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Archive for February, 2015

Footnote to the WHO Regional Meeting

On July 9 to 11, 2013, the World Health Organization (WHO) Meeting on Ageing and Health for the Western Pacific Region was held in Manila. Together with representatives from the Department of Health (DOH), the Department of Social Welfare and Development (DSWD) was tasked to present a Country Report on government policies and programs promoting elderly care and welfare in the Philippines. Other representatives from the DOH included Dr. Irma Asuncion, and DSWD’s regular partners, Dra. Elizabeth “Bambi” Caluag, and Ms. Remedies “Jing” Guerrero. Besides Atty. Germaine Trittle P. Leonin of the National Coordinating and Monitoring Board (NCMB) Secretariat, DSWD was also represented by Director Patricia Luna, Asst. Bureau Director Paz Sarino, Ms. Marlyn Moral of Social Technology Bureau and Ms. Fritzie Barrameda of Standards Bureau.
It has been a particular advantage for the Philippines to have clear mandates in our 1987 Constitution, identifying the senior citizens as a vulnerable and marginalized sector. Moreover, provisions on Social Justice and Human Rights clearly mandates raising the quality of life for all. Other national laws like the Magna Carta of Persons with Disabilities (PWDs) as well as the Accessibility Law are PWD-related legislation which may be taken advantage of by our senior citizens.
Meanwhile, the prime legal basis, Republic Act No. 9994 as the 3rd version of the senior citizens law tries to be a comprehensive, integrated piece of legislation for addressing the needs of the senior citizens. Besides healthcare provisions, it tackles educational opportunities, continuing employment, availment of livelihood skills training, as well as social pension benefits. And, besides the relevant legislations for senior citizens like the Expanded Senior Citizens Act of 2010, our national sectoral plan – the Philippine Plan of Action for Senior Citizens (PPASC) 2012-2016, especially the area of concern “Advancing Health and Well-being” was highlighted in the Country Report.
The DOH’s thrust of promoting “healthy living and active ageing” was also something to be proud of. A key to well-being is healthy eating and proper nutrition. Food choices and basic cooking preparations were just as important as the amount of food intake. Nutrition and proper eating is also a strategy which can be used effectively to address health issues and other diseases. Besides genetic tendencies and ageing consequences, lifestyle practices also contribute to health risks. Avoidance of vices such as smoking and alcohol drinking, and most of all drugs, was also emphasized. Being prone to certain injuries because of weakness and frailty, especially for those slowly ageing already, assistive devices and safe, age-friendly environments such as facilities and transport are important.
As such, with the healthcare needs being a major part of the ageing policies and programs, there is a need to focus on improving the health human resources component as well – be it institutionalizing geriatrics and gerontology as part of the curricula of various disciplines and not just the medical field, or giving specialized trainings for the “non-formal” medical practitioners, such as TESDA-trained caregivers and community-based, homecare caregivers.
It is also important that there should be a proper institutional arrangement or mechanisms in place to implement the policies and programs for senior citizens. Thus, the National Coordinating and Monitoring Board (NCMB) and its regional counterparts, the RCMBs, as well as the Office of Senior Citizens Affairs (OSCA) are quite significant. It was also interesting to cite that the active participation of our senior citizens groups, as organized and established federations and associations ensured the sector’s direct involvement in all matters pertaining to them. However, even as the DSWD and the DOH are able to work together and are currently coordinating well, it is still highly advisable that there be established a primary government agency which shall focus on the elderly population and all its related concerns, much like the other sectors of children, women and PWDs, for the purposed of having clear and unified policy directions, a specific budget allocation, including a dedicated workforce contingent.
Although the WHO meeting seemed mainly focused on healthcare for the elderly, most of the recommendations recognized the need for an integrated, comprehensive approach to elderly care. This includes an improved financial capability that meant continuing education, employment or livelihood opportunities, assured pension benefits, accessible and affordable health programs and services, etc. Based on the sharings of “Best Practices”, the Philippines should be proud of its government efforts and measures promoting and protecting the rights of our senior citizens. With all the recommendations about having an “integrated and comprehensive” approach to elderly care, our RA 9994 alone exactly seeks to accomplish that already.
Given the current discussions at the United Nations-level in New York, particularly the Open-ended Working Group on the proposed UN Convention on the Rights of the Elderly, a specific treaty or convention as an international human rights instrument which demands compliance is always a strong compelling basis for national governments to give attention to the needs of a particular sector. The DSWD provided essential comments and inputs to the country position the DFA hoped to advance in August 2013 in New York. The WHO, as a UN body, was requested to make a similar positive representation in New York to support this stance.

Addressing Elderly Health Issues under RA 9994

It cannot be helped that when one talks about ageing and the elderly, matters involving health are always included. Republic Act No. 9994 otherwise known as the Expanded Senior Citizens Act of 2010 is the third version of the senior citizens law. Since the first senior citizens act, RA 7432 and its successor RA 9257, the Philippine government has continuously sought to expand elderly benefits and privileges, and address various ageing issues especially those related to health concerns.
Guided by the national sectoral plan, the 5-year Philippine Plan of Action for Senior Citizens (PPASC) which in turn was anchored on international instruments such as the Madrid Plan of Action, the Macau Programme of Action as well as the Shanghai Implementation Strategy, a major area of concern focuses on advancing the health and well-being of Filipino seniors.
As such, one of the most expanded provisions of the RA9994 refers to medical benefits and health privileges of Pinoy senior citizens. While previously the most availed of discounted purchase pertained to drugs and medicines, under RA9994, the 20% senior citizens discount now applies to the discounted purchases of influenza and pneumonia vaccines for seniors. More importantly, the 20% SC discount likewise applies to essential medical supplies, devices, accessories and equipment used by seniors such as geriatric diapers, glucometers, blood pressure apparatus, wheelchairs, and walkers. Thus, it has been emphasized that commonly used assistive devices such as eyeglasses, hearing aids, and even dentures are also covered by the SC discount.
These major additions were brought about by relevant researches and studies from partners in the academe which looked into issues of health and economics affecting Filipino elderly. As such, many details were also clarified through active policy-making and coordination by the National Coordinating and Monitoring Board (NCMB). Chaired by the Department of Social Welfare and Development, the NCMB Secretariat regularly communicated and coordinated with the proper government agencies like the Department of Health (DOH), the Philippine Health Insurance Corporation (PhilHealth), and the Food and Drug Administration (FDA) formerly known as the Bureau of Food and Drugs (BFAD). Now, it has been declared that some doctor-prescribed vitamins and minerals used to treat deteriorating health conditions of the elderly must be discounted just like many maintenance drugs.
Another area which was greatly improved is on hospitalization benefits of seniors. Previously, this aspect was governed by the DOH through various issuances detailing computed discounts for room rates, laboratory and diagnostic tests, drugs and medicines, and even the professional fees of attending physicians. The new DOH guidelines, namely DOH Administrative Order No. 2012-0007, Series of 2012 now applies the 20% discount and the applicable 12%VAT exemption to the TOTAL hospitalization billing. Moreover, the separate availment of PhilHealth coverage has been institutionalized under the new rules. Seniors can get both their 20% SC discount and PhilHealth benefits during hospitalization.
It is also quite fortunate that the PhilHealth has been quite proactive and has been updating their rules and issuing relevant guidelines to facilitate availment of benefits especially for senior citizens. Among its improved programs and services are the “discounted” vaccines for seniors at selected Philhealth-accredited government hospitals to avoid affliction with influenza and pneumonia. Meanwhile, their “Lifetime Membership” program allows retirees and seniors to complete payment of a minimum number of months for automatic PhilHealth coverage which shall remain valid and in-effect until the senior eventually gets deceased. On the other hand, the “sponsored” program for indigent senior citizens is specifically mandated under the Mandatory Philhealth Coverage provisions of RA9994 and is being implemented in coordination with the Department of Social Welfare and Development’s National Household Targeting System (DSWD-NHTS). This same database of identified indigent senior citizens has also been utilized by the DOH as the basis for their FREE influenza and pneumonia vaccines program.
And speaking of particular benefits targeting indigent senior citizens, the Social Pension Program providing a monthly stipend of P500 has been found to make such an impact in improving the quality of life of poor elderly folk. Families report that they no longer feel so burdened caring for ageing parents or relatives because of this small allowance which helps with the family’s finances. The seniors themselves say they use the money they receive to buy their maintenance drugs, go for medical check-ups, or buy some food items like milk or rice. Evidently, this ultimately redounds to improved health and well-being of senior citizens.
Other significant health or medical-related provisions under RA9994 is the establishment of a geriatric ward in every government hospital, or at the very least a special unit reserved for sick senior citizens in all medical facilities. Already there is the Eva Macapagal National Center for Geriatric Health (NCGH) located near Malacanang which specializes in geriatric care and is equipped with state-of-the art facilities and equipment. Meanwhile, a comprehensive and integrated national health program for senior citizens must also be developed by the DOH as expressly provided for under RA 9994. Hence, their current program for “active ageing” includes the conduct of regular “fitness camps” for elderly government employees and soon-to-be retirees.
Admittedly, there is still much to be desired for a uniform and effective implementation of RA9994. Even with greater efforts from the concerned government agencies, the cooperation of the private sector is still essential. Thus, dialogues with the business establishments and appropriate orientations/trainings to familiarize them with relevant guidelines must also be encouraged.
The same goes for the senior citizens themselves; they must be given special lectures and capability-building sessions to inform them of their rights and privileges under RA9994, and how they can avail of these benefits and privileges properly and reasonably.