http://jlp-law.com/blog/full-text-of-house-bill-no-5043-reproductive-health-and-population-development-act-of-2008/

HOUSE BILL NO. 5043

AN ACT PROVIDING FOR A NATIONAL POLICY ON REPRODUCTIVE HEALTH, RESPONSIBLE PARENTHOOD AND POPULATION DEVELOPMENT,

AND FOR OTHER PURPOSES

Be it enacted by the Senate and the House of Representatives of the Philippines in Congress assembled:

SECTION 1. Short Title. - This Act shall be known as the “Reproductive Health and Population Development Act of 2008“.

SEC. 2. Declaration of Policy. - The State upholds and promotes responsible parenthood, informed choice, birth spacing and respect for life in conformity with internationally recognized human rights standards.

The State shall uphold the right of the people, particularly women and their organizations, to effective and reasonable participation in the formulation and implementation of the declared policy.

This policy is anchored on the rationale that sustainable human development is better assured with a manageable population of healthy, educated and productive citizens.

The State likewise guarantees universal access to medically-safe, legal, affordable and quality reproductive health care services, methods, devices, supplies and relevant information thereon even as it prioritizes the needs of women and children,among other underprivileged sectors.

SEC. 3. Guiding Principles. - This Act declares the following as basic guiding principles:

a. In the promotion of reproductive health, there should be no bias for either modern or natural methods of family planning;

b. Reproductive health goes beyond a demographic target because it is principally about health and rights;

c. Gender equality and women empowerment are central elements of reproductive health and population development;

d. Since manpower is the principal asset of every country, effective reproductive health care services must be given primacy to ensure the birth and care of healthy children and to promote responsible parenting;

e. The limited resources of the country cannot be suffered to, be spread so thinly to service a burgeoning multitude that makes the allocations grossly inadequate and effectively meaningless;

f. Freedom of informed choice, which is central to the exercise of any right, must be fully guaranteed by the State like the right itself;

g. While the number and spacing of children are left to the sound judgment of parents and couples based on their personal conviction and religious beliefs, such concerned parents and couples, including unmarried individuals, should be afforded free and full access to relevant, adequate and correct information on reproductive health and human sexuality and should be guided by qualified State workers and professional private practitioners;

h. Reproductive health, including the promotion of breastfeeding, must be the joint concern of the National Government and Local Government Units(LGUs);

i. Protection and promotion of gender equality, women empowerment and human rights, including reproductive health rights, are imperative;

j. Development is a multi-faceted process that calls for the coordination and integration of policies, plans, programs and projects that seek to uplift the quality of life of the people, more particularly the poor, the needy and the marginalized;

k. Active participation by and thorough consultation with concerned non-government organizations (NGOs), people’s organizations (POs) and communities are imperative to ensure that basic policies, plans, programs and projects address the priority needs of stakeholders;

l. Respect for, protection and fulfillment of reproductive health rights seek to promote not only the rights and welfare of adult individuals and couples but those of adolescents’ and children’s as well; and

m. While nothing in this Act changes the law on abortion, as abortion remains a crime and is punishable, the government shall ensure that women seeking care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner.

SEC. 4. Definition of Terms. - For purposes of this Act, the following terms shall be defined as follows:

a. Responsible Parenthood - refers to the will, ability and cornmitTrient of parents to respond to the needs and aspirations of the family and children more particularly through family planning;

b. Family Planning - refers to a program which enables couple, and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions, and to have informed choice and access to a full range of safe, legal and effective family planning methods, techniques and devices.

c. Reproductive Health -refers to the state of physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its funcitions and processes. This implies that people are able to have a satisfying and safe sex life, that they have the capability to reproduce and the freedom to decide if, when and how often to do so, provided that these are not against the law. This further implies that women and men are afforded equal status in matters related to sexual relations and reproduction.

d. Reproductive Health Rights - refers to the rights of individuals and couples do decide freely and responsibly the number, spacing and timing of their children; to make other decisions concerning reproduction free of discrimination, coercion and violence; to have the information and means to carry out their decisions; and to attain the highest standard of sexual and reproductive health.

e. Gender Equality - refers to the absence of discrimination on the basis of a person’s sex, in opportunities, allocation of resources and benefits, and access to services.

f. Gender Equity - refers to fairness and justice in the distribution of benefits and responsibilities between women and men, and often requires. women-specific projects and programs to eliminate existing inequalities, inequities, policies and practices unfavorable too women.

g. Reproductive Health Care - refers to the availability of and access to a full range of methods, techniques, supplies and services that contribute to reproductive and sexual health and well-being by preventing and solving reproductive health-related problems in order to achieve enhancement of life and personal relations. The elements of reproductive health care include:

1. Maternal, infant and child health and nutrition;

2. Promotion of breastfeeding;

3. Family planning information end services;

4. Prevention of abortion and management of post-abortion complications;

5. Adolescent and youth health;

6. Prevention and management of reproductive tract infections (RTIs), HIV/AIDS and other sexually transmittable infections (STIs);

7. Elimination ofviolence against women;

8. Education and counseling on sexuality and sexual and reproductive health;

9. Treatment of breast and reproductive tract cancers and other gynecological conditions;

10. Male involvement and participation in reproductive health;,

11. Prevention and treatmentof infertility and sexual dysfunction; and

12. Reproductive health education for the youth.

h. Reproductive Health Education - refers to the process of acquiring complete, accurate and relevant information on all matters relating to the reproductive system, its functions and processes and human sexuality; and forming attitudes and beliefs about sex, sexual identity, interpersonal relationships, affection, intimacy and gender roles. It also includes developing the necessary skills do be able to distinguish between facts and myths on sex and sexuality; and critically evaluate. and discuss the moral, religious, social and cultural dimensions of related sensitive issues such as contraception and abortion.

i. Male involvement and participation - refers to the involvement, participation, commitment and joint responsibility of men with women in all areas of sexual and reproductive health, as well as reproductive health concerns specific to men.

j. Reproductive tract infection (RTI) - refers do sexually transmitted infections, sexually transmitted diseases and other types of-infections affecting the reproductive system.

k. Basic Emergency Obstetric Care - refers to lifesaving services for maternal complication being provided by a health facility or professional which must include the following six signal functions: administration of parenteral antibiotics; administration of parrenteral oxyttocic drugs; administration of parenteral anticonvulsants for pre-eclampsia and iampsia; manual removal of placenta; and assisted vaginal delivery.

l. Comprehensive Emergency Obstetric Care - refers to basic emergency obstetric care plus two other signal functions: performance of caesarean section and blood transfusion.

m. Maternal Death Review - refers to a qualitative and in-depth study of the causes of maternal death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies.

n. Skilled Attendant - refers to an accredited health professional such as a licensed midwife, doctor or nurse who has adequate proficiency and the skills to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complication in women and newborns.

o. Skilled Attendance - refers to childbirth managed by a skilled attendant under the enabling conditions of a functional emergencyobstetric care and referral system.

p. Development - refers to a multi-dimensional process involving major changes in social structures, popular attitudes, and national institutions as well as the acceleration of economic growth, the reduction of inequality and the eradication of widespread poverty.

q. Sustainable Human Development - refers to the totality of the process of expending human choices by enabling people to enjoy long, healthy and productive lives, affording them access to resources needed for a decent standard of living and assuring continuity and acceleration of development by achieving a balance between and among a manageable population, adequate resources and a healthy environment.

r. Population Development - refers to a program that aims to: (1) help couples and parents achieve their desired family size; (2) improve reproductive health of individuals by addressing reproductive health problems; (3) contribute to decreased maternal and infant mortality rates and early child mortality; (4) reduce incidence of teenage pregnancy; and (5) enable government to achieve a balanced population distribution.

SEC. 5. The Commission on Population (POPC0NI). - Pursuant to the herein declared policy, the Commission on Population (POPCOM) shall serve as the central planning, coordinating, implementing and monitoring body for the comprehensive and integrated policy on reproductive health and population development. In the implementation of this policy, POPCOM, which shall be an attached agency of the Department of Health (DOH) shall have the following functions:

a. To create an enabling environment for women and couples to make an informed choice regarding the family planning method that is best suited to their needs and personal convictions;

b. To integrate on a continuing basis the interrelated reproductive health and population development agenda into a national policy, taking into account regional and local concerns;

c. To provide the mechanism to ensure active and full participation of the private sector and the citizenry through their organizations in the planning and implementation of reproductive health care and population development programs and projects;

d. To ensure people’s access to medically safe, legal, quality and affordable reproductive health goods and services;

e. To facilitate the involvement and participation of non-government organizations and the private sector in reproductive health care service delivery and in the production, distribution and delivery of quality reproductive: health and family planning supplies and commodities to make them accessible and affordable to ordinary citizens;

f. To fully implement the Reproductive Health Care Program with the following components:

(1) Reproductive health education including but not limited to counseling on the full range of legal and medically-safe family planning methods including surgical methods;

(2) Maternal, pen-natal and post-natal education, care and services;

(3) Promotion of breastfeeding;

(4) Promotion of male involvement, participation and responsibility in reproductive health as well as other reproductive health concerns of men;

(5) Prevention of abortion and management of post-abortion complications; and

(6) Provision of information and services addressing the reproductive health needs of the poor, senior citizens, women in prostitution, differently-abled persons, and women and children in war AND crisis situations.

g. To ensure that reproductive health services are delivered with a full range of supplies, facilities and equipment and that service providers are adequately trained for reproductive health care;

h. To endeavor to furnish local Family Planning Offices with appropriate information and resources to keep the latter updated on current studies and research relating to family planning, responsible parenthood, breastfeeding and infant nutrition;

i. To direct all public hospitals to make available to indigent mothers who deliver their children in these government hospitals, upon the mothers request, the procedure of ligation without cost to her;

j. To recommend the enactment of legislation and adoption of executive measures that will strengthen and enhance the national policy on reproductive health and population development;

k. To ensure a massive and sustained information drive on responsible parenthood and on all methods and techniques to prevent unwanted, unplanned and mistimed pregnancies, it shall release information bulletins on the same for nationwide circulation to all government departments, agencies and instrumentalities, non-government organizations and the private sector, schools, public and private libraries, tri-media outlets, workplaces, hospitals and concerned health institutions;

l. To strengthen the capacities of health regulatory agencies to ensure safe, high-quality, accessible, and affordable reproductive health services and commodities with the concurrent strengthening and enforcement of regulatory mandates and mechanisms;

m. To take active steps to expand the coverage of the National Health Insurance Program (NHIP), especially among poor and marginalized women, to include the full range of reproductive health services and supplies as health insurance benefits; and

n. To perform such other functions necessary to attain the purposes of this Act.

The membership of the Board of Commissioners of POPCOM shall consist of the heads of the following AGENCIES:

1. National Economic DevelopmentAuthority (VEDA)
2. Department of Health (DOH)
3. Department of Social Welfare and Development (DSWD)
4. Department of Labor and Employment (DOLE)
5. Department of Agriculture (DA)
6. Department of the Interior and Local Government (DILG)
7. Department of Education (DepEd)
8. Department of Environment and Natural Resources (DENR)
9. Commission on Higher Education (CHED)
10. University of the Philippines Population Institute (UPPI)
11. Union of Local Authorities of the Philippines (ULAFI)
12. National Anti-Poverty Commission (NAPQ
13. National Commission on the Role of Filipino Women (NCRFW)
14. National Youth Commission (NYC)

In addition to the aforementioned, members, there shall be three private sector representatives to the Board of Commissioners of POPCOM who shall come from NGOs. There shall be one (1) representative each from women, youth and health sectors who have a proven track record of involvement in the promotion of reproductive health. These representatives shall be nominated in a process determined by the above-mentioned sectors, and to be appointed by the President for a term of three (3)years.

SEC. 6. Midwives for Skilled Attendance. -Every city and municipality shall endeavor to employ adequate number of midwives or other skilled attendants to achieve a minimum ratio of one (1)for every one hundred fifty (150) deliveries per year, to be based on the average annual number of actual deliveries or live births for the past two years.

SEC. 7. Emergency Obstetric Care. - Each province. and city shall endeavor to ensure the establishment and operation of hospitals with adequate and qualified personnel that provide emergency obstetric care. For every 500,000 population, there shall be at least one (1) hospital for comprehensive emergency obstetric care and four (4) hospitals for basic emergency obstetric care.

SEC. 8. Maternal Death Review. - All LGUs, national and local government hospitals, and other public health units shall conduct maternal death review in accordance with the guidelines to be issued by the DOH in consultation with the POPCOM.

SEC. 9. Hospital-Based Family Planning. -Tubal ligation, vasectomy, intrauterine device insertion and other family planning methods requiring hospital services shall be available in all national and local government hospitals, except: in specialty hospitals which may render such services on an optional basis. For indigent patients, such services shall be fully covered by PhilHealth insurance and/or government financial assistance.

SEC. 10. Contraceptives as Essential Medicines. - Hormonal contraceptives, intrauterine devices, injectables and other allied reproductive health products and supplies shall be considered under the category of essential medicines and supplies which shall form part of the National Drug Formulary and the same shall be included in the regular purchase of essential medicines and supplies of all national and lord hospitals and other government health units.

SEC. 11. Mobile Health Care Service. -Each Congressional District shall be provided with a van to be known as the Mobile Health Care Service (MHOS) to deliver health care goods and services to its constituents, more particularly to the poor and needy, as well as disseminate knowledge and information on reproductive health: Provided, That reproductive health education shall be conducted by competent and adequately trained persons preferably reproductive health care providers: Provided, further, That the full range of family planning methods, both natural and modern, shall be promoted.

The acquisition, operation and maintenance of the MRCS shall be funded from the Priority Development Assistance Fund (PDAF) of each Congressional District.

The MHCS shall be adequately equipped with a wide range of reproductive health care materials and information dissemination devices and equipment, the latter including but not limited to, a television set for audio-visual presentation.

SEC. 12. Mandatory Age-Appropriate Reproductive Health Education. - Recognizing the importance of reproductive health rights in empowering the youth and developing them into responsible adults, Reproductive Health Education in an age-appropriate manner shall be taught by adequately trained teachers starting from Grade 5 up to Fourth Year High School. In order to assure the prior training of teachers on reproductive health, the implementation of Reproductive Health Education shall commence at the start of the school year one year following the effectivity of this Act. The POPCOM, in coordination with the Department of Education, shall formulate the Reproductive Health Education curriculum, which shall be common to both public and private schools and shall include related population and development concepts in addition to the following subjects and standards:

a. Reproductive health and sexual rights;

b. Reproductive health care and services;

c. Attitudes, beliefs and values on sexual development, sexual behavior and sexual health;

d. Proscription and hazards of abortion and management of post-abortion complications;

e. Responsible parenthood.

f. Use and application of natural and modern family planning methods to promote reproductive health, achieve desired family size and prevent unwanted, unplanned and mistimed pregnancies;

g. Abstinence before marriage;

h. Prevention and treatment of HIV/AIDS and other, STIs/STDs, prostate cancer, breast cancer, cervical cancer and other gynecological disorders;

i. Responsible sexuality; and

j. Maternal, peri-natal and post-natal education, care and services.

In support of the natural, and primary right of parents in the rearing of the youth, the POPCOM shall provide concerned parents with adequate and relevant scientific materials on the age-appropriate topics and manner of teaching reproductive health education to their children.

In the elementary level, reproductive health education shall focus, among others, on values formation.

Non-formal education programs shall likewise include the abovementioned reproductive Health Education.

SEC. 13. Additional Duty of Family Planning 0ffice. - Each local Family Planning Office shall furnish for free instructions and information on family planning, responsible parenthood, breastfeeding and infant nutrition to all applicants for marriage license.

SEC. 14. Certificate of Compliance. - No marriage license shall be issued by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office certifying that they had duly received adequate instructions and information on family planning, responsible parenthood, breastfeeding and infant nutrition.

SEC. 15. Capability Building of Community-Based Volunteer Workers. - Community-based volunteer workers, like but not limited to, Barangay Health Workers, shall undergo additional and updated training on the delivery of reproductive health care services and shall receive not less than 10% increase in honoraria upon successful completion of training. The increase in honoraria shall be funded from the Gender and Development (GAD) budget of the National Economic and Development Authority (NEDA), Department of Health (DOH) and the Department of the Interior and Local Government (DILG).

SEC. 16. Ideal Family Size. - The State shall assist couples, parents and individuals to achieve their desired family size within the context of responsible parenthood for sustainable development and encourage them to have two children as the ideal family size. Attaining the ideal family size is neither mandatory nor compulsory. No punitive action shall be imposed on parents having more than two children.

SEC. 17. Employers’ Responsibilities. - Employers shall respect the reproductive health rights of all their workers. Women shall not be discriminated against in the matter of hiring, regularization of employment status or selection for retrenchment.

All Collective Bargaining Agreements (CBAs) shall provide for the free delivery by the employer of reasonable quantity of reproductive health care services, supplies and devices to all workers, more particularly women workers. In establishments or enterprises where there are no CBAs or where the employees are unorganized, the employer shall have the same obligation.

SEC. 18. Support of Private and Non-government Health Care Service Providers. - Pursuant to Section 5(b) hereof, private reproductive health care service providers, including but not limited to gynecologists and obstetricians, are encouraged to join their colleagues in non-government organizations in rendering such services free of charge or at reduced professional fee rates to indigent and low income patients.

SEC. 19. Multi-Media Campaign. - POPCOM shall initiate and sustain an intensified nationwide multi-media campaign to raise the level of public awareness on the urgent need to protect and promote reproductive health and rights.

SEC. 20. Reporting Requirements. - Before the end of April of each year,the DOH shall submit an annual report to the President of the Philippines, the President of the Senate and the Speaker of the House of Representatives on a definitive and comprehensive assessment of the implementation of this Act and shall make the necessary recommendations for executive and legislative action. The report shall be posted in the website of DOH and printed copies shall be made available to all stakeholders.

SEC. 21. Prohibited Acts. - The following acts are prohibited:

a) Any health care service provider, whether public or private, who shall:

1. Knowingly withhold information or impede the dissemination thereof, and/or intentionally provide incorrect information regarding programs and services on reproductive health including the right to informed choice and access to a full range of legal, medically-safe and effective family planning methods;

2. Refuse to perform voluntary ligation and vasectomy and other legal and medically-safe reproductive health care services on any person of legal age on the ground of lack of spousal consent or authorization.

3. Refuse to provide reproductive health care services to an abused minor, whose abused condition is certified by the proper official or personnel of the Department of Social Welfare and Development (DSWD) or to duly DSWD-certified abused pregnant minor on whose case no parental consent is necessary.

4. Fail to provide, either deliberately or through gross or inexcusable negligence, reproductive health care services as mandated under this Act, the Local Government Code of 1991, the Labor Code, and Presidential Decree 79, as amended; and

5. Refuse to extend reproductive health care services and information on account of the patient’s civil status, gender or sexual orientation, age, religion, personal circumstances, and nature of work; Provided, That all conscientious objections of health care service providers based on religious grounds shall be respected: Provided, further, That the conscientious objector shall immediately refer the person seeking such care and services to another health care service provider within the same facility or one which is conveniently accessible: Provided, finally, That the patient is not in an emergency or serious case as defined in RA 8344 penalizing the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency and serious cases.

b) Any public official who prohibits or restricts personally or through a subordinate the delivery of legal and medically-safe reproductive health care services, including family planning;

c) Any employer who shall fail to comply with his obligation under Section 17 of this Act or an employer who requires a female applicant or employee, as a condition for employment or continued employment, to involuntarily undergo sterilization, tubal ligation or any other form of contraceptive method;

d) Any person who shall falsify a certificate of compliance as required in Section 14 of this Act; and

e) Any person who maliciously en ges in disinformation about the intent or provisions of this Act.

SEC. 22. Penalties. - The proper city or municipal court shall exercise jurisdiction over violations of this Act and the accused who is found guilty shall be sentenced to an imprisonment ranging from one (1) month to six (6) months or a fine ranging from Ten Thousand Pesos (P10,000.00) to Fifty Thousand Pesos (P50,000.00) or both such fine and imprisonment at the discretion of the court. If the offender is a juridical person, the penalty shall be imposed upon the president, treasurer, secretary or any responsible officer. An offender who is an alien shall, after service of sentence, be deported immediately without further proceedings by the Bureau of Immigration. An offender who is a public officer or employee shall suffer the accessory penalty of dismissal from the government service.

Violators of this Act shall be civilly liable to the offended party in such amount at the discretion of the proper court.

SEC. 23. Appropriations. - The amounts appropriated in the current annual General Appropriations Act for reproductive health and family planning under the DOH and POPCOM together with ten percent (10%) of the Gender and Development (GAD) budgets of all government departments, agencies, bureaus, offices and instrumentalities funded in the annual General Appropriations Act in accordance with Republic Act No. 7192 (Women in Development and Nation-building Act) and Executive Order No. 273 (Philippine Plan for Gender Responsive Development 1995-2025) shall be allocated and utilized for the implementation of this Act. Such additional sums as may be necessary for the effective implementation of this Act shall be Included in the subsequent years’ General Appropriations Acts.

SEC. 24. Implementing Rules and Regulations. - Within sixty (60) days from the effectivity of this Act, the Department of Health shall promulgate, after thorough consultation with the Commission on Population (POPCOM), the National Economic Development Authority (NEDA), concerned non-government organizations (NGOs) and known reproductive health advocates, the requisite implementing rules and regulations.

SEC. 25. Separability Clause. - If any part, section or provision of this Act is held invalid or unconstitutional, other provisions not affected thereby shall remain in full force and effect.

SEC. 26. Repealing Clause. - All laws, decrees, Orders, issuances, rules and regulations contrary to or inconsistent with the provisions of this Act are hereby repealed, amended or modified accordingly.

SEC. 27. Effectivity. - This Act shall take effect fifteen (15) days after its publication in at least two (2) newspapers of national circulation.

MAJOR IMPLICATIONS TO RECIPIENTS

http://www.petitiononline.com/xxhb5043/

1. EMPLOYERS: They shall provide free reproductive health care services, supplies, devices and surgical procedures (including vasectomy and ligation) to their employees, and be subjected to both imprisonment and/or a fine for non-compliance. (Section 17 states that employers shall provide for free delivery of reproductive health care services, supplies and devices to all workers more particularly women workers. (Definition of Reproductive Health and Rights Section 4, paragraph g, Section 21, Paragraph c and Section 22 on Penalties)

2. HEALTH CARE SERVICE PROVIDERS: They shall provide reproductive health care services such as giving information on family planning methods and providing services like ligation and vasectomy, regardless of the patient's civil status, gender, religion or age, and be subjected to imprisonment and/or a fine for non-compliance. (Section 21 on Prohibited Acts, Letter a, Paragraphs 1 to 5 and Section 22 on Penalties)

3. MARRIED MEN AND WOMEN: Husband or wives can undergo a ligation or vasectomy without consent or knowledge of the sexual partner. (Section 21 on Prohibited Acts, Letter a, Paragraph 2)

4. PARENTS/GUARDIANS/SCHOOLS: Children from age 10 to 17 shall be taught their sexual rights and the means to have a satisfying and "safe" sex life as part of their school curriculum. (Section 12 on Reproductive Health Education and Section 4 Definition of Family Planning and Productive Health, Paragraph b, c and d)

5. FILIPINO CITIZENS: Any person shall be subjected to imprisonment and/or pay a fine, for expressing an opinion against any provision of this law, if such expression of opinion is interpreted as constituting "malicious disinformation." (Section 21 on Prohibited Acts, Paragraph f and Section 22 on Penalties) The State shall take authority over a minor child who was raped and found pregnant. (Section 21, a, no.3)

6. HEALTH CARE CONSUMERS: Contraceptives shall be reclassified as essential medicines (Section 10) and government funds shall be allocated to reproductive services apart from basic services (Section 23).

Breast Examination

Vaginal Speculum Examination

Male Urethral Catheterization

Male Rectal Examination

Male Genitalia Examination

Andromeda Strain

Watch "The Andromeda Strain (2008)" Movie

The Major Histocompatibility Complex of Genes and Transplant Rejection

Uploaded on authorSTREAM by jphernandez

Major Histocompatibility Complex (MHC) and T Cell Receptors

Uploaded on authorSTREAM by jphernandez

Great Discoveries: UCSF Organ Transplant Experience

A Delicate Balance: Stem Cells Cancer and Immune Response

DNA Mutation

DNA Replication

DNA Structure

HIV Resistance

HIV Infection

Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents

Uploaded on authorSTREAM by jphernandez

Autoimmune Diseases

Uploaded on authorSTREAM by jphernandez

Major Classification of Serologic Tests and Techniques

Uploaded on authorSTREAM by jphernandez

Methicillin-Resistant Staphylococcus aureus

Uploaded on authorSTREAM by jphernandez

Sepsis and the Systemic Inflammatory Response Syndrome

Uploaded on authorSTREAM by jphernandez

Hypersensitivity Reactions

Uploaded on authorSTREAM by jphernandez

The Immune System

Uploaded on authorSTREAM by jphernandez

Complement Proteins

Specific Immunity, Antibodies

Antibody Mediated Immune Response

Cell Mediated Immune Response

WANTED PINOY NURSE FOR EXPORT: A Heritage of Care in Acculturation

“Together the nurse and the client creatively design a new or different care lifestyle for the health or well-being of the client. This mode requires the use of both generic and professional knowledge and ways to fit such diverse ideas into nursing care actions and goals. Care knowledge and skill are often repatterned for the best interest of the clients…Thus all care modalities require coparticipation of the nurse and clients (consumers) working together to identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care.”

When a Filipino nurse leaves her home town, she leaves with her values of care. She enters into a realm where change can quite be an obstacle but becomes her humble making as an evolving care provider and where social change begins to question her views of her cultural origin. Her preparations were laid to become the skilled practitioner but less is emphasized in becoming a transcultural practitioner. However, she is not to be left unequipped because her heart speaks the language of human caring, in greater confidence, as she makes her way to become acculturized in her new environment. She is able to blend well because her exeperience of home makes her effective, simple in terms but is transcending. Her compassion is her great esteem that in face of a new social climate, she is capable of a meaningful representation. The video clip above makes this representation as she, in the character of Ms. Nora Aunor with her mother, anticipates this phenomenon.

Leininger’s Culture Care Theory states that caring is the essence of nursing and unique to nursing. Four nursing metaparadigm concepts were redefined: (1) the term ‘nursing’ thus cannot explain the phenomenon of nursing—care has the greatest epistemic and ontologic explanatory power to explain nursing; (2) the term ‘person’ is too limited and culture-bound to explain nursing, as the concept of ‘person’ does not exist in every culture; (3) the concept of ‘health’ is not distinct to nursing as many disciplines use the term; and (4), the concept ‘environmental context’ (instead of ‘environment’), includes events with meanings and interpretations in particular physical, ecological, sociopolitical and/or cultural settings.

A client who experiences nursing care that fails to be reasonably congruent with his/her beliefs, values, and caring lifeways will show signs of cultural conflict, noncompliance, stress and ethical or moral concern. Care always occurs in a cultural context. Culture is a framework people use to solve human problems. Therefore, the practice of transcultural nursing addresses the cultural dynamics that influence the nurse–client relationship. This entails having care measures in harmony with the client's cultural view of health.

http://nursing.jbpub.com/sitzman/CH15PDF.pdf http://herkules.oulu.fi/isbn9514264312/html/x215.html

Looking at the Filipino Nurse

Filipino Nursing: A Caring Tradition, A Legacy in Crisis

We can never go away with the fact that each and every one of us have been the recipients of care by our Filipino Nurses. At some point, we have found that experience a piece of our holistic becoming in the present day, in which ourselves have followed that beacon. We are sharing that inherent tradition, as they came into legacy, being mirrored in the eyes of our brethren when we exeplify this calling compassionately. However, in the light of this noblest legacy, a crisis is rising in a robust pace. We our losing this profession for foreign market demands. This exodus is inevitable but what had been unfortunate is that the genesis of nursing professionals is basically for the exodus ahead. This trend has already transformed the professions in the Philippines. They are looking into nursing as a lucrative endeavor. Having said this, we are losing the opportunity for Filipinos to be the major consumer of quality health care. With this regard, I am sharing the article below.

http://www.pcij.org/stories/2005/nursing-crisis-galvez-tan.pdf

The National Nursing Crisis: 7 Strategic Solutions

Jaime Z. Galvez Tan M.D., M.P.H.

Introduction

At the rate we are losing monthly our highly skilled nurses to the United States, the United Kingdom, Ireland and the Netherlands, and with the Philippine government, via the Department of Health raising its hands in helplessness, offering no strategic solutions in sight, expect a worsening of the health crisis already plaguing our country. It is not only the nurses the country is losing, our medical doctors are now enrolling in nursing schools offering an abbreviated course for doctors to become nurses.

There is an acute shortage of nurses in the countries mentioned above which became palpable 3 to 4 years ago. The need will not just be for a year or two but for at least the next 10 to 15 fifteen years. So it will no longer be the roller coaster demand for foreign graduate nurses by developed countries which characterized the outflow of nurses from developing countries during the last 35 years but a persistent, chronic need is transpiring. The USA would need around 110,000 nurses a year while the U.K., Ireland, the Netherlands and other European countries would need another 50,000 nurses a year. Austria and Norway have also announced their need for foreign nurses this year. Japan is expected to open its doors to foreign nurses by 2005.

The Northern countries of the world are experiencing longer lifespan and the graying of their population. These factors create increasing pressure on their health systems for greater response mechanisms to the health problems of a growing proportion of the elderly. Their youth population no longer take interest in the nursing profession due to relatively difficult and riskier working conditions such as evening duties, care of the chronically ill and exposure to HIV/AIDS. Thus, there is a great demand for foreign graduate nurses.

The Problem

The Philippines will never be able to compete with the salary scales of nurses in these Northern countries. The basic monthly pay there is US$3,000-US$4,000 a month compared to the US$150-US$250 that nurses receive in the Philippines. Yes, our Filipino nurses are globally competitive in professional nursing care and practice but our Filipino salaries will never be competitive. Filipino doctors are going through a reversal of health human resource development by becoming nurses. Even specialist doctors are enrolling in nursing schools. The current income of doctors in the Philippines of US$300 to US$800 a month is still a pittance compared to the monthly salary of US or European based nurses. Hospitals in the USA even offer additional attractive benefits like residency visa status for nurses, their spouse and children plus other perks like subsidized housing and transportation.

In the year 2001, the Philippine Overseas Employment Administration (POEA), reported the departure of 13, 536 Filipino nurses to 31 countries. The majority went to the U.K. with 5, 383 nurses, Saudi Arabia with 5, 045 and Ireland 1,529. The POEA reported only 304 nurses going to the USA. This is definitely gross underreporting since the International Union of Nurses reported that close to 10,000 Filipino nurses were directly hired by US based hospitals in 2001 through their nursing job fairs held in various parts of the Philippines.

In 2002, the POEA further reports that a total of 11,911 Filipino nurses left for 33 countries. In 2003, POEA initially reported 8,968 nurses leaving. Again with underreporting of those who left for the USA. Clearly, the trend is here to stay. Sadly, this is no longer “brain drain” but more appropriately “brain hemorrhage” already of our Filipino nurses.

These annual outflow of Filipino nurses for Years 2001-2002 is two to three times greater than the annual production of licensed nurses during the same two year period. Since 1999, the Professional Regulation Commission (PRC) through the Board of Nursing gives licenses to only 5, 784 to 8,419 nurses annually. This is despite the increase of nursing schools from 142 to 240 within the last four years. There were only 40 nursing schools in the 1980s. So very soon, the Philippines will be bled dry of nurses.

With the proliferation of nursing schools, the quality of nursing education has shown signs of deterioration as measured by the proportion of nursing graduates who pass the Board of Nursing licensure examinations. In 2001, 54 percent (4,430 nurses) passed the nurse licensure examinations. In 2003, only 45 percent (4, 227 nurses) passed. Compare this with the average proportion who passed the nurse licensure examinations from 1994-1998 which was 57 percent.

Will the Philippine government just tolerate this trend of health human resource outflows to other countries? Will we, as Filipinos, just wait, standby and not do something about this health threatening situation now? Will the Department of Health act only when the catastrophe is already beyond resuscitation?

Seven Strategic Solutions

This national crisis in nursing and medicine is a very complex issue requiring strategic thinking, multidisciplinary approaches and long term goals. Since the problem is both global and national in scope, it also requires solutions that are global and national in nature.

A win-win strategic solution between the Philippines and the nursing importing countries of the North must be the ultimate goal in dealing constructively and resolving the crisis in nursing and medical human resources and services. There is no longer room for piece-meal approaches to this issue. But first, President Macapagal-Arroyo, the Cabinet and Congress leaders must accept that this is indeed a serious national problem deserving urgent attention and action.

A seven-point policy action agenda is hereby proposed:

One. Creation of a National Commission on Health Human Resources Development. Initially, through a Presidential Executive Order, and later as a legislative act, this National Commission will be composed of the leaders from the Executive and Legislative branches of government with participation from the private sector, academe and civil society groups involved in nursing and medical human resources development. With budgetary support and a lifespan of 3 to 5 years, its major tasks include: an intensive review of the past, current and future scenarios of the nursing and medical human resources; completion of a data base of Filipino health human resources; updating of the 25 year National Health Human Resources Policy and Development Plan (1996-2020) formulated with the guidance of Drs. Fernando Sanchez and Dennis Batangan in 1992-95 for the Department of Health; and the development of a unified health human resource development policy and a national policy research agenda on health human resources.

Two. Initiation of High-Level Bilateral Negotiations with Northern Countries Importing Filipino Nurses. Led by a team composed of Secretaries of the Department of Foreign Affairs (DFA), Department of Labor and Employment (DOLE), the National Economic Development Authority (NEDA), Commission on Higher Education (CHED), Department of Trade and Industry (DTI) and the Department of Health (DOH), bilateral discussions with the United States, United Kingdom, Republic of Ireland, Netherlands and Saudi Arabia will center on a partnership approach between the Philippines and these countries. The current approach to the importation of Filipino nurses by these rich countries has been lopsided and advantageous only to such countries while the Philippines continue to wallow in poverty, underdevelopment and inadequate health care. In the negotiations, these rich countries must be made to realize that the agenda and interests of their Departments/Ministries of Health and their Development Agencies can coincide. Thus for example, USAID, in behalf of the US government and DFID, in behalf of the United Kingdom, will include in their aid package to the Philippines, financial assistance to continuously train globally competitive nurses, constantly upgrading nursing education, nursing health services and nurse remuneration and offering nursing scholarships. Such aid will eventually benefit both countries e.g. the US and UK having a regular pool of nurses to serve their needs since many of these nurses will eventually work there, while the Philippines will be ensured also a regular production and supply of nurses for its health care system.

The Philippine Cabinet Bilateral Negotiation Team must be able to come up with concrete investment packages for nursing and health human resource development for discussions with these countries at the soonest possible time.

Three. North-South Hospital to Hospital Partnership Agreements. While bilateral country negotiations are on-going and the financial aid packages for nursing development eventually actualized, Northern country hospital to Philippine hospital/nursing school agreements should proceed with the same vigor and pace. Such partnership would focus on the provision of a financial grant given by the Northern country hospital for every Filipino nurse that enters its staff. The said financial grant will go to a Nursing Development Trust Fund of the Philippine hospital/nursing school, to be used to improve nurse salaries, training and nursing practice, upgrade hospital and educational facilities and nurse scholarships. Current estimated total cost of educating and producing a nurse that will pass the Philippine nursing licensure examinations are in the range of US$4,000 to US$7,000. Thus for example, the Philippine General Hospital (PGH) will enter into a partnership agreement with the Johns Hopkins University Hospital (JHUH) in Maryland, USA. JHUH will donate a negotiated amount to the PGH Nursing Development Trust Fund, for every nurse that it recruits from the PGH.

This is but just since hospitals from countries of the North do not spend a single centavo in the production, development, education and licensure of Filipino nurses. At the very least, they should be able to pay partially if not fully the cost of nursing development since they are going to benefit from the services of that nurse for at least 25 years.

Fourth. Institution the National Health Service Act. The Philippines is one of the few countries in SouthEast Asia that does not have a National Health Service Act. This is a compulsory requirement for all licensed health professionals to serve anywhere within the country for a number of years equivalent to the number of years it took them to study their health professions. While in the past there were attempts to have such a law passed, major objections centered on the individual human rights to move freely and practice their profession where each individual wants, such as in another country. However, with the globalization and active trading of health human resources and the inevitability of the severest brain drain to hit the Philippines, the country’s collective interest and collective rights should now prevail.

At best, health professionals graduating from state universities, schools and colleges must be covered by the National Health Service Act. Their education have been heavily subsidized with the taxes paid by the Filipino people. It is but right that they repay the country with their services equivalent to the number of years of subsidy. If the Philippine Military Academy (PMA) has been doing this since its foundation, government health sciences schools should no longer be exempted. Graduates from private health sciences schools can have a modified scheme in complying with the Act, but nevertheless should be covered as well.

With the National Health Service Act, the country will be able to program scientifically the exit of our health professionals, thus ensuring a steady maintenance of health human resources in all health facilities, whether rural or urban.

Fifth. Establish Philippine Nursing Registries. A nursing registry is corporately run human resource development center that provide hospitals, clinics and other health facilities with their nursing needs. It has management mechanisms that efficiently locates and monitors nursing human resource availability. It actively negotiates for better remuneration and benefits, better working conditions, keeping always nursing welfare high in its agenda. Usually private sector led, nursing registries can be created at the local level covering a specific geographical area. It can start within a local government unit (LGU) service area, either at the city, province or municipality level or a district health system (DHS) level, covering a network of public and private health facilities in various LGU locations. The registry can also center around a tertiary hospital and cover its referral units and catchment areas.

While nursing registries are functioning well in the United States and Europe, the Philippines still has to catch-up with this nursing development. The numerous colleges and schools of nursing should complement this service by making sure that their office of alumni affairs keep a regularly updated directory of all their graduates, keeping track not only of where they are but how they are, in terms of their human welfare and professional growth. With the era of advanced computer software systems and global communication technologies, there should be no more excuses for nursing schools to guarantee this.

Sixth. Expand Nursing Residency and Nurse Practitioner Training Programs. This strategy was adapted from the Board of Nursing-led policy workshops. Patterned after medical specialist residency training programs, all secondary and tertiary hospitals should start a similar one for nurses. These will also be three year residency training focusing on nursing specialties such as intensive care nursing, operating room nursing, emergency nursing, psychiatric nursing, neonatal care nursing, geriatric nursing and nurse counseling. There can also be fellowship programs centering on sub-specialty nursing such as cardiac care nursing, neurology care nursing, genetic nurse counseling, chronic care nursing, and palliative and hospice care. A Board of Nursing Specialties, entirely separate from the Board of Nursing of the Philippine Regulations Commission, should be established to regulate the production and development of these nursing residency and fellowship training programs.

Another nursing development program is the offering of nurse practitioner post graduate courses. Nurse practitioners are independent, highly skilled nurses that work in solo, group or networks. While the Philippines produces a lot of graduates of Masters in Nursing which focuses more on nursing management, administration and research, it has been lagging behind in developing a nurse practitioner education program. This will give room for clinical skills in the nursing areas of wellness, counseling, public health, community health, complementary and alternative health care. The course can be offered by colleges of nursing and can also be regulated by the Board of Nursing Specialties or another new board as well. Once this course is available, the time will come when Filipinos can benefit from direct nursing care from stand alone nurse clinics, nurse wellness centers and other modalities of nurse practitioners’ facilities.

The above mentioned developments in nursing education will become venues for nurses to comply with the National Health Service Act without neglecting their professional growth. These will also ensure better nurse holding mechanisms to maintain a steady pool of nurses to stabilize nursing care in our health care delivery system.

Seventh. Create the Philippine National Council for Nursing Concerns. This will be composed of all the major national organizations involved in nursing. Some of these are the Philippine Nurses Association, the Association of Deans of Colleges and Schools of Nursing, the Board of Nursing, the League of Government Nurses, and the Private Duty Nurses Association. The possible functions of this national council are: to develop a 10 year strategic plan for nursing development in the Philippines; to act as an oversight body for the implementation of all nursing policies, legislations and regulations; to be the locus for the national data bank on nurses and nursing; to be the national sounding board for all nursing issues and concerns; and to coordinate all efforts in uplift and upgrade the nursing profession. To ensure funds for its initial three years of operations, a Presidential Executive Order can be issued to create this National Council until it is able to source out its own financing like as was mentioned in strategic solutions #2 and #3, that is, bilateral aid funding or a percentage of the nursing development trust funds of hospitals and nursing schools. The President can also appoint the first ever Undersecretary of Health for Nursing Concerns, who should be a nurse, to chair this National Council.

Communicating The Art And Science of Human Caring: A point of inquiry in the triad of the patient, the person, and the nurse in health care systems

“I feel less of a nurse about how we do things in our profession. I can’t believe how little we care about the person in our patient. I can’t imagine what it must be like for the typical patient who is less identified as a person for human caring. They must be continually be exhausted and depressed.”