DOH PROGRAMS

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

RESPECTFULLY SUBMITTED TO: DR. AILEEN O. CAMANGEG, R.Ph. PCARE 101 INSTRUCTOR

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

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

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Table of Contents A Adolescent and Youth Health Program (AYHP) B Botika Ng Barangay (BnB) Breastfeeding TSEK Blood Donation Program C Child Health and Development Strategic Plan Year 2001-2004 CHD Scorecard Committee of Examiners for Undertakers and Embalmers Committee of Examiners for Massage Therapy (CEMT) Chronic Obstructive Pulmonary Disease Program Cardiovascular Disease Program D Dental Health Program Diabetes Mellitus Prevention and Control Program E Emerging and Re-emerging Infectious Disease Program Environmental Health Expanded Program on Immunization Essential Newborn Care F Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program

6 14 16 16 18 22 22 24 26 30 34 40 44 46 47 52 55 59 61 3

G Garantisadong Pambata 65 H Human Resource for Health Network Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control ) Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center Act of the Philippines) Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999)) Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges) Health and Well-being of Older Persons Healthy Lifestyle Program I Infant and Young Child Feeding (IYCF) Iligtas sa Tigdas ang Pinas Inter Local Health Zone Integrated Management of Childhood Illness (IMCI) K Knock Out Tigdas 2007 L Leprosy Control Program LGU Scorecard Licensure Examinations for Paraprofessionals Undertaken by the Department of Health M Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas) N National Tuberculosis Control Program 4

Natural Family Planning National Filariasis Elimination Program National Rabies Prevention and Control Program Newborn Screening National HIV/STI Prevention Program National Mental Health Program National Dengue Prevention and Control Program National Prevention of Blindness Program O Occupational Health Program P Persons with Disabilities Pinoy MD Program Philippine Cancer Control Program Province-wide Investment Plan for Health (PIPH) Philippine Medical Tourism Program Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat) R Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP) S Schistosomiasis Control Program Soil Transmitted Helminth Control Program Smoking Cessation Program U Urban Health System Development (UHSD) Program Unang Yakap (Essential Newborn Care: Protocol for New Life) 5

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

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

MOST COMMON CAUSES OF DEATH AMONG 10-24 YEARS OLD PER 10,000 POPULATION. Philippine Health Statistics, 2003 Male Rank

Cause of Death

No.

Female

Both

Rate No. Rate No.

Rate

1

Asssault

2,240 17.6 183 1.5 2,423

9.7

2

Transport Accidents

1,146 9.0 303 2.5 1,449

5.8

3

Event of undetermined intent

570

3.9

5.3

300 2.5

970

7

4

Symptoms, signs & abnormal clinical findings not elsewhere classified

602

4.7 352 2.9

954

3.8

5

Pneumonia

527

4.1 355 2.9

882

3.5

6

Tuberculosis of the Respiratory System

537

4.2 340 2.8

877

3.5

7

Chronic Rheumatic Heart Disease

447

3.5 426 3.5

873

3.5

8

Accidental drowning and submersion

596

4.7 215 1.7

811

3.2

9

Nephritis, nephrotic syndrome and nephrosis

385

3.0 332 2.7

717

2.9

Other accidents & late effects of transport/other accidents

518

4.1 113 0.9

631

2.5

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Leading Threats to Adolescents Health Accidents and other inflicted injuries Among 10- 24 age groups, this threat caused 27% of the total deaths (2003 data). Young males always exclusively succumb to injuries and females have the increasing mortality due to complications of pregnancy, labor delivery and puerperium. These data have been on the uptrend, a challenge to community-based or DOH-led programs. The threat is caused by the adolescent‘s exposure to poorly maintained roads and poorly managed traffic systems. Adolescents‘ increased mobility to urban areas needs a corresponding physical and infrastructure support in their quest for better opportunities and education pursuits. Another is the inability of the state to provide adequate number of police personnel leading to an increasing number of assault and transport accidents among the young males. Tuberculosis, Pneumonia, and Accidental drowning Close to 6% of young Filipinos who died in 2003 died of various forms of tuberculosis, followed by pneumonia that caused 4% of deaths. This health issue among the young has been declining through the years due to sustained nationwide programs that began in 1987 and has somehow caused to keep deaths down, hence efforts to continue sustaining becomes the challenge. The threat of HIV and other sexually – related diseases Reported cases increased substantially increased over the past year. Among the 1524 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 8

the adolescents‘ early engagement in health risk behavior, due to serious gaps of the knowledge on the dangers of drugs, as well as the cause as well as causes on the transmission of STD and HIV AIDS , dangers of indiscriminate tattooing and body- piercing and inadequate population education. Under this threat, young males are prone to engaging in health risk behavior and more young females are also doing the same without protection and are prone to aggressive or coercive behaviors of others in the community such that it often results to significant number of unwanted pregnancies,septic abortion and poor self-care practices. In addition, there are also other less common but significant causes of disease and deaths namely; Intentional self- harm –the 9th leading cause of death among 20-24 years old. In this age group, seven out of 10 who died of suicide were males. In age group of 1024 years old took up 34% of all deaths from suicide in 2003 Substance Abuse - 15-19 years old group has the claim of drug use; more males than females who are drug users and drug rehabilitation centers claim that majority of clients belong to age group of 25-29 years old. According to the SWS survey, 1996- 1.5M youth Filipinos and 1997- grew into 2.1M youth Filipinos are into substance abuse Nutritional Deficiencies –there are no specific rates for adolescent and youth, but there is the prevalence of anemia and vitamin A deficiency which may be also high for the adolescents and youth as those known for the younger and pregnant women. Disability – Filipinos aged 10-24 years old has an overall disability prevalence of 4%. The most common disability among this age group affected are speaking (35%), hearing (33%) and moving and mobility (22%) There are also vulnerable Filipino adolescents which can be classified in their respective areas of vulnerability VULNERABLE YOUNG FILIPINOS Sub-groups

Vulnerability areas

Young among the street-dwellers

Common infections, physical abuse or assault, sexual exploitation, drug use, road accidents

Out- of- school adolescents and youth

High risk behavior; smoking, alcohol use, drug abuse, high risk sexual behavior, risky work conditions leading to injuries and diseases

Urban –based male High risk behaviour; transport accidents , other youth inflicted injuries Female adolescents Sexual abuse, sexual exploitation , unwanted 9

pregranancies, abortion, unsafe pregnancy and insecure motherhood Not living with parents or family

Nutritional disorders, substance use and risky sexual behaviour, other inflcited injuries

Factors Causing Threats to Adolescents Health The alarming patterns of health issues affecting adolescents health is caused by the following factors operating in a systemic manner reinforcing further complexities in the health issues affecting adolescents . Socio-Cultural Factors Demographic Factors Continuing Rapid Population Growth The rapid population growth of the youth creates pressure to the state to expand education, health and employment forthis age group. The pressure creates an imbalance to the distribution and allocation of resources to various sectors especially the youth. The imbalance reinforces deeper the marginalization and deprivation of some sectors to basic services. A vicious cycle is created and more are having difficulties to access provision on health service delivery. Increased population movement The scarcity of local employment has triggered the participation of the youth in overseas work. The movement of the sector has caused displacement from families and love ones increase youth‘s vulnerability to exploitation, low paying jobs. According to a study in 2001, there were more than 6,000 workers in the teenage group overseas workers and it is most likely that they would land in overseas low paying work. Attitudes, Lifestyles, Sense of Values, Norms and Behaviors of Adolescents Health Risk Behaviors A significant proportion of young people engage in high-risk behaviors – 23% ever had pre- marital sex, 57% of first sex experience was unplanned and unplanned. About 70% - 80% of their most recent sexual experiences were unprotected (YAFS, 2002). The 2002 Young Adult Fertility and Sexuality Survey showed that the proportion of 15-24 year olds who were currently smoking, drinking and using drugs were 20.9%, 41.4% and 2.4%, respectively. The proportion is higher among males compared to 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 10

disorders; others spend the productive years of their life behind bars with hardcore lawless adults. Health Seeking Behavior Adolescents are more likely to consult the health center (45%) or government physician (19%) for their health needs (Baseline Survey for the National Objectives for Health, 2000). The most common reasons for not consulting were the lack of money, lack of time, fear of diagnosis, distance and disapproval of parents. Dental examination and BP monitoring were the most common reasons for consultation (62.4% and 37.8%, respectively). Similarly, Conditions relating to pregnancy, childbirth and post partum were among the leading reasons for utilization of inpatient, emergency room and outpatient health services at DOH-Retained Tertiary General Hospitals. Low Contraceptive Use The overall use of contraception among sexually active adolescents is at 20%. Nondesire for pregnancy and high awareness of contraceptive methods were not enough to encourage adolescents to use contraceptives. Among the reasons cited for the low contraceptive use were:  Contraceptives were given only to married individuals of reproductive age  Even if they were made available to adolescents, the culture says that it is taboo for young unmarried individuals to avail of contraceptive services and commodities.  Condom use is perceived mainly for STIs, HIV/AIDS prevention rather than contraception The practice Abortion and Unmet need for Contraception In 2000, induced abortion among adolescents reached 319,000. This is due to the inadequate knowledge on preventing unwanted pregnancies. Consequences of teenage pregnancies among young mothers include not being able to finish school and reduced employment options and opportunities. In addition, the social stigma and fear brought about by unwanted pregnancy pushes the young mother to resort to abortion. Although the disapproval rating for abortion remains to be high, there is an increasing trend among those who approve of it (from 4% to 6% in males and 3.5% to 4% in females).On contraceptive use , adolescents also don't use condoms for prevention of HIV,it's not only that they don't use them for contraception.

Risk of HIV/AIDS due to Unprotected Sex Adolescents including children living in extreme conditions and great exposure to sexual exploitation and abuse belong to high-risk categories threatened by unprotected sex. Latest data on these shows that majority of people engaged in sex work are young and 70 % of HIV infections involve male-to-male sex. The proportion of young people reported to have STDs/HIV and AIDS is increasing. The YAFS survey 11

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

social environment. This also deprives the adolescents from productive activities where they can develop themselves fully grown up and mature e economic and social being Moreover, communicationadvancement has also produced advertisements and television commercials whose image are not adolescent- friendly are paving the way for so much consumerism, distorted personal and family values THE ADOLESCENTS HEALTH PROGRAM IN THE PHILIPPINES 8. International Policies, Passages and Laws as anchors In International Laws  UN Convention on the Rights of Children  UN Convention the Action for the Promotion and Protection of the health of adolescents  Convention on the Elimination of all forms of discrimination againts women  1994 International Conference on Populaiton and Development ( ICPD)  1995 Fourth World Conference on Women  World Programme of Action for Youth 2000  MDG Goals :  Goal 2:Achieve Universal Primary Education  Goal 3:Promote Gender Equality  Goal 4 : Reduce Child Mortality  Goal 5: Improve Maternal Health  Goal 6:Combat HIV/AIDS, Malaria and other diseases National Laws and Policies o National Objectives for Health o Fourmula One for Health o Adolescent and Youth Health Policy (AYH) o Adolescent and Youth Health and Develoment Program o National Directional Plan for reaching the Un reahced Youth Population o Reproductive Health Program AO#1 s1998 o Local Government Code WHO, together with countries and areas in the Region and partner agencies, are working to promote healthy development of adolescents and reduce mortality and morbidity. In the Western Pacific Region, several technical units are working to implement interventions that improve adolescent health in the Region. The Philippines belong to the Western Pacific Region and is committed to: Recognize adolescents as ‗vulnerable and a ‗group in need‘ o Address Issues that have an evidence base 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 13

The Adolescents Youth and Heath Development Programs were established in 2001 under the oversight of the Department of Health in partnership with other government agencies with adolescent concerns and other stakeholders. The program is targeting youth ages 10–24, and the program provides comprehensive implementation guidelines for youth-friendly comprehensive health care and services on multiple levels—national, regional, provincial/city, and municipal. The program is solidly anchored on International and laws, passages and polices meant to address adolescent‘s health concerns. It is operating then within the facets and adolescents and youth health that includes disability, mental and environmental health, reproductive and sexuality, violence and injury prevention and among others. It employed strategies to ensure integration of the program into the health care system in addition, broader society such as building a supportive policy environment, intensifying IEC and advocacy particularly among teachers, families, and peers, building the technical capacity of providers of care, and support for youth; improving accessibility and availability of quality health services, strengthening multi-sectoral partnerships, resource mobilization, allocation and improved data collection and management. The program to address sexual and reproductive health issues likewise adopts gender-sensitive approaches. The primary responsibility for implementation of the AYHDP, and its mainstreaming into the health system, falls to regional and provincial/city sectors. Guidelines cover service delivery, IEC, training, research and information collection, monitoring and evaluation, and quality assurance.

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Botika Ng Barangay (BnB) I. What is Botika ng Barangay? Botika ng Barangay (BnB) - refers to a drug outlet managed by a legitimate community organization (CO) / non-government organization (NGO) and/or the Local Government Unit (LGU), with a trained operator and a supervising pharmacist specifically established in accordance with this Order. The BnB outlet should be initially identified, evaluated and selected by the concerned Center for Health Development (CHD), approved by the PHARMA 50 Project Management Unit (PMU) and specially licensed by the Bureau of Food and Drugs (BFAD) to sell, distribute, offer for sale and/or make available low-priced generic home remedies, over-thecounter (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-thecounter drugs and eight (8) prescription drugs as recommended by the National Drug Formulary Committee. Under Memorandum # 31 and its amendment, as much as 40 essential medicines that address common diseases can be made available in BnBs depending on the morbidity and mortality profiles of the community. And the policies surrounding the BnB (AO 144) ensure that such can be sustained in the medium term. II. Objectives The objectives of this Order are as follows: 1. To promote equity in health by ensuring the availability and accessibility of affordable, safe and effective, quality essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas. 2. To integrate all related issuances of the DOH that provides rules and regulations in the establishment and operations of BnBs; and 3. To define the roles and responsibilities of the different units of the DOH and other partners from the different sectors in facilitating and regulating the establishment of BnBs. III. Status of the Program Variants of the BnBs include Botika Binhi (funded by the members of the Peso for Health with counterpart from the local government unit), Health Plus (funded by the GTZ), Botika sa Parokya (funded by DOH and Office of the President) and the Botika ng Bayan (BNB) express under PITC/ PITC Pharma Inc. At present, about 16,350 BnB outlets have been established in the country. The initial target was to establish 1 BnB to serve 3 adjacent Barangays. However, due to the immensity of Barangays, and the need for more than 1 BnB in some poor adjacent barangays to better provide for the service, the target were changed to 1:1. Since absorptive capacity for the DOH-CHDs to establish BnBs is also limited due to resource and time constraints, the initial phasing of the target to achieve 1:1 is being done. Thus, for the next two (2) years, the target would be initially 1:2 except for 15

select areas that have high poverty incidence, conflict or Geographically isolated areas, and the like where the target would be 1:1. Sourcing of medicines for the initial seed capital of these medicines is done through PITC Pharma Inc. Issuances about Botika ng Barangay Issuances

Date

Title

Department Memorandum January No. 2011-0022 26, 2011

Moratorium on the Establishment of Botika ng Barangay (BnB) Nationwide

Department Memorandum February No. 2010-0033 12, 2010

Submission of Reports for the Impact Assessment of Maximum Drug Retail Price (MDRP) / Government

Department Memorandum February No. 2008-0038 21, 2008

Amendment to Memorandum No. 31 s. 2003 dated 17 February 2003 re: Drugs to be sold in Botika ng Barangays (BnBs)

Department Memorandum April 5, No. 2005-0046 2005

Utilization of Slow-Moving Pharma 50 Botika ng Barangay (BnB) Drugs and Medicines

Administrative Order No. 2005-0011

Supplemental Guidelines to Administrative Order No. 144 series 2004, entitled: "Guidelines for the Establishment and Operations of Botika ng Barangays (BnB) and Pharmaceutical Distribution Network (PDNs)" relative to the inclusion of other drugs which are classified as Prescription Drugs and other related matters

April 4, 2005

Botika ng Barangay Performance Department Memorandum November Monitoring Reports and Routine No. 118 s. 2004 22, 2004 Schedule of Submissions Administrative Order No. 144 s. 2004

April 14, 2004

Guidelines for the Establishment and Operations of Botika ng Barangays (BnB) and Pharmaceutical Distribution Network (PDNs)

Memorandum No. 31 s. 2003

February 17, 2003

Drugs to be sold in Botika ng Barangays (BnBs)

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

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

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

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Child Health and Development Strategic Plan Year 2001-2004 Introduction The Philippine National Strategic Framework for land Development for Children or CHILD 21 is a strategic framework for planning programs and interventions that promote and safeguard the rights of Filipino children. Covering the period 20002005, it paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a roadmap to achieve the vision. Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical and fundamental element in children's welfare. However, health programs cannot be implemented in isolation from the other component that determines the safety and well being of children in society. Children's Health 2025, therefore, should be able to integrate the strategies and interventions into the overall plan for children's development. Children's Health 2025 contains both mid-term strategies, which is targeted towards the year 2004, while long-term strategies are targeted by the year 2025. It utilizes a life cycle approach and weaves in the rights of children. The life cycle approach ensures that the issues, needs and gaps are addressed at the different stages of the child's growth and development. The period year 2002 to 2004 will put emphasis on timely diagnosis and management of common diseases of childhood as well as disease prevention and health promotion, particularly in the fields of immunization, nutrition and the acquisition of health lifestyles. Also critical for effective planning and implementation would be addressing the components of the health infrastructure such as human resource development, quality assurance, monitoring and disease surveillance, and health information and education. The successful implementation of these strategies will require collaborative efforts with the other stakeholders and also implies integration with the other developmental plan of action for children. Vision A healthy Filipino child is:  Wanted, planned and conceived by healthy parents carried to term by healthy mother born into a loving, caring, stable family capable of providing for his or her basic needs, delivered safely by a trained attendant  Screened for congenital defects shortly after birth; if defects are found, interventions to correct these defects are implemented at the appropriate time  Exclusively breastfed for at least six months of age, and continued breastfeeding up to two years, introduced to complementary foods at about six months of age, and gradually to a balanced, nutritious diet, protected from the consequences of protein-calorie and micronutrient deficiencies through good nutrition and access to fortified foods and iodized salt  Provided with safe, clean and hygienic surroundings and protected from accident, properly cared for at home when sick and brought timely to a health facility for appropriate management when needed. Offered equal access to good quality 19



 

curative, preventive and promotive health care services and health education as members of the Filipino society Regularly monitored for proper growth and development, and provided with adequate psychosocial and mental stimulation, screened for disabilities and developmental delays in early childhood; if disabilities are found, interventions are implemented to enabled the child to enjoy a life of dignity at the highest level of function attainable Protected from discrimination, exploitation and abuse Empowered and enabled to make decisions regarding healthy lifestyle and behaviors and included in the formulation health policies and programs, afforded the opportunity to reach his or her full potential as adult

Current Situation Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 live births, while neonatal death rate was 18 deaths per 1000 live births. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, and septicemia), nutritional deficiencies and birth-related complications. The probability of dying between birth and five years of age is 48 deaths per 1000 live births. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningitis and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents. The decline in mortality rates may be attributed partly to the Expanded Program of Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable diseases (tuberculosis, diptheria, tetanus, pertusis, poliomyelitis, Hepatitis B and measles). The Philippines has been declared as polio-free during the Kyoto Meeting on Poliomyelitis Eradication in the Western Pacific Region last October 2000. This however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved. Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997. 20

Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos. of age (NDHS). Several strategies were utilized to improve child health. The Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common childhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway. The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and seeking behaviors. It operates through health and nutrition posts established throughout the country. Gaps and Challenges Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for children‘s health. There is also the need to update and reiterate the policies on children's health particularly on immunization, micronutrient supplementation and IMCI. LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution. Pockets of low immunization coverage are attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization. Goal The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025. Medium-term Objectives for year 2001-2004 Health Status Objectives 1. Reduce infant mortality rate to 17 deaths per 1,000 live births 2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 live births 3. Reduce the mortality rate among adolescents and youths by 50% Risk Reduction Objectives 1. Increase the percentage 2. Increase the percentage 30% 3. Increase the percentage feeding at six months to 70% 4. Increase the percentage

of fully immunized children to 90% of infants exclusively breastfed up to six months to of infants given timely and proper complementary of mothers and caregivers who know and practice 21

home management of childhood illness to 80% 5. Reduce the prevalence of protein-energy malnutrition among school-age children 6. Increase the health care-seeking behavior of adolescents to 50% Services and Protection Objectives 1. Ensure 90% of infants and children are provided with essential health care package 2. Increase the percentage of health facilities with available stocks of vaccines and essential drugs and micronutrients to 80% 3. Increase the percentage of schools implementing school-based health and nutrition programs to 80% 4. Increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70% Strategies and Activities  Enhance capacity and capability of health facilities in the early recognition, management and prevention of common childhood illness  This will entail improvements in the flow of services in the implementing facilities to ensure that every child receive the essential services for survival, growth and development in an organized and efficient manner. Facilities should be equipped with the essential instruments, equipment and supplies to provide the services. Health providers shall have the knowledge and skills to be able to provide quality services for children. Existing child health policies, guidelines and standards shall be reviewed and updated, and new ones formulated and disseminated to guide health providers in the standard of care.  Strengthening community-based support systems and interventions for children's health Notable community-based projects and interventions, such as the health and nutrition posts, mother support groups, community financing schemes shall be replicated for nationwide implementation. Model building and dissemination of best practices from pilot sites has proven effective in generating support and adoption in other sites. More of these shall be initiated particularly for developing interventions to increase care-seeking and prevention of malnutrition in children.  Fostering linkages with advocacy groups and professional organizations and to promote children's health  Collaboration with the nongovernment sector and professional groups shall:  Conduct national campaigns on children's health  Conduct and support national campaigns for children  Initiate and support legislations and researches on children's health and welfare

22

 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. 23

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

  

1. 2. 3. 4. 5.

Curriculum for licensure examinations Manuals for Licensure Examinations Code of Ethics March 25, 2011 - National Capital Region May 3, 2011 - Visayas Region (Iloilo City) May 13, 2011 - Mindanao Regions (Cagayan de Oro City) June 30, 2011 - Butuan City (upon request) August 25, 2011 - Aklan (upon request)

Committee of Examiners for Massage Therapy (CEMT) Rationale Traditional medicine throughout the world recognizes the significance of therapeutic massage in managing stress, illness or chronic ailments. Massage therapy is considered the oldest method of healing that applies various techniques like fixed or movable pressure, holding, vibration, rocking, friction, kneading and compression using primarily the hands and other areas of the body such as the forearms, elbows or feet to the mascular structure and soft tissues of the body. Massage therapy can lead to significant biochemical, physical, behavioral and clinical changes in massage as well as the person giving the massage. It contributes to a higher sense of general well-being. Recognizing this, many healthcare professionals have begun to incorporate massage therapy as a complement to their routine clinical care. Efficacy of massage therapy in patient ranges from pretern neonates to senior citizens. Although the country has the training standards and regulations through the Technical Education and Skills Development Authority (TESDA), it lacks control / regulations over the training institutions, thus, anyone who calls himself/herself a massage therapist is one, regardless of training or experience. Objective: The Department of Health created the Committee of Examiners for Massage Therapy (CEMT) to regulate the practice of massage therapy in accordance to the provisions of the Sanitation Code of the Philippines (PD 856) and Executive Order No. 102 s. 1999, Reorganization and Streamlining of the Department of Health. It provides the CEMT the function to ensure that only qualified individuals enter the regulated profession and that the care and services which the massage therapists provide are within the standards of practice.

Strategies: To ensure that only qualified individuals enter the regulated profession and that the care and services which the massage therapists provide are within the standards of practice, the DOH-CEMT created: 1. CEMT Resolution No. 2011-001 - Three-Year Transition Period for Compliance to Administrative Order No. 2010-0034. 25

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: 26

   

1. 2. 3. 4. 5.

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

Clinics

and

Sauna

Chronic Obstructive Pulmonary Disease Program I.

Rationale:

Respiratory conditions impose an enormous burden on society. According to the WHO World Health Report 2000, the top five respiratory diseases account for 17.4% of all deaths and 13.3% of all Disability Adjusted Life Years (DALYs). Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis and lung cancer are among the leading 10 causes of death worldwide. Based partly on demographic changes in the developing world, but also on the changes in health care systems, schooling, income and tobacco use, the burden of communicable diseases is likely to lessen while the burden of chronic respiratory diseases (CRDs) including asthma, COPD, and Lung Cancer will worsen because of tobacco use and population ageing. COPD (CRD) is a major public health problem in the Philippines today. It occupies 7th among the latest list of top 10 causes of mortality. Significantly, the mortality trend in the last 3 decades shows a shift from acute infectious illness to chronic degenerative diseases. This is also true in the etiology of COPD. No large local study has been done to determine the prevalence of COPD in the Philippines. So far, estimates have been based primarily on morality statistics. These provide misleading figures because COPD is underdiagnosed and often not listed either as primary or contributory cause of death. A spirometry based study in 1997 in a rural community found irreversible airway obstruction in 3.7% of the population. Proceeding from an Asia-Pacific regional workshop in 2000 cited the prevalence of COPD in the Philippines as 6.3%. In 1998, International Study of Asthma and allergies in Childhood (ISAAC) survey reported the prevalence of asthma among 13-14 years old in the Philippines at 11.6% this level increased in the recently concluded WHO-funded National Asthma Epidemiology Survey (NAES) where the prevalence of definite asthma was placed at 4.3% in adults and 28.1% and 12.9% in children aged 13-14 and 6-7 years respectively. In all, among the respondents found to have asthma by the expert panel, about 33% of the children aged 6-7 years, 72% of school children and 28% of adults did not report prior knowledge of Doctor-diagnosed asthma to explain their 27

symptoms. Prevalence and occurrence of Chronic respiratory diseases is likely to increase and the extent of mortalities and financial cost necessitates a decisive plan of action-both preventive and therapeutic. A national program supported by the government, the scientific community, non-government organizations and people‘s organization is probably the optimal strategic approach to achieve a control of the rising prevalence of CRDs. A.

Policy Statement:

The prevention and control of chronic lifestyle related non communicable diseases shall be guided by the following policy statements. 1. The country shall adopt an integrated, comprehensive and community based response for the prevention and control of chronic, lifestyle related NCDs. 2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in mortality and morbidity due to chronic lifestyle related NCDs. 3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation of an integrated, comprehensive and community based response to chronic, lifestyle- related NCDs. B.

Objectives:

1. Decrease of morbidity and Mortality 2. Decrease in the economic burden of CVDs to the individual, family and community. Vision:

Improved quality of life for all Filipinos.

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

Scenario Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from COPD, occurred in low- and middle-income countries. Behavioral risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebrovascular disease. These important 28

behavioral risk factors of heart disease and stroke are discussed in detail later in this chapter. Referenced from: WHO-Global Status Report on Non-Communicable Diseases 2010 B.

Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to NonCommunicable Diseases. 1st: 2nd: 3rd: 4th: 7th: 10th:

Diseases of the Heart (CAD) Diseases of the Vascular System (Stroke) Malignant Neoplasm (Cancer) Injuries (Accidents) Chronic Obstructive Pulmonary Disease (COPD) Nephritis, Nephrotic Syndrom

Referenced from: NEC, Department of Health III.

Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt high risk behaviors and habits that may lead to the development of COPD. Will be implemented by setting:  Community-Based  School-Based  Industry-Based  Hospital-Based  Training, Research, Environmental support system are important components of the progress. IV.

Status of Implementation/Accomplishment

Program is well in place and its implementation is continuous from the community level (IEC) and screening Hospital (Definitive Diagnosis and treatment and rehabilitation.  Development of Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD).  1st Public Hearing on the Administrative Order on the National Policy on the Integrated Chronic Non-Communicable Disease Registry System (Cancer, Stroke, DM, and COPD) with CHD-NCR, Government and Private Hospitals and Non-Government Agencies.  Trained Hospitals for the Registry System entitled ―Users‘ training for the Unified Registry System‖. 29

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

Future Plan/Action:  Implement the program through the institutionalized integrated program of NCD-Lifestyle related diseases control program.  Development of Service Package for Chronic Obstructive Pulmonary Disease (COPD)  Development of Clinical Practice Guideline for COPD.  Development of Strategic Framework and a five Year Strategic Plan for COPD (2012-2016).

30

Cardiovascular Disease Program I.

Rationale:

Cardiovascular diseases (CVD),cancers, chronic respiratory diseases and diabetes (DM) are among the top killers in the Philippines, causing more than half of all deaths annually. Hypertension and diseases of the heart are among the ten leading causes of illnesses each year. These diseases are collectively known as Lifestyle Related Non-Communicable Diseases (NCDs), as defined in the National Objectives for Health 2005-2010, particularly because these diseases have common risk factors which are to a large extent related to unhealthy lifestyle. The risk factors involved are tobacco use, unhealthy diet, physical inactivity and alcohol use. The Food and Nutrition Research Institute (FNRD National Nutrition and Health Surveys in 1998 to 2008 (Acuin and Duante, 2010) showed that there is increasing prevalence in the associated risk factors between 1998 to 2008: hypertension from 2l%o to 25.3 %; diabetes from 3.9%o to 4.8%; among adults who are overweight, there has been a significant increase from 24.2% to 26.60/o; and those with high blood cholesterol levels had increased from 4Yo to 10.2%. Furthermore, the study found out that the following groups are at risk for NCDs: age group from the 40's onwards and those with Body Mass Index (BMI) > 23, dyslipidemia, high waist circumference and waist hip ratios. Moreover, dietary intake trends show increasing consumption of energy dense foods high in fats and sugars, while almost the entire adult population has low levels of physical activity in all domains: occupation, non-occupation, leisure, transportation. Children and adolescents are also exposed to the above-mentioned risks. Latest data from the Global Adult Tobacco Survey in 2009 shows prevalence of tobacco use (current smokers) among population 15 years old and above tobe28.3%o (17.3 million Filipinos); 47.7% of these are men (14.6 million) and 9%o are women (2.8 million). On the other hand, the prevalence of overweight among adolescents 9-11 years old has increased two folds from 2.4oh in 1993 to 4.8%;oin2005. Similarly, the prevalence rate of overweight for children 6-10 years old doubled from 0.8% in 2001 to 1.6%o in 2005. (Source: Philippine Nutrition Facts and Figures 2005). About 30Yo of teenage students are physically inactive, spending three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities. (Source: Philippines Global School-based Student Health Survey, 2007). And, data shows that in 2008 hazardous alcohol intake stands at26.90/o (FNRI-NNHeS 2008). The Philippine Renal Disease Registry (PRDR) illustrates that for 2009, diabetic nephropathy, a complication of diabetes remained the most common etiology of end stage renal disease while clinical hypertensive nephrosclerosis, a complication of hypertension ranked as the second most common etiology of end stage renal disease. Unless something is done to control these non-communicable diseases, renal complications will escalate to a degree that will compromise the current capacity to care for these types of patients. 31

The cost of care of lifestyle-related non-communicable diseases may cause people to fall into poverty and create a downward spiral of worsening poverty and illness. They also undermine the country's economic development. In response to the increasing prevalence of lifestyle related diseases in the country, vertical programs on the prevention and control of cardiovascular diseases, cancers and diabetes were put in place in the mid 1990's. The individual programs however, were focused on treatment and management of those who were already sick and thus were competing with each other for resources and for attention upon field implementation. A.

Policy Statement:

The prevention and control of chronic lifestyle related non communicable diseases shall be guided by the following policy statements. 1. The country shall adopt an integrated, comprehensive and community based response for the prevention and control of chronic, lifestyle related NCDs. 2. Health promotion strategies shall be intensified to effect changes that would lead to a significant reduction in mortality and morbidity due to chronic lifestyle related NCDs. 3. Complementary accountabilities of all stakeholders must be ensured and actively pursued in the implementation of an integrated, comprehensive and community based response to chronic,lifestyle related NCDs. B.

Objectives:

1. Decrease of morbidity and Mortality 2. Decrease in the economic burden of CVDs to the individual, family and community. Mission: To ensure that quality prevention and control and LRD services are accessible to all, especially to the vulnerable and at-risk population. Vision: A nation of Filipinos with Healthy Lifestyle and habits, living and working in clean and safe environment and with access to adequate medical care for CVD.

32

II. A.

Scenario Global Situation

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes caused an additional 1.3 million deaths. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from COPD, occurred in low- and middle-income countries. Behavioral risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebrovascular disease. These important behavioral risk factors of heart disease and stroke are discussed in detail later in this chapter. Population growth and improved longevity are leading to increasing numbers and proportions of older people, with population ageing emerging as a significant trend in many parts of the world. As populations age, annual NCD deaths are projected to rise substantially, to 52 million in 2030. Whereas annual infectious disease deaths are projected to decline by around 7 million over the next 20 years, annual cardiovascular disease mortality is projected to increase by 6 million and annual cancer deaths by 4 million. In low and middle-income countries, NCDs will be responsible for three times as many disability adjusted life years (DALYs) and nearly five times as many deaths as communicable diseases, maternal, perinatal and nutritional conditions combined, by 2030. B.

Local Situation:

Seven (7) out of 10 leading causes of mortality (death) are to Non-Communicable Diseases. 1st : 2nd: 3rd: 4th: 7th: 10th:

Diseases of the Heart (CAD) Diseases of the Vascular System (Stroke) Malignant Neoplasm (Cancer) Injuries (Accidents) Chronic Obstructive Pulmonary Disease (COPD) Nephritis, Nephrotic Syndrome

Referenced from: NEC, Department of Health

33

III.

Strategies implemented by DOH

Adopted in the context of health promotion in order to decrease the chances of the targeted population to adopt high risk behaviors and habits that may lead to the development of cardiovascular disease. Will be implemented by setting:  Community-Based  School-Based  Industry-Based  Hospital-Based  Training, Research, Environmental support system are important components of the progress. IV.

Status of Implementation/Accomplishment

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

Future Plan/Action:  Implement the program through the institutionalized integrated program of NCD-Lifestyle related diseases control program.  Development of Service Package for Cardiovascular Disease (CVD)  Development of Clinical Practice Guideline for Cardiovascular Disease (CVD) 34

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

Dental Health Program Oral disease continues to be a serious public health problem in the Philippines. The prevalence of dental caries on permanent teeth has generally remained above 90% throughout the years. About 92.4% of Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although preventable, these diseases affect almost every Filipino at one point or another in his or her lifetime. Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines YEAR

Prevalence Dental Caries

Peridontal Disease

1987

93.9%

65.5%

1992

96.3%

48.1%

1998

92.4%

78.3%

The oral health status of Filipino children is alarming. The 2006 National Oral Health Survey (Monse B. et al, NOHS 2006) investigated the oral health status of Philippine public elementary school students. It revealed that 97.1% of six-year-old children suffer from tooth decay. More than four out of every five children of this subgroup manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-year-old children suffer from dental caries and 49.7% of the same age group manifested symptoms of dentinogenic infections. The severity of dental caries, expressed as the average number of decayed teeth indicated for filling/extraction or filled permanent teeth (DMFT) or temporary teeth (dmft), was 8.4 dmft for the sixyear-old age group and 2.9 DMFT for the twelve-year-old age group (NOHS 2006). Table 2 - Dental caries Experience (Mean DMFT/dmft), per age groups, Philippines Age in Years

NMEDS 1982

NMEDS 1987

NMEDS 1992

NMEDS 1998

6 12

8.4 dmft 6.39

15-19 35-44

NMEDS 2006

14.18

5.52

5.43

4.58

8.51

8.25

6.3

14.82

14.42

15.04

2.9

Filipinos bear the burden of gum diseases early in their childhood. According to NOHS, 74% of twelve-year-old children suffer from gingivitis. If not treated early, 35

these children become susceptible to irreversible periodontal disease as they enter adolescence and approach adulthood. In general, tooth decay and gum diseases do not directly cause disability or death. However, these conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially dangerous systemic diseases and infections. Serious conditions include arthritis, heart disease, endocarditis, gastrointestinal diseases, and ocular-skin-renal diseases. Aside from physical deformity, these two oral diseases may also cause disturbance of speechsignificant enough to affect work performance, nutrition, social interactions, income, and self-esteem. Poor oral health poses detrimental effects on school performance and mars success in later life. In fact, children who suffer from poor oral health are 12 times more likely to have restricted-activity days (USGAO 2000). In the Philippines, toothache is a common ailment among schoolchildren, and is the primary cause of absenteeism from school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent epidemic, placing a heavy burden on Filipino schoolchildren. VISION: Empowered and responsible Filipino citizens taking care of their own personal oral health for anenhanced quality of life MISSION: The state shall ensure quality, affordable, accessible and available oral health care delivery. GOAL: Attainment of improved quality of life through promotion of oral health and quality oral health care. OBJECTIVES AND TARGETS: 1. The prevalence of dental caries is reduce Annual Target: 5% reduction of the prevalence rate every year 2. The prevalence of periodontal disease is reduced Annual Targets : 5% reduction of the prevalence rate every year 3. Dental caries experience is reduced Annual Target : 5% reduction of the mean dmft/DMFT for 5/6 years old and 12 years old children every year 4. The proportion of Orally Fit Children (OFC) 12-71 months old is increased Annual Targets: Increased by 20% yearly The national government is primarily tasked to develop policies and guideline for local government units. In 2007, the Department of Health formulated the Guidelines in the Implementation of Oral Health Program for Public Health Services (AO 2007-0007). The program aims to reduce the prevalence rate of dental caries to 85% and periodontal disease by to 60% by the end of 2016. The program seeks to achieve these objectives by providing preventive, curative, and promotive dental health care to Filipinos through a lifecycle approach. This approach provides a 36

continuum of quality care by establishing a package of essential basic oral health care (BOHC) for every lifecycle stage, starting from infancy to old age. The following are the basic package of essential oral health services/care for every lifecycle group to be provided either in health facilities, schools or at home. TYPES OF SERVICE (Basic Oral Health Care Package)

LIFECYCLE

Mother(Pregnant Women) **

Neonatal and Infants under 1 year old**

    

Oral Examination Oral Prophylaxis (scaling) Permanent fillings Gum treatment Health instruction

 

Dental check-up as soon as the first tooth erupts Health instructions on infant oral health care and advise on exclusive breastfeeding



Dental check-up as soon as the first tooth appears and every 6 months thereafter Supervised tooth brushing drills Oral Urgent Treatment (OUT) - removal of unsavable teeth - referral of complicated cases - treatment of post extraction complications - drainage of localized oral abscess Application of Atraumatic Restorative Treatment (ART)

 

Children 12-71 months old

**

      

Oral Examination Supervising tooth brushing drills Topical fluoride theraphy Pits and Fissure Sealant Application Oral Prophylaxis Permanent Fillings

 

Oral Examination Health promotion and education on oral hygiene, and adverse effect on consumption of sweets and sugary beverages, tobacco and alcohol

Other Adults (25-59 years old)

   

Oral Examination Emergency dental treatment Health instruction and advice Referrals

Older Person (60 years old and above)**

    

Oral Examination Extraction of unsavable tooth Gum treatment Relief of Pain Health instruction and advice

School Children (6-12 years old)

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

37

STRATEGIES AND ACTION POINTS: 1. Formulate policy and regulations to ensure the full implementation of OHP a. Establishment of effective networking system (DepEd, DSWD, LGU, PDA, Fit for School, Academe and others) b. Development of policies, standards, guidelines and clinical protocols - Fluoride Use - Tooth brushing - Other Preventive Measures 2. Ensure financial access to essential public and personal oral health services a. Develop an outpatient benefit package for oral health under the NHIP of the government b. Develop financing schemes for oral health applicable to other levels of care ( Fee for service, Cooperatives, Network with HMOS) c. Restoration of oral health budget line item in the GAA of DOH Central Office 3. Provide relevant, timely and accurate information management system for oral Health. a. Improve existing information system/data collection (reporting and recording dental services and accomplishments) - setting of essential indicators - Development of IT system on recording and reporting oral health service accomplishments and indices - Integrate oral health in every family health information tools, recording books/manuals b. Conduct Regular Epidemiological Dental Surveys – every 5 years 4. Ensure access and delivery of quality oral health care services. a. Upgrading of facilities, equipment, instruments, supplies

38

b. Develop packages of essential care/services for different groups (children, mothers and marginalized groups) -revival of the sealant program for school children - Tooth brushing program for pre-school children - outreach programs for marginalized groups c. Design and implement grant assistance mechanism for high performing LGUs - Awards and incentives - Sub-allotment of funds for priority programs/activities d. Regular conduct of consultation meetings, technical updates and program implementation reviews with stakeholders 5. Build up highly motivated health professionals and trained auxiliaries to manage and provide quality oral health care a. Provision of adequate dental personnel b. Capacity enhancement programs for dental personnel and non-dental personnel Current FHSIS Indicators/parameters: a) Orally Fit Child (OFC)– Proportion of children 12-71 months old and are orally fit during a given point of time. Is defined as a child who meets the following conditions upon oral examination and/or completion of treatment a) cariesfree or carious tooth/teeth filled either with temporary or permanent filling materials, b) have healthy gums, c) has no oral debris, and d) No handicapping dento-facial anomaly or no dento-facial anomaly that limits normal function of the oral cavity b) Children 12-71 months old provided with Basic Oral Health Care (BOHC) c) Adolescent and Youth (10-24 years old) provided with Basic Oral Health care (BOHC) d) Pregnant Women provided with Basic oral Health Care (BOHC) e) Older Persons 60 years old and above provided with Basic Oral Health Care (BOHC) Policy/Standards/Guidelines formulated/developed: a. AO. 101 s. 2003 dated Oct. 14, 2003 – National Policy on Oral Health b. AO 2007-0007 – Dated January 3, 2007 Guidelines In The Implementation Of Oral Health Program For Public Health Services In The Philippines 39

c. AO 4-s.1998 – Revised Rules and Regulations and Standard Requirements for Private School Dental services in the Philippines d. AO 11-D s. 1998 – Revised Standard Requirements for Hospital Dental services in the Philippines e. AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for Occupational Dental services in the Philippines f. AO 4-A s. 1998 – Infection Control Measures for Dental Health Services Trainings/Capacity Enhancement Program: Basic Orientation Course on Management of Public Health Dentist The training program was designed with the Public Health Dentists (PHDs) as the main recipients of the Basic Course on the Management of Oral Health Program. The training is expected to provide an in-depth understanding of the different roles and functions of the PHDs in the management and delivery of Public Health Services. A training module was developed for the basic course. Researches: a.

National Monitoring Evaluation Dental Survey (NMEDS).

The Department of Health (DOH) has been conducting nationwide surveys every five years (1977, 1982, 1987, 1992, and 1998) to determine the prevalence of oral diseases in the Philippines. Data gathered provide continuous information that enables planners to update data used in planning, implementation and evaluation of existing oral health programs. The latest NMEDS was conducted in 2011. Results will be available on the 1st quarter of 2012. Existing Working Group for Oral Health: National Technical Working Group (TWG) on Oral Health (DPO 2005-1197) Member Agencies:  Department of Health (NCDPC, HHRDB, NCHP)  DOH- Center for Health Development for CALABARZON  Philippine Dental Association  Department of Education  UP- College of Public Health  Department of Interior and Local Government

NCR,

Central

Luzon

and

 Department of Social Welfare and Development  Local Government Units ( Makati, Quezon City)

40

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

Diabetes Mellitus Prevention and Control Program I.

Rationale

Diabetes is a global concern that cuts across geographical boundaries regardless of race, sex, status and age. Diabetes and its complications impose a heavy burden to the individual, his family and society in general. Some of its serious effects are disability, poor quality of life and premature death. These impact not only on health care cost but more significantly on national growth and development. In recognition of the current and emerging importance of diabetes, a concerted effort has been organized to commonly address the diverse problems of the disease. The Non-Communicable Disease Control Service (NCDCS), Office for Public Health Services, presently Degenerative Disease Office of the National Center for Disease Prevention and Control Program is mandated and tasked through Executive Order No. 119 s. 1987, to anchor the Diabetes Mellitus Prevention and Control Program (DMPCP). Relative to this, the Administrative Order No. 16-A s. 1995 – The Diabetes Mellitus Prevention and Control Program in the Philippines was signed on September 15, 1995. However, with recent evidences showing that diabetes and other chronic lifestyle related non-communicable diseases (cardiovascular diseases, cancers and chronic respiratory diseases) sharing common risk factors (unhealthy diet, physical inactivity, smoking and alcohol use) should be addressed the most cost-effective way through prevention of the emergence of the risk factors in an integrated manner, employing health promotion strategies across the life course and intervening at the level of family and community. This is essential because the causal risk factors causing these illnesses are deeply entrenched in the social and cultural framework of the society. Thus, an integrated comprehensive program for the prevention and control of these noncommunicable lifestyle related diseases has to be put in place, hence, the signing of the Administrative Order No. 2011 – 0003, National Policy on Strengthening the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases on April 14, 2011. 41

Goal: To reduce morbidity, mortality and disability rates due to chronic lifestyle related NCDs through an integrated and comprehensive program on the prevention and control of lifestyle related diseases. Objectives: 1. To develop and promote an integrated and comprehensive program on the prevention and control of lifestyle related diseases in the country. 2. To engage all province-wide or city-wide health systems to adopt an integrated and comprehensive program on the prevention and control of lifestyle related diseases. 3. To achieve improvement in the following Key Performance Indicators from 2011-2016: Common Risk Factors  Reduction in prevalence of current smoking among adult males from 56.3 to 40.0  Reduction in prevalence of current smoking among adolescent female from 8.80 to 7.2  Reduction in prevalence of adults with high physical inactivity from 60.5 to 50.8  Increase in per capita total vegetable from 111.0 (g/day) to 133.0 (g/day) Intermediate Risk Factors  Reduction in prevalence of hypertension among adult males from 24.2 to 19.6.  Reduction in prevalence of adults with high fasting blood sugar from 3.4 to 3.4.  Reduction in the prevalence of central obesity (high waist circumference) among adult females from 18.3 to 12.81  Reduction in prevalence of high total serum cholesterol among adults from 8.5 to 8.5 Disease Control Reduction in mortality from non-communicable diseases at 2% per year through the Medium Development Goal max initiative. II.

Scenario

The estimated number of adults living with diabetes has soared to 366 million, representing 8.3% of the global adult population. This number is projected to increase to 552 million people by 2030, or 9.9% of adults which equates to 42

approximately three more people with diabetes every 10 seconds(Diabetes Atlas 5th Edition, 2011). In the Philippines, the prevalence of diabetes increased from 3.4% in 2003 to 4.8% in 2008 (NNHeS 2008). Diabetes also ranks 8thin the top 10 leading causes of death in the country (DOH- Health Statistics 2006). III.

Interventions/Strategies Implemented by DOH

The Action Framework for the National Program on the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases is based on the Causation Pathway Model for Major Chronic Diseases as contained in the World Health Organization Western Pacific Regional Action Plan for Addressing Non-Communicable Diseases, where the underlying determinants, common risk and intermediate risk factors that would lead to lifestyle-related diseases are identified. The Action Framework has seven action areas as follows: (1) Environmental interventions; (2) Lifestyle interventions; (3) Clinical interventions; (4) Advocacy; (5) Research, Surveillance, Monitoring and Evaluation; (6) Networking and Coalition building; and (7) Health System Strengthening. It draws primarily from the WHO Western Pacific Regional Framework for addressing Non-communicable Diseases and emphasizes the requirement for integrated comprehensive approaches that encompass and address the various levels of determinants and risks for non-communicable lifestyle related diseases. The framework clearly identifies areas for intervention according to the causation pathway by utilizing a comprehensive approach that simultaneously seeks to effect change at three levels: 1) Environmental Interventions such as policy and regulatory interventions seek to create a supportive environment for healthier choices. They address the multiple environmental determinants brought about for example, by globalization and urbanization that give rise to the development of unhealthy lifestyles. 2) Lifestyle interventions address the common risk factors and intermediate risk factors by providing population based lifestyle interventions (for example, information and education and behavioral interventions for those who are already at risk). 3) Clinical interventions, palliation and rehabilitation address the capacity of the health system to treat and manage diseases through screening, risk factor modification, clinical management, palliation and rehabilitation. To support change in these three levels of interventions, additional actions are needed in the following areas: advocacy, research, surveillance, monitoring and evaluation; networking and coalition building across all sectors of the government 43

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

Status of Implementation/Accomplishment

 Policy/Standard/Guidelines Development Development of Clinical Practice Guidelines on diabetes and other NCDs are ongoing.  Promotion and Advocacy Conduct of HEATHLY LIFESTYLE TO THE MAX Campaign This brings the problem of NCDs including diabetes high in the consciousness of all sectors and the Filipino public. This advocacy focuses on clear health priorities such as consumption of healthy diet, promoting physical activity, curbing the use of tobacco, alcohol, and illegal drugs, proper weight and stress management, early detection and control of hypertension.  Promotion of KALUSUGAN PANGKALAHATAN Encourages everyone to practice healthy lifestyle like exercise as physical inactivity increases the risk of non-communicable diseases specifically cardiovascular diseases and diabetes.  Coalition Building Together with other partners in the Phil. Coalition for the Prevention and Control of Non-Communicable Diseases, also known as Healthy Lifestyle Coalition, the DOH also encourages the Fast Food Establishments to offer healthier food choices by reducing the fat, sugar and salt content as well as trans-fatty acids in the food they serve. Serving of fresh fruits and vegetables and other sources of fiber are encouraged as well. Development of Guidelines on Healthy Eating/Food Labeling is also being undertaken together with other partners and stakeholders.  Surveillance A national and integrated registry system for chronic non-communicable diseases has been developed where health facilities like hospitals can report new cases of diabetes, cancer, stroke and chronic obstructive pulmonary diseases and statistics concerning incidence, mortality and survival can be generated. An 44

Administrative Order re: National Implementation of the Integrated Chronic NonCommunicable Disease Registry System has been drafted for approval. V.

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

Emerging and Re-emerging Infectious Disease Program Emerging and re-emerging infections (e.g., SARS, meningococcemia, Avian Influenza or bird flu, A (H1N1) virus infection) threaten countries all over the world. In 2003, SARS affected at least 30 countries with most of the countries from Asia. In response to its sudden and unexpected emergence, quarantine and isolation measures and rapid contract tracing were carried out. The Philippines was able to minimize the impact of SARS through effective information dissemination, risk communication, and efficient conduct of measures. The unexpected and unusual increase in cases of meningococcal disease (meningococcemia as the predominant form) in the Cordillera Autonomous Region resulted to at least 50% of cases in the early stage of occurrence. In 2009, the influenza A (H1N1) virus infection led to global epidemic, or most popularly known as pandemic. On June 11, 2009, a full pandemic alert was declared by the World Health Organization (WHO). However, some local health offices from many provinces were not able to respond effectively and rapidly. With the lack of strong linkages and coordinating mechanisms, the Department of Health (DOH) hopes to further improve the functionality and effectiveness of local response systems. Efforts to prepare for emerging infections with potential for causing high morbidity and mortality are being done by the program. Applicable prevention and control measures are being integrated while the existing systems and organizational structures are further strengthened. Goal: Prevention and control of emerging and re-emerging infectious disease from becoming public health problems. Objectives: 45

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 reemerging infectious diseases. Program Strategies: The DOH, in collaboration with its partner organizations/agencies, employs the key strategies: 1. Development of systems, policies, standards, and guidelines for preparedness and response to emerging diseases; 2. Technical Assistance or Technical Collaboration; 3. Advocacy/Information dissemination; 4. Intersectoral collaborations; 5. Capability building for management, prevention and control of emerging and re-emerging diseases that may pose epidemic/pandemic threat; and 6. Logistical support for drugs and vaccines for meningococcemia and anti-viral drugs and vaccine for Pandemic Influenza Preparedness. Partner Organizations/Agencies: The following organizations/agencies take part in achieving the goal of the program:        

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

46

Environmental Health Environmental Health is concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury. It is concerned primarily with effects of the environment to the health of the people. Program strategies and activities are focused on environmental sanitation, environmental health impact assessment and occupational health through interagency collaboration. An Inter-Agency Committee on Environmental Health was created by virtue of E.O. 489 to facilitate and improve coordination among concerned agencies. It provides the venue for technical collaboration, effective monitoring and communication, resource mobilization, policy review and development. The Committee has five sectoral task forces on water, solid waste, air, toxic and chemical substances and occupational health. Vision:

Health Settings for All Filipinos

Mission:

Provide leadership in ensuring health settings

Goals: Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion and mitigation of hazards and risks in the environment and workplaces. Strategic Objectives 1. Development of evidence-based policies, guidelines, standards, programs and parameters for specific healthy settings. 2. Provision of technical assistance to implementers and other relevant partners 3. Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and attainment of healthy settings Key Result Areas 1. Appropriate development and regular evaluation of relevant programs, projects, policies and plans on environmental and occupational health 2. Timely provision of technical assistance to Centers for Health Development (CHDs) and other partners 3. Development of responsive/relevant legislative and research agenda on DPC 4. Timely provision of technical inputs to curriculum development and conduct of human resource development 5. Timely provision of technically sound advice to the Secretary and other stakeholders 6. Timely and adequate provision of strategic logistics

47

Components        

Inter- agency Committee on Environmental Health IACEH Task Force on Water IACEH Task Force on Solid Waste IACEH Task Force on Toxic Chemicals IACEH Task Force on Occupational Health Environmental Sanitation Environmental Health Impact Assessment Occupational Health

Expanded Program on Immunization I.

Rationale

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

Scenario

Global Situation The burden. In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to diseases that could have been prevented by routine vaccination. This represents 14% of global total mortality in children under 5 years of age. Source: Weekly Epidemiological Record, WHO: No.46,2011,86.509-520) Burden of Diseases The immunization coverage of all individual vaccines has improved as shown in Figure 1: (Demographic Health Survey 2003 and 2008). Fully Immunized Child (FIC) coverage improved by 10% and the Child Protected at Birth (CPAB) against Tetanus improved by 13% compared to any prior period. Thus, the Philippines has now historically the highest coverage for these two major indicators.

48

III.

Interventions/ Strategies

Program Objectives/Goals: Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases. Specific Goals: 1. To immunize all infants/children against the most common vaccine-preventable diseases. 2. To sustain the polio-free status of the Philippines. 3. To eliminate measles infection. 4. To eliminate maternal and neonatal tetanus 5. To control diphtheria, pertussis, hepatitis b and German measles. 6. To prevent extra pulmonary tuberculosis among children. Mandates: Republic Act No. 10152―MandatoryInfants and Children Health Immunization Act of 2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health. Strategies:  Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay (REB) strategy REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in 2004 aimed to improve the access to routine immunization and reduce drop-outs. There are 5 components of the strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between the community and service, supportive supervision and maximizing resources.  Supplemental Immunization Activity (SIA) Supplementary immunization activities are used to reach children who have not been vaccinated or have not developed sufficient immunity after previous vaccinations. It can be conducted either national or sub-national –in selected areas.  Strengthening Vaccine-Preventable Diseases Surveillance This is critical for the eradication/elimination efforts, especially in identifying true cases of measles and indigenous wild polio virus Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

49

IV.

Status of implementation/ Accomplishment

All health facilities (health centers and barangay health stations) have at least one (1) health staff trained on REB. Polio Eradication:  The Philippines has sustained its polio-free status since October 2000.  Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to 83%. A least 95% OPV3 coverage need to be achieved to produce the required herd immunity for protection.  There is an on-going polio mass immunization to all children ages 6 weeks up to 59 months old in the 10 highest risk areas for neonatal tetanus. These areas are the following: Abra, Banguet, Isabela City and Basilan, Lanao Norte, Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.  Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to 1.38 in 2011. Only regions III, V and VIII have achieved the AFP rate of 2/100,000 children below 15 years old. (Source: NEC, DOH). A decreasing AFP rate means we may not be able to find true cases of polio and may experience resurgence of polio cases Measles Elimination  Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.  Implemented the 2-dose measles-containing vaccine (MCV) in 2009  MCV1 (monovalent measles) at 9-11 months old  MCV2 (MMR) at 12-15 months old.  Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood samples are withdrawn from all measles suspect to confirm the case as measles infection.  A supplemental immunization campaign for measles and rubella (German measles) was done in 2011. This was dubbed as ―Iligtas sa Tigdas ang Pinas‖ 15.6 million (84%) out of the 18.5 million children ages 9 months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between April and June 2011.  Rapid coverage assessment (RCA) was conducted in selected areas to validate immunization coverage, assess high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9- months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.  The Government of the Philippines spent PhP 635.7M for the successful conduct of the MR campaign.ss high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9- months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above 50

that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.  As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5 cases were epidemiologically-linked and 27 clinically confirmed. This means we have at least 60 ―true‖ measles at present. Measles is said to be eliminated if we have 1 case per million or below 100 cases in a year Maternal and Neonatal Tetanus Elimination  10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the areas categorized as low risk, at risk and highest risk based on the NT surveillance, skilled birth attendants and facility based delivery and the tetanus toxoid 2+ (TT 2+) vaccination.  Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk areas. An estimated 1,010,751 women age 15 - 40 year old women regardless of their TT immunization will receive the vaccine during these rounds. This is funded by the Kiwanis International through UNICEF and World Health Organization.  Control of other common vaccine-preventable diseases (Diphtheria, Pertussis, Hepatitis B and Meningitis/Encephalitis secondary to H. influenzae type B)  Continuous vaccination for infants and children with the DPT or the combination DPT-HepB-HiB Type B. Annex1 EPI Annual Accomplishment Report. DOH procures all the vaccines and needles and syringes for the immunization activities targeted to infants/children/mothers. Hepatitis B Control  Republic Act No. 10152 has been signed. It is otherwise known as the ―Mandatory Infants and Children Health Immunization Act of 2011, which requires that all children under five years old be given basic immunization against vaccine-preventable diseases. Specifically, this bill provides for all infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of birth.  One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and Newborn Care Package (EINC). In 2011, 11 tertiary hospitals are already EINC compliant.  The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by HBsAg prevalence to less than 1% in five-year-olds born after routine vaccination started 100% Hepatitis B at birth vaccination. Hepatitis B Coverage. Philippines, 2001-2011 Timing of administration/dose

2009

2010*

2011*

24 hours

62%

55%

24% 51

Hep B 3rd dose *both 2010 and 2011 data are as of October 2011

86%

81%

30%

Vaccines and cold chain management  Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions since 2003.  An effective vaccine management assessment was conducted last December 2011 and revealed cold chain capacity gaps from the national up to the implementers level.  A total of PhP 267 million is required to address the gaps identified during the assessment. Introduction to New Vaccines  For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization program. Immunization will be prioritized among the infants of families listed in the National Housing and Targeting System (NHTS) for Poverty Reduction nationwide.  The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2 vaccines. V.

Future Plan/ Action  Strengthening the Cold Chain to support the Immunization Program  Capacity Building for Health Workers for the Introduction of New Vaccines  Advocacy for the financial sustainability for the newly introduced vaccines for expansion.  Development of the comprehensive multi-year plan for immunization program.

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

52

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 nonmoving trend of decline, MDG 4 might not be achieved. Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy and NOH 2011-2016 Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels Objectives:  To provide evidence-based practices to ensure survival of the newborn from birth up to the first 28 days of life  To deliver time-bound core intervention in the immediate period after the delivery of the newborn  To strengthen health facility environment for breastfeeding initiation to take place and for breastfeeding to be continued from discharge up to 2 years of life  To provide appropriate and timely emergency newborn care to newborns in need of resuscitation  To ensure access of newborns to affordable life-saving medicines to reduce deaths and morbidity from leading causes of newborn conditions  To ensure inclusion of newborn care in the overall approach to the Maternal, Newborn, Child Health and Nutrition Strategy Stakeholders: 1. Both public and private sector at all levels of health service delivery providing maternal and newborn services 2. Health Professional Organizations and their member health professionals  Pediatricians/neonatalogists of the Philippine Pediatric Society (PPS) and the Philippine Society of Newborn Medicine (PSNbM)  Obstetrician-Gynecologists of the Philippine Obstetrical and Gynecological Society (POGS)  Perinatologists of the Perinatal Association of the Philippines, Inc., (PAPI)  Anesthesiologists and obstetric anesthesiologists of the Philippine Society of Anesthesiologists (PSA) and the Society for Obstetric Anesthesia of the Philippines (SOAP), 53

 Family medicine specialists of the Philippine Academy of Family Physicians (PAFP)  Nurses, Maternal and child nurses, intensive care nurses of the Philippine Nurses Association and its affiliate nursing societies  Midwives of the Integrated Midwives of the Philippines (IMAP), Philippine League of Government and Private Midwives, Inc. (PLGPMI), Midwives Foundation of the Philippines (MFP) and Well Family Midwives Clinic 3. Government regulatory bodies e.g. Professional Regulations Commission 4. Academe - professors and instructors from members schools and colleges of:  Association of Philippine Medical Colleges (APMC)  Association of Deans of Philippine Colleges of Nursing (ADPCN)  Association of Philippine Schools of Midwifery 5. Hospital, health care administrator and infection control associations    

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

6. Local government units - local chief executives and LGU legislative bodies Beneficiaries:  Newborns all over the country  Parents  Communities Program Strategies: 1. Health Sector Reform A. Policy and Guideline Issuance a) Administrative Order 2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care - December 1, 2009 b) Clinical Pocket Guide on Essential Newborn Care B. Aquino Health Agenda and Achieving Universal Health Care Administrative Order 2010-0036 C. PhilHealth Circular 2011-011 dated August 5, 2011 on Newborn Care Package D. Development of Operationalization of Essential Newborn Care Protocol in Health Facilities 2. Identification of Centers of Excellence 54

 Adoption of essential newborn care protocol(including intrapartum care and the MNCHN Strategy) 3. Curriculum Reforms  Curriculum integration of essential newborn care (including intrapartum care and the MNCHN Strategy) in undergraduate health courses  Integration and revision of board exam questions in licensure examinations for physicians, nurses and midwives 4. Social Marketing  Development of social marketing tools - Unang Yakap MDG 4 & 5 Major Activities and its Guidelines:  Conduct of one-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy)  Regional MNCHN Conference for CHDs and LGUs including DOH-retained hospitals and LGU hospitals Current Status of the Program A. What have been achieved/done 1. Policy was issued in December 1, 2009 2. DOH/WHO Scale-up Implementation was done in 11 hospitals 3. Advocacy Partners Forum on essential newborn care (including intrapartum care and the MNCHN Strategy) 4. One-day orientation-workshop on essential newborn care (including intrapartum care and the MNCHN Strategy) among health workers in different health facilities 5. Inclusion of dexamethasone and surfactant as core medicines in the essential medicines list for children in the Philippine National Formulary B. Statistics 1. Early outcomes of EINC implementation has shown reduction on neonatal deaths in select DOH-retained hospitals including deaths from neonatal sepsis and complications of prematurity

55

Partner organizations/agencies:        

National Nutrition Council Population Commission WHO UNICEF UNFPA AusAID USAID Health professional and academic organizations mentioned above.

Family Planning Brief Description of Program A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. The program is anchored on the following basic principles.  Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper upbringing and education of children so that they grow up to be upright, productive and civic-minded citizens.  Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is NOT a FP method:  Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It enables women to recover their health improves women's potential to be more productive and to realize their personal aspirations and allows more time to care for children and spouse/husband, and;  Informed Choice that is upholding and ensuring the rights of couples to determine the number and spacing of their children according to their life's aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children's and their own lives. Intended Audience: including adolescents Area of Coverage: Mandate:

Men and women of reproductive age (15-49) years old) Nationwide EO 119 and EO 102

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Vision: Empowered men and women living healthy, productive and fulfilling lives and exercising the right to regulate their own fertility through legally and acceptable family planning services. Mission: The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the availability of FP information and services to men and women who need them. Program Goals:  To provide universal access to FP information, education and services whenever and wherever these are needed. Objectives General  To help couples, individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health. Specifically, by the end of 2004: Reduce  MMR from 172 deaths 100,000 LB in 1998 to less than 100 deaths/100,000 LB  IMR from 35.3 deaths/1000 livebirths in 1998 to less than 30 deaths/1000 live births  TFR from 3.7 children per woman in 1998 to 2.7 chidren per woman Increase  Contraceptive Prevalence Rate from 45.6% in 1998 to 57%  Proportion of modern FP methods use from 28>2% to 50.5% Key Result Areas         

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

Strategies  Frontline participation of DOH-retained hospitals  Family Planning for the urban and rural poor 57

 Demand Generation through Community-Based Management Information System  Mainstreaming Natural Family Planning in the public and NGO health facilities  Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM  Contraceptive Interdependence Initiative Major Activities I. Frontline participation of DOH-retained hospitals  Establishment of FP Itinerant team by each hospital to respond to the unmet needs for permanent FP methods and to bring the FP services nearer to our urban and rural poor communities  FP services as part of medical and surgical missions of the hospital  Provide budget to support operations of the itenerant teams inclduing the drugs and medical supplies needed for voluntary surgical sterilization (VS) services  Partnership with LGU hospitals which serve as the VS site II. Family Planning for the urban and rural poor  Expanded role of Volunteer Health Workers (VHWs) in FP provision  Partnership of itenerant team and LGU hospitals  Provision of FP services III. Demand Generation through Community-Based Management Information System  Identification and masterlisting of potential FP clients and users in need of PF services (permanent or temporary methods)  Segmentation of potential clients and users as to what method is preferred or used by clients IV. Mainstreaming Natural Family Planning in the public and NGO health facilities  Orientation of CHD staff and creation of Regional NFP Management Committee  Diacon with stakeholders  Information, Education and counseling activities  Advocacy and social mobilization efforts  Production of NFP IEC materials  Monitoring and evaluation activities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM  Field of itinerant teams by retained hospitals to provide VS services nearer to the community  Installation of COmmunity Based Management Information System  Provision of augmentation funds for CBMIS activities

58

VI. Contraceptive Interdependence Initiative  Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and FP Itenerant Teams  Expansion of Philhealth benefit package to include pills, injectables and IUD  Social Marketing of contraceptives and FP services by the partner NGOs  National Funding/Subsidy VIII. Development /Updating of FP CLinical Standards IX. Formulation of FP related policies/guidelines. E.g. Creation of VS Outreach team by retained hospitals and its operationalization, GUidelines on the Provision of VS services, etc. X. Production and reproduction of FP advocacy and IEC materials XI. Provision of logistics support such as FP commodities and VS drugs and medical supplies Other Partners 1. Funding Agencies  United States Agency for International Development (USAID)  United Nations Funds for Population Activities (UNFPA)  Management Sciences for Health (MSH)  Engender Health  The Futures Group 2. NGOs  Reachout foundation  DKT  Philippine Federation for Natual Family Planning (PFNFP)  John Snow Inc. - Well Family Clinic  Phlippine Legislators Committee on Population Development (PLPCD)  Remedios Foundation  Family Planning Organization of the Philippines (FPOP)  Institute of Maternal and Child Health (IMCH)  Integrated Maternal and Child Care Services and Development, Inc.  Friendly Care Foundation, Inc.  Institute of Reproductive Health 3. Other GOs  Commission on Population  DILG  DOLE  LGUs

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Food and Waterborne Diseases Prevention and Control Program The program covers diseases of a parasitic, fungal, viral, and bacteria in nature, usually acquired through the ingestion of contaminated drinking water or food. The more common of these diseases are bacterial in nature, the most common of which are typhoid fever and cholera. These two organisms had been the cause of major outbreaks in the Philippines in the last two years. Parasitic organisms are also an important factor, among them capillariasis, Heterophydiasis, and paragonimiasis, which are endemic in Luzon, Visayas, and Mindanao. Cysticercosis is also a major problem since it has a neurologic component to the illness. The approaches to control and prevention is centered on public health awareness regarding food safety as well as strengthening treatment guidelines. Goal and Objectives: The program aims to: 1. Prevent the occurrence of food and waterborne outbreaks through strategic placement of water purification solutions and tablets at the regional level so that the area coordinators could respond in time if the situation warrants; 2. Procure Intravenous Fluid solutions, venosets and IV cannula for adult and pediatric patients in diarrheal outbreaks and to be stockpiles at the 17 Centers for Health Development (CHD) and the Central Office for emergency response to complement the stocks of HEMS; 3. Place first line and second line antimicrobial and anti-parasitic medicines such as albendazole and praziquantel at selected CHDs for outbreak mitigation as well as emergency stocks at the DOH warehouse located at the Quirino Memorial Medical Center (QMMC) compound; 4. Increase public awareness in preventable food-borne illnesses such as capillaria, which is centered on unsafe cultural practices like eating raw aquatic products; 5. Increase coordination between the National Epidemiology Center (NEC) and Regional epidemiology surveillance Unit (RESU) to adequately respond to outbreaks and provide technical support; 6. Procure Typhidot-M diagnostic kits for the early detection and treatment of typhoid patients; 7. Procure Typhoid vaccine and oral cholera vaccine to reduce the number of cases seen after severe flooding; 8. Provide training to local government unit (LGU) laboratory and allied medical personnel on the Accurate laboratory diagnosis of common parasites and proper culture techniques in the isolation of bacterial food pathogens; and 9. Provide guidance to field medical personnel with regard to the correct treatment protocols vis-à-vis various parasitic, bacterial, and viral pathogens involved in food and waterborne diseases. Beneficiaries/Target Population: 60

 The Food and Waterborne Disease Control Program targets individuals, families, and communities residing in affected areas nationwide. For parasitic infections, endemic areas are more common. Strategies/Management:  Case monitoring is maintained through the Philippine Integrated Disease Surveillance and Response (PIDSR) framework of NEC and the sentinel sites of the RESU. To add to that, quarterly reports of the regional coordinators supplement the data and the regular updating from NEC Outbreak Surveillance.  Outbreaks are being prevented though public education in print and radio stations. The need for safe food and water intake by adequate cooking and boiling of drinking water is inculcated to the public.  Multi-drug resistant cases of typhoid are monitored through reports from the hospital sentinel site and the data from the Research Institute of Tropical Medicine‘s Antibiotic Resistance & Surveillance Program. Partner Organizations/Agencies: The following organizations and agencies take part in the achievement of program objectives:     

University of the Philippines-National Institutes of Health (UP-NIH) Department of Agriculture-National Meat Inspection Service (DA-NMIS) Asia Centric Disease Bureau World Health Organization-Western Pacific Regional Office (WHO-WPRO) World Health Organization-Southeast Asia Regional Office (WHO-SEARO)

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Food Fortification Program Objectives:  To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem  To discuss various types of food fortification strategies  To provide an update on the current situation of food fortification in the Philippines Fortification as defined by Codex Alimentarius ―The addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups‖ Vitamin A, Vitamin A Deficiency (VAD) and its Consequences Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence Vitamin A deficiency - a condition characterized by depleted liver stores & low blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor absorption or utilization of vit. A in the body VAD affects children‘s proper growth, resistance to infection, and chances of survival (23 to 35% increased child mortality), severe deficiency results to blindness, night blindness and Bitot‘s spot Prevalence of Vitamin A Deficiency: 1993, 1998, 2003, 2008 (DOST – FNRI, NNS) Physiological State 1993 1998 2003

2008

6 months - 5 yrs.

35.3

38.0

40.1

15.2

Pregnant

16.4

22.2

17.5

9.5

Lactating 16.4 16.5 20.1 6.4 WHO Cut – off Point to be considered a public health problem = >15% Iron and Iron Deficiency Anemia (IDA) and its consequences Iron - an essential mineral and is part of hemoglobin, the red protein in red blood cells that carries oxygen from the lungs to the cells Iron Deficiency Anemia - condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood 62

IDA results in premature delivery, increased maternal mortality, reduce ability to fight infection and transmittable diseases and low productivity Iodine and Iodine Deficiency Disorders (IDD) Iodine -a mineral and a component of the thyroid hormones Thyroid hormones - needed for the brain and nervous system to develop & function normally Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various conditions (e.g. goiter, cretinism, mental retardation, loss of IQ points) Progress in the Philippines towards the Elimination of IDD, 1998-2008 Achievements Indicator Goal* 1998 2003 2008 Proportion of Households using Iodized Salt, >90 %

9.7

56.0 81.1

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

100200

71

201

132

Lactating Women

100200

-

111

81

Pregnant Women

150249

-

142

105

Proportion < 50µg/L, %

< 20

6-12 yrs.

35.8 11.4 19.7

Lactating Women

-

23.7 34.0

Pregnant Women *ICC-IDD 2007

-

18.0 25.8

Policy on Food Fortification ASIN LAW Republic Act 8172, ―An Act Promoting Salt Iodization Nationwide and for other purposes‖, Signed into law on Dec. 20, 1995 Food Fortification Law Republic Act 8976, ―An Act Establishing the Philippine Food Fortification Program and for other purposes‖ mandating fortification of flour, oil and sugar with Vitamin A 63

and flour and rice with iron by November 7, 2004 and promoting voluntary fortification through the SPSP, Signed into law on November 7, 2000 Status of the Philippine Food Fortification Program Status and Recommendations for the Sangkap Pinoy Seal Program  There are 139 processed food products with SangkapPinoySeal with 83% with vitamin A, 29% with iron and 14% with iodine (2008)  37% of the products are snack foods  Most of the products FDA analyzed are within the standard  Based on 2003 NNS Households‘ awareness of SPS- and FF-products is 11% and 14%, respectively, in 2008 awareness is 11.6%  Although awareness is low, usage of SPS-products is 99.2% Recommendations:  Review voluntary fortification standards as standards were developed prior to mandatory fortification  Conduct in-depth analysis of the coverage of SangkapPinoySeal of the 2008 NNS  Update list of Sangkap Pinoy Seal products as some companies have stopped using the seal in their products  Intensify promotions of Sangkap Pinoy Seal  Status and Recommendation on Flour Fortification with Vitamin A and Iron Status:  Based on FDA monitoring all local flour millers are fortifying with vitamin A and iron  94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A and iron respectively while 77% and 99% were fortified with vitamin A and iron respectively. In 2010 decrease in vitamin A due to non-fortified imported and market samples flour.  58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified according to standards. Recommendations:  Review fortificantsfor iron and possible other micronutrients to be added to wheat flour  Continue monitoring wheat fortification  Assist flour millers to improve quality of fortification  Need to show impact of flour fortification  Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A 64

Status:  Non – fortification by industry due to the unresolved issue of who will bear the cost of fortification brought about by the quedansystem of transferable certificates of sugar ownership.  Lack of premix production  Fortification of refined sugar would benefit mainly those in the high income group. Recommendations:  Continue discussions with sugar industry to explore a compromise for fortification ie. fortification of washed sugar  Review policy on mandatory fortification of refined sugar Status and Recommendations on Rice Fortification with Iron Status:  NFA is fortifying 50% of its rice in 2009 and 2010  With the non – fortification of NFA rice, private sector has an excuse for non – fortification of its rice.  There is limited commercial/private sector iron rice premix and iron fortified rice production and distribution mostly in Mindanao (Region XII and XI) with Gen San having the only commercial iron rice premix plant in the Philippines and Davao City implementing mandatory rice fortification in food outlets  NFA conducted communications campaign for its iron fortified rice thru the so called ―I-rice‖ campaign though issues remain on the acceptability of its product Recommendation:  Review of mandatory fortification of rice with iron Status and Recommendations on Cooking Oil Fortification with Vitamin A Status:  Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in 2009 and 94% in 2010)  Samples monitored were labeled and packed  FDA is not monitoring "takal" Recommendations:  To increase frequency of monitoring by FDA and other agencies such as PCA and LGU‘s, to ensure all oil refiners and repackersare monitored at least once a year 65

 Monitoring of ―takal‖ oil, use of test kit  Monitoring imported oil, FDA and BOC to coordinate  Review policy of mandatory fortification of oil to possibly limit to those mostly used by at risk population (coconut and palm oil)  Status and Recommendations on Salt Iodization Status:  Based on the 2008 NNS, 81.1% of households were positive for iodine using Rapid Test Kit (RTK)  In the same survey for Region III, 55.7% were positive for RTK but only 34.2% and 24.2% have iodine content >5ppm and >15ppm respectively using WYD Tester  For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm  FDA started implementing localization of ASIN Law with General Santos City as the 1stto have a MOA with FDA on localization Recommendation:  FDA to expand localization of ASIN Law  Set – up iodine titration for testing iodine in salt  Continue to intensify monitoring particularly imported and takal salt Food Fortification Day Theme 2010: EO 382 declares November 7 as the National Food Fortification Day

Garantisadong Pambata The Mandate: A.O. 36, s2010 Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos Goal 

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

Universal Health Care Strategies:  Financial risk protection.  Improved access to quality hospitals and facilities  Attainment of health-related MDGs by:  Deploy CHTs to actively assist families in assessing and acting on their health needs 66

Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC, IPP, GP for 0-14 years old  Aggressive promotion of healthy lifestyle change  Harness strengths of inter-agency and intersectoralcooperation with DepEd, DSWD and DILG 

EXPANDED GARANTISADONG PAMBATA Comprehensive and integrated package of services and communication on health, nutrition and environment for children available everyday at various settings such as home, school, health facilities and communities by government and nongovernment organizations, private sectors and civic groups. Objectives:  ›Contribute to the reduction of infant and child morbidity and mortality towards the attainment of MDG 1 and 4.  ›Ensure that all Filipino children, especially the disadvantaged group (GIDA), have equitable access to affordable health, nutrition and environment care. Partner Agencies:  Department of Education  Department of Social Welfare & Development  Department of Interior and Local Government  Department of Health  USAID  UNICEF  World Health Organization  Save the Children  Fit for School  World Vision  Plan Foundation  Philippine Dental Association

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GP Services Package Age by Year Health

Nutrition

0-1

Maternal health care Essential newborn care Immunization

Maternalnutrition Iron supplementation Vitamin A Early &exclusive breastfeeding Complementary feeding

1-5

Immunization Deworming IMCI

Breastfeeding Complementaryfeeding Vitamin A Iron supplementation Iodized salt at home

6-10

Deworming Booster immunization (Screening)

Proper nutrition Iodized salt at home

11-14

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

Proper nutrition Iron supplementation Iodized salt at home

Environment Water Sanitation Hygiene promotion Oral health Child injury prevention Treated bednets Smoke-free homes

Vitamin A Supplementation ›Policy remains the same for giving Vitamin A capsules: Routine: - every 6 months for 6-59 months preschoolers Therapeutic: - 1 capsule upon diagnosis regardless of when the last dose of VAC for preschoolers with measles - 1 capsule upon diagnosis except when child was given Vitamin A was given less than 4 weeks for preschoolers with severe pneumonia, persistent diarrhea, severely underweight - 1 capsule immediately upon diagnosis, 1 capsule the next day and another capsule after 2 weeks after for preschoolers with xerophthalmia Recording/Reporting:  FHSIS Records and Reports  GP Forms – submitted to NCDPC thru CHDs  April – preschoolers 6-59 months given VAC from November of past year to  April of the current year October – preschoolers 6-59 months given  VAC from May to October 68

Core Messages per Gateway Behavior MAGPASUSO  (Newborn to 6 mos) Pasusuhin ng gatas ni Nanay lang  (6 mos to 2 years old) Magpasuso at bigyan ng (mga masustansiyang ibatibang pagkain) ibang pagkain (pampamilyang pagkain).  Bumili/ Gumamit ng mga produktong may SANGKAP PINOY seal sa pagluluto. MAGPABAKUNA  Siguraduhing kumpletoang bakuna ni baby bago siya magdiwang ng unang kaarawan.  Pabakunahan ng MMR ang mga batang 1 taon hanggang 1 taon at 3 buwan. Ito ay laban sa tigdas, beke at rubella (German Measles) MAGBITAMINA A  Siguraduhing mabigyan (mapatakan) ng Bitamina A kada anim (6) na buwan ang inyong mga anak na edad 6 na buwan hanggang 5 taon MAGPURGA  Siguraduhing mapurga ang inyong mga anak na edad 1 hanggang 12 na taong gulang kada anim na buwan. GUMAMIT NG PALIKURAN  Gumamit ng kubeta o palikuran sa pagdumi at pagihi. MAGSIPILYO  Wastong pagsisipilyo ng ngipin ng dalawang beses sa isang araw, lalo na bago matulog. MAGHUGAS NG KAMAY  Maghugas ng kamay bago kumain at matapos gumamit ng kasilyas. Ugaliin din ang paghuhugas ng kamay matapos maglaro o humawak ng maduduming bagay.

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Human Resource for Health Network The Department of Health (DOH) spearheaded the creation of Human Resource for Health Network (HRHN), which is a multi-sectoral organization composed of government agencies and non-government organizations. The network seeks to address and respond to human resource for health (HRH) concerns and problems. HRHN was formally established during the launching and signing of the Memorandum of Understanding among its member agencies and organizations held on October 25, 2006. This network was grounded on the Human Resources for Health Master Plan (HRHMP) developed by the DOH and the World Health Organization (WHO). The HRHN was conceived to implement programs and activities that require multi-sectoral coordination. Vision: Collaborative partnerships for a better, more responsive and globally competitive HRH. Mission: The HRHN is a multi-sectoral organization working effectively for coordinated and collaborative action in the accomplishment of each member organization‘s mandate and their common goals for HRH development to address the health service needs of the Philippines, as well as in the global setting. Values: Upholds the quality and quantity of HRH for the provision of quality health care in the Philippines. Objectives: The objectives of the HRHN are as follows: 1. Facilitate implementation of programs of the HRHMP that would entail coordination and linkage of concerned agencies and organizations; 2. Provide policy directions and develop programs that would address and respond to HRH issues and problems; 3. Harmonize existing policies and programs among different government agencies and non-government organizations; 4. Develop and maintain an integrated database containing pertinent information on HRH from production, distribution, utilization up to retirement and migration; and 5. Advocate HRH development and management in the Philippines. Projects: During its first year of implementation, the HRHN has the following priority projects and activities: 1. Review and Harmonization of HRH Related Policies; 2. Development of HRHN Website; 3. Conduct of Capability Building Activities; and 4. Conduct of the National HRH Forum.

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Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control) Bureau or Office: National Center for Disease Prevention and Control Program Briefer Cognizant of its mandate and crucial role, the Philippine Department of Health (DOH) formulated the Health Care Program for Older Persons (HCPOP) in 1998. The DOH HCPOP (presently renamed Health Development Program for Older Persons) sets the policies, standards and guidelines for local governments to implement the program in collaboration with other government agencies, non-government organizations and the private sector. The program intends to promote and improve the quality of life of older persons through the establishment and provision of basic health services for older persons, formulation of policies and guidelines pertaining to older persons, provision of information and health education to the public, provision of basic and essential training of manpower dedicated to older persons and, the conduct of basic and applied researches. Target Population/Clients A. Older persons (60 years and above) who are: a. Well and free from symptoms b. Sick and frail c. Chronically ill and cognitively impaired d. In need of rehabilitation services B. Health workers and caregivers C. LGU and partner agencies Area of Coverage:

Nationwide

Mandate: International:  Vienna International Plan of Action on Ageing  General Assembly Resolutions Local:  Philippine Constitution (Article XIII, Section XI)  Republic Act 7876 - Senior Citizens Center Act of the Philippines  Republic Act No. 7432 - An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes  Proclamation No. 470 - Declaring the 1st week of October every year as "Elderly Filipino Week"  Philippine Plan of action for Older Persons (1999-2004) Vision: Healthy ageing for all Filipinos. 71

Goal:

A healthy and productive older population is promoted.

Health Development Program for Older Persons - R.A. 7876 (Senior Citizens Center Act of the Philippines) REPUBLIC ACT NO. 7876 AN ACT ESTABLISHING A SENIOR CITIZENS CENTER IN ALL CITIES AND MUNICIPALITIES OF THE PHILIPPINES, AND APPROPRIATING FUNDS THEREFOR. Sec. 1.Title. — This Act shall be known as the "Senior Citizens Center Act of the Philippines." Sec. 2.Declaration of Policy. — It is the declared policy of the State to provide adequate social services and an improved quality of life for all. For this purpose, the State shall adopt an integrated and comprehensive approach towards health development giving priority to elderly among others.chan robles virtual law library Sec. 3.Definition of Terms. — (a) "Senior citizens," as used in this Act, shall refer to any person who is at least sixty (60) years of age. (b) "Center," as used in this Act, refers to the place established by this Act with recreational, educational, health and social programs and facilities designed for the full enjoyment and benefit of the senior citizens in the city or municipality. Sec. 4.Establishment of Centers. — There is hereby established a senior citizens center, hereinafter referred to as the Center, in every city and municipality of the Philippines, under direct supervision of the Department of Social Welfare and Development, hereinafter referred to as the Department, in collaboration with the local government unit concerned. Sec. 5.Functions of the Centers. — The centers are extensions of the fourteen (14) regional offices of the Department. They shall carry out the following functions: (a) Identify the needs, trainings, and opportunities of senior citizens in the cities and municipalities;chan robles virtual law library (b) Initiate, develop and implement productive activities and work schemes for senior citizens in order to provide income or otherwise supplement their earnings in the local community; (c) Promote and maintain linkages with provincial government units and other instrumentalities of government and the city and municipal councils for the elderly and the Federation of Senior Citizens Association of the Philippines and other nongovernment organizations for the delivery of health care services, facilities, professional advice services, volunteer training and community self-help projects; and 72

(d) To exercise such other functions which are necessary to carry out the purpose for which the centers are established. Sec. 6.Center Workers. — The Secretary of the Department of Social Welfare and Development (DSWD) may designate social workers from the Department as the workers of the centers: Provided, however, That the Secretary may appoint other personnel who possess the necessary professional qualifications to work efficiently with the elderly of the community. The Secretary may also call upon private volunteers who are responsible members of the community to provide medical, educational and other services and facilities for the senior citizens. Sec. 7.Qualification/Disqualification. — A senior citizen who suffers from a contagious disease, or who is mentally unfit or unsound or whose actuations are inimical to other senior citizens as determined by the DSWD on the basis of an appropriate certification by a qualified government or private volunteer physician, may be denied the benefits provided in the Center. However, the center shall refer the senior citizen concerned to the appropriate government agency for the needed medical care or confinement. Sec. 8.Exemptions of the Center. — The Center shall be exempted from the payment of customs duties, taxes and tariffs on the importation of equipment and supplies used actually, directly and exclusively by the Center pursuant to this Act, including those donated to the Center. Sec. 9.Rules and Regulations. — Withinsixty (60) days from the approval of this Act, the DSWD, in coordination with other government agencies concerned, shall issue the rules and regulations to effectively implement the provisions of this Act. Any violation of this section shall render the concerned official(s) liable under Republic Act No. 6713, otherwise known as the "Code of Conduct and Ethical Standards for Public Officials and Employees" and other existing administrative and/or criminal laws. Sec. 10.Coordination of Government Agencies. — The DSWD, in coordination with the Department of Health and other government agencies and local government units, shall assist in the effective implementation of this Act and provide the necessary support services. Sec. 11.Appropriations. — The amount necessary to carry out the provisions of this Act shall be included in the General Appropriations Act of the year following its enactment into law and every year thereafter. The sum necessary for the continuous operation of the centers shall be subsidized in part by the DSWD and in part by the local government units concerned. Sec. 12.Repealing or Amending Clause. — All laws, decrees, executive orders, and rules and regulations, which are not consistent with this Act, are hereby modified, amended or repealed accordingly.chan robles virtual law library 73

Sec. 13. This Act shall take effect fifteen (15) days after its publication in two (2) newspapers of general circulation.

Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999)) The Global Movement for Active Ageing, which was conceived by the World Health Organization (WHO), will need the collaboration of many different partners from all over the world. Active ageing is the capacity of the people, as they grow older to lead productive and healthy lives in their families, societies and economies. The Global Movement will be a network for all those interested in moving policies and practice towards Actives Ageing. It will provide models and ideas for programme and projects that promote active ageing. The key messages of the Global Movement are: 1. CELEBRATE – Celebrate ageing ; getting older is good; the alternative dying prematurely is not 2. A SOCIETY FOR ALL Active ageing is key for older persons continuing to contribute to society; all dimensions for being active should be taken into account : the physical, mental, social, and spiritual 3. INTEGENERATIONAL SOLIDARITY Older persons should not be marginalized: reflecting the theme of the UN International Year of Older Persons, ―towards a society for all ages‖ What is the Global Embrace 1999? The Global Embrace, which will mark simultaneously the launching of Global Movement for Active Ageing 1999 International Year for Older Persons, is exactly as the title implies, a series of walk events embracing the globe: in time zone after time zone, ageing will be celebrated in cities around the world, through these walk events. The walk will start in countries in the Pacific, where the date line marks the start of a new day. Thus, the first walk will be in New Zealand ..followed by Australia, then Japan, Korea, China, Thailand, the Philippines, Indonesia and India.. Always at a set time, a group of cities, within the same time zone, will be starting their celebrations. Eventually, they will reach the Middle East, Africa, Europe, the America, until the very last locations will close the day and embrace. The Global embrace is a round the clock around the world party which every country is invited.

74

Objectives: 1. To inspire, to inform, to promote health and to provide enjoyment and good company. 2. Moreover, it will link the local project to a global community of similar concerns and people from all over the world. Target date : October 2, 1999 (Saturday) Target Pop. : General population Target venue : Quezon Memorial Circle, Quezon City (Metro Manila) simultaneous with La Union (Luzon), Metro Cebu (Visayas), and Metro Davao (Mindanao) As there are still negative stereotype associated with old age in many societies, a participatory event that promotes a positive image of ageing will assist in dissipating these stereotypes. This is a necessary precondition both for allowing the aged to make a contribution to the world as well as for building a harmonious global community and an intergenerational society. A. 2 The Message ― Kami ay para sa KSP‖ ( Kalusugan Sa Pagtanda or Healthy Ageing) Ageing is a NORMAL, dynamic process and NOT a DISEASE. It is the inevitable alternative to PREMATURE DEALTH. It can prevent or delay many disabling conditions that often accompany ageing through healthy lifestyle such as proper diet, exercise, avoidance of untoward stress, smoking and alcohol. A.3 The Walk Event The World Health Organization (WHO) Ageing and Health Programme has launched initiatives that encourage healthy ageing globally. To assist in the promotion, an annual celebration on October 2 (Saturday) as designated by the United Nation and mandated by law shall recognize the ―International Year of Older Persons (IYOP)‖ These celebratory event will be held at the Quezon Memorial Circle, Quezon City, 3 p.m. till midnight A. 4 Target Population Since the walk event promotes healthy ageing there is NO SPECIFIC TARGET POPULATION. Everybody (All ages) are encouraged to participate in the walk. There is NO competitive aspect to the event that people at all levels of physical activity are encouraged to take part. The primary aim is to promote intergenerational exchanges.

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Health Development Program for Older Persons - R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges) AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES. Be it enacted by the Senate and House of Representative of the Philippines in Congress assembled: SECTION 1. Declaration of Policies and Objectives – Pursuant to Article XV, Section 4 of the Constitution, it is the duty of the family to take care of its elderly members while the State may design programs of social security for them. In addition to this, Section 10 in the Declaration of Principles and State Policies provides: ―The State shall provide social justice in all phases of national development‖. Further, Article XIII, Section II provides: ―The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women and children.‖ Consonant with these constitutional principles the following are the declared policies of this Act: a) To motivate and encourage the senior citizens to contribute to nation building; b) To encourage their families and communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizens. In accordance with these policies, this act aims to: 1) Establish mechanism whereby the contribution of the senior citizens are maximized; 2) Adopt measures whereby our senior citizens are assisted and appreciated by the community as a whole; 3) Establish a program beneficial to the senior citizens, their families and the rest of the community that they serve. SECTION 2.Definition of Terms. – As used in this Act, the term ―senior citizen‖ shall mean any resident of the Philippines at least sixty (60) years old, including those who have retired from both government offices and private enterprises, and has an income of not more than Sixty thousand pesos (P60,000.00) per annum subject to review by the National Economic and Development Authority (NEDA) every three (3) years. 76

The term ―head of the family‖ shall mean any person so defined in the National Internal Revenue Code. SECTION 3.Contribution to the Community. – Any qualified senior citizens as determined by the Office for Senior Citizen Affairs (OSCA) may render his/her services to the community which shall consist of but not limited to any of the following: a) Tutorial and/or consultancy services; b) Actual teaching and demonstration of hobbies and income generating skills; c) Lectures on specialized fields like agriculture, health, environmental protection and the like; d) The transfer of new skills acquired by virtue of their training mentioned in Section 4, paragraph (d) e) Undertaking other appropriate services as determined by the Office for Senior Citizens Affairs (OSCA) such as school traffic guide, tourist aid, pre-school assistant, etc. In consideration of the services rendered by the qualified elderly, the Office for Senior Citizens Affairs (OSCA) may award or grant benefits or privileges to the elderly, in addition to the other privileges provided for under Section 4 hereof. SECTION 4.Privileges for the Senior Citizens. – The senior citizens shall be entitled to the following: a) The grant of twenty percent (20%) discount from all establishments relative to utilization of transportation services, hotels and similar lodging establishment, restaurants and recreation centers and purchase of medicines anywhere in the country: Provided, That private establishments may claim the cost as tax credit; b) A minimum of twenty percent (20%) discount on admission fees charged by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure, and amusements; c) Exemption from the payment of individual income taxes: Provided, That their annual taxable income does not exceed the poverty level as determined by the National Economic and Development Authority (NEDA) for that year; d) Exemption from training fees for socioeconomic programs undertaken by the OSCA as part of its work;

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e) Free medical and dental services in government establishment anywhere in the country, subject to guidelines to be issued by the Department of Health, the Government Service Insurance System and the Social Security System; f) To the extent practicable and feasible, the continuance of the same benefits and privileges given by the Government Service Insurance System (GSIS), Social Security System (SSS) and PAG-IBIG, as the case may be, as are enjoyed by those in actual service. SECTION 5.Government Assistance. – The Government shall provide the following assistance to those caring for and living with the senior citizen: a) The senior citizen shall be treated as dependents provided for in the National Internal Revenue Code and as such, individual taxpayers caring for them, be they relatives or not shall be accorded the privileges granted by the Code insofar as having dependents are concerned. b) Individuals or non-governmental institutions establishing homes, residential communities or retirement villages solely for the senior citizens shall be accorded the following: 1) Realty tax holiday for the first five (5) years starting from the first year of operations; 2) Priority in the building and/or maintenance of provincial or municipal roads leading to the aforesaid home, residential community or retirement village. SECTION 6.Retirement Benefits. – To the extent practicable and feasible retirement benefits from both the Government and the private sectors shall be upgraded to be at par with the current scale enjoyed by those in actual service. SECTION 7.The Office for Senior Citizens Affairs (OSCA). – There shall be established in the Office of the Mayor an OSCA to be headed by a Councilor who shall be designated by the Sangguniang Bayan and assisted by the Community Development Officer in coordination with the Department of Social Welfare and Development. The functions of this office are: a) To plan, implement and monitor yearly work programs in pursuance of the objectives of this Act; b) To draw up a list of available and required services which can be provided by the senior citizens; c) To maintain and regularly update on a quarterly basis the list of senior citizens and to issue nationally uniform individual identification cards which shall be valid anywhere in the country; 78

d) To serve as a general information and liaison center to serve the needs of the senior citizens. SECTION 8.Municipal Responsibility. – It shall be the responsibility of the municipality through the Mayor to ensure that the provisions of this Act are implemented to its fullest. SECTION 9.Penalties. – Violation of any provision of this Act for which no penalty is specifically provided under any other law, shall be punished by imprisonment not exceeding one (1) month or a fine not exceeding One thousand pesos (P1,000.00) or both. SECTION 10.Implementing Rules and Regulations. – The Secretary of Social Welfare and Development jointly with the Department of Finance, the Department of Tourism, the Department of Health, the Department of Transportation and Communications and the Department of Interior and Local Government shall issue the necessary rules and regulations to carry out the objectives of this Act. SECTION 11.Appropriation. – The necessary appropriation for the operation and maintenance of the OSCA shall be appropriated and approved by the local government units concerned. The National Government shall appropriate such amount as may be necessary to carry out the objectives of this Act. SECTION 12.Repealing Clause. – All provisions of laws, orders, and decrees, including rules and regulations inconsistent herewith are hereby repealed and/or modified accordingly. SECTION 13.Separability Clause. – If any part or provision of this Act shall be held to be unconstitutional or invalid, other provisions hereof which are not affected thereby shall continue to be in full force and effect. SECTION 14.Effectivity. – This Act shall take effect fifteen (15 days following its publication in one (1) national newspaper of general circulation. Approved, (SGD.) RAMON V. MITRA Speaker of the House of Representatives

(SGD.) NEPTHALI A. GONZALES President of the Senate

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

(SGD.) CAMILO L. SABIO Secretary General House of Representatives

(SGD.)ANACLETO D. BADOY, JR. Secretary of the Senate Approved: April 23, 1992

(SGD.) CORAZON C. AQUINO President of the Philippines GUIDELINES ON THE ISSUANCE OF THE NATIONALLY UNIFORM IDs OF SENIOR CITIZENS AS PER R.A. 7432 The national I.D. of Senior Citizens as per provision of RA 7432 is to be provided by the Department of Social Welfare and Development (DSWD) for free. A senior citizen who has an income of P60,000.00 and below per annum shall be granted the benefits per Section 4 of RA 7432. The process of securing the ID is as follows: 1. A Senior Citizen shall enlist at the Office for Senior Citizens Affairs (OSCA) established at the Office of the Mayor in his/her city or municipality; 2. The OSCA shall determine the eligibility of the senior citizen. All eligible senior citizens shall provide OSCA two (2) ID pictures taken within the year of enlisting at OSCA. One ID picture shall be attached to the OSCA registration form to be kept by the said office. The other picture shall be for the ID card; 3. The OSCA shall prepare the list of Senior Citizens to be certified by the local office of the Bureau of Internal Revenue and the local Civil Registrar‘s office; 4. Duplicate copy of the certified list of senior citizens shall be submitted by OSCA to the DSWD filed office; 5. The Bureau of Disabled Persons Welfare, DSWD shall send to the 14 DSWD Field Offices number of IDs needed by the Elderly of the region; 80

6. The DSWD Field Office shall release the IDs to the respective local OSCAs; 7. The OSCA shall issue the ID cards duly signed by the municipal/city Mayor to the qualified senior citizens; 8. The OSCA shall issue the nationally uniform ID card without cost to the Senior Citizen. In case the ID is lost, it must be reported to the local OSCA. Replacement shall be issued upon request by OSCA with corresponding cost. The cost per ID shall be determined by DSWD. The payment shall remain at OSCA as part of its funds. No ID cards of senior citizens shall be issued directly by the DSWD Central Office or its field offices. SOCIAL DEVELOPMENT COMMITTEE Resolution No. 1 (Series 1993) Approving the Implementing Rules and Regulations of R.A. 7432 Maximizing the Contribution of Senior Citizens to Nation Building, Grant Benefits and Privileges Whereas, the Philippine Constitution recognizes the duty of the family to take care of its elderly members with the state designing programs of social security for them, and the need for the state to promote social justice in all phases of national development, by making available essential social services to the priority groups such as the sick, elderly, disabled, women and children; Whereas, RA 7432 has been enacted to motivate and encourage senior citizens to contribute to nation building and to mobilize their families and the communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizen; Whereas, the Medium Term Philippine Development Plan (MTPDP) 1993-1998 aims to pursue a better quality of life for all Filipinos particularly the disadvantaged sectors by providing focused basic services to allow them to manage and control their resources, as well as benefit from developmental interventions; Whereas, the draft IR on R.A. 7432 was formulated by an Inter-agency Committee headed by the Department of Social Welfare and Development (DSWD), and participated in by the Department of Interior and Local Government (DILG), Tourism (DOT), Transportation and Communications (DOTC), Health (DOH) and Finance (DOF), including the National Federation of Senior Citizens Association of the Philippines (NFSCAP). NOW, THEREFORE, BE IT RESOLVED, AS IT IS HEREBY RESOLVED, by the Chairman and the members (of the NEDA, Board‘s Social Development Committee (SPC) Cabinet level, to approve the Implementing Rules and Regulations of R.A. 7432.

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

(Sgd.)Honorable Cielito F. Habito, Jr. Secretary for Socioeconomic Planning Co-Chairman, Social Development Committee

(Sgd.) Hon. Corazon Alma G. De Leon Acting Secretary Department of Social Welfare and Development

(Sgd.) Hon. Roberto S. Sebastian Secretary Department of Agriculture

(Sgd.) Hon. Ernesto D. Garilao Secretary Department of Agrarian Reform

(Sgd.) Hon. Juan M. Flavier Secretary Department of Health

(Sgd.) Hon. Rafael M. Alunan, III Secretary Department of Interior and Local Government

(Sgd.) Hon. Armand V. Fabella Secretary Department of Education, Culture and Sports

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

RULES AND REGULATIONS IN THE IMPLEMENTATION OF RA 7432, THE ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES

RULE I TITLE, PURPOSE AND CONSTRUCTION Article 1. Title – These Rules shall be known and cited as the Rules and Regulations implementing the Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes. Article 2. Purpose – These Rules are promulgated to prescribe the procedures and guidelines for the implementation of the Act to Maximize the Contribution of Senior Citizens to National Building, Grant Benefits and Special Privileges and for Other Purposes in order to facilitate the compliance therewith and to achieve the objectives thereof. Article 3. Construction – These Rules shall be construed and applied in accordance with and in furtherance of the policy and objectives of the law. In case of conflict and/or ambiguity, which may arise in the implementation of these rules, the concerned agencies shall issue the necessary clarification. In case of doubt, the same shall be construed liberally and in favor of the beneficiaries. RULE II DECLARATION OF POLICIES AND OBJECTIVES, SCOPE AND APPLICATION Article 4. Declaration of Policies and Objectives – Pursuant to Article XV, Section 4 of the Constitution it is the duty of the family to take care to its elderly members while the State may design programs of social security for them. In addition to this, Section 10 in the Declaration of Principles and State Policies provides: ―The State shall provide social justice in all phases of national development.‖ Further, Article XIII, Section II provides: ―The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health, and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women and children.‖ Consonant to these constitutional principles, the following are the declared policies of this Act: 83

a) To motivate and encourage senior citizens to contribute to nation building; b) To encourage their families and the communities they live with to reaffirm the valued Filipino tradition of caring for the senior citizens; In accordance with these policies, the Act aims to: a) Establish mechanisms whereby the contribution of the senior citizens are maximized; b) Adopt measures whereby our senior citizens are assisted and appreciated by the community as a whole; c) Establish a program beneficial to the senior citizens, their families and the rest of the community that they serve. Article 5. Definition of Terms – As used in these rules, the following terms shall be defined as follows: 5.1 Senior Citizen – any resident citizen of the Philippines, at least sixty (60) years old, including those who have retired from both government offices and private enterprises and has an income of not more than sixty thousand pesos (P60,000.00) per annum subject to review by the National Statistics Coordination (NSCB) every three (3) years. Senior Citizens earning sixty thousand pesos (P60,000.00) per annum may be tapped as resource persons to provide transfer technology and consultancy services or other services in the community. Those without income are necessarily covered by this definition. 5.2 Resident Citizen – refers to Filipino Citizen who establishes to the satisfaction of the Office of the Senior Citizens Affairs (OSCA) the fact of his physical presence in the Philippines for at least 183 days with a definite intention to reside therein. 5.3 Benefactor – shall mean any person whether related to the senior citizen or not who takes care of him or her as dependent. 5.4 Head of the Family – shall mean an unmarried or legally separated man or woman with one or both parents or with one or more brothers or sisters or with one or more legitimate, recognized, natural or legally adopted children and/or with one or more senior citizen living with and dependent upon him for their chief support where brother/s or sister/s or children are not more than twenty one (21) years of age unmarried and not gainfully employed or where such children, brother/s or sister/s, regardless of age are incapable of self-support because of mental or physical defect.

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5.5 National Identification Cards – are the ID cards provided for initially for free by the Department of Social Welfare and Development and issued through the Office for Senior Citizens Affairs (OSCA). 5.6 Office for Senior Citizens Affairs – otherwise known, as the OSCA shall be established in the Office of the Mayor as prescribed in the Act. 5.7 Department of Social Welfare and Development – otherwise known as DSWD in this rule, shall mean the national office located at Batasan Complex, Quezon City and its field offices in the fourteen regions of the country. 5.8 Municipal/City Federation of Senior Citizens – an organization of senior citizens in the locality which is affiliated with the National Federation of Senior Citizens‘ Associations of the Philippines (NFSCAP). In the absence of such organization, any organization of senior citizens in the locality duly accredited by the Sangguniang Bayan/Panglungsod. 5.9 Air Transportation Service – shall mean as the carriage of passenger by air. 5.10 Hotel – shall mean the building, edifice or premises or a completely independent part thereof, which is used for the regular reception, accommodation, or lodging of travelers and tourists and the provision of services incidental thereto for a fee. 5.11 Lodging Establishment – shall mean any of the following: a. Tourist Inn – a lodging establishment catering to transients which does not meet the minimum requirement of an economy hotel. b. Apartel – any building or edifice containing several independent and furnished or semi-furnished apartments, regularly leased to tourists and travelers for dwelling on a more or less long-term basis and offering basic services to its tenants, similar to hotels. c. Motorist Hotel – any structure with several separate units, primarily located along the highway, with individual or common parking space, at which motorists may obtain lodging and in some instances, meals. d. Pension House – a private, or family-operated tourist boarding house, tourist guest house or tourist lodging house, employing non-professional domestic helpers, regularly catering to tourist, and/or travelers, containing several independent lettable rooms, providing common facilities such as toilets, bathrooms/showers, living and dining rooms and/or kitchen and where a combination of board and lodging may be provided. The term lodging establishment shall include lodging houses, which shall mean such establishments as are regularly engaged in the hotel business, but which, 85

nevertheless, are not registered, classified and licensed as hotels by reason of inadequate essential facilities and services. 5.12 Restaurant – shall mean any establishment, duly licensed by the local government units (LGUs ), offering to the public, regular and special meals or menu, cooked food and short orders. Such eating-places may also serve coffee, beverages and drinks. RULE III CREATION OF THE OFFICE FOR SENIOR CITIZENS AFFAIRS Article 6. Office for Senior Citizens Affairs (OSCA) – There shall be established in the office of the Mayor and OSCA to be headed by a councilor who shall be designated by the Sangguniang Bayan/Panglungsod in coordination with the Department of Social Welfare and Development (DSWD) and the Municipal/City Federation of Senior Citizens. Article 7.The Functions of OSCA – The OSCA shall perform the following functions: a) To plan, implement and monitor yearly work programs in pursuance of the objectives of this Act; b) To mobilize the different local agencies to identify activities within their programs which can be undertaken by the senior citizens; c) To draw up a list of available and required services which can be provided by the senior citizens; d) To maintain a regular update on a quarterly basis a list of senior citizens; The regular quarterly update of the list of senior citizens shall be made on the first week of the first month of every quarter. e) To issue nationally uniform individual identification cards which shall be valid anywhere in the country; It shall the responsibility of the local Social Welfare Development Officer or any other officer performing such functions to review and process all applications f) To serve as a general information and liaison center to respond to the needs of the senior citizens, the OSCA shall: f.1 assist any complainant or aggrieved senior citizen in filing the appropriate action with the Office of the Public Prosecutor or with the concerned Agency/Department until same is finally terminated or resolved, and; 86

f. 2 assist the National Government in putting up the necessary appropriate notices of the mandatory elderly discount privileges/benefits under RA 7432, which shall be posted at a conspicuous place in all establishments. This shall be made as a requirement in the renewal of business licenses annually. The Municipal/City Federations of Senior Citizens shall assist OSCA in the foregoing functions: 8.1 to provide the initial nationally uniform identification cards which shall be issued through the OSCA. The nationally uniform individual identification cards shall contain the following information: a) Control Number, Date of Issue b) Name c) Address d) Age, as supported by a certified birth certificate from the Office of Civil Registrar; Birth date e) Annual income, as supported by a certificate of exemption from payment of income tax issued by the local office of the Bureau of internal Revenue (BIR) f) Picture g) Signature of senior citizen A senior citizen whose income is P60,000.00 and below annually shall be issued a national ID card, which contains the mandatory elderly, discount privileges/benefits under RA 7432. This shall be duly signed by the mayor of the senior citizen‘s locality, the Secretary of the Department of Social Welfare and Development (DSWD) and the Secretary of the Department of Interior and Local Government (DILG). This shall be non-transferrable. 8.2. to assist in developing the standards of programs and services of OSCA. 8.3. to provide technical assistance and monitor services and projects to be undertaken by the OSCA. RULE IV 87

CONTRIBUTIONS IN THE COMMUNITY Article 9.Contributions of Senior Citizens to the Community. Any qualified senior citizen as determined by the OSCA may render his/her services to the community, which shall consist of, but not limited to any of the following: a. tutorial and/or consultancy services; b. actual teaching and demonstration of hobbies and income generating skills; c. lectures on specialized field like agriculture, health, environmental protection; d. transfer of new skill acquired by virtue of their training mentioned in Section 4 of paragraph (d) of the Act; e. undertake other appropriate services as determined by the OSCA such as school traffic guide, tourist aide, pre-school assistance, etc. In consideration of services rendered by the qualified elderly, the OSCA may award or grant benefits/privileges to the elderly, in addition to the other privileges provided for under Section 4 of the Act. In the absence of resources, OSCA shall mobilize resources of the community to provide awards or incentives. Financially able institutions desiring to acquire services of the elderly shall be mobilized to provide a reasonable compensation e.g. transport, food, etc. for the duration of the senior citizen‘s services. Senior citizens earning above sixty thousand pesos (P60,000.00) annually can be granted some awards or benefits by the OSCA for services rendered to his community e.g. consultancy services, transfer of new technology, etc. RULE V PRIVILEGES AND BENEFITS OF SENIOR CITIZENS A senior citizen shall be granted twenty per cent (20%) discount from all establishments relative to utilization of transportation services, hotels and similar lodging establishments, restaurants and recreation centers and purchases of medicines, anywhere in the country. A. Transportation Benefits A. 1 Public Water Transportation – Every senior citizen who is a passenger of any public water transportation service as this term is understood under the Public Service Act, as amended, shall be entitled to a discount in the amount of not less 88

than twenty per cent (20%) of the fare charged or authorized, including discount of twenty per cent (20%) on purchases of meals or food items from the restaurant either operated by concessionaire or the carrier and medicines on board vessels. The Maritime Industry Authority (MARINA) is hereby directed to issue corresponding circulars or directives to the shipping industry for the implementation of these guidelines to ensure compliance herewith, as well as requirements to ship operators/ship owners to disseminate, by posters, handbills or pamphlets, the information about senior citizen on board vessels to maximize the benefits of the senior citizens. A senior citizen, unless his/her physical appearance shows that he/she undoubtedly 60 years old or above, may prove his/her age by any of, but not limited, to the following documents or papers: a. Official Identification Card from the OSCA of the LGUs, SSS/GSIS ID (old or new); b. Driver‘s License or Birth Certificate; c. Voter‘s ID or Voter‘s Affidavit; d. Residence Certificate (old or new); e. And other public/official record or document, from relevant government agencies. A.2 Public Land Transportation – every senior citizen who is a passenger of any public land transportation services stated below, shall be entitled to a discount in the amount of not less than twenty per cent (20%) of the fare authorized by the Land Transportation Franchising and Regulatory Board (LTFRB). The public land transportation referred to are the following: a. Bus (pub) b. Jeepney (puj) c. Taxi d. Shuttle Bus e. Tourist Bus f. Other modes of passenger land transportation devoted for public use and for a fee with general or limited clientele. The LTFRB is hereby directed to issue corresponding circular or directives to the public land transport sector for the implementation of these guidelines to ensure compliance herewith, as well as requirements to these operators to disseminate, by 89

posters, handbills or pamphlets, the information about senior citizens on board their vehicles to maximize the benefits of the senior citizens. Every senior citizen is entitled to a grant of twenty per cent (20%) discount on the use of Light Rail Transit (LRT) System. Senior citizens who would wish to avail of the discount privileges on LRTC shall be guided by the following procedures/conditions: a) Senior citizens shall personally apply for the issuance of discount tickets (in booklet form) at the Light Rail Transit Authority (LRTC) or METRO, Inc. with office at the Administration Building, LRTA Compound, Aurora Boulevard, Pasay City or at designated outlets at the LRT system by presenting their ID card issued by the OSCA. Discount tickets will be printed with control numbers and will allow a senior citizen to purchase LRT tokens at a twenty per cent (20%) discount. b) A senior citizen shall personally surrender to any LRT token teller on duty at any LRT station/terminal where he/she will board, a discount ticket for every token he/she will purchase. Upon surrender of the discount ticket and presentation of the national ID card by a senior citizen, he/she shall pay for the LRT token at twenty per cent (20%) discount. (A senior citizen is entitled to purchase only one (1) LRT token at discounted price every time he/she avails of the LRT System.) To avoid untoward incidents, senior citizens are discouraged from riding the LRT during peak hours from 7:00 A.M. to 9:00 A.M. and from 5:00 P.M. to 7:00 P.M. due to the volume of rider ship. Twenty per cent (20%) discount for LRT tokens are available only at LRTC stations/terminals. Discounted token are not available from off-station token vendors. A.3. Domestic Air Transportation – Every senior citizen who is duly certified by t he OSCA is entitled to twenty per cent (20%) discount from the Civil Aeronautics Board (CAB) approved and published airline rates for domestic air transportation services. This Act shall cover individuals, partnership, or corporations and all other entities engaged in the carriage of passengers by air. The following are the conditions required of a senior citizen to be able to avail of the twenty per cent (20%) discount on air transportation services: a. The senior citizen should present his/her identification card duly issued by OSCA in securing a passage ticket; 90

b. He/She should personally secure the passage ticket; c. The passage ticket shall be non-transferable. B. Hotels/Lodging Establishments Benefits – the twenty per cent (20%) discount privileges of the senior citizen from hotels/establishments shall be limited to room accommodation only. The DILG shall issue the necessary circulars or directives to tourism establishments for the implementation of these guidelines and to ensure compliance herewith. Likewise the Department of Tourism (DOT) shall issue the corresponding Administrative Order to DOT accredited establishments. v C. Recreation Center Benefits – A senior citizen is entitled to a minimum of twenty per cent (20%) discount on all admission fees charged by the theatres, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure and amusement. D. Purchases of Medicine Benefits – A senior citizen is entitled to a minimum of twenty per cent (20%) discount in the purchase of medicine for his personal use and according to his personal needs. In the purchase of medicine, a senior citizen or his doctor or the latter‘s duly authorized representative should always present the national identification card duly certified by the OSCA together with the doctor‘s prescription in case of prescription drugs. If over-the-counter, the number of drugs purchased shall be commensurate to the elderly person‘s needs. These discount privileges shall be limited and exclusive for the benefit of the senior citizen. E. Income Tax Benefits/Tax Credits – For purpose of claiming tax credits, private establishments are required to keep a separate record of sales made to senior citizens which shall include the name, identification number, gross sales, discount and date of transaction. A senior citizen whose annual taxable income does not exceed the poverty level as determined by NSCB shall be exempted from payment of individual income tax. Provided that: a) A senior citizen whose annual taxable income exceed the said poverty level shall be liable to the individual income tax for the full amount of his/her taxable income net of personal and additional exemptions; b) Annual taxable income shall refer to the annual gross compensation, business and other incomes as defined in Section 28 of the National Internal Revenue Code (NIRC) other than income subject to tax under paragraphs (b), (c), (d) and (e) of Section 21 of 91

the NICR which include certain passive incomes, capital gains from sale of shares of stock and capital gains from sale of real property; c) The senior citizen is a resident citizen; d) NEDA shall inform the Commissioner of Internal Revenue in writing and publish in a newspaper of general circulation the estimated poverty threshold. F. Training Fee Benefits – A senior citizen is exempted from training fees for socioeconomic programs undertaken by or in coordination with the OSCA as part of its work. G. Medical/Dental Benefits – A senior citizen is entitled to free medical and dental services in government establishments anywhere in the country subject to guidelines to be issued by the Department of Health (DOH), the Government Service Insurance System (GSIS) and the Social Security System (SSS). G.1 The DOH shall direct the government establishments in the entire country to provide free medical and dental services to senior citizens. a. The term ―free‖ shall mean free of charge on medical/dental services where capability and facility for such services are available, b. The term ―medical services‖ shall refer to services pertaining to the medical care/attendance and treatment given to senior citizens. It shall include health examinations, medical/surgical procedures within the competence and capability of DOH establishments/hospitals/units and routine/special laboratory examinations and ancillary procedures as required. c. The term ―dental services‖ shall refer to services pertaining to dental care/attendance and remedy given to senior citizens. It shall include oral examination, curative services like permanent and temporary fillings, extractions and gum treatment. d. Professional services – shall refer to services rendered or extended by medical, dental and nursing professionals, which shall also include services rendered by surgeons, EENT practitioners, gynecologists, urologists, neurologists, psychiatrists, psychologists and other allied specialists. e. Counseling services – shall refer to advices given by health professional, e.g. psychologists, psychiatrists, nutritionists, nurses and other allied health professionals in support to specific treatment of illnesses. Provision of all of the above-mentioned services shall be subject to availability of appropriate facilities and trained manpower expertise of the receiving establishment.

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f. Government establishments shall refer to and limited to DOH hospitals, which shall include general hospitals, medical centers and regional hospitals directly under the full control and supervision of the DOH. g. The term ―anywhere in the country‖ shall be construed to mean health privileges senior citizens may avail of from any hospital in the Philippines, as defined in these guidelines, irrespective of their place of residence/locality, subject to availability of facilities and manpower/technical expertise of the receiving establishment. The following are the health services that may be availed of for free in any government establishments, subject to availability of facilities and manpower/technical expertise of the receiving government establishment: a. Medical and dental services b. Out-Patient consultations c. Available medicines in all public health programs d. Available diagnostic and therapeutic procedures e. Use of operating rooms, special units and central supply items f. Accommodations in the charity ward g. Professional and counseling services To be able to avail of the aforementioned services, the following mechanics are stipulated: a. A senior citizen may obtain the benefits from any government establishment. b. He/she shall present his/her national ID card issued by the OSCA to the medical and social services or Medical Social Worker designated who shall determine the validity of his/her ID card. c. Non-presentation of the national ID card shall be sufficient reason for denial of free hospital benefits. d. In case of emergency, the medical benefits shall be accordingly provided by the receiving hospital even if the ID is not available. However, the national ID card should be presented within a reasonable time. Non-presentation of the national ID card shall be sufficient ground for charging the service already given and denial of further availment of the benefits.

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e. Should the senior citizen choose to be admitted to a private room/pay ward or be transferred from a free room to a pay room, the amount equivalent to the rate of a free room should be discounted from that of the pay room/ward. f. As regard referral or transfer of senior citizen-patient to another government establishment, the receiving hospital shall provide the full benefits under this rule. In case of transfer/referral between the DOH hospitals, procedures shall be based on the DOH Network Guidelines. The responsibilities of the government establishment are as follows: a. Provide all available medical and dental services, as defined in these guidelines that may be deemed necessary in the promotion of the health of senior citizens; b. Establish a system by which all senior citizens in dire need of health serve shall be given priority and utmost consideration; c. Establish and maintain a recording/reporting system which data may be used as inputs for program/project planning and evaluation; and d. Strengthen their competence and capability to evaluate and manage geriatic cases through continuing education. The responsibilities of senior citizens who are entitled to health benefits and privileges as indicated and certified by valid national identification cards issued by the OSCA, are as follows: a. Adhere to rules and regulations relative to the implementation of this program; b. Recognize that the government establishments have limitations and constraints in providing health services and not demand for services that are not available and beyond the level of their competence; c. Secure on their own payable services that are not covered by their health benefits and privileges stipulated herein; and d. Safeguard the integrity of their identification card and shall not allow their misuse and abuse. To the extent practicable and feasible, the continuance of the same benefits and privileges shall be given to senior citizens by the GSIS, SSS and PAG-IBIG as the case may be as are enjoyed by those in the actual service. G.2 Benefits extended to senior citizens who are retirees of the GSIS are as follows: a. Life Insurance 94

If a retiree opts to maintain his life insurance policy with the System, he may convert his compulsory life insurance into an optional insurance by paying directly to the System the monthly premiums due thereon (personal plus government share), up to its maturity date. Amount of monthly premiums shall be determined by the System. He will be entitled to receive benefits as enumerated below: 1. maturity benefit – retiree will receive the total face value of the policy, less any indebtedness thereon. 2. policy loan – loanable amount will not exceed 90% of the cash value of his insurance at the time of application. 3. death benefit – when the retiree dies while life insurance membership is in force prior to maturity date, the designated beneficiaries double indemnity. b. Retirement 1. Retirees under PD 1146 or RA 660 shall resume receiving their basic monthly pension (BMP) for life after the lapse of the 5-year guaranteed period. 2. Upon death of a pensioner who retired under PD 1146 or RA 660, the primary beneficiaries (legal spouse and minor children) shall receive a basic survivorship pension (BSP) equivalent to 50% of the BMP plus dependent‘s pension (DP) equivalent to 10% of the BMP for every minor child, if any, but not exceeding five. The spouse shall receive the BSP for life until she/he remarries. The minor children shall continue receiving DP until emancipated by marriage, gainful employment or upon reaching 21 years of age. A mentally or physically incapacitated child, however, shall receive DP for life. 3. Funeral Benefit – payable upon death of the retirees, pensioner or gratuitant, the latter must have retired with at least 20 years of service to be entitled to the benefit. c. Medicare Coverage:Employees who retired from the service before age 60 may opt to continue their membership within 6 months from date of retirement by contributing both personal and government shares of their Medicare premiums until their 60th birthday. However, a government employee who retires under RA 1616, PD 1146 or PD 1184 at age 60 or above or under RA 660 (regardless of age) are covered without paying contributions pursuant to PD No. 408. Effective January 1, 1992, their legal dependents are also extended Medicare benefits. Legal Dependents: 1. The legal spouse who is not a Medicare member. 95

2. The unmarried and unemployed children, including legitimated, acknowledged, legally adopted and step children below 21 years of age; 3. Children 21 years old or above with disability acquired before the age of 21. Benefits under the Medicare Act consist of: 1. Allowance for room and board 2. Allowance for drugs and medicines 3. Allowance for x-ray/laboratory examinations/others (―others‖ means items such as syringes, gloves, vaco sets, butterfly, contrast media and other agents used in establishing correct diagnosis). 4. Surgeon‘s fee 5. Medical Practitioner‘s fee 6. Anesthesiologist‘s fee 7. Operating room fee 8. Allowance for sterilization procedures Types of Non-Compensable Treatments 1. Cosmetic surgery or treatment 2. Optometric services 3. Psychiatric services 4. Services which are purely diagnostic d. Employees Compensation (PD 626) Only employment-connected injury or sickness resulting in disability or death is compensable. It therefore presupposes the existence of an employee-employer relationship at the time the contingency occurs. The legal and/or medical evaluation to determine compensability is lodged solely with the System. Type of Disability Benefits Temporary Total Disability (TTD) 96

1. daily income benefit of not less than P10,00 nor more than P90.00 for a period not exceeding 120 days and in severe cases up to 240 days. 2. medical and/or related services (for work-connected injury or sickness) consisting of: 2.1 hospitalization room and board supplies, x-ray, medicines, laboratory, professional fee. 2.2 ambulatory/d o miciliary care, services for hospitalization except room and board 2.3 reimbursement of medicines (in case of non-confinement) Permanent Partial Disability (PPD) 1. monthly income benefit (MIB) for the designated number of months of not less than P250.00 or more than P3,240.00. 2. medical and/or related services (for work-connected injury or sickness) (refer to 2.1 2.2 and 2.3) Permanent Total Disability (PTD) 1. monthly income benefit (MIB) of not less than P250.00 nor more than P3,240.00 plus 10% increment for each minor child not exceeding five starting from the youngest without substitution payable for life and guaranteed for 5 years. 2. medical and/or related services (refer to 2.1, 2.2 and 2.3) 3. rehabilitation services – consist of medical/surgical management, necessary appliances and supplies such as artificial leg and arm, wheelchair, crutches, etc. and vocational training and assistance for placement. DEATH A. Death of the Employee 1. MIB the same as in PPD (plus 10% thereof for each dependent child, not exceeding five) payable to: a. primary beneficiary/ies for life and/or as long as qualified b. secondary beneficiary/ies (in the absence of primary beneficiary/ies) for a period not ot exceed 60 months B. Death of a PTD Pensioner 97

1. MIB due to death (80% of the MIB after the 5-year guaranteed period) payable to: a. primary beneficiary/ies for life and/or as long as qualified b. secondary beneficiary/ies (in the absence of primary beneficiary/ies) MIB excluding dependent‘s pension of the remaining balance of the 5-year guaranteed period. 2. Funeral benefit of P3,000.00 payable upon the death of a covered employee or PTD pensioner to the person who can show incontrovertible proof that he shouldered funeral expenses. G.3 The SSS provides medical and dental services to its retirees and their dependents through the Medicare Program without the need for additional contributions. However, the Medicare Program does not cover the entire cost of hospitalization. The SSS medical staff in the regional offices render free consultation to SSS pensioners. The SSS regularly evaluates the level of pension of the retirees. The SSS involvement in this Act is limited only to its retirees since the SSS funds are held in trust for the exclusive benefits of the private workers and their beneficiaries. Usage of such funds for other purposes is not allowed under SSS charter. G.4 Membership in the PAG-IBIG Fund shall be open to all senior citizens who opt to continue with their provident savings in the Fund, even after their retirement from their employment or upon reaching the age of sixty (60) years. a. Senior citizens who wish to enlist with the PAG-IBIG Fund for the first time may do so upon proof of gainful employment, or of being self employed, or of membership in trade/service cooperative (e.g. farmers cooperatives, fishermen‘s cooperative, loom weavers association, handicraft maker‘s organization, and the like) and upon payment of the monthly minimum contribution rate as may be set up by the PAGIBG Fund from time to time. b. PAG-IBIG members of good standing shall be entitled to avail themselves of PAGIBIG loan privileges subject to the customary guidelines on loan availments. For PAGIBIG housing loans, the loan availments. For PAG-IBIG housing loans, the loan period shall not be more than twenty five (25) years but in no case shall it exceed the difference between the present age reckoned from the borrower‘s nearest birthday and his seventieth (70th) year; in the case of a joint and several loan, the loan period shall be based on the age of the youngest of the co-borrowers. RULE VI 98

GOVERNMENT ASSISTANCE Article 10. Personal Tax Exemption for Benefactor – A senior citizen shall be treated as dependent provided for in the NIRC and as such, shall be accorded the privileges granted by the Code insofar as having dependent are concerned. In determining personal exemptions allowable to individuals under Section 29 (k) (l) of the NIRC, a senior citizen may be granted as a dependent. For this purpose, the definition of the term Head of the family under the said Section shall be deemed amended to refer to the condition under Article (5) of this implementing rules and regulations. The OSCA shall require the senior citizen to declare his benefactor who will be granted the exclusive right to claim him as dependent and issue a identification thereof. The said certification shall be presented by the benefactor to the BIR for purposes of determining personal exemptions. The personal tax exemption shall take effect January 1992. Article 11.Property Tax Exemptions and Privileges for Individuals and NonGovernment Institutions. Individuals or non-government institutions establishing homes, residential communities or retirement villages solely for the senior citizen shall be accorded the following: a. One per cent (1%) property tax exemption for the first five years starting first year of operation: b. (1) The exemption is automatically withdrawn effective on the year after the institution ceases its operation before the end of the fifth year of operation. The owners of the properties shall thereafter be liable for the realty taxes applicable thereon. (2) The first year of operation shall be reckoned from the date the institution was granted a mayor‘s permit to operate the establishment. (3) The exemption shall apply prospectively. Establishments which are beyond their fifth year of operation shall not be entitled to refund of their payments or condonation of their realty tax delinquencies during their first five years of operation. However existing establishments which have been operating for less than five years shall be entitled to the exemption in the remaining of the five years. c. Priority in the building and/or maintenance of provincial or municipal roads leading to the aforesaid home residential community or retirement village. Provided that: in both cases, said exemption and priority shall apply only when said homes residential communities or retirement villages are non-stock, no-profit as such which shall be presented to the Assessor‘s Office of the LGUs concerned. 99

RULE VII PENALTY PROVISIONS Article 12.Penalties. Any person who willfully refuses to grant the privileges provided for by RA 7432 or violates any provision thereof and for which no penalty is specifically provided for by any existing law, shall be punished by imprisonment not exceeding one (1) month or a fine not exceeding One Thousand Pesos (P1,000.00) or both. Any organization, private government establishment and government department/bureau/agency/institution who willfully refuses to grant the privileges given to senior citizens or violates any provision of RA 7432 shall be administratively dealt with by any of the agency/department concerned including, but not limited to the cancellation of permit/s or franchise/s to operate to a business establishment or institution or public service. RULE VIII FINAL PROVISIONS Article 13.Implementation, Supervision, Monitoring and Technical Assistance. a. Municipal Responsibility. It shall be the responsibility of every municipality, through its chief executive, to ensure that the provisions of RA 7432 are operationalized and implemented to the fullest within its jurisdiction. b. The DILG, having been designated by the President to exercise general supervision over LGUs, by virtue of the Local Code, rule XI, shall ensure the compliance of LGUs with this Act. It shall likewise institute the necessary interventions aimed at enhancing the capacities of the LGUs in implementing the above-mentioned provisions. c. On a national scale, the DSWD, by virtue of its monitoring and technical assistance function shall ensure the viability and standard of the programs and services that are implemented, while the DILG shall ensure compliance of LGUs. Article 14.Appropriation. The municipality, through its Sangguniang Bayan shall appropriate funds on a yearly basis for the maintenance and other operating expenses of the OSCA to incorporate in the annual budget. The concerned provincial/municipal government agency shall likewise mobilize other sources of funds particularly those that are made available for local development activities by the national government, the legislature and the private sector. Article 15. Separatibility Clause, If, for nay reason/s, any part or provision of this Implementing Rules and Regulations shall be held unconstitutional or invalid, other 100

parts or provisions hereof which are not affected thereby shall continue to be in full force and effect. Article 16.Effectivity Clause. This Implementing Rules and Regulations shall take effect fifteen (15) days following its publication in one (1) national newspaper of general circulation. ADDENDUM REVENUE REGULATIONS NO. 2-94 (August 23, 1993) SUBJECT: Republic Act No. 7432 otherwise known as an Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes. To: All Internal Revenue Officers and Others Concerned. Section 1. SCOPE – Pursuant to Section 245 of the National Internal Revenue Code (NIRC) as amended, in relation to Section 10 of Republic Act No. 7432, these regulations are hereby promulgated to (1) implement the provisions of Section 4 and 5 (a) of the said Act granting tax exemption and other privileges to senior citizens, and (2) prescribe the guidelines for the availment thereof. SECTION 2.DEFINITIONS. – For purposes of these regulations: a. Act – refers to Republic Act No. 7432. b. Senior citizen – means any resident citizen of the Philippines at least sixty (60) years old, including those who have retired from both government offices and private enterprises, and has an income of not more than sixty thousand pesos (P60,000.00) per annum subject to review by the National Economic and Development Authority (NEDA) every three (3) years. The term ―qualified senior citizen‖ shall refer to a resident Filipino citizen who meets the statutory requirements of Section 2 of the Act and Section 2(b) of these regulations. c. Resident citizen – refers to a Filipino citizen with permanent/legal residence in the Philippines, and shall include those, who, having migrated to a foreign country, have returned to the Philippines with a definite intention to side therein, and whose immigrant visa has been surrendered to the foreign government. d. Dependent – a qualified senior citizen whether or not related to a benefactor with whom he lives and who takes care of him/her. e. Head of the Family – an unmarried or legally separated man or woman, with one or both parents, or with one or more brothers or sisters, or with one or more legitimate, 101

recognized natural or legally adopted children, living with and dependent upon him/her for their chief support, where such brothers or sisters or children are not more than twenty-one (21) years of age, unmarried and not gainfully employed or where such children, brothers or sisters, regardless of age are incapable of selfsupport because of mental or physical defect. The term ‗head of family‘ includes an unmarried or legally separated man or woman who is the benefactor of a qualified senior citizen as defined in Section 2 of the Act and these regulations. The term ―qualified senior citizen‖ shall refer to a resident Filipino citizen who meets the statutory requirements of Section 2 of the Act and Section 2(b) of these regulations. f. Benefactor – any person whether or not related to the senior citizen who takes care of the latter as a dependent. g. OSCA – refers to the Office for Senior Citizens Affairs. h. Income/Annual Taxable Income of a resident Senior Citizen shall refer to the annual gross compensation, business and other income received during each taxable year from all sources as defined in Section 28 of the NIRC, which shall not exceed the poverty level of P60, 000 or such amount as may thereafter be determined by the NEDA. However, income derived by a qualified senior citizen from the following sources: 1. Interest income from Philippine currency bank deposits, yield and other monetary benefit from deposit substitutes, trust fund and similar arrangements; royalties, prizes and winnings (Sec. 21 (c), NIRC); 2. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC); and 3. Capital gains from sales of real property (Sec.21(e), NIRC). shall not be included in the determination of his income/annual taxable income‘ which should not exceed the poverty level of P60,000 or such amount as may thereafter be determined by the NEDA for a certain taxable year inasmuch as income from such sources shall be subject to the corresponding income tax rates prescribed under Section 21 (c), (d) and (e) of the NIRC as amended. i. Tax Credit – refers to the amount representing the 20% discount granted to a qualified senior citizen by all establishments relative to their utilization of transportation services, hotels and similar lodging establishments, restaurants, drugstores, recreation centers, theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture, leisure and amusement, which discount 102

shall be deducted by the said establishments from their gross income for income tax purposes and from their gross sales for value-added tax or other percentage tax purposes. Sec. 3.INCOME TAX BENEFIT AND PRIVILEGES FOR THE SENIOR CITIZENS. – Senior citizens qualified as such by the Commissioner of Internal Revenue or his duly authorized representative who, for purposes of these regulations, is the Regional Director of the Revenue Region having jurisdiction of the city or municipality where they are permanent residents shall be entitled to the following tax benefit and privileges: a. Exemption from the payment of individual income tax provided that their annual taxable income does not exceed the poverty level of P60,000.00 or such amount as may be determined bt the NEDA for a certain taxable year. b. A 20% discount from all establishements relative to utilization of transportation services, hotels and similar lodging establishments, restaurants and recreation center, and on purchases of medicine anywhere in the country. c. A minimum of twenty perecent (20%) discount on admission fees charged by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure, and amusement. Sec. 4.RECORDING/BOOKKEEPING REQUIREMENTS FOR PRIVATE ESTABLISHMENTS. – Private establishments, i.e., transport services, hotels and similar lodging establishments, restaurants, recreation centers, drugstores, theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture leisure and amusement, giving 20% discounts to qualified senior citizens are required to keep separate and accurate record of sales made to senior citizens, which shall include the name, identification number, gross sales/receipts, discounts, dates of transactions and invoice number for every transaction. The amount of 20% discount shall be deducted from the gross income for income tax purposes and from gross sales of the business enterprise concerned for purposes of the VAT and other percentage taxes. Sec. 5.AVAILMENT OF INCOME TAX EXEMPTION. – Asenior citizen who shall avail of the exemption from income tax is required to submit the following documents to the Revenue District Officer (RDO) of the place where he is a permanent resident, who shall make the necessary verification and report for purposes of the income tax exemption to be issued by the Commissioner of Internal Revenue or his duly authorized representative: A. Certified true copy of his Birth Certificate/Baptismal Certificate or in the absence thereof, a certification from the National Statistics and Census Bureau or an affidavit by two (2) disinterested credible persons who know personally the senior citizen. 103

B. If he has a benefactor as defined in Section 2 (f) of these Regulations, Certification as to the name, address, occupation, Office or business address (office/business) and TIN of his benefactor; C. If employed, a copy of his withholding tax statement (BIR Form W-2) for the preceding taxable year; c. 1 A senior citizen who derives taxable (fixed) compensation income from only one employer in an amount not exceeding P60,000 per annum shall be exempt from income tax and consequently from the withholding tax prescribed under Section 72 Chapter 10, Title II of the National Internal Code, as amended. D. If self-employed, (i.e., practice of profession, or in business as single proprietorship) a copy of his income tax return (ITR) for the preceding taxable year together with the annual license or permit issued by the city or municipality where he has his principal place of business, supported by a copy of his declaration of sales or income. d.1 A senior citizen who derives taxable compensation income from two (2) or more employers, or who receives mixed income from employment and from business shall still file an income tax return. The RDO concerned shall transmit his verification report/recommendation to the said Regional Director, as duly authorized representative of the Commissioner, for issuance of the certificate of income tax exemption to the senior citizen. For purposes of applying for the OSCA ID Card, the duly stamped income tax return and or the BIR Certification shall be honored. Sec. 6.TAXABILITY OF SENIOR CITIZENS TO OTHER INTERNAL REVENUE TAXES. a. A senior citizen whose annual taxable income exceeds the poverty level of P60,000 or such amount as may thereafter be determined by the NEDA for a certain taxable year shall be liable to the individual income tax in the full amount thereof on his taxable income net of allowable deductions. b. Regardless of the amount of taxable income, a senior citizen who derives income from self-employment, business and practice of profession shall be subject to other internal revenue taxes which include but are not limited to the value added tax, caterer‘s tax, documentary stamp tax, overseas communications tax, excise taxes, and other percentage taxes. He shall therefore, file the corresponding business tax returns in accordance with existing laws, rules and regulations. c. He shall be subject to the 20% final withholding tax on, interest income from Philippine Currency bank deposit, yield and other monetary benefit from deposit substitutes, trust fund and similar arrangements; royalties, prizes (except prizes amounting to P3,000 or less which shall be subject to income tax at the rates 104

prescribed under Section 21, paragraph (a) or (f), NIRC) as the case may be, and winnings (except Philippine Charity Sweeptakes winnings). d. Capital gains from sales of shares of stock (Sec. 21 (d), NIRC). e. Capital gains from sales of real property (Sec. 21 (e), NIRC). Sec. 7.BASIC PERSONAL EXEMPTION ONLY FOR BENEFACTOR -. A qualified senior citizen living with and taken cared of by a benefactor whether related to him or not, shall be treated as a dependent and his benefactor shall be entitled to the basic personal exemption of P12,000 as head of the family, as defined in Section 2 (e) of these regulations. For purposes of claiming personal exemptions as head of family with dependent senior citizen, the identification card number issued by the OSCA shall be indicated in the ITR to be filed by the benefactor. The senior citizen shall indicate in a certification to be submitted to the RDO and the OSCA his benefactor who will be granted the exclusive right to claim him as dependent for income tax purposes. Caring for a dependent senior citizen shall not, however, entitle the benefactor to claim the additional exemption allowable to a married individual or head of family with qualified dependent children under Sec. 29 (1) (2) of the NIRC, as amended. Sec. 8.REPEALING CLAUSE. – All existing rules, regulations and other issuances or portions thereof inconsistent with the provisions of these regulations are hereby modified, repealed or revoked accordingly. Sec. 9.EFFECTIVITY. – These regulations shall take effect fifteen (15) days after publication in the Official Gazette or newspaper of general circulation whichever comes first and shall apply to income earned beginning January 1, 1992.

(Sgd.) ERNESTO LEUNG Acting Secretary of Finance RECOMMENDED BY: (Sgd.) LIWAYWAY VINZONS-CHATO Commissioner of Internal Revenue

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Health and Well-being of Older Persons Rationale The proportion of older persons is expected to rise worldwide. In the 1998 World Health Report, there were 390 million older people and this figure is expected to increase further (WHO). This growth will certainly pose a challenge to country governments, particularly to the developing countries, in caring for their aging population. In the Philippines, the population of 60 years or older was 3.7 million in 1995 or 5.4% of total population. In the CY 2000 census, this has increased to about 4.8 million or almost 6% (NSCB). At present there are 7M senior citizens (6.9% of the total population), 1.3M of which are indigents. With the rise of the aging population is the increase in the demand for health services by the elderly. A study done by Racelis et al (2003) on the share of health expenditure of Filipino elderly on the National Health Account, the elderly are ―relatively heavy consumers of personal health care (22%) and relatively light consumers of public health care (5%).‖ From out-of-pocket costs, the aged are heavy users of care provided by medical centers, hospitals, non-hospital health facilities and traditional care facilities. Cognizant of the growing concerns of the older population, laws and policies were developed which would provide them with enabling mechanisms for them to have quality life. RA 9257 or the Expanded Senior Citizens Act of 2003 (predecessor of RA 9994) provided for the expansion of coverage of benefits and privileges that the elderly may acquire, including medically necessary services. Parallel to this objective is the Department‘s desire to provide affordable and quality health services to the marginalized population, especially the elderly, without impeding currently pursued objectives and alongside health systems reform. One of the provisions of RA 9994 or the Expanded Senior Citizens act of 2010 is for the DOH to administer free vaccination against the influenza virus and pneumococcal diseases for indigent senior citizens. The DOH in coordination with local government units (LGUs), NGOs and POs for senior citizens shall institute a national health program and shall provide an integrated health service for senior citizens. It shall train community – based health workers among senior citizens health personnel to specialize in the geriatric care and health problems of senior citizens. Interventions/Strategies Implemented by DOH 1. Creation of a National Technical Working Group on the Health and Wellbeing of Older Persons (DPO. No. 2011- 3578 dated June 29, 2011 Chaired by NCDPC- Director III. 2. Planning Meeting for the Senior Citizens Immunization Program 3. Consultative Planning and Finalization of Immunization Guidelines for Indigent Senior Citizens 4. Provision of Pneumococcal and Flu Vaccines to Indigent Senior Citizens aged 60 years old and above using the NHTS of the DSWD including GO – NGO shelter homes in 2011 5. Conduct annual ―Summer Camp ni Lolo at Lola ― 6. Support the annual ―Walk for Life‖ for the elderly every October 106

Status of Implementation / Accomplishment 1. The total pneumococcal and influenza vaccines delivered to all CHD‘s for the CY 2011 were 197,000 and 173,000 respectively including the sub-allotment per region for HWOP activities. 2. Training and Orientation of Pneumo and Flu Vaccines for HWOP Coordinators 3. Signed Guidelines to Implement the Provisions Relevant to Health of RA 9994 or the Expanded Senior Citizens Act of 2010. 4. Summer Camp ni Lolo at Lola 2012 held at Davao, City. 5. Support World Health Day April 12, 2012 with the theme ― Ageing and Health ― in coordination with NCHP and WHO Future 1. 2. 3.

Plan / Action Pneumococcal and Influenza Vaccines for CY 2012 still with COBAC Support to Walk for Life Activity on October 2012. Summer Camp nina Lolo at Lola 2013

HEALTHY LIFESTYLE PROGRAM "MAG HL TAYO" NATIONAL HEALTHY LIFESTYLE CAMPAIGN RATIONALE: The Department of Health, cognizant of the increasing prevalence of lifestyle related diseases, has taken as one of its priorities for the year 2003, the Promotion of Healthy Lifestyles. The promotion of healthy lifestyles emphasizes the anti-smoking campaign, regular physical activity and weight control. It also includes healthy diet and nutrition, stress management and regular health check up. THE NATIONAL HEALTHY LIFESTYLE CAMPAIGN The National Healthy Lifestyle Campaign is being undertaken in collaboration with the Philippine Heart Association and a Coalition of Stakeholders composed of various medical societies, professional organizations, academe and other government agencies. As a year round advocacy and IEC campaign it aims to: 1. Raise the awareness of the Filipinos on the need to practice healthier lifestyles. 2. Raise the consciousness of policy makers on the need to provide the Filipinos with an environment supportive of healthy lifestyle. Healthy lifestyle in this context is defined as a way of life which promotes and protects one‘s health and well-being. The campaign promotes the following messages: 1. Don't smoke 2. Regular exercise 3. Eat a healthy diet everyday 107

4. Watch your weight/Weight control 5. Manage stress 6. Regular health check up TARGET AUDIENCES: Primary Audience: 1. All family members - grandparents, parents, sons and daughters belonging to the C-D-E economic classes in urban areas. 2. Each of the 5 healthy messages will specifically prioritize the following target audiences:  Adults to elderly for exercise  Schoolchildren for healthy diet  Mothers and daughters for watch your weight  Teenagers for Don't smoke  Working adults for manage stress 3. For purposes of this campaign, the profile of the family members are as follows:  Grandparents: 60 years old and above  Father: 40-45 years old  Mother 30-35 years old  Teenage son: 13-15 years old  Preteen daughter: 9-12 years old Secondary Audience: 1. Executives and employees of local government units 2. Legislators/politicians 3. Media COMMUNICATION HANDLE/ACTION TAGLINE 

MAG HL TAYO!

COMMUNICATION STRATEGIES The process of behavioral changes that will lead to the adoption of a healthy lifestyle in individuals is long and tedious. Thus, the healthy lifestyle campaign should be continuous, sustained and integrated. Because of limited resources, the DOH needs to start small but intense and hope that various sectors of society jump in the bandwagon. For the first year of implementation, the following strategies were adopted: 1. Convened the National Healthy Lifestyle Coalition composed of stakeholders from various sectors who formulated the health promotion and communication plan and implement them in their various capacities. 2. Developed, produced and disseminated the various IEC materials to be used for the campaign. 108

3. Highlight and schedule one Healthy Lifestyle message at certain times of the year in connection with other more popular health campaign or traditional or cultural celebrations of the country. 4. Mobilize politicians, legislators, media practitioners, and members of various government and non-government agencies and organizations to push laws, ordinances and activities to create supportive environments in communities and places where most people are congregating. Various activities lines up to drum up awareness are: 1. Tri-Media a. b. c. d. e. f. g.

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

handle:

2. High Profile Launching of the Campaign on February 16, 2003 3. conduct of Periodic "MAG HL TAYO" Campaign to celebrate various awareness weeks highlighting the following messages: a. February- - - Hearth Month- - - Exercise Regularly b. May 31/June- - - World No Tobacco Day/Month- - - Don't Smoke c. July- - - Nutrition Month- - - Eat a healthy Diet Everyday d. October- - - Mental Health Week- - - Manage Stress e. December - - - - - - - - - - - - - - - - - - Watch Your Weight The messages on regular health check up underlines all the other messages. REGIONAL ACTIVITIES The regions are given a free hand in implementing regional Mag HL Tayo Campaign based on their own needs and resources. They are also enjoined to observe the conduct of the scheduled periodic thematic Mag HL Tayo Campaign. Reports of various activities conducted should be submitted. .

Infant and Young Child Feeding (IYCF) I.

Profile/Rationale of the Health Program

A global strategy for Infant and Young Child Feeding (IYCF) was issued jointly by the World Health Organization (WHO) and the United Nations Children‘s Fund (UNICEF) in 2002, to reverse the disturbing trends in infant and young child feeding 109

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, nongovernment organizations, business sectors, professional groups, 110

academe and other stakeholders acknowledges their responsibilities and form alliances and partnerships for improving IYCF with no conflict of interest. 5. Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community empowerment. GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS GOAL: Reduction of child mortality and morbidity through optimal feeding of infants and young children MAIN OBJECTIVE: To ensure and accelerate the promotion, protection and support of good IYCF practice OUTCOMES: By 2016:  90 percent of newborns are initiated to breastfeeding within one hour after birth;  70 percent of infants are exclusively breastfeed for the first 6 months of life; and  95 percent of infants are given timely adequate and safe complementary food starting at 6 months of age. TARGETS: By 2016:  50 percent of hospitals providing maternity and child health services are certified MBFHI;  60 percent of municipalities/cities have at least one functional IYCF support group;  50 percent of workplaces have lactation units and/or implementing nursing/lactation breaks;  100 percent of reported alleged Milk Code violations are acted upon and sanctions are implemented as appropriate;  100 percent of elementary, high school and tertiary schools are using the updated IYCF curricula including the inclusion of IYCF into the prescribed textbooks and teaching materials; and  100 percent of IYCF related emergency/disaster response and evacuation are compliant to the IFE guidelines. II. Target beneficiaries of the program are infants (0-11 months) and young children (12 to 36 months years old or 1 to 3 years old) 111

III.

Action/Work Plan

KEY INTERVENTION SETTINGS AND SERVICES STRATEGIES,

PILLARS AND ACTION POINTS

STRATEGY1: Partnerships with NGOsand GOs in the coordination and implementation of the IYCF Program 1.1 Formalize partnerships with GOs and NGOs working on IYCF program coordination and implementation a. Strengthen the TWG to allow it to effectively coordinate the GOs and NGOs working for the IYCF Program The national TWG will remain but will be strengthened. It shall be constituted by: NCDPC as Chair, FHO as secretariat and representatives from NCDPC,FHO, NCHP, FDA, DJFMH, DSWD,CWC, NNC, ILO, WHO and UNICEF. This time, members of theTWG will be tasked to focus participation to the intervention setting where it ismost relevant. The TWG shall be reporting regularly to the Service Delivery Cluster Head. At the Regional level, the Regional Coordinators from the above offices shall collaborate in the implementation of the IYCF Program. To ensure that GO and NGO IYCF partners work together, the composition of the TWGs and AD Hoc committees shall be made up of representatives from the government and non-government sectors and the Ad Hoc Committees shall be chaired by the relevant agency where the intervention setting belongs. At the provincial, municipal and barangay levels the existing Coordinating Committees which has an interagency composition shall be the coordinating arm of the IYCF Program. This is where the participation of non-government entities will be facilitated. Mechanisms for coordination shall be devised to build a strong foundation for partnership between the LGU, the Coordinating Committees and local NGOs or private entities. A memorandum of agreement (MOA) shall be executed between DOH and other agencies invited to become members of the TWG. b. Organize functional Intervention Setting Committees (this is the same as the adhoc 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 112

The National Policy on IYCF created in 2005 has affirmed the MBFHI responsibility to NCHFD. Since MBFHI is now under the umbrella of the IYCF Program, it is in a better position to consolidate efforts towards MBFHI compliance. Thus the return of the MBFHI responsibility from NCHFD to NCDPC shall be pursued. The collaboration of NCHFD is still needed though as it has a direct hand on health facility development. At NCDPC the integration of IYCF in the MNCHN Action Plan shall be worked out in all aspects of the program and at the different levels of implementation. d. Augment human resource complement of NCDPC- FHO, IYCF program NCDPC-FHO as the secretariat of the TWG and supervising and supporting the IYCF Program will not be able to effectively carry out the technical, management and administrative roles and responsibilities without additional human resource. Funds shall be allotted for job orders for this purpose. e. Programmed contracting out of activities to organizations outside of DOH To achieve the objectives and targets of the IYCF program, it shall be implemented simultaneously in the different intervention settings and at a faster pace. This is a gargantuan task considering the extent of the developmental work, the management requirements, and the mobilization of the IYCF network and the sourcing of funds for implementation. Organizations and consultants that possess the expertise and the commitment to the IYCF program will be contracted out for complex activities that require time and effort beyond the capacity of the TWG and the Ad Hoc committees. These contracts shall be arranged based on need and awarded based on merit. STRATEGY 2: Integration of key IYCF action points in the MNCHN Plan of Action/Strategy 2.1 Institutionalize the IYCF monitoring and tracking system for national, regional and LGU levels a. Institutionalize the collection of PIR Data and generate annual performance report The established IYCF data set that are being collected during PIRs shall be further reviewed, revised as appropriate and institutionalized through a Department Circular and in collaboration with the other programs in the FHO. An IYCF Program annual performance report shall be generated at the end of every year based on the PIR data, the consolidated data from the unified monitoring and related data coming from research and studies as appropriate. Reports on the performance of developmental activities shall be collected as part of the data base and to be reported as needed to the Service Delivery Cluster Head. b. Maximize the use of the unified monitoring tool 113

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.

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3.2 Support Civil Society in the implementation and enforcement of IYCF related laws and regulations a. Institutionalize enforcement of MBFHI compliance in the regulatory function of the DOH The inclusion of the MBFHI requirements in the unified licensing/accreditation benchmarks of the BHFS and the Licensing Offices shall be pursued more vigorously in collaboration with BHFS and the Licensing offices of the CHDs. These offices are in a better position to enforce compliance in relation to their regulatory function and in their power to promulgate penalties for violations. b. Review and improve the processing of reports on violations on the Milk Code The handling of reports on violations shall be reviewed for thoroughness and timeliness from the time a report is submitted up to the final decision rendered on a case. Problematic areas and bottlenecks shall be identified and threshed out. Measures to ensure that all reports on violations are acted upon shall be devised. To ensure speedy resolution of cases, it is necessary to set deadlines on the processing of reports on violations. c. Invite the Professional Regulatory Board as a resource agency of the IAC Apart from companies who are actively marketing breastmilk substitutes, health professionals who have direct access and influence on pregnant and postpartum women are also among the most common violators of the law. The PRC as the legal authority that regulates the practice of the medical and allied professions can contribute to the development and enforcement of the IAC‘s regulatory function. d. Augment human resource of FDA as secretariat of the IAC The current load of violations cases being processed and the fulfillment of other responsibilities with regards to the Milk Code at FDA require a full time legal officer who will also assist the CHDs. Furthermore, the strengthened monitoring of compliance to the Milk Code will result in a surge on violation reports. FDA should be prepared to process such reports. An additional full time legal officer and an administrative/ clerical staff is required to facilitate and help speed up the process. e. Engage professional societies to come-up with measures for self monitoring and regulation 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. 115

The medical and allied professional societies are strong and active bodies that foster organizational development and discipline among its members. An advocating stance over a punitive approach may be the more prudent initial approach in this environment. There will be dialogue, negotiations and forging of agreements to push the Milk Code and other policies on IYCF. The professional societies will be engaged to participate in the development of the monitoring scheme within their ranks and in health facilities. They are a good resource in the development of schemes for MBFHI and related technical matters. Working arrangements/contracts may be forged to seal responsibilities and partnerships. Representatives from the professional societies will constitute the Speaker‘s Bureau which will be organized for the information dissemination/awareness campaign on the Milk Code, the Expanded Breastfeeding Promotion Act and the Policies on IYCF. STRATEGY 4: Intensified focused supportive to IYCF practices

activities

to

create

an

environment

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. 116

b. Establish protocols/standards on how to set-up and maintain MBF workplaces and integrated in the standards for healthy workplace The IYCF Program shall focus on the enforcement of the Expanded Breastfeeding Promotion Act of 2009 which mandates workplaces to establish lactation stations and/or grant breastfeeding breaks. Guidelines for the establishment and maintenance of MBF workplace shall be developed. It will learn from lessons of already established and successful MBF workplace. In as much as standards for the healthy workplace are already established, the MBF guidelines shall be integrated into those standards. The establishment of MBF workplaces initiated in factories shall be scaled up and efforts shall be expanded to include government and private offices in line with Expanded Breasfeeding Act. The current collaboration partners in the workplace setting may also need to be expanded to promote the establishment of the MBF workplace in government and private offices. With the multitude of workplaces scattered throughout the country, the expansion may require outsourcing of organizations to continue the MBF workplace efforts. c. Enhance the primary, secondary and tertiary education curricula on IYCF The enhancement of the primary, secondary and tertiary education curricula on IYCF shall be pursued. If necessary, a review of the curriculum will be done prior to the enhancement. Apart from the curriculum enhancement, training materials, books and teachers‘ guide shall also be updated. The initial collaboration for the enhancement of the primary, secondary and tertiary education curricula shall take place at the central office of DepEd (Bureau of Elementary Education and Bureau of Secondary Education) and TESDA. The enhanced curriculum, training materials, books and teacher‘s guide shall be field tested province-wide in three selected provinces, evaluated and further enhanced before a national implementation. d. Develop policy on IYCF in emergencies (IFE) and guidelines on the management of malnutrition, and IYCF in special medical conditions for the community A clear policy on IYCF is necessary to allow the program to define the guidelines that can be easily followed by GOs, NGOs and LGUs once such situations arise. The policy/guidelines shall address among others the issue of milk donations. Guidelines on the Community Management of Malnutrition, IYCF in special medical 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. 117

Disaster prone areas will be prioritized in the orientation. Training/orientation shall be a collaborative effort between the IYCF Program, HEMS and the NDCC. 4.2 Creation of a Regional and National incentive and awarding systems for the most outstanding IYCF champions in the different sectors of society a. Review and update the existing awarding system The current awarding system shall be reviewed. The search protocol shall be further refined to allow a wider search. The organization of the search committees in the local and national levels shall be formalized. Funds for the awards shall be ensured. b. Establish a recognition system for health facilities complying with EO51, RA10028 and the MBFHI National Policy Set up an annual recognition system for facilities, establishments complying with relevant IYCF legislations and regulations. The benefits provided for by the Milk Code to compliant health facilities shall be reviewed and improved/established parallel with the development of the incentive scheme for the Expanded Breastfeeding Promotion Act. Procedures for claiming benefits shall be established and made accessible in collaboration with PhilHealth, BIR and other relevant government offices. 4.3 Allocate/Raise /Seek resources for IYCF Research activities that document best practices in the Philippines a. Carry out an inventory of best practices on IYCF Identify best IYCF practices by allowing every province in the country to identify exemplary or creative activities on IYCF that boosted program services/performance. Validate the reports through CHDs and select the best practices for documentation and publication. b. Allocate resources and conduct IYCF related researches focusing on the documentation and measure of impact of noble experiences and interventions The documentation of IYCF best practices is considered a critical area that allows the development of models/ references for appropriate IYCF protocols and guidelines for implementation. Field personnel who are able to establish and provide successful models of IYCF services are often deficient in resources and skills to document the efforts. Resources to conduct IYCF related researchers, focusing on the documentation and measure of impact of noble experiences and interventions, will have to be allocated. STRATEGY 5: Engaging the Private Sector and International Organizations to raise funds for the scaling up and support of the IYCF program 118

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. 119

The competencies of teachers and administrators to teach the new IYCF updated curriculum and to appreciate the importance of MBF environment shall be enhanced. A training/seminar program on IYCF for teachers/ administrators will be developed. A core of teacher trainers in every region will be developed and organized to conduct the training/seminars nationwide. IV. Status of the Program A REVIEW FROM 2005 TO 2010 Objectives and Targets set in 2005-2010

Status of Achievement

Remarks

- 70% of newborns initiated to breastfeeding within 30 minutes

53.5% (NDHS 08)

40.7%(NDHS 1998)

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

34% (NDHS 2008)

33.5%(NDHS 2003)

- 50% of infants are exclusively breastfed for 6 months

22.2% (NDHS 2008)

16.1%(NDHS 2003)

OBJECTIVE 1: TO IMPROVE, PROTECT AND PROMOTE APPROPRIATE INFANT AND YOUNG CHILD FEEDING PRACTICES CHILD FEEDING PRACTICES

- median duration of breastfeeding 15.1months (NDHS 2008) is 18 months

13 months (NDHS 1998)

- 90% of 6-