Effectiveness of the Community-Based Rehabilitation Programs for Drug Surrenderees in

Tacloban City

(A Review on Related Literature)

Legal Basis

Treating drug dependence as a medical condition does not imply that illicit drug use is
condoned. Rather, the existence of illicit drug use is acknowledged. In the context of good public
health, the objective is to take appropriate measures to limit the harm to people who are affected
by drug use and dependence through community-based treatment, resulting in reintegration
back to society, thus affecting their families and the rest of the community positively.

The Philippine National Anti-Drug Strategy 2002 has recently been updated, and the
Philippine National Anti-Drug Plan of Action (NADPA) 2015-2020 published. In the foreword, its
purpose is defined as “to redefine the tasks of all National Government Agencies, Government-
Owned and Controlled Corporations, Local Government Units (LGU), Non-Government
Organizations, Community-Based Organizations, Private Organizations and other organizations
involved in the anti-drug campaign.” The NADPA expresses national concerns and charts the
response to drug use and abuse and efforts to prevent and control these problems. Its objectives
include the following:

a. to stop the production, processing, trafficking, financing and retailing of dangerous drugs,
precursors, and other essential chemicals;
b. to formulate policies in accordance with the new dangerous drugs law;
c. to develop and implement preventive education programs for various target groups;
d. to adopt and utilize effective treatment and rehabilitation and after-care programs;
e. to continue the conduct of research on vital aspects of the drug abuse problem;
f. to promote public awareness on the evils of dangerous drugs;
g. to reduce the production of marijuana and eventually eliminate its cultivation;
h. h. to forge and foster cooperation with regional and international agencies and
 counterparts and participate in drug-related international efforts.

The NADPA contains five strategic concepts, the second of which, the Demand Reduction
Strategy, addresses preventive education, research, and treatment and Rehabilitation.
Treatment and rehabilitation in the NADPA 2015-2020
To enhance easy access to treatment and rehabilitation of drug dependents:
1. continue providing financial support for the construction, maintenance and operation of
treatment and rehabilitation centers;
2. capacitate and accredit more physicians on diagnosis and management of drug
dependents;
3. set-up mechanisms to facilitate entry/admissions to drug rehabilitation centers;
4. implement a one-stop-shop treatment facility to encourage drug dependents to undergo
treatment and rehabilitation;
5. formulate policies in support of the inclusion of recovering drug dependents in the
coverage of the conditional cash transfer program.

Philosophy of the community-based approach

The core goal of the community-based treatment model is to ensure a holistic approach
to the treatment and care of drug users; the intensity of essential care varies according to the
nature and complexity of the problems experienced by the individual.

Benefits of community-based interventions

There are many benefits of community-based interventions, both for people who are affected
by drug use and dependence, as well as the community itself. Essential elements of the
community-based approach are the forging of close linkages and collaboration between service
providers in the community and the health sector, and social welfare support for rehabilitation
and reintegration. The process usually starts and is sustained by the community in which the drug
user and their family lives and is implemented with the assistance of all community organizations,
with a substantial contribution from the nongovernment sector:

 Active patient involvement aims to promote ownership and responsibility, changes in

individual behavior and improvement in the quality and utilization of health services.
 Community and service users play an important role in helping shape an approach that
ensures appropriate accountability and responsibilities of all those involved in the
delivery of services. There is increasing recognition that the process of service
development needs to be accountable to and shaped by a wide range of community
interests.
 Community-oriented interventions can increase community support for people with drug
problems and promote supportive public opinions and health policy. Community
information and empowerment can also help reduce discrimination and social
marginalization. Reducing the stigma of drug use is a factor that is likely to substantially
improve accessibility to treatment and reintegration into society.
 Mainstreaming drug dependence treatment in health and social care interventions not
only enables the treatment of a larger number of patients, but it also promotes a
paradigm change within society to acknowledge drug dependence as a multifactorial
disorder.
 Treatment provided in the community is less invasive than other treatments such as
residential or inpatient treatment, and less disruptive to the family, working and social
life, thereby fostering independence of the client or patient. It has the added advantage
of facilitating the use of a range of treatment and rehabilitation services that are more
accessible and affordable. Crucially, the community-based approach, by not sending drug
users away and out of sight, helps the community to understand the complexities of drug
problems and thereby helps reduce stigma and discrimination against drug users.

It is expected that the implementation of community-based drug treatment will enable

people with drug-related problems to have improved access to a range of quality services from
education, information and drug counseling, to assistance in stopping or reducing drug use. This
approach aims to help avoid the harmful health and social consequences of drug use, especially
HIV, hepatitis and sexually transmitted infections. People who are affected by drug use and
dependence will be offered help to improve the overall quality of their life and well-being through
social support for rehabilitation and reintegration into the community.

Considerations in Implementing Community-Based Interventions in the Philippines

Beyond utilizing evidence-based interventions, international guidelines advocate the

adaptation of evidence based treatment methodologies to local context and culture (UNODC,
2014). Cultural adaptation requires understanding local culture and context. A major challenge
in implementing community-based drug treatment in the Philippines is the lack of resources
allocated for mental health services. The country’s budget for health is only 2–3% of the national
budget, and mental health is a low priority. There is also a dearth of mental health professionals,
as well as a disparity in their distribution. For example, there is only one licensed psychologist for
every 100,000 Filipinos, and most psychiatrists and psychologists are located in urban areas
(Hechanova et al., 2015).

Another possible barrier to community-based interventions is the prevailing stigma on

drug users and a reluctance to seek treatment (Hechanova, Tuliao, Teh, Alianan, & Acosta, 2013;
Tuliao, Velasquez, Bello, & Pinson, 2016).Studies report that Filipinos are generally reluctant to
open up to strangers because they believe that seeing a professional means they are crazy, and
this will tarnish the reputation of their family (Hechanova et al., 2013). Rather than professionals,
Filipinos prefer to seek help from family, friends, religious leaders, and folk healers (e.g., Abe-
Kim, Gong, & Takeuchi, 2004; Tuliao, 2014).

The Philippines has also been described as a collectivist and interdependent culture.
Filipinos have a difficult time saying ‘no’ to friends and family (Hechanova & Waelde, 2017;
Tuliao, 2014). On the one hand, the tendency to conform can be a challenge for drug users who
want to quit. On the other hand, this can be harnessed by incorporating reference groups into
the intervention strategy (Dueck & Byron, 2012). This is supported by evidence that group based
interventions are a good venue for healing among Filipino survivors (Hechanova et al., 2015;
Hechanova, Waelde, & Ramos, 2016).

The Philippine culture is strongly rooted in spiritual and religious traditions. Filipinos draw
inner strength and support from their faith, and this functions as a protective factor, especially
among survivors of natural disasters (Hechanova et al., 2015; Hechanova & Waelde, 2017).
Participation in church rituals and prayer groups is a means to cope, and religious communities
are important social capital (Nakonz & Shik, 2009). As such, community-based interventions may
harness psycho-spiritual resources to enable healing.

Finally, another consideration in designing psychological interventions in the Philippines

is emotional expression. The Philippine culture has roots in Chinese culture, and a common belief
among Chinese is that talking about painful issues and experiences causes excessive and
unbalanced emotions that lead to illness (Haque, 2010). Dueck and Byron (2012) suggest that in
such cultures, projective approaches, such as using art and theatre, can facilitate emotional
expression. Studies show that disaster interventions in the Philippines incorporate music (e.g.,
Hechanova et al., 2015) and other art forms (e.g., Parr,2015).

Barangay Drug Affectation

As of December 2016, out of the total 42,036 barangays in the country, 19,717 or 46.91% are
drug-affected. NCR remains to be the most affected region with 1,705 or 99.94% of the region’s
total 1,706 barangays are affected. Region III and NIRO followed with 91.33% and 90.81% of their
barangays, respectively, are affected.

As provided in DDB Regulation No. 2, series of 2016, drug-affected barangays are classifed as
follows:

1. Seriously affected - reported presence of at least 1 clandestine laboratory or marijuana

plantation in the community, reported presence of more than 20% of the barangay’s total
 population are drug personalities (i.e. users, pushers, fnanciers) and reported presence
of 3 or more drug dens or “tiangges”
2. Moderately affected – reported presence of 2% to 20% of the barangay’s total population
are drug personalities (i.e. users, pushers, fnanciers)
3. Slightly affected – reported presence of less than 2% of total barangay population are
drug personalities (i.e. users, pushers, fnanciers)

Tacloban as the first Drug Cleared Highly Urbanized City in the Visayas

On Dec. 4, Tacloban City was also declared drug-free after having met the DDB
requirements. Tacloban City became the first Highly Urbanized City (HUC) in the Visayas to be
declared drug cleared when the Regional Oversight Committee on Barangay Clearing Operations
issued a certification stating that the City is drug-free after complying with the parameters set by
the Dangerous Drugs Board

Mayor Cristina G. Romualdez received the certification from Philippine Drug Enforcement
Agency (PDEA) Director Edgar Jubay and members of the oversight committee which included
representatives from the Department of Health, Philippine National Police and the Department
of Interior and Local Government.

The Chief Executive credited the drug-free status of the City to the concerted efforts of
drug enforcement agencies, anti-drug groups and the New Beginnings Rehabilitation Program of
the local government.

New Beginnings was the first local government rehab program implemented in Region 8
after President Rodrigo Duterte declared a decisive campaign on illegal drugs at the start of his
administration.
 To date, nearly 5,000 individuals have voluntarily surrendered to the Program which is
in coordination with the MASA MASID (acronym for Mamayang Ayaw Sa Anomalya, Mamayang
Ayaw sa Droga) and Double Barrel Reloaded of the DILG and Philippine National Police.

Mayor Romualdez also underscored the need to sustain the drug clear status of the
barangays; and reiterated the hardline stance of the City Government on illegal drugs. She added
that as a matter of policy, random drug tests of City Hall employees are being conducted.

The declaration meant that Tacloban met all 14 parameters set by the Dangerous Drugs
Board Regulation 3, Series of 2017, such as the non-availability of drug supply, absence of drug
den, pusher, and user; absence of clandestine drug laboratory; active involvement of barangay
officials in anti-drug activities; existence of drug awareness, preventive education and
information; and existence of voluntary and compulsory drug treatment and rehabilitation
processing desk.

All 138 barangays of Tacloban underwent a thorough and rigid scrutiny of the
requirements, as well as verification and validation processes conducted by the Oversight
Committee on Barangay Drug Clearing Operations prior to the declaration.

Tacloban City’s Community-Based Program For Drug Surrenderers

With the resumption of the Project Double Barrel of the Philippine National Police-
campaign against illegal drugs, the City Government of Tacloban under Mayor Cristina G.
Romualdez deemed it necessary to re-launch and institutionalize its Community-based
rehabilitation program for Drug Abuse Surrenderers dubbed New Beginnings.

In a Joint City Peace and Order Council- City Anti-drug Action Council meeting, Dr.
Gloria Fabrigas, Special Projects for Health In-charge presented the standardized Tacloban City
Drug Prevention, Control, Rehab and Recovery Program. Fabrigas who is the focal person of the
New Beginning program said the relaunching of the program in support of President Duterte
campaign on illegal drugs is set for March 28, 2017 at the Astrodome.
 The community-based rehab program – a priority initiative of Mayor Cristina G.
Romualdez is the first local government-led drug rehabilitation program in the region. The
Regional Department of Interior and Local Government considers the initiative a “showcase
program.” Its goal is to enhance protective factors and reduce risk for surrenderers through the
three “Pathways” Risk Assessment, Restoration, Growth and Development and Reintegration.

During Risk Assessment; data gathering and Life Coaching to be conducted by accredited faith-
based organization will be the main activities, while the Restoration, Growth and Development
part will focus on Psychosocial processing and skills training. the Reintegration: Integration to
family and community.

A surrenderer will undergo the 12 steps Recovery Modules which will comprise 8 to 12
weeks of coaching and therapeutic sessions depen.ding on his condition. A food subsidy and fare
allowance will be given the surrenderer submitting to the program

The New Beginnings Program will work closely with MASA MASID under the National
Government Agencies and a Technical Working Group: composed of the City health Office, City
Social Welfare and Development Office, TCPO, among others.

MASA MASID (acronym for Mamayang Ayaw Sa Anomalya, Mamayang Ayaw sa Droga) is
a community-based anti-criminality and corruption initiative mandated under DILG
Memorandum Circular 2016-116 signed by Secretary Ismael Sueno last September 2, 2016,

A re-assessment of surrenderers was recently conducted and on Wednesday March 15 the

orientation of 182 accredited Life Coaches was conducted at the MASA Office. Tacloban has
4,675 profiled drug surrenderers.
References:

https://www.unodc.org/documents/southeastasiaandpacific/Publications/2016/CBT_Guidance_Doc_Ph
ilippines_5_May_2016_low.pdf

https://www.researchgate.net/publication/323262856_The_Development_of_a_Community-
Based_Drug_Intervention_for_Filipino_Drug_Users

http://pdea.gov.ph/our-accomplishments/annual-reports

http://www.pna.gov.ph/articles/1020152

http://tacloban.gov.ph/tacloban-named-first-drug-free-highly-urbanized-city-in-the-
visayas/#.W6Mn3ugzaUk

http://tacloban.gov.ph/city-govt-to-relaunch-community-based-program-for-drug-
surrenderers/#.W6MxJ-gzaUk