MANILA – The Department of Health (DOH) in 2017 scored major successes with three landmark initiatives in preventive medicine.
Replicating the success of Davao City’s ban on smoking in public places, President Rodrigo Duterte on May 16 signed Executive Order (EO) 26 on establishing smoke-free environments in public and enclosed spaces.
Aiming to guarantee the right of every citizen in the country to breathe clean air, EO 26 prohibits smoking in “enclosed public places and public conveyances, whether stationary or in motion, except in designated smoking areas”. It also bars the selling of tobacco products to minors, as well as the selling and advertising of tobacco products within a 100-meter radius of areas frequented by minors, such as schools, playgrounds, and recreational facilities.
The order likewise tasks local government units (LGUs) to develop and carry out their own smoking cessation programs and form a task force to implement the EO with the help of the police. The order took effect on July 23.
Former health secretary, Dr. Paulyn Ubial, said the law makes it difficult for smokers to cling to their habit since there would be less areas where they could smoke, and at the same time protects non-smokers from second-hand smoke.
Preparing for the expected rise in the number of "quitters", the DOH launched Quitline on June 19.
"Smokers who want to kick the habit can call DOH Quitline 165-364 where they can get advice on steps on how to quit smoking," Ubial said, adding that smokers could also text “stopsmoke” at 29290-165-364.
Close on the heels of EO 26 was the EO regulating the use of firecrackers and other pyrotechnic devices, signed by the President on June 20.
In response to the longstanding call of health advocates for a policy that would prevent revelers, children and bystanders from getting maimed by firecrackers, EO 28 aims to confine the use of pyrotechnics to a community fireworks display, to be supervised by trained persons licensed by the police.
DOH Undersecretary Gerardo Bayugo said they had recorded 630 firecracker-related injuries in the 2016-2017 New Year celebration, 292 less than the total cases in the 2015-2016 holidays, and 319 less than the average from 2011 to 2015.
Bayugo attributed the declining trend to the circulation of news in 2016 that Duterte would sign an EO on regulating the use of fireworks.
"This year, we hope to see a further reduction of 50 percent, now that the ban is already in place," he said.
So far, 61 firecracker-related injuries, with four amputations, have been recorded by the DOH’s Epidemiology Bureau on Dec. 21-28, mostly in the National Capital Region (NCR). The figure is 47 cases less than in the same period last year.
Health Secretary Francisco Duque III, however, pointed out that the successful implementation of both EOs rests on LGUs.
"It is easy to have an EO but the success of its implementation is another story," said Duque in a media interview, adding that he intends to hold dialogues with LGUs to identify the challenges in enforcing the orders and find ways to address them.
Meanwhile, the law on the Tax Reform for Acceleration and Inclusion (TRAIN), signed by the President last Dec. 19, provides for an increase in excise taxes for cigarettes and sugar-sweetened beverages (SSB) that would support DOH efforts to promote a healthy lifestyle and prevent non-communicable diseases (NCDs).
The measure imposes a tax of PHP6 per liter for drinks that use caloric and non-caloric sweeteners and PHP12 per liter for drinks with high fructose corn syrup, in a bid to curb consumption of these products and address the rising incidence of diabetes and obesity in the country. This would also raise revenues for health programs that address these problems and compel the industry to develop healthier products.
The World Health Organization (WHO) lauded the passing of the law that makes the Philippines among the first countries in Asia to introduce a tax on sugary beverages.
"With millions of Filipinos who have become overweight and obese and with diabetes now afflicting more of our countrymen, we support a higher pricing policy for less healthy food and beverages as part of a multi-pronged strategy to combat NCDs," Duque said.
The law, he added, also supports the initiatives of the DOH in lowering the prices of medicines by exempting from the 12-percent value-added tax (VAT) all medicines for diabetes, high cholesterol and hypertension.
The implementation of the reproductive health law also received a boost when the temporary restraining order (TRO) on Implanon and Implanon NXT was deemed lifted after the Food and Drug Administration (FDA) announced on Nov. 10 that the two subdermal implants and 49 other contraceptives do not cause abortion.
Acting on a case filed by the Alliance for the Family Foundation Philippines Inc. (ALFI), the Supreme Court in June 2015 issued a TRO ordering a temporary stop to procuring, selling, and promoting the two hormonal contraceptives until they are declared non-abortifacient by the FDA.
The lifting of the TRO gave the DOH the green light to register, procure, distribute, and promote these contraceptive implants to the market. As such, the department again began distributing essential family planning commodities to rural health units across the country.
"The DOH intends to cascade all the family planning commodities to civil society organizations (CSOs) and local government units. This is to ensure that women would have access to all family planning products, as mandated in the RPRH (Responsible Parenthood and Reproductive Health) Law," said Duque.
The development was hailed by the Commission on Population (Popcom) and various non-governmental organizations (NGOs).
“This could not have come at a better time as depleted contraceptive supplies will now be augmented by over two hundred thousand implants. Annually one million women become new acceptors of modern family planning methods,“ Popcom executive director, Dr. Juan Antonio Perez III, said in a statement.
“With a major barrier to our family planning program removed, we can now assure that every Filipino of reproductive age is provided with the whole range of quality family planning products and services that are effective, medically safe and non-abortifacient," president of the NGO, Forum for Family Planning and Development, Benjamin de Leon, said.
A policy for mental health
The DOH and mental health advocates continued to push for the signing into law of the Comprehensive Mental Health Bill.
The House of Representatives on Nov. 20 approved on third and final reading a law on a national mental health policy. The Senate passed its own version in May.
House Bill No. 6452, known as the “Comprehensive Mental Health Act of 2017”, seeks to integrate mental health care in the general health delivery system, especially the programs of the DOH and the Department of the Interior and Local Government (DILG) for mentally disabled persons.
Both Houses have yet to meet to deliberate and reconcile their respective versions of the bill.
The DOH continued to intensify its campaign to encourage populations at risk of contracting the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) to get tested, with no less than 2015 Miss Universe Pia Wurtzbach having herself tested during an event held at SM Aura in Taguig last August 9.
Wurtzbach said she intends to use the social media campaign #Live2Luv to promote HIV testing in community centers and social hygiene clinics in the hope of making such tests regular medical exams.
"The DOH continuously supports the conduct of free HIV testing among key populations as delivered by Social Hygiene Clinics. HIV testing is essential in the prevention of HIV transmission, and a crucial step in providing life-saving treatment to diagnosed PLHIV (people living with HIV)," Duque said, citing the need to intensify the department’s programs to check the rise in the number of HIV/AIDS cases.
The health chief said about 200 Social Hygiene Clinics nationwide provide services to prevent the spread of HIV and sexually transmitted infections, while 51 DOH-designated treatment facilities extend free Anti-Retroviral Therapy (ART) to all PLHIV.
A total of 936 people were found to be infected with the virus last September, the DOH Epidemiology Bureau reported.
Of the figure, 806 did not show any symptom of HIV, 130 had full-blown AIDS, and 40 had died of the disease, according to the latest HIV/AIDS and ART Registry of the Philippines (HARP) report.
The September figures bring to 8,299 the total number of HIV cases reported nationwide in the first nine months of the year, with 1,021 AIDS cases and 374 deaths; and to 47,921 since HIV was first reported in January 1984, with 4,686 AIDS cases, and 2,343 deaths.
A total of 23,307 PLHIV are on ART.
In September, then health secretary Ubial and Metro Manila mayors signed a city resolution on the latter’s commitment to fast-track the implementation of coordinated quality and high-impact HIV interventions in the NCR.
Ubial also called on the City AIDS Councils to be proactive in rolling out new prevention and testing approaches, establishing facilities that offer integrated services for HIV care, and strengthening social protection for PLHIV and key populations.
Bird flu scare
As avian flu broke out in Pampanga in August, the DOH warned the public to take the necessary precautions by avoiding contact with wild birds and poultry farms.
The department sent a health team and prepared medicines to be sent to affected areas.
However, no human case of bird flu emerged. All those who showed flu symptoms, especially those who had direct contact with infected birds during culling and those who cared, slaughtered and dressed chickens and cleaned their coop, were monitored and tested negative.
‘Graduating’ from rehab
A year after the launch of the Mega Drug Abuse Treatment and Rehabilitation Center in Fort Magsaysay in Nueva Ecija, a total of 162 drug dependents have undergone rehab in the facility and have completed their therapy.
DOH Undersecretary Roger Tong-an said they were referred to their respective LGUs and the social welfare department to help them reintegrate into mainstream society, but their progress will be monitored to ensure that they do not suffer a relapse.
Next year, the department is planning to include livelihood training in the rehab program for drug dependents.
"We will be asking the patients what their passions are and then come up with a training program," Tong-an said in an interview, adding that they also plan to work closely with the Commission on Higher Education to provide alternative education to drug dependents who had dropped out of school.
TseKap in Marawi
When fighting in Marawi City displaced about 77,955 families or 367,990 individuals and drove them to evacuation centers or the homes of relatives and friends, the DOH responded by providing them medical assistance through the Tamang Serbisyo Para sa Kalusugan ng Pilipino (TSeKap), along with psychological intervention, and ensuring that the children and the elderly get proper nutrition.
The department recorded a total of 86 deaths since May 23, with common causes being pneumonia, sepsis, cardiovascular diseases, acute gastroenteritis, and prematurity.
As the five-month siege ended in October, Duque pledged to give priority to the rehabilitation of health infrastructure damaged during the war against Islamic State-inspired terrorists in the city.
Services at the Amai Pakpak Medical Center in Marawi were restored as soon as possible, to enable it to operate 24/7, along with the Dr. Abdullah Hospital. Links to 27 active referral hospitals near the city were also established and 22 barangay health stations were opened to the public.
The DOH central and regional offices extended a total of PHP222.38 million worth of logistics and funding assistance to hospitals and evacuation centers.
Meanwhile, the DOH had put on hold its dengue vaccination program immediately after Dengvaxia manufacturer, Sanofi Pasteur, disclosed on Nov. 29 that the vaccine, which had been administered to about 830,000 public school children under the DOH mass immunization program, was found to cause a severe case of the disease among recipients who had no prior infection.
This prompted the FDA to suspend the selling and distribution of Dengvaxia; and Congress and the Department of Justice to launch an inquiry on the controversial vaccine.
Former health secretaries and key health officials, even former president Benigno S. Aquino III appeared before the Senate.
In the meantime, the DOH announced that it will partner with the University of the Philippines - Philippine General Hospital (UP-PGH) to validate independently an allegation of death linked to Dengvaxia.
It also created a task force that would manage concerns related to the school-based immunization as part of efforts to monitor and attend to the health of the recipients. It would guide the DOH in ensuring that safeguards are in place to prevent similar incidents in the future, Duque said.
Noting that an average of 200,000 cases of dengue are reported every year, Duque, however, expressed hope that “this development would not in any way affect the DOH's expanded program on immunization because there have been countless lives saved from vaccine-preventable diseases".
The Expanded Immunization Program covers tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles.
The department is also planning to include Japanese encephalitis in the program for next year. A total of 133 cases of Japanese encephalitis were reported from Jan. 1 to Aug. 26 this year, and 53 of them were in Central Luzon. Of the 133 cases, nine patients died. Last year, some 193 people caught the disease over the same period, with 12 deaths reported.
Changing of the guards
After being rejected by the Commission on Appointment (CA) in October, Ubial passed on the baton, first to Dr. Herminigildo Valle as officer-in-charge, and eventually to Duque, who was making a comeback, having served the position from June 2005 to January 2010 under the term of then president Gloria Macapagal Arroyo.
Ubial had been grilled by the CA over some 15 foreign trips she took in the past year, as well as the management of PhilHealth.
In his first stint at the DOH, Duque pushed for two major legislations – the Universally Accessible, Affordable Quality Medicine Act of 2008, or the Cheaper Medicines Law; and the Food and Drug Administration Law of 2009. (PNA)