SAFE MOTHERHOOD PROGRAM

Contact Person:
Zenaida Dy Recidoro, RN, MPH
Telephone Nos.:
651-7800 loc. 1727-1730
The Philippines has committed to the Unites States millennium declaration that translated into a roadmap
a set of goals that targets reduction of poverty, hunger, and ill health. In the light of this government
commitment, the Department of Health is faced with a challenge: to champion the cause of women and
children towards achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat
HIV/AIDS, malaria and other diseases). Pregnancy and childbirth are among the leading causes for death,
disease and disability in women of reproductive age in developing countries. The Philippine government
commitment to the MDGs is among others, a commitment to work towards the reduction of maternal
mortality ratios by three-quarters and under five mortality by two-thirds by 2015 at all cost.
Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal mortality ratio,
increasing neonatal deaths particularly on the first week after birth, unmet need for reproductive health
services and weak maternal care delivery system, in addition to identifying the technical interventions to
address these problems, the DOH Safe Motherhood Program decided to focus on making pregnancy and
childbirth safer and sought to change fundamental societal dynamics that influence decision making on
matters related to pregnancy and childbirth while it tries to bring quality emergency obstetrics and
newborn care facilities nearest to homes. This move ensures that those most in need of quality health care
by competent doctors, nurses and midwives have easy access to such care.
Program Objectives
The program contributes to the national goal of improving womens health by:
1. Collaborating with Local Government Units in establishing sustainable, cost-effective approach of
delivering health services that ensure access of disadvantaged women to acceptable and high quality
maternal and newborn health services and enable them to safely give birth in health facilities.
2. Establishing core knowledge base and support systems that facilitate the delivery of quality maternal
and newborn health services with special focus in the upgrade of facilities designated to provide
emergency obstetrics and newborn care within the Kalusugan Pangkalahatan framework.
Program Components
Component A: Local Delivery of the Maternal- Newborn Service Package
This Component supports LGUs in mobilizing networks of public and private providers to deliver the
integrated maternal-newborn service package. In each province and city, the following are currently being
undertaken.
1. Establishment of critical capacities to provide quality maternal-newborn services through the
organization and operation of a network of Service of Delivery Teams consisting of:
a. Womens/ Community Health Teams
b. BEmONC Teams
c. CEmONC Teams
2. Establishment of Reliable Sustainable Support Systems for Maternal-Newborn Service Delivery
through such initiatives as:
a. Essential BemONC Drugs and Supplies and Contraceptive Security
b. Establishment of Safe Blood Supply Network in collaboration with the National Voluntary Blood
Program
c. Behaviour Change Interventions
d. Sustainable financing of local maternal-newborn services and commodities through locally initiated
revenue generation and retention activities.
Component B: National Capacity to sustain Maternal-Newborn services
1. Operational and Regulatory Guidelines
a. Manual of operation
b. Referral manual
c. Essential care practice guide for pregnancy, childbirth, postpartum and newborn care (BEmONC
Protocol)
d. CEmONC curriculum and protocol for service delivery
e. Maternal death reporting and review protocol
f. Issuance of relevant policies
2. Network of Training Providers
a. Currently, 29 training centers that provide BEmONC skills training are operating in the country.
3. Monitoring, Evaluation, Research and Dissemination
II. INTERVENTIONS AND STRATEGIES EMPLOYED
The Department of Health through the National Safe Motherhood Program introduces strategies to address
critical reproductive health concerns ( maternal and newborn health, adolescent health, family planning
and STI prevention) while confronting both demand and supply side obstacle to access for disadvantaged
women of reproductive age. Among the changes, the following have been systematically mainstreamed
into the safe motherhood service delivery network:
Strategic Change in the Design of Safe Motherhood Services
These changes involve (1) shift in emphasis from the risk approach that identifies high-risk pregnancies
during the prenatal period to an approach that prepares all pregnant for the complications at childbirth-
this change brought about the establishment of the BEmONC-CEmONC network, which is now part of the
MNCHN service delivery network and the inter-local health zones or the Local Health Area Development
Zones; (2) improved quality of FP counselling and expanded service availability, including the organization
of more Itinerant Teams providing permanent methods and IUD insertion on an outreach basis and (3) the
integration of STI screening into the antenatal care and Family planning protocols.
An Integrated Package of Womens Health and Safe Motherhood Services
The above changes in the delivery also involved a shift from centrally controlled national programs (MC,
FP, STI and AH) operating separately and governed system that delivers an integrated womens health and
safe motherhood service package. This service delivery strategy is focused on maximizing synergies
among key services that influence maternal and newborn health and on ensuring a continuum of care
across levels of the referral system.
Reliable Sustainable Support Systems
Support systems for Maternal-Newborn service delivery include systems for (1) drug and contraceptive
security, through a strategy of contraceptive self reliance (2) safe blood supply; (3) stakeholder behaviour
change, through a combination of advocacy and communication; (4) sustainable financing, through a
diversification of funding sources, principally driven by the development of client classification scheme so
that the poor gets public subsidies and the non-poor are charged user fees.
Stronger Stewardship and Guidance from the DOH Program Managers
DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on maternal-
newborn services (2) a system for accrediting providers of emergency obstetrics and newborn care
(BEmONC and CEmONC) training program and (3) monitoring, evaluation and research on the maternal;-
newborn strategies.
III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS
As of December 2012, the program accomplishment is 65%. This accomplishment is based on the
accomplishments vis-a-vis the targets of the programs of 3 indicators. These are: antenatal care, facility-
based delivery and post-natal care. The 2012 target for all indictors is 70%. The below target
accomplishments is brought about by the low post-natal coverage of 52%. Among the operations issues
that delays accomplishments of critical inputs relates to procurement and other external factors such as
LGU organizational structures and priorities.
IV. PLANS FOR 2013
For the current year, the program hopes to pursue the completion of sustainable support systems to
ensure the delivery of quality maternal-newborn health service package by the local health system. The
following have been planned for implementation:
1. Development of Guidelines on EmONC training and amendment the policy on BEmONC training fees.
2. Development of the BemONC Module for Midwives and pursue the submission of its final version.
3. Development of a mechanism for EmONC Post Training Evaluation and supportive supervision of
BEmONC Teams.
4. Collaborate with Training Centers on the conduct of BEmONC and CEmONC Skills Training.
5. Collaborate with Development Partners in the implementation of maternal-newborn initiative in
selected sites.
6. Monitor and evaluate program targets accomplishments and compliance to program protocols
a. Maternal Death Reporting and Review
b. Training on Emergency Obstetrics and Newborn Care
c. BemONC provision BEmONC provision assessment
OTHER SIGNIFICANT INFORMATION
The program participated in the multi-country survey on Maternal and Newborn Near-Miss Cases
organized by the Reproductive Health Research Unit of WHO HQ and with the Program Manager as country
coordinator. The study was published in the Lancet in its May 18, 2013 issue: Moving beyond essential
interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn
Health): a cross-sectional study.
The Maternal Health Program is a set of actions and services administered by the Department of Health to
aid women before, during and after pregnancy. The Philippines is tasked to reduce the maternal mortality
ratio (MMR) by three quarters by 2015 to achieve its millennium development goal.
This means a MMR of 112/100,000 live births in 2010 and 80/100,000 live births by 2015.
Year Expected MMR
2010 112/100,000 live births
2015 80/100,000 live births
The maternal mortality ratio (MMR) has declined from an estimated 209 per 100,000 live births in 1987-93
(NDHS 1993) to 172 in 1998. The Philippines found it hard to reduce mortality. Similarly, perinatal mortality
reduction has been minimal. It went down by 11% in 10 years from 27.1 to 24 per thousand live births.
Year Actual MMR
1987-1993 209/100,000 live births
1998 172/100,000 live births
The percentage of pregnant woman with at least four prenatal visits decreased from 77% in 1998 to 70.4
in 2003. In addition, pregnant women who received at least two doses of tetanus toxoid also decreased
from 38% in 1998 to 37.3% in 2003. Only about 76.8% of pregnant women received iron supplementation
during pregnancy.
The Philippine Health Statistics revealed that maternal deaths are due to:
Complication Percentage of total maternal deaths
Hypertension 25%
Postpartum Hemorrhage 20.3%
Pregnancy with abortive outcomes 9%
However births attended by health professionals increased from 56% in 1998 to 59.8% in 2003. There was
also a notable increase to 51% in 2003 from 43% in 1998 in the percentage of women with at least one
prenatal visit. Only 44.6% of postpartum women received a dose of Vitamin A.
The underlying causes of maternal deaths are delays in taking critical actions:
delay in seeking care, delay in making referral and delay in providing of appropriate medical management.
Other factors that contribute to maternal deaths includes closely spaced births, frequent pregnancies, poor
detection and management of high-risk pregnancies, poor access to health facilities brought about by
geographic distance and cost of transportation, and as well as health care and health staff who lack
competence in handling obstetrical emergencies. The overall goal of the Maternal Health Program is to
improve the survival, health and well being of mothers and unborn through a package of services all
throughout the course of and before pregnancy.
The Strategic Thrust for 2005-2010
Basic Emergency Obstetric Care (BEMOC)
Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the
DOH. The BEMOC strategy entails the establishment of facilities that provide emergency obstetric care for
every 125, 000 population and which are located strategically. The strategy calls for families and
communities to plan for childbirth and the upgrading of technical capabilities of local health providers.
Improve the quality of Prenatal and Postnatal Care
Pregnant women should have at least four prenatal visits with time for adequate evaluation and
management of diseases and conditions that may put the pregnancy at risk. Postpartum care should
extend to more women after childbirth, after a miscarriage or after an unsafe abortion.
Reduce womens exposure to health risks
Through the institutionalization of responsible parenthood and provision of appropriate health care
package to all women of reproductive age especially those who are:
less than 18 years old and over 35 years of age,
women with low educational and financial resources,
women with unmanaged chronic illness and
women who had just given birth in the last 18 months.
Appropriate Allocation of Resources
LGUs, NGOs and other stakeholders must advocate for health through resource generation and allocation
for health services to be provided and are in place in the health system.
To address the problem, packages of health services are provided to the clients. These essential health
care packages are available and are in place in the health system.
Essential Health Service Package Available in the Health Care Facilities
These are the packages of services that every woman has to receive before and after pregnancy and
or delivery of a baby.
Antenatal Registration
Pregnancy poses a risk to the life of every woman. Pregnant women may suffer complication and die.
Every woman has to visit the nearest facility for antenatal registration and to avail prenatal care services.
This is the only way to guide her in pregnancy care to make her prepare for child birth. The standard
prenatal visits that women have to receive during pregnancy are as follows:
Prental Visits Period of Pregnancy
1st visit As early in pregnancy as possible before four months or during
the first trimester
2nd visit During the 2nd trimester
3rd visit During the 3rd trimester
Every 2 weeks After 8th month of pregnancy till delivery.
Tetanus Toxoid Immunization
Neonatal Tetanus is one of the public health concerns that we need to address among newborns. To protect
them from deadly disease, tetanus toxoid immunization is important for pregnant women and child bearing
age women. Both mother and child are protected against tetanus and neonatal tetanus. A series of 2 doses
of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect baby
from neonatal tetanus. And the 3 booster dose shots to complete the five doses following the
recommended schedule provides full protection for both mother and child. The mother is then called as
a fully immunized mother (FIM).
Micronutrient Supplementation
Micronutrient supplementation is vital for pregnant women. These are necessary to prevent anema,
vitamin A deficieny and other nutritional disorders. They are:
Nutrie Dose Schedule Remarks
nt
Vitami 10,000 IU Twice a week starting Do not give Vitamin A supplementation before
nA on the 4thmonth of the 4th month of pregnancy. It might cause
pregnancy congenital problems in the baby.
Iron 60 Daily
mg/400
ug tablet
Treatment of Diseases and Other Conditions
There are other conditions that might occur among pregnant women. These conditions may endanger her
health and complication could occur. Follow first aid treatment:
Conditions/Diseases What to do Do not give
Difficulty of Clear airway
breathing/obstructio Place in her best position
n of airway Refer woman to hospital with EmOC
capabilities
Unconscious Keep on her back arms at the side
Tilt head backward (unless trauma is
suspected)
Lift chin to open airway
Clear secretions from throat
Give IVF to prevent or correct shock
Monitor VS every 15 minutes
Monitor fluid given. If difficulty of breathing
and puffiness develops, stop infusion
Monitor U.O.
Do not give oral rehydration solution to a
woman who is unconscious or has
convulsions.
Do not give IVF if you are not trained to do
so
Post Massage uterus and expel clots
partum bleeding If bleeding persists:
Place cupped palm on uterine fundus and
feel for state of contraction
 Massage fundus in a circular motion
Apply bimanual uterine compression if
ergometrine treatment done and
p[ostpartum bleeding still persists
Give ergometrine 0.2. IM and another dose
after 15 minutes.
Do not give ergometrine if woman has
eclampsia, pre-eclampsia or hypertension.
Intestinal parasite Giver mebendazole 500mg tablet single Do not give
infection dose anytime from 4-9 months of mebendazole in the
pregnancy if none was given in the past 6 first 1-3 months of
months pregnancy. This might
cause congential
problems in baby.
Malaria Give sulfadoxin-pyrimethamine to women
from malaria endemic areas who are in
1st or 2nd pregnancy, 500mg-25 mg tab,
3tabs at the beginning of 2nd to
3rd trimesters not less than one month
interval.
Clean and Safe Delivery
The presence of a skilled birth attendance will ensure hygiene during labor and delivery. It may also
provide safe and non traumatic care, recognize complications and also manage and refer the women to a
higher level of care when necessary. The necessary steps to follow during labor, childbirth and immediate
postpartum include the following:
Do a quick check upon admission for emergency signs:
Unconscious/convulsion
Vaginal bleeding
Severe abdominal pain
Looks very ill
Severe headache with visual disturbance
Severe breathing difficulty
Fever
Severe vomiting
Make woman comfortable
Establish rapport with the client by greeting and interviewing to make her comfortable.
Assess the woman in labor
Assessing the client is a reference guide for a health worker to determine its status during labor stage. This
can be done by taking the history of the ff:
Last menstrual period (LMP)
Number of pregnancy
Start of labor pains
Age/height
Danger signs of pregnancy
Taking the history through interview will help determine the clients condition during delivery of a baby.
Determine the stage of labor
Labor can be determined when womans response to contraction is observed pushing down and vulva is
bulging, with leaking amniotic fluid, and vaginal bleeding. A vaginal examination can be performed to
determine the degree of contraction.
Decide if the woman can safely deliver
By assessing the condition of the client and not finding any indication that could harm the delivery of a
baby, a trained health worker can decide a safe delivery of a mother.
Give supportive care throughout labor
There are many things that a woman needs to do during labor. This will help her deliver clean, safe and
free from fatigue. These are:
Encourage to take a bath at the onset of labor
Encourage to drink but not to eat as this may interfere surgery in case needed.
Encourage to empty bladder and bowels to facilitate delivery of the baby. Remind to empty bladder ever 2
hours
Encourage to do breathing technique to help energy in pushing baby out the vagina. Panting can be done
by breathing with open mouth with 2 short breaths followed by long breath. This prevent pushing at the
end of the first stage.
Monitor and manage labor
These re different stages of labor to watch out any danger signs
Stage What to do Not to do
First StageNot yet in Check every hour for emergency signs, Do not do vaginal
active labor, cervix frequency and duration of examination more
is dilated 0-3cm and contractions, fetal heart rate, etc. frequently than every 4
contractions are Check every 4 hours for fever, pulse, hours.
weak, less than 2 to BP and cervical dilatation
10 minutes. Record time of rupture of membranes
and color of amniotic fluid.
Assess progress of labor
Refer woman immediately to hospital
facility with comprehensive emergency
obstetrical care capabilities if after 8
hours, contractions are stronger and
more frequent but no progress in
cervical dilatation, with or without
membranes ruptured.
First StageIn Check every 30 minutes for
active labor, cervix emergency signs
is dilated 4 cm or Check every 4 hours for fever, pulse,
more BP and cervical dilation
Record time of rupture of membranes
and color of amniotic fluid
Record findings in partograph/patient
record.
Do not allow woman to push
unless delivery is imminent. It will just
exhaust the woman.
Do not give medications to speed
up labor. It may endanger and cause
trauma to mother and the baby.
Second StageCervix Check every 5 minutes for perineum
dilated 10 cm or thinning and bulging, visible descend
bulging thin of the head during contraction,
perineum and head emergency signs, fetal heart rate and
visible mood and behavior.
Continued recording in the partograph.
Do not apply fundal pressure to
help delivery the baby.
Third StageBetween Deliver the placenta
birth of the baby Check the completeness of placenta
and delivery of the and membranes
placenta Do not squeeze or massage the
abdomen to deliver the placenta
Others
Monitor closely within one hour after delivery and give supportive care
Continue care after one hour postpartum. Keep watch closely for at least 2 hours.
Educate and counsel on FP and provide FP method if available and decision was made by a woman.
Birth registration
Importance of BF
Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth
Schedule when to return for consultation for postpartum partum visits
Inform, teach and counsel the woman on important MCH messages:
1st Visit 1st week post partum preferable 3-5 days
2nd Visit 6 weeks post partum
Support to Breast Feeding
Most mothers do not know the importance of breastfeeding. A support care groups like nurses
have critical role to motivate them to practice breastfeeding.
Family Planning Counseling
Proper counseling of couples on the importance of FP will help them inform on the right choice of FP
methods, proper spacing of birth and addressing the right number of children. Birth spacing of three to five
years interval will help completely recover the health of a mother from previous pregnancy and childbirth.
The risk of complications increases after the second birth.

UNIVERSAL HEALTH CARE HIGH IMPACT FIVE (HI-5)

The Universal Health Care High Impact Five (UHC-Hi-5) is a strategy which aims to produce the greatest
improvements in health outcomes and the highest impact on the priority, vulnerable population, with focus
on five critical UHC interventions prioritizing the poor, providing tangible outputs which are "felt" within a
breakthrough period of 15 months through synchronized nationawide implementation of activities.
General Objective
To produce the greatest improvements in health outcomes and the highest impact on the population within
a short period of implementation.
Specific Objectives
To intensify regional operations and converge in priority poverty program areas.
To implement model plans on 5 key high impact interventions.
HI-5 Impact Activities
HI-5 Impact Activities (1 &2)
May 2015 June 2015 Sept 2015 Mar 2016
M2 M3 M6 M12
Impact 1 NDP Deployment
in Barangays
Impact 2 KP HI-5 Caravan KP HI-5 Caravan KP HI-5 Caravan

HI-5 Impact Activities (3)

July 2015 Oct2015 Jan 2015 Apr 2016
Impact 3
M4 M7 M10 M13
- RAIDERS Garantisadong Grantisadong
Mass deworming
- Mass deworming Pambata Pambata
- Nutrition (ASAPP)
- Blood donation
(voluntary)
and networking
HI-5 Impact Activities (4-6)
Dec 2015 Feb 2015
 M9 M11
Impact 4 Child Injury Prevention
(First Aid Kit)
Impact 5 Gawad Kalusugan
Impact 6 HIV Voluntary Testing
EXPANDED PROGRAM ON IMMUNIZATION
I. Rationale
The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and
mothers have access to routinely recommended infant/childhood vaccines. Six vaccine-preventable
diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and
measles. In 1986, 21.3% fully immunized children less than fourteen months of age based on the EPI
Comprehensive Program review.

II. Scenario
Global Situation
The burden
In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to diseases that
could have been prevented by routine vaccination. This represents 14% of global total mortality in children
under 5 years of age.

Source: Weekly Epidemiological Record, WHO: No.46,2011,86.509-520)

Burden of Diseases
The immunization coverage of all individual vaccines has improved as shown in Figure 1: (Demographic
Health Survey 2003 and 2008). Fully Immunized Child (FIC) coverage improved by 10% and the Child
Protected at Birth (CPAB) against Tetanus improved by 13% compared to any prior period. Thus, the
Philippines has now historically the highest coverage for these two major indicators.

Figure 1: Comparison of the 2003 and 2008 EPI indicators, Source: NDHS

III. Interventions/ Strategies

Program Objectives/Goals:

Over-all Goal:
To reduce the morbidity and mortality among children against the most common vaccine-preventable
diseases.

Specific Goals:
1. To immunize all infants/children against the most common vaccine-preventable diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.

Mandates:
Republic Act No. 10152MandatoryInfants and Children Health Immunization Act of 2011Signed by
President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children
under 5 including other types that will be determined by the Secretary of Health.

Strategies:
Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay (REB)
strategy
REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in
2004 aimed to improve the access to routine immunization and reduce drop-outs. There are 5 components
of the strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between
the community and service, supportive supervision and maximizing resources.
Supplemental Immunization Activity (SIA)
Supplementary immunization activities are used to reach children who have not been vaccinated or have
not developed sufficient immunity after previous vaccinations. It can be conducted either national or sub-
national in selected areas.

Strengthening Vaccine-Preventable Diseases Surveillance

This is critical for the eradication/elimination efforts, especially in identifying true cases of measles and
indigenous wild polio virus
Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

IV. Status of implementation/ Accomplishment

All health facilities (health centers and barangay health stations) have at least one (1) health staff trained
on REB.

Polio Eradication:
The Philippines has sustained its polio-free status since October 2000.
Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to 83%. A least 95% OPV3
coverage need to be achieved to produce the required herd immunity for protection.

Figure 2 OPV1 and OPV3 Coverage, Philippines, 2005-2010

There is an on-going polio mass immunization to all children ages 6 weeks up to 59 months old in the 10
highest risk areas for neonatal tetanus. These areas are the following: Abra, Banguet, Isabela City and
Basilan, Lanao Norte, Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.

Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to 1.38 in 2011. Only regions
III, V and VIII have achieved the AFP rate of 2/100,000 children below 15 years old. (Source: NEC, DOH). A
decreasing AFP rate means we may not be able to find true cases of polio and may experience resurgence
of polio cases

Measles Elimination
Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.
Implemented the 2-dose measles-containing vaccine (MCV) in 2009
MCV1 (monovalent measles) at 9-11 months old
MCV2 (MMR) at 12-15 months old.
Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood samples are
withdrawn from all measles suspect to confirm the case as measles infection.
A supplemental immunization campaign for measles and rubella (German measles) was done in 2011. This
was dubbed as Iligtas sa Tigdas ang Pinas 15.6 million (84%) out of the 18.5 million children ages 9
months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between April and June
2011.
Rapid coverage assessment (RCA) were conducted in selected areas to validate immunization coverage,
assess high quality and that there are NO missed child in every barangay. Overall RCA results showed that
70,594 (97.6%) out of 72,353 9 months to 8 years old living in the randomly selected barangays were
vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly
selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.
The Government of the Philippines spent PhP 635.7M for the successful conduct of the MR campaign.ss
high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594
(97.6%) out of 72,353 9 months to 8 years old living in the randomly selected barangays were
vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly
selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.
As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5
cases were epidemiologically-linked and 27 clinically confirmed. This means we have at least 60 true
measles at present. Measles is said to be eliminated if we have 1 case per million or below 100 cases in a
year

Maternal and Neonatal Tetanus Elimination

10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the areas categorized as
low risk, at risk and highest risk based on the NT surveillance, skilled birth attendants and facility based
delivery and the tetanus toxoid 2+ (TT 2+) vaccination.

Figure 3: Level of Risk for NT, Philippines

Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk areas. An estimated
1,010,751 women age 15 - 40 year old women regardless of their TT immunization will receive the vaccine
during these rounds. This is funded by the Kiwanis International through UNICEF and World Health
Organization.

Control of other common vaccine-preventable diseases (Diphtheria, Pertussis, Hepatitis B and

Meningitis/Encephalitis secondary to H. influenzae type B)
Continuous vaccination for infants and children with the DPT or the combination DPT-HepB-HiB Type B.
Annex1 EPI Annual Accomplishment Report. DOH procures all the vaccines and needles and syringes for
the immunization activities targeted to infants/children/mothers.
Hepatitis B Control
Republic Act No. 10152 has been signed. It is otherwise known as the Mandatory Infants and Children
Health Immunization Act of 2011, which requires that all children under five years old be given basic
immunization against vaccine-preventable diseases. Specifically, this bill provides for all infants to be given
the birth dose of the Hepatitis-B vaccine within 24 hours of birth.
One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and
Newborn Care Package (EINC). In 2011, 11 tertiary hospitals are already EINC compliant.
The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by
HBsAg prevalence to less than 1% in five-year-olds born after routine vaccination started 100% Hepatitis B
at birth vaccination.
Figure 4 Hepatitis B Coverage. Philippines, 2001-2011
Timing of administration/dose 2009 2010* 2011*
<24 hours 34% 38% 14%
>24 hours 62% 55% 24%
Hep B 3rd dose 86% 81% 30%
*both 2010 and 2011 data are as of October 2011

Vaccines and cold chain management

Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions since 2003.
An effective vaccine management assessment was conducted last December 2011 and revealed cold
chain capacity gaps from the national up to the implementers level.
A total of PhP 267 million is required to address the gaps identified during the assessment.

Introduction to New Vaccines

For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization program.
Immunization will be prioritized among the infants of families listed in the National Housing and Targeting
System (NHTS) for Poverty Reduction nationwide.
The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2 vaccines.

V. Future Plan/ Action

Strengthening the Cold Chain to support the Immunization Program
Capacity Building for Health Workers for the Introduction of New Vaccines
Advocacy for the financial sustainability for the newly introduced vaccines for expansion.
Development of the comprehensive multi-year plan for immunization program.

VI. Other Significant information worth mentioning

One significant milestone is that the budget allocation for the immunization program has continued to
increase year by year
The Government of the Philippines allocated budget for the immunization of all
infants/children/women/older persons nationwide. For 2012, the budget for EPI is PhP1.8 billion and
another P1.5 Billion for the immunization for senior citizen and children for the NHTS families. This is great
leap towards universal access to quality vaccines for the prevention of the most common vaccine-
preventable diseases.

Program Managers:
Dr. Joyce Ducusin
Medical Specialist IV
National Center for Disease Prevention and Control - Family Health Office
Telephone Number: 651-7800 locals 1726-1730
Ms. Luzviminda Garcia
Supervising Health Program Officer
National Center for Disease Prevention and Control - Family Health Office
Telephone Number: 651-7800 locals 1726-1730
NEWBORN SCREENING
Republic Act 9288

Newborn screening (NBS) is a public health program aimed at the early identification of infants who are
affected by certain genetic/metabolic/infectious conditions. Early identification and timely intervention can
lead to significant reduction of morbidity, mortality, and associated disabilities in affected infants. NBS in
the Philippines started in June 1996 and was integrated into the public health delivery system with the
enactment of the Newborn Screening Act of 2004 (Republic Act 9288). From 1996 to December 2010, the
program has saved 45 283 patients. Five conditions are currently screened: Congenital Hypothyroidism,
Congenital Adrenal Hyperplasia, Phenylketonuria, Galactosemia, and Glucose-6-Phosphate Dehydrogenase
Deficiency.

Current Status of NBS Implementation in the Philippines

Newborn Screening Legislation

NBS was integrated into the public health delivery system with the enactment of Republic Act 9288 or
Newborn Screening Act of 2004 as it institutionalized the National NBS System, which shall ensure the
following: [a] that every baby born in the Philippines is offered NBS; [b] the establishment and integration
of a sustainable NBS System within the public health delivery system; [c] that all health practitioners are
aware of the benefits of NBS and of their responsibilities in offering it; and [d] that all parents are aware of
NBS and their responsibility in protecting their child from any of the disorders. The highlights of the law
and its implementing rules and regulations are:

DOH is the lead agency tasked with implementing this law;

Any health practitioner who delivers or assists in the delivery of a newborn in the Philippines shall prior to
delivery, inform parents or legal guardians of the newborns the availability, nature and benefits of NBS;
Health facilities shall integrate NBS in its delivery of health services;
Creation of the Newborn Screening Reference Center at the National Institutes of Health and establishment
and accreditation of NSCs equipped with a NBS laboratory and recall/follow up program;
Provision of NBS services as a requirement for licensing and accreditation, the DOH and the Philippine
Health Insurance Corporation (PHIC)
Inclusion of cost of NBS in insurance benefits

Currently, there are four Newborn Screening Centers (NSCs) in the country: NSC-National Institutes of
Health in Manila; NSC- Visayas in Iloilo City; NSC-Mindanao in Davao City; and NSC-Central Luzon in
Angeles City. The four NSCs provide laboratory and follow up services for more than 3000+ health
facilities.

DOH, its partners and major stakeholders remain aggressive in identifying strategies to intensify
awareness in the communities and increase coverage among home deliveries. Among the recent efforts to
increase the newborn screening coverage are appointment of full-time Regional NBS Coordinators; opening
more G6PD Confirmatory Laboratories; partnership with midwives organizations; and production of
information materials targeting different groups of health workers and professionals.

Key Players in the Implementation

Organizational chart for the national implementation of Newborn Screening

Newborn Screening Statistics

As of December 2010, there are 2,389,959 babies that have undergone NBS and based on these data, the
incidences of the following disorders are: CH (1: 3,324); CAH (1: 9,446); PKU (1: 149,372); Gal (1: 108,635)
and G6PD deficiency (1: 52). The program has saved the following numbers of newborns from
complications and/or death: 719 from CH, 253 from CAH, 22 from Gal, 16 from PKU and 44 273 from G6PD
deficiency.

Coverage
As of December 2010, the coverage of NBS is at 35%.
Newborn Screening Centers

For Regions I, II, III & CAR

Unit Head: Dr. Florencio Dizon
Newborn Screening Center Central Luzon
Angeles City University Foundation Medical Center
MacArthur Highway, Barangay Salapungan, Angeles City
Telephone: (045) 6246502-03; Email: nsc@aufmc.org

Centers for Health Development

NBS Regional
CHD Mailing Address Business Phone
Coordinator
CHD 1 - (072) 2425315; Clarita B.
San Fernando, La Union
Ilocos (072) 2424773 Lewis, RN
CHD 2 - (078) 3046585; Leticia T.
Cagayan Tuguegarao City (078) 8446585; Cabrera, MD,
Valley (078) 8446523 MPA
CHD 3 - (045) 4552324;
Adelina
Central San Fernando, Pampanga (045) 9617649;
Cabrera, RN
Luzon (045) 9617654
CHD 4-A QMMC Compound, Project Maria Luisa M.
(02) 4403372
Calabarzon 4, Quezon City Malana, RN
CHD 4-B Quirino Hospital (02) 9134650; Ma. Teresa
Mimaropa Compound, Quezon City (02) 9115025 Castillo, MD
Carla A.
First Park Subdidivion, (052) 4830840 Orozco, MD,
CHD 5- Bicol
Daraga, Albay loc 517/516 MPH
MS III
CHD 6 -
Q. Abeto St., Mandurriao, Renilyn P.
Western (033)3210364
Iloilo City Reyes, MD
Visayas
CHD 7 - Nayda P.
Central Osmea Blvd., Cebu City (032) 4187633 Bautista,MD,
Visayas MPH
CHD 8-
Lilibeth
Eastern Candahug, Palo , Leyte (053)3235025
Andrade, MD
Visayas
CHD 9 -
Upper Calarian, Nerissa B.
Zamboanga (062)9830314-15
Zamboanga City Gutierrez, RN
Peninsula
CHD 10 - Ellenietta HMV
J.V. Seria St., Carmen,
Northern 088-22- 727400 N. Gamolo,
Cagayan de Oro City
Mindanao MD, MPH
CHD 11 - Ma. Clarose M.
J.P. Laurel Avenue, Davao (082) 3051907;
Davao Mascardo, RN,
City (082) 2214011
Region MPH
CHD 12 - ARMM Compound, Gov.
(064) 4217436;
Central Guttierez Ave, Cotabato Lucy Decio, RN
(064) 4218053
Mindanao City
CHD Pizarro St. cor. Narra Rd. (085) 3411452 Glynna B.
CARAGA Butuan City Andoy, MD,
 MPH
BGHMC Compound, (074) 4428096; Nicolas R.
CHD CAR
Baguio City (074) 4445255 Gordo, Jr, MD
Welfareville Compound,
(02) 7183097; Ma. Paz P.
CHD NCR Brgy. Addition Hills,
(02) 5354521 Corrales, MD
Mandaluyong City
Dayan
ORG Compound, Cotabato
CHD ARMM (064) 4217703 Sangcopan,
City
MD

DOH PROGRAMS

Adolescent and Youth Health Program (AYHP)

Botika Ng Barangay (BnB)

Breastfeeding TSEK

Blood Donation Program

Belly Gud for Health

Child Health and Development Strategic Plan Year 2001-2004

CHD Scorecard

Committee of Examiners for Undertakers and Embalmers

Committee of Examiners for Massage Therapy (CEMT)

Climate Change

Cardiovascular Disease

Chronic Obstructive Pulmonary Disease

Dental Health Program

Diabetes Prevention and Control Program

Emerging and Re-emerging Infectious Disease Program

Environmental Health

Expanded Program on Immunization

Essential Newborn Care

Family Planning Program

Food and Waterborne Diseases Prevention and Control Program

Food Fortification Program

Filariasis Control Program

Garantisadong Pambata

Human Resource for Health Network

Health Development Program for Older Persons - (Bureau or Office:

National Center for Disease Prevention and Control )

Health Development Program for Older Persons - R.A. 7876 (Senior

Citizens Center Act of the Philippines)

Health Development Program for Older Persons (Global Movement for

Active Ageing (Global Embrace 1999))

Health Development Program for Older Persons - R.A. 7432 (An Act to
Maximize the Contribution of Senior Citizens to Nation Building, Grant
Benefits and Special Privileges)

Health and Well-being of Older Persons

Infant and Young Child Feeding (IYCF)

Iligtas sa Tigdas ang Pinas

Inter Local Health Zone

Integrated Management of Childhood Illness (IMCI)

Knock Out Tigdas 2007

Leprosy Control Program

LGU Scorecard

Licensure Examinations for Paraprofessionals Undertaken by the

Department of Health

Malaria Control Program

Measles Elimination Campaign (Ligtas Tigdas)

Micronutrient Program

National Tuberculosis Control Program

Natural Family Planning

National Filariasis Elimination Program

National Rabies Prevention and Control Program

Newborn Screening

National HIV/STI Prevention Program

National Mental Health Program

National Dengue Prevention and Control Program

National Prevention of Blindness Program

National Mental Health Program

National Safe Motherhood Program

Occupational Health Program

Oral Health Program

Persons with Disabilities

Province-wide Investment Plan for Health (PIPH)

Philippine Medical Tourism Program

Provision of Potable Water Program (SALINTUBIG Program - Sagana at

Ligtas na Tubig Para sa Lahat)

Philippine Cancer Control Program

Rural Health Midwives Placement Program (RHMPP) / Midwifery

Scholarship Program of the Philippines (MSPP)

Schistosomiasis Control Program

Soil Transmitted Helminthiasis Control Program

Smoking Cessation Program

Urban Health System Development (UHSD) Program

Unang Yakap (Essential Newborn Care: Protocol for New Life)

Violence and Injury Prevention Program

Women's Health and Safe Motherhood Project

Women and Children Protection Program