Foreword
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Foreword
The Western Pacific Region faces a major new epidemic. Six out of ten deaths in this Region are caused by noncommunicable diseases, mainly cardiovascular disease, diabetes, and cancer. Many of these deaths are caused by a small group of common risk factors, and thus are amenable to prevention. However, this is a new epidemic. Many of our health systems are geared to respond to more traditional causes of disease: deficiency and infectious diseases. In order to reorient our systems to face these new challenges, we need action on many fronts. We need national action to develop healthy public policy. We need community action to reduce risk at local level. And we need to train our health workers to support prevention: through setting an example, through counselling and advocacy, and through direct service provision. This set of manuals represents a major step forward in this regard. It is a unique compilation of guidelines and pedagogical materials suitable for self-learning or for a workshop setting. It is consistent with all agreed guidelines for the Philippines and will serve as a resource for learning and a tool for service delivery. WHO is delighted to have supported this project technically and financially. I congratulate the Department of Health and the University of the Philippines on the product. WHO looks forward to continued collaboration on this project.
Shigeru Omi, MD, Ph.D. Regional Director WHO Regional Office for the Western Pacific
Foreword
The leading causes of mortality in the Philippines today are no longer communicable diseases but more chronic, debilitating noncommunicable diseases (NCDs). These include cardiovascular diseases like hypertension, coronary artery diseases and stroke; cancers, chronic obstructive pulmonary diseases and diabetes mellitus. Bronchial asthma, though not among the leading causes of mortality, is fast becoming a public concern and contributes greatly to morbidity. These illnesses are also called “lifestyle diseases” because nutrition, physical activity, smoking, alcohol drinking and stress contribute to their development. In fact, it is now recognized that these major NCDs share common risk factors and that modifying these risk factors using community-based approaches will have greater impact in the long-term and be more cost-effective than interventions that focus on individual behaviors alone. To address this need, the Philippine Department of Health, in collaboration with the World Health Organization Western Pacific Regional Office, is establishing an integrated community-based noncommunicable disease prevention project. It is called the National Healthy Lifestyle Program. The programme’s objectives include slowing down or reversing the increasing trend in the prevalence of lifestyle-related risk factors of NCDs, including smoking, unhealthy diet, and sedentary lifestyle, and creating a supportive environment for positive behavior change and healthy lifestyles. The University of the Philippines Manila College of Nursing was commissioned by the Department of Health with funding from the World Health Organization Western Pacific Regional Office to develop a training manual and implement a training programme for trainers and other health workers for two pilot areas. These areas included the municipality of Pateros in Metro Manila (representing an urban community) and the Province of Guimaras in Western Visayas (representing a rural community). A training needs assessment for each site was conducted towards the end of 2001, the results of which were used to develop the initial draft of the training manual. The draft manual was then field-tested during the training of trainers and two other training programmes for health workers in the two sites in 2002. After implementing the series of training workshops in Pateros and Guimaras, feedback was collected from the participants, particularly the trainers and end-users, and evaluation visits were conducted by the project team. Based on this valuable information, the draft manual was revised and enriched to the form you see now.
This training manual, therefore, serves as a guide for primary health care providers in promoting healthy lifestyles for individuals, groups, and communities. The approach to prevention and control of noncommunicable diseases is integrated and primarily community-based. It focuses on prevention and modification of major risk factors, such as unhealthy nutrition, sedentary lifestyle and smoking, which will prevent not only one, but most of the major NCDs. Emphasis is on population-based approaches that will impact on a larger portion of the population than individual or clinical approaches. Selection of content was based on a list of competencies expected of health workers, primarily, nurses, midwives and doctors, to fulfill their roles in promoting healthy lifestyle change. Existing Department of Health guidelines, clinical guidelines and consensus statements by expert groups regarding prevention and control of specific NCDs and risk factors provided the backbone for the content. Local guidelines were used whenever available, such as in hypertension, cancer, obesity, and asthma. If not available, international or regional guidelines endorsed by local experts were utilized such as in chronic obstructive pulmonary disease and diabetes. This training manual consists of four booklets and seven sessions. Participants suggested the booklet format because it is handier and more convenient. Effort was taken to make the format and language simple and more interesting to intended users of the manual. The first booklet is the Trainer's Guide. It contains a background of the project, a description of the training programme and manual, the instructional plan for each session, and the framework for the prevention and control of NCDs using an integrated approach. This is important, particularly for trainers and health workers in replicating this training programme for other health workers. Instructional plans contain the objectives per session, the key messages, and some suggested learning activities and activities to obtain participant feedback and evaluation. The three other booklets contain the content and reference materials needed for discussing and processing activities for each session. These booklets are good reference materials for health workers even after the training programme. Each booklet includes session objectives and key messages that health workers should keep in mind. This training manual is a vital instrument for enhancing the capability of primary health care providers to promote healthy lifestyle and ultimately contributing to the reduction in the morbidity and mortality due to noncommunicable diseases.
Manuel M. Dayrit, MD, Msc Secretary of Health Philippine Department of Health
Foreword
The University of the Philippines Manila fully subscribes to the thrust of the World Health Organization and the Department of Health on promoting healthy lifestyles as an approach to preventing noncommunicable diseases (NCDs). Thus, it supports and contributes to the efforts to make this strategy a success not only among individuals and groups but more importantly, among communities. The prevention and control of NCDs calls for an integrated, community-based approach that will require the committed and enlightened participation of community residents and primary health care workers. This training manual is meant to guide primary health care workers, especially nurses, midwives and doctors in fulfilling their roles and tasks as agents of positive lifestyle and behavior change. Through the production of this training manual by a team from the College of Nursing, led by Dr. Josefina A. Tuazon, UP Manila is happy to have performed its share in realizing the objective of Department of Health’s Integrated Communitybased Noncommunicable Disease Prevention project – the reduction in the mortality and morbidity rates due to NCDs. I commend the team members for putting together this very practical and easy-to-follow material that details specific objectives and activities for health workers. The writers should also be commended for incorporating fitting examples and simplifying application of guidelines for easier comprehension.
Marita V.T. Reyes, MD Chancellor University of the Philippines Manila
The Western Pacific Region faces a major new epidemic. Six out of ten deaths in this Region are caused by noncommunicable diseases, mainly cardiovascular disease, diabetes, and cancer. Many of these deaths are caused by a small group of common risk factors, and thus are amenable to prevention. However, this is a new epidemic. Many of our health systems are geared to respond to more traditional causes of disease: deficiency and infectious diseases. In order to reorient our systems to face these new challenges, we need action on many fronts. We need national action to develop healthy public policy. We need community action to reduce risk at local level. And we need to train our health workers to support prevention: through setting an example, through counselling and advocacy, and through direct service provision. This set of manuals represents a major step forward in this regard. It is a unique compilation of guidelines and pedagogical materials suitable for self-learning or for a workshop setting. It is consistent with all agreed guidelines for the Philippines and will serve as a resource for learning and a tool for service delivery. WHO is delighted to have supported this project technically and financially. I congratulate the Department of Health and the University of the Philippines on the product. WHO looks forward to continued collaboration on this project.
Shigeru Omi, MD, Ph.D. Regional Director WHO Regional Office for the Western Pacific
Foreword
The leading causes of mortality in the Philippines today are no longer communicable diseases but more chronic, debilitating noncommunicable diseases (NCDs). These include cardiovascular diseases like hypertension, coronary artery diseases and stroke; cancers, chronic obstructive pulmonary diseases and diabetes mellitus. Bronchial asthma, though not among the leading causes of mortality, is fast becoming a public concern and contributes greatly to morbidity. These illnesses are also called “lifestyle diseases” because nutrition, physical activity, smoking, alcohol drinking and stress contribute to their development. In fact, it is now recognized that these major NCDs share common risk factors and that modifying these risk factors using community-based approaches will have greater impact in the long-term and be more cost-effective than interventions that focus on individual behaviors alone. To address this need, the Philippine Department of Health, in collaboration with the World Health Organization Western Pacific Regional Office, is establishing an integrated community-based noncommunicable disease prevention project. It is called the National Healthy Lifestyle Program. The programme’s objectives include slowing down or reversing the increasing trend in the prevalence of lifestyle-related risk factors of NCDs, including smoking, unhealthy diet, and sedentary lifestyle, and creating a supportive environment for positive behavior change and healthy lifestyles. The University of the Philippines Manila College of Nursing was commissioned by the Department of Health with funding from the World Health Organization Western Pacific Regional Office to develop a training manual and implement a training programme for trainers and other health workers for two pilot areas. These areas included the municipality of Pateros in Metro Manila (representing an urban community) and the Province of Guimaras in Western Visayas (representing a rural community). A training needs assessment for each site was conducted towards the end of 2001, the results of which were used to develop the initial draft of the training manual. The draft manual was then field-tested during the training of trainers and two other training programmes for health workers in the two sites in 2002. After implementing the series of training workshops in Pateros and Guimaras, feedback was collected from the participants, particularly the trainers and end-users, and evaluation visits were conducted by the project team. Based on this valuable information, the draft manual was revised and enriched to the form you see now.
This training manual, therefore, serves as a guide for primary health care providers in promoting healthy lifestyles for individuals, groups, and communities. The approach to prevention and control of noncommunicable diseases is integrated and primarily community-based. It focuses on prevention and modification of major risk factors, such as unhealthy nutrition, sedentary lifestyle and smoking, which will prevent not only one, but most of the major NCDs. Emphasis is on population-based approaches that will impact on a larger portion of the population than individual or clinical approaches. Selection of content was based on a list of competencies expected of health workers, primarily, nurses, midwives and doctors, to fulfill their roles in promoting healthy lifestyle change. Existing Department of Health guidelines, clinical guidelines and consensus statements by expert groups regarding prevention and control of specific NCDs and risk factors provided the backbone for the content. Local guidelines were used whenever available, such as in hypertension, cancer, obesity, and asthma. If not available, international or regional guidelines endorsed by local experts were utilized such as in chronic obstructive pulmonary disease and diabetes. This training manual consists of four booklets and seven sessions. Participants suggested the booklet format because it is handier and more convenient. Effort was taken to make the format and language simple and more interesting to intended users of the manual. The first booklet is the Trainer's Guide. It contains a background of the project, a description of the training programme and manual, the instructional plan for each session, and the framework for the prevention and control of NCDs using an integrated approach. This is important, particularly for trainers and health workers in replicating this training programme for other health workers. Instructional plans contain the objectives per session, the key messages, and some suggested learning activities and activities to obtain participant feedback and evaluation. The three other booklets contain the content and reference materials needed for discussing and processing activities for each session. These booklets are good reference materials for health workers even after the training programme. Each booklet includes session objectives and key messages that health workers should keep in mind. This training manual is a vital instrument for enhancing the capability of primary health care providers to promote healthy lifestyle and ultimately contributing to the reduction in the morbidity and mortality due to noncommunicable diseases.
Manuel M. Dayrit, MD, Msc Secretary of Health Philippine Department of Health
Foreword
The University of the Philippines Manila fully subscribes to the thrust of the World Health Organization and the Department of Health on promoting healthy lifestyles as an approach to preventing noncommunicable diseases (NCDs). Thus, it supports and contributes to the efforts to make this strategy a success not only among individuals and groups but more importantly, among communities. The prevention and control of NCDs calls for an integrated, community-based approach that will require the committed and enlightened participation of community residents and primary health care workers. This training manual is meant to guide primary health care workers, especially nurses, midwives and doctors in fulfilling their roles and tasks as agents of positive lifestyle and behavior change. Through the production of this training manual by a team from the College of Nursing, led by Dr. Josefina A. Tuazon, UP Manila is happy to have performed its share in realizing the objective of Department of Health’s Integrated Communitybased Noncommunicable Disease Prevention project – the reduction in the mortality and morbidity rates due to NCDs. I commend the team members for putting together this very practical and easy-to-follow material that details specific objectives and activities for health workers. The writers should also be commended for incorporating fitting examples and simplifying application of guidelines for easier comprehension.
Marita V.T. Reyes, MD Chancellor University of the Philippines Manila
