DEPARTMENT OF HEALTH PROGRAMS I.

List of Topics: Adolescent and Youth Health and Development Program Botika Ng Barangay Breastfeeding Program / Mother and Baby Friendly Hospital Initiative Blood Donation Program Reported by: Joana Pearl Ibarra

Adolescent and Youth Health and Development Program (AYHDP)

In line with the global policy changes on adolescents and youth, the DOH created the Adolescent and Youth Health and Development Program (AYHDP) which is lodged at the National Center for Disease Prevention and Control (NCDPC) specifically the Center for Family and Environmental Health (CFEH). The program is an expanded version of Adolescent Reproductive Health (ARH) element of Reproductive Health which aims to integrate adolescent and youth health services into the health delivery systems. The DOH, with the participation of other line agencies, partners from the medical discipline, NGOs and donor agencies have developed a policy on adolescent and youth health as well as complementary guidelines and service protocol to ensure young peoples health needs are given attention. The Program shall mainly focus on addressing the following health concerns regardless of their sex, race and socioeconomic background: Growth and Development concerns Nutrition Physical, mental and emotional status * Reproductive Health Sexuality Reproductive Tract Infection (STD, HIV/AIDS) Responsible Parenthood Maternal & Child Health Communicable Diseases Diarrhea, Dengue Hemorrhagic Fever, Measles, Malaria, etc. * Mental Health Substance use and abuse Intentional / non-intentional injuries Disability Other issues and concerns such as vocational, education, social and employment needs where the DOH has no direct mandate nor control, shall be coordinated closely with other concerned line agencies, and NGOs. Vision: Well-informed, empowered, responsible and healthy adolescents and youth. Mission: 1

Ensure that all adolescent and youth have access to quality health care services in an adolescent and youth friendly environment. Goal: The total health, well being and self esteem of young people are promoted. Objectives: By the year 2004: Health Status Objectives: * reduce the mortality rate among adolescents and youth Risk Reduction Objectives: reduce the proportion of teenage girls (15-19 years old) who began child bearing to 3.5 % (baseline-7% in 1998 NDHS) increase the health care seeking behavior of adolescents to 50% (baseline: still to be established) increase the knowledge and awareness level of adolescent on fertility, sexuality and sexual health to 80% (baseline: still to be established) increase the knowledge and awareness level of adolescents on accident and injury prevention to 50% (baseline: still to be established) Services and Protection Objectives: increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70%. (baseline- still to be established) establish specialized services for occupational illnesses, victims of rape and violence, substance abuse in 50% of DOH hospitals integrate gender-sensitivity training and reproductive health in the secondary school curriculum. Establish resource centers or one stop shop for adolescents and youth in each province. Guiding Principles: 1. Involvement of the youth The AYHDP shall involve the young people in the design, planning implementation, monitoring and evaluation of activities and program to ensure that it is acceptable, appealing and relevant to them. In so doing, they become part of the solution rather than the problem. Further, it: (1) favors the acquisition of valuable skills including interpersonal skills, (2) gives young people self confidence, 2

(3) promotes individual self esteem and competence, and (4) contributes to a sense of belonging. 2. Rights Based Approach In all aspects of program implementation, the promotion of young peoples rights shall be applied. This is to ensure protection of adolescent and youth against neglect, abuse and exploitation and guaranteeing to them their basic human rights including survival, development and full participation in social, cultural, educational and other endeavors necessary for their individual growth and well being. 3. Diversity of adolescents needs and problems The program shall recognize the diverse characteristic and needs of adolescents in different situations. Their concerns and perception vary by demographic and socioeconomic characteristics, sex and circumstances. But even how diverse the problems are, oftentimes they have common roots, its underlying causes are closely connected and the solutions are similar and interrelated. They are addressed most effectively by a combination of intervention that promote healthy development. 4. Gender & health perspective A gender perspective shall be adopted in all processes of policy formulation, implementation and in the delivery of services, especially sexual and reproductive health. This perspective will act upon inequalities that arise from belonging to one sex or the other, or from the unequal power relation between sexes. Adolescents have distinct and complex gender differences in behavior patterns, socialization process and expected roles in family, community and society. A gender gap exist in terms of opportunities in education and employment and access to health services. Girls are often victims of traditional, discriminatory and harmful practices, including sexual abuse and exploitation. Besides, their individual development needs are also neglected because of the persistent and stereotypical roles that they are expected to perform. On the other hand, young boys can be particularly vulnerable, such as those in situations in armed conflict or crises. Adults often perpetuate traditional gender roles that trap young people in high risk behavior. They can therefore play a major role in helping them change their attitudes and prevent exploitation of adolescents. Program Strategies: The DOH shall adopt a two pronged inextricably linked and overarching strategies: * To Promote healthy development among young adults by building their life coping skills; promoting positive values and by creating a safe and supportive environment for their growth and development; * To prevent and respond to adolescent health problems through provision of adequate, accurate and timely information about their health, rights and other issues and through 3

the availability of integrated, quality and gender sensitive adolescent health services that will bring about positive behavior and healthy lifestyle. 1. Service provision The program shall ensure the access and provision of quality gender responsive biomedical and psychosocial services. Eventually, these will contribute to the reduction of maternal, infant, child and young peoples morbidity and mortality, ensure the quality of life of the families and communities; and promote total health and well being of Filipino adolescents and youth. 2. Education and Information Early education and information sharing for adolescents and service information providers: the parents, teachers, communities, church, health staff, media and NGOs on adolescent health concerns and an intensified and responsive counseling services geared towards adolescent health shall be done. This aims to increase knowledge and understanding of a particular health issue, and with the explicit intention of motivating the young people to adopt healthy behavior and to prevent health hazards such as unwanted pregnancies, STDs, substance use / abuse, violent behavior and nutritional deficiencies. 3. Building skills Adolescents and youth shall have life skills training to enable them to deal effectively with the demands and challenges of everyday life. It refers to skills that enhance psychosocial development, decision making and problem solving; creative and critical thinking; communication and interpersonal relations , self awareness, coping with emotions and causes of stress. Examples of these skills are: Self care skills eg. how to plan and prepare healthy meals or ensure good personal hygiene and appearance. * Livelihood skills eg. how to obtain and keep work. Skills for dealing with specific risky situations eg. how to say no when under peer pressure to use drug. Further, life skills shall be integrated in the training module for health workers as well as in the school curricula. On the other hand, service providers, parents and teachers shall also be equipped with competencies to influence behavior of adolescents and promote healthy development and prevent health problems.

4. Promoting a safe and supportive environment A safe and supportive environment is part of what motivates young people to make healthy decisions. It refers to an environment that: (1) nurtures and guides young people towards healthy development; (2) provides the least trauma, excessive stress, violence and abuse; (3) provides a positive close relationship with family, other adults and peers;

(4) provides specific support in making individual responsible behavior choices. While intervention should now focus on the action that will facilitate growth and development and encourage adolescents and youth to practice healthy behavior, the following major aspects of social environment have to be considered: 1. Relationship with families, service providers and significant others. Adults contribute to a supportive climate for behavioral choices through positive relationship. They can substantially enrich the lives of young people through their fundamental role as parents and care-givers 2. Social norms and cultural practices This involve what people typically do in all areas of life and peoples expectation of others. These forces usually shape the lives of young people thus it is important to take note of the attitudes and practices that are harmful to them. Attitudes and norms concerning (a)early marriage, (b)sexual behavior among young people, (c)access to information about sexuality may need to be addressed. 3. Mass Media and entertainment The media is a very important component in influencing social norms that encourage adolescent to make responsible health behavior choices. It also provides great potential to communicate and mobilize community support on adolescent health issues. 4. Policies and legislation Promoting policies and legislation for adolescent health can ensure young people have the opportunities and services they need to promote and protect their own health. 5. Monitoring and Evaluation This is to ensure the smooth implementation of the program. Regular monitoring and evaluation will be conducted to identify the status, issues, gaps and recommendations. A scheme shall be developed which will include indicators, monitoring tools and checklist. Monitoring will be through conduct of field visits, consultative meeting and program implementation review. 6. Resource mobilization The Department of Health have prepared a 10 year work plan for AYHDP. The budgetary requirements will be sourced out from national and international donor agencies. Advocacy with LGUs, other GOs and NGOs shall be conducted on sharing of existing resources where AYHDP will be integrated.

Botika Ng Barangay (BnB)

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Botika ng Barangay Profile: currently being updated. The 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 Administrative Order No. 144 s.2004. The BnB outlet should be initially identified, evaluated and selected by the concerned Center for Health Development (CHD), approved by the National Drug Policy-Pharmaceutical Management Unit (NDP-PMU 50), and specifically licensed by the Bureau of Food and Drugs (BFAD) to sell, distribute, offer for sale and/or make available low-priced generic home remedies, over-the-counter (OTC) drugs and two (2) selected, publicly-known prescription antibiotic drugs (i.e. Amoxicillin and Cotrimoxazole). The BnB program aims 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.

Promotion of Breastfeeding program / Mother and Baby Friendly Hospital Initiative (MBFHI)
Realizing optimal maternal and child health nutrition is the ultimate concern of the Promotion of Breastfeeding Program. Thus, exclusive breastfeeding in the first four (4) to six (6) months after birth is encouraged as well as enforcement of legal mandates. The Mother and Baby Friendly Hospital Initiative (MBFHI) is the main strategy to transform all hospitals with maternity and newborn services into facilities which fully protect, promote and support breastfeeding and rooming-in practices. The legal mandate to this initiative are the RA 7600 (The Rooming-In and Breastfeeding Act of 1992) and the Executive Order 51 of 1986 (The Milk Code). National assistance in terms of financial support for this strategy ended year 2000, thus LGUs were advocated to promote and sustain this initiative. To sustain this initiative, the field health personnel has to provide antenatal assistance and breastfeeding counseling to pregnant and lactating mothers as well as to the breastfeeding support groups in the community; there should also be continuous orientation and re-orientation/ updates to newly hired and old personnel, respectively, in support of this initiative.

Blood Transfusion
Who can donate? To ensure the safety of blood supplied, donors must meet certain requirements before donating. You may be eligible to be a blood donor if you weigh more than 45 kilograms (100 lbs.) for 250 ml. of donated blood, 50 kilograms (110 lbs.) for 450 ml. of donated blood are in good health are aged 16-65 years of age ( for ages 16 & 17, parental consent is needed) blood pressure in safe range - 90- 160 mmHg systolic 60-100mmgHg diastolic hemoglobin is at least 125 g/l (12.5 g/dl)

Conditions that can prevent you from sharing your blood Diabetes Cancer Hyperthyroidism Cardiovascular diseases Severe psychiatric disorder Epilepsy / convulsions Severe bronchitis & other lung disorders, such as TB AIDS, Syphilis & other sexually transmitted diseases (past or present) Malaria Kidney & liver diseases, such as Hepatitis Prolonged bleeding Use of prohibited drugs

Where can I donate? Listed are the following DOH / private hospitals and PNRC blood service facilities where you can donate your blood: Steps on how to donate blood: Go to the nearest BLOOD COLLECTION UNIT (BCU) located in a government hospital Register as a potential blood donor Your health history will be taken A physical examination follows to check on your weight, temperature, pulse and blood pressure.

A blood test will be done to know your blood group type

What happens to your blood after you donate? Unless whole blood is urgently needed, your blood donation, once cleared by all screening tests, is separated into its components - and using the particular component needed by a patient, it is now possible to use a single donation to treat several patients suffering from different illnesses. The technique is known as 'blood component therapy'. Who receives blood? From a single blood donation, up to 13 products can be produced, all serving a vital function to others in need. Those who receive blood form donations include:

patients suffering from shock lost 20% or more of blood in an accident loss in surgery leukemia childbirth major trauma liver transplants hemophilia

What are the blood components in common use? Red cell concentrates are the most widely used blood component. Most patients requiring transfusions are in need of the oxygen-carrying capacity of the red cells, however few require whole blood. Most require red cells only. Red cell concentrates contain all the red cells of a unit of blood in about half the original volume. These red cells are mixed with special additive solution containing extra glucose and other substances to keep the cells alive and functioning. Platelet concentrates are used to control bleeding due to platelet deficiencies. These may be caused by disease (e.g. leukemia) or may follow severe hemorrhage. Platelet concentrates can be stored for 5 days. Cryoprecipitate is occasionally used for the treatment of Haemophilia A, the most common inherited bleeding disease, but is more commonly used in the treatment of massive bleeding. How is blood kept free from bacteria? Blood is collected with special care to avoid contamination, then kept cold to prevent bacteria from growing. Refrigerators with thermostatic controls keep the blood temperature between 4degC and 6degC. An alarm sounds if it varies outside these 8

limits and an auxiliary power source is used to keep the refrigerator operating if the power supply fails. When blood is transported, similar temperatures are maintained by using insulated carrying boxes and ice refrigerated delivery vehicles. For how long can blood be stored? Whole blood and red cell concentrates were in the past stored for four weeks. With the new blood preservatives the shelf life can be safely extended to five weeks. Plasma can be stored frozen for 12 months. What to expect when donating... Upon arrival at the blood collection unit/blood bank, you will be asked to fill up a Donor's Form. It is important that we protect both you and the patients who receive your blood from suffering any adverse affects from your donation. Therefore, on your first visit, you will be interviewed about your past and present medical history. This will take about 15 minutes and is confidential. To ensure that your hemoglobin (iron) level is high enough for you to donate, a small sample of blood from your finger will be tested. (We don't want you to be anemic after you donate). Before you donate blood, your blood pressure will be measured. The donation takes 510 minutes. Approximately 450cc of blood will be taken, which is about 7-9% of the blood volume of an average adult. The volume will be replaced by your body within 24-48 hours and by drinking more fluids. Every time you donate, your blood is tested for diseases such as HIV (AIDS), Syphilis and both Hepatitis B&C. Your donation is also checked to identify and confirm your blood group. After donating blood... Keep an eye on your dressing. You should leave the adhesive dressing on your arm for at least 3 hours but not more than twelve (12) hours. Do not be alarmed if some bruising or discoloration occurs. It will disappear in a few days. Avoid carrying heavy objects with your donating arm. And do not smoke for the next 2 hours and avoid alcohol intake for the next twelve (12) hours. Eat regular meals and increase fluid intake following your donation. 9

II. List of Topic: Cancer Control Program Child Health Diabetes Mellitus Prevention Program Dengue Control Program

Reported by: Dara Jecyn Magno

Philippine Cancer Control Program

The Philippine Cancer Control Program, begun in 1988, is an integrated approach utilizing primary, secondary and tertiary prevention in different regions of the country at both hospital and community levels. Six lead cancers (lung, breast, liver, cervix, oral cavity, colon and rectum) are discussed. Features peculiar to the Philippines are described; and their causation and prevention are discussed. A recent assessment revealed shortcomings in the Cancer Control Program and urgent recommendations were made to reverse the anticipated cancer epidemic. There is also today in place a Community-based Cancer Care Network which seeks to develop a network of selfsufficient communities sharing responsibility for cancer care and control in the country.

Child Health and Development Strategic Plan

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

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Children's Health 2025 contains both mid-term strategies, which is targeted towards the year 2004, while long-term strategies are targeted by the year 2025. It utilizes a life cycle approach and weaves in the rights of children. The life cycle approach ensures that the issues, needs and gaps are addressed at the different stages of the child's growth and development. The period year 2002 to 2004 will put emphasis on timely diagnosis and management of common diseases of childhood as well as disease prevention and health promotion, particularly in the fields of immunization, nutrition and the acquisisiton of health lifestyles. Also critical for effective pallning and implementation would be addressing the components of the health infrastructure such as human resource development, quality assurance, monitoring and disease surveillance, and health information and education. The successful implementation of these strategies will require collaborative efforts with the other stakeholdres and also implies integration with the other developmental plan of action for children. VISION A healthy Filipino child is: * Wanted, planned and conceived by healthy 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 corrrect these defects are implemented at the appropriate time * Exclusively breastfed for at least six months of age, and continued breasfeeding up to two years * Introduced to compementary foods at about six months of age, and gradually to a balanced, nutritious diet * Protected from the consequences of protein-calorie and micronutirent deficiencies through good nutrition and access to fortified foods and iodized salt * Provided with safe, clean and hygienic surroundings and protected from accidents * 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 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, explitation 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 11

Current Situation Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, septicemia), nutritional deficiencies and birth-realted complications. The probability of dying between birth and five years of age is 48 deaths per 1000 livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningities and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents. THe decline in mortality rates may be attributed partly to the Expanded Program of Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable diseases (tuberculosis, diptheria, tetanus, pertussis, poliomyelities, Hepatitis B and measles). The Philippines has been declared as polio-free druing the Kyoto Meeting on Poliomyelities Eradication in the Western Pacific Region last October 2000. This. however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urrgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved. Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997. Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos of age (NDHS). Several strategies were utilized to omprove child health. THe Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common chldhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway. The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and 12

seeking behaviors. It operates through health and nutrition posts established throughout the country. Gaps and Challenges Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for childrens health. There is also the need to update and reiterate the policies on children's health particularly on immunization, micronutrient supplementation and IMCI. LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution. Pockets of low immunization coverage is attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization. Goal The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025. Diabetes Do you suspect you have diabetes? Do you have to urinate three to four times at bedtime? Do you feel unusual thirst? Do you get tired easily? Did you have a rapid loss of weight? If you do, you may be suffering from Diabetes. Dont waste time. Consult your doctor immediately. What is diabetes? Diabetes is a serious chronic metabolic disease characterized by an increase in blood sugar levels associated with long term damage and failure or organ functions, especially the eyes, the kidneys, the nerves, the heart and blood vessels. How does one become a diabetic? Diabetes occurs when insulin is not adequately produced by the pancreas. It also happens when the body cannot properly use insulin. Insulin is a hormone necessary for the proper utilization of sugar by muscles, fat and liver. 13

What are the complications of diabetes? In diabetics, blood sugar reaches a dangerously high level which leads to complications.

Blindness Kidney failure Stroke Heart Attack Wounds that would not heal Impotence

What are the types of diabetes? Type 1 Insulin dependent diabetes Develops during childhood or adolescence and affects about 10% of all diabetic patients. Sufferers require a lifetime of insulin injection for survival since their pancreas cannot produce insulin. Type 2 Non-insulin dependent diabetes How will you know if you are a diabetic? If you urinate frequently, experience excessive thirst and unexplained weight loss. If your casual blood sugar (plasma glucose) level is higher than 200mg/dl. If you have fasting plasma glucose level of not more than 126mg/dl. If you have any these symptoms, especially if you are overweight or hypertensive, you should see your doctor right away for proper guidance and treatment. Who are at risk of diabetes? children of diabetics obese people people with hypertension people with high cholesterol levels people with sedentary lifestyles What can you do to control your blood sugar? 1. Diet Therapy Avoid simple sugars like cakes and chocolates. Instead have complex carbohydrated like rice, pasta, cereals and fresh fruits. Do not skip or delay meals. It causes fluctuations in blood sugar levels. Eat more fiber-rich foods like vegetables. Cut down on salt. Avoid alcohol. Dietary guidelines recommend no more than two drinks for men and no more than one drink per day for women.

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2. Exercise Regular exercise is an important part of diabetes control. Daily exercise . . . Improves cardiovascular fitness Helps insulin to work better and lower blood sugar Lowers blood pressure and cholesterol levels Reduces body fat and controls body weight Exercise at least 3 time a week for ate least 30 minutes each session. Always carry quick sugar sources like candy or softdrink to avoid hypoglycemia (low blood sugar) during and after exercise. 3. Control your weight If you are overweight or obese, start weight reduction by diet and exercise. This improves your cardiovascular risk profile. It lowers your blood sugar It improves your lipid profile It improves your blood pressure control 4. Quit smoking. Smoking is harmful to your health. 5. Maintain a normal blood pressure. Since having hypertension puts a person at high risk of cardiovascular disease, especially if it is associated with diabetes, reliable BP monitoring and control is recommended. See your doctor for advice and management. If there is no improvement in blood sugar what advice can I expect my doctor to give? There are drug therapies using oral hypoglycemic agents. Your doctor can prescribe one or two agent, depending on which is appropriate for you. 1. Sulfonylurea Glibenclamide, Gliclazide, Glipizide, Glimepiride, Repaglinide 2. Biguanide Metformin 3. Alpha-glucosidase Inhibitors Acarbose 4. Thiazolidindione Troglitazone, Rosiglitazone, Proglitazone. Remember If you have the classic symptoms of diabetes: See your doctor for blood sugar testing Start dieting

eat plenty of vegetables avoid sweets such as chocolates and cakes cut down on fatty foods

Exercise regularly If you are obese, try to lose some weight 15

Avoid alcohol drinking and stop smoking If you are hypertensive, consult your doctor for advice and management Dengue Control Program One of the major health problems during rainy season is the incidence of Dengue Hemorrhagic Fever. It occurs in all age groups. This disease (transmitted by Aedes, a day-biting mosquito) is preventable but is prevalent in urban centers where population density is high, water supply is inadequate (resulting to water storage and a good breeding place for the vector), and solid waste collection and storing are also inadequate. The thrust of the Dengue Control Program is directed towards community-based prevention and control in endemic areas. Major strategy is advocacy and promotion, particularly the Four Oclock Habit which was adopted by most LGUs. This is a nationwide, continuous and concerted effort to eliminate the breeding places of Aedes aegypti. Other initiatives are the dissemination of IEC materials and tri-media coverage.

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III. List of Topics: Dental Health Program Emerging Disease Control Program Environmental Health Expanded Program on Immunization

Reported by: Michelle Ann Jancilan

Dental Health Program

ComprehensiveDental Health Program aims to improve the quality of life of the people through the attainment of the highest possible oral health. Its objective is to prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing their prevalence. Targeted priorities are vulnerable groups such as the 5-12 year old children and pregnant women. Strategies of the program include social mobilization through advocacy meetings, partnership with GOs and NGOs, orientation/updates and monitoring adherence to standards. To attain orally fit children, the program focuses on the following package of activities: oral examination and prophylaxis; sodium fluoride mouth rinsing; supervised tooth brushing drill; pit and fissure sealant application; a-traumatic restorative treatment and IEC. The Program also integrates its activities with the Maternal and Child Health Program, the Nutrition Program and theGarantisadong Pambata activities of the WHSMP.

Emerging Disease Control Program

Emerging infectious diseases are newly identified and previously unknown infections which cause public health problems either locally or internationally. These include diseases whose incidence in humans has increased within the past two decades or threatens to increase in the near future.

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Environmental Health
Environmental Health is concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury. It is concerned primarily with effects of the environment to the health of the people. Program strategies and activities are focused on environmental sanitation, environmental health impact assessment and occupational health through inter-agency collaboration. An Inter-Agency COmmittee on Environmental Health was created by virute of E.O. 489 to facilitate and improve coordination among concerned agencies. It provides the venue for technical collaboration, effective monitoring and communication, resource mobilization, policy review and development. The Committee has five sectoral task forces on water, solid waste, air, toxic and chemical substances and occupational health. Vision: Health Settings for All Filipinos Mission: Provide leadership in ensuring health settings Goals: Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion and mitigation of hazards and risks in the environment and worksplaces. Strategic Objectives: 1. Development of evidence-based policies, guidelines, standards, programs and parameters for specific healthy settings. 2. Provision of technical assistance to implementers and other relevant partners 3. Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and attainment of healthy settings Key Result Areas: Appropriate development and regular evaluation of relevant programs, projects, policies and plans on environmental and occupational health

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Timely provision of technical assistance to Centers for Health Development (CHDs) and other partners Development of responsive/relevant legislative and research agenda on DPC Timely provision of technical inputs to curriculum development and conduct of human resource development Timely provision of technically sound advice to the Secretary and other stakeholders Timely and adequate provision of strategic logistics

Components:

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

Expanded Program on Immunization

Children need not die young if they receive complete and timely immunization. Children who are not fully immunized are more susceptible to common childhood diseases. The Expanded Program on Immunization is one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of six (6) immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles) Special campaigns have been undertaken to improve further program implementation, notably the National Immunization Days (NID), Knock Out Polio (KOP) and Garantisadong Pambata (GP) since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and improved surveillance system.

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IV. List of Topics: Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program FOURmula One Reported by: Novelenn Hinoyog

Family Planning
Brief Description of Program A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. The program is anchored on the following basic principles. * Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens. * Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is NOT a FP method: * Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It enables women to recover their health improves women's potential to be more productive and to realize their personal aspirations and allows more time to care for children and spouse/husband, and; * Informed Choice that is upholding and ensuring the rights of couples to determin the 20

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. E. Intended Audience: Men and women of reproductive age (15-49) years old) including adolescents F. Area of Coverage: Nationwide G. Mandate: EO 119 and EO 102 H. 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. I. 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. J. Program Goals: To provide universal access to FP information, education and services whenever and wherever these are needed. K. 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% L. Key Result Areas 21

1. Policy, guidelines and plans formulation 2. Standard setting 3. Technical assistance to CHDs/LGUs and other partner agencies 4. Advocacy, social mobilization 5. Information, education and counselling 6. Capability building for trainers of CHDs/LGUs 7. Logistics management 8. Monitoring and evaluation 9. Research and development M. Strategies I. Frontline participation of DOH-retained hospitals II. Family Planning for the urban and rural poor III. Demand Generation through Community-Based Management Information System IV. Mainstreaming Natural Family Planning in the public and NGO health facilities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM VI. Contraceptive Interdependence Initiative N. 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

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* Orientation of CHD staff and creation of Regional NFP Management Committee * Diacon with stakeholders * Information, Education and counseling activities * Advocacy and social mobilization efforts * Production of NFP IEC materials * Monitoring and evaluation activities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM * Field of itinerant teams by retained hospitals to provide VS services nearer to the community * Installation of COmmunity Based Management Information System * Provision of augmentation funds for CBMIS activities VI. Contraceptive Interdependence Initiative * Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and FP Itenerant Teams * Expansion of Philhealth benefit package to include pills, injectables and IUD * SOcial Marketing of contraceptives and FP services by the partner NGOs * National Funding/Subsidy VIII. Development /Updating of FP CLinical Standards IX. Formulation of FP related policies/guidelines. E.g. Creation of VS Outreach team by retained hospitals and its operationalization, GUidelines on the Provision of VS services, etc. X. Production and reproduction of FP advocacy and IEC materials XI. Provision of logistics support such as FP commodities and VS drugs and medical supplies O. 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 23

* Philippine Federation for Natual Family Planning (PFNFP) * John Snow Inc. - Well Family Clinic * Phlippine Legislators Committee on Population Development (PLPCD) * Remedios Foundation * Family Planning Organization of the Philippines (FPOP) * Institute of Maternal and CHild HEalth (IMCH) * Integrated Maternal and CHild Care Services and Development, Inc. * Friendly Care Foundation, Inc. * Institute of Reproductive Health 3. Other GOs * Commission on Population * DILG * DOLE * LGUs

Food and Waterborne Diseases Prevention and Control Program

Profile: Food and Waterborne Diseases (FWBDs) are among the most common causes of diarrhea. In the Philippines, diarrheal diseases for the past 20 years is the number one cause of morbidity and mortality incidence rate is as high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 population. From 1993 to 2002, FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/foodborne diseases were the most common outbreaks investigated by the Department of Health. Also, outbreaks from FWBDs can be very passive and catastrophic. Since most of these diseases have no specific treatment modalities, the best approach to limit economic losses due to FWBDs is prevention through health education and strict food and water sanitation. The Food and Waterborne Disease Prevention and Control Program (FWBDPCP) established in 1997 but became fully operational in year 2000 with the provision of a budget amounting to PHP551,000.00. The program focuses on cholera, typhoid fever, hepatitis A and other foodborne emerging diseases (e.g. Paragonimiasis). Other diseases acquired through contaminated food and water not addressesd by other services fall under the program.

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The Food Fortification program is the government's response to the growing micronutrient malnutrition, which have been prevalent in the Philippines for the past several years. Food Fortification is the addition of Sangkap Pinoy or micronutrients such as Vitamin A, Iron and/or Iodine to food, whether or not they are normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency with one or more nutrients in the population or specific population groups. Sangkap Pinoy or micronutrients are vitamins and minerals required by the body in very small quantities. These are essential in maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children. Past studies have shown that worldwide, the problem of malnutrition has been the cause of death of 60% of children less than 5 years old.

For the Philippines, Nutrition surveys since 1993 have been showing increasing prevalence of micronutrient malnutrition, particularly that of Vitamin A Deficiency Disorder (VADD), Iron Deficiency Anemia (IDA) and Iodine Deficiency Disorder (IDD) among children and women of reproductive age, who are the most at-risk groups to micronutrient malnutrition.

Fourmula One
What is FOURmula ONE for Health? Defining the Road Map for Reforms FOURmula ONE for Health is the implementation framework for health sector reforms in the Philippines for the medium term covering 25

2005-2010. It is designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements. This document provides the road map towards achieving the strategic health sector reform goals and objectives of FOURmula ONE for Health from the national down to the local levels. FOURmula ONE for Health engages the entire health sector, including the public and private sectors, national agencies and local government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a brighter future for generations to come. F1 Component No. 1: HEALTH FINANCING

F1 Component No.2: HEALTH REGULATION

F1 Component No. 3: HEALTH SERVICE DELIVERY

F1 Component No.4: GOOD GOVERNANCE IN HEALTH

Fourmula One for Health Goals

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Over-all Goals: The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine Development Plan: * Better health outcomes; * More responsive health system; and * More equitable healthcare financing.

V. List of Topics: Garantisadong Pambata GMA 50 / Parallel Drug Importation (PDI) Human Resource Health Network Healthy Lifestyle Program

Reported by: Kyle Golindang

27

GMA 50 / Parallel Drug Importation (PDI)

no input ( Access denied on the website)

Human Resources for Health Network

The Human Resources for Health Network (HRHN) is a multi-sectoral organization in the Philippines that is composed of government agencies and non-government organizations with the aim of addressing and responding to HRH issues and problems. NATIONAL HEALTHY LIFESTYLE CAMPAIGN The Department of Health (DOH) spearheaded the creation of this network which was formally established during its launching and signing of the Memorandum of RATIONALE: Understanding among its member organizations last October 25, 2006. 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 Prior to the creation of the HRHN, the DOH together with the World Health Organization (WHO) National Healthy Human Resources isfor Health Master inPlan (HRHMP) The developed the Lifestyle Campaign being undertaken collaboration with HRHMP serves as Association andframework and road map composedsupport HRH the Philippine Heart a conceptual a Coalition of Stakeholders that will 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 ones health and well-being. The campaign promotes the following messages: 28

1. 2. 3. 4. 5. 6.

Don't smoke Regular exercise Eat a healthy diet everyday Watch your weight/Weight control Manage stress 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. 2. 3. Executives and employees of local government units Legislators/politicians Media

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.

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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: Tri-Media Campaign with a communication handle: "MAG HL TAYO" a. Exposure on TV and Radio of infomercials developed b. Press releases c. Articles/write ups on various publications/magazines d. Rounds of TV and Radio visits to talk about healthy lifestyle e. Postings of posters on strategic places: buses/LRT/MRT f. Distribution of flyers to target population g. Distribution of journalist's manuals to various media outlets 2. High Profile Launching of the Campaign on February 16, 2003 3. conduct of Periodic "MAG HL TAYO" Campaign to celebrate various awareness weeks highlighting the following messages: a. February- - - Hearth Month- - - Exercise Regularly b. May 31/June- - - World No Tobacco Day/Month- - - Don't Smoke c. July- - - Nutrition Month- - - Eat a healthy Diet Everyday d. October- - - Mental Health Week- - - Manage Stress e. December - - - - - - - - - - - - - - - - - - Watch Your Weight 1. 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.

VI. List of Topics: Knock-Out Tigdas Leprosy Control Program 30

Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas)

Reported by : Natasha Jade Guinayon

Knock Out Tigdas 2007

Knock-out Tigdas 2007 is a sequel to the 1998 and 2004 Ligtas Tigdas mass measles immunization campaign. All children 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated against measles from October 15 - November 15, 2007 , door-to-door. All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball court, town plazas and other identified public places will also offer FREE vaccination services during the campaign period. Other services to be given include Vitamin A Capsule and deworming tablet. Knockout Tigdas for the period of the Barangay and SK Elections Executive Order No. 663 Promotional materials What is Knock-out Tigdas (KOT) 2007? Knock-out Tigdas 2007 is a sequel to the 1998 and 2004 Ligtas Tigdas mass measles immunization campaigns. This is the second follow-up measles campaign to eliminate measles infection as a public health problem. What is the over-all objective of the Knock-out Tigdas? The Knock-out Tigdas is a strategy to reduce the number or pool of children at risk of getting measles or being susceptible to measles and achieve 95% measles immunization coverage. Ultimately, the objective of KOT is to eliminate measles circulation in all communities by 2008. What does measles elimination mean? Measles elimination means: 1. Less than one (1) measles case is confirmed measles per one million population. 2. Detects and extracts blood for laboratory confirmation from at least 2 suspect measles cases per 100,000 populations. 3. No secondary transmission of measles. This means that when a measles case occurs, measles is not transmitted to others. 31

Who should be vaccinated? All children between 9 months to 48 months old ( born October 1, 2003 January 1,2007) should be vaccinated against measles. When will it be done? Immunization among these children will be done on October 15-November 15, 2007. How will it be done? Vaccination teams go from door-to-door of every house or every building in search of the targeted children who needs to be vaccinated with a dose of measles vaccines, Vitamin A capsule and deworming drug. All health centers, barangay health stations, hospitals and other temporary immunization sites such as basketball court, town plazas and other identified public places will also offer FREE vaccination services during the campaign period. My child has been vaccinated against measles. Is she exempted from this vaccination campaign? No, she is not. A previously vaccinated child is not exempted from the vaccination campaign because we cannot be sure if her previous vaccination was 100% effective. Chances are a vaccinated child is already protected, but no one can really be sure. There is 15% vaccine failure when the vaccine is given to 9 months old children. We want to be 100% sure of their protection. What strategy will be used during the campaign? It is a door-to-door strategy. The team goes from one-household to another in all areas nationwide. My child had measles previously, is he exempted in this campaign? There are many measles-like diseases. We cannot be sure exactly what the child had, especially if the illness occurred years ago. Anyway, the vaccination will not harm a child who already had measles. The effect will also be like a booster vaccination. The previously received measles immunization has formed antibodies, with the booster shot it will strengthened the said antibodies. Is there any overdose, if my child receives this booster immunization? Antibodies in the blood which provide protection against disease decrease as the child grows older. Booster vaccinations are needed to raise protection again. Measles vaccination during the said campaign will be a booster vaccination for a previously vaccinated child. The childs waning internal protection will increase. The child will not 32

harm because there is no vaccine overdose for the measles vaccine. The measles vaccine is even known to enhance overall immunity against other diseases. What will happen to my child after receiving the measles immunization? Normally, the child will have slight fever. The fever is a sign that the childs vaccine is working and is helping the body develop antibodies against measles. The best thing to do when the child has fever is to give him paracetamol every four (4) hours. Give him plenty of fluids and breastfeed the child. Ensure that the child has enough rest and sleep. What will happen after the Knock-out Tigdas 2007? To interrupt measles circulation by 2008, ALL children ages 9 months will continue to routinely receive one dose of the measles vaccine together with the vaccines the other disease of the childhood like polio, diphtheria, pertussis, etc. All children with fever and rashes have to be listed and tested to verify the cause of the infection. ALL 18 months old children will be given a second dose of measles immunization to really ensure that these children are protected against measles infection. What other services will be given? Vitamin A capsule will be given to all children 6 months to 71 month old and deworming tablet to 12 months to 71 months old nationwide. Leprosy Control Program Leprosy Control Program envisions to eliminate Leprosy as a human disease by 2020 and is committed to eliminate leprosy as a public health problem by attaining a national prevalence rate (PR) of less than 1 per 10,000 population by year 2000. Its elimination goals are: reduce the national PR of <1 case per 10,000 population by year 1998 and reduce the sub-national PR to <1 case per 10,000 population by year 2000. Kilatis Kutis Campaign. Program thrust is towards finding hidden cases of leprosy and put them on Multi-Drug Therapy (MDT), emphasizing the completion of treatment within the WHO prescribed duration. Strategies are case-finding, treatment, advocacy, rehabilitation, manpower development and evaluation.

Malaria Awareness Month - November 2007

Malaria is a disease caused by protozoan parasites called Plasmodium. It is usually transmitted through the bite of an 33

infected female Anopheles mosquito. Malaria may also be transmitted through the following:

Transfusing blood that is positive for malaria parasites Sharing of IV needles (especially among IV drug users)

Transplacenta (transfer of malaria parasites form an infected mother to her unborn child)

Ligtas Tigdas 2004 is a special nationwide vaccination month for children who are at high risk of getting measles. The Department of Health identified these children to be those between the ages of 9 months to less than 8 years old. During the Ligtas Tigdas 2004, 100% of the children in this age group will be vaccinated. Other children are not classified as high risk. The Philippine Measles Elimination Campaign of which the Ligtas Tigdas 2004 is only one component. PMEC includes continuing routine vaccination of infants at 9 months old after Ligtas Tigdas 2004; the catch-up mass vaccination done in 1998; continuing monitoring or disease surveillance and Follow-up campaign such as Ligtas Tigdas 2004 which may have to be repeated every 4 or 5 years.Vitamin A capsules will also be given to children 9 months to below 6 years of age. The ? LIGTAS TIGDAS? should be done to rapidly reduce the number of children at risk of getting measles infection which has accumulated in the past years. This nationwide campaign supports the routine vaccination given on a regular basis at the health centers. It is a Door-to-Door campaign. ? BakunaDOORS? (Vaccination Teams) led by doctors, nurses and midwives will visit every home and school to vaccinate children against measles which will be done in the whole month of February 2004

VII. List of Topics: Natural Family Planning Newborn Screening Nutrition 34

Occupational Health Program Reported by : Divine Faith Ungui

Newborn Screening
Basic Information about Newborn Screening What are the disorders included in the Newborn Screening Package? 1. Congenital Hypothyroidism (CH) CH results from lack or absence of thyroid hormone, which is essential to growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within (4) weeks, the baby's physical growth will be stunted and she/he may suffer from mental retardation. 2. Congenital Adrenal Hyperplasia (CAH) CAH is an endocrine disorder that causes severe salt lose, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies may die within 7-14 days. 3. Galactosemia (GAL) GAL is a condition in which the body is unable to process galactose, the sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts. 4. Phenylketonuria (PKU) PKU is a metabolic disorder in which the body cannot properly use one of the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the body causes brain damage. 5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def) G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency may have hemolytic anemia resulting from exposure to certain drugs, foods and chemicals.

What is Newborn Screening?

35

Newborn Screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. Why is it important to have Newborn Screening? Most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. When is Newborn Screening done? Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for more accurate results. How is Newborn Screening done? Newborn screening is a simple procedure. Using the hell prick method, a few drops are taken from the baby's heel and blotted on a special absorbent filter card. The blood is dried for 4 hours and sent to the Newborn Screening Laboratory. (NBS Lab). Who will collect the sample for Newborn Screening? A physician, a nurse, a midwife or medical technologist can do the newborn screening. Where is Newborn Screening Available? Newborn screening is available in practicing health institutions (hospitals, lying-ins, Rural Health Units and Health Centers). If babies are delivered at home, babies may be brought to the nearest institution offering newborn screening. When is the Newborn Screening results available? Newborn screening results are available within three weeks after the NBS Lab receives and tests the samples sent by the institutions. Results are released by NBS Lab to the institutions and are released to your attending birth attendants or physicians. Parents may seek the results from the institutions where samples are collected. A negative screen mean that the result of the test is normal and the baby is not suffering from any of the disorders being screened. In case of a positive screen, the NBS nurse coordinator will immediately inform the coordinator of the institution where the sample was collected for recall of patients for confirmatory testing. What should be done when a baby has a positive newborn screening result? 36

Babies with positive results should be referred at once to the nearest hospital or specialist for confirmatory test and further management. Should there be no specialist in the area, the NBS secretariat office will assist its attending physician. Disorder Effect Effect if SCREENED and treated Screened SCREENED CH (Congenital Hypothyroidism) Mental Retardation Normal Severe CAH (Congenital Adrenal Death Alilve and Normal Hyperplasia) GAL (Galactosemia) Death or Cataracts Alive and Normal PKU (Phenylketonuria) Severe Mental Retardation Normal G6PD Deficiency Severe Anemia, Kernicterus ormal N

Nutrition
Vitamin A Supplementation Policy on Vitamin A Supplementation Program * The Philippine government is committed to virtually eliminate VAD * ECCD Law: DOH role is to ensure Vitamin A supplementation * Administrative Order No. 3-A, s. 2000: Guidelines of Vitamin A and Iron Supplementation * Therapeutic supplementation: all cases of VAD * Preventive supplementation: 1. Universal - children 6-59 months 2. Regular/routine - Pregnant and Lactating women, High-risk children 3. Supplementation during emergencies Food Fortifcation The Food Fortification program is the government's response to the growing micronutrient malnutrition, which is prevalent in the Philippines for the past several years. Food Fortification is the addition of Sangkap Pinoyor micronutrients such as Vitamin A, Iron and/or Iodine to food, whether or not they are normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency with one or more nutrients in the population or specific population groups. Sangkap Pinoy or micronutrients are vitamins and minerals required by the body in very small quantities. These are essential in maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children. 37

Nutrition surveys since 1993 have been showing increasing prevalence of micronutrient malnutrition, particularly that of Vitamin A Deficiency Disorder (VADD) and Iron Deficiency Anemia (IDA) among children and women of reproductive age, who are the most at-risk groups to micronutrient malnutrition. Garantisadong Pambata (GP) is a campaign to support the various health programs to reduce childhood illnesses and deaths by promoting positive child care behaviours. GP is a program of the Department of Health in partnership with the Local Government Units (LGUs) and other government and non-government organizations.

Occupational Health Program

Vision/Mission Statement Health for all occupations in partnership with the workers, employers, local government authorities and other sectors in promoting self-sustaining programs and improvement of workers' health and working environment.

Program Objectives and TargetsTo promote and protect the health and well being of the working population thru improved health, better working conditions and workers' environment.Priority TargetsUnderserved/small scale and high risk groups in industryOccupational Health ProgramsIndustrial HygieneGeneral Objective

To promote and protect the health and safety of workers in industry

Specific Objectives To develop the capabilities and competencies of field health personnel in industrial Hygiene To formulate policies, standards, regulations and guidelines on Occupational Health and Sanitation for industrial workers To provide technical assistance on health and safety measures to protect the workers from occupational hazards/stresses in the work environment

Strategies/Activities

Policy development Manpower development Promotion of Industrial Hygiene consciousness among target groups Provision of Industrial Hygiene instruments for monitoring in selected regions Inspection of workers Monitoring Special investigations Advocacy thru the "Healthy Workplace Campaign" Intersectoral linkages 38

Occupational Toxicology General Objectives: To promote the health and well being of workers exposed to hazardous substances in small scale/non-institutional industries and to institute appropriate intervention measures among workers with occupationally-related illnesses To reduce morbidity and mortality of occupationally related poisonings Specific Objectives To develop training programmes/post graduate courses for medical and allied personnel To establish a mechanism for toxicovigilance/surveillance of work-related poisonings To establish an integrated system of monitoring, reporting and evaluation of all occupationally-related poisonings Develop an information databank on occupational toxicology and hazardous chemical substances used in industry Recommends codes of practices/intervention measures including detoxification to minimize adverse effects of hazardous chemicals Conduct research studies to establish baseline data for biological exposures, epidemiological and applied studies Undertake social mobilization/advocacy activities among target sectors in noninstitutional industries Provide timely and accurate health advisories to target clienteles Strategies/Activities Health surveillance and monitoring Orientation seminars and training Information campaign in coordination with local leaders

Advocacy and NetworkingHealthy Workplace Campaign Launched in 1995 as a multi-sectoral health promotion strategy to build supportive environments thru advocacy, networking and community action Top 25 Healthy workplaces awarded by Pres. Fidel V. Ramos at Malacaang in 1996 1998 awardees honored by the First Lady Dr. Loi Ejercito at Malacaang, August, 1998

VIII. List of Topics: Health Development Program for Older Persons (Elderly Health) 39

Pinoy MD Persons with Disabilities Program Pnuemonia and Other Acute Respiratory Infections (ARI's) Reported by: Miguel Andrei Chacon

Health Development Program for Older Persons (Elderly Health)

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

Pinoy MD Program
"Gusto kong Maging Doktor"

40

A Medical Scholarship Grant for Indigenous People, Local Health Workers, Barangay Health Workers, Department of Health Employees or their children. This is a jJoint program of the Department of Health (DOH), Philippine Charity Sweepstakes Office (PCSO), and several State Universities and Medical Schools.

Persons with Disabilities

The Philippine Registry for Persons with Disabilities National Center for Disease Prevention and Control Degenerative Diseases Office Department of Health September 27, 2005 Rationale & Significance The Constitution of the Republic of the Philippines recognizes every Filipino citizens right to health. Recognizing this basic constitutional right, the government has worked to ensure that the role and contributions of Filipinos with disabilities in nationbuilding are given the appropriate attention by the international community. Last July 31, 2002, the Philippines issued a statement and assured the internatonal community that the country will recognize the protection and promotion of the Rights and Dignity of PWDs. The Philippines was the main sponsor of resolution 56/115 on the Implementation of the World Programme of Action Concerning Disabled Persons: Towards a society for all inthe 21st Century. National policies had been put in place to address the problems of disabled persons. The Accessibility Law or Batasang Pambansa No. 844 was passed to increase the mobility and access of a group of disabled persons to jobs and recreational facilities. Republic Act No.7277, otherwise known as, An Act Providing for the Rehabilitation, Self-Development, and Self-Reliance of Disabled Persons and Their Integration into the mainstream of Society and for Other Purposes, was passed in September 1995. The implementing rules and regulations of this Act required the Department of Health to establish a national registration and reporting system for specific types of disabilities. With the frontline services of the Department of Health devolved to the local government units, the final implementation of this Act now rests with the Local Government Units (LGUs). The LGUs had also been empowered to implement the Community-Based rehabilitation (CBR) for PWDs by Executive Order 437, dated June 21, 2005. Hence the PRPWD can now serve as a spring board for executing the CBRP.

Materials & Methods 41

The tool used in the PRPWD was a Personal Information Sheet (PIS) developed by the Classifications and Standards Work Group for the PRPWD. The technique used in collecting the data was the survey. The case definitions, procedures and practices of that survey was contained in the first version of the Manual of Operations for the PRPWD. The PIS were collated at the Municipal or City Health Office, where a summary table for gender, age and locality was generated using a calculator. The tables were either hand carried or sent by snail mail to the Provincial Health Office by the Health Officer or through the Department of Healths Local Representatives who sent the provincial summaries to the regions, thence the national office. A national summary was produced using a calculator at the National Office.

Pnuemonia and Other Acute Respiratory Infections (ARI's)

no input (access denied on the website)

IX. List of Topics: 42

Rabies Control Program Smoking Cessation Program Soil Transmitted Helmenthiasis TB Control Program Reported by : Krystle Ann Centina

Rabies Control Program

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This chapter deals with soil-transmitted helminthiasis (STH) in general. The reader is informed of the disease's magnitude, burden of infection, effects on the overall health of children, prevalence, and means of control. The chapter also provides a historical background and current concepts on STH.

I. General Description Synonyms: Soil-transmitted helminthiasis Geohelminths Intestinal parasitism Soil-transmitted helminthiasis is an infection or disease caused by soil-transmitted helminths. The three most common soil-transmitted helminthes are:

3. Ancylostoma duodenale and 1. Ascaris lumbriocoides2. Trichuris trichiura Necator americanus (Roundworm) (Whipworm) (Hookworm)

The common signs and symptoms of STH include:

1. Abdominal pain and enlargement 2. Anemia 3. Weight loss 4. Malnutrition 5. Loss of appetite

Table 1. Survey on the prevalence of intestinal parasitic infections in the Philippines, 1987 (n=90)

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Parasite Entamoeba histolytica Entamoeba hartmanni Entamoeba coli Entamoeba nana Iodamoeba butschlii Protozoa Giardia lamblia Chilomastx mesnilli Parasites found <1% Trichomonas hominis Balantidium coli Ascaris lumbricoides Trichuris trichiura Hookworm Strongloides stercoralis Capillaria philippinesis Heterophyes eterophyes Echinostoma ilocanum Didymozoid Helminths Parasites found <1% Enterobius vermicularis Physaptera sp. Taenia sp. Hymenolepis diminuta Hymenolepis nana Dyphyllobotrium latum Paragonimus westermani

Percentage of Prevalence Range (%) Average (%) 2-8 5 1-10 4 9-29 22 6-19 10 1-4 1 2-10 8 0-3 1 1-39 9-77 29-90 14-65 0-3 0-2 0-2 0-1 1-9 1-39 12 48 74 38 1 <1 1 5 1 12

SMOKING CESSATION PROGRAM

SMOKING: Its Origin The tobacco plant, scientifically known as Nicotiana tabacum, is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. Tobacco is considered addicting because it contains the chemical nicotine. Sniffing and chewing tobacco originated in North America and Europe. It was Christopher Columbus who introduced tobacco into Europe. It then became very popular with the Portugese, Spanish, French, British, and Scandinavians. 44

Why is cigarette smoking dangerous? In 1960s, medical research on tobacco showed smoking to be strongly linked to heart and lung diseases. Smoking may be even more dangerous now than 30 years ago because the lower levels of tar and nicotine in cigarette brands make smokers inhale more deeply. In the US . . . . Only 42 of male lifelong smokers reach the age of 73 compared to 78% of nonsmokers 25.7% of the adult population (47 million people) continue to smoke despite repeated warnings on the hazards of cigarette smoking. 28% of the male population and 23% of women smoke Despite the known dangers of smoking, television, radio, and print ads continue to promote a number of cigarette brands

What are the chemicals in tobacco smoke? Tobacco contains nicotine, as well as tar. Both substances get deposited in the bronchi and the lungs. The other chemicals found in tobacco are: 1. 2. 3. 4. 5. 6. 7. Acetone Ammonia Carbon Monoxide Carbon Dioxide Hydrogen Cyanide Methane Benzopyrene

These chemicals are the major factors responsible for smoking related diseases like coronary heart disease, atherosclerosis, stroke, emphysema, acute bronchitis and cancers of the nose, pharynx, larynx (voice box), and lungs What are the effects of nicotine on the body? Nicotine gives the so-called positive effects which include: 1. Enhancement of memory and alertness 2. Improvement of skills and work performance 3. Alteration of mood, reduced stress, improvement in sociability and even euphoria However, these effects are fleeting and are far outweighted by negative effects. These include: 1. 2. 3. 4. Shortness of breath Chronic cough Increased heart rate and blood pressure Ulcer-like stomach pains (hunger pains), nausea and diarrhea 45

5. 6. 7. 8.

Reduction of fertility Early onset of menopause in women Tremors, especially in the inexperienced user Sweating with the smell of nicotine

Others related to gastro-intestinal effects: 1. Appetite suppression specifically for simple carbohydrates (sweets) 2. Inability to taste food 3. Decreased efficiency of food digestion and metabolism What is second-hand smoke? Second-hand smoke is smoke exhaled by a smoker and inhaled by other people. Non-smokers who are exposed to second-hand smoke are more at risk because the particles in the exhaled smoke are smaller. They reach deeper into the lungs of the passive smokers. The unfortunate non-smoker exposed regularly to second-hand smoke, is prone to specific health risks which include: 1. Increased risk of heart disease 2. Increased risk of lung cancer 3. Increase frequency of respiratory infections and asthmatic bronchitis in infants and children 4. Chronic irritation of the eyes, nose and throat especially among children What are the long-term effects of cigarette smoking? Long-term smoking can contribute significantly to the acceleration of the following health problems: 1. Nicotine addiction 2. Coronary artery disease at least 20% of deaths are smoking-related 3. Heart disease - Smokers in their 30s and 40s have a heart attack rate that is five times their non-smoking peers 4. Hardening of the arteries and complication of blocked arteries, hypertension, blood clots 5. Stoke People who smoke a pack a day have almost two and a half times the risk of getting a stroke 6. Peptic ulcer disease 7. Lung diseases chronic obstructive pulmonary diseases such as chronic bronchitis and emphysema; smoking caused nearly 85,000 deaths in 1990 due to these diseases. 8. Cancers oral, especially of the respiratory tract and the oral cavity, nose, pharynx, larynx, lung, cervical, urinary bladder, kidney, and pancreas; smoking accounts for 85% of all lung cancers 9. Disease of the oral cavity, e.g., irritation and infection of the gums and teeth 46

10.

Delayed wound healing

Smoking can cause the following problems in women: 1. 2. Reproductive disturbances (such as, infertility) Problems during pregnancy include: a. Fetal abnormalities and even death 3. b. Low-birth weight infants

Why is very hard to quit smoking? Withdrawal is a difficult process. About 70% of smokers want to quit. In one study of women smokers who wanted to quit, 80% of them were unable to. This is because nicotine increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations. Even after years of non-smoking, about 20% of ex-smokers still have occasional cravings for cigarettes. What are the signs and symptoms of nicotine withdrawal? Withdrawal symptoms begin as soon as 4 hours after one decides to quit smoking or after the last cigarette, generally peak in intensity at three to five days, and disappear after two weeks. These symptoms start with headache, anxiety, irritability, tremors, poor concentration, and hunger pains. Other signs and symptoms include insomnia and depression, sweating, constipation and diarrhea. What are the benefits of quitting smoking? Chronologically, these are the benefits when one decides to quit smoking: 1. 2. 3. 4. 5. 6. Within 20 minutes, the blood pressure and pulse rate drop to normal, the body temperature of the hands and feet returns to normal. Within 8 hours, the carbon monoxide level in blood drops to normal and the oxygen level I blood increases to normal. Within 24 hours, the risk of a sudden heart attack decreases. Within 48 hours, the nerve endings begin to regenerate and a persons ability to smell and taste begins to return to normal. Within 2 weeks to 3 months, blood circulation improves and lung function increases up to 30%. Within 1 to 9 months, overall energy increases, signs and symptoms of coughing, nasal congestion, fatigue, and shortness of breath are markedly reduced. Natural cleansing mechanisms of the respiratory tract returns to 47

normal, so that the body is able to handle mucus, clean the respiratory tract, and prevent respiratory infections. 7. 8. 9. Within 1 year, risk of coronary heart disease is reduced by 50%. Within 5 years, the risk of dying from lung cancer is reduced by 50%. The risk of cancer of the mouth is half that of a tobacco user. Within 10 years, the risk of dying lung cancer, stroke and heart attack is the same as that of a non-smokers.

When is the best time to quit smoking? The sooner a smoker quits smoking, the better. It is never too late to quit. No one is too old too quit. Because the first two weeks are critical success, smokers should seek all the help they can during this period. Here is a tip to help smoker decide when to quit smoking: A smoker should choose a particular date to quit when his level of stress is lowest. Example: Women should not start during the premenstrual period when stress is high. What are ways to quit smoking? 1. Scheduled reduction the process of slowly reducing the number of cigarettes per day until one has stopped completely. 2. Nicotine Replacement Therapy (NRT) a smoker who stops smoking is given small amounts of nicotine over a period of six weeks or more to reduce withdrawal signs. The nicotine is given either as chewing gum. patch, nasal spray or cigarette-like inhaler. Consult your physician about NRT. 3. Totally quitting smoking without any outside help. What should smokers do while they are quitting? 1. Exercise. Take deep breaths, dance, run, wall jump up and down, stretch. 2. Drink plenty of water and eat fruits and vegetables. Take plenty of vitamins and minerals. Carrots, apples, singkamas, chewing gum, and candies are good munching foods to replace the feel of a cigarette in the mouth. 3. Take naps, warm baths or showers during intensive cravings to smoke. 4. Tell friends and family that you have stopped smoking. This will make you feel embarrassed when they catch you smoking. 5. Change activities or habits that are associated with smoking. For instance, find other ways to finish a meal without smoking. Go out for a walk, go to a place where smoking is prohibited, doodle instead of smoking while talking on the phone. Advice to smokers: 48

While is was once a fad to smoke, it has now become dangerous to health. Smoking is abnormal. It is very addicting and very hard to stop. Smoking not only affects other people who inhaled second-hand smoke. Smoking contributes significantly to diseases that shortens life and is leading cause of death like heart attack, stroke, respiratory diseases which make smokers pulmonary cripples as in asthma, emphysema, bronchitis, recurrent infections, and cancer.

National TB Control Program

The rising incidence of tuberculosis has economic repercussions not only for the patients family but also for the country. Eighty percent of people afflicted with tuberculosis are in the most economically productive years of their lives, and the disease sends many self-sustaining families into poverty. The rise in the incidence of tuberculosis has been due to the low priority accorded to anti-tuberculosis activities by many countries. The unavailability of anti-TB drugs, insufficient laboratory networking, poor health infrastructures, including a lack of trained health personnel, have also contributed to the rise in the incidence of the diseases. According to the World Health Organization, the Philippines ranks fourth in the world for the number of cases of tuberculosis and has the highest number of cases per head in Southeast Asia. Almost two thirds of Filipinos have tuberculosis, and up to five million people are infected yearly in our country. In 1996, WHO introduced the Directly Observed Treatment Short Course (DOTS) to ensure completion of treatment. The DOTS strategy depends on five elements for its success: Microscope, Medicines, Monitoring , Directly Observed Treatment, and Political Commitment). If any of these elements are missing, our ability to consistently cure TB patients slips through our fingers.

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