VI.

DOH Programs Related to Family Health

Objectives:
o Manage resources efficiently and effectively.
o Apply management and leadership principles in providing direction to manage a community-
based program.
o Use appropriate strategies/approaches to plan community health programs and nursing service.
o Evaluate specific components of health programs and nursing services based on
parameters/criteria.
o Maintain a positive practice environment.

A. Expanded Program on Immunization (EPI) (Department of Health, 2019)

I. Rationale
The Expanded Program on Immunization (EPI) was established in 1976 to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines. Six
vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria,
tetanus, pertussis and measles. In 1986, 21.3% “fully immunized” children less than fourteen months of
age based on the EPI Comprehensive Program review.

II. Scenario
Global Situation
The burden
In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to
diseases that could have been prevented by routine vaccination. This represents 14% of global
total mortality in children under 5 years of age.

III. Interventions/ Strategies

Program Objectives/Goals:
Over-all Goal:
To reduce the morbidity and mortality among children against the most common vaccine-
preventable diseases.
Specific Goals:
1. To immunize all infants/children against the most common vaccine-preventable diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus.
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.

Mandates:
Republic Act No. 10152 “Mandatory Infants and Children Health Immunization Act of 2011”
Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for
children under 5 including other types that will be determined by the Secretary of Health.

Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is adopted in all parts of the country.
Immunization is done monthly in barangay health stations, quarterly in remote areas of the country.
 62

Routine Immunization Schedule for Infants

The standard routine immunization schedule for infants in the Philippines is adopted to provide
maximum immunity against the seven vaccine preventable diseases in the country before the child's
first birthday. The fully immunized child must have completed BCG 1, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2,
OPV 3, HB 1, HB 2, HB 3 and measles vaccines before the child is 12 months of age.

Vaccine Minimum Number Dose Minimum Route Site Reason

Age of Interval
at 1st Doses Between
Dose Doses
Bacillus Birth or 1 dose 0.05 None Intradermal Right BCG given at
Calmette- anytime mL deltoid earliest
Guérin after region possible age
birth of the protects the
arm possibility of
TB meningitis
and other TB
infections in
which infants
are prone
Diphtheria- 6 weeks 3 doses 0.5 6 Intramuscular Upper An early start
Pertussis- old mL weeks(DPT outer with DPT
Tetanus 1), 10 portion reduces the
Vaccine weeks of the chance of
(DPT 2), 14 thigh, severe
weeks Vastus pertussis.
(DPT 3) Lateralis
(L-R-L)
Oral Polio 6 weeks 3 doses 2-3 4 weeks Oral Mouth The extent of
Vaccine old drops protection
against polio is
increased the
earlier the
OPV is given.
Keeps the
Philippines
polio-free.
Hepatitis B At birth 3 doses 0.5 4 weeks Intramuscular Upper An early start
Vaccine mL interval outer of Hepatitis B
portion vaccine
of the reduces the
thigh, chance of
Vastus being infected
Lateralis and becoming
(R-L-R) a carrier.
Prevents liver
cirrhosis and
liver cancer
which are
more likely to
develop if
infected with
Hepatitis B
early in life.
About 9,000
died of
complications
 63

of Hepatitis B.
10% of
Filipinos have
Hepatitis B
infection.
Measles 9 months 1 dose 0.5 None Subcutaneous Upper At least 85%
Vaccine old mL outer of measles can
(not MMR) portion be prevented
of the by
arms, immunization
Right at this age.
deltoid

General Principles in Infants/Children Immunization

 Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months
or as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe
to vaccinate a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or
malnutrition) or who has already been vaccinated against measles.
 If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule
should be resumed using minimal intervals between doses to catch up as quickly as possible.
 Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg per day),
minor infections with low fever (below 38.5º Celsius), diarrhea, malnutrition, kidney or liver
disease, heart or lung disease, non-progressive encephalopathy, well controlled epilepsy or
advanced age, are not contraindications to vaccination. Contrary to what the majority of doctors
may think, vaccines against hepatitis B and tetanus can be applied in any period of the pregnancy.
 There are very few true contraindication and precaution conditions. Only two of these conditions
are generally considered to be permanent: severe (anaphylactic) allergic reaction to a vaccine
component or following a prior dose of a vaccine, and encephalopathy not due to another
identifiable cause occurring within 7 days of pertussis vaccination.
 Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried
vaccine. A sterile needle and sterile syringe must be used for each vial for adding the diluent to
the powder in a single vial or ampule of freeze-dried vaccine.
 The only way to be completely safe from exposure to blood-borne diseases from injections,
particularly hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus
(HIV) is to use one sterile needle, one sterile syringe for each child.

Tetanus Toxoid Immunization Schedule for Women

When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not
only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants.

Vaccine Minimum Percent Duration of Protection

Age/Interval Protected

 protection for the mother for the first delivery

TT1 At 20th weeks AOG 0%

TT2 At least 4 weeks 80%  infants born to the mother will be protected from
later neonatal tetanus
 gives 3 years protection for the mother
TT3 At least 6 months 95%  infants born to the mother will be protected from
later neonatal tetanus
 gives 5 years protection for the mother
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TT4 At least 1 year later 99%  infants born to the mother will be protected from
neonatal tetanus
 gives 10 years protection for the mother
TT5 At least 1 year later 99%  gives lifetime protection for the mother
 all infants born to that mother will be protected

Care for the Vaccines

To ensure the optimal potency of vaccines, a careful attention is needed in handling practices at
the country level. These include storage and transport of vaccines from the primary vaccine store down
to the end-user at the health facility, and further down at the outreach sites. Inappropriate storage,
handling and transport of vaccines won't protect patients and may lead to needless vaccine wastage.
A "first expiry and first out" (FEFO) vaccine system is practiced to assure that all vaccines are
utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done
to identify those close to expiring. Vaccine temperature is monitored twice a day (early in the morning
and in the afternoon) in all health facilities and plotted to monitor break in the cold chain. Each level of
health facilities has cold chain equipment for use in the storage vaccines which included cold room,
freezer, refrigerator, transport box, vaccine carriers, thermometers, cold chain monitors, ice packs,
temperature monitoring chart and safety collector boxes.

4 Main Types of Vaccines (Department of Health and Human Services, n.d.)

1. Live-attenuated vaccines
Live vaccines use a weakened (or attenuated) form of the germ that causes a disease.
Because these vaccines are so similar to the natural infection that they help prevent, they create a
strong and long-lasting immune response. Just 1 or 2 doses of most live vaccines can give you a lifetime
of protection against a germ and the disease it causes.
But live vaccines also have some limitations. For example:
 Because they contain a small amount of the weakened live virus, some people should talk to
their health care provider before receiving them, such as people with weakened immune
systems, long-term health problems, or people who’ve had an organ transplant.
 They need to be kept cool, so they don’t travel well. That means they can’t be used in countries
with limited access to refrigerators.
Live vaccines are used to protect against:
 Measles, mumps, rubella (MMR combined vaccine)
 Rotavirus
 Smallpox
 Chickenpox
 Yellow fever

2. Inactivated vaccines
Inactivated vaccines use the killed version of the germ that causes a disease.
Inactivated vaccines usually don’t provide immunity (protection) that’s as strong as live vaccines. So you
may need several doses over time (booster shots) in order to get ongoing immunity against diseases.
Inactivated vaccines are used to protect against:
 Hepatitis A
 Flu (shot only)
 Polio (shot only)
 Rabies
 65

3. Subunit, recombinant, polysaccharide, and conjugate vaccines

Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the germ — like its
protein, sugar, or capsid (a casing around the germ).
Because these vaccines use only specific pieces of the germ, they give a very strong immune response
that’s targeted to key parts of the germ. They can also be used on almost everyone who needs them,
including people with weakened immune systems and long-term health problems.
One limitation of these vaccines is that you may need booster shots to get on going protection against
diseases.
These vaccines are used to protect against:
 Hib (Haemophilus influenzae type b) disease
 Hepatitis B
 HPV (Human papillomavirus)
 Whooping cough (part of the DTaP combined vaccine)
 Pneumococcal disease
 Meningococcal disease
 Shingles

4. Toxoid vaccines
Toxoid vaccines use a toxin (harmful product) made by the germ that causes a disease. They create
immunity to the parts of the germ that cause a disease instead of the germ itself. That means the
immune response is targeted to the toxin instead of the whole germ.
Like some other types of vaccines, you may need booster shots to get on going protection against
diseases.
Toxoid vaccines are used to protect against:
 Diphtheria
 Tetanus

B. Integrated Management of Childhood Illnesses (IMCI) (Department of Health, 2019)

One million children under five years old die each year in less developed countries. Just five
diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half
of these deaths and malnutrition is often the underlying condition. Effective and affordable
interventions to address these common conditions exist but they do not yet reach the populations most
in need, the young and impoverish.
The Integrated Management of Childhood Illness strategy has been introduced in an increasing
number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth
and development and is based on the combined delivery of essential interventions at community, health
facility and health systems levels. IMCI includes elements of prevention as well as curative and
addresses the most common conditions that affect young children. The strategy was developed by the
World Health Organization (WHO) and United Nations Children’s Fund (UNICEF).
In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and
hospital staff were capacitated to implement the strategy at the frontline level.

Objectives of IMCI
 Reduce death and frequency and severity of illness and disability, and
 Contribute to improved growth and development
Components of IMCI
 Improving case management skills of health workers
11-day Basic Course for RHMs, PHNs and MOHs
5 - day Facilitators course
5 – day Follow-up course for IMCI Supervisors
 66

 Improving over-all health systems

 Improving family and community health practices

Rationale for an integrated approach in the management of sick children

Majority of these deaths are caused by 5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of
childhood illness are caused by these five conditions
Most children have more than one illness at one time. This overlap means that a single diagnosis
may not be possible or appropriate.

Who are the children covered by the IMCI protocol?

 Sick children birth up to 2 months (Sick Young Infant)
 Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI
 All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all
Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL
BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital
 The children and infants are then assessed for main symptoms. For sick children, the main
symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick
young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely
assessed for nutritional, immunization and deworming status and for other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’s classification within one or more symptom
groups rather than a diagnosis.
 IMCI management procedures use limited number of essential drugs and encourage active
participation of caretakers in the treatment of children
 Counseling of caretakers on home care, correct feeding and giving of fluids, and when to
return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILD’S ILLNESS

The child’s illness is classified based on a color-coded triage system:
PINK – indicates urgent hospital referral or admission
YELLOW – indicates initiation of specific Outpatient Treatment
GREEN – indicates supportive home care

Steps of the IMCI Case management Process

The following is the flow of the iMCI process. At the out-patient health facility, the health worker
should routinely do basic demographic data collection, vital signs taking, and asking the mother about
the child's problems. Determine whether this is an initial or a follow-up visit. The health worker then
proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and
other processes.
Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals.
Once admitted, the hospital protocol is used in the management of the sick child.

C. Early Essential Intrapartum and Newborn Care (EEINC) (World Health Organization, 2019)

The EINC initiative of the Philippine Department of Health- Non Communicable Diseases
Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions
(NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being
funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
 67

The EINC practices are evidenced- based standards for safe and quality care of birthing mothers
and their newborns, within the 48 hours of Intrapartum period (labor and delivery) and a week of life
for the newborn. Developed and field tested by international and local experts, EINC practices reflect
current knowledge. EINC distinguishes the necessary practices in the delivery and care for the newborn
and the mother, from the unnecessary. In December 2009, the Secretary of the Department of Health
Francisco Duque signed Administrative Order 2009-0025, which mandates implementation of the EINC
Protocol in both public and private hospitals. Likewise, the Unang Yakap campaign was launched.

The recommended EINC practices during the intrapartum period include continuous maternal
support by having a companion of choice during labor and delivery, freedom of movement during labor,
monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia,
position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-
routine episiotomy, and active management of the third stage of labor (AMTSL).

The recommended EINC practices for newborn care are time- bound interventions at the time of
birth include immediate and thorough drying of the newborn, early skin-to-skin contact between
mother and the newborn, properly-timed cord clamping and cutting and Unang Yakap ( First Embrace)
of the mother and her newborn for early breastfeeding initiation.

The unnecessary interventions during labor and delivery, which do not improve the health of
mother and child, are eliminated. These are enemas and shavings, fluid and food intake restriction, and
routine insertion of intravenous fluids. Fundal pressure to facilitate second stage of labor is no longer
practiced, because it resulted to maternal and newborn injuries and death.

Likewise, the unnecessary interventions in newborn care include routine suctioning, early
bathing, routine separation from the mother, foot printing, application of various substances to the
cord, and giving pre-lacteals or artificial infant milk formula or other breast-milk substitutes.

D. Newborn Screening (Department of Health, 2019)

DESCRIPTION
The Comprehensive Newborn Screening (NBS) Program was integrated as part of the country’s
public health delivery system with the enactment of the Republic Act no. 9288 otherwise known as
Newborn Screening Act of 2004. The Department of Health (DOH) acts as the lead agency in the
implementation of the law and collaborates with other National Government Agencies (NGA) and key
stakeholders to ensure early detection and management of several congenital metabolic disorders,
which if left untreated, may lead to mental retardation and/or death. Early diagnosis and initiation of
treatment, along with appropriate long-term care help ensure normal growth and development of the
affected individual. It has been an integral part of routine newborn care in most developed countries for
five decades, either as a health directive or mandated by law. It is also a service that has been available
in the Philippines since 1996. Under the DOH, NBS is part of the Child Development and Disability
Prevention Program at the Disease Prevention and Control Bureau.

VISION
 The National Comprehensive Newborn Screening System envisions all Filipino children will be
born healthy and well, with an inherent right to life, endowed with human dignity; and reaching
their full potential with the right opportunities and accessible resources

MISSION
 To ensure that all Filipino children will have access to and avail of total quality care for the
optimal growth and development of their full potential.
 68

GOAL
 To reduce preventable deaths of all Filipino newborns due to more common and rare congenital
disorders through timely screening and proper management

PROGRAM OBJECTIVES
 By 2030, all Filipino newborns are screened; Strengthen Quality of service and intensify
monitoring and evaluation of NBS implementation; Sustainable financial scheme; Strengthen
patient management

PROGRAM COMPONENTS
 Operations / Systems and Network; Service Delivery; Strengthen health promotion/Alliance
building for ENBS; Efficient data management; Monitoring and Evaluation; Financing Scheme

TARGET POPULATION
 Filipino newborns

AREA OF COVERAGE
 Nationwide

POLICIES AND LAWS

 Republic Act No. 9288 or the Newborn Screening Act of 2004
 Administrative Order No. 2018-0025: National Policy and Strategic Framework on Expanded
Newborn Screening for 2017-2030
 Administrative Order No. 2014-0045 or the Guidelines on the Implementation of the
Expanded Newborn Screening Program

Basic Information about Newborn Screening

Newborn screening
 Newborn Screening (NBS) is a simple procedure to find out if the baby as a congenital
metabolic disorder that may lead to mental retardation or even death if left untreated.
When is newborn screening done?
o Newborn screening is ideally done immediately after 24 hours from birth.
How is newborn screening done?
o A few drops of blood are taken from the baby’s heel, blotted on a special absorbent
filter card and then sent to Newborn Screening Center (NSC).
Who will collect the sample for newborn screening?
o The blood sample for NBS may be collected by any of the following: Physician, nurse,
medical technologist or trained midwife.
Where is newborn screening available?
o Newborn screening is available in Hospitals, Lying –ins, Rural Health Units, Health
Centers and some private clinics. If babies are delivered at home, babies may be
brought to the nearest institution offering newborn screening.
When are newborn screening available?
o Results can be claimed from the health facility where NBS was availed. Normal NBS
results are available by 7 – 14 working days from the time samples are received at
the NSC.
o Positive NBS results are relayed to the parents immediately by the health facility.
Please ensure that the address and phone number the parents provide to the health
facility are correct.
 69

What is the meaning of the newborn screening result?

o A negative screen means that the NBS result is normal.
o A positive screen means that the newborn must be brought back to his/her health
practitioner for further screening.
What should be done when a baby is tested a positive NBS result?
o Babies with positive results must be referred at once to a specialist for confirmatory
testing and further management. Should there be no specialist in the area, the NBS
secretariat office will assist its attending physician.

Expanded Newborn Screening (ENBS)

 The ENBS program increased the screening panel of disorders from six (6) to more than
twenty-eight.
 The ENBS screening costs P1750 and is included in the Philhealth Newborn Care Package.
Importance to have newborn screening
 Most babies with metabolic disorders look “normal” at birth. By doing NBS, metabolic
disorders may be early to prevent consequences of untreated conditions.

What are the disorders tested for expanded newborn screening?

The disorders tested for newborn screening are:
(1) Endocrine Disorders
 Congenital Hypothyroidism (CH)
 Congenital Adrenal Hyperplasia (CAH)
(2) Amino Acid Disorders
 Homocystinuria
 Hypermethioninemia/Methionine Adenosine Transferase Deficiency
 Maple Syrup Urine Disease
 Phenylketonuria
 Tyrosinemia Type I
 Tyrosinemia Type II, III
(3) Fatty Acid Disorders
 Carnitine Palmioyltransferase I Deficiency
 Carnitine Palmioyltransferase II Deficiency
 Carnitine Uptake Deficiency
 Glutaric Acidemia Type II
 Long Chain Hydroxyacyl-CoA Dehydrogenase Deficiency
 Medium Chain-Acyl-CoA Dehydrogenase Deficiency
 Very Long Chain-Acyl-CoA Dehydrogenase Deficiency
 Tri-functional Protein Deficiency
(4) Organic Acid Disorders
 3-Methylcrotnyl CoA Carboxylase Deficiency
 Beta Ketothiolase Deficiency
 Glutaric Acidemia Type I
 Isovalerica Acidemia
 Methylmalonic Acidemia
 Multiple Carboxylase Deficiency
 Propionic Acidemia
(5) Urea Cycle Defect
 Citrullinemia
 Argininosuccinic Aciduria
(6) Hemoglobinopathies
 70

 Alpha Thalassemia
 Beta Thalassemia
 Hemoglobin C
 Hemoglobin D
 Hemoglobin E
 Sickle Cell Disease
(7) Others
 Galactosemia
 Glucose-6-Phosphate Dehydrogenase Deficiency
 Cystic Fibrosis
 Biotinidase Deficiency

Why screen the baby?

Effect If NOT SCREENED Effect if SCREENED and

TREATED early
Endocrine Disorders
-Severe Mental Retardation - Normal
- Death - Alive
Amino Acid Disorders
-Mental retardation - Alive
-Coma and death from metabolic crisis - Normal growth
- Normal intelligence
For some, learning
Problems to others
Fatty Acid Disorders
- Developmental and physical delays -Usually healthy in between
- Neurologic impairment episodes of metabolic crises
- Sudden death - Alive
- Coma
- Seizure
-Enlargement of the heart & liver
- Muscle weakness
Organic Acid Disorders
-Developmental delay - Alive
- Breathing problems - Most will have normal
-Neurologic damage development with episodes of
- Seizures metabolic crises
- Coma
- Early death
Urea Cycle Defect
-Seizure - Alive
- Mental retardation - Normal intelligence
- Death
Hemoglobinopathies
-Painful crises - Alive
- Anemia - Reduces the frequency of
- Stroke painful crises
- Multi-organ failure - May reduce the need for
- Death blood transfusions
 71

E. BEmONC / CEmONC
Basic Emergency Obstetric and Newborn Care (BEmONC ) or Comprehensive Emergency Obstetric and
Newborn Care (CEmONC)
 BEmoNC – Basic emergency obstetric and newborn care (BEmONC) is a primary health
care level initiative promoted in low- and middle-income countries to reduce maternal
and newborn mortality
 CEmONC – Comprehensive Emergency Obstetric and Newborn Care services, more
commonly known as CEmONC, are the interventions provided to pregnant women and
newborns experiencing fatal complications, including severe bleeding, infection,
prolonged or obstructed labor, eclampsia, and asphyxia in the newborn.

Administrative Order no. 2011-0014: Guidelines on the Certification of Health Facilities with Basic
Emergency Obstetrics and Newborn Care (BEmONC) Capacity

Certification- Process and procedure of external assessment or examination by which an individual or

facility is determined to possess a minimally acceptable body of knowledge and/or skills with
capacity to provide the standards of care with adequate resources which includes drugs, supplies,
standard equipment and physical infrastructure.

Definition of Basic Emergency Obstetric and Newborn Care

Health facilities that can perform the following six signal obstetric functions:
 Parenteral administration of oxytocin in the third stage of labor
 Parenteral administration loading dose of anti-convulsants
 Parenteral administration of initial dose of antibiotics
 Performance of assisted deliveries (Imminent Breech delivery)
 Removal of retained products of conception
 Manual removal of retained placenta

These facilities are also able to provide emergency newborn interventions, which include the minimum:
 Newborn Resuscitation
 Treatment of neonatal sepsis/infection
 Oxygen support
It shall also capable of providing blood transfusion services on top of its standard functions.

Definition of BEmONC Capable Facility

A health facility that can either be a primary/district hospital, RHU or BHS/Lying-in clinic with
complete complement of BEmONC trained personnel (doctor, nurse and midwife) operating 24/7 or on-
call basis after regular office/clinic hours. Such facilities can be certified by the DOH after meeting the
standard requirements for certification.

Requirements for BEmONC Certification

 Health facilities shall operate 24/7 ( either by on-manned or on-call);
 Presence of required supplies and drugs;
 With existing equipment required for maternal and child health care;
 With minimum existing physical structure in accordance to MCP standards;
 Complete BEmONC trained personnel complement: doctor, nurse and midwife.
 72

F. Nutrition (Magtubo, 2017)

Philippine Plan of Action for Nutrition

The PPAN 2017-2022 is a results-based plan of action to stem the progression and improve
Filipino problems on nutrition such as wasting, stunting, micronutrient deficiencies and
overweight/obesity. PPAN is a response to a landscape situational analysis of nutrition in the country
which indicated that malnutrition in various grounds remained high, according to the NNC.
The nutrition plan is crucial in the attainment of the United Nations-established Sustainable
Development Goals (SDGs), which calls for ending hunger, achievement of food security, and improved
nutrition. The plan of action is likewise a part of the Philippine Development Plan.

Malnutrition in various forms

According to a 2015 National Nutrition Survey supervised by the Food and Nutrition Research
Institute (FNRI), 33.4 percent (3.8 million) of children were suffering from growth stunting while 7.1
percent (807.057) are wasted. While these are commonly-cited problems when mentioning
“malnutrition,” the NNC also mentioned they need to counter overweight and obesity problems among
Filipino adults.
UNICEF, in 2016, noted that the Philippines, along with Indonesia, Malaysia, and Thailand, is
facing the double burden of malnutrition. Obesity rate among children aged below 5 years escalated to
about 400 percent from a mere 1 percent in 1992. The rise is highly attributed to diet that is high in
processed ingredients, sugar and fat, as well as a sedentary lifestyle.
The Philippine Association for the Study of Overweight and Obesity Inc (PASOO) in 2014 noted
that 3 out of 10 Filipinos are overweight or obese.
The incidence of obesity is more common in the 40-49.9 age group and least prevalent among
those aged 70 and above. The report also noted there are more obese female than male. Stress leading
to comfort eating, increased portions of unhealthy food, and sedentary lifestyles were cited as causes.
In addition, “Micronutrient deficiency which adversely affects a child’s survival also remains a
public health concern,” according to the proponents, citing 24.8 percent of pregnant women are
nutritionally at risk due to iodine deficiency disorder.
“The cost of malnutrition greatly affects the country’s economy with a total loss of Php 328
billion in 2013 due to impacts of child stunting on education and productivity,” they added.

PPAN targets
The updated PPAN will be in place for 6 years – until 2022, and by then, the proponents hope to
reduce wasting from 7 percent to less than 5 percent, and stunting to 28 percent, decrease
micronutrients deficiencies, and halt the increase in overweight rates.
Secretary of Health Paulyn Ubial, also a member of the governing board, said that the PPAN is
the country’s bible for nutrition, and it will also support the World Health Assembly Global Targets in
improving maternal, infant and young child nutrition by the year 2025.
Additionally, Secretary Ubial noted that “15 to 20 years from now, these stunted children, if
they survived, will enter the workforce and instead of driving the engine of the economy will become
the burden of society, and because malnutrition permeates into the next generation the cycle
continues.”

Strategies
PPAN’s strategic thrusts include the First 1,000 Days of Life, the provision of complimentary
nutrition-specific and nutrition-sensitive programmes, mobilization of local government units to reach
geographically-isolated and disadvantages areas (GIDA) as well as indigenous people.
According to a PPAN draft for 2017-2022, the plan will include a team of consultants, key
informant interviews, focus group discussion, inter-sectoral consultation and national consultation.
 73

PPAN Programmes
The updated PPAN comes with eight nutrition-specific programmes meant to address the
immediate causes of malnutrition such as scant food supply, lower nutritional intake, poor care giving
and parenting practices, as well as infectious diseases.
The programme will include immunization, de-worming, food and agriculture systems,
conditional cash transfers, as well as a lifestyle-centered approach (school intervention, breastfeeding,
supplementary feeding, community-based health food environment, and workplace).
“This will be complemented by the nutrition-sensitive programmes which are already existing
developmental programmes that can be tweaked to produce nutritional outcomes,” noted the PPAN in
a briefing.

G. MhGap

WHO Mental Health Gap Action Programme (mhGAP)

Mental, neurological, and substance use disorders are common in all regions of the world,
affecting every community and age group across all income countries. While 14% of the global
burden of disease is attributed to these disorders, most of the people affected - 75% in many low-
income countries - do not have access to the treatment they need.

The WHO Mental Health Gap Action Programme (mhGAP) aims at scaling up services for
mental, neurological and substance use disorders for countries especially with low- and middle-
income. The programme asserts that with proper care, psychosocial assistance and medication, tens
of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and
begin to lead normal lives– even where resources are scarce.

Scaling up is defined as a deliberate effort to increase the impact of health-service

interventions that have successfully tested in pilot projects so that they will benefit more people, and
to foster sustainable development of policies and programmes. However, pilot or experimental
projects are of little value until they are scaled up to generate a larger policy and programme impact.

Scaling up involves the following tasks:

 Identification of a set of interventions and strategies for health- service delivery, and
planning of a sequence for adoption of these actions and of the pace at which interventions
can be implemented and services expanded.

 Consideration of obstacles that hinder the widespread implementation of the selected

interventions, and the options that are available to deal with these obstacles; and

 Assessment of the total costs of scaling up and sustaining interventions in a range of

generalizable scenarios.

These tasks require a clear understanding of the type and depth of constraints that affect a
country’s health system. Such constraints could operate at different levels, such as community and
household, health-service delivery, health-sector policy and strategic management, cross-sectoral
public policies, environment and context.

Reference for DOH PROGRAMS RELATED TO FAMILY HEALTH

Cuevas, F. P. (2007). Public health nursing in the Philippines. Philippines.
Department of Health. (2019). Retrieved from https://www.doh.gov.ph/
Magtubo, C. A. (2017). PPAN 2017-2022: Updated national nutrition plan launched. Retrieved from
https://today.mims.com/ppan-2017-2022--updated-national-nutrition-plan-launched-