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 1995-2009 % Coverage

4. 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 (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 (3.1-87.9) Designated training hospital1.4 (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)

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: 2000 2010: 600,000

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…