Completion Report of Student Exchange Programme“Education of Global Medical and Health Science Leaders in the Coming
Generation in Cooperation and Collaboration with ASEAN Countries”
at the City Health Office, City Government of Muntinlupa
and the University of the Philippines(15th February-15th March, 2017)
Reported by Chika Tanaka
Ph.D. course student, Department of Health Sciences, Kobe University, Japan
22nd March 2017

Contents
1

Objective

2

Mental health programmes provided by the local government3

2.1

Current situation of primary health care and mental health care provision

2.2

Challenges on integration of mental health care into primary health care

2.3

Mental health care programme after natural disasters

2.4

Programmes for illicit drug users

2.5

Other health programmes related to mental healthAcknowledgments1

1.

Objective
I joined this student exchange programme to learn about the following three things in thePhilippines; 1) the mental health programmes provided by the local government; 2) the current
situation of people with mental disorders living in the community; 3) the primary health care system.
This report focuses on the first purpose, the mental health programmes provided by the local
government, and summarises my knowledge based on the experiences of my one-month field workat the City Health Office of the city government of Muntinlupa.

Figure 1. Home visits to people with mental disorders
with a nurse and midwife and barangay health workers
by tricycle.

Figure 2. Interviews were conducted with about 40 people
with mental disorders and their families to learn about theircurrent situations.

2.

Mental health programmes provided by the local government

2.1.

Current situation of primary health care and mental health care provisionMuntinlupa city has 9 “barangays” (the localadministrative division) and operates 13 health centres.
The health centres offer a wide range of primary healthcare programmes such as consultation, treatment, healtheducation, immunization, check-ups, and home visits.
Since health centres are located in each barangay and theservices

areofferedwithoutanycharge,thoseprogrammes are accessible and affordable for theFigure 3. Prenatal check-up by a midwife at ahealth centre.

community people including the destitute. The standard
contents of each programme are defined by the Department of Health (DOH), the national
governmental body. The major nation-wide programme contents for health centres include mother andchild care, immunization, communicable disease, non-communicable disease, dental health,2environmental sanitation, and public nutrition.
Since the DOH has not developed any programme for mental health care at health centre level,
health centres in Muntinlupa city does not cater for people with mental health problems. If a physician
judges that a patient needs some psychiatric consultation and treatment, the patient will be referred
either to a psychiatric out-patient service at the city general hospital or to a national hospital which isspecialised in mental health care in another city. According to the physicians at health centres, thefrequency of the referrals from each health centre to those facilities with psychiatric care is less thanonce or twice a year.

2.2.

Challenges on integration of mental health care into primary health care
The Philippines does not have mental health legislation but there are ongoing efforts to pass thebills such as “Philippine Mental Health Act of 2014” and “Philippine Mental Health Act of 2015”
which aim to create a mental health care system that responds to the people’s mental health needs inequity with their physical health needs (1). According to the mental health programme coordinator of
the city, the DOH has a plan to integrate mental health care into primary health care and might be
developing clinical tools such as diagnostic and treatment guidelines of mental disorders for medical
doctors at health centres.
To learn about the challenges on theintegration of mental health care into primary healthcare, I conducted interviews with the stake holders.
The interviewees were 25 people in total. The
number by the affiliation (and qualification) of theinterviewees were as follows: DOH 3; City Health
Office 4, health centres 18 (medical doctors 6,
nurses 7, midwives 2, barangay health workers 2,
health education and promotion managers 1). The
summaryofchallenges

perceived

byinterviewee are as follows:-theFigure 4. Health centres have medical doctors, nurses,
nursing aids, midwives, dentists, dental hygienists,sanitation inspectors, nutritionists, barangay healthworkers, and health education and promotion managers.

Only the medical doctors with a “S2 license” are allowed to prescribe psychotropic medicines.
However, there is only a very limited number of medical doctors who has the S2 license at healthcentres, because they have to bear the cost for S2 license acquisition and renewal.

-

Medical doctors need to pay the fee for a special type of prescription pads, which is required forprescription of psychotropic medicines.

3-

There is no data on mental health needs such as prevalence of mental disorders.

-

Medical doctors, nurses, midwives, and barangay health workers do not have enough knowledge,
skills and experience on mental health care and the welfare services for people with mental
disabilities.

-

Health centres do not have enough educational materials on mental health.

-Community people might try to hide their mental health problems and avoid to visit healthcentres.

-

Health centres lack the facilities which can protect patients’ privacy.

-

Health centres lack the facilities which care for people who are at risk of harming self and others.

2.3.

Mental health care programme after natural disasters
Muntinlupa city has an original Mental Health

Psychosocial Support （ MHPSS ） programme whichcaters for people who are affected by disasters. Since theLaguna de bay is located east of the city, eight out of ninebarangays are prone to flooding. Also, the West Valley
Fault line lies within the eastern part of the city.
Moreover, in summer season there are a number of fireincidents in the city. I am reporting about an activity ofFigure 5. Burnt houses after the fire.

MHPSS which I observed in the following paragraphs.
A fire incidence which burned 40 housesand affected 160 people occurred in an area where
the informal settlers live. The Health Emergency
Management Staff (HEMS) of the City Health
Office, which is comprised of a variety of
specialists such as doctor, nurse, epidemiologist,
Figure 6. Child victims colouring pictures.

logistician, driver, sanitation inspector, social
worker, and nutritionist), visits the affected area on

a daily-basis and provides health services from the day of the fire until the evacuation centre wasclosed.

4I observed a nurse of HEMS implementing a part of MHPSS
for affected children one day after the fire incident. When wearrived there, there were about a hundred people who lost theirhouses and stayed in the evacuation area in the middle of the burnt
houses without adequate shelter. As the nurse called children
together under a tent, about 25 children from toddlers to about 10year-olds gathered around. First, the nurse and children prayed
together and sang songs. Then the colouring books were distributed
Figure 7. The HEMS Nurse
implementing MHPSS to the children.

to children. The children looked so happy and concentrated oncolouring their favourite pictures. After that, the nurse called

each of the children to come to the front and encouraged him/her to introduce his/her name, age andwhat he/she coloured to a round of applause. At the same time, the nurse gave some snacks to thechildren. The children looked so content despite being under a stressful situation. The session lasts
about 40 minutes.

2.4.

Programmes for illicit drug users
The Comprehensive Dangerous Drugs Act of2002 (R.A. 9165) regulates illicit drug use as well as
defines the responsibilities of stake holders on
reintegration of drug users into society. I will reportabout the reintegration programme of the city.
After the new administration of president
Duterte in 2016, Philippine National Police visited
those suspected of being involved in the illicit drug

Figure 8. Group therapy for surrenderees with druguse.

market to encourage them to surrender. The name ofsurrenderees will be on the watch list but they receive an amnesty and gain services for their recovery.
The estimated number of people who are involved in the illicit drug market in Muntinlupa cityis 13,000 (2.6% of the entire population) and 9,351 people have surrendered before the 15th January
2017. The Drug Abuse Prevention and Control Office (DAPCO) of the city government implements
a comprehensive reintegration programme, named MAPALAD programme, in collaboration with theCity Health Office and the Social Service Division. (Please refer to the appendix of my summary ofthe programme for further information based on the interviews with DAPCO officers.)

5First, the drug dependence severity and other basic profilesof surrenderees are assessed. Those who are assessed as severely
dependent are referred to national or private treatment
rehabilitation centres. On the other hand, those who are assessed
as mildly or moderately dependent undergo the community basedrehabilitation.
The community based rehabilitation is comprised of two
programmes, which are group therapy and livelihood support. In
group therapy, surrenderees attend group sessions such as 12steps programme once a week which are facilitated by religiousorganisations and operated by the Barangay Anti-Drug Abuse
Councils.

Figure 9. Livelihood support for
surrenderees with drug use. (Thelecturer is showing how to producesome washing-up liquid for sale.)

There are 5 types of livelihood supports, which are microfinance, skills training, scholarship, job finding, and food processing. To gain those livelihood
supports, surrenderees need to attend the group therapy for at least 3 months.

2.5.

Other health programmes related to mental health
The other programmes of the city which are related to mental health care includes psychosocial

care for people with HIV/AIDS. Also, the City Health Office has recently implemented some training
related to mental health for health professionals, such as training on stress management at work place,community-based rehabilitation for drug users, MHPSS for children, and palliative care.

3.

Acknowledgments
I would like to express my sincere gratitude to Muntinlupa City Mayor Jaime Fresnedi, and themembers of the Muntinlupa City government, especially City Health Office, health centres, Drug
Abuse Prevention and Control Office, Barangay Anti-Drug Abuse Councils, Bahay Pag-asa, Social
Service Department, and Hospital ng Muntinlupa, and its citizens as well as the graduates, researchers,and administrative staff of the Graduate School of Health Sciences of Kobe University for theirsupports of my field work.
Specifically, my deepest appreciation goes to Dr. Maria Teresa R. Tuliao and Dr. Magdalena C.
Meana of City Health Office and Professor Cecilia A. Ladines-Llave of the University of thePhilippines for their supports, arrangements and supervisions not only on my field work but also on
my life with my 2-year old daughter in the Philippines. I am honored and pleased to have such fantastic

6

supervisors who I truly respect as a public health professional and a researcher.
Lastly, I wish to thank my thesis advisor, Professor Hiroya Matsuo for his guides,encouragements and supports on my research. I could never have this opportunity without the strong
relationship based on trust which he has built with Muntinlupa City Health Office and the Universityof the Philippines over decades. When I have almost given up my visit to the Philippines with mydaughter, he is the one who encouraged and supported me to make it happen.

Reference
1. Tina G. Santos (2016, July 18). DOH makes mental health bill priority. INQUIRER.net.,
Retrieved from http://newsinfo.inquirer.net/796693/doh-makes-mental-health-bill-priority

Figure 10. The members of social service department
after the transfer of the minors with drug dependence
to the national treatment and rehabilitation centre.

Figure 12. Night out with the members of Drug Abuse
Prevention and Control Office who also gave me many
opportunities to learn about MAPALAD programme

Figure 11. Dr. Tuliao (right) kindly took us to many places
such as Manila Zoo with her family on weekends.

Figure 13. Having a fun time with Professor Cecilia Llave at
her house.

Figure 14. Certificate awarding. Dr. Meana, me, Mayor Jaime
Fresnedi, Dr. Tuliao (From left)

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