Presented by:Presented by:Ma. Joyce U. Ducusin, MD, MPHMa. Joyce U. Ducusin, MD, MPHMedical Specialist IV, NCDPCMedical Specialist IV, NCDPCDepartment of HealthDepartment of Health

Hepatitis B Immunization In the Philippines: A Progress Report

Background

 Indicators 2009

Population 92 million

Birth Cohort 2.5 million

Facility deliveries (%) 44.2%

Outreach Proportion No data

Hepatitis B Immunization Coverage, PHL 1995-2009

% C

ove

rag

e

HBV Activities (2005 – 2009)

• 2005-2007: – 100% HBV budget secured from DOH

• 2006-Jan 1 2007: – DOH Issuance of HBV at birth and inclusion of

HBV3 in FIC– Start of birth dose implementation

• 2007-9 (“We’re back” It’s all in the follow up…)– Hospital Assessments – Community HBV birth dose scale-up in NCR– Strengthening Routine Immunization

Hospital assessments

• Followed our usual Formula of 3 A’s+3 F’s : – Assess– Analyze with staff present– Agree on next steps– Follow-up (at least 3 visits)

• 91 largest hospitals, expanded to 300• Surveys showed HBV birth dose increase from

22% to 70%• Provided focus on what needed to be done to

scale up in hospitals

Potential predictor of having high (>90% vs <10%) documented birth dose coverage in 2007 study

Odds ratio* (95% confidence interval)

Presence of copy of immunization policy

3.9 (0.7 – 21.2)

Presence of copy of hepatitis B vaccination policy

4.7 (1.2 – 18.0)

Standing order for hepatitis B vaccination administration

4.8 (1.3 – 18.1)

Staff trained on hepatitis B 14.4 (3.1-87.9)

Designated training hospital 1.4 (0.4-5.1)

Accredited by national health insurance agency

1.5 (0.2-7.3)

Accredited by Philippine Pediatrics' Society

1.5 (0.4-5.7)

Community HBV Birth Dose Scale-up in National Capital Region (NCR)

• Followed our usual Formula of 3 A’s+3 F’s : – Assess: Target Client Lists were evaluated, health

facilities assessed (using a modified Child Survival Monitoring Checklist)

– Analyze with staff present to reach particularly home births

– Agree on next steps– Follow up (at least 3 visits)

• Sites: – 2007: 9 (2 cities)– 2008: 77 (5 per city)– 2009: 4 complete cities

  Birth dose <24 hours

  Before After

Place of Delivery  

Home 51 (17%) 180 (86%)

Lying-In Clinic 36 (26%) 46 (75%)

Hospital 63 (27%) 58 (64%)

Unrecorded  82 (15%) 8 (24)%

Total 232 (19%) 292 (74%)

Community HBV Birth Dose Scale-up in National Capital Region (NCR), 2007

HBV Birth Dose Immunization Rate: District II and by LGU in NCR

34.5%29.2%

14.9%

74.4%

49.0%

57.9%

42.9%

29.5%

69.9% 68.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Taguig City Pasig City Marikina City Quezon City District II

Before

After

Strengthening Routine Immunization

• Followed our usual Formula of 3 A’s+3 F’s : – Assess, Analyze, Agree on next steps– Follow up (at least 3 visits)

• Since 2004; national/subnational staff, WHO and STOP teams have followed this procedure for more than 650 Health Centers and Barangay Health Stations using the Child Survival Monitoring Checklists

• Pentavalent vaccine (DPT-HBV-HiB) introduced in 3 regions

Reaching the Urban

Poor

Population Included: • 2004: 2000• 2010: 600,000

Concern

Administration of Hepatitis B at birth is done at a time that interrupts other time bound

essential newborn care procedures…

Essential Newborn

Care Protocol was

developed to address these

and other issues

The Way Forward: Principles

• Follow our usual Formula of 3 A’s+3 F’s for all hospitals and local facilities nationwide: – Assess– Analyze with staff present– Agree on next steps– Follow up (at least 3 visits)

• Evidence-based policies – Reaching home births with a HBV birth dose as an

interim measure until facility deliveries increases to >90%

The Way Forward

• Continued Hospital Improvements: – Cost to assess 100 hospitals: USD 20,000– Total Hospitals: 1500– Each hospital will need at least 3

assessments to get meaningful change– Total Expected Cost: USD 300,000 x 3 visits

• USD 900,000

The Way Forward:

• Continued Health Facility Improvements with a community focus: – Cost to scale up to ¼ NCR (4 LGUs):

• USD 50,000

– Total Local Government Units: 121– Total Expected Cost: USD 1.5 Million

The Way Forward:

• Continued Scale-up of Reaching the Urban Poor: – Total cost to scale up to 600,000: USD 500,000 – Total urban poor: 12.3 million– Each health facility will need at least 3

assessments– Total Expected Cost: USD 10.3 Million

External Inputs Needed to Achieve 2012 Targets

• Support resource mobilization

• When the time comes,

technical and financial assistance for the serosurvey…