Bernadette J Madrid MD Head Child Protection Unit University of the Philippines Manila and Executive Director Child Protection Network Foundation PHILIPPINE SITUATION Population more than 92 million ID: 184981
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Slide1
Building Support for the Primary Prevention of Child Maltreatment
Bernadette J. Madrid, MD
Head, Child Protection Unit
University of the Philippines Manila
and
Executive Director
Child Protection Network FoundationSlide2
PHILIPPINE SITUATION
Population : more than 92 million
Annual population growth rate: 2.04
Poverty incidence worsened:
24.4% (2003) to 26.7% (2006)
High income inequality compared to Asian neighbors
Off-track in meeting MDG targets for
Poverty
Education
Maternal health
Malnutrition Slide3
PHILIPPINE SITUATION
Low spending on social protection programs
0.3% of GDP in 2007 to 0.8% in 2008
Lack of policy & institutional coordination
Social protection has a narrow base of beneficiaries
Social protection programs are: numerous; with limited reach; inadequately funded; short-lived
High leakage rateSlide4
Philippine National Budget Year 2008
Source: E-Net Philippines, 2008.
National budget: 2008
Education = 13.8%
Social Welfare
= 5.64%
Health = 1.6%
The budget cannot cover for basic servicesSlide5
Traditional Political SupportIn the Philippines, education has the highest political support and still it is not enough. There are just so many deficiencies in education.
CSR of corporations and individual donors usually support education.
The Philippines is just preparing for public kindergarten and after ten years: K12.Slide6
Support for Primary Prevention of Child Maltreatment
“It is unlikely that political leaders will support the level of resources needed to develop high-quality programs targeted at preventing child maltreatment , which will be seen as affecting only a small proportion of children. “
Michael Wald (2009)
Preventing Maltreatment or Promoting Positive
Dev’t
-
Where should a community focus its resources? In Dodge &
Coleman (Ed),
Preventing Child Maltreatment
Community Approaches.
New York: The Guilford Press.Slide7
Stages of Building Support for the Primary Prevention of Child Maltreatment
CPU Network & Department of Health in partnership with WHO Slide8
Stages of Building Support for the Primary Prevention of Child Maltreatment
CPU Network & Council for the Welfare of Children in partnership with WHOSlide9
Objectives of the First National Meeting on Preventing Child Maltreatment
Recognize
that child abuse and neglect is an important problem in
the Philippines
today and has life-long impact on risk behaviors and chronic disease
.
Appreciate that child abuse and neglect is preventable and that there are prevention programs that have been shown to work.Slide10
Objectives of the First National Meeting on Preventing Child Maltreatment
Understand the problems that have prevented programs from being adapted in a wider scale.
4. Take the steps necessary to come up with a national plan on the prevention of child abuse and neglect.Slide11
PARTICIPANTSof the First National Meeting
Leaders and policy makers
Health
Social Welfare
Education
Academe
Professional Societies
International Org
Congress
Local
governmentLegalLaborMediaNGO’sSlide12
NEXT STEPS recommended by the First National Meeting:
Creation/Expansion of Inter-Agency Committee?
National Plan for Primary Prevention of Child Maltreatment (to include framework for coordination)
Integration of Prevention of Child Maltreatment in public health programs
Data Management
Evaluation Tool to measure effectiveness of the interventionsSlide13
What was obviousThe Department of Health did not really want to lead the process.
Child Maltreatment is seen as a social problem and as such the leadership should naturally be the Department of Social Welfare and Development.Slide14
Long Term Effects of Child MaltreatmentAdverse Childhood Experiences (ACEs)
still have profound effect 50 years later
Transformed from psychosocial experience into organic disease, social malfunction and mental illnessACEs are the main determinant of the health & social well-being of the nation.Slide15
Results of the Metro Manila ACE Study
Those who were sexually abused are:
12 times more likely to engage in early sex; 9 times more likely to have early pregnancy; 5 times more likely to commit suicide.
Ramiro, Madrid, Brown 2010
Child Abuse & Neglect 34: 842-845Slide16
Results of the Metro Manila ACE Study
Individuals who felt that they were not loved during childhood are:
Twice as likely to smoke, use illicit drugs,
have early sex and multiple sex partners
5 times more likely to commit suicide.
Ramiro, Madrid, Brown 2010
Child Abuse & Neglect 34: 842-845
Slide17
Strong graded response between number of ACEs & poor healthBronchitis/
emphysema
AsthmaIschemic Heart DiseaseHypertensionTuberculosis
Skin problems
UTI
Liver problems
GI problems- ulcers,
constipation
, indigestionDepression
Ramiro, Madrid, Brown 2010Child Abuse & Neglect 34: 842-845Slide18
Bernadette J. Madrid, MDLaurie Ramiro, PH.D.John Go, MDJuanita Basilio, MD
Child Maltreatment Prevention in the Philippines: A country situation analysis
Supported by WHO, 2009Slide19
OBJECTIVES OF THE STUDY
1. To do a
national situation analysis
on child maltreatment
prevention using
secondary
data and stakeholder
interviews
;
2. T
o assess how municipalities and
barangays
implement their child maltreatment primary prevention program.Slide20
Study SettingsThe study had a national and local coverage. Three
barangays
in the city of Manila, 3 in Quezon City and 3 in rural San Juan, Batangas.Slide21
METHODOLOGY
Aspects of prevention programs targeted:
1.
Prevention readiness
refers to the knowledge, attitudes and attributions that policy makers and opinion leaders have about child maltreatment.
Qualitatively assessed through structured conversations with key individuals and content analysis of official documents and reports.
Quantitatively assessed using Community Readiness Model of
Plested
, et al.
(2006).Slide22
2.
Prevention resources
are what
actually exist
by way of information
and information
systems
; and
resources
of government and
non-government
agencies specifically
tasked
to prevent child maltreatmentSlide23
Community Readiness Model
(
Plested
, Edwards, & Jumper-Thurman, 2006)
A model for community change that integrates a community’s culture, resources and level of readiness to more effectively address an issue.
Allows communities to define issues and strategies in their own context
Builds cooperation among organizations and individuals
Increases community capacity for prevention and intervention
Encourages and enhances community effortsSlide24
9. High Level of
Community Ownership
8. Confirmation / Expansion
7. Stabilization
6. Initiation
5. Preparation
4. Preplanning
3. Vague Awareness
2. Denial / Resistance
1. No Awareness
STAGES OF COMMUNITY READINESSSlide25
Intervention level
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
State
& society
Implementing legal reform and human rights
Translating the CRC into national laws
Very many laws: PD 603- The Child & Youth Welfare Code
RA 7610 – Child Protection
RA 7658 – Prohibiting child labor
RA 9231 – Worst form of child labor
RA 9262 - Against Domestic Violence
RA 9208 - Anti Trafficking
RA 9344 – Juvenile Justice Law
RA 9775 – Anti child pornography
Very many policies, local government codes
Child 21 (2025) –child sensitive & child friendly society
serves as the road map
National Plan of Action for Children- 5- year frame
MDGs
Child Maltreatment Prevention in the Philippines: A country situation analysis
(Madrid, Ramiro, et. al. 2009)Slide26
Intervention level
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
State
& society
Implementing legal reform and human rights
Most laws are unfunded or the funds is “ embedded” in a department’s budget
Too many implementing bodies specified in the mandates
It is not clear how it will be implemented in the local level
There is no sanction if it is not implemented
Since it is unfunded and no personnel, it is made to fit into services already in place
Child Maltreatment Prevention in the Philippines: A country situation analysis
(Madrid, Ramiro, et. al. 2009)Slide27
Intervention level
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
State
& society
Introducing beneficial social and economic policies
Providing early childhood education and care
Early Childhood Care and Development Act
Ensuring universal primary and secondary education
Philippine National Plan of Action to Achieve Education for All
by year 2015
Investing in good social protection systems
Achieving Universal Health Care for All Filipinos embodied in
DOH Administrative Order No. 2010-0036
Child Maltreatment Prevention in the Philippines: A country situation analysis
(Madrid, Ramiro, et. al. 2009)Slide28
Intervention level
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
State
& society
Changing cultural and social norms
Pending bill: Anti-corporal punishment
Reducing economic inequalities
Tackling poverty
Conditional Cash Transfer (3 Ps)
Environmental risk factor reduction
No Smoking in public places
Clean Air Act
Child Maltreatment Prevention in the Philippines: A country situation analysis
(Madrid, Ramiro, et. al. 2009)Slide29
Intervention level
Developmental stage
< 3 years
3-11 years
12-17 years
Relationships
Home visitation programs;
Parenting
parenting programs e.g. PES
Parenting
programs e.g. PES
Individual
Increasing access to child
care services, social support
Life skills education
UNICEF Child Friendly School
Model
Personal Safety Lessons in Schools
Child Maltreatment Prevention in the Philippines: A country situation analysis
(Madrid, Ramiro, et. al. 2009)Slide30
Programs for the prevention of child maltreatment
Most of the programs were established not specifically to prevent child maltreatment but to improve the health, education and social status of the child.
The implementation is based on the “limited good principle”.
No evaluation of program effectiveness (A.I.D.S.)
Provisions for children are scattered across various departments, without any formal connections or consistent policy or practice.
NGO’s and international organizations fill in the gaps.
Slide31
Child Maltreatment Prevention in the Philippines:
A country situation analysis
Very few leaders except for those directly involved e.g. social welfare, health, know about the different laws involving children.
There is really no separate budget for children.
No updated data on child maltreatment.
(Madrid, Ramiro, et. al. 2009)Slide32
Level of Prevention Readiness
City/Municipality
Stage
of Community Readiness
1
. Quezon City
Stage 5
(Preparation
Stage)
2. Manila Stage 4 (Preplanning Stage)
Post workshop
Stage 7 (Stabilization Stage)
3
. San Juan,
Batangas
Stage 3
(Vague Awareness Stage)
Post workshop
Stage 2 (Denial
Stage)Slide33
Common Next Steps for the 3 areas involved in the study
1. Baseline survey on child maltreatment prevalence
Quezon city – all forms of CAN
San Juan – corporal punishment
2. Orientation and training of leaders of the community
3. Information dissemination to community members about child abuse and neglect and the programs of the city.
4. Plan for evaluationSlide34
Way to GoFormation of a coalition of government agencies and NGO’s that will steer the country’s direction towards prevention of child maltreatment
National Prevalence Study on Child Maltreatment
Invest on a primary prevention program that is population-based; has been shown to work and can generate political support: Parenting ProgramSlide35
National Network to End Violence Against Children
Government Agencies
Council for the Welfare of ChildrenDepartment of Social Welfare & Development
Department of Education
Department of Health
Department of Labor and Employment
Department of Interior and Local government
Philippine National Police
Non-government Agencies
Child Protection Network
Parenting Foundation of the PhilippinesOpen Heart Foundation, Inc.Lunduyan Foundation, Inc.
Asia-Pacific Regional NGO Representative to Follow-Up VAC Recommendations
National Council for Social Development
PLAN International, Inc.
Save the Children
ECPAT
UNICEF ManilaSlide36
Thank You!