Recommendations:

Based on the results of the program review, we came up with the following recommendations that can be implemented as interventions that target the whole population and high- risk individuals: Full adaptation and implementation of the Healthy Lifestyle program through:

1) Promoting Healthy Lifestyle

The goal of promoting healthy lifestyle is the practice of the following behaviors: Engaging in regular physical activity Having a healthy diet and eating more fruits and vegetables Avoiding tobacco and alcohol use Promoting healthy lifestyle supports personal and social development through the following activities: Develop information, education and communication (IEC) materials that will improve knowledge and behavior of the target population on healthy lifestyle. Conduct advocacy campaigns and activities among identified partners who have direct impact or influence to preventing and controlling NCDs, e.g. education, agriculture, private sector, etc. Coordinate with different community groups youth, informal sector, sports clubs, civic organizations where healthy lifestyle can be integrated in their activities and regular meetings Convene barangay officials to cascade the healthy lifestyle promotion initiatives down to the community level Implement healthy settings, primarily healthy workplaces and health-promoting schools, for promotion of healthy lifestyle

2) Building Healthy Public Policies and Supportive Environments

The main goals of public health policy for NCD prevention and control are: Improve the health of the population, especially the most disadvantaged Respond to needs and expectations of people who have chronic diseases Provide financial protection against the costs of ill-health Building healthy public policy requires diverse but complementary approaches, such as legislation, fiscal measures, taxation, and organizational change. This can be done through the following: Develop or adopt policies that support local NCD prevention and control:

Local ordinances to implement RA 9211, specifically, banning of smoking in public places, schools, amusement parks frequented by children, workplaces, government buildings, hospitals; regulation of sale of cigarettes among minors; and banning of advertisements of tobacco products in the community Local ordinances or resolutions enjoining the communities, workers and children to join exercise programs School ordinance to support smoke-free, alcohol-free, drugfree and sports-oriented schools to promote health and well-being of students, faculty and other school personnel; provision of healthy foods in the school canteen and banning of foods that are deemed unhealthy; Orient stakeholders regarding impact of transport design to physical activity of the population Encourage LGU to build parks and areas for recreation and physical activity, e.g. bicycle lanes, walk pathways, etc Organize community activities to promote healthy diet and physical activity Regularly monitor compliance to the regulations and consistently administer agreed-upon penalties to those found not complying to the regulations

3) Establishing Coalitions and Partnerships

Coalition and partnerships bring together different parties to achieve shared goals on NCD prevention and control. Strengthening partnerships within the health sector is crucial, but it is also necessary to reach out to other key players and engage in intersectoral action as the underlying causes of noncommunicable diseases lie outside the health sector. The health sector should provide the leadership for establishing coalitions and partnerships at all levels of governance. LGUs need to engage potential partners including those outside the health sector to participate in the implementation of the local NCD prevention and control program LGUs can establish a local coalition to facilitate multisectoral activities. They can review existing committees that can serve as the coordinating body.

4) Making Health Services Available and Accessible

The health care needs of individuals vary according to the presence or absence of risk factors and the severity of their health conditions. Specific health care procedures and services are organized into the following categories: (1) risk factor assessment, (2)

lifestyle modification, (3) screening and diagnosis of NCDs, (4) management of major NCDs, and (5) rehabilitation; and (6) palliative care. To make health services available and accessible, the following may be used: Ensure availability of package of interventions in the local health facilities Make available affordable medications Adopt the Risk Assessment tool in all health facilities Adopt and comply with DOH-endorsed clinical practice guidelines Strengthen referral systems among health facilities Organize support groups, e.g. obesity and diabetes clubs, cancer support, etc

5) Strengthening Program Management

To ensure the effective and efficient implementation of NCD prevention and control, the following are essential: (1) training/ capacity building , (2) supervision, (3) surveillance, monitoring and evaluation. These are essential in ensuring a unified direction of efforts, maximizing outcomes given limited resources, and instilling an open, coordinative and participative spirit among stakeholders. To further strengthen the program management, the following can be done: Collect and analyze data using DOH-prescribed monitoring and evaluation tools Conduct semi-annual program review Disseminate results of monitoring and evaluation Submit accomplishment reports Document good practices in the implementation of the program Utilize results in subsequent planning and policy and program development

6) Ensuring Stable Financing

Chronic NCDs are a major cause and a huge economic burden to individuals, their families and society. They cause disability, premature deaths and undermine the economic development of the country. To ensure stable financing, the following can be implemented:

Advocate for LGUs to increase budget allocation for NCD prevention and control Conduct resource generation from development agencies, private sectors and other partners Expand PhilHealth membership for the support of some clinical packages in NCD Design a local financing scheme as needed and develop corresponding

guidelines and protocols for its implementation Monitor the collection and utilization of finances to ensure that these are prioritized for promoting healthy lifestyle

Since noncommunicable diseases will likely persist as a major public health problem brought about by globalization, urbanization and continued exposure to and uptake of unhealthy lifestyles by the population, it is thus important that the momentum of relevant and productive work be sustained by the health sector and other key stakeholders. Noncommunicable diseases should continue to be included in the health and development agenda of national and local governance. Promoting healthy lifestyle is geared towards the process of enabling people to increase control over their health and to improve their health behaviors in relation to prevention and control of NCDs. It is about people making healthy choices and living healthy lives.