DOH.NCIP-DILG JOINT MEMORANDUM CIRCULAR NO. 2013.0119 April20t3

FOR : AII DOII, NCIP and DILG Units, Levels and Attached Agencies, LocalGovernment Units, Indigenous Cultural Communities/fndigenousPeoples, and all concerned public, private and Civil Society Organizations

SUBJECT: Guidelines on fhe Deliverv of Basic Heaith Services for tndieenousCultural Communities/Indieenous p.,elBles

I. Rationale #The Universal Health Care (JHC/trklusugan Pangfalatratan (I(P) strategy of the Departmeirtof Health (DOH) is directed towards achieving better health outcomes, sustained healthfilancing, and responsive health systems. It hopes to attain these by. ensuring that allFilipinos, especially the disadvantaged groups, have equitable access to affordaLle healthcare' This means that essential health services must be gvqn not only to those who can affordit but also to those who are financially and socialy disadvantaged.

The strategy known as the Geographically-Isolated and Disadvantaged Areas (GIDA) HealthSystems Development (HSD) aims to establish a health system that will address healthinequity in GIDAs and improve availability and access to health resources and services,thereat. A key course of action of GIDA HSD is the exte,nsion of basic and regular healthfacility-based services to these far-flung areas and marginalized populations-. Thus, anessential health package that integrates all bar,i _' 1,;,]ri; service progmms, including resourcesand systems, among others, need to reach these i; ser,,,,imtaged groups,

The Indigenous Peoples, who are among the most $r6dyz1taged of the Philippine populace,comprise around l3Yo of the entire Philippine population that are considerably vulnerable toinequities in health. The magnitude of poor healftr outcornes urmong IPs remains to beestablished since disaggregation of health data by ethnicity ig not available and poses anotherform of inequity specifri on health information. Current data from the DOH however revealsthat municipalities and provinces considered to have a large GIDA and IP population havepoor health indicators compared to municipalities and provinces that are more accessible. Theisolation of IPs contributes to the barriers in their access to health services. This can beattributed to physical segregation and socio-cultural exclusion. Far distance of the healthcenter is one of the top reasons that IPs sampled in a2012 research stated for not visiting thehealth center. This contributes to IPs relying mainly on their indigenous health systems andpractices, some in accordance and some contrary to safe health practices.

ln order to bring culture-sensitive and safe {gpnth se;yices tc IP communities, the NationalCommission on Indigenous Peoples (NclP)'p{pyi4g's outrehch health scrvice activities incoordination with the DOH and Local Covernnitint Units (LGUs). At most, NCIP's healthservice outreach is a measure to address an urgent health need/gap with minimal longtermsustainability. If this situation will remain uncorrected, the health status of ICCsltPs will

oontinue to deteriorate. The objective of providipg Universal Health Care for all will not beachieved. There is, therefore, a need to irrteeraie-the culture-sensitive approaches of NCIpinto the DOH and LGUs' health programs.

The delivery of health services are devolved to the LGUs. But delivery of health service toIPs may be complex. IP communities are geographically defined by their Ancestral Domainsthat may be covered by geographic areas of various sizes and at times under several LGUs.DILG is mandated to esta'olish a systern of cooperation among LGUs to ensure efficient andeffective service delivery to the public and provide general supervision over LGUs, Thus, thecollaboration with DILG is o'f paramount importance in the effective implanentation of IPhealth programs.

The DOH can bring effective health service programs and NCIP can assist to design andpromote it in a more culture-sensitive mantrer and DILG can provide supervision andmonitoring of program implementation by LGUs.

In view of the above, partnership/collaborp -oii iet$,een the NCIP, DOH and DILG is vital tothe pursuit of better health service delivery alid b.ehlth outcomes for IPs. Such partnership isformally forged through this Joint Memorandrrm Circutar

II. Statement/I)eclaration of PolicyThis Circular supports the following national policies and policy declarations:

1. Universal Health Care (UEC)/f(alusugan Pang!<alahatan (KP) (AO 2010-0036) seeksto improvg strearnline and scale up previous health reform strategies in order to addressinequities in health outcomes by ensuring that all Filipinos, especially those belongrng tothe lowest income quintiles, have eqrritable access to health care.

2. The Indigenous Peoples Rights Act of 1997 (IPRA) RA 8371 guarantees the access ofindigenous peoples to basic services, including health. Interventions towards ttre healthdevelopment of IPs shall be implemented in a manner that promotes the important rights

'bf IPs to self-governance, empowermeni eiC c-uitural integrity.

The Four intsr-related Bundles "[' t,.igl4- shall \govern the development andimplementation of health policies, programs hnd projects for IPs towards self-governanceand self-determination towards sustainable development. These rights refer to a) rights toAncestral DomainMands; b) rights to self-govemance and empowerment; c) social justiceand human rights; and d) rights to cultural integrity.

3. UN Declaration on the Rights of Indigenous Peoples 2007 (UNDRIP). lndigenouspeoples have the riglrt to a), the improvement of thsir economic and social oonditionswithout discrimination, including in the areas of education, employment, sanitation, ,rndhealth, among others; b) develop priorities and strategies for exercising their right todevelopment, ffid to be actively involved in developing health, housing, and otherprograms; c) taditional medicines, rnaintain their health practices, conserve fheir vitalmedicinal resources, and access health and social services without discrimination; d) theenjoyment of the highest attainao-Ie sr.amrl6r"{ of physical and mental health, and; e)maintain, conkol, protect and develop fte{ i)*cqlturat heritage, traditional.knowledge and

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cultural expressions, and the manifestation of their sciences, techrnologies and cultures;and ii) intellectual property over such cultural heritage, traditional knowleCge and culturalexpressions, and science and technology.

The Local Government Code (RA 7160) provides for the establishme,nt in every localgovernment unit an accountable, efficielit, afld dynamic organizational structure andoperating mechanism that will meet the pi:oqity needs and service requirernents of itscommunities. LGUs need to ensure and support the preservation and enrichment ofculture, promote health and safety, and enhance economic prosperity and social justice ofits inhabitants, among othe$. Specifically, LGUs shall exercise powers and dischargefunctions and responsibilities appropriate or incidental to efficient and effective provisionof basic services facilities that include health and sanitation.

Primary Ilealth Care (PHC), together with health systems strengthening and the agreedminimum essential health packages, is the core framework for achieving universal aocessto quality services for improved health outcomes for all. It shall enable IPs activeparticipation and involverne,nt for better health and self-reliance.

The Traditional and Alternative Medicine Act (TAMA) of 1997 (RA S423) declaresthat it is the policy of the State to improve the quality and delivery of health care servicesto the Filipino people through the developrnent of traditional and alternative health careand its integration into the national healt\paue delivery system. It shall also be the policyof the State to seek a legally workable basis fifwlrich indigenous societies, i.e. IPs wouldown their knowledge of traditional medicine.-\ltfhen such knowledge is used by outsiders,the indigenous societies can require the perrnitted users to acknowledge its source and candemand a share of any financial return that may come from its authorized commercialuse.

III.ObjectivesThis Circular aims to set the guidelines that will address access, utilization, coverage, andequity issues in the provision of basic health care services for ICCs/IPs to achieve betterhealth outcomes.

Specifically, these guidelines intend to provide directions for:1. Making basic health services available and culture-sensitive,2. Providing equitable distribution of needed health resources,3. Ensuring non-discrimination of ICCs/IPs in the delivery of health services,4. Managing geographical, financial and sopic--cyltural barriers so that IPs can access

basic health services, and ' ',u''

5. Strengthening recognition, promotioq and respect of safe and beneficial taditionalhealth practices.

IV.Scope or CoverageThese guidelines uppty to all units, levels and attached agencies of the DOH, NCIP, DILGICCs/IPs, LGUs, IP organizations, Official Development Assistance (ODA) partners, privateorganizations and other entities that havo mandates, stakes and interests on the delivery ofhealth services to ICCs/IPs.

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Definition of TernsIndigenous Cultural Communities (ICCs)/Indigenous Peoples (IPs) - refer to, as

defined by IPRA, a group of people or homogenous societies identified by self-ascriptionand ascription by others, who have continuously lived as organized community oncommunally bounded and defined territory, and who have, under claims of ownershipsince time immemorial, ocoupied, possessed and utilized such territories, sharingcornmon bonds of language, customs, traditions and other distinctive cultural traits, orwho have, through resistance to political, social and cultural inroads of colonization, non-

indigenous religions and cultures, becan:e h.rit;rically differentiated from the majority ofFilipinos. ICCs/IPs shall likewise include peoples who are regarded as indigenous on

account of their descent fiom the populations whioh inhabited the country, at the time ofconquest or colonization, or at the time of inroads of non-indigenous religions and

cultures, or the establishment of present state boundaries, who retain some or ail of their

own social, economic, cultural and political institutions, but who may have

displaced from their traditional domains or who may have resettled outside

Ancestral Domains.

.r\ncestral Domain (AD) - refers to all areas generally belonging to ICCs/IPs comprising

lands, inland waters, coastal areas, and nafural resources ttterein, held under a claim ofownership, occupied or possessed by ICCs/IPs, by themselves or through ancestors,

mmmunally or individually since time immemorial, continuously to the present except

when intemrpted by war, force majeure or displacernent by force, dec6it, stealth or as a

consequence- of goremment projects or any other voluntary dealings entered into by

government and private individuals/corporations, and which are necessary to ensure their

economic, social and culfural welfare. ft sha,li include ancestral lands, forest, pasture,

residential, agricultural, ffid other l#4s ,inqividually owned whether alienable and

disposable or oth*oire, hunting grounds, tuHfl grounds, worship areas, bodies of water,

rnineral and other natural resources, and lands which may no longer be exclusively

occupied by ICCs/IPs but from which they haditionally had access to for their subsistence

and naditional activities, particularly the home ranges of ICCs/IPs who are still nomadic

and/ot shifting cultivators. (RA 8371 Chapter 2, Section 3'a)

Ancestral Domain Sustainable Develryment and Protection PIan (ADSDPP) - refers

to the consolidation of the plans of ICCVIPs within an Ancestral Domain for the

sustainable management and development of their land natural resources as weltr as the

development of human and culta:al resources based on their indigenous knowledge,

systerns and practices. Such plan shall be the basis of the Five Year Master Plan for

beentheir

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ICCs/IPs. (NCIP AO No. I Series of 2004)4, Mobile Indigenous Peoples - are IPs/ICCs whose livelihood depends on extensive

Ancestral Domain and seasonaVweatt,'r'ij r'J{rie'} that rnake them periodically move and

settle in livelihood-conducive areas v{44ur thr;ir Ancestral Domain. Mabile IPs include

shifting cultivators or those who ar9 tradiiioq4tly nomadic.

5. Geographically Isolated & Disadvant$ged Areas (GlDAlFar-flung areas and

**frnuiirrd populations which rq:lude islanils, mountainous areas, conflict-affected

*"*i (CRes),lniemally-displaced persons (IDPq; and ICCs/IPs'

6' Essential health packages (EHP) - define iire basic minimum health services coveringthe promotive' preventivl, aiagnosti"^*at.crr"ti"J*p""* of health care; determine theresowces needed; an! identifv the functional and s-tnroturat components for the bestpossible provision of these services trrut r"rpona -io

tt e needs of the community,erpecially the poor and marginalized.

7' Free Prior rnfor111cr11e1{Plc) - as used in RA B3lt,it shall mean the consensusof all me'mbers of the ICCsAPs to be detenriined in accordance with their respectivecustomary laws and practices, free from any external manipulation, interference andcoercion, and obtained after fully disclosing the intent and scope of the activity, in alanguage and process understandable to tt""ro***ity. Ga g3Zr Chapter 2, Section3,e)

8' Indigenous Knowledge, Systems and Practices (IKSP) - these are systems, institutions,mechanisms, and technologies comprisir.g r. unique body of knowledge evolved throughtime that embody pattems of relationship-s terwe"o *oamong p*pi"r, their lands andresource environme'nt, including such spherE of relationstrips irhicU ma-y include social,political, cultural, economig

"itigiorr. sptre"E, ana **cn ale the direct outcome of theindigenous peoples, responses to cemai" "eeds

consisting of adaptive mechanisms whichhave allowed indigenous peoples to survive and thrive *i*rin tireir given socio-cultural

9' Essential medicinesr- these are medicines that satisff the priority health care needs offlre population and which are selected based on the e*riience of their efficacy, safety, andoomparative cost-effectiveness. These medicines shall be made """il"tiu *d affordableat all times' The prioritization of the health ;;;;;r shall be based on the burden ofdisease.

L0' I'raditional health pracdce - is any practice claiming to heal ..ttrat does not fall withinthe realm of conventionar medicin.,,i ii fr.o,r_entty gou;; ;A ;;h";;'*y medicineor integrative medicine, which in gener.plr;gf"rjd the same interve,ntions when used in

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11' Upgrading of health facilities - refers to improvement of health facilities, in terms of

12' culture-sensitivity in health care mearur policymdkers and health workersacknowledge and respect cultural diversity among trre pop"tu"e since this has an effect onvalues, learning,_blhavior, health practicJs and oirtcomes. This should be reflected in theperformance of their fu nctions.

VI.GeneraI Guidelinesl. SeMce Delivery Framework for ICCs/Ips

The DoH's Universal Health Care hopes to ensure the achievement of the health syste,mgoals of better health out@mes, zustained rreair,r financing and responsive health ,yrt"-,by gnsuring that all-Filipinos, especihliy,uid disadvaitaged g";p in-itre spirit oisolidarity, have equitable access to affordalilotiuality heatth ilo ila are protected.from

financial risks. This goal must also be realized in ICCslIPs. Universal Health Careenvisions: t) ICCsAPs with improved health outcomes, 2) health systerns responsive toICCIP culture, needs and concems, and 3) health financing sustained for health servicesfor ICCs/IPs. A key feature of ICC/P Health Service Delivery is the extension ofessential health packages to ICCS/IPs.

In thp design and delivery of this essenti4l health package, LGU, DOH, NCIP and DILGmust consider'the social and cultural determinants that affect health practices of anindividual and his human rights and social justice. lndigenous peoples have four (4) basicrights under the IPRA. These are rights to l) Ancestral Domain/land 2) social justice andhuman rights 3) self-governance and empowerment, and 4) cultural integrity that are allworking toward self-govemance and self-determination toward sustainable development.Health service delivery in ICCs/IPs needs to acknowledge and consider these riglrts.

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While extension of essential health packages to ICCs/IPs are meant to address equity

concerns on availabilitS access and quahty, the delivery of EHPs in ICCs/tPs should

iecognize, promote and respect the culture and practices of ICCs/IPs that are safe and

beneficial. There should be an effort to work towards interfacing medicine and science

with ICC/P culturq practices and rights, without compromising the achievement offavorable health outcomes. I

The delivery of these health services r,:rqt.dlso be designed in a sustainable way. Toachieve ttris, it should allow empowerm€rnt'pf-individual ICC/IPs to influence the deliveryof the EIIP and integrate it into their existing community health delivery system. Theyshould also be allowed for self-governanci and management of such a systcrn. The end

goal is the realization of UHC through a concerted effort of the ICCs/IPs and relevantgovernment agencies.

2. Guiding PririciplesThe following shall serve as the basic guiding principles in the delivery of health services

to ICCs/IPs:

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Equity in healthEssential health services must be grven not only to those wto can afford it but also tothose who are financially and socially disadvantaged ICCs/IPs, particularly the poor.They shall be a priority beneficiary in the provision of logistics, technical andfinancial assistance on health, and have preferential access to health care that needs tobe made available and affordable.

Promoting equity in health aims to ensure adequate access and increase in utilizationof health services contributing to better health outcomes and decrease healthdisparities between ICCsIIPs and non-IPs, +,lrough the extension of basic and regularhealth facility-based services to far-#uug areas and marginalized populations.

Favorable health outcomes as the primary goalFavorable and better health outcomes for IPs are the primary goal of health seryicedelivery to ICCs/trPs. Goals of providing benefit, ensuring safety and quality (saving

lives, improving health and quality of life) are of paramount conceffi, ffi well as healthpromotion/advocacy on and provision of basic and essential quality pubiic healthservices and programs, standing on sound scientific process and evidence.

Culturesensitivity in healthCulture-sensitivity acknowledges the Existence of traditionaVindigenous healthsystems and IKSP. It also takes into account the differences between the current and

preferred cultural beliefs and practices on heatth care and IKSP, and the health

services offered by the tocal Government Units, DOH and other health care

providers. Health care providers should not see traditional and cultural beliefs and

practices and IKSP as an obstacle or b,erriero health care.

Research shall be encouraged to idffi'oti*, traditions and practices that are safe,

benefrcia\ and scierrtifi.ca\\y accqttable, against those which ate dangetous,

detrimental and harmful- There should be positive reinforcement and support ofpractices that are safe and acceptablo, and provision of waming and caution against

practices that might be harmful

Culture sensitivity shall be promoted through culture-sensitive orientation/training to

health workers, policymakers and other stakeholders

d. Respect for Human Rights, and Gender and DevelopmentThe delivery of health services for ICCs/IPs shall reflect the development perspective

and process that is participatory and empowering, equitable, sustainable, free fromviolence, respectful of human rights and supportive of self-deterrrination and

actualization of hu** potentials. It shail ."Jk to achieve gender equality as a

fundamental value that should be ge,fl,e.q1ed in health dwelopment choices and

contends that women are active agents ofhealth development.

VII.. Specific GuidelinesThe EHP piilars identified in the WHo-commissioned study Develoryment of an Essential

Hetzlth Package (08 September 20IQ shall be adapted/expanded for ICC/P health service

detivery. The iollowing-strategies intend to create the environment for the extension of

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service delivery to IP areas and to ensure the sustairta,bility of interventions towards IP health

development.

A. GovernanceHealth governance shall establish the mechanisms for leadership, accountability,

stewardsfiip and meaningful participation of ICCs/IPs, in concemed levels . ofpolicymaking and decision+naking, as full partners in their own health developmont.

1. To facilitate the implementation and institutionalization of this Circular, it is

recommended that the Local Health Board (LHB) at the provincial, city and

municipal levels of governance, elevate to the S.anggUniang Panlalawigan, Lungsod'

and Bayan the passage of an ordinance in zupport of this circular.

Health programs/projects and activities in the ADSDPP shall be included in the local

health p*r liki the Province/city-wide Investment Plan for Health (P/CIPH),

Municipal-wide lnvesfiIent Plan fu tieaith (MIPH), and Annual Operations Plan

(AOP) on health. Thus, ttre P/GIPH, I{Pf+ ana aQ!1 shall incorporate the health

service needs, and programs/projects for'ICCs/ps. LGU (province, city, municipality

and barangay) "ooni"tprtUsupport

for ICC/P health development shall be

incorporated in the LGU annuat budget. This shall be reflected in the Annual

Investment Plans (AIP) and the Local Divelopment Investment Plans (LDIP)'

Ips shall have representation/mernbership in LHBs, inter-local hLalth zoneldistrict

health systern $LHADHS) boartl, negionat Development Councils (RDCs), among

other similar local, regionai and nationil structures that include the health agenda' The

Department of Interiir & Local Governmekt Memorandum Circular No' 2010'll9

"Mandatory Representation of Indigenous Cultural Communities or Indigenous

peoples in policy-making Bodies and6*rer Legislative Councils" shall be re-enforced

for this purpose.

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4- LGUs shall recognize, coordinate an,rl ro-r'na.nage heatth service delivery where there

;;;;tt" int;LGU boundaries yf .tgct/P areas and mobile IPs' Thus the ICCiP

health care systefir and structure shatl 6A',fi1;rfaced with the regular health system and

structure. For such collaboration, the iri:utincial/City Health Offioer and Ce'nter for

Health Development may take the roie of coordinator and technical assistance'

provider.5. To promote self-governance, community-managed health care shall be encouraged in

ICCs/Ips. The rJte of barangays or, th" health development of ICCs/IPs shall be

identifi ed and skengthened.

B. Iluman Resources for IlealthIIuman resources for health shall address the shortage in quantity*d qT4'tv o^f t'yT*resources by i";;;;g ,rr" r"*Ul inptoring thelapacity, and providing for other

mechanisms that will manage such shortages'

,\ human resourc,es for health plan for ICCsllPs shall be developed recognizing the need

tlor a comprehensive and strategic resipunse .r.o qR--li*itations in the hea]th service

delivery that affect most IP communitiqt'. iiiu,ql* shall cover systems and capacity

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building based on the nature of strategies to address shortage in quantity and quality ofhuman resources.

SystemsICC/P health workers shall be encouraged to be a part of the Rural Health Unit(Rllti) staffto promote firther understriding the ICCsTIPs and partioipate as allies ofthe RHU to advocate for some needed i:eha','ior change among the ICCs/tPs.1.1 Heatth facilities shatl be composedrof trained and culture-sensitive health workers

providing'locally adapted and culture sensitive care that will lead to increasedsatisfaction and utilization of health service.a. LGUs with ICC/P population shall be encouraged to have a mixed-culture

workforce on health including IPs, in their health facilitiesb. Extra effort shall be made to hire an IP health worker (doctor, nurse, midwife

etc.) to be in the regular health workforce of the DOH and LGUs. LGUs are

encouraged to give priority to an IP health worker to be hired if the post ofassignment is in IP communities.

1.2 The following options to address the shortages in human resources for health inICCsAP areas may be considered:a- Support for health workers in ICC/IP areas, e.g. regular provision of

transportation allowance, organization and regular deployment of mobilehealth teams to deliver healtfu pelvites to ICCs/IP areas that have diffrcultyaccessinghealthcare, etc.' . rcr,.,,,'

b. Expansion of DOH Human ReCddrce Deployment Program. The Doctors tothe Barrios Program (DTTB) program shall be expanded to cover moredoctor-less ICC/P areas. The DOH shall also consider developing extensionservice for nurses and midwives to ICC/P areas with competitiveremuneration package.

Capacity Building2.1 Eligible IPs shall be supported to undergo formal education to become doctors,

nurses, and midwives. Eligible IPs shall be tained andlor capacitated to become

BHWs leading to their being part of the regular public health workforce.Eligibility shall bedefined in a separate issuance.

2.2 Hilots and traditional birth attendants must also be trained to assume an

altemative/complementary role in a safe and effective health system.

2.3 Scholarship opportunities shall be expiored to be provided for IPs on health

,.-;!ili? IPs shall be trained on balSlc iiealth and ernergency/first-aid services insupport of a community-managed h?alth care. Basic health and emergency/first-

aid services are coniidered immediate health care that the community can respond

to in the absence of a health worker.2.5 Current and newly-hired health workers and health care providers at all levels

shall be trained sn culture-se,nsitivity in the performance of their regular work-

The health care provider shall practice culture-sensitivity when offering the health

services to ICCs/IPs following the LEARN method which includes:

' Listening carefully to the ICCsllPs perceptions,

' Explain carefully the health service to be provided

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' Acce,pt the difference in perception if the explanation was not accepted. Recomme,nd andr Negotiate for a mutually acceptable compromise.

lnfrastructure and equipmentInfrasfucture and equipment shall address the shortage in quantity and quality offacilities by increasing the number, improving the quality, and providing for othermechanisms that will rnanage such shortages. These should not require high technologyand high cost or heavy equipment to be delivered or one that requires a signiflcant supplyof water or electricity thatis often not available in these areas.

1. Construction and/or renovation of birthing facilities, BHS and establishment of healthand nutrition posts/rernqte health stations shall be prioritized for ICCs/IP areas, and

shall incorporate appropriate indigenous design and materials. A perrranently stayinghealth worker, at least a midwife, shall be provided in the bffiingfacilities/BHS/health and nutrition post/remote health station. Culture-sensitivebirthing or care facilities may also be setup in RHUs, district hospitals or provincialhospitals.

2. LGUs shall work towards identiffing and making available water, electricity and

efficient comrnunications system and./or alternatives in health facilities in IP areas. Inreferral health facilities liki hospitals, IP wards with culture-sensitive health workersmust be provided.

3. Health facilities in IP areas shall, likewise, include the following skuctr:relsystem, as

appropriate like:. mobile clinics. culture-sensitive birthing facuitl

4. Telernedicine; which expands the rbach ilf medical specialist support services to

sfiategic underserved communities through the use of information and communicationtechnology QCT) systems, shall be explored for ICCIP areas.

Supply of essential medicines, rational use, delivery and its alternativesTimely supply and delivery of esseirtial medicines and its altsrnatives shall be e,nzured toall health care facilities and ICCIP communities. [t shall also recognize *ie development,

safe and rational use of beneficial traditioral and/or alternative medicines.l. Essential medicines and other special packages shall be equitably allocated and

distributed for .ICCs/IPs with health needs through a mechanism that shall be

developed for this purpose. Adherence to the Philippine National Drug Formularyshall be observed.

2. Delivery systems for, and the ratirllrel use cf beneficial traditional medicines shall be

developed and implemented. ReseEcf,ghaSl be encouraged on the following:. Effectiveness of herbal medicines ' 'b' Search for more herbal medicines

' Improvingproduction of herbal medicines

D.

E.

3. Herbal medicines as weli as IKSPs that. ane shown to be beneficial and safe shall beencouraged. Behavioral change interv-,ntion may be done for unsafe and ineffectiveherbal treatment and practices in a culture-sensitive manner.

4. Regular culture--sensitive trainiriig/education and information/communicationmaterials on the rational use of medicines shall be designed and provided. Communityhealth volunteers may be tapped for this purpose.

Service standardsServiee standards shall serye as the quality control mechanism for the services renderedin the EHPs at all levels of health care facilities that will ensure access, adequacy andappropriateness for the ICC/P population served. These shall cover operationalprocedures, protocols and guidelines ofhealth programs and services that shall be in placeand delivered to ICCs/IPs, and made culture-sensitive.1. The EHP shall be delivered to the ICCsiIPs based on their need on a regular basis,

like monthly for continuing care needs and immediately for acute care needs. Itshould be delivered and provided rl*n standards that include safe and effectiveindigenous knowledge, sysierrs.aud prpctipeg. Financiat and technical assistance mustbe given to LGUs and IP communities for their health facilities to meet thesestandards.

Z. In situations where ICCsiIPs are internally-displaced due to natural and/or human-made disasters and armed-conflic! among othcrs, minimum health service package inemergencies and disasters shall be provided without undue discrimination and in amanner that is culturally appropriate and sensitive.

3. Health programs and services shall be reviewed and adapted to cultural and localconditions,.and designed considering that ICCsllPs are generally in GIDAs, with veryminimal transportation and resources available. Such adaptation must not sacrifice theeffectiveness and safety of health senrice delivery.

4. Environmental health and sanitation sr'.,ices shall be strengthened in consideration ofclimate-change and existing practices. cf,ICQp/IPs.

5. Positive reinforcement approach/metfrodtdf,Af U" employed to promote acceptabilityand utilization of health programs and services.

f inancing sources and managementlinancing sources and management shall identifu all possible sources of funds, as wellas drafting the scheme for proper budgetary allocation bf resources for IP health servicedelivery.1. The DOI{, througfo PhilHealth, and NCIP shall collaborate with the Departunent of

Social Welfare & Development (DSWD) on the improvement of coverage in terms ofenrolment, utilization and availmtirrt, among others, of financially-disadvantaged IPsto the PhilHealth Sponsored Prograrn and qualification'to the Conditional Cash

Transfer (CCT/aPs). Financially-disadvantaged/IPs shall be automatically enrolled inPhilHealth Sponsored Prograrn subiecl to a validation system. Financially-disadvantaged IPs/ICCs shall be defiped

1X e s+*ate issuance.

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Health facilities in ICCs/IP areas shall be made eligible for PhilHealth accreditation as

appropriate. The LGUs shatl initiate the development and implementation of a

facilities upgrading and financing plan, with assistance of the DOH. Fund sources

from DOH include Harmonized Resource Transfer (HRT) Funds, EmergencyResponse funds, among others, can be the source of fund allocation for ICC/IP healthfacilities.

Funds from the LGUs, DOH, NCIP, DILG and other National Govemment Agencies

shall be tapped for funding of the impleme,ntation of the JMC. PDAF and other

special funds may also be tapped

Other health financing options shall be explored and designed with free prior-informed consent (FPIC), such as the following:4,1 Community-based health financing complementary to PhilHealth Sponsored

Program is foreseen to address the out-of-pocket cost of patients relative to the

occtrrence of illness in the family, which are not covered in the PhilHealthSponsored Program. These costs may include medicines, kaveling expenses to

and from health facilities, living allowance for the companion during hospital

admission, ilnong others.4.2 Applicable public private parfirerships (PPP) schemes may be encouraged with

the Consent of IP communities ard with socio-cultural safety nets in place. PPP is

foreseen to augment the limited financial and material resources required to

deliver health services in IP areas.

4.3 Resources and funding from partner Official Development Agencies (ODAs),

Civil Society Organizations (CSOs) and Non-Govemment Organizations (NGOs)

shall also be tapped and integrated to IP health service as described in this

Circular.

G. I\{anagement slrcternshtlanagement systems shall include processes/procedures, and tools for the development

and organization of health service delivery for IPs that includes health information

system, health facility systern, referral system, health education, and monitoring and

evaluation.

1. Ilealth informationl.l Health statistics and da4 including medicine-reporting/recording, shall be

disaggregated for IPs and non-IFs to guide prioritization for future program

development and imPlementatiod. :

a. Civil regiskation of IPs shall be sq$ortea to establish health statistics/data on

e*rnicity.1.2 Regular reporting of MDG-related indicators shall be covered to provide fresh

data for timely and appropriate action of health leaders/managsrs at all levels ofhealth care. \

2. Referral sistem2.7 Referral protocols shall be formally agreed upon togethf Yitl, concerned

ICCsAP areas with the indigenous health referral system interfaced with the

2.

3.

mainstream health referral system. The development of the referral system shallconsider inter-LGU boundaries and reporting protocols during healthemergencies, among others.

2.2 An IP health workei or an lP-oriented health worker shall be designated in healthfacilities to attend to referrals and facilitate provision ofcare to Ips.

.2.3 Ensure access of IPs/ICCS to acute care/in-patient and emergenoy servicesthrough the health referral system.

2.4 Collaborative arraugement with other govemment agencies and people that haveaccess to ICCs/IP areas, such as the Departnrent of Environment & NaturalResources (DENR) or the Armed Forces of the Philippines (AfP)/PhilippineNational Police) (PNP) or any uniformed personnel, among others, shall beencouraged.

3. Ilealth promotion and education3.1 Safe and beneficial traditional home care shall be promoted in recognition of

existing practices.3-2 Health educational and promotional resources and referenceVmanuals on field

practice shall be reviewed and customized considering use of local language andsimple/indigenous illustrations, visuals and concepts, for better comprehension,and clarity of instruction.

3.3 Active participation of IPs/ICCs shall be engaged in health .promotion andeducatiorq especially in the development of related materials and resources.

4. tlealth faciUty/organization4-l A staff who will attend to IP needs and concerns shall be designated in health

facilities covering a population.of ICCs/IPs. Other qualifications of the designatedstaff shall be determined.

4.2 DOH regional ofEces and DOH-retaine.d hospitals, health facilities at theprovincial, city an{ municipal levels shall establish an IP desl/designate staffwho will ooordinate and/or attend to IP needs and concems on health. An existingsimilar structure that can accommodate the said function may be tapped.

5. Monitoring & evaluationA systern for monitoring and evaluation of the implonentation of the JMC shall bedeveloped and pre-tested with the participation of ICCs/IPs and shall be designed fortheir own appreciation and utility.

II. Collaboration and partuershipCollaboration and partnership shall include community participation, health partnersand government agencies partnerships, multi-sectoral.partnerships, alliance-building, andnetworkingl. The role of IP health workers and BHWs in ICCs/IP areas as ICC P community

representatives shall be strengthenedr Aside frcm their regular role as support healthservice providers. The IP health workers ar,e, enyisioned to facilitate their communitiesthrough oommunity organization/mobilizati.o,r5 among others, towards a community-managed health care.

13

Collaboration between Local Chief Executives, congressional representatives andother government agencies shall be encouraged to increase the available resources forICC/IP health service delivery.

Public-private and IP partnership mechaaisms shall be developed to augment thelimited financial, material and human resources needed to deliver heatth sirvices inICCs/IP areas. These shall provide a more active role for ICCsAPs in the PPP loop.

VI[. [rnplementing ArrangementsA. Main implementing agencies

L The DOH, NCIP and DILG will be the main implernenting agencies and shalloversee the implementation and monitoring of activities within this JMC.

2. Inter-agency Committees at national, regional and province levels to overseeplanning, irnplementation, and M&E shall be organized. Existing similar structuresthat can accommodate the said function may be tapped.

B. Year l ActivitiesThe following outlines the immediate activities for implementation in Year l."Funding ofthese activities. shall corne from regular operations budget of concerned agenciesconsistent with their respective mandates. ' ,- ,:

""" i'i''

Immediate Activities Aeencies Resoonsible1. Policy advocacy/orientation on the JMC DOH. NCIP & DILG2. Development of a joint strategic & action plan on

JMC implementationDOH, NCIP & DTLG

3. Organization/expansion of existing lnter-agencycommittees at national and regional levels and inselected provinces

DOH, NCIP & DTLG

4. Listing/updating/rnapping of ICCsAPs NCIP and LGUs (all levels)

5. Mobilization for the development of ICC/P healthdata disagpreqation svstem

DOH, DILG and NCIP

6. Local adaptation of this Circular Pilot LGUs, DILG7. Inclusion in 2014 Province/City-wi{e Invephnent

Pans for Health/Annual Operational Plahsl of theextension/expansion of coverage of health facility-based services in at least one (l) ICCIIP area inprovinces and cities with significant ICC/IPPopulation

LGUs (Province and HUCs)

8. Design of culture-sensitivity orientation module forhealth providers

DOH and NCIP

9. Conduct of culture-senSitive orientation for selectedDOH staffand IP Health Technical Team

DOH and NCIP

l0.Inventory of CHD and LGU initiatives onalternative health service delivery projects specificfor ICCs/IPs

DOH, NCIP, LGUs

2.

3.

C. Financing lfealth Service Delivery to IpsCommitment frorr identified financial sources shall be established and strengthened tosupport health services for Ips.1'- The DOH, NCIP *O nfiC shall collaborate to ensure adequate financing to health

infiastructure, health human resource and health and social services to ICCs/Ip areas.This can be achieved by specific allocation in their annual budget through the GeneralAppropriations Act enacted annually by Congress.

Other potential funding'sources that are nof limited to those listed in Section VII. F,such as existing DOH guidelines on clessification and availme,lrt of governmenthospital services (AO 5l-As200l).

The DOH, NCIP and DILG shall also advocate to the LGUs to increase IP healthbudget and utilize its gender and development (GAD) allocation.to IP communities.

LGUs may also utilize its regular and other fund sources for health services for IPs.

D. Roles & Responsibilities1. Functions of main implementing agencies

As the main implernenting bodies of this Circular, the DOH, NCIP, DILG CentralOffices are responsible for the following:l.l Development of sEategies and action plaru issuance of related policies, and

execution of a Memorandum of Agreement with other agencieVorganizations, asnecessary

1.2 Allocatiou of funds and logistics , ;

1.3 Oversight function1.4 Monitoring and evaluation "'1r'

1.5 Capacity building and technical assistance.

2. Specific functions of main implementing agencies/bodies2.1 DOH

d. Central OfficeThe DOH central officg througlr its program units and relevant attachedagencies, shall also be responsible for the:

l. Development of the design and delivery of the culture-sensitive EHPs

ii. Development of culture-sensitive health education, health promotion

... and behavior change communication sftategy.111. Development and implementation of facilities upgrading plan for

health facilities in ICCs/IP Ereprs, in partnership with LGUs.b. Regional Offices

The Centers for Health Development/DoH Regional Offices, through itstechnical progr:rm staff and the DOH representatives, shall provide technicalassistance to LGUs, conduct training and capaeity building, advocate to LGUsand monitor and evaluate activities covered by the JMC.

2.

3.

4.

2.2 NCIPa. Central Ofr"e

The NCIp cgntral ofEce shall be psponsible for the following:i- Lead in the deveror*r".i-Ii';;;il1?",","* modure on curture-sensitivity in health careii' Ensue that the socio-curtural perspective of ICCvIps is incomoratedin a{l as,nects

9f the implementi rri"rrrr" irraciii' Listing/mapping/updating of ICCs/Ips ioi"*r, of socio.economic and

5ffifiH*: profiles, ;.rs -.,ih*'; I tp* to,.rp rr"ara f,.gru,n

b. Regional OlfiiesThe NCIp regional offrces shall:i' provide technical assistance to provinciar officesii.

*::lrl" the conducr of Eainil; oo-.u]*r.-sensitivity for hearth

iii. Advocate to LGUs andiv. Facilitate the conauciof fplC when necessaryv. Monitor and evaluate ,fhe culture-sens*rr, aspect of activitiescovered by the JMCc. Provincial Offices/Community Sentice Centers

The.NCIP provincial om.nlio*iii"tiity ffi; Centers shau:i' conduct or assist in the dil'.,t ";'-ali#; on ICClp hearth at thecommunity rever, in coordination with LGu ileatn offices-ii' Be responsiblg for getting community support and participationiii. Gathering informatio' i*rrury for monitoring.and evaluation ofimplementation. -J

iv' Ensure inclusion of health activities in the ADSDpp in the Aops onhealthv- Facilitate representation of ICcs/Ips in Local Hearth Boards2.3 DILG

a. Central OfrceThe DILG Central Office shall:i' Iszue enabling policies to its attached agencies and different levels ofLGUs

ii' Monitor and waluate the impleme,ntation of policies relwant to Iphealth bylGusiii. Re-enforce adequate partibipdtion of Ip leaders in LGU governance inhealth.

Regional AficesThe DILG Regional Offices

i. Provide technical assistance to provincial Officesii. Assist in the conduct of traininsiii. Advocate to LGUs and e

iv. Monitor and evaluateProvincial OfiicesThe DILG Provincial Offices

i. Provide technicar assistance to Municipal offices under itsjurisdictionii. Assist in the conduct of training

iii. Advocate to LGUs andiv. Monitor and evaluatev. Gather information on the implementation of ICC/IP-health related

circularsvi. Ensure LGU budget appropriation for ICCAP health programs and

servicesd. Municipal Ofices

The DILG Municipal Officesi. Provide technical assistance to barangays under its jurisdictionii. Assist in the conduct of nainingiii. Advocate to barangays :,

iv. Monitor and evaluatev. Gather information on the implementation of lP-health related

2.4 Lo cal Government Unitsa. LGUs shall primarily implemenUdeliver health services for ICCs/IPs.b. Provincial, City, Municipal and Barangay LGUs shall appropriate the

necessary and available funding and resources for the conduct of activities inthe JMC that are within their jurisdiction, including maintenance of relatedinfrastructure and equipment.

2.5 LGU LeaguesThe Leagues of Provinces, Cities and Municipalities shall advocate to LGUs theimplementation of this Circular and shall carry the ICCiP hpultt, in its sectoral

agenda/activities. Promote LGU support and prioritization in allocation of funds2.6 IP communities/organizations

IP leaders, communities and organizations being the beneficial recipient ofactivities related to the Circular shdl extend theiq fuIl suppgrt to theimplementation of the activities. It shall encourage a senss of cooperation andvoluntarism among its members.

3. Other Partners3.1 Other National Government Agencies

The DSWD, CHED, NAPC, PNP, AFP and other NGAs shall be consulted forassistance in , the implementation of the JMC, especially those concerningeducational, social, cultural, financial and other issues that miglt prevail in thecommunity and affect the implementation of activities within the JMC.

3.2 Official Development Assistance PartnersThe ODA partners may also be conzulted for assistance in the implernentation and

funding of the activities related to the Circular.3.3 Other agencies/organizations

Other ag6ncies/orginizations shall be consulted and/or engaged, as necessary, forcoordination and/or operationaliza-tion of.this Circular considet'ing thb multi-sector@ncerns of ICC/IP health developn;eot. .

;

Research and documentation , *'4't

1. The evidence and literature on ICC/P heatttr and development shall be enriched

through research and documentation of LGU and ICCs/IPs working stategies and

initiatives towards ICCAP health development. DOH, NCIP and DILG shall include

IP health and development in its respective research agenda. FPIC shall be observedin all research undertakings for this purpose.

2. Research shall be prioritized on the development of herbal medicines and safety of Iphealth practices. The academe and other research institutions shall be tapped to jointlyundertake research on ICCIIP health anti development.

3. Research shall be conducted on the effectiveness of ICC/P health practices andculhre vis-i-vis mainstream practice of medicine. Research ou@uts shall be used asinputs to policy developmen! prograrn design, development and implementation.

I)L EffectivityThis Circular shall take effect immediately. A joint strategic and action plan providingspecific directions and guide.lines on implementation shall be developed following theissuance of this Circular. This Circular is an evolving document and shalt be reviewed andupdated as deemed necessary.

ENRIQIJE T. ONASecretary, DOH

H'PA*ID H,;Im[ o$t/.ICIP Y

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