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4.

03
Violence and Injury Prevention Program

Group 8 October 16, 2015

I.Introduction  With the increasing mortality, morbidity, and disability due to


II.Violence and Injury Prevention (VIP) Program violence and injury, there is a need to complement and
III. VIP Program Strategies enhance the existing policy on Violence and Injury Prevention
IV. Policies in order to rise to the challenge of addressing this rapidly
V. Objectives growing public health concern. It is also imperative to develop
VI. Scope an action framework that serves as the strategic road map
VII. General Guidelines
towards the prevention of violence and injuries.
VIII. Specific Guidelines
IX. Implementing Mechanism
A. Violence and Injury Prevention Program VIOLENCE AND INJURY PREVENTION PROGRAM (VIPP)
B. Program Management Committee The objectives of the VIP Program are the following:
X. Monitoring and Evaluation 1. To reduce the number of deaths from violence and injuries
A. Online National Electronic Injury Surveillance System 2. To reduce disability caused by violence and injury
B. Philippine Network for Injury Data Management 3. To enhance capacity of CHDs and other stakeholders in the
System prevention of violence and injury
XI. Roles and Responsibilities
4. To develop & implement evidence-based policies, standards
and guidelines in the prevention of violence and injury
INTRODUCTION/RATIONALE 5. To strengthen collaboration with stakeholders in the
 2009 (WHO): road crashes, suicide and violence were among prevention violence and injury
the main causes of death worldwide for people aged 10 to 24 6. To ensure reliable, timely, and complete data and
years researches on violence and injury
 2011 (WHO): injuries were responsible for 9% of all deaths 7. To advocate for alternative health financing schemes for
with road traffic injuries claiming nearly 3,500 lives each day, trauma care
making it among the 10 leading causes of mortality globally.
 In 2011, the Violence Prevention Alliance (VPA) developed
the plan of action geared towards increasing the priority of VIP PROGRAM STRATEGIES
evidence-informed violence prevention, building the A. Evidence-Based Research and Electronic Surveillance
foundations for violence prevention, and implementing violence System
prevention strategies. o Multi-disciplinary and multi-sectoral interventions shall be
 United Nations General Assembly proclaimed 2011–2020 to developed based on evidence-based research. DOH shall
be a Decade of Action for Road Safety to stabilize and establish and institutionalize a system of data reporting,
reduce global road traffic fatalities by 2020. recording, collection, management and analysis at the
 2010 (The Global Burden of Diseases, Injuries, and Risk national, regional, and local levels. An information system,
Factors Study): interpersonal violence, road injury, that is, Online National Electronic Injury Surveillance System
drowning, and self-harm (suicide) ranked 6th, 11th, 17th, (ONEISS) and Philippine Network for Injury Data
and 27th, respectively, on the leading causes of premature Management System (PNIDMS), shall be fully
deaths in the Philippines operationalized for this purpose.
 2005-2010: Accidents are the fifth leading cause of mortality
for this period as reported in the Philippine Health Statistics B. Networking and Alliance Building
 2010-2012 (The Online National Electronic Injury Surveillance o DOH shall promote partnerships with and among
System [ONEISS]): stakeholders to build alliance and networks and to generate
o Transport or vehicular crash was the leading cause of resources for activities related to VIPP.
unintentional injuries
o Interpersonal violence (mauling/assault, contact with C. Capacity Building and Community Participation
sharp objects, and gunshot) was the leading cause of o DOH shall develop and enhance the violence and injury
intentional injuries. prevention capabilities of a wide range of sectors and
 DOH: stakeholders at the national, regional and local levels.
o Focal agency with respect to violence and injury
prevention D. Advocacy
o Shall design, coordinate and integrate plans, projects and o DOH shall advocate to LGUs for ordinance development and
activities of various stakeholders into a more effective and lobby to Congress for enactment of laws.
efficient system geared towards violence and injury
prevention E. Equitable Health Financing Package
 The Violence and Injury Prevention Program o DOH, in collaboration with various stakeholders, shall
o Has been institutionalized as one of the programs of the advocate to health financing institutions and financial
Disease Prevention and Control Bureau (DPCB) formerly, intermediaries, i.e. the Philippine Health Insurance
National Center for Disease Prevention and Control Corporation (PHIC) and insurance companies, the
(NCDPC). development and implementation of policies that would be
o The program aims to reduce mortality, morbidity and beneficial for the victims of all forms of violence and injury.
disability due to the following intentional and unintentional
injuries: F. Service Delivery
1. Road traffic injuries o In collaboration with stakeholders, DOH shall institutionalize
2. Interpersonal violence including bullying, torture and systems and procedures for the integration and provision of
violence against women and children services at the community level. In collaboration with various
3. Falls stakeholders, DOH shall undertake advocacy, information
4. Occupational and work-related injuries and education, political support, and multi-sectoral action on
5. Burns and fireworks-related injuries violence and injury prevention. Appropriate interventions at
6. Drowning all levels of prevention shall be crucially provided.
7. Poisoning and drug toxicity
8. Animal bites and stings G. Six (6) E’s.
9. Self-harm / suicide o Strategies shall utilize the concept of the six E’s in the
10. Sports and recreational injuries prevention of violence and injuries. The six E’s are the
 The program is in coordination with the following: Child Injury following:
Prevention Program, Violence Against Women and 1. Education entails wide dissemination of information and
Children Program and other DOH Offices communication related to violence and injury prevention
 In the first quarter of 2013, the Essential Non-Communicable 2. Enactment / Enforcement of laws and policies related
Disease Division (ENCDD), together with the Development to violence and injury prevention
Academy of the Philippines (DAP), developed the 5-year 3. Empowerment of all stakeholders in the
Strategic Plan for 2013-2017. implementation of VIPP. This also covers the provision of

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Violence and Injury Prevention Program (VIPP) 3.03

psychosocial support to the victims of violence and injury time for going to school/work and the time going home
to help them recover from the psychological trauma from school / work respectively
4. Engineering control provides the most effective way of
reducing the cause and impact of violence and injuries.
This involves the improvement of facilities and
infrastructures to promote safe environments
5. Emergency Medical Services prior to hospital care. This
is vital in providing pre-hospital trauma life support to the
injured on site at the soonest possible time so as to
prevent needless mortality or long-term morbidity or
permanent disability
6. Engagement in surveillance and research to promote
evidence-based, substantial, scientific, and systematic
approach to VIPP.

H. Monitoring and Evaluation


o DOH, together with various stakeholders, shall identify
indicators, targets and milestones for program monitoring Figure. Injury cases reported by External Causes of Injury from
and evaluation purposes. There shall be a regular audit and January to March 2015
feedback mechanism of all VIPP-related strategies and
activities.  Pre-admission data
o 83% of all reported cases were injury cases brought to
 According to the factsheet of the Online National Electronic the ER; 16.7% were Out-Patient cases; only 0.3% were
Injury Surveillance System from January-March 2015 in-patient cases.
o NCR has the most number of reporting facilities per square o The most commonly sustained injuries were open-
area (Relative to actual area covered by each region) while wounds, abrasions and contusions.
region 4A has the least  alarming since there is a need o Since majority of the cases were accidental in nature, most
for more reporting facilities in other provinces, especially of the reported cases occurred on the road at 42.4%
the far-flung and hard to reach areas. while 29.1% occurred at their homes.
o Majority of the injury cases have been reported by the  Hospital data
family member of the injured patient which accounts for o Transport and vehicular crash-related cases:
51%. Around 46.4% of the reported cases were consistently the most common cause of injury.
reported by the injured persons themselves. This o Majority of these cases that were brought to the ER were
number is lower than the previous group because other not fatal and improved after treatment and were
injuries are too severe and leave the patient debilitated discharged (82.2%).
which then entail the family members to be the ones to
report the injury case.
o Males (69.5%) are more exposed to injury than females
(30.5%) from birth up to the age of 65. This may be
because males are generally more active in work and play
than females which make them more prone to injury.
o However, for the age group above 65 years old, more
females were injured than males.

Figure. Injury cases reported by Type of Injury


from January to March 2015

 Vehicular accidents
o More males (71.9%) were involved than females
(28.1%), disproving the myth that men are better drivers
than women. This is could be attributed to the drink-and-
drive attitude of men and their generally more aggressive
driving.
o Majority of the reported vehicular related injuries were
Figure. Injury cases reported by Age from Jan to March 2015 from the 20–59 age group (52.9%) mainly because
they are the ones who drive.
 Majority of the total reported injury cases (56%) came from o As for the 0 – 19 age group, they account for 28.5%
the age group of 20 – 59. This could be because this is the and could be attributed to their careless behavior as
age group that are mainly engaged in occupational hazards and pedestrians, especially younger children.
vehicular accidents, being active in their everyday life. o Alcohol intoxication: major cause of risk factor for
 Age group of 0 – 19 years old accounted for 36.7% of the vehicular accident-related injuries
total reported injury cases which could imply that there are a o Motorcycles: The most common mode of transport in
number of accidents involving younger children. These may these injuries (56%)
include cases of child abuse, unsuspecting vehicular accidents o Alarmingly, only 2.5% of these cases were wearing
or even bullying. protective helmet. Additionally, only 4.4% of the
 January had the highest reported number of injury cases reported car accident cases were wearing seatbelt at the
(37.4%) of all cases mainly because of fireworks-related cases. time of incident. This implies the need for proper education
 When it comes to time of occurrence, it varies with the external of motorists and drivers alike for the importance of
cause of injury. The most common causes of reported injuries precautionary measures while driving.
and their time of occurrence are the ff:
o Fall-related injuries  8:00–11:59 am POLICIES
o Assault and sharp object-related: 8:00–11:59 pm The issuance on Violence and Injury Prevention shall be guided
(could be attributed to more violence occurring during by the following policy statements:
night time) 1. The 1987 Philippine Constitution on Article II Section
o Vehicular accident-related injuries: 8:00–11:59 am & 15 states the right of the people to health protection and
4:00–7:59 pm, attributed to the rush hours during the promotion. Article 13 Section 11, on the other hand, states

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Violence and Injury Prevention Program (VIPP) 3.03

the availability to the people of all essential goods, health and SCOPE
social services at affordable cost. This administrative order provides the action framework for the
2. The Aquino Health Agenda (AHA), through the the so-called effective implementation of Violence and Injury Prevention
Kalusugan Pangkalahatan (KP), aims to achieve universal Program in the Philippines. It covers all units and
health care for all Filipinos. The National Objectives for instrumentalities including attached agencies of the DOH. It also
Health (NOH) 2011-2016 aims to reduce morbidity and applies to all concerned national government agencies (NGAs),
mortality from accidents and injuries. local government units (LGUs), academe, civil society
3. Culture of safety shall be the essence of Violence and Injury organizations, faith-based organizations, community-based
Prevention Program organizations, private sectors, and other relevant multi-sectoral
4. The integrated, comprehensive, and sustainable multi- stakeholders.
sectoral approach to prevent violence and injury shall be
developed at the grassroots level in close collaboration with GENERAL GUIDELINES
committed multi-stakeholders. A. Evidence-based Research and Electronic Surveillance
5. Highly effective and sustainable strategies shall be developed System
to effect changes that would lead to a significant reduction in o Multi-disciplinary and multi-sectoral interventions shall be
mortality, morbidity and disability from violence and injuries. developed based on evidence-based research. DOH shall
6. Establishing an emergency medical service system at the establish and institutionalize a system of data reporting,
prehospital and hospital levels and ensuring the development recording, collection, management and analysis at the
of a sustainable mental health care after trauma-related national, regional, and local levels. An information system:
emergencies are of paramount significance to VIPP. Online National Electronic Injury Surveillance System
(ONEISS) and Philippine Network for Injury Data
OBJECTIVES Management System (PNIDMS) shall be fully
General Objective: To reduce mortality, morbidity, and operationalized for this purpose
disability due to violence and injuries.
Specific Objectives: B. Networking and Alliance Building
1. Promote a culture of safety in key settings such as home, o DOH shall promote partnerships with and among
schools, workplaces, and communities; stakeholders to build alliance and networks and to
2. Enhance the capacity of Regional Offices, Local Government generate resources for activities related to VIPP.
Units (LGUs), and other stakeholders as well as strengthen
collaboration with them in the prevention of violence and C. Capacity Building and Community Participation
injury o DOH shall develop and enhance the violence and injury
3. Develop and implement evidence-based policies, standards prevention capabilities of a wide range of sectors and
and guidelines stakeholders at the national, regional and local levels.
4. Ensure reliable, timely, and complete data and researches
related to violence and injury prevention D. Advocacy
o DOH shall advocate to LGUs for ordinance development
NATIONAL OBJECTIVES OF HEALTH FOR ACCIDENTS and lobby to Congress for enactment of laws.
AND INJURIES
OBJECTIVE 1: E. Equitable Health Financing Package
Mortality secondary to accidents and injuries is reduced. o DOH, in collaboration with various stakeholders, shall
Indicator Target Baseline advocate to health financing institutions and financial
Mortality rate from intermediaries, i.e. the Philippine Health Insurance
accidents and 35 deaths by 39.1 Corporation (PHIC) and insurance companies, the
injuries per 2016 (2011) development and implementation of policies that would be
100,000 population beneficial for the victims of all forms of violence and injury.
Mortality rate from
transport accidents 17.5 deaths 21.1 F. Service Delivery
per 100,000 By 2016 (2011) o In collaboration with stakeholders, DOH shall
population institutionalize systems and procedures for the integration
and provision of services at the community level. In
OBJECTIVE 2: collaboration with various stakeholders, DOH shall
Database for accidents and injuries is established. undertake advocacy, information and education, political
Indicator Target Baseline support, and multi-sectoral action on violence and injury
National Database prevention shall be crucially provided.
Database
for Specific
established by None G. Six (6) E’s.
Accidents and
2010 o Strategies shall utilize the concept of the six E’s in the
Injuries
prevention of violence and injuries.
a. Education entails wide dissemination of information
RISK REDUCTION OBJECTIVES
and communication related to violence and injury
1. Increase the use of safety belts among motor vehicle
prevention
occupants by at least 75%
b. Enactment / Enforcement of laws and policies
2. Increase the use of helmets among motorcyclists by at least
related to violence and injury prevention
50%
c. Empowerment of all stakeholders in the
3. Encourage the use of protective gears among cyclists and
implementation of VIPP. This also covers the
skaters by at least 50%
provision of psychosocial support to the victims of
4. Reduce the use of firecrackers during festivities by at least
violence and injury to help them recover from the
50%
psychological trauma
5. Increase the level of awareness on common causes and
d. Engineering control provides the most effective way
preventive measures of accidents and suffocation or foreign
of reducing the cause and impact of violence and
bodies
injuries. This also involves the improvement of
facilities and infrastructures to promote safe
SERVICES AND PROTECTION OBJECTIVES
environments
1. Increase the number of regional hospitals and medical centers e. Emergency Medical Services prior to hospital
with Burn and Trauma Unit. care. This is vital in providing pre-hospital trauma life
2. Develop and institutionalize the Injury Prevention and Control support to the injured on site at the soonest possible
program and surveillance network in all regional and time so as to prevent needless mortality or long-term
provincial health facilities. morbidity or permanent disability
3. Develop and disseminate information campaign materials on f. Engagement in surveillance and research to
injury prevention and control. promote evidence-based, substantial, scientific, and
4. Increase the number of surgeons in regional hospitals and systematic approach to VIPP.
medical centers trained on burn and trauma management
5. Increase the number of regional health personnel trained on H. Monitoring and Evaluation
the epidemiology, prevention and control of accidents and o DOH, together with various stakeholders, shall identify
injuries indicators, targets and milestones for program monitoring

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Violence and Injury Prevention Program (VIPP) 3.03

and evaluation purposes. There shall be a regular audit o Interpersonal Violence-Related Injuries including
and feedback mechanism of all VIPP-related strategies and Violence Against Women and Children (VAWC),
activities Bullying and Torture
o Animal Bites and Stings
SPECIFIC GUIDELINES o Self-Harm/ Suicide
A. Public policies shall be developed and will include legislation, o Occupational and Work-Rekated Injuries
administrative issuances, fiscal measures and organizational o Poisoning and Drug Toxicity
constitution and bylaws that would effect changes towards 3. To ensure a more comprehensive and integrated approach,
creating safe environments and promoting safety-first PMC shall collaborate with other programs from the Family
mentality and behavior. Supportive environments for the Health Office and other concerned offices
actual implementation of those public policies and the 4. The Undersecretary/ Assistant Secretary of Health who
provision of infrastructure where safety is the primary concern has the direct supervision over the Degenerative Disease
shall be made available. Safety-first behaviors are also Office shall designate a National Program Coordinator
encouraged and promoted at all ages. who shall be working together with the National Focal
B. Community-based interventions to be implemented shall Person (Program Manager)
not be limited to capacity-building at the grassroots level that
would make available well-trained, competent and gender- PROGRAM MANAGEMENT COMMITTEE
sensitive first responders. Interventions shall also include the  Provide direction and technical support on policies and plans
provision of community-based mental health, rehabilitative pertaining to the prevention of violence and injury
and palliative care. The pre-hospital care or pre-hospital  Provide the forum for coordinating all aspects of the
trauma life support shall ensure the availability and implementation of the program
accessibility of well-trained and competent first responders  Chaired by the Director IV of the Disease Prevention and
and/or emergency medical technicians in times of trauma- Control Bureau (DPCB) with the following members:
related emergencies. o Chief of the Essential Non-Communicable Disease Division
C. Hospital Care Rehabilitation shall include preventing o National Focal Person (Program Manager) of VIPP
further the complications of those trauma-related o Representatives from CHED, DepEd, DOTC, DPWH, DOLE,
emergencies and to lessen the burden of disability due to DSWD, DILG, MMDA, and Philippine National Police.
violence and injury. o Representatives from specialty societies and other agencies
D. Advocacy activities shall include information drive, education / organizations which can greatly contribute to the various
and communication campaign geared towards promotion of aspects of violence and injury prevention.
safety and hence, prevention of injuries.  Subdivided into sub-committees to undertake more specific
E. All stakeholders shall be enjoined and encouraged to policy interventions and activities in relation to each area of
participate in the surveillance system and to contribute to concern. Each sub-committee shall have an inter-disciplinary
the research agenda to further the strategies in composition.
implementing the VIPP.  PMC Functions:
F. The formation of the Violence and Injury Prevention o Recommend to the Secretary of Health VIPP-related plans,
Alliance (VIPA) shall make more stakeholders involved in programs, strategies and activities
the promotion of safety and prevention of violence and injury. o Ensure the implementation of integrated, comprehensive,
G. Health Systems Strengthening shall be done to provide sustainable and gender-responsive community-based VIPP
sustainable community-based health services such as but not o Ensure the collection and analysis of violence- and injury-
limited to emergency medical services at the hospital and related data
hospital levels, mental health care after trauma-related o Empower and engage all the stakeholders to participate in
emergencies and rehabilitative care. the VIPP thru Violence and Injury Prevention Alliance
H. Monitoring and evaluation of VIPP based on key result areas (VIPA)
and key performance indicators shall be done regularly to o Monitor and evaluate the VIPP regularly through program
gauge the status and progress of VIPP. implementation review
o Initiate and undertake inter-agency collaboration through
formal and informal modes
o Endorse support of researches in the clinical,
epidemiological, public health and knowledge management
areas as well as evaluate them
o Others that may be identified and approved by the Secretary
of Health
 PMC Sub-committee Functions:
o Align their plans and programs to the goals and objectives of
VIPP
o Implement their strategies and activities in close
collaboration with PMC
o Contribute to the electronic surveillance system and
research agenda of DOH
IMPLEMENTING GUIDELINES o Develop key result areas and key performance
1. The DOH shall be the focal agency responsible for designing, indicators to monitor and evaluate the program
coordinating and integrating plans, programs, strategies and o Provide technical assistance and much needed support for
activities of various stakeholders into an effective and efficient the success of VIPP
system geared towards violence and injury prevention. o Recommend creative and innovative approaches in the
 VIPP is hereby institutionalized as one of the core VIPP implementation
programs of the National Center for Disease o Issue relevant and up-to-date standards and guidelines
Prevention and Control (NCDPC). duly approved by various concerned stakeholders
2. The Program Management Committee (PMC) shall be
organized to oversee the implementation, monitoring and PHILIPPINE NETWORK FOR INJURY DATA MANAGEMENT
evaluation of the program and to ensure its sustainability. SYSTEM (PNIDMS)
 PMC Sub-committees according to following key areas of  Multi-sectoral organization which intends to establish and
concern: maintain a coordinated data management system that can
o Road Traffic Injuries link, integrate, or combine injury data from various sources or
o Burns and Fireworks-related Injuries systems
o Drowning  Provide an overall picture for policy makers and decision
o Falls makers at the national, regional and local level
o Sports and Recreational Injuries

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Violence and Injury Prevention Program (VIPP) 3.03

ROLES AND RESPONSIBILITIES


 Provide direction and technical support on policies and plans pertaining to the prevention of
Program Management
violence and injury
Committee (PMC)
 Provide the forum for coordinating all aspects of the implementation of the program.
 Oversee the implementation of the national policy and program on Violence and Injury Prevention
 Establish standards and package of services on violence and injury prevention and ensure their
quality, access and availability at all levels of the health system
 Provide technical assistance to the LGUs and other partners on public health interventions for
National Center for violence and injury
Disease Prevention and  Support the design of health financing as related and applicable to violence and injury
Control (NCDPC) prevention in collaboration with PhilHealth and other partners
 Conduct regular monitoring and evaluation of the burden of disease related to violence and
injury; and
 Ensure participation of other DOH offices and bureaus and coordinate with partners within and
outside the health sector for the effective implementation of the national program
 Support the development and implementation of the Safety-First Promotion Campaign including
the IEC materials in various formats as a major strategy for the prevention and control of violence
and injury
National Center for
 Advocate with other government agencies, non-government organizations, private sectors,
Health Promotion
development partners and other relevant stakeholders for support in policy development and
(NCHP)
resource generation towards the creation of supportive environments for safety promotion
 Provide technical assistance in safety promotion and communications to ensure environmental
interventions at the following settings: home, school, workplace and community.
 Establish and sustain public health and hospital surveillance systems including registries for
violence and injuries
National Epidemiology  Oversee management and dissemination of data on mortality, morbidity and disability due to
Center (NEC) violence and injury
 Support conduct of population-based surveys on risk factors associated with violence and injury.

 Maintain the registry software


 Address technical problems accordingly
 Train users on how to operate the registry system
Information  Assist in the formulation of policies, procedures, guidelines and relevant protocols to ensure
Management Service continuous operations and develops program interventions as needed
(IMS)  Perform database and network management activities
 Manage the help desk support to ensure continuous operations; and
 Provide funding on information and communication technology resources based on the DOH
Information System Strategic Plan or other DOH directives or issuances
 Provide technical assistance in the development of learning interventions for health
Health Human
professionals on the prevention, control and management of violence and injury
Resource Development
 Facilitate integration of prevention and control of violence and injury in the academic curriculum
Bureau (HHRDB)
of health professionals.
 Ensure access and availability to quality hospital and facility-based services of patients
involved in violence and injury
National Center for
 Facilitate development and implementation of hospital-based information and surveillance
Health Facility
system to gather data particularly on mortality, morbidity and disability from violence and injury
Development (NCHFD)
 Support funding for the availability and rational distribution of ambulances and other
appropriate equipment that can provide effective life-saving pre-hospital emergency services.
Bureau of Health  Ensure the safety and accessibility of health facilities through compliance with the prescribed
Facilities and Services standards on physical ability, equipment and personnel
(BHFS)
Bureau of  Coordinate with international development partners and other external institutions or technical
International Health and resource assistance on violence and injury prevention.
Cooperation (BIHC)
Philippine Health  Develop and implement health insurance package for clients at risk and involved in violence and
Insurance Corporation injury to reduce financial burden and impoverishment of individuals and families.
(PHIC)
Violence and Injury  Provide much-needed support to the advocacy on safety culture.
Prevention Alliance
(VIPA)
4 Operation Clusters  Ensure the implementation of Violence and Injury Prevention Program by the Regional Offices
 Provide technical assistance to the LGUs and oversee the local implementation of Violence and Injury
Centers for Health
Prevention Program. They shall also establish the standards for an efficient hospital referral system
Development (CHDs)
within the locality
 Ensure provision of quality promotive, preventive, curative, rehabilitative and palliative care for
DOH hospitals
patients involved in violence and injury
Local Government  Adopt and implement the Violence and Injury Prevention Program and provide services and
Units (LGUs) necessities in primary health facilities and hospitals in their localities
Non-government  Assist in the implementation of Violence and Injury Prevention Program
organizations,
professional groups,
other national
government agencies/
organizations, private
sector and the
academe

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Violence and Injury Prevention Program (VIPP) 3.03

KEY FINDING BY EXTERNAL CAUSE OF INJURY

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Violence and Injury Prevention Program (VIPP) 3.03

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