Fcm 3.03 - Violence And Injury Prevention Program

4.03 Violence and Injury Prevention Program Group 8 I. II. III. IV. V. VI. VII. VIII. IX.

Introduction Violence and Injury Prevention (VIP) Program VIP Program Strategies Policies Objectives Scope General Guidelines Specific Guidelines Implementing Mechanism A. Violence and Injury Prevention Program B. Program Management Committee X. Monitoring and Evaluation A. Online National Electronic Injury Surveillance System B. Philippine Network for Injury Data Management System XI. Roles and Responsibilities

INTRODUCTION/RATIONALE  2009 (WHO): road crashes, suicide and violence were among the main causes of death worldwide for people aged 10 to 24 years  2011 (WHO): injuries were responsible for 9% of all deaths with road traffic injuries claiming nearly 3,500 lives each day, making it among the 10 leading causes of mortality globally.  In 2011, the Violence Prevention Alliance (VPA) developed the plan of action geared towards increasing the priority of evidence-informed violence prevention, building the foundations for violence prevention, and implementing violence prevention strategies.  United Nations General Assembly proclaimed 2011–2020 to be a Decade of Action for Road Safety to stabilize and reduce global road traffic fatalities by 2020.  2010 (The Global Burden of Diseases, Injuries, and Risk Factors Study): interpersonal violence, road injury, drowning, and self-harm (suicide) ranked 6th, 11th, 17th, and 27th, respectively, on the leading causes of premature deaths in the Philippines  2005-2010: Accidents are the fifth leading cause of mortality for this period as reported in the Philippine Health Statistics  2010-2012 (The Online National Electronic Injury Surveillance System [ONEISS]): o Transport or vehicular crash was the leading cause of unintentional injuries o Interpersonal violence (mauling/assault, contact with sharp objects, and gunshot) was the leading cause of intentional injuries.  DOH: o Focal agency with respect to violence and injury prevention o Shall design, coordinate and integrate plans, projects and activities of various stakeholders into a more effective and efficient system geared towards violence and injury prevention  The Violence and Injury Prevention Program o Has been institutionalized as one of the programs of the Disease Prevention and Control Bureau (DPCB) formerly, National Center for Disease Prevention and Control (NCDPC). o The program aims to reduce mortality, morbidity and disability due to the following intentional and unintentional injuries: 1. Road traffic injuries 2. Interpersonal violence including bullying, torture and violence against women and children 3. Falls 4. Occupational and work-related injuries 5. Burns and fireworks-related injuries 6. Drowning 7. Poisoning and drug toxicity 8. Animal bites and stings 9. Self-harm / suicide 10. Sports and recreational injuries  The program is in coordination with the following: Child Injury Prevention Program, Violence Against Women and Children Program and other DOH Offices  In the first quarter of 2013, the Essential Non-Communicable Disease Division (ENCDD), together with the Development Academy of the Philippines (DAP), developed the 5-year Strategic Plan for 2013-2017.

October 16, 2015  With the increasing mortality, morbidity, and disability due to violence and injury, there is a need to complement and enhance the existing policy on Violence and Injury Prevention in order to rise to the challenge of addressing this rapidly growing public health concern. It is also imperative to develop an action framework that serves as the strategic road map towards the prevention of violence and injuries. VIOLENCE AND INJURY PREVENTION PROGRAM (VIPP) The objectives of the VIP Program are the following: 1. To reduce the number of deaths from violence and injuries 2. To reduce disability caused by violence and injury 3. To enhance capacity of CHDs and other stakeholders in the prevention of violence and injury 4. To develop & implement evidence-based policies, standards and guidelines in the prevention of violence and injury 5. To strengthen collaboration with stakeholders in the prevention violence and injury 6. To ensure reliable, timely, and complete data and researches on violence and injury 7. To advocate for alternative health financing schemes for trauma care VIP PROGRAM STRATEGIES A. Evidence-Based Research and Electronic Surveillance System o Multi-disciplinary and multi-sectoral interventions shall be developed based on evidence-based research. DOH shall establish and institutionalize a system of data reporting, recording, collection, management and analysis at the national, regional, and local levels. An information system, that is, Online National Electronic Injury Surveillance System (ONEISS) and Philippine Network for Injury Data Management System (PNIDMS), shall be fully operationalized for this purpose. B. Networking and Alliance Building o DOH shall promote partnerships with and among stakeholders to build alliance and networks and to generate resources for activities related to VIPP. C. Capacity Building and Community Participation o DOH shall develop and enhance the violence and injury prevention capabilities of a wide range of sectors and stakeholders at the national, regional and local levels. D. Advocacy o DOH shall advocate to LGUs for ordinance development and lobby to Congress for enactment of laws. E. Equitable Health Financing Package o DOH, in collaboration with various stakeholders, shall advocate to health financing institutions and financial intermediaries, i.e. the Philippine Health Insurance Corporation (PHIC) and insurance companies, the development and implementation of policies that would be beneficial for the victims of all forms of violence and injury. F. Service Delivery o In collaboration with stakeholders, DOH shall institutionalize systems and procedures for the integration and provision of services at the community level. In collaboration with various stakeholders, DOH shall undertake advocacy, information and education, political support, and multi-sectoral action on violence and injury prevention. Appropriate interventions at all levels of prevention shall be crucially provided. G. Six (6) E’s. o Strategies shall utilize the concept of the six E’s in the prevention of violence and injuries. The six E’s are the following: 1. Education entails wide dissemination of information and communication related to violence and injury prevention 2. Enactment / Enforcement of laws and policies related to violence and injury prevention 3. Empowerment of all stakeholders in the implementation of VIPP. This also covers the provision of

Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS

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Violence and Injury Prevention Program (VIPP) psychosocial support to the victims of violence and injury to help them recover from the psychological trauma 4. Engineering control provides the most effective way of reducing the cause and impact of violence and injuries. This involves the improvement of facilities and infrastructures to promote safe environments 5. Emergency Medical Services prior to hospital care. This is vital in providing pre-hospital trauma life support to the injured on site at the soonest possible time so as to prevent needless mortality or long-term morbidity or permanent disability 6. Engagement in surveillance and research to promote evidence-based, substantial, scientific, and systematic approach to VIPP. H. Monitoring and Evaluation o DOH, together with various stakeholders, shall identify indicators, targets and milestones for program monitoring and evaluation purposes. There shall be a regular audit and feedback mechanism of all VIPP-related strategies and activities.  According to the factsheet of the Online National Electronic Injury Surveillance System from January-March 2015 o NCR has the most number of reporting facilities per square area (Relative to actual area covered by each region) while region 4A has the least  alarming since there is a need for more reporting facilities in other provinces, especially the far-flung and hard to reach areas. o Majority of the injury cases have been reported by the family member of the injured patient which accounts for 51%. Around 46.4% of the reported cases were reported by the injured persons themselves. This number is lower than the previous group because other injuries are too severe and leave the patient debilitated which then entail the family members to be the ones to report the injury case. o Males (69.5%) are more exposed to injury than females (30.5%) from birth up to the age of 65. This may be because males are generally more active in work and play than females which make them more prone to injury. o However, for the age group above 65 years old, more females were injured than males.

3.03 time for going to school/work and the time going home from school / work respectively

Figure. Injury cases reported by External Causes of Injury from January to March 2015  Pre-admission data o 83% of all reported cases were injury cases brought to the ER; 16.7% were Out-Patient cases; only 0.3% were in-patient cases. o The most commonly sustained injuries were openwounds, abrasions and contusions. o Since majority of the cases were accidental in nature, most of the reported cases occurred on the road at 42.4% while 29.1% occurred at their homes.  Hospital data o Transport and vehicular crash-related cases: consistently the most common cause of injury. o Majority of these cases that were brought to the ER were not fatal and improved after treatment and were discharged (82.2%).

Figure. Injury cases reported by Type of Injury from January to March 2015

Figure. Injury cases reported by Age from Jan to March 2015  Majority of the total reported injury cases (56%) came from the age group of 20 – 59. This could be because this is the age group that are mainly engaged in occupational hazards and vehicular accidents, being active in their everyday life.  Age group of 0 – 19 years old accounted for 36.7% of the total reported injury cases which could imply that there are a number of accidents involving younger children. These may include cases of child abuse, unsuspecting vehicular accidents or even bullying.  January had the highest reported number of injury cases (37.4%) of all cases mainly because of fireworks-related cases.  When it comes to time of occurrence, it varies with the external cause of injury. The most common causes of reported injuries and their time of occurrence are the ff: o Fall-related injuries  8:00–11:59 am o Assault and sharp object-related: 8:00–11:59 pm (could be attributed to more violence occurring during night time) o Vehicular accident-related injuries: 8:00–11:59 am & 4:00–7:59 pm, attributed to the rush hours during the

 Vehicular accidents o More males (71.9%) were involved than females (28.1%), disproving the myth that men are better drivers than women. This is could be attributed to the drink-anddrive attitude of men and their generally more aggressive driving. o Majority of the reported vehicular related injuries were from the 20–59 age group (52.9%) mainly because they are the ones who drive. o As for the 0 – 19 age group, they account for 28.5% and could be attributed to their careless behavior as pedestrians, especially younger children. o Alcohol intoxication: major cause of risk factor for vehicular accident-related injuries o Motorcycles: The most common mode of transport in these injuries (56%) o Alarmingly, only 2.5% of these cases were wearing protective helmet. Additionally, only 4.4% of the reported car accident cases were wearing seatbelt at the time of incident. This implies the need for proper education of motorists and drivers alike for the importance of precautionary measures while driving. POLICIES The issuance on Violence and Injury Prevention shall be guided by the following policy statements: 1. The 1987 Philippine Constitution on Article II Section 15 states the right of the people to health protection and promotion. Article 13 Section 11, on the other hand, states

Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, GONZAGA V, LAURILLA, SOLIS

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Violence and Injury Prevention Program (VIPP)

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the availability to the people of all essential goods, health and social services at affordable cost. The Aquino Health Agenda (AHA), through the the so-called Kalusugan Pangkalahatan (KP), aims to achieve universal health care for all Filipinos. The National Objectives for Health (NOH) 2011-2016 aims to reduce morbidity and mortality from accidents and injuries. Culture of safety shall be the essence of Violence and Injury Prevention Program The integrated, comprehensive, and sustainable multisectoral approach to prevent violence and injury shall be developed at the grassroots level in close collaboration with committed multi-stakeholders. Highly effective and sustainable strategies shall be developed to effect changes that would lead to a significant reduction in mortality, morbidity and disability from violence and injuries. Establishing an emergency medical service system at the prehospital and hospital levels and ensuring the development of a sustainable mental health care after trauma-related emergencies are of paramount significance to VIPP.

OBJECTIVES General Objective: To reduce mortality, morbidity, and disability due to violence and injuries. Specific Objectives: 1. Promote a culture of safety in key settings such as home, schools, workplaces, and communities; 2. Enhance the capacity of Regional Offices, Local Government Units (LGUs), and other stakeholders as well as strengthen collaboration with them in the prevention of violence and injury 3. Develop and implement evidence-based policies, standards and guidelines 4. Ensure reliable, timely, and complete data and researches related to violence and injury prevention NATIONAL OBJECTIVES OF HEALTH FOR ACCIDENTS AND INJURIES OBJECTIVE 1: Mortality secondary to accidents and injuries is reduced. Indicator Target Baseline Mortality rate from accidents and 35 deaths by 39.1 injuries per 2016 (2011) 100,000 population Mortality rate from transport accidents 17.5 deaths 21.1 per 100,000 By 2016 (2011) population OBJECTIVE 2: Database for accidents and injuries is established. Indicator Target Baseline National Database Database for Specific established by None Accidents and 2010 Injuries

SCOPE This administrative order provides the action framework for the effective implementation of Violence and Injury Prevention Program in the Philippines. It covers all units and instrumentalities including attached agencies of the DOH. It also applies to all concerned national government agencies (NGAs), local government units (LGUs), academe, civil society organizations, faith-based organizations, community-based organizations, private sectors, and other relevant multi-sectoral stakeholders.

A.

GENERAL GUIDELINES Evidence-based Research and Electronic Surveillance System o Multi-disciplinary and multi-sectoral interventions shall be developed based on evidence-based research. DOH shall establish and institutionalize a system of data reporting, recording, collection, management and analysis at the national, regional, and local levels. An information system: Online National Electronic Injury Surveillance System (ONEISS) and Philippine Network for Injury Data Management System (PNIDMS) shall be fully operationalized for this purpose

B.

Networking and Alliance Building o DOH shall promote partnerships with and among stakeholders to build alliance and networks and to generate resources for activities related to VIPP.

C.

Capacity Building and Community Participation o DOH shall develop and enhance the violence and injury prevention capabilities of a wide range of sectors and stakeholders at the national, regional and local levels.

D.

Advocacy o DOH shall advocate to LGUs for ordinance development and lobby to Congress for enactment of laws.

E.

Equitable Health Financing Package o DOH, in collaboration with various stakeholders, shall advocate to health financing institutions and financial intermediaries, i.e. the Philippine Health Insurance Corporation (PHIC) and insurance companies, the development and implementation of policies that would be beneficial for the victims of all forms of violence and injury.

F.

Service Delivery o In collaboration with stakeholders, DOH shall institutionalize systems and procedures for the integration and provision of services at the community level. In collaboration with various stakeholders, DOH shall undertake advocacy, information and education, political support, and multi-sectoral action on violence and injury prevention shall be crucially provided.

G.

Six (6) E’s. o Strategies shall utilize the concept of the six E’s in the prevention of violence and injuries. a. Education entails wide dissemination of information and communication related to violence and injury prevention b. Enactment / Enforcement of laws and policies related to violence and injury prevention c. Empowerment of all stakeholders in the implementation of VIPP. This also covers the provision of psychosocial support to the victims of violence and injury to help them recover from the psychological trauma d. Engineering control provides the most effective way of reducing the cause and impact of violence and injuries. This also involves the improvement of facilities and infrastructures to promote safe environments e. Emergency Medical Services prior to hospital care. This is vital in providing pre-hospital trauma life support to the injured on site at the soonest possible time so as to prevent needless mortality or long-term morbidity or permanent disability f. Engagement in surveillance and research to promote evidence-based, substantial, scientific, and systematic approach to VIPP.

H.

Monitoring and Evaluation o DOH, together with various stakeholders, shall identify indicators, targets and milestones for program monitoring

RISK REDUCTION OBJECTIVES 1. Increase the use of safety belts among motor vehicle occupants by at least 75% 2. Increase the use of helmets among motorcyclists by at least 50% 3. Encourage the use of protective gears among cyclists and skaters by at least 50% 4. Reduce the use of firecrackers during festivities by at least 50% 5. Increase the level of awareness on common causes and preventive measures of accidents and suffocation or foreign bodies SERVICES AND PROTECTION OBJECTIVES 1. Increase the number of regional hospitals and medical centers with Burn and Trauma Unit. 2. Develop and institutionalize the Injury Prevention and Control program and surveillance network in all regional and provincial health facilities. 3. Develop and disseminate information campaign materials on injury prevention and control. 4. Increase the number of surgeons in regional hospitals and medical centers trained on burn and trauma management 5. Increase the number of regional health personnel trained on the epidemiology, prevention and control of accidents and injuries

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Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, GONZAGA V, LAURILLA, SOLIS

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Violence and Injury Prevention Program (VIPP) and evaluation purposes. There shall be a regular audit and feedback mechanism of all VIPP-related strategies and activities SPECIFIC GUIDELINES A. Public policies shall be developed and will include legislation, administrative issuances, fiscal measures and organizational constitution and bylaws that would effect changes towards creating safe environments and promoting safety-first mentality and behavior. Supportive environments for the actual implementation of those public policies and the provision of infrastructure where safety is the primary concern shall be made available. Safety-first behaviors are also encouraged and promoted at all ages. B. Community-based interventions to be implemented shall not be limited to capacity-building at the grassroots level that would make available well-trained, competent and gendersensitive first responders. Interventions shall also include the provision of community-based mental health, rehabilitative and palliative care. The pre-hospital care or pre-hospital trauma life support shall ensure the availability and accessibility of well-trained and competent first responders and/or emergency medical technicians in times of traumarelated emergencies. C. Hospital Care Rehabilitation shall include preventing further the complications of those trauma-related emergencies and to lessen the burden of disability due to violence and injury. D. Advocacy activities shall include information drive, education and communication campaign geared towards promotion of safety and hence, prevention of injuries. E. All stakeholders shall be enjoined and encouraged to participate in the surveillance system and to contribute to the research agenda to further the strategies in implementing the VIPP. F. The formation of the Violence and Injury Prevention Alliance (VIPA) shall make more stakeholders involved in the promotion of safety and prevention of violence and injury. G. Health Systems Strengthening shall be done to provide sustainable community-based health services such as but not limited to emergency medical services at the hospital and hospital levels, mental health care after trauma-related emergencies and rehabilitative care. H. Monitoring and evaluation of VIPP based on key result areas and key performance indicators shall be done regularly to gauge the status and progress of VIPP.

IMPLEMENTING GUIDELINES 1. The DOH shall be the focal agency responsible for designing, coordinating and integrating plans, programs, strategies and activities of various stakeholders into an effective and efficient system geared towards violence and injury prevention.  VIPP is hereby institutionalized as one of the core programs of the National Center for Disease Prevention and Control (NCDPC). 2. The Program Management Committee (PMC) shall be organized to oversee the implementation, monitoring and evaluation of the program and to ensure its sustainability.  PMC Sub-committees according to following key areas of concern: o Road Traffic Injuries o Burns and Fireworks-related Injuries o Drowning o Falls o Sports and Recreational Injuries

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o Interpersonal Violence-Related Injuries including Violence Against Women and Children (VAWC), Bullying and Torture o Animal Bites and Stings o Self-Harm/ Suicide o Occupational and Work-Rekated Injuries o Poisoning and Drug Toxicity 3. To ensure a more comprehensive and integrated approach, PMC shall collaborate with other programs from the Family Health Office and other concerned offices 4. The Undersecretary/ Assistant Secretary of Health who has the direct supervision over the Degenerative Disease Office shall designate a National Program Coordinator who shall be working together with the National Focal Person (Program Manager) PROGRAM MANAGEMENT COMMITTEE  Provide direction and technical support on policies and plans pertaining to the prevention of violence and injury  Provide the forum for coordinating all aspects of the implementation of the program  Chaired by the Director IV of the Disease Prevention and Control Bureau (DPCB) with the following members: o Chief of the Essential Non-Communicable Disease Division o National Focal Person (Program Manager) of VIPP o Representatives from CHED, DepEd, DOTC, DPWH, DOLE, DSWD, DILG, MMDA, and Philippine National Police. o Representatives from specialty societies and other agencies / organizations which can greatly contribute to the various aspects of violence and injury prevention.  Subdivided into sub-committees to undertake more specific policy interventions and activities in relation to each area of concern. Each sub-committee shall have an inter-disciplinary composition.  PMC Functions: o Recommend to the Secretary of Health VIPP-related plans, programs, strategies and activities o Ensure the implementation of integrated, comprehensive, sustainable and gender-responsive community-based VIPP o Ensure the collection and analysis of violence- and injuryrelated data o Empower and engage all the stakeholders to participate in the VIPP thru Violence and Injury Prevention Alliance (VIPA) o Monitor and evaluate the VIPP regularly through program implementation review o Initiate and undertake inter-agency collaboration through formal and informal modes o Endorse support of researches in the clinical, epidemiological, public health and knowledge management areas as well as evaluate them o Others that may be identified and approved by the Secretary of Health  PMC Sub-committee Functions: o Align their plans and programs to the goals and objectives of VIPP o Implement their strategies and activities in close collaboration with PMC o Contribute to the electronic surveillance system and research agenda of DOH o Develop key result areas and key performance indicators to monitor and evaluate the program o Provide technical assistance and much needed support for the success of VIPP o Recommend creative and innovative approaches in the VIPP implementation o Issue relevant and up-to-date standards and guidelines duly approved by various concerned stakeholders PHILIPPINE NETWORK FOR INJURY DATA MANAGEMENT SYSTEM (PNIDMS)  Multi-sectoral organization which intends to establish and maintain a coordinated data management system that can link, integrate, or combine injury data from various sources or systems  Provide an overall picture for policy makers and decision makers at the national, regional and local level

Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, GONZAGA V, LAURILLA, SOLIS

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Violence and Injury Prevention Program (VIPP)

Program Management Committee (PMC)

National Center for Disease Prevention and Control (NCDPC)

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National Center for Health Promotion (NCHP)

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  National Epidemiology Center (NEC)

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Information Management Service (IMS)

Health Human Resource Development Bureau (HHRDB)

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National Center for Health Facility Development (NCHFD) Bureau of Health Facilities and Services (BHFS) Bureau of International Health Cooperation (BIHC) Philippine Health Insurance Corporation (PHIC) Violence and Injury Prevention Alliance (VIPA) 4 Operation Clusters Centers for Health Development (CHDs)

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ROLES AND RESPONSIBILITIES Provide direction and technical support on policies and plans pertaining to the prevention of violence and injury Provide the forum for coordinating all aspects of the implementation of the program. Oversee the implementation of the national policy and program on Violence and Injury Prevention Establish standards and package of services on violence and injury prevention and ensure their quality, access and availability at all levels of the health system Provide technical assistance to the LGUs and other partners on public health interventions for violence and injury Support the design of health financing as related and applicable to violence and injury prevention in collaboration with PhilHealth and other partners Conduct regular monitoring and evaluation of the burden of disease related to violence and injury; and Ensure participation of other DOH offices and bureaus and coordinate with partners within and outside the health sector for the effective implementation of the national program Support the development and implementation of the Safety-First Promotion Campaign including the IEC materials in various formats as a major strategy for the prevention and control of violence and injury Advocate with other government agencies, non-government organizations, private sectors, development partners and other relevant stakeholders for support in policy development and resource generation towards the creation of supportive environments for safety promotion Provide technical assistance in safety promotion and communications to ensure environmental interventions at the following settings: home, school, workplace and community. Establish and sustain public health and hospital surveillance systems including registries for violence and injuries Oversee management and dissemination of data on mortality, morbidity and disability due to violence and injury Support conduct of population-based surveys on risk factors associated with violence and injury. Maintain the registry software Address technical problems accordingly Train users on how to operate the registry system Assist in the formulation of policies, procedures, guidelines and relevant protocols to ensure continuous operations and develops program interventions as needed Perform database and network management activities Manage the help desk support to ensure continuous operations; and Provide funding on information and communication technology resources based on the DOH Information System Strategic Plan or other DOH directives or issuances Provide technical assistance in the development of learning interventions for health professionals on the prevention, control and management of violence and injury Facilitate integration of prevention and control of violence and injury in the academic curriculum of health professionals. Ensure access and availability to quality hospital and facility-based services of patients involved in violence and injury Facilitate development and implementation of hospital-based information and surveillance system to gather data particularly on mortality, morbidity and disability from violence and injury Support funding for the availability and rational distribution of ambulances and other appropriate equipment that can provide effective life-saving pre-hospital emergency services. Ensure the safety and accessibility of health facilities through compliance with the prescribed standards on physical ability, equipment and personnel

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Coordinate with international development partners and other external institutions or technical and resource assistance on violence and injury prevention.

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Develop and implement health insurance package for clients at risk and involved in violence and injury to reduce financial burden and impoverishment of individuals and families.

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Provide much-needed support to the advocacy on safety culture.

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Ensure the implementation of Violence and Injury Prevention Program by the Regional Offices Provide technical assistance to the LGUs and oversee the local implementation of Violence and Injury Prevention Program. They shall also establish the standards for an efficient hospital referral system within the locality Ensure provision of quality promotive, preventive, curative, rehabilitative and palliative care for patients involved in violence and injury Adopt and implement the Violence and Injury Prevention Program and provide services and necessities in primary health facilities and hospitals in their localities Assist in the implementation of Violence and Injury Prevention Program

DOH hospitals

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Local Government Units (LGUs) Non-government organizations, professional groups, other national government agencies/ organizations, private sector and the academe

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Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, GONZAGA V, LAURILLA, SOLIS

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Violence and Injury Prevention Program (VIPP)

3.03 KEY FINDING BY EXTERNAL CAUSE OF INJURY

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Violence and Injury Prevention Program (VIPP)

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Violence and Injury Prevention Program (VIPP)

Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, GONZAGA V, LAURILLA, SOLIS

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