February 5, 2015

DOH ADMINISTRATIVE ORDER NO. 2015-0004

 

I. Background

Persons with disabilities (PWDs), according the UN Convention on the Rights of Persons With Disabilities, include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

The International Classification of Functioning, Disability and Health (ICF) refers to disability as "an umbrella term covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations". The ICF's definition of disability denotes a negative interaction between a person (with a health condition) and his or her contextual factors (environmental and personal factors). A comprehensive approach in interventions is then necessary for persons with disabilities (PWDs) as it entails actions beyond the context of health, but more on helping them to overcome difficulties by removing environmental and social barriers (WHO, 2013).

Globally, over 1 billion people, or approximately 15% of the world's population, have some form of disability. About 110 to 190 million people 15 years and older have significant difficulties in functioning. Moreover, the rapid spread of chronic diseases and population ageing contribute to the increasing rates of disability. About 80% of the world's PWDs live in low-income countries, wherein majority are poor and cannot access basic services. With their conditions, PWDs need greater attention and considerations in terms of health needs, without discrimination. However, reports show that PWDs have less access to health services and therefore have greater unmet needs (WHO, 2012.)

In the Philippines, the results of the 2010 Census of Population and Housing (CPH, 2010) show that of the household population of 92.1 million, 1.443 million Filipinos or 1.57%, have a disability. Region IV-A, with 193 thousand PWDs, was recorded to have the highest number of PWD among the 17 regions, while the Cordillera Administrative Region (CAR) had the lowest number with 26 thousand PWDs. There were more males, who accounted for 50.9% of the total PWD in 2010, compared to females, with 49.1% with disability. For every five (5) PWD, one (18.9%) was aged 0 to 14 years, three (59.0%) were in the working age group (15-64 years old), and one (22.1%) was aged 65 years and above (NSO, 2013).

The mandate of the DOH to came up with a national health program for PWD was based on Republic Act No. 7277, "An Act Providing for the Rehabilitation and Self-Reliance of Disabled Persons and Their Integration into the Mainstream of Society and for Other Purposes" or otherwise known as "The Magna Carta for Disabled Persons'' and the Implementing Rules and Regulations (IRR) of RA 7277. This document stipulated that the DOH is required to: (1) institute a national health program for PWDs, (2) establish medical rehabilitation centers in provincial hospitals, and (3) adopt an integrated and comprehensive program to the Health Development of PWD, which shall make essential health services available to them at affordable cost. In response to this, the DOH issued Administrative Order No. 2006-0003, which specifically provides the strategic framework and operational guidelines for the implementation of Health Programs for PWDs.

In 2013, a Medium Term Strategic Plan (2013-2017) was developed to strengthen the existing health program for PWDs. However, in the review done for the purpose, it was noted that in the implementation of the program in the past years, there were operational issues and gaps identified that need to be addressed. These include among others, the need to strengthen multi-sectoral action to harmonize efforts of stakeholders; clarify delineation of roles and responsibilities of concerned government agencies working for PWDs; strengthen national capacity, both facilities and manpower, to provide rehabilitation services for PWDs from primary to tertiary level of care; provide access to health facilities and services for PWDs; and, strengthen registration database for PWDs. aSIAHC

Recently, the Word Health Organization released the Global Disability Action Plan 2014-2021. This document intends to help countries direct their efforts towards specific actions in order to address health concerns of persons with disabilities. The Action Plan identified three major objectives: to remove barriers and improve access to health services and programmes; (2) to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation; (3) to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services.

Considering all of the above, there is a need to align the current needs and challenges in the implementation of the Health and Wellness Program for Persons With Disabilities (HPPPWD) with the thrusts and goals of Kalusugang Pangkalahatan or Universal Health Care, the Global Disability Action Plan 2014-2021, and, the direction the program should take in the succeeding years as articulated in the newly developed strategic plan, thus, this revision of Administrative Order No. 2006-0003.

II. Objectives

This Order provides the new framework that shall guide national and local actions towards strengthening implementation of the Health and Wellness Program for Persons with Disabilities (HPPWD) in attaining UHC and the above Disability Action Plan 2014-2021.

III. Scope and Coverage

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 persons with disabilities, and other relevant partners in the health sector.

IV. Health and Wellness Program for Persons with Disabilities

The health and wellness program for persons with disabilities shall consider the following in the development of supportive policies and guidelines:

A. Vision: A country where all persons with disability, including children and their families, have full access to inclusive health and rehabilitation services.

B. Mission: A program designed to promote the highest attainable standards of health and wellness for PWDs by fostering a multi-sectoral approach towards a disability inclusive health agenda.

C. Objectives:

• To address barriers and improve access and reasonable accommodations of PWDs to health care services and programs.

• To ensure the accessibility, availability, appropriateness and affordability of habilitation and rehabilitation services for PWDs, including children with disabilities.

• To ensure the development and implementation of policies and guidelines, health service packages, including financing and provider payment schemes for health services of PWDs.

• To enhance capacity of health providers and stakeholders in improving the health status of PWDs.

• To strengthen collaboration and synergy with and among stakeholders and sectors of society to improve response to a disability inclusive health agenda through regular dialogues and interactions.

• To provide the mechanism in facilitating the collection, analysis and dissemination of reliable, timely and complete data and researches on health-related issues of PWDs in order to develop and implement evidence-based policies and interventions.

D. Action Framework for the Health and Wellness Program of Persons with Disabilities

The Action Framework for the Health and Wellness Program of Persons with Disabilities is adapted from the three major objectives of the WHO Global Disability Action Plan 2014-2021. As applied in the country, program actions or interventions shall focus on the following areas: (1) removal of barriers and improve access to health services and programs; (2) strengthening and expansion of rehabilitation, habilitation, assistive technology, and community-based rehabilitation; (3) strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services.

Figure 1 depicts the Action Areas that the Health and Wellness Program for Persons with Disabilities shall focus its interventions along the thrusts and goals of Kalusugang Pangkalahatan or Universal Health Care.

Action Area 1: Removal of barriers and improve access to health services and programs. People with disabilities, including children, encounter a range of attitudinal, physical and systemic barriers when they attempt to access health care such as physical barriers related to the architectural design of health facilities or health providers' lack of adequate knowledge and skills in providing services for persons with disabilities, among many others.

Therefore, actions or interventions shall be under taken to ensure that persons with disabilities have access, on an equal basis with others, to health facilities and services. It is important to identify all of these barriers and institute collective actions to remove these barriers and improve access of persons with disabilities to health services and programs.

Action Area 2: Strengthening and expansion of rehabilitation, habilitation, assistive technology, and community based rehabilitation. Habilitation and rehabilitation are "sets of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimal functioning, in interaction with their environments". Encompassing medical care, therapy and assistive technologies, they shall begin as early as possible and be made available as close as possible to where people with disabilities live. SCHTac

Increasing government investments in habilitation, rehabilitation and provision of assistive technologies are expected actions or interventions that must be put in place. This is going to be beneficial in the long run because they build human capacity and can be instrumental in enabling people with limitations in functioning to remain in or return to their home or community, live independently, and participate in all aspects of life. They can reduce the need for formal support services as well as reduce the time and physical burden for caregivers.

Action Area 3: Strengthening collection of relevant and internationally comparable disability data and support disability researches. Data is needed to strengthen health care systems, as it informs policy and interventions. These can be collected through dedicated disability surveys, or disaggregating data from other data collection efforts by disability status, and research.

Interventions along this action area should ensure that data collected would be internationally comparable and results of researches and studies done are used for informing policy and resource allocation. The use of the Philippine Registry for Persons with Disability is an intervention that shall be strengthened and made fully operational.

Figure 1: Action Framework for the Health and Wellness Program for Persons with Disabilities

V. General Guidelines:

 

A. The DOH shall develop systems, policies, and guidelines that shall facilitate the operationalization of the Health and Wellness Program for Persons with Disabilities in the country. Cognizant that disability is a cross-cutting issue involving all sectors and diverse actors particularly the persons with disabilities themselves, the Department of Health shall ensure that in the development and implementation of the Health and Wellness Program for Persons With Disabilities, this wide range of stakeholders and partners, both private and government, shall be consulted, with issues and recommendations incorporated in the ensuing plans and programs that shall be developed.

B. The DOH shall develop mechanisms to ensure a disability inclusive health agenda, in particular, that policies and programs developed for health and development, disability dimensions are included and highlighted.

C. The program is designed to ensure improved health and well-being for persons with disabilities. As such promotion of health and wellness shall be the core strategy with prevention activities focusing on early identification and intervention to prevent the development of secondary or co-morbid health conditions that are often associated with disability, prevention of the development of new impairments and prevention of existing impairments becoming worse.

D. Health services and programs developed for PWDs shall cater to various age groups addressing age-related health needs throughout the human life cycle.

E. Primary level health facilities such as rural health centers and primary hospitals shall provide appropriate services particularly on early detection, screening and proper referral.

F. Secondary and tertiary health facilities such as hospitals shall provide appropriate rehabilitation services and shall be fully equipped and manned accordingly.

G. Community participation shall also be enhanced to strengthen awareness on prevention activities as described above.

H. Interventions shall address health equity concerns and take into consideration the needs of the most vulnerable and marginalized sectors.

I. Research, surveillance, monitoring, and evaluation shall be institutionalized for sound policy formulation, planning, and decision-making processes. Capability of stakeholders to collect, analyze, disseminate, and utilize evidences shall be enhanced.

J. Networking and partnership with other sectors shall be strengthened to ensure synergies, avoid overlapping and duplication of activities, and prevent unnecessary competition in the implementation of initiatives. Commitment of stakeholders to the national plan of action on addressing PWD health and wellness concerns shall be strengthened.

K. Sustained funding and financial protection for the poor and the marginalized groups shall be pursued.

L. Monitoring and evaluation mechanisms shall be institutionalized to aid implementation and planning for subsequent actions.

VI. Specific Guidelines

A. The DOH shall provide leadership in promoting health and wellness for persons with disabilities and institute the following measures:

1. Develop a national program and plan of action on the health and wellness for PWDs, advocate and provide template for the integration of the said program and plan into the annual health action plans of local government units and other partners.

2. Strengthen health systems by:

a. Establishing program structure and provide funding for the purpose.

b. Strengthening human resources capacity and use innovative approaches to health workforce development, with a special focus on primary health care to equip health care providers with the necessary skills, knowledge and attributes to deliver effective services in promoting health and wellness for PWDs.

c. Facilitating resource mobilization and establishing sustainable financing mechanisms. AIDTHC

d. Promoting equitable access to and rational use of cost-effective health products and services related to the promotion of health and wellness for PWDs, particularly assistive devices and rehabilitation services.

e. Investing on strengthening and expanding rehabilitation services at all levels of care.

f. Strengthening referral mechanisms to ensure continuity of care and complementation of services within the health system.

g. Ensuring operationalization of the online registration of persons with disabilities at the level of primary health care.

3. Collaborate with local government units, private sector, and other partners to:

a. Deliver evidence-based and cost-effective primary, secondary, and tertiary prevention interventions to promote health and wellness for PWDs with emphasis on primary health care.

b. Adopt, implement and monitor the use of evidence-based guidelines and establish standards of health care for PWDs and integrate whenever feasible their management into primary health care.

c. Develop and disseminate health service frameworks and packages, clinical practice guidelines and evidence-based decision-making support tools to health care providers to ensure timely screening, diagnosis, and management of disabilities.

d. Establish and support programmes to empower individuals and communities to develop health literacy, to take on self-care responsibilities and to become resources for themselves and others in promoting health and wellness.

e. Implement and monitor cost-effective approaches for the early detection, screening, diagnosis and management of various disabilities.

f. Establish and support effective partnerships and develop collaborative networks with other stakeholders in order to encourage and promote community participation and grassroots mobilization and establish a broad base of support thus ensuring acceptability and effectiveness of policy and interventions.

4. Engage in health promotion and advocacy initiatives through the following:

a. Developing, implementing and sustaining health promotion initiatives on promoting health and wellness for PWDs with prevention activities focusing on early identification and intervention to prevent the development of secondary or co-morbid health conditions that are often associated with disability, prevention of the development of new impairments and prevention of existing impairments becoming worse through improving access to health care and population-based public health programmes, and barrier removal.

b. Utilizing media and social marketing to increase knowledge and awareness in the promotion of health and wellness for PWDs.

c. Designing and implementing an advocacy campaign to mobilize political and grassroots support and raise the priority accorded to health and wellness of PWDs.

5. Ensure the inclusion of health and wellness of PWDs in the national unified health research agenda by:

a. Investing in epidemiological, behavioral and health system research for health and wellness of PWDs.

b. Working with partners and academic institutions for implementation of research initiatives.

c. Disseminating research findings and utilize the same for policy and program development.

6. Strengthen surveillance, monitoring, and evaluation systems for health and wellness of PWDs.

7. Develop standards for rehabilitation services including assistive devices.

8. Advocate for the establishment and strengthening of regulatory mechanisms to include among others the following:

a. Fiscal policies that would make assistive devices/technology available through pricing, taxation, subsidies and other market incentives;

b. Enhanced regulation on the provision of 20% discount on all health related services for PWDs;

c. Enhanced regulation on the implementation of universal design to all health related infrastructures, equipment and other implements.

B. Implementation Arrangement

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 for Persons with Disabilities chaired by the Director of the Disease Prevention and Control Bureau.

The members of the TWG consist of representatives from the Health Promotion and Communications Service, Disease Prevention and Control Bureau-Essential Non-Communicable Disease Division, Family Health Office, Office of Special Concerns, Knowledge Management Information Technology Service, Epidemiology Bureau, Health Policy Development and Planning Bureau, Bureau of Local Health Development, and the Executive Director of the National Council on Disability Affairs and such other bureaus and offices deemed relevant and competent by the Cluster Head.

C. Roles and Responsibilities

The following offices and institutions shall assume the following roles and responsibilities:

1. The TWG shall provide direction and technical support on policies and plans pertaining to the health and wellness program for persons with disabilities. It shall also provide the forum for coordinating all aspects of the implementation of policies and programs. The Disease Prevention and Control Bureau Essential Non-Communicable Disease Division shall provide the secretariat to the Technical Working Group.

2. The Disease Prevention and Control Bureau (DPCB) shall:

a. Oversee the implementation of the national policy and program on the Health and Wellness Program for Persons with Disabilities.

b. Establish standards and package of services on the program and ensure their quality, access, and availability at all levels of the health system.

c. Provide technical assistance and augmentation funds to the LGUs and other partners on implementation of these service packages.

d. Support the design of health financing for the health care needs of PWDs in collaboration with PhilHealth and other partners.

e. Conduct regular monitoring and evaluation on the implementation of the program.

f. Ensure participation of other DOH offices and bureaus and coordinate with partners within and outside the health sector for the effective implementation of the national program.

3. The Health Promotion and Communications Bureau (HPCB) shall:

a. Provide the lead in the development and implementation of a national advocacy campaign to promote and health and wellness for PWDs.

b. Advocate with other government agencies, non-government organizations, private sector, development partners, and other relevant stakeholders for support in policy development and resource generation towards the promotion of health and wellness for PWDs.

c. Provide technical assistance to ensure health promotion interventions at the 3 health promotion settings: community, school and workplace.

4. The Health Policy Development and Planning Bureau (HPDPB) shall:

a. Support the development of relevant policies on health and wellness for PWDs.

b. Assist in securing adequate funding for the program.

c. Facilitate and support program evaluation studies and researches.

5. The National Epidemiology Center (EB) and the Knowledge Management Information Technology Service (KMITS) shall:

a. Establish and sustain public health and hospital surveillance systems including the online registry for PWDs.

b. Facilitate collection, analysis, and dissemination of data on PWDs.

c. Support conduct of population-based surveys on disability.

6. The Health Human Resource Development Bureau (HHRDB) shall:

a. Develop, update as necessary and implement training and development plan of health, medical and allied, professionals, particularly those in primary health care facilities and hospitals on addressing health and rehabilitation needs of PWDs.

b. Facilitate integration of health and wellness of PWDs in the academic curriculum of health professionals.

c. Ensure availability and equitable distribution of disability related health professionals.

7. The Health Facility Development Bureau (HFDB) shall:

a. Ensure access and availability to quality hospital and facility-based services and universally designed infrastructure and facilities including rehabilitation, habilitation, assistive devices, and other support services for persons with disabilities.

b. Establish standards for an efficient hospital referral system.

c. Facilitate development and implementation of hospital-based information and surveillance system to gather data particularly on mortality and morbidity on persons with disabilities.

8. The National Center for Pharmaceutical Access and Management (NCPAM) shall develop guidelines and standards and provide mechanisms to ensure that affordable, but quality medicines are always available for persons with disabilities, and to ensure that PWDs are given priority.

9. The Bureau of International Health Cooperation (BIHC) shall coordinate with international development partners and other countries for technical and resource assistance on the promotion of health and wellness for PWDs.

10. The Philippine Health Insurance Corporation (PHIC) shall develop and implement health insurance package for persons with disabilities that will include screening, diagnosis, treatment and management, rehabilitation and provision of assistive device and other appropriate support services to reduce the financial burden and impoverishment of individuals and families with disabilities.

11. The Regional Offices (ROs) shall provide technical assistance and lead the regions to ensure local implementation of the Health and Wellness Program for PWDs.

12. DOH hospitals shall ensure provision of quality rehabilitation services for PWDs.

13. The Local Government Units (LGUs) shall adopt and implement the National Program on Health and Wellness for PWDs and provide services and products in primary health care facilities and hospitals in their localities.

14. Non-government organizations, professional groups, other government organizations, private sector, the Academe, and Civil Societies shall assist in the implementation of the Health and Wellness Program for Persons with Disabilities.

D. Funding

The Department of Health — Disease Prevention and Control Bureau and Regional Offices shall provide funds for technical assistance, monitoring, and health promotion campaigns, and to augment funds for local implementation, to ensure the operationalization of this policy and program framework. Local government units shall be encouraged to provide funds for products and services in their respective communities as well as other government agencies, non government organizations and other stakeholders to provide counterpart funds as appropriate to ensure the implementation of the Health and Wellness Program for PWDs.

VII. Repealing Clause

Administrative Order 2006-0003 and other related issuances inconsistent or contrary to the provisions of this Administrative Order are hereby repealed, amended or modified accordingly. All other provisions of existing issuances which are not affected by this Order shall remain valid and in effect. HCaEAT

VIII. Effectivity

This Order shall take effect immediately.

(SGD.) JANETTE LORETO-GARIN, MD, MBA-HActing SecretaryDepartment of Health

Published in The Philippine Star on February 22, 2015.