1. These slides are mainly from the 75-slide “AMIGA-UP CHDP Presentation” developed by Dr Paterno & Dr Opina-Tan TO ALL CONSULTANTS: (A) An updated edition will be presented to the UP- DFCM by January next year (B) This is for your use during the December 12 residents’ community medicine report (all pictures were removed)

2. UP MANILA COMMUNITY HEALTH AND DEVELOPMENT PROGRAM PROVINCIAL GOVERNMENT OF CAVITE through THE AMIGA INTER LGU HEALTH COLLABORATION COUNCIL A lfonso M endez I ndang G en. Emilio Aguinaldo A madeo

3. Community Health and Development Program a partnership between the University and the Local Government and the people of the municipality where planning, implementation, monitoring and evaluation are done with the active participation of the community

4. CHDP History 2007 UP BOR approved creation of UP Manila Community Health and Development Program Identified a common site for immersion of students from different colleges Formed a partnership with the Municipality of San Juan, Batangas in 2007 2013 –MOA with San Juan, Batangas ended –MOA with AMIGA Interlocal Health Zone was signed

5. CHDP Conceptual Framework

6. CHDP CONCEPTUAL FRAMEWORK UNIVERSITY of the PHILIPPINES as an effective instrument of national development COMMUNITY as a partner for development UP’s resources as inputs: academic knowledge, skills, human resources, network A university better equipped to be an effective instrument of national development PRIMARY HEALTH CARE Interdisciplinary / Intersectoral (Integrative) Addressing social determinants of health Rights-based approach to health Training – community is not a classroom Research – community is not a laboratory Service – community is not a charity case A healthier and more empowered community A higher level of understanding of the university’s role in national development

7. Use of Primary Health Care as a Guiding Framework Health is a human right People have the right and duty to participate in all stages of program devt Health is multi-factorial and therefore efforts must be comprehensive, multi-sectoral & inter- disciplinary Government have the main responsibility for the provision of services Services & strategies must be appropriate, accessible, acceptable, affordable, available, effective, empowering, equitable & efficient

8. Addressing the Social Determinants of Health Governance Economics Gender Environment Religion Education Socio-cultural beliefs

9. Use of the Rights-Based Approach to Devt Human Rights are: > Universal > Non-Discriminatory > Inalienable > Interdependent > Inclusive People must Participate in the devt of programs that are meant to fulfill rights There must be Accountability if human rights are violated

10. CHDP Vision Statement An academic community imbued with social responsibility, professionalism, compassion, and sense of nationalism, facilitating socioeconomic, political and cultural development in partnership with the Filipino people.

11. CHDP Mission Statement The UPM CHDP promotes participatory socioeconomic, political and cultural development, in which health is included, with the community, utilizing the Primary Health Care Approach. The program also provides reality-based and interdisciplinary community field experiences that can help students internalize their roles in nation building.

12. CHDP General Objectives to provide learning opportunities for both the faculty and students of the University of the Philippines in the principles and practice of community health and development (LEARNING) to assist communities attain increasing capacities in their own health care and development through the Primary Health Care approach (SERVICE & RESEARCH)

13. CHDP Coregroup Monthly meeting Assists in program planning, implementation and evaluation and CHDP policy-making Faculty member/members –community immersion subject/course –field practice course Voluntary basis

14. AMIGA-UP Partnership

15. AMIGA Inter-LGU Health Collaboration Council 5 Municipalities in Cavite AA lfonso M endez I ndang G en. Aguinaldo A madeo

16. Interlocal Health Zone Introduced by WHO as Integrated Health System or District Health System Primary objective –Improve the efficiency and effectiveness of the health delivery system Integration of the public health services (RHU) and the hospital services (District Hospital)

17. AMIGA Inter-LGU Health Collaboration Council Memorandum of Agreement signed last February 2013 –AMIGA Interlocal Health Zone –Provincial Government of Cavite –UP Manila

18. AMIGA (Formulated by AMIGA, September 2004) Vision –Malusog na pamayanan na may kakayahan at pagkakaisa Mission –Ang samahang AMIGA, sa pakikipag-ugnayan sa iba’t ibang samahan, ay maghahatid ng abot-kaya, mataas na antas, tapat at taos-pusong paglilingkod pangkalusugan lalo’t higit sa nangangailangan tungo sa pangkalahatang kagalingan ng pamayanan ng Alfonso, Mendez, Indang, Gen Aguinaldo at Amadeo

19. Alfonso (Dr. Evangeline Manzo) 1 st class6998 hectares Pop – 60 630 32 bgys Mendez (Dr. Jose Auditor) 5 th class2325 hectares Pop – 33 520 26 bgys Indang (Dr. Rosa Alegre) 1 st class8920 hectares Pop – 77 598 36 bgys Gen Aguinaldo (Dr. Vicente Gloriani - AMIGA president ) 5 th class5383 hectares Pop – 19 069 14 bgys Amadeo (Dr. Melinda Villanueva) 4 th class4790 hectares Pop – 33 457 26 bgys

20. Activities of AMIGA and UP CHDP

21. 1.AMIGA Orientation (March 5-7, 2013 / half-day per town) 2. Problem Identification & Prioritization April-July 2013 FGD’s (May to July 2013) Town & Barangay-Level Community Appraisal anchored on the 6 building blocks (April to Dec) Barangay Assemblies (April to Dec) Ang unang pumasok sa isip ko na gagawin ng UP ay ang sumusunod: Naisip ko din na sana gawin ng UP ang sumusunod: Sana ay HINDI gawin ng UP ang sumusunod:

22. 3. July 18 Meeting * Presentation and Validation of Data Collected From April to July * Identification of AMIGA-wide program focus for the AMIGA-UP Partnership

23. Data Collected Health status Perceived health needs by the community Description of the health system (based on the 6 building blocks)

24. Top Causes of Morbidity Source: Municipal Annual Reports AlfonsoMendezIndangGen AguinaldoAmadeo 1. Upper Respiratory Tract Infection 2. Acute Nasopharyngitis 3. Acute Tonsillopharyngitis 4. Hypertension 5. Urinary Tract Infection 6. Acute gastroenteritis 7. Wounds 8. Diabetes Mellitus 9. Bronchial Asthma 10. Allergy 1.Upper Respiratory Tract Infection 2.Fever of unknown origin 3.Abdominal Pain 4.Other Non infective Gastroenteritis & Colitis 5.Other Disorder of Urinary System 6.Cough 7.Dizziness 8.Rash and other Non specific Skin Eruption 9.Certain early complications of Trauma, not elsewhere classified 10.Dorsalgia 1.Common Colds 2.Skin Diseases 3.Urinary Tract Infection 4.Acute Respiratory Tract Infection 5.Hypertension 6.Bronchial Asthma 7.Gastrointestinal Tract Disorders 8.Diarrheal Diseases 9.Tension Headache 10.Arthritis 1.Common Colds 2.Acute Tonsillitis 3.Urinary Tract Infection 4.Infected Wounds 5.Pneumonia 6.Allergic Contact Dermatitis 7.Hypertension 8.Bronchitis 9.Diarrhea 10.Gastritis 1.Hypertension 2.Wound 3.Upper Respiratory Tract Infection 4.Osteoarthritis 5.Skin diseases 6.Urinary Tract Infection 7.Acute Gastroenteritis

25. Top Causes of Mortality Source: Municipal Annual Reports AlfonsoMendezIndangGen AguinaldoAmadeo 1.Acute Myocardial Infarction 2.Cancer 3.Cerebrovascular Accident 4.Pneumonia 5.Diabetes Mellitus 6.Renal Failure 7.Congestive Heart Failure 8.Electrolyte Imbalance secondary to Senile Debility 9.Vehicular Accident 10.Chronic Obstructive Pulmonary Disease 1.Cancer 2.Acute Myocardial Infarction 3.Chronic Obstructive Pulmonary Disease 4.Congestive Heart Failure and other complications of heart diseases 5.Pneumonia 6.Cerebrovascular Accident 7.Diabetes MellitusType II 8.Chronic Renal Failure 9.Unspecified severe protein-calorie malnutrition 10.Fetal death of unspecified causes 1.Myocardial infarction 2.Cardiovascular accident 3.Degenerative disease 4.Diabetes 5.Congestive heart failure 6.Cancer 7.Pneumonia 8.Kidney diseases 9.Pulmonary Tuberculosis 10.Shock 1.Acute Myocardial Infarction 2.Cancer 3.Cerebrovascular Accident 4.Accidents (accidents, gunshot wounds, drowning) 5.Renal Disease 6.Pneumonia 7.Chronic Obstructive Pulmonary Disease 8.Diabetes Mellitus with complications 9.Septicemia 10.Bronchial Asthma 1.Cerebrovascular Disease 2.Cancer 3.Pneumonia 4.Acute Myocardial Infection 5.Gunshot wound

26. GROUP/SECTOR# of FGDs Senior Citizens3 BHWs8 Miyembro ng 4Ps9 Midwives5 Brgy Council2 Elementary School teachers1 Pastoral council1 Persons with disability1 TOTAL30 Frequency of Focus Group Discussions Conducted per Sector or Group (May to July)

27. AMIGA’s Top 5 Perceived Health Problems based on FGDs (May-July 2013) 1. Problema sa kalinisan/ basura 2. Problemang pinansyal 3. Kulang sa gamot 4. Pagkakaroon ng sakit (non-communicable) 5.5 - Problema sa bisyo (alcohol, sigarilyo, drugs) 5.5 - Kakulangan sa health staff

28. Choices for Priority Problem (Problems identified by the health leaders during the July 18 discussion) Non communicable diseases – hypertension and diabetes Budget for health Inadequate human health resources Patients with disabilities Solid Waste Management Supply of medicines Animal Bite Center Lack of livelihood

29. Hypertension and Diabetes This prioritized problem on NCD’s (HPN & DM) were chosen by the health leaders of the community on July 18 based on: Morbidities and mortalities reports from RHUs Limited health programs for control of Hypertension and Diabetes

30. 4. Problem Tree Analysis by the Community (July-Oct 2013) Conducted in every town (several barangays per town) / More than 30 SGD’s Initial question to get the discussion started: “Bakit hindi kontrolado ang hypertension at diabetes sa inyong komunidad?”

31. 5. October 11 meeting AMIGA Health & LGU leaders, together with UP Manila discussed the results of the problem tree analysis done from July to Oct Some general strategies to address the factors that were identified and analyzed in the problem tree discussions were discussed Formulation of criteria for the selection of priority barangays

32. 6. Dec 6 Meeting Selection of Priority Barangays Per Town (based on a criteria collectively developed by AMIGA & UP during the October 11 meeting) Formulation of Goals: * Increase the proportion of controlled HPN & DM by 25% in selected barangays in 5 years * Not more than 25% of pre-HPN and those with risk factors will develop the disease in 5 years (Primary Prevention Goal)

33. Discussion of Proposed General Strategies –Prevalence Study –HPN and DM registry Risk Factor Assessment –Capacity-building of health workers on the detection and management of Hypertension and Diabetes Screening Assessment Treatment Counseling

34. Discussion of Proposed General Strategies –Education and information campaigns –Provision of equipment needed for HPN and DM management –Provision of anti-hypertension and hypoglycemic agents to pateints –Collaboration with existing organizations – DM Club, CHTs, schools –Implementation of anti-smoking ordinance

35. Upcoming AMIGA & UP Activities Conduct a prevalence study on Hypertension and Diabetes Conduct a baseline study: > Determine prevalence of behavioral risk factors such as tobacco use & diet -and- biological risk factors such as obesity > Determine the current knowledge, attitudes and practices of the community on Hypertension and Diabetes (Proposals that will be developed by AMIGA & UP to accomplish the researches stated above will be submitted to relevant bodies for approval and funding)

36. Upcoming AMIGA & UP Activities Engagement of –organized groups in the community and barangays who are potential partners for program development and implementation Interprofessional Education Program –Patient and Family Care Medicine, Nursing, Pharmacy, Social Work