Health-Promotions-Strategy-Administrative-Order-2021-0063.pdf

Republic of the Philippines Department of Health OFFICE OF THE SECRETARY __...

Republic of the Philippines Department of Health OFFICE OF THE SECRETARY __ DEC 16 2621 ADMINISTRATIVE ORDER No. 2021 - p63 SUBJECT: Health Promotion Framework Strategy 2030 L BACKGROUND Republic Act No. 11223 or the Universal Health Care (UHC) Act, mandates the Heaith Promotion Bureau (HPB) to formulate a framework strategy which shall provide a comprehensive and coordinated approach to health promotion to ensure that every Filipino has access to information that build personal skills and opportunities that engage in strengthening community action, and also to ensure that all people are enabled to participate in the creation of supportive environments. Towards this goal, the HPB, together with its partners and stakeholders, developed the Health Promotion Framework Strategy (HPFS) which serves as the national health promotion roadmap and the basis for all policies, programs, plans, and activities on health promotion. The HPFS provides foundational strategies for (1) increasing health literacy with focus on reducing non-communicable diseases, (2) implementing population-wide health promotion interventions across social determinants of health, (3) exercising policy coordination across government instrumentalities to ensure attainment of the framework strategy and its programs, and (4) providing technical support to local research and development relevant to the directions of the HPFS. Relative thereto, and to guide all efforts on health promotion at the national, regional, and local platforms, the DOH issues these guidelines to provide the framework and strategies for the effective and efficient HPFS implementation. 11. OBJECTIVES A. General Objective: This Order aims to provide the framework, direction, and strategies for the planning, development, and implementation of health promotion policies, programs, plans, and activities. B. Specific Objectives: 1.To provide strategic direction for the improvement of health literacy and the use of health literacy assessments in the planning and development of health promotion interventions; 2. To identify priority areas for health promotion and the settings in which the settings-based approach for health promotion shall be implemented; 3. To promote and provide basis for technical support to local research and development programs and projects on health promotion; and 4. To provide guidance on the roles and participation of the DOH, CHDs, LGUs, and other partners and stakeholders for health promotion. Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113 Direct Line: 711-9502; 711-9503 Fax: 743-1829 & URL: http://www.doh.gov.ph; e-mail: [email protected] 9 IIL SCOPE OF APPLICATION This Order shall apply to DOH Central Office Bureaus and Services, Centers for Health Development, all DOH attached agencies, Ministry of Health - Bangsamoro Autonomous Region in Muslim Mindanao, LGUs and their respective health facilities, other National Government Agencies (NGAs), non-government organizations and civil society partners, development partners, academic partners, and all other concerned entities. Iv. GUIDING PRINCIPLES The adoption and implementation of the provisions of this Order shall be guided by the following principles: A. Equity - The needs of all population groups (i.e. infants, children, adolescents, adults, and the elderly), especially the marginalised, shall be prioritised in the planning, development, and implementation of policies, programs, and activities, and in the delivery of services. The accessibility, affordability, and acceptability of resources and environments that can help minimize disadvantages shall be ensured. B. Participation - Community, stakeholder, or partner participation shall be an integral component in decision-making and problem-solving processes for health, to ensure that the development, implementation, monitoring and evaluation of policies, plans, programs, and activities are responsive, acceptable, and relevant to those that will be most affected. C. Partnerships - All policy-determining and implementing units, bodies, or committees in the public health sector, upon engagement with partners, shall ensure professional and ethical practice in championing and prioritizing the promotion and protection of the public health and well-being. Partnerships shall be conducted in ways that build public trust and confidence, and that protect the institution’s integrity, independence, credibility, reputation, and effectiveness. D. Responsiveness - Health promotion policies, programs, plans, and activities shall be responsive to evolving needs and emerging determinants of health, and anchored on cost-effective strategies to ensure that resources are well-allocated and maximized to achieve the most benefit for Filipinos. GENERAL GUIDELINES A. The Health Promotion Framework Strategy (HPFS) 2030 (4nnex A) shall set the overall direction and strategies for health promotion towards achieving the goal of ensuring that (i) all Filipinos are health literate, (ii) settings are health-enabling, and (iii) public policies are supportive and protective of health. B. The development, implementation, monitoring, and evaluation of health promotion policies, programs, and activities shall foster whole-of-system, whole-of-government, and whole-of-society approach. All implementing entities, partners and stakeholders shall align their respective health promotion interventions with the HPFS for unified action. C. Implementation of all health promotion policies, programs, plans, and activities shall be guided by the strategies of the HPFS, namely: healthy governance, healthy settings, and health literacy. D. In accordance with the HPFS, all health promotion policies, programs, and activities shall focus on the identified priority areas and action areas, and shall be implemented using the lifestage and settings-based approaches as provided for below: 1. Priority Areas for Health Promotion. All health promotion interventions shall be anchored on the following priority areas (PAs) or risk factors: a. Diet and Physical Activity - Nutrition shall be improved through healthy diets, and physical activity shall be increased to reduce all forms of malnutrition and prevent development of non-communicable diseases; Environmental Health - Sustainable lifestyles and resilient communities shall be fostered to minimize environmental risks and climate impacts on health; Immunization - Vaccine use shall be promoted to reduce the incidence of vaccine-preventable diseases, disabilities, and deaths; Substance Use - Tobacco use, illicit drug use, and harmful use of alcohol shall be prevented to reduce or eliminate the ill effects or associated health conditions; Mental Health - Psychosocial and mental well-being shall be increased and protected to reduce the burden of mental health disorders and incidence of suicide; Sexual and Reproductive Health - Positive sexual and reproductive behaviors shall be promoted to reduce early and unwanted pregnancies, incidence of HIV infection, and sexually-transmitted diseases; and Violence and Injury Prevention - Safe and inclusive communities shall be fostered to eliminate the various forms of violence and injuries, including interpersonal violence or gender-based violence, as well as road traffic, fireworks, and occupational related injuries. 2. Action Areas for Implementation. Guided by the Ottawa Charter and Bangkok Declaration for Health Promotion, provided are the implementation action areas on which health promotion efforts and interventions shall focus on: a. Developing healthy public policies - Legislation, fiscal measures, and/or organizational policies that promote health and wellbeing and that reduce health inequities shall be enacted at the national and local levels; Creating supportive environments - The natural and built environments shall be protected and conserved as part of the health promotion strategy. As such, assessing the potential health impacts of policies, programs, and projects that may have an impact on health or the health sector shall be an essential prerequisite in critical intersectoral collaborations; Developing personal skills - Appropriate and useful information, education, and life skills shall be provided to target individuals and population groups to enable the adoption of healthy behaviors, and increase options and control over their own health; Strengthening community action - Opportunities or platforms for meaningful participation shall be established and institutionalized to facilitate the active involvement of community members in local policy and decision-making processes that contribute to their health status; and Reorienting health services - Health services shall increasingly shift focus on health promotion and disease prevention. 3. Implementing Approaches. Recognizing the individual, social, and physical or structural influences on health and health-seeking behaviors, health promotion  interventions on the foregoing priority risk factors and action areas shall be anchored on the following: a. Life course approach - Health shall be promoted through the life course approach, recognizing that health behaviors are shaped by the presence or absence of social networks, support (or lack thereof) that they provide, social norms, cultures, inequalities, and other attributes of an entire population; and b. Settings-based approach - Health shall be accelerated by creating health- supportive environments where policies are health-promoting, physical structures are conducive to health, and quality and responsive health services are available, affordable, and accessible to all members of the community. VI. POLICY FRAMEWORK A. Vision - The DOH envisions a Healthy Pilipinas wherein health-literate and health- seeking individuals, health-enabling settings, and health-supporting governance are present, and achieving optimum health is possible. Mission - The DOH, guided by the HPFS, shall make healthy behaviors the easier choice for everyone, everytime, everywhere. Core Values - The DOH in carrying out its mission shall embody at all times the values of integrity, excellence, commitment, professionalism, teamwork, compassion and respect for human dignity, and stewardship of the health of the people. Goals - The DOH, guided by the HPFS, shall ensure that all Filipinos are health literate, settings are health-enabling, and public policies are supportive and protective of health. Implementation Strategies. To accelerate the promotion of health at all levels, the HPFS provides the following key strategies: 1. Healthy Governance - Recognizing that health and well-being are multifactorial which require actions from the whole of government and society, health promotion shall aim to influence governance in both health and non-health sectors at the national and local levels. a. Leadership and Governance in Health i. The Health Promotion Bureau (HPB) shall serve as the national lead office in-charge of the development, implementation, and monitoring and evaluation of health promotion policies, programs, and activities. The HPB, for this purpose, shall accelerate the goals of health promotion by exercising multisectoral policy coordination, facilitating capacity development for local implementation, and fostering partnerships, inline with the provisions of Section 30 of the UHC Act. ii. At the local level, consistent with DOH AO No. 2020-0042 or the “Health Promotion Framework Strategy in Province-wide and City-wide Health Systems”, LGUs shall ensure the following: ® The Health Promotion Committee shall be created by the Local Health Board (LHB) to provide guidance to the LHB on matters related to health promotion, particularly on issues concerning the determinants of health and health risk factors;  eo The Health Promotion Unit, which shall ensure the development and implementation of health promotion policies and programs in the LGU, shall be established as part of the Local Health Office with appropriate human resource complement in accordance with Section 30.5 of the UHC Act IRR; and ¢ Barangay Health Workers shall be provided with necessary and appropriate capacities to serve as barangay-level health promotion officers. b. Intersectoral Action - Policy and program development and implementation in other sectors shall consider potential health outcomes and considerations, to promote health equity and address the various social determinants of health. The HPB, for this purpose, shall extend all necessary support to relevant NGAs and partners, and shall foster inter-agency collaborations to plan, develop, implement, and monitor policies, programs, and activities that promote co-benefits for both or all sectors involved. c. Partnerships for Health - Collaborations with other government agencies, non-government, civil society, or community organizations, professional societies, the academe, the private sector, or other entities shall be fostered in developing, implementing, and monitoring of health promotion policies, programs and activities, consistent with the principle of partnership as enshrined in the Bangkok Charter for Health Promotion. For this purpose: i. All partnerships with the public health sector shall be developed and implemented in accordance with the goals and objectives of the HPFS, and in conformity with the public health sector’s strategic directions, technical norms, and standards. ii. Conflicts of interest in relation to development and implementation of policies, programs, and activities of the partnership shall be effectively managed and, where appropriate, avoided to prevent any potential risks and undue influence, and to protect the independence and objectivity of the public health sector in the performance of its mandates, iii. All engagements, projects, or activities with entities, including the tobacco and alcohol industries or milk industries within the scope of prohibition of the Executive Order No. 51 or the Milk Code, whose interests, goals, and objectives contradict those of the DOH or the public health sector shall not be permitted. 2. Healthy Settings - Consistent with the seftings-based approach of the World Health Organization (WHO), health promotion initiatives shall be designed and implemented strategically in key settings, to ensure that the environments wherein individuals live, learn, and work are promotive and protective of health. For this purpose, the priority settings shall include, but are not limited to: a. Healthy Communities - LGUs, pursuant to Sections 17 and 30 of the UHC Act, shall enact stricter ordinances that strengthen and broaden existing health policies and shall implement proactive and effective health promotion programs that: (a) promote health literacy and healthy lifestyle among their constituencies, (b) reduce the prevalence of non-communicable diseases and their risk factors particularly tobacco use and alcohol use, (c) lower the incidence of new infectious diseases, (d) address mental health, and (e) improve health indicators.  b. Healthy Schools - Learning institutions, pursuant to Section 30 of the UHC Act and/or IRR, shall be designated as healthy settings, and shall formulate programs and modules on health literacy and health rights to be integrated in formal and/or informal curricula, programs, and co-curricular activities. ¢. Healthy Workplaces - Health promotion measures shall be instituted in the workplace setting to promote and protect the health, safety, and well-being of the workforce. Areas of interventions, as based on identified needs, may include: physical work conditions, psychosocial environment, and personal health resources including lifestyle in the workplace. 3. Health Literacy - At the individual level, health literacy interventions shall be developed and implemented to improve people’s ability to: (i) understand and use health-related information, (ii) inform health-related decisions, and (iii) increase health-seeking behaviors. For this purpose: a. Health literacy assessments shall be conducted to determine the baseline and changes in people’s health literacy levels; b. Findings from the health literacy assessments shall inform the planning, design and development, and implementation of targeted and responsive health literacy interventions; and c. The scope of assessments shall include: health literacy; knowledge, attitudes, and practices or behaviors related to the seven priority areas of the HPFS; and pertinent social determinants of health. VII. MONITORING AND EVALUATION A. The conduct of all monitoring and evaluation-related activities of the HPFS shall be all the responsibility of stakeholders responsible for its implementation, which include the DOH and attached agencies, other concerned NGAs, CHDs, LGUs, development partners, academic partners, and non-government organizations. B. The Monitoring and Evaluation (M&E) Framework in Annex B which illustrates the relationship between the inputs, activities, and outputs to the expected outcomes and impact of the HPFS, shall guide the monitoring and evaluation of the implementation of HPFS at the national, regional, and local levels. C. HPB shall lead the overall implementation of the monitoring and evaluation activities of the HPFS at the national level, while CHDs, through the Health Promotion Units, shall develop more specific frameworks to monitor local implementation of HPFS in coordination with relevant stakeholders. D. HPB shall regularly collect data and information on the progress of the HPFS using a list of health and health-related indicators. Monitoring of the indicators shall be conducted regularly by the reporting units, while evaluation of the HPFS shall be conducted in accordance with relevant policies and guidelines on planning, monitoring, and evaluation of programs, activities, and projects in the DOH. E. The HPFS M&E Framework and its indicators shall be reviewed and/or updated every medium-term to reflect new strategies and data sources. A report shall be generated reflecting the latest available data. VIII. ROLES AND RESPONSIBILITIES A. The Health Promotion Bureau shall: 1. Be responsible for healthy public policy and reorient health systems to prioritize health promotion and disease prevention, and increase health literacy; ‘ 9  2. Lead the formulation, implementation, and updating of the HPFS which serves as the basis for all health promotion policies, programs, and activities; 3. Implement population-wide health promotion policies and programs across social determinants of health and behavioral risk factors; 4. Promote and provide technical, logistical, and financial support to local research and development of local policies and programs based on the HPFS; and 5. Exercise multi sectoral policy coordination and enter into partnerships with the national government agencies, LGUs, private sector, civil society organizations, professional societies, and the academe, among others to ensure the attainment of the HPFS.. The Bureau of Local Health Systems Development shall: 1. Align the identified priorities of the HPFS with the priority local health systems programs through the Local Investment Plan for Health; and 2. Provide technical assistance in cascading health promotion interventions to local health systems.. The Disease Prevention and Control Bureau shall: 1. Coordinate plans, policies, programs, and activities for disease prevention and control with the HPB, especially for implementation of such using the healthy- settings approach; 2. Lead in enabling relevant health services on disease conditions related to the priority areas of the HPFS; and 3. Provide technical assistance and support in the implementation of the health promotion components of the disease programs.. Other DOH Bureaus and Services shall: 1. Provide technical assistance in the planning, implementation, and monitoring of health promotion policies, programs, and activities, where applicable.. The Centers for Health Development shall: 1. Establish a Health Promotion Unit for their respective regions; 2. Facilitate implementation of the HPFS and national policies for regional and local applications; 3. Provide technical assistance to LGUs for the implementation of health promotion initiatives aligned with the HPFS, including capacity-building and monitoring and evaluation; 4. Facilitate building of regional and local networks of health promotion champions and partners; 5. Monitor the implementation of health promotion policies, programs, and activities in area of assignment; and 6. Submit technical and evaluation reports in the implementation of health promotion activities and projects.. The Local Government Units are strongly enjoined to: 1. Develop local ordinances on the abovementioned priority areas for LGUs; 2. Align the planning, development and implementation of health promotion policies, programs, and activities with the priorities and strategies of the HPFS; 3. Foster a network of health promotion partners, movers, and stakeholders at the focal level; and 4. Monitor the implementation of LGU-specific health promotion interventions. IX. SEPARABILITY CLAUSE Should any provision of this Order or any part thereof be declared invalid, the other provisions, insofar as they are separable from the invalid ones, shall remain in full force and effect. X. REPEALING CLAUSE Related issuances not consistent with the provisions of this Order, including DOH AO No. 58 s. 2001, are hereby revised, modified, or rescinded accordingly. Nothing in this Order shall be construed as a limitation or modification of existing laws, rules, and regulations. XI. EFFECTIVITY This Order shall take effect fifteen (15) days after publication to an official gazette or a newspaper of general circulation. 7 sot F CISCO T. DUQUE III, MD, MSc Secretary of Health  Annex A. Health Promotion Framework Strategy 2030 A Healthy Pilipinas wherein health-literate and health-seeking Vision individuals, health-enabling settings, and health-supporting governance are present, and achieving optimum health is possible To make healthy behaviors the easier choice for everyone, everytime, oo Mission everywhere Integrity, excellence, commitment, professionalism, teamwork, compassion and Core Values respect for human dignity, and stewardship of the health of the people Goals Filipinos are health literate, settings are health-enabling, and public policies are health-supporting Life Stage Approach Seftings-Based Approach Implementation Approaches PP Pr any Oncoor yaonatal Healthy Communities Childhood ! Adolescence Heaithy Schools Adulthood Older Adult Healthy Workplaces “3 Diet and Sexual and Violence Lo Priority Physical Environmental Immunization Substance Mental Reproductive and injury Areas Activity eal use Salt Health Prevention & = iH Developing Creating Developing Strengthening Reorienting Action Personal Healthy Public Supportive Community Health A reas Policies Environments Skills Action Services Annex B. Health Promotion Framework Strategy Monitoring and Evaluation Framework INPUTS OUTPUTS 11 OUTCOMES IMPACT HEALTH EQUITY Improved Behavioral Better Health Outcomes Outcomes Reduced premature mortahty from NCD Cansuming heatthy diet i |] Reduced all foems of matnutnlion Reduced exposure 10 Engaging in physical activity environmental sks N Reduced number of indrviduals, Policies and Standards Healthcare Provider Healthy Environment alfected by climate-refated Practicing sustainable festyle disasters Regulation Networks Healthy Governance Reduced prevalence of vaccine Capacity Building Patient-based Education Healthy Seltings tproved sanitation preventable diseases Technical Assistance Reduced current users disaster preparedness Ll tobacco Population-based health tmproved Sectoral and Local services Engagements Public health policies and Getting fully wnmunized ~ Reduced current bioge drinkers Premium Subsidies standards Health Literacy Avoud smoking 4 Reduced current drug users Financial Suppart Social and behavioral Change inbehaviors health change communication promoting Reduced burden of mental heaith Human Resources for packages Avoid harmful alcohol use disorders Health Infrastructure Commodities Capable individuals on HIA. HPSR, and PAR Avord drug use / Reduced incidence of su.cde Reduced early and unwanted Individual-based health Practicing self-care pregrancies services Reduced new HIV infections Demand Generation #vaiding risky sexual behavier [