The Philippine National Strategic Framework for lan Development for CHildren or CHILD 21 is a strategic framework for planning programs and interventions that promote and safegurad the rights of Filipino children. Covering the period 2000-2005, it paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a roadmap to achieve the vision.
Children's Health 2025, a subdocument of CHILD 21, realizes that health is a critical and fundamental element in children's welfare. However, health programs cannot be implemented in isolation from the other component that determine the safety and well being of children in society. Children's Health 2025, therefore, should be able to integrate the strategies and interventions into the overall plan for children's development.
Children's Health 2025 contains both mid-term strategies, which is targeted towards the year 2004, while long-term strategies are targeted by the year 2025. It utilizes a life cycle approach and weaves in the rights of children. The life cycle approach ensures that the issues, needs and gaps are addressed at the different stages of the child's growth and development.
The period year 2002 to 2004 will put emphasis on timely diagnosis and management of common diseases of childhood as well as disease prevention and health promotion, particularly in the fields of immunization, nutrition and the acquisisiton of health lifestyles. Also critical for effective pallning and implementation would be addressing the components of the health infrastructure such as human resource development, quality assurance, monitoring and disease surveillance, and health information and education.
The successful implementation of these strategies will require collaborative efforts with the other stakeholdres and also implies integration with the other developmental plan of action for children.
A healthy Filipino child is:
- Wanted, planned and conceived by healthy parentsCarried to term by healthy motherBorn into a loving, caring. stable family capable of providing for his or her basic needsDelivered safely by a trained attendant
- Screened for congenital defects shortly after birth; if defects are found, interventions to corrrect these defects are implemented at the appropriate time
- Exclusively breastfed for at least six months of age, and continued breasfeeding up to two yearsIntroduced to compementary foods at about six months of age, and gradually to a balanced, nutritious dietProtected from the consequences of protein-calorie and micronutirent deficiencies through good nutrition and access to fortified foods and iodized salt
- Provided with safe, clean and hygienic surroundings and protected from accidentsProperly cared for at home when sick and brought timely to a health facility for appropriate management when needed.Offered equal access to good quality curative, preventive and promotive health care services and health education as members of the Filipino society
- Regularly monitored for proper growth and development, and provided with adequate psychosocial and mental stimulationScreened for disabilities and developmental delays in early childhood; if disabilities are found, interventions are implemented to enabled the child to enjoy a life of dignity at the highest level of function attainable
- Protected from discrimination, exploitation and abuse
- Empowered and enabled to make decisions regarding healthy lifestyle and behaviors and included in the formulation health policies and programsAfforded the opportunity to reach his or her full potential as adult
Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, septicemia), nutritional deficiencies and birth-realted complications.
The probability of dying between birth and five years of age is 48 deaths per 1000 livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningities and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents.
The decline in mortality rates may be attributed partly to the Expanded Program of Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable diseases (tuberculosis, diptheria, tetanus, pertussis, poliomyelities, Hepatitis B and measles).
The Philippines has been declared as polio-free druing the Kyoto Meeting on Poliomyelities Eradication in the Western Pacific Region last October 2000. This. however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urrgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved.
Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997.
Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos of age (NDHS).
Several strategies were utilized to omprove child health. THe Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common chldhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway.
The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and seeking behaviors. It operates through health and nutrition posts established throughout the country.
Gaps and Challenges
Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for childrens health. There is also the need to update and reiterate the policies on children's health particularly on immunization, micronutrient supplementation and IMCI.
LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution.
Pockets of low immunization coverage is attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization.
The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025.
Medium-term Objectives for year 2001-2004
Health Status Objectives
1. Reduce infant mortality rate to 17 deaths per 1,000 live births
2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 livebirths
3. Reduce the mortality rate among adolescents and youths by 50%
Risk Reduction Objectives
1. Increse the percentage of fully immunized children to 90%
2. Increase the percentage of infants exclusively breastfed up to six months to 30%
3. Increase the percentage of infants given timely and proper complementary feeding at six months to 70%
4. Increase the percentage of mothers and caregivers who know and practice home management of childhood illness to 80%
5. Reduce the prevalence of protein-energy malnutrition among school-age children
6. Increase the health care-seeking behavior of adolescents to 50%
Services and Protection Objectives
1. Ensure 90% of infants and children are provided with essential health care package
2. Increase the percentage of health facilities with available stocks of vaccines and esential drugs and micronutrients to 80%
3. Increase the percentage of schools implementing school-based health and nutrition programs to 80%
4. Increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70%
Strategies and Activities
* Enhance capacity and capability of health facilities in the early recognition, management and prevention of common childhood illness
This will entail improvements in the flow of services in the implementing faciities to ensure that every child receive the essential services for survival, growth and development in an organized and efficient manner. Facilities should be equipped with the essential instruments, equipment and supplies to provide the services. Health providers shall have the knowledge and skills to be able to provide quality services for children. Existing child health policies, guidelines and standards shall be reviewed and updated, and new ones formulated and disseminated to guide health providers in the standard of care.
* Strengthening community-based support systems and interventions for children's health
Notable community-based projects and interventions, such as the health and nutrition posts, mother support groups, community financing schemes shall be replicated for nationwide implementation. Model building and dissemination of best practices from pilot sites has proven effective in generating support and adoption in other sites. More of these shall be initiated particularly for developing interventions to increase care-seeking and prevention of malnutrition in children.
* Fostering linkages with advocacy groups and professional organizations and to promote children's health
Collaboration with the nongovernment sector and professional groups shall:
* Conduct national campaigns on children's health
* Conduct and support national campaigns for children
* Initiate and support legislations and researches on children's health and welfare
* Development of comprehensive monitoring and evaluation system for child health programs and projects