Foreword

The Western Pacific Region faces a major new epidemic. Six out of ten deaths in this Region are caused by
noncommunicable diseases, mainly cardiovascular disease, diabetes, and cancer. Many of these deaths
are caused by a small group of common risk factors, and thus are amenable to prevention.

However, this is a new epidemic. Many of our health systems are geared to respond to more traditional
causes of disease: deficiency and infectious diseases. In order to reorient our systems to face these new
challenges, we need action on many fronts. We need national action to develop healthy public policy. We
need community action to reduce risk at local level. And we need to train our health workers to support
prevention: through setting an example, through counselling and advocacy, and through direct service
provision.

This set of manuals represents a major step forward in this regard. It is a unique compilation of guidelines
and pedagogical materials suitable for self-learning or for a workshop setting. It is consistent with all agreed
guidelines for the Philippines and will serve as a resource for learning and a tool for service delivery.

WHO is delighted to have supported this project technically and financially. I congratulate the Department of
Health and the University of the Philippines on the product. WHO looks forward to continued collaboration
on this project.

Shigeru Omi, MD, Ph.D.

Regional Director
WHO Regional Office for the Western Pacific
Foreword

The leading causes of mortality in the Philippines today are no longer communicable diseases but more
chronic, debilitating noncommunicable diseases (NCDs). These include cardiovascular diseases like
hypertension, coronary artery diseases and stroke; cancers, chronic obstructive pulmonary diseases and
diabetes mellitus. Bronchial asthma, though not among the leading causes of mortality, is fast becoming a
public concern and contributes greatly to morbidity.

These illnesses are also called “lifestyle diseases” because nutrition, physical activity, smoking, alcohol
drinking and stress contribute to their development. In fact, it is now recognized that these major NCDs
share common risk factors and that modifying these risk factors using community-based approaches will
have greater impact in the long-term and be more cost-effective than interventions that focus on individual
behaviors alone.

To address this need, the Philippine Department of Health, in collaboration with the World Health
Organization Western Pacific Regional Office, is establishing an integrated community-based
noncommunicable disease prevention project. It is called the National Healthy Lifestyle Program. The
programme’s objectives include slowing down or reversing the increasing trend in the prevalence of life-
style-related risk factors of NCDs, including smoking, unhealthy diet, and sedentary lifestyle, and creating a
supportive environment for positive behavior change and healthy lifestyles.

The University of the Philippines Manila College of Nursing was commissioned by the Department of Health
with funding from the World Health Organization Western Pacific Regional Office to develop a training
manual and implement a training programme for trainers and other health workers for two pilot areas. These
areas included the municipality of Pateros in Metro Manila (representing an urban community) and the
Province of Guimaras in Western Visayas (representing a rural community).

A training needs assessment for each site was conducted towards the end of 2001, the results of which were
used to develop the initial draft of the training manual. The draft manual was then field-tested during the
training of trainers and two other training programmes for health workers in the two sites in 2002. After
implementing the series of training workshops in Pateros and Guimaras, feedback was collected from the
participants, particularly the trainers and end-users, and evaluation visits were conducted by the project
team. Based on this valuable information, the draft manual was revised and enriched to the form you see
now.
This training manual, therefore, serves as a guide for primary health care providers in promoting healthy
lifestyles for individuals, groups, and communities. The approach to prevention and control of
noncommunicable diseases is integrated and primarily community-based. It focuses on prevention and
modification of major risk factors, such as unhealthy nutrition, sedentary lifestyle and smoking, which will
prevent not only one, but most of the major NCDs. Emphasis is on population-based approaches that will
impact on a larger portion of the population than individual or clinical approaches.

Selection of content was based on a list of competencies expected of health workers, primarily, nurses,
midwives and doctors, to fulfill their roles in promoting healthy lifestyle change. Existing Department of Health
guidelines, clinical guidelines and consensus statements by expert groups regarding prevention and control
of specific NCDs and risk factors provided the backbone for the content. Local guidelines were used
whenever available, such as in hypertension, cancer, obesity, and asthma. If not available, international or
regional guidelines endorsed by local experts were utilized such as in chronic obstructive pulmonary disease
and diabetes.

This training manual consists of four booklets and seven sessions. Participants suggested the booklet format
because it is handier and more convenient. Effort was taken to make the format and language simple and
more interesting to intended users of the manual.

The first booklet is the Trainer's Guide. It contains a background of the project, a description of the training
programme and manual, the instructional plan for each session, and the framework for the prevention and
control of NCDs using an integrated approach. This is important, particularly for trainers and health workers
in replicating this training programme for other health workers. Instructional plans contain the objectives per
session, the key messages, and some suggested learning activities and activities to obtain participant
feedback and evaluation.

The three other booklets contain the content and reference materials needed for discussing and processing
activities for each session. These booklets are good reference materials for health workers even after the
training programme. Each booklet includes session objectives and key messages that health workers
should keep in mind.

This training manual is a vital instrument for enhancing the capability of primary health care providers to
promote healthy lifestyle and ultimately contributing to the reduction in the morbidity and mortality due to
noncommunicable diseases.

Manuel M. Dayrit, MD, Msc

Secretary of Health
Philippine Department of Health
Foreword

The University of the Philippines Manila fully subscribes to the thrust of the World Health Organization and the
Department of Health on promoting healthy lifestyles as an approach to preventing noncommunicable
diseases (NCDs). Thus, it supports and contributes to the efforts to make this strategy a success not only
among individuals and groups but more importantly, among communities.

The prevention and control of NCDs calls for an integrated, community-based approach that will require the
committed and enlightened participation of community residents and primary health care workers.

This training manual is meant to guide primary health care workers, especially nurses, midwives and doctors
in fulfilling their roles and tasks as agents of positive lifestyle and behavior change. Through the production
of this training manual by a team from the College of Nursing, led by Dr. Josefina A. Tuazon, UP Manila is
happy to have performed its share in realizing the objective of Department of Health’s Integrated Community-
based Noncommunicable Disease Prevention project – the reduction in the mortality and morbidity rates due
to NCDs.

I commend the team members for putting together this very practical and easy-to-follow material that details
specific objectives and activities for health workers. The writers should also be commended for
incorporating fitting examples and simplifying application of guidelines for easier comprehension.

Marita V.T. Reyes, MD

Chancellor
University of the Philippines Manila