Urban-health-system-development.docx

URBAN HEALTH SYSTEM DEVELOPMENT (UHSD) PROGRAM RATIONALE In developing countries, the rapid rate of urbanization has outpaced the ability of governments to build essential infrastructure for health and social services. Among many features of urbanization in developing countries include greater population densities and more congestion, concentrated poverty and slum formation, and greater exposure to risks, hazards and vulnerabilities to health (eg. violence, traffic injuries, obesity, and settlement in unsafe areas). The concentration of risks is seen in the poorest neighbourhood’s resulting to health inequities. From the above, it will require more than the provision and use of health services to improve the health of urban populations. UHSD must help cities address the challenges of rapid urbanization brought about by the interplay of different social determinants of health. UHSD GOALS AND OBJECTIVES A. Goals 1. To improve Health System Outcomes Urban Health Systems shall be directed towards achieving the following goals: i. Better Health Outcomes; ii. More equitable healthcare financing; and iii. Improved responsiveness and client satisfaction 2. To influence social determinants of health the DOH must help influence social determinants of health in urban settings, with focused application on urban poor populations particularly those living in slums 3. To reduce health inequities Urban Health Systems Development seeks to narrow the disparity of health outcome indicators between the rich and the poor B. General objective: To address the Urban Health challenge C. 1. 2. 3.

Specific objectives: To establish awareness on the challenges of Urban Health; To initiate inter-sectoral approach to Urban Health Systems Development; and To guide LGUs to develop sustainable responses to the Urban Health challenge

COMPONENTS The following are the developmental components of the UHSD Program: 1. Programs and Strategies - Healthy Cities Initiative (HCI): the approach of continuously improving health and social determinants of health, and continually creating and improving physical and social environments shall be continued and further strengthened. - Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a strategy of going to every depressed barangay to reach the urban poor, vulnerable groups and hidden slums to increase access to health services. - Environmentally Sustainable and Healthy Urban Transport (ESHUT) initiatives which include the development or enhancement of existing projects that improve the policy, design and practice of an urban transport system and lead to improvement of health and safety of urban population. 2. Planning Tools and Framework - Urban Health Equity Assessment and Response Tool (Urban HEART): a tool to facilitate identification of and response to health equity concerns. It is used as a situational assessment, monitoring and planning tool particularly for Highly Urbanized Cities, in tandem with the Local Government Unit (LGU) Scorecard. - City-wide Investment Planning for Health (CIPH): a framework for the development of public investment plans in health covering the utilization, mobilization and rationalization of the city’s relatively abundant resources, more extensive capabilities and stronger institutions to attain health system goals. 3. Capability Building Short Course on Urban Health Equity (SCUHE) is a 6-month course offered to cities and urban stakeholders that aims to improve the knowledge, practice and skills of health practitioners, policy and decision-makers at the national, regional and city levels to identify and address urban health inequities and challenges, particularly in relation to social determinants of health.

GENERAL PRINCIPLES 1. Healthy urbanization. Urban Health Systems (UHS) must promote healthy urbanization so that cities develop in ways that achieve better health and avoid risks to ill health under conditions of rapid urbanization. Healthy urbanization is the desired direction of urban health systems development that aims to protect and promote public health rather than threaten or erode health of individuals and communities in urban areas. 2. Inter-sectoral action. UHS must be designed through inter-sectoral collaboration with people and institutions from outside the health sector to influence a broad range of health determinants and generate responses producing sustainable health outcomes. Major influences that shape the health of populations and the distribution of health inequities are located outside the health sector. The fact that most of these influences lie outside of the exclusive jurisdiction of the health sector, requires the health sector to engage with other sectors of government and society to address the determinants of health and well-being. 3. Inter-city coordination. Inter-city coordination between contiguous cities is important because a city, particularly if it is not a Highly Urbanized City may not have all the resources, institutions and capacities to be able to respond to the entire health needs of its constituents, and may thus benefit from resources, institutions and capacities of other cities through inter-city or inter-LGU coordination. 4. Social cohesion. Social cohesion is action through core groups. Social cohesion refers to the strength of relationships and the sense of solidarity among members of a community. One indicator of social cohesion is the amount of social capital a community has. Social capital deals with shared group resources,like a friend-of-a-friend’s knowledge of a job opening. Individuals have access to social capital through their social networks, which are webs of social relationships.Social networks are sources of multiple forms of social support, such as emotional support (e.g., encouragement after a setback) and instrumental support (e.g., a ride to a doctor’s appointment). 5. Community participation. Community participation must be integrated in all aspects of the intervention process, including planning, designing, implementing, and sustaining any project/program.

Community participation requires going beyond consultation to enable citizens to become an integral part of the decision- making and action process. This is not confined to a response to initiatives or agendas set in motion by politicians and professionals. It reflects the need for the development of more active communities in their own right: people seeing a need and acting upon it, for example, as advocates, pressure groups or self-help groups. Community participation draws on the energy and enthusiasm that exists within communities to define what that community wants to do and how it wants to operate. Communities have the right to participate in decision-making processes and to articulate their own concerns and priorities and recognizes that the community participation process can inherently promote health. Priority is given to community participation by emphasizing the importance of specific community-based action, the transfer of resources and decisionmaking powers to communities and community representation on steering committees. 6. Empowerment. Empowerment is enabling individuals and communities to have ultimate control over key decisions involving their wellbeing through strategies such as building knowledge and purchasing power, and mechanisms to increase client accountability. Empowerment' refers to the process by which people gain control over the factors and decisions that shape their lives. It is the process by which they increase their assets and attributes and build capacities to gain access, partners, networks and/or a voice, in order to gain control. "Enabling" implies that people cannot "be empowered" by others; they can only empower themselves by acquiring more of power's different forms (Laverack, 2008). It assumes that people are their own assets, and the role of the external agent is to catalyse, facilitate or "accompany" the community in acquiring power. Community empowerment, therefore, is more than the involvement, participation or engagement of communities. It implies community ownership and action that explicitly aims at social and political change. Community empowerment is a process of re-negotiating power in order to gain more control. It recognizes that if some people are going to be empowered, then others will be sharing their existing power and giving some of it up (Baum, 2008). Power is a central concept in community empowerment and health promotion invariably operates within the arena of a power struggle. Community empowerment necessarily addresses the social, cultural, political and economic determinants that underpin health, and seeks to build partnerships with other sectors in finding solutions.

Briefer on the Urban Health Equity Assessment and Response Tool (Urban HEART) I. Rationale: Rapid unplanned urbanization gives rise to urban poverty, health problems, and health inequities in the cities. Disparities in health system outcomes between the affluent and the poor are becoming more prominent in highly urbanized areas as government sectors find it hard to cope with the increasing demands of the fast growing population of urban poor. To address the above concerns, the Urban HEART or the Urban Health Equity Assessment and Response Tool was developed by the WHO Centre for Health Development in Kobe, Japan to assist Ministries of Health of countries in systematically generating evidence to assess and respond to unfair health conditions and inequity in the urban setting. It was initially launched in Tehran, Iran on April 2008, and the Philippines along with Iran, Zambia, and Brazil were the pilot sites to test the Urban HEART in each country. Seven cities initiated the use of the Urban HEART in the Philippines in 2008-2009, namely: Paranaque City, Taguig City, Olongapo City, Naga City, Tacloban City, Zamboanga City, and Davao City. The cities helped develop the tool for applicability in varied urban settings in the country. Urban Health Systems need to establish evidence on the status of the disadvantaged population in the highly urbanized areas in order to develop objective interventions to address inequities. Department Memorandum No. 2010-0207 dated August 20, 2010 on the “Use of the Urban Health Equity Assessment and Response Tool in Highly Urbanized Cities” is intended to help Highly Urbanized Cities (HUCs) generate systematic data on health inequities to guide effective interventions.

DOH-FDA Administrative Order No. 2011-0008 of the Department of Health, issued by then Health Secretary Esperanza Cabral in March 2010, ordering the removal of the phrase “no approved therapeutic claim” from all advertisements, promotional and sponsorship activities and materials of those products. In lieu of that phrase, the following message was ordered posted: Mahalagang Paalala: Ang (name of product) ay hindi gamot at hindi dapat gamiting panggamot sa anumang uri ng sakit. Important reminder: This is not a medicinal drug and should not be used to treat the symptoms of any disease).” The same message is required to be clearly and audibly voiced over in audio advertisements or promotions, without being cut off, in the last line regardless of their duration.

MATIAS H. AZNAR MEMORIAL – COLLEGE OF MEDICINE PREVENTIVE COMMUNITY MEDICINE (PCM III)

Report on

URBAN HEALTH SYSTEM DEVELOPMENT (UHSD) PROGRAM OF THE REPUBLIC OF THE PHILIPPINES DEPARTMENT OF HEALTH

GROUP 1 Maico, Dohina Niko (Leader, section A) Members Section A:

Adrales, Ferd F. Barcinas, Nikki Nina A. Bien, Charisma April D. Biong, Michelle A. Correos, Katty Limjap, Angela Amor N. Tan, Rejeane Joy Tiu, Glayza P. Veloso, Joseph Patrick Wagas, Jejomar

Section C:

Balandra, Melissa S. Cabudoy, Caress Mae G. Cedeňo, Charmaine Cinco, Ellen Fatima M. Cortado, Ana Joy Dumadag, Zalea Mae D. Ismael, Juhanisa Lagarnia, Patrick Daniel Parete, Jenice Solaiman, Norolheir S. Tandino, Alana