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1 \ COMMUNITY EMPOWERMENT FOR HEALTH THROUGH PHILIPPINE INTEGRATIVE MEDICINE WITHIN THE CONTEXT OF ALTERNATIVE HEALTH CARE SYSTEMS DEVELOPMENT (Training and Advocacy Component) END OF PROJECT REPORT 1 With Funding Support of Evangelischer Entwicklungsdienst

2 COMMUNITY EMPOWERMENT FOR HEALTH THROUGH PHILIPPINE INTEGRATIVE MEDICINE WITHIN THE CONTEXT OF ALTERNATIVE HEALTH CARE SYSTEMS DEVELOPMENT (Training and Advocacy Component) Table of Contents Acronyms 3 Page I. Context National Health Situation 4 Organizational Development 8 II. Accomplishment for the Period Training 10 Advocacy, Linkages and Networking 43 Collective Leadership and Management 48 III. Significant Developments/ Lessons Learned Effects and Initial Impacts of Program Activities 54 IV. Future Plans and Directions 56 ANNEX A - Narrative Report Matrix B - Summary of PIM Trainings

3 ACRONYMS AHI ART Department BEC BHST BHW CBRP CHCF CHP CHW CMHP CO CUPA DKMP EAP IFRS KFLC KFI KMPI KUMARE MHO NIH PAA PIM PRRM RHU SCC-CEREA SDM SSAFI WHO Asian Health Institute Advocacy, Research and Training Department Basic Ecclesial Communities Basic Health Skills Training Barangay Health Worker Community Based Recovery Program Community Health Care Financing Community Health Program Community Health Worker Community Managed Health Program Community Organizing Claretian Urban Poor Apostolate Demokratikong Kilusan ng Magbubukid ng Pilipinas Ear Acupuncture Practitioner Institute for Formation and Religious Studies Kalimayahan Family Life Center Kalimudan Foundation Incorporated Kaunlaran ng Manggagawang Pilipino, Inc. Kilos Unlad ng Mamamayan ng Real Municipal Health Office National Institute of Health Philippine Academy of Acupuncturists Philippine Integrative Medicine Philippine Rural Reconstruction Movement Regional Health Unit Southern Christian Colleges - Community Education Research and Extension Administration Silsilah Dialogue Movement Sorsogon Social Action Foundation Inc. World Health Organization 3

4 COMMUNITY EMPOWERMENT FOR HEALTH THROUGH PHILIPPINE INTEGRATIVE MEDICINE WITHIN THE CONTEXT OF ALTERNATIVE HEALTH CARE SYSTEMS DEVELOPMENT (Training and Advocacy Component) I. CONTEXT A. National Health Situation In 2008, one of the major developments in the Philippine health care system is the approval or enactment of the Republic Act 9502 or otherwise known as Universally Accessible Cheaper and Quality Medicines Act of This mandated the Department of Health, Bureau of Food and Drugs and the Intellectual Property Office to issue the implementing rules and regulations for RA The new law will give way to parallel importation of cheaper medicines from other countries and at the same time will also induce local pharmaceutical companies to complement the rising competition in the market. It will also allow the Department of Health to issue compulsory licenses to other manufacturers to produce generic drugs for domestic use in cases of extreme public health need. The DOH is also mandated to conduct a price regulation on the maximum retail prices of the medicines. RA 9502 will also generate the acceleration of government efforts to put up more government pharmacies selling cheap medicines to the poor. At present, there are 1,746 Botika ng Bayan outlets and 11,572 Botika ng Barangay outlets nationwide which are selling 24 classes of essential types of medicine for hypertension, asthma, diabetes and for common infections. With the new law in place, majority of the poor people shall have access to quality and affordable medicines in their respective localities. Also during this year, the Philippine Health Insurance Corporation (PhilHealth) has increased its benefits to its members to cope with the rising medical and health expenses during this phase of global economic slowdown. A billion pesos will be added to the 2009 budget of the sponsored (indigent) program of the National Health Insurance Program to fully fund the premium of the sponsored (indigent) members. The agency will also provide PhilHealth benefits to displaced workers including them in the sponsored group of members. This is PhilHealth s contribution to the government s economic stimulus package. There was also a plan to amend and update the provisions of Republic Act 7883 Magna Carta for Health Workers which will benefit the barangay health workers in the issues of security of tenure, adequate training, health benefits and other entitlements. This will eventually professionalize and recognize the contribution of barangay health workers in the delivery of health services especially in the rural areas. Barangay health workers have been vanguards in the government s effort to combat the most common diseases such as tuberculosis, polio, malaria, etc. 4

5 In February 2009, the Philippine Health Insurance (PhilHealth) also expanded the benefit packages that it provides its members. One of the benefit packages is the coverage of the 4th Normal Spontaneous Delivery in accredited facilities nationwide. The new package took effect January 1 of this year, at a case rate of P4, inclusive of hospital and doctor's fees. PhilHealth also introduced the Outpatient Malaria Package worth P as part of the country's response to the global aim of combating malaria as called for in the Millennium Development Goals of the United Nations. The PhilHealth also introduced the Voluntary Surgical Contraception Package and the Tiered Payment of the Professional Fees of accredited physicians to ensure that the medical care services that they provide are of the highest quality that PhilHealth members deserve. The Board of PhilHealth also approved the revised Case Type Classification to update the benefits by providing a more appropriate case type classification with corresponding ICD-10 codes. During the previous implementation of case type classification, cancer cases receiving chemotherapy and/or radiotherapy as well as chronic renal failures undergoing dialysis were previously classified as Case Type "A". These have been upgraded to Case Type "C". PhilHealth has also added traditional, complementary and alternative medical (TCAM) benefits for certain diseases for use of its staff. TCAM has been seen by PhilHealth as an alternative to expensive Biomedical treatments. PhilHealth experiences gained from these TCAM services shall be useful for the agency as it prepares for TCAM benefit packages in view of accreditation of acupuncture and chiropractic practitioners and clinics by the Philippine Institute for Traditional and Alternative Health Care (PITAHC), the government agency overseeing the development of TCAM in the Philippines. The major global health issue for 2009 is the worldwide spread of the H1N1 Influenza virus. World Health Organization (WHO) reported in August 2009, there were 182,000 laboratory confirmed cases while 1,799 deaths were reported in 177 countries. Through the WHO monitoring network, it is apparent that rates of influenza illness continue to decline in the temperate regions of the southern hemisphere, except in South Africa where pandemic influenza H1N1 appeared slightly later than the other countries of the region. Active transmission is still seen in some later affected areas of Australia, Chile and Argentina even as national rates decrease. Areas of tropical Asia are reporting increasing rates of illness as they enter their monsoon season, as represented by India, Thailand, Malaysia, and Hong Kong, four places in the region which have active surveillance programs. Tropical regions of Central America, represented by Costa Rica and El Salvador, are also seeing very active transmission. In the Philippines, the Department of Health reported last July 2009, 2,688 confirmed AH1N1 cases with 3 deaths and 2,543 fully recovered patients out of the confirmed cases and there were 959 new cases reported. Health education on the prevention and management of AH1N1 was intensified in various schools, hospitals, barangays and provinces in the country to prevent further increase in the number of AH1N1 cases. Health Secretary Francisco Duque III strengthened the department s information and education 5

6 campaign on the prevention of the H1N1 virus to different schools, barangays and provinces in the country. Duque also convened another DOH Command Conference attended by members of the A (H1N1) Task Force, the DOH regional health directors, the chiefs of hospitals of all the 72 DOH-retained hospitals in the country, and some representatives from the private sector. The said conference became a venue to prepare the health care facilities on the anticipated increase in the number of H1N1 cases in the country. Another health concern in the Philippines was the rising number of Dengue cases. From January to December 2009, a total of 54,741 dengue cases were admitted to different sentinel hospitals nationwide. The cases reported are 21 %higher compared to the number of Dengue cases admitted last year (45,329). Most of the cases were from the following regions: National Capital Region (22%), Region IVA (13%), Region VII (12%), Region VI (9%), Region XI (6%), and Region XII (6%). The Department of Health sought the support of the Department of Education to intensify the information and education campaign for the prevention of dengue. In September 26, 2009, Ketsana (typhoon Ondoy) traversed the Philippines affecting most parts of Luzon including the National Capital Region. 512,092 families were affected and several barangays were evacuated after the continuous rains caused heavy flooding in Metro Manila and other parts of Luzon. The 40-year record-breaking 41.6-centimeters total rainfall in a single day left many Filipinos homeless. The total cost of damaged is estimated at P108.9M (US$2.3 million). Relief operations have sprung up from every corner of the world. People from different sectors, civil society organizations and other professional organizations expressed their willingness to help and offer whatever they can to ease and share the burden of the less fortunate especially those who were affected by the typhoon. On October 17, 2009, the National Epidemiology Center (NEC) reported that the number of Leptospirosis cases and deaths in Metro Manila and southern Tagalog was recorded at 1,336 with 96 deaths. The National Statistics Office (NSO) reported that about 2.9 million Filipinos were jobless in 2009 and the unemployment rate was estimated at about 7.7 percent. According to NSO, more males (64.6%) were without jobs than females (35.4%). The jobless and underemployed Filipinos were also the victims of the typhoons Ondoy and Pepeng. They also don t have access to basic health services. In 2010, Dr Esperanza Cabral was appointed by President Gloria Macapagal Arroyo as the new Health Secretary from January to June During Cabral s term she championed the memorandum on prohibition of smoking on government agencies, hospitals, health centers, schools and public places. In March 2010, the Department of Health has implemented the new set of price reductions for the following drugs/medicines: anti-hypercholesterolemia (Ezetrol and Vytorin),antihypertensive (Cozaar and Hyzaar), anti-depressant (Seroxat), anti-psychotic (Leponex), anticancer (Tykerb, Zoladex, Zoladex LA and Leunase), anti-asthma (Ventolin Rotapack), anti- 6

7 coagulant (Coumadin and Fraxiparine), anti-glaucoma (Betoptic, Ciloxan, Isoptocarpine and Quinax), medicines for prostate disorders (Avodart) and fluids for patients on kidney dialysis. Drugs for anti-hepatitis B/anti-viral (Revovir), antibiotic/anti-bacterial (Levofloxacin Winthrop), anti-inflammatory/pain reliever (Meloxicam Winthrop) and anti-asthma (Seretide with a new device) were also included in the Government Mediated Access Price (GMAP). About 11 drug companies responded to the government s request on price reduction. Secretary Cabral also supported the phase-out of mercury containing devices such as thermometers and sphygmomanometers in all health care facilities and encouraged all government and private hospitals to eliminate the use of mercurial thermometers and sphygmomanometers due to its hazardous effects to health and the environment especially when broken. The administrative order was signed by the former Health Secretary Francisco Duque III. In May 2010, Benigno Simeon Aquino III was elected as President of the Republic of the Philippines. During his state of the nation address, he mentioned that the plan for universal coverage of the Philippine Health Insurance (PhilHealth) for the Filipinos shall take place by identifying the number of Filipinos who are in need of health insurance. The Department of Social Welfare and Development shall initiate the National Household Targeting System to identify those who are in need of support and health care. Around 9 billion pesos is needed to ensure full health insurance coverage of approximately 5 million poor Filipinos. The newly appointed Health Secretary Enrique Ona is also prioritizing the implementation of the 100% health insurance coverage for the Filipinos during his term. In December 2010, Health Secretary Enrique Ona signed the Administrative Order entitled, the Aquino Health Agenda: Achieving Universal Health Care for All Filipinos. The overall goal of the Universal Health Care is to ensure the achievement of the health system goals of better health outcomes, sustained health financing and responsive health system by ensuring that all Filipinos, especially the disadvantaged group in the spirit of solidarity, have equitable access to affordable health care. The Universal Health Care is an approach that seeks to improve, streamline and scale up the reform strategies in Health Sector Reform Agenda (HSRA) and Fourmula One in order to address inequities in health outcomes by ensuring that all Filipinos, especially those belonging to the lowest two income quintiles, have equitable access to quality health care. It shall also strengthen the National Health Insurance Program (NHIP) as the prime mover in improving financial risk protection, generating resources to modernize and sustain health facilities, and improve the provision of public health services to achieve the Millennium Development Goals (MDGs). Through all of these developments in the health sector, INAM still finds its mission relevant in providing integrated health services and PIM trainings to its target clientele. Given the global effects of climate change, the socio-economic and political situation in the country, INAM is beginning to be more environmentally conscious and continues to pursue its 7

8 mission in promoting and propagating Philippine Integrative Medicine (PIM) to its target groups. INAM s new direction for the next project cycle is truly challenging given the national and health situation of the country. B. Organizational Development In 2008, INAM identified its direction focusing on three major components: Enhancement of Philippine Integrative Medicine (PIM), Sustainability and Collective Leadership. Enhancement of PIM shall be realized through the promotion of PIM through the different programs and services such as: integration of other health systems into the clinic services, trainings using the PIM curriculum, promotion of PIM curriculum during cluster consultations, documentation of Community Based Recovery Program s experiences and promotion of PIM through different medium. To effectively implement PIM enhancement, all INAM staff shall undergo different types of capability building to prepare them for the different challenges that the organization would encounter during the project cycle. The following were the training needs identified: PIM levels 2 and 3, review of traditional Chinese medicine in preparation for Philippine Institute for Traditional and Alternative Health Care (PITAHC) accreditation for non-medical acupuncturists, basic management skills, program management and development. Collective Leadership resides in the Executive Committee who is mainly responsible for program and financial management of approved projects. The Executive Committee is accountable to the general assembly, composed of all INAM staff, and to the Board of Trustees. Collective leadership is also a means of preparing all INAM staff to actively participate in the decision making process of the departments and the whole organization as well. It also refers to the coordination or synchronization of the different departments to maximize both human and financial resources to effectively implement the projects based on INAM s current direction. At the community level, collective leadership and management includes coordination but highlights the premium of participation in view of enabling communities to make decisions and manage their programs according to their collective hopes and aspirations in pursuit of their total well being. Concretely, this means that local leadership in communities reside among a group of people chosen by them, e.g., health committees, core groups, etc. that have undergone training processes (this is integrated in the 3 levels of the PIM curriculum). This group is tasked with monitoring of a health program implementation, planning and periodic assessment (the time frame for this is determined by them). This local leadership is accountable to their communities. Sustainability would include sustainability of INAM s programs and financial sustainability. Enhancement and popularization of PIM to the communities, partner NGOs, academe and other sectors would greatly contribute to the sustainability of INAM s different programs which could also directly or indirectly contribute to the financial sustainability of the 8

9 organization. INAM has already developed its sustainability plan for the next project cycle. The financial sustainability of the organization will eventually support the different programs and services of INAM and also the well being of all INAM staff. In 2009, all INAM staff identified the broad strokes for the second half of 2009 up to the first half of The broad strokes shall focus on: Program Management, Ecology and Accountability-Responsibility of the different departments. A staff development plan shall be created by all departments addressing the needs of the staff in relation to Program Management based on INAM s current direction and level of PIM consciousness. This shall comprise the basic theories and/or components of program management and appreciate its applicability considering the level of PIM consciousness, manner of conducting the daily activities of INAM and giving value to relationships (with INAM staff, patients and partner organizations). One of the most significant decisions made by all INAM staff during the 2009 annual organizational meeting was giving value to accountability and responsibility. All staff will no longer be required to use the bundy clock for time monitoring. However, a detailed plan of action for the next six months shall be required to all departments. The plan should be according to the general direction of the organization and the broad stokes for This decision will also provide the organization to work collectively as a team, considering proper time management, better quality of work outputs and a better perspective on time and work with emphasis on the individual s responsibility. Each department shall also develop their own mechanisms or system of monitoring that would ensure responsibility and accountability of each staff. A staff development plan shall also be created to address the needs of the staff in relation to the Ecological Dimension of Philippine Integrative Medicine (PIM). This was a result from INAM s successful tree planting activity in a mountain being taken cared and managed by the CARE foundation in Rizal province. The said activity opened the interest of most of the INAM staff for the care of the environment since this has a direct relation to health and climate change. It has been agreed that the staff development sessions on ecology should be within the perspective of PIM. The Sustainability of the organization remains a major focus of the organization. All the departments were advised to implement their sustainability plans in the coming period in order to draw lessons from it and provide basis for developing a comprehensive plan and strategies for the sustainability of INAM and its programs and services. During the third quarter of 2009, the Administration Department had its PIM Level 3 and documenting process trainings as part of the department s capability building. PIM Level 3 primarily focuses on enhancing basic management skills while the Documenting Process training emphasizes the importance of recording or documenting important aspects of the work being done by the Admin staff which is very important in enhancing the financial system, inventory, office management and for sustainability initiatives of the organization. 9

10 The Advocacy/Networking, Research and Training (ART) Department had their staff development session on Facilitation wherein their skills were enhanced to further prepare them for the actual conduct of PIM trainings in the communities. The Facilitator s Guide Manual developed in the previous period was also used during the staff development session. The Integrated Health Service Department and Community based Recovery Department had their review of their PIM Levels 1 and 2, some of their staff joined the ART training team in providing PIM trainings in the communities to observe the process of facilitating the training and conducting the community surveys. Philippine Integrative Medicine (PIM) was also promoted during the conduct of community clinics and health education during the height of the calamity period where typhoons Ondoy and Pepeng hit most of the areas in Metro Manila and the whole of Luzon provinces. INAM conducted a series of community clinics: October 9, 2009 at Sitio Batasin, Barangay San Juan, Taytay, Rizal. Three hundred families (300) were affected by the flood and up to this time are still recovering from the damages incurred by typhoon Ondoy. The families are residing 800 meters away from the flood way and their source of income are mostly coming from fishing, kangkong harvesting and seasonal jobs such as carpentry, construction workers, etc. A total of two hundred fifty four (254) patients were served and one hundred seventy two (172) or 67.71% were mostly children complaining of fever, cough, colds, loose bowel movement and skin diseases. Eighty two (82) or 32.29% were adults complaining of skin diseases, hypertension, muscle/ joint pains and symptoms of upper respiratory tract infection. October 11, 2009 at Villa Espaňa 2, Barangay Tatalon, Quezon City. Relief goods were distributed to 500 families in the community. A feeding program for 350 children was also conducted. 112 patients were treated with Ear acupuncture for stress and trauma management. Barangay Tatalon is also being considered as a prospective partner community of INAM Philippines especially for the Community Based Recovery Program. October 17, 2009, INAM together with its volunteer doctors and nurses went to Barangay Banaba, San Mateo, Rizal to provide integrated health services to the affected families of the barangay. The medical mission was conducted in a private school located within the vicinity of the barangay. Stress debriefing was held for community members who were traumatized by the flood and ensuing disaster. This process became very helpful for the survivors in order to socialize their experience and normalize their lives. Health education on Upper Respiratory Tract Infection and symptoms of Leptospirosis were also presented to the community members. Around 290 patients availed the services and consulted the medical doctors. Out of the total number of patients, 124 or 42.75% were children complaining of loose bowel movement, cough, colds, fever and skin rashes. 166 or 57.24% patients were adults mostly diagnosed with hypertension, upper respiratory tract infection, gastroenteritis, skin diseases and musculoskeletal disorders. 10

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