MANILA, Philippines – The government’s program to vaccinate every child even in far-flung areas is facing manpower and logistical issues, a Department of Health (DOH) official told a Senate panel on Tuesday, September 24.

At the hearing of the Senate committee on in a Senate health and demography, DOH Disease Prevention and Control Bureau officer-in-charge Anthony Calibo said the challenges in implementing the Expanded Programme on Immunization (EPI) include the lack of health workers at the ground level, the communication of vaccination campaigns, and the monitoring of materials delivery.

The hearing focused on monitoring DOH efforts in line with the recent resurgence of polio in the Philippines. The country had been polio-free for the last 19 years before the first case of resurgence was reported in a child in Lanao del Sur on September 19. 

The third-dose polio vaccination coverage dropped to 66% in 2018 – its lowest in recent years, according to Calibo. 

The Universal Health Care Act mandates the deployment of health human resources (HHR) through the National Health Human Resource Master Plan. Additionally, deployment to geographically isolated and disadvantaged areas (GIDAs) is prioritized. (EXPLAINER: What Filipinos can expect from the Universal Health Care Law)

Manpower, logistical lapses

Current systems in place mandate vaccine monitoring teams in each local government unit (LGU). These include the municipal health officer, and public health nurses and midwives trained by the regional coordinator for the expanded immunization program.

However, Calibo said that the immunization program is “really understaffed,” and that the DOH should muster momentum from the top down through more human resources.

“Our colleagues at the World Health Organization would tell us, ‘You’re doing the most impossible thing: You have a big country to work with, you have a large population of infants you have to cover, and yet the technical capacity is down to two persons at the central level, and at the regional offices, you only have one medical officer and a nurse coordinator and a cold chain manager,’” he said.

Asked if they had requested for additional manpower, Calibo said that the DOH proposed for creation of an immunization unit in the DOH because of the department’s difficulty in catching up with increasing public demand for immunization and threats of disease resurgence.

While this was not approved, what was provided instead was the creation of items for oral health. While Calibo does not discredit the importance of oral health, he said that an immunization unit was of “prime importance” in providing timely technical assistance to LGUs.

While there are numerous campaigns in place for public health workers to reach every child in every barangay, such as Una Sa Lahat Bakuna, Calibo said there must be a reconfigured study on how to go about this, as the process is more “reactive” than planning-centered. 

He also mentioned the need to revisit the monitoring system for the cold chain, the process that ensures that vaccines are delivered at the needed temperatures to maintain quality.

This was backed by Eastern Samar Governor Ben Evardone, who said that the logistical problems in rural areas were “very evident.” 

Deployment issues?

Evardone also talked about his observations about the lack of proper manpower in local hospitals.

“Isa pa pong problema ngayon ang kawalan ng mga doktor at mga nars sa mga ospital. Nagiging kakompitensya naming mga governors ang DOH. ‘Yung NDP, ang lalaki ng mga sweldo, taga-lista lang ng sinong buntis, sinong nakapag-appointment… ‘Yung mga nars sa mga ospital, nag-aalisan na sa mga ospital, kasi P17,000 na lang ang mga sweldo eh,” he said.

(One problem is the ack of doctors and nurses in the hospitals. The DOH is competing with governors. The Nurse Deployment Program  offers big salaries for people doing clerical work like listing down appointments. Meanwhile, the nurses at the hospital leave because they only get a salary of P17,000.)

Calibo said, however, that the NDP follows service-rendering deployment programs and if they are only doing secretarial or statistical work, then this should be an oversight that must be addressed.

Evardone said that there are difficulties in mobilizing trained nurses from the NDP, which he claimed is a common concern among other governors.

“Talagang wala kaming doctors, nurses; nandoon sa DOH. Kaya sana lang hindi lang review ng tasks of NDP, sana ipagamit din ang mga nars ng DOH dito,” he said.

(We really don’t have doctors or nurses; they’re there at the DOH. So I hope this isn’t just a matter of reviewing the tasks of NDP personnel, I hope the DOH nurses can already be deployed here.)

Representatives from the Philippine Hospital Association and the Philippine Pediatric Society also emphasized the lack of manpower as a major challenge in local hospitals.

Scare from inadequate communications

The understaffing problem spills into negative impressions that parents may have towards vaccines, especially in light of the Dengvaxia controversy in 2017. 

Campaigns like Una Sa Lahat Bakuna not only strive to widen the coverage of vaccinations, but also to address the need to gain public trust to reduce vaccine hesitancy. 

Since there are less people on the ground, Calibo said the loss of face-to-face interaction contributes to uncertainties parents may have on getting their children vaccinated.  

“I think one of the main challenges is that the communication materials are very top-heavy. They require dissipation at the ground level. This has been the weakest link, especially in terms of response…. Admittedly, there are some parents who may not be well-informed about vaccinations and their safety,” he said.

Calibo cited studies that if there is proactive cooperation among local governments from the chief executives to the public health workers, then vaccination coverage is improved because of constituents would appreciate  that the government is delivering services.

“Be it in public or private settings, communication is critical, and although we do have social media platforms for health promotions with diligent posting, there is still no replacement for face-to-face communication. Interpersonal communication really assures the parent because that’s the human aspect of assuring them that the vaccines are safe,” he said.  

Apart from vaccinations, Calibo also emphasized that the communities need sanitary environments and capacity for children to be well-nourished. – Rappler.com