HEALTH AND WELLNESS PROGRAM FOR SENIOR CITIZEN

Description

In support of the RA 9257 (The Expanded Senior Citizens Act of 2003) and the RA 9994
(Expanded Senior Citizen Act of 2010), the Department of Health issued Administrative Orders
for health implementors to undertake and promote the health and wellness of senior citizens as
well as to alleviate the conditions of older persons who are encountering degenerative diseases.  

With the goal of Health and Wellness Program for Senior Citizen of promoting quality of life
among older persons and contribute to the nation building, the HWPSC intends to provide the
following:

 focused service delivery packages and integrated continuum of quality care,

 patient-centered and environment standard to ensure safety and accessibility
for senior citizens,
 equitable health financing,
 capacitated health providers in the implementation of health programs for
senior citizens,
 data base management, and
 strengthened coordination and collaboration with other stakeholders involved
in the implementation of programs for senior citizens.

In the current Philippine Health Agenda (2017 - 2022), guarantees that centralize health services
for care in all life stages, service delivery networks, and financial risk protection, geriatric health
is mentioned as an area of concern.  All senior citizens are mandatorily covered by the Philippine
Health Insurance Corporation by virtue of Republic Act No. 10642 “An act granting mandatory
national health insurance program of PhilHealth for all senior citizens”.

Vision

A country where all Filipino senior citizens are able to live an improved quality of life through a
healthy and productive aging.

Mission

Implementation of a well-designed program that shall promote the health and wellness of senior
citizens and improve their quality of life in partnership with other stakeholders and sectors.

Objectives

 To ensure better health for senior citizens through the provision of focused
service delivery packages and integrated continuum of quality care in various
settings.
  To develop patient-centered and environment standards to ensure safety and
accessibility of all health facilities for the senior citizens.
 To achieve equitable health financing to develop, implement, sustain,
monitor and continuously improve quality health programs accessible to
senior citizens.
 To enhance the capacity of health providers and other stakeholders including
senior citizens group in the implementation of health programs for senior
citizens.
 To establish and maintain a database management system and conduct
researches in the development of evidence-based policies for senior citizens.
 To strengthen coordination and collaboration among government agencies,
non-government organizations, partner agencies and other stakeholders
involved in the implementation of programs for senior citizens.

Program Components

1. The Policy, Standards and Regulation component shall develop a unified patient-

centered and supportive environment standards to ensure safety and accessibility
of senior citizens to all health facilities and to promote healthy ageing in order to
prevent functional decline among senior citizens.
2. The Health Financing component shall promote health financing schemes and
other funding support in all concerned government agencies and private
stakeholders to provide programs that are accessible to senior citizens.
3. The Service Delivery component shall ensure access of senior citizens to essential
geriatric health services including preventive, promotive, treatment, and
rehabilitation services from the national to the local level.
4. The Human Resources for Health component shall capacitate the health care
providers in both national and local government to be able to effectively provide
technical assistance and implement the program for senior citizens.
5. The Health Information component shall establish an information management
system and maintain a repository of data.
6. The Governance for Health component shall coordinate and collaborate with the
local government units and other stakeholders  to ensure an effective and efficient
delivery  of health services at the hospital and community level.

Policies and Laws

 Madrid International Plan of Action on Aging

 Regional Framework for Action on Aging and health in the Western Pacific
2014-2019
 The 1987 Philippine Constitution
 Aquino Health Agenda
 Philippine Plan of Action for Senior Citizens (2012-2016)
 Republic Act No. 9257 – “An Act Granting Additional Benefits and
Privileges to Senior Citizens amending for the purpose of Republic Act no.
7432, otherwise known as “An Act to Maximize the Contribution of Senior
 Citizens to Nation Building, Grant benefits and Special Privileges and for
Other Purposes”
 Republic Act No. 9994 – “An Act Granting Additional Benefits and
Privileges to Senior Citizens, Further Amending Republic Act no. 7432”

 Strategies, action Points and Timeline

1. Participatory Governance for health through the life course

2. Strengthened Service Delivery for older populations
3. Advocacy and Promotion of healthy aging
4. Evidence-based Decision Making

Program Accomplishments/ Status

1. Provision of influenza and pneumococcal vaccine

2. Wellness camp for senior citizens
3. Elderly Filipino week (Walk for Life) Celebration

Calendar of Activities

Presidential Proclamation No. 470, series of 1994 declares the First Week of October of every
year as Elderly Filipino Week (Linggong Katandaang Pilipino) Celebration
ADOLESCENT HEALTH AND DEVELOPMENT PROGRAM

Description

In April 2000, DOH issued the Administrative Order 34- A s 2000, the Adolescent and Youth
Health (AYH) Policy, creating the Adolescent Youth Health Sub-program under the Children’s
Health Cluster of Family Health Office. In 2006, the department created the Technical
Committee for Adolescent and Youth Health Program, composed of both government and non-
government organizations dedicated to uplifting the welfare of adolescents and tasked to
revitalize the program. Due to an increasing health risky behaviour among our Filipino
adolescents,

DOH embarked on revising the policy and to focus on the emerging issues of the adolescents
which are the 10 – 19 years old.

In March 21, 2013, DOH with the support of the United Nations Population Fund (UNFPA)
Philippines, revised the policy and served the Administrative Order 0013 - 2013 National Health
Policy and Strategic Framework on Adolescent Health and Development (AHDP). The Strategic
Framework 2013 is designed in accordance with this goal.

In 2015, DOH AHDP Program revived the National External Technical Working Group (TWG)
on AHDP. This is composed of different stakeholders from the government, non-government,
academe, and youth – led organizations. In 2016, DOH recognized the need for harmonization of
programs within the department that caters 10 – 19 years old. The AHDP Program convened the
first DOH – Internal Technical Working Group. This aims to ensure that all programs are
working together for the betterment of the adolescents in the country. It is also an avenue to
discuss indicators, policies, strategies, and service delivery at the national and local
implementation levels. The External and Internal TWGs on AHDP are multi -sectoral,
collaborative approaches to fulfil the goal, vision, and mission of the program. In 2017, both
TWGs revised the strategic framework, and developed a logical framework, and monitoring and
evaluation framework of the program.

Vision

The AHDP envisions a country with well informed, empowered, responsible and healthy
adolescents who are leaders in the society

Mission

Its mission is to ensure that all adolescents have access to comprehensive health care and
services in an adolescent-friendly environment.

Objectives

Improve the health status of adolescents and enable them to fully enjoy their rights to health.
Program Components

1. Nutrition
2. National Safe Motherhood
3. Family Planning
4. Oral Health
5. National Immunization Program
6. Dangerous Drugs Abuse Prevention and Treatment
7. Harmful Use of Alcohol
8. Tobacco Control
9. Mental Health
10. Violence & Injury Prevention
11. Women and Children Protection
12. HIV/STI

Policies and Laws

 Republic Act 10354 (The Responsible and Reproductive Health Act of 2012)
 Administrative Order No. 2013-0013 (National Policy and Strategic
Framework on Adolescent Health and Development)
 Administrative Order No. 2017-0012 (Guidelines on the Adoption of
Baseline Primary Health Care Guarantees for All Filipinos)
 Proclamation 99 s.1992 (Linggo ng Kabataan)

Strategies, action Points and Timeline

 Health promotion and behavior change for adolescents

 Adolescent participation in governance and policy decisions
 Developing/transforming health care centers to become adolescent-friendly
facilities
 Expanding health insurance to young people
 Enhancing skills of service providers, families and adolescents
 Strengthening partnerships among adolescent groups, government agencies,
private sectors, Civil Society organizations, families and communities
 Resource mobilization
 Regular assessment and evaluation

Program Accomplishments/ Status

Health Education and Promotion

o Advocacy and awareness raising activities such as Adolescent Health TV

segment and Healthy Young Ones
Provision of Health Services

o Establishment of Adolescent-Friendly Health Facilities Nationwide

includes:
a. Core package of adolescent health services (AO 2017-0012)
available at the different levels of the health care system and in
settings outside the health care system.
b. Institutionalize linkage between school, community, civil society
organizations and health facilities in a service delivery network
(SDN).
c. Trained health and non-health personnel nationwide with the
following:
a. Competency Training on Adolescent Health
b. Adolescent Job Aid (AJA) Training
c. Adolescent Health Education and Practical Training
(ADEPT)
d. Healthy Young Ones (HYO) Training
e. Adolescent Health and Development Program Manual of
Operations (MOP) Training

Calendar of Activities

The celebration of Linggo ng Kabataan every second week of December

Statistics

Violence: Sixteen percent (16.6%) of women age 15-19 have experienced physical violence at
least once in their life and 4.4% are survivors of sexual violence. Seventeen percent (17%) of
Young Adult Fertility and Sexuality Survey in 2013 (YAFSS) adolescent respondents have
experienced violence in the past year, and 23 % have been aggressors of violence between the
aged 15 – 24 years old. Almost half (47.7%) of 13-15 year old schoolchildren in the 2013 Global
Scholl Health Survey (GSHS) have experienced bullying and 4.8% of YAFSS adolescents have
been harassed using technology.

Alcohol, Tobacco, and Illegal Substances: In the 2013 National Nutrition Survey (NNS), 6.8%
of adolescents are current smokers and 5.7% are former smokers. Fifteen percent (15.6%) of
YAFSS (2013) respondents are current smokers and 2.6% have ever used drugs. In YAFSS,
8.1% of adolescents 15-19 years old have ever passed out drunk. The 2015 Global Youth
Tobacco Survey (GYTS), together with Global School Based Health Survey (GSHS) and YAFS
describe other risk behaviors. In 2015, GSHS found that 18.2% of schoolchildren 13-15 years
old have experienced being really drunk at least one drinking alcohol once one or more days
during the past 30 days. According GSHS, 11.0% have smoked cigarettes in the past month. In
2015, GYTS analyzed that a total of 16.0% of the respondents currently use any tobacco product
(smoked tobacco and/or smokeless tobacco) and 28.1% of students are ever tobacco users.
Malnutrition: It is a double burden with 12.4% of adolescents wasted and 8.3% overweight or
obese. The latter is somewhat expected given that 42.2% consume soft drinks one or more times
per day while only 13.9% were physically active for a total of at least 60 minutes daily on five or
more days during the past week. On the other hand, one in three (37.2%) pregnant adolescents
are nutritionally at risk (based on weightfor- height classification, P<95).

Sexual and Reproductive Health: While General Fertility (GF) has significantly decreased
since 1970, Age Specific Fertility Rates (ASFR) of adolescents has changed little. The 2017
National Demographic and Health Survey (NDHS) places adolescent ASFR at 47 livebirths per
1,000 women 15-19 years old, up from 57 in the 2013 NDHS. According to YAFSS 4, data
shows that in the Philippines, an increasing proportion of adolescents and young people have
early sexual encounters. In 2013, 1 in 3 young people report having premarital sex. The
prevalence of early sexual encounters has increased over the last 20 years. Males are more likely
to report having premarital sex than females. In 2013, 36% of males reported having early sexual
encounters compared to 29% of females. The highest levels of early sexual encounters are
reported in NCR (41%) & Central Luzon (31%) regions. Also, many young people marry young,
and it is important that they have good information before they are married so that they can make
healthy, informed decisions.

HIV and AIDS: In April 2017, there were 629 new HIV antibody sero-positive individuals
reported to the HIV/ AIDS & ART Registry of the Philippines (HARP) [Table 1]. More than half
were from the 25-34 year age group while 30% were youth aged 15-24 years. 33 adolescents
aged 10-19 years were reported. All were infected through sexual contact (8 male-female sex, 19
male-male sex, 6 sex with both males & females). From January 1984 to April 2017, 1,606 (4%)
of the reported cases were 19 years old and below. Seven percent (111 out of 1,606) were
children (less than 10 y/o) and among them, 108 were infected through mother-to-child
transmission, 1 through blood transfusion and 2 had no specified mode of transmission. Ninety
three percent (1,495 out 1,606) were adolescents. Among these, 1,359 (91%) were male. Most
(93%) of the adolescents were infected through sexual contact 185 male-female sex, 843 male-
male sex, 367 sex with both males & females), 85 (6%) were infected through sharing of infected
needles, 8 (<1%) through mother-to-child transmission, and 7 had no specified mode of
transmission.
CHILD HEALTH AND DEVELOPMENT STRATEGIC PLAN

INTRODUCTION
The Philippine National Strategic Framework for lan Development for CHildren or CHILD 21 is
a strategic framework for planning programs and interventions that promote and safegurad the
rights of Filipino children. Covering the period 2000-2005, it paints in broad strokes a vision for
the quality of life of Filipino children in 2025 and a roadmap to achieve the vision.

              Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical
and fundamental element in children's welfare. However, health programs cannot be
implemented in isolation from the other component that determine the safety and well being of
children in society. Children's Health 2025, therefore, should be able to integrate the strategies
and interventions into the overall plan for children's development.

             Children's Health 2025 contains both mid-term strategies, which is targeted towards the
year 2004, while long-term strategies are targeted by the year 2025. It utilizes a life cycle
approach and weaves in the rights of children. The life cycle approach ensures that the issues,
needs and gaps are addressed at the different stages of the child's growth and development.

                The period year 2002 to 2004 will put emphasis on timely diagnosis and management
of common diseases of childhood as well as disease prevention and health promotion,
particularly in the fields of immunization, nutrition and the acquisisiton of health lifestyles. Also
critical for effective pallning and implementation would be addressing the components of the
health infrastructure such as human resource development, quality assurance, monitoring and
disease surveillance, and health information and education.

               The successful implementation of these strategies will require collaborative efforts with
the other stakeholdres and also implies integration with the other developmental plan of action
for children.

Vision

A healthy Filipino child is:

 Wanted, planned and conceived by healthy parentsCarried to term by healthy

motherBorn into a loving, caring. stable family capable of providing for his or her
basic needsDelivered safely by a trained attendant
 Screened for congenital defects shortly after birth; if defects are found,
interventions to corrrect these defects are implemented at the appropriate time
 Exclusively breastfed for at least six months of age, and continued breasfeeding up
to two yearsIntroduced to compementary foods at about six months of age, and
gradually to a balanced, nutritious dietProtected from the consequences of protein-
calorie and micronutirent deficiencies through good nutrition and access to fortified
foods and iodized salt
  Provided with safe, clean and hygienic surroundings and protected from
accidentsProperly cared for at home when sick and brought timely to a health facility
for appropriate management when needed.Offered equal access to good quality
curative, preventive and promotive health care services and health education as
members of the Filipino society
 Regularly monitored for proper growth and development, and provided with
adequate psychosocial and mental stimulationScreened for disabilities and
developmental delays in early childhood; if disabilities are found, interventions are
implemented to enabled the child to enjoy a life of dignity at the highest level of
function attainable
 Protected from discrimination, exploitation and abuse
 Empowered and enabled to make decisions regarding healthy lifestyle and
behaviors and included in the formulation health policies and programsAfforded the
opportunity to reach his or her full potential as adult

Current Situation

           Deaths among children have significantly decreased from previous years. In the 1998
NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death rate was 18
deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in
Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no
antenatal care or medical assistance at the time of delivery. Top causes of illness among infants
are infectious diseases (pneumonia, measles, diarrhea, meningitis, septicemia), nutritional
deficiencies and birth-realted complications.

             The probability of dying between birth and five years of age is 48 deaths per 1000
livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age
group) are pneumonia, diarrhea, measles, meningities and malnutrition. About 6% die of
accidents i.e. submersion, foreign bodies, and vehicular accidents.

             The decline in mortality rates may be attributed partly to the Expanded Program of
Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable
diseases (tuberculosis, diptheria, tetanus, pertussis, poliomyelities, Hepatitis B and measles).

           The Philippines has been declared as polio-free druing the Kyoto Meeting on
Poliomyelities Eradication in the Western Pacific Region last October 2000. This. however, is
not a reason to be complacent. The risk of importing the poliovirus from neighboring countries
remains high until global certification of polio eradication. There is an urrgent need for sustained
vigilance, which includes strengthening the surveillance system, the capacity for rapid response
to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials,
and maintaining high routine immunization until global certification has been achieved.

               Malnutrition is common among children. The 1998 FNRI survey show that three to
four out of ten children 0-10 years old are underweight and stunted. The prevalence of low
vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996
levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%,
however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to
78% in 1997.

             Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural
areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20%
among children 4-5 mos of age (NDHS).

             Several strategies were utilized to omprove child health. THe Integrated Management of
Childhood Illness aims at reducing morbidity and deaths due to common chldhood illness. The
IMCI strategy has been adopted nationwide and the process of integration into the medical,
nursing, and midwifery curriculum is now underway.

             The Enhanced Child Growth strategy is a community-based intervention that aims to

improve the health and nutritional status of children through improved caring and seeking
behaviors. It operates through health and nutrition posts established throughout the country.

Gaps and Challenges 

        Many Local Health Units were not adequately informed about the Framework for Children's
Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and
Children's Health 2025 to serve as the template for local planning for childrens health. There is
also the need to update and reiterate the policies on children's health particularly on
immunization, micronutrient supplementation and IMCI.

         LGUs experienced problems in the availability of vaccines and essential drugs and
micronutrients due to weakness in the procurement, allocation and distribution.

       Pockets of low immunization coverage is attributed largely to the irregular supply of

vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of
immunization.

Goal

The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by
the year 2025.

Medium-term Objectives for year 2001-2004

Health Status Objectives

          1. Reduce infant mortality rate to 17 deaths per 1,000 live births

          2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 livebirths
          3. Reduce the mortality rate among adolescents and youths by 50%
Risk Reduction Objectives

         1. Increse the percentage of fully immunized children to 90%

         2. Increase the percentage of infants exclusively breastfed up to six months to 30%
         3. Increase the percentage of infants given timely and proper complementary feeding at six
months to 70%
         4. Increase the percentage of mothers and caregivers who know and practice home
management of childhood illness to 80%
        5. Reduce the prevalence of protein-energy malnutrition among school-age children
        6. Increase the health care-seeking behavior of adolescents to 50% 

Services and Protection Objectives

       1. Ensure 90% of infants and children are provided with essential health care package
       2. Increase the percentage of health facilities with available stocks of vaccines and esential
drugs and micronutrients to 80%
       3. Increase the percentage of schools implementing school-based health and nutrition
programs to 80%
       4. Increase the percentage of health facilities providing basic health services including
counseling for adolescents and youth to 70%

Strategies and Activities

* Enhance capacity and capability of health facilities in the early recognition, management and
prevention of common childhood illness

This will entail improvements in the flow of services in the implementing faciities to ensure that
every child receive the essential services for survival, growth and development in an organized
and efficient manner. Facilities should be equipped with the essential instruments, equipment and
supplies to provide the services. Health providers shall have the knowledge and skills to be able
to provide quality services for children. Existing child health policies, guidelines and standards
shall be reviewed and updated, and new ones formulated and disseminated to guide health
providers in the standard of care.

* Strengthening community-based support systems and interventions for children's health

Notable community-based projects and interventions, such as the health and nutrition posts,
mother support groups, community financing schemes shall be replicated for nationwide
implementation. Model building and dissemination of best practices from pilot sites has proven
effective in generating support and adoption in other sites. More of these shall be initiated
particularly for developing interventions to increase care-seeking and prevention of malnutrition
in children.

* Fostering linkages with advocacy groups and professional organizations and to promote
children's health
Collaboration with the nongovernment sector and professional groups shall:

* Conduct national campaigns on children's health

* Conduct and support national campaigns for children

* Initiate and support legislations and researches on children's health and welfare

* Development of comprehensive monitoring and evaluation system for child health programs
and projects