-based projects and interventions, such as the health and nutrition posts, mother support groups,
community financing schemes shall be replicated for nationwide implementation. Model building and
dissemination of best practices from pilot sites has proven effective in generating support and adoption in other
sites. More of these shall be initiated particularly for developing interventions to increase care-seeking and
prevention of malnutrition in children.

* Fostering linkages with advocacy groups and professional organizations and to promote children's health

Collaboration with the nongovernment sector and professional groups shall:

11
 * Conduct national campaigns on children's health

* Conduct and support national campaigns for children

* Initiate and support legislations and researches on children's health and welfare

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

CHD SCORECARD

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

COMMITTEE OF EXAMINERS FOR UNDERTAKERS AND EMBALMERS

Rationale

Embalming is the funeral custom of cleaning and disinfecting bodies after death. It has been part of the funeral
parlors so with our lives. For the past decades, embalming has been undergoing profound transformational events,
not only in the Philippines but worldwide. Today, embalming is also considered an art. It is done to preserve the
dead body from natural decomposition and for restoration for a more pleasing appearance. Likewise, the procedure
is significant for restoration of evidences such as in medico-legal cases.

These changes were made possible by the multitudes of forces converging in the national as well as the local levels,
which is impacting on the quality of embalming practice in the country. Embalmers today should therefore, be
looked up to, because of the significant manifold tasks they are rendering including the counseling assistance they
are providing the bereaved parties.

Objective:

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

Strategies:

To ensure that only qualified individuals enter the regulated profession and that the care and services which the
embalmers provide are within the standards of practice, the DOH-CEUE created:

1. CEUE Resolution No. 2011-001 - Three Year Transition Period for Compliance of Administrative Order No.
2010-0033.

2. Memorandum dated August 10, 2010 - to the Centers for Health Development (CHDs) Human Resource
Development Units (HRDUs) regarding Updates on the Committee of Examiners for Undertakers and Embalmers
(CEUE) Program.

3. Administrative Order No. 2010-0033 - Revised Implementing Rules and Regulations of PD 856 Chapter XXI
Governing Disposal of Dead Persons

4. CEUE Resolution No. 2010-001 - Adoption of the Code of Ethics for Embalmers in the Philippines

5. CEUE Resolution No. 2009-001 - Creation of the Committee for Continuing Embalmers Education Council
(CEEC)

12
 6. CEUE Resolution No. 2008-001 - Conduct of Licensure Examination for Embalmers in Centers for Health
Development (CHDs) to conduct a simultaneous licensure examination in the Central Office and the CHDs with a
minimum of 50 examinees for cost effectiveness.

7. Department Memorandum No. 2008-0009 - Designation of DOH Human Resource Development Units (DOH-
HRDUs) as Coordinators for Embalmers Program" to facilitate immediate response to queries and complaints
regarding the embalming practice.

8. CEUE Resolution No. 2008-001 - Accredited Training Institutions and Training Providers for Embalmers for CY
2008-2011 to regulate existing and potential training providers and training institutions for embalmers for the
enhancement and maintenance of its professional standards.

9. CEUE Resolution No. 2008-002 - Extension of Moratorium as per CEUE Resolution No. 2007-001.

10. CEUE Resolution No. 2007-001 - Moratorium on the Non-renewal of Licenses of Embalmers for the past five
(5) years and over with the aim of providing chance to licensed embalmers who were unable tio renew their
licenses for the past five years and over.

11. Administrative Order No. 2007-0020 - Policies and Guidelines for the Accreditation of Training Institutions,
Training Programs and Training Providers for Embalmers in the Philippines with the aim of institutionalizing the
continuing education program for embalmers in the country. Hence, to ensure the maintenance of efficient, ethical
and technical, moral and professional standards in its practice, taking into account the quality of care to be rendered
to respective clientele. At the same time, the regulation ensures the global competitiveness of the Filipino
embalmers.

12. Department Circular No. 2007-0139 - Reiteration on the observance of precautionary measures in the disposal
of dead persons.

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

Program Status

Nationwide information dissemination of the following:

Administrative Order No. 2010 - 0033 (Disposal of Dead Persons)

Curriculum for licensure examinations
Manuals for Licensure Examinations
Code of Ethics
1. March 25, 2011 - National Capital Region
2. May 3, 2011 - Visayas Region (Iloilo City)
3. May 13, 2011 - Mindanao Regions (Cagayan de Oro City)
4. June 30, 2011 - Butuan City (upon request)
5. August 25, 2011 - Aklan (upon request)
COMMITTEE OF EXAMINERS FOR MASSAGE THERAPY (CEMT)

Rationale

Traditional medicine throughout the world recognizes the significance of therapeutic massage in managing stress,
illness or chronic ailments. Massage therapy is considered the oldest method of healing that applies various
techniques like fixed or movable pressure, holding, vibration, rocking, friction, kneading and compression using
primarily the hands and other areas of the body such as the forearms, elbows or feet to the mascular structure and
soft tissues of the body.

Massage therapy can lead to significant biochemical, physical, behavioral and clinical changes in massage as well
as the person giving the massage. It contributes to a higher sense of general well-being. Recognizing this, many
healthcare professionals have begun to incorporate massage therapy as a complement to their routine clinical care.
Efficacy of massage therapy in patient ranges from pretern neonates to senior citizens. Although the country has the

13
 training standards and regulations through the Technical Education and Skills Development Authority (TESDA), it
lacks control / regulations over the training institutions, thus, anyone who calls himself/herself a massage therapist
is one, regardless of training or experience.

Objective:

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

Strategies:

To ensure that only qualified individuals enter the regulated profession and that the care and services which the
massage therapists provide are within the standards of practice, the DOH-CEMT created:

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

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

Program Status

Nationwide information dissemination of the following:

Administrative Order No. 2010-0034 (Massage Clinics and Sauna Establishments)

Curriculum for Licensure Examinations
Manuals for Licensure Examinations
Code of Ethics

14
 1. March 25, 2011 - National Capital Region

2. May 3, 2011 - Visayas Regions (Iloilo City)

3. May 13, 2011 - Mindanao Region (Cagayan de Oro City)

4. June 30, 2011 - Butuan City (upon request)

5. August 25, 2011 - Aklan (upon request)

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 pag-aaral, ang dalawang sanhi ng climate change ay ang:

1. Natural na pagbabago ng klima ng buong mundo nitong mga nagdaang matagal na panahon. Ito ay sama-
samang epekto ng enerhiya mula sa araw, sa pag-ikot ng mundo, at sa init na nagmumula sa ilalim ng lupa na
nagpapataas ng temperatura o init sa hangin na bumabalot sa mundo.

2. Mga gawain ng tao na nagbubunga ng pagdami o pagtaas ng carbon dioxide at iba pang greenhouse gases )
GHGs). ANg GHGs ang nagkukulong ng init 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.

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

CARDIOVASCULAR DISEASE

Contact Person:

Franklin C. Diza, MD, MPH

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

15
 POLICY STATEMENT

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

1. The country shall adopt an integrated, comprehensive and community based response for the prevention and
control of chronic, lifestyle related NCDs.

2. Health promotion strategies shall be intensified to effect changes that would lead to significant reduction in
mortality and morbidity due to chronic lifestyle related NCDs.

3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation
of an integrated, comprehensive and community based response to chronic lifestyle related NCDs.

OBJECTIVE

1. Decrease of morbidity and mortality

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

STRATEGIES IMPLEMENTED

Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt
high risk behaviours and habits that may lead to the development of cardiovascular disease

Will be implemented by setting:

Community-based

School-based

Industry-based

Hospital-based

Training, research, environmental support system are important components of the progress

STATUS OF IMPLEMENTATION / ACTION

Program is well in place and its implementation is continuous. Focus of implementation is in the community level
and other settings.

Development of Administrative Order on the National Policy on the integrated chronic non-communicable disease
registry system (cancer, stroke, DM and COPD).

1st public hearing on the Administrative Order on the National Policy on the integrated chronic non-
communicable disease registry system with CHD-NCR, government and private hospitals and non-government
agencies.

Trained hospitals for the registry system entitled Users training for the Unified Registry System.

Trained CHDs for the Registry system.

Establishment of Philippine Coalition on the prevention and control of NCD.

A training manual for health workers on promoting healthy lifestyle.

Healthy lifestyle advocacy campaign.

16
 Manual of operations on the prevention and control lifestyle related non-communicable diseases in the
Philippines.

Training manual for Health workers: WHO/ DOH smoking cessation clinic: Helping smokers quit.

FUTURE PLAN/ACTION

Implement the program through the institutionalized integrated program of NCD-lifestyle related diseases control
program.

Development of service package for cardiovascular diseases.

Development of clinical practice guideline for cardiovascular disease.

Development of strategic framework and five year strategic plan for cardiovascular disease (2012-2016).

MISSION

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

VISION

A nation of Filipinos with healthy lifestyle and habits, living and working in clean and safe environment and with
access to adequate medical care for CVD.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Contact Person:
Franklin c. Diza, MD, MPH

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

POLICY STATEMENT:

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

1. The country shall adopt an integrated, comprehensive and community based response for the prevention and
control of chronic, lifestyle related NCDs.

2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in
mortality and morbidity due to chronic lifestyle related NCDs.

3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the
implementation of an integrated, comprehensive and community base response to chronic lifestyle related NCDs.

OBJECTIVES

1. Decrease of morbidity and mortality

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

17
 STRATEGIES IMPLEMENTED BY THE DOH

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

Will be implemented by setting:

Community-based

School-based

Industry-based

Hospital-based

Training, research, environmental support system are important components of the progress

STATUS OF IMPLEMENTATION / ACTION

1. Development of Administrative Order on the National Policy on the integrated chronic non-communicable
disease registry system (cancer, stroke, DM and COPD).

2. 1st public hearing on the Administrative Order on the National Policy on the integrated chronic non-
communicable disease registry system with CHD-NCR, government and private hospitals and non-government
agencies.

3. Trained hospitals for the registry system entitled Users training for the Unified Registry System.

4. Trained CHDs for the Registry system.

5. Establishment of Philippine Coalition on the prevention and control of NCD.

6. A training manual for health workers on promoting healthy lifestyle.

7. Healthy lifestyle advocacy campaign.

8. Manual of operations on the prevention and control lifestyle related non-communicable diseases in the
Philippines.

9. Training manual for Health workers: WHO/ DOH smoking cessation clinic: Helping smokers quit.

FUTURE PLAN/ACTION

Implement the program through the institutionalized integrated program of NCD-lifestyle related diseases
control program.

Development of service package for cardiovascular diseases.

Development of clinical practice guideline for cardiovascular disease.

Development of strategic framework and five year strategic plan for cardiovascular disease (2012-2016).

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

VISION: Improved quality of life for all Filipinos.

DENGUE PREVENTION AND CONTROL PROGRAM

18
 The National Dengue Prevention and Control Program was first initiated by the Department of Health (DOH) in
1993. Region VII and the National Capital Region served as the pilot sites. It was not until 1998 when the program
was implemented nationwide. The target populations of the program are the general population, the local
government units, and the local health workers.

Vision: Dengue Risk-Free Philippines

Mission: To improve the quality of health of Filipinos by adopting an integrated dengue control approach
in the prevention and control of dengue infection.

Goal: Reduce morbidity and mortality from dengue infection by preventing the transmission of the
virus from the mosquito vector human.

Objectives:

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

Health Status Objectives:

Reduce incidence from 32 cases/100,000 population to 20 cases/100,000 population;

Reduce case fatality rate by <1%; and
Detect and contain all epidemics.

Risk Reduction Objectives:

Reduce the risk of human exposure to aedes bite by House index of <5 and Breteau index of 20;
Increase % of HH practicing removal of mosquito breeding places to 80%; and
Increase awareness on DF/DHF to 100%.

Services & Protection Objectives:

Establish a Dengue Reference Laboratory capable of performing IgM capture ELISA for Dengue
Surveillance;
Increase the % of 1 and 2 government hospitals with laboratory capable of platelet count and
hematocrit; and
Ensure surveillance and investigation of all epidemics.

Partner Organizations/Agencies:

The following organizations/agencies take part in the achievement of the programs objectives:

World Health Organization (WHO)

United Nations childrens 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)
DIABETES PREVENTION AND CONTROL PROGRAM

19
 Contact Person:
Rosemarie P. Holandes

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

GOAL

To reduce morbidity, mortality and disability rates due to chronic lifestyle related non-communicable
diseases through an integrated and comprehensive program on the prevention and control of lifestyle
related diseases.

OBJECTIVES

1. To develop and promote an integrated and comprehensive program on the prevention and control of
lifestyle related diseases in the country.

2. To engage all province-wide or city-wide health systems to adopt an integrated and comprehensive
program on the prevention and control of lifestyle related diseases.

3. To achieve improvement in the following key performance indicators from 2011-2016.

INTERVENTIONS / STRATEGIES IMPLEMENTED BY DOH

The action framework has seven (7) action areas as follows: (1) Environmental Interventions (2) Lifestyle
interventions (3) Clinical interventions (4) Advocacy (5) Research, surveillance, monitoring and
evaluation (6) Networking and coalition building (7) Health system strengthening

STATUS IMPLEMENTATION/ ACCOMPLISHMENT

Policy/standard/ Guidelines Development

Development of clinical practice guidelines on diabetes and other NCDs are on-going

Promotion and Advocacy

Conduct of healthy lifestyle to the MAX campaign- this advocacy focuses on clear health priorities such
as consumption of healthy diet, promoting physical activity, curbing the use of tobacco, alcohol and
illegal drugs, proper weight and stress management, early detection and control of hypertension.

Coalition Building

Also known as healthy lifestyle coalition, the DOH encourages the fast food establishments to offer
healthier food choices by reducing the fat, sugar and salt content as well as trans-fatty acids in the food
they serve.

Future Plan/ Action

Printing and dissemination of clinical practice guidelines on diabetes- Orientation/forum will be

conducted among NCD coordinators in CHDs and hospitals to discuss details of the CPG. Experts from
diabetes societies will be invited as speakers.

Continue conduct of promotion and advocacy activities and partnership with specialty societies and
other stakeholders on NCD prevention and control including diabetes.

Ensure implementation of diabetes registry

Together with National Center for Health Promotion and other experts on diabetes, develop various
information-education materials on the prevention and management o diabetes for dissemination to
various clients.

EMERGING AND RE-EMERGING INFECTIOUS DISEASE PROGRAM

20
 Emerging and re-emerging infections (e.g., SARS, meningococcemia, Avian Influenza or bird flu, A (H1N1)
virus infection) threaten countries all over the world.

In 2003, SARS affected at least 30 countries with most of the countries from Asia. In response to its sudden
and unexpected emergence, quarantine and isolation measures and rapid contract tracing were carried out. The
Philippines was able to minimize the impact of SARS through effective information dissemination, risk
communication, and efficient conduct of measures.

The unexpected and unusual increase in cases of meningococcal disease (meningococcemia as the
predominant form) in the Cordillera Autonomous Region resulted to at least 50% of cases in the early stage of
occurrence.

In 2009, the influenza A (H1N1) virus infection led to global epidemic, or most popularly known as
pandemic. On June 11, 2009, a full pandemic alert was declared by the World Health Organization (WHO).

However, some local health offices from many provinces were not able to respond effectively and rapidly.
With the lack of strong linkages and coordinating mechanisms, the Department of Health (DOH) hopes to further
improve the functionality and effectiveness of local response systems.

Efforts to prepare for emerging infections with potential for causing high morbidity and mortality are being
done by the program. Applicable prevention and control measures are being integrated while the existing systems
and organizational structures are further strengthened.

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

Objectives:

The program aims to:

1. Reduce public health impact of emerging and re-emerging infectious diseases; and

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

Program Strategies:

The DOH, in collaboration with its partner organizations/agencies, employs the key strategies:

1. Development of systems, policies, standards, and guidelines for preparedness and response to emerging diseases;

2. Technical Assistance or Technical Collaboration;

3. Advocacy/Information dissemination;

4. Intersectoral collaborations;

5. Capability building for management, prevention and control of emerging and re-emerging diseases that may pose
epidemic/pandemic threat; and

6. Logistical support for drugs and vaccines for meningococcemia and anti-viral drugs and vaccine for Pandemic
Influenza Preparedness.

21
 Partner Organizations/Agencies:

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

World Health Organization (WHO)

United Nations Childrens 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 non-biological agents of disease and injury. It is concerned
primarily with effects of the environment to the health of the people.

Program strategies and activities are focused on environmental sanitation, environmental health impact assessment
and occupational health through inter-agency collaboration. An Inter-Agency COmmittee on Environmental Health
was created by 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

22
 IACEH Task Force on Water
IACEH Task Force on Solid Waste
IACEH Task Force on Toxic Chemicals
IACEH Task Force on Occupational Health Environmental Sanitation Environmental Health Impact
Assessment Occupational Health

EXPANDED PROGRAM ON IMMUNIZATION

I. Rationale

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers
have access to routinely recommended infant/childhood vaccines. Six vaccine-preventable diseases were initially
included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. In 1986, 21.3% fully
immunized children less than fourteen months of age based on the EPI Comprehensive Program review.

II. Scenario

Global Situation

The burden

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

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

Burden of Diseases

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

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 vaccine-preventable diseases.

23
 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. 10152MandatoryInfants and Children Health Immunization Act of 2011Signed by President
Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5
including other types that will be determined by the Secretary of Health.

Strategies:

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

Barangay (REB) strategy

REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in 2004
aimed to improve the access to routine immunization and reduce drop-outs. There are 5 components of the
strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between the community
and service, supportive supervision and maximizing resources.

Supplemental Immunization Activity (SIA)

Supplementary immunization activities are used to reach children who have not been vaccinated or have not
developed sufficient immunity after previous vaccinations. It can be conducted either national or sub-national in
selected areas.

Strengthening Vaccine-Preventable Diseases Surveillance

This is critical for the eradication/elimination efforts, especially in identifying true cases of measles and indigenous
wild polio virus

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

IV. Status of implementation/ Accomplishment

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

24
 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.

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

There is an on-going polio mass immunization to all children ages 6 weeks up to 59 months old in
the 10 highest risk areas for neonatal tetanus. These areas are the following: Abra, Banguet, Isabela
City and Basilan, Lanao Norte, Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.

Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to 1.38 in 2011.
Only regions III, V and VIII have achieved the AFP rate of 2/100,000 children below 15 years old.
(Source: NEC, DOH). A decreasing AFP rate means we may not be able to find true cases of polio and
may experience resurgence of polio cases

Measles Elimination

Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.
Implemented the 2-dose measles-containing vaccine (MCV) in 2009

MCV1 (monovalent measles) at 9-11 months old

MCV2 (MMR) at 12-15 months old.

Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood
samples are withdrawn from all measles suspect to confirm the case as measles infection.
A supplemental immunization campaign for measles and rubella (German measles) was done in
2011. This was dubbed as Iligtas sa Tigdas ang Pinas 15.6 million (84%) out of the 18.5 million
children ages 9 months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between
April and June 2011.
Rapid coverage assessment (RCA) 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

25
 least 60 true measles at present. Measles is said to be eliminated if we have 1 case per million or
below 100 cases in a year

Maternal and Neonatal Tetanus Elimination

10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the areas
categorized as low risk, at risk and highest risk based on the NT surveillance, skilled birth attendants
and facility based delivery and the tetanus toxoid 2+ (TT 2+) vaccination.

Figure 3: Level of Risk for NT, Philippines

Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk areas. An estimated
1,010,751 women age 15 - 40 year old women regardless of their TT immunization will receive the
vaccine during these rounds. This is funded by the Kiwanis International through UNICEF and World
Health Organization.

Control of other common vaccine-preventable diseases (Diphtheria, Pertussis, Hepatitis B and

Meningitis/Encephalitis secondary to H. influenzae type B)

Continuous vaccination for infants and children with the DPT or the combination DPT-HepB-HiB Type B. Annex1
EPI Annual Accomplishment Report. DOH procures all the vaccines and needles and syringes for the immunization
activities targeted to infants/children/mothers.

Hepatitis B Control

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

Figure 4 Hepatitis B Coverage. Philippines, 2001-2011

Timing of administration/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

26
 Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions since 2003.
An effective vaccine management assessment was conducted last December 2011 and revealed cold
chain capacity gaps from the national up to the implementers level.
A total of PhP 267 million is required to address the gaps identified during the assessment.

Introduction to New Vaccines

For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization
program. Immunization will be prioritized among the infants of families listed in the National Housing
and Targeting System (NHTS) for Poverty Reduction nationwide.
The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2
vaccines.

V. Future Plan/ Action

Strengthening the Cold Chain to support the Immunization Program

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

VI. Other Significant information worth mentioning

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

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

27
 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 affiliate
nursing societies

g. Midwives of the Integrated Midwives of the Philippines (IMAP), Philippine League of Government and Private
Midwives, Inc. (PLGPMI), Midwives Foundation of the Philippines (MFP) and Well Family Midwives Clinic

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

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

a. Association of Philippine Medical Colleges (APMC)

b. Association of Deans of Philippine Colleges of Nursing (ADPCN)

c. Association of Philippine Schools of Midwifery

5. Hospital, health care administrator and infection control associations

a. Philippine Hospital Association (PHA)

b. Private Hospitals Association of the Philippines (PHAP)

c. Philippine College of Hospital Administrators

d. Philippine Hospital Infection Control Society

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

Beneficiaries:

a. Newborns all over the country

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 b. Parents

c. communities

Program Strategies:

1. Health Sector Reform

a. Policy and Guideline Issuance

i) Administrative Order 2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care - December 1,
2009

ii) Clinical Pocket Guide on Essential Newborn Care

b. Aquino Health Agenda and Achieving Universal Health Care - Administrative Order 2010-0036

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

d. Development of Operationalization of Essential Newborn Care Protocol in Health Facilities

2 Identification of Centers of Excellence

- Adoption of essential newborn care protocol(including intrapartum care and the MNCHN Strategy)

3. Curriculum Reforms

- Curriculum integration of essential newborn care (including intrapartum care and the MNCHN Strategy) in
undergraduate health courses

- Integration and revision of board exam questions in licensure examinations for physicians, nurses and midives

4. Social Marketing

- Development of social marketing tools - Unang Yakap MDG 4 & 5

Major Activities and its Guidelines:

a. Conduct of one-day orientation-workshop on essential newborn care (including intrapartum care and the
MNCHN Strategy)
b. Regional MNCHN Conference for CHDs and LGUs including DOH-retained hospitals and LGU hospitals

Current Status of the Program

A. What have been achieved/done

1. Policy was issued in December 1, 2009

2. DOH/WHO Scale-up Implementation was done in 11 hospitals

3. Advocacy Partners Forum on essential newborn care (including intrapartum care and the MNCHN Strategy)

29
 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.

FAMILY PLANNING

Brief Description of Program

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

The program is anchored on the following basic principles.

Responsible Parenthood which means that each family has the right and duty to determine the
desired number of children they might have and when they might have them. And beyond responsible
parenthood is Responsible Parenting which is the proper 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:

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 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

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 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 Community-Based 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 support operations of the itenerant teams inclduing the drugs and medical
supplies needed for voluntary surgical sterilization (VS) services

Partnership with LGU hospitals which serve as the VS site

II. Family Planning for the urban and rural poor

Expanded role of Volunteer Health Workers (VHWs) in FP provision

Partnership of itenerant team and LGU hospitals

Provision of FP services

III. Demand Generation through Community-Based Management Information System

Identification and masterlisting of potential FP clients and users in need of PF services (permanent
or temporary methods)

Segmentation of potential clients and users as to what method is preferred or used by clients

IV. Mainstreaming Natural Family Planning in the public and NGO health facilities

Orientation of CHD staff and creation of Regional NFP Management Committee

Diacon with stakeholders

Information, Education and counseling activities

Advocacy and social mobilization efforts

32
 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 support such as FP commodities and VS drugs and medical supplies

Other Partners

1. Funding Agencies

United States Agency for International Development (USAID)

United Nations Funds for Population Activities (UNFPA)

Management Sciences for Health (MSH)

Engender Health

The Futures Group

2. NGOs

Reachout foundation

DKT

Philippine Federation for Natual Family Planning (PFNFP)

John Snow Inc. - Well Family Clinic

Phlippine Legislators Committee on Population Development (PLPCD)

Remedios Foundation

Family Planning Organization of the Philippines (FPOP)

33
 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

DESCRIPTION

FWBDs refer to the limited group of illnesses characterized by diarrhea, nausea, vomiting with or without fever,
abdominal pain, headache and/or body malaise. These are spread or acquired through the ingestion of food or water
contaminated by disease-causing microorganisms (bacterial or its toxins, parasitic, viral).

VISION

Zero Mortality from FWBDs

MISSION

To reduce morbidity and mortality due to FWBDs

OBJECTIVES

To guarantee universal access to quality FWBD-PCP intervention and services at all stages of the
life
To guarantee financial risk protection of clients availing diagnosis, management and treatment for
FWBDs
To guarantee a responsive service delivery network for the prevention and control of FWBDs

PROGRAM COMPONENTS

A. Policy, Plans and Organizational Support. This component ensures that supportive policies, directional
and annual plans are developed and updated to govern the design and implementation of the FWBD-PCP.
It shall ensure that organizational support to the FWBD-PCP is in place at various levels of operations.
This includes establishment of partnership between DOH and LGUs and with other partners in the other
sectors.
B. Diagnosis, Management and Treatment. This component ascertains the proper diagnosis as well as
prompt management and treatment of patients suffering from FWBDs. Focus will be given to the
development of clinical practice guidelines (CPGs) on FWBD diagnosis, management and treatment.
Diagnosis will encompass strengthening the laboratory services and the use of rapid diagnostic test
(RDTs). In the management and treatment, support for the establishment and sustained operations of ORT
corners in the hospitals and even in outpatient health facilities will be provided. Training of health
providers will be undertaken on the CPGs and overall FWBD-PCP management.
C. Quality Assurance System. This component ensures the quality of diagnostic services of FWBD cases.
This requires regular test, validation and follow-up of laboratory capacities and competencies of medical
technologists as well as provision of the necessary laboratory supplies and equipment.
D. Logistic Management. This component guarantees that essential drugs/medicines, supplies and
equipment are in place and available at the point of service. While the LGUs are mainly responsible for

34
 placing-in these commodities and other logistics at their level, the DOH shall design a system for
forecasting the needs nationwide and design a procurement, allocation and distribution system to ensure
these reach the facilities with proper tracking and monitoring of their utilization.
E. Capability Building. This component secures the quality of services by training the service providers on
the standards and protocols on the diagnosis, management and treatment of FWBDs. It shall also develop
the managerial and supervisory capability of FWBD-PCP managers/coordinators at various levels of
administration to ensure the efficient and effective implementation of the Program.
F. Health Promotion and Advocacy. This component ensures the prevention of FWBDs which hinges on
the promotion of proper practices on water, sanitation and personal hygiene. It takes off from the
development of an overall Health Promotion and Communication Plan aimed at effecting behavior change
among community members and garnering support from key stakeholders through advocacy. It also
encompasses collaboration with the Environmental Health and Sanitation Unit on the installation of safe
water and sanitation facilities.
G. Monitoring and Evaluation, Research, Surveillance and Response. Under this component, necessary
system and tools will be developed to ensure that quality and timely data are generated as basis for
decision-making, prioritization of resources and appropriate and immediate response to any outbreak. A
FWBD Surveillance System that will provide a comprehensive epidemiologic information, on current
situation on FWBD, in an area will be strengthened. Regular monitoring of the status of FWBD-PCP
implementation will be carried out including special researches or studies as needed.
H. Outbreak Response/Disaster Management. This component ensures that any outbreak due to FWBD in
any area is properly monitored and immediately responded to especially during disaster or emergency
situations where the affected population became most prone to these infections as in evacuation centers or
flooded areas.

TARGET POPULATION/ CLIENT

FWBD by Sex

Based on EBs data in 2016, there were slightly more males generally experiencing FWBDs (cholera, typhoid,
Hepa A, rotavirus and paralytic shellfish poisoning) than females. However, for acute bloody diarrhea, there were
more females than males reported experiencing the disease in the same year.

FWBDs by Age Group

Majority of the reported acute bloody diarrhea in 2016 were among the 1-4 year old children. Rotavirus as
characterized occurs mainly among the same age group and those below 1 year old. As for Hepa A, mostly affected
are the 15 to 39 year olds and also notable among the younger age group (5-14 years old). As for typhoid, cholera
and paralytic shellfish poisoning, highest number of cases reported was among the 5-14 years old.

FWBDs by Geographical Areas

The Visayas Region particularly Regions 7 and 8 came out as hosts of the highest incidence of FWBDs in the
country. Incidence of acute bloody diarrhea is highest in Region 7 and also the host of the highest number of
reported Hepa A and Typhoid cases in 2016. Region 8 on the other hand had the highest incidence of cholera and
paralytic shellfish poisoning. Region 1 came out highest in the incidence of rotavirus in the same year.

AREA OF COVERAGE

FWBDs are usually manifested as diarrhea. Based on the 2015 Global Health Observatory (GHO) data, diarrhea
accounts for 9% of the total deaths among children below 5 years old. In the Philippines, a total of 11,876 cases of
acute bloody diarrhea (ABD) were reported from sentinel sites nationwide in the same year. In addition, 830
Hepatitis A cases and 74 cases of paralytic shellfish poisoning were also reported. The Philippine Health Statistics
data showed that diarrhea placed 5th as a leading cause of morbidity among general population in 2010 from being
the top or second leading cause in the 1990s. Morbidity rate due to diarrhea has gone down from 1,520/100,000
population in 1990 to 347.3/100,000 population in 2010. Despite this decline however, several notable outbreaks
continue to occur. It is believed that since the occurrence of FWBDs is essentially related to economic and socio-
cultural factors.

PARTNER INSTITUTIONS

The management and implementation of the FWBD-PCP are shared responsibility among the following offices:

A. Department of Health Central Office

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 1. Infectious Disease Office (IDO) - Disease Prevention and Control Bureau (DPCPB)

The overall management and coordination of the FWBD-PCP is lodged in the IDO-DPCB. It takes the lead in
setting the overall direction and focus of the Program.

Formulate and disseminate national policies, standards and guidelines governing the
management and implementation of the FWBD-PCP
Develop strategic plans and cascade this to the regional offices for adoption
Ensure the provision/delivery of quality diagnosis, management and treatment services of
FWBDs
Design and undertake training program on various components of the program
Manage the logistics requirements of the Program
Secure financing for the FWBD-PCP
Establish partnership with other national government agencies and other partners in the
private sector
Undertake monitoring and evaluation of the status and performance of the FWBD-PCP
Coordinate with HPCS and other entities in promoting WASH practices and key messages
on prevention and control of FWBDs
Monitor together with EB any outbreak due to FWBD and coordinate with HEMB for the
immediate response

2. Environmental Health and Sanitation

Provide technical assistance to the regions and LGUs to comply with the provisions and
requirements of the Sanitation Code in the Philippines;
Formulate policies, guidelines and standards in promoting increased access to safe water and
sanitation services
Design strategic approaches to achieve zero open defecation areas nationwide
Develop and promote guidelines on healthy wash, sanitation and hygiene practices among
food handlers, and other concerned institutions
Coordinate with the Department of Environment and Natural Resources (DENR) for
interventions that will support the prevention and control of FWBDs

3. Epidemiology Bureau (EB)

Establish, operate and sustain FWBD surveillance nationwide

Support LGUs in case investigation of reported FWBD cases and in providing immediate
and proper response
Inform/communicate with the DOH-IDO and other offices concerned of any impending or
notable FWBD outbreaks
Generate timely FWBD surveillance reports and disseminate to concerned DOH offices
Coordinate with RITM in taking the lead to develop a work and financial plan and/or
proposal funding for the surveillance.
Provide assistance to RESUs and LESUs if needed in the investigation of cases of food and
waterborne illness.
Notify the WHO through the National IRR (International Health Regulations) Focal Point
when the assessment indicates a food or waterborne disease event is notifiable pursuant to
paragraph 1 of Article 6 and Annex 2 and to inform WHO as required pursuant to Article 7
and paragraph 2 of Article 9 of IHR (Annex 3.8A).

4. Health Emergency Management Bureau (HEMB)

Provide technical assistance in developing plans in times of emergencies and disasters.

Mobilize WASH resources through Regional DRRM-H Manager to ensure adequate and safe
water through water quality surveillance, disinfection / treatment in coordination with
DPCB-EOH.
Augment logistic support to FWBD during emergencies and disaster situations.

5. Health Promotion and Communication Services (HPCS)

36
 Formulate and design a communication plan to address the poor health seeking behavior of
the community and their unhealthy food and water practices including personal hygiene
Develop key IEC messages for various groups of audiences relative to the prevention and
control of FWBDs
Design appropriate media channels and materials to communicate the key FWBD prevention
and control messages
Track improvement in the awareness, attitudes and practices of the targeted population on
FWBD prevention and control

6. Research Institute for Tropical Medicine (RITM) and National Reference Laboratories (Parasitology,
Bacterial Enterics and Viral Enterics)

Perform laboratory testing for samples referred for the FWBD surveillance and outbreak
investigation
Provides technical support for specimen collection, transport and storage for the referring
hospitals
Provides laboratory technical support, training and quality assurance to the subnational,
regional and other laboratories
Provides linelist of laboratory results to EB and RESU, and individual laboratory results to
the RESU, in the form of transmittals (for distribution to the DRUs)
Refer a subset of samples to the designated Regional Reference Laboratory (RRL) for
quality assurance purpose
Performs further studies to determine other etiologies of FWBD
Maintain continuous coordination/communication with stakeholders to promote information
exchange
Train laboratory personnel in the diagnosis of FWB pathogens
Provide external quality assurance program for laboratory diagnosis for FWB pathogens
Evaluate test kits and reagents in coordination with FDA
Develop and offer confirmatory assays for other FWB pathogens
Conduct research relevant to FWB program
Provide recommendation to LRD office as to the need for activation of Outbreak Codes to
mount multidepartment, division-level response as appropriate
Conduct laboratory surveillance for the FWB pathogens

7. Food and Drug Administration (FDA)

Perform microbiologic tests on food samples submitted to the laboratory

Provide EB with a monthly report of etiologic agents of food and waterborne diseases on
food samples tested
Monitor the safety of pre-packaged food in the market and issue Public Advisory / Warning
to prevent consumption of contaminated food
Undertake surveillance of microbiologic agents of food and waterborne diseases which are
transmissible to humans Alert the DOH offices in cases of unusual increases in the number
of reported organisms known to cause food and waterborne disease in humans. (To be
deleted) (Transfer to DA)

B. DOH Regional Offices

1. Infectious Disease Prevention and Control Cluster

Disseminate national policies, standards and guidelines governing the management and
implementation of the FWBD-PCP
Develop local plans and cascade to LGUs
Undertake training related to FWBD-PCP to local government unit
Provide logistic support on FWBD-PCP to LGU
Monitor and evaluate the implementation of the program to LGU
Coordinate with the regional environmental and Occupational Health on the implementation
of the FWBD-PCP
Assist RESU in monitoring incidence of FWBDs
Coordinate with other partners in the region for the management of the FWBD-PCP
2. Regional Epidemiology and Surveillance Unit (RESU)

37
 Encode data on patients with laboratory confirmed Salmonella and other food and
waterborne infections
Analyze surveillance data and activate EICT outbreak investigation when deemed necessary
Provide technical assistance during trainings on laboratory-based surveillance to be
conducted among hospital staff or sentinel sites
Fill up laboratory request forms and submit appropriately-labeled stool specimens from
patients and samples of suspected food/water vehicles to the appropriate DOH or DA
laboratory for microbiologic tests
Encode and collate epidemiologic data from LGUs (Provincial/City Epidemiology
Surveillance Unit, P/CESU), and hospital sentinel sites on the occurrence of Salmonella and
other food and waterborne disease and submit to EB
Submit monthly report to EB on notifiable diseases. (StratPlan PIDSR Report)
Notify EB through the National IRR (International Health Regulations) Focal Point when
the assessment indicates a food or waterborne disease event is notifiable pursuant to
paragraph 1 of Article 6 and Annex 2 and to inform WHO as required pursuant to Article 7
and paragraph 2 of Article 9 of IHR (Annex 3.8A)
3. Environmental and Occupational Health Unit
Provide technical assistance to LGUs to increase HHs with access to safe water and with
sanitary toilet, and achievement of zero defecation area
Implement the preventive measures of FWBD
Assist in the investigation of FWBD Outbreaks
Support campaign of prevention and control of FWBD
4. Provincial DOH Office
Advocate for LCEs support to FWBD-PCP
Lobby to LGUs for funds/budget for FWBD-PCP through inclusion in the annual budget
Ensure adaption of DOH policy by LGU through ordinances
Monitor implementation of FWBD
Provide logistic / fund to EOH for FWBD prevention campaign.

C. Other Government Agencies

1. Department of Interior and Local Government (DILG)

Support the DOH and DA in the collection and documentation of food-borne illness data,
monitoring and research
Participate in training programs, standards development and other food safety activities to be
undertaken by the DA, DOH and other concerned national agencies
2. Department of Education
Integrate messages on proper water, food and sanitary practices including personal hygiene
in the school curriculum
Support and expand the implementation of WINS in public schools
Integrate hand-washing practices during school feeding programs
3. Department of Agriculture
Develop and transfer technologies that will improve and sustain the development of the
livestock industry which ensure food security and competitiveness of the local produce in
the global market
Plan, coordinate and implement research and development programs on swine, beef cattle,
poultry, small ruminants and equine on areas of genetics and breeding system, animal
nutrition and feed resources utilization, herd management, animal health and disease control,
containment and eradication of diseases, post-production, value-added meat products and
by-products technology and animal waste management
Submit report of all investigations involving foodborne disease
Alert the Department of Health agencies in cases of unusual increase in the number of
reported organisms known to cause foodborne disease in humans (DA, BAI)
4. Department of Social Welfare and Development
Proper water, food and sanitary practices including personal hygiene of DSWD residential
centers, canteen, caterers
Support and expand implementation of hand-washing practices during feeding programs
Ensure that DSWD residential centers, canteen, caterers, and DSWD-food for work and
feeding programs use and serve fortified foods with Sangkap Pinoy Seal, if available
Use and serve fortified foods such as rice, wheat, flour, oil and refined sugar in DSWD relief
operations and encourage LGUs and NGOs to follow the same

38
 Authorize food manufacturers to use the DOH seal of acceptance as guide for consumers in
selecting nutritious foods (DSWD)
5. Department of Environment and Natural Resources
Control the construction and maintenance of waterworks, sewerage, and sanitation systems
and other public utilities
Prohibiting dumping of waste products detrimental to the plants and animals or inhabitants
therein
Prohibiting of leaving an exposed or unsanitary conditions refuse or debris or depositing in
ground or in bodies of water
Raise awareness on the importance of maintaining reliable and effective treatment of
wastewater
Endeavor to achieve social justice by ensuring the integrity of our ecosystems on which
local communities depend for food and livelihood
Strive to recycle wastewater to benefit communities and not to allow untreated wastewater
that will harm people (DENR)

D. Local Government Units (LGUs)

The LGUs are primarily responsible in the delivery of quality FWBD diagnosis, management and treatment and
conduct of preventive and control interventions at the local level. Specifically, the LGUs are expected to:

o Enforce the implementation of the Code of Sanitation of the Philippines (PD No. 856,
December 23, 1975): (i) sanitation particularly in public markets, slaughterhouses, micro
and small food processing establishments and public eating places, (ii) codes of practice for
production, post-harvest handling, processing and hygiene, (iii) safe use of food additives,
processing aids and sanitation chemicals and (iv) proper labeling of prepackaged foods
o Ensure access of households to safe drinking water, safe water and sanitation facilities
o Inspect food establishments on adherence to standards sanitation practices
o Provide training to food handlers and regulate
o Ensure proper waste disposal
o Establish, operate and sustain local epidemiology and surveillance units with the following
tasks:
o Register cases of laboratory confirmed Salmonella and other food and
waterborne infections identified from the local government unit (LGU) in the
surveillance.
o Fill up laboratory request forms and submits appropriately labeled specimens
from patients and samples of suspected food/water vehicles to the appropriate
DOH or DA laboratory for microbiological tests
o Provide technical support for training on laboratory-based surveillance to
hospital staff of sentinel sites
o Encode and collate epidemiologic data on the occurrence of Salmonella and
other food and waterborne infections to the EB
o Submit monthly reports of food and waterborne diseases to RESU
o Notify RESU when the assessment indicates a food and waterborne disease
event is notifiable pursuant to paragraph 1 of Article 6 and Annex 2 of IHR and
to inform WHO as required pursuant to Article 7 and paragraph 2 of Article 9 of
IHR (Annex 3.8A)

E. Hospitals

Attend to cases of diarrhea (no signs, some signs, severe signs of dehydration)
Request for basic laboratory workups in case of complications
Carry out further investigation as deemed necessary
Refer cases appropriately to specialties/sub-specialties when needed
Observe proper hydration and monitoring of hemodynamic status Encourage oral rehydrating
solution as soon as patient can tolerate
Give appropriate anti-microbial if indicated
Provide health education including handwashing, sanitation, hygiene will be provided
Give IEC materials to patient/s prior to discharge

F. Laboratories

39
 1. Subnational Laboratories

Perform laboratory testing of samples from FWBD cases referred by the disease reporting units, as
well as from cluster/outbreak investigations. (we should refer this to our 'algorithm')
Participate in monitoring and evaluation visits by the DOH FWBD Monitoring team
Participate in the laboratory quality assurance program
Provide laboratory results to the National Reference Laboratories and RESU
Coordinate with the National Reference Laboratories for technical concerns (specimen collection,
transport, storage, testing and troubleshooting)

2. Regional Laboratories

Perform direct fecal smear, modified acid fast staining, formalin ether concentration technique,
kato-katz and RDT for detection of FWB parasites

3. Tertiary Hospitals

Perform direct fecal smear, modified acid fast staining, formalin ether concentration technique,
kato-katz and RDT for detection of FWB parasites

4. Level 3 Laboratories

Perform direct fecal smear, modified acid fast staining, formalin ether concentration technique,
kato-katz and RDT for detection of FWB parasites

5. Level 2 Laboratories

Perform direct fecal smear, kato-katz and modified acid fast staining for detection of FWB parasites

6. Level 1 Laboratories

Perform direct fecal smear and kato-katz for detection of FWB parasites

7. Rural Health Units

Perform direct fecal smear and kato-katz for detection of FWB parasites
FAMILY PLANNING

Population/Family Planning Issue

Senate Bill No. 1546: "Reproductive Health Act of 2004"

House Bill No. 16: "Reproductive Health Act of 2004"

The Truth About the P50M CFC Contract with DOH

CFC-DOH Partnership

Letter to the Editor: Philippine Daily Inquirer

FAMILY PLANNING

Brief Description of Program

A national mandated priority public health program to attain the country's national health development: a health
intervention program and an important tool for the improvement of the health and welfare of mothers, children and

40
 other members of the family. It also provides information and services for the couples of reproductive age to plan
their family according to their beliefs and circumstances through legally and medically acceptable family planning
methods.

The program is anchored on the following basic principles.

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

INFANT AND YOUNG CHILD FEEDING (IYCF)

I. Profile/Rationale of the Health Program

A global strategy for Infant and Young Child Feeding (IYCF) was issued jointly by the World Health Organization
(WHO) and the United Nations Childrens Fund (UNICEF) in 2002, to reverse the disturbing trends in infant and
young child feeding practices. This global strategy was endorsed by the 55th World Health Assembly in May 2002
and by the UNICEF Executive Board in September 2002 respectively.

In 2004, infant and young child feeding practices were assessed using the WHO assessment protocol and rated poor
to fair. Findings showed four out of ten newborns were initiated to breastfeeding within an hour after birth, three
out of ten infants less than six months were exclusively breastfed and the median duration of breastfeeding was
only thirteen months. The complementary feeding indicator was also rated as poor since only 57.9 percent of 6-9
months children received complementary foods while continuing to breastfed. The assessment also found out that
complementary foods were introduced too early, at the age of less than two months. These poor practices needed
urgent action and aggressive sustained interventions.

To address these problems on infant and young child feeding practices, the first National IYCF Plan of Action was
formulated. It aimed to improve the nutritional status and health of children especially the under-three and
consequently reduce infant and under-five mortality. Specifically, its objectives were to improve, protect and
promote infant and young child feeding practices, increase political commitment at all levels, provide a supportive
environment and ensure its sustainability. Figure 1 shows the identified key objectives, supportive strategies and
key interventions to guide the overall implementation and evaluation of the 2005-2010 Plan of Action. The main
efforts were directed towards creating a supportive environment for appropriate IYCF practices. The approval of
the National Plan of Action in 2005 helped the Department of Health (DOH) and its partners, in the development of
the first (1st) National Policy on Infant and Young Child Feeding. Thus on May 23, 2005, Administrative Order
(AO) 2005-0014: National Policies on IYCF was signed and endorsed by the Secretary of Health. The policy was
intended to guide health workers and other concerned parties in ensuring the protection, promotion and support of
exclusive breastfeeding and adequate and appropriate complementary feeding with continued breastfeeding. (1)

GUIDING PRINCIPLES

The IYCF Strategic Plan of Action upholds the following guiding principles:

1. Children have the right to adequate nutrition and access to safe and nutritious food, and both are essential for
fulfilling their right to the highest attainable standard of health. (5)

2. Mothers and Infants form a biological and social unit and improved IYCF begins with ensuring the health and
nutritional status of women. (5)

3. Almost every woman can breastfeed provided they have accurate information and support from their families,
communities and responsible health and non-health related institutions during critical settings and various
circumstances including special and emergency situations.(5)

4. The national and local government, development partners, non-government organizations, business sectors,
professional groups, academe and other stakeholders acknowledges their responsibilities and form alliances and
partnerships for improving IYCF with no conflict of interest.

41
 5. Strengthened communication approaches focusing on behavioral and social change is essential for demand
generation and community empowerment.

GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS

GOAL:

Reduction of child mortality and morbidity through optimal feeding of infants and young children

MAIN OBJECTIVE:

To ensure and accelerate the promotion, protection and support of good IYCF practice

OUTCOMES:

By 2016:

90 percent of newborns are initiated to breastfeeding within one hour after birth;
70 percent of infants are exclusively breastfeed for the first 6 months of life; and
95 percent of infants are given timely adequate and safe complementary food starting at 6
months of age.

TARGETS:

By 2016:

50 percent of hospitals providing maternity and child health services are certified MBFHI;
60 percent of municipalities/cities have at least one functional IYCF support group;
50 percent of workplaces have lactation units and/or implementing nursing/lactation breaks;
100 percent of reported alleged Milk Code violations are acted upon and sanctions are
implemented as appropriate;
100 percent of elementary, high school and tertiary schools are using the updated IYCF
curricula including the inclusion of IYCF into the prescribed textbooks and teaching
materials; and
100 percent of IYCF related emergency/disaster response and evacuation are compliant to the
IFE guidelines.

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

III. Action/Work Plan

KEY INTERVENTION SETTINGS AND SERVICES

STRATEGIES, PILLARS AND ACTION POINTS

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

1.1 Formalize partnerships with GOs and NGOs working on IYCF program coordination and implementation

a. Strengthen the TWG to allow it to effectively coordinate the GOs and NGOs working for the IYCF Program

The national TWG will remain but will be strengthened. It shall be constituted by: NCDPC as Chair, FHO as
secretariat and representatives from NCDPC,FHO, NCHP, FDA, DJFMH, DSWD,CWC, NNC, ILO, WHO and
UNICEF. This time, members of theTWG will be tasked to focus participation to the intervention setting where it
ismost relevant.

The TWG shall be reporting regularly to the Service Delivery Cluster Head. At the Regional level, the
Regional Coordinators from the above offices shall collaborate in the implementation of the IYCF
Program. To ensure that GO and NGO IYCF partners work together, the composition of the TWGs and AD Hoc
committees shall be made up of representatives from the government and non-government sectors and the Ad Hoc
Committees shall be chaired by the relevant agency where the intervention setting belongs.

At the provincial, municipal and barangay levels the existing Coordinating Committees which has an
interagency composition shall be the coordinating arm of the IYCF Program. This is where the participation of
non-government entities will be facilitated. Mechanisms for coordination shall be devised to build a strong
foundation for partnership between the LGU, the Coordinating Committees and local NGOs or private entities.

A memorandum of agreement (MOA) shall be executed between DOH and other agencies invited to become
members of the TWG.

b. Organize functional Intervention Setting Committees (this is the same as the ad-hoc committee)

The years covered by this action plan will be marked with many developmental activities in all the
intervention settings. The TWG shall create a committee for each of the intervention setting. The committees
shall be chaired by the relevant agency/ office. Other government and non-government agencies will be invited to
the committees relevant to their mandate.

c. Return the MBFHI responsibility from NCHFD to NCDPC

The National Policy on IYCF created in 2005 has affirmed the MBFHI responsibility to NCHFD. Since MBFHI is
now under the umbrella of the IYCF Program, it is in a better position to consolidate efforts towards MBFHI
compliance. Thus the return of the MBFHI responsibility from NCHFD to NCDPC shall be pursued. The
collaboration of NCHFD is still needed though as it has a direct hand on health facility development. At NCDPC
the integration of IYCF in the MNCHN Action Plan shall be worked out in all aspects of the program and at the
different levels of implementation.

d. Augment human resource complement of NCDPC- FHO, IYCF program

NCDPC-FHO as the secretariat of the TWG and supervising and supporting the IYCF Program will not be able
to effectively carry out the technical, management and administrative roles and responsibilities without additional
human resource. Funds shall be allotted for job orders for this purpose.

e. Programmed contracting out of activities to organizations outside of DOH

To achieve the objectives and targets of the IYCF program, it shall be implemented simultaneously in the
different intervention settings and at a faster pace. This is a gargantuan task considering the extent of the
developmental work, the management requirements, and the mobilization of the IYCF network and the
sourcing of funds for implementation.

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

STRATEGY 2: Integration of key IYCF action points in the MNCHN Plan of Action/Strategy

2.1 Institutionalize the IYCF monitoring and tracking system for national, regional and LGU levels

a. Institutionalize the collection of PIR Data and generate annual performance report

43
 The established IYCF data set that are being collected during PIRs shall be further reviewed, revised as appropriate
and institutionalized through a Department Circular and in collaboration with the other programs in the FHO.

An IYCF Program annual performance report shall be generated at the end of every year based on the PIR
data, the consolidated data from the unified monitoring and related data coming from research and studies as
appropriate. Reports on the performance of developmental activities shall be collected as part of the data base
and to be reported as needed to the Service Delivery Cluster Head.

b. Maximize the use of the unified monitoring tool

The CHDs through its Regional Coordinators shall be required to use and consolidate the unified monitoring tool.
A simple data management program shall be developed to facilitate the consolidation of data extracted from
monitoring. Reports shall be required two weeks after the end of every quarter.

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

The current records and reports being collected by the DOH Field Health Information System will remain as the
main source of data from health facilities. However, collaboration with NEC and IMS to improve data quality
and include data on complementary feeding is essential.

2.2 Participation of the IYCF Focal person in MNCHN planning and monitoring activities

a. Designate the IYCF Focal Person as a regular member of the team working for the development and
implementation of the MNCHN Strategy

The IYCF Focal Person shall ensure that the IYCF action points become an agenda of the MNCHN
Strategy and thus ultimately the IYCF services forms a part of the integrated services for mothers and children. In
the MNCHN planning and monitoring, the IYCF Focal Person shall help ensure that in the multitude of
activities, critical IYCF action points and indicators are not overlooked.

STRATEGY 3: Harnessing the executive arm of government to implement and enforce the IYCF related
legislations and regulations (EO 51, RA 7200 and RA 10028)

3.1 Consultation mechanism with the IAC and DOJ for the enforcement of the Milk Code and with other relevant
GOs for other IYCF related legislations and regulations

a. Devise and implement a consultation mechanism to bring together the IAC, DOJ and other relevant GOs for
IYCF related legislations and regulations

The Committee for Industry Regulation shall devise and implement a consultation mechanism to facilitate the
implementation and enforcement of IYCF related laws and regulations. This will require participation of higher
levels of authority in the GOs.

The goal of the consultation mechanisms is to develop activities that will focus on facilitating the process of
monitoring of compliance and enforcement of IYCF related laws and regulations not only at the national level
but also at regional and local levels and in the five IYCF intervention settings.

3.2 Support Civil Society in the implementation and enforcement of IYCF related laws and regulations

a. Institutionalize enforcement of MBFHI compliance in the regulatory function of the DOH

The inclusion of the MBFHI requirements in the unified licensing/accreditation benchmarks of the BHFS and the
Licensing Offices shall be pursued more vigorously in collaboration with BHFS and the Licensing offices of the
CHDs. These offices are in a better position to enforce compliance in relation to their regulatory function and
in their power to promulgate penalties for violations.

b. Review and improve the processing of reports on violations on the Milk Code

The handling of reports on violations shall be reviewed for thoroughness and timeliness from the time a report is
submitted up to the final decision rendered on a case. Problematic areas and bottlenecks shall be identified and
threshed out. Measures to ensure that all reports on violations are acted upon shall be devised.

44
 To ensure speedy resolution of cases, it is necessary to set deadlines on the processing of reports on violations.

c. Invite the Professional Regulatory Board as a resource agency of the IAC

Apart from companies who are actively marketing breastmilk substitutes, health professionals who have direct
access and influence on pregnant and postpartum women are also among the most common violators of the law.
The PRC as the legal authority that regulates the practice of the medical and allied professions can contribute to
the development and enforcement of the IACs regulatory function.

d. Augment human resource of FDA as secretariat of the IAC

The current load of violations cases being processed and the fulfillment of other responsibilities with regards to
the Milk Code at FDA require a full time legal officer who will also assist the CHDs. Furthermore, the
strengthened monitoring of compliance to the Milk Code will result in a surge on violation reports. FDA
should be prepared to process such reports. An additional full time legal officer and an administrative/ clerical
staff is required to facilitate and help speed up the process.

e. Engage professional societies to come-up with measures for self monitoring and regulation

Monitoring of overt advertisements and marketing of breast milk substitutes is a persistent challenge.
Monitoring of compliance to the Milk Code among health workers and medical and allied professional
organizations is much more difficult. Promotion of breast milk substitutes is more personal and concealed.

The medical and allied professional societies are strong and active bodies that foster organizational development
and discipline among its members. An advocating stance over a punitive approach may be the more
prudent initial approach in this environment. There will be dialogue, negotiations and forging of agreements to push
the Milk Code and other policies on IYCF. The professional societies will be engaged to participate in the
development of the monitoring scheme within their ranks and in health facilities. They are a good resource in the
development of schemes for MBFHI and related technical matters. Working arrangements/contracts may be
forged to seal responsibilities and partnerships.

Representatives from the professional societies will constitute the Speakers Bureau which will be organized for the
information dissemination/awareness campaign on the Milk Code, the Expanded Breastfeeding Promotion Act and
the Policies on IYCF.

STRATEGY 4: Intensified focused activities to create an environment supportive to IYCF practices

4.1 Modeling the MBF system in the key intervention settings in selected regions

a. Set up Models of MBFHI and MNCHN implementation in key strategic hospitals and referral networks

Regional Hospitals and selected private hospitals shall be developed as models of MBFHI and MNCHN
implementation to help create an impact and to serve as showcases for other health facilities.

If these hospitals are currently training facilities for obstetrics and pediatrics residency program, the
MBFHI environment will certainly add value to the training.

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

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

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

The IYCF Program shall focus on the enforcement of the Expanded Breastfeeding Promotion Act of 2009 which
mandates workplaces to establish lactation stations and/or grant breastfeeding breaks. Guidelines for the

45
 establishment and maintenance of MBF workplace shall be developed. It will learn from lessons of already
established and successful MBF workplace. In as much as standards for the healthy workplace are already
established, the MBF guidelines shall be integrated into those standards.

The establishment of MBF workplaces initiated in factories shall be scaled up and efforts shall be expanded to
include government and private offices in line with Expanded Breasfeeding Act. The current collaboration partners
in the workplace setting may also need to be expanded to promote the establishment of the MBF workplace in
government and private offices. With the multitude of workplaces scattered throughout the country, the
expansion may require outsourcing of organizations to continue the MBF workplace efforts.

c. Enhance the primary, secondary and tertiary education curricula on IYCF

The enhancement of the primary, secondary and tertiary education curricula on IYCF shall be pursued. If
necessary, a review of the curriculum will be done prior to the enhancement. Apart from the curriculum
enhancement, training materials, books and teachers guide shall also be updated.

The initial collaboration for the enhancement of the primary, secondary and tertiary education curricula shall
take place at the central office of DepEd (Bureau of Elementary Education and Bureau of Secondary Education)
and TESDA. The enhanced curriculum, training materials, books and teachers guide shall be field tested province-
wide in three selected provinces, evaluated and further enhanced before a national implementation.

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

A clear policy on IYCF is necessary to allow the program to define the guidelines that can be easily followed
by GOs, NGOs and LGUs once such situations arise. The policy/guidelines shall address among others the issue
of milk donations. Guidelines on the Community Management of Malnutrition, IYCF in special medical
conditions such as errors of metabolism or HIV positive mothers shall also be developed for implementation.

Camp managers and organized local nutrition clusters shall be oriented on the IFE guidelines.

Disaster prone areas will be prioritized in the orientation. Training/orientation shall be a collaborative effort
between the IYCF Program, HEMS and the NDCC.

4.2 Creation of a Regional and National incentive and awarding systems for the most outstanding IYCF champions
in the different sectors of society

a. Review and update the existing awarding system

The current awarding system shall be reviewed. The search protocol shall be further refined to allow a wider
search. The organization of the search committees in the local and national levels shall be formalized. Funds for
the awards shall be ensured.

b. Establish a recognition system for health facilities complying with EO51, RA10028 and the MBFHI
National Policy

Set up an annual recognition system for facilities, establishments complying with relevant IYCF legislations and
regulations. The benefits provided for by the Milk Code to compliant health facilities shall be reviewed and
improved/established parallel with the development of the incentive scheme for the Expanded Breastfeeding
Promotion Act. Procedures for claiming benefits shall be established and made accessible in collaboration with
PhilHealth, BIR and other relevant government offices.

4.3 Allocate/Raise /Seek resources for IYCF Research activities that document best practices in the Philippines

a. Carry out an inventory of best practices on IYCF Identify best IYCF practices by allowing every province
in the country to identify exemplary or creative activities
on IYCF that boosted program services/performance. Validate the reports through CHDs and select the best
practices for documentation and publication.

b. Allocate resources and conduct IYCF related researches focusing on the documentation and measure of impact
of noble experiences and interventions

The documentation of IYCF best practices is considered a critical area that allows the development of models/
references for appropriate IYCF protocols and guidelines for implementation. Field personnel who are able to
establish and provide successful models of IYCF services are often deficient in resources and skills to document the

46
 efforts. Resources to conduct IYCF related researchers, focusing on the documentation and measure of impact
of noble experiences and interventions, will have to be allocated.

STRATEGY 5: Engaging the Private Sector and International Organizations to raise funds for the
scaling up and support of the IYCF program

5.2 Setting up of a fund raising mechanism for IYCF with the participation of International Organizations and
the Private Sector

a. Set-up the fund raising mechanism

The development and sustainability of IYCF activities partly depends on the availability of resources. At the
national level, where many developmental activities will take place, the regular sources of funds are not
sufficient. At the local levels, the poorer more problematic areas have the least resources to promote, protect and
support good IYCF practices. It is critical for the IYCF Program 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 user friendly monitoring tools.

The competencies of teachers and administrators to teach the new IYCF updated curriculum and to appreciate
the importance of MBF environment shall be enhanced. A training/seminar program on IYCF for teachers/
administrators will be developed. A core of teacher trainers in every region will be developed and organized to
conduct the training/seminars nationwide.

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).

47
 The lower the coverage, the faster is the accumulation of unimmunized susceptible infants, resulting in measles
outbreaks in different areas of the Philippines. Laboratory confirmed measles cases continued to be reported all
over the country, which indicates uninterrupted circulation of measles virus transmission resulting to illness and
deaths among children.

Mass measles immunization campaigns provide a second opportunity to catch missed children, but these are
done every 2-3 years interval and therefore not enough to prevent seasonal outbreaks from occurring in areas with
low immunization coverage. The administration of a 2nd dose of measles containing vaccines on a routine schedule
will provide this second opportunity at an earlier time and ensure the protection against measles of
infants/children who failed to be protected during the first dose.

As a response to interrupt the transmission of the measles virus and prevent a potential large measles outbreak to
occur, there is an urgent need to conduct a measles supplemental immunization activity this April 2011. All children
ages 9-95 months old nationwide should be given a dose of measles-rubella vaccine through a door-to-door
vaccination campaign. Unlike previous campaign, a measles-free certification will be issued to city/province
meeting all the criteria of (1) all barangays passed the RCA with no missed child and 95% and above house
marking accuracy; (2) there are no measles cases for the next 3 months after the campaign and (3) measles
surveillance indicators have met the national standards

INTER LOCAL HEALTH ZONE

An ILHZ is defined to be any form or organized arrangement for coordinating the operations of an array and
hierarchy of health providers and facilities, which typically includes primary health providers, core referral hospital
and end-referral hospital, jointly serving a common population within a local geographic area under the
jurisdictions of more than one local government.

ILHZ, as a form of inter-LGU cooperation is established in order to better protect the public or collective health of
their community, assure the constituents access to a range of services necessary to meet health care needs of
individuals, and to manage their limited resources for health more efficiently and equitably.

For these to happen, existing ILHZs in the country must strengthen their operations and sustain their functionality.
Regardless of the organizational nature of each ILHZ, whether these are formally organized, informally organized
or DOH-initiated, the overall aim is to make each ILHZ functional in order to perform its abovementioned purposes
and tasks.

It must be recognized that a good inter-LGU coordination in health is one that secures health benefits for the people
living in LGUs that are coordinating with one another. A functional ILHZ therefore is to be viewed as one that
provides health benefits to its individual residents and to the zone population as a whole. The ILHZ functionality is
defined mainly by observable zone-wide health sector performance results in terms of:

(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 inter-local health services.

Replication of Exemplary

Replication: Sharing Good Practices and Practical Solutions to Common Problems

By virtue of Administrative Order No. 2008-0006, dated January 22, 2008, the DOH has adopted the integration of
replication strategies in its operation.

Replication is learning from and sharing with others exemplary practices that are proven and effective solutions to
common and similar problems encountered by local government units, with the least possible costs and effort. The
underlying principle of replication is to avoid reinventing the wheel and benefiting from already tested solutions.

48
 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.

3. Simple and doable so that they can be replicated

Criteria for Selecting Exemplary Health Practices within one year and a half or less.

1. LGU-initiated solutions initiated to address one or more 4.
health issues or problems encountered.
2. High level of sustainability
Consistent with existing health policies
LGU support
Had been in place for more than three ears
Widely participated and supported by the
communities
Adopted as a permanent structure or
program with regular budgetary support
Adopted as a permanent structure or
program with regular budgetary support
Community representation in decision
making bodies and committees
Cost effective and cost efficient
Mobilization and utilization of
indigenous resources
Minimal support 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

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

One million children under five years old die each year in less developed countries. Just five diseases (pneumonia,
diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and malnutrition
is often the underlying condition. Effective and affordable interventions to address these common conditions exist
but they do not yet reach the populations most in need, the young and impoverish.

The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of
countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and development
and is based on the combined delivery of essential interventions at community, health facility and health systems
levels. IMCI includes elements of prevention as well as curative and addresses the most common conditions that
affect young children. The strategy was developed by the World Health Organization (WHO) and United Nations
Childrens Fund (UNICEF).

In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital
staff were capacitated to implement the strategy at the frontline level.

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

49
 5 day Follow-up course for IMCI Supervisors

Improving over-all health systems

Improving family and community health practices

Rationale for an integrated approach in the management of sick children

Majority of these deaths are caused by 5 preventable and treatable conditions namely: pneumonia,
diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood illness are caused
by these five conditions

Most children have more than one illness at one time. This overlap means that a single diagnosis may not be
possible or appropriate.

Who are the children covered by the IMCI protocol?

Sick children birth up to 2 months (Sick Young Infant)

Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI

All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and
all Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND
LOCAL BACTERIAL INFECTION. These signs indicate immediate referral or admission to
hospital
The children and infants are then assessed for main symptoms. For sick children, the main
symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick young
infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for
nutritional, immunization and deworming status and for other problems
Only a limited number of clinical signs are used
A combination of individual signs leads to a childs classification within one or more symptom
groups rather than a diagnosis.
IMCI management procedures use limited number of essential drugs and encourage active
participation of caretakers in the treatment of children
Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to
clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILDS ILLNESS (please see enclosed portion of the IMCI Chartbooklet)
The childs illness is classified based on a color-coded triage system:

PINK- indicates urgent hospital referral or admission

YELLOW- indicates initiation of specific Outpatient Treatment

GREEN indicates supportive home care

Steps of the IMCI Case management Process

50
 The following is the flow of the iMCI process. At the out-patient health facility, the health worker should
routinely do basic demographic data collection, vital signs taking, and asking the mother about the child's
problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI
process by checking for general danger signs, assessing the main symptoms and other processes indicated in the
chart below.

Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. Once
admitted, the hospital protocol is used in the management of the sick child.

THE INTEGRATED CASE MANAGEMENT PROCESS

KNOCK OUT TIGDAS 2007

Knock-out Tigdas Logo

Knock-out Tigdas 2007 is a sequel to the 1998 and 2004 Ligtas Tigdas mass measles immunization campaign.
All children 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated against
measles from October 15 - November 15, 2007 , door-to-door. All health centers, barangay health stations, hospitals
and other temporary immunization sites such as basketball court, town plazas and other identified public places will
also offer FREE vaccination services during the campaign period.

Other services to be given include Vitamin A Capsule and deworming tablet.

Knockout Tigdas for the period of the Barangay and SK Elections

Executive Order No. 663
Promotional materials

What is Knock-out Tigdas (KOT) 2007?

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

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

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

What does measles elimination mean?

Measles elimination means:

1. Less than one (1) measles case is confirmed measles per one million population.

2. Detects and extracts blood for laboratory confirmation from at least 2 suspect measles cases per 100,000
populations.

3. No secondary transmission of measles. This means that when a measles case occurs, measles is not transmitted to
others.

Who should be vaccinated?

51
 All children between 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated
against measles.

When will it be done?

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

How will it be done?

Vaccination teams go from door-to-door of every house or every building in search of the targeted children who
needs to be vaccinated with a dose of measles vaccines, Vitamin A capsule and deworming drug.

All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball
court, town plazas and other identified public places will also offer FREE vaccination services during the campaign
period.

My child has been vaccinated against measles. Is she exempted from this vaccination campaign?

No, she is not. A previously vaccinated child is not exempted from the vaccination campaign because we cannot be
sure if her previous vaccination was 100% effective.

Chances are a vaccinated child is already protected, but no one can really be sure. There is 15% vaccine failure
when the vaccine is given to 9 months old children. We want to be 100% sure of their protection.

What strategy will be used during the campaign?

It is a door-to-door strategy. The team goes from one-household to another in all areas nationwide.

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

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

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

Antibodies in the blood which provide protection against disease decrease as the child grows older. Booster
vaccinations are needed to raise protection again. Measles vaccination during the said campaign will be a booster
vaccination for a previously vaccinated child. The childs waning internal protection will increase. The child will
not harm because there is no vaccine overdose for the measles vaccine. The measles vaccine is even known to
enhance overall immunity against other diseases.

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

Normally, the child will have slight fever. The fever is a sign that the childs vaccine is working and is helping the
body develop antibodies against measles.

The best thing to do when the child has fever is to give him paracetamol every four (4) hours. Give him plenty of
fluids and breastfeed the child. Ensure that the child has enough rest and sleep.

What will happen after the Knock-out Tigdas 2007?

To interrupt measles circulation by 2008, ALL children ages 9 months will continue to routinely receive one dose of
the measles vaccine together with the vaccines the other disease of the childhood like polio, diphtheria, pertussis,
etc. All children with fever and rashes have to be listed and tested to verify the cause of the infection.

ALL 18 months old children will be given a second dose of measles immunization to really ensure that these
children are protected against measles infection.

What other services will be given?

52
 Vitamin A capsule will be given to all children 6 months to 71 month old and deworming tablet to 12 months to 71
months old nationwide.

Additional messages:

Once the child is vaccinated, the posterior upper left earlobe will be marked with gentian violet, so
do not try to remove for the purpose of validation.
Houses will also be marked, so do not erase.

I heard that there are cases where the child who was vaccinated who became seriously ill or died. Is this true?

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

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;

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.

53
 Beneficiaries:

The Malaria Control Program targets the meager-resourced municipalities in endemic provinces, rural poor residing
near breeding areas, farmers relying on forest products, indigenous people with limited access to quality health care
services, communities affected by armed conflicts, as well as pregnant women and children aged five years old and
below.

Program Strategies:

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

1.Early diagnosis and prompt treatment

Diagnostic Centers were established and strengthened to achieve this strategy. The utilization of these
diagnostic centers is promoted to sustain its functionality.

2. Vector control

The use of insecticide-treated mosquito nets, complemented with indoor residual spraying, prevents malaria
transmission.

3. Enhancement of local capacity

LGUs are capacitated to manage and implement community-based malaria control through social
mobilization.

Program Accomplishments:

For the development of health policies, the Malaria Medium Term Plan (2011-2016) is already in its final draft
while the Malaria Monitoring and Evaluation Framework and Plan is being drafted. The Malaria Program is being
monitored in six provinces as the Philippine Malaria Information System is being reviewed and enhanced.

In strengthening the capabilities of the LGUs, trainings are conducted. These include: series of Basic and Advance
Malaria Microscopy Training; Malaria Program Management Orientation and Training for the rural health unit
(RHU) staff; and Data Utilization Training. Also, there are the Clinical Management for Uncomplicated and Severe
Malaria and the Malaria Epidemic Management.

Lastly, health services are leveraged through the provision of anti-malaria commodities.

Partner Organization/Agencies:

The following organizations/agencies take part in achieving the goals of Malaria Control Program:

Pilipinas Shell Foundation, Inc, (PSFI)

Roll Back Malaria (RBM); World Health Organization (WHO)
Act Malaria Foundation, Inc
Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI)
Research Institute of Tropical Medicine (RITM)
University of the Philippines-College of Public Health (UP-CPH)
Philippine Malaria Network
Australian Agency for International Development (AusAID)
Asia Pacific Malaria Elimination Network (APMEN)
Malaria Elimination Group (MEG)
Local Government Units (LGUs)

54
 MICRONUTRIENT PROGRAM

Contact Person:
Liberty Importa
Telephone Nos.:
651-7800 loc. 1726-1730

Micronutrient deficiencies can cause inter-generational consequences. The level of health care and nutrition that
women receive before and during pregnancy, at childbirth and immediately post-partum has significant bearing on
the survival, growth and development of their fetus and newborn. Undernourished babies tend to grow into
undernourished adolescents. When undernourished adolescents become pregnant, they in turn, may give birth to
low-birth weight infants with greater risk of multiple micronutrient deficiencies.

Micronutrient deficiencies have considerable impact on economic productivity, growth and national development.
Widespread iron deficiency is estimated to decrease the gross domestic product (GDP) by as much as 2% per year
in the worst affected countries. Conservatively, this translates into a loss of about Php 172 per capita or 0.9% of
GDP. Productivity losses for anemic manual laborers have been documented to be as high as 9% for severely
stunted workers and 5% and 17% for workers engaged in moderate and heavy physical labor respectively
(Micronutrient Supplementation Manual of Operations)

Mandate: AO 36, s. 2010

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

Goal of Micronutrient:

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

Objectives:

1. Contribute to the reduction of disparities related to nutrition through a focus on population groups and areas
highly affected or at risk to malnutrition

2. To provide vitamin A capsules, iron and iodine supplements to treat or prevent specific micronutrient
deficiencies

3. Go to scale with key interventions on micronutrient supplementation, food fortification, salt iodization and
nutrient education.

4. Revive, identify, document and adopt good practices and models for nutrition improvement.

5. Build Nutrition human resource in relevant departments/ agencies.

Scenario:

1. Child Under nutrition

The 2008 National Nutrition survey, FNRI-DOST showed a significant decline in the prevalence of underweight-
for-age under five children since 1990. However, the overall decline was not fast enough. In 2008 a 20.6%
prevalence rate was recorded which is equivalent to an average annual percentage point decrease of 0.37%,
however, it is lower than the targeted 0.55 annual percentage point reduction from 2000 to achieve one of the
targets of Millennium Development Goal I. In addition, stunting (32.2%) among under fives (an indication of
prolonged deprivation of food and frequent bouts of infections) and wasting indicative of a lack of food or infection
or both on the hand, remained at bout the 6% from 2003 to 2008.

1. Maternal Under nutrition

55
 For the past 10 years, the nutritionally-at-risk pregnant women gradually decreased since 1998, with an average
change of 0.44% per year. (FNRI National Nutrition surveys 2008)

2. Micronutrient Deficiencies

The 2008 National Nutrition Survey reported significant gains as levels of Vitamin A deficiency among 6-months
infants to 5 years old children, pregnant and lactating women but still is a public health problem based on WHO cut
off 15%. Furthermore, the prevalence rate of Iron deficiency anemia among children decreased significantly.
However, percentage levels of IDA among infants 6 years old (55.7%) and pregnant women (42.5%) remain at
levels that are considered high as per WHO classification of <40% public health problem.

Iodine Deficiency is a public health problem among pregnant and lactating women. In 2008, the median UIE
among 6-12 year old children was 132/ug/L, indicating adequate iodine status and only <20% of the children had
UIE less than 50 ug/L. The elimination of iodine deficiency has been sustaines from 2003-2008.

Among pregnant women, the median UIE was 105 ug/L represents insufficient iodine intake. Iodine deficiency in
this group persists. While lactating women the median UIE was 81 ug/L represents mild iodine insufficiency.

INTERVENTIONS/ STRATEGIES EMPLOYED OR IMPLEMENTED

1. Micronutrient Supplementation- is the provision of pharmaceutically prepared vitamins & minerals for
treatment or prevention of specific micronutrient deficiency.

2. Food Fortification- the addition of essential micronutrients to widely consumed food product at levels above
its normal state.

3. Improving diet/ dietary diversification- the adoption of proper food and nutrition practices thru nutrition
education food production & consumption.

4. Growth monitoring and promotion- is an educational strategy for promoting child health, human
development and quality of life through sequential measurement of physical growth and development of
individuals in the community.

STATUS OF IMPLEMENTATION/ ACCOMPLISHMENT

The following policies were formulated and implemented:

AO No. 2010-0010: revised Policy on Micronutrient Supplementation to support achievement of

2015 MDG Targets to reduce under-five and maternal deaths and micronutrient needs of other
population groups
AO No. 2007-0045: Zinc Supplementation and reformulated Oral rehydration salt in the
Management of diarrhea among children
ASIN Law- R.A. 8172, An act promoting salt iodization nationwide and for other purposes,
signed into law on Dec. 20, 1995
Food fortification law, R.A. 8976, An act establishing the Philippine Food Fortification Program
and for other purposes mandating fortification of flour, oil and sugar with Vit 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
Department Memorandum No. 2011-0303 Micronutrient powder supplementation for children 6-
23 months
Micronutrient supplementation manual of operations was developed to guide local, regional and
national managers and implementers in providing good quality micronutrient supplementation services
to targeted populations nationwide

Accomplishment

Vitamin A Supplementation 2011 Coverage

FUTURE PLAN / ACTION

1. Focus on population groups and areas affected or at-risk to micronutrient malnutrition

56
 2. Scale up with key interventions such as micronutrient supplementation, food fortification 7 dietary
diversification through food based approach

3. Development & formulation of strategic plan 2012-2016

OTHER SIGNIFICANT INFORMATION

Micronutrient supplementation is a crucial for child survival, it significantly reduces:

1. The risk from mortality by 23-34%

2. Deaths due to measles by about 50%

3. Deaths due to diarrhea by about 40%

MENTAL HEALTH PROGRAM

Contact Person:
Nelson Mendoza

GOAL: Quality Mental Health Care

OBJECTIVE: Implementation of a mental health program strategy

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

STAKEHOLDERS

To ensure the sustainability and effectiveness of the National Mental Health Program, certain committees and teams
were organized.

1. National Program Management Committee (NPMC) it is chaired by the Undersecretary of Health of the
policy standards development team for service delivery and co-chaired by the Director IV of the National Center
for Disease Prevention and Control (NCDPC)

FUNCTIONS:

Oversee the development of mental health measures for sub-programs and components.

Integrate the various programs, project and activities from the various program development and management
groups for each sub-program.

Manage the various sub-programs and components of the national mental health program.

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

Recommend to the Secretary of Health a master plan for mental health aligned with the mandates and thrusts
of various government agencies.

2. Program Development and Management Teams (PDMT)- under NPMC, PDMT shall be established
corresponding to the four sub-programs of the National Mental Health Program.

FUNCTIONS:

Formulate and recommend policies, standards, guidelines approaches on each specifics sub-program on
mental health.

57
 Develop a plan of action for each specific sub-program in consultation with mental health advocates and
stakeholders.

Develop operating guidelines, procedures, protocols for the mental health sub-program.

Provide technical assistance to other mental health teams according to sub-program funds.

3. Other Partners and Stakeholders

Ensuring the availability of competent, efficient, culturally and gender-sensitive health care professionals
who will provide mental health services.

Identifying mental health needs of the population and refer findings to the appropriate mental care provider

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

INTERVENTIONS / STRATEGIES EMPLOYED/IMPLEMENTED BY DOH

1. Health Promotion and Advocacy

Enrichment of advocacy and multimedia information, education and community (IEC) strategies targeting the
general public, mental health patients and their families.

2. Service Provision

Enhancement of service delivery at the national and local levels will enable the early recognition and treatment of
mental health problems.

3. Policy and legislation

The formulation and institutionalization of national legislations, policies, program standards and guidelines shall
emphasize the development of efficient and effective structures, systems and mechanisms that will ensure equitable
accessible, affordable and appropriate health services for the mentally ill patients, victims of disaster and other
vulnerable groups.

4. Encouraging the development of a research culture and capacity

The program shall support researches and studies relevant to mental health, with focus on the clinical behaviour,
epidemiology, public health treatment options and knowledge management.

5. Capacity building

Training shall be conducted on psychosocial care, the detection and management of specific psychiatric morbidity
and the establishment of mental health facilities.

6. Public-Private Partnership

Inter-sectoral approaches and networking with other government agencies, non-government organizations, academe
and private service providers shall be pursued to develop partnership and expand the involvement of stakeholders.

7. Establishment of database and information system

This is needed to determine the magnitude of the problem to serve as basis for shifting the program for being
institutional and treatment focused on being preventive, family focused and community oriented.

8. Development of model programs

58
 Best practices for prevention of substance abuse and risk reduction for mental illness can be replicated in different
LGUs in coordination with other agencies involved in mental health and substance abuse prevention programs.

9. Monitoring and evaluation. Results of program monitoring and evaluation shall be used in formulating and
modifying policies, program objectives and action plans to sustain the mental health initiatives and ensure
continuing improvement in the delivery of mental health care.

LEPROSY CONTROL PROGRAM

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

Mission: To ensure the provision of a comprehensive, integrated quality leprosy services at all levels of health care

Goal: To maintain and sustain the elimination status

Objectives:

The National Leprosy Control Program aims to:

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

Beneficiaries:

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

NLCP Strategy
Universal Health Care
Global Strategy
(2011-2016)
(Kalusugang
(2006-2010)
Pangkalahatan)
MDG& NOH
Provision of
Sustain leprosy
Quality Leprosy Governance
control in all
services at all for Health
endemic countries
levels
Strengthen
Health System Service
routine & referral
Strengthening Delivery
service
Ensure high Capability building of Policy,
quality diagnosis, an efficient, effective, Standards &
case management, accessible human and Regulations

59
 recording &
reporting in all
facility resources
endemic
communities
Establish the Develop policies/
Sentinel Surveillance guidelines/ sentinel Human
System to sites/referral centers Resources for
monitor Drug (Luzon,Visayas & Health
Resistance Mindanao)
Develop
procedures/ tools
that are
home/community- Collaborate with
Health
based, integrated and NEC/RESU/ PESU /
Information
locally appropriate MESU
for Self Care/POD,
rehabilitation
services (CBR)
Health
NLAB, NCCL
Financing
RA 7277- Rights of
PWD & Caregivers
BP 34- Accessibility &
Human Rights Law
PhilHealth Insurance
Package

PERSONS WITH DISABILITIES

HEALTH AND WELLNESS PROGRAM FOR PERSONS WITH DISABILITIES

BACKGROUND

Persons with disabilities (PWDs), according the UN Convention on the Rights of Persons With Disabilities, include
those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various
barriers may hinder their full and effective participation in society on an equal basis with others.

The International Classification of Functioning, Disability and Health (ICF) refers to disability as an umbrella
term covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body
function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action;
while a participation restriction is a problem experienced by an individual in involvement in life situations. The
ICFs definition of disability denotes a negative interaction between a person (with a health condition) and his or
her contextual factors (environmental and personal factors). A comprehensive approach in interventions is then
necessary for persons with disabilities (PWDs) as it entails actions beyond the context of health, but more on
helping them to overcome difficulties by removing environmental and social barriers (WHO, 2013).

Globally, over 1 billion people, or approximately 15% of the worlds population, have some form of disability.
About 110 to 190 million people 15 years and older have significant difficulties in functioning. Moreover, the rapid
spread of chronic diseases and population ageing contribute to the increasing rates of disability. About 80% of the
worlds PWDs live in low-income countries, wherein majority are poor and cannot access basic services. With their
conditions, PWDs need greater attention and considerations in terms of health needs, without discrimination.
However, reports show that PWDs have less access to health services and therefore have greater unmet needs
(WHO, 2012.)

In the Philippines, the results of the 2010 Census of Population and Housing (CPH, 2010) show that of the
household population of 92.1 million, 1.443 million Filipinos or 1.57%, have a disability. Region IV-A, with 193
thousand PWDs, was recorded to have the highest number of PWD among the 17 regions, while the Cordillera

60
 Administrative Region (CAR) had the lowest number with 26 thousand PWDs. There were more males, who
accounted for 50.9% of the total PWD in 2010, compared to females, with 49.1% with disability. For every five (5)
PWD, one (18.9%) was aged 0 to 14 years, three (59.0%) were in the working age group (15-64 years old), and one
(22.1%) was aged 65 years and above (NSO, 2013).

The mandate of the DOH to come up with a national health program for PWD was based on 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 or otherwise known as The Magna Carta for Disabled
Persons andthe Implementing Rules and Regulations (IRR) of RA 7277. This document stipulated that the DOH is
required to: (1) institute a national health program for PWDs, (2) establish medical rehabilitation centers in
provincial hospitals, and (3) adopt an integrated and comprehensive program to the Health Development of PWD,
which shall make essential health services available to them at affordable cost. In response to this, the DOH issued
Administrative Order No. 2006-0003, which specifically provides the strategic framework and operational
guidelines for the implementation of Health Programs for PWDs.

In 2013, a MediumTerm Strategic Plan (2013-2017) was developed to strengthen the existing health program for
PWDs. However, in the review done for the purpose, it was noted that in the implementation of the program in the
past years, there were operational issues and gaps identified that need to be addressed. These include among others,
the need to strengthen multi-sectoral action to harmonize efforts of stakeholders; clarify delineation of roles and
responsibilities of concerned government agencies working for PWDs; strengthen national capacity, both facilities
and manpower, to provide rehabilitation services for PWDs from primary to tertiary level of care; provide access to
health facilities and services for PWDs; and, strengthen registration database for PWDs.

Recently, the World Health Organization released the Global Disability Action Plan 2014-2021. This document
intends to help countries direct their efforts towards specific actions in order to address health concerns of persons
with disabilities. The Action Plan identified three major objectives: to remove barriers and improve access to
health services and programmes; (2) to strengthen and extend rehabilitation, habilitation, assistive technology,
assistance and support services, and community-based rehabilitation; (3) to strengthen collection of relevant and
internationally comparable data on disability and support research on disability and related services.

Considering all of the above, the Health and Wellness Program of Persons with Disabilities currently has been
configured to address all the issues discussed above, and aligned with the thrusts and goals of Kalusugang
Pangkalahatan or Universal Health Care, the Global Disability Action Plan 2014-2021, and, the direction the
program should take in the succeeding years as articulated in the newly developed strategic plan.

II. HEALTH AND WELLNESS PROGRAM FOR PERSONS WITH DISABILITIES

A. Vision:A country where all persons with disability, including children and their families, have full access to
inclusive health and rehabilitation services.

B. Mission:A program designed to promote the highest attainable standards of health and wellness for PWDs by
fostering a multi-sectoral approach towards a disability inclusive health agenda.

C. Objectives:

To address barriers and improve access and reasonable accommodations of PWDs to health care
services and programs.
To ensure the accessibility, availability, appropriateness and affordability of habilitation and
rehabilitation services for PWDs, including children with disabilities.
To ensure the development and implementation of policies and guidelines, health service packages,
including financing and provider payment schemes for health services of PWDs.
To enhance capacity of health providers and stakeholders in improving the health status of PWDs.
To strengthen collaboration and synergy with and among stakeholders and sectors of society to
improve response to a disability inclusive health agenda through regular dialogues and interactions.
To provide the mechanism in facilitating the collection, analysis and dissemination of reliable,
timely and complete data and researches on health-related issues of PWDs in order to develop and
implement evidence-based policies and interventions.

D. Action Framework for the Health and Wellness Program of Persons with Disabilities

The Action Framework for the Health and Wellness Program of Persons with Disabilities is adapted from the three
major objectives of the WHO Global Disability Action Plan 2014-2021. As applied in the country, program actions
or interventions shall focus on the following areas: 1) removal of barriers and improve access to health services

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 and programs; (2) strengthening and expansion of rehabilitation, habilitation, assistive technology, and community-
based rehabilitation; (3) strengthen collection of relevant and internationally comparable data on disability and
support research on disability and related services.

Figure 1 depicts the Action Areas that the Health and Wellness Program for Persons with Disabilities shall focus its
interventions along the thrusts and goals of Kalusugang Pangkalahatan or Universal Health Care.

Action Area 1:Removal of barriers and improve access to health services and programs. People with
disabilities, including children, encounter a range of attitudinal, physical and systemic barriers when they attempt to
access health care such as physical barriers related to the architectural design of health facilities or health providers
lack of adequate knowledge and skills in providing services for persons with disabilities, among many others.

Therefore, actions or interventions should be under taken to ensure that persons with disabilities have access, on an
equal basis with others, to health facilities and services. It is important to identify all of these barriers and institute
collective actions to remove these barriers and improve access of persons with disabilities to health services and
programs.

Action Area 2: Strengthening and expansion of rehabilitation, habilitation, assistive technology, and
community based rehabilitation. Habilitation and rehabilitation are sets of measures that assist individuals, who
experience or are likely to experience disability, to achieve and maintain optimal functioning, in interaction with
their environments. Encompassing medical care, therapy and assistive technologies, they should begin as early as
possible and be made available as close as possible to where people with disabilities live.

Increasing government investments in habilitation, rehabilitation and provision of assistive technologies are
expected actions or interventions that must be put in place. This is going to be beneficial in the long run because
they build human capacity and can be instrumental in enabling people with limitations in functioning to remain in
or return to their home or community, live independently, and participate in all aspects of life. They can reduce the
need for formal support services as well as reduce the time and physical burden for caregivers.

Action Area 3: Strengthening collection of relevant and internationally comparable disability data and
support disability researches. Data is needed to strengthen health care systems, as it informs policy and
interventions. These can be collected through dedicated disability surveys, or disaggregating data from other data
collection efforts by disability status, and research.

Interventions along this action area should ensure that data collected would be internationally comparable and
results of researches and studies done are used for informing policy and resource allocation. The use of the
Philippine Registry for Persons with Disability is an intervention that should be strengthened and made fully
operational.

Figure1: Action Framework for the Health and Wellness Program for Persons with Disabilities

PROVINCE-WIDE INVESMENT 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:

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 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
globally-recognized standards, and making these services equitably available for both Medical Travellers and local
patients.

Objectives:

1. To increase competitiveness by compliance to recognized bodies that implement national and international
healthcare organization accreditation

2. Institutionalize policies and enact legislation for high level quality healthcare and patient safety standards in all
health facilities

3. Continue collaboration with national government agencies, LGUs, private sector organizations and academe
involved in quality healthcare and patient safety, international medical travel and wellness services, retirement,
trade and tourism

4. Continue advocacy in all regions of the country on quality healthcare and patient safety, international medical
travel and wellness services, retirement, trade and tourism through quad media approach, capacity building
activities and collaborative participation in international forum and conferences

Stakeholders/Beneficiaries:

Private clinics/centers, Public and Private Hospitals, National Government Agencies, Private Specialty
Clinics/Centers providing Dermatology, plastic surgery, ophthalmology and dental medicine, Geriatric and
Treatment and Rehabilitation Centers for substance abuse

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 governments main
actions in addressing the plight of Filipino households in such areas.

The program aims to contribute to the attainment of the goal of providing potable water to the entire country and
the targets defined in the Philippine Development Plan 2011-2016 Millennium Development Goals (MDG), and the
Philippine Water Supply Sector Roadmap and the Philippine Sustainable Sanitation Roadmap. To attain this
objective, One Billion and Five Hundred Million Pesos (Php 1,500,000,000) is appropriated to the DOH through

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 Item B.I.a of the 2011 General Appropriations Act (GAA). The appropriation is a grant facility for LGU to develop
infrastructure for the provision of potable water supply.

A. OBJECTIVES

1. To increase water service for the waterless population

2. To reduce incidence of water-borne and sanitation related diseases

3. To improved access of the poor to sanitation services

B. TARGETS

1. Increased water service for the waterless population by 50%

2. Reduced incidence of water-borne and sanitation related diseases by 20%

3. Improved access of the poor to sanitation services by at least 10%

4. Sustainable operation of all water supply and sanitation projects constructed, organized and supported by
the Program by 80%.

II. ABOUT THE STAKEHOLDERS/ BENEFICIARIES

The program is designed to be implemented by DOH, NAPC and DILG. The NAPC will perform as the lead
coordinating agency, the DOH will provide the funding and ensure the implementation of various water supply
projects and the DILG will be in-charge of the capacity building of LGUs. The implementing guidelines define the
specific roles of each agency.

The DOH, NAPC and DILG used the data from the National Household Targeting System for Poverty Reduction
for identification of the target municipalities which compose of the following:

115 Waterless Municipalities

Waterless Areas based on the following thematic concerns:

Poorest waterless barangays with high incidence of water borne diseases

Resettlement areas in Bulacan, Rizal, Cavite, Laguna, Batangas and Albay

Health Centers without access to safe water

III. PROGRAM COMPONENT/ACTIVITIES

A. Rehabilitation/expansion/upgrading of Level III water supply systems including appropriate water treatment
systems.

B. Construction/rehabilitation/expansion/upgrading of Level II water supply systems.

C. Construction/rehabilitation of Level I water supply systems in areas, where such facilities are only applicable.

D. Provision of training for existing or newly organized water users associations/ community-based organizations.

E. Support for new and innovative technologies for water supply delivery and sanitation systems.

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

PHILIPPINE CANCER CONTROL PROGRAM

Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new
cases and 8.2 million cancer related deaths in 2012 (WHO). More than 60% of worlds total new annual cases occur
in Africa, Asia and Central and South America. These regions account for 70% of the worlds cancer
deaths (WHO). It is expected that annual cancer cases will rise from 14 million in 2012 to 22 within the next 2
decades (WHO).

Cancer is one of the four epidemic non-communicable diseases (NCDs) or lifestyle-related diseases (LRDs) which
include cardiovascular diseases, diabetes mellitus, and chronic respiratory diseases. According to Dr. Antonio
Miguel Dans in his paper Introduction to Non-Communicable Diseases in August 2014, the NCDs are now
considered a silent disaster of massive proportion that is ravaging the Filipino population, killing 300,000 victims
a year, 800 every day, and 33 every hour. Its toll on lives is likened to two 747 planes packed with passengers
crashing every day. Those NCDs share common risk factors, such as tobacco use, unhealthy diet, insufcient
physical activity and the harmful use of alcohol.

Cancer remains a national health priority in the country with significant implications for individuals, families,
communities, and the health system. Cancer is the third leading cause of morbidity and mortality in the country
after diseases of the heart and the vascular system (Philippine Health Statistics 2009). Among Filipino men, the 6
most common sites of cancer diagnosed in 2010 (Globocan) were lung, liver, colon/rectum, prostate, stomach, and
leukemia. Among Filipino women the 6 most common sites diagnosed were breast, cervix, lung, colon/rectum,
ovary and liver. Furthermore, 189 of every 100,000 Filipinos are afflicted with cancer while four Filipinos die of
cancer every hour or 96 cancer patients every day, according to a study conducted by the University of the
Philippines Institute of Human Genetics, National Institutes of Health.

In response to this growing and alarming epidemic of cancer, there is a need to revisit and strengthen the Philippine
Cancer Control Program which started in 1990 through Administrative Order No. 89-A s. 1990, amending A.O. No.
188-A s. 1973. Hence, the National Cancer Control Committee (NCCC) developed the National Cancer Prevention
and Control Action Plan (NCPCAP) 2015-2020.

The National Cancer Prevention and Control Action Plan 2015-2020 shall cover the following key areas of
concern:

1. Policy and Standards Development

a. Development of National Policy on the Integration of Palliative and Hospice Care into the Philippine
Health Care System
b. Development and Operationalization of National Cancer Prevention and Control Website and
Social Media Sites
c. Development of Comprehensive National Policy on Cancer Prevention and Control
d. Establishment of National Cancer Center and Strategic Satellite Cancer Centers
e. Expansion of PhilHealth Z Benefit Package Coverage to Other Cancers
o PhilHealth Z-Benefit Package for catastrophic diseases (breast, prostate, cervical
cancers and childhood acute lymphocytic leukemia) is an in-patient package which
includes mandatory diagnostics, operating room expenses, doctor/professional fees,
room and board, and medicines.

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 2.) Advocacy and Promotions

a. Cancer Awareness Campaigns

1. National Cancer Consciousness Week

2. Colon and Rectal Cancer Awareness Month
3. Cancer in Children Awareness Month

4. Cervical Cancer Awareness Month

5. Prostate Cancer Awareness Month

6. Lung Cancer Awareness Month

7. Liver Cancer Awareness Month

8. Breast Cancer Awareness Month

9. Cancer Pain Awareness Month

b. Partnership with DepEd, CHED, DOLE-Bureau of Working Conditions, and Civil Service
Commission

3.) Capacity Building and Resource Mobilization

a. Training of Trainers on Cervical Cancer Prevention and Control

b. Training of Trainers on Palliative and Hospice Care
o Palliative and hospice care has been the missing link in our health care delivery
system. Our Universal Health Care or Kalusugan Pangkalahatanwould not be complete
without integrating palliative and hospice care into the existing promotivepreventive
curative-rehabilitative continuum of care. It is therefore imperative to institutionalize
and integrate palliative and hospice care both in the hospitals or health facilities and in
community or home-based level.
c. Training of Trainers on Patient Navigation Program
o Patient Navigation Program / Medicine Access Program: It provides chemotherapy
for early stage breast cancer and acute lymphocytic leukemia and other diagnostic
standard procedures for eligible patients at no cost. This project involves seven (7)
government hospitals, namely: Philippine General Hospital, Jose Reyes Memorial
Medical Center, East Avenue Medical Center, Rizal Medical Center, Amang Rodriguez
Memorial Medical Center, Philippine Childrens Medical Center and Bicol Regional
Training and Teaching Hospital.

4.) Service Delivery

a. Availability of Free Cervical Cancer Screening in all trained RHUs

b. Availability of cryotherapy equipment in every province (81 provinces)
c. Availability and accessibility of screenings for selected cancers in all trained RHUs
d. School-based HPV vaccination of 9 to 13-year-old females
e. Hepatitis B vaccination for all health workers nationwide

5.) Information Management and Surveillance

a. Establishment of National Cancer Registry (hospital- and population-based)

b. Development and Operationalization of Cancer Helpline (including Telemedicine)

6.) Research and Development

a. Establishment of National Research and Development Program for Cancer Control

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 b. Research: Study on the Socio-Economic Burden and Impact Assessment of Cancer in the Philippines
c. Determination of Cancer Incidence in the Philippines 2008-2013

PUBLIC HEALTH ASSOCIATE DEPLOYMENT PROGRAM (PHADP)

I. Background/Description
The overall goal of Universal Health Care or Kalusugan Pangkalahatan is to improve health outcomes, provide
financial risk protection and provide quality access to health services especially to the poor. With this, the
Department of Health (DOH) through its Deployment of Human Resources for Health (HRH) Program deploys
doctors, nurses, midwives, dentists and other health professionals as a strategy in support to the attainment of
Universal Health Care. While the DOH deployed HRH and rural health based health workers are intense in
providing public health and clinical services, there is also a need to strengthen the other administrative and
managerial concerns in the rural health unit such as operational health planning, researches, disease surveillance,
staff capability building and program management. As such, the DOH has designed the Public Health Associate
Deployment Project (PHADP) which deploys Public Health Associates (PHAs) assigned in RHUs and work
alongside with other HRH focusing on the implementation of DOH programs and health plans.

PHADP is a two-year project to employ PHAs that are assigned in areas identified by the DOH, giving priority to
municipalities under the 43 provinces identified by the Department of Budget and Management as Focus
Geographical Areas. Deployment of PHAs nationwide started on 2015.

II. Objectives

The PHA Deployment Program aims to:

a. Augment the workforce in the rural health units from identified municipalities of needed public health
associates;
b. Improve performance of health systems in the Rural Health Units;
c. Provide work experience and employment for public health graduates in rural areas and underserved
communities; and
d. Enhance the competencies of the public health associates aligned with the demand in the work
environment.

III. Functions of PHAs

a. Participate in the development of health related programs and strategies;

b. Assist in the preparation of project proposals, plans, health promotion and communication materials and
other related documents;
c. Assist in the collection and validation of health related data/information; and
d. Participate in the analysis of health related data/information.
e. Assist in the encoding/updating of data/information in the established DOH information Systems.
f. Submit health reports/data/information to DOH Regional Office and Central Office.
g. Coordinate with different stakeholders for the submission of national health data reports.

IV. Minimum Qualification Standards

Education: Graduates of any four year health-related courses

V. Target Population/Client
a. All 1,634 municipalities and cities nationwide

b. National Government Priority Areas

- 44 Focus Geographical Areas (FGA) with 1,045 Municipalities
- Accelerated and Sustainable Anti-Poverty (ASAP) municipalities
- Whole Nation Initiative (WNI) municipalities
- Areas with Bottom-Up Budgeting (BuB) programs
- Geographic location and socio-economic classification of the area (GIDA, ICC/IP areas, national
priority areas
for poverty reduction)

VI. Salaries and Benefits

Salary- 19,940.00/month

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 GSIS- 500.00/year
PHIC- 200.00/month

VII. Policies and Laws

Department Memorandum No. 2015-0383

VIII. Program Accomplishments/Status

In 2015, a total of 834 PHAs were deployed nationwide.
As of May 2016, a total of 884 PHAs were deployed nationwide.

IX. Updates
Hiring of additional 928 PHAs for deployment on July to December 2016. (Refer to Department Memorandum No.
2015-0383-A)

PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH PROGRAM

Vision

The Unit shall serve as the champion of Public-Private Partnerships for the health sectors
sustainable development in universal health care, service delivery network and services for the well
and sick.

Mission

The Unit shall facilitate and optimize Public-Private Partnerships in the health sector for the
development of health infrastructure and services.

Core Values

Professionalism

We commit to demonstrate values of altruism, efficiency, accountability, competence, ethics and respect in the
promotion of health financing through PPP.

Passion for health service excellence

We adhere to extend relevant, timely and efficient support services in managing PPP projects for health.

Pro-active

We intend to initiate PPP projects that are accessible, appropriate and responsive with the health care needs of the
people.

Humanistic

We dedicate to implement PPP projects that would contribute towards the enhancement of Filipinos state of health
and well-being.

Objectives

Develop and integrate in the over-all PPP effort, incentives, which are aligned with both
departmental goals and expected health outcomes;

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 Promote and provide a focused approach that harmonizes existing PPP applicable legal and
administrative mandates as well as internal strategies and procedures;
Prioritize PPPs that meet national and local government objectives of addressing adequately the
health service needs of the poor;
Foster a culture of transparency, fairness and robust competition; and
Continually assess the collective experiences on PPPs in the health sector so as to be able to adapt
public policies and approaches to new developments and needs to sustain accessibility to quality
healthcare.

Program Services

Channeling of health-related investments

Concept planning in PPPs for Health
Assistance in project development financing
Project processing
PPP capacity building services
PPP knowledge management services

Stakeholders/Beneficiaries

Public healthcare facilities

National and local government agencies
Healthcare personnel
Healthcare clients
Bilateral/ Multi-lateral financial institutions

Partner Organizations and Agencies/ Networks:

Department of Trade and Industry - Board of Investments (DTI-BOI)

National Economic Development Authority (NEDA)
Public Private Partnership Center (PPPC)
World Bank-International Finance Corporation (WB-IFC)
Japan International Cooperating Agency (JICA)
Asian Development Bank (ADB)
United States Agency for International Development- Health Policy Development Program
(USAID-HPDP)
NEWBORN SCREENING PROGRAM

DESCRIPTION

Newborn screening (NBS) is an essential public health strategy that enables the early detection and management of
several congenital metabolic disorders, which if left untreated, may lead to mental retardation and/or death. Early
diagnosis and initiation of treatment, along with appropriate long-term care help ensure normal growth and
development of the affected individual. It has been an integral part of routine newborn care in most developed
countries for five decades, either as a health directive or mandated by law. In the Philippines, it is a service
available since 1996.

VISION

The National Comprehensive Newborn Screening System envision all Filipino child will be born healthy and well,
with an inherent right to life, endowed with human dignity; and Reaching her/his full potential with the right
opportunities and accessible resources.

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 MISSION

To ensure that all Filipino children will have access to and avail of total quality care for the optimal growth and
development of their full potential.

GOAL

By year 2025, all Filipino newborns are screened for the more common and life-threatening congenital metabolic
disorders

PROGRAM COMPONENTS

Operations / Systems and Network; Service Delivery; Strengthen health promotion/Alliance building for ENBS;
Efficient data management; Monitoring and Evaluation; Financing Scheme

TARGET POPULATION

Filipino newborns

AREA OF COVERAGE

Nationwide

PARTNER INSTITUTIONS

The following institutions/units and bodies are the primary partners of DOH-Family Health Office at the national
level to ensure that appropriate policies, standards, logistics and technical assistance are available to all
implementing units:

National Technical Working Group for Newborn Screening (NTWG- NBS)

National Institutes of Health (NIH)

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 Newborn Screening Reference Center (NSRC)
Epidemiology Bureau (EB)
Health Facilities and Services Regulatory Bureau (HFSRB)
Health Facility Development Bureau (HFDB)
National Center for Health Promotion (NCHP)
NIH - Institute of Human Genetics (NIH-IHG)
Department of the Interior and Local Government (DILG)
Council for the Welfare of Children (CWC)
Philippine Health Insurance Corporation (PhilHealth)

POLICIES AND LAWS

RA 9288 or the Newborn Screening Act of 2004 and DOH AO No. 2014-0045 or the Guidelines on the
Implementation of the Expanded Newborn Screening Program

STRATEGIES ACTION POINTS AND HIGHLIGHTS

1. Operations/ Systems/ Network

Expanded Newborn Screening (eNBS) has been made available since December of 2014.
This panel now covers more disorders to be tested (endocrinology, hemoglobinopathies,
metabolic). Recognizing that eNBS is more beneficial for newborns, the program looks
forward to the full transition from the NBS 6-test to eNBS by 2018. This will ensure the
continuity and sustainability of quality testing and follow-up service to newborns in the
country.
Development of a reference laboratory for confirmation of metabolic disorders.
Establishment of a treatment/referral network and other components necessary for the
efficient implementation of the program.
Increase in the number of G6PD confirmatory centers, ideally one center per province.
Today, a total 25 G6PD laboratory are established.
Establishment of additional Newborn Screening Centers (NSCs) in strategic areas in the
country (Region 7, Bicol Region, Southern Mindanao) in the next 4 years. The timing of the
opening of the NSCs is dependent on the volume of samples from the catchment area of the
proposed sites. NSC in Northern Luzon was opened on May 2017.
Upgrading of Newborn Screening National Laboratory Information Systems

2. Treatment and Management

Identification of regional NBS follow-up clinics to handle the long term follow up of
confirmed patients. Today, there are 14 Continuity Clinics nationwide.
Undertake collaborations with medical subspecialty organizations (e.g. pediatric
hematology, neonatology and pediatric endocrinology) critical in the proper and
standardized referral and management of positive cases, in line with the expansion of
screening.
Conduct of Monthly Case Audits among NSCs to ensure that babies with positive screens
are provided with prompt and appropriate management essential for preventing debilitating
consequences of the disorders being screened. The Case Audits are attended by the NSC
Follow-up Teams and the adviser of the Newborn Screening National Follow-up Committee
(NNSFC) chair, and presided by the National Follow-up Coordinator.
Facilitate provision of scholarships to new MS Genetics Counseling students. These
prospective graduates are expected to respond to the counseling need of the patients and
their families who will be identified positive by the program.
Support fellows-in-training in the fields of Pediatric Endocrinology and Clinical Genetics at
the Philippine General Hospital

3. Financing

Currently, PHIC is funding the basic screening of six disorders for P550 for its members.
The expanded newborn screening costs P1500 and remains as an option to parents, wherein
PhP 550 is covered by PHIC and the remaining PhP 950 as an out of pocket expense of the
family. Discussions with PHIC for possible full coverage of expanded newborn screening is

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 ongoing. The successful transition from the NBS 6-test to eNBS is dependent on the
financing capacity of the program to implement eNBS in full.

4. Advocacy/ Promotion/ Linkages

Inclusion of NBS in the assessment criteria of performance-based grants (e.g. those in

scorecards) to serve as leverage for the LGUs to make sure all their MCP accredited
facilities are performing NBS package.
Incorporation of NBS in pre-natal education
Inclusion of NBS in curricula for public health, medical, nursing, midwifery, and law
schools
Development of expanded newborn screening IECs for various audiences

5. Program Monitoring and Evaluation

DOH and DILG to continue program monitoring of strict implementation of the Law and the
IRR and strengthen the capacity of the NSRC, ROs and LGUs in regulatory and monitoring
aspects.
The DOH and program implementers to remain aggressive in identifying strategies to
intensify awareness in the communities and increase coverage among home deliveries

6. Capability Building

The Regional Offices will continuously provide capability building activities to increase the
knowledge of the health professionals included in the Womens Health Teams or Barangay
Health Teams on the importance of NBS and help empower parents to plan and prepare for
the cost of having their baby undergo newborn screening.

PROGRAM ACCOMPLISHMENT STATUS

Today, the Department of Health and partnering stakeholders remain aggressive in its efforts to push the numbers of
screened babies upward across the nation and to ensure quality standards in the implementation of the National
Comprehensive Newborn Screening System (NCNBSS).

Table 1 summarizes the phases and milestones of the Newborn Screening program in the country.

February 22, 1996 First organizational meeting attended by representatives from different PPS and POGS accredited hospitals in Metro Ma

April 02, 1996 Creation of the NBS Study group composed of Pediatric and OB-Gynecology consultants from participating hospitals. P

June 27, 1996 Commencement of the Philippine Newborn Screening Project in 24 participating hospitals (18 private and 6 government

June 1996 September 1997 Coordination with the New South Wales Newborn Screening Program in Australia for test performance and analysis

September 18, 1997 Start of operation of the Newborn Screening Laboratory at the National Institutes of Health, UP Manila
Inclusion of the Newborn Screening Program in Child Health 2025, a planning framework on childrens health of the De
March 1999
for all Filipino children by the year 2025
Creation of the Inter-agency Task Force on Newborn Screening composed of representatives from DOH as Chair, Institu
July 30, 1999
DILG, midwives association, and other health groups
January 03, 2000 Issuance of Administrative Order # 1-A s 2000 by the Department of Health stating the Policies for the Nationwide Impl

July 19, 2000 Newborn Screening Study Group declared as Outstanding Health Research Awardee (OHRA) by the Philippine Council
Issuance of Department Order No. 29-C s 2001 by DOH, Subject: Creation of the National Technical Working Group o
February 07, 2001 Prevention and Control. The group was tasked to provide direction and guidance for the nationwide implementation of
by DPO 2005-1660 to reconstitute the NTWG membership
February 21, 2003 First National Awarding Ceremonies for the Outstanding Achievers in the Implementation of Newborn Screening sponso
Canadian International Development Agency (CIDA) awards a financial grant to the Institute of Human Genetics to inte
May 01, 2003
Regions 4, 6, 10, with funds allocated for the writing of a Manual of Operations for newborn screening

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December 09, 2003 Issuance of DOH Administrative Order No 121, s 2003, Subject: Strengthening Implementation of the National Newbo

January 20, 2004 Issuance of the Presidential Proclamation No. 540, Subject: Declaring the First Week of October of each year as Natio

April 07, 2004 Enactment of Republic Act 9288 known as the Newborn Screening Act of 2004

October 07, 2004 Signing of the Implementing Rules and Regulations of the Newborn Screening Act

December 02, 2005 Opening of the 2nd Newborn Screening Center in Visayas at West Visayas State University Medical Center

January 22, 2006 Inclusion of NBS in the licensing requirement of Philippine hospitals; 90% of NBS fee covered by national health insura

January 02, 2007 Opening of Scholarships for Genetics and Endocrinology for regions without specialists

December 2007 Inclusion of Newborn Screening in the PhilHealth Newborn Care Package (NCP)

June 12, 2008 Issuance of DOH Memo No. 2009 0123 imposing the following targets: 30% - 2008, 50% - 2009 and 85% by 2010

June 28, 2008 Creation of the NTWG Panel of Expert Committee

August 08, 2008 Issuance of AO No. 2008 0026 and 2008 - 0026A by DOH imposing penalties for non-implementation and/or overpric

May 20, 2009 Setting up of additional G6PD Confirmatory Centers

July 7, 2009 Creation of the National Newborn Screening Follow-up Committee (NNSFC)

October 5, 2009 Opening of the 3rd Newborn Screening Center in Mindanao at the Southern Philippines Medical Center (formerly Davao

October 2010 Opening of the 4th Newborn Screening Center at the Angeles University Foundation Medical Center Central Luzon

February 2011 Creation of the Committee on Storage, Use and Disposal of the Residual Dried Blood Spots (DBS)

June 2011 Initial offering of the MS Genetic Counseling Program by the Philippine General Hospital (PGH) Department of Pedia

January 2012 Inclusion of Maple Syrup Urine Disease (MSUD) in the NBS Panel of Disorders

September 2013 Opening of the 5th NSC in Region 4A (CALABARZON) at Daniel O. Mercado Medical Center in Tanauan City, Batang

May 2014 Setting up of Continuity Clinics in different parts of the Country

December 2014 Expanded Newborn Screening inclusion of more than 20+ disorders in the NBS Panel of Disorders

May 2017 Opening of the 6th NSC in Northern Luzon at the Mariano Marcos Memorial Hospital and Medical Center

Table 1. Milestones in the History of Newborn Screening in the Philippines

STATISTICS AND REPORTS

NBS program has grew from one to six (6) operational Newborn Screening Centers (NSC); from 24 pilot hospitals
to 6,411 Newborn Screening Facilities (NSFs), of which 1,337 health facilities are offering the expanded newborn
screening services; from one to twenty-five (25) G6PD Confirmatory Centers; and now with 14 continuity clinics
for the long term management of patients.

RABIES PREVENTION AND CONTROL PROGRAM

Rabies is a human infection that occurs after a transdermal bite or scratch by an infected animal, like dogs and cats.
It can be transmitted when infectious material, usually saliva, comes into direct contact with a victims fresh skin
lesions. Rabies may also occur, though in very rare cases, through inhalation of 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

73
 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.

4. Advocacy

The rabies awareness and advocacy campaign is a year-round activity highlighted on two occasions
March as the Rabies Awareness Month and September 28 as the World Rabies Day.

5. Training/Capability Building

Medical doctors and Registered Nurses are to be trained on the guidelines on managing a victim.

6. Establishment of ABTCs by Inter-Local Health Zone

Rabies Facilities (NARIS website)

Private Animal Bite Centers

Public Animal Bite Centers
Regional Diagnostic Centers

7. DOH-DA joint evaluation and declaration of Rabies-free islands

Program Achievements:

The DOH, together with the partner organizations/agencies, has already developed the guidelines for managing
rabies exposures. With the implementation of the program strategies, five islands were already declared to be
rabies-free.

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 In 2015, 217 rabies cases and 783,879 animal bites or rabies exposures were reported. A total of 486 ABTCs were
established and strategically located all over the country. Post Exposure Prophylaxis against rabies was provided in
all the 486 ABTCs.

Partner Organizations/Agencies:

The following organizations/agencies take part in attaining the goal of the National Rabies Prevention and Control
Program:

Department of Agriculture (DA)

Department of Education (DepEd)
Department of Interior and Local Government (DILG)
World Health Organization (WHO)
Animal Welfare Coalition (AWC)
BMGF Foundation
WHO/BMGF Rabies Elimination Project
1. Bill and Melinda Gates Foundation
2. World Society for the Protection of Animals (WSPA)
3. Medical Research Council (MRC)
SAFE MOTHERHOOD PROGRAM

Contact Person:
Zenaida Dy Recidoro, RN, MPH
Telephone Nos.:
651-7800 loc. 1727-1730
The Philippines has committed to the Unites States millennium declaration that translated into a roadmap
a set of goals that targets reduction of poverty, hunger, and ill health. In the light of this government
commitment, the Department of Health is faced with a challenge: to champion the cause of women and
children towards achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat
HIV/AIDS, malaria and other diseases). Pregnancy and childbirth are among the leading causes for 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 Safe Motherhood Program 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 facilities nearest to homes. This move ensures that those most in need of
quality health care by competent doctors, nurses and midwives have easy access to such care.

Program Objectives

The program contributes to the national goal of improving womens health by:

1. Collaborating with Local Government Units in establishing sustainable, cost-effective approach of

delivering health services that ensure access of disadvantaged women to acceptable and high quality
maternal and newborn health services and enable them to safely give birth in health facilities.

2. Establishing core knowledge base and support systems that facilitate the delivery of quality maternal
and newborn health services with special focus in the upgrade of facilities designated to provide
emergency obstetrics and newborn care within the Kalusugan Pangkalahatan framework.

Program Components

Component A: Local Delivery of the Maternal- Newborn Service Package

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 This Component supports LGUs in mobilizing networks of public and private providers to deliver the
integrated maternal-newborn service package. In each province and city, the following are currently being
undertaken.

1. Establishment of critical capacities to provide quality maternal-newborn services through the

organization and operation of a network of Service of Delivery Teams consisting of:

a. Womens/ Community Health Teams

b. BEmONC Teams

c. CEmONC Teams

2. Establishment of Reliable Sustainable Support Systems for Maternal-Newborn Service Delivery

through such initiatives as:

a. Essential BemONC Drugs and Supplies and Contraceptive Security

b. Establishment of Safe Blood Supply Network in collaboration with the National Voluntary Blood
Program

c. Behaviour Change Interventions

d. Sustainable financing of local maternal-newborn services and commodities through locally initiated
revenue generation and retention activities.

Component B: National Capacity to sustain Maternal-Newborn services

1. Operational and Regulatory Guidelines

a. Manual of operation

b. Referral manual

c. Essential care practice guide for pregnancy, childbirth, postpartum and newborn care (BEmONC
Protocol)

d. CEmONC curriculum and protocol for service delivery

e. Maternal death reporting and review protocol

f. Issuance of relevant policies

2. Network of Training Providers

a. Currently, 29 training centers that provide BEmONC skills training are operating in the country.

3. Monitoring, Evaluation, Research and Dissemination

II. INTERVENTIONS AND STRATEGIES EMPLOYED

The Department of Health through the National Safe Motherhood Program introduces strategies to
address critical reproductive health concerns ( maternal and newborn health, adolescent health, family
planning and STI prevention) while confronting both demand and supply side obstacle to access for
disadvantaged women of reproductive age. Among the changes, the following have been systematically
mainstreamed into the safe motherhood service delivery network:

Strategic Change in the Design of Safe Motherhood Services

These changes involve (1) 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 and the inter-local health zones or the Local Health Area
Development Zones; (2) improved quality of FP counselling 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 antenatal care and Family planning protocols.

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 An Integrated Package of Womens Health and Safe Motherhood Services

The above changes in the delivery also involved a shift from centrally controlled national programs (MC,
FP, STI and AH) operating separately and governed system that delivers an integrated womens health and
safe motherhood service package. This service delivery strategy is focused on maximizing synergies
among key services that influence maternal and newborn health and on ensuring a continuum of care
across levels of the referral system.

Reliable Sustainable Support Systems

Support systems for Maternal-Newborn service delivery include systems for (1) drug and contraceptive
security, through a strategy of contraceptive self reliance (2) safe blood supply; (3) stakeholder behaviour
change, through a combination of advocacy and communication; (4) sustainable financing, through a
diversification of funding sources, principally driven by the development of client classification scheme
so that the poor gets public subsidies and the non-poor are charged user fees.

Stronger Stewardship and Guidance from the DOH Program Managers

DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on
maternal-newborn services (2) a system for accrediting providers of emergency obstetrics and newborn
care (BEmONC and CEmONC) training program and (3) monitoring, evaluation and research on the
maternal;-newborn strategies.

III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS

As of December 2012, the program accomplishment is 65%. This accomplishment is based on the
accomplishments vis-a-vis the targets of the programs of 3 indicators. These are: antenatal care, facility-
based delivery and post-natal care. The 2012 target for all indictors is 70%. The below target
accomplishments is brought about by the low post-natal coverage of 52%. Among the operations issues
that delays accomplishments of critical inputs relates to procurement and other external factors such as
LGU organizational structures and priorities.

IV. PLANS FOR 2013

For the current year, the program hopes to pursue the completion of sustainable support systems to ensure
the delivery of quality maternal-newborn health service package by the local health system. The following
have been planned for implementation:

1. Development of Guidelines on EmONC training and amendment the policy on BEmONC training
fees.

2. Development of the BemONC Module for Midwives and pursue the submission of its final version.

3. Development of a mechanism for EmONC Post Training Evaluation and supportive supervision of
BEmONC Teams.

4. Collaborate with Training Centers on the conduct of BEmONC and CEmONC Skills Training.

5. Collaborate with Development Partners in the implementation of maternal-newborn initiative in

selected sites.

6. Monitor and evaluate program targets accomplishments and compliance to program protocols

a. Maternal Death Reporting and Review

b. Training on Emergency Obstetrics and Newborn Care

c. BemONC provision BEmONC provision assessment

OTHER SIGNIFICANT INFORMATION

The program participated in the multi-country survey on Maternal and Newborn Near-Miss Cases
organized by the Reproductive Health Research Unit of WHO HQ and with the Program Manager as
country coordinator. The study was published in the Lancet in its May 18, 2013 issue: Moving beyond
essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal
and Newborn Health): a cross-sectional study.

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 SCHISTOSOMIASIS CONTROL PROGRAM

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

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

Objectives:

The Schistosomiasis control Program has the following objectives:

1. Reduce the Prevalence Rate by 50% in endemic provinces; and

2. Increase the coverage of mass treatment of population in endemic provinces.

Program Strategies:

The Schistosomiasis Control Program employs the following key interventions:

1. Morbidity control: Mass Treatment

2. Infection control: Active Surveillance

3. Surveillance of School Children

4. Transmission Control

5. Advocacy and Promotion

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

SMOKING CESSATION PROGRAM

Rationale:

78
 The use of tobacco continues to be a major cause of health problems worldwide. There is currently an estimated 1.3
billion smokers in the world, with 4.9 million people dying because of tobacco use in a year. If this trend
continues, the number of deaths will increase to 10 million by the year 2020, 70% of which will be coming from
countries like the Philippines. (The Role of Health Professionals in Tobacco Control, WHO, 2005)

The World Health Organization released a document in 2003 entitled Policy Recommendations for Smoking
Cessation and Treatment of Tobacco Dependence. This document very clearly stated that as current statistics
indicate, it will not be possible to reduce tobacco related deaths over the next 30-50 years unless adult smokers are
encouraged to quit. Also, because of the addictiveness of tobacco products, many tobacco users will need support
in quitting. Population survey reports showed that approximately one third of smokers attempt to quit each year
and that majority of these attempts are undertaken without help. However, only a small percentage of cigarette
smokers (1-3%) achieve lasting abstinence, which is at least 12 months of abstinence from smoking, using will
power alone (Fiore et al 2000) as cited by the above policy paper.

The policy paper also stated that support for smoking cessation or treatment of tobacco dependence refers to a
range of techniques including motivation, advise and guidance, counseling, telephone and internet support, and
appropriate pharmaceutical aids all of which aim to encourage and help tobacco users to stop using tobacco and to
avoid subsequent relapse. Evidence has shown that cessation is the only intervention with the potential to reduce
tobacco-related mortality in the short and medium term and therefore should be part of an overall comprehensive
tobacco-control policy of any country.

The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH, Philippines GATS Country Report, March
16, 2010) revealed that 28.3% (17.3 million) of the population aged 15 years old and over currently smoke tobacco,
47.7% (14.6 million) of whom are men, while 9.0% (2.8 million) are women. Eighty percent of these current
smokers are daily smokers with men and women smoking an average of 11.3 and 7 sticks of cigarettes per day
respectively.

The survey also revealed that among ever daily smokers, 21.5% have quit smoking. Among those who smoked in
the last 12 months, 47.8% made a quit attempt, 12.3% stated they used counseling and or advise as their cessation
method, but only 4.5% successfully quit. Among current cigarette smokers, 60.6% stated they are interested in
quitting, translating to around 10 million Filipinos needing help to quit smoking as of the moment. The above
scenario dictates the great need to build the capacity of health workers to help smokers quit smoking, thus the need
for the Department of Health to set up a national infrastructure to help smokers quit smoking.

The national smoking infrastructure is mandated by the Tobacco Regulations Act which orders the Department of
Health to set up withdrawal clinics. As such DOH Administrative Order No. 122 s. 2003 titled The Smoking
Cessation Program to support the National Tobacco Control and Healthy Lifestyle Program allowed the setting up
of the National Smoking Cessation Program.

Vision: Reduced prevalence of smoking and minimizing smoking-related health risks.

Mission: To establish a national smoking cessation program (NSCP).

Objectives:

The program aims to:

1. Promote and advocate smoking cessation in the Philippines; and

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

Program Components:

The NSCP shall have the following components:

1. Training

79
 The NSCP training committee shall define, review, and regularly recommend training programs that are consistent
with the good clinical practices approved by specialty associations and the in line with the rules and regulations of
the DOH.

All DOH health personnel, local government units (LGUs), selected schools, industrial and other government
health practitioners must be trained on the policies and guidelines on smoking cessation.

2. Advocacy

A smoke-free environment (SFE) shall be maintained in DOH and participating non-DOH facilities, offices,
attached agencies, and retained hospitals. DOH officials, staff, and employees, together with the officials of
participating non-DOH offices, shall participate in the observance and celebration of the World No Tobacco Day
(WNTD) every 31st of May and the World No Tobacco Month every June.

3. Health Education

Through health education, smokers shall be assisted to quit their habit and their immediate family members shall be
empowered to assist and facilitate the smoking cessation process.

4. Smoking Cessation Services

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

LEVEL OF
STAFFING Intervention Package DRUGS/MEDS EQUIPMENTS
CARE
Risk
assessment/
Risk screening
(Note: Use Risk
Assessment
Form)
Assess for Risk
Tobacco Use Assessment
Tool
PRIMARY If smoker, do
Brief Quit
LEVEL Contract
BHW Intervension
I. Barangay None
RM Advice (5 A's)
Health
Station See Attached
Protocol
If non- Referral
smoker, Form
Congratulate
and advice
continue
Healthy
Lifestyle
activity

80
 Above Plus

Quit Clinic

(Use DOH Protocol or other

suggested protocols e.g.
Motivational Interview, Patient Assessment Tool:
SDA Protocol, etc. as
available) Stages of
change
DOH WHO
Protocol Mental Health
provides: Checklist
Assessment Motivation
of client's and Confidence
PRIMARY Smoking to quit
LEVEL History, Current Smoking
Smoking Status Use
History and
and Readiness of
II. RHU Current
to stop smoking Nicotine
Smoking Status
Replace
Planning for Self-test for
ment
Above Plus clients reason for
therapy
Readiness to smoking
particul
SECONDARY Nurses Doctor stop smoking (Horn's
s and other arly
LEVEL Quit day: Nicotine Smoker's Selt-
health Pharmacologic, test)
personnel patch
Psychological and Fagerstrom
and Behavioral Nicotine Nicotine
Interventions Gum is Dependencetest
advocat Self-test on
TERTIARY - Identifying and address ed Readiness to
LEVEL triggers for going back into stop smoking
smoking Previous
attempts to stop
- Dealing with cravings to smoking
smoke
Form:
- Managing withdrawal
syndromes Quit
Contract
Monitoring
and Prevention
of Relapse

Quit Lines

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.

VIOLENCE AND INJURY PREVENTION PROGRAM

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 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 20112020 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,
contact 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 Administrative 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 2014-0002 Revised National Policy on Violence and Injury Prevention which serves as the
overarching Administrative Order of different policies concerning violence and injuries and shall include the
service delivery mechanism and the well-defined 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

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 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.

VIP Program Objectives

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 Multi-disciplinary 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, 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.

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.

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 support, and multi-sectoral action on violence
and injury prevention. Appropriate interventions at all levels of prevention shall be crucially provided.

G. Six (6) Es. Strategies shall utilize the concept of the six Es (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;

83
 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 support 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 pre-hospital trauma
life support 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 feedback
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 injury-related 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 feedback.

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 support 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 members include more than twenty inter-agencies and multi-
sectoral organizations.

Program Management Committee (PMC)

The PMC shall provide direction and technical support 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

84
 program. It shall be chaired by the Director IV of the Disease Prevention and Control Bureau (DPCB) with the
following members:

a) Chief of the Essential Non-Communicable Disease Division

b) National Focal Person (Program Manager) of VIPP

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

Philippine National Police.

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

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

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

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.

PMC shall have the following functions:

a) Recommend to the Secretary of Health VIPP-related plans, programs, strategies and

activities

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

responsive community-based VIPP

c) Ensure the collection and analysis of violence- and injury-related data

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

Injury Prevention Alliance (VIPA)

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

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

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

knowledge management areas as well as evaluate them

h) Others that may be identified and approved by the Secretary of Health

WOMEN AND CHILDREN PROTECTION PROGRAM

I. BACKGROUND AND RATIONALE

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 The Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos embodied in Administrative
Order No. 2010-0036, dated December 16, 2010 states that poor Filipino families have yet to experience equity
and access to critical health services. A.0. 2010-0036 further recognizes that the public hospitals and health
facilities have suffered neglect due to the inadequacy of health budgets in terms of support for upgrading to expand
capacity and improve quality of services.

AHA also states the poorest of the population are the main users of government health facilities. This means that
the deterioration and poor quality of many government health facilities is particularly disadvantageous to the poor
who needs the services the most.

In 1997, Administrative Order 1-B or the Establishment of a Women and Children Protection Unit in All
Department of Health (DOH) Hospitals was promulgated in response to the increasing number of women and
children who consult due to violence, rape, incest, and other related cases.

Since A.O. 1-B was issued, the partnership among the Department of Health (DOH), University of the
Philippines Manila, the Child Protection Network Foundation, several local government units, development
partners and other agencies resulted in the establishment of women and child protection units (WCPUs) in DOH-
retained and Local Government Unit (LGU) -supported hospitals. As of 2011, there are 38 working WCPUs in 25
provinces of the country. For the past years, there have been attempts to increase the number of WCPUs especially
in DOH-retained hospitals but they have been unsuccessful for many reasons.

The experience of these 38 women and children protection units reflect that:

1. Over the last 7 years from 2004 to 2010, all these WCPUs handled an average of 6,224 new cases with a
mean increase of 156 percent. The 2010 statistics presented a record high of 12,787 new cases and an
average of 79.86 percent increase from 2009. More than 59 percent were cases of sexual abuse; more than
37 percent were physical abuse and the rest on neglect, combined sexual and physical abuse and minor
perpetrators. More than 50 percent of these new cases were obtained from WCPUs based in highly
urbanized areas across the country. Figures show there is a need to continue to raise awareness on
domestic violence to have more accurate recording and reporting;
2. The National Demographic and Health Survey of 2008 reveals that one in five women aged 15-49 are
physically abused and one out of 10 of the same age group are sexually abused. This figure runs into
millions of abused women nationwide who do not seek any help or assistance;
3. A consistent and adequate budget is necessary to sustain a women and children protection unit once it is
established;
4. The source of budget cited in A.O. 1-B is subjected to multiple interpretations and is dependent on the
priorities of the local chief executive and/or the healthcare facility management;
5. There is no standard quality of service;
6. Doctors and social workers are reluctant to take on the task due to heavy workload of women and child
protection work, lack of training and feeling of inadequacy, and the nature of work, which among others
requires responding to subpoenas and appearing in court;
7. All the WCPUs are being managed by part-time personnel who are given add-on responsibilities and their
appointments are not classified as regular plantilla positions;
8. Women and child protection work is a new field and a pool of professionals must be recruited and trained
to sustain the work; and
9. Women and children protection work has gone beyond being a health advocacy to becoming an essential
health service addressing the needs of victims of violence against women and children.

The strategies espoused by the AHA, specifically the service delivery network (SDN) and public-private
partnership (PPP), will be utilized in the institutionalization of the women and children protection program
nationwide. A health SDN is composed of a network of health service providers at different levels of care from
levels 1: health centers or women and childrens desks offering primary services, 2: district health facilities offering
secondary care and 3: regional and national hospitals with tertiary care. An SDN can be as small as an Inter-Local
Health Zone or as large as a regional SDN with a regional hospital serving as the end-referral hospital. The most
efficient system for women and child protection facilities follows the SDN model where a complete and integrated
women and child protection unit is located in a strategic hospital.

The primary goal is to identify where the women and children protection units will be located across the
country and to ensure that there will be at least one in each province. Hospitals, whether public or private, which do
not have a women and child protection unit may be trained to refer the victims to women and children protection
coordinators (WCPCs) and WCPUs in other hospitals where the staff is trained in recognizing, recording, reporting
and referring abuse cases. This will ensure that all women and children victims of violence who seek medical care
have access to health services provided by trained, competent, and caring health personnel.

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 II. GOALS AND OBJECTIVES

GOAL: To institutionalize and standardize the quality of service and training of all women and children protection
units.

GENERAL OBJECTIVES:

1. Establish at least one women and children protection unit in every province;

2. Ensure that all health facilities have competent and trained gender-responsive professionals who will coordinate
the services needed by women and children victims of violence;

3. Standardize and maintain the quality of health care services rendered by all women and children protection
units;

4. Ensure the sustainability of women and childrens protection unit programs through appropriate organizational
and budgetary support;

5. Create and maintain a centralized and harmonized database for all reports submitted by the different women
and children protection units.

III. SCOPE AND COVERAGE

This issuance shall apply to the entire health sector, including the DOH hospitals, LGU-supported health
facilities, private hospitals, and other attached agencies involved in the implementation of the AHA.

Health professionals from private hospitals seeing patients who they suspect are victims of abuse are duty-
bound to refer the said individuals to concerned government agencies for appropriate response in accord with either
Republic Act Nos. 7610 [1] or 9262[2].

IV. DECLARATION OF POLICY

This issuance supports the Government Health Reform Agenda, the Convention on the Rights of the Child, the
Convention on the Elimination of All Forms of Discrimination Against Women, the Beijing Platform for Action, the
Child Protection Law,[3] the Anti-Violence Against Women and Their Childrens Act of 2004,[4] Anti-Rape Act of
1998,[5] the Rape Victim Assistance and Protection Act of 1998[6], and the Magna Carta of Women (2009).[7]

The DOH shall thereby contribute to the realization of the countrys goal of eliminating all forms of gender-based
violence and promoting social justice.[8]

V. GUIDING PRINCIPLES

This issuance is governed by the following principles:

1. Rights-based approach. Identification and treatment of violence against women and children is anchored on
respect for and recognition of the rights of women and children as mandated by the Philippine Constitution, the
Convention on the Elimination of All Forms of Discrimination Against Women, the Convention on the Rights of
the Child, and the Beijing Platform for Action.

2. Best interest of the child. All actions concerning victims of abuse, neglect, and maltreatment shall take full
account of the childrens best interests. All decisions regarding children shall be based upon the needs of individual
children, taking into account their development and evolving capacities so that their welfare is of paramount
importance. This necessitates careful consideration of the childrens physical, emotional/psychological,
developmental and spiritual needs. Adequate care shall be provided by multidisciplinary child protection teams
when the parents and/or guardians fail to do so. In cases whether there is doubt or conflict, the principle of the best
interest of the child shall prevail.

3. Holistic service delivery. Care focused on the whole person addressing the bio-medical, psycho-social, and
legal concerns.

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 4. Respect for diversity and non-discrimination. Holistic and appropriate health care delivered shall be coupled
with respect for cultural, religious, developmental (including special needs), gender and sexual orientation, and
socio-economic diversity. All women and children victims of violence shall have a right to receive medical
treatment, care, and psycho-social interventions.

5. Evidence-based interventions and approaches. Policies and guidelines shall be developed in accordance with
recent data gathered through prevalence surveys, efficacy studies, and other research done locally and
internationally. Recommendations from international organizations may also be utilized when appropriate.

6. Multidisciplinary approach. Recognition, reporting, and care management of cases involving violence against
women and children are be best achieved through medical, psycho-social, and legal teamwork including the mental
health intervention and local government unit response and cooperation, whenever necessary.

VI. IMPLEMENTING RULES AND GUIDELINES

1. Committee on Women and Children Protection Program. The Committee on Women and Children Protection
Program, hereinafter referred to as the Committee, shall be primarily responsible for policymaking, coordinating,
monitoring, and overseeing the implementation of this revised issuance.

2. Composition. - The Committee shall be composed of the following:

a. Undersecretary of Health Service Delivery as ex officio Chairperson;

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

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

d. A regional director of the Department of Health;

e. A hospital director of a DOH-retained hospital;

f. Executive Director of the Philippine Commission for Women;

g. Executive Director of the Council for the Welfare of Children;

h. Executive Director of the Child Protection Network Foundation;

i. One representative each from the Philippine Pediatrics Society, the Philippine Obstetrics and Gynecological
Society, Inc., the Philippine Psychiatric Association, the Philippine Psychological Association, the Philippine
College of Emergency Medicine, the Philippine College of Surgeons, and the Philippine Academy of Family
Physicians, Inc.

The Chairperson shall appoint a Vice-Chair from among the Committee members who shall preside over the
meeting in the formers absence.

The Committee shall designate from among its members a program manager who will be given appointment
by the Undersecretary of Health through a Department Personnel Order.

The Committee may create a technical working group, as the need arises, to help it in the performance of its
functions.

3. Term. The Committee shall hold office for three (3) years and may be reappointed or until their successors
shall have been appointed.

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

1. Identify and recommend strategically-located DOH-retained and LGU-supported hospitals for WCPU
establishment using geographical and population ratio criteria;

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

5. Reportorial Functions. The Committee shall submit to the Office of the Secretary of Health its annual report
on policies, plans, programs and activities on or before the last working day of February.

6. Meetings. The Committee shall meet regularly at least once every quarter. The venue shall be agreed upon by
the members. Special meetings may be requested by the Chairperson or any Committee member, as the need arises.

The Committee members and program manager shall be entitled to an honorarium for every meeting.

VII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES

A. Department of Health at the National Level

1. The Committee shall be under the direct supervision of the Office of the Undersecretary for Health
Services Delivery.
2. The specific office/s to be designated by the Undersecretary for Health Services Delivery shall be
primarily responsible for:

a. The overall execution of the revised policy and manual of operations on Women and Children Protection
Program;

b. Accreditation of WCPUs;

c. Generation mobilization of resources for the operations of WCPUs.

B. Philippine Health Insurance Office (PhilHealth)

The PhilHealth shall develop a service package for all WCPU patients that will facilitate the provision of inpatient
and outpatient services.

C. Centers for Health Development

1. Disseminate the policy for adoption and implementation by LGU health systems in the different localities
within their respective regions;
2. Provide technical assistance to LGUs in organizing WCPU activities and developing relevant technical
references and information, education and communication (IEC) materials;
3. Generate resources to strengthen the implementation of the policy and manual of operations for WCPUs;
4. Formulate and implement advocacy plans to generate stakeholders support, particularly the local
officials;
5. Monitor the implementation of the policy and guidelines in both public and private hospitals, and in
different localities in their respective regions;
6. Undertake regular review with LGUs on the progress of the WCPU policy and guidelines.

D. Local Government Units

1. Provincial / City Health Office

a. Train private and public health workers on the women and children protection program;

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 b. Advocate with municipalities/cities and other concerned agencies and stakeholders to adopt and implement the
revised policy on the women and children protection program;

c. Generate and allocate resources in support of WCPU provision (e.g., counterpart funds for training,
procurement of additional WCPUs, etc);

d. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their
treatment and care protocols.

2. Regional and provincial hospitals

a. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their
treatment and care protocols;

a. Allocate budget sufficient for the operations of WCPUs;

b. Conduct training and orientation on 4Rs;

c. Maintain an accurate and complete database on WCPU clients.

D. Child Protection Network Foundation, Inc.

1. Provide expertise and technical support for the establishment of WCPUs and the central database on
childrens cases;
2. Extend guidance to the trained physicians and social workers in WCPUs;
3. Coordinate with the Philippine Commission for Women, Council for the Welfare of Children and non-
government organizations (NGOs) regarding matters related to womens and childrens health and gender
concerns;
4. Participate in the implementation of the WCPU policy including its manual of operations.

E. Philippine Commission on Women

1. Provide expertise and technical assistance on gender-responsive delivery of services by the WCPU service
providers and the central database on womens cases;
2. Assist the DOH in monitoring the implementation of the WCPU using the Performance Standards and
Assessment Tools for Services Addressing VAW in the Philippines;
3. Require all hospitals to allocate from their gender and development (GAD) budget the funds required to
create, operate, and maintain WCPUs and to report the use of their GAD funds to PCW.

VIII. REQUIREMENTS FOR THE ESTABLISHMENT OF WOMEN AND CHILDREN PROTECTION

UNITS

The Committee shall ensure that all present and future WCPUs comply with the criteria mandated in this revised
policy and its Manual of Operations.

All WCPUS, depending on the number of their personnel, range of services rendered, and annual budget shall be
classified as Levels I, II and III facilities. Minimum criteria for each of these units are enumerated in the Manual of
Operations of this policy.

XI. MANUAL OF OPERATIONS

The Committee on Women and Children Protection Program shall regulate the establishment and operations
of all WCPUs in the Philippines.

I. MINIMUM REQUIREMENTS FOR ALL HOSPITALS

A. Training. The Committee shall require that all hospital personnel undergo training on the recognition,
reporting, recording and referral (4Rs) of cases of violence against women and children.

B. Women and Children Protection Coordinator. Hospitals without a women and children protection unit shall
have a women and children protection coordinator (WCPC) responsible for coordinating the management and
referral of all violence against women and children cases in the hospital.

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 II. The minimum standard criteria shall be maintained by all WCPUs.

A. Organizational Structure - The WCPU shall:

1. Be an integral part of the hospital;

2. Be under the Office of the Chief of Clinics;
3. Be supervised by a WCPU head who shall have the following responsibilities:
a. Integrate and operationalize the multidisciplinary functions of the WCPU
b. Prepare the annual work and financial plan, including budget preparation,

4. Submit quarterly reports to the Office of the Undersecretary for Health Services Delivery.
5. Have the following minimum staff, preferably with regular plantilla positions, who shall be primarily
responsible to the WCPU:
a. a trained physician and
b. a trained social worker.

B. Facilities - The WCPU shall:

1. Be permanently situated in a designated area, preferably near the emergency room of the hospital;
2. Be spacious enough to accommodate all the services provided by the facility, such as:

a. A separate room for interviews and crisis counselling

b. A separate room for medical examination;
c. A reception area to accommodate those waiting to be served, including their companions. The reception
area must have culture- and gender-sensitive information materials on violence against women and children
(VAWC)
d. Filing cabinets and other furniture/equipment that will ensure the security and confidentiality of files
and records;

3. Have its own toilet or comfort room;

4. Have the following fixtures:
a. Examination table
b. Desk and chairs
c. Washing facilities with clean running water
d. Light source, and
e. Telephone line
f. Computer and printer
g. Office supplies

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

a. Digital camera
b. Rape kit
c. Speculum of different sizes
d. Blood tubes
e. Syringes, needles and sterile swabs
f. Examination gloves
g. Pregnancy testing kits
h. Microscope slides
i. Measuring devices like rulers and calipers
j. Urine specimen containers
k. Refrigerator for storage of specimens
l. Analgesics, medicines for STI prophylaxis, and emergency contraceptives
m. Labels
n. Medical forms including consent forms and anatomical diagrams
o. Colposcope (Optional)
p. Video camera for recording the forensic interview (optional)
q. Tape recorder (optional)

III. LEVELS OF CARE DELIVERED BY WCPUs

A. Level I WCPU

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 1. Personnel

A trained physician, and

A trained and registered social worker.

2. Services. A level I WCPU provides

Minimum medical services in the form of medico-legal examination, acute medical treatment,
minor surgical treatment, monitoring & follow-up
In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology
and the form attached as Annexes A and B, respectively, to this Manual of Operations
A full coverage, 24/7
Minimum social work intervention such as safety (and risk) assessment, coordination with other
disciplines (i.e., Department of Social Welfare and Development (DSWD) or the local social welfare
and development office (SWDO), police, legal, NGOs)
Peer review of cases
Proper documentation and record-keeping
Expert testimony in court
Networks with other disciplines and agencies

3. Training Capability

Training on 4Rs

4. Research

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

B. Level II WCPU

1. Personnel

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

2. Services

Medical services similar to a Level I WCPU including rape kits and surgical intervention.
In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology
and the form attached as Annexes A and B, respectively, to this Manual of Operations
Full coverage, 24/7
Social work intervention similar to that of a Level I WCPU plus case management and case
conferences
Additional services in the form of police investigation or mental health care
Proper documentation and record-keeping using the Child Protection Management Information
System (CPMIS)
Expert testimony in court
Peer review of cases
Availability of specialty consultations (ENT, ophthalmology, surgery, OB-Gyne, pathology)
Networks with other disciplines and agencies.

3. Training Capability

Training on 4Rs
Residency training

4. Research

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

C. Level III WCPU

1. Personnel

At least two (2) trained physicians;

At least two (2) trained and registered social workers;
A registered nurse;
A trained police officer; and
A mental health professional

2. Services

Medical services of a Level 2 WCPU

In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology
and the form attached as Annexes A and B, respectively, to this Manual of Operations
Full coverage, 24/7
Social work intervention of a Level 2 WCPU capacity plus long-term case management
Mental health care
Police investigation
Nursing services
Peer review of cases
Death review
Proper documentation and record-keeping using the CPMIS
Expert testimony in court
Availability of specialty consultations (i.e., ENT, ophthalmology, surgery, OB-gyne, pathology)
Other support services (i.e., livelihood, educational)
Networks with other discipline and agencies
Availability of subspecialty consultations (e.g., child development, forensic psychiatry, forensic
pathology)

3. Training Capability

Training on 4Rs
Competence and facility to run residency training and specialty trainings

4. Research

Proper documentation of experiences which will serve as inputs for policy research, formulation
and program improvement;
Conduct of empirical investigations on women and children protection work;
Publication of such research studies in reputable journals and/or presentation in scientific
conferences or meetings.

IV. TRAINING AND EDUCATION IN WOMEN AND CHILDREN PROTECTION

A multi-disciplinary training program will address human resource needs of women and child protection
units and womens and childrens desk as well as create and sustain a woman- and child-sensitive hospital
environment. The women and children protection program in the central office will set directions and define a
career path for medical and paramedical graduates who might be interested in professionally pursuing this line of
work. This will be made available not only to hospital personnel but to community and interested organizations that
would like to avail of the training. Training areas may focus on the following:

1. For trainees to acquire/enhance attitudes necessary in the management of acute and chronic causes of
crisis such as sensitivity, compassion, confidentiality and empathy.

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 2. For the trainees to develop/strengthen their skills in early detection, screening, interviewing, physical
examination, use of appropriate diagnostic procedures, management, counseling and referral.
3. For the trainees to have additional knowledge on understanding of conditions leading to crisis, recognition
of early sign of crisis identification, analysis of aggravating/contributory factors including family
factors/stresses, understanding of the impact of crisis on the individual the family and the community
management of patients and their families networking, linkage development and referral.

V. MINIMUM REQUIREMENTS OF A TRAINED WOMEN AND CHILDREN PROTECTION

SPECIALIST

1. Physician

Six (6)-week Child Protection Specialist Training for Physicians of the Child Protection Network
Foundation or its equivalent

2. Social Worker

Four (4) -week Child Protection Specialist Training for Social Workers of the Child Protection
Network Foundation or its equivalent

3. Police Officer

Four (4)-week Child Protection Specialist Training for Police Officers of the Child Protection
Network Foundation or its equivalent

[1] Republic Act 7610: Anti-Child Abuse Law

[2] Republic Act 9262: Anti-Violence Against Women and their Children Act
[3] Republic Act No. 7610
[4] Republic Act No. 9262
[5] Republic Act No. 8353
[6] Republic Act No. 8505
[7] Republic Act 9710
[8] DOH Performance Standards and Assessment Tools for Services Addressing Violence against Women in the
Philippines, 2008 (ed), at p.9.

WOMEN'S HEALTH AND SAFE MOTHERHOOD PROJECT

I. RATIONALE

The Philippines has committed to the United Nation millennium declaration that translated into a roadmap a set of
goals that targets reduction of poverty, hunger and ill health. In the light of this government commitment, the
Department of Health is faced with a challenge: to champion the cause of women and children towards achieving
MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6(combat HIV/AIDS, malaria and other
diseases). Pregnancy and child birth are among the leading causes of death, disease and disability in women of
reproductive age in developing countries. The Philippine government commitment to the MDGs is, among others, a
commitment to work towards the reduction of maternal mortality ratios by three-quarters and under-five mortality
by two-thirds by 2015 at all cost.

Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal mortality ratio,
increasing neonatal deaths particularly on the first week after birth, unmet need for reproductive health services and
weak maternal care delivery system, in addition to identifying the technical interventions to address these problems,
the DOH with support from the World Bank decided to focus on making pregnancy and childbirth safer and sought
to change fundamental societal dynamics that influence decision making on matters related to pregnancy and
childbirth while it tries to bring quality emergency obstetrics and newborn care to facilities nearest to homes. This
moves ensures that those most in need of quality health care by competent doctors, nurses and midwives have easy
access to such care.

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 Project Development Objectives and Indicators

The Project contributes to the national goal of improving womens health by:

1. Demonstrating in selected sites a sustainable, cost-effective model of delivering health services access of
disadvantaged women to acceptable and high quality reproductive health services and enables them to safely attain
their desired number of children.

2. Establishing the core knowledge base and support systems that can facilitate countrywide replication of project
experience as part of mainstream approaches to reproductive health care within the Kalusugan
Pangkalahatan framework.

Project Components

Component A: Local Delivery of the WHSM Service Package

This component supports LGUs in mobilizing networks of public and private providers to deliver the integrated
WHSM-SP. In such project site, the following are currently being undertaken:

1. Establishment of Critical Capabilities to Provide Quality WHSM Services through the organization and
operation of a network of Service Delivery Teams consisting of:

a. Womens Health Teams

b. BEmONC Teams

c. CEmONC Teams

d. Itinerant Teams

2. Establishment of Reliable Sustainable Support Systems for WHSM Service Delivery:

a. Drug and Contraceptive Security

b. Safe Blood Supply

c. Behavior Change Interventions

d. Sustainable financing of local WHSM services and commodities

Component B: National Capacity

1. Operational and Regulatory Guidelines (Manual of Operations)

2. Network of Training Providers

3. Monitoring, Evaluation, Research and Dissemination

II. INTERVENTIONS AND STRATEGIES EMPLOYED

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 The Department of Health through the Womens Health and Safe Motherhood Project 2 introduces new strategies to
address critical reproductive health concerns while confronting both demand and supply side obstacles to access for
disadvantaged women of reproductive age. Among the changes that the Project introduced and has systematically
mainstreamed into the current National Safe Motherhood Program are the following:

Strategic Change in the Design of Womens Health and Safe Motherhood Services

WHSMP2 brought about strategic changes in the way services are delivered to clients particularly the
disadvantaged and underserved. These changes involve (1) a shift in emphasis from the risk approach that
identifies high-risk pregnancies during the prenatal period to an approach that prepares all pregnant for the
complications at childbirth this change brought about the establishment of the BEmONC CEmONC network,
which is now part of the MNCHN service delivery network; (2) improved quality of FP counseling and expanded
service availability, including the organization of more Itinerant Teams providing permanent methods and IUD
insertion on an outreach basis and (3)the integration of STI screening into the maternal care and family planning
protocols.

An Integrated Package to Womens Health Services

The above changes in service delivery will likewise involve a shift from centrally controlled national programs
(MC, FP, STI and AH) operating separately and governed independently at various levels of the health system to an
LGU governed system that delivers an integrated womens health and safe motherhood service package. This
service delivery strategy is focused on maximizing synergies among key services and on ensuring a continuum of
care across levels of the referral system. At the ground level, this implies that a woman, whatever her age and
specially if she is disadvantaged, who seeks care from a public health provider for reproductive health concerns,
could expect to be given a comprehensive array of services that addresses her most critical reproductive health
needs.

Reliable Sustainable Support Systems

Support Systems for WHSM service delivery include systems for (1) drug and contraceptive security, through a
strategy of contraceptive self reliance; (2) safe blood supply; (3) stakeholder behavior change, through a
combination of performance based grants and advocacy and communication; (4) sustainable financing, through a
diversification of funding sources, principally given by the development of client classification scheme so that the
poor gets public subsidies and the non-poor are charged user fees.

Stronger Stewardship and Guidance from the DOH

DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on WHSM services,
(2) a system for accrediting providers of integrated WHSM service package training program; and (3) monitoring,
evaluation and research on the new WHSM strategies.

The Project is implemented in LGUs in 2 phases:

Phase 1 (2006-2012): Sorsogon in the Bicol region and Surigao del Sur in the Caraga Region

Phase 2 (2009-2012): Albay, Catanduanes and Masbate

III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS

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 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.

TUBERCULOSIS CONTROL PROGRAM

The National TB Control Program, organized in 1978 and operating within a devolved health care delivery
system, is one of the public health programs being managed and coordinated by the Infectious Diseases for
Prevention and Control Division (IDPCD) of the Disease Prevention and Control Bureau (DPCB) of the
Department of Health (DOH). Headed by a Program Manager and supported by 20 technical and administrative
staff it has the following mandate; (1) develop policies, standards and the national strategic plan, (2) manage
program logistics, (3) provide leadership and technical assistance to the lower health offices / units, (4) manage
data, and (5) conduct monitoring and evaluation. The programs TB diagnostic and treatment protocols and
strategies, issued through the Manual of Procedures, are in accordance the policies of World Health Organization
(WHO) and the International Standards for TB Care (ISTC). The roadmap for TB control towards TB elimination
is the 2017-2022 Philippine Strategic TB Elimination Plan (PhilSTEP).

The NTP closely works with various offices of the DOH such as the Health Promotion and Communication
Service (HPCS) for advocacy, communication and social mobilization, the Epidemiology Bureau (EB) and the
Knowledge and Management Information and Technology Services (KMITS) for data management, Health Policy
Development and Planning Bureau (HPDPB) for policy and strategic plan formulation, Logistics Management
Division (LMD), Central Office Bids and Awards Committee (COBAC) and Food and Drug Administration (FDA)
for drug and supplies management, the National TB Reference Laboratory of the Research Institute for Tropical
Medicine (NTRL-RITM) for laboratory network management, Lung Center of the Philippines (LCP) for PMDT
related research and training activities and the 17 ROs for technical support to the PHOs/CHOs and implementing
units. It also coordinates with the Philippine Health Insurance Corporation (PhilHealth) for the TB-DOTS
accreditation and utilization of the TB-DOTS outpatient benefit package.

The 17 Regional Offices (ROs) through its Regional NTP teams manages TB at the regional level while the
provincial health office (PHOs) and city health offices (CHOs), through its provincial /city teams are responsible
for the TB control efforts in the provinces and cities. TB diagnostic and treatment services is part of the basic
integrated health services that are provided by DOTS (currently means delivery of treatment services) facilities
which could either be the public health facilities such as the RHUs, health centers, hospitals; other public health
facilities such as school clinics, military hospitals, prison/jail clinics; NTP-engaged private facilities such as the
private clinics, private hospitals, private laboratories, drug stores and others. Community groups such as the
community health teams and barangay health workers participate in community-level activities.

NTP closely works with the 17 government offices and 5 private organizations in compliance with the
Comprehensive and Unified Policy (CUP) issued by the Office of the President in 2003. Under the framework of
public-private mix (PPM) collaboration in TB-DOTS, NTP collaborates with non-governmental organizations such
as the Philippine Coalition Against TB (PhilCAT), a consortium of 60 groups, and the 100-year old Philippine TB
Society, Inc. (PTSI) and many others. Various developmental partners and their projects provide technical and
financial support to NTP such as the World Health Organization (WHO), United States Agency for International
Development (USAID), Management Sciences for Health (MSH), Global Fund Against AIDS, TB and Malaria
(Global Fund) through the Philippine Business for Social Progress (PBSP), Research Institute of TB/Japan Anti-TB
Association (RIT/JATA), Korean Foundation for International Health (KOFIH), Korean International Cooperation
Agency (KOICA), International Committee of the Red Cross (ICRC) and HIVOS-KNCV.

NTP Manager:

Dr. Anna Marie Celina G. Garfin

DOH-Disease Prevention Control Bureau

Contact Number: (632) 310-5713

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 Ang TB ay isang uri ng sakit na dulot mikrobyong Mycobacterium tuberculosis na madalas makaapekto ng baga.
Maaari ring maapektuhan ang ibang pang bahagi ng katawan gaya ng buto, utak, bato, at atay.

Alamin ang tamang impormasyon para sa iyong matagumpay na paggaling.

Paano nakakahawa ang TB?

Ang TB ay naipapasa kung ang isang tao ay makalanghap ng mikrobyo ng TB na nasa hangin galing sa ubo o
bahing ng taong may TB.

Tandaan na ang TB ay:

HINDI namamana.
HINDI nakukuha sa pagpapagod, pagpupuyat, o pagkatuyo ng pawis sa likod.

HINDI naipapasa sa paggammit ng kubyertos o baso ng taong may TB.

HINDI nakukuha sa kagat ng lamok.

HINDI naipapasa sa paggammit ng damit o kumot ng taong may TB.

Paano ginagamot ang TB?

Ang TB-DOTS o Tutok Gamutan ang pinakamabisang paraan para magamot ang TB. Kailangan lamang ng di
bababa sa 6 buwang tuloy-tuloy na gamutan. Iinumin ang mga gamot para sa TB araw-araw sa gabay ng health
service provider. Importanteng hindi mahinto ang gamutan upang hindi umabot sa pagiging drug resistant ang TB
(DR-TB), dahil magiging mas matagal ang gamutan (hanggang 24 na buwan) o maging dahilan ng iyong
pagkamatay.

Ano ang mga side effects ng gamutan?

Posible na ika'y makaranas ng mga side effects gaya ng pangangati ng balat, kawalan ng gana kumain,
pamamanhid ng paa, at iba pa. Ito ay panandalian lamang at di kailangan ikabahala. Importanteng ipaalam sa iyong
health service provider ang iyong mga nararamdaman upang malunasan ito kaagad.

Ano ang mangyayari 'pag hindi mo tinapos ang gamutan?

Kapag hindi nakumpleto nang tama ang pagpapagamot, maaaring maging Multi-Drug Resistant (MDR) na ang TB
mo. Kapag umabot na sa MDR-TB, hindi na magiging mabisa ang mga gamot na kasalukuyan mong iniinom.

Ang MDR ay isang malalang uri ng TB dahil:

mas mahirap gamutin

mas mahal at mas marami ang kailangang gamot

mas matagal ang gamutan, umaabot ng 18-24 na buwan.

Mas madalas na mararanasan ang mga side effects ng mga gamot para sa MDR-TB gaya ng pagkahilo, pagsusuka,
pananakit ng tiyan, lagnat, kawalan ng gana, at iba pa. Kaya importante na makumpleto mo nang tama ang iyong
kasalukuyang gamutan

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 Patient-centered Care

Ang inyong health service provider (HSP) ay nakahandang magbigay sa iyo ng alagang makatao, kaya
mahalagang maipahiwatig sa kanya ang mga posibleng maging problema o hadlang sa iyong gamutan.
Matutulungan kayo ng iyong health service provider na tugunan ang posibleng mga hadlang sa iyong gamutan.

Mga Responsibilidad mo bilang pasyente

Ipaalam ang mga nauukol na impormasyon sa iyong health service provider, gaya ng mga nakaraang at
kasalukuyang karamdaman.
Sundan ang schedule ng pag-inom ng gamot araw-araw para masiguro ang paggaling.

Tumulong sa pag-iwas sa pagkalat ng TB sa komunidad sa pamamagitan ng paghikayat sa mga kakilalang

nagpapakita ng sintomas ng TB na kumonsulta agad sa Center.

Makiisa sa mga kapwa pasyente sa pamamagitan ng pagsuporta sa kanilang pagpapagaling at pagbahagi

ng tamang kaalaman na natutunan habang nagpapagamot.

Bilang pasyente, karapatan mong:

1. Magamot nang tama at libre na naaayon sa International Standards for Tuberculosis Care.
2. Tumanggap ng makataong serbisyo nang walang diskriminasyon o paghuhusga.

3. Mabigyan ng tama, malinaw at napapanahong impormasyon tungkol sa TB, ireresetang gamot, at

posibleng side effects nito.

4. Base sa mga ibinabahaging mga alternatibo, pumili ng naaangkop na gamutan at ang magiging epekto
nito.

5. Pangalagaan ang iyong pribadong buhay at karangalan tungkol sa iyong kondisyong medikal.

6. Makamit ang hustisya at lunas kung nalabag ang karapatan mo bilang pasyente.

7. Mabigyan ng seguridad sa trabaho pagkatapos ng gamutan at rehabilitasyon.

UNANG YAKAP (ESSENTIAL NEWBORN CARE: PROTOCOL FOR NEW LIFE)

Unang Yakap: Essential Newborn Care (ENC)

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 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.

UNIVERSAL HEALTH CARE IMPLEMENTERS PROJECT (UHCIP)

I. Background/Description

In order to bridge the gaps in the Philippine health system and to reduce barriers in accessing health care services
especially among marginalized communities, the Aquino administration launched its Health Agenda called
Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), in 2010. Universal Health Care is
defined as the provision to every Filipino of the highest possible quality of health care that is accessible, efficient,
equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered
public. Moreover, while the Philippines is on target for most of its Millennium Development Goals (MDG), it is
lagging behind in reducing maternal and infant mortality. Therefore, strengthening of public health efforts towards
the attainment of UHC and MDGs must be done.

In line with this, the Department of Health (DOH) launched High-Impact Five (Hi-5) last June 2015 which aims to
produce major improvements in health outcomes and the highest impact among the vulnerable population. The Hi-
5 strategies focuses on five (5) critical UHC interventions, namely: reduction of infant mortality rate; lowering
under-five mortality rate; reducing maternal mortality rate; halting Human Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome (HIV/AIDS); and increasing the service delivery networks in poor communities.
National implementation of the Hi-5 activities involves intensifying and synchronizing regional operations through
a convergence approach in priority poverty program areas. Thus, the Universal Health Care Implementers Project
(UHCIP) was conceptualized to accelerate the attainment of UHC and Hi-5 strategies. Currently, the project
deploys physicians who focus on localization of UHC policies and sustainable health financing in order to protect
marginalized communities from health financial risks.

II. Objectives

The Universal Health Care Implementers (UHCI) Project aims to:

a. Improve local health systems that will support the countrys attainment of UHC or Kalusugan
Pangkalahatan;

b. Provide quality service delivery to marginalized population of the country to accelerate the attainment of
Universal Health Care (UHC); and

c. Foster independence in the communitys health care delivery system.

III. Functions of UHC Implementers

a. Develops local health systems / programs / projects in the locality based on the UHC-HI5 Strategy;

b. Manages the mobilization of resources and projects related to UHC-HI-5 program implementation in the
RHU;

c. Develops / conducts capability building interventions / initiatives / packages for health workers and other
stakeholders in the local government unit relative to UHC-HI5;

d. Develops and implements advocacy projects and strategies for UHC-HI5 programs;

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 e. Conducts regular medical consultations relative to achieving health objectives of the UHC-HI5 strategy;

f. Manages UHC-HI5 data such as reporting, recording and analysis of data; and

g. Conducts epidemiology investigation whenever necessary.

IV. Minimum Qualification Standards

Education: Doctor of Medicine

V. Target Population/Client

a. (274) 5th and (39) 6th class municipalities

b. National Government Priority Areas

- 44 Focus Geographical Areas (FGA) with 1,045 Municipalities

- Accelerated and Sustainable Anti-Poverty (ASAP) municipalities
- Whole Nation Initiative (WNI) municipalities
- Areas with Bottom-Up Budgeting (BuB) programs
- Geographic location and socio-economic classification of the area (GIDA, ICC/IP areas, national
priority areas for poverty reduction)

c. LGU Hospitals (Level 1 or 2)

VI. Salaries and Benefits

Salary- 56,000.00/month
GSIS- 500.00/year
PHIC- 300.00/month

10-POINT SOCIOECONOMIC AGENDA OF THE DUTERTE ADMINISTRATIO

1. Continue and maintain current macroeconomic policies, including fiscal, monetary, and trade policies.
2. Institute progressive tax reform and more effective tax collection, indexing taxes to inflation.
A tax reform package will be submitted to Congress by September 2016.
3. Increase competitiveness and the ease of doing business. This effort will draw upon successful models used to
attract business to local cities
(e.g., Davao) and pursue the relaxation of the Constitutional restrictions on foreign ownership, except as
regards land ownership,
in order to attract foreign direct investment.
4. Accelerate annual infrastructure spending to account for 5% of GDP, with Public-Private Partnerships playing
a key role.
5. Promote rural and value chain development toward increasing agricultural and rural enterprise productivity and
rural tourism.
6. Ensure security of land tenure to encourage investments, and address bottlenecks in land management and
titling agencies.
7. Invest in human capital development, including health and education systems, and match skills and training to
meet the demand
of businesses and the private sector.
8. Promote science, technology, and the creative arts to enhance innovation and creative capacity towards
self-sustaining, inclusive development.
9. Improve social protection programs, including the governments Conditional Cash Transfer program, to protect
the poor
against instability and economic shocks.
10. Strengthen implementation of the Responsible Parenthood and Reproductive Health Law to enable especially
poor couples
to make informed choices on financial and family planning.

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 PINGGANG PINOY: HEALTHY FOOD PLATE FOR FILIPINO ADULTS

Pinggang Pinoy is a new, easy to understand food guide that uses a familiar food plate model to convey the right
food group proportions on a per-meal basis, to meet the bodys energy and nutrient needs of Filipino adults.
Pinggang Pinoy serves as visual tool to help Filipinos adopt healthy eating habits at meal times by delivering
effective dietary and healthy lifestyle messages.

Will Pinggang Pinoy replace the FNRI Daily Nutritional Guide (DNG) Pyramid

The Pinggang Pinoy can be used side by side with the existing DNG Pyramid for Filipinos but it will not replace
it. According to FNRI, Pinggang Pinoy is a quick and easy guide on how much to eat per mealtime, while the DNG
Pyramid shows at a glance the whole day food intake recommendation.

Both the Pinggang Pinoy and the DNG Pyramid for Filipinos are based on the latest science about how our food,
drink, and activity choices affect our health.

The DNG Pyramid is a simple, trustworthy guide in choosing a healthy diet. It builds from the base, showing that
we should eat more foods from the bottom part of the pyramid like vegetables, whole grains and less from the top
such as red meat, sugar, fats and oils. When its time to eat, most of us use a plate. So it is just appropriate to use the
Pinggang Pinoy as a guide for a typical balanced meal.

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