Saturday, March 12, 2016

Advancing the SDGs in the context of VYLH-Philippines Advocacies


  • With the recent end of the Millennium Development Goals (MDGs), the global community has moved towards the adoption of 17 Sustainable Development Goals (SDGs) that are set to be completed from 2016-2030.
  • Building on the eight Millennium Development Goals (MDGs), the SDGs aim to end poverty, fight inequality, tackle climate change and protect the environment.
  • VYLH-Philippines advocacies primarily respond to the Health SDG (Goal 3) particularly the prevention of newborn deaths and promotion of universal health coverage.
  • In addition to this, promoting public awareness on the importance of folic acid supplementation in the prevention of neural tube defects addresses prevention of potential newborn deaths, and the nutritional needs of women in the reproductive age, at the same time.
  • Meanwhile, the enactment and future implementation of the RA 10747 (Rare Diseases Act of the Philippines) will not only address the health of Filipino rare disease patients but also their inclusion to society.

Health Promotion and Advocacy Update
Series of 2016


What are the SDGs?

The Sustainable Development Goals, also known as Global Goals, were adopted by world leaders at the UN Sustainable Development Summit on 25 September 2015. The 17 goals set for another fifteen years, 2030, aim to end poverty, fight inequality, tackle climate change and protect the environment. The SGDs are included in the 2030 Agenda for Sustainable Development.


Moving Forward: From MDGs to SDGs

Built on the progress made by the Millennium Development Goals (MDGs) or the eight anti-poverty targets that the world committed to be achieved by 2015, the SDGs have a broader sustainability agenda that go beyond the MDGs. Adopted in 2000, the MDGs were targets that tackled poverty, hunger, disease, gender inequality and access to water and sanitation.

Based from a World Health Organization release, “the 17 SDGs are broader and more ambitious than the MDGs, presenting an agenda that is relevant to all people in all countries to ensure that "no one is left behind." The new agenda requires that all three dimensions of sustainable development – economic, social and environmental – are addressed in an integrated manner”.


VYLH-Philippines and Its Advocacies

The Volunteers Youth Leaders for Health – Philippines (VYLH-Philippines) is a national collaboration of youth leaders of youth organizations in universities and communities in the Philippines. This novel undertaking is part of an international effort to establish the March of Dimes - Global Network for Maternal and Infant Health (GNMIH) participated by youth counterparts in China and Lebanon linked by the common interest of volunteerism and public service, to improve birth outcomes worldwide through advocacy.



Since its inception in July 2009, the leaders of the VYLH network have been conducting advocacy and promotional work in their respective schools and communities focusing on the following health concerns:


  • Increasing awareness among women in their reproductive age on the significance of folic acid supplementation in the prevention of birth defects;
  • Increasing public awareness in saving babies from mental retardation and death through newborn screening; and
  • Lobbying public support for the urgent passage of the Rare Disease Act, an act addressing the needs of patients with rare, orphan disorders.

Causes of 2.761 M deaths during the
neonatal period, worldwide (2013/WHO)
In 2015, promoting prematurity awareness was placed as an advocacy for consideration of the network. According to the WHO, prematurity is the leading cause of death in children under the age of 5 worldwide. In social media, materials and infographics on global and national statistics on premature births, complications and risk factors were posted and shared in time for World Prematurity Day (November 17). One of the points highlighted in the campaign is the importance of awareness in the prevention of preterm births.

Furthermore, the network has also played an active role in promoting the concern on birth defects - awareness, prevention, care and research, as it participated as an international partner of World Birth Defects Day (March 3) this 2016.

Both birth defects and preterm births contribute to more than 40 percent of neonatal deaths in  2013(WHO). The two are also within the scope of the goals and programs of GNMIH.

  
VYLH-Philippines Advocacies and the SDGs

In the MDGs, the VYLH-Philippines advocacies fall within the two health goals: MDG4 (reduce child mortality), and MDG5 (improve maternal health). While the health goals were previously placed in separate MDGs (4, 5, and 6), these goals were combined and placed in a single SDG – Goal 3: Ensure healthy lives and promote well-being for all at all ages. There are also some advocacies particularly the folic acid awareness campaign and rare disease advocacy that correspond to other targets aside from SDG 3.


In promoting folic acid awareness, volunteer youth leaders are also promoting the nutritional needs of women in the reproductive age and this has an impact to the well-being of their future child - a target under Goal 2: Hunger and Food Security. It is known that folic acid supplementation is the only proven neural tube defect (NTD) prevention method, to date. Neural tube defects are problems in the development of the brain and the spinal cord. Data from the FNRI-DOST have also shown that 1 out of 5 women in the Philippines is folate deficient (2008 National Nutrition Survey). This shows that public awareness on the importance of folate and folic acid is also low among Filipinos.
SDG 2 HUNGER AND FOOD SECURITY: End hunger, achieve food security and improved nutrition and promote sustainable agriculture
The work done on lobbying public support for a rare disease act, its recent enactment and future implementation support SDG targets related to the welfare of persons with disability. SDGs that relate to persons with disability include Sustainable Development Goals 4, 8 and 10.
SDG 4 QUALITY EDUCATION: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

SDG 8 DECENT WORK & ECONOMIC GROWTH: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all 
SDG 10 REDUCED INEQUALITIES: Reduce inequality within and among countries
RA10747 has included a provision which grants “Person with Disability (PWD)" rights and benefits as defined by law (Article IV, Section 10) to persons with rare disease. Government agencies such as the DILG, DepED, DSWD and DOLE were also tasked to ensure that persons with rare disease are given the opportunity to be productive members of society and that they are given the same rights and benefits as PWDs (Article VI, Section 18).

The act also recognizes the importance of a "culturally-sensitive public education and information campaign" on the nature of rare disease in helping the public understand the special needs of persons afflicted with rare diseases, as well as their right against ridicule and discrimination. Such campaign would involve the participation of concerned government agencies, professional societies and non-government organizations, including the youth (Article VI, Section 17). At present, the network has to define its new role in the rare disease advocacy.
The Health Goal: SDG 3
"The 2030 Agenda for Sustainable Development heralds a new era of global public health, offering the opportunity to strive for a global development agenda of unprecedented scope and ambition." (WHO)
According to the WHO, it may be considered, at first glance, that health has a less central role in the SDGs than the MDGs with just one out of the 17 SDGs set specifically for health. However, this SDG is broad with a wide spectrum covered by 13 specific targets. Moreover, almost all of the other 16 goals are directly related to health or will contribute to health indirectly.” SDG 3 also reflect a new focus on noncommunicable diseases, the toll of injuries and determinants of health (such as urbanization, pollution and climate change), and the achievement of universal health coverage.

Two of the thirteen SDG 3 targets that are reflected by the VYLH-Philippines advocacies center on preventable newborn deaths and universal health coverage. 
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.

3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
 
For the complete list of SDG3 targets visit, http://www.who.int/topics/sustainable-development-goals/targets/en/

Child Mortality in the Philippines

The Philippines has reported a great decline in child mortality and high probability of meeting MDG4 - reducing the mortality rate of children under 5 by two-thirds. According to a 2014 report, both infant and under-five mortality were reported to decline to numbers close to the 2015 targets as early as 2011.

Photo: Philippine Daily Inquirer
There are three periods of life monitored in early childhood mortality: neonatal (0-28 days), infant (1-11 months) and under-five (1-4 years old). The 2013 WHO Country profile for the Philippines shows that it is estimated that 47% of child mortality in the Philippines are neonatal deaths.

From all neonatal deaths, 39% were caused preterm complications, the leading cause of newborn mortality. In 2011, 11,290 deaths were attributed to preterm complications – the equivalent of 31 newborn deaths every day (UNICEF Philippines/Born Too Soon)

Photo: Philippine Country Profiles (WHO Western Pacific/
Countdown to 2015 MNCH)
On the other hand, 15% of neonatal deaths were associated with congenital anomalies. Congenital malformations has also been part of the top 10 leading causes of infant mortality in the past 50 years (1960-2010/DOH). 

Notably, neonatal deaths in the country have remained unchanged for the past twenty years. Promoting the public’s awareness on strategies and choices that would prevent or lessen preterm births and certain birth defects can certainly help in reducing child and neonatal mortality in the country.

Promoting Universal Health Coverage

While promoting newborn screening, VYLH-Philippines volunteers also promote the benefits of Philippine Health Insurance Corporation (PHIC/PhilHealth) membership through the newborn care package. According to PhilHealth, the Newborn Care Package which includes NBS and Newborn Hearing Screening tests at a package rate of P1750 ensures the well-being and survival of babies, particularly to babies with inborn errors of metabolism. 

VYLH volunteers also inform the public on the existing PhilHealth coverage for newborn screening which is now offered in two options: basic and expanded. While the package currently completely covers the fee for the basic 6-test panel of disorders amounting to 550 pesos, parents who opt for the expanded test covering 28 disorders (including the basic panel) would shoulder the remaining amount. It is hoped that in the future, PhilHealth coverage will include expanded newborn screening. Such change will give an equal opportunity for the expanded test to every Filipino child.

Aside from NBS promotion, the recently enacted Rare Disease act mentions the provision of a  basic benefit package from PhilHealth, which shall be provided in accordance with its guidelines. Aside from this, medical assistance to rare disease patients would also be appropriated from the revenues of Sin Tax Reform Act (RA10351) (Article VII, Section 21). Fiscal incentives such as exemptions to taxes and customs duties will also be given to donations for the purchase and importation of orphan drugs or orphan products for the sole use of rare disease patients, as certified by the FDA (Article VII, Section 22).

These mechanisms supporting the health needs of rare disease patients support what Senator Pia Cayetano mentioned during her sponsorship speech of the bill in the Senate - including the rare disease sector in public health policy will promote universal health care by making sure that nobody is left behind. 

Conclusion

It is undeniable that the state of health of a nation and its people is a major consideration, contributor and beneficiary of sustainable development policies such that social, economic and environmental factors have an impact on health, and in turn benefit from a healthy population. Aside from SDG 3 and its specific targets, other SDG targets can directly impact health. In this review, VYLH-Philippines and its advocacies were identified to respond to six specific targets under five goals: Goal 2, 3, 4, 8 and 10.

The WHO has also noted that more than saving lives in developing countries as previously covered by the MDGs, the SDGs are involved in creating healthier societies and promoting the well-being of mankind. Likewise, it is also important to know that the Global Goals speak about and fight for equity by addressing the needs of women, children, the poorest and most disadvantageous groups. In terms of the VYLH-Philippines advocacies, these groups would include the unborn, newborns, and rare disease patients and their families.

Through the individual, humble, and collective efforts of volunteer youth leaders (VYLs) on the fulfillment of the network's advocacies, the VYLH-Philippines, as a network, will continuously aim to remain true to its mission of empowering the youth for health, and providing service that would advance the SGDs in the Philippines to its capabilities. #RPascual

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The Global Goals. http://www.globalgoals.org/
Republic Act 10747 (Rare Diseases Act of the Philippines) http://www.gov.ph/2016/03/03/republic-act-no-10747/
Congenital Anomalies (WHO Fact Sheets). http://www.who.int/mediacentre/factsheets/fs370/en/
Preterm Birth (WHO Fact Sheets) http://www.who.int/mediacentre/factsheets/fs363/en/
1 in 5 pinays is folate deficient (DOST Media Release). http://region4a.dost.gov.ph/news/12-updates/631-1-in-5-pinays-is-folate-deficient
Child death rate now lower, but maternal mortality up (Philippine Daily Inquirer) http://newsinfo.inquirer.net/631866/child-death-rate-now-lower-but-maternal-mortality-up
PH 'likely' to meet education, infant mortality MDGs (Rappler) http://www.rappler.com/nation/66783-philippines-progress-report-mdgs
Philippines Country Profile (Countdown to 2015: Tracking Progress in Maternal, Newborn and Child Survival) http://www.countdown2015mnch.org/documents/2014Report/Philippines_Country_Profile_2014.pdf
Sponsorship Speech of Senator Pia Cayetano for SB2990. http://senatorpiacayetano.com/?p=2915

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