National Policy on the Health and Wellness Program for Senior Citizens

March 5, 2015

DOH ADMINISTRATIVE ORDER NO. 2015-0009

 

I. Rationale

According to the World Health Organization (2014), the world population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.

The Philippine Statistics Authority most recent estimate of the current population pegs it at 92,337,852 (NSO 2010) with 6.8 percent of the population aged 60 years old and over (estimated to be at 97 M as of 2013). This is in comparison to the 6.0 percent of senior citizens in just a decade earlier. The greatest concentration of senior citizens is in Region IV-A (12.2 percent), NCR (11.9 percent) and Region III (11.3 percent). This figure is not showing any indication of slowing down. By the end 2016 it would be 7.8 percent of the population. There will be 13.8% or approximately 19.6 million Filipinos over the age of 60 by 2040.

Faced with this impending demographic trend of population aging, the Philippines is preparing to meet its considerable effects across all sectors of society. In accordance with the 1987 Philippine Constitution Article II Section IX, the Republic Act of 9257 (The Expanded Senior Citizen's Act of 2003) and Republic Act 9994 (Expanded Senior Citizens Act of 2010), sustainable measures are being undertaken to promote the health and wellness of senior citizens as well as to alleviate the conditions of senior citizens suffering from degenerative diseases/palliative conditions.

The decadal average annual (exponential) growth rate of 3.64 percent of the population 60 years and over makes the older population growth rate faster than the total population, meaning the doubling time of the older population is shorter than the total population. What does this means in terms of functional health? A local study conducted by the Population Institute of the University of the Philippines (UP) looking at the Active Life Expectancy and Functional Health Transitions among Filipino Older Persons (Cruz, Saito, Natividad, 2007) showed that as we anticipate future expansions in the size of older population, a corresponding increase in the projected number with disability is expected, more for females than males. The expected declines in functional health (specifically, in the ability to perform the normal everyday activities of daily living) due to the presence of chronic degenerative aliments like osteoporosis, dementia, sarcopenia, osteoarthritis, hearing and visual impairment, fractures among others can result in significant restrictions in lifestyles, modification in recreational and leisure activities, social isolation, poor nutrition, depression, and an overall decrease in the duality of life.

Future policies should thus be able to respond to such eventualities with appropriate mechanisms for prevention of severe declines in functional health, with wellness programs as well as health services particularly long term care services for the increased number of inactive older people needing support. ECHSDc

The Philippines is clearly faced with a two-fold burden of first, addressing communicable and degenerative diseases aggravated by the absence of a national geriatric health agenda to oversee the development of research-based programs and second, implementing integrated delivery of geriatric services in every tertiary hospital as well as community-based health care program promoting healthy aging. Universal Health Care encompasses addressing the needs of the Filipino Senior Citizen, and the formalization of this policy is a necessary step towards ensuring systems will be put in place to achieve better health outcomes for our senior citizens.

Indeed, this Order supports the call of the Philippine Plan of Action for Senior Citizens 2012-2016 which envisions, "a society for all ages where the senior citizens are empowered to achieve active aging."

II. Objectives

This Order provides a national policy that shall guide the national and local actions towards the implementation of the Health and Wellness Program for Senior Citizens.

III. Scope

This Order shall cover all units and instrumentalities including attached agencies of the DOH. It shall also apply to local government units (LGUs), non-government organizations (NGOs), professional organizations, private sector, organizations of senior citizens, and other relevant partner in the health sector.

IV. Legal Basis/Mandate

This issuance on Health and Wellness Program for Senior Citizens shall be guided by the following policy statements:

1. Madrid International Plan of Action on Aging (Adopted by the Second World Assembly on Ageing in 2003). This sets out priority areas and action points towards the goal of ensuring that societies and individuals live with security and dignity while maintaining their full participation and human rights.

2. Regional Framework for Action on Aging and Health in the Western Pacific 2014-2019. It considers current evidence and new ideas as a starting point for further discussions within countries and in the Region.

3. The 1987 Philippine Constitution on Article II Section IX provides that "The State shall adopt an integrated and comprehensive approach to health development which shall endeavour to make essential goods, health and other social services available to all people at affordable cost. There shall be priority for the needs of the underprivileged sick, elderly, disabled, women and children."

4. Aquino Health Agenda through Administrative Order No. 2010-0036 and Section 7 of Executive Order 43 series 2011, the so called Kalusugan Pangkalahatan (KP) aims to achieve universal health care for all Filipinos.

5. Philippine Plan of Action for Senior Citizens (2012-2016) will serve as a strategic framework in developing action plans to further address the challenges brought about by socio-economic and environmental drifts. And also as a guide for all government agencies, local government units, civil society organizations and other stakeholders in planning, policy formulation and program development to promote and protect the rights and the best interest of the Filipino senior citizen.

6. Republic Act No. 9257 (2003) "An Act Granting Additional Benefits and Privileges to Senior Citizens to Senior Citizens amending for the purpose Republic Act No. 7432, otherwise known as "An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other purposes".

7. Republic Act No. 9994 (Enacted February 15, 2010) "An Act Granting Additional Benefits and Privileges to Senior Citizens, Further Amending Republic Act No. 7432". The Expanded Senior Citizens Act of 2010 is anchored on augmenting the benefits and services given to the elderly. This law is centered on securing the roles and functions of the implementing body and concerned agencies.

V. Definition of Terms

For purposes of this issuance, the following terms, abbreviations and definitions apply.

1. Aging refers to a lifelong process of growing older in all respects (cellular, organ, whole-body) throughout the life-course (WHO).

2. Health System is defined as "all organizations, people and actions whose primary intent is to promote, restore or maintain health." (WHO) CSDcTA

3. Senior Citizen or Elderly refer to any Filipino citizen who is a resident of the Philippines, and who is sixty (60) years old or above. It may apply to senior citizens with dual citizenship status provided they prove their Filipino citizenship and they have been residents for at least six (6) months in the Philippines.

VI. Statement of Principles

1. The Health and Wellness Program for Senior Citizens (HWPSC) shall consider the following in the development of supportive policies and guidelines.

VISION:

A country where all Filipino senior citizens are able to live an improved quality of life through a healthy and productive aging.

MISSION:

Implementation of a well designed program that shall promote the health and wellness of senior citizens and improve their quality of life in partnership with other stakeholders and sectors.

GOAL:

Quality of Life among older persons is promoted and contributes to the nation building.

2. HWPSC intends to achieve the following objectives:

• To ensure better health for senior citizens through the provision of focused service delivery packages and integrated continuum of quality care in various settings

• To develop patient-centered and environment standards to ensure safety and accessibility of all health facilities for the senior citizens

• To achieve equitable health financing to develop, implement, sustain, monitor and continuously improve quality health programs accessible to senior citizens

• To enhance the capacity of health providers and other stakeholders including senior citizens group in the implementation of health programs for senior citizens

• To establish and maintain a database management system and conduct researches in the development of evidence-based policies for senior citizens

• To strengthen coordination and collaboration among government agencies, non-government organizations, partner agencies, and other stakeholders involved in the implementation of programs for senior citizens

3. HWPSC shall adopt the WHO Regional Framework on aging and health. These are the four pillars or action areas where the program interventions are based on:

a. Fostering an age-friendly environments through action, engagement and collaboration across sectors and stakeholders, including communities, families and older persons

b. Promoting healthy aging across the life-course and prevent functional decline and disease among senior citizens

c. Reorienting and strengthening health systems to make them responsive to the needs of senior citizens through the provision of acceptable, accessible and effective health services across the continuum of care.

d. Strengthening the evidence-based policy- and decision-making on aging and health.

4. HWPSC shall focus on six program components where health interventions are possible, effective and able to be implemented with a clear and actionable role for all sectors.

a. The Policy, Standards and Regulation component shall develop a unified patient-centered and supportive environment standards to ensure safety and accessibility of senior citizens to all health facilities and to promote healthy ageing in order to prevent functional decline among senior citizens. TaDIHc

b. The Health Financing component shall promote health financing schemes and other funding support in all concerned government agencies and private stakeholders to provide programs that are accessible to senior citizens.

c. The Service Delivery component shall ensure access of senior citizens to essential geriatric health services including preventive, promotive, treatment, and rehabilitation services from the national to the local level.

d. The Human Resources for Health component shall capacitate the health care providers in both national and local government to be able to effectively provide technical assistance and implement the program for senior citizens.

e. The Health Information component shall establish an information management system and maintain a repository of data.

f. The Governance for health component shall coordinate and collaborate with the local government units and other stakeholders to ensure an effective and efficient delivery of health services at the hospital and community level.

VII. Implementing Guidelines

1. HWPSC shall be in accordance with the thrust of Universal Health Coverage — Aquino Health Agenda, National Objectives for Health 2011-2016 and Millenium Development Goals (2005-2015), supported by the recommendation of the WHO Regional Framework for Action on Aging and Health in Western Pacific (2014-2019), as applicable.

2. HWPSC shall be one of the programs of the Disease Prevention and Control Bureau. A HWPSC National Program Coordinator shall be designated to perform technical and administrative functions pertaining to the operation of the Health and Wellness Program for Senior Citizens.

3. A Technical Working Group shall be organized to ensure coordination and sustainability of the HWPSC which is composed of representatives from DOH, different national government agencies, specialty societies, non-government organizations, and other recognized stakeholders. The membership, participation and functions shall be indicated in a pertinent department issuance. The TWG shall provide direction and technical support on policies and plans pertaining to the health and wellness program for senior citizens.

4. To ensure a comprehensive approach of the health and wellness program for senior citizens, integration of the health and wellness program for senior citizens into the other programs of the Disease Prevention and Control Bureau (DBCB) shall be intensified.

5. In coordination with local government units, NGO's and PO's for senior citizens, DOH shall institute a national health program and shall provide an integrated health service for senior citizens.

6. In coordination with academic institutions and societies, DOH shall train community based-health workers including senior citizens and health personnel to specialize in the geriatric care and health problems of senior citizens.

7. The oversight for the implementation of this Order shall rest with the Assistant Secretary of Health, Office for Technical Services supported by the Technical Working Group (TWG) on Health and Wellness Program for Senior Citizens chaired by the Director of the Disease Prevention and Control Bureau.

VIII. Roles and Responsibilities

1. Department of Health — Central Office shall (1) develop systems, policies and guidelines that will facilitate the implementation of the Health and Wellness Program for Senior Citizens including the monitoring and evaluation of each program activities; (2) develop capacity of the regional offices personnel in assisting the LGUs to ensure the implementation of the Health and Wellness Program for Senior Citizens Program.

As such, the following offices shall have the following responsibilities:

a. The Disease Prevention and Control Bureau shall (1) develop plans and policies for the implementation of the Health and Wellness Program for Senior Citizen; (2) provide technical assistance and conduct monitoring and evaluation of program operation; (3) ensure the participation of other DOH offices/stakeholders in program activities where needed. ETCcSa

b. The Epidemiology Bureau and the Knowledge Management Information Service shall be responsible in the development of a national reporting and surveillance system as well as the development of methodologies for the generation, collection and distribution of information and knowledge on the possible establishment of the national registry for senior citizens.

c. The Health Promotion and Communication Service shall be responsible in the formulation of standards and development of information, education communication, and advocacy strategies for the implementation of the health and wellness of senior citizens.

d. The Health Policy Development and Planning Bureau (HPDPB) shall ensure the integration of the Health and Wellness Program for Senior Citizens in the national program plan of action, including inclusion in the DOH Research Agenda proposals.

e. The Health Human Resource Development Bureau (HHRDB) shall be responsible in the development of standards in the curriculum and the training of all types of health professionals, who are responsive, culturally sensitive and consistent with the national and local human resource development goals.

f. The Bureau of International Health Cooperation shall ensure that the program has strong network linkages with international health institutions and agencies that will ensure the inclusion, participation, cooperation and collaboration of the Philippines in the global scene for senior citizens.

g. The Bureau of Local Health Systems and Development shall be responsible in the integration of the program into the local health system.

h. The Health Facilities Development Bureau shall ensure that the capacity of government hospitals (DOH and local government hospitals) shall be upgraded and enhanced to provide adequate quality care services, by undertaking capacity needs assessment, capacity enhancement investment, and capacity utilization monitoring.

i. The Health Facilities and Services Regulatory Bureau shall (1) ensure the safety and accessibility of health facilities through compliance with the prescribed standards on physical facility, equipment and personnel (2) ensure the establishment of accreditation/licensing guidelines and requirements for geriatric wards, hospitals and chronic care facilities including but not limited to nursing homes, group living, assisted living, transitional or intermediate care, hospice care facilities.

2. The Regional Offices shall lead the region in the implementation of the programs and projects for the health and wellness program for senior citizens. It shall also provide technical assistance and guidance to the LGUs in the implementation of program strategies and activities.

3. The DOH hospitals and medical centers shall ensure the availability of quality care services to its clients through the establishment of appropriate capabilities and competencies in their respective units. It shall also establish a senior citizens ward in every government hospital.

4. The Philippine Health Insurance Corporation (PHIC) shall develop appropriate relevant health service packages for senior citizens.

5. Local Government Units shall organize themselves into service delivery networks that will manage and implement the health and wellness program for senior citizens activities. LGUs shall pass the necessary local legislation (ordinances, resolutions) to implement program and activities. It shall also provide counterpart funds for implementing their investment plan.

6. Non-Government Organizations, academe and other organizations small initiate, assist, coordinate in addressing general concerns of the Health and Wellness Program for Senior Citizens. HcACST

7. Civil Societies shall assist the Local Government Units in achieving their health objectives and identify the health needs of the senior citizens and advocate program support for them.

8. Donor and Technical Partner Agencies shall provide technical assistance and guidance, necessary funding according to the investment plan developed for the Health and Wellness Program for Senior Citizens, as well as in accordance with partnerships entered into with local government units and other stakeholders.

IX. Funding

The Department of Health Central Office and Regional Offices shall provide the essential funds for program or project implementation, technical assistance, monitoring, and health promotion campaigns to ensure the operationalization of this policy and system framework. Local government units shall be enjoined provide funds in the implementation of the program. Furthermore, other government agencies, non-government organizations and other stakeholders are encouraged to provide counterpart funds as appropriate to ensure the implementation of this Order.

X. Effectivity

This Order shall take effect fifteen (15) days after its publication in two (2) newspaper of general circulation.

(SGD.) JANETTE LORETO-GARIN, MD, MBA-HActing Secretary

Published in The Philippine Star on March 29, 2015.