CRS Study On Affordability Accessibility Philippines

FINAL REPORT
Child Restraints in the Philippines:

A Baseline Study on the Availability, Affordability and Acceptability
of Child Restraints in the Philippines
August 15, 2017
Philippines
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Project Proponents
Principal Investigator
Hilton Lam, MHA, PhD
Co-Investigators
Wilfrido A. Atienza, MBA

Adovich S. Rivera, MD
Lead Research Associate
Red Thaddeus D. Miguel, MD, MBA
Research Staff
Amelyn E. Asence, RN
Ma. Angelica Q. Castro, PTRP
Sheryl Joyce Grijaldo
Demi Arantxa Sepa, RN
`
Administrative Staff
Maria Eleanor Candelaria, RN
Implementing Agency
Foundation for the Advancement of Clinical Epidemiology
Cooperating Agency
Institute of Health Policy and Development Studies, National Institutes of Health,
University of the Philippines Manila
Funding Agency
World Health Organization
Total Budget
PHP 1,467,400.00
Duration of Project
3 months
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TABLE OF CONTENTS
List of Tables and Figures 4
Executive Summary 5
Introduction 9
Objectives 11
Methodology 12
Study Design 12
PART 1: Supply-side Data 13
PART2: Demand-side Data 15
PART 3: Development of Recommendations 16
Data Analysis 17
Results 17
PART 1: Supply-side Data 25
PART 2: Demand-side Data 25
PART 3: Development of Recommendations 38
Review of Related Literature 38
Company X 44
Workshop 51
Role of Transport Network Vehicles Service 55
Discussion 56
Conclusion and Recommendation for Policy 59
Bibliography 64
Annexure 67
ANNEX A. UP RGAO Certificate of Registration 67
ANNEX B. Informed Consent for Supplier-end Respondents for In-depth 68
interview
ANNEX C. Tool for Suppliers In-depth interview 70
ANNEX D. Tool for Extraction of Sales Information 71
ANNEX E. Assumed Consent for Consumer Survey 73
ANNEX F. Assumed Consent for Consumer Survey in Filipino 74
ANNEX G. Tool for Survey 75
ANNEX H. Tool for Consumers In-depth interview 79
ANNEX I. Tool for Transportation Network Company 80
ANNEX J. Letter to Transportation Network Company 82
ANNEX K. Letter to Stakeholders for Workshop 83
ANNEX L. Letter Inviting Key Informants for Interview 84
ANNEX M. Letter to Malls 85
ANNEX N. Letter to Land Transportation Office 86
ANNEX O. Curriculum Vitae of Principal Investigator 87
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LIST OF TABLE AND FIGURES
Table 1. Summary of Objectives and Methods

Table 2. Child Restraint Brands Found
Table 3. Average and Range of Prices of Different Types of Child Restraints According to
Different Types of Suppliers
Table 4. Brand New Vehicles in the Market with IsoFix
Table 5. Characteristics of Survey Respondents
Table 6. Level of Awareness of Respondents to Child Restraints
Table 7. Knowledge of Participants Regarding
Table 8. Respondents Seatbelt Use Practices
Table 9. Child Restraint Use and Proper Positioning of Child Passenger
Table 10. Rate of Use of Child Restraints According to Age Group of Child Passenger
Table 11A. Community Interventions
Table 11B. Post-partum interventions
Table 12. Financial Ratios based on Income Statement for 4 Philippine-based
Distributors of Child Restraint
Table 13. Financial Ratios based on Income Statement and Balance Sheet for 4 Philippine-based
Distributors of Child Restraint
Table 14. Growth Rate for 4 Philippine-based Distributors of Child Restraint
Table 15. Assumptions for Company X
Table 16. Income Statement of Company X (2018, 2019, 2020, 2021, 2022)
Table 17. Balance Sheet of Company X (2018, 2019, 2020, 2021, 2022)
Table 18. Cash Flow of Company X (2018, 2019, 2020, 2021, 2022)
Table 19. Vertical Analysis of Company X, Alpha, Bravo, Charlie, and Delta
Table 20. Financial Ratios of Company X with Alpha, Bravo, Charlie, and Delta
Figure 1. Average Attitude Scores Regarding Safety and Child Restraint Use
Figure 2. Average Attitude Scores Regarding Information, Availability and Advocacy Among
Respondents
Figure 3. Average Attitude Scores On Usage
Figure 4. Manner of Obtaining Child Restraints
Figure 5. Source of Purchased Child Restraints
Figure 6. Source of Information for (A) Determining Type of Child Restraints (B) How to Use Child
Restraints
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EXECUTIVE SUMMARY
Introduction: Child restraints are known to lower the risk of injuries and mortality in children involved in
vehicular crashes. Promulgation and declaration of child restraint laws across the world significantly
changes the practices of parents and drivers in that even the awareness of coming laws were enough
to boost voluntary compliance. Internationally the effectiveness of child restraints has been apparent,
as rates of injuries and deaths have been decreasing due to legislation and promotion of these devices.
It has also been found that child restraints are cost-effective in several countries. In aid of possible
legislation this study sheds light on the availability of child restraints in the country that fit international
standards; their affordability, acceptability, and accessibility.
Objectives: The study aims to become a baseline for the availability, affordability and acceptability of
child restraints in the country. Specifically, the study’s goals are to: (1) determine the availability and
access to child restraints that conform to international standards in the Philippines, (2) determine the
availability of vehicles with ISOFix in the country, (3) determine knowledge, attitudes, and behavior
among Filipino car users on child safety and the use or non-use of child restraints, (4) determine
acceptability and affordability of child restraints among car users eligible for the study, (5) recognize the
role of Transportation Network Vehicle Services in the use of child restraints in the country, and (6)
identify points, and measures that promote the use of child restraints among Filipino drivers with
children.
Methodology: This study follows a mixed methods design comprising of collecting and analyzing
primary and secondary data, that included a literature review, driver/parent survey, review of available
suppliers and merchandise from physical stores in malls, online sources, and directly from suppliers,
key informant interviews with child restraint users and could-be users, company agents in this market,
transportation network corporations, and scoping of vehicles with IsoFix. The study was divided into
three parts. The first part of the study focused on the supply-end of the market looking into the
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availability, and affordability of these restraints and IsoFix in the country. The second part of the study
investigated the demand-side of the market, uncovering child restraints applicability in the Philippines
through knowledge, attitudes, and perceptions of the child restraint market. Lastly, the third part of the
study looked into means of promoting, implementing, and monitoring child restrain use in the country.
This section relies heavily on literature review of lessons from international policies and studies on the
use and legislation of child restraints, a workshop with stakeholders, promulgation of a prototype
company, and key informant interviews with Transportation Network Vehicles Services. Descriptive
statistics based on responses were generated. Perceptions were tested using the Mann-Whitney U
statistic to test for differences based on residence. Excel and Stata 12 were used in the sorting,
cleaning, and analysis of quantitative data. Thematic and context analysis was to explore connections
of specific premises in the responses unearthed during key informant interviews, and the workshop.
Results: While there is no local producer of child restraints, there is a vibrant core group of
international producers in the Philippines. The price survey found 68 brands of child restraints, with 7
being locally distributed, and 7 attainable through online purchase and delivery, from company sites,
and 30 from general online shopping sites. Based on these companies the average, rear-facing only
products were PhP 9,781.34, boosters were priced at PhP 3,598.00, while combination products, on
average, were PhP 10,518.19. The average prices of brand-new seats were PhP 5,755.44 and second-
hand were on average PhP 3,535.00. Based on the mall scoping done in 15 malls, all malls carried
child restraints. With 124 products inspected in malls, 83% of the products had proof of ECE R44
certification was noted. Based on the key informant interviews with local suppliers it was found that they
were mostly companies that usually supply other children’s goods as well. It was noted that their targets
were mostly first time parents in the upper income market segment. In terms of knowledge, attitudes,
and behavior among Filipino car users on child safety and the use or non-use of child restraints, 93.4%
of respondents reported wearing seatbelts, and 91.8% reported being compliant in terms of positioning
their child in the proper seat pursuant to Republic Act No. 8750. Of the overall sample, 18.5% reported
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to have ever used a child restraint. 9.4% of the sample on the other hand, is currently using restraints
for their children, and in terms of children who were supposed to be on child restraints, only 6.3% were
currently using child restraints. However, only half of all respondents ever heard of the term “child
restraints”, while 59.5% has ever seen a child restraint prior to the survey. Knowledge on appropriate
use of child restraints is quite low among all respondents. In terms of attitudes and perception,
respondents agree that child restraints prevent severe injury and that the wrong restraints can lead to
severe injuries. In terms of information, respondents were unsure about the amount of information
about child restraints they receive or they come upon. In terms of finding out which child restraints to
acquire, consumers inquire or learn about child restraints through: (1) independent research, (2)
information from someone they knew, and (3) information from sales staff. Most respondents
purchased their child restraints. The most common source of bought child restraints was the
department store followed by baby shops and car accessory shops. In terms of the role of TNVS, both
companies interviewed support interventions for road safety especially for children. Though both are
willing to collaborate with the government, and agree in the need for a proper design in policy for child
restraint, only one expressed support for legally mandating its use. After running an archetypal
company, it was noted to be profitable with a likelihood of strong growth in the projected 5 years.
Conclusion: Child restraints were found to be available and accessible to Filipino consumers. For
parents and drivers of children 13 years and below, child restraints currently distributed in the country
are perceived to be affordable. Though the perceptions, and practices of Filipino drivers have been
shown to put importance on the safety of their children passengers, the knowledge on child restraints
are low. Child restraints are acceptable to Filipinos especially if a law mandates its use. On brand new
vehicles being sold it is shown that they are ready with IsoFix. Transportation Network Vehicle
Services, while expressing priority for safety, are not content if legislation will actually be beneficial.
With this, the following are recommendations for policy:
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1. The law should be considerate of the socio-economic situation in the country and its creation
should involve all stakeholders, specifically the parents of children whose income may not allow
a budget for child restraints.
2. Prices should be driven down by increasing the number of players in the supply and distribution
of child restraints in the Philippines. Further, the government may look for other means for
decreasing prices such as supporting rental services, offering coupons, and partnering with car
companies to give out child restraints with car purchases.
3. With an increase supply expected, the law should also provide guidance on the development of
national standards that will not compromise competition, yet assure consumers that all
approved child restraints are of acceptable quality.
4. There should be simple and clear implementation guidelines for law enforcement.
5. Finally, there should be increased efforts to improve knowledge about child restraints and
activities that advocate for their use.
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I. INTRODUCTION
“The safety of the people should be the highest law.”

–Marcus Tullius Cicero
At the core of legislation is the mandate to protect citizens and strive to complement their
pursuits in life. Necessity of laws becomes apparent when the people’s safety is compromised or their
rights are obstructed. When there are preventable damages therefore, especially to a family’s health,
laws or programs should attempt to address them, as the consequences otherwise may be great, and
each collision may affect more than one life.
One movement that embodied this in actuality was the promulgation and declaration of child
restraint laws across the globe. The impact of these laws were so significant that even the awareness
of coming laws were enough to boost voluntary compliance and alter the trend of morbidity and
mortality among children. A study by Nakahara, Ichikawa, and Nakajima (2015) entitled, “Effects of
Increasing Child Restraint Use in Reducing Occupant Injuries Among Children Aged 0–5 Years in
Japan”1, police data on child vehicle occupant injuries from 1990 to 2009, and calculating morbidity
rates using a joint point regression model, the investigators were able to reveal an increasing trend of
0.03% per month (95% confidence interval [CI], −0.02% to 0.09%) until the change-point in December
1997 (95% CI, July 1996 to January 1999), which then changed to a decreasing trend of −0.14% per
month (95% CI, −0.16 to −0.11), with an overall trend change of −0.17% (95% CI, −0.23 to −0.11). This
was 3 years prior to the implementation of their laws and thus they were able to conclude that
prelegislative voluntary compliance was enough to change the trends in child morbidity.
Moreover, once the laws are implemented, the effects of such laws further impact the trends in
child morbidity and mortality, “in the United States, the number of motor vehicle fatalities and serious
injuries has been reduced through a combination of increased attention to age appropriate restraint use
and rear seating position… 7 in the 10 years from 1999 to 2008, the number of children younger than
15 years who died in motor vehicle crashes in the United States declined by 45%”. Specifically for
children aged < 1 year old, they conclude that these restraints, “are effective at preventing nonfatal
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injuries when compared with seat belts; effectiveness estimates have ranged from 71% to 82%
reduction in serious injury risk,”2. Another study by Abrogast et al (2009) held that, “Booster seat use
reduces the risk for serious injury by 45% for children aged 4–8 years when compared with seat belt
use alone,”3, the significance of this risk reduction is amplified by a National Highway Traffic Safety
Administration (NHTSA) report (2009) that seat belt use in itself, “reduces the risk for death and serious
injury by approximately half,”4. In summary, internationally the effectiveness of child restraints has been
apparent as rates of injuries and deaths have been decreasing due to legislation and promotion of
these devices. In World Health Organization’s most recent Global Status Report on Road Safety 2015,
investigation of international road safety studies have made them conclude, “seat-belts and child
restraints are extremely effective at saving the lives of car occupants in the event of a crash,”5. Shew et
al (1995) reported that child restraints in the USA are cost-effective6 if used correctly.
Peden (2004) reported that, “Road traffic injuries are a major public health problem and a
leading cause of death and injury around the world. Approximately 1.2 million people are killed each
year in road crashes worldwide, with up to 50 million more injured. Over 95% of these deaths and
injuries occur in the low- and middle-income countries of Africa, Asia, Latin America, the Caribbean and
Eastern Europe.”7 Peden further reports that the distribution of trends greatly differs per country, “In
contrast, over the same period road deaths increased in low- and middle-income countries by between
50% and 100%. Data suggest that these trends will continue and that by 2020 road traffic deaths will
increase by 83% in low- and middle-income countries, and decrease by 27% in high-income countries.
These figures amount to a predicted global increase of 67% by 2020.”7 The Philippines, with estimated
traffic fatalities at 10,379 just for 2013,5 is a country that faces an intimidating future in terms of road-
associated injuries.
Children can be considered vulnerable road users. Based on 2013 death data by the Philippine
Statistics Authority, 7.2% of transport deaths were children 0 to 14 years old. Meanwhile, the ONEISS
2014 data showed that 25.7% of victims were below 14 years of age. However, there currently are no
legislation or protocols on child restraints for Filipinos. Republic Act No. 8750 also known as Seat Belts
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Use Act of 1999, is the closest the country has in protecting children from vehicular accidents with
restraints. Unfortunately, there is no mention of child restraints in this act and instead merely includes
the following section to tackle children’s safety, “Section 5. Children Prohibited to Sit in Front Seat: —
Infants and/or children with ages six (6) years and below shall be prohibited to sit in the front seat of
any running motor vehicle.”8 Medina (2016) in an Inquirer news article reports that in 2017, there have
been, “60,583 cases from January to July.”9
II. OBJECTIVES
(1) Determine the availability and access to child restraints that conform with international
standards in the Philippines
(2) Determine the availability of vehicles with ISOFix in the country
(3) Determine knowledge, attitudes, and behavior among Filipino car users on child safety and the
use or non-use of child restraints
(4) Determine acceptability and affordability of child restraints among car users eligible for the study
(5) Recognize the role of Transportation Network Vehicle Services in utilizing child restraints in the
country
(6) Identify points, and measures that promote use of child restraints among Filipino drivers with
children
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III. METHODOLOGY
A. Study Design
A mixed methods design was undertaken comprising of collecting and analyzing primary and
secondary data, that included a literature review, driver/parent survey, review of available suppliers and
merchandise from physical stores in malls, online sources, and directly from suppliers, key informant
interviews with child restraint users and could-be users, companies agencies in this market, and
transportation network corporations, and scoping of vehicles with IsoFix (Table 1). The study was
divided into three parts. The first part of the study focused on the supply-end of the market looking into
the availability, and affordability of these child restraints and IsoFix in the country. The second part of
the study investigated the demand-side of the market, uncovering child restraints applicability in the
Philippines through knowledge, attitudes, and perceptions of the child restraint market. Finally, the third
part of the study looked into means of promoting, implementing, and monitoring child restrain use in the
country. This section relies heavily on literature review of lessons from international policies and studies
on the use and legislation of child restraints, a workshop with stakeholders, and key informant
interviews with Transportation Network Vehicles Services.
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Table 1. Summary of Objectives and Methods
Objective Variable Method
1. Determine the availability and Availability Survey distributors
access to child restraints that
conform with international Accessibility Survey distributors
standards in the Philippines
2. Determine availability of Availability Survey car dealers
vehicles with ISOFix in the
country.
3. Determine the knowledge, Knowledge, Focus group discussion with
attitude, and behavior among attitudes, drivers/parents
eligible respondents on child and Survey of drivers (LTO recruitment)
safety and the use or non-use behavior
of child restraints
4. Determine acceptability and Acceptability Survey of drivers (LTO recruitment)
affordability of child restraints Affordability Survey of drivers with costs compiled
among car users eligible for from Objective 1
the study
5. Recognize the role of Impact and Key informant interviews with TNVS
Transportation Network role of companies
Vehicle Services in utilizing TNVS
child restraints in the country
6. Identify points, and measures Measures to Instigate a policy analysis and review of
that promote use of child promote use related literature
restraints among Filipino of child
drivers with children restraints Computation of financial statements of a
prototype child restraints company
Key informant interviews with automobile,

trade, and transportation industry and
agencies
B. PART 1: Supply-side Data
Supply side respondents were distributors of child restraints in the Philippines from December
2016 to February 2017. In order to get the list of distributors of child restraints, the research
investigators compiled the list of companies available on two (2) well known international organization
of child restraints manufacturers, the Safe Ride News Publication and the Manufacturers Alliance for
Child Passenger Safety Members. After collating the list of brands and companies, the investigators
then contacted them inquiring about distribution in the Philippines. All locally present distributors were
requested to participate in the study. Out of the 7 local brands found to be distributed in the Philippines,
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five (5) agreed to participate in key informant interviews. Interviews were conducted face-to-face and a
supplemental written questionnaire was given to companies. Interviews were transcribed, translated,
and coded accordingly. The interviews were on issues in supplying and distributing child restraints in
the Philippines. These stakeholders were also invited to share inputs on possible methods or means
that child restraints may be promoted in the country. For those that had no local partners, online
communication and inquiry was done. Snowballing was implemented to identify other companies and
brand not present on the list.
For the store survey, the investigators visited 15 malls in Quezon City, Manila City, San
Fernando City, Cebu City, and Davao City. The malls were chosen based on proximity to Land
Transportation Offices and their relative sizes. The investigator team members then pretended to be
potential buyers and approached the stores offering child restraints in these malls. They then asked for
brochures, inquired about the products, and investigated the models physically available.
The third part for the supply of child restraints was data collected from online stores. For this,
the team put together a four-member group that undertook a simultaneous online scoping in 9 identified
base sites. From these base sites and connecting links found within these sites the team members then
collected all possible child restraint models available on the sites on April 28, 2017. The search terms
inputted were “child car seat”, “baby car seat”, “child restraints”, “age-appropriate child restraints”, and
“child car restraint”.
Finally, to complete the supply side of child restraints the availability of IsoFix in brand new car
models in the Philippines was also investigated. In order to do this, a list of car companies was
compiled through online searches of all car companies in the Philippines. This was primarily through
searches on car fanciers’ websites, car associations and clubs, and through brand websites. Data
collectors were sent during the weekdays of March 27, 2017 to April 8, 2017, to car show rooms of
these companies. The data collectors pretended to be interested customers and looked at car seats for
the presence of ISOFIX in all cars in their brochure that was present in the car showroom. Also, the
data collectors retrieved from salesmen the list of all cars from the company verifying these with online
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listings. Any car that was not seen personally by the group was either telephoned in by our researchers
to sales representatives of the company, or a search was done online to learn about the specific model.
C. PART 2: Demand-side Data
The second part of the study dealt with the knowledge, attitudes, and perceptions of potential
and existing consumers of this market. A questionnaire based on previously reported surveys
internationally was created. This was then modified to be applicable to the local setting. After seven (7)
rounds of pretesting, the tool was used to explore the rationale, logic, and behaviors of the demand-
side in purchasing, attempting to purchase, or dismissing the need to equip their cars with these child
restraints. Further the tool also tackles perceptions of these individuals to the life saving restraints’
affordability, accessibility, and competency to comprehend proper use.
With the tool in hand, the group then set out to conduct the survey. The survey target was 1000
non-random respondents through Land Transportation Offices, License Renewal Center, and
Registration Centers in the regions of National Capital Region, Region III, Region VII, and Region XI. In
each site, an average of 250 private four-wheel vehicle owner/drivers with child passengers 13 years
and bellow were recruited. Data collectors approached individuals and screened them for eligibility. If
eligible and willing to participate, respondents were asked to complete the questionnaire where they
were asked on their current status of ownership of child restraints, their attitudes towards owning child
restraints, child safety, their mental proficiency to properly use the device, their knowledge in
installation and utilization of car seat modifications, their financial capability to purchase these
restraints, and their perceived benefits and/or impediment on owning child restraints.
These 250 were respondents from either rural or urban residences. With the definition of rural or
urban being made on the basis of their permanent residence. If they permanently lived in an area that
was considered as a city by the Philippine Statistics Office then they were considered as an urban
participant, otherwise they would be considered a rural respondent. The distribution of rural and urban
respondents follow the distribution of car owners in the area based on LTO’s registration data.
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Those who drove public utility vehicles (e.g. jeep, bus, taxi) and school buses exclusively were
excluded.
Finally, key informant interviews were done on selected respondents from all the sites. In these
interviews, informants represented those who used child restraints from rural areas, those who did not
use child restraints from rural areas, those who use child restraints from urban areas, and those who
didn't use child restraints from urban areas.
D. PART 3: Development of Recommendations
Alongside the collection of data, the investigators conducted a literature review to analyze
possible policies that could be put into place. A review of literature on interventions to promote child
restraints was carried out throughout the first two (2) months of the study period. Embase and PubMed
databases were accessed. The keywords used were “child restraints”, “child car seat”, “booster seat”,
“promotion”, and “increased use”.
Furthermore, financial analyses on currently active child restraint distribution companies were
performed. From these calculations as proxies and using known assumptions in the market, a
propositioned company to act as a prototype child restraint company in the upcoming market was
created. Using this company named Company X, comparative financial analysis to investigate the
profitability of entering the market with current market setting was done.
After the surveys, and financial statements were analyzed and themes extracted, open
discussions with agencies and organizations concerned were instigated through a workshop, which
tackled the current condition of child restraints in the country and subsequently brought to light were the
means to promote the use of child restraints in the country. Agencies from transportation and trade, as
well as key stakeholders in child safety and automobiles were invited to partake in an open discussion.
The aim of the workshop was to validate findings and identify strategies for promoting the use of child
restraints in the Philippines.
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Finally, in order to understand the impact of proposed strategies, legislation and
recommendations, key informant interviews with two (2) Transportation Network Company we
conducted.
E. Data Analysis
Descriptive statistics based on responses were generated. Based on responses to the survey
mean and median values of attitudes were determined. Statistical analysis looked into the number of
users, adequacy of knowledge and practices. Perceptions were tested using a Mann-Whitney U test to
look for statisticsl differences based on residence. Excel and Stata 12 were used in the sorting,
cleaning, and analysis of quantitative data.
Thematic and context analysis was used to explore connections of specific premises in the
responses unearthed during key informant interviews, and the workshop carried out.
IV. RESULTS
PART 1: Supply-side Data
Overview of Price Survey
Sources of child restraints in the country are from either a physical store, an online store, or
through child restraints being given to them either as gifts or were borrowed. For physical stores this
would include malls, department stores, specialty stores for babies or cars, and from car brands. In
terms of online sources, this could either be directly from the manufacturer, online stores distributing
child restraints, or through private sellers selling either used or brand new products. Those that were
given were either hand me downs or lent or given brand new by friends or relatives.
In the survey conducted on availability and selling price it was found that there was no locally
producing or manufacturing child restraint company in the Philippines. While there is no local producer
of child restraints, there is a vibrant core group of international producers in the Philippines. A total of
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68 active brands of child restraints are currently active in the market. The proponents then contacted
these brands and asked if there were local exclusive or indirect distributors in the country. Of the 68
brands identified, seven (7) of these brands were found to be distributed in the country. The following
table summarizes the current brands of child restraints in the Philippines:
Table 2. Child Restraint Brands Found

Sources Number of
Brands
Local distributor (price provided by company) 5
Local distributor (price obtained from online store) 2
No local distributor but international delivery available from 7
company’s online store
No local distributor, international delivery not available from 18
company store
Products found through online scoping 36
Total Brands Found 68
Product Availability and Price
Five (5) of the seven (7) brands identified to have local distributors in the Philippines, provided a
combined list of 71 products. Of the 71 products on this combined list none of them front-facing only,
18% were booster seats, 27% were rear-facing only seats, and 55% were a combination or convertible
seats (e.g. rear and front-facing, front-facing and booster, rear to front-facing with booster). On
average, rear-facing only products were PhP 9,781.34, boosters were priced at PhP 3,598.00, while
combination products, on average, were PhP 10,518.19 (Table 3).
Online scoping in three Philippine online stores, which were oftentimes referred to by
interviewed parents/drivers was done with search terms “child car seat”, “baby car seat”, “child
restraints”, “age-appropriate child restraints”, and “child car restraint”, yielded a total 80 products. Of
these 80 products, twenty (20) were available second-hand and sixty (60) were available brand-new.
The average prices of brand-new seats were PhP 5,755.44 and second-hand were on average PhP
3,535.00. Prices for brand new products varies from PhP 7,632.48 for rear-facing only, PhP 8,425.15
for front-facing only seats, PhP 6,219.30 for booster seats, to 4,479.67 for combination seats.
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The highest price for rear-facing only is from “No local distributors, but can be ordered online” at
PhP 23,745.78, for front-facing only and booster seat it was from ”No local distributor, but international
delivery not available from company store” at PhP 10,698.65 and PhP 4,977.47 respectively, while for
combination it was from “Local distributor (price obtained from online store)” at PhP 34,901.22.
In terms of the lowest price, rear-facing only and booster seat was lowest in “Local distributor
(price obtained from online store)” at PhP 6,078.57 and 2,089.20 respectively, and front-facing only and
combination was lowest in “Second-hand products found through online scoping” at PhP 4,666.67 and
PhP 3,050.00 respectively.
Table 3. Average and Range of Prices of Different Types of Child Restraints

According to Different Types of Suppliers
Local distributor (price
provided by company) % Average Lowest Highest
(71 products) Cost in PhP Cost in PhP Cost in PhP
Rear-facing only 27 % 9,781.34 4,273.85 15,999.75

Front-facing only 0% - - -
Booster seat 18 % 3,598.00 1,186.84 6,173.55
Combination 55 % 10,518.19 4,273.85 24,999.75
All products 100% 9,053.93 1,186.84 24,999.75
Local distributor (price

obtained from online store) % Average Lowest Highest
(40 products) Cost in PhP Cost in PhP Cost in PhP
Rear-facing only 13% 6,078.57 3,798.93 8,073.25

Booster seat 5% 2,089.20 1,329.32 2,849.08
Combination 82% 34,901.22 4,748.78 84,365.00
All products 100% 29,657.79 1,329.32 84,365.00
No local distributor but

international delivery % Average Lowest Highest
available from company’s Cost in PhP Cost in PhP Cost in PhP
online store
(12 products)
Rear-facing only 8% 23,745.78 - -

Booster seat 42 % 4,119.36 1,899.23 8,225.15
Combination 50 % 13,906.99 11,160.26 18,521.60
All products 12% 10,648.71 1,899.23 23,745.78
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No local distributor,
international delivery not % Average Lowest Highest
available from company Cost in PhP Cost in PhP Cost in PhP
store (18 products)
Rear-facing only 20 % 8,939.11 3,087.01 15,434.59

Front-facing only 2% 10,268.65 - -
Booster seat 45 % 4,977.47 1,187.31 11,870.75
Combination 33 % 10,235.80 2,968.28 31,768.63
All products 100% 7,586.91 1,187.31 31,768.63
Brand new products found

through online scoping (60 % Average Lowest Highest
products) Cost in PhP Cost in PhP Cost in PhP
Rear-facing only 32 % 7,632.48 1,299.75 32,999.75

Front-facing only 3% 8,452.15 1,600.00 15,990.00
Booster seat 8% 6,219.30 2,999.00 8,999.75
Combination 57 % 4,479.67 599.00 24,999.75
All products 100% 5,755.44 599.00 32,999.75
Second-hand products
found through online % Average Lowest Highest
scoping (20 products) Cost in PhP Cost in PhP Cost in PhP
Rear-facing only 0% - - -
Front-facing only 30 % 4,666.67 500.00 9,000.00
Booster seat 0% - - -
Combination 70 % 3,050.00 1,000.00 7,500.00
All products 100% 3,535.00 500.00 9,000.00
In the online search, it is noted that while most had specifications listed, the majority of these
child restraints did not have certification classifications or markings with the child restraint photos
provided or the information laid out.
All 15 malls caries child restraints but only 83% of the products presented with proof of ECE
R44 certification.
20
ISOFIX Situation in the Philippine Car Brands
A total of 220 cars were identified and majority (84%) was IsoFix equipped. Seven percent (7%)
could be equipped upon request while 9% did not have IsoFix (Table 4). Almost all of those that did not
have ISOFIX were either a two-seater high performance vehicle or vans with seating capacity of 10 or
greater.
Table 4. Brand New Vehicles in the Market with IsoFix

# of Vehicles
(n = 220 vehicles)
Vehicles with built in IsoFix 84 %
Vehicles sold without IsoFix but 7 %
may be installed upon request
Vehicles with seats that can’t 9 %
accommodate IsoFix
Total 100 %
Overview of Key Informant Interviews
Out of the 7 local brands found to be distributed in the Philippines, five (5) agreed to participate
in key informant interviews. In terms of experience in the Philippine market the range was from 0 to 30
years, with one (1) brand marked “0” years as they were still finalizing their entry into the market, while
another has been involved in the market ever since the late 1980s.
Current Market Situation based on Key Informant Interviews
The representatives perceived that there are now many of child restraint options in the current
market unlike in the past. They recalled that in the past it would just be a hand full of them and that it
was either one brand or the other. Currently however, they described the range of options from global
brands to brands that were merely copying the design of well-known brands. They also mentioned that
aside from quality and safety, consumers are now also looking at durability, ability to use for multiple
age groups, portability, comfort, aesthetics, and even the fad of the design. In order to keep with the
times, the representatives mention that they now have to reformulate their marketing. They shared that
21
aside from the conventional points of sales such as department stores and baby shops, they now also
utilize baby fairs, parenting events, and online stores. A few also are using or planning to use social
media to advertise their products instead of the traditional media such as television and radio. They
claim that they have to start fronting their products in online platforms, as there is unfair competition
from online sellers. According to the representatives interviewed, these online sellers have an
advantage in that they need not to comply with customs regulations that they so painstakingly abide by.
These online sellers merely ship the products from friends, family, or business partners through
backdoor channels and they are now able to sell their products at lower prices than those offered by
authorized and regulated distributors.
“--- to be honest, being a distributor in the Philippines is not easy. We're paying
everything. Taxes... Customs... And everything to bring that in here. So we do the
legalities for that. However, these online sellers come along. They will order abroad,
send it here… and they actually get it easily. They don't go through a process. This is
unfair for us because we have to pitch for certain brands.”
Consequently, another problem that the representatives say these online private sellers have
are the lack of quality control. Unlike larger companies such as theirs, these online sellers, they claim,
distribute products that have not been properly inspected by trained quality inspectors.
Target Market
Almost all of the respondents mentioned that their target population was upper income
households. One specifically mentioned the “millennial parent” as a target, which they felt, may in fact
be using child restraints since they “want to look stylish”. Another mentioned targeting “new parents”.
According to them this target market usually dictates the prices for the other market segments. This
however is a situation wherein they perceive that consumers may now begin to value child restraints as
22
more of a luxury item rather than a legally required item, and consequently only a few will want to buy
one.
“This will obviously be in the upper scale, A-B market, mainly because of the pricing.
Since it's not a legal thing to need a car seat. The ones who would want a car seat are
the ones who travel. So they have to have money to travel and to have a car, and
specifically a car with a three-point seatbelt”
Pricing of Products
When asked about how they set prices, one shared that the principal or manufacturer is strict
about the price they can set and allow slight adjustments only for added expenses (e.g. transportation,
additional testing). Others said that they try to avoid setting the price too steep to avoid being perceived
as a luxury good.
“What we did was, we priced it at this much for us to benefit from it but also so that the
consumers will benefit from it. We don't want them to feel that the price is too steep. We
don't want them to think that it’s one of those products that are just too expensive. But
our aim is to get it on a lower price from our supplier. Because we want to gain more not
by adding more, but by paying less from our supplier. Because when you increase the
prices too much, it becomes a luxury then. It becomes one of those 36,000 peso car
seats that only a few could afford. And why would you buy something if it's too much?”
The respondents were asked if price would change upon the passage of the law. Most said that
the law will not likely affect prices. Although, they want to provide it at more affordable prices, they are
not likely to lower the prices. They want to remain as brands that sells products based on quality,
despite costing more than others. They said that price they set reflect the quality of the products they
23
sell and that this is manifested by the regulations each has passed. They think that the high prices is
acceptable since it is for the child’s safety and protection. A few pointed out that despite availability of
cheaper brands people would still prefer to buy their products because of their higher priced products’
reputation and credibility.
Deterrents to Use of Child Restraints
They acknowledged that the price is a deterrent to higher rate of use as the product is likely
affordable only to those in the upper income group. One respondent even stated that they do not
distribute a certain brand because the price of their product is too high even for the upper income
groups. Another respondent shared this sentiment of child restraints being viewed as a luxury good and
thus stressed the need for education efforts.
“So I have a product with an advocacy that's still in its infancy that I will have to educate,
and push towards people seeing the importance of it rather than the luxury of it. There
are people with the notion that child restraints are only for the rich, and foreigners.”
Yet another deterrent would be the issue of low education about child restraints among the
population. One company plans to conduct education activities as a key part of their marketing plan to
address this issue.
“We plan to cater parents in general, so we want to do education as early as when
they're expecting. So we aim to penetrate the market by joining events that cater to
these individuals. That would be parenting classes and breastfeeding classes, which are
things that I'm already a part of from my other business venture. Though it is not
expected that you would attend a breastfeeding class and someone's there from our
company, I think when you plant seeds in people's minds, it will eventually grow into a
24
tree. So I'm hoping that when we plant seeds of car safety and the importance of it,
parents with toddler or preschooler will consider our brand, or even consider buying any
other brand.”
One respondent shared that education will also help gather support for the policy of mandating
the use of child restraints. The respondent pointed out that a restrictive law should be explained to the
population prior to implementation.
“Because we can't just pass a law that restricts people from doing things without telling
them why it’s needed. People accuse the government of creating and implementing laws
without thinking about it. The reason people have this idea however is because they
don't inform people of the why of the law or the reason behind it. The government just
informs us that this will fix things, but they never explain how. This is the reason why
only a few people really understand why the law is enacted and why it should be
followed.”
Finally, the large space actually taken up by the child restraint inside a vehicle could also be a
deterrent for some potential users. The respondent explained that one seat is equivalent to one adult
passenger. This could be problematic for families who cannot afford to buy larger vehicles.
PART 2: Demand-side Data
A total of 1,004 respondents who were either drivers or owners of vehicles with child
passengers 13 years and below participated in the study survey. Overall, 25.0% of these respondents
lived in rural areas. The average age of respondents was 39.69 years (±11.77). Majority of the
respondents were male (84.0%). Most (65.0%) were also married and were Roman Catholic (75.3%).
25
Only 15.1% were unemployed with a quarter (26.7%) involved in service and sales. The other common
occupation types were managers (17.8%) and clerical (11.2%).
The average number of 4-wheel vehicles owned was 0.82 (n = 992, SD: 0.69) with 74.7%
owning at least one car. The most common vehicles frequently driven were: sedan (48.2%), SUV
(24.9%), and van (14.2%). Respondents on average drove 22 hours per week (n = 1,002, SD: 20) and
had experience of 14 years driving (SD: 11 years). On average, respondents have 1.56 child
passengers (n = 1,003, SD: 0.79) (Table 5).
Table 5. Characteristics of Survey Respondents

Characteristics Urban Rural Overall
Geographic distribution (n Respondents)
Luzon 120 130 250
Visayas 213 43 256
Mindanao 191 59 250
NCR 227 21 248
Total 751 253 1004
Age in years (mean ± SD) 39.84 ± 11.89 39.24 ± 11.42 39.69 ± 11.77
Sex (% Female) 15.58 17.39 16.04
Religion (%)
Roman Catholic 78.86 78.93 78.86
Evangelical/Christian 13.66 13.20 13.66
Iglesia ni Cristo 4.29 4.13 4.29
Muslim 2.19 2.53 2.19
Others 1.00 1.20 1.00
Occupation
Armed Forces 0.3 0.0 0.2
Managerial 17.2 19.8 17.8
Professional 6.4 4.7 6.0
Technical 5.7 5.9 5.8
Clerical 12.3 7.9 11.2
Sales and Services 28.0 22.9 26.7
Agriculture 0.9 3.6 1.6
Skilled Manual 1.6 2.4 1.8
Unskilled Manual 0.3 0.8 0.4
Elementary 2.7 2.4 2.6
OFW or Unspecified 2.0 4.0 2.5
Religious 0.4 0.4 0.4
Retired 5.5 4.7 5.3
Student 2.4 3.6 2.7
Ownership of At least one Car (%)
74.26 75.93 74.68
26
Type of Frequently Driven Vehicle
Sedan 47.9 49.0 48.2
Sports Utility Vehicle 24.2 26.5 24.9
Utility Van 5.1 5.9 5.3
Pick-up 14.2 14.2 14.2
Asian Utility Vehicle 3.1 1.6 2.7
Unclassified 2.8 2.8 4.7
Number of child passengers (mean ± 1.58 ± 0.80 1.52 ± 0.77 1.56 ± 0.79
SD)
Years of Driving in years (mean ± SD) 14.40 ± 11.36 14.57 ± 10.96 14 ± 11
Age at Acquisition of LTO license in 23.05 ± 7.07 23.62 ± 6.73 23 ± 7
years (mean ± SD)
Hours of Driving per week 23.0 ± 21.0 18.0 ± 16.2 21.7 ± 20.0
(mean ± SD)
Knowledge
About half (51.5%) have heard of the term “child restraint” while 59.5% have seen a child
restraint prior to the survey. Together, the majority (66.8%) of the respondents was aware of (seen or
heard of) “child car seats” or “child restraints”. The rate of awareness was not significantly different
between urban (66.9%) and rural (66.8%) respondents (Table 6).
Table 6. Level of Awareness of Respondents to Child Restraints

Urban Rural Total
Overall awareness 66.9 66.8 66.8
Heard of the term 52.2 49.4 51.5
Have Seen 59.7 58.9 59.5
The respondents were asked about knowledge of age recommendations for different types of
child car seats. Twenty percent (20.9%) were able to mention that infant carrier should be utilized at
birth or 0 years old. However, less than 10% were able to mention the maximum age when this carrier
type can be used. Knowledge about appropriate ages for rear-facing, front-facing, and booster seats
were low (<10%) for each type. The respondents were also asked about weight and height
recommendations for seats following UN44 and UN 129 regulations. Knowledge was similarly low with
less than 10% giving appropriate responses (Table 7).
27

Table 7. Knowledge of Participants Regarding
A. Age-based use of child restraints
Start Stop Start Stop Start Stop Start Stop

% Correct (Urban) 20.9 3.9 4.1 7.1 0.4 0.1 5.5 5.6
% Correct (Rural) 24.9 5.1 3.6 6.7 0.8 0.0 7.9 4.7
% Correct (Overall) 21.9 4.2 4.0 7.0 0.5 0.1 6.1 5.4
B. Weight-based use of child restraints

%Correct (Urban) % Correct (Rural) % Correct (Overall)
Group 0 7.7 5.9 7.3
Group 0+ 0.0 0.0 0.0
Group 1 start 0.0 0.8 0.2
Group 1 end 0.0 0.0 0.0
Group 2 end 0.5 0.4 0.5
Group 3 end 0.0 0.0 0.0
C. Age and Height-based use of child restraints

%Correct % Correct % Correct
(Urban) (Rural) (Overall)
Start of use for rear-facing 7.1 9.9 7.8
End of use for rear-facing 0.1 0.0 0.1
Start of use for front-facing 0.0 0.0 0.0
End of use for front-facing 0.0 0.0 0.0

Attitude
Respondents agreed that child restraints prevent severe injury and that the wrong restraints can
lead to severe injuries. Respondents also disagreed that it is just as safe for children to sit in front
compared to sitting in the back.
There seems to be neutral view about the need for child restraints when they drive.
Disaggregated to never users and ever users, however, show that users felt the need for the device
28
while never users were ambivalent about it. Similarly, ever users were not comfortable without child
restraints while never users were neutral about it, (Figure 1).
Average Attitude Score

Figure 1. Average attitude scores regarding safety and child restraint use

In terms of information, respondents were unsure about the amount of support they receive or
they come upon. They also disagreed that information given by car sales persons and physicians were
sufficient. However, respondents generally would like to encourage others to use restraints.
Ever users felt that child restraints were easy to purchase but were ambivalent about the
expensiveness of restraints. Never users were neutral about the ease of purchasing restraints and were
more inclined to agree that they were expensive, (Figure 2).
29

Figure 2. Average Attitude Scores Regarding Information, Availability and Advocacy Among
Respondents

For those who were currently using child restraints, an additional set of questions on child
restraints were asked of them (Figure 3). Overall, respondents agreed that they would use child
restraints every time they travel with a child and would make sure children use restraints. They also
expressed intent to replace restraints if their child grows out of it. Further, they also felt that child
restraints stored offered sufficient information about restraints, that child restraints were easy to install,
and that they were satisfied with their ability to use them.
30

Figure 3. Average Attitude Scores on Usage
Practices
Respondents were asked if they wore seatbelts the last time that they drove or sat in the front
passenger seat. Majority (93.4%) reported that they did wear seatbelt, with no significant difference
between urban (93.5%) and rural (93.3%) respondents (Table 8). In terms of having a child passenger
in the proper seat, most (91.8%) were also compliant, with no significant difference between the two
subpopulations (urban – 91.5%, rural 92.9%) (Table 9). The reference for proper seating was based on
Republic Act No. 8750, more commonly known as the Seat Belts Use Act of 1999.
Table 8. Respondents Seatbelt Use Practices

Urban Rural Total
(n = 751) (n = 253) (n = 1,004)
Always 81.0 81.7 81.5
Most of the time 8.7 9.0 8.9
Sometimes 9.8 5.5 6.6
Occasionally 0.4 3.2 2.4
Not at all 0.0 0.4 0.3
31
In the overall sample, 18.5% reported to have ever used a child restraint. There was a slightly
higher rate of use among rural respondents (19.2%) compared to urban respondents (16.6%). This
difference was not statistically significant (Table 9).
Table 9. Child Restraint Use and Proper Positioning of Child Passenger

Urban Rural Total
Ever Used Child Restraints 16.6 19.2 18.5
Currently using child restraints 10.5 6.3 9.4
Had child in proper seat last time they drove 91.5 92.9 91.8
with a child passenger
9.4% of respondents were current users. For current users, utilization of child restraints was
slightly higher for urban (10.4%) compared to rural (6.3%). Likewise, the difference was not statistically
significant.
The rate of use among child passengers of respondents was computed. Among 1,569 children,
as represented by their adult respondents to the survey, 6.3% were currently using child restraints.
There was a significant difference in rate of use with 7.0% of urban children being users compared to
the 3.9% of rural children. There was also decreasing use of child restraints with age with highest rates
of use among those 0 to 6 months (23.21%) and those >6 months to < 1 year (17.39%). The rate
continue to decline from 9.85% among 1 to <4 year olds down to 2.71% among ≥7 year olds, (Table
10).
Table 10. Rate of Use of Child Restraints According to Age Group of Child Passenger
Age group Number % User OR Interpretation
0 to 6 months 56 23.21 1 (reference)
>6 mo to < 1 yr 69 17.39 0.69(NS) Same level as
reference age group
1 to <4 yrs 335 9.85 0.36 (S) Lower level of use
compared to
reference age group
4 to <7 yrs 260 7.69 0.27 (S) Lower level of use
compared to
reference age group
7 or older 848 2.71 0.09 (S) Lower level of use
compared to
reference age group
32
Most respondents purchased the child restraints they used (urban: 52.8%, rural: 59.5%), (Figure
4). However, around 20% used child restraints that were given to them (urban: 21.5%, rural 16.7%).
The most common source of bought child restraints was the department store followed by baby shops
and car accessory shops (Figure 5). Online stores ranked in 5th place as a source for bought child
restraints.
Figure 4. Manner of Obtaining Child Restraints
33
Figure 5. Source of Purchased Child Restraints
In terms of deciding which child restraints to acquire, the most common ways consumers would
decide were through: (1) independent research, (2) information from someone they knew, and (3)
information from sales staff. In terms of learning how to install the child restraints, most common ways
were through, learning from the sales person and learning from seeing someone (Figure 6).
34
(A)

(B)
Figure 6. Source of Information for (A) Determining Type of Child Restraints (B)
How to Use Child Restraints
35
Key informant interviews of drivers/parents
The team conducted key informant interviews with drivers/parents, representing would be users,
previous users, and current users. In general respondents viewed child restraints as devices that can
improve safety of child passengers.
“The reasons— it is for the safety of the child and the parents as well. It is not allowed
that the child uses the seatbelt. The child should use a child car seat because he/she is
safe there.”
Another current user likewise felt that child restraints were needed, and cited that it is a
requirement when transporting children:
“I know that it is required when you transport a baby. I know for a fact that you need to
put the baby in a car seat because it’s safer. Although, it is not a trend here in the
country.”
While one current user uses it because the parents of the child passengers required her to do
so, another mentioned that she uses the child restraint because it was convenient.
“Well, when we had our third baby, we reside at Minglanilla and my in-laws live at Naga.
When my wife drops our third baby at Naga, it is just her and the baby. No one else
accompanies her. For the safety of child, it is also convenient because my wife can
drive and there is no need for someone else to accompany her to hold the child.”
A few cited their experience of going abroad or interacting with foreigners wherein they
observed that foreigners use child restraints when they travel, and from this experience learned the
need to use child restraints as well. Some also lived in countries where there are legislations on the use
of child restraints. On the other hand, others mentioned that they saw it on television, and online.
Further, some also mentioned relatives and friends who were using child restraints or shared
36
information about it, thus encouraging them to use child restraints. One interviewed respondent
mentioned that their car salesman informed them about child restraints.
In terms of the non-users who were interviewed, they mentioned that they were not aware of
child restraints. One cited the silence and lack of a standard law about child restraints as a factor for
this lack of awareness.
“It is not emphasized here in the Philippines, it is only the seatbelts that are emphasized
here. The child is not allowed sit in front.”
There were however non-users who were aware but mentioned that it was not available in the
market at the time when they needed it. Another non-user said she tried using it but her child did not
like it so she stopped using it. Finally, one participant from Cebu, felt that,
“vehicular accidents rarely occur here because it is very traffic” and thus, she does not feel the
need to use them. She did mention that it might be needed for long distance travel, as “we cannot
predict what happens on the road, if we encounter an accident.”
Non-users were then asked about their views on a possible law on child restraints. Many were
supportive of it citing the need to protect the safety of child passengers.
“It is better to have a law. You wouldn't know what will happen on the road. If you’d just
hold the baby, you might lose grip and have him/her injured.”
There were however some respondents who were apprehensive about the law. For example,
one cited support for the law “as long as it is collective and had been deliberated upon.” Another
mentioned that it would be difficult to implement, while yet another felt that it is only for the rich as they
are the only ones who can afford to have their own car.
With regards to possible legislation, there were also those that completely opposed a possible
passing of a law on child restraints. A common reason cited was that use of child restraints is that the
37
law would take the choice of the parent from either utilizing child restraints or not. For these individuals,
the use of child restraints must be the choice of the parents. In addition, another common reason for
not supporting legislation on child restraint was because this is not part of our culture. As one explains,
a law should not be introduced on child restraints in the country as restraints have not been recognized
in the country as a need, and therefore “its use has not been ingrained in our culture.”
When asked how much they were willing to pay for child restraints, the range was between PhP
1,000 to PhP 5,000. Further, they claim that they will buy it especially if law required it and if their
budget then would allow it.
PART 3: Development of Recommendations
REVIEW OF RELATED LITERATURE
A review of literature on interventions to promote child restraints was done. Embase and
PubMed databases were accessed. The keywords used were “child restraints”, “child car seat”,
“booster seat”, “promotion”, and “increased use”. Only studies with before-after on controlled designs
were accepted. The team was able to locate three (3) systematic reviews, which covered literature
published up to 2006. An additional nine (9) articles published from 2006 to 2017 were also found.
The tables below show a summary of the articles (Table 11A, and 11B). Table 8A refers to
community interventions (e.g. education only or complex interventions) and Table 8B refers to post-
partum intervention. Overall, there is good evidence that educational effort, especially if targeted
towards children, increased usage of child restraints in the target population. Combining education with
other interventions such as incentives, discounts, and law enforcement also led to increased use.
However, education of parents or mothers in hospitals was not so effective. One study (Geddis 1982),
showed an effect but this was only during the first trip of the infant from the hospital to the home. On
follow-up four to six months later, the rate of use among the control group caught up with the
intervention group.
38
Table 11A. Community Interventions
Title/Author Year Geography Design Population Intervention Results
Child Care Centers: a 1993 Indianapolis, Educational Two day care - Education: Five Control: 0%
Community Resource for Indiana clinical trial centers with low month program – 20 Trial: significant
Injury Prevention. income, minority minute class for increase 36% (p <
families with children 0.01)
Stuy M, Green M, Doll J children aged 2-6 - Incentives
(n = 2) - Positive
Reinforcement
Teaching Car Passenger 1985 California Controlled 13 Preschool - Child and parent Control: increase by
Safety to Preschool trial programs education (Riding with 1.7%
Children Bucklebear program) Trial: significant
increase 22.4%
Chang A, Dillman A, Leonard (p<0.001)
M, English P
Interventions in Preschool 1987 Newcastle, Randomized Parents and Control vs Child Control: From 59.9%
to Increase the Use of Australia controlled children 3-5 years Education vs Parent to 60.3%, Not
Safety Restraints by trial old attending 45 education (including significant
Preschool Children. preschools reminder about Child Education:
random police check) From 60.6% to
Bowman JA, Sanson-Fisher 75.0%, Significant
RW, Webb GR Parent Education:
From 59.9% to
62.8%, Not significant
Use of Child Booster Seats 2003 Seattle Prospective Parents and Multi-faceted Control: From 17.3%
in Motor Vehicles Following non- children 4-8 years community booster to 20.2%, Non-
a Community Campaign: A randomized old in 12 seat campaign significant
Controlled Trial controlled communities (increase discount Trial: From 13.3% to
cluster trial booster seat coupons, 26.1%, Signficant
Beth E, Koepsell T, Bennet E, car seat training
Rivara F programs for law
enforcement,
childcare provision
and education,
healthcare provision,
community coalition,
community education)
39
A Preschool Program for 2000 Washington Non- Parents of children Injury prevention Control: From 23.6
Safety and Injury State randomized 4-5 years old program via education to 28.6
Prevention Delivered by controlled, enrolled in Head during home visits Trial: From 26.7 to
Home Visitors cluster trial Start Program 48.7
Johnston BD, Britt J,

D’Ambrosio L, Mueller BA,
Rivara FP
Methods to Increase 2005 Indianapolis, Randomized Parents and Distribution with Control: From 39.4
Booster Seat Use in 4- to 6- Indiana controlled, children 4-6 years education (DE) vs to 52.2.
Year-old Children. cluster trial old in nine day incentive with DE: From 42.6 to
care centers and education (IE) vs 66.7
O’Neil J, Brizendine EJ, preschools control IE: From 34.7 to 48.8.
Robbins JK, et al
No statistical
significant difference
between groups
Effects of Intervention on 2000 Virginia Randomized Parents of children Coupon for purchase Booster seat
Booster Seat Purchase: controlled 3.5-8 years old of booster + Pamphlet purchase
Field Study trial entering retail toy on use of booster
store seats ($30) (C+P) vs C+P: 34%
Stevens SL Pamphlet only (P) vs P: 38%
Coupon only (C) vs C: 41%
Control Control: 3%
Evaluation of Community- 2008 Michigan Controlled 1 Low income Community-wide Observed restraint
Based Programs to pre-/post- community and 1 program use of 4-8 years old
Increase Booster Seat Use design Hispanic
community Low income group:
St. Louis RM, Parow JE, Eby From 19.0% to 16.9%
DW, Bingham CR, Control: From 9.7 to
Hockanson HM, Greenspan 16.8%
Hispanic group:
From 9.7% to 14.9%
Control: From 18.2%
to 14.8%
40
Effects of a Booster Seat 2009 Colorado Randomized 39 Child care Training of center Booster seat use of 4
Education and Springs, controlled centers in Urban staff + parent to 8 year olds
Distribution Program in Colorado cluster trial area education session + Control: From 36 to
Child Care Centers on Child distribution + 42
Restraint Use Among additional promotion Trial: From 40 to 41
Children Aged 4 to 8 Years. activities initiated by a
Thoreson S, Myers L, Goss center Not statistically
C, and DiGuiseppi C significant
Evaluation of an Education, 2012 Sydney, Randomized Preschools Buckle-Up Safely Restraint use of 3 to
Restraint Distribution, and Australia controlled Program: training of 5 year olds
Fitting Program to Promote cluster trial staff + parent
Correct Use of Age- education session + Control: 31%
Appropriate Child subsidy for booster + optimally restrained
Restraints for Children information packet Trial: 43% optimally
Aged 3 To 5 Years: a restrained
Cluster Randomized Trial.
Keay L, Hunter K, Brown J,
Simpson JM, Bilston LE,
Elliott M, Stevenson M, Ivers
Boosting Restraint Norms: 2013 Philadelphia Non- Two communities Social marketing Observed child
A Community Delivered randomized at outskirts of the campaign “Boosting restraint use
Campaign to Promote control trial city Restraint Norms” Control: From 57.9%
Booster Seat Use. delivered by to 59.8%
Bryant-Stephens T, Garcia- community partners Trial: From 38.9% to
Espana JF, Winston FK 50.0%
A Systematic Review of 2014 Australia Systematic International Focused on studies Use of child restraints
Community Interventions to review that addressed 2 Increased from 12.4
Improve Aboriginal Child modifiable to 41% with
Passenger Safety determinants of MVC: distribution +
populations and education
Ishikawa T, Oudie E, systems + community
Desapriya E, Turcotte K, Pike edication + CPS tech
I training
Increased from 35 to
51 % with community
education and
incentives alone
41
Table 8B. Post-partum interventions
SafeSmart Safety Seat 1989 Maricopa RCT Six health Postpartum education Usage rate
Intervention Project: A county, department clinics
Successful Program for the Arizona (900 low income, SafeSmart program – Control: From 12.8%
Medically-Indigent ethnically diverse 1 on 1 counseling to 30.0%
parent groups) either coercive or Counseling: From
Liberato C, Eriacho B, incentive vs. control 25.1% to 35.3%
Schmiesing J, Krump M (verbal advise only)
Increasing the Protection of 1982 Kansas city, RCT Mothers from OB Postpartum education On discharge: 67%
Newborn Infants in Cars Kansas ward in one difference between
hospital Free infant car seat with demo group and
Christophersen ER, Sullivan loan with demo vs No group with no demo
MA demonstration with in terms of use of car
infant car seat loan seats
On follow-up (4 to 6
weeks) 6% difference
between both groups
Evaluation of Programs 1987 Pittsburgh, Controlled Mother-infant pairs Postpartum education No statistical
Designed to Increase the Pennsylvani trial in 3 hospitals for C – seats for sale in differences between
Protection of Infants in Cars a middle-upper class gift shop groups in terms of car
families Intervention 1 - seat use
Reisinger KS, Williams AF literature distributed,
seats displayed at
lounge, seat for sale Control: increase by
at ward, 15%
demonstrations given
on purchase Intervention 1:
Intervention 2 - increase by 14%
literature, seat Intervention 2:
displayed at lounge, increase by 12%
convenient to Intervention 1:
purchase, Individual increase by 17%
education session
Intervention 3 – offer
of free car seat plus
demonstration
42
Promoting Child Passenger 1989 Martinez Controlled Two HMO clinics Control – usual care <1 year-old group
Safety in Children Served and Walnut pre-post- Intervention – Control: Increase by
By a Health Maintenance Creek, design Education based on 8.8%
Organization California Health Belief Model - Intervention:
poster, waiting room Increase by 2.9%
Chang A, Hearey CD, films, discuss by
Gallagher KD, English P, Pedia, pamphlets, 1 – 4 year old group
Chang PC home visit by safety Control: Increase by
specialist 11.4%
Intervention:
Increase by 23.9%
Parent Education: Its Effect 1982 Dunedin, Controlled Mother-infant pairs Post-partum Use of restraints:
on the Way Children are New trial in a hospital education
Transported in Cars Zealand Intervention 1 – At hospital discharge
mother received Control: 18%
Geddis DC, Pattengell R pamphlet Intervention 1: 37%
Intervention 2 – film + Intervention 2: 49%
pamphlet
During follow-up at 6
months
Control: 62%
Intervention 1: 60%
Intervention 2: 62%
Evaluation of an Infant Car 1990 Montreal, Controlled Community health Prenatal classes plus Use of restraint
Seat Program in a Low- Quebec, pre-post- center in low postnatal home visit
Income Community Canada design income vs no program At 0-6 months
neighborhood Control: 27%
Robitaille Y, Legault J, Abbey Intervention: 41%
H, Pless I
At 7-17 months
Control: 50%
Intervention: 50%
43
Notably, several papers looked at the impact of legislation on the use of child restraints in a
country. Nakahara et al (2015) reported that legislation mandating the use of child restraints in
Japan was started in April 2000 with a noticeable jump in rate of use from 1999 to 2000. The
surveys up to 2010 showed that rate of use have been stable indicating that announcement of a
pending legislation actually increase child restraints used as much as when the law was
implemented. In the same analysis, however, they showed that there was no change in morbidity
rate ratios for child injuries upon introduction of the law.
COMPANY X
To broaden the current understanding on the market of child restraints in the Philippines, a
financial analysis of the current companies distributing child restraints in the Philippines was
undertaken for 4 company’s financial statements from the Securities and Exchange Commission
from the fiscal years of 2012-2015.
In this report the 4 companies for anonymity, have been labeled Alpha, Bravo, Charlie and
Delta. Income statement Return on Equity was analyzed, specifically, the percentage of profit after
income taxes that the companies have earned on its average common stockholders’ balances
during the year. Since, some companies had preferred dividends, this was deducted from the net
income. Thus in terms of return on equity, company Delta had the highest return at 13.4%, followed
by Charlie (2.4%), Bravo (1.2%), and Alpha had negative return at -1.5% after all the years were
averaged. In terms of the Net Profit Margin of the four companies, to derive these values the
following formula was used: [Net Income After Tax/Net Sales = Net Profit Margin]. Charlie with 1%
had the highest net profit margin, while Bravo had 0.3%, Delta at 0.2%, and Alpha again was
negative at -0.3% (Table 12).
Table 12. Financial Ratios based on Income Statement for 4

Philippine-based Distributors of Child Restraint
Alpha Bravo Charlie Delta
Return on Equity (1.5%) 1.2% 2.4% 13.4%
Net Profit Margin (0.3%) 0.2% 1.0% 0.2%
44
With regards to current ratio, the highest ratio for assets over liabilities was Charlie with 2.7,
followed by Bravo 2.2, Delta 0.7, and again Alpha had the lowest current ratio at 0.5. Looking at the
asset turnover, or the company’s ability to generate sales based on their assets, Delta had a
turnover of 5.1, Bravo’s turnover was 2.8, Charlie’s was 1.5, and again Alpha had the lowest
turnover at 1.2. In terms of the turnover of assets, the average number of days necessary to convert
receivables to cash for these companies. Bravo’s Collection Period was a mere 6 days, Delta 42
days, while Alpha had the longest at 71 days. Values for Charlie could not be calculated due to
lacking entries on their balance sheet. In terms of how long it would take these companies to turn its
inventories into sales it was 12 days for Delta, 48 days for Alpha, and 142 days for Bravo. With
regards to the days payable for each of the company to get a complete picture of their turnovers,
the days payable for Bravo was fast at 27 days, compared to Delta’s 80 days, and Alpha’s 449
days. The financial leverage of the companies, with the use of their debt to equity ratio was
analyzed. Delta had the highest debt to equity ratio at 15.4, followed by Bravo at 0.8, then Charlie at
0.6, and last was Alpha at -4.9 (Table13).
Table 13. Financial Ratios based on Income Statement and Balance Sheet for 4
Philippine-based Distributors of Child Restraint
Current Ratio 0.5 2.2 2.7 0.7
Asset turnover 1.2 2.8 1.5 5.1
Collection Period 71 6 - 42
Inventory days 48 days 142 days - 12 days
Days payable 449 days 27 days - 80 days
Debt to Equity Ratio (4.9) 0.7 0.6 15.4
In terms of the revenue growth rate of the 4 companies for the 4 financial years as presented
on their financial statements, Alpha has the highest growth rate at 30.0%, then Bravo at 13.0%,
Charlie with minimal growth rate, and Delta having a decreasing growth rate of 4.0% (Table 14).
Table 14. Growth Rate for 4 Philippine-based Distributors of Child Restraint

Revenue Growth Rate 30.0% 13.0% < 0.0% (4.0%)
45
With the situation of the Philippine distributors from their financial statements, the
investigators then explored the fitness of a new company in this market with the current players and
similar environment. To begin this endeavor the investigators needed to make some assumptions
for a small to medium sized company, labeled “Company X”, entering the market in the National
Capital Region (NCR) and distributing through a physical store. These are summarized in the
following table (Table 15):
Table 15. Assumptions for Company X

Assumption Source Value
NCR population growth rate Philippine Statistics Office, release 1.6%
date - 31 May 2016
Number of households in NCR Philippine Statistics Office, release 3,095,766
date - 31 May 2016
% of households with children and Philippine National Demographic and 16.0%
with car Health Survey 2013
Number of Households in NCR Extracted value from NDHS 2013 495,323
with car and children
% of households with child Survey done at LTO sites 20.6%
restraints
% of households with car and 1- % of households with CRS 79.4%
children without child restraints
Number of households that can Based on NDHS and Child Restraint 393,462
still purchase child restraints Study
% of respondents that purchase Survey done at LTO sites 38.3%
from actual stores stores
Number of households that Survey done at LTO sites 150,696
purchase from stores
Market share of the Company X Assumed 10.0%
Sales volume Based on previous assumption 15,070
With the sales volume calculated based on earlier mentioned assumptions, the selling price
per unit was then taken from the scoping done earlier in the study. This allowed the investigators to
calculate for gross profit, the operating expenses over revenue to calculate for the revenue and a
probable operating expense for Company X. Taking all these together, the picture of the income
statement projected to 5 years of Company X is represented (Table 16).
Having the income statement at hand, the (a) Trade Receivable/Revenue, (b)
Inventory/Revenue, (c) Other Assets/Revenue, (d) Non-current Assets/Revenue, (e) Accounts
46
Payable/Revenue, and (f) Other Current Liabilities/Revenue were derived. The choice to use Bravo
and Delta companies instead of the other 2 (Alpha and Charlie) for the computation of current
liabilities was because they have been in the business longer, have a cleaner and more complete
financial statement, and because they have physical stores where they sell their products, and also
because Company X would be catering to the same markets as Bravo and Delta. The balance
sheet of Company X (Table 17).
Taking then an arbitrary value of 2.0%, Company X’ cash statement and balance sheet, a
derived common stock of Php 20,684,877.0, an average income of 30.0%, and an inflation rate of
3.0% (mid-point of values from the Philippine Development Plan Inflation End-of-plan Target), the
following is Company X’ cash flow (Table 18).
Table 16. Income Statement of Company X (2018, 2019, 2020, 2021, 2022)
2018 2019 2020 2021 2022
Revenues 158,504,808 165,839,459 173,513,514 181,542,679 189,943,385
Cost of Goods (126,011,322) (131,842,370) (137,943,244) (144,326,430) (151,004,991)
Sold
Gross Profit 32,493,486 33,997,089 35,570,270 37,216,249 38,938,394
Operating (19,020,577) (19,900,735) (20,821,622) (21,785,121) (22,793,206)
Expenses
Income Before 13,472,909 14,096,354 14,748,649 15,431,128 16,145,188
Income Tax
Income Tax (4,041,873) (4,228,906) (4,424,595) (4,629,338) (4,843,556)
Net Income 9,431,036 9,867,448 10,324,054 10,801,789 11,301,631
Beginning - 9,431,036 10,824,620 12,282,690 13,808,232

Retained
Earnings
Net Income 9,431,036 9,867,448 10,324,054 10,801,789 11,301,631
Common - (8,473,864) (8,865,984) (9,276,248) (9,705,497)
Dividends
Adjustments - - - - -
Ending 9,431,036 10,824,620 12,282,690 13,808,232 15,404,366
Retained
Earnings
47
Table 17. Balance Sheet of Company X (2018, 2019, 2020, 2021, 2022)
2018 2019 2020 2021 2022
Assets
Current Assets
Operating cash 3,170,096 3,316,789 3,470,270 3,630,854 3,798,868
Trade receivables 11,095,337 11,608,762 12,145,946 12,707,988 13,296,037
Inventory 25,360,769 26,534,313 27,762,162 29,046,829 30,390,942
Other assets 3,170,096 3,316,789 3,470,270 3,630,854 3,798,868
Total current assets 42,796,298 44,776,654 46,848,649 49,016,523 51,284,714
Non-current Assets
Total Non-current
Assets 7,925,240 8,291,973 8,675,676 9,077,134 9,497,169
Total Assets 50,721,538 53,068,627 55,524,325 58,093,657 60,781,883
Liabilities
Accounts payable 19,020,577 19,900,735 20,821,622 21,785,121 22,793,206
Other current
liabilities 1,585,048 1,658,395 1,735,135 1,815,427 1,899,434
Total Current Liabilities 20,605,625 21,559,130 22,556,757 23,600,548 24,692,640
Total Liabilities 20,605,625 21,559,130 22,556,757 23,600,548 24,692,640
Equity
Common stock 20,684,877 20,684,877 20,684,877 20,684,877 20,684,877
Retained earnings 9,431,036 10,824,620 12,282,690 13,808,232 15,404,366
Total Equity 30,115,913 31,509,497 32,967,568 34,493,109 36,089,243
Total Liabilities and

Equity 50,721,538 53,068,627 55,524,325 58,093,657 60,781,883
48
Table 18. Cash Flow of Company X (2018, 2019, 2020, 2021, 2022)
2018 2019 2020 2021 2022
Net income 9,431,036 9,867,448 10,324,054 10,801,789 11,301,631
Add: Depreciation 0 0 0 0 0
Operating Cash Flow 9,431,036 9,867,448 10,324,054 10,801,789 11,301,631
Inc./(Dec.) - Accounts
payable 19,020,577 880,158 920,887 963,500 1,008,085
Inc./(Dec.) - Other
current liabilities 1,585,048 73,347 76,741 80,292 84,007
Total Operating
Sources 20,605,625 953,505 997,627 1,043,791 1,092,092
Inc./(Dec.) - Trade
receivables 11,095,337 513,426 537,184 562,042 588,049
Inc./(Dec.) - Inventory 25,360,769 1,173,544 1,227,849 1,284,666 1,344,113
Inc./(Dec.) - Other assets 3,170,096 146,693 153,481 160,583 168,014
Inc./(Dec.) - Marketable
securities - 8,473,864 8,865,984 9,276,248 9,705,497
Inc./(Dec.) - Non-current
assets 7,925,240 366,733 383,703 401,458 420,035
Total Non-Operating
Uses 7,925,240 8,840,597 9,249,686 9,677,706 10,125,533
Beginning operating cash 0 3,170,096 3,316,789 3,470,270 3,630,854

Inc./(Dec. - Operating
cash 3,170,096 146,693 153,481 160,583 168,014
Ending Operating Cash 3,170,096 3,316,789 3,470,270 3,630,854 3,798,868
The projected financial statement for Company X is presented in relation to Alpha, Bravo,
Charlie, and Delta, (Table 19). Company X’ total current assets was 84.0%, which was closest to
the 94.0% of Bravo. Charlie was 98.0%, Delta 63.0%, and Alpha’s total current asset was just
50.0%. Consequently, for total non-current assets Alpha had 50.0%, Bravo 6.0%, Charlie 2.0%,
Delta 37.0%, and within the range was Company X at 16.0%. A total liability for Company X is
41.0% and for Bravo it was 42.0%. In terms of equity, Bravo had a vertical count of 58.0%, and
Company X correspondingly had 59.0%.
49
Table 19. Vertical Analysis of Company X, Alpha, Bravo, Charlie, and Delta
Alpha Bravo Charlie Delta Company X
Assets
Current Assets
Operating cash 15.0% 1.0% 13.0% 2.0% 6.0%
Trade receivables 18.0% 5.0% - 44.0% 22.0%
Inventory 10.0% 81.0% - 14.0% 50.0%
Other assets 8.0% 8.0% 85.0% 6.0% 6.0%
Total current assets 50.0% 94.0% 98.0% 63.0% 84.0%
Non-current Assets
Total Non-current
Assets 50.0% 6.0% 2.0% 37.0% 16.0%
Total Assets 100.0% 100.0% 100.0% 100.0% 100.0%
Liabilities
Total Current Liabilities 98.0% 42.0% 36.0% 94.0% 41.0%
Non-current Liabilities 28.0% - - - -
Loans 28.0% - - - -
Total Non-current
Liabilities 126.0% 42.0% 36.0% 94.0% 41.0%
Equity
Share Capital 2.0% 26.0% 78.0% 4.0% 37.0%
Deficit (28.0%) - - - -
Retained earnings - 31.0% (70.0%) 3.0% 22.0%
Total Equity (26.0%) 58.0% 64.0% 6.0% 59.0%
Total Liabilities and

Equity 100.0% 100.0% 100.0% 100.0% 100.0%
The financial ratios for Alpha, Bravo, Charlie, and Delta beside the financial ratios of
Company X, are presented (Table 20). Company X has the highest return on equity and net profit
margin. Company X’ return on equity is 31.3%, above the 13.4% of Delta, which previously was the
highest. Likewise Charlie’s 1.0% which is the highest net profit margin compared to the 4 other
companies, is far from Company X’ 6.0%. In terms of current ratio, Company X at 2.1 fares well
among the higher Bravo and Charlie. Company X’ asset turnover is at 3.1 which comes second to
Delta’s 5.1. Collection period for Company X was in the middle at 26 days. For Inventory days,
again Company X is somewhere in the middle with 73 days. For days payable Company X isn’t far
from Delta’s 88 days, and Bravo’s 27 days. Thus it can be projected that new candidate companies
50
like Company X in this child restraints market might have a revenue growth rate of 4.63% per
annum. Overall, Company X can be considered a good investment.
Table 20. Financial Ratios of Company X with Alpha, Bravo, Charlie, and Delta
Alpha Bravo Charlie Delta Company X
Return on equity (1.5%) 1.2% 2.4% 13.4% 31.3%
Net profit margin (0.3%) 0.3% 1.0% 0.2% 6.0%
Operating Cash Flow 9,431,036 9,867,448 10,324,054 10,801,789 11,301,631
Curent Ratio 0.52 2.21 2.74 0.67 2.08
Asset turnover 1.16 2.77 1.53 5.12 3.13
Collection Period 71 6 - 42 26
Inventory days 48 days 142 days - 12 days 73 days
Days payable 449 days 27 days - 80 days 55 days
Debt to Equity Ratio (4.89) 0.74 0.56 15.38 0.68
Curent Ratio 0.52 2.21 2.74 0.67 2.08
Revenue Growth Rate 30.0% 13.0% < 0.0% (4.0%) 4.6%
WORKSHOP
A workshop was conducted at Armada Hotel, 2108, Marcelo H. del Pilar, Manila on the 2nd of
June 2017. The workshop was attended by 37 participants, and began at 8AM and ended at
4:30PM. The following stakeholders were represented in the workshop:
1. Philippine Senate
2. Philippine House of Representatives
3. Department of Trade and Industry
4. Department of Health
5. Department of Transportation
6. Automobile Association Philippines
7. Ateneo School of Government
8. World Health Organization
9. Imagine Law
10. New Vois Association of the Philippines
11. Philippine Red Cross
51
12. Land Transportation Office
13. IDEALS, Inc.
14. VERA Files
15. EuroPlay
16. Safe Kids
17. Vital Strategies
The morning session was allotted for presentation of the results. After the results were
presented, the participants were allowed to ask clarifications about the study. In the afternoon, the
participants were split into five groups and asked to discuss the five objectives. The groups were
divided accordingly:
Group 1. Determine the availability and access to child restraints that conform with
international standards in the Philippines.
Group 2. Determine the availability of ISOFix vehicles in the country.
Group 3. Determine knowledge, attitudes, and behavior among Filipino car users on child
safety and the use or non-use of child restraints
Group 4. Determine acceptability and affordability of child restraints among car users
eligible for the study
Group 5. Identify points, and measures that promote use of child restraints among Filipino
drivers with children
Group 2, however, mentioned that because none of them were experts in IsoFix, they felt
that they will not be able to discuss lengthely the objective assigned to them, thus they were instead
asked to discuss objective 5.
Each group was asked to answer the following questions:
1. Do you agree/disagree with the presented results? Why?
2. What are the possible risks in mandating or promoting child restraint use in the
Philippines?
52
3. What are concrete ways for agencies, lawmakers, and other stakeholders to support the
legalization, and promote the use of child restraints in the Philippines?
The groups were then allowed to work on their outputs for two hours and then a plenary
session was held where each group was given 10 minutes to present their work. During their
presentations, other participants were allowed to ask questions regarding the outputs, if they had
any.
In general, the participants agreed with the results in given the scope and the objectives.
They agreed with the conclusion that awareness and education should be targeted to increase
usage. Also, they agreed that child restraints are available but are not certain if the products are
affordable. Finally, they also agreed that there should be more players in the child restraint market.
Limitations pointed out by the workshop participants include the limited generalizability and
representativeness of the results. Some found the measured level of awareness and use was
surprisingly high but others predict that the results represent the upper level of awareness and the
awareness would be lower if the general population is surveyed. It was also pointed out that the
attitudes represent only a limited segment of the population (i.e. those who drive cars) despite the
fact that the law might affect others such as parents without cars but who use taxis or Uber/Grab.
They also pointed out that knowledge was more on the technical aspects of child restraints. Finally,
the participants requested an analysis considering socio-economic information. However, that was
not within the scope of the study.
Participants pointed out that the policy should be inclusive and considerate of the socio-
economic situation in the country. Child restraints are not affordable and most of the riding public
use jeepneys or tricycles and not cars. However, given the rising popularity of Uber and Grab, the
policy will then affect families who have no cars but will need child restraints. There is then a need
to look into how the policy of child safety should be implemented in public vehicles.
When asked about how to minimize risks, the group recommends the development a clear
communication plan involving a massive information campaign. They also stress the need to involve
all stakeholders in policy development.
53
They also expressed concerns about enforcement of the policy. One is on the standards.
They recommended creating standards that will not compromise competition. A group suggested
that use of conformity marks that will facilitate enforcement. There is also a need to develop a
simple implementation mechanism that will allow law enforcers to comply with the law easily.
Many of the recommendations on how child restraints could be promoted focused on
increasing awareness about child restraints with efforts to making it a norm. The different groups
called for increased efforts to improve knowledge about child restraints and activities that advocate
for its use. One group also suggested that education should be done through mass media.
The participants all stated that there is a need to improve awareness and knowledge of the
general population regarding child restraints. The efforts should try to make owning and using a
child restraint a norm. The preference of embracing the child should be changed. A multisectoral
approach is suggested but one group stressed that there should be more government efforts
towards educating the population. Others suggested alternative methods such as using television
shows such as telenovelas, involving mass communication schools and students in developing
these campaigns, and social media campaigns. One group also pointed out that education efforts
should involve the health workers and suggested that child restraints should also be available in
hospitals.
The groups all agreed on their desire to ensure affordability of the child restraints. One
recommended method was to increase the number of players in the market and improve
competition to drive prices down. Several groups also suggested using alternative ways to obtain
child restraints such as exchange and distribution programs. There was also a suggestion to
promote alternative ways to finance child restraints such as bundling with car loans and discount
programs.
The groups however cautioned that with the entry of new players in the market in an effort to
lower prices would put the Philippines at risk of entry by low quality products. One participant
likened the experience with the helmet law with entry of sub-standard helmets. Thus, the groups
recommended that the government set a standard, which could be complied with by companies.
54
One participant cautioned against the creation of a too strict standard, which would necessitate
change in the product for the Philippines alone as it might drive away potential suppliers.
Other recommendations include ensuring joint efforts of government agencies, continuous
research, and consistent enforcement.
ROLE OF TRANSPORT NETWORK VEHICLES SERVICES (TNVS)
A rising type of transportation in the Philippines is through TNVS providers. These providers
use privately owned vehicles to provide their services and thus might be covered by the proposed
legislation. Two companies which are currently accredited to operate in the Philippines regarding
their stance on child restraints, were contracted. A set of questions was sent to both companies and
written responses from each were obtained.
Both companies expressed support interventions for road safety especially for children,
however, only one of the two company explicitly expressed support for legally mandating its use.
The other company called for more efforts in educating the public about child restraint, suggesting
that this method will lead to increased voluntary use. Both companies expressed willingness to
collaborate with the government in relation to this policy but ask that it be “properly designed”.
According to these two (2) companies, the legislation should be in concurrence with promotion
activities.
Several activities the companies may do if the legislation pushes through would be to include
an educational campaign for their drivers and passengers, participate in the development of the
implementing rules and regulation, and introduce incentives in support of early adoption.
Although neither currently offers child restraint rental with their services in the Philippines,
both have existing models in other countries, which they can apply in the country. For example one
company works with a “third-party safety focused organization” in order to provide the service while
the other can create a customized version of an existing service wherein one can request a booster
seat when they book a ride.
Both models entail an added premium on top of their usual fees for a regular ride since it will
need additional equipment and time for the driver. The companies will also have to conduct
55
activities to train their drivers regarding the added service. Both cited that this new service (i.e. use
of child restraint owned by either the driver or the company) will cause the passengers to bear the
increased cost of the procurement of child restraints. On their end, both companies likewise
mentioned that their companies would also incur costs with this legislation since they will have to
educate their drivers about the policy and the use of the device.
V. DISCUSSION
Our survey demonstrated that use of child restraints was low among potential users in the
Philippines. Evidence from other countries suggested that introducing legislation would increase the
rate of use. Behavior of Filipino drivers towards the seatbelt law also suggests that compliance with
a child restraint law will also occur. Interviews also revealed that parents value the safety of their
children and would likely use this technology if convinced that it is needed for safety. However,
there are some key differences between seatbelts and child restraints that would hinder compliance.
Seatbelts are integral parts of cars while child restraints are accessories, which would need to be
purchased separately. In addition, even parents without cars would need to purchase them directly
or indirectly, if they ever need to ride a 4-wheel vehicle with their child. In addition, families will likely
need to purchase more than one device as the child grows. One alternative would be to use the
more expensive devices, which can be adjusted according to a child’s dimensions. The population
we interviewed, which likely represents the higher earners of society, had the mistaken notion that
the current prices (PhP 1,000 to PhP 5,000) of child restraints as being high. Noteworthy is that
there are available products even at the lower prices specifically though online stores.
The effect of the proposed law on market prices is still uncertain, however one hypothesis
that was raised by participants of the workshop was that with a rise in demand and introduction of
new players in a competitive market, the price is expected to decrease, eventually.
One supplier interviewed, however, mentioned that the prices of their products will not likely
decrease even with the introduction of the law in order to avoid the perception of the marketthat
their products are not selling or are of poor quality. Our view is that it is acceptable to have higher
priced child restraints as long as there are also more affordable options in the market. To achieve
56
this scenario, the role of competition and new players would be vital in expanding the range of
prices in the market. The government should thus facilitate entry of new players by addressing
common issues of business in the country such as corruption, smuggling, and excessive red tape,
while on the incentive size, tariff exemptions and increase tax credits may be useful.
The accompanying program with the new law should include suggestions on the financing of
child restraints. In other countries, child restraints can be rented. Rental could be done at
hospitals10, 11, or when hailing a ride from a TNVS. There could also be the introduction of discount
coupons12 for child restraints. Finally, some companies have created trade-in events or services
where old child restraints can be exchanged for new ones that are more appropriate to the growing
child passenger.
Although we call for facilitation of entry of new players, these companies should be
monitored and regulated due to the nature of their products. We want to avoid the scenario of rapid
entry of sub-standard or uncertified child restraints in the market. Already, we observed that not all
products sold online and in malls had certification such as the UN ECE 44 or the US FMVS. Key
informants also mentioned the presence of look-alike type of products, which resemble the branded
products but came from different manufacturers. Currently, there are no policies or standards
approved by regulatory agencies in the Philippines regarding child restraints outside of those by the
FDA for devices for infants, which tests only for toxicity. The creation of these standards should
occur immediately after completion of, or simultaneously with the development and passing of the
legislation.
There is also a need to address the issue of awareness, education, and cultural acceptability
of child restraints. Our results suggest that drivers have favorable attitudes towards child restraints
and safety devices for children. However, this has not been translated to reported use of child
restraints even among those who have heard of child restraints. Our key informant interviews
manifested that drivers would comply with the policy if legislated but there would those who would
be resistant or begrudgingly comply, as it may seem like an added expense. There is also the
pervasive cultural preference of embracing small children even though it is not necessarily safer.
Some parents interviewed still feel that holding a child on their lap is more secure and safer.
57
Educational interventions should be done even while the legislation is being reviewed in
Congress. These interventions will facilitate acceptance of the policy and help correct any unsafe
practices and beliefs of the population. Current agencies involved in road safety could include the
use of child restraints in their road safety marketing materials. The survey highlighted common
sources of information, and from these sources, efforts should be made to make sure that these
sources contain the correct information.
The Philippines is fortunate to have access to the wealth of experiences of other countries
on how they promote child restraint use. The available evidence showed that education with the
proper incentives (e.g. free distribution or discounts) could lead to increase in usage. However,
there is still a great deal of work to be done, as many of these countries are either developed
nations and/or western countries with a very different demographic and legislative backgrounds.
Interventions designed in these countries will have to be adapted to our local setting. Further, it is
also important to conduct our own studies, including crash studies, and dynamic mechanical
studies, looking into the effectiveness of these interventions with our nation’s roads, weather
conditions and transportation situation before rolling these products out on a massive scale.
It has been shown that the Internet and social media can and should be taken advantage of
in spreading awareness about child restraints especially with the increasing Internet use among the
potential child restraints users. As shared by key informants, young parents would often seek
knowledge about how to take care of their children online.
The power of the Internet is such that whenever someone types in search terms for “taking
care of children” or the like, search results can be configured to include “proper use of child
restraints” and the like. Further, it is imperative that sources of information be reliable, preferably
cleared by government agency.
Given the limited time and budget available, our study has several limitations. One is that the
study population is not the general population. This limits the generalizability of the results. The
results also likely represent the higher estimates in terms of use and awareness as we included
people who are likely to use child restraints. This limitation, however, highlights that use is indeed
low in the Philippines. A related limitation is that we relied on reported use rather than observed use
58
of child restraints. This could again increase the estimate of use. We are also thus unable to assess
if the child restraints were properly installed and employed in terms of the appropriateness for the
child’s dimensions and in terms of the technique of the user.
For the supply side, we limited our mall scoping to just a few sites in urban areas in the
Philippines. The limited data showed that price variations exist in different areas, as a baseline, and
a bigger study would thus be able to provide more precise and representative estimates on the cost.
We also were able to assess ISOFIX compliance only in brand new models, not taking into account
the majority of cars roaming the streets in our country that are not brand new models or may include
“owner types” which are built from parts. The actual compliance of vehicles currently in the
Philippine roads would likely be lower. For the recommendations, the financial scenario of Company
X used available financial statements of companies from their filed statements in the Securities and
Exchange Commission. As seen from practices of other industries, this may be undervalued in
order to adjust due taxes. Therefore the projected profitability of Company X may be understated.
VI. CONCLUSION AND RECOMMENDATIONS FOR POLICY
In conclusion, uncovered in this study, was that child restraints were in fact available and
accessible in the country. The study found a total of 68 brands of child restraints. Of these, our
country has 7 local distributors, another 7 brands may be acquired through international shipping,
60 through internet sellers, and 20 through second hand resellers. We also found child restraints in
every one of the 15 malls visited in Metro Manila, Cebu City, Davao City, and San Fernando City. In
our study it was found that 20% of child restraints were previously used by another child.
In terms of knowledge, attitudes, and behavior among Filipino car users on child safety and
the use or non-use of child restraints, 93.4% of respondents reported that they wear seatbelts, and
91.8% are compliant in terms of positioning their child in the proper seat pursuant to Republic Act
No. 8750. Of the overall sample, 18.5% reported to have ever used a child restraint. 9.4% of the
sample on the other hand are currently using child restraints with a slightly higher rate of use for the
urban population compared to rural. In terms of children who were supposed to be on child
59
restraints, only 6.3% were currently using child restraints. There was a significant difference in rate
of use with urban children compared to the lower compliance of rural children.
About half of all respondents ever heard of the term “child restraints”, while 59.5% has ever
seen a of child restraint prior to the survey. The difference in the rate of awareness between urban
and rural was not significantly different. It was noted that knowledge was very low (10%) among all
respondents.
In terms of attitudes and perception, respondents agree that child restraints prevent severe
injury and that the wrong restraints can lead to severe injuries. The average scores suggested a
neutral view about the need for child restraints when they drive. Disaggregated to never users and
ever users, however, show that users feel the need for the device while never users were
ambivalent about it. Similarly, users are not comfortable without child restraints while never users
are neutral about it. In terms of information, respondents were unsure about the amount of support
about child restraints they receive or they come upon.
In terms of finding out which child restraints to acquire, consumers inquire or learn about
child restraints through, (1) independent research, (2) information from someone they knew, and
(3) information from sales staff. Most respondents purchased the child restraints. The most common
source of bought child restraints was the department store followed by baby shops and car
accessory shops.
Child restraints were found to be affordable for Filipino consumers interviewed despite their
misconceptions that child restraints are too expensive. Of all products found to be available in the
Philippines directly from local distributors, on average, rear-facing only products were PhP 9,781.34,
boosters were priced at PhP 3,598.00, while combination products, on average, were PhP
10,518.19. For online products, the average prices of brand-new seats were PhP 5,755.44 and
second-hand were on average PhP 3,535.00. Prices for brand new products varies from PhP
7,632.48 for rear-facing only, PhP 8,425.15 for front-facing only seats, PhP 6,219.30 for booster
seats, to 4,479.67 for combination seats. The average price from malls on the other was PhP
8,864.52. This complies with the range of the drivers interviewed claiming that they were willing to
60
pay between PhP 1,000.00 to PhP 5,000.00 for child restraints, and that they will buy it especially if
it were required by law and if their budget then would allow it.
In terms of certification, not all of the child restraints inspected had certifications. In those
closely investigated in physical stores, only 83% of the products displayed proof of ECE R44
certification.
We found that almost all of the current car models being sold in the country are equipped
with ISOFix seats. Of the 220 cars investigated 84% were IsoFix equipped. Seven percent (7%)
could be equipped upon request while only nine percent (9%) did not have IsoFix
In terms of the role of TNVS, two national companies interviewed support interventions for
road safety especially for children. Though both are willing to collaborate with the government, and
agree in the need for a proper design in policy for child restraint, only one expressed support for
legally mandating its use. With both companies having models of utilizing child restraints in other
countries, the companies state that mandating the use of child restraints in the country would incur
them, their drivers, and the consumers with increased cost.
With these results of the demand-side and the supply-side of the market, running a literature
review, exhibiting a prototypical company based on current distributor’s financial statements, and
validating the results through a comprehensive workshop with key stakeholders, the following are
the identified points, and measures that would promote the use of child restraints among Filipino
drivers with children:
1. The law should be considerate of the socio-economic situation in the country and its creation
should involve all stakeholders. The legislation to be created mandating the use of child
restraints will incur additional cost to both private vehicle owners and those who use public
transportations and therefore should take into account the added burden purchasing or
renting these child restraints will bring to the Filipino people. Further, the law should address
the issue of public transport. Because child restraints will be required for every child
passengers, this will have to include children from all socio-economic backgrounds. This
therefore will include children being brought to school in school, jeepneys, and in tricycles.
61
The legislation must be clear about how it will mend the added expense of these vehicle
operators or from the parents of these children whose income may not allot a budget for
child restraints purchase at current prices.
2. The study was able to show that in fact, going into the child restraints market is profitable,
and a demand exists even without the law in place. However, as the scoping showed two (2)
companies control most of the market, and there are only seven (7) companies in the
Philippine market. This low supply may be bringing up the prices and making child restraints
a less priority for parents. Prices therefore should be driven down by increasing players in
the supply and distribution of child restraints in the Philippines. Further, the government may
look for other means for decreasing prices such as supporting rental services, offering
coupons, partnering with car companies to give out child restraints with car purchases, or
instituting trade in programs so the upgrading of child restraints as the child grows would
incur minimal costs, instead of having to buy at least 3 different child restraints before the
child grows out of the need to be in child restraints.
3. With an increase supply expected, the law should also provide guidance on the development
of national standards that will not compromise competition, yet assure consumers that all
approved child restraints are of acceptable quality. Agencies must perform biomechanical
studies, as well as make sure that child restraints coming in the country, and those that may
be manufactured in the country have guidelines and specifications set for the Filipino child’s
body frame. Also crash studies should be performed by the Government to check for any
differences in the use of child restraints with local vehicles and public transportation (eg.
jeepneys have no doors, owner type vehicles are not completely covered in steel, etc.). The
Government should implement strict but fair standards in the importation of child restraints,
and in the permit of any company who wishes to enter the market. Business incentives such
as tariff on income tax exemptions, for a limited time, may be explored.
62
4. There should be simple and clear implementation guidelines for law enforcement. The
misuse or the non-use of child restraints are difficult to perceive due to a number of factors
such as the darkness of car window tint, the different sizes of Filipino children, and the age
of the child, just to name a few. In order to mend this, the guidelines in the implementation of
a possible law should be carefully planned with law enforcement. Training, and a simple and
direct parameter must be in place to minimize ambiguities in enforcing the law.
5. Finally, there should be increased efforts to improve knowledge about child restraints and
activities that advocate for its use. There must be a two-pronged approach to the promoting
child restraint. The first is educating the Filipino people on the need for child restraint.
Parents and consumers need to be aware that child restraint has the capacity to prevent
injury or save a child’s life. The second, consumers must be aware of the proper use of child
restraint. They have to be informed on what model is appropriate for their child at a given
period in the child’s development, how to correctly install it, and how to accurately keep a
child in the proper configuration throughout the ride. In order to achieve these two goals of
promotion, other stakeholders such as physicians, sales representatives, and car dealers
must also be trained in educating consumers.
63
VII. Bibliography
1. Nakahara S, Ichikawa M, Nakajima Y. Effects of Increasing Child Restraint Use in Reducing
Occupant Injuries Among Children Aged 0–5 Years in Japan. Traffic Inj Prev [Internet]. 2015
Jan 2;16(1):55–61. Available from: http://dx.doi.org/10.1080/15389588.2014.897698
2. Children C, Services T. Child Passenger Safety Guidelines Child Passenger Safety
Guidelines. 2011;(June).
3. Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of Belt Positioning Booster
Seats: An Updated Assessment. Pediatrics [Internet]. 2009;124(5):1281–6. Available from:
http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2009-0908
4. NHTSA. Traffic Safety Facts. Www-NrdNhtsaDotGov [Internet]. 2009;(May):Volume: 2001,
Issue: June, Pages: 232. Available from: http://www-
nrd.nhtsa.dot.gov/Pubs/811620.pdf%5Cnhttp://www-nrd.nhtsa.dot.gov/Pubs/809778.pdf;
Date Accessed: June 28, 2017
5. World Health Organization. Global Status Report on Road Safety 2015. WHO Libr Cat Data
Glob [Internet]. 2015;340. Available from:
http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/; Date Accessed:
July 3, 2017
6. Shew R, Dardis R. Russell Shew and Rachel Dardis An Economic Analysis of Child
Restraints. 1995;417–31.
7. Peden M. World Health Organization dedicates World Health Day to road safety. Inj Prev
[Internet]. 2004;10(2):67–67. Available
from:http://ip.bmj.com/cgi/doi/10.1136/ip.2004.005405; Date Accessed: July 3, 2017
8. Republic of the Philippines. An Act Requiring the Mandatory Compliance by Motorists of
Private and Public Vehicles to Use Seat Belt Devices, and Requiring Vehicle Manufacturers
to Install Seat Belt Devices in All Their Manufactured Vehicles.
9. Medina M. Did You Know: Road Crash Cases [Internet]. Inquirer; 2016. Available from:
http://newsinfo.inquirer.net/833560/did-you-know-road-crash-cases; Date Accessed: June 29,
2017
64
10. Colleti R, Hospital-Based Rental Programs to Increase Car Seat Usage. Pediatrics Volume
71, Issue 5. May 1983.
11. Kedikoglou S, Belechri M, Dedoukou X, Spyridopoulos T, Alexe D, Pappa E, Stamou A,
Petridou E. A Maternity Hospital-Based Infant Car-Restraint Loan Scheme: Public Health and
Economic Evaluation of an Intervention for the Rediction of Road Traffic Injuries.
Scandinavian Journal of Public Health. January 1, 2005.
12. Ebel B, Koepsell T, Bennet E, Rivara F. Use of Child Booster Seats in Motor Vehicles
Following a Community Campaign: A Controlled Trial. JAMA. 2003;289(7):879-884.
doi:10.1001/jama.289.7.879
Review of Literature Bibliography
Community Interventions
1. Stuy M, Green M, Doll J. Child Care Centers: a Community Resource for Injury
Prevention. The Journal of Developmental and Behavioral Pediatrics. 1993 Aug;14(
4):224-9.
2. Chang A, Diliman A, Leonard M, English P. Teaching Care Passenger Safety to

Preschool Children. Pediatrics. 1985 Sep;76(3):425-8.
3. Bowman JA, Sanson-Fisher RW, Webb GR. Interventions in Preschool to Increase the
Use of Safety Restraints by Preschool Children. Pediatrics. 1987 Jan;79(1):103-9.
4. Beth E, Koepsell T, Bennet E, Rivara F. Use of Child Booster Seats in Motor Vehicles
Following a Community Campaign: A Controlled Trial. JAMA. 2003 Feb 19;289(7):879-
84.
Post-partum Intervensions
5. Liberato C, Eriacho B, Schmiesing J, Krump M. SafeSmart Safety Seat Intervention

Project: A Successful Program for the Medically Indigent. Patient Education and
Counseling. April 1989 13 (2): 161-170.
6. Christophersen ER. Sullivan MA. Increasing the Protection of Newborn Infants in Cars.
Pediatrics. 1982 Jul;70(1):21-5.
7. Reisinger KS, Williams A. Evaluation of Programs Designed to Increase the Protection

of Infants in Cars. Pediatrics. 1978 Sep;62(3):280-7.
8. Chang A. Hearey CD, Gakkagher KD, English P, Chang PC. Promoting Child Passenger
Safety in Children Served by a Health Maintenance Organization. Patient Education and
Counseling. 989 Jun;13(3):297-307.
65
9. Geddis DC, Pattengell R. Parent Education: Its Effect on the Way Children are
Transported in Cars. N Z Med J. 1982 May 12;95(707):314-6.
10. Robitaille Y. Legault J, Abbey H, Pless I. Evaluation of an Infant Car Seat Program in a
Low-Income Community. American Journal of Diseases of Children. 1990
Jan;144(1):74-8.
66
ANNEX A. UP RGAO Certificate of Registration
67
ANNEX B. Informed Consent for Supplier-end Respondents for In-depth interview
Name of Principle Investigator: Hilton Lam, MHA, PhD

Name of Organization: Foundation for the Advancement of Clinical Epidemiology, Inc.
Name of Sponsor: World Health Organization
Name of Project and Version: Age-appropriate Child Restraints in the Philippines: A Baseline Study on the
Availability, Affordability and Acceptability of Age-appropriate Child Restraints in the Philippines
Information and Purpose of the Study:

Greetings! I am Dr. Hilton Lam of the Foundation for the Advancement of Clinical Epidemiology. I, together with my fellow
researchers, am conducting a study funded by the World Health Organization regarding child restraints in the Philippines. I
am going to give you information and invite you to be part of this research. You do not have to decide today whether or not
you will participate in the research. This consent form might contain words that you might not comprehend. You may ask
about these things. If you have questions later, you may ask those to me or to my research staff.
Study Design and Selection of Participants:

This study requires a group discussion with or interviews with stakeholders in child safety in the Philippines. There will be
around 30 to 40 respondents for this method.
Voluntary Participation and Right to Refuse or Withdraw:

Participation in this study is voluntary. It is your choice if you want to participate or not. You can change your decision at
any time and withdraw participation even after you agreed to participate in the beginning. You may stop participating at
any time that you wish without any repercussions and we will then remove your responses from notes and transcripts.
Procedure and Duration:

As a participant, you will sit in an interview that will last 15 to 20 minutes or in a group discussion that will last 30 to 40
minutes. We will ask about your experiences with using or supplying Age-appropriate Child Restraints in the country.
Further, we will ask you on models you offer or purchased, suggested specifications, certifications acquired, retail prices,
and sales information. I will take down notes during the interview and with your permission audio record our interview.
Risks:
There are no foreseen risks in participating in this study.
Benefits:
You will not receive any direct benefits for participating in this study. Data will be used to develop policies and programs
that may benefit you in the future. A token in the form of food worth PhP 150.00 will be provided.
Confidentiality:
The information to be collected in this interview will be anonymous and confidential. The report will not contain identifying
information about any respondent. A data protection plan is in place to protect private information. The ability to ensure
confidentiality will be limited due to the group nature of data collection. We will request all participants to avoid disclosing
identities of other participants to non-participants.
How the information will be used:

The information you provide will be used in aid of legislation for child restraints. The results of the study may be published
in academic and government journals and activities.
Who to Contact:
If you have any questions, you can ask them before we proceed. You may also contact the following:
Name: Hilton Lam, MHA PhD
Address: Room 315, Don Santiago Building, Taft Avenue, Ermita Manila
Phone Numbers: (63-2) 525-4098
Email: [email protected]
This study has been reviewed and approved by ____ Research Ethics Board, which is a committee whose task it is to
make sure that research participants are protected from harm. If you wish to find about more about the IRB, contact Dr.
____, UPMREB Review Panel __, 2/F Paz Mendoza Building, 547 Pedro Gil St., Ermita 1000 Manila, Email:
[email protected], Tel: +63 2 5222684, Mobile: +639273264910. Do you have any further questions?

68
Part II: Certificate of Consent
I have been invited to participate in research about child restraints. I have read the foregoing
information, or it has been read to me. I have had the opportunity to ask questions about it and any
questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a
participant in this study
Print Name of Participant__________________

Signature of Participant ___________________
Date ___________________________
Day/month/year
I have witnessed the accurate reading of the consent form to the potential participant, and the individual
has had the opportunity to ask questions. I confirm that the individual has given consent freely.
Print name of witness____________

Signature of witness _____________
Date ________________________
Day/month/year
69
ANNEX C. Tool for Suppliers In-depth interview
Code Question Response
I. Company Identifiers
Q101 Name and title of person answering the questionnaire
Q102 Company Name
Q103 Address of Company, and other locations if applicable
Q104 Name of CEO and other key officials
Q105 Number of employees
Q106 History of company
II. Company Profile

Q201 Title of Head Office
Q202 Legal Status of Company
Q203 Founding Year
Q204 Business Activities
III. Products
Q301 What are the products that you offer? What are their
specifications?
Q302 What certifications have you garnered?
Q303 What standards are upheld?
Q304 How do you inspect, and ensure quality?
Q305 How do you decide which restraints to purchase or produce?
IV. Pricing
Q401 What is your annual turnover on your businness?
Q402 What is the contribution of Child Restraints on your annual sales?
Q403 Where do you source these Child Restraints?
Q404 What are the going rate for these child restraints?
Q405 What are the best sellers?
Q406 In your opinion, why do these sell best among other choices?
V. Promotions
Q501 Who is your market?
Q502 How do you capture this market?
Q503 How do you advertise?
Q504 What do you capitilize when you market your products?
VI. Placement
Q601 How do you plan your placement in the market?
Q602 Where are your product found?
Q603 Where do the product sell better?
Q604 How do you maximize visibility?
70
ANNEX D. Tool for Extraction of Sales Information
A. Company Information
Questions Current Annual Mean (5 years)
Company Net Sales
Gross Profit
Operating Cash Flow
Diluted Net Earnings
Brands
Segments
Products
Models Available
Volume produced/purchased
Volume sold
Net sales per model
Cost of goods sold
Advertising Expense
Conditions
Legal Function
Environment
Personnel
Quality
71
B. Child Restraint Data
Brand Name
Company
Model Name
1 Rearward Facing Child Restraint
Type (if convertible, check all) v
Forward Facing Child Restraint
v
Booster seat
Intended age (as described in brochure)
v to years old
Recommended weight (as described in brochure) Kg
Recommended length/height (as described in brochure) Cm
Certificating body
Available locations
Available online No___ Yes___, if yes, where? ________________
Price PhP
Model Name
v
Booster seat
Intended age (as described in brochure) v to years old
Certificating body
Available locations
Price PhP
Model Name
v
Booster seat
Certificating body
Available locations
Price PhP
Model Name
v
Booster seat
Intended age (as described in brochure)
v to years old
Certificating body
Available locations
Price PhP
Model Name
v
Booster seat
Certificating body
Available locations
Price PhP
72
ANNEX E. Assumed Consent for Consumer Survey
Name of Principle Investigator: Hilton Lam, MHA, PhD

Name of Project and Version: Age-appropriate Child Restraints in the Philippines: A Baseline
Study on the Availability, Affordability and Acceptability of Age-appropriate Child Restraints
in the Philippines
Dear Participant,
Greetings! We are from the Foundation of the Advancement of Clinical Epidemiology. You have in
your hand a questionnaire for our study entitled, “Age-appropriate Child Restraints in the
Philippines: A Baseline Study on the Availability, Affordability and Acceptability of Age-
appropriate Child Restraints in the Philippines”. The team has been contracted by the World
Health Organization – Philippines, to conduct this baseline study on child restraints that will be used
in support of legislation for road safety. We are inviting you because you are a driver of a four-wheel
vehicle and have children. Your participation is voluntary and your refusal to participate will not
involve penalty or loss of benefits to which you are otherwise entitled, and you may discontinue
participation at any time without penalty or loss of benefits.
We will keep your responses anonymous and confidential. We do not expect you to experience any
harm due to participation. We also do not expect any direct benefits; however, the results may help
in developing road safety policies and programs. Upon completion of this survey, we will provide
you with a token worth PhP 40. If you agree to participate, kindly answer the survey form below to
the best of your abilities. Kindly refrain from using references or consulting other individuals
regarding survey responses. By returning the completed survey, it is assumed that you give your
consent to participating in this survey.
If you have any questions, please ask. If you have additional questions later, contact
Name: Hilton Y. Lam, MHA, PhD
Address: Unit 21M 8 Adriatico, J Bocobo corner Padre Faura, Ermita, Manila
Thank you for your time, and taking part in this important study!

73
ANNEX F. Assumed Consent for Consumer Survey in Filipino
Pangalan ng Principal Investigator: Hilton Lam, MHA, PhD

Pangalan ng Organization: Foundation for the Advancement of Clinical Epidemiology
Pangalan ng Sponsor: World Health Organization
Pangalan ng Project and Version: Age-appropriate Child Restraints in the Philippines: A
Baseline Study on the Availability, Affordability and Acceptability of Age-appropriate Child
Restraints in the Philippines
Dear Participant,
Magandang araw! Kami ay taga Foundation of the Advancement of Clinical Epidemiology. Hawak
mo ngayon ay isang sorbey para sa pag-aaral, “Age-appropriate Child Restraints in the
Philippines: A Baseline Study on the Availability, Affordability and Acceptability of Age-
appropriate Child Restraints in the Philippines”. Nagsasagawa kami ng pag-aaral na
pinondohan ng World Health Organization upang masuri ang kondisyon ng paggamit at pagbenta
ng Age-appropriate Child Restraints sa bansa. Gagamitin ang impormasyon para sa mga batas at
programa para sa Age-appropriate Child Restraints. Boluntaryo o kusang-loob ang pakikilahok mo
dito. Karapatan mong mamili kung makikilahok ka o hindi. Maaari ka magpalit ng pasya sa
anumang oras at bawiin ang pakikilahok kahit na pumayag ka pa sa simula. Mananatiling itong
confidential at walang pangalan ang kokolektahin ng mga tagapagsaliksik. Tanging mga pinagsama
na mga sagot ang isasama sa kanilang ulat. Hindi nila babanggitin ang iyong pangalan. Wala
kaming nakikitang panganib sa pakikilahok mo sa pag-aaral. Wala kayong makukuhang direktong
benepisyo sa pakikilahok sa pag-aaral. Gagamitin ang mga rekomendasyon ng pag-aaral para
gumawa ng mga batas at mga programa na maaring makaroon ng benepisyo sa iyo. Kung matapos
mo ang panayam, bibigyan ka ng pagkain na naghahalagang PhP 40 para sa iyong oras. Kung
sumasangayon kang lumahok, pakisagutan lang ang pagsisiyasat na ito sa abot ng iyong
kakayahan, at wag gumamit ng mga references, o mga sagot ng ibang tao. Sa pamamagitan ng
pagbalik ng nakumpletong survey, ito ay nagpapakita na nagbibigay kayo ng pahintulot sa
pakikilahok sa sorbey na ito.
Kung may mga tanong ka, maaari mo itong tanungin bago tayo magpatuloy. Maaari mo ring
tawagan ang sumusunod:


Salamat sa iyong oras at sa pagsali sa mahalagang pag-aaral na ito!

74
ANNEX G. Tool for Survey
Screening
1. Do you have children/siblings 13 years old or younger? Yes
v No
2. Do you drive a car, van or SUV? Yes
v No
3. Have you driven a car, van or SUV in 2016 with a child 13 years Yes No
or younger as a passenger?
v
(If yes on all, may proceed with the questionnaire)
Child Restraint Study

Consumer Knowledge, Awareness, Practices
Tool A: Version 1.3, February 13, 2017
I. Demographics
Q101 Age
Q102 Sex Male Female
v
Q103 Civil Status Single Married Widow Separated
Other ______
Q104 Religion Roman Catholic Muslim Evangelical
Iglesia ni Kristo Christian Others
Q105 City or municipality
Q106 Province
Q107 Occupation
Q108 Types of 4-wheel vehicles
Q109 4-wheel vehicle most used
II. General Information

Q201 How long have you known how to drive a 4-wheel
vehicle? ______ years
Q202 When did you first get your LTO registered

driver’s license? ______ year old
Q203 On average, how many hours in a week do you

drive a 4-wheel vehicle? ______ hours
Q204 How many 4-wheel vehicles do you own? ______ vehicles
III. Practices
Q301 The last time you drove a 4-wheel vehicle, did you Yes
use a seatbelt?
v No
Q302 How often do you use a seatbelt when driving or Always (10/10 times)
sitting on a 4-wheel vehicle? v
Most of the time (8/10times)
Sometimes (5/10times)
v
Occasionally (3/10 times)
Not at all (0/10 times)
v
75
Q303 The last time your child(-ren) less than 18 years old rode in the 4-wheel vehicle with you,
where were they seated?
Age Is his/her height less Position in Car
(Youngest than 145 cm (4’9 ft)?
to oldest)
Front Seat Rear Seat Sitting on Adult
v v v
Front Seat
v Rear Seat v Sitting on Adult v
v v v
Front Seat
v Rear Seat v Sitting on Adult v
v v v
IV. Awareness
Q401 Have you heard of child restraints/child car seats? Yes
v No
Q402 Where is the best place for a child 6 year old to sit in a car? Front Seat
v
Rear Seat
v
Sitting on Adult
v
Q403 Have you ever seen a child restraint/child car seat prior to this Yes
interview?
v
No
Q404 How old should a child be before s/he should start and stop using the following car seat?
Start: ______ yo Start: ______ yo Start: ______ yo Start: ______ yo

Stop: ______ yo Stop: ______ yo Stop: ______ yo Stop: ______ yo
Don’t know Don’t know Don’t know Don’t know
V. Preference
Rate how much you agree with the following statements (check the box that applies)
Q501
Strongly Disagree Agree Strong
Disagree ly
Agree
Child restraints prevent severe injury or death in vehicle
accidents.
Children in the wrong restraints are likely to have more severe
injuries if there is a crash.
Child restraints are too expensive to buy or hire.
There is no need for child restraints where I drive
I feel comfortable even without child restraints
There is adequate support and information about child
restraints.
It is easy to purchase child restraints
I encourage others to use child restraints
It is just as safe for children over the age of 7 years to sit in the
front passenger seat as it is in the back seat.
76
VI. Child Restraint Users
Q601 Have you used child restraints/child car seats? Yes (continue to next question)
v
No (end of survey)
v
Q602 Are you currently using child restraints/child car Yes No
seats?
v
Q603 Which of the following images most resemble the one you use?
Q604 What are the ages, weight and height of the child using the child restraint/child car seat?
Age (Youngest to oldest) Height (Feet, Inches) Weight (Kg)
1.
2.
3.
Q605 How did you obtain the car
v Borrowed from relative, friend, neighbour
safety seat? Given by a relative, friend, neighbour
Purchased brand new
v
Purchased second hand
Came with the car
v
v Others ______________________
Q606 If you purchased a car safety Did not purchase car safety seat
seat, where did you buy one? Specialty shop for children and babies
Specialty shop for cars and car accessories
v
Purchased second hand
Department store/General merchandise section?
v
Online store/seller
v
v Individual dealer
Relative, friend, neighbour
v
Others ______________________
v
Q607 How did you hear about the car Independently researched
v
safety seats? I saw someone with a car safety seat
v
Informed by someone I know
v
Tv, media, journal, advertisement
v
Advice from doctor/nurse
v
Advised by car salesman
v
Other ______________________
v
Q608 How did you know which one to Independently researched
get?
v
I saw someone with a car safety seat
v
v
Informed by the sales persons
v
v
Other ______________________
v
77
Q609 How did you learn how to install Independently researched
and use the child restraint?
v
I saw someone with a car safety seat
v
v
Informed by the sales persons
v
v
Other ______________________
v
Q610 Kindly rate your agreement with the following statements:
Strongly Disag Agree Strongly
Disagree ree Agree
I would use a child restraint every time I travel with my
child in my vehicle.
I would insist that my child wears a restraint even if
s/he doesn’t want to.
I would buy a new restraint as soon as my child
needs/grows out of one.
It is easy to install child restraints by yourself.
I am satisfied with my ability to correctly fit and use
child restraints.
I encourage others to use and inform them how to
properly select and use child restraints
-Thank you! Kindly return the form and avail of your token.-
78
ANNEX H. Tool for Consumers In-depth interview

Question Response
1. How long have you been driving?
2. How long have you had your driver’s
license?
3. What is your annual income? Range of
Php 50,000

4. How many children do you have? What
are their ages and height?
5. Have you ever heard of child restraints?
6. Have you ever used child restraints?
If never used Age-Appropriate Child Restraints

7. Why haven’t you used Child restraints?
8. At what price range would you most
likely buy one?
9. Are you aware of any laws regarding
child restraints in the country
10. Why do you think we should not have
laws on child restraints?
11. Has anyone informed you about Child-
restraints?
12. Do you plan to buy one eventually?
If with usage of Age-appropriate Child restraints

13. How did you acquire your restraints?
14. Why did you get your restraints?
15. What model is your Child-restraint?
How is it used?
16. Where did you learn about Child-
restraints
17. Do you encourage others to use Child-
restraints?
18. What measures can be taken to
increase proper usage?

79
ANNEX I. Tool for Transportation Network Company

Name of Principal Investigator: Hilton Lam, MHA, PhD
Name of Project: Child Restraints in the Philippines: A Baseline Study on the
Availability, Affordability and Acceptability of Age-appropriate Child Restraints in the
Philippines
Dear Dr.,
Greetings!
We are from the Foundation for the Advancement of Clinical Epidemiology. We have been
contracted by the World Health Organization – Philippines, to conduct the study entitled,
“Child Restraints in the Philippines: A Baseline Study on the Availability,
Affordability and Acceptability of Age-appropriate Child Restraints in the
Philippines”.
The objectives of this study are: to (1) determine the availability and access to age-
appropriate child restraints that conform with international standards in the Philippines, (2)
determine knowledge, attitudes, and behavior among Filipino car users on child safety and
the use or non-use of child restraints, (3) determine acceptability and affordability of age-
appropriate child restraints among car users eligible for the study, and (4) identify points,
and measures that promote use of child restraints among Filipino drivers with children.
In line with these objectives, we will explore Transportation Network Companies’

perceptions, attitudes, and impressions on the practicality and appropriateness on a
possible directive mandating child restraint use in the country.
Your participation is voluntary and you may discontinue participation at any time. Though
we intend to withhold the names of the employees, we plan to include company names in
the final report of the study to highlight the companies in the country. If you do wish to
withhold this information however, we will be glad to strike off any identifying information.
We do not expect you to experience any harm due to participation. We also do not expect
any direct benefits; however, the results may help in developing road safety policies and
programs. If you agree to participate, kindly answer the Key Informant Interview Form
below to the best of your abilities. By returning the Form that follows, it is assumed that you
give your consent to participating in this survey.
If you have any questions, please ask. If you have additional questions later, contact
Thank you for your time, and taking part in this important study!
80
Date: Day_______________ Month __________________ 2017
General Information
1. Name and Position
2. Organization
3. Address of Organization
4. Name of Chief Executive
Officer of Organization
5. History of Company
6. Years in Business
7. Business activities

Please answer the following questions.
Q101 In your opinion, is there a need to legally mandate child
restraint use in the country? Why or why not?
Q102 What is your organization’s likely stance towards
legislation mandating child restraint use in the
Philippines?
Q103 Does your company offer any child restraint services in
the Philippines? If yes, how is this implemented?
Q104 Does your company offer any child restraint services in
other countries? How is this implemented and what
experiences in other countries will you likely apply in the
Philippines?
Q105 What are the strategies that your company plans to offer
in the event that a legislation requiring child restraint use
is implemented to companies such as yours in the
country?
Q106 Do you think these strategies will affect your consumers
(eg. Pricing, Comfort, Application Interface, etc.)?
Q107 If there is legislation requiring child restraints for child
passengers in the country, how will your company
comply with the law? How will this affect your business
and operations?
Q108 What are the possible risks and disadvantages to your
industry if lawmakers mandate child restraint use in the
country?
Q109 What efforts should be prioritized by the government in
order to succeed in mandating child restraint use in the
country?
Q110 Do you agree that your company and/or your drivers will
be liable, in case a passenger is unrestrained? Why or
why not?
Q111 Others, please specify:
-Thank you!
81
ANNEX J. Letter to Transportation Network Company

FOUNDATION FOR THE ADVANCEMENT
FOUNDATION
Æ

OF CLINICAL EPIDEMIOLOGY, INC.

7 June 2017

(Name)
Officers and members of Position
The Board of Council
Organization

Address

Jacinto Blas V. Mantaring III, MD
President Dear (Name),

Olivia T. Sison, MSPH Greetings!
Secretary

Hilton Y. Lam, PhD My team has been contracted by the World Health Organization (WHO) Philippines,
Treasurer to implement the study entitled, “Age-appropriate Child Restraints in the Philippines:

A Baseline Study on the Availability, Affordability and Acceptability of Age-
appropriate Child Restraints in the Philippines”.

The objectives of this study are: to (1) determine the availability and access to age-

appropriate child restraints that conform with international standards in the
Philippines, (2) determine knowledge, attitudes, and behavior among Filipino car
users on child safety and the use or non-use of child restraints, (3) determine
acceptability and affordability of age-appropriate child restraints among car users
Board Members
eligible for the study, and (4) identify points, and measures that promote use of child
restraints among Filipino drivers with children.

Marissa M. Alejandria, MD
This endeavor is in support of future legislations and national programs on Age-
Vicente Y. Belizario, Jr., MD
appropriate Child Restraints use in the Philippines.
Nina T. Castillo-Carandang, MSc
As part of the study, we will explore Transportation Network Companies’
Cynthia P. Cordero, MSc perceptions, attitudes, and impressions on the practicality and appropriateness on a

possible directive mandating child restraint use in the country. We are requesting for
Amelia R. Fernandez, MD your participation in this study by sharing your inputs through the attached self-
administered key informant interview questionnaire.
Noel R. Juban, MD

Mary Ann D. Lansang, MD If you have any questions, please do not hesitate to contact our staff at (02)579-1097
(look for Angelica Castro), 0922-723-9946 or via email ([email protected]). Our
Agnes D. Mejia, MD staff will follow-up on our request.

Carlo Irwin A. Panelo, MD
We thank you for your time and kind consideration on this matter.

Sincerely,

ADDRESS Hilton Lam, MHA, PhD

Don Santiago Building
Room 315, Principal Investigator

Taft
Avenue, Ermita Manila
1000 Philippines

Telefax No.: (63-2) 525-4098


82
ANNEX K. Letter to Stakeholders for Workshop
FOUNDATION FOUNDATION FOR THE ADVANCEMENT

Æ


Date

Name

Officers and members of Position
The Board of Council Department/Office
Company/Organization/Affiliation

Jacinto Blas V. Mantaring III, MD Address
President

Olivia T. Sison, MSPH
Secretary Dear Surname,

Hilton Y. Lam, PhD
Treasurer Greetings!

We are pleased to invite you to a workshop on the results of our study
entitled, “Child Restraints in the Philippines: A Baseline Study on the
Availability, Affordability and Acceptability of Child Restraints in the
Philippines” conducted from March – May 2017. This will be held on June
2, 2017, from 9:00 am – 4:30 pm at Armada Hotel Manila, 2108 M.H.
Del Pilar St., Malate, Manila (Hotel tel. no: (02) 526 0888).
Board Members

The objective of this workshop is to present the findings of our study,

garner insights and advice for policy and promotion of child restraints use

Vicente Y. Belizario, Jr., MD in the country, and to discuss updates on pending bill on child restraints.

Nina T.
Castillo-Carandang, MSc As a stakeholder when it comes to child car safety, your opinions are
Cynthia P. Cordero, MSc crucial to the discussions on this topic. There is no registration fee for the
participants and all necessary materials will be provided. Pay parking is
Amelia R. Fernandez, MD available across the street.

Noel R. Juban, MD
If you have any questions, please do not hesitate to contact our staff at

Mary Ann D. Lansang, MD
(02)579-1097 (look for Angelica Castro), 0922-723-9946 or via email
Agnes D. Mejia, MD ([email protected]). Our staff will follow up on your attendance on or
before [date].
We look forward to hearing from you and hope that you would be willing
to accept our invitation to this event.

ADDRESS
Sincerely,
Room 315, Don Santiago Building
Taft Avenue, Ermita Manila
1000 Philippines

Telefax No.: (63-2) 525-4098
Email: [email protected] Principal Investigator

83
ANNEX L. Letter Inviting Key Informants for Interview

FOUNDATION
Æ

Date

Name
Position
Company
Address

Officers and members of

The Board of Council Dear Ms./Mr. Surname,

My team has been contracted by the World Health Organization (WHO) Philippines,
Jacinto Blas V. Mantaring III, MD to implement the study entitled, “Age-appropriate Child Restraints in the Philippines:
President
Olivia T. Sison, MSPH appropriate Child Restraints in the Philippines”.
Secretary
The objective of this study is to (1) determine the availability and access to age-
Hilton Y. Lam, PhD appropriate child restraints that conform with international standards in the

Treasurer


appropriate Child Restraints use in the Philippines. The expected duration of the
Board Members study is from March 2017 to the end of May 2017.

Marissa M. Alejandria, MD As part of the study, we will investigate the availability of these constraints through
surveying suppliers, distributors, importers, and manufacturers of child restraints in

Vicente Y. Belizario, Jr., MD the Philippines. To give us a good grasp on the condition on your end of this market,
Castillo-Carandang, MSc we would like to ask for an interview with you regarding Age-appropriate Child
Nina T.
Restraints that you offer preferably on [date range]. If you are not available on the

said dates, we can reschedule the interview on the best time that you are available.
Cynthia P. Cordero, MSc

Amelia R. Fernandez, MD We are also requesting for a list of models, suggested specifications, certifications,
retail prices, and sales data on these child restraints that you offer in the country to
Noel R. Juban, MD supplement our understanding of the current situation. Though we intend to
Mary Ann D. Lansang, MD withhold the names of the employees, we plan to include product and company
names in the report of the study to highlight available models in the country. If you
do wish to withhold this information however, we will be glad to strike off any
Agnes D. Mejia, MD
identifying information.
If you have any questions, please do not hesitate to contact our staff at (02)579-1097
(look for Angelica Castro), 0922-723-9946 or via email ([email protected]). Our

staff will follow-up on our request.


ADDRESS

Sincerely,
Taft Avenue, Ermita Manila
1000 Philippines

Telefax No.: (63-2) 525-4098 Principal Investigator
84

ANNEX M. Letter to Malls

FOUNDATION
FOUNDATION
FOR THE ADVANCEMENT
Æ

Date

Mall
Company
Officers
and members of Address
The Board of Council

Jacinto Blas V. Mantaring III, MD Dear Sir/Ma’am,
President
My team has been contracted by the World Health Organization (WHO) Philippines,
Olivia T. Sison, MSPH
to implement the study entitled, “Age-appropriate Child Restraints in the Philippines:
Secretary
Hilton Y. Lam, PhD appropriate Child Restraints in the Philippines”.
Treasurer
The objective of this study is to (1) determine the availability and access to age-
appropriate child restraints that conform with international standards in the

Board Members
appropriate Child Restraints use in the Philippines. The expected duration of the

Marissa M. Alejandria, MD study is from March 2017 to the end of May 2017.

Vicente Y. Belizario, Jr., MD
As part of the study, we will investigate the availability of these constraints through
Nina T. Castillo-Carandang, MSc surveying suppliers, distributors, importers, and manufacturers of child restraints in
the Philippines. We would like to request for a list of models, suggested
Cynthia P. Cordero, MSc specifications, certifications, and retail prices on these child restraints that you offer
in the country to supplement our understanding of the current situation. Though we
Amelia R. Fernandez, MD intend to withhold the names of the employees, we plan to include product and

company names in the report of the study to highlight available models in the
Noel R. Juban, MD
country. If you do wish to withhold this information however, we will be glad to
Mary Ann D. Lansang, MD strike off any identifying information.

Agnes D. Mejia, MD If you have any questions, please do not hesitate to contact our staff at (02)579-1097
Carlo Irwin A. Panelo, MD (look for Angelica Castro), 0922-723-9946 or via email ([email protected]). Our
staff will follow-up on our request.


Sincerely,

ADDRESS


Taft Avenue, Ermita Manila Hilton Lam, MHA, PhD
1000 Philippines Principal Investigator
Telefax No.: (63-2) 525-4098
85
ANNEX N. Letter to Land Transportation Office

FOUNDATION
jenn OF CLINICAL EPIDEMIOLOGY, INC.
Æ

Date

Name
Position
Land Transportation Office

Address

Officers and members of

The
Board of Council
Dear Ms./Mr. Surname,

Jacinto Blas V. Mantaring III, MD My team has been contracted by the World Health Organization (WHO) Philippines,
President to implement the study entitled, “Age-appropriate Child Restraints in the Philippines:

Olivia T. Sison, MSPH A Baseline Study on the Availability, Affordability and Acceptability of Age-
appropriate Child Restraints in the Philippines”. This is in support of planned
Secretary
legislation regarding child restraints.
Hilton Y. Lam, PhD

Treasurer One of the objectives of the study is to determine knowledge, attitudes, and behavior
among Filipino car users on child safety and the use or non-use of child restraints. To

achieve this, we plan to conduct surveys among Filipino drivers. We would like to
request permission and endorsement to conduct survey from [date range] at the
following sites:

1. Land Transportation Office [Region] (Address), Driver’s License Renewal
and Car Registration
Board Members 2. Land Transportation Office (Address), Driver’s License Renewal and Car
Registration

We will send teams of data collectors to recruit and interview drivers renewing

Vicente Y. Belizario, Jr., MD licenses, and registrations. We might also request to occupy a small area in the lobby
or waiting area to set-up our interview station. Rest assured, we will coordinate with

Nina T. Castillo-Carandang, MSc local offices to minimize workflow disruptions during our data collection.

Cynthia P. Cordero, MSc If you have any questions, please do not hesitate to contact our staff at (02)579-1097
(look for Demi Sepe/Sheryl Grijaldo), [contact number] or via email (email address).

Amelia R. Fernandez, MD Our staff will follow-up on our request.
Noel R. Juban, MD
Mary Ann D. Lansang, MD

Sincerely,
Agnes D. Mejia, MD

Principal Investigator

ADDRESS
Don Santiago
Room 315, Building
Avenue, Ermita Manila
Taft
1000 Philippines
Telefax No.: (63-2) 525-4098

86
ANNEX O. Curriculum Vitae of Principal Investigator

Residence: Unit 16R, One Adriatico Place, Ermita, Manila;
Mailing address: 75 Apo Street, Quezon City, Philippines
Provincial Address: 22 Sevilla St., Zamboanga City, Philippines
Email: [email protected], [email protected]
EDUCATION and ACADEMIC AWARDS
Ph.D. in Health Economics

University of Tokyo, Faculty of Medicine, Department of Health Economics, Administration,
Policy, Health Promotion Sciences and Bioethics, 2004, GPA 4.00 (4.00 scale)
Monbukagakusho (Japanese Ministry of Education and Science) Research Grant
Doctoral Dissertation: “Factors affecting Individual Time Preferences for Health: A Philippine-
USA comparative study”
Master of Hospital Administration

University of the Philippines, Manila, College of Public Health, Department of Health Policy and Public
Health Administration, 2000, GWA 1.32 (1.00 scale) (Top 2), Dean’s List
Master Thesis: “An evaluation of the billing system of the Private Pay Services of the
Philippine General Hospital”
B.A. Business Administration and Economics and B.A. Biology

Whittier College, Department of Biology, and Department of Business Administration and Economics,
1992, GPA 3.53 (4.00 scale)
John Greenleaf Whittier Centennial Academic Scholarship
Dean’s List
Omicron Delta Epsilon (International Honor Society in Economics)
Undergraduate Research: “Wildlife corridors in the San Fernando Valley”, “Feasibility study
on establishing a child care center for Rancho Los Amigos Medical Center Hospital (a Los
Angeles County health facility)”
RESEARCH EXPERIENCE: HEALTH ECONOMICS, FINANCE, AND POLICY CONSULTANCY
Director
Institute of Health Policy and Development Studies (IHPDS)
National Institutes of Health
UP Manila – 2012 to present
Program Coordinator
Metro Manila Health Research and Development Consortium (MMHRDC) – 2013 onward
Council Member, as Pharmaco-economics experts

Formulary Executive Council
Philippine National Formulary
Researches on Pharmaceutical Supply System and the Davao Region
“Assessing Options to Improve TB Commodities Supply Management in Philippines”. A

research study funded by Systems for Improved Access to Pharmaceuticals and Services
(SIAPS), Management Sciences for Health (MSH). 2014-2015. As Principal Investigator.
“Strengthening the Financial Management of Health Facilities in the Davao Region”. A

research study funded by the Department of Health, Davao Regional Office. 2014 to present.
As Principal Investigator.
87
“Improving National Tuberculosis Program Supply Chain Performance: Costing of Proposed
Options”. Funded by the Systems for Improved Access to Pharmaceuticals and Services
(SIAPS), Management Sciences for Health (MSH). 2013-2014. As Principal Investigator.
“Public Private Partnerships in Health (Pharmacy, Hospital management, Laboratory,

Emergency Services, and Birthing facilities”, 2011 – 2013, Asian Development Bank. As
Health Financing Expert
“Provincial Health Facilities Rationalization for Davao Region” Funded by the Davao Regional
Office, Department of Health. 2009-2010. As Investment Expert.
“Cost Effectiveness Analysis of Anti -rotavirus vaccine vs IMCI”, National Center for
Pharmaceutical Access and Management, Department of Health, March 2012 to present. As
Coinvestigator.
“Cost Effectiveness of the Human Papilloma Virus (HPV) Vaccine”, National Center for
Pharmaceutical Access and Management, Department of Health, November 2012-August
2013. As Co-investigator.
“Cost Effectiveness Analysis of PCV 10 vaccines vs PCV 13 vaccines”, National Center for
Pharmaceutical Access and Management, Department of Health, 2011-2012. As Project
leader.
“Botika ng Bayan (Village pharmacies) Summit,” WHO-WPRO, February 1- November 4,

2007. As co-organizer.
“Towards an Enhanced Health Care System by Community Managed Health Care Program
to Achieve Better Health Outcomes: A community participatory Research”. Funded by the
University of the Philippines System. 2012-2016.
“Crafting A Methods Manual for the Conduct of Economic Evaluation of Medicines”, National
Center for Pharmaceutical Access and Management, Department of Health, October 2014 to
present. As Co-investigator.
“An Analysis of Noncompetitive Business Practices within the Philippine Pharmaceutical

Industry, and their Effects on Retail Prices of Medicines and Medications. A research funded
by the Institute of Health Policy and Development Studies, 2001. As Principal Investigator.
“PhilCAT Membership Empowerment Study, Philippine Coalition Against Tuberculosis”.

A research study funded by the Philippine Coalition Against Tuberculosis. 2007. As
Coinvestigator
Other Researches
“Assessment of the Service Delivery Network for Geographically Isolated an Disadvantaged

Areas in the Philippines.” A research study funded by the Department of Health. 2014-2015.
As Principal Investigator.
“District Health Management training course” A 4 weeks intensive training course for
managers from Southeast Asia. GIZ (Government of Germany), 2011- 2012. As Health
Financing Expert
“Development of a Client Satisfaction Tools for DOH Hospitals”, A research study funded by
the Department of Health. 2014-2015. As Principal Investigator.
“Determining the Socio-Economic Burden of Violence in the Philippines”. A research study

funded by the Department of Health. 2015 to ongoing. As Principal Investigator.
88
“Costing of Cancer adjuvant treatments for Breast, Lung, Colon, Rectal cancers and
Lymphomas, towards an adjuvant insurance program”, 2010, Roche Pharmaceutical. As
Project Leader.
“Feasibility Study on the establishment of an Emergency Fund for the Philippine Integrated
Disease Surveillance and Response Program”, 2009-2010, WHO Philippines. As Project
Leader.
“Rapid Assessment Tool for the Estimation of Cost of Damages to Health Facilities
during Disasters, 2010, WHO Philippines. As Project Leader.
“The feasibility and design of a private hospital for El Nido town”, Malampaya Foundation,
Inc. August 2008 - February 2009. As Co-investigator.
“The feasibility and design of a community based health care system for indigent community
members living the Isabela Province”, Institute of Public Health Management, February 2005
-June 2006. As Project leader.
“Training Workshop on Rationalization of Health Facilities for Centers for Health Development
(CHDs),” Department of Health, April 21-30, 2008. As Investment planning expert.
“Business Planning for Public Health,” Indevelop, ADB Grant for Localization of F1, Mindoro
Oriental, Ilocos Norte, Ifugao, Philippines, 2007. As Health Financing expert.
“Business case for Public Private Partnership (PPP) management of Quirino Memorial
Medical Center (QMMC)”, Asian Development Bank, 2013. As Co-investigator.
“Social Marketing Plan for Clinic ng Bayan”, Clinic ng Bayan, 2013. As Co-investigator.
“Evaluation of the PHIC Case Rate and Global Budgeting”, Philippine Institute for
Development Studies, 2012-Ongoing. As Project leader.
Quality Assurance
“Strengthening the Quality Assurance Framework of the National Voluntary Blood Service
Program (NVBSP) of the Philippines: A Management Operations study”, 2012-2013,
Philippine Department of Health. As Project leader.
“TQM in Blood Banking”. Hospital and Operations Services, Philippine Department of Health,
2000. As lecturer in TQM monitoring and evaluation
Health and Hospital Policies and Procedures
“Crafting of policies on the practice of profession for Nurses, Dentists and Allied Medical
Professionals for the Philippines”, 2012-2014. Philippine National Institutes of Health. As
Project leader.
Hired, and managed 29 consultants to craft 35 baseline policy scans pertaining to the USAID
Strategic Objective Agreements 3 (SoAg3), USAID Health Policy Development Project,
HPDP, UP Diliman School of Economics, 2006-2008.
“Development of Schistosomiasis Philhealth Package Based on Actuarial Studies, Solicitation

of Accreditation from Philhealth and Board Resolution and Guideline Development for
Accessing Funds from Philhealth”, Department of Health, 2013-ongoing. As Project leader.
“Wheelchair Services, Utilization and Turnover in Low Resource Settings” A cross-sectional

mixed method study”. Funded by the Jhpiego. 2013 to 2014. As Principal Investigator.
89
“Determination of Prevalence of Injuries of Vehicular Crashes in the Philippines”, Jan 2014 to
present. As Project leader.
“Evaluation of the Mobile Health Education Program of the Bureau of Quarantine”, PCHRD,
2013 to present. As Co-investigator.
Policy Analysis on Asbestos in the Philippines”, UP College of Public Health, November

2013-2014. As Co-investigator.
“Post Incident Evaluation of EMS First Responders to Typhoon Yolanda”, Pacific Disaster
Center, March 2014 to present. As Project leader.
“A Morphological, Molecular, Genetic, Phytochemical, and Anti-Thrombocytopenic Profiling of

Different Euphorbia Hirta Linn Plants in the Philippines, October 2012-2014. As Co-
investigator.
Institute of Health Policy and Developmental Studies,

National Institutes of Health (NIH), 1999 –2000
Senior Research Associate
Project Leader, Philippine National Healthcare Factbook (June 2003, UPM Publishing,
Winner of National Academy of Sciences and Technology (NAST) Outstanding Book Award,
2006)
Data manager, Effects of the Economic Crisis on HIV-AIDS Programs
Co-organizer, RTD on Agricultural Reform, Policy Forum on Elderly Policy Forum on

Women’s Health, RTD on Health Sector Reform
Clinical Trials
Long Beach Research Foundation, Long Beach Veterans Administration Medical Center,
USA, 1992- 1995
Clinical Trials Manager
Managed more than 20 USFDA mandated phase II clinical trials on human volunteers
Educated and monitored volunteers’ medication compliance and adverse events,
Maintained legal records of laboratory reports, patient visits and endoscopic
procedures
Rancho Los Amigos Medical Center, USA, 1989-1990

Administrative Intern
Maintained monthly JCAHO compliance updates for the CEO
Member, Medical Center Child Care Center Planning Committee

Performed cost management analyses for all of the Medical Center's departments,
Analyzed special funds and trust accounts of the medical center
OTHER WORK EXPERIENCE
Lam Aqua Industry, (Lam Family Company) 1995-2009

VP in Charge of Finance
Sourced funding for expansion of plastics recycling factors; Designed, obtained contract
licenses and implemented Poultry Farming venture; Designed, obtained contract licenses and
implemented San Miguel Company Beverages Distributorship; founding member and original
Member of the Board of Director of Zamboanga City Poultry and Livestock Multipurpose
Cooperative
90
Office of the Vice Chancellor for Administration, University of the Philippines, Manila, 2000
Evaluated the feasibility of submitted project proposals; Organized the University of the
Philippines, Manila Social Marketing Plan Workshop
Office of the Undersecretary for Mindanao Economic Affairs, Zamboanga City, 1997-1998
Evaluated project proposals and project monitoring programs; Speech writing and delivery
coach
Joshua Medical Clinic, Cerritos, California, USA

Enrolled Clinic as a provider for third party payors; Made recommendations or the
restructuring of the Clinic's Corporate Charter
Rio Hondo Community Hospital, Downey, California, USA

Assessed and recommended solutions to the inhouse laboratory's space needs in the midst
of a merger with the much larger, nearby Downey Community Hospital.
World Health Organization, Western Pacific Regional Office, Manila, Philippines

Co-Investigator, “REINA Disaster Rehabilitation Plans, 5-year post Disaster Revisit”, 2009-
2010, WHO WPRO.
Health Cluster Coordination Assistant, 2006 Floodings, Philippines, December 2006-January

2007.
Assistant Project Coordinator, the Mass Casualty Management Systems of Fiji, The
Philippines, Singapore, and Vietnam, June 2005-April 2006.
Temporary Adviser on Mass Casualty Management and Hospital Disaster Management,

January 10-15, 2006.
Co-Investigator, Post-Disaster Health Sector rehabilitation needs of the Quezon Province

municipalities of: Infanta, General Nakar and Real, February – November 2005.
Primary Investigator, Economic Gains of Health Promotion: A review of literature,

WHO WPRO, November 22-25, 2004.
Program Designer and Workshop Lecturer, Unlad Kabayan Training Program on Basic Fraud and
Forgery, Philippine Overseas Worker Welfare Association, Tokyo, Japan, 2002.
ASSOCIATE PROFESSOR, The University of the Philippines, Manila, College of Medicine,

Department of Clinical Epidemiology, 2005 to present
Lecturer on Economic Evaluations in Clinical epidemiology, required core course for MS in

Clinical Epidemiology.
Course coordinator for Hospital Policy and Procedures Techniques and Tools , required core
course for MS in Clinical Epidemiology.
Guest Speaker on Pharmacoeconomics in Oncology for the Philippine Society of Medical

Oncology
Guest Speaker on the Economics of Disasters for the Centennial Grand Scientific Symposium
Lecturer on: Priority Setting; and Markov Modeling for the PhilHealth Workshop on Burden of
Disease and Benefits Package Setting.
Workshop presentor, “Re-inventing Midwives: Enhancing the Midwives’ Role in Healthcare

Delivery”.
91
ARTICLES/ MANAGEMENT
Quizon RR, Lam HY, Lopez JCF, Lomboy MFTC, and Rivera ATF. Policy Alternatives to Reduce
the Health and Economic Effects of Continued Asbestos Use in the Philippines. Acta Medica
Philippina. Vol 48, No 3 (July – Sept 2014)
Lam HY, Belizario VB, Juban NR, Alejandria MM, Castillo-Carandang N, Arcellana-Nuqui E, Mirasol
MA, Cordero CP, Sison OT, and Rivera AS. Assessing the Residual Risk for Transfusion
Transmitted Infections in the Philippine Blood Supply. Yale Journal of Biology and Medicine. 87
(2014).
Kassebaum N, Bertozzi-Villa A …. Lam HY…..Murray CJL, and Lozano R. Global, regional, and
national levels and causes of maternal mortality during 1990–2013: a systematic analysis for
the Global Burden of Disease Study 2013. Lancet. DOI. 10.1016/20140-6736(14)60696-6.
Published online May 2, 2014. www.thelancet.com
Naghavi M, Wang H, Lozano R…. Lam H….Lopez AD, and Murray CJL. Global, regional, and
national age-sex specific all- cause and cause-specific mortality for 240 causes of death, 1990-
2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 395: 1117-71.
Dec 18, 2014. Doi: 10.1016/S01406736(14)61682-2.
Lam HY, Belizario VB, Juban NR, Alejandria MM, Castillo-Carandang N, Arcellana-Nuqui E, Mirasol
MA, Cordero CP, Sison OT and Tayao L. Current Practices of Blood Service Facilities in the
Philippines. UP Manila Journal. 17:21-38. 2013.
De Paz SLM, Sumalde AAM, Cruz CJG…Lam HY.. Montano NE, and Heralde FM. Not all Taua-
tauas are alike: morphological genetic, phytochemical and anti-thrombocytopenic profiling of
different Euphorbia hirta Linn. Plants from the Philippines. Phil J Res Dev. 19 (1): 39-49. March
2015.
Reyes A, Pcifico R, Benitez B, Villanueva-Uy E, Lam H, and Ostrea EM. Use of the Griffiths Mental
Development Scales in an agro-industrial province in the Philippines. Child: Care, Health, and
Development. Vol 3, Issue 3, pg 354-360. January 2010.
Juban NR, Lam HY, and Go MV. Mass Casualty Management (MCM) System assessment in the
Western Pacific Region. Southeast Asian Journal of Tropical Medicine Public Health. Vol 40, Supp
1, 2009
Juban NR, Lam HY, and Go MV. Use of Community Development Process in Developing Post-
disaster assessment tools. Southeast Asian Journal of Tropical Medicine Public Health. Vol 40,
Supp 1, 2009
Lam HY. History and Overview of Health Economics and Clinical Economics. Clinical
Economics Self Instructional Manual (SIM). INCLEN 2007.
Lam HY. Cost Measurement and Analysis. Clinical Economics Self-Instructional Manual (SIM).
INCLEN. 2007.
Lam HY. Outcome Measurements. Clinical Economics Self-Instructional Manual (SIM). INCLEN.
2007.
Juban NR, Lam HY, and Go MV. Development of a Health Sector Rehabilitation Plan for the
REINA Municipalities. An oral presentation at the Health Emergencies and Disasters Research
Forum. Manila, Philippines. 20 April 2006.
Lam HY. The Economics of Disasters and Disaster Fund. An oral presentation at the Health
Emergencies and Disasters Research Forum. Manila, Philippines. 20 April 2006.
92
Juban NR, Lam HY, Go MV. Mass Casualty Management (MCM) System Assessment Western
Pacific Region. WHO WPRO. 2006. A poster presentation at the 8th Asia-Pacific Conference on
Disasters Medicine (APCDM) in Tokyo 20-22 November 2006.
Lam HY. The Mass Casualty Management System of Singapore. A poster presentation at the 8th
Asia-Pacific Conference on Disasters Medicine (APCDM) in Tokyo 20-22 November 2006
Herbosa TH, Lam HY and Prudente E. Emergency Management of Hospital Disasters: The
Philippine General Hospital Experience. An oral presentation at the Health Emergencies and
Disasters Research Forum. Manila, Philippines. 20 April 2006.
Herbosa TH, Gundran CP, and Lam HY. Mass Mercury Poisoning in a High School: ICS in
Response to a Medical Outbreak. An oral presentation at the Health Emergencies and Disasters
Research Forum. Manila, Philippines. 20 April 2006.
Lam HY and Yasuki K. Economic Status, Lifestyle and Health Outcomes: Empirical evidence
for health promotion. A structural equation model poster presentation during the Japan Society of
Public Health Annual Meeting, Kyoto, Japan, November 22-26, 2003.
Lam HY. Corporatization of Public Hospitals; Good Management, Bad Public Health?
Workshop on Health Care Policy and Systems in Developing Countries using cases and Simulations,
Tokyo, Japan, February 22-28, 2001.
Lam HY. Patient Absconding and the Missionary Hospital. Workshop on Health Care Policy and
Systems in Developing Countries using cases and Simulations, Tokyo, Japan, February 22-28, 2001.
Lam HY. Double Apportionment Method of Cost Finding. A computer software program,
commissioned by the Philippine Department of Health, Cost Finding and Rate Setting Workshop,
2000
Lam HY. Building a Politically Enhanced Healthcare Delivery System for KAMANAVA.
Strategic Management Planning for KAMANAVA (Kalookan, Malabon, Navotas, Valenzuela) Health
System
Lam HY. Future Directions, a Feasibility Study for Pasig General Hospital. Financial Audit for
Pasig General Hospital
Lam HY. Discharge Planning Survey. Rancho Los Amigos Medical Center, Downey, California,
USA. Assessed the Medical Center's "after care" services
Lam HY. Linen and Food Services Survey. Rancho Los Amigos Medical Center, Downey,
California, USA Monitored, evaluated and recommended improvements to the Food Service
Department and Linen Service Department to make these frontline services more responsive to their
patients/clients
Lam HY. Employees' Child Care Needs Survey. Commissioned by the Rancho Los Amigos
Medical Center's "Ten Year Plan" as part of its commitment to provide better employee benefits
COMPUTER SKILLS
AMOS, Lotus 123, MYOB Business, SAS, Corel Draw, MS Access, Peach Tree Accounting, SPSS, Epiinfo/
Epi2000, MS Excel, Photoshop, STATA, FilemakerPro, MS Word, Powerpoint, WordPerfect, proficient in both
Macintosh and Windows OS
RESEARCH TOOLS
Health Econometric Modelling, Delphi, Economic evaluations, Field Surveys, Epidemiology, Focus Group
Discussions, Monte Carlo Markov Modelling, Key Informant Interviews, Policy Analysis, Round Table
Discussions, Meta-analysis, Statistics, Structural Equation Modelling
93

CRS Study On Affordability Accessibility Philippines

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FINAL REPORT

Child Restraints in the Philippines:

Hilton Lam, MHA, PhD

Wilfrido A. Atienza, MBA

Lead Research Associate

Red Thaddeus D. Miguel, MD, MBA

Maria Eleanor Candelaria, RN

List of Tables and Figures 4

Table 1. Summary of Objectives and Methods

standards; their affordability, acceptability, and accessibility.

With this, the following are recommendations for policy:

a budget for child restraints.

companies to give out child restraints with car purchases.

approved child restraints are of acceptable quality.

activities that advocate for their use.

“The safety of the people should be the highest law.”

each collision may affect more than one life.

been, “60,583 cases from January to July.”9

standards in the Philippines

(2) Determine the availability of vehicles with ISOFix in the country

use or non-use of child restraints

interviews with Transportation Network Vehicles Services.

Key informant interviews with automobile,

B. PART 1: Supply-side Data

brand not present on the list.

“child car restraint”.

C. PART 2: Demand-side Data

affordability, accessibility, and competency to comprehend proper use.

didn't use child restraints from urban areas.

D. PART 3: Development of Recommendations

“promotion”, and “increased use”.

restraints in the Philippines.

cleaning, and analysis of quantitative data.

PART 1: Supply-side Data

Overview of Price Survey

table summarizes the current brands of child restraints in the Philippines:

Table 2. Child Restraint Brands Found

Product Availability and Price

combination products, on average, were PhP 10,518.19 (Table 3).

PhP 3,050.00 respectively.

Table 3. Average and Range of Prices of Different Types of Child Restraints

Rear-facing only 27 % 9,781.34 4,273.85 15,999.75

Local distributor (price

Rear-facing only 13% 6,078.57 3,798.93 8,073.25

No local distributor but

Rear-facing only 8% 23,745.78 - -

Rear-facing only 20 % 8,939.11 3,087.01 15,434.59

Brand new products found

Rear-facing only 32 % 7,632.48 1,299.75 32,999.75

provided or the information laid out.

Table 4. Brand New Vehicles in the Market with IsoFix

Overview of Key Informant Interviews

Current Market Situation based on Key Informant Interviews

authorized and regulated distributors.

everything. Taxes... Customs... And everything to bring that in here. So we do the

unfair for us because we have to pitch for certain brands.”

specifically a car with a three-point seatbelt”

reputation and credibility.

Deterrents to Use of Child Restraints