PROGRAM REVIEW

A. PROGRAM TITLE: Healthy Lifestyle Program B. AREA OF ASSIGNMENT: Rural Health Unit, Masaplod Norte, Dauin, Negros Oriental C. DATE OF EXPERIENCE: November 9, 2012December 15, 2012 D. OVERVIEW OF THE MUNICIPALITY OF DAUIN: The Municipality of Dauin is a 4th class municipality located 15.5 km South of the City of Dumaguete. It has a total land area of 144312 hectares or 144.32 sq. km and a population of 25, 842, with 5, 656 as the total number of households. There are 23 barangays, 3 are urban, 19 upland and 1 island barangay. Agriculture is the backbone of the municipalitys economy, which utilizes 30% of the total land area. The 2 major crops are coconut and corn. Dauin is labeled as the resort capital of the Province of Negros Oriental because of the presence of numerous resorts and dive shops catering to tourists. Because of this, diving is the primary reason why foreigners come and the marine life of Apo Island is at par or even better than that of the other famous diving sites. There is a marine sanctuary in every coastal barangay operated by the bantay dagat, which is a major contributor to the local income. The coastal resource management program is well managed which is in line with the administrations thrust, which is food security. The lying- inn clinic and TB DOTS center made possible thru the grant of the European Commission and counterpart of the LGU are now fully operational. Almost 100% of the deliveries are facility- based to safeguard the lives of the mother and child. The local government is on its 9th year of enrolling indigent families into the Medicare Para sa Masa of Philhealth that provides health insurance coverage. Simple laboratory procedures like CBC. Urinalysis, Blood typing, Sputum Exam, Fecalysis and Pregnancy test are available in the Main Health Center with corresponding fees as provided for in the ordinance. Lately, another health insurance, the Provincial Health Insurance of Negros Oriental (PHINO) is gaining ground in the Municipality. It started with the enrollment of some bantay dagat members and now all the Barangay Health Workers are encouraged to enroll. The low malnutrition rate has been consistent for the past years, which could be attributed to proper implementation of health programs, strong LGU support and linkages with other line agencies and NGOs. Dauin is an active member of the Metropolitan Inter- Local Health Zone.

The new administration under the leadership of Mayor Neil B. Credo is very supportive of all the DOH programs. The Municipality has conducted a Bloodletting activity, medical and dental mission last May 5, 2011 in cooperation with the MILHZ, Philippine National Red Cross and Energy Development Corporation. The EDC- sponsored Operation Tuli followed this on May 24, 2011, which was very successful. The Municipality of Dauin has its very own Rural health Unit that is very well supported under the very abled leadership of the Municipality Mayor. The Rural Health Unit of Dauin started as Dauin Puericulture in 1948 where a doctor and a nurse only manned it. Eventually, it evolved into a Rural Health in 1975 where midwives became essential part of the workforce in the 1980s. BHWs were added to the team as part of the primary Health Program in order to reach out to other members of the Community in the far- flung areas. To date, the RHU has 23 main staff- 1 MHO (Medical Doctor) in the person of Dr. Melpha B. Yee, 1 Dentist, 1 Dental Aide, 1 Medical technologist, 1 PHN, 13 RHMs, 1 Sanitary Inspector, 1 Clinic Clerk and 2 Center Aides. It also has 156 BHWs as part of the healthcare team, 140 of whom are accredited. Dauin RHU has the following facilities: Doctors clinic, Dental Clinic, Laboratory, Prenatal/ Family Room, and the newly added lying- inn Clinic and TB DOTS Center. Being an organization, the RHU envisions its services to be of great help and significance by the vision statement, The Dauinanons will acquire good health in a holistic manner at all times through the intensive healthcare approach and in a client- friendly environment. The organization exists to serve its purpose as reflected by its mission statement which is as follows: Provision of quality healthcare services through consistent delivery of various intensive healthcare approaches to good health, permanent supply of medicines and other health related resources at the center, complete healthcare facilities and equipment, and early detection of illnesses and diseases that need prompt medical attention. Its main objectives are, (1) to maintain zero maternal death, (2) to decrease under five mortality rate, (3) and to further decrease malnutrition rate among preschool and school children. Dauin RHU has a number of health services being offered for the use and benefit of the community people living in the municipality, which are the following: A) Safe Motherhood Program

1) Maternal Care 2) Family Planning Program B) Child Care 1) Newborn Screening 2) Exclusive breastfeeding 3) EPI 4) Micronutrient Supplementation 5) IMCI C) D) E) F) G) H) I) J) K) National Tuberculosis Program Dengue Prevention and Control Program Rabies Prevention and Control Program Voluntary Blood Donation Program Leprosy Prevention and Control Program Promotion of Healthy Lifestyle Dental Program Environmental Sanitation Program Laboratory Services

These numerous programs for health, serve as a method of preventive, curative and rehabilitative care for the welfare of its citizens. The people in the municipality can all come to the RHU and seek help for their health problems, where they are to be given proper assessment, treatment, referral, and rehabilitation. With all these programs implemented, it is also necessary to keep track of its progress, efficiency and effectivity. Thus, morbidity and mortality rates , as well as their causes are being closely monitored and reported monthly. The table below shoes the top 10 causes of morbidity and mortality per 100,000 population, in 5 years average (2006-2010), and as well as a comparative data in the year 2011.

Table 1: Morbidity Leading Causes, Number and Rate per 100, 000 population 5 years average (2006 to 2010 and 2011) Municipality of Dauin Causes 5 years average Number Rate Bronchitis 1, 101 4, 516 Viral Fever 834 3, 421 Wound, All 344 1, 411 Types Hypertension 318 1, 304 Diarrhea 243 997

2011 Number 939 190 269 110 181

Rate 3, 634 735 1,041 426 700

ARI Pneumonia Bronchial Asthma Dengue UTI

226 180 59 48 41

927 738 242 197 168

263 140 73 6 27

1, 018 542 282 23 104

Table 2: Mortality Leading Causes, Number and Rate per 100, 000 population 5 years average (2006 to 2010 and 2011) Municipality of Dauin Causes 5 years average Number Rate CVD 1, 101 4, 516 Septicemia 834 3, 421 Malignancies 344 1, 411 Pneumonia 318 1, 304 CVA 243 997 COPD 226 927 Renal Disease 180 738 DM 59 242 Accidents 48 197 Liver Diseases 41 168

2011 Number 939 190 269 110 181 263 140 73 6 27

Rate 3, 634 735 1,041 426 700 1, 018 542 282 23 104

In Barangay Masaplod Norte, where we are assigned, it is divided into 7 Puroks with 321 households, in which each has approximately 30-50 households. Currently, Purok 5 has the most number of 51 households, Purok 1 has the least number of 33 households, while Purok 2 has 41 and Purok 3 has 42 households. Furthermore, Puroks 4, 6 and 7 has 154 households collectively. Geographically, Purok 1 is located near the beach, where the new Barangay Hall is also found. The rest are located on the other side of the road where the main livelihood are farming corn crops and where coconut trees grow numerously. Purok 3 is located at the upmost corner where it meets with Barangay Tunga-Tunga. Walking around the different Puroks, almost everything is covered with fruit-bearing trees and shrubs with little spaces for flowers to grow. There are many patches of land, owned by the residents that are full of grown crops, with sineguelas trees line along the way. Some residents own a carabao, cow, a pen of pigs, and poultry. In Purok 3, the people use the Masaplod River is used by the residents for bathing, washing clothes and dishes, and sometimes watering the plants. However, the river water is never used for drinking or cooking because of

its bitter-sour taste or aplod, which according to the residents, was where Masaplod Norte and Sur, where named for. During our preliminary interview and introduction to the residents, most of them only complained of some colds and cough, which they already sough help for at the Marina Mission Clinic of Silliman University. Some have hypertension while others claim that they have family members who are diabetic. Furthermore, many claim that with their heavy work and household chores, it is already an enough exerise for the day.

E. PROGRAM GOALS AND OBJECTIVES The healthy lifestyle programs goal is defined by this statement: Reduce the toll of morbidity, disability and premature deaths, due to chronic, non-communicable lifestyle related disease. To narrow it down, the program has 3 general objectives that describes its purpose of existence, which are described by the following paragraphs. 1. First, analyze the social, economic, political and behavioral determinants of NCD that will serve as the bases for: a. Developing policy guidelines; b. Setting legislative and political directions, and c. Providing financial measures to support NCD prevention and control. The initial step in developing a plan for NCD prevention and control is the assessment of disease burden in a locality. It consists of NCD surveillance to identify vulnerable population groups along with the social, political, economic and cultural factors that predispose population to NCD. 2. The second objective is to reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factors. The NCD prevention and control program must focus on modification of unhealthy lifestyles and behaviors that predispose populations to NCD. To hasten this, the health sector should lobby for a health protective environment by: a. Proposing healthy public policies that encourage health-promoting settings in school, workplaces and communities. b. Encouraging governments to provide protection against activities by industry and commerce that promote unhealthy products and lifestyle c. Communicating the consequences of major risk factors of NCD, paying particular attention to the most vulnerable population.

3. Lastly, the program aims to strengthen health care for people with NCD through health sector reforms and cost effective interventions. In order to contribute to the improved health status of individuals and respond to the communitys basic health care needs, there must be enhanced capability to take action to address these major NCD risk factors. Enhanced capability reiterates the value of strong community participation combined with institution-building and appropriate, cost-effective health interventions.

F. EVALUATION OF PROGRAM GOALS AND OBJECTIVES The NCD prevention and control program is a worlwide as well as a national effort to mitigate the prevalence of noncommunicable diseases contributing to the lessening of the global burden of disease as well as for the improvement of the total quality of life of the people. As claimed by Dr. Yee, the municipality of Dauin has an NCD program that was adopted but we lack enforcement and implementation of the program. She views that there is a need for reactivation of the program with the help of various government sectors and the constituents of the municipality. Further more, Mrs. Sibala expressed that, the activities intended for NCD prevention and control program have been distributed to other programs. The free BP taking done by the RHU is a way of monitoring the hypertensive patients, as well as a way to detect early hypertension. Along with this, the RHU also provides to its hypertensive patients some maintenance medications for free. In the barangay level, the BHWs, find their way in the various Puroks and take charge of monitoring the BP of identified hypertensive patients. Health education is also provided by the RHU and Barangay Health Station personnel to their patients, most particularly about health and nutrition. The health education is always in cooperation with any fields of nursing, as a way of self-care, self-sufficiency, and prevention. As an example, pregnant mothers are educated about proper and adequate nutrition during pregnancy, ro sustain her and the baby until delivery. Lactating mothers are also educated about the right kind of food to take when breastfeeding her newborn. Some maintenance medications for diabetic patients are also available, and if not, these patients get proper referral to Negros Oriental Provincial Hospital (NOPH), for proper and adequate intervention. Based on the statistics from the RHU, hypertension is the 4th in the 10 leading causes of morbidity and CVD is the leading cause of mortality. Therefore, this strengthens the idea that the activities under the NCD Prevention and Control program indeed have a great relevance towards adressing the health needs of the community.

The program on Healthy Lifestyle is considered as responsive to the identified health problem of the community. This is due to the fact that the leading cause of mortality is CVD which is lifestyle-related. Many of the causes of morbidity are also related to health. CVA, COPD, Renal Diseases, and DM occupy the 4th to 7th spot respectively, with MVA and liver diseases following in 9th and 10th. Based on the data that we had gathered, the healthy lifestyle program is somehow a very young program in its implementation, wherein its activities are being distributed to the different health programs in the RHU, mostly in the form of health education. Nevertheless, majority are with the knowledge, especially of the recent anti-smoking campaign of the municipality. Furthermore, most of the residents in Masaplod Norte are also aware of the harmful effects of smoking to the body, claiming that they got most of their acquired information from the television commercials and from the informative posters, placed strategically in the RHU. As observed and as claimed by the community people during our encounter with them in the community setting in Masaplod Norte, the activities being chosen to be implemented by the RHU, like BP taking, lanoratory services, antismoking campaign, and free maintenance medications were somehow efficient in its implementation for the following reasons: In BP taking, majority of the people are aware of the service by the RHU, although a few were without the knowledge that it can be acquired for free. Most of the community people were very enthusiastic of the activity although many has expressed the concern of distance and difficulty of transportation from their Purok to the Poblacion. For the laboratory services, many of the people were very appreciative when they found out about it, and some were actually aware and have already tried the service. In the aspect of the free maintenance medications, majority of the community people were without any knowledge of the fact that they actually avail some of their maintenance medications in the health center for free. Majority of the people were aware of the anti-smoking campaign because, according to them, a person from the municipality come to them every Sunday to tell them about the anti-smoking ordinance. Many of them were knowledgeable of the basic rules and penalties of the ordinance. Almost all of the community people that we interviewed, smokers included, were able to express that the ordinance is going to be a beneficial tool not just for them to stop their smoking but also for the younger children. Encouraging citizens to participate, this program could enhance their health not immediately but slowly if the program will be constantly moving and

contracting. With the help of health workers and authorized persons as well, the efficacy of this program is rest assured as this helps the community to have basic knowledge on how to improve their lifestyles as well as how to prevent diseases related to their individual lifestyles. The said program might give them the idea on how to modify their unhealthy lifestyles slowly but surely. Also, it is efficient not only to the community people but also to us students for it delivers a service-learning activity which adds to our learning experience. The program is also progressing according to plan since we have seen interests in our community partners which are the health workers and especially the citizens who are eager in improving their health as they are encouraged to join and participate such program every time we do house to house visits. In takes a lot of time for the impact of such a program to be measured and evalualted. The student nurses believe that in time, with the proper planning, controlling, implementation, and evaluation, the healthy lifestyle program may be of a great help to make a significant impact on the beneficiaries and the community in achieving a healthy lifestyle. The researchers believe that the program is still possible to make a significant impact through active advertisement and giving of information and services of health centers closely to the people/ households in Dauin. An estimated 80% of premature heart disease, stroke, and type-2 diabetes, and 40% of cancer, could be avoided through healthy diet, regular physical activity, and avoidance of tobacco use. This can be one of the many benefits if an individual follows the healthy lifestyle program. Non-communicable disease cases mortality and morbidity rates might decrease. The health of an individual may improve and the average lifespan may lengthen. Despite its great benefits, healthy lifestyle programs needs budget to be enforced. There will also be an economic downfall to those companies whose products are to be avoided like cigarettes, tobacco and alcohol, and this will also affect the economy because of the big taxes they contribute through sales and exports. Tobacco farmers will also be affected. To keep a healthy lifestyle, people would have to modify their diet and out-do with high in fat or sodium foods. This will be a burden especially to the minorities who settle with affordable dried fish and canned goods. All factors must be taken into consideration, all the pros and the cons of a program. However, it all boils down to the well-being of the people. Since health is a crucially important matter, it would be unwise to disregard the myriad health benefits of healthy lifestyle programs.

Lifestyle management boils down to scheduling and clarity of purpose. Adopt the mindset that that exercise is a vital component of your life and take steps to make its inclusion non-negotiable, even to yourself. The program helps us all become healthy, fit and responsible individuals who can perform activities of daily living well. It helps decrease mortality/morbidity rate which are caused by NCDs. By following the program, it will increase the average lifespan of people and be able to see the wonders and beauty of the world a little longer.

G. PROGRAM STRATEGIES The program has different 4 key intervention strategies that is designed to help in the implementation of the healthy lifestyle program, which are the following: 1. Establishing program direction and infrastructure. A community diagnosis gives good information on risk factors and prevalence of NCD, in the community. This becomes the basis for program plan and action and provides for rational resourcing. Establishing a team to manage the program is a must. 2. Changing environments. Establishing partnership and intersectoral coordinating mechanism in order to develop policies and programs that ensure health and environment are not compromised by economic progress.

3. Changing lifestyle. Raising public awareness by producing and disseminating information through mass media, health campaigns, public information systems and school education. At the community level, mothers classes, barangay assemblies, posting in community bulletin boards or in places where most people frequent or converge, such as sari-sari stores or marketplaces are examples of activities that can be easily carried out. 4. Reorienting health services. Reorienting focus of health service delivery from cure to health promotion or wellness.

H. ANALYSIS ON THE IMPLEMENTATION OF THE PROGRAM STRATEGIES IN THE LIGHT OF THE MANAGEMENT FUNCTIONS (PLANNING, ORGANIZING, DIRECTING, AND CONTROLLING) There is a noticeable epidemiologic shift from infectious to noncommunicable diseases (NCDs) over the years. In 2007, seven of the ten leading causes of death are non-communicable in etiology. Twenty percent (20%) of the total deaths are due to heart diseases followed by cerebrovascular diseases (11%) and malignant neoplasms (10%). The causes of this growing trend are attributed to the changing socioeconomic, cultural, political and environmental climate. Globalization and urbanization serve as conduits for the promotion of unhealthy habits and behaviors. The growing problem of NCDs has pushed policy makers to craft effective strategies to mitigate the enormous economic and social costs they bring. According to World Health Organization, cardio-vascular diseases, stroke and diabetes are estimated to reduce the Gross Domestic Product (GDP) from 1-5 percent in low and middle countries (World Health Organization, 2011; Abegunde & Stanciole, 2006). In response to the growing threat, institutions like World Health Organization have already conceptualized general frameworks on the prevention and control of NCDs that is adapted by various countries. The municipality of Dauin, a fourth class municipality incorporates their NCD prevention and control program into the various health services they offer to their catchment area. This ranges from diagnostic tools, medications and alternative therapies. However, there is no bigger umbrella that unifies these essential services into a program for NCD prevention and control. This strengthens the notion from our clinical instructor that the program is fragmented. These are their services in the light of the management functions: Health Planning Services BP Monitoring BP is taken only from those who visit the clinic or the RHU. There are no current or annual plans in how it is implemented. Directing Every purok has a BHW that is delegated with the task of taking BP among the people in her assigned area. Midwives and nurses (RN Heals) can also take BP and Organizing BP can be taken anytime during office hours of the RHU or brg health station. For emergency cases when clinics are closed, residents Controlling For high BP cases, residents are immediately referred to the hospital, or are given with antihypertensi ve medications with the

make necessary referrals.

suspected with high BP is brought to the health center by contacting the BHW, or can be immediately brought to the hospital.

Blood Sugar Monitoring and CBC

Anti-smoking Campaign

There are no weekly, monthly or annual plans or schedules made in taking the blood sugar or complete blood count of the residents or those at risk for lifestylerelated diseases. This is a recent program implemented by the LGU of Dauin patterned and in accordance with the RA 9211 or the national AntiTobacco Act of the Philippines. They are still in their observation

This is taken for FREE in NOPH laboratory with appropriate referral made for residents who came to the RHU and wishes for their blood sugar or complete blood count to be taken.

Residents can avail of the free laboratory at NOPH only if they have the referral slip coming from the RHU. However, there is no free transportatio n for those going to the hospital. All health and Smoking is government prohibited 24 professionals hours in all are encouraged public places to promote the in Dauin. All program and residents are its benefits persuaded to among the be vigilant in Dauinanons. reporting Further, the violations of PNP are tasked the campaign. in prohibiting Health smoking and Education enforcing the about the illnecessary effects of rules, smoking are provisions and also widely

prescription of the MHO. Every BHW is also having a patientmonitoring list for those BP they have taken, with appropriate actions that were taken as necessary. When residents are found to have abnormal findings in his/her laboratory results, they are given with appropriate management and are referred back to the RHU for monitoring. Violators are dealt according to the degree and frequency of violation. Further, selling of tobacco products in sari-sari stores is also controlled.

phase, and reactive planning is employed whenever a problem occurs. Nutrition Counseling This is done as a routine health teaching to children in schools, to pregnant women, and to residents who needs special modifications in their diets. During the month of July, Dauin is one with the Philippines in implementing and promoting proper nutrition in their area of responsibility. This has been present after doing benchmarking of the program from other municipalities.

fines to those who have violated.

This is primarily done by the BHW in every purok they are assigned. Midwives gives advises to pregnant women about the nutrients or food choices they should increase. Teachers in schools especially in the primary level also incorporate nutrition topics during EPP, MAPEH and other related subjects.

HATAW Exercise

All residents who are interested are allowed to join in the free exercise done in the municipal park of Dauin.

enforced throughout the municipality. IEC materials are also widely distributed. Everybody can be given counseling on nutrition as they request it in the RHU. IEC materials are placed in very health station, school and in the RHU. However, Malnourishm ent and obesity are only regularly monitored and managed in schools. Fortification requirements in staple foods are also strictly observed. A fitness and dance instructor has been hired to lead the exercise. Sound systems are provided by the LGU.

People who require modifications in their diets are dealt accordingly as they are counseled by the MHO, PHN or midwives. Stores who violate the fortification requirement are usually revoked with their license.

This program discontinued only after some months after its implementati on. The MHO claimed, gikapoy rapud as one of the reasons for its

discontinuanc e. Provision of The RHU of All residents The PHN gives Reciepients of Medications Dauin adheres who comply to adequate the service (for lifestyleto the DOH in with the amount of are related its Vit A requirements medications continuously diseases) and supplementati for this service to the monitored for Vitamin on twice a are given free midwives as their Supplementati year. medications for seen in the adherence to on their lifestyle referral slips the related of residents treatment. diseases (ex. receiving this Requests are Captopril for service. The also made in hypertensives). midwives are getting the Supplementati the ones who medications ons (milk. monitors from Vitamins, etc) adherence to appropriate are also done the treatment health offices. when regimen. resources are available.

These analyses we have made are useful in the development of multisectorial framework for monitoring, prevention and control of these diseases in the light of the management functions (planning, directing, organizing, controlling) in the implementation of an NCD program. In this light, we aim to gather a wide range of information on leading NCDs, from mortality, morbidity and their social determinants. Scanning of existing laws and policies related to NCDs will also be performed. Through this, a systematic and comprehensive review will be made that would be essential in unifying the varied health services and in the creation of an NCD prevention and control program for the municipality of Dauin.

I. PROGRAM RECOMMENDATIONS Based on the results of the program review, we came up with the following recommendations that can be implemented as interventions that target the whole population and high- risk individuals. Not all of these recommendations may be considered priority considering the limited LGU resources in Dauin. But please factor in these recommendations in your future plans for municipality.

Full adaptation and implementation of the Healthy Lifestyle program through: 1) Promoting Healthy Lifestyle The goal of promoting healthy lifestyle is the practice of the following behaviors: Engaging in regular physical activity Having a healthy diet and eating more fruits and vegetables Avoiding tobacco and alcohol use Promoting healthy lifestyle supports personal and social development through the following activities: Develop information, education and communication (IEC) materials that will improve knowledge and behavior of the target population on healthy lifestyle. Conduct advocacy campaigns and activities among identified partners who have direct impact or influence to preventing and controlling NCDs, e.g. education, agriculture, private sector, etc. Coordinate with different community groups youth, informal sector, sports clubs, civic organizations where healthy lifestyle can be integrated in their activities and regular meetings Convene barangay officials to cascade the healthy lifestyle promotion initiatives down to the community level Implement healthy settings, primarily healthy workplaces and healthpromoting schools, for promotion of healthy lifestyle

2) Building Healthy Public Policies and Supportive Environments The main goals of public health policy for NCD prevention and control are: Improve the health of the population, especially the most disadvantaged Respond to needs and expectations of people who have chronic diseases Provide financial protection against the costs of ill-health Building healthy public policy requires diverse but complementary approaches, such as legislation, fiscal measures, taxation, and organizational change. This can be done through the following: Develop or adopt policies that support local NCD prevention and control: Local ordinances to implement RA 9211, specifically, banning of smoking in public places, schools, amusement parks

frequented by children, workplaces, government buildings, hospitals; regulation of sale of cigarettes among minors; and banning of advertisements of tobacco products in the community Local ordinances or resolutions enjoining the communities, workers and children to join exercise programs School policies to support smoke-free, alcohol-free, drug-free and sports-oriented schools to promote health and well-being of students, faculty and other school personnel; provision of healthy foods in the school canteen and banning of foods that are deemed unhealthy; Orient stakeholders regarding impact of transport design to physical activity of the population Encourage LGU to build parks and areas for recreation and physical activity, e.g. bicycle lanes, walk pathways, etc Organize community activities to promote healthy diet and physical activity Regularly monitor compliance to the regulations and consistently administer agreed-upon penalties to those found not complying to the regulations

3) Establishing Coalitions and Partnerships Coalition and partnerships bring together different parties to achieve shared goals on NCD prevention and control. Strengthening partnerships within the health sector is crucial, but it is also necessary to reach out to other key players and engage in intersectoral action as the underlying causes of noncommunicable diseases lie outside the health sector. The health sector should provide the leadership for establishing coalitions and partnerships at all levels of governance. LGUs need to engage potential partners including those outside the health sector to participate in the implementation of the local NCD prevention and control program LGUs can establish a local coalition to facilitate multisectoral activities. They can review existing committees that can serve as the coordinating body.

4) Making Health Services Available and Accessible The health care needs of individuals vary according to the presence or absence of risk factors and the severity of their health conditions. Specific health care

procedures and services are organized into the following categories: (1) risk factor assessment, (2) lifestyle modification, (3) screening and diagnosis of NCDs, (4) management of major NCDs, and (5) rehabilitation; and (6) palliative care. To make health services available and accessible, the following may be used: Ensure availability of package of interventions in the local health facilities Make available affordable medications Adopt the Risk Assessment tool in all health facilities Adopt and comply with DOH-endorsed clinical practice guidelines Strengthen referral systems among health facilities Organize support groups, e.g. obesity and diabetes clubs, cancer support, etc

5) Strengthening Program Management To ensure the effective and efficient implementation of NCD prevention and control, the following are essential: (1) training/ capacity building , (2) supervision, (3) surveillance, monitoring and evaluation. These are essential in ensuring a unified direction of efforts, maximizing outcomes given limited resources, and instilling an open, coordinative and participative spirit among stakeholders. To further strengthen the program management, the following can be done: Collect and analyze data using DOH-prescribed monitoring and evaluation tools Conduct semi-annual program review Disseminate results of monitoring and evaluation Submit accomplishment reports Document good practices in the implementation of the program Utilize results in subsequent planning and policy and program development

6) Ensuring Sustainable Health Care Financing Chronic NCDs are a major cause and a huge economic burden to individuals, their families and society. They cause disability, premature deaths and undermine the economic development of the country. To ensure stable financing, the following can be implemented: Advocate for LGUs to increase budget allocation for NCD prevention and control Conduct resource generation from development agencies, private sectors and other partners Expand PhilHealth membership for the support of some clinical packages in NCD

 Design a local financing scheme as needed and develop corresponding guidelines and protocols for its implementation Monitor the collection and utilization of finances to ensure that these are prioritized for promoting healthy lifestyle Since noncommunicable diseases will likely persist as a major public health problem brought about by globalization, urbanization and continued exposure to and uptake of unhealthy lifestyles by the population, it is thus important that the momentum of relevant and productive work be sustained by the health sector and other key stakeholders. Noncommunicable diseases should continue to be included in the health and development agenda of national and local governance. Promoting healthy lifestyle is geared towards the process of enabling people to increase control over their health and to improve their health behaviors in relation to prevention and control of NCDs. It is about people making healthy choices and living healthy lives.