Health Policy Notes

Volume 3 : Issue 1 (November 2008) / Department of Health, Manila, Philippines

Accelerating Non- Communicable Table 1 Projected forgone national income due to heart
disease, stroke and diabetes, selected countries, 2005-2015
Disease Prevention and Control In the
(billions of constant 1998 international dollars)
Philippines

Federation
Burden of Disease Caused by Non-

Tanzania
Pakistan

Russian
Canada

Nigeria
Brazil

China
communicable Diseases

India

U.K.
Estimated
Non-communicable diseases (NCD) or lifestyle diseases Income Loss 2.7 0.5 18.3 8.7 0.4 1.2 11.1 1.6 0.1
represent a significant burden on public health regardless in 2005
of the country’s economic development and are likely to
account for an increasing share of diseases in the future, Estimated
Income Loss 9.3 1.6 13.18 54.0 1.5 6.7 66.4 6.4 0.5
particularly in developing countries. Globally, 60% of
in 2015
deaths are currently due to these diseases, amounting to
more than 40 million deaths annually in both developing Accumulated
and developed countries.1 Projected trends show that loss in 2005 49.2 8.5 557.7 236.6 7.6 30.7 303.2 32.8 2.5
by 2020, NCDs are expected to account for 73% of global value
mortalities and 60% of the disease burden. Each year at
least: 2 Source: Preventing Chronic Diseases: A Vital Investment, p. 78

• 4.9 million people die as a result of tobacco use; This ominous epidemiologic situation and its implications
are likewise reflected in the Western Pacific Region where
26% of the world’s population resides. In this region
• 1.9 million people die as a result of physical inactivity;
over 75% of deaths are attributable to non-communicable
diseases, compared to 14% of deaths caused by
• 2.7 million people die as a result of low fruit and communicable diseases. Cardiovascular disease and
vegetable consumption; malignant cancers cause more deaths in middle- and low-
income countries and areas within the Western Pacific
• 2.6 million people die as a result of being overweight Region than all communicable diseases combined 4
or obese;
Fig. 1 Mortality Trends of Selected Non-communicable Diseases,
• 7.1 million people die as a result of raised blood 1990-2003, Philippines.
pressure; and

• 4.4 million people die as a result of raised total
cholesterol levels.

According to the WHO report entitled Preventing
Chronic Diseases: A Vital Investment, countries can incur
national income losses as a result of the impact of deaths
from NCDs on the labor supply and savings. The
following data shows that the estimated loss in 2005 for
China was 18.3 billion, 11.0 billion for the Russian
Federation and 9 Billion for India. According to the
report, these losses accrue over time because each year
more people die. Estimates for 2015 for the same countries
Source: DOH, 1990-2003.
are between approximately three and six times those of
2005. The cumulative and average losses are higher in
the larger countries like China, India and the Russian
Federation, and are as high as 558 billion international
dollars in China.3

al (2006) summarized the changes in function.g.6 hand. Adult incidence of diabetes from 1998 to 2007 is likewise alarming at 8. and diet. health professionals and various organizations — a disquieting threat to the health of Fig. political and environmental climate.1 shows the unabated Alarmingly. diabetes. and urban physical infrastructure are needed to support Source: FNRI. 2003. because their rates have historically 4. indoor and outdoor air pollution). Hypercholesterolemia 8. system. diabetes prevalence has Heredity increased significantly over the years to 20. Philippines The causes of this growing trend are attributed to the changing socioeconomic. cancer. FNRI NNHeS. 2 Trends in Overweight among Children 0-10 years.5%. lifestyle and diet and its health benefits through the analysis predispose individuals to major NCDs – cardiovascular of NCD-related epidemiologic studies (Table 3). current prevalence of tobacco use. 5 their effects on health. Obesity 4. avoidance of smoking can result to a decrease in the risk of having cardiovascular disease. Three of these diseases are in showed that although awareness of risk factors is very high the top 5 positions (diseases of the heart and the vascular among Filipinos. Physical inactivity 60. health facilities. 2003 and encourage these changes. As shown below. DOH.9 require changes in behaviors related to smoking. Filipinos! 1993-2005. According to the 2003 NNHeS. Causes of Chronic diseases UNDERLYING COMMON MODIFIABLE INTERMEDIATE RISK MAIN CHRONIC SOCIOECONOMIC. and many cancers in high-income populations (Willett 2002). an outcome 3. 90% of Filipinos has one cataract and sexual dysfunctions. Morbidity trends in 2003. These intermediate risk factors. obesity and impaired lung Willet. unhealthy diets.8 . Fig. These diseases make up 40% of all alcohol drinking and physical inactivity are moderately Filipino deaths. heart diseases. leading causes of illness. and 3) preventing these diseases will 6.5% diabetes. 1.5% that is not surprising. raised blood glucose. stroke. Koplan et. Globalization and urbanization serve as conduits for the promotion of unhealthy habits and behaviors (e.7 These risk factors give rise to intermediate risk factors such as raised blood pressure. promotive and curative interventions implemented by the 2).06% among Filipino adults at present.6% activity. cancers). dental disease. This disease (heart disease and stroke). showed that hypertension and heart diseases are These risk factors are not only prevalent among adults.8% without drugs or expensive medical facilities.g.2 HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) In the Philippines. on the other high and intake of fruits and vegetable is relatively low. tobacco and alcohol use. Overweight 20% medical facilities. Diabetes 4. Hypertension 22.2003 Urbanization NON-MODIFIABLE Overweight/obesity Chronic Respiratory Population ageing RISK FACTOR Diseases Age Diabetes Following the same trend. in turn. physical 7.5 been extremely low in developing countries with few 5. Their analysis led to the following conclusions: 1) reducing identified. Smoking 34. or more of these seven prevalent risk factors: Table 2 Prevalent Risk Factors. food policies. younger children are already showing the increase of NCD mortalities in spite of preventive. RISK FACTORS FACTORS DI SEASES CULTURAL. cancer. and physical inactivity) and environmental changes (e. chronic review showed the possible relatedness of risk factors and respiratory disease and diabetes. propensity of becoming overweight at an early age (Fig.POLITICAL AND ENVIRONMENTAL Unhealthy diet Raised blood pressure Heart Disease DETERM INANTS Physical inactivity raised blood glucose Stroke Globalization Tobacco use Abnormal blood lipids Cancer Source: FNRI. unhealthy lipid profiles. 2) low rates of these diseases can be attained 2. diabetes and COPD are 5 of the 10 leading causes risk factors for lifestyle related diseases in the Philippines of deaths in the country. modifiable dietary and lifestyle risk factors Prevalent Risk Factors Rate could prevent most cases of coronary artery disease. cancers. vascular Local studies conducted to investigate the prevalence of diseases. investments in education. cultural.

This then leads 1. interrelatedness of chronic diseases and poverty. It also shows that the 4.9 Investments in NCD prevention and control programs are essential. in Policy Development in Support of an Integrated Non-communicable Disease Prevention and Control Program in the Philippines Project. A study on costs. Global and National Integrated Frameworks to curb the growing NCD epidemic Source: Disease Control Priorities in Developing Countries. much more in low and middle income countries. Not surprisingly among diabetics. The following figure explains that poor people are more Box 1. p. The goal was to support Member States in their The WHO report entitled Preventing Chronic Diseases: efforts to reduce the toll of morbidity. Social health insurance covers 79% of those in the formal sector. 2005 . lesser access to good and quality care and poorer chances in preventing 2. to the and Lifestyle Factors and Chronic Diseases detriment of the poor. 834 The World Health Organization (WHO) highlighted the need for integration in the mid 1980’s. Source: Howard Research and Instructional Systems Inc. Such is vital to note in designing policies and programs for NCDs. It recurs and needs to be halted as it can result to more deaths and deeper poverty 5. manner. Improved productivity and efficiency (e. have lesser choices to pursue a healthier lifestyle and have higher levels of risky behaviors. 2006.g. Ease of implementation at the point of first contact with the patient sick of chronic diseases. Median daily cost of maintenance medicines is PHP 25/day. relationship of NCDs and poverty as demonstrated by reduced duplication of services) the factors is more than linear. Cost savings resulting from training one multi-purpose worker vs.580. Improved user satisfaction and convenience (via the opportunity for more personalized consultations and records) 7. but lowest at 15% among the informal sector. The discussions above showed that both several single purpose workers the obese people in developed countries and the impoverished in developing countries are at risk to get 3. availability. to hamper the increasing chronic disease trends and reduce poverty. and 40% maintain regular laboratory tests.14) was adopted. taking action both against actual diseases and against their underlying causes and encouraging more community participation and self care 6. Medicines too in general are more expensive compared with other Asian countries. only 69% are able to sustain regular consultations. the Global Strategy for the Prevention and Control of NCDs (WHA53. non-government and private providers). Cost-effective health services to increased risk to disease. During the 53rd Poverty and Non-Communicable Diseases World Health Assembly in 2000. complications. 76% maintain regular medication. HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) 3 Table 3 Convncing and Probable Relationships between Dietary The cost of care for chronic diseases is often high. Improved equity (redistributing responsibilities for health care for specific groups among public. second edition. disability and A Vital Investment (2006) documented the premature mortality related to NCDs. Improved health status by addressing health problems in a holistic situations. and affordability of diabetes care in the Philippines indicate that the median out-of-pocket expenditures for out-patient care is PhP 687 and hospitalization is PhP 8. Advantages of Implementing an Integrated Approach susceptible to chronic diseases because they are materially in Health Services Delivery deprived. Better use of staff time.

safe and healthy food for all Filipinos by the NEDA. Prevention and Control Program The Integrated NCD Prevention and Control Program A. GOVERNANCE (INCDPCP) of the Department of Health commenced with the formulation of the Framework for the Integrated Linkages and Partnerships Community-Based NCDPCP in 2000. there is a need proportion of NCD cases given appropriate treatment and to expand partnerships to other sectors. it involves the early education INCDPCP challenges are categorized according to this interventions by the DepED. The vision of the INCDPC Program is to improve the quality of life of all A core national coalition of stakeholders mostly Filipinos. such as health centers. analysis of rural and urban area transitions and its effect on food availability by LGUs and DA. In F1. The report put forth that the approach . more equitable health care financing. healthier food and drinks through research by the FNRI. The INCDPCP and other programs of the DOH is guided the trend towards addressing the NCD issues involves by FOURmula One for Health (F1). focusing on the aspects of GOVERNANCE. · Focuses on common risk factors cutting across specific diseases guided by a life course perspective. discovery of new mechanisms to deliver CARE FINANCING. funding. Integration is an act of combining parts into an integral whole thus uniting several components that are typically · Encompasses the three levels of disease prevention: regarded as separate. The intergovernmental approach to NCDs was promoted by Tiglao in 2001 in her study entitled Evaluation of the DOH Programs on the Prevention and Control of Lifestyle Diseases. Apart from the integration of primary. To population to risks related to NCDs such as smoking. care. The adoption of the integrated and comprehensive including the private sector. schools. The following To meet this objective. 10 · Make explicit links to other government programs. 4 HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) 4 Continuous emphasis on the need to address the Challenges to the Sustainable increasing NCD problems worldwide led to the creation and endorsement of the action plan for the prevention Implementation of the Integrated and control of non-communicable diseases during the Non-communicable Disease Sixty First World Health Assembly (2008). interventions are to achieve better health outcomes. This is the numerous stakeholders thereby needing integrated Department of Health’s current framework in the strategies to tackle them. the concept of integration is also about the active involvement of key organizations within · Emphasizes strategies which would benefit entire a network that plans. Globally. stipulation of food and nutrition labeling and standards SERVICE DELIVERY. health and community concerns due to the multi- sectoral nature of issues related to NCDs. Its objectives are to reduce the exposure of from the health sector is currently in place. implementation of critical health interventions. more fully and effectively address the social and unhealthy diet. REGULATION and HEALTH by the DTI. well- being and quality of life”. The Canada Health Transition Fund expresses this aptly as a “coordinated network of · Integrate across settings. and the over-all planning to ensure available. community based organizations. implements and delivers to pursue population or large sections of the population a unified endpoint. regulation of fast food and framework. stakeholders involved in the organization. adequate. physical inactivity and to increase the economic determinants of NCDs. This multi-sectoral nature can be demonstrated by the obtain a more res ponsive he alth system and a need to increase the access of Filipinos to healthier food. secondary and tertiary level program components. workplaces and communities delivery and governance of services to support health. This will help approach: harmonize national efforts to prevent and control NCDs. and emphasizes The problems caused by NCDs are perceived as both inter-sectoral action.

This way. 2001 A br oad er n etw or k o f gov er nm ent a nd • Demonstration Project: Integrated Community-Based NCDPC in Pateros and Guimaras. sector.r ela te d i ss ues is v ita l to 2002 co mp lem en t t he ef fo rts o f t he DO H and t he Philippine Coalition for the Prevention of Non. nongovernmental agencies with national mandates to a ddr es s N CD. The indicators and targets were based on the consensus forged among the • The Degenerative Disease Office consisting of two divisions was stakeholders and were benchmarked against the National mandated to manage the NCDPCPs under the National Center for Disease Prevention and Control. Continuous advocacy on the integrated approach will expand • Pilot Study on Breast Cancer Intervention Study in Pateros and Pilot Study in Guimaras the community-based CRD Program initiated inter-agency and inter-sectoral collaboration. tobacco use and unhealthy diet Co mmu ni cab le Di sea ses (PCP NCD ). menu options to the public 2005 The different experiences in addressing the NCD problem throughout the world is expanding. 2000 To date and partnering with the DOH is the Philippine • DOH commissioned: External evaluation study to assess the effects of Coalition for the Prevention of Non-Communicable the existing programs as basis for integration. diversifying and • Training of national government agencies on HL (DILG. evolving. DSWD.) shown by the program milestones (Box 2) . Such is also reflected in the INCDPCP. • The Healthy Lifestyle approach: recognition of 3 major risk factors: physical inactivity. There is an urgent need to enhance awareness among the health workforce • The Philippine Coalition for the Prevention of Non-Communicable and convince more stakeholders. • The demonstration project in Guimaras and Pateros was assessed and results show very promising results Various community models and best practices have been 2006 shared and disseminated among partners. As DOT. Government leadership and commitment shall remain at the forefront to 2003 coordinate multi-sectoral efforts in addressing the problems related to NCDs. With the DOH at the core. • 3rd Public Health Convention on NCD Prevention and Control . The collaboration between the DOH and the PCPNCD resulted in outputs such as the creation of the • The Training Module for Health Service Providers on the Integrated NCDPCP developed NCD Key Performance Indicators. strengthened and expanded • DOH in partnership with Philippine Heart Association staged a national partnerships advocate the whole-of-government and advocacy program on the prevention and control of cardiovascular and other chronic diseases whole-of-society approaches. DepED. progress over • A Policy Development Study completed identifying policy agenda in the recent years has yielded notable lessons which have support to the integrated NCDPC Program provided impetus for the further development of the INCDPCP in collaboration with its partners. on the cost- • Scanning of NCD-related laws and policies effectiveness of this approach. HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) 5 to an integrated program on lifestyle diseases should be Box 2. Nutrition and Health Survey and Philippines Global Youth Tobacco Survey results. Diseases (PCPNCD). multi- sectoral synergy will be realized towards • DOH initiated talks with commercial food establishments to offer healthier achieving global and national goals on NCDs. etc. INCDPCP Milestones holistic and must be complemented by a network of agencies from different sectors – public and private. It is composed of 44 agencies/ • Formulated the Framework for the Integrated Community-Based organizations and NGOs that are largely from the private NCDPCP. including Diseases established those from the other sectors. • Launching of the “Mag HL Tayo Campaign” • Nationwide training of Regional NCDPC Coordinators and Training staff/ Policy Advocacy HEPOs on the promotion of HL • Passing of the Anti-Tobacco Law The health sector has adopted the integrated and comprehensive approach towards prevention 2004 and control of NCDs.

Health services and products addressing NCD needs are generally available at the field level. . but this is not aggregated at the national mechanism and a good referral system are critical in the level to provide information for use in program delivery of services. is true even for DOH-run hospitals that have established Referral systems will also have to be enhanced to more their own information systems. At present. The same implemented and monitored at all levels of care. INCDPCP Milestones collaboration with private organizations/ institutions that help fund the system. Similarly. 2008 Data generated from national population-based surveys. e. the continuity of care so that the lifestyle improvements realized by the individual clients are further enhanced Hospitals also collect data on diseases encountered. SERVICE DELIVERY relevant data for continuing policy enhancement and program response. logistics (drugs/medicines/supplies). etc are done by different • The DOH-NCDPC adaptation of the WHO Preventing Chronic Diseases: professional organizations in selected facilities but A Framework for Action for the Philippines collected data remains untapped and not linked to DOH. The INCDPCP recently stipulated the guidelines for the overall delivery of NCD prevention and control services The Field Health Service Information System (FHSIS). disseminate. There is currently no mechanism that allows hospitals to process The NCD package of services needs to be adopted. The main source of NCD mortality and morbidity data is especially at the public health facilities. equipment. The Philippine Health local government resources and priorities. and sustained. it is important to ensure the country. secondary and tertiary which monitors implementation of DOH programs. at various levels of care – primary. physical notably cancers. Monitoring and Surveillance There is a need to invest on health information systems that covers and tracks trends and program performance Surveillance System for non-communicable on NCDs. cancer data is collected 2007 only in Metro Manila and extrapolated to come up with • Post NCD survey in Guimaras and Pateros national estimates. Other chronic diseases registries. However. vital health data and link these with the DOH.6 HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) Functional cancer registries are maintained in Box 2. Wider Statistics derive data from death registries nationwide and access and availability should be advocated and has tracked over the years the continuing dominance of ensured. The of consultations done at the RHU level. diseases and risk factors is available but and utilize available data should be continued. diabetes registry. efforts to harmonize. noncommunicable diseases among the leading causes of mortality in the country. forms for recording the services.11 effectively prevent and manage NCDs. particularly at the level of communities. currently limited. care.g. monitoring. The data more accurately refers to number packages necessary to implement the services. set-up. but can guideline underscores that in the delivery of the NCD nonetheless provide an estimate of the NCD burden in prevention and control services. and intervention and diabetes. stroke registry. There is a need to enhance information systems to generate timely and B. but widely from the Philippine Health Statistics. implementation. • 4 Public Health Convention on NCD Prevention and Control th such as the National Nutrition and Health Survey (NNHeS) and the Global Youth Tobacco Survey (GYTS) • Finalization of manual of operations for community-based NCD prevention serve as management benchmarks for most NCD-related and control initiatives. and evaluation. Establishing a monitoring and feedback including NCDs. The requirements set by the guidelines include includes reporting for cases of hypertension and heart the type or category of personnel and their competencies. these surveys require huge resources and thus are done only every 3-5 years. national prevalence perceived to be at varying levels depending of surveys. disease and excludes other noncommunicable diseases. chronic obstructive pulmonary disease. and cancer registry.

There is a need to enhance and ill-health. There need to come up with additional regulatory is a need to put in place mechanisms to protect mechanism to support and strengthen current individuals and families from financial difficulties initiatives on NCD prevention and control. part of hypertensive disease. to be supplemented by a sustained mass Heart Failure $34. WHO recommends a salt * Totals do not add up because of rounding and overlap. and catastrophe in dealing with NCDs.8 media campaign aimed to encourage dietary change within household and communities.S for 2008 is projected to be more than $488 billion.4 salt content of processed foods and condiments by manufacturers.12 † Includes coronary heart disease. .4 reduction (of 2-4. Similarly. In a developed country like the U. Republic Act 9211. 200814 purchasing healthy food products. cardiac dysrhythmias. pulmonary heart disease.13 disclosure of the contents of food products. Many are often not able to continue ensure efficient implementation of these policy with treatment and care. rheumatic heart disease. United States. contributing to the instruments already in place. which can be complemented by information dissemination Table 4 Estimated Direct and Indirect Costs of Major activities to influence consumer behavior in selecting and Cardiovascular Diseases and Stroke*. heart implementation however remains to be a major concern.6 g/d) in salt consumption has been shown to reduce absolute systolic blood pressure.. HEALTH CARE FINANCING Some policies and legislations are already in NCDs often result to catastrophic expenditures. Stroke $65. cardiomyopathy.S. place to facilitate implementation of relevant plunging many families deeper into poverty and interventions. This amount includes health care The Bureau of Food and Drugs (BFAD) play an important expenditures and productivity losses due to death and role in ensuring the availability of safe and nutritious food disability. is leading the way to ensure diseases are significant in both developing and developed supportive environment for healthy lifestyle. congestive heart failure. The cost of heart disease local government units to implement said law. Cardiovascular Diseases In Billions BFAD can likewise liaise with agencies like the National Heart Diseases† $287. REGULATION D. Heart Disease and Stroke Statistics—2008 Update. and stroke in the U. and other or ill-defined “heart” diseases.3 Nutrition Council to put in place policies that encourage reduced salt consumption in the population. Source: American Heart Association. HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) 7 C. diseases and stroke are the topmost (1st and 3rd) causes of faced with the massive marketing strategy of tobacco mortality for both men and women as these comprise companies and the need for continued advocacy among more than 35% of all mortalities. otherwise known as the Tobacco The health care costs related to non-communicable Regulation Act of 2003. Critical and basic is the p ro pe r stroke is projected to increase in the U. The economic impact of heart disease and to the public. Its effective countries.S.5 Reduction can be achieved by voluntary reduction in the Hypertensive Disease $69. due to its aging im pl eme nta ti on of nu tri ti on la bel ing a nd population. Moderate Coronary Heart Disease $156. there is a growing burden of diseases due to NCDs. intake of no more than 5g/dl.

026 2.271 (6. a recent study on the Economic HMOs 7. the National 26.1 direct cost of diabetes to the health care sector is about US$ 16. plans 5.019 28. This was their response when asked about the reasons for not taking blood pressure drugs every day or for taking less than the recommended.6%. Private sources accounted for more Source: PNHA. This is primarily due to the cost of complications but includes the ongoing requirement PhilHealth for medications.7%) and social insurance (9.295 180.792 51.5) pocket medical costs of treating major diseases attributable to smoking amounted to 9. 11%) expenditures. The results showed that 67-92% of the respondents from NCR. because data on costs of NCD treatment and out-of-pocket expenditures are not readily All Sources 165.9%) (48. Non-communicable diseases can (58. PNHA. Of (PhilHealth and Employees’ Compensation) expenditure this.17 To have a clearer picture of the economic impact of these diseases on families in Private Insurance 4. 2005 than 50% of all sources.4% was allocated on drugs and medicines. 200519 developed countries within the Western Pacific Region.935 19.616 106.2 compared with US$ 550 million in 1990. Region IV-A.8 HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) On the other hand.7%0 2.4%) 12. It on Health (2000) reported that of the total expenditures. For Australia. laboratory assessments. As shown OOP increased in 2005 (46. 75% of diabetes cases and 90% of cancer cases are diagnosed in Private Sources 96.772 23. On specific health expenditures.344 6.6%) (11%) 24.18 Others 1.848 developing countries. Further. also demonstrated that though the rate of Social insurance 1. 15 According to the Western Pacific Declaration on Diabetes (2001) people with diabetes Social Insurance 15. In Japan.9 people without diabetes.082 * Burden of Smoking-Related Disease in Thailand by Employer based Leartsakulpanitch et al (2007) estimated the direct out-of.1% private out-of-pocket expenditures over all types of fund sources for health.084 4.481 19. the Family Expenditure 28. and (Medicare) 15. supplies.7%. 20 increased.4 the developing region.857.6 therefore contribute to the Region’s burden of poverty due to high out-of pocket expenditures.02 million baht.903 5.4%) and is higher than government (30.755 (2.079 7.5 GDP in 2006. Further. retard national Out of Pocket 77. in 2006 on hypertension and the compliance to medications of PhilHealth members and dependents point to indications of difficulties faced by the members and dependents with hypertension.922 720 million was spent on diabetes health care in 1995 (30. 0.772 9.21 .9 and across countries.158 6.4 available. VII and X think that the medicines for hypertension cost too much.953 2.48% of Private Schools 2.7%) (28.9% or 35 billion pesos were spent on medical care. Sources Amount in Million Growth like Australia and Japan have estimated that about 5-10% of Funds Pesos rate(%) of the total health care can be attributed to the care of 2004 2005 diabetes and its complications. at least US$ Government 50.4%) (59. 46.524 87.16 Employees’ Compensation 454 646 42.1) budget in 1998. a more current study conducted by PhilHealth pocket expenditures in 2005. the cost of having diabetes in Table 4 Sources of Funds for Health.94 billion and accounted for 6% of total health Local 24.102 In the Philippines.1%) 10.899 consume a greater proportion of health care costs than (9.651 10. 50-83% of the respondents cited financial reasons as the cause for missing or taking less blood pressure drugs than the prescribed amount.253 24. the National Health Accounts (2005) is presented as substitute to show the dominance and utilization of / Revised *less than 0.9% to 48. it was still not enough to lower private out-of.4 It is likewise noteworthy that in the Region.508 development and can widen the health inequities within (46.4 relatively frequent visits to health professionals.

Enhancing referral systems will also provide for the continuity of interventions along the spectrum of non- communicable diseases. mechanisms such as funding. support value and to improve the coverage of the all approach towards the integrated prevention and indigents and those in the informal economy. • Health promotion and advocacy are cross-cutting Ou t. resource allocation. Way Forward • Improve social health protection though the The following recommendations aim to improve health enhancement PhilHealth’s benefit package to cover outcomes and access of Filipinos to relevant health lifestyle diseases. Different financing Such circumstances can further plunge families. Only direction will give way to organizational and technical 26% answered they were prepared for future acute care quality and expand the social accountability of various with their own money or private insurance. To improve the over. of the INCDPCP and its partners. efforts to disseminate and utilize economically disadvantaged families are more at risk of data for policy enhancement and program getting sick.22 • Improve the surveillance system on NCDs. stakeholders and sectors to address the NCD related Philhealth coverage was lowest among the informal sector problems. Similarly. into cycles of ill. Effective access their incidence and prevalence and. As seen. there is a need and social responsibility are the principles upheld in to: pursuing this recommendation. availability and affordability of • Strengthen linkages with relevant government and non- diabetes care in the Philippines revealed that nearly three. . macro level expenditures related to NCDs Information systems at the level of public health ar e dev as tat in g f or de vel op ed an d d ev elo pi ng facilities and hospitals should be established and economies. and borrowed money or pawned assets. Sixty seven percent (67%) experienced of the Philippine Coalition for the Prevention of shortage of money because of diabetes-related Non-Communicable Diseases (PCPNCD). to mention the medicines that need to be taken co nt inu ou sly a nd ho spi ta lizat ion a nd • Ensure sustainable financing to support the initiatives rehabilitation events that should be attended to. This condition is multiplied many times linked to the DOH for harmonized national data on over at the micro level especially because socio. government agencies to improve their regard of the fourths of the respondents answered that they had given problem. In the study. especially those who are poor. Local Social health protection mechanisms primarily through governments should be encouraged to increased their PhilHealth and social safety nets play very vital roles in resources and investments for NCD prevention and ensuring Filipinos’ financial protection and access control. support implementation of NCD prevention and control policies. to increase support for NCD prevention up diabetes care because of financial difficulties at one and control and to complement the existing efforts time in the past. contracting and reimbursement can be utilized to health. have less access to good quality care and they management should be continually pursued. commonly have to pay out-of-pocket for health expenses.po cke t exp en dit ur es re lat ed to t he interventions that the broad network of stakeholders treatment of non-communicable diseases can be can collaboratively engage in as part of social catastrophic as NCDs are chronic in nature and responsibility. not as support to other interventions to change behavior. This will ensure access and availability of relevant services and products in the communities and among affected and vulnerable populations. Such should be consistently provided require long-term and expensive treatment. Explore control of selected lifestyle diseases thereby lowering social safety nets to address NCDs. HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) 9 A study on the costs. to increase the benefit package’s services and financial protection. affordability and availability of quality NCD health care services to Filipinos. . Sustained financing will contribute to the to quality health care in times of ill-health. plans and programs. at 15%. NCDs.of. poverty and social exclusion. This expenditure. • Operationalize and promote integrated approach to NCD prevention and control at the local level.

medassocthai.cdc.html > development and relevance of services. 59-69) ment (Geneva: WHO. Lagrada/ Production Staff: Angel Santiago. 90 (9): 1925-9.. Global Strategy for the Prevention and Control of Non-communicable Diseases. Rose G. Enrique A. 2008. fruits. Rosette S. However. October 20. Dir. Daida Mendoza. To further fill in program data needs.html> the R&D agenda can comprise joint evaluation 16 Ibid. August 5. The Economic Burden of Smoking-Related Disease in Thailand: A Prevalence-Based Analysis. et al. Tayag/ Technical Consultants: Dr. 10 Howard Research and Instructional Systems Inc.. Policy Development in Support of an Integrated Non-communicable Disease Prevention and Control Program in the Philip- 2 World Health Organization. October 25. 2008< http://www. DOH and Ms. ber 25.gov/NCCDPHP/publications/AAG/ • To promote technical quality and contribute to policy dhdsp. 2006) References: 22 Higuchi.24 18 Jittrakul Leartsakulpanitch. John Julliard Go/Editorial Staff: Ms. 8 Walter Willet. there is a need to 4 World Health Organization and Tim Evans et al. (Geneva: 2002) 23 Jennifer dela Rosa et al.2008 < http:// www. Declaration on Diabetes.int/rcm/en/rc59/rc_resolutions/WPR_RC59_R5.wpro. Maylene M.Tiglao et. Primary Health Care: 3) Providing subsidies/ tax breaks to encourage Six Dimensions of Inquiry. and the Philippine NGO Council in the development and production of this policy brief.pdf> cited in dela Rosa. Dir. tobacco control and good 17 WHO Western Pacific Region. M. 2006 and milk) 11 Department of Health. Dr. Regional NCD Prevention and Control Frame- nutrition and relevant national policies such as the work. there is a need 14 Ibid. 13 Center for Disease Control.nscb. delivery of services and health care financing thereby 19 National Statistics Coordination Board . External evaluation study of DOH programs on the need support include the prevention and control of lifestyle diseases in the Philippines. Oliveros. 2005 <http://www. CDC March 6. . The policies the 6 Teodora V.Integration. 20 Department of Health. 21 Anita Wagner et al. J.wpro. (Manila: DOH. M. Gonzales. (Manila: 2008) to curb the increasing NCD trends. improve tobacco control. Philippine National Health Accounts.al .dcp2. J Med Assoc Thai 2007. The DOH also likes to acknowledge the support of the World Health Organization. October 23.ph/stats/pnha/2005/ creating a “seamless and smooth system” to achieve sources. February 2008. Health Policy Notes volume 2.ab. Rissa Reyes. Dir. and the legislation of graphic health warnings to 12 The Lancet. 2001.g. Liezel P. DACP and PHIC. UP-NIH. August 2008 4) amendment of the Food Fortification Law. World Health Report 2003.10 HEALTH POLICY NOTES 3:1 (NOVEMBER 2008) • To promote social responsibility. Costs.gov. National Objectives for Health 2005-2010 (Manila: commitment of all public and private stakeholders DOH. This note was prepared by Ms. Policy Development in Support of an Integrated Non-communicable Disease Prevention and Control Program in the Philippines Project. WPRO..who. Beltran. Vergeire. 2008<http://www. researches on the implementation of administrative orders promoting exercise. issue 3. to fulfill the research and development agenda in collaboration with government agencies and private 15 WHO Western Pacific Region. Octo- organizations. WPRO.htm> Food Fortification Act. December 8.who. et al. enhance or change policies NCD Prevention and Control Framework WPR/RC59/6.pdf> NCD prevention and control policies and programs. October 23. 2005) and integrated planning must be set in place before objectives can be fully realized. Precilla Cuevas. 2008 <http://www.org/pubs/DCP> 2) Mandating fast food chains and restaurants to keep public informed of the nutritional value of food 9 Higuchi. September 2008.ca/ about/phc/resource/3.asp> good health outcomes and coverage. Program Manager LRD’s. 2008 <http://www. FM et consumption of health food (e. Dr. Tobacco Control Act and Salt Iodization Act.9_1925_1574. 2008 offerings.2008<http://www. Disease Priorities in Developing Countries: Prevention of Chronic Diseases by Means of Diet and Lifestyle Changes. availability and affordability of diabetes care in the Philippines. et al. Jenny dela Rosa. Addressing Nation’s Killers. Regional There is a need to create. Yolanda E. 2008 1 World Health Organization . Manila Office. The World Bank Group 2006. Lorenzo. availability and affordability of diabetes care in the Philippines. Preventing Chronic Diseases: A Vital Invest. An Outpatient Drug Benefit for PhilHealth Members with Hypertension (Manila: WHO. Dr. 2006. pines Project. 2001) 1) Lowering of saturated fat and lower salt content in 7 Philippine Cardiovascular Outcome Study – Diabetes Mellitus. (Manila: DOH. October 25. (Geneva: 2003) pursue the policy agenda in collaboration with government agencies and private organizations to: 1 5 World Health Organization Regional Office for the Western Pacific. Nita Valeza. WPR/RC59/6. Volume 370.gov.11.et al.org/ • The integrated approach provides for harmonized journal/files/Vol90_No. Ma. 53rd World Health Assembly Provisional Agenda item 12. Costs. Virginia G.health. 52) Editorial Board: Dir.int/wpdd/declaration. Leslie Motin. 2007. Ala. 2008 food offerings especially in fast food chains and restaurants. vegetables al. Soe Nyunt- U.