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Presented by: Ma. Joyce U. Ducusin, MD, MPH Medical Specialist IV, NCDPC Department of Health Hepatitis B Immunization In the Philippines: A Progress Report.

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Presentation on theme: "Presented by: Ma. Joyce U. Ducusin, MD, MPH Medical Specialist IV, NCDPC Department of Health Hepatitis B Immunization In the Philippines: A Progress Report."— Presentation transcript:

1 Presented by: Ma. Joyce U. Ducusin, MD, MPH Medical Specialist IV, NCDPC Department of Health Hepatitis B Immunization In the Philippines: A Progress Report

2 Background Indicators2009 Population92 million Birth Cohort2.5 million Facility deliveries (%)44.2% Outreach ProportionNo data

3 Hepatitis B Immunization Coverage, PHL % Coverage

4 HBV Activities (2005 – 2009) : –100% HBV budget secured from DOH 2006-Jan : –DOH Issuance of HBV at birth and inclusion of HBV3 in FIC –Start of birth dose implementation (Were back Its all in the follow up…) –Hospital Assessments –Community HBV birth dose scale-up in NCR –Strengthening Routine Immunization

5 Hospital assessments Followed our usual Formula of 3 As+3 Fs : –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

6 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 B14.4 ( ) Designated training hospital1.4 ( ) Accredited by national health insurance agency 1.5 ( ) Accredited by Philippine Pediatrics' Society 1.5 ( )

7 Community HBV Birth Dose Scale-up in National Capital Region (NCR ) Followed our usual Formula of 3 As+3 Fs : –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

8 Birth dose <24 hours BeforeAfter Place of Delivery Home51 (17%)180 (86%) Lying-In Clinic36 (26%)46 (75%) Hospital63 (27%)58 (64%) Unrecorded 82 (15%)8 (24)% Total232 (19%)292 (74%) Community HBV Birth Dose Scale-up in National Capital Region (NCR), 2007

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

10 Strengthening Routine Immunization Followed our usual Formula of 3 As+3 Fs : –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

11 Reaching the Urban Poor Population Included: 2004: : 600,000

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13 Concern Administration of Hepatitis B at birth is done at a time that interrupts other time bound essential newborn care procedures…

14 Essential Newborn Care Protocol was developed to address these and other issues

15 The Way Forward: Principles Follow our usual Formula of 3 As+3 Fs 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%

16 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

17 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

18 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

19 External Inputs Needed to Achieve 2012 Targets Support resource mobilization When the time comes, technical and financial assistance for the serosurvey…


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