WENDELL A.

ESCALANTE BSN-IV NEPTUNITES 2017

EntrepreNurse
Year launched: 2010
Program Website Middle-income (40-60%)
Project EntrepreNurse Higher middle-income (60-80%)
Approach Health focus
Financing Care Primary care
o Contracting PARENT ORGANIZATIONS
Organizing Delivery PHILLHEALTH

o Cooperative Government

Target geography Cooperatives Development

Authority (CDA)
Rural
Department of Labor and
Target Population Employment (DOLE) Region XI
General population Department of Health
Target income level Not-for-profit
Bottom 20% Philippine Nurses Association
Lower-middle income (20-40%) (PNA)
Summary
EntrepreNurse is a project initiated by the Department of Labor and Employment
(DOLE) to facilitate nurse entrepreneurship by giving opportunities to
unemployed licensed nurses to create cooperatives servicing health care needs
of the rural poor communities.

Program goals
An initiative of DOLE, in collaboration with BON-PRC, DOH, PNA, UPCN, OHNAP and
other government and non-government entities to promote nurse entrepreneurship by
introducing a home health care industry in the Philippines.

Key program components

In collaboration with Department of Health (DOH) and Philippine Health Corporation, the
project aims to engage unemployed nurses on cooperatives and entrepreneurial
management of nurses clinics that offers reduced cost of primary and home health care
services to indigent or poor rural communities. These cooperatives can also market
diagnostic services and community based pharmacies like Botika ng Barangay.

The selection of areas must consider the business viability of entrepreneurship. The
business program design should be based on actual needs of the community.
EntrepreNURSE nurses shall organize among themselves as an institution and/or
organization (cooperative) manning and running a business enterprise; all risk and
benefits are equally divided. The cooperatives deploy licensed nurses to poor rural
communities with little or no access to basic health care and with substantial
populations of sick, elderly and disabled patients on a one nurse per month per village
basis.

The nurses will act both as health educator and health care provider. Their services will
be compensated no less than P1,000 (approximately USD 23) per visit by the local
government unit (LGU), PhilHealth, health maintenance organizations (HMOs), by the
patients themselves on a per visit basis, or from grants from local and foreign donors.
Currently, DOLE is also providing assistance in the form of grants to 5 piloted
cooperatives established in five provinces of Region 11.

Number of facilities/outlets involved:

5facilities/outlets

Number of clients served

December 2014: clients

Funding

Primary source of funding:

o Government
Additional source(s) of funding:
o Donor
The idea that nurses could engage in the independent practice of nursing is allowed
in both Republics Acts 7164 and 9173 which regulate the practice of nursing, but
somehow, something got lost in the translation and all our nurses were encouraged to
achieve their dreams by working abroad. Project Entreprenurse, an initiative of the
Department of Labor and Employment piloted in Davao, aims to change the outlook of
nurses in the country and help them recognize that nurse entrepreneurship is a viable
option for them. Faced with bleak prospects of formal employment in the local jobs
market and dwindling opportunities abroad, the nurses of Davao have answered the call
of the DOLE to engage in nursing-related businesses for themselves, such as home
health care, outsourced health service delivery, lying-in clinics, etc. The DOLE will
provide the start-up capital for the cooperatives.

Nearly 500 nurses in Region 11 have now banded together to form nurses
cooperatives and are busy complying with the requirements for registration with the
Cooperative Development Authority as a cooperative. After registration, they will be
assisted by MASICAP to put together business plans that they can use to ask for grants
from government and non-government sources. Among the potential sources of
revenues for the cooperatives are the local government units, Philhealths capitation
fund, foreign donors and migrant Filipino organizations abroad. The DOH will be a
critical partner as source of data on the status of health services delivery in poor rural
communities. Even before CDA registration, the Davao del Norte group, buoyed by the
expression of total support by Governor Rodolfo del Rosario, have already started
negotiating with local chief executives, with successful results.

I believe that the significant impact of these newly-formed nurses

cooperatives will be in public health, where they are expected to contribute to the
achievement of our Millennium Development Goals on maternal and child mortality,
explained Undersecretary Carmelita Pineda who is one of the prime movers of the
initiative. USEC Pineda was the focal person of the DOLE for the hugely successful
Project NARS, which deployed freshly graduated nurses to the poorest municipalities in
the country for six months.

Project Entreprenurse will push the boundaries of nursing practice in the

country, predicted Dr. Josefina Tuazon, Dean of the UP College of Nursing and an
active member of the small group pushing for the project.

This initiative will change the face of nursing in the country, echoed Board
of Nursing member Marco Antonio Sto. Tomas, who has been pushing for nurse
entrepreneurship for years.

On the other hand, DOLE Secretary Marianito Roque and DOH Secretary
Esperanza Cabral, member and chair of the Philhealth Board, both vowed in a recent
planning workshop for Project Entreprenurse to initiate changes in the composition of
the package of benefits for Philhealth members to include home and rehabilitative
services, a move seen as critical in sustaining the operations of the newly-organized
nurses cooperatives.

PREVENTION OF BLINDNESS PROGRAM

Government Mandates and Policies :
Administrative Order No. 179 s.2004: Guidelines for the Implementation of
the National Prevention of Blindness Program
 Department Personnel Order No. 2005-0547: Creation of Program
Management Committee for the National Prevention of Blindness Program
Subcommittees: Refractive Error/Low Vision, Childhood Blindness, Cataract
Proclamation No. 40 declaring the month of August every year as Sight
Saving Month
Vision:
All Filipinos enjoy the right to sight by year 2020
Mission:
The DOH, Local Health Unit (LGU) partners and stakeholders commit to:
1. Strengthen partnership among and with stakeholder to eliminate avoidable
blindness in the Philippines;
2. Empower communities to take proactive roles in the promotion of eye health
and prevention of blindness;
3. Provide access to quality eye care services for all; and
4. Work towards poverty alleviation through preservation and restoration of
sight to indigent Filipinos.
Goal:
Reduce the prevalence of avoidable blindness in the Philippines through the
provision of quality eye care.
The program has the following objectives:

General Objective No. 1: Increase Cataract Surgical Rate from 730 to

2,500 by the year 2010
Specific:
1. Conduct 74,000 good outcome cataract surgeries by 2010;
2. Ensure that all health centers are actively linked to a cataract referral
center by 2008;
3. Advocate for the full coverage of cataract surgeries by Philhealth;
4. Establish provincial sight preservation committees in at least 80% of
provinces by 2010;
5. Mobilize and train at least one primary eye care worker per barangay by
2010;
6. Mobilize and train at least one mid-level eye care health personnel per
municipality by 2010;
7. Improve capabilities of at least 500 ophthalmologists in appropriate
techniques and technology for cataract surgery;
8. Develop quality assurance system for all ophthalmology service facilities
by 2008; and
9. Ensure that 76 provincial,16 regional and 56 DOH retained hospitals are
equipped for appropriate technology for cataract surgery.
General objective no 2: Reduce visual impairment due to refractive errors
by 10% by the year 2010
1. Institutionalize visual acuity screening for all sectors by 2010;
2. Ensure that all health centers are actively linked to a referral center by
2008;
3. Distribute 125,000 eye glasses by 2010;
4. Ensure that the hospitals and of health centers have professional eye
health care providers by 2010;
5. Ensure establishment of equipped refraction centers in municipalities by
2008; and
6. Establish and maintain an eyeglass bank by 2007.

General objective no 3: Reduce the prevalence of visual disability in

children from 0.3% to 0.20% by the 2010
1. Identify children with visual disability in the community for timely
intervention;
2. Improve capability of 90% of health worker to identify and treat visual
disability in children by 2010; and
3. Establish a completely equipped primary eye care facility in municipalities
by 2008.

Burden of Blindness and Visual Impairment : Global Facts

The Philippines is a signatory in the Global Elimination of Avoidable
Blindness: Vision 2020 The Right to Sight. The Vision 2020 was initiated by the
International Agency for Prevention of Blindness (IAPB), World Health Organization
(WHO), and the Christian Blind Mission (CBM), Vision 2020 aims to develop
sustainable comprehensive health care system to ensure the nest possible vision for
all people and thereby improve the quality of life.
According to WHO estimates :
Approximately 314 million people worldwide live with low vision and
blindness
Of these, 45 million people are blind and 269 million have low vision

145 million people's low vision is due to uncorrected refractive errors (near-
sightedness, far-sightedness or astigmatism). In most cases, normal vision
could be restored with eyeglasses
Yet 80% of blindness is avoidable - i.e. readily treatable and/or preventable

90% of blind people live in low-income countries

Restorations of sight, and blindness prevention strategies are among the

most cost-effective interventions in health care
Infectious causes of blindness are decreasing as a result of public health
interventions and socio-economic development. Blinding trachoma now
affects fewer than 80 million people, compared to 360 million in 1985
Aging populations and lifestyle changes mean that chronic blinding conditions
such as diabetic retinopathy are projected to rise exponentially
 Women face a significantly greater risk of vision loss than men

Without effective, major intervention, the number of blind people worldwide

has been projected to increase to 76 million by 2020

Burden of Blindness and Visual Impairment : Local Facts

Number of blind people: 592,000 (based on 2011 estimated population of
102M & 2002 blindness prevalence of 0.58%)
Number of persons with moderate or severe visual impairment: 2 million
(2011 popn. & 2002 prevalence of 2.04%)
Number of blind due to cataract: 367,000 (62%)

Number of blind due to EOR: 59,000 (10%)

Number of blind from cataract below poverty line: 92,000 (25%, NSCB 2009
figures]; figure est. doubled to include first & second quintiles
RP Prevalence of Blindness (%), 2002

RP Prevalence of Low Vision (%), 2002

RP Prevalence of Visual Impairment (%) , 2002

Interventions/Strategies employed or Implementation by the DOH

 1. Advocacy and Health Education
This includes patient information and education, public information and education
and intersectoral collaboration on eye health promotion and the nature and extent
of visual impairments particularly its risk factors and complications and the
need/urgency of early diagnosis and management.
2. Capability Building
This component shall focus on ensuring the capability of national and local
government health facilities in delivering the appropriate eye health care services
especially to the indigent sector of the population. Program shall provide training for
coordinators at regional and provincial levels; will ensure the availability of and
access to training programs by program implementers. It shall include
strengthening treatment/management capabilities of existing personnel and
operating capabilities of facilities conducting cataract operations etc., taking into
outmost consideration basic quality assurance and standardization of procedures
and techniques appropriate to each facility/locality.
3. Information Management
The program shall develop an information management system for purposes of
reporting and recording. As far as practicable, this system shall consider and will
build on any existing mechanism. The system shall be national in scope, although
the mechanism shall consider the regional and local needs and capabilities.
4. Networking, Partnership Building and Resource Mobilization
An important component of the program is networking and partnership building
to ensure that services are available at the local level. This shall include public-
private and public-public partnership aimed at building coalition and networks for
the delivery of appropriate eye health care services at affordable cost especially to
the indigent sector. This component shall also focus on ensuring that the highest
appropriate quality services are made available and accessible to the people.
5. Supervision, Monitoring and Evaluation
The Program shall be coordinated by a national program coordinator from the
Degenerative Disease Office of the National Center for Disease Prevention and
Control, Department of Health. The national program coordinator shall oversee the
implementation of program plans and activities with the assistance of the regional
coordinators from the Centers for Health Development.
A system of monitoring program plans and activities shall be developed and
implemented taking into consideration the provision of the local government code
as well as the organic act of Muslim Mindanao, and any similar issuances/laws that
will be passed in the future.
A program review shall be conducted as needed. Result of program evaluation
shall be used in formulating policies, program objectives and action plans.
6. Research and Development
The program shall encourage the conduct of researches for purposes of
developing local competence in eye health care and for other purposes that may be
necessary. The development and dissemination of clinical practice guidelines for eye
health shall form part of the research agenda of the program.
The program shall support researches/studies in the clinical behavior (KAP) and
epidemiological (trends) areas. It also aims to acquire information that is utilized for
continuing public health information and education, policy formulation, planning and
implementation.
7. Service Delivery
 Service delivery for the prevention of Blindness Program shall be covered by the
principle of best practice. In collaboration with the local government units and
stakeholders, the program shall develop systems and procedures for the integration
and provision of services at the community level. This means primary eye
prevention concentrating on health education, advocacy and primary eye
interventions; Secondary prevention; screening/early detection/basic management/
counseling, referral and/or definitive care and tertiary prevention: management of
complications, continuing care and follow up including rehabilitation. The following
areas will be the priority areas for services to be provided by the National
Prevention of Blindness Program:
a. Cataract Surgeries
b. Errors of Refraction
c. Childhood Blindness
Activities for the Vitamin A Deficiency Disorder, for practical purposes, shall be led
by the Family Health Office also of the NCDPC.
A Referral System shall form part of services delivered by the program. This is to
ensure that all patients receive quality eye health care at appropriate levels of
health care delivery system. All rural health units should be linked to an eye care
referral center.
Cataract
Cataract, the opacification of the normally clear lens of the eye, is the most
common cause of blindness worldwide. It is the cause in 62% of all blindness in the
Philippines and is found mostly in the older age groups. The only cure for cataract
blindness is surgery. This is available in almost all provinces of the country; however
there are barriers in accessing such services. Interventions will therefore consist of
increasing awareness about cataract and cataract surgery; as well as improving the
delivery of cataract services. The parameter used worldwide to monitor cataract
service delivery is the Cataract Surgical Rate.
Errors of Refraction
Errors of refraction is the most common cause of visual impairment in the country
(prevalence is 2.06% in the population). Errors of refraction are corrected either with
spectacle glasses, contact lenses or surgery. The services to address the problem of
EOR are provided mainly by optometrists. However, the provision of the eyeglasses
or lenses (who should provide, how is it provided, etc.) has to be addressed.
Childhood Blindness
The prevalence of blindness among children (up to age 19) is 0.06% while the
prevalence of visual impairment in the same age group is 0.43%. The problem of
childhood blindness is the highly specialized services that are needed to diagnose
and treat it. However, screening of children for any sign of visual impairment can be
done by pediatricians, school clinics and health workers.

Future Plan/Action:
Development of Service Package for Prevention Blindness Program

Development of Clinical Practice Guidelines for Prevention Blindness

Program
Development of Strategic Framework and a Five Year Strategic Plan for
Prevention Blindness Program (2012-2016)
 Continue conduct of promotion and advocacy activities and partnership
with National Committee for Sight Preservation, Specialty Societies and other
stakeholders on PBP
Creation of PBP Registry System

Ensure the implementation of the National Prevention of Blindness

Program

Status of Implementation/Accomplishment:
Department of Health supports prevention of blindness and vision
impairment
o Signatory of all World Health Assembly resolution on Vision 2020 and
blindness prevention.
o National Prevention on Blindness Program under Non-Communicable
Disease Cluster.
o Funded 3 national surveys of blindness 1987, 1955 and 2002.
o Planning workshop 2004 crafted 5 year development plan for eye care
2005-2010 assisted by IAPB / ICEH.
o AO 179 issued on Nov. 2004 by Sec. Dayrit creating Guidelines for
Implementation of the National Prevention Blindness Program (NPBP) which set-up
the Program Management Committee (PMC)
o Blindness prevention and rehabilitation of persons with irreversible
blindness are incorporated in the health program for persons with disability of DOH

The following programs/projects are included in the Maternal and Child

Care Program of DOH:
o Expanded Program for Immunization (includes vaccination for diseases that
causes blindness)
o Vitamin A provision for pregnant mothers and children to prevent vitamin A
deficiency
o Comprehensive newborn care includes prophylaxis for ophthalmia
neonatorum
o Newborn screening includes screening for galactosemia which cause
congenital cataract

Several activities in the PBP

o Consultative and Planning Workshop on PBP, October 2011

o National Eye Summit, Manila Grand Opera Hotel, Manila last October 2009
o Strategic Planning Workshop on the National Sight Preservation and
Blindness Program 2008
o Training of Trainors of Primary Eye Care conducted 2007
Other Significant information:
Available Human Resources:

Ophthalmologists - 1,573 registered PAO members as of

January 27, 2011
- 95% is in private practice
Optometrists - 10,266 registered with Philippine Board
of Optometry as of July 2010

Financial Resources

o DOH provides funds largely for technical assistance for training, capacity building
activities, and augmentation of funds for local program implementation.
o Philippine Health Insurance Corporation covering personal eye care services
(hospital based)

Partner Organizations:

Aside from the collaborating divisions in the DOH, the following

institutions partake in the program:
Local Government Units (LGUs)

National Committee for Sight Preservation (NCSP)

Philippine Academy of Ophthalmology

Philippine Information Agency

Optometric Association of the Philippines

Rotary International

Integrated Philippine Association of Optometrists

Foundation for Sight

Helen Keller International

Lions Club International

Tanggal Katarata Foundation

UP - Institute of Ophthalmology

Christian Blind Mission

Resources for the Blind

SentroOfthalmologico Jose Rizal

World Health Organization

PERSONS WITH DISABILITIES

HEALTH AND WELLNESS PROGRAM FOR PERSONS WITH

DISABILITIES
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 ICFs 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 worlds 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 worlds 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 come 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 andthe 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 MediumTerm 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.
Recently, the World 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, the Health and Wellness Program of Persons with
Disabilities currently has been configured to address all the issues discussed above,
and aligned 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.
II. HEALTH AND WELLNESS PROGRAM FOR PERSONS WITH DISABILITIES
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 should 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 should begin as early as possible and be made
available as close as possible to where people with disabilities live.
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 should be strengthened and made
fully operational.
Figure1: Action Framework for the Health and Wellness Program for Persons with
Disabilities