Second National Communications should be encouraged, where at present they are inadequate as line agency mandates are quite focused with their department deliverables, rather than having an integrated approach. 2.3 Initiatives in climate change Quite recently, foreign funded projects for climate change and health adaptation initiatives have come to fore. These initiatives should be harnessed to build up the database that will form the foundation for future climate change and health studies and learning. USAID through the Manila Observatory/KLIMA initiative15, Packard Foundation through the Population, Health and Environment (PHE) initiative were just some projects, the British embassy and educators forums for climate change for teachers in the early to late 90’s. Climate change and Health then became part of the awareness and orientation forums that were characteristic of these initial activities. Other projects which are ongoing or were undertaken with the DOH and its attached agencies were: the UNFCCC-UNDP-EMB (2007-2009) funded Second national communications (SNC) for climate change with a section on health; WHO-MDG-F (Spanish assisted 2008-10) disease surveillance system for climate related diseases for Metro Manila and other provinces16 where a NEDA led capacity assessment was also done for climate change; the ADB funded (2006-08) project on strengthening epidemiological surveillance and response (ESR) system for communicable diseases17. WhiIe the project is indirectly related to climate change, it follows diseases (hopefully tagging also possible climate sensitive diseases), with the establishment of a comprehensive system for investigation, case management, and mitigation of communicable disease control; the JICA-CESM study (2008-09) for climate change and policy in the Philippines; presently GTZED (2008-11) Adaptation to Climate Change and Conservation of Biodiversity in the Philippines (ACCBio) Project with health policy formulation support. 2.4 Health Devolution Health devolution of services has played an important part in defining response mechanisms to health. It should be noted that the central office Department of Health now acts as a technical assistance provider and it is the local health manager that implements the health program in their locality. So decision making processes will be in great part a function of the local chief executive and the local medical officer of the province and municipality. General central office health directives are followed up to the level that the resources- both human and financial are locally available and dedicated. It will be interesting to note that those that have understood the effects of climate change have moved forward with their initiative to secure the health of its constituents as seen in the 2007 Albay Declaration.18 15 USAID funded DEVCAP initiative. Available from http://www.klima.ph/projects/cdm.htm World Health Organization- Millenium Development Goals-financing project (Spanish grant) 2008-11 17 Strengthening Epidemiological Surveillance and Response for Communicable Diseases in Indonesia, Malaysia, and the Philippines. Available from http://www.adb.org/Documents/TACRs/REG/39068-REG-TCR.pdf 18 http://www.albaydeclaration.we.bs/ 16 11