Expanded Programme on Immunization in the Philippines
From the experience in the Field Trip from 4th to 17th March 2018
Atitto P1, Awuni K.T1, Somphet V1, M.Sato1(1:International Health Development Course, Nagasaki University School of Tropical Medicine and Global Health )Introduction

Expanded Programme on Immunizations remains one of the most important cost-effective approaches towards reducing vaccine-preventable diseases among
infants worldwide (WHO, 2013). Presently, immunization coverage has improved worldwide with about 130 countries achieving 90% DPT3 coverage. Over 640
million children vaccinated, 9 million future deaths averted, and more than $100 billion spent on averting illness globally (GAVI 2017). The Master of Public
Health students of School of Tropical Medicine and Global Health, Nagasaki University, Japan, as part of their field trip in March 2018, explored the Philippines’
health system and interventions implemented with specific focus on EPI activities.
Location, Observations and Findings
The Philippines is one of the South-East Asian Island countries. It has 17
regions, out of which two regions were visited: Manila, the national capitaland Eastern Visayas. There were lectures, participation in conference-typediscussions on EPI, visit to health delivery points such as Barangay healthstations and interactions with staff and Barangay volunteers. Otheradministrative places supporting the Philippines health system like
Department of Health, WPRO, San Lazaro Hospital were visited.
Observations showed Philippines considered EPI as a key indicator ofquality health care. The EPI programme has improved over the years andcontinues to make gains while introducing new vaccines. However, thePhilippines Demographic and Health Survey (PDHS), 2017, reported 70%
immunization coverage for fully immunized children compared to 86%
global coverage (WHO 2018). This could plausibly be attributed to thedengue vaccine scare, numerous islands that are hard to reach, humanresources, in addition to vaccine supply management and distribution.
Measles outbreak recently occurred in metro-Manila. According to thePDHS 2017, measles vaccination coverage is 80.4% yet there are sporadic
measles outbreaks. This coverage is below global target of 95% and might
have contributed to the sporadic outbreaks, whilst a sustained coverage of≥90% would prevent outbreaks as shown in figure 2.

Figure 2: measles vaccination coverage and reported cases in the Philippines
1998 -2014

Figure 1: Immunization coverage in the Philippines by region – 2017

Source: CDC Morbidity and Mortality Weekly Report. Vol. 64/ No. 13. April 2015.
*MCV: Measles Containing Vaccine

Strengths of the Philippines EPI Programme* Strong health system* Enthusiastic workforce* Dedicated and motivated Barangay Health Volunteers
Lessons learnt* Barangay health workers bridge health facility and community relations* Access can improve service utilization* Health care rumours can negatively affect public health services such asimmunizationsStrategies adopted to improve immunization coverage
By DOH Philippines*Generate demand for immunization services and build-up multi-sectoral support
for national immunization programme*Strengthen surveillance and response*Build up supervision, monitoring and evaluation* Institute supportive governance, financing and regulatory measures
WHO country office support to Philippines EPI* Strengthening the national immunization programme* Strengthening the vaccine national regulatory authority* Strengthening vaccine-preventable disease surveillance* Achieving elimination of measles, and maternal and neonatal tetanus* Developed mass media campaign videos/messages to encourage caregivers tovaccinate their children
WPRO* Developed the regional framework for implementation of the “global Vaccine
Action Plan in the Western Pacific” (2012-2020)* Empower national immunization programmes through policy and strategy
development* Cooperation and partnership* Scaling up advocacy* Improve monitoring and surveillance systems* Provide guidance for immunization and multi-year strategic plans* Improving data quality, analysis, utilization and for decision making support

Conclusion* The Philippines has a strong health system with an enthusiastic workforce* Immunizations reduce morbidity and mortality due to vaccine preventablediseases and the Philippines have introduced more innovative strategies toimprove their coverage and are being supported by WHO country office andWPRO.
* Good opportunity for students to acquire practical skills and knowledge
about public health interventions
References:
GAVI Alliance for vaccines, (2017), Annual progress report, accessed on May 4
2018 (www.gavi.org/progress-report/).
Philippine Statistics Authority (PSA) and ICF. (2018). Philippines National
Demographic and Health Survey 2017: Key Indicators. Quezon City, Philippines,and Rockville, Maryland, USA: PSA and ICF.
WHO, 2013, World Immunization Week, accessed on June 15 2018,(http://www.who.int/campaigns/immunization-week/2013/en/).
WHO, 2018, Immunization Fact Sheets, accessed on June 15, 2018(http://www.who.int/en/news-room/fact-sheets/detail/immunization-coverage).