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A Review of Policies Relating to Speech and Language Development of Children in
the Philippines
1 1 2 3
Angelica Anne E. Latorre *, Ana Kriselda B. Rivera , Paul Adlai Quitiquit , Carl Abelardo T. Antonio
*Corresponding author's email address: aalatorre.impact.ptsi@gmail.com
1College of Public Health, University of the Philippines Manila
2School of Medicine, Saint Louis University
3Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
Abstract
This paper is a review of the current initiatives in the field of speech and language development (SLD) of Filipino
children. In general, the national policies related to SLD have focused on language in education (58%),
prevention of language development disorders (17%), regulation of speech pathology practice (17%), and
provision of equal rights for persons with disabilities (8%). The Universal Newborn Hearing Screening and
Intervention Act of 2009 is a relatively new policy that still needs to be thoroughly introduced to many
healthcare practitioners. Meanwhile, the integration of the native language as medium of instruction under the
Enhanced Basic Education Act of 2013 creates significant concerns among teachers and parents. On the other
hand, the Magna Carta for Disabled Persons lacks specific provisions for children with language problems.
Major barriers to successful implementation include lack of awareness and understanding of the rationale of
policies, accessibility problems, and limited financial coverage of services.
Keywords: speech and language development; Filipino children; Philippines
R E V I E W A R T I C L E
Introduction
Language is a system of rule-governed structures and
symbols with attached meanings [1]. It allows self-
expression and social interaction, and thus, is a key to
inclusion in society [2]. It is not only expressed through
speaking, but in reading, writing and gestures as well.
Language is mainly an acquired skill which greatly relies on
mutual communication and is heavily influenced by the
one's environment.
Recently, language has been recognized as a foundation
for education and a vital tool in achieving long-term
development results. Evidences on the relationship
between language and education, language and health,
and more importantly, the linkage of education and health
to development have been clearly established over the
years.
In the Philippines, data on language development is
limited. Most of the studies focus on clinical cases and
speech pathology. Moreover, only few studies probe on
policies regarding speech and language development in the
context of health, and there is no existing research that
investigates the collaborative effort of age ncies in
promoting language development among children. This
paper aimed to provide a snapshot of the country's
initiatives as well as examine the implementation of
national program s related to speech and language
development.
Speech and Language Development in the Philippines: An
Overview
First words, like a child's first step, are milestones that
parents eagerly await. In the first few days of life, a baby's
cry signals the caregiver that there is a need for food and
comfort. At 6-11 months, children starts to babble and can
say, “bababa”. A child soon recognizes the voice of his/her
parents or caregivers and starts to detect differences in
speech sounds during the first year of life. Later on, they are
able to distinguish sounds and sort out the building blocks
Philippine Journal of Health
Research and Development
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Phil J Health Res Dev January-March 2017 Vol.21 No.1, 31-36
that compose the words of her native language. Typically,
other words swiftly follow as the child learns the power of
speech and master the rules of language. By age three or
four, most children are proficient at expressing themselves,
they are fairly comprehensible, and need to be reminded
that someone else might have something to say.
However, s ome chi ldre n stru ggle in expressin g
themselves, calling objects by the wrong name, or saying
words that are hard to understand. Others may be unable to
make sense of what is said to them. Speech and language
skills are critical for young children as they begin to enter the
world around them. Even a slight delay in language
development may result in tantrums, interfere with
learning, impair social skills, and undermine self-esteem.
Definition of the terms delay and disorder has been
established by experts. The former refers to the acquisition
of language which is similar to the milestone expected in a
younger child whereas disorder is language development
which deviates from the normal pattern [1]. In the
Philippines, there is dearth of data on the prevalence of
speech and language development problems especially
among children. In fact, the latest data on language
development problems in the Philippines can be obtained
from Department of Education's (DepEd) data on Special
Education (SPED) enrolment in government elementary
schools during SY 2012-2013 and it recorded a total of 5,857
students with speech and language impairment [3]. In
addition, the results of the National Household Census in
2010 revealed that 50, 862 (5%) of the population have oral
defects or speech impairment. This proportion is higher
compared with the findings of 1995 Household Census
wherein 36,771 (4%) have speech impairment [3,4,5].
However, neither the report on household census nor the
data from DepEd provide information regarding the age
distribution and type of speech and language impairment
among the respondents.
Despite the growth in the prevalence of speech and
langu age prob lems, it wa s only in 2014 when the
Department of Health called for the development of
wellness program for persons with disabilities (PWDs)
wherein the role of speech and language pathologists (SLPs)
in national development was recognized. This is in response
to international treaties such as, United Nations Convention
on the Human Rights of Persons with Disabilities and the
Incheo n Strateg ies to Ma ke the Right Real, which
emphasized the need to ensure the right of PWDs to
participate and access social services [6]. However, there
exists no specific program for addressing the needs of those
with language disorder and it is also not integrated in the
Child Development Program of the Department of Health.
This may be suggestive of the low priority given to speech
and language development (SLD).
The lack of program for SLD may have an effect on the
availability of servi ces for those with d isorders or
delays. Among the government hospitals in the country,
it is only Philippine General Hospital which offers speech
therapy services. The rest of facilities that provide
speech and language therapy are privately–owned and
majority are situated in cities. This raises accessibility
issues partic ular ly for peop le l ivin g be low poverty
threshold and for the provincial dwellers. In addition,
the rarity of speech and language courses in the country
may also be a factor. There are only three universities
which offer the program namely, University of the
Philippines-Manila, University of Sto. Tomas, and Cebu
Doctors' University. The limited number of academic
insti tutions w ith undergradua te degree on Spe ech
Pathology resu l t e d in the low g eneration o f new
pro fessionals. In fa c t , t h e official webs i t e o f the
Philippine Association of Speech Pathologists listed 246
members only of as of this writing [6].
In terms of policies related to SLD, majority (58%) of
laws found after searching the online records of the
Senate of the Philippines and National Commission for
Culture and t he Arts have focus ed on language in
education. Due to the multitude of dialects used in the
archipelago, identification of medium of instruction (MOI)
became a debate since the Commonwealth. Fluctuations
in language policies show the struggle of the government
to achieve balance between globalization and age-
appropriate learning especially during primary years of
education. Other policies are related to preventing
language development disorders (17%), provision of equal
rights to those with disabilities (8%), and regulation of
speech pathology practice in the Philippines (17%). There
is no existing policy that will require provision of speech
pathology or therapy among government hospitals and
Ph ilippi ne Healt h Insurance Co mpany ( PhilH e alth)
coverage of speech and language services. Figure 1 shows
the distribution of policies on SLD. The succeeding
sections of this paper will focus on the discussion of
Universal Newborn Hearing Screening and Intervention
Act of 2009 (R.A. 9709), Enhanced Basic Education Act of
2013 (R.A. 10533), and Magna Carta for Disabled Persons
(R.A. 7277).
32 Phil J Health Res Dev January-March 2017 Vol.21 No.1, 31-36
Development of Children in the Philippines
Republic Act 9709: Universal Newborn Hearing Screening
and Intervention Act
The first five years of life is often considered as a critical
phase in the language development of a child. Hearing
facilitates normal acquisition of language during this
period. Thus, children with hearing problems typically
present significant delays in their language development
[9,10].
Hearing loss can either be congenital or acquired after
birth. Several prenatal, natal and postnatal risk factors
both infectious and genetic in nature are listed as causes of
hearing loss in infants [11]. Congenital hearing loss
remains to be the most common congenital disorder
among newborns [11,12]. Studies have documented
delays in language development, with some likewise
affecting cognitive and psychosocial development, of
children who either have unilateral or bilateral permanent
hearing loss at mild, moderate, severe and profound
ranges [9,10].
It is therefore important to identify and address hearing
problems early on after birth before it begins to impede
language development. According to Hyde [13], infant
hearing screening and early intervention programs are
justifiable because of the following reasons: (1) its absence
may lead to detrimental consequences in the life of a child
and his/her family, (2) it brings about significant benefit in
terms of earlier improved hearing for the child, (3) it brings
about s i gnifi c a n t benefi t o n lon g - t e rm lan g u a ge
development, (4) such programs provide substantial
organizational support and benefits, and (5) there is
negligible harm to the client provided that programs are
well designed and executed [13].
In the Philippines, newborn hearing screening is
already being conducted even before a national policy was
made. A ltho ugh preli mina ry data we re no t always
optimistic, it still provided evidence for future studies and
later on, for the creation of a legislation. An analysis of the
newborn hearing screening at the Philippine General
Hospital that was conducted prior to the passage of
Republic Act 9709 showed initial failure rates to be 33% for
the high-risk population and 11% for the non-high-risk
population. Very few “referred” babies returned for re-
screening despite the hospital having personnel who was
tasked to do the follow-up on the patients. The study cited
distance and financial constraints as possible reasons for
the failure rates [14]. The Philippine Pediatric Society
recommended that Department of Health (DOH) initiate
research on local incidence, feasibility and cost benefit
Figure 1. Distribution of Policies Related to Language Development by Focus Area
Language in
Education
Prevention of
Speech and
Language
Problems
Regulating SLP
Profession
Equal Rights Law
33
Phil J Health Res Dev January-March 2017 Vol.21 No.1, 31-36
Development of Children in the Philippines
analysis of the universal hearing screening; and start an
extensive information campaign regarding its importance
[15]. On the other hand, a study on the awareness and
basic knowledge on newborn hearing screening among
obstetric and pediatric residents in tertiary hospitals in the
National Capital Region (NCR) was conducted in 2005. In
the study, 72.9% of obstetric residents and 93.0% of
pediatric residents responded that they were aware of the
newborn hearing screening. However, of those who were
aware, only 14.3% of obstetric residents and 53.8%
pediatric residents were found to be truly knowledgeable
of the test and its procedures. Private hospital residents
had a higher proportion on both awareness and knowledge
than residents from government hospitals [16].
In 2007, a task force formed by the Philippine Society of
Otola ryngology Head and Neck Surgery (PSO-H NS)
together with the Philippine National Ear Institute (PNEI)
working g roup st udied and evaluated prospects of
implementing a universal newborn hearing screening
program. Studies conducted by the PNEI and reports from
the task force were endorsed to Sen. Loren Legarda.
Enacted in 2009, Republic Act 9709, or the Universal
Newborn Hearing Screening and Intervention Act, serves
as the legal basis for the creation of the Universal Newborn
Hearing Screening Program (U NHSP ). The program
institutionalizes measures for the prevention and early
diagnosis of hearing loss in newborns. Moreover, the
program is tasked to provide necessary intervention,
follow-up, counselling and other support services to the
families of newborns found to have hearing difficulties. In
the Philippines, newborn hearing screening is mandatory
[17]. All babies born in hospitals need to be screened for
hearing loss before being discharged, while those born
outside hospital must be screened within three months of
birth. The cost of hearing screening is included in the
PhilHealth benefit package [18]. There are 25 newborn
hearing screening centers nationwide; 4 of which are
located in Region 4 (CALABARZON) and the remaining
centers are all found in NCR. These screening centers
provide various hearing procedures but most of them offer
otoacoustic emission (OAE) tests [19].
In instances wherein childbirth is done at home or in far
flung areas with no access to machines, the “Baah” test
could be used. The “Baah” test is a reflexive behavioral test
which uses the word “baah” to stimulate a reaction (crying
or being startled) from the baby [20]. The “Baah” test is
actually found to have a potential to be a cost-effective and
accurate screening tool for hearing impairment. The test is
suitable for infants born in rural communities wherein
there are no readily available machines [21].
From the results of the study of Ignacio, et al., [16], it is
cl ea r t h at n o t a ll d o c t o rs a r e fu ll y a wa r e a nd
knowledgeable of the newborn hearing screening. As
indicated in the study, private doctors seemed to be
familiar with the test because the machines used for
hearing screening are readily available in their hospitals as
opposed to a lower proportion of familiarization among
go v e r n m e nt d o c tors. Since government hospitals
accommodate the greater public, the doctors here must be
knowledgeable of newborn hearing and be equipped with
the needed machines for screening. It was also mentioned
in the study that obstetricians share responsibility with
pediatricians during the perinatal period. Obstetricians
are able to identifying potential risk factors during
pregnancy and childbirth – some of which may be risk
factors for congenital and early-onset hearing loss.
According to World Health Organization, newborn
hearing screening programs should have a clearly defined
screening protocol based on local circumstances and that
regular monitoring be done to guarantee that this protocol
is properly implemented. Aside from timely diagnosis and
intervention, it is important for the program to incorporate
fellow parent or family-support groups which can provide
as s ist a nc e an d k n ow- h ows b as e d o n t h ei r ow n
experiences with a hearing-impaired child [18].
Language in Education Policy: Shifting to Mother Tongue-
Based Multilingual Education (MTB-MLE)
Philippines, having approximately 180 ethnic groups
and each one with its own dialect, is a linguistically diverse
country [22]. Although this reflects richness of Philippine
culture, it became a major roadblock in achieving the
country's goal of providing quality education for all. The
use of a national language, which is seen as a tool in
building a cohesive nation, while maintaining the use of
English as key to economic growth became the impetus for
the changing policies on language in education since the
Commonwealth. For many years, mother tongue was seen
as an auxiliary language as children were forced to learn
both English and Tagalog in classrooms [23].
However, recent evidences suggest that mastery of the
mo t h er tongue is im p o rtant in bi l i ngualism si n c e
everything acquired in the home language, including
34 Phil J Health Res Dev January-March 2017 Vol.21 No.1, 31-36
Development of Children in the Philippines
background and experiences in communicating through it,
is transferred to the second language [24,25]. Academic
co mp et e n c e is negatively a ffected an d c o g n it iv e
development is interrupted if a child is exposed to a new
language without ensuring proficiency in home language
before the age of five [26].
These findings fuelled the move towards mother-tongue
based learning in many ethnically diverse communities and
in the Philippines, lead to the enactment of RA 10533,
“Enhancing the Philippine Basic Education System”, in 2012.
This act mandates the use of native language as MOI from
kindergarten to third grade with mother language transition
programs from Grade 4 to 6 until such time when Filipino
and English can become the primary language of instruction
at the secondary level [27].
Despite the existing arguments that this law continues
to position local dialects as less superior than English and
Filipino, implementation of MTB-MLE in many communities
was proven to be an effective tool in improving education
outcomes. According to UNESCO, children who receive
second language as the medium for instruction at the start
of formal education are more likely to repeat school years
and experience frustration. As a result, high drop-out rates
is observed among these children. This further perpetuates
th e vic i o u s c y cle o f m a rginaliza tion and p overty.
Conversely, children who were taught using their native
language at the primary level were observed to gain literacy
and numeracy skills more quickly [2].
In addition, mother tongue-based learning has been
shown to promote gender equality and improve health
outcomes. Global figures indicate that about two-thirds of
the illiterate people worldwide are women. This is because
young girls and women in ethnic communities are often
expected to stay at home where local dialect is the only
langua ge use d. The u se of native tong ue as MO I,
particularly among this marginalized portion of the
population, resulted in longer years of education and
better educational achievement for women [2]. Positive
effects of education, especially among girls in developing
countries, have been linked to smaller, healthier families,
and lower infant mortality rates.
Despite the promising results of mother tongue-based
learning in ethnolinguistically diverse communities,
implementation of R.A. 10533 remains a challenge as
Philippines is the first country in Southeast Asia which
institutionalized such program [28, 29]. A study published
by Wa-Mbaleka enumerated five important considerations
in the success of MTB-MLE in the Philippines. First,
instructional materials in local dialects are not readily
available. This creates a mismatch between the educational
materials and the p olicy. Second, teachers are not
adequately trained in teaching using the local languages.
Capacity-building of implementers should have been
conducted before the program was implemented. Third,
primary school teachers may not have solid training on L1 or
L2 learning research and theories. In fact, result of a study
that was conducted in Bicol Region reported that both
teachers and parents are not adequately informed
regarding the rationale for shifting to MTBLE. Fourth, some
local languages may not be perceived as important for
formal education as English remains to be the MOI in
tertiary education. Lastly, parents may perceive a negative
effect of the policy on future employability since English
language is still viewed as key to wider communication and
global development [28,29]. Clearly, there is a need for
further study on the effect of MTBLE at the national level
since Philippines is the only country that adopted a
nationwide policy on primary education program using the
mother tongue.
RA 7277: Magna Carta for Disabled Persons
Promotion of the welfare of Persons with Disabilities
(PWD), which is led by the Department of Social Welfare
and Development, is mandated in Republic Act 7277
otherwise known as the Magna Carta for Disabled Persons.
The policy stipulates that able-bodied and disabled
Filipinos have the same rights and privileges, and equalizes
the opportunities for PWDs to participate in development
activities by providing social, health, educational and
employment services for PWDs. However, this law is not
specific for children with language problems and provision
of speech therapy and day care services for children with
disability are the only services related to speech and
language impairment. Moreover, accessibility issues
hamper the success of this policy since governmental
therapy service is offered only in UP-PGH [30].
Conclusion
Policies relating to speech and language development in
the country are few. Already existing policies seem to be
dispersed and weak in implementation. There are still
di s c us s ion s o n t h e ma t ter of id e n tif y in g wh i ch
language/dialect will be used as medium of instruction in
primary education. Lack of awareness of policies, particularly
35
Phil J Health Res Dev January-March 2017 Vol.21 No.1, 31-36
Development of Children in the Philippines
the Universal Newborn Hearing Screening and Intervention
Act, is also an issue among health workers and the general
public. Monitoring and evaluation of policies should be
regularly done. Outcomes and issues encountered from the
implementation should be assessed and should give way to
future amendments and improvements of policies.
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