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                                         LEPROSY
                                         (Hansen’s Disease)



About Leprosy
Leprosy, also known as Hansen’s Disease is a chronic,mildly communicable disease caused by infection
from Mycobacterium leprae, a rod-shaped, acid-fast bacillus. It primarily affects the skin; the mucous
membranes, especially those in the nose; and the peripheral nervous system.

Leprosy exacts a high physical and social toll. If left untreated, it can result in deformity and disability. In
many societies, people with leprosy have been made outcasts from their communities.

The Norwegian doctor, Gerhard Armauer Hansen first observed M. leprae as an acid-fast, alcohol-fast,
strong Gram-positive bacillus in tissue specimens from leprosy patients in 1873. The following year, he
proposed that the bacteria caused leprosy; hence the name 'Hansen's Disease' emerged.

M. leprae infection occurs primarily in human beings. Researchers do not know exactly how the bacteria are
transmitted. For many years, leprosy was believed to be transmitted through skin-to-skin contact. However,
experts now consider this unlikely because M. leprae are not usually found on the skin’s surface. Most
evidence suggests that people become infected by inhaling the bacteria. With each cough or sneeze of an
untreated Person With Leprosy (PWL), the bacilli are discharged as droplets. Prolonged, close contact with
infectious persons is likely to increase the risk of transmission.



Leprosy in the Philippines

When the National Leprosy Control Program (NLCP)
was established in 1986, there were 38,570
registered leprosy patients in the country. That
number translated into a Prevalence Rate (PR) of
7.2 per 10,000 Filipinos.

By the end of 1998, with 7,005 registered patients
and a PR of 0.90 per 10,000 population, leprosy was
no longer considered as a public health problem by
both the Department of Health (DOH) and the World
Health Organization (WHO).

In 2004, the number was further reduced to 3,149
registered cases and a PR of 0.38 per 10,000
population.

From January 1 to December 31, 2004, a total of 2,120 new cases of leprosy were diagnosed and all were
put under treatment with MDT.

The NLCP is under the supervision of the National Center for Disease Prevention and Control (NCDPC) of
the DOH headed by Dr. Yolanda Oliveros; and the Infectious Disease Office headed by Dr. Jaime Lagahid.
Dr. Leda Hernandez is Chief of the Division that handles leprosy while Dr. Francesca Gajete is the National
Program Manager.

The areas or agencies that reported the most number of leprosy cases at the end of 2004 were



                                           Leonard Wood Memorial ...........151
                                           Quezon City ........................... 146
                                           Cebu Province ......................... 108
                                           Pangasinan ............................. 94
                                           Sulu ........................................ 87
                                           Nueva Ecija .............................. 81
                                           Eversley Childs Sanitarium.. ...... 75
                                           Manila ...................................... 74
                                           Cotabato North .......................... 68
                                           Ilocos Sur .................................. 67
                                           Northern Leyte............................ 67
                                                                November 7
                                                        Food Fortification Day!


The Food Fortification program is the
government's response to the growing
micronutrient malnutrition, which have been
prevalent in the Philippines for the past several
years.

Food Fortification is the addition of Sangkap
Pinoy or micronutrients such as Vitamin A, Iron
and/or Iodine to food, whether or not they are
normally contained in the food, for the purpose
of preventing or correcting a demonstrated
deficiency with one or more nutrients in the
population or specific population groups.

Sangkap Pinoy or micronutrients are vitamins
and minerals required by the body in very small
quantities. These are essential in maintaining a
strong, healthy and active body; sharp mind;
and for women to bear healthy children.
                                                       Lani Mercado and
Past studies have shown that worldwide, the            daughter Loudette are the
problem of malnutrition has been the cause of          two endorsers of the Food
death of 60% of children less than 5 years old.        Fortification Program


                                                    Based on the results of the 2003
                                                    National Nutrition Survey of the
                                                    Food and Nutrition Research Institute
                                                    (FNRI), the prevalence of VADD and
                                                    IDA among children and women of
                                                    reproductive age continue to be high,
                                                    and for children, they're even higher
                                                    than that of 1998. Iodine Deficiency
                                                    Disorder (IDD) has substantially
                                                    declined among children and
                                                    pregnant women although it remains
                                                    high among lactating women.

                                                    To address this problem, the
                                                    Philippines has embarked on a three-
For the Philippines, Nutrition surveys since        pronged strategy of micronutrient
1993 have been showing increasing prevalence        supplementation, dietary
of micronutrient malnutrition, particularly that    diversification and food fortification.
of Vitamin A Deficiency Disorder (VADD), Iron       While all strategies are
Deficiency Anemia (IDA) and Iodine Deficiency       simultaneously implemented to
Disorder (IDD) among children and women of          complement one another, studies
reproductive age, who are the most at-risk          show that food fortification is the
groups to micronutrient malnutrition.               most cost-effective and sustainable
                                                    to address micronutrient
                                                    malnutrition.
SMOKING: Its Origin

         The tobacco plant, scientifically known as Nicotiana tabacum, is a plant grown for
its leaves, which are smoked, chewed, or sniffed for a variety of effects. Tobacco is
considered addicting because it contains the chemical nicotine. Sniffing and chewing
tobacco originated in North America and Europe. It was Christopher Columbus who
introduced tobacco into Europe. It then became very popular with the Portugese, Spanish,
French, British, and Scandinavians.

Why is cigarette smoking dangerous?

        In 1960’s, medical research on tobacco showed smoking to be strongly linked to
heart and lung diseases. Smoking may be even more dangerous now than 30 years ago
because the lower levels of tar and nicotine in cigarette brands make smokers inhale more
deeply. In the US . . . .

        Only 42 of male lifelong smokers reach the age of 73 compared to 78% of non-
         smokers
        25.7% of the adult population (47 million people) continue to smoke despite
         repeated warnings on the hazards of cigarette smoking. 28% of the male
         population and 23% of women smoke
        Despite the known dangers of smoking, television, radio, and print ads continue to
         promote a number of cigarette brands

What are the chemicals in tobacco smoke?

        Tobacco contains nicotine, as well as tar. Both substances get deposited in the
bronchi and the lungs. The other chemicals found in tobacco are:

    1.   Acetone
    2.   Ammonia
    3.   Carbon Monoxide
    4.   Carbon Dioxide
    5.   Hydrogen Cyanide
    6.   Methane
    7.   Benzopyrene

 These chemicals are the major factors responsible for smoking related diseases like
coronary heart disease, atherosclerosis, stroke, emphysema, acute bronchitis and cancers
of the nose, pharynx, larynx (voice box), and lungs

What are the effects of nicotine on the body?

         Nicotine gives the so-called “positive effects” which include:

         1. Enhancement of memory and alertness
         2. Improvement of skills and work performance
         3. Alteration of mood, reduced stress, improvement in “sociability” and even
              euphoria

    However, these effects are fleeting and are far outweighted by negative effects. These
    include:

         1.   Shortness of breath
         2.   Chronic cough
         3.   Increased heart rate and blood pressure
         4.   “Ulcer-like” stomach pains (hunger pains), nausea and diarrhea
         5.   Reduction of fertility
         6.   Early onset of menopause in women
         7.   Tremors, especially in the inexperienced user
         8.   Sweating with the smell of nicotine

    Others related to gastro-intestinal effects:

         1. Appetite suppression specifically for simple carbohydrates (sweets)
         2. Inability to taste food
         3. Decreased efficiency of food digestion and metabolism

What is second-hand smoke?

         Second-hand smoke is smoke exhaled by a smoker and inhaled by other people.
Non-smokers who are exposed to second-hand smoke are more at risk because the
particles in the exhaled smoke are smaller. They reach deeper into the lungs of the passive
smokers.

   The unfortunate non-smoker exposed regularly to second-hand smoke, is prone to
specific health risks which include:

    1. Increased risk of heart disease
    2. Increased risk of lung cancer
    3. Increase frequency of respiratory infections and asthmatic bronchitis in infants and
         children
    4. Chronic irritation of the eyes, nose and throat especially among children

What are the long-term effects of cigarette smoking?

        Long-term smoking can contribute significantly to the acceleration of the following
health problems:

    1. Nicotine addiction
    2. Coronary artery disease – at least 20% of deaths are smoking-related
    3. Heart disease - Smokers in their 30s and 40s have a heart attack rate that is five
         times their non-smoking peers
    4. Hardening of the arteries and complication of blocked arteries, hypertension,
         blood clots
    5.   Stoke – People who smoke a pack a day have almost two and a half times the risk
         of getting a stroke
    6. Peptic ulcer disease
    7. Lung diseases – chronic obstructive pulmonary diseases such as chronic
           bronchitis and emphysema; smoking caused nearly 85,000 deaths in 1990 due to
           these diseases.
    8.     Cancers – oral, especially of the respiratory tract and the oral cavity, nose,
           pharynx, larynx, lung, cervical, urinary bladder, kidney, and pancreas; smoking
           accounts for 85% of all lung cancers
    9.     Disease of the oral cavity, e.g., irritation and infection of the gums and teeth
    10.    Delayed wound healing

Smoking can cause the following problems in women:


    1. Reproductive disturbances (such as, infertility)
    2. Problems during pregnancy include:

           a. Fetal abnormalities and even death

    3. b. Low-birth weight infants

Why is very hard to quit smoking?

         Withdrawal is a difficult process. About 70% of smokers want to quit. In one study
of women smokers who wanted to quit, 80% of them were unable to. This is because
nicotine increases the activity of dopamine, a chemical in the brain that elicits pleasurable
sensations. Even after years of non-smoking, about 20% of ex-smokers still have
occasional cravings for cigarettes.

What are the signs and symptoms of nicotine withdrawal?

          Withdrawal symptoms begin as soon as 4 hours after one decides to quit smoking
or after the last cigarette, generally peak in intensity at three to five days, and disappear
after two weeks. These symptoms start with headache, anxiety, irritability, tremors, poor
concentration, and hunger pains. Other signs and symptoms include insomnia and
depression, sweating, constipation and diarrhea.

What are the benefits of quitting smoking?

           Chronologically, these are the benefits when one decides to quit smoking:

      1.       Within 20 minutes, the blood pressure and pulse rate drop to normal, the body
             temperature of the hands and feet returns to normal.

      2.      Within 8 hours, the carbon monoxide level in blood drops to normal and the
             oxygen level I blood increases to normal.

      3.      Within 24 hours, the risk of a sudden heart attack decreases.

      4.       Within 48 hours, the nerve endings begin to regenerate and a person’s ability
             to smell and taste begins to return to normal.
      5.       Within 2 weeks to 3 months, blood circulation improves and lung function
             increases up to 30%.

      6.     Within 1 to 9 months, overall energy increases, signs and symptoms of
             coughing, nasal congestion, fatigue, and shortness of breath are markedly
             reduced. Natural cleansing mechanisms of the respiratory tract returns to normal,
             so that the body is able to handle mucus, clean the respiratory tract, and prevent
             respiratory infections.

      7.     Within 1 year, risk of coronary heart disease is reduced by 50%.

      8.     Within 5 years, the risk of dying from lung cancer is reduced by 50%. The risk of
             cancer of the mouth is half that of a tobacco user.

      9.     Within 10 years, the risk of dying lung cancer, stroke and heart attack is the
             same as that of a non-smoker’s.

When is the best time to quit smoking?

         The sooner a smoker quits smoking, the better. It is never too late to quit. No one is
too old too quit. Because the first two weeks are critical success, smokers should seek all
the help they can during this period.

           Here is a tip to help smoker decide when to quit smoking:

           A smoker should choose a particular date to quit when his level of stress is
lowest.

Example: Women should not start during the premenstrual period when stress is high.

What are ways to quit smoking?

    1. Scheduled reduction – the process of slowly reducing the number of cigarettes per
           day until one has stopped completely.
    2.     Nicotine Replacement Therapy (NRT) – a smoker who stops smoking is given
           small amounts of nicotine over a period of six weeks or more to reduce withdrawal
           signs. The nicotine is given either as chewing gum. patch, nasal spray or cigarette-
           like inhaler. Consult your physician about NRT.
    3.     Totally quitting smoking without any outside help.

What should smokers do while they are quitting?

    1. Exercise. Take deep breaths, dance, run, wall jump up and down, stretch.
    2. Drink plenty of water and eat fruits and vegetables. Take plenty of vitamins and
           minerals. Carrots, apples, singkamas, chewing gum, and candies are good
           munching foods to replace the feel of a cigarette in the mouth.
    3.     Take naps, warm baths or showers during intensive cravings to smoke.
    4.     Tell friends and family that you have stopped smoking. This will make you feel
           embarrassed when they catch you smoking.
    5.     Change activities or habits that are associated with smoking. For instance, find
           other ways to finish a meal without smoking. Go out for a walk, go to a place where
       smoking is prohibited, doodle instead of smoking while talking on the phone.

Advice to smokers:

         While is was once a fad to smoke, it has now become dangerous to health.
Smoking is abnormal. It is very addicting and very hard to stop. Smoking not only affects
other people who inhaled second-hand smoke. Smoking contributes significantly to
diseases that shortens life and is leading cause of death like heart attack, stroke,
respiratory diseases which make smokers “pulmonary cripples” as in asthma, emphysema,
bronchitis, recurrent infections, and cancer.
                            Avian Flu (Bird Flu)

                            Bird flu or avian influenza is a contagious disease of birds
                            ranging from mild to severe form of illness. all birds are
                            thought to be susceptible to avian influenza, though some
                            species are more resistant to infection than others. Some
                            forms of bird flu infection can cause illness to humans.

    Bird flu is caused by 15 subtypes of influenza A virus affecting chicken, ducks and
    other birds. Viruses of low pathogenicity can, mutate into highly pathogenic viruses.

    To date, all outbreaks of the highly infective form have been caused bu influenza A
    /H5N1 virus, the only subtype that cause severe outbreaks in humans.




    Most Recent Situation and Cumulative Cases on Avian Influenza (WHO)



                                ...........................
                                  Last Updated: 09 January, 2006




           Executive Order No.280
    Defining the Powers, Functions , and Responsibilities of Government Agencies in
    Response to Avian Influenza (AI) or Bird Flu Virus and Related Matters Thereto.
                        PRIMER ON MENINGOCOCCEMIA


Identification: This disease is also called meningococcal meningitis or cerebrospinal fever. It is
an acute disease caused by a gram negative bacteria Neisseria meningitidis. The infection may
be asymptomatic, may be restricted to the nasopharynx, or exhibit upper respiratorytract
infections. It may cause meningococcal septicemia, or meningitis. Incubation period lasts for 2-10
days with an average of 3-4 days.

                                                                          0
The disease is characterized by sudden onset of high grade fever (>38 C) lasting for 24 hours.
Other signs and symptoms are petechial and/or purpuric rashes appearing within 24 hours after
onset of fever, and signs of meningeal irritation such as: headache, nausea and vomiting, stiff
neck, bulging fontanel (among infants), seizure or convulsions, and sensorial changes.

Diagnosis: Diagnosis is confirmed by demonstration of the bacteria in a gram-stained smear of
the cerebro-spinal fluid (CSF) and the isolation of the bacteria from the CSF blood.

Occurrence: The disease is usually sporadic (cases occur alone or may affect household
members with intimate contact). Although primarily a disease of children, it may occur among
adults especially in conditions of forced overcrowding such as institutions, jails and barracks. It
occurs more in males than females.

Mode of transmission: Transmission is by direct contact with respiratory droplets from nose and
throat of infected persons. Carriers may exist without cases of meningitis. Transmission via
inanimate objects (personal belongings of cases) is insignificant.

Prevention and Control: Preventive measures are geared towards reducing overcrowding and
exposure to droplet infection. Immunization of civilians is not recommended as duration of
protection is limited.

Treatment and Prophylaxis: Treatment is effected by antibiotics and if given early, fatality rate is
rendered less than 10%. Aqueous Penicillin G may be given to both children and adults.
Chloramphenicol may be given in cases of Penicillin allergy.

Prophylaxis is reserved for those who have intimate contact with the patient; household
members, boyfriend/girlfriend, sexual partners, hospital personnel who did suctioning of
secretions and/or mouth resuscitation. Rifampicin is the drug of choice and may be given to both
children and adults.
MURANG GAMOT




                                   PMU 50                         Rolando Enrique Domingo, MD
                                   1st Bldg. 12, San Lazaro Cpd., Project Executive Officer for PMU 50
                                   Sta. Cruz, Manila              Assistant Secretary of Health
                                   Tel. No. 781-25-16;
                                            338-33-88             Timothy J. Badoy, MD
                                                                  Project Coordinator
                                                                  Chief, Policy, Planning & Advocacy, BFAD
List of Drugs | Participating Hospitals | Comparative Price | Inventory Report of Pharma 50 | Botika ng
Barangay Initiative | Drug Consignment System | Botika ng Barangay Monitoring System | ARSP
Progress Report 2005 |Drug Price Reference Index (DPRI)



Downloadable Forms:
BnB Quarterly Performance Report
BnB Drug Re-Order Support Quarterly Report



                                             Background

Health care is central to the concept of development and that a health policy of
conscious intervention through public agencies is required in order to reach certain
basic health objectives. In order to achieve these health objectives provisions for the
basic requirement of preventive, promotive and curative health care services must
be top priority.

An essential component of a health policy includes measures to promote the rational
use of drugs and ensure the availability of medicines of adequate quality at a
reasonable price. To date the cost of medicines in the Philippines remains hign and is
even higher by 40% to 70% compared to other ASEAN countries. Moreover, our
budget for drugs and medicines is too small to procure sufficient quantities of low-
cost, essential drugs for the population in need.

In 23 July 2001, H.E. President Gloria Macapagal-Arroyo made a commitment to
lower the prices of drugs and medicines frequently bought by the poor by 50%.

What is GMA 50%?

GMA 50 is the name of the Department of Health (DoH) undertaking to effect the
SONA pledge of President Gloria Macapagal-Arroyo. The primary goal of the project
is to ensure that affordable, high quality, safe and effective drugs and medicines are
always available, especially to the poor.

How does GMA 50 intend to attain its objective?

The strategies that GMA 50 will employ are:

A. Short-term (2001 SONA - 2002 SONA)
   1. Continue the importation of high quality, safe, effective and affordable drugs
        and medicines for as long as the prices in the country remain high.
   2.   Expand, as appropriate the list of drugs and medicines for importation. The
        list will contain essential drugs needed to treat the prevailing causes of
        morbidity and mortality.
   3.   Increase the number of outlets. Initially, the outlets will be limited to public
        health facilities i.e., DoH and LGU retained hospitals, Botika ng Barangay, and
        NFA rolling stores. However, initial meetings with private retail outlets are
        being conducted to draw up the guidelines for their involvement.

B. Medium and Long-term (SONA 2002 and beyond)

   1. Promote the use of Generic drugs and medicines.

        Basically, generic counterparts of branded drugs are far lower in prices.
        However, generic product in the country has very low acceptability to the
        medical practitioners and general public, as reflected in the sales and use.
        There is a need to ensure the quality, safety and efficacy of these products
        through regulations and other measures.

   2. Ensure continuous supply of high quality, safe, effective and affordable drugs
        and medicines, whether imported or locally manufactured. (i.e.Toll
        Manufacturing for selected drugs and medicines, the PITC to procure for
        government health facilities, encourage local production, etc).
   3.   Develop reimbursement scheme for medicines with PhilHealth (Reference
        price for 100 most commonly needed/claimed drugs and medicines, PHIC to
        reimburse Generic drugs, etc).
   4.   Work with the pharmaceutical industry/organization/companies for them to
        reduce significantly the prices of drugs and medicines.
   5.   Work with the local retail industry for them to pass on to the consumers the
        low price of drugs and medicines, and
   6.   Wage war versus substandard drugs.

Who are involved?

Reducing the prices of drugs and medicines requires the cooperation and
collaboration of many organizations, both private and public. As of today, the major
players are:

        A. Public

           1. Department of Health
           2. a) Bureau of Food and Drugs
               b) Philippine Health Insurance Corporation
           3. Department of Trade and Industry

               a) Philippine International Trade Corporation
               b) Philippine Health Insurance Corporation

           4. Philippine Charity Sweepstakes
             5. National Food Authority
             6. Local Government Units



B. Private

             1.   Association of Drug Industries in the Philippines
             2.   Philippine Healthcare Association of the Philippines
             3.   Chamber of Filipino Pharmaceutical Manufacturers and Distributors
             4.   Filipino Drug Association
             5.   Generics Association of the Philippines
             6.   United Laboratories, Inc.
             7.   Drugstore Association of the Philippines

What have we accomplished so far?

   1. Undertaken 2 importation of 8 drugs and medicines and distributed in 30 DOH
        retained hospitals.
   2. Third shipment of about 40 drugs and medicines in transit to be distributed in
        73 DOH retained hospitals
   3.   Approval of a Special License to Operate for the Botika ng Barangay and
        National Food Authority Rolling Stores to sell over-the-counter drugs and
        medicines.
   4.   Lagundi and Sambong are sold in NFA rolling stores in Metro Manila.
   5.   Develop the operational guidelines for establishing Botika ng Barangay.

What needs to be done?

    Agency                                      Expectation
                           Promote rational drug use
Department of              Strengthen the capability of the Bureau of Food and Drugs
Health                     Intensify the promotion of generic drugs and medicines


Philippine
                           Import drugs and medicines at affordable prices
International
Trade
Philippine                 Source of funds
Charity
Sweepstakes
                           Increase enrollment to PHIC
Local                      Procure, use and sell affordable high quality drugs &
Government                  medicines
Units                      Practice rational drug use
                         Price reference
Philippine Health
                         Drug reimbursement scheme for generic drugs & medicines
Insurance
                         Health packages
Corporation


Board of                 Incentives to local pharmaceutical firms
Investments


Four Rights in Food Safety
Right Source:
• Always buy fresh meat, fish, fruits & vegetables.
• Always look for the expiry dates of processed foods and avoid buying the
expired ones.
• Avoid buying canned foods with dents, bulges, deformation , broken seals
and improperly seams.
• Use water only from clean and safe sources.
• When in doubt of the water source, boil water for 2 minutes.

Right Preparation:
• Avoid contact between raw foods and cooked foods.
• Always buy pasteurized milk and fruit juices.
• Wash vegetables well if to be eaten raw such as lettuce, cucumber,
tomatoes & carrots.
• Always wash hands and kitchen utensils before and after preparing food.
• Sweep kitchen floors to remove food droppings and prevent the harbor of
rats & insects.

Right Cooking:
• Cook food thoroughly. Temperature on all parts of the food should reach 70
degrees centigrade.
• Eat cooked food immediately.
• Wash hands thoroughly before and after eating.

Right Storage:
• All cooked foods should be left at room temperature for NOT more than
two hours to prevent multiplication of bacteria.
• Store cooked foods carefully. Be sure to use tightly sealed containers for
storing food.
• Be sure to store food under hot conditions (at least or above 60 degrees
centigrade) or in cold conditions (below or equal to 10 degrees
centigrade). This is vital if you plan to store food for more than four to five
hours.
• Foods for infants should not be stored at all. It should always be freshly
prepared.
• Do not overburden the refrigerator by filling it with too large quantities of
warm food.
• Reheat stored food before eating. Food should be reheated to at least 70
degrees centigrade.

Rule in Food Safety: “When in doubt, throw it out!”
                           2005 World TB Day Commemoration
                        TB Network: Sama-samang Sugpuin ang TB



 What is TB       10 Roles of a TB-      TB vs. NTP-       Microscopy NTP-
                                                                           Microscopy Centers
 Network?         D.O.T.S. Advocate       D.O.T.S              D.O.T.S.


What is TB Network?
  1. It is the official communication handle of the National Tuberculosis Control
      Program or NTP that will stand for DOH’s re-energized fight against TB.
  2. It is a product of DOH’s collaboration with the LGUs, PhilCAT, and Philhealth.
  3. It is a “special group” dedicated to help/ take care of TB symptomatics and TB
      patients.


  a. Initially, it comprises regular health workers in the RHUs, MHOs and PHOs.
  b. Eventually, it will include everyone in the community who wish to help in the
      administration and financing of D.O.T.S.; family and relatives of TB symptomatics /
      patients, church, church organizations, civic organizations, NGOs, schools,
      companies/corporations.


  4. TB Network comes with several information materials, such as print ads, radio and TV
      commercials. Poster of this TB Network as endorsed by Secretary Dayrit himself and with
      its battle cry “Kakampi Laban sa TB” will also be distributed as soon as ready.
  5. It is participated in by the different stakeholders like donor agencies, private sector, non-
      government organizations, academe, professional societies, pharmaceutical companies
      and other TB DOTS partners and individual advocates united as one for a common
      cause.
  6. Members of TB Network have also expanded to a huge number of other government
      agencies as also members of the Comprehensive & Unified Policy for TB Control in the
      Philippines or C.U.P.
  7. DOH in cooperation with all the involved agencies as members of TB Network
        continuously works hand-in-hand in increasing case detection and cure rates in
        accordance with the NTP Targets every year.
  8. In the end, it can blossom into a systematic, well-oiled, nationwide movement for the
        eventual complete eradication and/or control of TB-spearheaded by DOH.


Creative Considerations
  1. Create a strong branding for NTP
  2. Establish a human connection between the NTP and Target Audiences
  3. Employ a unique visual device that is attractive, impactful, and memorable




10 Roles of a TB-D.O.T.S. Advocate
  1.    Shares experiences and accomplishments in terms of cure and referral to
        TB Network.
  2.    Disseminates right information on TB through available Information,
        Education, and Communication (IEC) campaign materials.
  3.    Serves as moral support to TB patients and fellow advocates.
  4.    Refers individuals with cough for two weeks or more to the nearest
        D.O.T.S. center for proper management.
  5.    Conducts health education activities on how TB disease is acquired and
        developed.
  6.    Promotes D.O.T.S. services of TB Partners including private sector.
  7.    Advocates D.O.T.S. as the Strategy for curing TB.
  8.    Participates during NTP activities including National Health Events, if
        possible.
  9.    Encourages other people from different sectors to be a TB D.O.T.S.
        Advocate.
  10.   Assists the treatment partner or may serve as the treatment partner, if
        necessary.
TB vs. NTP-D.O.T.S
What is TB?

Tuberculosis is an infectious disease caused by TB bacteria ( tuberculosis) that primarily affects the
lungs. This condition is known as pulmonary tuberculosis (PTB). You may also have tuberculosis
in the bones, meninges, joints, genito-urinary tract, liver, kidneys, intestines and heart and this is
called extra-pulmonary tuberculosis.

What are some of the relevant TB statistics?

The Philippines is among the 22 high-burdened countries in the world according to W.H.O. TB is
the 6th leading cause of illness and the 6th leading cause of deaths among the Filipinos. Most TB
patients belong to the economically productive age- group (15-54 years-old) according to the 2nd
National Prevalence Survey in 1997.

How does one get TB?

One gets infected with TB if he inhales the germs released from air droplets when a pulmonary
TB patient coughs, sneezes and spits. A PTB patient whose sputum is positive for the TB
germs/bacteria, if left untreated, may infect approximately 10-20 persons in two years.

How is TB diagnosed?

Pulmonary TB is suspected if a person has symptoms of cough for more than 2 weeks, fever,
chest and back pains, poor appetite, loss of weight and hemoptysis. He should seek medical
consultation and his sputum should be examined to detect the presence of TB germs/bacteria.

How is TB treated?

Tuberculosis is a curable disease. Patients are prescribed with appropriate regimen to render
them non-infectious and cured, as early as possible. The treatment for TB is a
combination of 3-4 anti-TB drugs. NEVER should we prescribe a SINGLE DRUG for TB
treatment! This will worsen the patient’s condition.

What is D.O.T.S. ?

D.O.T.S. stands for Directly-Observed Treatment Short-course. It is a comprehensive strategy
endorsed by the World Health Organization (WHO) and International Union Against Tuberculosis
and Lung Diseases (IUATLD) to detect and cure TB patients.

There are five elements of DOTS that need to be fulfilled. These are:

    a. political commitment
    b. quality sputum microscopy for diagnosis
    c.   regular supply of anti-TB drugs
    d. standardized recording and reporting of TB data
    e. supervised treatment by a treatment partner


According to the WHO Report on the TB Epidemic, 1997:

DOTS cure TB patients and it can produce cure rates as high as 95% even in the poorest countries.
DOTS prevent new infections among children and adults.
DOTS can stop resistance to anti-TB drugs.
DOTS is cost-effective.

How can we avail of D.O.T.S. Services?

DOTS services are available in the rural health units, city health centers and govern ment
hospitals around the country. Currently, there are also private facilities that are offering DOTS
services to their clients.

Is TB curable?

YES! TB can be cured through D.O.T.S.

What is the National TB Program of the Government?

The National TB Program (NTP) is the Government’s commitment to address the TB problem in
the country. The NTP is being implemented nationwide in all government health centers and
government hospitals. Its objectives are to detect active TB cases (at least 70%) and cure them
(at least 85%). Achieving and sustaining targets will eventually result to the decline of the TB
problem in the Philippines.
Briefer on the National Voluntary Blood Services Program
(NVBSP)
Background:

By virtue of RA 7719 otherwise known as the "National Blood Services Act of 1994" the
Department of Health in cooperation with the Philippine National Red Cross (PNRC) and Philippine
Blood Coordinating Council (PBCC) and other government agencies & non-government
organizations is mandated to plan and implement a National Voluntary Blood Services Program
(NVBSP). A National Voluntary Blood Services Program Committee was then created and chaired
by the Secretary of Health.

The NVBSP was also established as the program management arm of the Department and has
been institutionalized within the organization structure of the Office of Health Facilities Standards
and Regulation of the Department.

The NVBSP Unit whose mission is to ensure safe, adequate, accessible and rationally-used blood
supply operates with a separate PS/MOOE/CO Budget (Attached Appendix A).

In CY 1998, the newly created 144 DOH-NVBSP Permanent Plantilla items were distributed to
DOH-NCR and Regional Hospitals (Appendix B) as manpower augmentation to implement NVBSP
activities.

Distribution as follows:

       DOH NVBSP Unit (Central Office) 30 items
       DOH NCR/Regional Hospitals 144 items

Corresponding Personnel Services for the above purpose were being prepared sub-alloted by the
NVBSP Unit monthly to recipient Hospitals.

In CY 2000, the Department of Health implemented Executive Order No. 102 s. 1999 which aims to
streamline Central Office Personnel to 50%. The implementation had adversely affected the DOH-
NVBSP Unit. (Central Office ) Staff. Three (3) NVBSP Unit personnel signified voluntary
deployment; and all others were transferred under mandatory deployment as follows:

       Lung Center of the Philippines 25
       DOH-NCHFD 4
       DOH-NCR/RegionalHospitals 114

By virtue of EO 102 s. 1999, all (144) NVBSP Plantilla items were integrated to respective
hospitals/office.

Of the 25 NVBSP Personnel deployed to LCP, 6 were re-assigned to other hospitals to augment
their 24 hr. Blood Bank operations.
       Las Piñas District Hospital 1 MS II
       Ospital ng Maynila Medical Center 2 (1 MS III, 1 MT I)
       Philippine General Hospital 3 (1 MS III, 2 MT 1)

One (1) DOH deployed personnel assigned to NVBSP, MS II, was also re-assigned to Las Piñas
District Hospital to support the NVBSP.

Also by virtue of EO 102 s. 1999 thru Department Order 88-K s. 2001 (Appendix C), the Technical
Operations of the NVBSP Unit was transferred to the Lung Center of the Philippines (LCP) now
known as the NVBSP-LCP unit. Which is also identified as the core unit for the future Philippine
Blood Transfusion Center which shall be build within LCP compound (project proposal was
submitted to NEDA for JICA grant.

                                       Current Operations

1. The NVBSP Unit was transferred to the Lung Center of the Philippines. In such transfer P 20 M
NVBSP funds supposedly will be released from DBM. Only P 9.2 M was released for CY 2001.

2. NVBSP Budget for CY 2002 under LCP must be part of the LCP budget proposal.

3. The NVBSP-LCP unit was directly under the office of the Executive Director under its National
Health Programs Services.

4. . Under the LCP organizational structure the NVBSP Unit has been merged with LCP Blood Bank
as based Blood Bank category B. The merging will assume function of the future National Blood
Center, the Philippine Blood Transfusion Center.

5. As per Department Order No. 88-K s. 2001, the NVBSP LCP and NVBSP – NCHFD
responsibilities are stated (Appendix D).

6. The CY 2001 and CY 2002 accomplishment report of NVBSP-LCP (Appendix D).

For CY 2003 budget of the NVBSP-LCP Unit - was requested for transfer of funds of PS and
MOOE to DOH Central office.

The breakdown are as follows:

Personnel Services (PS)                            =        P 4.861 M
Maintenance and Other Operating Expenses           =        P 15.139 M
                                                            ___________
                                                   Total    P 20 M
Ligtas Tigdas 2004 is a special nationwide
vaccination month for children who are at high
risk of getting measles. The Department of
Health identified these children to be those
between the ages of 9 months to less than 8
years old.

During the Ligtas Tigdas 2004, 100% of the
children in this age group will be vaccinated.
Other children are not classified as high risk.

The Philippine Measles Elimination Campaign
of which the Ligtas Tigdas 2004 is only one
component. PMEC includes continuing routine
vaccination of infants at 9 months old after
Ligtas Tigdas 2004; the catch-up mass
vaccination done in 1998; continuing
monitoring or disease surveillance and Follow-
up campaign such as Ligtas Tigdas 2004 which
may have to be repeated every 4 or 5
years.Vitamin A capsules will also be given to
children 9 months to below 6 years of age.

The “LIGTAS TIGDAS” should be done to
rapidly reduce the number of children at risk of
getting measles infection which has
accumulated in the past years. This nationwide
campaign supports the routine vaccination
given on a regular basis at the health centers.

It is a Door-to-Door campaign.
“BakunaDOORS” (Vaccination Teams) led by
doctors, nurses and midwives will visit every
home and school to vaccinate children against
measles which will be done in the whole month
of February 2004
DOH Issuances

       Department Circular No. 273-A, s. 2003

Implementation of the Health Promotion Plan for the
Philippine Follow-up Measles Elimination Campaign
2004

       Department Order No. 162-E, s. 2003

Creation of Sub-Committee for Social
Mobilization/IEC on
Philippine Measles Elimination Campaign dubbed as
"Ligtas Tigdas"

       Memorandum No. 164-A, s. 2003

Identifying Priority Areas for Philippine Measles
Elimination Campaign for February 2004

       NCDPC Order No.123-E, s. 2003

Authority for Seclected NCDPC Staff to monitor Pre-
Implementation Activities of Philippine Follow-Up
Measles Elimination Campaign and Garantisadong
Pambata Campaign on October 2003 to November
2003.

Other Agency Issuances

       DENR Memorandum
       DepEd Memorandum
       PMA Circular
       DND Department Order
       Executive order

Others

       Summary of Partners Commitment/Donation
What is measles and why is it dangerous?

   Measles is a highly contagious disease caused
by a virus. It affects mostly children. It is easily and
very rapidly transmitted through air or direct contact.

     Children who suffer from measles may
experience complications including pneumonia,
encephalitis, blindness, deafness, ear infection,
diarrhea and dehydration.

   Complications due to measles can cause death.

Who can get measles?

       Any person young and old who has not
        been vaccinated against measles.

       A child who has been vaccinated may not
        necessarily develop enough protection
        against measles and so he/she needs to be
        vaccinated again.

       Not all persons who say they had measles
        really had measles. There are other
        diseases that may look like measles with
        rashes which maybe mistaken for measles.

What are the signs and symptoms of measles?

    A child with measles usually has blotchy rashes
all over the body for 3 days or more. She or he also
has fever and at least any one of the following:

       Cough
       Runny nose
       Reddish eyes

How do you prevent measles?

      Through measles vaccination starting 9
months of age.

My child has been vaccinated against measles.
Is she exempted from this LIGTAS TIGDAS
Month?

        NO. The measles vaccine she gets during
        the LIGTAS TIGDAS campaign will
       increase her protection against measles.

My child had measles previously, is he
exempted in this campaign?

       NO. There are many measles-like diseases.
       The LIGTAS TIGDAS vaccination will not
       harm a child and will even serve to increase
       his immunity against measles.

Is there any overdose, if my child receives this
measles vaccine during this month?

       NONE.       Antibodies in the blood which
       provide protection against the disease
       decrease as the child grows older. The
       child will not be harmed because there is no
       vaccine overdose for the measles vaccine.
       The measles vaccine is even known to
       enhance overall immunity against other
       diseases.

What will happen to my child after receiving the
measles immunization?

       Nothing. However, some children will have
       a slight fever. The fever may last from 1 to
       2 days.

       The best thing to do when the child has a
       slight fever is to give him paracetamol every
       four hours. Give him plenty of fluids. If the
       child is breastfeeding continue doing so.
       Ensure that the child has enough rest and
       sleep.

What will happen after the “Ligtas Tigdas”?

       All children who turn 9-11 months old after
       2004 must receive one dose of the measles
       vaccine together with the vaccines against
       other diseases of childhood like polio,
       diphtheria, pertussis, etc.

       All children suspected of having measles
       have to be reported to the health workers.

       Health workers who receive reports of
       suspected measles must investigate the
       case/s.
Republic Act 8792 otherwise known as                           ANNOUNCEMENT
the Electronic Commerce Act of 2000
under sections 27 and 28, which
prescribes that within two (2) years from
the effectivity of the Act, all agencies of
the government shall be required to use
electronic data messages, electronic
documents, and electronic signatures and
to promote the use of the same in the
government and to the general                                  VERSION 2.01a
public.
      For comments, suggestions & problems:
         Email us at: dtomis@co.doh.gov.ph or
 Contact: Information Mgt. Service at 711-6744 (Telefax)
                    or nearest CHD                             TRAINING SCHEDULE
     For complete List of Contact Persons see              FOR LABORATORY HEADS
                   Technical Support

                                                           The Seminar /Workshop on the Manual of Operations
                                                           for Heads of Drug Testing Laboratories (HOL) will be
                                                           conducted by the National Reference Laboratory -
                                                           East Avenue Medical Center (NRL-EAMC) on May 21-
The general objective of the project is to                 25, 2007 from 8AM-5PM at the East Avenue Medical
make efficient and effective the current                   Center, East Avenue, Diliman, Quezon City.
systems and procedures of accrediting
drug test centers, registering clients,                    FOR ANALYSTS
verifying and confirming drug test results
through the development and                                There will be a seminar/workshop the Manual of
                                                           Operations for Analysts of DTL which will be
implementation of computer-based                           conducted by the NRL-East Avenue Medical Center
systems.                                                   (NRL-EAMC) on September 26-28, 2007 at the East
                                                           Avenue Medical Center.

                                                           There will be a seminar/workshop the Manual of
                                                           Operations for Analysts of Screening DTL which will
The project is the development and                         be conducted by the NRL-East Avenue Medical Center
implementation of the computer-based                       (NRL-EAMC) on May 2-4,2007 at the Sampaguita
Drug Test Operations and Management                        Gardens, New Washington, Kalibo, Aklan.
Information System (DTOMIS). DTOMIS
contains the following systems:                                 DEPARTMENT MEMO
                                                           1. Department Memorandum No. 2005-0076 -
1. Drug Test Center (DTC) Licensing                        Terms and Conditions for the use of the DTOMIS
   and Accreditation System    (DTCLAS).                   software

                                                           2. Department Memorandum No. 2005-0059-A -
2. Drug Test Center Results Verification                   Amendment to Dept. Memorandum 2005-0059 dated
   System (DTCRVS). The system enables                     April 25, 2005 re: "Downloading of latest DTOMIS
   entry and management of data (e.g.
                                                           Software version"
   Name of Client, Sex, Date of Birth and                  3. Department Memorandum No. 2005-0076 -
   others) that shall identify the                         Transfer of Installation and Department
   uniqueness of the client.                               Memorandum No. 2005-054 Orientation for the
                                                           Drug Test Operation and Management Information
                                                           System (DTOMIS) from Information Management
                                                           Service to CHD - Metro Manila effective April 26,
                                                           2005

                                                           For Reference to other DOH Guidelines/
                                                           Issuances see
  List of Accredited
 DRUG TEST CENTERS       1. All Drug Test Laboratories must first verify
                         the status of Drug Test Applicants before
                         conducting the test in accordance with the
                         approved MANUAL OF OPERATIONS of
                         DTOMIS. Failure to comply to such procedure
                         may adversely affect the accreditation status
                         of the erring DTL.


                         2. The installation of DTOMIS software to all
Drug Proficiency Test    accredited Drug Test Lab. (DTL) is a
Program                  continuing process. Hence, all DTL should seek
                         assistance from their respective Centers for
                         Health Development (DTCs).




                            DTOMIS SCHEDULE
                        Schedule of Test Kits Inspection
 National Reference
 Laboratory
                  NATIONAL HEALTHY LIFESTYLE PROGRAM

INTRODUCTION


Situationer:

The rapid rise of non-communicable diseases represents one of the major health challenges to
global development in the coming century. This growing challenge threatens economic and social
development as well as the lives and health of millions of people.


In 1998 alone, non-communicable diseases are estimated to have contributed to almost 60% of
deaths in the world and 43% of the global burden of disease. Based on current trends, by the
year 2020 these diseases are expected to account for 73% of deaths and 60% of the disease
burden.


Low and middle income countries suffer the greatest impact of non-communicable diseases. The
rapid increase in these diseases is sometimes seen disproportionately in poor and disadvantaged
population and is contributing to widening health gaps between and within countries. For
example, in 1998, of the total number of deaths attributable to non-communicable diseases, 77%
occurred in developing countries, and the disease burden they represent, 85% was borne by low
and middle income countries.


Philippine Data


In the Philippines, increasing life expectancy, urbanization and lifestyle changes have brought
about a considerable change on the health status of the country. Globalization and social change
has influenced the spread of non-communicable or lifestyle/degenerative diseases by increasing
exposure to risk. As the country's per capita income increases, the social and economic
conditions necessary for the widespread adoption of risky behaviors gradually emerge. This in
turn has brought a considerable challenge to the country's health policy and health system to
address emerging lifestyle/degenerative diseases amidst the unfinished agenda of communicable
health.


Recent statistics have sounded out the alarm. The life expectancy of Filipinos in 1999 has gone
up to 69 years. The process of aging brings out myriad health problems which are degenerative
by nature. Mortality statistics in 1997 shows that 7 out of 10 leading causes of deaths in the
country are diseases which are lifestyle related (diseases of the heart and the vascular system,
cancers, chronic obstructive pulmonary diseases, accidents, diabetes, kidney problems).
Morbidity statistics show that diseases of the heart ranks 6th as the leading cause of illness in the
country.


In a study conducted by FNRI in 1998, it was found out that 2 in every 10 Filipino adults, 20 years
and over, or 21% of the population, are hypertensives and is increasing in prevalence after age
40 years. Four percent (4%) of the population have blood glucose levels of 125 mg/dl and above,
and an increasing prevalence of hyperglycemia after the age 40 years. The proportion of adults
with total cholesterol 240 mg/dl and above is 4% with prevalence of hypercolesterolemia peaking
at age 40 years. Adults with total triglyceride levels  
 

 
 
 
 
 
 
 

    
 
 
 
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 
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In a recent study by Tiglao et al, (2000) 32.2% are ever smokers or having smoked at one point in
their lives. Current smokers are 23.5% (73.1% of the ever smokers) 78.5% are males while
21.4% are females. Among the current smokers 13.6% began smoking at the age of 6-14 years
old; 51.4% began at the age of 15-19 years old; 19.6% 20-24 years; 6.8% 25-29 and 8.5% 30-70
years old. A study done by NDHS in 1998 revealed that 60% of the households nationwide have
at least one smoker.


In the same study by Tiglao et al, 38.9% of the sample population are alcohol drinkers, with
recorded age of initiation at 6 - 71 years old. Half of the drinkers (50.3%) started drinking at ages
15-19, the teenage years; while 8.5% started at less than 14 years. More than half (58.1%) are
light drinkers, meaning they usually take less than four drinks; about 37% are moderate drinkers
(4-12 drinks) while a small proportion (5.9%) are heavy drinkers (>12 drinks). Number of drinks is
equivalent to 1 glass of wine, 1 shot of liquor, or 1 cocktail.


Again, in the same study, 79.1% of the respondents claim that they have some form of exercise
or engage in some physical activities. More than half (54.4%) engages in low to moderate
physical activities - walking, jogging, bending, stretching, yoga, exercise for pregnant women,
weaving, sewing, gardening. Thirty one percent (31.1%) engages in sustained physical activity -
household chores, peddling, farming, carpentry, fishing, serving. Only 14.6% participates in
vigorous forms of physical activities - brisk walking, push up, weightlifting, PE class, taebo,
sports. Most popular form of physical activity is walking followed by household chores.


Looking at the weekly consumption of fruits and vegetables, Tiglao et al's study revealed that a
big majority (81.3%) of the respondents claim to eat fruits and vegetables four or more times a
week; 10.7% thrice a week; 3.9% twice a week; 3.4% once a week; while 0.7% admitted they
don't eat fruits and vegetables.


Rationale of the Program


Four of the most prominent non-communicable diseases are linked by common preventable risk
factors related to lifestyle. These are cardiovascular disease, cancer, chronic obstructive
pulmonary disease and diabetes. The risk factors involved are tobacco use, unhealthy diet and
physical inactivity. Action to prevent these diseases should therefore focus on controlling s in an
integrated manner. Intervention at the level of family and community is essential for prevention
because the causal risk factors are deeply entrenched in the social and cultural framework of the
society. Addressing the major risk factors should be given the highest priority in the global
strategy for the prevention and control of lifestyle related diseases.


The mandate of the Department of Health is to promote and protect health lifestyles. For common
understanding, healthy lifestyle has been operationally defined as a way of life that promotes and
protects health and well being. This would include practices that promotes health such as healthy
diet and nutrition, regular and adequate physical activity and leisure, avoidance of substances
that can be abused such as tobacco, alcohol and other addicting substances, adequate stress
management and relaxation; and practices that offer protection from health risks such as safe sex
and responsible parenthood.
Our goal is to reduce the toll of morbidity, disability and premature deaths due to lifestyle related
diseases. One of the components of the major strategies employed will be health promotion,
across the life course and prevention of the emergence of the risk factors in the first place. This is
where a serious campaign on healthy lifestyle would be most relevant. Thus the development and
installation of the National Healthy Lifestyle Program in the Department of Health


GOAL


Reduce prevalence of lifestyle diseases particularly cardiovascular diseases, cancers, diabetes
and chronic obstructive pulmonary diseases.


OBJECTIVES


General


Reduce prevalence of major risk factors specifically smoking, physical inactivity and unhealthy
diet and nutrition.


Specific


    1. Develop the program components of the National Healthy Lifestyle Program
                a. Tobacco Control Program
                b. Lifestyle Physical Activity Program
                c.      Healthy Diet and Weight Control Program
                d. Stress Management Program
                e. Control of Alcohol Use Program
    2. Launch a Comprehensive Healthy Lifestyle Advocacy and Health Promotion Campaign:
              Key Messages:
                a. Exercise regularly
                b. Eat a healthy diet everyday
                c.      Watch your weight / Weight control
                d. Don't smoke
                e. Manage stress
                f.      Have a regular health check-up
    3. Institutionalize the promotion of healthy lifestyle in local government units.
    4. Quality assurance through Sentrong Sigla.
    5. Support research on behavior change and best practice on the promotion of healthy
           lifestyle.
STRATEGIES


  1. PROGRAM, POLICY AND STANDARDS DEVELOPMENT
        a. Creation of Task Forces for each program component.
        b. Pilot implementation of the Integrated Community Based Non-Communicable
             Disease Prevention and Control Project (WHO Demonstration Project - Guimaras
             and Pateros).
        c.   Inclusion of healthy lifestyle promotion in the Sentrong Sigla standards.
        d. Issuance of an administrative order to mandate the mandatory inclusion of
             nutrition facts/information on prepackaged food labels.
        e. Issuance of guidelines in the promotion of healthy lifestyle.
        f.   Formulation of an integrated and comprehensive national policy on issues
             relating to healthy lifestyle (nutrition, environmental/urban planning,
             transportation, etc.).
  2. INSTITUTIONALIZATION AND CAPABILITY BUILDING
        a. Implementation of the National Healthy Lifestyle Program nationwide through
             local government units.
        b. Training health workers on the promotion of healthy lifestyles.
        c.   Technical assistance in the development of local policies/resolutions relative to
             healthy lifestyles.
        d. Establishment of Wellness Centers in health facilities across the country.
  3. ADVOCACY AND HEALTH PROMOTION
        a. Development and Launching of a Comprehensive Health Lifestyle Advocacy and
             Health Promotion Campaign.
        b. Organization of a Healthy Lifestyle Coalition among various stakeholders.
        c.   Development/production/distribution of advocacy/IEC materials.
        d. Observance of Healthy Lifestyle as a common theme during conventions,
             meetings, congresses of various groups being represented in the coalition during
             the year 2003 and beyond.
        e. Highlighting periodically a year round thematic advocacy/IEC campaigns on
             specific healthy lifestyle messages.
                     January - Regular health check up
                     February - Exercise regularly
                     May/June - Don't smoke
                     July - Eat a healthy diet
                     October - manage stress
                     December - Watch your weight / Weight control
4. RESEARCH DEVELOPMENT
     a. Behavior change and best practice on healthy lifestyle promotion.
5. MONITORING AND EVALUATION
   Doctors to the Barrios
      (DttB) Program

What is DTTB Program?

The Doctors to the Barrios Program is
the deployment of doctors as Rural
Health Physicians to doctorless
municipalities, usually hard to reach,
economically underdeveloped areas.


Who can apply?
Licensed Physicians

       willing to be assigned in
        remote, depressed
        municipalities for at least two
        (2) years
       interested in facilitating
        community development
       willing to render community
        health service
                                         RATIONALE
Given the reality where there is a varying pace of development and inequitable distribution of
scarce resources, 271 municipalities were identified in 1992 to be doctorless and lacking in the
capability to provide adequate health services resulting in high mortality and morbidity rates in
these areas.

The Doctors to the Barrios (DTTB) Program was created by the DOH in May 1993 to address this
need. Its vision is that all municipalities in the Philippines shall have doctors. Its mission is to
deploy competent, committed, community-oriented and dedicated doctors to the doctorless
municipalities. Although the Doctors to the Barrios Program deploys doctors to municipalities, as
the Municipal Health Officers of these municipalities, these doctors reach and serve all the barrios
of the municipality, including the most inaccessible ones. Hence the program name: Doctors to
the Barrios, remains appropriate.

The doctors of the DTTB program shall be the health leaders/managers in developing local health
systems in a devolved set-up. To attract doctors to serve in these far-flung and difficult areas of
the country, the DOH packaged professional and financial incentives for the physician under the
Program.

Of the original 271 municipalities identified, 198 municipalities were served, many among these
were served more than once due to exigency of service. Other municipalities have also been
identified as doctorless in the succeeding years. Thus, the need to continue the DTTB Program.

                                                          th
The Doctors to the Barrios Program (DTTB), now on its 9 year of implementation, has
decentralized its program management to the Centers for Health Development (CHD). In effect,
the CHD shall be responsible for the implementation of the DTTB program, the recruitment,
selection and deployment of DTTBs in their respective regions with the participation of a team
from DOH-Central Office and other stakeholders, and the monitoring and supervision of the
DTTBs.

                                        OBJECTIVES
    1. To ensure quality health care service to depressed, marginalized and underserved areas
       through the deployment of competent and community-oriented doctors.
    2. To effect changes in the approach to health care delivery by the stakeholders in health.
                                          COVERAGE
The following areas will be given priority:

                                                                         th      th
    1. Depressed, unserved/underserved, hard to reach and critical 5 and 6 class
       municipalities without doctors for at least two (2) years.
    2. Depressed, unserved/underserved, hard to reach and critical municipalities with
       RHPs/MHOs on study leave.
        rd      th
    3. 3 and 4 class municipalities needing additional doctors to achieve the doctor to
       population ratio (1:20,000).

        (Definition of Depressed, Unserved/underserved, Hard to reach, and critical areas
        adapted from Target Areas for Development, TADs Criteria)

                Depressed
                    - No or low productive crops, nor lack of resources for marketing.
                    - Low income population
                Unserved/underserved
                    - Government personnel covers areas rarely, e.g. once a month
                    - Inadequate sanitary facilities
                Hard to reach
                    - No roads, or presence of trails only, presence of hanging bridges
                    - Reached by hiking, boat or horse, rafts, trolleys, etc.
                    - Irregular transportation
                    - Lack of or inadequate communication service
                Critical
                    - Existence of endemic diseases in relation to total population of the village
                    - Critical peace and order situation

Of the original 271 municipalities identified, 198 municipalities were served, many among these
were served more than once due to exigency of service. Other municipalities have also been
identified as doctorless in the succeeding years. Thus, the need to continue the DTTB Program.

                                                           th
The Doctors to the Barrios Program (DTTB), now on its 9 year of implementation, has
decentralized its program management to the Centers for Health Development (CHD). In effect,
the CHD shall be responsible for the implementation of the DTTB program, the recruitment,
selection and deployment of DTTBs in their respective regions with the participation of a team
from DOH-Central Office and other stakeholders, and the monitoring and supervision of the
DTTBs.

                                         STRATEGIES
    1. Networking with LGUs, NGOs, GOs and other stakeholders in the implementation of the
       DTTB Program.
    2. Strengthening community support for local health care delivery system through the
       District Health System (DHS)
    3. Strengthening the leadership and management capabilities of the DTTB.
    4. Strengthening the program management by decentralization of the program to the
       Centers for Health Development (CHD)
    5. Partnership with Academe, Professional Societies and private/business institutions in the
       conduct of human resource development and other related activities; e.g.
            A Masteral Course with Ateneo Graduate School of Business (AGSB) and Pfizer,
                Inc.
   Establishment of the DTTB Training and Learning Center and Virtual Library.

				
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Description: DOH Programs is intended as nursing board exam review notes and nursingboard exam reviewer for nurses and students. It can serve as CHN Review Notes and Communicable nursing review notes. It includes facts about the following garantisadong pambata, leprosy, philippine food fotification program, smoking, avian flu, meningococcemia, murang gamot, Rights to food safety, TB Network, TB DOTS, Tuberculosis, National Voluntary Blood Services Program, Ligtas Tigdas, National Healthy Lifestyle Program, and Doctors to the barrios program.