Mental Health Action Plan 2013-2020 PDF

WEEK 13  A commitment is needed from all partners to respond to this urgent public health need and the time to act is now! DEFINITION OF TERMS...

WEEK 13  A commitment is needed from all partners to respond to this urgent public health need and the time to act is now! DEFINITION OF TERMS Objectives of mhGAP  Blood Bank – a place where supplies of blood or plasma for transfusion are stored. The development of the mental health action program (mhGAP)  Blood Donation – process of collecting, testing, preparing, and reflects WHO’s commitment to closing this gap by scaling up care for storing blood and blood components mental health and substance use disorders. The key objectives of the  Confirmatory Test. – An analytical test using a device, tool or action program are: equipment with a different chemical or physical principle that is more specific which will validate and confirm the result of the 1. To reinforce the commitment of governments, international screening test. organizations, and other stakeholders to increase the allocation of  Insurance – a thing providing protection against a possible financial and human resources for care of mental health and eventuality. substance use disorders.  Public Health – is the science of protecting and improving the 2. To achieve much higher coverage with key interventions in the health of people and their communities. countries with low and lower middle incomes that have a large  Senior Citizen – an elderly person, especially one who is retired proportion of the global burden of mental health and substance use and living on a pension. disorders.  Schizophrenia – is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some Through these objectives, mhGAP provides evidence-based guidance combination of hallucinations, delusions, and extremely and tools to advance toward achieving the targets of the mental disordered thinking and behavior that impairs daily functioning health action plan 2013-2020. and can be disabling.  Dementia – is not a specific disease but is rather a general term To accomplish this goal, the mhGAP Initiative will focus on reducing for the impaired ability to remember, think, or make decisions the risk factors and the burden of mental and brain conditions and that interferes with doing everyday activities. on promoting mental health positive effects derived from addressing these conditions will also serve to: mhGAP (MENTAL HEALTH GLOBAL ACTION PROGRAM)  Increase governments’ awareness and responsiveness to  In 2008, WHO launched the mental health gap action mental health issues programme (mhGAP) in response to the wide gap between the  Enhance the quality and effectiveness of mental health resources available and the resources urgently needed to services address the large burden of mental, neurological, and substance  Reduce stigma and discrimination. And by doing so, to take use disorders globally. important steps towards  Through mhGAP, WHO aims to provide health planners, policy-  Reducing the risk factors and burden of a range of makers, and donors with a set of clear and coherent activities conditions (both mental and physical) and programmes for scaling up care for mental, neurological  Enhancing the mental health of the population. and substance use disorders.  WHO recognizes the need for action to reduce the burden, and THE TREATMENT GAP to enhance the capacity of Member States to respond to this  Mental, neurological, and substance use disorders are highly growing challenge. mhGAP is WHO’s action plan to scale up prevalent in all regions of the world, and they are major services for mental, neurological and substance use disorders contributors to disease, premature death, and disability for countries especially with low and lower middle incomes. worldwide.  The priority conditions addressed by mhGAP are:  They are also frequently associated with high levels of stigma o Depression and human rights violations, particularly in low- and middle- o Schizophrenia and other psychotic disorders income countries. o Suicide  The essence of mhGAP is partnership to reinforce and to o Epilepsy accelerate effort and increase investments towards providing o Dementia services to those who do not have any. o Disorders due to use of alcohol o Disorders due to use of illicit drugs o Stigma and human rights violations, particularly in low- and o Mental disorders in children. middle-income countries.  The mhGAP package consists of o About 1 person in every 10 worldwide is suffering from a mental o Interventions for prevention health disorder o Management for each of these priority o About 1 person in 4 families has a member with a mental health conditions. disorder  Successful scaling up is the joint responsibility of governments, o Only 1% of the global health workforce provides mental health health professionals, civil society, communities, and families, care with support from the international community. o Most low- and middle-income countries spend less than US$ 2 per  The essence of mhGAP is building partnerships for collective person on the treatment and prevention of mental health action. disorders o 76-85% of people with a mental health disorder in lowand middle- 5. To set standards for compliance in different aspects of income countries do not receive treatment services THE CASE FOR ACTION PROGRAM COMPONENTS 1. The alarming burden of mental disorders - Leading 1. Wellness of Daily Living contributors include depression, substance abuse, schizophrenia, and dementia. This burden creates an  All health/social/poverty reduction/safety and security enormous toll in terms of suffering, disability, and programs and the like are protective factors in general for economic. the entire population 2. Economic impact Lost wages, combined with the possibility  Promotion of Healthy Lifestyle, Prevention and Control of of catastrophic health care costs, can seriously affect Diseases, Family wellness programs patients and their families’ financial situation, creating or  School and workplace health and wellness programs worsening poverty. 2. Extreme Life Experience 3. Physical comorbidity 4. Stigma and discrimination  Provision of mental health and psychosocial support 5. New Hope through Treatment Advances (MHPSS) during personal and community wide disasters THE STARTLING GAP BETWEEN EFFECTIVE AND AVAILABLE SERVICES 3. Mental Disorder Collectively, these recommendations can help close the gap between 4. Neurologic Disorders the current mental health situation and that which can be achieve 5. Substance Abuse and other Forms of Addiction 1. Provide treatment in primary care 2. Make psychotropic medicines available  Provision of services for mental, neurologic and substance 3. Give care in the community use disorders at the primary level from assessment, 4. Educate the public treatment and management to referral; and provision of 5. Involve communities, families and consumers psychotropic drugs which are provided for free. 6. Establish national policies, programs and legislation  Enhancement of mental health facilities under HFEP 7. Develop human resources 8. Link with other sectors STRATEGIES, ACTION POINTS AND TIMELINE 9. Monitor community mental health  Governance 10. Support more research  Service coverage DOH MENTAL HEALTH PROGRAM  Advocacy  Evidence VISION  Regulation A society that promotes the well-being of all Filipinos, supported by MENTAL HEALTH ACT [REPUBLIC ACT NO. 11036] transformative multi-sectoral partnerships, comprehensive mental health policies and programs, and a responsive service delivery AN ACT ESTABLISHING A NATIONAL MENTAL HEALTH POLICY FOR THE network PURPOSE OF ENHANCING THE DELIVERY OF INTEGRATED MENTAL HEALTH SERVICES, PROMOTING AND PROTECTING THE RIGHTS OF MISSION PERSONS UTILIZING PSYCHIATRIC, NEUROLOGIC AND PSYCHOSOCIAL HEALTH SERVICES, APPROPRIATING FUNDS THEREFOR, AND FOR To promote over-all wellness of all Filipinos, prevent mental, OTHER PURPOSES psychosocial, and neurologic disorders, substance abuse and other forms of addiction, and reduce burden of disease by improving access CHAPTER I to quality care and recovery in order to attain the highest possible level of health to participate fully in society. GENRAL PROVISIONS OBJECTIVES Section 1. Short Title. - This Act shall be known as the "Mental Health Act." 1. To promote participatory governance and leadership in mental health Section 2. Declaration of Policy. - The state affirms the basic right of 2. To strengthen coverage of mental health services through all Filipinos to mental health as well as the fundamental rights of multi-sectoral partnership to provide high quality service people who require mental health services. aiming at best patient experience in a responsive service The state commits itself to promoting the well-being of people by delivery network ensuring that; mental health is valued, promoted and protected; 3. To harness capacities of LGUs and organized groups to mental health conditions are treated and prevented; timely, implement promotive and preventive interventions on affordable, high quality, and culturally-appropriate mental health case mental health is made available to the public; mental health service are free from 4. To leverage quality data and research evidence for mental coercion and accountable to the service users; and persons affected health by mental health conditions are able to exercise the full range of human rights, and participate fully in society and at work free from the political, economic, social cultural, civil or any other stigmatization and discrimination. field. It includes all forms of discrimination, including denial of reasonable accommodation. Special measure solely to The State shall comply strictly with its obligations under the United protect the rights or secure the advancement of persons Nations Declaration of Human Rights, the Convention on the rights of with decision-making impairment capacity shall not be Persons with Disabilities, and all other relevant international and deemed to be discriminatory; regional human rights conventions and declarations. (f) Drug Rehabilitation refers to the processes of medical or The applicability of Republic Act No. 7277, as amended, otherwise psychotherapeutic treatment of dependency on known as the "Magna Carta for Disabled Persons", to person with psychoactive substances such as alcohol, prescription drugs, and other dangerous drugs pursuant to Republic Act, mental health conditions, as defined herein, is expressly recognized. 9165, otherwise known as the "Comprehensive Dangerous Section 3. Objectives. - The objectives of this Act are as follows: Drugs Act of 2002". Rehabilitation process may also be applicable to diagnosed behavioral addictions such as (a) Strengthen effective leadership and governance for mental gambling, internet and sexual addictions. The general intent health by, among others, formulating, developing, and is to enable the patient to confront the psychological, legal, implementing national policies, strategies, programs, and financial, social, and physical consequences. Treatment regulations relating to mental health; includes medication for co-morbid psychiatric or other (b) Develop and establish a comprehensive, integrated medical disorders, counseling by experts and sharing of effective and efficient national mental health care system experience with other addicted individuals; responsive to the psychiatric, neurologic, and psychosocial (g) Impairment or Temporary Loss of Decision-Making needs of the Filipino people; Capacity refers to a medically-determined inability on the (c) Protect the rights and freedoms of persons with psychiatric, part of a service user or any other person affected by a neurologic, and psychosocial needs; Filipino people; mental health condition, to provide informed consent. A (d) Strengthen information systems, evidence and research for service user has impairment or temporary loss of decision- mental health; making capacity when the service user as assessed by a (e) Integrated mental health care in the basic health services; mental health professional is unable to do the following: and (f) Integrate strategies promoting mental health in educational (1) Understand information concerning the nature of a institutions, the workplace, and in communities. mental health condition; Section 4. Definitions. - As used in this Act, the following terms are (2) Understand the consequences of one's decisions and defined as follows: actions on one's life or health, or the life or health of others; (a) Addiction refers to a primary chronic relapsing disease of (3) Understand information about the nature of the brain reward, motivation, memory, and related circuitry. treatment proposed, including methodology, direct effects, and Dysfunctions in the circuitry lead to characteristic biological, possible side effects; and psychological, social, and spiritual manifestations. It is characterized by the inability to consistently abstain (4) Effectively communicate consent voluntarily given by a impairment and behavioral control, craving, diminished service user to a plan for treatment or hospitalization, or recognition of significant problems with one's behavior and information regarding one's own condition; interpersonal relationships and a dysfunctional emotional (h) Informed Consent refers to consent voluntarily given by a response; service user to a plan for treatment, after a full disclosure (b) Carer refers to the person, who may or may not be patient's communicated in plain language by the attending mental next-of-kin or relative, who maintains a close personal; health service provider, of the nature, consequences, relationship and manifests concern for the welfare of the benefits, and risks of the proposed treatment, as well as patient; available alternatives; (c) Confidentiality refers to ensuring that all relevant (i) Legal Representatives refers to a person designated by the information related to persons with psychiatric, neurologic, service user, appointed by a court of competent jurisdiction, and psychological health needs is kept safe from access or or authorized by this Act or any other applicable law, to act use by, or disclosure to, persons or entities who are not on the service user's behalf. The legal representative may authorizes to access, use, or possess such information; also be a person appointed in writing by the service user to (d) Deinstitutionalization refers to the process of transitioning act on his or her behalf through an advance directive; service users, including persons with mental health (j) Mental Health refers to a state of well-being in which the conditions and psychosocial disabilities, from institutional individual realizes one's own abilities and potentials, scopes and other segregated settings, to community-based settings adequately with the normal stresses of life, displays that enable social participation, recovery-based approaches resilience in the face of extreme life events, works to mental health, and individualized care in accordance with productively and fruitfully, and is able to make a positive the service user's will and preference; contribution to the community; (e) Discrimination refers to any distinction, exclusion or (k) Mental Health Condition refers to a neurologic or restriction which has the purpose or effect of nullifying the psychiatric condition characterized by the existence of a recognition, enjoyment or exercise, on an equal basis with recognizable, clinically-significant disturbance in an others, of all human rights and fundamental freedoms in individual's cognition, emotional regulation, or behavioral  that reflects a genetic or acquired dysfunction in the communication; and the use of assistive devices and neurological, psychosocial, or developmental process technology; and underlying mental functioning. The determination of (v) Supported Decision Making refers to the act of assisting a neurologic and psychiatric conditions shall be based on service user who is not affected by an impairment or loss of scientifically-accepted medical nomenclature and best decision-making capacity, in expressing a mental health- available scientific and medical evidence; related preference, intention or decision. It includes all the (l) Mental Health Facility refers to any establishment, or any necessary support, safeguards and measures to ensure unit of an establishment, which has, as its primary function, protection from undue influence, coercion or abuse. the provision of mental health services; (m) Mental Health Professional refers to a medical doctor, CHAPTER II psychologist, nurse social worker or any other RIGHTS OF SERVICE USERS AND OTHER STAKEHOLDER appropriately-trained and qualified person with specific skills relevant to the provision of mental health services. Section 5. Rights of Service Users. - Service users shall enjoy, on an (n) Mental Health Service Provider refers to an entity or equal and nondiscriminatory basis, all rights guaranteed by the individual providing mental health services as defines in this Constitution as well as those recognizes under the United Nations Act, whether public or private, including, but not limited to Universal Declaration of Human Rights and the Convention on the mental health professionals and workers, social workers Rights of Persons with Disabilities and all other relevant international and counselors, informal community caregivers, mental and regional human rights conventions and declarations, including health advocates and their organizations, personal the right to: ombudsmen, and persons or entities offering nonmedical alternative therapies; (a) Freedom from social economic, and political discrimination (o) Mental Health Service refer to psychosocial psychiatric or and stigmatization, whether committed by public or private neurologic activities and programs along the whole range of actors; the mental health support services including promotion, (b) Exercise all their inherit civil, political, economic, social, prevention, treatment, and aftercare, which are provided by religious, educational, and cultural rights respecting mental health facilities and mental health professionals; individual qualities, abilities, and diversity of background, (p) Mental Health Worker refers to a trained person, volunteer without discrimination on the basis of physical disability, or advocate engaged in mental health promotion, providing age, gender, sexual orientation, race, color, language, support services under the supervision of a mental health religion or nationality, ethnic, or social origin; professional; (c) Access to evidence-based treatment of the same standard (q) Psychiatric or Neurologic Emergency refers to a condition and quality, regardless of age, sex, socioeconomic status, presenting a serious and immediate threat to the health race, ethnicity or sexual orientation; and well-being of a service user or any other person (d) Access to affordable essential health and social services for affected by a mental health facilities and mental health the purpose of achieving the highest attainable standard of condition, or any other person affected by a mental mental health; condition, or to the health or well-being of others, requiring (e) Access to metal health service at all levels of the national immediate medical intervention; health care system; (r) Psychosocial Problems refers to a condition that indicates (f) Access to comprehensive and coordinated treatment the existence of dysfunctions in a person's behavior, integrating holistic prevention, promotion, rehabilitation, thoughts and feelings brought about by sudden extreme, care and support, aimed at addressing mental health care prolonged or cumulative stressors in the physical or social needs through a multidisciplinary, user-driven treatment environment; and recovery plan; (s) Recovery-Based Approach refers to an approach to (g) Access to psychosocial care and clinical treatment in the intervention and treatment centered on the strengths of a least restrictive environment and manner; service user and involving the active participation, as equal (h) Humane treatment free from solitary confinement, torture, partners in care, of persons with lived experiences in mental and other forms of cruel inhumane, harmful or degrading health. This requires integrating a service user's treatment and invasive procedures not backed by scientific understanding of his or her condition into any plan for evidence; treatment and recovery; (i) Access to aftercare and rehabilitation when possible in the (t) Service User refers to a person with lived experience of any community for the purpose of social reintegration and mental health condition including persons who require or inclusion; are undergoing psychiatric, neurologic or psychosocial care; (j) Access to adequate information regarding available (u) Support refers to the spectrum of informal and formal multidisciplinary mental health services; arrangements or services of varying types and intensities, (k) Participate in metal health advocacy, policy planning, provided by the State, private entities, or communities, legislation, service provision, monitoring, research and aimed at assisting a service user in the exercise of his or her evaluation; safeguards and measures to ensure protection legal capacity or rights, including; community services; from undue influence, coercion or abuse. personal assistants and ombudsman; powers of attorney (l) Confidentiality of all information, communications, and and other legal and personal planning tools; peer support; records, in whatever form or medium stored, regarding the support for self -advocacy; nonformal community caregiver service user, any aspect of the service user's mental health, networks; dialogue systems; alternative , and manual or any treatment or care received by the service user, which  information, communications, and records shall not be illegal or unlawful involuntary treatment or confinement, disclosed to third parties without the written consent of the and other violations. service user concerned or the service user's legal representative, except in the following circumstances: Section 6. Rights of Family Members, Carers and Legal Representatives.- Family members, carers and duly designated or 1) Disclose is required by law or pursuant to an order issued by a court appointed legal representative of the service user shall have the right of competent jurisdiction; to: (2) The service user has expressed consent to the disclosure; (a) Receive appropriate psychosocial support from the relevant government agencies.; (3) A life-threatening emergency exists and such disclosure is (b) With the consent of the concerned service user, participate necessary to prevent harm or injury to the service user or other in the formulation, development and implementation of the persons; service user's individual treatment plan; (4) The service user is a minor and the attending mental health (c) Apply for release and transfer of the service user to an professional reasonably believes that the service user is a victim of appropriate mental health facility; child abuse; or (d) Participate in metal health advocacy, policy planning, legislation, service provision, monitoring, research and (5) Disclosure is required in condition with an administrative, civil, or evaluation. criminal case against a mental health professional ethics, to the extent necessary to completely adjudicate, settle, or resolve any issue or Section 7. Rights of Mental Health Professionals. Mental health controversy involved therein; professional shall have the right to: (m) Give informed consent before receiving treatment or care, (a) A safe and supportive work environment; including the right to withdraw such consent. Such consent (b) Participate in a continuous professional development shall be recorded in the service user's clinical record; program; (n) Participate in the development and formulation of the (c) Participate in the planning, development, and management psychosocial care or clinical treatment plan to be of mental health services; implemented; (d) Contribute to the development and regular review of (o) Designate or appoint a person of legal age to act as his or standards for evaluating mental health services provided to her legal representative in accordance with this Act, except service users; in cases of impairment or temporary loss of decision- (e) Participate in the development of mental and health policy making capacity; and service delivery guidelines; (p) Send or received uncensored private communication which (f) Except in emergency situations, manage and control all may include communication by letter, telephone or aspects of his or her practice, including whether or not to electronic means, and receive visitors at reasonable times, accept or decline a service user for treatment; and including the service user's legal representative and (g) Advocate for the rights of a service user, in cases where the representatives from the commission on Human Rights service user's wishes are at odds with those of his or her (CHR); family or legal representatives (q) Legal services, through competent counsel of the service WEEK 14 user's choice. In case the service user cannot afford the service user cannot afford the services of a counsel, the PUBLIC HEALTH LAWS Public Attorney's Office, or a legal; aid institution of the service user or representative's choice, shall assist the What is Pubic Health Law? service user;  Public health laws are such legal forces and duties of (r) Access to their clinical records unless, in the opinion of the organized society, by which conditions for maintaining attending mental health professional, revealing such citizen’s health are ensured.’’ information would cause harm to the service user's health  Public health law refers to a statute, or rule or local or put the safety of others at risk. When any such clinical ordinance that has the purpose of promoting or protecting records are withheld, the service user or his or her legal the public health. representative may contest such decision with the internal review board created pursuant to this Act authorized to Objectives of Public Health Act: investigate and resolve disputes, or with the CHR; (s) Information, within the twenty-four (24) hours of admission  To protect and promote public health to a mental health facility, of the rights enumerated in this  Control the risk to public health section in a form and language understood by the service  Promote the control of infectious diseases user; and  Prevent the spread of infectious diseases (t) By oneself or through a legal representative, to file with the  Recognizes the role of local governments in protecting appropriate agency, complaints of improperties, abuses in public health mental health care, violations of rights of persona with mental health needs, and seek to initiate appropriate Importance of Public Health Laws investigation and action against those who authorized The chief objective of international health laws is to improve health status at international level.   To eradicate health risks for global environment or minimize R.A. 2382 – Philippine Medical Act of 1959. them.  This act defines the practice of medicine in the country.  Legal intervention by making health policies and laws, ex. to prevent non-communicable disease, diabetes.  No person shall engage in the practice of medicine in the  Introduction and management of new techniques in area of Philippines unless he is at least twenty-one years of age, has health like biotechnologies, information etc. satisfactorily passed the corresponding Board Examination, and is a holder of a valid Certificate of Registration duly  To prevent health risks which may happen due to issued to him by the Board of Medical Examiners. international travel.  Objectives: This Act provides for and shall govern The following are list of categories of Laws, Orders, Decrees and (a) the standardization and regulation of medical Circulars education; (b) the examination for registration of physicians I. GOVERNANCE AND GENERAL APPLICATION (c) the supervision, control and regulation of the practice of medicine in the Philippines. R.A. 7160 – or the Local Government Code R. A. 7875 – National Health Insurance Act  This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.  An act instituting a national health insurance program for all  The Code aims to transform local government units into Filipinos and establishing the Philippine Health Insurance self-reliant communities and active partners in the Corporation for the purpose attainment of national goals thru’ a more responsive and accountable local government structure instituted thru’ a RA 3573 system of decentralization.  requires reporting of all cases of communicable diseases  Hence, each province, city and municipality has a LOCAL and administration of prophylaxis HEALTH BOARD (LHB) which is mandated to propose annual budgetary allocations for the operation and maintenance of R.A. 8980 - Early Childhood Care and Development (ECCD) their own health facilities.  promulgates a comprehensive policy and a national system COMPOSITION OF LHB: for ECCD (Early Childhood Care and Development), Provincial Level providing funds therefore and for other purposes. 1. Governor – chair R.A. 7719 – National Blood Services Act 2. Provincial Health Officer – vice chairman  promotes voluntary blood donation to provide sufficient 3. Chairman, Committee on Health of Sangguniang supply of safe blood and to regulate blood banks. Panlalawigan  This act aims to inculcate public awareness that blood 4. DOH representative donation is a humanitarian act 5. NGO representative R.A 6758 City and Municipal Level  Standardizes the salary of government employees including 1. Mayor – chair the nursing personnel. 2. MHO – vice chair 3. Chairman, Committee on Health of Sangguniang Bayan R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials 4. DOH representative and Employees 5. NGO representative  It is the policy of the state to promote high standards of Effective Local Health System Depends on: ethics in public office.  Public officials and employees shall at all times be 1. The LGU’s financial capability accountable to the people and shall discharges their duties 2. A dynamic and responsive political leadership with utmost responsibility, integrity, competence and 3. Community empowerment loyalty, act with patriotism and justice, lead modest lives R.A. 1082 – Rural Health Act. uphold public interest over personal interest.  An act strengthening health and dental services in the rural R.A. 7305 – Magna Carta for Public Health Workers areas, and providing funds therefore.  This act aims: to promote and improve the social and  It created the 1st 81 Rural Health Units. economic well-being of health workers, their living and  amended by RA 1891; more physicians, dentists, nurses, working conditions and terms of employment; to develop midwives and sanitary inspectors will live in the rural areas their skills and capabilities in order that they will be more where they are assigned in order to raise the health responsive and better equipped to deliver health projects conditions of barrio people, hence help decrease the high and programs; and to encourage those with proper incidence of preventable diseases qualifications and excellent abilities to join and remain in government service. P.D. No. 651 A.O. No. 2006-0012 Implementing Rules and Regulations of E.O. 51 or Milk Code  Requires that all health workers shall identify and encourage the registration of all births within 30 days  specifies the Revised Implementing Rules and Regulations following delivery. of E.O. 51 or Milk Code, Relevant International Agreements,  Requiring the registration of births and deaths in the Penalizing Violations thereof and for other purposes Philippines which occurred from January 1, 1974 and thereafter. R.A. 8172 – Salt Iodization Act (ASIN LAW) P.D. NO. 79  This Act requires the addition of iodine to all salt intended for animal and human consumption in order to eliminate  Defines, objectives, duties and functions of POPCOM micronutrient malnutrition in the country.  The Commission on Population (POPCOM) is a government R.A. 8976- also known as the PHILIPPINE FOOD FORTIFICATION ACT agency mandated as the over-all coordinating, monitoring and policy making body of the population program  provided the policy on mandatory fortification of staple foods and voluntary fortification of processed foods or food P.D. No. 965 products  Requires applicants for marriage license to receive instructions on family planning and responsible EO no. 382 parenthood.  Provided for the observance of the NATIONAL FOOD Letter of Instruction (LOI) No. 949 FORTIFICATION Day in November 7. A. O. No. 2005-0014- National Policies on Infant and Young Child  legal basis of PHC dated OCT. 19, 1979 Feeding:  promotes development of health programs on the community level 1. All newborns must be breastfed within 1 hour after birth 2. Infants must be exclusively breastfed for 6 months. Ministry Circular No. 2 of 1986 3. Infants be given timely, adequate and safe complementary  includes AIDS as notifiable disease foods 4. Breastfeeding be continued up to 2 years and beyond II. FOOD AND NUTRITION AO 36, s2010 R.A. – 7600 – Rooming in and Breastfeeding Act of 1992  also known as EXPANDED GARANTISADONG PAMBATA  AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE HEALTH INSTITUTIONS WITH ROOMING-IN AND III. MEDICINES AND DRUG REGULATION BREASTFEEDING PRACTICES AND FOR OTHER PURPOSES. R.A. 6675 – Generics Act of 1988  This law is in promotion of the State policy to encourage the practice of breastfeeding in the Philippines  Which promotes, requires and ensures the production of an  states the rules and regulations which contain standard adequate supply, distribution, use and acceptance of drugs procedures to be followed for rooming-in and breastfeeding and medicines identified by their generic name. in all private and government health institutions.  Specific provisions are made for complicated births. The R.A. 8423 right of the mother to breastfeed and the right of the infant  Mandates the Philippine Institute of Traditional and to receive breastmilk is expressed, and mothers may only Alternative Health Care (PITAHC) "to improve the quality exercise their right to bottle feed after being fully informed and delivery of health care services to the Filipino people of the benefits of breastfeeding and by expressing their through the development of traditional and alternative intention to formula feed in writing. health care and its integration into the national health care EO 51- Phil. Code of Marketing of Breast milk Substitutes delivery system"  It shall also be the policy of the State to seek a legally  regulates the marketing of infant milk formula, other milk workable basis by which indigenous societies would own products, foods and beverages, as well as feeding bottles their knowledge of traditional medicine. When such and teats knowledge is used by outsiders, the indigenous societies  The Code applies to the marketing, and practices related can require the permitted users to acknowledge its source there to, of the following products: breastmilk substitutes, and can demand a share of any financial return that may including infant formula; other milk products, foods and come from its authorized commercial use beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable, R.A. 6425 – Dangerous Drugs Act with or without modification, for use as a partial or total  It stipulates that the sale, administration, delivery, replacement of breastmilk; feeding bottles and teats. distribution and transportation of prohibited drugs is  It also applies to their quality and availability, and to punishable by law. information concerning their use.   Unlawful Prescription of Regulated Drugs RA 4073  The penalty of imprisonment ranging from four years and one day to eight years and a fine ranging from four  advocates home treatment for leprosy thousand to eight thousand pesos shall be imposed upon R.A. 7846 any person who, unless authorized by law, types of illegal drugs  mandates Compulsory Hepatitis B Immunization among  Below are some types of illegal drugs. infants and children less than 8 yrs old o Cannabis (Marijuana) o Cocaine A.O. No. 2006- 0015 o MDMA/Ecstasy or party Drugs In Australia,  defines the Implementing guidelines on Hepatitis B MDMA/Ecstasy are also known as E, pills, caps, Immunization for Infants pingers, M&M, doopa, love drug, disco biscuits, XTC, X and eccy. (pills or capsules) R.A. 2029 o GHB (gamma-hydroxybutyrate), is also known as fantasy, grievous bodily harm, GBH, liquid ecstasy,  mandates Liver Cancer and Hepatitis B Awareness Month liquid E, G, or Gina. (vials in fish shape) Act (February) o Hallucinogens V. ENVIRONMENT o Heroin o Inhalants P.D. No. 856 – Code on Sanitation o Ketamine o Methamphetamine  It provides for the control of all factors in man’s environment that affect health including the quality of R. A. 9165 – the new Dangerous Drug Act of 2002 water, food, milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution  This Act repealed Republic Act No. 6425, otherwise known and control of nuisance as the Dangerous Drugs Act of 1972, as amended, and providing funds for its implementation. Under this Act, the R.A. 8749 – Clean Air Act of 2000 Dangerous Drugs Board (DDB) remains as the policy-making and strategy-formulating body in planning and formulation  a comprehensive air quality management policy and of policies and program on drug prevention and control. program which aims to achieve and maintain healthy air for  Any dangerous drug in the following quantities, all Filipinos. o 1. 10 grams or more of opium; P.D. No. 825 o 2. 10 grams or more of morphine; o 3.10 grams or more of heroin;  Provides penalty for improper disposal of garbage. o 4. 10 grams or more of cocaine or cocaine hydrochloride; VI. HUMANITY o 5. 50 grams or more of methamphetamine R.A. 7432 – Senior Citizens Act hydrochloride or "shabu"; o 6. 10 grams or more of marijuana resin or  An act to maximize the contribution of senior citizens to marijuana resin oil; nation building, grant benefits and special privileges and for o 7. 500 grams or more of marijuana; other purposes o 8. 10 grams or more of other dangerous drugs such as, but not limited to, R.A. 7277- Magna Carta for PWD’s methylenedioxymethamphetamine (MDMA) or "ecstasy",  provides their rehabilitation, self-development and self- paramethoxyamphetamine (PMA), trimethoxyamphetamine (TMA), reliance and integration into the mainstream of society lysergic acid diethylamine (LSD), gamma hydroxybutyrate (GHB), and those similarly designed or newly introduced drugs and their WEEK 15 derivatives, without having any therapeutic value or if the quantity PHILIPPINE CULTURE, VALUES AND PRACTICES IN RELATION TO possessed is far beyond therapeutic requirements, as determined and HEALTHCARE OF INDIVIDUALS AND FAMILIES promulgated by the Board in accordance to Section 93, Article XI of this Act. VALUES OF FILIPINO NURSES IV. DISEASE PREVENTION (VACCINES) AND TREATMENT P.D. No. 996 Work Ethic  Requires the compulsory immunization of all children below As a group, Filipino nurses are well liked because they are (1 yr) 8 yrs. of age against the 6 childhood immunizable hardworking. They place high value on responsibility and seldom diseases. complain. “Many [Filipino nurses] work nights, holidays and/or overtime. So, during this time of nursing shortage, one can rely on a Filipino nurse to volunteer to cover the shift”. It is not unusual to find Filipino nurses who work two jobs. The financial rewards, job security, and personal advancement that U.S. jobs provide to Filipino nurses female genders, their native language is what hinders them from are valued. precisely using he or she in spoken English. Frequently, this leads to confusion. Spirituality Close Family Ties Filipino nurses are very religious people. There is a deep faith in God that is reflected in the expression of bahala na “it is up to God” or Filipino nurses have strong family ties. While in the United States, “leave it to God.” This tends to be incorrectly equated with an their close friends become their family members. As a result, they expression of fatalism and a passive acceptance of or resignation to perpetuate the cultural burden (as a downside) thus making it more fate. Bahala na may also apply to acceptance of illness or malady. difficult and taking them longer to assimilate into the mainstream culture of their adopted country. They tend to eat the same food and Sensitivity mingle with individuals of the same ethnic background. Unmarried Filipino nurses recoil at the question, “Are you pregnant?” HEALTH BELIEFS, BEHAVIORS, AND PRACTICES when they go for a medical checkup. Because the Philippine society considers sexual relationships not to occur outside of marriage, it Preventive Health seems odd to them that they would be questioned, although they are aware that this is part of a routine health assessment. Filipinos are Because most of their time is devoted to work, going for preventive generally sensitive and equally sensitive to the feelings of others, so health checkups takes a backseat. Yet, one may hear a Filipino they try to find a way to say things diplomatically. extolling the importance of preventive health to her patients or clients. Filipino nurses have a tendency to self-diagnose, self- Interpersonal Relationships medicate, and seek alternative therapies. In rural areas in the Philippines, people go for Hilot for relief of pain and aches instead of Filipinos are generally quiet. Very conservative families do not allow seeking medical attention. In an alternative context, Hilot may refer their younger members to join the conversation of adults without an to a practitioner or the practice of chiropractic manipulation and invitation. They are sometimes hesitant to articulate their views, massage for the diagnosis and treatment of musculoligamentous and especially if it is different from the majority, as it might indicate musculoskeletal ailments. discordance with the team or group. Engaging in arguments, especially with someone who is older or holds an authority position, Home Remedies is considered uncivilized. Filipinos also have difficulty turning down requests from supervisors to whom they feel obligated. Three concepts underlie Filipino American health beliefs and practices: flushing, heating, and protection. Each identifies a basic Respect and Reverence process used to promote good health. Flushing keeps the body free from debris, heating maintains a balanced internal temperature, and One’s position in society, professional achievements, and age carry a protection guards the body from outside influences. Although lot of weight in the Philippine society. Physicians, lawyers, priests, Western and scientific concepts are similar, Filipino theories are engineers, teachers, and nurses are among the well-respected founded on different premises. Flushing is based on the notion that professionals in the Philippines. Hence, their opinion is generally the body is a container that collects impurities, heating means that accepted without question. Filipino values and traditions provide a hot and cold qualities must be balanced in the body, and protection framework for conduct and mode of communication. involves safeguarding the body’s boundaries from supernatural as Because of a high regard for the elderly and authority, Filipinos tend well as natural forces. not to oppose or contradict other views for fear of embarrassing the Pain Tolerance other party. “Filipinos generally are neither assertive nor aggressive and may often appear guarded or reticent. Nurses often Generally speaking, Filipino nurses have a high tolerance to pain. For misunderstand this need for passivity and do not appreciate the example, one of the author’s sisters has severe arthritis, yet she culturally induced motivation to maintain harmonious balance continues to do housework regardless of her pain. Filipino nurses between man and nature” normally use home remedies such as liniments and topical ointments and manage pain before seeking medical care or while under medical Modesty treatment. Health care providers need to probe more into the cause Filipino nurses find it uncomfortable to accept even a well-deserved and degree of pain from Filipino patients to elicit more information. compliment. For example, if someone gives a complement like, “Your The elderly group, in particular, is unlikely to complain about their dress is beautiful!” the answer might be, “Not really. I bought it pain because they do not want to have extra burdens being imposed cheap.” Or if someone says, “You are so knowledgeable,” the answer on caregivers. might be, “Not really, I just happen to know it.” Yet they are proud of their accomplishments in a sort of quiet way. As a result, many have culture-based barriers to marketing themselves Privacy Language Filipinos are mostly reserved and private people. As patients, they may not readily reveal their personal and health information. Women Respect is integrated in the Filipino language. Reference to the elderly in particular are sensitive to touching another individual as well as is the use of the third person. Hence, when spoken to assertively in a being touched. “Young female service providers should practice direct way, Filipinos feel offended. There is no gender differentiation discretion with regard to touching older Filipino male patients such as in the Filipino language. Although they are fully aware of the male and laying one’s hand on the patient’s hand or shoulder to reassure  Mental illness connotes a weak spirit, and may be attributed comfort in moments of distress” to divine retribution as a consequence of personal and ancestral transgression HEALTH BELIEFS AND PRACTICES ARE ORIENTED TOWARDS  Lack of culturally oriented mental health services PROTECTION OF THE BODY. Health Beliefs and Behaviors: Indigenous Health Beliefs FLUSHING CONCEPT OF BALANCE (TIMBANG)  The body is thought to be a vessel or container that collects and eliminates impurities through physiological processes  This concept is central to Filipino self-care practices and is such as sweating, vomiting, expelling gas, or having an applied to all social relationships and encounters. appropriate volume of menstrual bleeding.  According to this principle, health is thought to be a result of balance, while illness due to humoral pathology and HEATING stress is usually the result of some imbalance.  Adapts the concept of balanced between “hot” and “cold”  Rapid shifts from “hot” to “cold” cause illness and disorder. to prevent occurrence of illness and disorders.  Illustrated below are a range of humoral balances that influence Filipino health perceptions: PROTECTION o Rapid shifts from “hot” to “cold” lead to illness o “Warm” environment is essential for maintaining  Safeguards the body’s boundaries from outside influences optimal health such as supernatural and natural forces. o Cold drinks or cooling foods should be avoided in COPING STYLES the morning o An overheated body is vulnerable to disease; a  Coping styles common among elderly Filipino Americans in heated body can get “shocked” times of illness or crisis include: o When cooled quickly, it can cause illness o A layer of fat maintains warmth, protecting the Patience and Endurance (Tiyaga): the ability to tolerate uncertain body’s vital energy situations o Imbalance from worry and overwork create stress Flexibility (Lakas ng Loob): being respectful and honest with oneself and illness o Emotional restraint is a key element in restoring Humor (Tatawanan ang problema): the capacity to laugh at oneself balance in times of adversity o A sense of balance imparts increased body awareness Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable and predestined will of God, in which the patient, Health Beliefs and Behaviors: Theories of Illness family members and even the physician should not interfere Physical and mental health and illness are viewed holistically as an Conceding to the wishes of the collective (Pakikisama) to maintain equilibrium model. In contrast, other explanatory models may include group harmony mystical, personalistic and naturalistic causes of illness or disease (Anderson, 1983; Tan, 1987; Tompar-Tiu & Sustento-Seneriches, Responses to Mental Ilnesses 1995). Indigenous traits common among elderly Filipino Americans when MYSTICAL CAUSES faced with illness related to mental conditions:  Mystical causes are often attributed to experiences or DEVASTATING SHAME (HIYA) behaviors such as ancestral retribution for unfinished tasks  Sensitivity to criticism (Amor Propio) or obligations.  Common Perceptions of Filipinos about Mental Illness  Some believe that the soul goes out from the body and  Unwillingness to accept having mental illness, which leads wanders, a phenomenon known as Bangungot, or that to the avoidance of needed mental health services due to having nightmares after a heavy meal may result in death. fear of being ridiculed PERSONALISTIC CAUSES  Involvement of other coping resources such as reliance on family and friends or indigenous healers, and dependence  Personalistic causes are associated with social punishment on religion which can diminish the need for mental health or retribution from supernatural forces such as evil spirit, services witch (Manga ga mud) or sorcerer (mangkukulam).  Prioritizing of financial and environmental needs which  The forces cast these spells on people if they are jealous or preclude the need for mental health services feel disliked.  Limited awareness of mental health services resulting in  Witch doctors (Herbularyo) or priests are asked to limiting access counteract and cast out these evil forces through the use of  Difficulty in utilizing mental health services during usual prayers, incantations, medicinal herbs and plants. For hours because of the unavailability of working adult family protection the healer may recommend using holy oils, or members  wearing religious objects, amulets or talismans (anting education and knowledge. The application of information and anting). communication technologies in health has rapidly increased for the past years and gained significance not only in the Department of NATURALISTIC CAUSES Health but in the entire health sector. The DOH has continuously addressed the challenges and demands to further improve health  Naturalistic causes include a host of factors ranging from care service deliveries and outcomes. Many countries have natural forces (thunder, lightning, drafts, etc.) to excessive recognized the importance of adopting information and stress, food and drug incompatibility, infection, or familial communication technology in health, also called as eHealth, to susceptibility. optimize processes and improve data collection, processing and SEVEN COMMON FILIPINO CULTURAL BELIEFS analysis. The adoption of ICT has provided concrete foundation for health investments and innovations. Countries have formulated their 1) NAMAMANA (Inheritance) own eHealth agenda to establish direction and plan the necessary  Namamana is the Filipino language translation of acquiring steps to achieve their intended vision, mission, and goals. a behavioral or disease trait from a parent. 2) LIHI (Conception or maternal cravings) The National Objectives for Health, 2005-2010 and the 2011-2016  Like namamana, lihi is a concept used to explain why some prioritized the use of ICT in various reforms areas, critical health children are noted to have certain specific characteristics. It programs, and specific areas in health administration. In 2005 and is believed that an offspring will take the features of the 2013, the Philippines was signatory to the 58th and 66th World Health food that the mother has craved for while she is in the lihi Assembly Resolution. The 58th World Health Assembly advocated the period. following: 3) PASMA (Hot and cold syndrome)  Draw up a long-term strategic plan for developing and  Pasma is roughly defined as an “exposure illness” which implementing eHealth services in the various areas of occurs when a condition considered to be “hot” is attacked health sectors including health administration which by a “cold” element and vice versa (Tan 2008) includes an appropriate legal framework and infrastructure 4) SUMPA AND and encourage public and private partnership; 5) GABA (Curse)  Develop the infrastructure for ICTs for health as deemed  Sumpa and gaba are beliefs in the Filipino culture pertaining appropriate to promote equitable, affordable and universal to a curse. access; 6) NAMALIGNO (Mystical and supernatural causes)  Build on closer collaboration with private and non-profit  beliefs in supernatural beings are widespread in the sectors in ICTs; Philippines. Specifically, namaligno is a Filipino belief that a  Reach communities, including vulnerable groups, with disease is caused by an intervention of a supernatural or a eHealth services appropriate to their needs; mystical being (Abad 2013)  Mobilize multi-sectoral collaboration for determining 7) KALOOB NG DIYOS (God’s will) evidence-based eHealth standards and norms and to share  Kaloob ng Diyos means God’s will. When a Filipino the knowledge of cost-effective models, thus ensuring individual experiences an unexpected event in their life, quality, safety and ethical standards and respect for the whether negative or positive, it is typically attributed to the principles of confidentiality of information, privacy, equity grace of God. and equality; WEEK 16  Establish national centers and networks of excellence for eHealth best practice, policy coordination, and technical NEW TECHNOLOGIES RELATED TO PUBLIC HEALTH ELECTRONIC support for health-care delivery, service improvement, INFORMATION information to citizens, capacity building, and surveillance; and The Department of Health (DOH) is mandated to be the over-all  Establish and implement national electronic public-health technical authority on health that provides national policy direction and develop national plans, technical standards and guidelines on information systems and to improve, by means of health. It is also a regulator of all health services and products, and information, the capacity for surveillance of, and rapid provider of special or tertiary health care services and of technical response to, disease and public-health emergencies. assistance to other health providers especially to local government eHealth in the Philippines units. The implementation of Kalusugan Pangkalahatan or Universal Health Care is directed towards ensuring the achievement of the Developing software for Field Health Services and Information health system goals of better health outcomes, sustained health System, and has continuously developed or built other application or financing and responsive health system. information systems. The use of ICTs in the DOH has remarkably supported and improved some of the functions of the Department. The World Health Organization defines eHealth as the use of ICTs have been used in the areas of innovative technological changes, information and communication technologies for health. It supports networking and infrastructure, office automation, development and the delivery of health services and management of health systems to implementation of computer-based systems. From the limited become more efficient and effective. eHealth is described also as a resources in terms of ICT personnel and funds, the DOH Management means to ensure that “the right health information is provided to the has augmented the budget on ICT to fully accomplish and support the right person at the right place and time in a secure, electronic form to ICT strategic goals and direction. optimize the quality and efficiency of health care delivery, research, Existing information systems and data sources are being integrated or Key Strategic Guiding Principles harmonized to eventually address other challenges like establishment of the DOH data warehouse, quality database and establishment of a Key strategic guiding principles in the development of Philippines more responsive information system and access to and sharing of eHealth Strategic Framework and Plan are as follows: knowledge products. For remote and underserved areas and 1. eHealth must serve the needs of the client or person. vulnerable populations, the DOH has implemented telemedicine in 2. Collaboration and partnerships with key health care selected pilot areas through the National Telehealth Center, National stakeholders are critical in realizing the country’s eHealth Institute for Health, University of the Philippines, Manila. The DOH vision. has also developed and implemented mobile technology solutions in 3. Users’ must be involved at all phases of development and reporting cases through the Health Emergency Management Staff’s - implementation to gain commitment for implementation. Surveillance in Post Extreme Emergencies and Disasters (SPEED) with 4. A strategic approach in terms of phases enables more focus, support from WHO. There are several mobile technology applications and judiciously and efficiently make use of resources to developed and for implementation, e.g. Text TB for reporting achieve the eHealth vision. inventory of tuberculosis drugs, maternal and neonatal death 5. eHealth activities must be aligned or harmonized, without reporting, and routine health data reporting. controlling health care providers to implement local eHealth Vision eHealth solutions. 6. The presence of entities that have already started eHealth By 2020 eHealth will enable widespread access to health care must be recognized so as not to constraint their continuing services, health information, and securely share and exchange advancement and gain their support. patients’ information in support to a safer, quality health care, more 7. Human resource can be made available by building equitable and responsive health system for all the Filipino people by capability to implement the eHealth agenda in the country transforming the way information is used to plan, manage, deliver and and promote transparency and public accountability. monitor health services. 8. Implementation of eHealth must comply to relevant laws and regulations. The strategic vision describes the Philippines Health System that has 9. Investments must be made on areas that deliver the been enabled by eHealth. It shows how eHealth will be used to greatest benefits to health consumers, health care address health system’s priority goals and challenges to deliver health providers, and healthcare managers; and ensure no outcomes. The Aquino Health Agenda on achieving Universal Health duplication in terms of time, effort and resources. Care or Kalusugan Pangkahalatan for all Filipinos is a continuing commitment to health sector reform and achieving the Millennium eHealth Components Development Goals. The National Objectives for Health 2011-2016 has set the health program goals, strategies, performance indicators The components are the building blocks to achieve the stated vision. and targets towards achieving KP. The overall goal is to achieve health There were initial identified components to realize the outcomes of system goals of financial risk protection, better health outcomes, and eHealth in the Philippines, i.e. enabling structures and resources, responsive health system for the Filipino people. mission-critical health application systems, Philippine Health Information System, Knowledge Management for Health, and eHealth has proven to provide improvements in health care delivery telemedicine/mHealth services. The groupings are more information and is at the core of responsive health system. eHealth will improve or application systems based and were reviewed together with the the quality and safety of the health system through empowerment of National eHealth Strategy Toolkit. Updated components are health consumers to better manage their health records; availability governance, strategy and investment, eHealth solutions (services and of information like single view of the patients’ information at the point applications), standards and interoperability, infrastructure, of care, decision support tools and knowledge-based information legislation/policy and compliance, and human resource thereby reducing medical errors, improved treatment and monitoring; and availability of information for efficient and effective Components Description surveillance and monitoring of diseases and management of health 1) Governance Directs and coordinates eHealth activities at all levels like hospitals eHealth will also support a more equitable health system through and health care providers. Critical presence of information about the availability, location, expertise and areas of governance are services of health care providers. This will provide health consumers management of the eHealth agenda, with ready information for reference purpose and health care stakeholders’ engagement, strategic architecture, clinical safety, providers for referral process. Electronic consultations in rural, management and operation, remote and disadvantaged areas can be made accessible or available. monitoring eHealth will provide a more responsive health system because and evaluation, and policy oversight. information can be securely shared and exchanged without repeating 2) Legislation, Formulation of the required Policy and legislations, policies and compliance effort and time in providing the same information to different health Compliance to support the attainment of the care providers; use of eHealth solutions to speed up processes like eHealth vision. Examples of these are ordering system and results reporting; reduced time and cost of the national legislations, policies, health consumers undergoing unnecessary or duplicated diagnostic and tests; improved diagnosis and treatment activities; reduced travel regulations on how health time using telehealth services; and efficient and effective disease information are stored, accessed and monitoring and response. shared across geographical and  health sector boundaries; others. Examples of eHealth implementation of unique health solutions are electronic identifier; implementation of health/medical/personal records, national health data standards; and electronic referrals, medications software certification or management, distance learning and accreditation electronic resources, 3) Standards and Promotes and enables exchange of telemedicine, mobile health, adverse Interoperability health information across event monitoring, disease geographical and health sector surveillance, among others. boundaries through use of common standards on data structure, terminologies, and messaging. One HEALTH INFORMATION MANAGEMENT SYSTEMS IN PUBLIC HEALTH strategy to ensure compliance to health data standards for SYSTEM/ DEVELOPER KEY INFORMATION interoperability is the BizBox A set of web-based for various implementation of software health care institutions such as certification or accreditation where hospitals and rural health units. eHealth solutions must comply in Community Health Information One of the pioneering EMR order to be certified as able to Tracking System (CHITS) developed in 2004 by the exchange health information. University of the Philippines - 4) Strategy and Develops, operates and sustains the Manila. Investment national eHealth vision. These The relevant customized forms components support the based on DOH and Philhealth development of a strategy and plans programs in CHITS were to serve as guide in the organized into modules for implementation of the eHealth easier workflow integration. agenda. Investment refers to the eHealth TABLET for Informed Key product features of eHatid: funding or amount needed for Decision Making of LGU’s EMR software application for executing the strategies and plans. (eHatid) mobile android devices, 5) Infrastructure Establishes and supports health dashboard, and a Mayor- information exchange, i.e. the Doctor sharing of health information across Communication as a channel geographical and health sector for decision making and sharing boundaries, and implementation of of health-related information. innovative ways to Event-based Surveillance and An online health event deliver health services and Response System (ESR) surveillance reporting system. information. Infrastructure includes It involves reporting all health physical technology and events (existing or rare) that software platforms, services and raise concern, fear, alarm in the applications to support health community which may have information exchange. Examples of known, suspected or possible these are high-speed data impact on human health. connectivity and computing Integrated Clinic Information As an integrated system, it is infrastructure, like computers and System (iClinicSys) linked to other DOH home mobile devices for the collection, grown systems such as the recording and exchange of electronic Maternal and Neonatal Death information, among others. Reporting, Tuberculosis 6) Human Workforce or manpower to develop, Information System, Injury Resource operate or implement the national Reporting and Chronic Non- eHealth environment such as the Communicable Disease health workers who will be using Reporting. eHealth in their line of works, health Integrated Hospital Operations It has modules for the following care providers, information and and Management Information areas in the hospital: admitting, communication technology workers, System (iHomis) outpatient, emergency room, and others billing and cashier, nursing, 7) eHealth Required services and applications to pharmacy, dietary, laboratory Solutions enable widespread access to health and radiology. care services, health information, Integrated Tuberculosis It has a case management health reports, health care activities, Information System (IT IS) module that captures patient’s and securely share and exchange demographic profile, TB