1 - DOH Central Library

"Evaluating the implementation ·01 the strateDV lor•'iHealthforAllbvvear 2000 IiIiICOMMON FRAMEWORK:THIRD EVALUATIONCFEl3IiPrepared bv:FOREIGN ASSISTANCE COORDINATING SERVICE!~ i.! Cdo/to 4, !FELICITAS s.v. URETA, MO, MPHIIDirector III~~-----~~=1~~I,I'

Tie LOC/!L qOVE(]?J{'M'E:N'TCCYlYE wliicli Iiad' tlie startofimplementation in1993 stiff6ears great impact inpolicy development for liea[tli at tlie present time.'Focus oftlie Department 0fJfea[tli stiffworRJ towards sucli concept tliat "liea[tliisa 6asic human. riglit anais 60tli a means anaan endin development ".rrTie ;N;4.rr10;N;4.L J{'E;4.LTJ{ PL;4.;Nenvisions that 6y tlie year2020, tlie societalimage is tliat ofa socia[[y ana economically productive popuiation witli [ongerfife expectancy, Iow infant. mortality, Cess aisa6ifity, witli adequate slielier,education ana means ofuveuliooa.'Iliere was a remarfist6Ce economic upsurge in the country from 1995 to tliepresent witli tlie !J?flmos administration. However, population growtli rate is stiffvery liigli. 9rtore financiai resources wi[[6e tlie demandfor social services as thepopulation gets 6igger ana educated. rrTie extra population 6:.raen wi[[ 6e ahindrance to wliatever adJustments that are necessary to 6ring about acceleratedprogress ana deoeiopment:!J?flpia urbanization, as 06serveaglO6a[[y, wi[[aefinitefy cause increase in urbanliea[tli pr06Cems.Industrialization, as part of rapid' economic growtli, wi[[ofcourse 6e a forceariving centripetal' movement ofpopulation towards areas ofgrowtli tliat wi[[overwliefm tlie government's capa6iuty to provide adequate sociaiinfrastructuresanaservices.'Ihere wouU also 6e pr06Cems regarding industriai hazards ana toxic wastes,work. refated"/ occupationalliea[tli problems, anagrowtli ofslums (6ecause oftheinflux,oftlie workforce in thearea).Environmentaiaegraaation, tliougli a[readj 6egillning to permeate consciousnessofmany Filipinos, issti[[a majorprobiem in tlie country.rrTie liea[tli status of tlie country lid remarfist6fy improved" 6ut communicabiediseases are sti[[ prevalent coupied' witli tlie problems of tlie eUerfy ana tlieaegenerative diseases.rrTie present situations that liaa Been mentioned in tlie precedinfFparagrapflS aredirectfy affecting thetrends ofpoficy development.It is wortli mentioning tliat tlie ®"esid"ent of tlie Pliiuppines, 'Fid"ef 0/. !J{{lmos,liaa incfuaea tlie SOCI;4.L !J?!t','FO~ ;4.q'EJ{(j);4. (SCJ?j'l) witli tlie inclusion ofDepartment of Health111[lllljiliillJlll~1111D483Hl.18 Evl / Evaluating theImplementation of thestrategy forheal1

tfie POVE~ )l.£L'E'V!)l.'lIO:N 'FV:N([J (

S'Ec:nO:N 2. PR:F.:N([)S I:NSOCIO'ECO:NO:MIC ([)'E'VE£OP:M'E1fl2.1 'Economic TrendsqrossNationai Product: (q:NiP)current price (infCation ofcurrent year) fflP 2,278,495,000,000constant price (infCation of1985)fflP 881,592,000,000qross([)omestic

was pfip 29.54

2.2 CDemograpfiic Trends• )tnnua{growtfi rate• TotaiPertiCity rate,• Crude 6irtfi rate per1000 pop• Cnufe aeatfi rate per1000 pop(1995)(2000)ref. 06/95a(1990-95)(95-2000)ref. JfSO(1995)(2000)ref. 05/95a(1995)(2000)ref. 06/95a2.21.944.033.5828.325.16.35.9'There is sti{{ a fast growing popuCation; tfiere is a rising num6er of ur6anawe«ers 6ecause ofextensive migration.Slou: reduction infertiCity anacontinued' close spacing of6irtfi are observedanatfiere is continued' fiinfi ieoe! oj mainutrition especially amOllg female children.)tmollg aifferent geograpliic regions, Carge ana growing disparities in liea{tlistatusare evident.Pacts:• Life expectancy at 6irtli lias risenfrom 57 years in 1960 to 65 years in1995.• CPliilippine mortality rates from communicable diseases, incCud'inginfections, parasitic ana nutritional aeficiency liave progressiveCyd'ecCined'aggregatefy 6y 74% over tlie past 40 years.2.3 Socia{'Irena19931995• jIau{t literacy rate (m)• )tau{t Citeracy rate (f)91.6%93.2%92.8%92.3%96.0% 94.3%.5

'l1ie PfiiCippines, as a country values education as one r.if tfie foundation ofprogress. )Is PiCipinos, sucfi clamor for education spells out future r.if tfieirownseloes, tlieirfami{ies anatlieir communities as we{['l1irougli tlie years, aau{t Citeracy rate is maintained'at a liigli standard' (92,8% in1993).J{ea{tli services are fiowever, stiffinaccessible to many r.iftliepopulation.~;2.3.1 Factors that affectsaccess to liea{tli services:2.3.1.1. racFt r.if information needed to mal

)ls mentioned' in tfie previous section, tfie Socia( ~fonn )lgend'a (S)l

Significant foreign assisted projects were Iaunched' ana implemented forimprovement ofliea{tli in nutrition 6y tfie (]JOJ{.'Wortli mentioning is tlie Vr6an Jfea{tli ana Nutrition Project (VJf:NP) (UIB­I(]J)l loan ana)lus)lI(]J grant) that addresses ur6an lieaCtIi problems in 21liigliCyurbanized'areas in three (3) regions-:N0R., rRsgion 'Vll ana ~gion X )l (]3aseuneStudies was done anafinislieain fate 1995 to earCy 1996 (jina{ copy of resultsIiad' not been out as yet) wliicli wi{{6asica{{y position enougli issues anaproblemsin nutrition oftlie udian poor. t .'11ie project (VJf:N

)'l country wide implemented (Women's Heaiui and" Safe :Motfierfiood" Projectstartedin fate 1996) wi[[develop sucli Life Cycfe )'lpproacfi into a country-wideimplementation.In addition, 1997 wi[[ 6e tfie yearfor tfie fauncfiing oftiie Integrated"CommunityJ{ea[tfi Service ®'oject (ICJrsp) wfiicfi wi[[alsa deafwitfi communities' nutritioninterventions.Incidenta{(y, VJ['J{(]' is tfie first project mat~aged"approacfi.6y tfie ([)OJ{ in a deuolution'11ie devefopment ofmetfiod"ofogies and"/or approaches to 6e used" in training and"FEC materials d"evefopment must now 6e mod"ified" under devolution and" it is verymucfi needed"to include indicatorsfor 6efiaviorafcfiange.

5) (]Ji{[onaicoho!andsubstance abuse;c) ~anaatory inclusion of tfie phrase ''Smoking is aangerous for yourJ{eaftfi" in cigarette pacf{} and advertisements; anatf) rJa>J!s imposition on cigarettes ana afcoflOfic 5everages (?).LiRswise, tfie Department of J{ea[tfi fias Iaunchea ana continuously advocatedtfiefoffcwing:1. "'Yosi Kadiri" - a cfiaracter wfiicft· represents 5aa effects ana Ead'practice ofsmoking;2. (]Jan of smofijng inside tfie VOJ{ offices ana hospitals witfi wliicfiseuerai D;;Vs fiaa passed' resolutions ana ordinances of tfie samenature fifeping tfie environment smoRsfree (~anifa, Quezon City ana~aF

I3.1. qellera{ iProtection of tlie Enoironment (/f.ir, 'Water, Soil; PooaSafety,Housinq, 'Wor/(pwce)'Urhanizatioti alia Industrialization. wliicli at present are 60tli ill a rapidpace aefilliteCy liaa a direct illf{uellce 011 liea{tli alia tlie environment.CJ{apia urbanization liaa 6rouglit a quite sigllificallt number of urban.aweffers exposed to liiglijactor sucli a1 smo!ijllg, stress, liigli risk. fivillgassociated witli more dominate {ifestyCe related' conditions sucli asaccidents, cardio-vascular disease ma{igllallcies to mention a few.Industrialization ill turn also causes tremendous imflux, ofpopulation,60tli worliforce alia their [amilies to growtli centers wlio wi« 6e (are ?)exposedto industriaftiazatds, toxic waste aliawork.reWtetf/occupatiolla{liea{tli probiems. 'Ihese two are at most basic causes ofrapidpopulationgrowtli wliicli interact witli other factors tliat eventually Ceaa toenoironmentaiaegratioll3.1.1. )lirPo«utioll of air is attributed to progress - Iiouever, very strollgmovements are 6eillg implemented' to promote prevention. of airpollution sucli as:a) ordinances aliaresolutions tliat impose punishment for vehideswli~1i p{iglit ttie streets tliat are "smof

3.1.2. 'Water Quality'For improvement of tfie quality of 60aies of water, tfie "SaBip(jJasig" movement is tfie first anaforemost. There are also activeattempts to save :ManiCa (]Jay ana Laguna LaRs from pollutantstfiataaverseEy affect not onEy man 6ut also marine 6ft.It is 6ut evident (according to trw (]JOJ{ annuafreport) tfiat tfiereis an increasing access to safe wat~r suppEy ana sanitary toiletfacilities 6ut several'problems are encountered":a) unavaiCa6illty ofdata tfiat can prove tfie exact portion oftfie population wfio fiave access to safe watersuppEy;6) privatization oftfie water system ana sewerage autfioritywitfi two separate companies;c) inadequate inuoluement of tfie community regardingprojects to improve watersuppEy;d) genera{ conditions of tfie distributions system (pipes) tfiatfiaa 6een used'for almost over a century or more; anae) poor coordination among sector agencies.'I1iere are fiowever, severaistrategies 6eing done speariieaded 6ytfie (]JOJ{;a) 'Water summit (:Marcti 7, 1997)-6) ./fnnua{ Nationai 'Water ana Sanitation Consciousness(]Jay;c) Capacity 6uiftfingfor LqVs;d) '.Expanaing area of coverage for Local 'Waterwork,rDistricts ana tfie CBarangay waterwork,r ana Sanitation./fssociation;e) Continuous sociai mobilization, aavocacy ana resourcemobilization at ttie nationai ana wca{ government units;antifJ Standardization oftecfinowgy witfigooaquality control:'I1iere are also some specific projects lIRs ttie 'First 'Water suppEyProjects ana ottier similar programs supporting ttie improvementanasustenance ofgooaquality antisafe watersuppEy. '13

3.1.3. PooaSafetyVpsurge offooa reCatea diseases is stiff a major pro6rem in tfiewfiore country.Jl.Ctfiougfi tfie rote of tfie (]Jureau of 'Fooa ana Vrugs Iiad Beenexpanded' ana enhanced, sti{{, tfiere are certain fiappenings anaincidences of commodities gaining entry to tfie country tfiru tfie6ac~00~ ,'I1ie Coae on Sanitation fiaa 6een revised aboia afew years 6ack.ana tfiere is continuous evaluation of activities 60tfi on tfienationalanaLqV reveCs wfiicfi strengtfien ana 6uiCt tfie capacityof'food'manufacturers anafooa handlers onfood'safety.9t1.ost of tfie CocaC government units, particuCarCy most 6ig cities,organize 'FooaJfanarer's seminars for fooa establishment: notonCy of fioteCs ana restaurants 6ut also ofsmallentrepreneurs anaambulant[ood'vendors.3.1.4. CfiemicaCSafety

ISome LqVs fiaa optedto do sometfiing fiR! tfiat in ?4.anifa wfierefiousing provision were 6eing constructed arong tfie railroads but,tfiis is onCy 6enefiting afew.~a( estate business are now presentCy em6arliing in row-costfiousing outside ?4.etro-?4.anifa anamost go'vemment worR!rs tend'topatronize sucfi fiousing projects.3.1. 6. 'Wor/(pface'I1ie

Toilet. [acilities ana otfier excreta disposal' activities are tfie su6ject ofmost community partnership for liea{tli projects 60tli of tfie CommunityJ{ea{tli Service andEnvironmentalHealtii Service.3.3. Summary - Conc{usion'Efforts for improvement for\ (zea{tli ana environment factors Iiauesu6stantia{{y 6een addressed' 6) tlie CPlii6ppine government witfi tliespecial row 6eing pCayed" 6y tlie (])oJ{ ana otlier members of tlie liea{tlisector anatlie liea{tfi related'sector.•16

4.1 Human ~sourcesfor J{ea{tnrJ

Employment of liea(tli professionals liaa6een very aifficu(t; a num6er ofpliysicians ana dentists could' not esta6(isli private practice especia([y isur6an centers 6ecause ofstiffcompetitions.J{ea(tli science schools' output cannot 6e supported' 6y tlie nationaieconomy so tliat a 6ig proportion of these graauate migrate to otfiercountries; 6u(ft of them went to :Nortli }lmerica from 1950 to 1970 anatlien eventua([y 6egan to go to tlie :Mitftf(e 'East (aoctors, dentists ananunes) \r]Wugli estimates reveals tliataround 40% ofdoctors, 20% ofdentists ana65% ofnurses liaa(eft tlie country in tlie fate 80's 6ut up to the presentyear, tliey stiff continue to (eave. Pliysica( ana occupational therapist,graauates of tlie newer sources couid' not seeft employment in Iiospitais,ana 60tli govemment ana private, so most of them liave been. finaingemployment abroad.Tactors affectino J{J{CJ{im6afance:a) Lacli,ofnationaipo(jcies, particufatfy one that places nationaiinterestana needs above others;6) J{ea(tli ana liuman resource deoelopment (J{J{

6) to provide opportunities for qualified' ana tfeserving 6arangayliea{tli workgrs, midunues ana nurses to grow professionaffyana 6uiGfup theircareer witliin theirarea ofassignment.'ITie Department of J{ea{tli is presently liaving capa6iuty 6uiGfing anaupgrading offacilities to adopt new technologies for distance reamingana self-instructiouai materials witli tlie concept that developed liea{tlipersonnelcannotjust reave tfieirpostfor training 6ecause oftfie cfiange oftfie (])OJ{ responsibilities. In addition, Ito ensure ciearer patli anacontinuing professional education for fiea[tfi workgrs, tlie CJ{C/h forgetf6etween tfie wOJ{anaLqV Iiad'integrated'an Jl1R!j) component.4.2 Tinanciai!J?!sourcesfor J{ea[tli• 'Iotai national lieartli expenditures as 1991percentage ofqJI{(P;• q>ercentaee of national lieartfi expenditure 1993aevoteato wcarfieartli care;• 'Tatar eovernment fieartfi expenditure as a 1988percentage ofqJI{(P;• 'Tatar eovernment liea{tli expenditure as a 1993percentage ofthe totaigovernment expenditure;• 'Tatargovernment lieartli expenditure per capita;• !J?!current government fiea[tli expenditure as apercentllfJe of totai eovernment lieartliexpenditure; ana• q>ercentage of recurrent eovernment liea[tliexpenditure eoine to salaries.2.3%5.0%1.91%2.8%J{ea[tli expenditure as proportion of qJI{(P lias not reached' more tlian 3%(mucli lower than 5% of 'WJ[O) since Gotli tlie national ana Iocaigovernment does not consider J{'EjlLTJ( as a fiigfi priority issue. Inaadition, [amities anaindiviauaCs could'not affocatefunds anaoftentimesunderspendfor lieartli care.jl NationarJ{eartli Insurance Law was signetfIast eany 1995 anti therewas a Commissionformed, however; implementation ofsucli lias not Gemfert Gy tlie most oftlie population at tlie present time.19

:M'F/Dle;tfJ{fj; lias continuously served the empfoyea sector ana theirimmediatefamify members a{tliougli sucli is not enougli to augment liea{tlifinances for tlieir immediate needs. Continuity ana integrity of liea{tliservice 6y the LqVs after devolution is insured tlirougli variousmechanism, foremost of wliicli in tlie adoption of tlie CJ{e;t. SeueraiCegisCative actionsfor tlie revision oftlie intemairevenue allOcation (I

'Even in a aevo[vea set-up tFie rDOJ{ still provides essential arugs anaotfier suppiies especia[[y for tfie verticai pu6fic Fiea[tfi programs sucfi astFie:a) 'E.x;panaeaProgram on Immunization6) Tuberculosis Contro[Programc) :Mararia Contro[Programd) Scfiistosomiasis Contro[Programe) Pamify (P[anning Program ana many otFierProcurement of arugs for tFiese verticai programs are done at tfienational/cenirai fever using appropriate procurement policies witfi strictQuafity Contro[ Distribution. is 6asea on eitfier prevalence ana/or targetpopulation. Lili.!wise, vaccines, syringes ana other supplier are procured6y the rDO a[tfiougli there are some amounts 6eing donated' 6yforeignagencies.'ITie 'Iuhercuiosis Contro[ Program 6eing one of tfie priorities of tfiepresent rDOJ{ management is enhanced'6y tfie transfer of'WJ[O fUlufs forits implementation. 'Witli resources coming from tfie goP ana 7Jl(J{O plustliat 6eing supported' 6y JICJI ana severaiforeign assisted project fili.!VJ{:N'P, tfie program is expected to 6e a fittfe more successfui tluui tfieprevious year.'ITie Pamify Prall/ling Program lias 6een tlie recipient of£ogistics (famifyplanninq methods) manaqed' 6y uie Jolin Snow; there are Iiowever otlierorganizations that support tlie program.)1 'V'oCunteer CB£ooarDonation Program is 6eing impCementea 6y tfie rDOJ{wliicli aduocates tfie Iiospitals to maintain lieir own 6£ooa 6anIiJ witliprecise quafity controlsupported'6ya raw passed'in 199.:Most of the facilities for Fiea[tli service aefivery assures adequate anaavaira6Ce essentiaiarugs anaotlier supplies.Department of HealthD483!-fl.1S Ev1• 1•21

4.5 IntemationalPartnersliipfor J{ea{tli• 'Tfie amountfor intemationaiaid'for liea{tli received' 1991 0.94%as a percentage of total government liea{tliexpenditure VS$ 400~ "" )Is collated'from profiles offoreign assisted' projectssubmitted'to 'F)ICS.~uftifatera{ ana 6ifatera{ grants (ana foan) lid 6een received 6y tlieliea{tli sector particufarfy the CDOJ{ after tlie 'ECDS)I revoluuon. ~ost oftlie extemai support were [ocused to programs covering cliiU survival,maternal care ana famify pfanning; nutrition, community-:NqO-CDOJ{partnerships, government Eospitai development ana upgracfing; Iiea[tlicare financing; national arug po{icy implementation; human resourceaevefopment programs anaesta6fuliment oftlie 7>1.u{ti-7>1.eaia center.'For tlie aforementioned projects/programs, desiqnated' CDOJ{ programmanagers prepare aetaifetf, comprehensive matrix; tliat reflects tlie programttirust/strateqies/actioities, 6ucfgetary ana other resource requirements,procurement plans ana implementation schedules. rrTie 'I''JICS in itsmandated role ('EO 119) is now 6eginning to coordinate affthe 'I''JIPS intlie CDOJ{,4.6 Summary - Conclusionqeneraffy speaRjng, tlie avaifa6ifity of liea{tli resources liaa improved'tlirougli stiff not so adequate for tlie need's of t/ie popufation. J{owever,improvements on tlie socio-economic ana pofitica{ environment liaatremendously reached gooa fevers Which is gaining a rise that promisesgooa perspective for a fifisfy improved /iea{tli situation for tlie wliofecountry.•22

5.1 J{ea[tfi PoCicies anaStrategies'Even after almost four (4) years ofimplementation oftlie provisions ofLocai government Coae, aevo[ution, stiff causes some untowara impacton the liea[tli sector because of discontent amollg those that wereaevo[vea, tlie conditions ofdevoiued' fospitalS alia tlie a17'ay ofproblemsthat beset communities wlien communica6w ana infectious aiseasesaffects an alarming number ofcases, resurgence anaupsurge ofcases dueto preoaient diseases, ana tlie risliJ wlierein members of fiousefioUfs wfioare pooranaare not aware ofcommon preventa6w conditions/diseases areexposed.'llie (])OJ{ also assumed'a new row tliat: concerns mainEy tlie preservationofthe national liea[tli goa[considering area-based' needs, natiouaipubiicfiea[tli mission/vision anaintemationalrelations.'llie approuai ana subsequent signing of tlie "Nationai J{eaCtIi pran"(1995-2020) in rate 1996 sent messages for development of tfie liea[tlisystem witli tlie "J{ea(tli in tlie Hands of tlie Peopfe" as the 9uiaingprinciple.The pian (:NJfp) recognizes tfie interaction oftfie fiea[tfi sector analiea[tfireiatedsectors witfi tfie population tfiat wa to recognize tfie cruciai rowtfiat otfierfactors pray wliicfi are beyond' tfie liea[tli sectorin inf[uencinganadetermining fieaCtfi outcomes.'llie (])OJ{ now recognize tfiat fiea[tfi couid no Conger 6e viewed as anexdusiue concern oftfiegroup oftechnicalexperts 6ut tfiat tfiougfi tfiereare avaira6w fieaCtfi care services, social, environmental, poiitical; cuituraiana economic factors greatEy affect tfie fiea[tfi status of tfie country'spopuiations.NationaipoCicy directions wiff 6e 6aseamainEy on tfie Naiional J{ea[tfipran using tfie forrowing consideration:a) an activeEy participating community;6) intersectoralcoordination; .c) equitabie distribution. of fiea[tfi anaotherresources;23

a; use ofeffective teclinofogy tliat is afforaa6Ce ana respect sensi6ifitiesoftlie people;e) practice ofsoundmanagement; anaf) deuelopment oftlie requisite liea{tli liuman resources.'Ilie strategy aevefopea wi{{ produce success indicators wliicli are asf offows:a) we{{nourished'population;6) safe arinlijng waterfor all;c) sanitary disposalofhuman anaanimaiwaste;a; minimaienuironmentailiazardS fiR! pollution;e) communicable diseases no fonger a majorproblem;f) clironic diseases under control:g) psychosociaiwe{{6eing; anaIi) access to appropriate liea{tli arefor all:5.2 IntersectoraiCooperationSeveral unlfertalijng liaa demonstrated tliat focused. sustained anaconsultative participation in liea{tli activities 6y a{{ sectors anastaR!lioUfers Iead' to a certain fever of success wliicli is 6eyona commonexpectations.:More ana more program liaa6een recognized' to set up strong, indiuidualfink.J to fi{{ in wliatever gaps exist ana achieved' strong interfinlijngamong:• intra CDOJ{• intrasectora{• intersectoraiLocalgovernment assistance, liea{tli research, liea{tli po{icy development,CegisCative Iiaison, mental liea{tli, disaster management ana traditionalmedicine are 6ut tliefew eJ(flmpCe we can mention. -.'. 1•24

Speciaiattention could'6e twoprominent projects sucli as:• Vr6an J{ea[tn anaNutrition. Cfroject wnicn is in a atnJo[veasetup thatfinfi.§ the centrai([)OJ{ to specific Iocai nea[tn units in answer to tnedevolution. process that naa separated tiie ([)OJ{ structure from tne£qVs in imprementing ftea[tfi services;• 'Women's J{ea[tfi ana Safe 9rlotnernooa projects that covers tlieprovinces nationwidefor concern rif.women anatheircfiiUren.~;'I1ie Social' CJ

Not muck pr06fems are seen in tfie operations of retained nospitaCs,houever, those tfiat were deuoiued, present almost tfie same fieigfit ofproblems as observed'among deoolued'pu6flC nea{tn personnel.'Eacfi provinciailiospitaiis attachedto a province [under the office of tlieProvincia{ (lovernor) ana iRpra{ J{ea{tfi 'Units are attached' to amunicipality (under tne Office oftfie :Municipa{:Mayor).)t district hospital, wliicn is in 6etween tlie provinciaihospitaiana tliefirst referral fever, spans to two or more municipalities. '11iis reafity sliowtfiat tlie district hospital'fa«S under tfie jurisdiction of tfie prouinciaigovernor wfiicn are fieaftfi facdities tfiat are not atiequateEy equipped' tofunction effectiveEy post devoluuon.'11ie ifJOJ{ is sti{{ up to now trying to negotiate some support to upgratiesucfi aevo{veahospitals, Personne£capa6i£ity 6ui{tfing sucfi as in training,motivation ana supervision 60tli administrative ana tecluucai fiaa giventfie ifJOJ{ a major cfia{fenge. '11irougfi tfie J{ea{tli :Manpower Developmentana 'Training Service (J{:MifJ'TS) oftlie Office oftfie CliiefofStaff(OGS)seueraistrategies are a{reaay in place to address tfie matter.'11iere is a now at present, on going review, revision ana redefining ofroles, responsi6ifities ana function of fiea{tli institutions ana fiea{tfipersonnei in tlie Iocai government feveCs using tlie 6est coordinativeprocesses identified,5.4 :Manageria{Process(jJefore ana after devolution, bottom-up anaarea-based' planninq standsas a fia{{mark. ofthe ifJOJ{, '11iere is continuous consultation, monitoringana feed'6aclijng processes sucli as national staff conferences,muliiseaoral duster meetings ana support to tfie wca{ fiea{tfi boards(LJ{(jJ) tfirougfi tfie assignment ofcompetent ifJOJ{representative.'11ieCJ{CJt is one mechanism wfierein on negotiations, broader anaforward' wolijng nationai concerns ana 06jectives are in most instances6ecome part of tlie ioca! liea{tli programs. Otlier resuits aeriveaauringnegotiations witli tlie £qv is tlie great opportunity to aduocate, orientana sliaring of!UlOwfeage ana slij«S ana tlie partnersliip tliat is based' onmutuai respect anacomplementarity. '11ie CRsgiona{J{eaftfi Offices provitie,26'

tfie venuefor tfie manaqerialprocess to worttas if.fectiveEy anaejficientEyin tfie pursuit ofa comprehensive/expanded sectorai boundaries for 60tfienvironmentalanasustainable development concern.5.5 J{ea{tfi Information System}I Cong reorganized' weattness in tfie fiea{tfi information system sucfi asunderreporting of events/cases, incomfCete reports for fiea{tfi faciiities,gaps in service statistics, tfeCays in reporting ana processing is nowcompounded' 6y somewfiat unavaiCa6iCity of ana/or inaccessibility toLco generatea information. 'Ihere is also aifficu{ty in retrieving anavaiidation of information. 'ITie maintenance of tfie Pief([ J{ea{tfi ServiceInformation System (PJ{SIS) aeveCopea tfirougfi VS}IICD ana 'WJ{Osupport stiffftoras anais 6eing uti{izea6y tfte JfeaCtIi Information Service(J{IS). 'ITie 9rtanagement }Iavisory Service (:M.JLS) togetfter witli the 9rtu{ti9rteaw Center are in tfte jinisfting phase in tfie development of "J{ea{tliNet"for tfie 25priority provinces oftfie Social~form }Igenaa.}I Local}Irea J'{etworl{jng (L}Ig.[) is now 6eing aeveCopea 6y tfie 94JISwfiiCe 'Witfe }Ire J'{etworl{jng ('W}Ig.[) is 6eing negotiated' 6y tfie VJl!NPfor installation.5.6 Community }Iction.'ITie community ana tfie famiEy are now tfie priority/jocus of tfie CDOJ{management. 'I1iefollowing initiatives supports sucfi statement:1. sustained Cogistic support to tfie community volunteer worlisrs(Co/HWs ana(]3Jl1Ws);2. provision ofawanfs ana incentives to community volunteer worlisrs6y tfie CDOJ{ana/orcommunities tfiemsefves;3. aeveCopment of community association for fiea{tfi maintenanceschemes;4. Provision ofawardsfor successfulcommunity initiated'projects undertfieJ{eaftfi ana9rtanagement Information System (J{}I9rtlS) Project;5. training ofa/some responsi6CefamiEy mem6er as fiea{tfi Iisepers; ana6. continued teach-ins among mother's du6s, indiqenous people, groupsanaotfiers..,•27

}! Community Data (j3oara ((JlYB) is Geing encouraged to Ge setup anapreparedGy eadi Garangay tfirougfi tfie (j3arangay ®{C communities.Seuerai Community CFartnersfiip for J{ea(tfi CFrojects (0PHCF) are Geingmanaqed anafinancea Gy some foreign assistedprojects Eifig cpj{(])cp anaVJfNP.5.7 'Emergency CFrepareaness'I1iere is a Nationai Disaster coortfinating Committee wfiicfi is aninteragency committee wfiicfi ordieastrated disaster ana rescue operationat tlie nationa(CeveCIn answer to emergencies, tfie (])OJ{ haue a (])isaster ?,[anagement Vnitana tfie Stop (]).'E.}!. r[,J{ CFroject. }!financial allocation nave Geen set intlie yearfy (])OJ{ Gudfjet, lunoever, tfie country's ana (])OJ{'s preparednessana response capabilities are stiff hampered Gy limitedresources especia(Eythatfor communication system ana moGiEity equipments. The (])OJ{, forits peiformance liaa 6een uPBratfinB capa6iEities witli some juntfinBsupportfrom foreign sources.5.8 J{ea(tfi CJ

~searcfi proposals are screened6y an etfiica(review committee and e:x;pertrecognizedin tfie researcfi topic.'Ilie 'F/]fJ{iR,. as an institutionalization effort oftfie ([)OJ{ was given its'own Cine 6udiJet in tfie CDOJ{ 6udiJet and sucfi a milestone causedgeneration of interest ana participation in fiea(tfi researcfi as weff asgreater resourcesfor implementation.,'For tecfinorogy deveropment, tlie CBiorogica( Production Service (CBPS) istunu 6eing preparedfor modernization since a new service 6uiUfing wiff6econstructed in tfie VP-Los CBanos compound'. Procurement of criticaffyneeaeaequipmentfor vaccine production andits qua£ity testing/contro(isin tlie offing.'Ilie establisliment of Nationai 'Vaccine Contro()'l utfiority is stiff in tfiepreparatory pfiase.'Ilie CBureau of'Food and CDrugs function anaroles are 6eing strenqthenedto address occurring concerns reratedto tlie bureaus' manaate.In Iine witli tlie national government's thrust, deveropment anapromotion of Plii£ippine medicine, particuiariy in scientific researcfi ontraditional'and fiea£ing metiiods in tlie wider Cine ofmedicinal'piants andin attainment ofself sufficiency in tfie production ofessential tfierapeuticpreparations, the CDOJ{ created a /Iraditionai Medicine Vnit witfisubsequeni upgrading of J{er6a( Processing prants in tliree (3) regions,name(y CRsgion II, 10/anaXIII.'11ie aforementioned steps are important strategies towards anappropriate, afforaa6t'e ana fiJcaffy appfica6t'e ana accepta6fe fieaCtfitecfinofiJgy.5.9 Summary - Conclusion'Ilie aeveropment of tlie fiea(tfi system wfietfier at tfie nationai and/or([)epartment of J{ea(tfi lid taR!n steps for esta6lisliing fin~ages witfi.aifferent agencies in tfie government, non-government organizations andtlie private sectors wliicli paves tfie way for a more integratea anacoordinated'approacfi to fiea(tfi. anaoveraffdevefiJpment...•29

szcnos« 6. JI1E;WI'J{Sf£~VICES6.1 Kea(tfi f£aucation ana!Promotion}I.ctivities for fieaftfi education ana promotion fias afways 6een givingpriority oy tfie (]JOK management e~mpfifiea oy tfie provision of goorfoud'getary appropriation/allocation\6.1.1 Hospitaias Center ofWetrness'Ihis unaertaking stimulated most fiospitafs to program severalactivities to enfiance tfieir facifity for 6eing a "Center ofWetrness ". Innovation fiR.! enfiancement ofpharmacies anrf"Ciea«anrf qreen !Project" of fiospitaf groundS are e}\flmpfe of wfiatliospitals fiar! wfiicfi were given merits anaawarrfs.6.1.2. (]Jevefopment of Jletwor!ijng witfi government agencies and nongovernmentorganizations is continuously 6ei1lfJ utufertaR.!n suclias:6.1.2. a "C1'uroF( Ciasses" ana 7rtotfier (fasses" for fflC supportat tfie community fevefs wfierein individuals, [amiliesandcommunities share tfie Boarof acfiievi1lfJ fieaftli caretliroUfjIi practical actions as extenders of liea(tli careservices and/or major actors in (tea(tli improvements.6.1.2.6 Community assembiies anrfatafogues ahout prevaifingfieaftli issues anrfpr06fems done in a regufar basis.6.1.3 5WaJ(jmum utifization of tlie in-media support on promotions oflieaftli campaigns/programs ana preventive campaigns against tliecurrent fieaftfi tliat fiaa afways 6een a6fe to create awareness anafiar! mooed peopfe to taR.! coordinated efforts ana actions onirfentijiea fieaftfi neerfs. If£C campaign usualfy accompanies suchactivities such as the "}I.flS (]Jisease" or Nationai Immunization(]Jay {NI(]J) tfiat liar! 6een overw(te(mingfy successfultogether witfitfie "Tour O'cfocF(Ua6it" faunclierf witfi tfie present Secretary forthe (]Jengue controfprogram tfiat was not onfy effective 6ut waswetraccepterf 6y tfie population. asa wliofe.•30

Secretary Cannencita :N. ,%ocfica lias been very active in tliepromotion of aifferent liea{tli campaign in tlie 'Tri-:Mecfia ana fiasa{ways been very cordial ana accommadatinq to invitations ofinstitutions'Ilie

7rf.ost hospital, wlietlier government owned' or private liad' a{read'y beenaccredited' as a 7rf.otlier43a6y 'Ftientfty Hospitai (7rf.(]3PJ{) after a veryactive nationwide campaign ofthe (j)OH witli the a6l"e support of tlieVNIC'E'F.Seoeraiforeign assisted'projects (,F)f.Ps) lias 6een Iaunclied' wliicli focused'onwomen's liea{tli and'safe mothertioodand'famiEy pt:anning finea) 'Women's Hea{tli and'Safe 7rf.otlier~ood'6) Vr6anHea{tli and''Nutrition. Projectc) Integrated''FamiEy Pt:anning and'7rf.aterna{and'Clii{([Careto mention afew.6.3 Immunization• Percentage oftlie e{igi6l"e popuiation. (infant reacliing 1995 86.4%theirfirst 6irtlid'ay) tliat Eaoe 6een fu{fy immunized'according to nationaiimmunization pofuy• Percentage ofinfant reacliing theirfirst 6irtlid'ay that 1995 85.77%liad' 6een fu{fy immunized' against (j)iplitlieria,'Tetanus, and'wliooping Cougfi• Percentage ofinfant reacliing theirfirst 6irthd'ay that 1995 87.72%liave 6eenfu{fy immunized'against poliomyelitis• Percentage of infants reaching their first 6irtlid'ay 1995 86.55%that Iiaue 6eenfu{fy immunized'against measles• Percentage of infants reaching their first 6irtlid'ay 1995 89.4%that lias 6eenfu{fy immunizedagainst Tuberculosis• Percentage ofwomen that Iiave 6een immunized'witli 1995 69.29%'Tetanus t[o~oid (PI) during pregnancy• Percentage of tlie population tliat liave 6eenimmunized'witli Hepatitis (]3 vaccinesThe National Immunization (j)ay in 1994 (lad' 6een very successful;liowever in 1995, a controversial issue was 6rouglit up 6y the CatlioficCliurcli about tlie effect of tetanus to;widwfiicfi l"ed' into acontroversyandvarious reactionsfrom different sectors ofsociety. 'l1ie response on the:J{I(j) was a fittl"e alScouraging Because oftlie campaiqn done in tfie pulpit.• 1•32

)I somewfiat (uR.!waml activity was observed'in 1996 anatfie number oftfie eCigi6Ce population tliat was Grougnt for immunization seemed to 6eCow.SeueraiIocaigovemment units fiaa institutedseveralstrategies to improveimmunization coverage especially in certain areas in ?t1.etro-?t1.aniCa. )Is anexample, Pasay City, one of tfie smallest city in land' area, Iiad'continuousiy aduocated tlieforrowing action pian since 1988:\ ,.'a) fiea{tn centers liaa6een open from 8:00)I?t1. to 5:00 P:M. witliout anynoonbreak, ::Monaays to 'Fridays;6) a{{ neaCtIi centers practice the "'Everycfay is Immunization (J)ay';' inorder not to liave mucli vaccine wastage, tlie liea{tli center staffprepares a very effective scneauCe offieUactivities in tfie morning anain tlie afternoon;c) continuos updates on immunization especialiy, capaGiuty Guzlding onimmunization tecliniques for a{{ types of lieaCtli worR.!rs-pliysicians,nurses ana midwives. 'Ihe paramedicalliea{tli worR.!rs are also trainedespecia{{y on sociai mobilization ana advocacy. ?t1.ost oftlie volunteercommunity lieaCtIi worR.!rs are very active on tlieir campaign; anad) ::Montliry peifomlance review of aifferent fiea{tli centers re:immunization.Tliese strategies liaa continuously contributed' to liigli immunizationperformance in Pasay City.On January 1997 to present date (::Marcli 1997) a measles upsurge wasobserved'witfi liot spots in Tondo ana otlier areas in norui ::Metro ::ManiCa.'ITie Secretary ofJ{eaCtli liaa mobilized' a{{ regions to participate in tliestrict ::Measl'es Surveillance. Tortunateiy, in Iate 'FeGruary ana earry'Marcn tne number ofmeasles cases ana aeatfis hadGem contained. It isnotewortliy to mention tliat tfie cases ana aeatrlS of measles affected' amucli youllger crop ofcliiUren tfiat is as young as four months wfiicli isvery surpnslllg.PouomyeCitis, tlirougli tlie "R.!IOC!tOUt PoCio" campaign wi{{6e eradicated6efore tne year 2000 if tfie campaign wi{{ 6e successfui ana fu{{ysupported6ya{{sectors.•33

6.4 Prevention antiControlof£oca[[y 'Entfemic Diseases'lTie 'IIB control program, as previously mentioned' liad' 6een sufficientlyfunded' 6y tlie goP, JICJl and'WlfO. 'To mention tliat 'Wlfo liad'rea[[yseen tlie maqnitude of tlie pr06rem 6y affowillfJ tlie vOJ{ to reprogrammost of tlie bienniai 6ud'get for 'IIB controi ill 1996. Intensified' casefilld'ing and'otlier activities had' reducedand'sustained' tlie 'IIB prevalencerate at about 3 per thousand' population. Capa6ifity 6ui{(fing of\mallpower had' 6een tlie focus togetlier witli upgrad'ing of microscopycenters as weff as tlie conduction of operational and' evaluationstudies/activities to improve tlie national'IIB controlprogram.rBesid'es, additionaifUlu£s from JICJl and''WlfO, tliere areforeign assisted'projects tliatactively support tlie 'IIB controtprogram oftlie von'lTie 9.1.afaria Control Program, after tlie 6an of ([)

'ITie Leprosy Controi

)'lcute f%spiratory (]Jiseases (C)'liRJ) wliicli had' liaa gooa orientationstrategies are now 6eing manaqed' 6y coordination inuoiuement of'famiiies(especiaffy motfiers) volunteer fiea(tfi worligrs ana communities witfi tfieIocal pu6uc liea(tli centers on determining cases tfiat needs furtfiermanagement eitfier at tfie fiea(tfi center orat tfie referredhospitals.Incidence of cardia vascular diseases is on tfie risk. ana the VOJ{ liaastrengtlienea tfie foffowing aifferent aawuies for its' prevention anacontrol:a) Pe6ruary as tlie Heart :Montli6) ''J{)'l'T)'l'W'' wliicfi features "'Edi ~rcise" wfiicfi is on tfie fourtfiyear wliicfi is participated' 6y tlie Presiaent of the rpfiiuppines(exercises done at aay6reaR/aawn)c) u(jJantay Presyon" wfiicli includes clioffatera( rever testing inaddition. to 6raoapressure taf{jngId) Nutrition Education. on controlofheart anavascular conditions)'laequate provision in tlie VOJ{ 6udfJet are used'for purcliasing a1U{jstliatwiff6e distriinuedto cases icfentijietf.'Treatment of injuries in one fieU of endeavor that had' called' mucliattention especiaffy Because ofseoeralnaturaedisaster anacalamities tfiat6eset tfie country.'1Jery recent(y however, a 6ig fire ragea a "disco" joint wliicfi claimedseveral uves ana illjurea liunaretfs. '71ie management ana treatment ofthese cases were very expensive since most puGuc medical centers couid'not manage a great number at a time. In addition, not enougli anaappropriate[acilities anaa1U{js are avairaGre.)'l plan is Geing developed to liave a u(jJurn" unit in eacli oftlie retainedVOJ{ hospitais wfiicli wiff simulate done in tlie Pliiuppine qenera(Hospital'(rpqJl).6.6. Summary - ConclusionjlCtliougli so mucli liaaBee« done onimprovement oflieaCtli services in tliewliore country, it is stiff acfverse(y affected Gy tlie economic situation intlie country (tliougli a(rea£y on tlie rise) ana stiff persistent pro6remGrouglit ahout Gy tlie deooiution process of tfie Locaiqovernment Coae..,•36

SP.c;q]O:N 7. ~S I:NJf'EjWI'J{S'T;4TVS7.1 Life f£xpectancy• Life f£xpectancy at 6irtli (5W) 1995 65.58• Life Expectancy at 6irtli (P) 1995 70.83• Life f£xpectancy at aBe 65 (5W)• Life f£xpectancy at age 65 (P)\7.2 5WortaCity• Infant 5WortaCity

'ITie Pifipino nation is fiea{tfiier toaay tfian in 1960's ana rife expectancy at 6irtfifias Iessenfrom 57 years in 1960 to 65years in 1995. 'ITiefoffowing are some gooanews in tfie ([)OJ{annuaireport prepared6y tfie IntemalPfanning Service (IPS)• Pfiifippine mortaiity rates from communicable diseases includinqinfections, parasitic anti nutritionai aeficiency liaoe progressivefyaecfineail{Jgregatefy at 74% over tfiefact 40years.t• certain diseases fili! polio ana neonatal tetanus are neanngeradication due to wider coverage ofimmunization program• 'Matema{'Mortafity rate fias constantfy decreased'over tfie years• fieiafitenea awareness of famifies ana communities on fiea{tfipromotion anadisease promotion• use of fierGa{ medicine is sfowfy gaining grounaana fier6a{ processingplants fiave 6een operationalin selected'regions• increasing access to safe watersuppfy anasanitary toiletfacifities• improved cfiiGf suruiuai ana deveiopment seroices including tfieesta6fisfiment of motfier-6a6y frient[{y fiospitafs for 6reastfeed'illgpromotion• fast growing num6er of fiea{tfi initiatives to so{ve inequita6fealStri6ution of fiea{tfi[acuities ana fiuman resource• ([)OJ{ lias become more responsive ana continuos to perform 6etter inproviding direction anafacifitating provision ofquafity fiea{tfi services• mulu-sectoral ana mu{ti-aiscipfinary participation in fiea{tfi caredevelopment infast increasing•38

Iiowever, tliere are several statements tliat stiff lias to 6e deaCt witfi mucliattention:• population isstifffast growing• tliere is a rising num6er ofur6an aweffers exposed to riskfactors suclias smolijng, stress, fiigfi-ris{ Civing associatedwitfi more dominant cifestyCe - related iffness sucli as caraif vascular diseases, maliqnanciesanaaccidents'• tfiere fias 6een an aggregate increase of285% in mortaCity rates due tomaliqnant neoplasma; cardia vascular diseases, accidents ana chronicdegenerative disease over tfie past 40 years• many infants ana cfii{tfren stiff suffer ana ate from communicablediseases sucli as diarriiea ana pneumonia wliil:1i are actuaffypreventable ana can 6e easiCy manage at nome (tfiougfi some citiesaCreadj fiave effective ana efficient {nowCediJe of managing cases atfiome)• sCow reduction infertiCity anacontinued'close spacing of6irtfts• deatli related' to pregnancy ana cliiU 6irtn remains to 6e a Ceadingcause offemaCe aeatfis in tne country• continued fiigfi CeveCs ofmaCnutrition especiaffy amongfemaCe chiidren• :MaCaria, Scfiistosomiasis ana goiterare persist to 6e fiigfiCy endemic inseCecteaareas• tfie incidence ofJ{Irr) is sCowCy muCtipCying affecting not onCy malesana'females ofreproductive age 6ut also infantsanacni{tfren• fiigfi rate ofaisa6iCity, 11 persons/1, 000 population fiave s~me form ofatsa6iCity sucfi as orthopedic handicap, 6Cinaness, deafness, mentalretardation anaspeecfi impairment• Carge ana growing dispatties til fieaCtfi status among differentgeograpfiic regions•39

• poorenuironmentaisanitation• new tfireatsfrom environmentalaegratfaticn• underfundinq ana underspendinq for fiea{tfi care 6y individuals,families, government anaothersectors• knu coverage anasupport ~ver ofe:xjsting compulsory national fiea{tfiinsurance system .• rising anaprohibited. costofa11J{js anahospitalization Iimitinq accessofmargina{izelf'families to quauty anaafforaa6Ce fiea{tfi care• maldistrihution anainaccessibility stiffcharacterize our fiea{tfi system• rapid' turnover ana maldistribution of fiea{tfi fiuman resourcesinterrupting aeuvery offiea{tfi sennces• inadequate basic service coverage in many areas exacerbated' 6y tfieoccurrence ofnaturaeanaman-made disasters,40

Sf£[710:N8. OWLOO'j( POI]{TJ[f£ PV'1VtRSE'TIie fo«Owing paragraphs exemplifies tfie directions for tlie future contained intlie :Nationa{J{ea{tli pfan(1995-2020) oftlie !J{epu6fic oftlie Pliifippines:Overa{[ goa£:'To malis tfie Pifipino population to achieve a feveroffiea{tfi , tfiat wi{[a«Ow tliemto Iead' a soci4ffy ana economically productive life, witfi wTlfJer rife expectancy,Iou: infant mortality, ww matemaimortality antiIess aisa6i{ity tfirougfi access ofeveryone to essentiallieaftli care.C13roaa06jectives:jI.'To promote equity in liea{tli statusamong a{[segments ofsociety.'TIie lieaftli of trw genera{ population wi{[ 6e continuouslypromotedanamaintained:'TIie fieaftfi groups margina{ieetf 6y poverty, geograpliic anaculiurai isolation, armed conflict, ana man-made ana naturaedisasters wi{[6e given fiiglier priority.C13. 'To address specific liea{tli probiems oftlie populationJ{ea{tfi problems of vu{nera6fe sectors of tfie population sucfi asinfants ana cfiiUfren, women ana tlie eUferfy wi{[ 6e given specialattention togetfier witfi pr06fems regarding malnutrition,communicable diseases ana non-communicable diseases. Ora{fieaftfi ana mentalfiea{tfi wi{[6e promoted as an inteqral'part oftotai fiea{tfi; emerging fiea{tfi concerns resufting from continuedur6anieation ana industrialization sucfi as occupational fiea{tfiana safety, ur6an ana environmentai liea{tli sanitation wi{[ 6eemphasized.C. 'To upgraae tlie status ana transform tlie liea{tli care aeftvery system intoone tliat is responsive, tiynamic, liigfify efficient anaeffective in providingsolutions to tlie clianging liea{tli needs oftfie population. !J{estructuring oftlie rwa{tfi care tfefivery system. wi{[ fie done so tfiat it can atfequatefyrespond' to tlie tfemandS of trw peopie anti adj'ust to tlie evo{ving ana.41

emerging hearth concerns at a pace that ~eps up with the rate ofaevelOpment.The organization ana management of the hearth system wi{{ 6estrenqtliened, operations ana capabilities of tfie hea{tfi sector wi{{ 6eimproved' ana developed; ana P/PFICFE:Jfl' ana rR,j/.'l10:JVjlL use oflimited' hearth resources wi«6e promoted to ensure the effective defiveryof adequate, acceptable, accessi6Ce ana jlPPOCJ?SDjlCBDE quality hea{tfiservices to the people. \ ,([). 'To promote active anasustainedpeople's participation in hearth care,'Tlie participation of ilufivitfuars, [amities, communities anapeople's orqanization in fieafth care ana hea{tfi deoelopmeut wi{{(je encourage, mo(ji{izea, ana enhanced' untie selfrdiance anasustainability in hea{tli amonq tlie people is attained. Jreaftfiinformation ana education wi{{ 6e intensified' to create anempowering fiea{th awareness ana consciousness among the peoplethat wi{{proper tfiem to contribute effectivdy in fieaCtfi promotion,disease prevention, home anacommunity care. 'Ihe participation oftfie people in fieaftfi pfanning, implementation. monitoring anaevaluation ana in policy or decision matUng at a{{ Cevers wire 6esOUf:Jht.1. Strategies to promote equity in hearth eliminating pocfists ofiffhearth inthe country entails proper identificatior: ofpriority groups ana areas, aswe{{as 6roadening tlie sectoralanageographic coverage ofliea{th servicesusing heaCtIi care approacfies that wi{{ ensure promotion of essentiallieaftli needs, promote equity anawi{{(jring lieafth doser to tlie people.1.1 (]Jriorityfor tlie vu(nera6l'e anamaqinalized'givingpriority to the hearth of marpinalizedsectors tiDes not meanthat the hearth of the genera{ population wi{{ 6e Ceft 6ehina.Provicfing adequate anaessentiai(lea{th services to allwiffremainthe basic rule wfiil'e equity in liea{th is 6eing ensured, ,•42

Hea(tfi anti Iieahfi-reiated' sectors wi{{ need' to concentrate tfieirefforts on tfie aisaavantagea, unserved areas or sectors.Itttersectorai collaboration. wi{{6e tfie /(sy in provitfing sustainablesolutions to tfie critical issues ana concerns reieuant to tfie fieartfiservices sucfi as tfie inadequacy of6asic social services, continuingpoverty of tfie majority of tfie population, poor enuiroumentafsanitation, isolation ofinadequacies communities , poor peace anaartier situation, among others.!J?fsource allocation wi{{ fiave tofoffow tfie order ofpriorities foradequate support to fiea(tfi anaotfier socialinterventions.1.2 Cllimary Hea(tfi Care as tfie 'K!y JlpproacfiIn ensuring equity in fiea(tfi, primary fiea(tfi care wi{{continue to6e tfie centerpiece approacfi of tfie country's fiea(tfi care aeCiverysystem in tfie future. It is tfie first feve( ofcontact ofindividuals,famiCies anacommunities witfi tfie nationalfiea(tfi system 6ringingfiea(tfi care as dose as possible to wfiere tfie people five or wor/{.anaconstitutes tfiefirst element ofcontinuing fieaCtfi care process.}Is mucfi as possibie, tfie essentialelement ofPJ{C wi{{6e aeHvereaat the first point of contact, anti tfie rest of tfie fiea(tfi system,from tfie next. fiigfier CeveC to tfie top, wi{{ 6e considered equaffyresponsible for its' aefivery to create a smootfiCy functioningreferra(anasupport system to tfie peripfiery.!J?fnewea interest ana support of a{{ sectors in tfie propagation,adoption ana sustained implementation. of PJ{C wi{{ 6e sougfittfiroUfJfi aavocacy ana sociai mobilization: Jl comprefiensiveprogram ofadvocacy at a{{ CeveCs witfi fu{{ understanding of tfiePJ{C approacfi wi{{6e esta6ClSfieato develop tfie politicai'wi{{anacommitment to tfie adoption. of PJ{C as a k,ey strategy foracfiieving Heartfifor Jl{{6y year2000 anaHea(tfi in tfie 'Hands oftfie 'Fifipino PeopCe 6y year2020.1.3 'Empfiasis onPromotive anaPreventive Heartfi CarePromotive ana preventive fiea(tfi care offers an appropriate anacost-effective approacli in upCiftillfJ tlie state of lieartfi of tfienation. 9r1ajority of diseases affecting tfie population are43

communicable, meaning pre1Jenta6Ce. On tfie otfier Iiand, tfie risingincidence of non-communicable diseases is attributed' to tfiepredominance ofunfiea{tfiy {ifestyCe ana6efiaviors. Promotive antipreventive fieaCtfi care Iimits tfie needed' expensive curative fiea{tficare wfiicfi is often tfie cause of unaffroaa6iCity ana inaccessibilityto liea{tli care.Hea{tliy fijestyCes ana 6eliaviors promotion wi{{ 6e integrated" 11Ia{{forms ofliea{tfi information ana elucationprograms.2. Strategies to 'Minimize Specific Hea{tfi Pr06Cems'Ma{nutrition, communicable ana non-communicable diseases, orai anamental fiealtfi pr06Cems, ana lieaCtfi consequences 6roU!Jlit about 6ycontinuedur6anization, industrialization ana enuironmentaiaegraaationwi{{ 6e addressed' tliroU!Jfi tlie ae1JeCopment of relevant liea{tli programs.)l.ctua{(rea{tfi needs of tfie client population wi{{6e determined tliroU!J1i atfioroU!J1i situational anaCysis invo{ving tfie 6eneficiaries 6y means ofconsultative ana participatory pfanning ana decision. maf{jng processes.([Jerceivea liea{tli needs of tfie target population wi{{ 6e considered based'on emerging trends, patterns ana directions tofaciiaate earCy interventionBefore tlie probiem assumes uncontroff.a6Ce proportions. ([JeopCe or client­6ased" and" outcome-oriented approached instead" of tfie traditionaiprogram-6asea approaclies in tlie pfanning, impCementation, monitoringana evaluation. of liea{tfi ana poverty alleoiation programs wi{{ 6eempCoyea to affow integration ana convergence of resources, creating agreater impact on target 6eneficiaries.'Iherefore, tliere is a need'for constant coff.a60ration 6etween tfie liea{tfiana fiea{tfi-refatea sectors to achieve tlie common objective of impro"J!inBtlie quaCity oflife oftlie 'FiCipino people.2.1 Promotion ofHea{tli'V'u{nera6Ce Sectors oftlie ([Jopufation2.1.1 Infants and"CliiUren2.1.1.a•IntegrateaCliiUfTiooa(j)e1JeCopment)l.n integrated' approacli to cliila liea{tli orientedprograms on liea{tli, nutrition anaeducation needs to44

6e adopted to respond to cliildren's needin a liolisticanacoordinated'manner.2.1.1.6 CfiiUSurviuai'Interventions on causes ofpersistence of fiigfi cfiiUana infant mortafity rates must givepriority to fiigfirisk.chiidre« margina{ize{ 6y demoqraphic, economic,environmental, geograpfiic; peace ana order reiatedanaculturaifactors.2.1.1.cCfiiUsafetyCfii[([fiooa accidents fiave 6een steatfify rlSmg mproportion necessitating efforts or interventionsgearea at tfie creation ana provision ofa safe anaconducive environment to five in.2.1.1.a

fl,aofescence sienaCs tfiat stage wfierein youtfi Becomesmore aware of tfie opposite se;t ana more curiousabout sexual' issues so tfiat education regardingreproductive fiea{tfi is needed.fl,60rtion, contraception, responsible parenthood,fl,[(DS anaotfier seJ(JUl((y transmitted" disease are onCya few of tfie topics wfiere tfie youtfi sfiouGf 6einformed". VnwanteJpregnancies ana earCy marriagesare pro6fems tfiat results from Cack. of adolescenteducation.2.1.2.cSmoRjng, fl,Ccofio{fl,6use ana(])rug DependenceStarting famiCy anagooapeer reCationsfiip need" to 6estrengtfienea to esta6Cisfi so{iI! value foundationamong tfie young. ScfiooCs ana cfiurcfi could' reinforcegooa morae values. Information ana educationcampaign specifica«y targetting youtfi as we« asrehabiiitation programs for tfiose wfio are dependenton fiarmfu{ substances (cigarettes, aCcofio{ and drugs)Iiaoe to oe improved.2.1.2.d 'Youtfi Occupationa{J{ea{tfi andsafety2.1.3 WomenSafety measures to avoid exposure to environmentaiandindustrial fiazard's must 6e in piace in as mucli asa sienificant portion oftfie youtfi are worRjng.2.1.3.aWomen's J{ea{tfi'"•Women's fiea{tfi and intervention programs wi« fiavetogo 6eyondpregnancy and'otlier reproductive fiea{tfiissues ana give particular attention to fieaCtfi anafiea{tfi-reCated concerns stemming from tlie socioeconomicstatus and genaer rotes of women in tliecountry.46

2.1.3.6 Saft'MotlierliooaSafe motherliood' is not onfy concerned' witli safeaeuvery 6ut also covers tlie entire' period ofpregnancy, from conception to 6irtli ana even 6eyona.J{ea{tli 6efore, aUring ana after pregnancy musttherefore 6e ensured tlirougli the prevention of tooearfy or too fate pregnancies, adequate prenatalanapostnatalcare,•proper nutrition, minimized exposureto harmfu! substances or conditions sucli as smol(jngana al'colio~ safe aeuvery ana the proper spacing anatiming of6irtli.2.1.3.c!J

2.1.4 'E[(ferCy2.1.4. a J{ea{tfiy Aging Promotion'11iis wi{{ aea{ witfi proConging tfie period' ofproauctivity ana improving tfie quaCity ofoutputs oftfie e[(ferCy population to fie(p tfiem retain tfieir senseofself-wortfi anatfieir entfiusiasm towards rife.\.2.1.4.6 geriatric ~fia6ititation~fia6iCitation from cfironic after effects of chronicaegenerative diseases among tfie eUerCy populationpCays a very important role in fie(ping tfiem regainimpairedpfiysica{ ana mentalfunctions feading to agenera((y improvedquaCity ofCiving.2.1.4. c Home-Based'orCommunity-Based''E[(ferCy CareHome-based or community-Based. care wi{{enable old'people to spendmore significant time witfi tfie peopleclosest to tfieir heart, consistent witfi tfie strolliJPiCipino value of I?geping tfie famiCy cCose-Jtnit anaa{ways togetfier.2.2 AaaressilliJ Specific J{ea{tfi Pr06fems2.2.1 Integrated' Prevention ana Control of CommunicableDiseasesIn contro{[ing communica6fe diseases, an integrated'approacfi neea to 6e aaoptea to alknu convergence ofresources amolliJ different. programs. 'Targetjocusea insteadoftfie traditionalprogram-6asea approacfi wi{{prove morecost-effective anaefficient.I•48

2.2.2 J{I'fJ Infection/;UCDS Prevention anaContro{2.2.2.aJ{I'fJ Infection/jIBDS jIwareness andEducatiottSpeciai I'EC campaigns ana J{I'fJ/jIlCDS informationana education. intenaea for 1Iu{nera6k ana specificgroups must include even elementary schooi cliiUrento create greater im~act..;;2.2.2.6 J{I'fJ Infection/jIlCDS Pre1lention, 'Treatment ana~lia6iCitationjIn expansion ofc01lerage ofJ{I'fJ/jIlCDS seTVlCes ISneeded' to incCuae thousands of cases tliat lidremainedundetected'anaunreported'untienow.2.2.3 Non-Communicahle Diseases Pre1lention, Controt ana~lia6iCitationa>u6Cic liea{tli intervention strategiesfor non-communicablediseases must also incCucfe tlie emerging diseases for carefulstudies, formuCation anainitiation.2.2.4 Nutrition2.2.4.aNutrition Promotion anaConsumer Information. 2.2.4.6 Nutrition Disease Prevention anaControl2.2.4. c 'FooaSecurityStrict enforcement ana monitoring offooa quaCityana safety standards in commerciai esta6Cisfiments isneeaeato safeBuaratlie liea{tli oftlie consumer.•49

2.2.5 Ora[J{ea[tfi2.2.5.aOra[J{ea[tfi anaJ{ygiene CJ>romotionPrimary target of orai fiea[tfi ana fiygiene promotionwi[[ 6e tfiose witfi Iotu education ana sti[[ do notpractice oralfiygiene.2.2.5.6 CDenta[Disease CJ>rev~ntion anaContro[2.2.6 9r1.enta[J{ea[tfijIccess to afforaa6fe ana quafity aenta[care servicesmust 6e improved.2.2.6.aStress 9r1.anagement and Crisis Intervention2.2.6.6 CDrng anajIfcofio[jI6use !J?§/ia6ifitation2.2.6.c 'Treatment ana !J?§1ia6ifitation of 9r1.enta[[y-i[[Patients2.2.6. a Specia[CJ>rojectsfor o/u[nera6fe groupsCreation of speciai mental fieaftfi programs forstreetcfiiUfren, overseas contract worli.§rs ana victimsof tfie armed' conflict, violence ana disasters must 6eaimed' at improving tfie socio-economic conditions oftfiese unfortunate peopie since tfiey are mostvu[nera6fe to trw development ofmentaij[[ness.2.2.7 Occupation-rJ

2.2.8 '.En'llironmenta{andVr6an J{ea{tfi2.2.8.aDisaster 9.1.anagement arufContro{2.2.8.6 Po{{ution 9.1.anagement2.2.8.cCommunity 'WaterSuppCy antiSanitation2.2.8.a So{Uf 'Waste ana lewerage Co(f£ction (J)isposa{ aruf9.1.anagement2.2.8.e2.2.8fCfiemica{StifetyVr6an '.En'llironmenta{J{ea{tfi3.· Strategies to Create )'l rJ

3.4 J{ea{tfi Human. rRssource (j)e1iefopment3.4.1 Sustained J{J{IJ?!J) pfanning infrastructure strategic anaoperationafpfanning at a{{ fevers.:Major}lctivities:a. (j)evefoping a J{J{IJ?!J) pfanning infrastructure tosustain strategic a~a operationai pfanning at a{{fevers6. Deoeiopment ofJ{J{IJ?!J) f.egisfative agenaac. Deueiopment ofJ{J{1J?!J) researcfi agenaa3.4.2 1?jztiona{ana'Efficient System ofJ{J{IJ?!J) (]JroauctionComponents:a. Cl

c. Sustaina6fe retention of personnel in areas wfieretfiey are needed;a. 'Esta6[lSfiment ana observation. of career patfiway;anae. Continuing deveiopment offiea{tfi worfisrs\,3.4.4 )Is a genera{ overall supporting strategy, efforts wi{{ 6eaevotea as we{{ to tfie activities of promotion, advocacyana networfjng, ana tfie strengtfiening oftfie informationsystem.3.5 J{eartfi Care 'Financing3.5.1 (fromotion anafinancing scfiemesa. Nationai'Heahli Insurance System6.

3.5.6 'Funding ofLoca{J{ea{tfi Services3.5.7 Vse oj'E:{Jerna{Support3.6 J{ea{tfi Infonnation System)lccurate ana time{y infonnati~n is necessary in a{{ aspects offiea{tfi aevefopment ana its avalfa6ility wi{{ 6e ensured' tfirougfitfie creation of an effective ana efficient fiea{tfi informationsystem.3.7 rJ?,fsearcfi ana(])evefopmentContinued' researcfi ana development is needed' to continuouslymaintain tfie relevance ana capa6ility of tfie fiea{tfi care aeliverysystem to respond to tfie evo{ving nationai ana tocal fiea{tfisituation.3.8. :Maximize use of)lppropriate 'Tecfinofogy7Tie use oj tecfinofogy tfiat is proven to 6e safe, effective anabeneficiai to tfie people wi{{6e propaqated' ana use of traditional'ana indiqenousforms ofmedicine wfiicfi are effective ana safe wi{{6e promoted".4. Strategies to 'Transfonn J{ea{tn Into)l Comprehensiue ana Sustained'Nationalconcern4.1 Peopfe 'Empowerment ana Participation'Ihe ftey to a successful nationalnea{tn movement is the PEOPL'E- for tfiey are tfie prime movers, ana at tfie same time, tfiebeneficiaries offiea{tfi orany type ofdevelopment4.2 Participatory ana Consu{tative CJ>rocess in J{ea{tfi Pfanning anaPolicy Formuiation54

4.3 jlavocacy anaSocial:M06ilizationPu6lic adoocacy is a very powetfuitool to let autliorities listen totlie people ana Rgy people listen to otherpeople4.4 Community Organizing ana Deveiopment Coffective jlctionSprings Prom Vnity\4.5 Community-CJ3aseaandHome-BasedHeaiui CareThis approacli wi[[aefinitefy 6ring liealtli closer to tlie people anawi[["put liealtli in tlieir hands"4.6 !Building Partnersliips in J{ealtli :Meclianisms wi[[ 6e aevelopeaana implemented for continued ana strengthened' intersectoraico«a60ration among a[[ sectors concerned witli tlie upliftment oftlie quality oflife oftlie people.55

INDICATORSFOR THETHIRD EVALUATION, ';, ,~ .

INDICATORSFOR 1l1E THIRD EVALUATlON"ClIONJUSTIFICATiONGl,OBAL twA COMMmfENT(WHAU.U)IFORIN Die It. TO R SOTHfR ASPECTS OF HEALTHDEVELOPMENT• 'I 1~ '. •• "'':>',, ,: ,~. , . ~ '\," .. ;,' ... _ ) ..iGrou ndonaI pnxIuctIIf gfOISdomeltic~percapiUI(purdIating~of~..)GNP Cl#fel\1 price flrlllalicln of eurmrtpar)I comta'lt poce fllll2dOn of 1M5}2,218,4i5.000,oooAl,502,000.000"" N5C8~ NInual gruw1tI tile (QIlTllnt 1995-9llICI)IlS\IIIt); " of poor in rural_uI" of poor (lOCal)1lS.3MI,S447.0",51 _IiI ,. of......==...- ..('Mo of o-a3 mo..)n.wboms 'MIighinQ..1eUt 2500g% of c::hiIdren 'IWhOM ~-agt and',... '9U... n,1ft'· 18.3""-. AnnuaillOfllU.tiOn gn;JWtIl ratlIITotal fltl'tility I'II1tI• ClUdedate rat. F* 1000IXl9(1995)·2.22(2000) • 1.94"'f. OlWSI I(11m-iS). '.031(95-2000) - 3.511tW. NSO(1m) - 21.3(2000) • 25.1"".....(1"5) • U(20001 • ;H",f. 0&951------1I 'lloof pop.Ution.15and OWl' (m)...mo IlI'lI regWt"..,. (baMdonlhe ln6·11'llo •boUt....)I,.of pqltIlatiMage 15 8tld -1I1-'»..tepMttmoken (baod on lhD1m - 71'llo, balh MXeS)II20'"" NCOCSREFERENCE;HSO""HSHS.....HH"NODCSHSCBNaliOM! St4tiStic:li 0l!iCIPhilippineFlelclHn!lll StatiSbBased onOper.rion rll'tll*lll Dat8 1993/ NultIlion~. DOHPtlifqline Popu!alion PYo;tdJon 19i5-2020.NSONdonal H.allh PlanN~ DiINse conlrlII s.t"Iic:e- DOHNational Statatisticll CoordiNtlon Board

_~NJlCATORlI FOR tHE THlRDEVALUAnoNJUS T I • I CAT ION .. 0 R IN D I C A TO R 1IiQl.08AL A COMMITMENT(WHAM..MI OTHER WHA REaOLUT1ON OTHER ASPECTS OF HEALTH DEVELOPMENT•'lit 01the poputatlOn WIJlute clmtlng nteravdI!* In the nome Of'wi reuonable -au10M • Il1O.0m. 12..9«1'"'" • 72.0m. 12194lJ4.2 fN1dIIlBICIUI'e$S..-,.,-,.,-111111 2.ft '11i1S13 • S..,.,PI'rysQns per '0.000 pocUIllon~per10.000~Nul'$eS per 10,000 POPJI8llol'l~ per 10,000 poJalIIItlonOenlistsper 10,000 pop.diItlolIother I'leIlh caR pltNidef (ft:b1lng~heaIll 'fIIOIbfSlper 10.000 IJOPU!'IlDll1993 • lUI,., "'"1992 • 43.0rwf. fZOS2tl1993 • lA.4,.l IPS1983 • $.0• IPS'983 • 5.0tW. IPS,....,...".. .,I."",,,", 'IiI 4.4 Essenti-' drugs kJgI:dJc:s and'lit 01asentIIII dnIlP hdabIe In • ull'lP!' of,...,fK:ilItla:4.5~~for ,.t.moun(of~aid b /lIUIh r.c:eMId.. 1;;1/lIHIlI."oIkUI~"""~"'.NHP..." I'Z/'Iol8,ZIt2bIPSM"IPu.u.m.l and ChIdHnIfl~~~CClrnmbslclnII'IlerMI~ s.rw:..DOHPUllonalHedh PlIInP.,.,

INDICATORS FOR 11iE llfIRD EVALUATIONSECllONJUSTIFICATIONGLOBAL HFACOMMll1lllENT (WHA34.36)FORI N 0 I C A TO R SOlliER WHA.RESOLUTION0ntER ASPECTS OF HEALTH OEVELOPIIENTI6.2 MatemlIl and child heallhfF~pIanning1! (F~ III'MlrepocIuctive health)! 6.3 Immunization6." PreventiOI1and control ofIoeaIly ancIamic diseases% or pnagnant WlIn'len attenaecI by trained! penonneI during pntgnanc:y\ % of 0eliverMS attended by trained peraonnoII..of infants attended by tnIineclpenomelI, % of women of childbearing ape using ~ planning15· "7)";";1" of the aHgibie population (i.a.lnfanta readUng theirI lim biI1hday ) ~ hubHn fully immunizedao:orcling to nation8llmmuniz8tion poIiclos; % of infants reac:hing ItMlirtint birthdlly Ih8t lui...been fuItyirntnUniz.o IIg8inst dipl'tteri8. tetanus.I IIl'lCI whooping cough% of infants lUe:tIing their first birthday Ih8t have, been lulIy~IIg8inst poliomyelitis". of infants reathing their lint birII'IdayIh8t havebeen fully immunized again4t measles". of inflJnt5 rnthlng theirfirst bir1l'ldlly that lui".been fully imrnul1ized againat tuban::uIosis: ". of woman that have been fully Immunized wilt!tetamn toxiod (IT) during pregnancyI1995 85~"'l HIS1995 85.3%ref. PFHS1995 .......,. NIS1995 82~,.,. HIS1995 • &6..... I% of the population that has been irmIUnizad with1W. PFHS ~ B 'llaa::ine. % of Infants read1ing their first bir1hday that lui... been1995 • 85.77%' immunized with yellowfevervao::ine (in~,.,.~ ililtllJta~J1995 • 87.n'fIf. 0&'SI5tI1995 • 86.55'"ffIf. otW5tI1995 • 89."'"ref. 0&95b1995 - 69.29'110 iref. otW.5b I1995 7~,." NHP6.5 Treatment of commondisaueS and injurieIREFERENCE:061950PFHSNHPHISMatemaland Child Haalth $etvica· DOHPhilippine Fielc:l Health StatisticsNational Health PlanHealthlnteUigel'\C8 ServtCll

INDICATORS FORTHETHIRD EVALUATIONJUSTIFICAT ON F 0 A: IN 0 I C A TO R SOTHER ASPECTS OF HEALTH DEVELOPMENT7.1 LA eJ;lKlanCyLM~ 8l birth (m)19.565.58IJfeeq»ctancy at age 65 (maltl.)UfII~at.ge 65 (fem*')1.2 MDrIaI.i!yProt.bilily of dying before 51tlbirthday (m),~of dying blJtor. 5Itl1:lil1hday If)IMalamalmort.aIity rata per 100,000w.bitIl'I1-171.14Mortalityfrom ARI in dUldrenunder 5IMortII~ In:lmdiarrtIoe.1disease. in chHdnin: under 5I Mortality from maltriI,,~ Moftdty from muslnMortIIlity fromtubm:U\OliI'00'147.4 MOl1lIllly frgm CVD (all tyDo.) 19" 2&.5ref. HIS20.'MOl1lIlit)' rrom cancer (aUtype.) ".0MOlUIlIyrrom trdc acc:iciefrtt12MOl1lI5ty Inxn wor1l. acc:ldanb.., m. HIS(IS ".100,000 population)as.•,.•1.3 MortlilicIlrNo.ofnewcuu of polio--PnI118lenc:cl of iodInlIdeficiency disotden inPIlIII8I.nCfl of Yitllmin A deficiency di.ord.nOFYT.1. 12r-.nlll'lll.n 1181Ue)(IS ptKlOO.ooo popul~J'00'0.'63,4'00''00' ".,'994 D.' m.Mp'00'D.'104.5'00'nsf. nhp'00' •••'00'4U ref.nhp'00'1S.1 ret. nIIp'00'O,O!! reI. nhpref. • • 1993, HISHDiwbilityREF~-------06106H,S....,.MpNSPN.tion.1 SlIiU,\iet Cootdin.\ion Bo.rdH'81ltlln!lllligBnce SeMce· DOHPhilippine Population Projee\iQn1995-2020, NSON.tional H..lItl ~N.bOf\al SuMJy on Blindno... N.bOMl Imtitute of Opthalmology1995 • 0.7'10,." NSP

PageSSheetSJUS T I Fie A T ION FOR IN 0 I C A TO R 5GLOBAL HfA COMMITMENT (WHA34.3e)OTHER WHA RESOLUTIONOTHER ASPECTS OF HEALTH DEVELOPMENT•5.1 Heallh policies andstrategies'" of heattll budget allocated 10preventive and promotiveI heallh service• No. of communlty-based project Ihru community NGOJ, DOH partnerarop on;a. Comprehensive nutrition services includingsalt portlfIcationb. Matemal' and child heaifh programc. Famity ptanning program5.2 Inbnodor8l o::w:>yeiatkiilStatus of implementation of incorno-seCUl"lIyandmedk:are protectfve measuresAvaJIablllt)' d II unit, stnu::tutes Of point P1nOOresponsible fOfpol:icy plannIng. '" I amounl Ofhealth b~get a1Jocated for: policy formulatlon5.4 Managerial processNo. f type of system and proceduresestabUshed5.5 Health Information system,Availabilityof adequate l1onnatIon technology5.6 CommunIty don,5.7 Emergency preparednessNo. I kinds of traditional medicines producedlutJllz6

APPENDIX :A. MEDIUM - TERM PHILIPPINE DEVELOPMENTPLAN ( 1993 - 1998 )B. NATIONAL HEALm PLAN ( 1995 - 2000)SPECIFIC OBJECTIVES AND HEALTHSTATUS TARGETS 2000C. GROSS NATIONAL PRODUCT AND GROSS DOMESTICPRODUCT BY INDUSTRIAL ORIGIND. REQUESTED REPORT OI? DATA WITOIN UNITS/SERVICESOF THE DOHE. PRIMARY DEALTO CARE ALLOCATION OF FUNDSTO THE REGIONAL OFFICES OF THE DOH, i, I, III· 1 IIII,'..,I· "j· ],0:,.I.,I',:,,!/

A. MEDIUM TERM PUILlPPINE DEVELOPMENTPLAN (1993 -1998)•..-,

.•..... ,.~.. __ ,,_ "....• , ~-..• --"')PHH.,F.PP!NE51\~If,~1 tt~~:..~_,. IIH~ ' .~.-....c . "~!.,.~" ,~. ~ ,*Nl '''- .... ~

~..\/~ VISION,A DOH with a:Structure..That is lean but responsive- to the needs of the clientele ;- to the high expectations of the public- to the redefined functions as a results ofdevolutionWith clear directions, focused tasks and goals, realisticpriorities andtargets' ...PeopleSystems &ProceduresMISSIONCenterofexcellenceSense of public service, excellence, personal integrityand moral courageHigh professionalized leadersMaximum transparency, strict accountabilitySimple but efficient and effective(Universal access to quality health serviceA. PlUORITY PROGR~MS1. SAFE MOTHERH.OOD AND WOMEN'S HEALTH...,• Maternal Care• Family Planning• Nutrition• Vitamin A Deficiency• Iron Deficiency Anemia• Iodine Deficiency Disorder...~','.'", ,•...'•..'I', 'i.I, .r •..~~:. ~, ...

y~ ",'" .,...2. cuu,o SURVIVAL PROGRAM (EARLY CI-IlLDHOODDEVELOPMENT)'. Expanded Program on Immunization• Control ofDiarrheal Diseases• . Control ofAcute Respiratory Infection• Underfive Clinic/Growth Monitoring• Breastfceding Promotion• Baby-Friendly Hospital Initiative• Nutrition ,• Protein-Energy Malnutrition Prevention Program• Vitamin ADeficiency• 'Iron Deficiency Anemia• Iodine Deficiency Disorder3, CONTROL OF PREVALENT DISEASES (AFFECTING THE,WORKFORCE)• Communicable Disease Control• Tuberculosis• Malaria• Schistosomiasis• Leprosy• AIDS/STD.+ Non-CommuniCable Disease Control• Cardiovascular Diseases• Cancer/Smoking Cessation• Community-Based Disability Prevention Program• Blindness Prevention• Occupational Health• Dental Health, ".. ,"

' 4. HEALTH SERVICE CAPACITY IMPROVEMENT+ Voluntary Blood Donation• National Drug Policy, + Hospital Carc'Improvement program• Hospital Center lor Wcllness+ Traditional Medicine5. NATIONALI-lEALTH INSURANCE6. ENVIRONMENTAL HEALTH7. LICENSING AND REGULATION8. DEVOLUTION (LOCAL GOVERNMENT ASSISTANCE)B. GOALS/TARGETS1. Health Stutus• Increase the average life expectancy from 68.3 years in 1994 to69.7 years in 1998.tReduce infant mortality rate from 54.0 pCI'I ,000 Iivebirths in1994 to 49.4 in 1998.• Reduce crude death rate from 6.2 per 1,000 population in 1994 to5.7 ill 1998.• Reduce crude birth rate per 1,000 population from 26.8 in 1994 to24.5 in 1998.2. Nutritional StatustDecline percentage of preschool children moderately andseverely underweight from 11.2% in 1994 to 8.4% in i9.98..,I\','.',';" , .(.v, I" j...., (, , ..",. '

• Decrease proportion of school children 7-10 moderately and,",severely underweight from 11.2% in 1994 to 8.4% in 1998.• Reduce prevalence of anemia among infants from 45.0 in 1994to 28.2 in 1998.• Reduce prevalence ofVitamin A Deficiency/Bitot's Spotamong pre-schoolers from 0.10 in 1994 to 0.04 in 1998.,• Reduce prevalence of Iodine Deficiency Disorder/Goiter from6.4 in 1994 to 4.4 in 1998.3. Family Planning• Reduce fertility rate from 3.40 in 'l994 to 3.23 in 1998.• Increase the proportion of family planning acceptors to currentusers from 41.5% in 1994 to 38.1 5% in 1998.• Increase contraceptive prevalence rate from 40.58 in 1994 to42.79 in 1998."4. ServiceTargets4.1 Child Survival Program• Eradication ofpoliomyelities by the end of 1995.• Elimination of neonatal tetanus by 1995 (i.e. reduceneonatal tetanus rate to 1per 1,000 livebirths).+ Reduction ofmeasles mortality by 95 pel' cent andmeasles morbidity by 90 pel' cent among children underfive years of age, compared to the 1985 levels......."'. :.,, )', .. '., ,1-.•,, (.'

• Achievement and maintenance ofat least 90 per centlevel lully immunized children, Q~d at least 80 percentTetanus Toxoid 2 immunization coverage ofpregnantwomen.• Adequate management of pneumonia and other acuterespiratory infections among children under five years oldin at least,sO per cent of all government health facilities,including 562 government hospitals.,• . Achievement of 80 per cent Oi'al Rehydration Therapyuse among children under five years old afflicted withdiarrhea nationwide.• Uni versal salt iodization by 1995.• Virtual elimination of Vitamin A deficiency by 1995.• All hospitals rendering maternity and newborn serviceswill be mother/baby friendly.• Increased access to safe water from 73 per cent to 84 percent ofall households.• Increased access to sanitary toilets from 68 per cent to 81per cent of all households. .4.2 Other Priority Programs• Reduce the prevalence ofsmear positive tuberculosis by40% from 3.011000 in 1994 to 1.3/1000 by year/2000.• Reduce malaria annual parasite incidence from 5.1 in1994 to 2.5 in 1998.• Reduce the prevalence ofschistosomiasis from 504 in1994 to 3.54 in 1998.0·'1."

.re.POLICIES AND STRATEGIES• Develop and mainialn social safety nets.• Implementation of Income-Security and Medicare ProtectiveMeasures.• Direct public resources and efforts to basic social services,disadvantaged regions, and spccilie groups.\• Preventive and promotive health services with a focus ondebilitating disease with the private sector assuming an activerole in the provision of curative care. .• Use of Traditional Medicines and other indigenous resourcesand technology.• . Community-Based, comprehensive nutrition services andmaternal and child health including the-family planningprogram.• Groups with health risks, including adolescents, military,male, and high-risk women as well as premarital couple,particularly those belonging to low-income groups as focusof family planning information and services.• Promote balance, among population, resources,' and environment toensure sustainable development.• Implement Family Planning Program vigorously as a keyinstrument in moderating population growth.• Strengthen the mechanism for planning policy formulation andimplementation at all levels. .,... ~

. "+ Provide the necessary infrastructure facilities to facilitate andimprove delivery or basic social services. ,,,,• Upgrade the capacity and capability ofhospitals at thedifferent levels focusing 011 the frontline, ambulatory andout-patient services." 'vmnlldplwonllmlill, asof6/19/96."",.."•..I;IJ

'.,.. ', .:.:..'~: .B. NATIONAL BEALm PLAN (1995 - 2000)SPECIFIC OBJECTIVES ANDBEALm STATUSTARGETS 2000

NATIONAL llEALTII1'LAN (1995· 20UR)Specific Objectlves and Health Statu~"8rgets2UUUTo pn••ce dae· ...... till ale .......JNliiW"'''' iodINIfq v~bIe IIt'den.......... dllcb'eII, WOllIN,_~tldealyIleal'" Status 'hi 15 2000To ioo me tho avCQ8C liIe To ukeue tho lMlI'lI8O life crxpo::faacy ata:pec:tancy at birth binh fivm 67.4in 1995 to 70)'lllU'l .To reduoe iulint, cbild and maternal To reduco iuJauI lIIOltIIity rato &omlDlX1aIIty 48.911000 llvebinhs in 1995 to 41.211000Iivebir1ha............T. replace rerdUtf to allure....ladTo redooe the c:bikI mortaIitynte &om18,8/1000 clIikl popuIatioo Ia 1995 to13211000 dIikl popWatioaTo Rlduce the mateiJJll1Dorlality rate &om0.7/1000 IMbirtht in 1.995 to 0.6/1000IivebbtbsTo reduce population growth t'J. To Rlduce the population growth rate ftvmIevd in. hannouy wilb ecooomic 2.4% in 1995 to 2.o-AcIevdopmaJt. :'To reduce tho crude birtb l1Ite 8vm29.7/1000 pOpu1aIioo is J99S 10 J8.WJOOO~ "Tonaa••rllidJtJ .... 1IOItIIitJ,.,.CD -kaMe dlinuaTo reduce the DIOlbidity aod To reduee the Jm)I\Ility I1Ile of poallDODiamortality from the fuIluwing ~ lUJIOIl8 undtrtiveI byIt'""25%wmu·mImhIc diseases: ·l1'.1lterespiratory infections; flIth....ted To reduce cIianbea epitocIes 1"'008 ~diaeua aucb III dianbDa1 disea'lCl, year old cbildren byatleut 20%c:bol«a IIIiI bepatitia N, _......'.Dy-tlaDBmitted diIeases ~lJcb To reduce dia.rtbea IflIOeiato' IDOIUIityas mv/AIDS, syphilis,' iUld 1WlOIl8()..4 year oldd.tiJdren byld teat SO% .

,,,.To prevent and c:ootIoi dloi«. outbreeb·-To establish the aetual Incidml:o orinte8tinaI paruitism and Hepatitis ATo rcduL'c lilY tr~ 8Ild to Rducemdrbidity and IJIOI1a1ity 8!ISOCiatecl withmv infectioD end AIDS, and itacompIiI:ationJTo roduw the inddcoce of ~ IDlI~ iofectiOl1l by loe",To c1imioato'eradicato the fuUowiogimnaJniabIe diJJeeaes: poliOlJlyetitii,neonatal tdlInus, mea3les,dipbtberia, and palUSllisTo eradicate poIioBlyelltisTo eliminate oeoDBlaI tetaous (less than1/1000 IiVClbinhs)To reduce the~of melIIIea by 95%aod masles &alba by90%To control the prevll1eoce of ,_ndlOOI1a1.ity . froO! chnmiccooununicable d~To reduce the iucideoco aocllDOltlllit.y tivmdiphthaia and pet1U8lli1 by SO%To reduce the prcvaIeoce ofsniar.poeitivetuberculosis from 3.211000 pop"letjnn in1995 IcJ at Icast 2.1/1000 popuIatiooTo reduce the amp..1risk of~ftomtubcrcu10liJ tiom 1.9Y. in 1995 to I.'"To reduce the mortality fulm tubawIoIiafrom 26.5/100,000 popuIatioo in 1995 to17.41100,000 popu1IIiooTo reduce the pIlMIlaace ndO oflepn.., tolesatban JlI0.000~ .To comrol tbc fullowing vector- To reduce the IOOlbidity rate froni deuguebomedilellllCll: dea.lgUC iDfoctioo, infection by40%__I.";. IICbi •• _-A....·11,*""pa s· .-fI1Iriais .'." ~:. •·.. ,Jci.: ::i~........~

SIJledfic: Objectives"To reduce malaria lIIOfbidily from‏·‏ooסס‎29/10‎ ooסס‎88110‎ in 1995 toTo reduce malaria morlaIity ft'oml.S/100000 in 1995 tu ooסס‎1.0110‎To reduce tho lMS1III infectioo rate ofIldJilto8Ollliasis in the endemic areu by 10-"yearly to a level of2%To reduce the IDOfbidily rate or micrOmariarale by III least 30%To nduce Ibe ~u orud1II0rtlllty fronl DOll fOIUIuicabiedlHuaTo reduce nlOlbidily flUm CIlJlle(.c;rardiUVlllClJ1I1f diJeases, and itscomplications and other c1egco:..divediaeases byat least25%To mIuce lIlOI1II1ily. fivql ."~.cardiovaswlar di9cam &: its coibp\icatioas.and other degeoeralive diIeucs by at Ieut. 5%" To improve the quality of lIlIIViv1II of CIDCCl'and stroke patieotsTo reduce morbidity from mental i1IneIa by25%and ita compIicatioos by25%To reduce accidenm IIId deaths due toalooboI and" othc:r~abuIo.disorderby2S%,"To nxluce deaths due to diebetes by 30%and reduce compUcationa of dial!'" by40%,

....~To redace dte Rational ..oIdIIgprevalmceReduce IIIJIOkiJI8 p1cvlllcllcc aJlJong Reduce lllooldll3 pnMIleooc 8JllOD8 llduJIJadults (age 18 years andab

,.--------:--_._-----,-----:"..,......-----------,Specific OI~n:~i.Yes__._.To .rCllhK:o prcvaknce of irondeficieocy llIIaJlia .moog:".-:~=::=..==:....::~~=.=;:;;:;.._-1lIe.lib Status Tllmm 2000a) inlilnlsTo reduce tbe proportion of low-birthwUght inl8utI to leu than 10-;'b) prelICbooIers,. c) pregnantJlaetati.ug~ To roduco nutriliONll anemia in pcegnantand lactating II10thcra by 2OY.To diminate other miCrol1Ulrieut VIl1ua1 elimination of the collMlqUCl8Ce8 of1llll1mJtrition and their complicatil1l1$ iOllinc doficien

'.Specific O~jcdiveBi_. __",UetiCh S~tU8 'fllTo redlK:e MlOhu/(uiclIUIl(l nndother substance abulIC r",lalcdproblema aud dillOnJelBTo reduce slreP-relaled pmblell\8and dilleaHll1'1I retlllce the iMkIoeooo of aJooboIIDicotiDeaud ntller eubftanco abulediaurden by 25'1.aud its 00IIlIClqUC0Cel by 25%.To im:rclSe practice of aJteruative a-Jtbyli.lestyle by25%\To promote ouopaCioIlUl1 beail' aadWet)', ,To reduce the incidence of To reduce the casesof~occupation-related diseases, aeci- aocidents. diseases and deatbI by 5%dentaand deathsTo pr'OmOte eevlrowaeotAI ....tallonud _imiu eeviro...eDUsI poIhatloaaDd.......To rcduoe the incidence of ICUle IUdcbnmic oocupatiooII pWooiup by 10%To reduce the cases ofpoUution andother eovirollloontal IllWlId-nllatoddi!eaBeslconditiOllllTo reduce the bealtb collStlCJUe'lOtlSof poor ~iromnental sanitationTo have ilIfe water ror allTo reduce the QHS of poI1ulioo IDd odJa'ClllVirouolCtlt·rdated d__cooditiooI by60%To reduce the iDcideoce of WIla'..oomcdiseaaes,by SO% ( pIeue refer 10 dimbeaIDII c:boIera)To reduce the inciI:IesP of fiItIH'eIateddiseases. (plcaae refer to tarpIa fordiarrhea, c:boIera, inteetirwI peruitiPD lOllllepiditis A),-To have 90% ofboullebold with IOtUi toIllfe water IUppiy , .To have satUtuy toilet futilities IIIIdproper gasbege disposal rol" allTo have 80%ofhouJebolds witb unitarytoilet J8l:iIities,.. '.'s .'. '. '.',', ".' .

,'OlIo"C. GROSS NATIONAL PRODUcr AND GROSSDOMESTIC PRODUCT BY INDUSTRIAL ORIGIN:' :, •

. ,., 1 iI PPIHEB iI : 'jI": ;tV..nONAlACCULtN1SOF1HEPHI 'I Asof J13IHI y 991:":" _.~l",lt InPt'""nl I . ; . I , ; .".alE 7. ~. no.J, 'lJ,'IIONAl PD.OIJI 'I' I., ·r '-. ANO cnoss UOI.'oS IIi: ~HOO\'C By,/.IOll TriAl' ORiGINla" 101.'01. . , , I ' , I, I • I' .. IGrr.'wthRalell II jI,I-li'I'- - -:If-'--- - - -t-- -'--'-__-i-.i+ ! . , , '1'..~'I--J!---,",","-__~CURIWlTPRlCF,S9~·e5 111\.98~! AT COpS" '---"I~IJS 1Il,I,' • '. I ~4-9p---- ------t'~--- .;.,-f-"_'--:'c...'I. -'f-l-.--i-i-__ iI A'3RI.FISHE~·rrOAESTR'{a.AQrlClJlll'f' a~d nst,~ryI, FOI·8l'Y I .1'-4:6.60,'13 077.'XDUSTAY SEFro~o. '.1'n 1n9 ~ QU8Ir,!ngb '..lanufacJu,1nJr Cor'atruct'nn 1" .'&

.......-.D. REQUESTED REPORT OF DATA WITHINUNITS/SERVICES OF ma DOH, ",

..r,~INDICATORS FOR THE THIRD EVALUATIONRATE PER 100.000 POPULATIONr==-=-c-"'==----=~~.=~-" .; -.o.""~-"=-=.-- ....-- -"""1' ,-_.. "Y-E--A---=R-'-' - . '-"~~::J$Jj;CTl9N/JU~TlFlcATIQN FOR IN.DICATORS 1'199ir-][11J?IT-1992 II 199LJIRA:mJL!t~TKILJ!ATJj; II BA:rE IA. DEMOGRAPHIC TRENDS1. Annual Population Growth RateTotal fertility rate 4.03 4.03 4.03 4.03Crude birth rate 26.3 25.8 25.8 25.1Crude death rate 5.1 4.7 4.9 4.8B. TRENDS IN HEALTH STATUS\1. Life Expentancya. Life expentacy at birth 64.6 64.6 64.6 64.62. Mortalitya. Infant mortality rate 56.6 55.1 58.5 52b. Maternal mortality rate 209 203.1 197.31 191.4Ic. Mortality from acute respiratoryIinfections in children under 5 473.8 179.3 200.611 147.4Id. Mortality from diarrheal diseases inIchildren under 5 87.6 25.9 31.41 29.3e. Mortality from Malaria 1.5 1.5 1.3 1.2/1f. Mortality from Measles 5.6 3.5 4.9 4.5g. Mortality from Tuberculosis 39.2 35.9 30.8 35.4h. Mortality from Cardiovascular diseases(All types) 54.2 51.8 11. 1I 28.5i. Mortality from Cancer (All types) 35.6 32.8 34 1 35j. Mortality from Traffic accidents 14.7 4.5 4.9 1 5.4k. Mortality from Work accidents3. MorbidityIPrevalence of Leprosy 4.6 3.2 2.9 0.9Incidence of Malaria 118.7 76.6 71.3 63.4Incidence of Measles 69.2 55.9 83.5i 83.1Incidence of Neonatal TetanusNo. of new cases of Polio 0.2 0.6 0.7 0.1Incidence of Tuberculosis 246.1 193.8 209.6 104.5,..."'I.., .. ...

"./1,% Birthweight ofIivebirths

i• 1·-Department of Health jI~I~'" !I~ ~~m ~I •'. D483__H1.18 EV1/Eva!uatingthe impfem~tatlon of_~ strategy forhealA\