It's the holiday season!

Many thanks to everyone who has become part of HAIN's fruitful year. Cheers to a more blessed 2010 to all of us!

The Religion, Gender and Sexuality National Conference

Anchored on the theme “Reclaiming Our Bodies, Voices & Spaces”, HAIN organized the national conference on Religion, Gender and Sexuality (RGS) last November 12-13 at MMLDC in Antipolo City. About 70 reproductive health advocates graced the occasion, most of whom were training graduates of RGS workshops which HAIN has been conducting since 2005.

The Conference’s overall aim was to provide a stage for further examination of the complex relationship between reproductive health, sexuality and religion. It also provided a forum for an exchanged of each other’s experiences in program implementation and advocacy in the context of RGS.

Rep. Edcel Lagman (District 1, Albay), a staunch RH advocate and author of the RH Bill in the House of Representatives, gave the keynote address. Lagman stressed on the need to counter Church oppositions to advance RH programs in the communities and not be undermined by their issues on morality.

HAIN’s executive director, Dr. Edelina Dela Paz, and a representative from the Provincial government of Rizal gave the welcome remarks.

Resource speakers of the RGS workshops also joined and served as speakers in the plenary which included Fr. Percy Bacani, of the Missionaries of Jesus, Sr. Helen Graham of Maryknoll Sisters and Prof. Yasmin Lao of Al Mujadillah. Other resource speakers who shared about the current issues in reproductive health were Rina Jimenez David (Philippine Daily Inquirer), Ana Victoria Simon (form the office of Quezon City Vice Mayor Herbert Bautista) and Atty. Claire P. Luczon of Womenlead Foundation, Inc.

Some of the RGS fellows also presented their experiences in RH and RGS advocacy and how they have shared the learning in their respective communities. At the end of the conference, each of the delegates has shared their commitment in advancing RH advocacy amidst the continuing oppositions from some members of the religious community.

To date, HAIN has conducted 10 RGS workshops producing more that 200 fellows from different parts of the country. The RGS workshops were held to give RH advocates some tools for discernment to make informed decisions about gender and sexuality-related issues, including family planning, abortion, and homosexuality. The workshops also serve as venue for RH advocates to be able to reconcile their personal faith with their work.

With pride, we can say that many of the RGS fellows, have become champions of RH as we now become resource persons ourselves in forums and discussions on various RH and RGS issues. Many of us also engage in regional and national campaigns to push for the passage of RH bill and implementation of a comprehensive RH program. The knowledge and experience we have gained from the workshop enhanced our capacity and confidence in facilitating community educations, community organizing and in handling RH advocacy activities.

At the conference, we have reclaimed our bodies, voices and spaces. RGS fellows are now more confident to argue and defend their faith vis-à-vis RH advocacy.

The conference was made to happen with support from the David and Lucile Packard Foundation.

Youth Declaration at the 5th APCRSHR

We, the youth1 participants of the 5th Asia Pacific Conference on Reproductive and Sexual Health and Rights, held in Beijing, China on 17-20 October 2009, call upon policy makers and decision makers from government, donors, private sectors, as well as civil society to actively address SRHR of young people as a global goal with specific time bound indicators. 2

We believe that the meaningful participation of young people plays a vital role in improving their reproductive and sexual health and rights. Embracing the fact that our communities are a reflection of the contributions made by each of its members, including young people, we are committed to finding innovative and effective strategies to meet the challenges that all young people are facing in fulfilling our sexual and reproductive health and rights.

We call upon policy-makers, decision makers, governments, donors, private sector, civil society and all young people to make every effort to work hand-in-hand in realizing achieving the goals of ICPD and MDGs' towards creating an enabling environment, so that all young people are empowered to enjoy their sexuality and protect themselves from harm.

ALL PARTICIPANTS OF THE 5th APCRSHR YOUTH FORUM ACKNOWLEDGE THAT:

ICPD PoA and MDGs continue to play a key role in Asia and the Pacific regional sexual and reproductive health and rights movements. Under the above mentioned frameworks, consistent actions of national governments, courageous political commitments, and positive policy changes for population, health, and the environment have contributed significantly to the comprehensive development of young people and adolescents in Asia and the Pacific region. However, we believe that it is necessary to think beyond Cairo and acknowledge the limitations of the ICPD Plan of Action, by pushing for a more inclusive and progressive agenda.

The efforts made to provide integrated reproductive health services and education that are comprehensive, sexpositive, gender-sensitive, youth-friendly, youth-driven, which recognize the evolving capacities of young people are an invaluable investment in the present and future of the region.

DESPITE THE PROGRESS, HOWEVER, ALL PARTICIPANTS OF THE 5TH APCRSHR YOUTH FORUM REALIZE THAT:

Denying young people accessible sexual and reproductive health services and education is a violation of young people's human rights and their right to development, as affirmed by the ICPD and the Beijing Platform for Action.

A significant number of young people in Asia and the Pacific do not have enough knowledge about sexual and reproductive health and rights. This leaves them potentially vulnerable to coercion, stigma and discrimination; abuse, violence and exploitation; unintended pregnancies, unsafe abortion and sexually transmitted infections, including HIV.

Significantly, poverty and regional disparity in social and economic development is the largest barrier in realizing the sexual and reproductive health and rights of young people.
____________ _________ _________ _

1Paragraph 2, Global Partners in Action: NGO forum on Sexual and Reproductive Health and Development
2 Such as the Millennium Development Goals
____________ _________ _________ _________ _____

TO ADDRESS THESE ISSUES, WE URGE NATIONAL GOVERNMENTS AND CIVIL SOCIETIES:

To fulfill sexual and reproductive health and rights, as they are an inalienable aspect of young people's right to health.

To recognize that gender affects young people's lives and experiences. Young people, especially young girls are deeply affected by harmful gender stereotypes and gender inequality. Therefore, actions should be taken towards addressing issues due to gender disparities such as child marriage, forced marriage, early and forced pregnancy.

To provide mechanism for easier access to funding and support for youth-led and youth focused initiatives and establish strong and sustainable partnerships between States, decisions makers, international agencies, donors, and NGO's, government, civil societies, and young people.

To ensure the involvement of young people at all programmatic, policy and decision-making and budget planning and distribution at the national, regional and international level.

To invest in young people as a priority in population and development strategies with programming specifically directed at increasing access to information, education, counseling and skills that enable young people to make decisions about their own wellbeing.

Consequently, States should ensure that the different sectors of society are fully informed, sensitized on youth issues and empowered to act in the best interests of young people.

To develop and enforce non-discriminatory sexual and reproductive health related laws and policies at local, national, regional and international levels particularly those concerning young people. This includes eliminating legal and policy barriers, which restrict young people's access to essential services, such as parental and spousal consent, age of consent and issues of confidentiality. Furthermore, to assess the credibility of programmes, ensure transparency, and close monitoring that is driven towards positive progressive results.

To guarantee universal access to comprehensive sexuality education for all young people, and ensure that all existing SRH services are youth-friendly, non-judgmental, recognize and respect diversity and are accessible to all young people, including underserved groups.

WE, THE PARTICIPANTS OF THE 5th APCRSHR YOUTH FORUM:

Commit our individual capacities towards improving the health and well-being of our societies.

Commit to sharing accountability towards protecting the health and rights of all individuals.

Commit to enhance understanding across geographical regions, cultural and religious diversities with a vision to achieve inclusive social development with sustainability.

Commit to continue promoting sexual and reproductive health and rights as a primary component of equal opportunity and human development. We would like to emphasize that many of the mentioned demands have been made at various instances in the last 15 years. This document has to be seen in continuity with those that have come before.

We Commit. We Recommend. We Deserve.

YOUTH DECLARATION AT THE 5TH APCRSHR
BEIJING, CHINA. 17 OCTOBER, 2009

Community organizing: letting the people take charge

Central to the concept of advocacy is empowerment – the idea that the poor, the uneducated, and the powerless can actually fi nd their voices and their strength to fi ght for their own causes. Wallerstein (1992) defi nes empowerment as “a social action process that promotes participation of people, organizations, and communities towards the goals of increase individual and community control, political efficacy, improved quality of community life and social justice.” With this definition, the task of empowering the people seems to be a daunting one.

And this is where community organizing comes in. Community organizing (CO) involves bringing together people, who, through their proximity with each other or through the same situation they are facing, are banded together by common causes and ideals.

CO is not a one-shot approach; it takes time to build and strengthen a community. Partners in advocacy In her paper, “ Revisiting community organizing and participatory action research,” Dr. Erlinda Palaganas listed knowing one’s self as the first step in CO. According to Palaganas, an organizer must answer the following
questions:

• Do you like working with and for the people?
• Do you believe in people’s capacity to change?
• Do you believe that people have the potentials to contribute to their own development?
• Do you believe that people should be empowered to make decisions on matters affecting them?
• Will you support people’s decisions?
• Are you committed to serving the people’s interest?

In the first step, two things are quite clear: fi rst, ego has no place in CO, and second, and organizer must be deeply committed to the ideals of his or her work. The relationship between an organizer and the community is not one of teacher - student or benefactor – beneficiary. Rather, it is a partnership where they both learn from each other and work together, side-by-side.

Many projects with good intentions have failed simply because the implementers failed to listen to the community. Often, they would bring in new concepts or technology, without validating with the community if these are appropriate and applicable in the local context.

Or worse, they came in with a patronizing and even smug attitude. This is a pitfall for many college-educated health professionals and advocates who may harbor the idea that their education makes them more superior to ordinary people; most of whom probably never finished elementary. Another danger with this kind of thinking is that instead of empowering the community, it will only teach them to rely on dole-outs.

By considering the community as important partners, they would also start to embrace the program as their own, thereby guaranteeing its sustainability. Rather than simply
coming in and giving the community a set of solution to their problems, a good organizer knows how to stand back and let the community decide for themselves. In this way, the community will not look at the program as a mere imposition of outsiders.

Listening skills and empathy are thus important tools in an organizer’s arsenal. An organizer must fi rst win the trust and support of the community. This can be done through constant and honest dialogues with the members and finding out what their issues are.

Integrating with the community is a vital component of CO. Integration entails knowing the community, sharing the people’s concerns, and understanding their perspectives. It allows an organizer to gain a fi rst-hand experience of the situation in the community.

Once a community has been organized, the next task is to identify leaders and train them to build their communications and leadership skills to prepare them for the task of advocating their own causes. Selecting leaders is not arbitrary; the community must also be involved. Leaders do not only come from the ranks of village chieftains or elders, they could also come from the ranks of traditional healers. Palaganas cited the following qualifications and characters that can help an organizer identify a leader:

• comes from the poor sector of the community and is directly engaged in economic production;
• must possess integrity and credibility;
• is receptive to changes;
• must have an analytical and critical mind;
• must be able to communicate effectively;
• must be interested in the upliftment of the community

Empowerment: educating the people
In a training sponsored by the Medical Transparencies Alliance, and which was attended by organizations from Peru and Asia, one of the facilitators pointed out that an organizer/advocate should be prepared to stand aside once the community has found their collective voices.

Some organizations have taken this step further: they actually train community members on health concepts and even certain medical procedures. The Council for Health and Development (CHD), the national organization of community-based health programs in the Philippines, conducts a variety of trainings for its community health workers (CHW), ranging from first aid, alternative medicine (e.g. acupuncture), production of herbal medicines, and basic microscopy, among others. The trainings are conducted by the organization’s network of health professionals, as well as experienced CHWs.

CHD’s approach belies the myth that barely educated people cannot be taught complex ideas, particularly when it comes to health and medical concepts. In many areas in the Philippines where health professionals and health facilities are sorely lacking, CHWs have been a community’s important fi rst line of defense against ill health. More importantly, CHWs are not mere healers; they are also leaders and listeners well respected in the community, to whom the people run to for help.

The politics of health
An organized community is also an active player in a nation’s political scene. Keeping in mind that health issues are also affected by socio-political and economic determinants, organized communities conduct mobilizations to speak up against certain issues. They are keenly aware that health is simply not the absence of disease; it is also a manifestation of the prevailing sociopolitical and economic conditions. They are not passive players, waiting for change to come. Rather, they actively participate in demanding for social changes and in fighting for their rights.

While organized communities do have the clout, they can only wield this if they have the numbers. And this is where networking plays a major part. Networking involves
building alliances with other groups and individuals who share the same sentiments and who advocate the same cause.

Confronting the challenges
Organizing a community entails facing challenges, ranging from opposition, lack of resources, and even harassment. Since CO has a strong political component, it is inevitable that the ruling class may feel threatened and they might act irrationaly just to protect the status quo. Community organizing is indeed challenging, but no task is too daunting for a deeply committed and passionate organizer. An organizer’s reward is the satisfaction of seeing a previously timid community become organized
and outspoken.

Sources:
Wallerstein, Nina. Community Organizing and Empowerment Principles of Public Health. http://hsc.unm.edu/som/fcm/mph/Curriculum/community%20organizing%20empowerment%20
pph%202005.ppt.

Palaganas, Caster. Revisiting Community Organizing and Participatory Action Research (CO-PAR).

By Ross Mayor for Health Alert Asia Pacific, Issue 16. For copies of the newsletter, please request to hain@hain.org

Pass the RH Bill!

We urge our legislators to pass the the Reproductive Health Bill this year. The link below shows why we need a comprehensive RH program here in the Philippines.

http://likhaancenterforwomenshealth.blogspot.com

Health Alert's last issue out now

The last issue of Health Alert is a reiteration of the importance of advocacy as a part of any NGO's work. But rather than focusing solely on the basics, the issue also highlights other facets of advocacy, which are often not discussed in full, such as community organizing. The issue also discusses the latest trends, taking into account the advances in the field of technology and how advocates can maximize these. The article, "Navigating the health information highway," discusses both the opportunities and challenges in making health information available. "HealthDev.net - a platform for Citizen Journalism and social networking on TB and HIV issues" introduces a web-based tool, which advocates can utilize to inform and educate the public on key health issues. There is also a sidebar on blogging, which is fast becoming another tool for advocacy. Three articles provide tips on key advocacy strategies. Two of these provide tips on writing and public speaking, while the other one discusses the importance of localizing a content, as well as how this can be done.

Since its launch in 2003, Health Alert Asia Pacific Edition has strived to promote health and development by providing practical information and critical analysis of the issues. We hope that it truly have been helpful in your advocacy, training, and research.

The newsletter’s success has been due to your contribution to the project – articles submitted, information shared, feedback letters – all of these are very much appreciated.

However, due to lack of project funding, HAIN temporarily ends the print production of Health Alert. Nevertheless, back issues of the magazine will still be offered for free to new readers via HAIN and our websites to ensure that Health Alert continues to generate value as a source of best practice and accurate information on health.

HAIN also plans to continue Health Alert in the Internet so that we can continue sharing health information.. In which case, we welcome any health-related articles that you would like to be published online. Feel free to email us at hain@hain.org for any inquiries, suggestions, and message.

We thank you for your support and we offer you our heartfelt gratitude and respect.

To request electronic copy of the newsletter, please write to hain@hain.org or hain1985@gmail.com

Maximum Drug Retail Price: Deceitful and Illusory

Consumers still have to find out that the prices of medicines in the next few months will remain expensive despite the Maximum Drug Retail Price or Executive Order 821 signed by Mrs. Arroyo last July 27, 2009.

EO 821 is deceitful and illusory. EO 821 will not have a significant impact on bringing down the prices of medicines for the Filipino people.

EO 821 listed five medicines for compulsory compliance and 16 other essential medicines for voluntary compliance to treat hypertension, diabetes, cancer, bacterial infections and amoebiasis. EO 821 stands to benefit the users of these medicines; but it should include more essential medicines that are most widely used and are first-line medicines needed for the treatment and cure of more prevalent diseases in the country. Medicines that should have been included are those needed to treat the 10 leading causes of morbidity and mortality which include respiratory diseases, pneumonia and tuberculosis, among others.

In addition, EO 821 sets the compulsory maximum drug retail prices (MDRP) of five medicines. Price regulation of medicines is a step in the right direction. However, the MDRP under EO 821 is misleading. The mechanism used in determining the drugs for compulsory MDRP has been pegged on the drug originator price which though slashed to about 50 percent is still expensive. Take the example of Amlodipine which is used to lower blood pressure. Under EO 821, MDRP of Amlodipine 10mg is P38.50, about half the price of its originator brand medicine Norvasc 10 mg sold at P77 in a leading drug store. Why set an MDRP for this medicine at this amount when its generic equivalent is sold at P15 at a known drugstore selling generic medicines?

In related developments, private hospitals plan a hospital holiday in the light of the Aug. 15 deadline on implementing EO 821. At the end of the day, hospital holiday will affect patients. Hence, the government must exhaust all means to settle the problem and spare the people another burden.

In the interest of the Filipinos, the list of medicines to be placed under MDRP should include more essential medicines that are widely used. The MDRP should be pegged at prices that an ordinary worker can afford with his meager income. Government should promote and make available quality generic medicines as a viable alternative to expensive brand medicines.

The Filipinos have long awaited relief from the high prices of medicines in the country. Unfortunately, the law failed in its promise of more affordable prices for medicines. Mrs. Arroyo's lack of sincere measures to regulate the prices of essential medicines is in effect an expression of collusion with big pharmaceutical companies.#

This press statement was released August 13, 2009 during a press conference at Tree House Restaurant in Quezon City. The press conference was organized by Consumers' Action for Empowerment and Health Action Information Network (HAIN). For more details about the campaign, please contact:

Eleanor M. Nolasco, RN
Convener, Consumers' Action for Empowerment
Mobile: 0905-3255223

MSMs and transgender tackle HIV-AIDS issue

HIV infections are on the rise in the Philippines, with 85 new infections registered in May 2009 alone. This is the highest reported in a month, and brings the total for 2009 (January to May) to 322. Most of these cases (88%) were men, with the 20-24 year age group reporting the most cases (29%). Fifty-seven percent of the reported cases came from the National Capital Region (NCR). All cases reported sexual contact as the mode of HIV transmission, with homosexual contact (36%) as predominant.

The other populations at risk from HIV-AIDS include female sex workers and their male clients and injecting drug users. The vulnerable populations of Overseas Filipino Workers (OFWs), out-of-school youth, and street children are also at high risk, and require comprehensive and targeted programmes as well. In 2007, an estimated 7,490 people were living with HIV, up from the estimated 6,000 in 2002.

All the main ingredients for an epidemic are present in the country. First, HIV transmission through unprotected sex accounts for 89% of reported cases. Second, condom use among the most at-risk populations remains below the universal access target of 90%.

Given this situation, the Government of the Philippines and the United Nations Development Programme (UNDP) launched a three-year programme entitled “Promoting Leadership and Mitigating the Negative Impacts of HIV and AIDS on Human Development.” Its first project is the 1st National Conference on HIV-AIDS by Men Who Have Sex with Men (MSM) and Transgender Filipinos, being held July 23-24 at Greenhills Elan Hotel.

This project will define the profile of MSM and transgender Filipinos as well as their changing behaviors. It will also map and assess existing programs, and recommend advocacy strategies and cost. It will further pilot-test these strategies to scale up the national MSM response, including involvement in shaping of policy.

Renaud Meyer, the Country Director of UNDP, said: “This programme demonstrates UNDP’s commitment to contribute to the global response to combat AIDS, which is embodied in Goal 6 of the Millennium Development Goals (MDGs) – to reverse and halt the spread of HIV-AIDS and other diseases. Our overall goal is to support improved human development outcomes and contribute to the attainment of the goals of the Philippines’ national AIDS response through comprehensive leadership programmes. This project – which aims to develop the capacity of MSMs and transgender Filipinos as well as their organizations – is a significant step in this direction.”

The national conference fulfills two of the five components of the UNDP programme. These are to provide strategic information and community leadership among MSM and transgender Filipinos, as well as provide knowledge, community, and advocacy to promote a deeper understanding of HIV and AIDS. The three other components of the programme are:

*Leadership for effective and sustained responses to HIV and AIDS;
*Strengthening institutional capacities and partnerships on HIV and migration; and
*Mitigating the economic and psycho-social impacts of HIV and AIDS.

For this programme, the UNDP is working closely with relevant Government agencies such as the Department of Interior and Local Government (DILG), Department of Labor and Employment (DOLE), Department of Social Welfare and Development (DSWD), TLF Sexuality, Health and Rights Educators Collective, Inc. (TLF SHARE), Health Action Information Network (HAIN), and the Philippine National AIDS Council (PNAC).

State of the ‘Nanays’

Anticipating the State of the Nation Address next Monday is another SONA, the “State of the Nanay Address” taking place this afternoon at the University of the Philippines Bahay ng Alumni.

This alternative SONA is born of civil society’s “frustration over the deliberate sidetracking of the Reproductive Health (RH) Bill in Congress,” said Elizabeth Angsioco, secretary general of the Reproductive Health Advocacy Network (RHAN), composed of various organizations involved in reproductive health and women’s rights. “We are clueless as to whether the President will acknowledge the importance of the bill’s passage in her official SONA,” added Angsioco, and the “State of the Nanay Address,” she said, is the group’s way of pointing out that the reproductive health of mothers, children, women and men is as important as her other priorities.

Since it’s doubtful if the President will even deign to mention reproductive health in her SONA (she is said to be “allergic” to the term which is commonly used in the United Nations and by the rest of the world), the alternative SONA could also be a way of informing the Filipino public just how mothers have been faring under the Arroyo administration.

It has often been mentioned in this space that an average of 11 Filipino women die every day in this country due to pregnancy and childbirth-related complications. If the kidnap and rape of the young daughter of a narcotics agent can so enrage the President as to make her reconsider her long-standing policy against carrying out the death penalty, shouldn’t the daily, preventable deaths of 11 women move her in equal measure? After all, she is a woman, a mother, and a grandmother. Maternal deaths are very much a part of reproductive health.

Read more...
Source: Rina Jimenez David. At Large. Philippine Daily Inquirer. July 22, 2009

Early marriage: a different perspective for teenage pregnancy

The prevalence of early marriage in Autonomous Region in Muslim Mindanao (ARMM) in the Philippines is diffi cult to monitor considering that there is insuffi ciency of data due to low rate of registration of births and marriages.

One recent research by Nisa Ul Haqq Fi Bangsamoro (NISA) and Al-Mujadillah Development Foundation (AMDF), which was conducted in Sulu, Basilan, Maguindanao, Tawi-Tawi, Lanao del Sur and Shariff Kabunsuan, has found out that the youngest bridal age is nine. Out of 598 respondents, 17 percent aged from nine to fourteen and 83 percent were at the range of fi fteen to seventeen upon marriage.

At present, close to 40 percent of the respondents are raising one to three children, 27.9 percent with four to six, 19.2 percent attend to more than seven children, while 13.7 percent do not have children yet. This illustrates that the younger a girl marries, the more she will likely to bear many children.

The study identifi ed six determinants on why early marriage is happening in the region. These are:

• religious beliefs
• cultural practices
• economic conditions
• personal circumstances
• forced/arranged marriage,
• and political reasons.

Many consider early marriage as a protection against Zina (extramarital and premarital sex) and is perceived to be an effective way in following the Sunnah (the way and the manners of Prophet Mohammad). This is also to preserve the chastity of women to protect the family’s honor. In addition, there is also a widespread perception that women are weak and in need of protection. Forty-one percent of the respondents have revealed that they were motivated by the idea that the husband
would be a good provider and 30.10 percent confessed that a dowry was seen as an economic opportunity. More than half of the girl-brides who admitted having romantic
relationships with their would-be husbands said that peer influence and the need to escape from parental control have been factors in the decision to marry early.

Majority of the respondents (86.2 percent) said that their marriages were arranged while 34 respondents confided that they were abducted. A small percentage cited political reasons and these are: to forge political alliances and settle family disputes.

The prevalence of early marriage in ARMM can be a major possible reason why this region has one of the highest maternal mortality rate (MMR) in the Philippines.

Article by Amanah Lao. The article is published in Health Alert Asia Pacific newsletter (Issue 15) by HAIN. For copies of the newsletter, please write to hain@hain.org

Searching JSTOR through HAIN

Health Action Information Network is currently subscribing to JSTOR, an online digital archive of academic journals, scholarly works and other materials needed for research and teaching. Mainly covering Arts and Sciences, the collection includes core journals in economics, history, political science, and sociology, as well as in other key fields in the humanities and social sciences. This collection also contains titles in ecology, mathematics, and statistics. Overall, there are 119 titles in twenty-one disciplines. Example of titles include-

· Annual Review of Sociology
· Anthropological Review
· Anthropology Today
· Applied Statistics
· Current Anthropology
· Demography
· Family Planning Perspectives
· International Family Planning Digest
· International Family Planning Perspectives
· International Family Planning Perspectives and Digest
· Journal of Health and Human Behavior
· Journal of Health and Social Behavior
· Journal of the History of Ideas
· Man
· Population and Development Review
· Population Index
· Population Literature
· Population Studies
· Population: An English Selection
· Studies in Family Planning
· World Politics

How to Access JSTOR Collection
The collection is available to development partners of HAIN by sending an email request on specific topics or journal articles that you wish to search. Our staff will conduct the research and will deliver the materials to you online at no cost. Charges will apply to those who are requesting for printing and mailing.

For more information, please contact Emie or Tere at 952-6409 or 952-6312
Or email us at emie.devera@hain.org, noemi.leis@hain.org, tere.godito@hain.org

Influenza A (H1N1) Brief Situation Report for Partners in the Philippines

(Click on image to enlarge)

WHO Philippines
Influenza A (H1N1) Brief Situation Report for Partners in the Philippines
Number 28, 25 May 2009

Updates as of 10 AM, 24 May 2009 (figures may change due to the rapidly evolving situation)

• Department of Health announces the country’s second confirmed case in a 50-year old female with history of travel to the US
• People are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness (fever, cough, runny nose, body aches)
• Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care.
• The practice of good health habits including adequate sleep, eating nutritious food, and keeping physically active are some of the general preventive measures for influenza.
• The Lancet announced the launching of its H1N1 Flu Resource Center at www.TheLancet.com/H1N1-flu , a microsite for physicians, nurses, pharmacists, and health care professionals.
  

WHO Actions
Published Clinical Management of Human Infection with new influenza A (H1N1) virus; initial guidance: http://www.who.int/csr/resources/publications/swineflu/clinical_managmentH1N1_21_May2009.pdf
The WHO library has shared more scientific information on Influenza A(H1N1) with this link: http://atoz.ebsco.com/CustomTab.asp?id=10243
The document "WHO technical advice for case management of Influenza A(H1N1) in air transport" has been posted on web site (http://www.who.int/ihr/ports_airports/en/index.html).
Instructions for storage and transport of suspected or confirmed influenza A (H1N1)
human and animal specimens and virus isolates
http://www.who.int/csr/resources/publications/swineflu/storage_transport/en/index.html
The latest WHO recommendations and situation updates can be found at http://www.who.int/ and at http://www.wpro.who.int/philippines

HAIN in Ilocos

PhilHealth Update

Here’s a pop quiz to check your knowledge about PhilHealth, our national health insurance system. Give your answers to the following questions, then read on to find out which of them you got right.

Can domestic employees (your yaya, driver) be enrolled? Can a sidewalk vendor enroll herself? What about overseas Filipino workers? Can an illegitimate child be a beneficiary?

I recently had to call a friend, Dr. Madeline Valera at Philippine Health Insurance Corp. (PhilHealth) to ask some of those questions and ended up with a lot of information that I thought I should use two columns to share with readers. Dr. Valera, senior vice president for health finance policy, is proud of what PhilHealth is doing right now, but she is also full of dreams around how PhilHealth could do more.

Social solidarity

For all the cynicism people have about our public health care system, I have to say PhilHealth does make a difference. It’s evolved through the years, expanding the number of medical procedures that are reimbursable and extending PhilHealth to self-employed people and the informal sector.

Before we go into specifics about who and what can be covered, I did want to talk a bit about the principles that guide public health insurance, which will allow me to push readers to explore how they can use PhilHealth to help others.

Government health care systems vary across the world, the strongest ones built on a national health care system financed by government, through contributions of its citizens. Many European countries use such a system, with citizens paying a fixed amount of their income, ranging from 7 percent to 12 percent, going to the national health service. That percentage may seem high but in those countries people do get many benefits—for example, paying a fixed price for each prescription (regardless of the type of medicine), and getting almost all hospital services for free. They even get a transportation allowance!

Our system, unfortunately, is more closely patterned after the United States’, where health care is left largely to the private sector and, supposedly, free-market competition. The assumption here is that competition leads to better health care.

In a way, that assumption is true . . . but only if you can afford the private hospitals. If you can’t, then you better have coverage from health maintenance organizations (which we have as well in the Philippines) but which have many limitations, including the cost of premiums. The last resort you have in such a system would be government health insurance and public institutions but in both the US and the Philippines, even that system is inaccessible.

Health insurance is based on social solidarity, the rich paying more to help the poorer members of society. Not only that, there is solidarity in the sense that young, healthy people pay for the greater health risks of children, the elderly, the chronically ill (e.g., someone with a very serious kidney disease), and the disabled. Social solidarity through health insurance becomes even more important in times of a financial crisis. Just think, for example, of the overseas workers losing their jobs abroad and coming home with some savings that can be wiped out completely with one major illness.

The financial crisis has certainly made Americans rethink their health care, wondering if maybe a bit of “socialistic” health care might not be too bad. Public health insurance does benefit individuals and society. After all, if you don’t do your share to help take care of the elderly or the poor, then you still end up losing because the entire country ends up with too many unhealthy people. That’s actually what’s happening in the Philippines, with the poor having to run to politicians for doles (which actually come from our taxes), or to richer relatives and kinder employers, as many of my readers have experienced. In all these cases, the help is limited and can pay only for substandard care, sometimes leading to even more expenses.

Who can enroll?

Who can enroll in PhilHealth? The answer is simple: anyone can, as long as you pay the premiums, which are based on income and range from P100 to P750 a month. You can be self-employed as a sidewalk vendor, in which case you pay the total premium yourself; or you can be a corporate executive who will pay P375 a month while your company pays another P375. Overseas workers can also enroll, and this is important for the families they leave behind, as well as for themselves, because hospitalization expenses incurred overseas can also be reimbursed, subject to certain limitations.

There is a cap on monthly premiums, meaning the rate is the same for anyone with a monthly income of P30,000 and above. This cap has been criticized by the likes of former health secretary Alberto Romualdez, and rightly so since in a way those earning P30,000 a month are actually subsidizing someone earning P300,000 a month.

What you do need to know is that paying premiums for a quarter, which is the minimum, doesn’t automatically allow you to reimburse medical expenses. Self-employed PhilHealth members need to have paid a year’s premiums while those who are employed by someone else need only to have paid six months. Those sponsored by local governments units (many politicians offer such sponsorship for a few months or a year, especially as elections approach) or who are overseas workers and pay premiums on an annual basis are entitled to benefits right after enrollment.

These differences are important. If you’re self-employed then, you cannot just enroll in PhilHealth when you find yourself pregnant, hoping to have your hospital delivery covered. But if you are working for someone, and have been remitting premiums for at least six months, you are covered.

This takes us to potential beneficiaries. PhilHealth’s enrollment forms emphasize that you can only enroll someone you are married to, described in Tagalog as “tunay na asawa,” as long as he or she is not a PhilHealth member. You can also enroll children below the age of 21, whether they are legitimate (“anak na galing sa tunay na asawa”) or illegitimate, unemployed and single. (Those distinctions are important: that means if you have an 18-year-old child who is married, he or she will have to take out Philhealth individually. ) PhilHealth also allows children over the age of 21, but who have a congenital disability, to be covered as a parent’s beneficiary.

Finally, a PhilHealth member can enroll their parents (as well as step-parents) who are over the age of 60, who are not PhilHealth members and who earn less than P1,000 a month. Note that someone over the age of 60 and made 120 monthly contributions to PhilHealth will now be covered for the rest of his or her life, without paying any more premiums.


By Michael Tan, Pinoy Kasi, Philippine Daily Inquirer, May 20, 2009

PhilHealth coverage and ‘folk illnesses’

Last Wednesday I explained why we need a government health insurance system like PhilHealth, and who can become members and beneficiaries. Today we’ll go into some of the medical expenses that can be covered.

The information I’m using comes mainly from Dr. Mads Valera, the senior vice president for health policy at Philippine Health Insurance Corp. (PhilHealth) , who very kindly gave me three hours to run through some of the more important benefits. We also had some interesting discussions about bangungot [nightmare] possibly being a genetic problem, and which I’ll share in a future column. (If you need some information right away, you can look at my book, “Revisiting Usog, Pasma, Kulam.”)

Last Wednesday I gave a pop quiz eligibility for PhilHealth membership. Let’s do another pop quiz about coverage. Which of these are covered by PhilHealth: natural deliveries, dialysis, cataract operations, liposuction? Let me make it more difficult by asking if usog, pasma, kulam and bangungot are covered.

Usog and other “folk illnesses” are not covered by PhilHealth unless two important conditions are fulfilled. First, your physician must give a diagnosis for a condition that is recognized by Western medicine and by PhilHealth (e.g., bangungot might actually be a heart problem called “long QT syndrome,” but then that syndrome still isn’t recognized by PhilHealth); and second, your expenses for treating the recognized illness must be incurred during hospitalization, and this can include room and board, some diagnostic procedures and medicines.

Maternity packages

Let me give you the answers now to the other questions in the pop quiz.

For a long time, only caesarian deliveries were reimbursable, a policy which was criticized because it seemed to encourage both patients and obstetricians to go for a caesarian even if it was not necessary.

PhilHealth has since modified that policy, offering a “maternity care package” that includes “spontaneous natural deliveries.” The package is for P4,500, with plans to increase this to P6,500. The package can be used both in hospitals as well as in accredited lying-in clinics, but not for home deliveries.

The expansion to include lying-in clinics is a welcome one because many low-income Filipinos prefer going to a lying-in clinic, which is cheaper than a hospital. The P4,500 reimbursement goes a longer way to cover costs incurred in a clinic rather than in a hospital.

In principle, the maternity package can cover pre- and post-natal care as well, but PhilHealth is still fine-tuning how this can happen, and what would be included for pre- and post-natal care.

Let’s move on with the pop quiz. Yes, hemodialysis is covered if it is used for end-stage renal disease. In terms of reimbursement payments made by PhilHealth, hemodialysis was in fact at the top of the list in 2008. (In terms of actual payments though, caesarian deliveries topped the list, PhilHealth paying out P2.6 billion.)

Cataract removal? Again, yes, this is covered, and is an important benefit for the elderly.

Cosmetic vs reconstructive

Finally, liposuction. Even if the liposuction is conducted in a hospital, technically, it would not be covered because cosmetic procedures are not covered. Note though that some “reconstructive” procedures are covered. PhilHealth uses the definitions of the Philippine Association of Plastic, Reconstructive and Aesthetic Surgery to make the distinction: “Cosmetic surgery is surgery performed primarily to improve or change a person’s appearance, which is already normal but may not conform to one’s self image. In contrast, reconstructive surgery is performed primarily to improve or correct body deformities resulting from trauma, disease or birth defects.”

Here’s a concrete example of how this distinction is made: silicone breast implant would not be reimbursable if done only for “cosmetic” purposes, but if it is done after the removal of breasts (e.g., in cancer), it would be considered “reconstructive.”

PhilHealth relies on medical specialists to draw up guidelines to what illnesses and medical procedures can be reimbursed, and it’s almost fascinating to look at how they evaluate the cases.

There are many debates on what procedures should be covered. Cosmetic procedures are not reimbursable because they’re considered too much of an individual concern, without any life-threatening implications. In richer countries though, some cosmetic procedures are allowed—even sex reassignment, for example—because the low self-esteem of the individual might lead to serious depression, or even suicide.

Rare illnesses are also generally excluded in PhilHealth, but one could argue, too, that precisely because they’re so rare, and expensive to treat, society should help the patient and his or her family.

For a country like the Philippines, priorities need to be built around what’s most needed by the majority of the population, and right now that would mean the poor. PhilHealth’s important “if” for reimbursement is hospitalization and this ends up excluding many basic medical procedures that the poor need. For example, I was asked for help recently by an employee whose father was having problems with urination. The urologist had ordered ultrasound to determine if there were stones or not, and a PSA to see if there was prostate cancer. The family could not afford the procedures, but asked around and were told that if they checked into a hospital, the procedures could then be performed and reimbursed through PhilHealth. It’s a roundabout way, and risky in the sense that they could incur more expenses around the hospitalization than PhilHealth will cover, but that’s how health care works (or doesn’t work) in our system.

PhilHealth helps to make it easier to survive in our system, but we need to do our part as well, making sure our employees, including household help, are covered. Meanwhile, expect more voices to be heard from socially-oriented physicians to continue to expand PhilHealth’s coverage. With elections around the corner, we might want to pressure politicians as well to be clear on how they view PhilHealth’s role.


By Michael Tan, Pinoy Kasi, Philippine Daily Inquirer, May 22, 2009

HAIN joined 2009 AIDS Candlelight Memorial

Quezon Memorial Circle, May 15, 2009

RGS Level 2

HAIN conducted the Level 2 workshopn on Religion, Gender and Sexuality (RGS) at Hotel Elizabeth in Baguio City last May 2-4. Nineteen RGS fellows from NCR, Visayas and Mindanao joined the workshop together with resource speakers which included Dr. Mike Tan, Fr. Percy Bacani and Dr. Caster Palaganas.

The RGS level 2 workshop was designed to:
* Discuss current updates on issues relating to RGS
* Identify bottlenecks in advocating RH in the communities
* Formulate possible strategies to advance RH advocacy and services in the communities amidst Church objections
* Recognize lessons learned from various groups in advocating RH vis-a-vis religion issues
* Design training modules to educate RH and RGS issues in different community settings or sectors
* Formulate a strategic plan on how they will use the modules in educating their respective communities/sectors on RGS issues and concerns

Kalusugan Ko, Karapatan Ko: Antipolo City Health Workers Training-Workshop

HAIN has trained health workers of Antipolo City on Antipolo gender, sexual and reproductive health concepts and principles in relation to primary health care approach.

A total of 49 participants from 16 barangays of Antipolo City gathered in a training workshop last March 2009 at Loreland Farm Resort, Antipolo City. This lived-in activity aims to build the capacity of barangay health workers, barangay nutrition scholars, nurses and midwives on topics related to reproductive health.

The participants were divided into batches. First batch of health workers attended March 12-14, 2009 were from District 1 -Barangays Bagong Nayon, Beverly Hills, Inarawan, Mambugan, Mayamot, Muntindilaw, San Isidro and Sta. Cruz. It was followed by second batch last March 19-21, 2009 from Barangays Calawis, Cupang, Dalig, Dalig, Dela Paz, San Luis, San Jose, San Juan and San Roque.

Both trainings included lecture discussions on gender, international mechanisms related to sexual and reproductive rights, principles of primary health care, adolescent reproductive health, STD, HIV and AIDS, natural fertility management, modern family planning methods and interactive workshops on leadership skills and communication strategies. The participants are expected to echo their learning in their respective communities.

HAIN organized the event with support from the David and Lucile Packard Foundation, in collaboration with the City Health Office. The Provincial Government of Rizal had extended their support with the presence of Vice-Governor Francisco San Juan, Jr. and local officials of Antipolo City as represented by Councilor Marino Bacani, Kagawad Toriano Garcia (in behalf of Brgy. Captain Leyva) and Mr. Rowell Macapagal (in behalf of Mayor Leyble) from City Social Welfare and Development Office.

The said activity is part of HAIN’s on-going project in Antipolo that aims to develop baseline information on health issues, program intervention and strategies towards information and education on primary health care and reproductive health among Antipolo residents. As part of this project, HAIN conducted a community needs assessment in Antipolo last year to assess the training needs of the health workers as well as information needs of the community.

10 Reasons Why You Should Kick the Habit of Smoking

Without doubts, smoking cigarettes continues to be blamed for major respiratory illnesses. Margaux Salazar’s 100 REASONS WHY YOU SHOULD KICK THE HABIT enumerates the types of smoker:

* Fiddler: uses cigarettes to give him/her something to do with his/her hands.
* Nervous Type: uses cigarettes to hide feelings of anger, fear, or frustration (though it never solves any problem).
* Habitual Type: has the unconscious habit of having a cigarette in his/her mouth but gains no real pleasure.
* Pleasure Seeker: tries to create a plus pleasant feeling when driving, eating, etcetera, where he/she can’t find substitutes thereof.
* Real Addict: has physical craving that increases with more cigarettes.
* Pep Craver: tries to use cigarettes as a stimulant to get him/herself going-a “lift”.

Out of 100, Salcedo cited ten reasons why this habit must be (gradually) stopped:
* Every cigarette you smoke takes ten minutes off your life.
* Each cigarette makes fatty deposits stick in your arteries. It disrupts your blood vessels. It leads to high blood pressure.
* It may lead to cancer of the mouth. It may lead to cancer of the larynx which surfaces to the neck and spreads to lymph glands. Most laryngeal cancers begin near the vocal chords, causing hoarseness and other changes in the voice.
* It increases the risk of gum disease and tooth loss thus, damages teeth and causes bad breath. It dries the skin thus, lowers the amount of nutrients for the skin and lessens the protection from skin-damaging agents.
* Tobacco is the world’s leading cause of death, followed by lower respiratory infection and AIDS.
* In the Philippines, ten Filipinos die by the hour of tobacco-related diseases. It is estimated that 20,000 Filipinos die each year due to smoking-related illnesses and this is expected to rise steadily over the next few years.
* A smoker more than 40 years old with one or more of the following: chronic cough, lots of phlegm, and breathlessness may be suffering from chronic obstructive pulmonary disease (COPD). Women with COPD are most likely to die than men.
* It can cause impotence. The other reproductive side effects of smoking include menstrual problems, reduced fertility, and premature menopause. Women smokers have an increased risk of cervical and vulvar cancer. They also have lower fertility rates. Those who use oral contraceptives at the same time are up to 40 times more likely to have a heart attack.

Smoking and exposure to second-hand smoke among pregnant women are a major cause of spontaneous abortions, stillbirths, and sudden infant death syndrome (SIDS). It increases the risk of low-birth weight babies and health and developmental problems.

According to the American Council on Science and Health, smoking during pregnancy has been recognized as the single most important determinant of poor fetal growth in the developed world.

* Women who stop smoking reduce their risk of dying prematurely. Ten to 15 years after quitting, a female ex-smoker’s risk of stroke is almost equal to that of a woman who never smoked.

* Spouses of smokers have an approximately 30 percent increased risk of lung cancer.

Although non-smokers get lung cancer, the risk is about ten times greater for smokers.

Passive smoking is known to cause fetal growth impairment, infant, bronchitis, pneumonia, and middle ear disease in children. Exposure to smoke is responsible for up to 13 percent asthma cases, 13 percent of ear infections, and 20 percent of all lung infection in children under five.

In the first twenty minutes after quitting, the blood pressure returns to normal and circulation improves in hands and feet. After eight hours, the oxygen levels in the blood normalize and chances of heart attack drop. At 24 hours, carbon dioxide is eliminated from the body and the lungs start to clear out mucus and other debris.

Two days later, nicotine is no longer detected in the body and the ability to taste and smell is improved. Within 72 hours, breathing becomes easier and energy levels increase. On the second to 12th week, the blood circulation improves. Then breathing improves after three to nine months.

If you are smoke-free for five years, the risk of heart attack drops to half of that of a smoker and if you reach ten years, the risk of lung cancer drops to half and the risk of heart attack falls to the same level as a non-smoker.

Citation:
Salazar, Margaux. “100 REASONS WHY YOU SHOULD KICK THE HABIT”. Style Weekend: December 26, 2008, pages 15-17.

Consumers’ Action for Empowerment Launched

February 20 marked the successful launching of Consumers’ Action for Empowerment at Sulo Hotel with thirty-four organizations, five community health associations, and at least four groups from media as attendees.

Shortened for Consumers’ Action, this group stresses the need to unite and assert for the people’s right on access to safe, affordable, quality, and effective medicines. The group believes that it is high time for the creation of a consumers’ group to be participated by community leaders, people’s organizations, hospital workers, advocates, religious institutions, teachers, women’s groups, and consumers in light of the passage of Universally Accessible Cheaper and Quality Medicines Act of 2008 (RA 9502).

Dr. Eleanor A. Jara, member of Consumer’s Action Secretariat and Executive Director of CHD, remains “not very optimistic” and reckons in a statement the inherent flaws of RA 9502:

The law failed to dismantle foreign control over the drug industry which is one of the reasons why millions are unable to buy life-saving essential meds because of exorbitant prices. Multinational companies dictate high prices through the World Trade Organization – Trade Related Aspects of Intellectual Property Rights Agreement (WTO-TRIPS).

There is no true local drug industry in the Philippines. Local manufacturers can only produce 200 kinds of essential medicines despite the fact that 80 % of the more than 17,000 registered drugs are already off-patent. Instead of developing the local drug industry, the government encourages parallel importation which promotes the policy of dependence and which can eventually kill the local drug manufacturers.

Despite the clamour and strong recommendation of the health sector representatives and people’s organizations, the law omitted the creation of a Drug Price Regulatory Board which could have been ensured the democratic representation of consumers and other stakeholders.

‘Strengthening’ BFAD by leaving it to generate its own income with the goal of cutting it off from the national budget is tantamount to government reneging on its obligation and makes BFAD more vulnerable to private interests and influences.

The said group, which is spearheaded by Council for Health and Development (CHD), Health Action Information Network (HAIN), Health Alliance for Democracy (HEAD), Health Students’ Action (HSA), Community Medicine Foundation (COMMEDF), Kilos Bayan Para sa Kalusugan, and MEDHERBAL PHARMACY, shall act as a watchdog of consumers on accessibility of safe and essential medicines including drug price monitoring on a nationwide scale and networking with other concerned groups and individuals.

Minding Mental Health

On the positive side, the global community’s understanding of different mental illnesses have grown by leaps and bounds. Unlike in the early centuries where mentally-impaired patients were either tortured, imprisoned, or killed on the wrong belief that the person was possessed by evil spirits, there is now a growing awareness that people suffering from mental disability needs treatment and care.

And now, for the not-so good news. Despite the advancements in the fi eld of mental health, a large percentage of the global population still has no access to treatment and care. In addition, the number of people suffering from certain mental illnesses is expected to sharply rise in the years to come. These issues are discussed in the editorial, “Untangling the mental haywire,” which also looks into the relatively new phenomenon of Internet addiction.

Suicide is a pressing mental health concern and this is discussed in the article “Intended death: a look at suicidal behavior.” The sidebar shows how health workers and advocates can tap the media in preventing suicides, not just in providing the public with information but also through the responsible coverages of suicide cases.

In conflict-ridden areas, much of the intervention focuses on the physical health of the civilians, but the article “The hidden battlefi eld” shows a neglected area of concern - mental health. The article details how the stressors generated by wars affect the mental health of both the civilians and combatants.

“Community-based mental health programs: back to basics” shows how the implementation of community-based programs can help bridge the treatment gap in developing countries.

It provides tips on how to implement a community-based program, as well as examples from three countries which have tapped the involvement of the community and the family in caring for a patient.

The last article, “Crash and burn” looks into the mental health of NGO staff and humanitarian aid workers, whose needs have been largely overlooked as they go about the business of helping other people.


Source: Issue No. 14, Health Alert Asia Pacific
HAIN will post the articles inside this issue separately. If you like to request for copies of the newsletter, please email hain@hain.org

Primary health care-based approach to sexual and reproductive health and rights

As we celebrate the 30th year anniversary of the Alma Ata declaration on Primary Health Care, and as the debate on reproductive health continues, HAIN is proud and happy to publish this material entitled, “Primary Health Care Approach to Sexual and Reproductive Health and Rights.”

The comprehensive primary health care (PHC) approach articulated at Alma Ata remains as relevant today as it was 30 years ago. Certainly, sexual and reproductive health and rights are integrated in the concepts of primary health care.

The PHC approach has provided the shift in perspective from a medicalized and biomedical framework to a more sociopolitical-cultural and biopsychosocial approach to health.

The principles of PHC clearly embody the role of social determinants in health, ie, poverty, inequity, social injustice, as factors lying outside the medical and public health services that strongly determine health. As we look at the experiences of countries, it is evident that countries which achieved the more lasting improvements in health were those with a commitment to equitable development.

It is on these premises that the focus on sexual and reproductive health should not be on population control or sex act itself (as is the direction of the current debate), but on population as it relates to poverty, environment, education and other social issues. The campaign for the recognition of sexual and reproductive health and rights should be seen in the over all pursuit of human rights, including the right to health and the right to development. These rights can only be attained if we struggle against unequal and unjust social, economic and political structures which are the root causes of poverty, ill health, and underdevelopment.

HAIN hopes that that material will provide our readers this perspective.

-- from the preface of the book by Dr. Edelina de la Paz, Executive Director of HAIN