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Women and Children Protection Program

Submitted by rhisdill on September 29, 2011 - 10:21 I. BACKGROUND AND RATIONALE The Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos embodied in Administrative Order No. 2010-0036, dated December 16, 2010 states that poor Filipino families have yet to experience equity and access to critical health services. A.0. 2010-0036 further recognizes that the public hospitals and health facilities have suffered neglect due to the inadequacy of health budgets in terms of support for upgrading to expand capacity and improve quality of services. AHA also states the poorest of the population are the main users of government health facilities. This means that the deterioration and poor quality of many government health facilities is particularly disadvantageous to the poor who needs the services the most.

In 1997, Administrative Order 1-B or the Establishment of a Women and Children Protection Unit in A Department of Health (DOH) Hospitals was promulgated in response to the increasing number of women and children who consult due to violence, rape, incest, and other related cases.

Since A.O. 1-B was issued, the partnership among the Department of Health (DOH), University of the Philippines Manila, the Child Protection Network Foundation, several local government units, development partners and other agencies resulted in the establishment of women and child protection units (WCPUs) in DOH-retained and Local Government Unit (LGU) -supported hospitals. As of 2011, there are 38 working WCPUs in 25 provinces of the country. For the past years, there have been attempts to increase the number of WCPUs especially in DOH-retained hospitals but they have been unsuccessful for many reasons. The experience of these 38 women and children protection units reflect that: Over the last 7 years from 2004 to 2010, all these WCPUs handled an average of 6,224 new cases with a mean increase of 156 percent. The 2010 statistics presented a record high of 12,787 new cases and an average of 79.86 percent increase from 2009. More than 59 percent were cases of sexual abuse; more than 37 percent were physical abuse and the rest on neglect, combined sexual and physical abuse and minor perpetrators. More than 50 percent of these new cases were obtained from WCPUs based in highly urbanized areas across the country. Figures show there is a need to continue to raise awareness on domestic violence to have more accurate recording and reporting; The National Demographic and Health Survey of 2008 reveals that one in five women aged 15-49 are physically abused and one out of 10 of the same age group are sexually abused. This figure runs into millions of abused women nationwide who do not seek any help or assistance; A consistent and adequate budget is necessary to sustain a women and children protection unit once it is established;

The source of budget cited in A.O. 1-B is subjected to multiple interpretations and is dependent on the priorities of the local chief executive and/or the healthcare facility management; There is no standard quality of service; Doctors and social workers are reluctant to take on the task due to heavy workload of women and child protection work, lack of training and feeling of inadequacy, and the nature of work, which among others requires responding to subpoenas and appearing in court; All the WCPUs are being managed by part-time personnel who are given add-on responsibilities and their appointments are not classified as regular plantilla positions; Women and child protection work is a new field and a pool of professionals must be recruited and trained to sustain the work; and Women and children protection work has gone beyond being a health advocacy to becoming an essential health service addressing the needs of victims of violence against women and children.

The strategies espoused by the AHA, specifically the service delivery network (SDN) and public-priva partnership (PPP), will be utilized in the institutionalization of the women and children protection program nationwide. A health SDN is composed of a network of health service providers at different levels of care from levels 1: health centers or women and childrens desks offering primary services, 2: district health facilities offering secondary care and 3: regional and national hospitals with tertiary care. An SDN can be as small as an Inter-Local Health Zone or as large as a regional SDN with a regional hospital serving as the end-referral hospital. The most efficient system for women and child protection facilities follows the SDN model where a complete and integrated women and child protection unit is located in a strategic hospital.

The primary goal is to identify where the women and children protection units will be located across th country and to ensure that there will be at least one in each province. Hospitals, whether public or private, which do not have a women and child protection unit may be trained to refer the victims to women and children protection coordinators (WCPCs) and WCPUs in other hospitals where the staff is trained in recognizing, recording, reporting and referring abuse cases. This will ensure that all women and children victims of violence who seek medical care have access to health services provided by trained, competent, and caring health personnel. II. GOALS AND OBJECTIVES GOAL: To institutionalize and standardize the quality of service and training of all women and children protection units. GENERAL OBJECTIVES: 1. Establish at least one women and children protection unit in every province; 2. Ensure that all health facilities have competent and trained gender-responsive professionals who will coordinate the services needed by women and children victims of violence; 3. Standardize and maintain the quality of health care services rendered by all women and children protection units; 4. Ensure the sustainability of women and childrens protection unit programs through appropriate organizational and budgetary support; 5. Create and maintain a centralized and harmonized database for all reports submitted by the different women and children protection units.

III. SCOPE AND COVERAGE

This issuance shall apply to the entire health sector, including the DOH hospitals, LGU-supported health facilities, private hospitals, and other attached agencies involved in the implementation of the AHA. Health professionals from private hospitals seeing patients who they suspect are victims of abuse are duty-bound to refer the said individuals to concerned government agencies for appropriate response in accord with either Republic Act Nos. 7610 [1] or 9262[2]. IV. DECLARATION OF POLICY

This issuance supports the Government Health Reform Agenda, the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination Against Women, the Beijing Platform for Action, the Child Protection Law,[3] the Anti-Violence Against Women and Their Childrens Act of 2004,[4] Anti-Rape Act of 1998,[5] the Rape Victim Assistance and Protection Act of 1998[6], and the Magna Carta of Women (2009).[7] The DOH shall thereby contribute to the realization of the countrys goal of eliminating all forms of genderbased violence and promoting social justice.[8] V. GUIDING PRINCIPLES This issuance is governed by the following principles: 1. Rights-based approach. Identification and treatment of violence against women and children is anchored on respect for and recognition of the rights of women and children as mandated by the Philippine Constitution, the Convention on the Elimination of All Forms of Discrimination Against Women, the Convention on the Rights of the Child, and the Beijing Platform for Action. 2. Best interest of the child. All actions concerning victims of abuse, neglect, and maltreatment shall take full account of the childrens best interests. All decisions regarding children shall be based upon the needs of individual children, taking into account their development and evolving capacities so that their welfare is of paramount importance. This necessitates careful consideration of the childrens physical, emotional/psychological, developmental and spiritual needs. Adequate care shall be provided by multidisciplinary child protection teams when the parents and/or guardians fail to do so. In cases whether there is doubt or conflict, the principle of the best interest of the child shall prevail. 3. Holistic service delivery. Care focused on the whole person addressing the bio-medical, psycho-social, and legal concerns. 4. Respect for diversity and non-discrimination. Holistic and appropriate health care delivered shall be coupled with respect for cultural, religious, developmental (including special needs), gender and sexual orientation, and socio-economic diversity. All women and children victims of violence shall have a right to receive medical treatment, care, and psycho-social interventions. 5. Evidence-based interventions and approaches. Policies and guidelines shall be developed in accordance with recent data gathered through prevalence surveys, efficacy studies, and other research done locally and internationally. Recommendations from international organizations may also be utilized when appropriate. 6. Multidisciplinary approach. Recognition, reporting, and care management of cases involving violence

against women and children are be best achieved through medical, psycho-social, and legal teamwork including the mental health intervention and local government unit response and cooperation, whenever necessary. VI. IMPLEMENTING RULES AND GUIDELINES 1. Committee on Women and Children Protection Program. The Committee on Women and Children Protection Program, hereinafter referred to as the Committee, shall be primarily responsible for policymaking, coordinating, monitoring, and overseeing the implementation of this revised issuance. 2. Composition. - The Committee shall be composed of the following: a. Undersecretary of Health Service Delivery as ex officio Chairperson; b. Undersecretary for the Local Affairs of the Department of the Interior and Local Government or his/her authorized representative; c. Undersecretary for Policy of the Department of Social Welfare and Development or his/her authorized representative; d. A regional director of the Department of Health; e. A hospital director of a DOH-retained hospital; f. Executive Director of the Philippine Commission for Women;

g. Executive Director of the Council for the Welfare of Children; h. Executive Director of the Child Protection Network Foundation; i. One representative each from the Philippine Pediatrics Society, the Philippine Obstetrics and Gynecological Society, Inc., the Philippine Psychiatric Association, the Philippine Psychological Association, the Philippine College of Emergency Medicine, the Philippine College of Surgeons, and the Philippine Academy of Family Physicians, Inc. The Chairperson shall appoint a Vice-Chair from among the Committee members who shall preside over the meeting in the formers absence. The Committee shall designate from among its members a program manager who will be given appointment by the Undersecretary of Health through a Department Personnel Order.

The Committee may create a technical working group, as the need arises, to help it in the performance of its functions. 3. Term. The Committee shall hold office for three (3) years and may be reappointed or until their successors shall have been appointed. 4. Functions. The Committee shall have the following functions: Identify and recommend strategically-located DOH-retained and LGU-supported hospitals for WCPU establishment using geographical and population ratio criteria; Formulate standard protocols and procedures and the manual of operations for multidisciplinary care for women and children victims of abuse and violence;

Set the policy for criteria and procedure for accreditation of women and children protection units to be forwarded to the Bureau of Standards and Regulation for appropriate action by the Department of Health (DOH); Lay down the policy for minimum requirements for training programs that are gender responsive, such as the Certificates for Women and Child Protection Specialty Program and other relevant residency programs; Monitor and evaluate the efficacy, effectiveness and sustainability of creation, operations, and maintenance of WCPUs; Recommend policy reforms and new guidelines anchored on evidence-based interventions and approaches; Harmonize existing databases and create a central databank for women and children protection cases; and Perform other functions as may be necessary for the implementation of the revised issuance. 5. Reportorial Functions. The Committee shall submit to the Office of the Secretary of Health its annual report on policies, plans, programs and activities on or before the last working day of February. 6. Meetings. The Committee shall meet regularly at least once every quarter. The venue shall be agreed upon by the members. Special meetings may be requested by the Chairperson or any Committee member, as the need arises. The Committee members and program manager shall be entitled to an honorarium for every meeting. VIII. ROLES AND RESPONSIBILITIES OF PARTNER AGENCIES A. Department of Health at the National Level The Committee shall be under the direct supervision of the Office of the Undersecretary for Health Services Delivery. The specific office/s to be designated by the Undersecretary for Health Services Delivery shall be primarily responsible for: a. The overall execution of the revised policy and manual of operations on Women and Children Protection Program; b. Accreditation of WCPUs; c. Generation mobilization of resources for the operations of WCPUs. B. Philippine Health Insurance Office (PhilHealth) The PhilHealth shall develop a service package for all WCPU patients that will facilitate the provision of inpatient and outpatient services. C. Centers for Health Development Disseminate the policy for adoption and implementation by LGU health systems in the different localities within their respective regions; Provide technical assistance to LGUs in organizing WCPU activities and developing relevant technical references and information, education and communication (IEC) materials; Generate resources to strengthen the implementation of the policy and manual of operations for WCPUs;

Formulate and implement advocacy plans to generate stakeholders support, particularly the local officials; Monitor the implementation of the policy and guidelines in both public and private hospitals, and in different localities in their respective regions; Undertake regular review with LGUs on the progress of the WCPU policy and guidelines. D. Local Government Units 1. Provincial / City Health Office a. Train private and public health workers on the women and children protection program; b. Advocate with municipalities/cities and other concerned agencies and stakeholders to adopt and implement the revised policy on the women and children protection program; c. Generate and allocate resources in support of WCPU provision (e.g., counterpart funds for training, procurement of additional WCPUs, etc); d. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols. 2. Regional and provincial hospitals a. Require all hospitals to implement the revised policy and its manual of operation as an integral part of their treatment and care protocols; a. b. c. Allocate budget sufficient for the operations of WCPUs; Conduct training and orientation on 4Rs; Maintain an accurate and complete database on WCPU clients.

D. Child Protection Network Foundation, Inc. Provide expertise and technical support for the establishment of WCPUs and the central database on childrens cases; Extend guidance to the trained physicians and social workers in WCPUs; Coordinate with the Philippine Commission for Women, Council for the Welfare of Children and nongovernment organizations (NGOs) regarding matters related to womens and childrens health and gender concerns; Participate in the implementation of the WCPU policy including its manual of operations. E. Philippine Commission on Women Provide expertise and technical assistance on gender-responsive delivery of services by the WCPU service providers and the central database on womens cases; Assist the DOH in monitoring the implementation of the WCPU using the Performance Standards and Assessment Tools for Services Addressing VAW in the Philippines; Require all hospitals to allocate from their gender and development (GAD) budget the funds required to create, operate, and maintain WCPUs and to report the use of their GAD funds to PCW. IX. REQUIREMENTS FOR THE ESTABLISHMENT OF WOMEN AND CHILDREN PROTECTION UNITS

The Committee shall ensure that all present and future WCPUs comply with the criteria mandated in this revised policy and its Manual of Operations. All WCPUS, depending on the number of their personnel, range of services rendered, and annual budget shall be classified as Levels I, II and III facilities. Minimum criteria for each of these units are enumerated in the Manual of Operations of this policy. MANUAL OF OPERATIONS The Committee on Women and Children Protection Program shall regulate the establishment and operations of all WCPUs in the Philippines. I. MINIMUM REQUIREMENTS FOR ALL HOSPITALS A. Training. The Committee shall require that all hospital personnel undergo training on the recognition, reporting, recording and referral (4Rs) of cases of violence against women and children. B. Women and Children Protection Coordinator. Hospitals without a women and children protection unit shall have a women and children protection coordinator (WCPC) responsible for coordinating the management and referral of all violence against women and children cases in the hospital. II. The minimum standard criteria shall be maintained by all WCPUs. A. Organizational Structure - The WCPU shall: Be an integral part of the hospital; Be under the Office of the Chief of Clinics; Be supervised by a WCPU head who shall have the following responsibilities: a. Integrate and operationalize the multidisciplinary functions of the WCPU b. Prepare the annual work and financial plan, including budget preparation, 4. Submit quarterly reports to the Office of the Undersecretary for Health Services Delivery. 5. Have the following minimum staff, preferably with regular plantilla positions, who shall be primarily responsible to the WCPU: a. a trained physician and b. a trained social worker. B. Facilities - The WCPU shall: Be permanently situated in a designated area, preferably near the emergency room of the hospital; Be spacious enough to accommodate all the services provided by the facility, such as:

a. A separate room for interviews and crisis counselling b. A separate room for medical examination; c. A reception area to accommodate those waiting to be served, including their companions. The rece area must have culture- and gender-sensitive information materials on violence against women and children (VAWC) d. Filing cabinets and other furniture/equipment that will ensure the security and confidentiality of files records; Have its own toilet or comfort room;

Have the following fixtures: a. Examination table b. Desk and chairs c. Washing facilities with clean running water d. Light source, and e. Telephone line f. Computer and printer g. Office supplies Have readily available supplies and equipment for medical examination, including: a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. III. Digital camera Rape kit Speculum of different sizes Blood tubes Syringes, needles and sterile swabs Examination gloves Pregnancy testing kits Microscope slides Measuring devices like rulers and calipers Urine specimen containers Refrigerator for storage of specimens Analgesics, medicines for STI prophylaxis, and emergency contraceptives Labels Medical forms including consent forms and anatomical diagrams Colposcope (Optional) Video camera for recording the forensic interview (optional) Tape recorder (optional)

LEVELS OF CARE DELIVERED BY WCPUs

a. Level I WCPU 2. Personnel A trained physician, and A trained and registered social worker. 3. Services. A level I WCPU provides Minimum medical services in the form of medico-legal examination, acute medical treatment, minor surgical treatment, monitoring & follow-up In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations A full coverage, 24/7 Minimum social work intervention such as safety (and risk) assessment, coordination with other disciplines (i.e., Department of Social Welfare and Development (DSWD) or the local social welfare and development office (SWDO), police, legal, NGOs) Peer review of cases Proper documentation and record-keeping Expert testimony in court

Networks with other disciplines and agencies 4. Training Capability Training on 4Rs 5. Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement b. Level II WCPU 1. Personnel A trained physician; A trained and registered social worker, also with full-time coverage of duties at the WCPU; and A trained police officer or a trained mental health professional. 2. Services Medical services similar to a Level I WCPU including rape kits and surgical intervention. In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations Full coverage, 24/7 Social work intervention similar to that of a Level I WCPU plus case management and case conferences Additional services in the form of police investigation or mental health care Proper documentation and record-keeping using the Child Protection Management Information System (CPMIS) Expert testimony in court Peer review of cases Availability of specialty consultations (ENT, ophthalmology, surgery, OB-Gyne, pathology) Networks with other disciplines and agencies. 6. Training Capability Training on 4Rs Residency training 7. Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement c. Level III WCPU 1. Personnel At least two (2) trained physicians; At least two (2) trained and registered social workers; A registered nurse;

A trained police officer; and A mental health professional 2. Services Medical services of a Level 2 WCPU In the preparation of the medico-legal certificate and report, the WCPU shall utilize the terminology and the form attached as Annexes A and B, respectively, to this Manual of Operations Full coverage, 24/7 Social work intervention of a Level 2 WCPU capacity plus long-term case management Mental health care Police investigation Nursing services Peer review of cases Death review Proper documentation and record-keeping using the CPMIS Expert testimony in court Availability of specialty consultations (i.e., ENT, ophthalmology, surgery, OB-gyne, pathology) Other support services (i.e., livelihood, educational) Networks with other discipline and agencies Availability of subspecialty consultations (e.g., child development, forensic psychiatry, forensic pathology) 3. Training Capability Training on 4Rs Competence and facility to run residency training and specialty trainings 4. Research Proper documentation of experiences which will serve as inputs for policy research, formulation and program improvement; Conduct of empirical investigations on women and children protection work; Publication of such research studies in reputable journals and/or presentation in scientific conferences or meetings. IV. TRAINING AND EDUCATION IN WOMEN AND CHILDREN PROTECTION

A multi-disciplinary training program will address human resource needs of women and child protection units and womens and childrens desk as well as create and sustain a woman- and child-sensitive hospital environment. The women and children protection program in the central office will set directions and define a career path for medical and paramedical graduates who might be interested in professionally pursuing this line of work. This will be made available not only to hospital personnel but to community and interested organizations that would like to avail of the training. Training areas may focus on the following: For trainees to acquire/enhance attitudes necessary in the management of acute and chronic causes of crisis such as sensitivity, compassion, confidentiality and empathy. For the trainees to develop/strengthen their skills in early detection, screening, interviewing, physical examination, use of appropriate diagnostic procedures, management, counseling and referral. For the trainees to have additional knowledge on understanding of conditions leading to crisis,

recognition of early sign of crisis identification, analysis of aggravating/contributory factors including family factors/stresses, understanding of the impact of crisis on the individual the family and the community management of patients and their families networking, linkage development and referral. V. MINIMUM REQUIREMENTS OF A TRAINED WOMEN AND CHILDREN PROTECTION SPECIALIST 1. Physician Six (6)-week Child Protection Specialist Training for Physicians of the Child Protection Network Foundation or its equivalent 2. Social Worker Four (4) -week Child Protection Specialist Training for Social Workers of the Child Protection Network Foundation or its equivalent 3. Police Officer Four (4)-week Child Protection Specialist Training for Police Officers of the Child Protection Network Foundation or its equivalent

[1] Republic Act 7610: Anti-Child Abuse Law [2] Republic Act 9262: Anti-Violence Against Women and their Children Act [3] Republic Act No. 7610 [4] Republic Act No. 9262 [5] Republic Act No. 8353 [6] Republic Act No. 8505 [7] Republic Act 9710 [8] DOH Performance Standards and Assessment Tools for Services Addressing Violence against Women in the Philippines, 2008 (ed), at p.9. Program Manager: Ms. Norma Escobido National Center for Disease Prevention and Control - Family Health Office Phone: 651-7800 locals 1726-1730 Email: norway_es_santos@yahoo.com Copyright Department of Health All Rights Reserved

San Lazaro Compound, Sta. Cruz, Manila

(+632) 651-7800

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