presented by: ma. joyce u. ducusin, md, mph medical specialist iv, ncdpc department of health...
TRANSCRIPT
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…