Category: Citizen-centered Services

Name of the Organization

Provincial Veterinary Office of Marinduque

Name of the Office/Unit that leads the implementation of this best practice entry

Provincial Veterinary Office of Marinduque

Focus Area of the Best Practice

Leadership, Strategy, Citizens / Customers

Date the best practice was first implemented

01 January 2004 – up to present

Summary of the Best Practice

The Marinduque Veterinary Field Hospital (MVFH) is an integral program that reinforces the Marinduque mobile veterinary services, which seeks to provide compassionate veterinary care to companion and farm animals in rural and small communities. It is the first innovative method of bringing veterinary service to the countryside.

The concept started way back in 2004 with continuous upgrading and innovation to meet the ever-changing needs of the time. The Veterinary Field Hospital provides multi-faceted services catering to the mandate of the Provincial Veterinary Office by providing animal health services such as the spay and neuter program, animal production services, information and dissemination campaigns, veterinary medical missions on calamity stricken areas not only in the province of Marinduque but also in other parts of the country that includes animal and wildlife rescue including marine mammal rescues and rehabilitation. The goal is to extend help to pet owners, livestock farmers, and all animal lovers to make them our leading partners in promoting responsible pet ownership and making them successful farmers and empowered citizens.

Objectives

Its main objective is to boost the office’s mandate by bringing veterinary services right to the doorsteps of our constituents. Those mandates include the control and manage the outbreak of highly contagious and deadly animal diseases with economic and public health importance and in situations resulting in the depletion of animals for work and human consumption, and to enforce all laws and regulations for the prevention of cruelty to animals, to eradicate, prevent or cure all forms of animal diseases and to regulate the keeping of domestic animals and to protect wildlife.

Unique key features

The Marinduque Veterinary Field Hospital is equipped with proper tools, medicines, and basic facilities that provide proper veterinary services in aesthetic pleasure free of charge to rural and marginalized communities. The MVFH is deployed every Tuesday to Thursday, servicing all Barangays all year round through a systematic and highly coordinated manner to maintain its cooperation with local government partners and efficient and effective delivery of veterinary services to the community.

The Challenge

In the late 90s and early 2000s, an average of seven and a maximum of twelve human deaths due to rabies were a predominant occurrence in a 95,925 hectares island Province. A relatively high number on a small island. Factors observed contributing to the problem were:

1. While a high number of dog bite incidences occurred, only 576 in 2001 and 237 in 2010 were reported to local health facilities compared to 2155 in 2018. This means that in the late 90s and early 2000s, the community and dog bite victims had little knowledge of the correlation between the number of stray dogs, dog bites, rabies, anti-rabies programs, and health care programs against the dreaded disease.
2. Though fairly in the early 2000s, rabies vaccination reached approximately 7,000 dogs and cats vaccinated annually. But still, human deaths were prevalent, and many dog bite victims were not subjecting themselves to proper health programs to address the rabies incidence. This means that the community may have been participating less in the anti-rabies programs, information and dissemination campaigns, and other related veterinary services. The consequential effect of this low knowledge and awareness of the community was low citizen participation in the policies and programs related to addressing the rabies problem, relatively high numbers of contributory factors that cause the disease spread, and the consequential high human mortality rate.

Due to these factors, the Provincial Veterinarian was initially compelled to address the rabies problem radically by eliminating stray dogs accompanied by jabs of other mobile veterinary field services. The early stage of veterinary mobile field services in 2004 used traditional methods, medicines, newspaper drapes, and conducting spay and neuter surgeries and other treatment and surgical procedures for all animals under the waiting sheds. Only a few appreciated the services at that time yet had introduced the dynamics to the community. The radical approach brought instant and effective effects that eliminated rabies and ceased human deaths due to rabies in 2006, and the introduction of mobile veterinary services was clearly emphasized. However, the efforts still gained negative criticism and deterred measures against the skeptic community.

Fortunately, with continuous effort and innovation of the team leader and the introduction of external organizations such as the Japan International Cooperative Agency and Humane Society International, who extended their arms, helped reboot the methodologies and upgrade the technology conducted to maintain the hard-earned rabies-free status, preserve the momentum of delivering other veterinary services to other animals closer to their homes and increase the capability to respond the increasing number of wildlife animals brought for rescue and treatment. This resulted in innovation from essential mobile veterinary services to now as Marinduque Veterinary Field Hospital program incorporated with the creation of the Marinduque Animal and Wildlife Rescue Emergency Response Team.

Solution and Impact

The early stage of veterinary mobile field services in 2004 used traditional methods, medicines, newspaper drapes, and basic equipment’s while conducting spay and neuter surgeries and other treatment and surgical procedures for all animals under the waiting shed. The mobile veterinary field service, accompanied by the radical approach of stray dog elimination at that time, brought instant and bold results, specifically the cessation of human deaths due to rabies and the declaration of the rabies-free status of the province. Yet, it received tremendous negative and deterring criticism. Several outside organizations were contacted and supported to maintain its hard-earned results, resulting in upgrades and a dynamic shift of methodologies to continually deliver and sustain the significant intended impact on the community.

International foundations such as Japan International Cooperative Agency (JICA) and Humane Society International (HSI) provided support to alleviate the measures by providing technology transfer and equipping the Provincial Veterinary Office through modern spay and neuter programs. The program’s main activity is the surgical removal of the reproductive organs of dogs and cats to prevent the birth of unwanted litters contributing to the overpopulation of unwanted animals that increases the transmission of rabies. The main concept and goal of the program are that the higher the number of dogs spayed and neutered will decrease the number of stray dogs that transmits the virus, resulting in a reduced transmission factor, which then increases the probability of eliminating the rabies virus in the ecology of the province. The equipping and technology transfer activity allows the PVO to provide spay and neuter programs to every barangay in the most efficient, effective, and aesthetic way. Though it was conducted in the early ‘90s under a waiting shed, the upgrade of technology and facilities gained traction in the community resulting in increased community participation and confidence in the program.

At first, technical skills were developed under the HSI and JICA training. Efficient and effective methodologies were transferred as well as latest medicines were provided. This is followed by providing basic to advanced surgical tools and equipment and immediately implementing the activities. Along the way of implementation and the consequential support of our impressed local government leaders’, innovations were hasted, modern mobile tents and advanced medical tools were purchased and used, effective communication and coordination with local officials were strengthened, and intensification of information and dissemination efforts during daily deployment was instituted.

Up to now, the deployment of the Veterinary Field Hospital is every Tuesday to Thursday. Barangays were selected based on the number of dog bite incidents, the incidence of rabies deaths, dog and human population density, local initiatives, community requests, the number of stray dog population, geographical location, topography, and season. When barangays are selected, proper communication and coordination with local officials will follow. Methods of communication include official letters, radio announcements, house-to-house calls, and local postings to inform all community members to participate in the program. Follow-up phone calls and currently, online posts are also currently conducted. Upon arrival at the barangay, a strategic selection of field hospital sites in the barangays will be made. When the field hospital is established on-site, registration, surgical operation, medical treatments, and information dissemination are then conducted. Every animal brought will be served according to its needs, free of charge. This is conducted the whole year round in every barangay of the province.

As equipment and surgical procedure are eventually innovated and upgraded, the citizen’s participation in the services and mandates of the office has also increased. This allows information and dissemination campaigns to become very effective to the point where many other animals with different diseases were brought to the facility extending the services from spay and neuter to multi-faceted mobile veterinary services. The eventual attention and impact on the community impressed our leaders, who then gave full support to the team initiatives extending the office budget allocation, allowing the program to be innovated more freely and obtain more upgrades. Along with the innovative development of the Marinduque Veterinary field hospital program is the creation and activation of the Marinduque Animal and Wildlife Emergency Response Team.

The mobile veterinary hospital caters to all animal health services, animal welfare services, animal disease diagnostic services, animal and wildlife rescues, and calamity veterinary missions.

With the effectiveness of the information dissemination campaign, the general community increases their awareness and becomes empowered regarding animal and wildlife health care and the related laws and regulations. The resultant effect is the increase in reports of animal diseases and wildlife medical and situational cases to be responded to, and as the response is conducted, the accomplishment of the mandates is achieved.

Performance and Result

Before the program was implemented, human deaths reached twelve in the late ‘90s. In 2001, a list of six deaths occurred, while making the radical approach, zero human deaths resulted starting 2006 up to now. The province was then officially declared rabies-free in 2010. While doing the mobile field hospital in 2004, dog bite incidence reported increases from 576 in 2001 and 237 in 2009; it now became 2171 in 2017 and 2115 in 2018. This data may appear bad, but this also says that dog bite victims are now subjecting themselves to local health units and avails health programs against the disease; even dog and catscratches were considered bite cases. The more dog bite victims subjecting themselves to health programs, the more lives are saved. The dog bite numbers addressed by the Local human health agencies indicate the success of the PVO information dissemination campaign.

Companion animals brought to spay, and castration programs also increased since the implementation of the field hospital. In 2012, only 150 dogs and cats were brought, which increased to 994 in 2013. In 2018 it peaked at 3157 until it was disrupted due to COVID. Right now, it further improves, as in 2018, a barangay operation averaged 20-50 for spaying and neutered, while last month’s operation averaged 60-100 dogs and cats brought for spay and neutering with other animals brought for treatments and medical consultations.

In 2003 livestock animals undergoing prophylactic medication such as deworming were 2,694, and vitamin administration was 927, while animals subjected to treatment were 2.246 with zero wildlife rescued. There was a massive decline in 2004, where only 248 were dewormed, 137 were administered with vitamins, and only 728 were treated. When the MVFH program was launched to bolster animal health services in 2018, 5,059 livestock animals were dewormed and underwent prophylactic treatment, with 3,473 being administered with vitamins and 4,362 various animals treated, plus 14 wildlife rescued. Last year there were 17 wildlife animals rescued, rehabilitated and released, and this year, during the third quarter, there are already 56 wildlife animals rescued, rehabilitated and released.

Another significant indirect impact of the project is that even livestock animals and livestock animal farmers were reached and served aesthetically and effectively. Communities in rural areas also received a modern approach to veterinary services for their companion animals in their barangays. Providing such a class of service at their doorstep also eliminates the cost of transportation and precious time, which can now be converted to supplement other necessities and important day-to-day activities.

Increased awareness of the general community of wildlife also grows. Immediate reports from the general community to situational and medical cases of wildlife animals to be responded to increased. In the previous years, an average of 18 wildlife rescues, rehabilitations, and releases were conducted, while now 2022, third quarter, we have already responded to 59 animal wildlife cases. Mainstream media are now covering several of our rescue efforts, intensifying people’s awareness. Now, the local community prefers reporting animal wildlife situational cases (even poisonous snakes) rather than killing them immediately. This means that wildlife is now truly protected through community awareness and empowerment as a result of the creation and efforts of the Marinduque Animal and Wildlife Rescue Emergency Response Team and the success of information dissemination campaigns during the deployment of the Marinduqueveterinary Field Hospital.

Innovation

The program was also highly admired and modeled by Veterinary Universities and other local government veterinary offices in cities and provinces. Due to these comments, Marinduque Mobile veterinary services has become a hub for veterinary student internships at different veterinary schools, such as Central Luzon University and Dela Salle Araneta University, and training areas for local government veterinarians of various cities and provinces in the country, such as Paranaque City, San Jose del Monte Bulacan City, San Juan City, Manila, Palayan City, Nueva Ecija, Puerto Princesa City and the Province and Municipalities of Palawan, Calapan city and the entire Province of Mindoro Oriental and Mindoro Occidental, and Province of Romblon. On several occasions, the Team and the Mobile Field Hospital Program became guests in these cities and provinces to provide veterinary services in those areas. Furthermore, animals and communities affected by calamities were also served, such as in the typhoon Yolanda, the Taal volcano eruption, and bird flu outbreak in Luzon, and operation saving laguna pit bull.

Replicability

As of now, several Local Government veterinary offices have adopted and replicated the project, which includes the Paranaque City Veterinary office, Mindoro Oriental and Occidental Provincial Veterinary Office, and San Jose Del Monte, Bulacan. Highly urbanized and prosperous cities such as Cebu and San Jose Del Monte Bulacan have applied such technology effectively and were supported by their leaders resulting in the creation of the San Jose Del Monte Bulacan Veterinary Hospital And Cebu City Veterinarymobile spay and neuter Bus. The most successful one is the Province of Romblon; with the help of the team and full replication of the program, they achieved rabies-free status.

Another indirect effect of the program is the motivation created by trained veterinary interns; they now appreciate Local government practice, which is uncommon nowadays. Most of those trained are now embracing local government veterinary practice.

Milestones

The multi-faceted veterinary services fortified by the Marinduque Veterinary Field Hospital program gained multiple recognitions, achievements, and awards.

In 2012, the province was officially declared a rabies-free Province by the Department of Agriculture, Department of Health, and National Rabies Prevention and Control Committee, even though there have been no reported cases since 2006. It was awarded on 28 September 2012. Marinduque completed and satisfied all the requirements prescribed by the National Rabies Prevention and Control Committee. Marinduque was declared a Rabies Free Zone by a joint declaration of the Department of Health and Department of Agriculture during the celebration of World Rabies Day held at Makati City Hall, Makati City. The NRPCC again awarded the Province of Marinduque a plaque of recognition for the unwavering support, tireless dedication, and excellence of the rabies program toward the national goal of rabies-free Philippines on 28 September 2016 and 2018. And on 27 September 2018, The Department of Health awarded a plaque of recognition to the Province of Marinduque for maintaining its rabies-free status for the past six years.

On 16 December 2005, an Award of Excellence was also given to the Provincial Veterinary office by the AusAID FAO eradication Project DA Bureau of Animal Industry National FMD Task Force in implementing programs that eliminate and prevent Foot and Mouth Disease spread and incursion without vaccination.

On 6 June 2014, the team was recognized as a semi-finalist in Search for Outstanding Public Officials and Employees. The Committee on Presidential Lingkod Bayan and CSC Pagasa Awards awarded it.

In September 2014, the team received the Civil Service Commission Pagasa Award. It is given in the merit of the team’s commitment to ensuring the welfare of animals and wildlife species in Marinduque and other provinces. In the award, the team was also recognized as the first animal welfare group to set foot in the impact zone in Leyte after the onslaught of Yolanda through operation “Sagip Hayop,” where affected animals, including livestock, were rescued and preserved as a source of income and food. The initiative also saved millions of pesos for the government in terms of possible disease outbreaks. Furthermore, the award also recognizes the remarkable team dedicated to upholding animal welfare led them to initiate projects that protect various wildlife species from poachers and made Marinduque a rabies-free zone.

On 18 May 2016, by introducing an innovative out of the box approach, the team leader was recognized as an Outstanding Provincial Veterinarian by the Provincial, City, and Municipal Veterinarians League of the Philippines In recognition of his invaluable achievement and dedication to Provincial Veterinarian of the Province of Marinduque and for his dedicated and unselfish efforts for the interest of the veterinary profession. Subsequently, the Team Leader was also recognized by his alma mater (Central Luzon State University) as one of its outstanding alumni for his far from the ordinary, innovative works.

Implementation Timeline

In 2002, a radical approach to eradicating rabies by eliminating stray dogs was initiated. In 2004, the Marinduque Provincial Veterinary Office introduced and implemented the Marinduque Veterinary Fieldhospital delivering Veterinary mobile field service. In 2006, there were no reported cases of human mortality brought by rabies or animals infected with rabies.

In 2010, the modern spay and neuter program was implemented as a main component activity of the Marinduque veterinary field hospital to complement the anti-rabies program of the province with a scientific approach to controlling the dog and cat population. In 2012, The Province of Marinduque was declared by the department of health and the Bureau of Animal Industry as a Rabies free province. In 2013, partnerships, collaborations, technology, and equipment transfer were conducted with Japan International Cooperative Agency and Humane Society International. From 2014 to the present, due to national recognition and impressed local leaders, the office has increased its budget allocation and has been supported dearly to this day. Innovations and upgrades continue, and services are further developed and improved.

Testimonials

The program received positive feedback from clients, young veterinarians, local government veterinarians, companion animals, livestock farmers, and everyday citizens who availed of the services in the province while doing veterinary medical missions in other parts of the country. Here are some:

“A very reliable institution in terms of veterinary services, both in public service and wildlife rescue. This institution is a hallmark of advocacies that young and aspiring veterinarians can learn from. Even places far from urbanization learn about the importance of our wildlife and the whole environment with their community service. I learned a lot of approaches to wildlife rescue just by reading their posts. Having such an institution serve our community is something to celebrate and appreciate, as their advocacies are not easy to serve. We would like to send our deepest appreciation and gratitude to PVet Marinduque for continuing their advocacies and inspiring us young veterinarians.” – Dr. Cid Brent G. Aurelio, DVM, Veterinarian.

Albert Einstein once said, “You can never solve a problem on the level on which it was created”; you have to rise above it through innovation and creativity. This drive to innovate is characterized by the Provincial Veterinary Office of Marinduque and is exemplified by their Mobile Field Veterinary Hospital (MFVH). Population control of dogs and cats is crucial in effective Rabies control and prevention. As Marinduque is one of the few Rabies-free provinces in the Philippines, maintaining its status requires the cooperation of everyone. The ability to bring veterinary technical services to remote areas enhances the pet owners’ compliance with local ordinances. Here in Oriental Mindoro, pet owners were fortunate to have experienced the free spay and neuter services at the MFVH. The spay and neuter activity was a big hit here in Calapan City, Naujan, Victoria, and Puerto Galera municipalities. The MFVH served as a safe space to do surgeries; asepsis, crowd control, and surgical comfort are some factors that are achieved. However, it should be noted that without the talented and dedicated people behind the MFVH, it is just a tent. The good news is that the PVO Marinduque is generous enough to share the concept and technical skills. As a local government veterinarian, I have experienced first-hand how the MFVH operates and have been fortunate enough to join them in other provinces of MIMAROPA. Even our staff gained hands-on experience as the MFVH staff mentored them in various activities. We have embarked on having our field veterinary hospital because of our exposure to Marinduque’s innovation, and we hope to achieve the same level of expertise and service provision in our province. – Dr. Alfredo Manglicmot, Veterinarian 4 of the Provincial Veterinary Office of Mindoro Oriental.

The opportunity to be given my paw and cat vaccination is a relief for me as a recipient of the said initiatives from the Provincial veterinary of Marinduque; it helps me feel worried, for most of the dogs in our community are not vaccinated for quite some time. We sometimes pay more for vaccination if our dog bites someone. Still, because of the vaccination of the provincial veterinarian headed by Dr. Victoria and his staff, we are grateful because we will not seek in different municipalities to have our dog and cat vaccinated. They also do ligation surgery for owners who wish to make their paws and cats healthier. As one of the recipients, I am beyond grateful and hope this program will accommodate more people. Thank you so much to one of your recipients and our community here in Sta. Cruz Marinduque. More power and job well done. – Mr. Arjay Peneda, Baranggay Lapu-Lapu, Sta. Cruz Marinduque

The Veterinary Field Hospital/ Mobile Field Service conducted by the PVO of Marinduque was helpful, especially here in our province, where many in the community cannot afford to visit the clinic/office. Creating a setup like this is tiring but fulfilling once you see how many animals/pets your service and when you see those happy and thankful owners. So a big salute to the PVO for the job well done, and I hope more Provinces/ Cities will also see the benefits of having a Veterinary Field Hospital/ Mobile Field Service. – Ms. Irish Ann Revilla, Veterinary Student at Cavite State University

Name of the Organization

Quezon City Government

Name of the Office/Unit that leads the implementation of this best practice entry

Quezon City Health Department

Focus Area of the Best Practice

Strategy, Citizens / Customers

Date the best practice was first implemented

06 November 2017 – up to present

Summary of the Best Practice

The Community-Based Mental Health Program (CBMHP) of Quezon City is an integrated and comprehensive approach to delivering appropriate services to promote mental health in the community and provide services to those with mental illness. The program aims to promote a shift from hospital-based care to a community-based mental health care delivery system. This can be achieved by integrating mental health care in primary health care services; prevention, control, and treatment of mental illness at all levels; and promotion of mental wellness in the community.

The CBMHP ensures that mental health services are delivered by primary mental health care facilities that support or treat people with mental disorders in a home rather than a psychiatric hospital.

Community services:

1. Mental health services integrated with primary health care in all the health centers of QC
2. Diagnosis and initiation of treatment by specialists either in the hospital setting or in community outreach activities.
3. Psychiatric wards of general hospitals (for scale-up)

Program Strategies:

1. Capacity building of health center staff and community leaders
2. Promoting mental health in the workplace and the community includes the Young Healthy Mind interactive learning for adolescents integrated with the Teen Walk To Health.
3. Decentralization of patients from QCGH through the Mental Wellness Access Hubs (MWAH) facilities to provide psychotropic drugs in health centers.
4. Outreach ‘mentoring’ sessions in the community for diagnosis and treatment of patients with mental disorders.
5. Provision of Psychosocial support in HOPE Facilities and the community in lockdown areas.

Because of this initiative, Quezon City may yet be the only LGU wherein all the health centers can integrate mental health services in primary care. Thousands have already been reached through community activities in all city districts. At the moment, there are over 180 patients registered and receiving free medicines in barangay health centers.

The Challenge

The Philippine World Health Organization (WHO) Special Initiative for Mental Health conducted in 2020 shows that at least 3.6 million Filipinos are encountering mental health issues as the Philippines continues to face the COVID-19 pandemic. According to the Department of Health (DOH) Disease Prevention and Control Bureau, about 1.14 million Filipinos have depression, 847,000 are battling alcohol-use disorders, and 520,000 others were diagnosed with bipolar disorder.

Amid the increasing burden of mental illness, the country has limited human resources and mental health facilities. Furthermore, even fewer general practitioners are trained in managing common mental health problems. In addition, to support from healthcare services, people with mental illness require social support and care to enable them to be active community members.

Mental health care gaps between the supply and the demand for services always existed and were further magnified by the COVID-19 pandemic. Feelings of vulnerability, uncertainty, fear of death, stress, and isolation were experienced by most people, especially those who were quarantined.

In the Philippines, there needs to be a mental health registry that localizes patients. The exact burden of the disease in Quezon City can only be estimated. The Quezon City General Hospital (QCGH) reported 1,083 cases of accessing the OPS from June 2017-March 2018. Hospitals like the National Center for Mental Health (NCMH), East Avenue Medical Center (EAMC), Quirino Memorial Medical Center (QMMC), Veterans Memorial Medical Center (VMMC), UERM Medical Center, and Armed Forces of the Philippines Medical Center (AFPMC) have difficulty in identifying and reporting cases involving QC residents.

Mental health services in Quezon City have been highly specialized and institutionalized, but patient care has to continue beyond institutional facilities. Barangay Health Workers (BHWs) have identified mentally ill patients discharged from the hospitals with recurrence of symptoms because of lack of follow-up and inability to purchase maintenance medicines. Mental health services were not within reach of the residents, especially the poor and underserved. Hence, the need for a community-based mental health program–to make services within reach of the people.

Solution and Impact

The Quezon City CBMHP, was developed to integrate mental health into primary care and to make mental health services accessible in the community. The CBMHP Ordinance of the city was passed in 2015, way ahead of the Mental Health Act of 2018.

Innovative strategies cited in the city’s CBMHP ordinance include:

1. Capacitating health center staff and community leaders
   • Training of BHWs and Barangay leaders on “Kalusugang Pangkaisipan,” a module developed by the Philippine Mental Health Association (PMHA) for community lectures on promoting mental health and erasing the stigma of mental illness.
   • Training of health staff on the Mental Health Gap Action Program (mhGAP) of the WHO.
2. Health Promotion
   • Workplace – conduct of the Mental Health Summit, which is the “All is well” series in 2018 and 2019 for the Quezon City Health Department (QCHD) staff.
   • Community – “Kalusugang Pangkaisipan” lectures in health centers using flip-tarps reproduced by the city; Community-based Mental Health Handbook for Community Health Workers (CHWs)
   • Young Healthy Mind interactive learning for adolescents integrated with the Teen Walk To Health.
   • Decentralization of patients from QCGH.
3. Mental Wellness Access Hubs (MWAH) were identified per district where psychotropic drugs are stored. MWAH doctors were assigned as coordinators for districts to facilitate patient referrals and care.MWAH facilities keep an inventory of medicines and maintain a Mental Health Registry.
4. There are currently six functional MWAH facilities (one in each of the six districts of Quezon City).
5. Mentoring sessions – outreach activities for patients with symptoms of mental illness conducted by health center staff in partnership with UNILAB, PMHA, and QCGH.
6. Provision of Psychosocial Support in HOPE Facilities and lockdown areas, including services like Basic Services and Security (shelter, vaccines, food), Community and Family Support (inquiry desk), Focused Non-specialized services (psychological first aid, 112 helpline access), and Specialized services(referrals, MWAH psychotropic drugs, and teleconsultation)

Replicability

Mental disorders are prevalent in all societies and create economic and social difficulties for the community. In the Philippines, the Mental Health Act was passed in 2018 – ensuring access of patients to mental health services at all levels of the national healthcare system.

In Quezon City, the program has been initiated ahead of the national law, and the city has been investing in its implementation for the past five years. Other communities must also prioritize mental health concerns and develop programs to address them. Here are the reasons we invest in integrating mental health services in primary care:

1. Mental health disorders can lead to high psychosocial and economic costs for the community.
2. Early diagnosis and treatment can decrease the disease burden of MH disorders*
3. The treatment gap for mental disorders is big.
4. Primary mental health care services are less expensive than psychiatric hospitals.
5. Mental and physical health problems are interwoven
6. Mental health care is important to address the needs of those with mental disorders and promote the mental health of all people.

The risk for mental illness spares no one, as experienced during the pandemic. An effective program must be tailor-made and focused on meeting the needs of a specific community. Barangays all over the country have health facilities where mental health services can be integrated with proper training of health workers. To improve health-seeking behavior and prevent stigma, residents must be taught to see mental illness as important as any other disease being treated in health centers.

The DOH and other agencies can be engaged to provide technical and funding support for training, health promotion materials, and medicines. The initiative, though, has to come from the community creating an opportunity to strengthen health governance.

Review/Next Steps Planned

While the CBMHP of QC is focused on promoting MH in the community, other sectors of society also have mental health needs that must be addressed.

1. In scaling up, there are plans to expand the CBMHP services:
   • Expand and institutionalize the outreach ‘mentoring’ activities through the “Adopt a District” project by hospitals in Quezon City, wherein a regular quarterly activity will be conducted per district. This project will eventually expand the network of facilities included in the decentralization of patients for integration into the community.
   • While there are challenges to the limited outreach schedules on community lectures, online materials must be developed to increase reach in integrating MH promotion in health centers.
   • For continuity of care, an acute inpatient service can be established in any of the LGU hospitals, providing pediatric psychiatric services.
   • Organize a community support group to be an advocate for promoting mental health in the community. This may be composed of but not limited to family members of patients with mental illness.
   • Screening for anxiety and depression in the health facility aligned with the risk assessment of adults 20 years old and above.
   • The challenge in reporting is that MH services in institutions are available to all, not only to Quezon City residents. A policy must be developed with the institutions to facilitate more comprehensive and accurate data collection.
2. Adopting other provisions of the Mental Health Health Act:
   • Workplace – The MH program developed by CSC needed to be implemented in public offices and will be piloted in QCHD. Currently, QCHD is being assisted by a psychologist and will be utilizing a screening tool for depression and anxiety for health workers returning from quarantine.
   • Schools – There needs to be an improvement in the capacity of the Schools Division Office to implement the ”We care for your Mental Health” program in all the public schools in the city. This is being piloted in District 4 before its full implementation.
   • Suicide Prevention Strategy – A crisis management program framework needs to be developed in the city, including setting up a crisis hotline in collaboration with DOH and NCMH.

Milestones

The CBMHP of QC has achieved the following since its implementation:

1. Training of 51 doctors, 83 nurses, and 14 midwives on WHO Mental Health Gap Action Program – with all health centers having at least one trained staff. All health centers in QC may integrate MH services in primary care. Training of 300 Barangay Health Workers on “Kalusugang Pangkaisipan” of PMHA so they may conduct lectures on MH care and recognize symptoms of mental illness.
2. Health Promotion activities:
   • For the Staff:
     • “All is Well” series for QCHD staff – 600 attendees on lectures on depression and stress management.
     • Online webinar series on self-care and stress management – 221 frontline health workers attended at least one session.
     • Psychosocial counseling group session for health responders. 13 sessions with 118 participants, including doctors, nurses, contact tracers, sanitation staff, and BHERT members.
   • For the Community:
     • Regular monthly pre-clinic lectures on “Kalusugang Pangkaisipan” were conducted in health centers with approximately 20 participants per session.
     • ‘Young Healthy Mind’ interactive learning for adolescents participating in Teen Walk to Health activities. Fifty-two sessions were conducted from 2017 to Q1 of 2020, reaching 6,488 adolescents. An online version was piloted in the Teen Health Quarter (THQ), and four sessions were conducted with 49 participants.
3. Conducted 4 “Mentoring” Outreach activities, where 71 patients were seen and continuing medications
4. Hospitals, especially the LGU-owned QCGH, were engaged in integrating MH care in the community through coordination with MWAH facilities. A total of 182 patients are registered in the city and receiving free maintenance medicines.
5. During the pandemic, psychosocial support was provided to 38,440 patients in 12 HOPE facilities, with basic services like temporary shelter and food. Affected lockdown areas, with 20,995 families and 60,362 individuals given community and family support through the provision of inquiry desks, access to medical services, and vaccines.

Testimonials

1. Patients with mental illness in the community for care and maintenance of medicines. One patient in a Mental Wellness Access Hub verbalized that:
   • “Mas mabilis akong gumaling dito kasi kasama ko ang aking pamilya at meron akong gamot…importante yung gamot…Malaking bagay po na hindi natitigil (ang gamot)… di na po ako irritable… di na natatakot at nakaka-imagine ng nakakatakot.”
2. With health workers in the field, the program started with the “All is well” series. The conduct of this activity was not pushed through during the lockdown. The program opted to provide online psychosocial services in partnership with Philippine Mental Health Association (PMHA). Health workers were able to avail of these services. Feedback was positive:
   • “I had simple expectations from the counseling with psychologists, and it was just to have some simple quality time to listen to a pep talk with experts. But I gained a lot more. Though I came late because of a work conflict, it was a spontaneous unloading of pent-up emotions and uncertainties since the pandemic changed our world and work scenario. It was cathartic to speak about what I valued more while in the midst of the pandemic. Though, as a public health worker, doing service was the call of duty, it was also a time to love myself (self-preservation), and I learned from the counseling team that it was alright to cry and be sad, to stop and rest awhile and to speak up for oneself when our mental stability was being threatened. It was also a time to be reminded that nothing on earth is permanent, that change would bring in the new normal, and that, as human beings, we should move forward to adopt a post-pandemic defense mechanism. I would like to commend them for coming in at the most opportune time, as we need strangers to just listen to our thoughts on the challenges of the pandemic. Thank you, as it cleared many unnecessary burdens from my mind.”
   • “Group session was very welcoming and intimate with a feeling of privacy; thus, participants could express their present feelings well. I connected my personal experience to how everyone felt and was happy to have shared it. Time seemed short because sharing was fun and helpful.”

Since Quezon City is the first LGU in NCR that enacted an ordinance and implemented strategies, this is being benchmarked by the regional DOH Mental Health Program.

Name of the Organization

Philippine National Police

Name of the Office/Unit that leads the implementation of this best practice entry

Manila Police District Mobile Force Battalion

Focus Area of the Best Practice

Operations, Basic Services

Date the best practice was first implemented

24 October 2018 – up to present

Summary of the Best Practice

In their bid to reduce the crime rate and illegal activities in their jurisdiction, the Manila Police District (MPD) has been implementing the MPD Mobile Library project, Ang Guro Kong Pulis. The project aims to provide basic social welfare services through non-formal education to Children in Conflict with the Law (CICL), street children, and indigent minors. Since its implementation, the project has received much recognition and has been replicated in many areas.

Background of the Problem

Prior to the implementation of the project, MPD has seen through its regular patrolling and personal experiences that many street children and CICL are begging, doing unsolicited car washing, serving as illegitimate parking attendants, and illegally vending along the areas of Roxas Boulevard, Malate, and Ermita. Meanwhile, they have also used the areas of Taft Avenue and Baywalk as areas to converge, sleep, and do other types of illegal activities. Their presence in these areas can be attributed to a lack of an effective strategy from the local government unit (LGU) and the MPD.

And although the LGU in tandem with MPD have already been conducting regular rescue programs for street dwellers across the entire City of Manila, their effort has not been enough as the rescued street dwellers would return to those areas after they were released from LGU Rescue Center. After all, the Rescue Center cannot accommodate all of the rescued individuals due to a lack of manpower, the burden of such logistics, and the lack of other resources required.

During dialogues with members of CICL and through our investigations, we found out that a majority of our target audience are also “solvent users” or are inhaling illegal chemical substances, engaged in gang rivalry—and potentially violence, robbery, and the women, in particular, have also been engaged in prostitution.

Solution and Impact

To reduce the crime rate, the MPD Mobile Library Ang Guro Kong Pulis project was established on 24 October 2018. It hoped to achieve its objective by providing basic social welfare services through non-formal education to CICL, street children, and disadvantaged minors.

Before implementation, MPD conducted an area study and a survey of affected CICL and non-affected street children to identify their needs. They devised a plan in collaboration with higher education institutions and government agencies.

For the project’s actual roll-out, the unit’s issued troop carrier vehicle was converted into a mobile library outfitted with detachable bookshelves. As time progressed, an LED TV, a laptop, and some rechargeable speakers were added to the mobile library to make the learning activity more interactive.

The project is implemented every Wednesday and Friday along Malate Baywalk, Roxas Boulevard, Luneta Park, and the Ermita area. Every day, they could accommodate about one hundred fifty (150) beneficiaries who belong to the poorest of the poor. Beneficiaries ranged from 5-year-olds to 19-year-olds.

Aside from the regular police teachers, there have also been volunteer students, teachers from private schools, and private individuals who have provided teaching services. NGOs have also provided sponsorships such as medical, dental, feeding, and outreach activities. The project has also received donations such as LED TVs, toys, sports supplies, school supplies, and groceries, all of which have been used to supplement their services.

Overall, the MPD has considered the project a success since its commencement. It has been so successful that—although sessions are only held twice a week, they have considered conducting more frequent sessions as they have seen demand from the students. Moreover, students of the project and their parents have also expressed that this is a rare opportunity where they felt the support of the LGU, and they were incredibly grateful for the basic services and donations are given through the mobile library. Likewise, this uplifted morale has led MPD to consider the presence of police teachers an effective tool in crime prevention.

Because of its proven success, the project has also engaged in a replication process that inspires other groups to do the same. Notable examples include the Alegado Foundation based in the United States, The Philippine National Police-Special Action Force-Special Action Companies (PNP-SAF-SAC) 55, SAC 61, The Philippine Army 68 IB, and The Philippine Marine Battalion Landing Team 1 in the areas Sulu, Tawi-Tawi, and Negros Oriental, and with PNP Region 10 in areas such as Bukidnon, Lanao del Norte, Misamis Occidental, and Cagayan de Oro. Notably, the project was replicated by PNP Region 10 to see its effectiveness in countering local armed conflict.

In replicating the project in other areas, most PNP units adopted the same concept: their issued mobile vehicles were also converted into rolling libraries. On the other hand, the Philippine Army and Philippine Navy converted their large vehicles into mobile libraries. Crucially, in Mindanao, the PNP SAF, Philippine Army, and Philippine Marines rolled out their projects in far-flung areas, in the homes of ethnic people, and areas of local armed conflict.

Over time, the MPD has also adopted the project as part of its service of providing non-formal education. It also serves as a pipeline for students to eventually enroll in formal education under the Alternative Learning System established in partnership with the Department of Education (DepEd) Manila. In June 2019, the MPD Alternative Learning System was launched, and it started with 40 students from former students, other less fortunate constituents, and CICL.

Milestones

The project received recognition from the National Capital Region Police Office’s (NCRPO) Press Club 3rd Anniversary Special Awards for Innovative Programs. It was awarded by none less than the NCRPO Regional Director PDIR Guillermo L Eleazar. The project’s representative was also invited as a Guest of Honor and Speaker and to be the recipient of recognition from the University of Santo Tomas Volunteers for United Nations Children’s Fund (UNICEF). And also, during the celebration of Manila Police District 2019 Culmination of Police Community Relation Month, Police Brigadier General (PBGEN) Vicente D Danao Jr bestowed the program as Best Practice of the Year. Likewise, it was also recognized by the NCRPO as the 2019 Best Practice of the Year.

Name of the Organization

Department of Social Welfare and Development Field Office VIII

Name of the Office/Unit that leads the implementation of this best practice entry

Regional Resource Operations Section (RROS) under Disaster Response Management Division (DRMD)

Focus Area of the Best Practice

Strategy, Operations, Management and Perspectives on Productivity and Quality

Date the best practice was first implemented

5 March 2018 – up to present

Summary of the Best Practice

Regional Resource Operations Section (RROS) of the Department of Social Welfare and Development (DSWD) Field Office VIII is changing the game in emergency response. Since 2018, the field office has been implementing the Family Food Packs (FFP), which introduced the following innovations:

• Transition from plastic bags to Family Food Pack boxes
• Installation of racking systems
• Use of the assembly line method and rollers

Altogether, these innovations improved how FFPs were packaged, produced, and stored and are currently being implemented at RROS.

During emergencies, especially during post-disaster response, the FFPs become a common sight to affected families, who often depend on these boxes for survival, as these boxes contain enough food to feed a family of five for two to three days.

As the chair of the Food and Non-Food Item (FNFI) Cluster of the National Disaster Risk Reduction and Management Council (NDRRMC), DSWD is responsible for the production, storage, and distribution of these FFPs. And true to its commitment, DSWD has indeed produced and distributed these relief items where they are needed–from the Yolanda-ravaged communities in 2013 to the highlands of San Jose de Buan in 2019, and even to the locked-down municipality of Burauen during the middle of the COVID-19 pandemic, FFP made a difference.

It all started when the Department of Social Welfare and Development’s RROS under the Disaster Response and Management Division (DRMD) thought of a response to DSWD’s Administrative Order 01, Series of 2018. RROS was responsible for ensuring the availability, accessibility, and readiness of resources, food and non-food items, and the administration of necessary support before and during disaster operations. The RROS is further subdivided into the Warehousing and the Donations Unit.

The Challenge

A few years ago, DSWD FO Vlll’s FFPs were packed in plastic bags. The production process needed to be more streamlined. All raw materials (canned goods, rice, coffee, etc.) would be placed on low tables. Volunteers and DSWD workers would gather around these tables, sort and place these raw materials into plastic bags marked with the DSWD logo. After repacking the food items into FFPs, these plastic bags would then be placed inside a sack and then stacked on top of pallets and on top of each other. Each sack was then marked with the production date and the expiration date. The expiration date was based on the food item with the nearest expiration date. Using this information, it became easier to plan which sacks should first be distributed.

This method required plenty of effort and was slow and exhausting. The goods were more susceptible to damage due to compression in the stacking and were not environment-friendly due to the heavy use of plastic materials.

Solution and Impact

The evolution of Family Food Pack (FFP) from plastic to carton boxes did not happen overnight. Gradual improvements had to be implemented in stages.

Stage 1: Transition from Plastic Bags to Boxes (2018)

The transition from plastic bags to boxes started in 2018 when DSWD FO VIII outsourced boxes from DSWD Field Office X, 51,777 pcs of slotted carton boxes costing Php1,967,526.0–a considerable Savings generated by the department since those were considered extra boxes of Field Office X.

Stage 2: Installation of Racking System (2018)

By mid-2018, DSWD acquired a racking system, a storage solution designed to stack materials in rows with multiple levels, which was handed over when the local branch of the International Organization for Migration (IOM) shut down its office. This paved the way to generating another savings of Php 231,034.40 for 20 sets of racks. Resulting in easier storing of relief items, protecting contents from stacking pressure and extra storage space available for more FFPs and raw materials.

Innovation

Stage 3: Assembly Line Method and Rollers (2018-2019)

Taking inspiration from the National Resource Operations Center (NROC) in NCR and Visayas Disaster Resource Center (VDRC) in Cebu, RROS implemented an assembly line method.
Using this method, repackers would stand alongside the table, FFPs would be pushed from one end of the table to the other, making small stops along the way and sealed by taping the boxes.
This streamlined system sped up the process and more FFPs were produced. However, this method had one challenge as this entails more effort in pushing the boxes along the table.
RROS devised an alternative solution through recycling materials (PVC Pipes, ball bearings, found steel, nuts/bolts) to create a fully functional Do-It-Yourself (D.I.Y) roller system. This effectively reduced strain on the part of the repackers, making the process smoother.

Performance and Results

These innovations resulted in more efficient production, storage and delivery of the FFPs, as follows:

• More environmentally-friendly. Due to the switch to boxes, DSWD was able to reduce the usage of plastic.
• Easier identification of the DSWD brand. Beneficiaries are easily able to differentiate between relief items from the LGUs and OSWO through the packaging.
• Boxes are more secure. Once sealed, beneficiaries are assured that the relief items packed at the RROS are exactly what they will receive. Boxes also prevent accidental spillage of relief items due to rough handling during relief operations.
• Easier organization and storage. The FFP box is stackable up to 100 FFPs per pallet, enabling easier storage compared to plastic bags.
• Vertical storage frees up floor space. Due to the racking system, FFPs are stored vertically increasing Storage Capacity and meeting the required minimum of 20,000 FFPs. (See Annex I)
• Faster production of FFPs. Increased number of FFPs produced in a day reaching new heights at 5000 FFPs (during Odette Relief Operations)–double the previous production figures.

Replicability

This ingenuity has already caught the attention of several DSWD Field Offices and Local Government Units.

In July 2019, RROS staff participated in the 2nd National Resource and Logistics Management
Conference held in Cebu City, where each DSWD Field Office across the country presented its Best Practices. Later that year, these innovations were also featured during DSWD NCR’s benchmarking activity, where a visit to inspect these innovations at RROS.

In 2020, RROS was invited as a resource agency by the Provincial Local Government Unit of Western Samar for the training of Municipal Social Welfare and Development Officers (MSWDOs) and Municipal Disaster Risk Reduction and Management Officers (MDRRMOs), imparting these best practices, encouraging them to replicate at the local level.

Insights of these innovations were also put into practice during the augmentation of the relief operations related to the Cotabato earthquakes last October 2019. RROS assisted in organizing the arrival of relief items and donations from various DSWD Field Offices and other agencies.

These innovations are incorporated in the Operations Manual for the Disaster Response Management Division, aiming to achieve full mechanization in the efficient production of FFPs and provide quality relief items for its dependents.

Milestones

Last January 2022, the good practice documentation “Nang Dahil sa Kahon” of DRMD Field Office VIII gained recognition when it was awarded as the Best Knowledge Management Initiative under the Innovation Category of the 2021 Program on Awards and Incentives for Service Excellence (PRAISE) Awards.

In July 2019, DSWD FO VIII also gained recognition when it won the Over-all Winner in Good Practice Presentation on Resource and Logistics Management during the 2nd National Resource and Logistics Management Conference held in Cebu City participated by the DSWD Field Offices across the 17 Regions in the Philippines.

RROS was also invited in 2020 as a resource agency by the Provincial Local Government Unit of Western Samar for the training of Municipal Social Welfare and Development Officers (MSWDOs) and Municipal Disaster Risk Reduction and Management Officers (MDRRMOs) from the province and imparting these best practices, encouraging them to replicate at the local level. Another LGU, the Municipal Government of Catarman, Northern Samar, is currently arranging with the RROS for the conduct of a similar training this August of 2022.

These innovations were also practiced during the relief operations for the families affected by the Cotabato earthquakes last October 2019 during the augmentation for the relief operations, providing technical assistance in organizing and proper storage of relief items and donations.
Furthermore, these innovations are continually being implemented as RROS enlarges its operations in 2019 when the new warehouse in Palo, Leyte was opened.

These new innovations are also incorporated in the Operations Manual for the Disaster Response Management Division in the pursuit of full mechanization in producing FFPs ensuring efficiency and providing quality relief items to families who depend on them after disasters.

Testimonials

The continuous improvement of the operations of RROS in producing FFPs gained positive feedback from beneficiaries who witnessed the transformation of FFPs distributed in the aftermath of typhoon Yolanda to its latest and more dignified form.

“Isa akong survivor ng bagyong Yolanda at yung bagong dating na bagyo, yung bagyong Odette. Nakatanggap ako ng relief goods mula sa DSWD Regional Office. Para sa akin, dati, di natin alam kung yung mga ipinamigay mula sa DSWD Region, di natin alam kung binawasan, dahil kapag naka-box siya, malalaman agad kapag binawasan kasi selyado siya ng packing tape.” – Nanay Lenny (Yolanda Survivor 2013 and Odette Survivor 2021)

“Ayos naman, mas maganda ko yung ngayong naka-box kasi selyado talaga siya hindi na makakasabing kulang.” – Nanay Yolanda (Yolanda Survivor 2013 and Odette Survivor 2021)

More so, the innovations applied yielded improvements of how FFPs are stored to ensure the quality and further increase the number of FFPs produced and stored through the Racking System and in speeding up the production through the Assembly Line Method and Rolling System.

“‘Yung storage dati, nilalagay lang yung paleta sa floor. Di talaga kami nakaka-storage ng marami kasi limitado lang ang lugar. Tapos ngayong may racking system na tayo, nakakapag-storage na tayo ng mas marami. Nama-maximize na natin yung lugar. Mas marami na yung goods na pwede nating i-stack at mas mabilis mag-store, mabilis bilangin at mabilis na rin ang pag-imbentaryo,” said Mark Anthony Tabones, Project Development Officer (Logistics).