Republic of the Philippines Department of Health OFFICE OF THE SECRETARY JAN 2.0 201 ADMINISTRATIVE ORDER No. 2014 - 0002 SUBJECT: — Revised National Policy on Violence and Injury Prevention 1. RATIONALE The first global study on premature deaths in 2009 (WHO Report) revealed that road crashes, suicide and violence were among the main causes of death worldwide for people aged 10 to 24 years. In 2011 (WHO Report), injuries were reported to be responsible for 9% of all deaths with road traffic injuries claiming nearly 3,500 lives each day, making it among the 10 leading causes of mortality globally. In response to the foregoing, WHO called upon Member States to develop measures to prevent road traffic injuries and violence. WHO recommended that, such policies, strategies and plans of action be concrete and contain objectives, priorities, timetables and mechanisms for evaluation. In the Western Pacific, WHO called on its Member States to take firmer action to reduce the region's more than 600 suicides per day. At the September 2011 Fifth Milestones in a Global Campaign for Violence Prevention (GCVP) Meeting in South Africa, the Violence Prevention Alliance (VPA) developed the plan of action geared towards increasing the priority of evidence- informed violence prevention, building the foundations for violence prevention, and implementing violence prevention strategies. Likewise, the United Nations General Assembly adopted Resolution 64/255 proclaiming 2011-2020 to be a Decade of Action for Road Safety to stabilize and reduce global road traffic fatalities by 2020. The Global Burden of Diseases, Injuries, and Risk Factors Study conducted in 2010 showed that interpersonal violence, road injury, drowning, and self-harm (suicide) ranked sixth, ith, 17th, and 27th, respectively, on the leading causes of premature deaths in the Philippines. Accidents are the fifth leading cause of mortality for the period of 2005-2010 as reported in the Philippine Health Statistics of the National Epidemiology Center. The Online National Electronic Injury Surveillance System (ONEISS) Fact Sheet for 2010-2012 revealed that transport or vehicular crash was the leading cause of unintentional injuries and interpersonal violence (mauling/assault, contact with sharp objects, and gunshot) was the leading cause of intentional injuries. Bulding 1 Sn Lazaro Compound, Ral Avenue, ta. Cruz, 1003 Manila «Trunk Une 651-78-00 Direct ine: 71-9503 Fax: 743-1829; 743-1786 © URL: htto://wwudoh gov. e-mall: osec@doh.zov.0h y #In the first quarter of 2013, the Essential Non-Communicable Disease Division (ENCDD), together with the Development Academy of the Philippines (DAP), developed the 5- year Strategic Plan for 2013-2017. One of the major recommendations from the stakeholders during the review of Violence and Injury Prevention Program (VIPP) was the revision of Administrative Order No. 2007-0010 or the “National Policy on Violence and Injury Prevention Program”. It was noted that there was no clear-cut action framework for the program and the creation of alliance of all the stakeholders of violence and injury prevention was not given attention. With the increasing mortality, morbidity, and disability due to violence and injury, there is a need to complement and enhance the existing policy on Violence and Injury Prevention in order to rise to the challenge of addressing this rapidly growing public health concern. It is also imperative to develop an action framework that serves as the strategic road map towards This new issuance shall serve as the overarching Administrative Order of different policies concerning violence and injuries and shall include the service delivery mechanism and the well-defined roles and responsibilities of the Department of Health and other major players. prevention of violence and. injuries II, DECLARATION OF POLICIES This issuance on Violence and Injury Prevention shall be guided by the following policy statements: A. The 1987 Philippine Constitution on Article II Section 15 states the right of the people to health protection and promotion and Article 13 Section 11 states the availability to the people of all essential goods, health and social services at affordable cost. B, The Aquino Health Agenda (AHA), through Administrative Order No. 2010-0036 and Section 7 of Executive Order 43 series 2011, the so-called Kalusugan Pangkalahatan (KP), aims to achieve universal health care for all Filipinos. The National Objectives for Health (NOH) 2011-2016 aims to reduce morbidity and mortality from accidents and injuries. C. Culture of safety shall be the essence of Violence and Injury Prevention Program. D. The integrated, comprehensive, and sustainable multi-sectoral approach to prevent violence and injury shall be developed at the grassroots level in close collaboration with committed multi-stakeholders. E. Highly effective and sustainable strategies shall be developed to effect changes that would lead to a significant reduction in mortality, morbidity and disability from violence and injuries.F. Establishing an emergency medical service system at the prehospital and hospital levels and ensuring the development of a sustainable mentai health care after trauma- related emergencies are of paramount significance to VIPP. ILL. OBJECTIVES A. General Objective: To reduce mortality, morbidity, ond and injuries. bility due to violence B. Specific Objectives: 1. Promote a culture of safety in key settings such as home, schools, workplaces, and communities; 2. Enhance the capacity of Regional Offices, Local Government Units (LGUs), and other stakeholders as well as strengthen co'laboration with them in the prevention of violence and injury; 3. Develop and implement evidence-based policies, standards and guidelines; and 4. Ensure reliable, timely, and complete data anc: researches related to violence and injury prevention IV. SCOPE This Administrative Order provides the action framework for the effective implementation of Violence and Injury Prevention Program in the Philippines. It covers all units and instrumentalities including attached agencies of the DOH. It also applies to all concerned national government agencies (NGAs), local government units (LGUs), academe, civil society organizations, faith-based organizations, community-based organizations, private sectors, and other relevant multi-sectoral stakeholders. V. DEFINITION OF TERMS AND ACRONYMS For purposes of this issuance, the following terms shall be defined as follows: A. Bullying — any severe or repeated use of physical act or gesture, written or electronic expression or combination thereof, resulting to fear, physical, emotional harm, damage to property, creation of hostile environment and infringement of rights of another person. B. CHED - refers to Commission on Higher Education Civil Society Organization — refers to a broad array of organizations that are essentially private and outside the institutional structures of government, but at the same time are not primarily commercial and do not exist primarily t0 distribute profits to their directors or owners. This includes registered charities, non-government organizations (NGOs), professional societies and advocacy groups, D. DepEd — refers to Department of Education E, DILG — refers to Department of the Interior and Local Government. DOLE ~ refers to Department of Labor and Employment . DOTC ~ refers to Department of Transportation and Communication |. DPWH — refers to Department of Public Works and Highways DSWD — refers to Department of Social Welfare and Development Emergency Medical Service System - a compretensive system that provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to vietir~s of sudden illness or injury. . Injury - Any damage to the body resulting from acute exposure to thermal, mechanical, chet heat or oxygen. or electrical energy or from the absence of such essentials as Injury Surveillance ~ refers to the ongoing systematic collection, analysis, and interpretation of injury-related data that are essential for planning, implementation and evaluation of policy makers. The application of gathered data to prevention and control constitutes the final link of the surveillance chain, Intentional Injury — refers to injury resulting from interpersonal, collective, or self- inflicted violence. It includes homicide, assault, suicide and suicide attempt, sexual assault and violence among family members and intimate members or injury resulting from deliberate violence inflicted by oneself or another person. . Interpersonal Violence - divided into two subcategories: Family and intimate partner violence — that is, violence largely between family members and intimate partners, usually, though not exclusively, taking place in the home, Community violence — violence between individuals who are unrelated, and who may or may not know each other, generally taking place outside the home. The former group includes forms of violence such as child abuse, intimate partner violence and abuse of the elderly. The latter includes bullying, youth violence, random acts of violence, rape or sexual assault by strangers, and violence in institutional settings such as schools, workplaces, prisons and nursing homes. MMDA ~ refers to Metropolitan Manila Development Authority Safety — a state in which hazards and conditions leading to physical and Psychological harm or injury are controlled in order to preserve the health and wellbeing of individuals and the community. Unintentional Injury — refers to injury that is not inflicted by deliberate means. It also refers to death or disability resulting from accidental circumstances such as, but not limited to, falls, drowning, road traffic injuries, asphyxiation, electrocution, bums, animal bites and stings. Violence ~ the intentional use of physical force or power, threatened or actual, against @ person, or against a group or community, that either results in or has a highlikelihood of resulting in injury, death, psychological harm, or deprivation. This also refers to the intentionality of committing the act itself, irrespective of the outcome it produces. VI. GENERAL GUIDELINES A. Evidence-Based Research and Electronic Surveiliance System — Multi-disciplinary and multi-sectoral interventions shall oe developed based on evidence-based research. DOH shall establish and institutionalize a system of data reporting, recording, collection, management and analysis at the national, regional, and local levels. An information system, that is, Onlin National Electronic Injury Surveillance System (ONEISS) and Philippine Network for Injury Dats Management System (PNIDMS), shall be fully operationalized for this purpose. B, Networking and Alliance Building — DOH shal! promote partnerships with and among stakeholders to build alliance and networks and to generate resources for activities related to VIPP. C. Capacity Building and Community Participation - DOU shall develop and enhance the violence and injury prevention capabilities of a wide range of sectors and stakeholders at the national, regional and local levels. D. Advocacy — DOH shall advocate to LGUs for ordinance J2velopment and lobby to Congress for enactment of laws. E, Equitable Health Financing Package — DOH, ‘in collaboration with various stakeholders, shall advocate to health financing institutions and financial intermediaries, ie. the Philippine Health Insurance Corporation (PHIC) and insurance companies, the development and implementation of policies that would be beneficial for the victims of all forms of violence and injury. F. Service Delivery — In collaboration with stakeholders, DOH shall institutionalize systems and procedures for the integration and provision of services at the community level. In collaboration with various stakeholders, DOH shall undertake advocacy, information and education, political support, and multi-sectoral action on violence and injury prevention. Appropriate interventions at all levels of prevention shall be crucially provided. G. Six (6) B's, Strategies shall utilize the concept of the six E’s (Education, Enactment / Enforcement, Empowerment, Engineering, Emergency ‘Medical Service, and Engagement in surveillance and research) in the prevention of violence and injuries. 1. Education entails wide dissemination of information and communication related to violence and injury prevention; 2. Enactment / Enforcement of laws and policis prevention; 3. Empowerment of all stakeholders in the implementation of VIPP. This also covers the provision of psychosocial support to the victims of violence an to help them recover from the psychological trauma; 's related to violence and injury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; and 6. Engagement in surveillance and research to promote evidence-based, substantial, scientific, and systematic approach to VIPP. H. Monitoring and Evaluation — DOH, together with various stakeholders, shall identify indicators, targets and milestones for program monitoring and evaluation purposes. ‘There shall be a regular audit and feedback mechanism of all VIPP-related strategies and activities. VII. SPECIFIC GUIDELINES The action framework (Figure 1) shall be the foundation where the plans, programs, strategies, and activities related to VIP shall be anchored. A. Public policies shall be developed and will include legislation, administrative issuances, fiscal measures and organizational constitution and by-laws that would effect changes towards creating safe environments and promoting safety-first mentality and behaviour. Supportive environments for the actual implementation of those public policies and the provision of infrastructure where safety is the primary concem shall be made available. Safety-first behaviours are also encouraged and promoted at all ages. B. Community-based interventions to be implemented shall not be limited to capacity- building at the grassroots level that would make available well-trained, competent and gender-sensitive first responders. Interventions shall also include the provision of community-based mental health, rehabilitative and palliative care. The prehospital care or prehospital trauma life support shall ensure the availability and accessibility of well-trained and competent first responders and/or emergency medical technicians in times of trauma-related emergencies. C. Hospital Care and Rehabilitation shall include preventing further the complications of those trauma-related emergencies and to lessen the burden of disability due to violence and injury. D. Advocacy activities shall include information drive, education and communication campaign geared towards promotion of safety and hence, prevention of injuries. E, All stakeholders shall be enjoined and encouraged to participate in the surveillance system and to contribute to the research agenda to further the strategies in implementing the VIPP. F. The formation of the Violence and Injury Prevention Alliance (VIPA) shall make more stakeholders involved in the promotion of safety and prevention of violence and injury. G. Heaith Systems Strengthening shall be done to provide sustainable community-based health services such as but not limited to emergency medical services at the pre- ‘ *hospital and hospital levels, mental health care after trauma-related emergencies, and rehabilitative care, H, Monitoring and evaluation of VIP based on key result areas and key performance indicators shall be done regularly to gauge the status and progress of VIP. Figure 1: Action Framework for Violence and Injury Prevention Rec Lee acre ieiee cd Rea eos ca RUF Bg BOs Da ty DIT Ea DUETO Pre inca VIOLENCE Sess tena’ Pt eel 3 enon ant) RVirareeanit td ‘VIII. IMPLEMENTING MECHANISM A. Violence and Injury Prevention Program (VIPP) 1. The DOH shall be the focal agency responsible for designing, coordinating and integrating plans, programs, strategies and activities of various stakeholders into an effective and efficient system geared towards violence and injury prevention. VIPP is hereby institutionalized as one of the core programs of the National Center for Disease Prevention and Control (NCDPC). 2. The Program Management Committee (PMC) shall be organized to oversee the implementation, monitoring and evaluation of the program and to ensure its sustainability. PMC shall then be subdivided into Sub-Committees according to the following key areas of concern: a) Road Traffic Injuries b) Burns and Fireworks-Related Injuries ©) Drowning 4) Falls ©) Sports and Recreational Injuries£) Interpersonal Violence-Related Injuries including Violence Against Women and Children (VAWC), Bullying, and Torture 2) Animal Bites and Stings h) Self-Harm / Suicide i) Occupational and Work-Related Injuries ) Poisoning and Drug Toxicity 3. To ensure a more comprehensive and integrated approach, PMC shall collaborate with other programs from the Family Health Office and other concerned offices. 4. The Undersecretary / Assistant Secretary of Health who has the direct supervision over the Degenerative Disease Office shall exercise oversight function on VIPP. DDO shall act as the Secretariat and shall designate a National Program Coordinator who shall be working together with the National Focal Person (Program Manager). B. Program Management Committee (PMC) 1. Composition of PMC ‘© PMC shall be chaired by the Director IV of the National Center for Disease Prevention and Control (NCDPC) with the following members: a) Division Chief of the Degenerative Disease Office (DDO) b)_ National Focal Person (Program Manager) of VIPP ¢) Representatives from CHED, DepEd, DOT! 'C, DPWH, DOLE, DSWD, DILG, MMDA, and Philippine National Police. 4) Representatives from specialty societies and other agencies / organizations which can greatly contribute to the various aspects of violence and injury prevention. © PMC members shall be nominated by the agency / organization that they represent. Their membership to the PMC shall be on annual basis. Renewal or replacement of membership shall be the exclusive prerogative of the represented agency / organization. ‘© PMC shall be subdivided into Sub-Committees to undertake more specific policy interventions and activities in relation to each area of concer. Each Sub-Committee shall have an inter-disciplinary composition. ‘* The composition of PMC shall be provided in pertinent Department issuances in addition to written agreements such as Memorandum of ‘Agreement (MOA) or Memorandum of Understanding (MOU) with the involved agencies and stakeholders. ea2. Functions of the PMC © PMC shall have the following functions: a) Recommend to the Secretary of Health VIPP-related plans, programs, strategies and activities b) Ensure the implementation of integrated, comprehensive, sustainable and gender-responsive community-based VIPP ©) Ensure the collection and analysis of violence- and injury-related data d) Empower and engage all the stakeholders to participate in the VIPP thru Violence and Injury Prevention Alliance (VIPA) ©) Monitor and evaluate the VIPP regularly through program implementation review 1) Initiate and undertake inter-agency collaboration through formal and informal modes g) Endorse support of researches in the clinical, epidemiological, public health and knowledge management areas as well as evaluate them h) Others that may be identified and approved by the Secretary of Health * Each Sub-Committee shall have the following functions: a) Align their plans and programs to the goals and objectives of VIPP b) Implement their strategies and activities in close collaboration with PMC ©) Contribute to the electronic surveillance system and research agenda of DOH 4) Develop key result areas and key performance indicators to monitor and evaluate their program ©) Provide technical assistance and much-needed support for the success of VIPP 1) Recommend creat implementation g) Issue relevant and up-to-date standards and guidelines duly approved by various concerned stakeholders. and innovative approaches in the VIPP IX. ROLES AND RESPONSIBILITIES The following offices and institutions shall assume the following roles and responsibilities: A. The Program Management Committee (PMC) shall provide direction and technical support on policies and plans pertaining to the prevention of violence and injury. It shall also provide the forum for coordinating all aspects of the implementation of the program. B. The National Center for Disease Prevention and Control (NCDPC) shall: 1) Oversee the implementation of the national policy and program on Violence and Injury Prevention; 2) 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; 9 Ww ¥3) Provide technical assistance to the LGUs and other partners on public health interventions for violence and injury; 4) Support the design of health financing as related and applicable to violence and injury prevention in collaboration with PhilHfealth and other partners; 5) Conduct regular monitoring and evaluation of the burden of disease related to violence and injury; and 6) 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 C. The National Center for Health Promotion (NCHP), shall: 1) 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; 2) Advocate with other government agencies, non-government organizations, private sector, development partners, and other relevant stakeholders for support in policy development and resource generation towards the creation of supportive environments for safety promotion; and 3) Provide technical assistance in safety promotion and communications to ensure environmental interventions at the following settings: home, school, workplace and community. D. The National Epidemiology Center (NEC), shall: 1) Establish and sustain public health and hospital surveillance systems including registries for violence and injuries; 2) Oversee management and dissemination of data on mortality, morbidity and disability due to violence and injury; and 3) Support conduct of population-based surveys on risk factors associated with violence and injury. E. The Information Management Service (IMS) 1) Maintain the registry software; 2) Address technical problems accordingly; 3) Train users on how to operate the registry system; 4) Assist in the formulation of policies, procedures, guidelines, and relevant protocols to ensure continuous operations, and develops program interventions as needed; 5) Perform database and network management activities; 6) Manage the help desk support to ensure continuous operations; and 7) Provide funding on information and communication technology resources based on the DOH Information System Strategic Plan or other DOH directives or issuances. F. The Health Human Resource Development Bureau (HHRDB) shall: 1) Provide technical assistance in the development of learning interventions for health professionals on the prevention, control and management of violence and injury; 2) Facilitate integration of prevention and control of violence and injury in the academic curriculum of health professionals. 10 wo ¥G. The National Center for Health Facility Development (NCHFD), shall: 1) Ensure access and availability to quality hospital and facility-based services of patients involved in violence and injury; 2) Facilitate development and implementation of hospital-based information and surveillance system to gather data particularly on mortality, morbidity and disability from violence and injury; and 3.) Support funding for the availability and rational distribution of ambulances and other appropriate equipment that can provide effective life-saving pre- hospital emergency services. H. The Bureau of Health Facilities and Services (BHFS), shall ensure the safety and accessibility of health facilities through compliance with the prescribed standards on physical facility, equipment and personnel. I. The Bureau of International Health Cooperation (BIHC) shall coordinate with international development partners and other external institutions for technical and resource assistance on violence and injury prevention. J. The Philippine Health Insurance Corporation (PHIC) shall develop and implement health insurance package for clients at risk and involved in violence and injury to reduce financial burden and impoverishment of individuals and their families. K. The Violence and Injury Prevention Alliance (VIPA) shall provide much-needed support to the advocacy on safety culture. L. The four (4) Operation Clusters shall ensure the implementation of Violence and Injury Prevention Program by the Regional Offices. M. The Centers for Health Development (CHDS), shall provide technical assistance to the LGUs and oversee the local implementation of Violence and Injury Prevention Program. They shall also establish the standards for an efficient hospital referral system within the locality. N. DOH hospitals shall ensure provision of quality promotive, preventive, curative, rehabilitative, and palliative care for patients involved in violence and injury. . The Local Government Units (LGUs) shall adopt and implement the Violence and Injury Prevention Program and provide services and necessities in primary health care facilities and hospitals in their localities, P. Non-government organizations, professional groups, other national government agencies / organizations, private sector, and the academe shall assist in the implementation of Violence and Injury Prevention Program. X. FUNDING The National Center for Disease Prevention and Control ~ Degenerative Disease Office and Centers for Health Development - Noncommunicable Disease Program shall provide funds for technical assistance, monitoring, and safety promotion campaigns to ensure the operationalization and implementation of this policy and program framework. Local government units shall provide funds to provide necessities and services in their respective communities. Other government agencies, nongovernment organizations and other stakeholders shall provide counterpart funds as appropriate to ensure the implementation of Violence and Injury Prevention Program. 1 wXI. REPEALING CLAUSE Administrative Order No. 2007-0010 and other related issuances inconsistent with the provisions of this Order are hereby repealed, modified, or rescinded accordingly. All other provisions of existing issuances which are not affected by this Order shall remain valid and in effect, XIL EFFECTIVITY ‘This Order shall take effect immediately after its publication in a newspaper of general circulation. ENRIQUE T. ONA, MD Secretary of Health 2