Proposal Form (R06 - ) (PHL-R06-ML)

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Proposal Form (R06 - ) (PHL-R06-ML)
PROPOSAL FORM
SIXTH CALL FOR PROPOSALS
Country Coordinated Proposal for Malaria
Philippines
An intensified strengthening of local response and health
systems to consolidate the gains in malaria control in
rural Philippines through public private partnership
Submitted by the
Country Coordinating Mechanism
3 August 2006
Philippine Malaria Proposal
1 Proposal Overview
1.1 General information on proposal
Applicant Name
Country Coordinating Mechanism
Country/countries
Philippines
Applicant Type
Please tick one of the boxes below, to indicate the type of applicant. For more information, please refer to the
Guidelines for Proposals, section 1.1 and 3A.
X
National Country Coordinating Mechanism
Sub-national Country Coordinating Mechanism
Regional Coordinating Mechanism (including small island developing states)
Regional Organization
Non-Country Coordinating Mechanism Applicant
Proposal component(s) and title(s)
Please tick the appropriate box or boxes below, to indicate components included within your proposal. Also specify the
title for each proposal component chosen. For more information, please refer to the Guidelines for Proposals, section
1.1.
Component
HIV/AIDS
1
Tuberculosis
X
Title
Malaria
1
An intensified strengthening of local response and health systems to
consolidate the gains in malaria control in rural Philippines through public
private partnership
Currency in which the Proposal is submitted
Please tick the appropriate box. Please note that all financial amounts appearing in the proposal should be
denominated in the selected currency only.
X
US$
Euro
1
In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS and/or tuberculosis components should include
collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for different epidemic
states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’ available at
http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
Philippine Malaria Proposal Round 6
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1 Proposal Overview
1.2 Proposal funding summary per component
Funds requested for each component (i.e. HIV/AIDS, tuberculosis and/or malaria) in table 1.2 below must be the
same as the totals of the corresponding component budget in table 5.1.
Table 1.2 – Total funding summary
Component
Total funds requested (Euro / US$)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
HIV/AIDS
0
0
0
0
0
0
Tuberculosis
0
0
0
0
0
0
Malaria
0
0
0
0
0
0
Total
0
0
0
0
0
0
1.3 Previous Global Fund grants
Table 1.3 – Previous Global Fund grants
Component
Previous grants
Rounds
Current Amount* (Euro / US$)
HIV/AIDS
Round 3 and Round 5
US$ 12,006,887.00
Tuberculosis
Round 2 and Round 5
US$ 58,635,707.50
Malaria
Round 2 and Round 5
US$ 26,138,181.00
HSS/Other
*
Aggregate all past grants, including approved but as yet unsigned amounts. These amounts should include Phase 2
where this has been approved/signed. For more detailed information, see the Guidelines for Proposals, section 1.3.
Philippine Malaria Proposal Round 6
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2 Eligibility
Only those Proposals that meet the Global Fund’s eligibility criteria will be reviewed by the
Technical Review Panel.
Eligibility is a multi-step process that depends on the income level of the country (or countries) applying for funding and,
in some cases, disease burden.
Please read through this section carefully and consult the Guidelines for Proposals, section 2, for further guidance on the
steps to be followed by each applicant.
2.1 Technical eligibility
2.1.1 Country income level
Please tick the appropriate box in the table below. For proposals from multiple countries, complete the
referenced information separately for each country (see the Guidelines for Proposals, section 2.1).
Country/countries
X
Philippines
Low-income
Complete section 2.2 only
Lower-middle income
Complete sections 2.1.2, 2.1.3 and 2.2
Upper-middle income
Complete sections 2.1.2, 1.2.3, 2.1.4 and 2.2
2.1.2 Counterpart financing and greater reliance on domestic resources
Please enter information on counterpart financing in table 2.1.2 below if the country(ies) listed above are
classified as Lower-middle income or Upper-middle income.
Non-CCM Applicants do not have to fulfill the counterpart financing requirement.
The table should be filled in for each component included in this proposal. For definitions and details of
counterpart financing requirements, see the Guidelines for Proposals, section 2.1.2.
Important note: The field “Total requested from the Global Fund” in table 2.1.2 below should equal the request in
section 5 and table 5.1 for each corresponding component.
Table 2.1.2 – Counterpart financing
Table 2.1.2 – Counterpart financing continued
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Table 2.1.2 – Counterpart financing continued
(Euro / US$)
Component
Financing sources
Year 1
Year 2
Year 3
estimate
Year 4
estimate
Year 5
estimate
1,222,336
Total requested from
the Global Fund (A)
[from table 5.1]
Malaria
11,929,558
4,368,100
2,726,424
2,098,367
1,330,000
1,289,000
1,085,000
985,000
Counterpart
financing (B) [linked
to the disease control
program]
Counterpart financing
as a percentage of
total financing:
[B/(A+B)] x 100 = %
10.0
22.8
28.5
31.9
975,000
44.4
2.1.3 Focus on poor or vulnerable populations
All proposals from Lower-middle income and Upper-middle income countries must demonstrate a focus on poor
or vulnerable population groups. Proposals may focus on both population groups but must focus on at least one
of the two groups. Complete this section in respect of each component.
Describe which poor and/or vulnerable population groups your proposal is targeting; why and how
these populations groups have been identified; how they were involved in proposal development
and planning; and how they will be involved in implementing the proposal
(Maximum half a page per component).
The proposal is targeted to the rural poor population including subsistence farmers, settlers in frontier
areas, forest-related workers and the indigenous populations (IPs) of the Philippines. In particular,
6,000,000 out of 11,000,000 IPs constitute at-risk population living in areas with the lowest socioeconomic development opportunities and where occasional political and tribal conflicts pose peace and
security risks. Health services for this high risk population are provided by the local government units led
by the barangay (village) units under the municipal government. In addition, civil society organizations
including faith- based organizations and community-based organizations that have limited resources and
technical capacity to provide these services have established linkages and infrastructure for health
services in these areas. Through the National Commission on Indigenous Peoples (NCIP), we have
invited representatives from these civil society organizations to provide inputs through concept proposals
and participate during the writing of the proposal. These organizations include faith-based organizations
(FBOs), non-government organizations (NGOs), and community-based organizations (CBOs) that will be
considered for selection as sub-recipients in the implementation of the project.
The Country Coordinating Mechanism published an advertisement in a national daily newspaper inviting
concept proposals. Six concept proposals have been reviewed and five were integrated into the country
coordinated proposal. (Annex 1) The Global Fund Round 2 project personnel have also undertaken
consultations with the Local Government Units to determine the capacity building requirements from the
Mayors, Municipal Health Officers, and the malaria control program implementers from the community.
Their inputs have been summarized and incorporated into the proposal (Annex 2).
In addition, the results of the external evaluation undertaken by the Western Pacific Regional Office
th
Malaria Project Officers of the WHO in the 18 month of implementation of the project were reviewed and
Philippine Malaria Proposal Round 6
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2 Eligibility
th
their findings also guided the malaria proposal for the 6 round (Annex 3).
2.1.4 High disease burden
Proposals from Upper-middle income countries must also demonstrate that they face a very high current disease
burden. Please enter such information in the section below in respect of each component. Please note that if the
applicant country falls under the “small island economy” lending eligibility exception as classified by the World
Bank/International Development Association, this requirement does not apply (see section C in Attachment 1 to
the Guidelines for Proposals).
Confirm that the country(ies) is(are) facing a very high current disease burden, as evidenced by data
from WHO and UNAIDS. (Please see the Guidelines for Proposals, section 2.1.4 for more information on the
definition of high disease burden.)
2.2 Functioning of Coordinating Mechanism
To be eligible for funding, all applicants, other than Non-CCM Applicants and Regional Organizations
must meet the Global Fund’s minimum requirements for Coordinating Mechanisms.
For additional information regarding these requirements, see:
•
The Guidelines for Proposals, section 2.2 and
•
The CCM Guidelines.
Please note that your application must provide documentation to show how the applicant
meets these minimum requirements. You will be asked to re-confirm this in the Checklist at the
end of section 3.
2.2.1 Broad and inclusive membership
a) People living with and/or affected by the disease(s)
Provide evidence of membership of people living with and/or affected by the disease(s).
(This may be done by demonstrating corresponding Coordinating Mechanism membership composition and
endorsement in table 3B1.2, and 3B.1.3 in section 3B of the Proposal Form.)
The CCM membership includes people living with HIV (PAFPI since 2002) and TB (Samahang Lusog
Baga since 2005). Also included as a member since 2002, the Kilusan Ligtas Malaria is a private-public
partnership in the Local Government Unit of the Province of Palawan that has been implementing a
malaria control program in that province for 5 years now. Membership also includes the National Council
of Indigenous Peoples (NCIP), a government agency which administers matters pertaining to the needs of
the Indigenous population that constitute one of the at-risk populations for malaria. (Please refer to 3B1.2
and 3B1.3 and 3B) These organizations participate in the CCM meetings and have been invited in the
preparation of this proposal.
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b) Selection of non-governmental sector representatives
Provide evidence of how those Coordinating Mechanism (CM) members representing each of
the non-governmental sectors (i.e. academic/educational sector, NGOs and community-based
organizations, private sector, religious and faith-based organizations, and multi-/bilateral
development partners in country) have been selected by their own sector(s) based on a
documented, transparent process developed within their own sector.
(Please summarize the process and, for each sector, attach as an annex the documents showing the
sector’s transparent process for CM representative selection, and the sector’s minutes or other
documentation recording the selection of their current representative. Please indicate the applicable annex
number.)
st
In June 2005, the 1 Forum of the Philippine Partnership against TB, Malaria and AIDS was held at the
Philippine International Convention Center, integrated into the program of the International Congress of
Chemotherapy, held in the Philippines, hosted by the Philippine Society of Microbiology and Infectious
Diseases (PSMID) under the auspices of the International Society of Chemotherapy (ISC). That forum was
attended by partners in the Philippines lead by the newly installed Secretary of Health, Dr. Francisco
Duque, the UN agencies lead by the World Health Representative to the Philippines, and various
stakeholders including other bilateral agencies, Government sector representatives, the academe, and the
civil society organizations including organization of people living with the diseases (PLWHA, PLWT) The
malaria at-risk population was represented by the attendance of several indigenous peoples in the Forum.
The forum informed the stakeholders of the Philippine Department of Health Strategies for the control of
TB, Malaria and HIV/AIDS, Global Fund, the Country Coordinating Mechanism (CCM): its functions and
how members are chosen, the projects that GF supports in the Philippines, and the status of the
implementation of those projects. During the forum, there was a breakout session where participants were
asked to identify which sector they belong to. Participants of each sector assembled and elected from
among themselves their nominees for membership. During the breakout session, the draft document of
the Mission, Vision Statements of the Partnership was also discussed for the inputs of the various
stakeholders. The revised document was the output of the forum and was made part of the minutes of that
forum (Annex 4).
On World TB Day, March 24, 2006, the Philippine Coalition against Tuberculosis organized a forum for
the launch of the Global Plan 2 for TB. During that forum, all stakeholders in the Philippine Partnership
against TB, Malaria, and AIDS were invited to attend and during the specified period from 3:00 to 8:00 PM,
they were requested to cast their ballots for one or more (as indicated in the ballots circulated) nominees
originally agreed upon in the stakeholders meeting during the first Forum. The election was done under
the supervision of the Commission on Election that was organized by the Country Coordinating
Mechanism. A total of 45 stakeholders cast their votes and the new members of the Private Sector
Representatives to the Country Coordinating Mechanism were elected at that time. The New members
were invited to attend the June CCM meeting. (Annex 5 Report of the Commission on Election to the
CCM submitted in the April Meeting of the CCM).
2.2.2 Documented procedures for the management of conflicts of interest
Where the Chair and/or Vice-Chair of the Coordinating Mechanism are from the same entity as the
nominated Principal Recipient(s) in this proposal, describe and provide evidence of the applicant’s
documented conflict of interest policy to mitigate any actual or potential conflicts of interest arising in
regard to the applicant’s operations or responsibilities.
(Please summarize and attach the policy as an annex. Please indicate the applicable annex number.)
Resolving conflict of interest issues is specified in the Guidelines of the Philippine Country Coordinating
Mechanism. Specifically, the Guideline states:
•
•
The Principal Recipient cannot be the Chairman of the Country Coordinating Mechanism.
In deliberations of the CCM where the PR may be the actual beneficiary, the PR must inhibit itself
from the discussions. (Annex 6)
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2 Eligibility
2.2.3 Documented and transparent processes of the Coordinating Mechanism
As part of the eligibility screening process for proposals, the Global Fund will review supporting documentation
setting out the CCM’s proposal development process, the submission and review process, the nomination
process for Principal Recipient(s), as well as the minutes of the meeting where the CCM decided on the
elements to be included in the proposal and made the decision about the Principal Recipient(s) for this
proposal.
Please describe and provide evidence of the CCM’s documented, transparent and
established:
a) Process to solicit submissions for possible integration into this proposal.
(Please summarize and attach documentation as an annex and indicate the applicable annex number.)
The need for a submission of a proposal for malaria control was presented to the CCM based on the
recognized need expressed by the Local government units to sustain the gains of the Round 2 Malaria
project. It was agreed that the Malaria TWG meeting discuss the matter in the meeting that was going to be
held the following day. During that meeting, members of the Management Committee representing the
Malaria Technical Working Group (TWG) approved the development of a country coordinated proposal.
(Annex 7)
As previously stated, advertisement for request for concept proposals was published in a daily national
circulation July 1, 2006. (Annex 1) A total of 6 concept proposals were received. Of these submitted, five
were considered appropriate for incorporation into the proposal as judged by the Screening committee, one
of which would constitute an operational research on the burden of illness to determine the impact of the
malaria interventions. The writing committee was formed by the stakeholders and subsequent meetings
and consultations among the four proponents ensued. The coordinated country proposal was then planned
and developed by the writing committee with inputs from various stakeholders. The draft coordinated
country proposal was presented to the CCM in the 18 July 2006 meeting and it was agreed that a final
completed proposal be circulated by email July 27, 2006 to the members of the CCM and the approval be
confirmed by referendum (Annex 8).
The National Commission on Indigenous Peoples (NCIP) is actively involved in the proposal development,
and provides a link with other community-based, faith-based organizations that already have an
infrastructure in the areas where malaria is endemic. Through them, other FBOs and CBOs providing
health services to the IPs will be invited to participate in the project during implementation.
Consultations with select local government officials in Agusan del Norte, Surigao del Sur, and Cagayan
province were undertaken to discuss their compliance with the initial MOU to provide compensation to the
additional malaria program personnel funded by the GF Round 2 project only for the phase 1 of the project.
In addition, the staff of the LGUs have also been interviewed using an open-ended instrument to determine
what their perception of the challenges to sustaining the project are and how they would envision that these
could be answered. The output of their interview will be appended as Annex 2.
b) Process to review submissions received by the CCM for possible integration into this proposal.
(Please summarize and attach documentation as an annex and indicate the applicable annex number.)
The CCM Executive Secretary, Dr. Jaime Lagahid authorized the formation of a Proposal Screening
Committee on July 13, 2006 meeting of the Malaria Technical Working Group. The findings of the
screening committee were presented by Dr. Raman Velayudhan who summarized it and the report is
reflected in the CCM minutes of the July 18, 2006 at Tiara Hotel (Annex 8). He reported that there were six
submissions of concept proposals and one was rejected outright because the proposal was on a
commercial product testing as an intervention for larval control. The remaining 4 concept proposals would
th
be integrated into the 6 round country coordinated proposal, with an additional one considered as an
operational research.
c) Process to nominate the Principal Recipient(s) and oversee program implementation.
(Please summarize and attach documentation as an annex and indicate the applicable annex number.)
As agreed in the 18 July CCM to decide on the PR in a referendum and incorporate inputs into the country
coordinated proposal for malaria, the CCM Secretariat issued a request for nomination of PRs for the
Philippine Malaria Proposal Round 6
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2 Eligibility
Round 6 Malaria Country coordinated proposal. An election by referendum was subsequently held with
only one nominee that was subsequently confirmed. (Annex 9)
d) Process to ensure the input of a broad range of stakeholders, including CCM members and
non-CCM members, in the proposal development process and grant oversight process.
(Please summarize and attach documentation as an annex and indicate the applicable annex number.)
The concept proposals submitted in response to a published advertisement were reviewed by a screening
committee. The proposals approved were then endorsed to the writing committee for incorporation into the
country coordinated proposals. Out of 6 submitted concept proposals, 5 were endorsed to the writing
committee. Continuing meetings with stakeholders and proponents (FBOs, CBOs, and NGOs that
submitted concept proposals for incorporation into the coordinated country proposal were undertaken July
20, 21, and 22. After the completion of the first draft of the proposal, it was agreed at the July 18 CCM
meeting that the draft will be circulated by July 27, 2006 to CCM members for their inputs and final
approval.
The country coordinated proposal was presented to the mancom of the TWG for Malaria (July 28, 2006)
with the special participation of non-health public sector CCM members including the NCIP, the
Department of Interior and Local Government (DILG), and the Department of National Defense (DND) for
their inputs into the proposal. Thereafter, the draft country coordinated proposal was circulated by email to
the members of the CCM for their review and comments.
There will be capacity building for the CCM in implementing the project and exercising grant oversight
functions. Presentation of outputs on regular CCM meetings will inform the CCM members of the inputs
and outputs in the implementation of the activities under each objective.
Philippine Malaria Proposal Round 6
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3A Applicant type
This section contains information on the applicant. Please see the Guidelines for Proposals, section 3A, for more
information regarding the nature of different applicants.
All Coordinating Mechanism Applicants (whether national, sub-national, regional (C)CMs) and Regional
Organizations must also complete section 3B of this Proposal Form and provide the documented evidence requested.
Non-CCM Applicants do not complete section 3B. These applicants must fully complete section 3A.5 of this Proposal
Form and provide documentation as an attachment to this proposal supporting their claim to be considered as eligible for
Global Fund support outside of a Coordinating Mechanism structure.
3A.1 Applicant
Table 3A.1 – Applicant
Please tick the appropriate box in the table below, and then go to the relevant section in this Proposal Form, as
indicated on the right hand side of the table.
complete sections 3A.2 and 3B
Sub-national Country Coordinating Mechanism
complete sections 3A.3 and 3B
Regional Coordinating Mechanism
(including small island developing states)
complete sections 3A.4 and 3B
Regional Organization
complete section 3A.5 and 3B
Non-CCM Applicants
complete section 3A.6
X National Country Coordinating Mechanism
Philippine Malaria Proposal Round 6
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3A Applicant type
3A.2 National Country Coordinating Mechanism (CCM)
For more information, please refer to the Guidelines for Proposals, section 3A.2, and the CCM Guidelines.
Table 3A.2 – National CCM: basic information
Name of national CCM
Date of composition (yyyy/mm/dd)
Country Coordinating Mechanism
2002 May 5
Philippine Malaria Proposal Round 6
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3A Applicant type
3A.2.1 Mode of operation
Describe how the national CCM operates. In particular:
• The extent to which the CCM acts as a partnership between government and other
actors in civil society, including the academic and educational sector; non-government and
community-based organizations; people living with and/or affected by the diseases and the
organizations that support them; the private sector; religious and faith-based organizations; and
multi-/bilateral development partners in-country; and
• How it coordinates its activities with other national structures (such as National AIDS
Councils, Parliamentary Health Commissions, National Monitoring and Evaluation Offices and
other key bodies).
(For example, address topics including decision-making mechanisms and rules, constituency consultation
processes, the structure and key focus of any sub-committees, frequency of meetings, implementation
oversight processes, etc. The recommended length of response is a maximum of one page. Please provide
terms of reference, statutes, by-laws or other governance documentation relevant to the CCM, and a diagram
setting out the interrelationships between all key actors in the country as an annex to this proposal. Please
indicate the applicable annex number.)
The CCM is a stand-alone committee of a broad private public partnership drawing from members of the
civil society that have been elected in a transparent and well documented manner, from nomination to final
election, coordinated by a commission on election formed by the CCM secretariat. Members from the
government sector and from the United Nations Agency and bilateral development partners and donor
countries to the GF are selected separately through mechanisms that are supervised by the office of the
WHO country representative. The civil society representatives are broadly categorized into: 1. Academe,
2. People Living with the Disease, 3. Private Professional Organizations, 4. NGOs, 5. FBOs and 6.
Public-Private coalitions involved in the control and/or advocacy for the three diseases including the
Philippine National AIDS Committee (PNAC). The composition of the CCM is shown in the organizational
chart in the updated guidelines of the CCM ( Annex 6).
The election of the civil society representatives to the CCM is held in a transparent, open, and well
documented process. A first forum of The Partnership Partnership to fight TB, AIDS and Malaria was held
June 4, 2005 and will meet thereafter biennially. Nominees from the different sector representatives
present at that meeting was held. The candidates stood up for election in another meeting held jointly with
the PhilCAT launch of the Global Plan to Stop TB 2006-2015 on March 24, 2006. A report on the election
in the June 13, 2006 CCM meeting is reflected in the minutes of CCM meetings. (Annex 10 and 11) CCM
members representing these various stakeholders are present in all CCM meetings and are invited to join
monitoring meetings of the GF projects. They are likewise enjoined to inform their respective sector
constituents regarding the matters taken up by the CCM for information and for consultation. Membership
is a two year term and members are elected in an overlapping fashion to maintain continuity. Issues on
conflict of interest are resolved as indicated in the guidelines.
Representatives from these 6 sectors are active members of the CCM in addition to the 8 members from
the UN agencies and developmental bilateral partners and donor countries to the GF, and the 10
members from the Government Sector headed by the Department of Health. CCM meetings are held twice
every quarter, the first meeting within the quarter is to receive reports on the program implementation for
CCM approval prior to submission to the Global Fund. The second meeting within the quarter is to discuss
the results of program implementation, with focus on the attainment of targets set within the period,
problems encountered, and issues that need to be resolved in the level of the CCM. Decisions are made
on the basis of consensus. Subcommittees within the CCM, referred to as technical working groups
(TWG) for each of the three disease components, provide guidance to the implementing sub-recipients
on technical and programmatic issues with technical experts provided by the UN agencies program
officers in each of the three disease components, the academe, and the DOH. There are a total of 35
members of the CCM. Of these, 10 (40%) are from the public sector and 25 (60%) are from the nongovernment sector comprising of 2 from the academe, 6 from NGOs, 2 from people living with the disease,
2 from faith based organizations, 2 from private sector, 3 from coalitions, and 8 from UN agencies and
developmental bilateral partners or government of donor countries to the GF. CCM members are
responsible for the dissemination of the CCM proceedings to their own constituents. In the deliberation of
the coordinated country proposals, these various agencies are encouraged to contribute in the proposal.
They are likewise encouraged to join the monitoring and supervision missions to be informed of the status
of the GF project implementation. The various component projects of the GF support the development of
capacity at the DOH National Epidemiology Center (NEC) to harmonize GF monitoring and evaluation
with the DOH.
Philippine Malaria Proposal Round 6
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3A Applicant type
3B.1 Coordinating Mechanism membership and endorsement:
National/Sub-national/Regional Coordinating Mechanisms
3B.1.1 Leadership of Coordinating Mechanism
Table 3B.1.1 – National/Sub-national/Regional (C)CM leadership information
(not applicable to Non-CCM and Regional Organization applicants)
Chair
Vice Chair
Name
Dr. Ethelyn Nieto, MD
Dr. Aye Aye Thwin
Title
Undersecretary of Health
Public Health Affairs
Chief , Office for Population, Health
& Nutrition
Organization
Department of Health,
Government of the Philippines
United States Agency for International
Development (USAID)
Mailing address
Department of Health
San Lazaro Compound
Manila, Philippines
USAID/Philippines
8F PNB Financial Center,
Roxas Boulevard,
Pasay City, Philippines
Telephone
63 2 7116808
+63 2 552 9865
Fax
63 2 7116808
+63 2 552 9865
E-mail address
[email protected]
[email protected],
[email protected], [email protected];
[email protected]
Philippine Malaria Proposal Round 6
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3A Applicant type
3B.1.2 Membership information
Please note that to be eligible for funding, national/sub-national/regional Coordinating Mechanisms must
demonstrate evidence of membership of people living with and/or affected by the diseases. It is recommended
that the membership of the CCM comprise a minimum of 40% representation from non-governmental sectors.
For more information on this, see the Guidelines for Proposals section 3B.1, and the CCM Guidelines.
The table below must be completed for each national/sub-national/regional Coordinating Mechanism member,
and the table will therefore need to be extended to cover numerous members.
Under “Type”, please specify which sector the CCM member represents: academic/educational; government;
non-governmental and community-based organizations; people living with HIV/AIDS, tuberculosis and/or
malaria; the private sector; religious/faith-based organizations; or multi-/bilateral development partners in
country.
Table 3B.1.2 – National/sub-national/regional (C)CM member information
National/Sub-National/Regional (C)CM member details
Chairperson
Agency/organization
Department of Health
Website
Public Health Sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
www.doh.gov.ph
Sector
represented
Government
Name of
representative
!"$#!"#&%'
( * )*+-,.,.,
CCM
member
since
March 2002
Title in agency
Undersecretary
Fax
632 711 -6075
E-mail address
[email protected]
Telephone
632 711-6075
Main role in the
Coordinating
Mechanism and the
proposal
development
Development of the Country
coordinated proposal
Mailing
address
Department of Health
Bldg. 1, San Lazaro Compound,
Rizal Avenue, Sta. Cruz
1101 Manila, Philippines
Website
www.usaid.org
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Vice Chairperson
Agency/organization
United States Agency for
International Development (USAID)
Bilateral development partner
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Development Partner
Dr. Aye Aye Thwin
Philippine Malaria Proposal Round 6
Sector
represented
CCM
member
since
Sept 2002
13
3A Applicant type
Title in agency
Sr. Technical Adviser
Fax
632 522-9800 loc 5410
E-mail address
[email protected]
Telephone
632 522-9869
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
PNB Financial Center
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 3
Agency/organization
Department of Health – Center for
Health Development – Cordillera
Administrative Region
Website
Health -Regional Level
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
www.shell.com
www.pilipinasshellfoundation.org
www.malampaya.com
Sector
represented
Government
Public Health Sector
Name of
representative
Dr. Myrna C. Cabotaje
CCM
member
since
September 2002
Title in agency
Director IV
Fax
6374 442- 8098
E-mail address
[email protected]
Telephone
6374 442-8097
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
Center for Health Development
Cordillara Administrative Region
Baguio City
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 4
Agency/organization
/100324$5687:9
;5<$=5>@?6ACB?5
< 6EDF&?;$68?GIH
[email protected]?;$6NM>PO5Q$9
GN5$;R
S K4< 9$AKL?&;$6
Website
Non-health Public Sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Public Sector
Sector
represented
Name of
representative
Dr. Dulce Estrella-Gust
CCM
member
since
February 2005
Title in agency
Executive Director
Fax
63(2)928-6690
E-mail address
[email protected]
Telephone
63(2)928-6728
Philippine Malaria Proposal Round 6
14
3A Applicant type
Main role in the
Coordinating
Mechanism and the
proposal
development
th
Review
Mailing
address
5 Floor
Mabini Building
Meralco Ave.
Pasig City
Website
www.ritm.gov.ph
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 5
Agency/organization
Research Institute of Tropical
Medicine
Public Health Sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Title in agency
E-mail address
Main role in the
Coordinating
Mechanism and the
proposal
development
Sector
represented
Public Sector
Dr. Remigio Olveda
Dra. Dorina Bustos
Medical Director/
Medical Specialist
[email protected]
Technical Input /Proposal writing
CCM
member
since
March 2002
Fax
(632) 842 -2245
Telephone
(632) 809-7599
Mailing
address
Filinvest Corporate City,
Alabang
1770 Muntinlupa City
Philippines
Website
www.cec.eu.int
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 6
Agency/organization
European Council
Bilateral Development Partners
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Development Partners
Sector
represented
Name of
representative
Dr. Fabrice Sergent /
Ms. Rita Bustamante
CCM
member
since
October 2003
Title in agency
Individual Expert for Health
Fax
632 812 - 6686
E-mail address
[email protected]
[email protected]
Telephone
632 812 -6421
Mailing
address
7th Floor
Salustiana Ty Tower
Perea St. cor Paseo de Roxas
Ave.,
Makati City
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Philippine Malaria Proposal Round 6
15
3A Applicant type
Member 7
Agency/organization
German Technical Cooperation
Agency (GTZ)
Website
Bilateral Development Partners
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Development Partners
Name of
representative
Dr. Michael Adelhardt
CCM
member
since
June 2003
Title in agency
Program Manager
Fax
632 711 -6142
E-mail address
[email protected]
Telephone
632 742-3417
Mailing
address
9th Floor
PDCP Bank Center
Herrera cor. Leviste St. Salcedo
Vilage
Makati City
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 8
Agency/organization
Japan International Cooperating
Agency (JICA)
Website
Bilateral Development Partners
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Development Partners
Name of
representative
Dr. Mie Kasamatsu
CCM
member
since
Sept 2002
Title in agency
Technical Adviser
Fax
632 373-9534
E-mail address
[email protected]
Telephone
632 772-2068 to 70 loc.110
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
Ground Floor,
RITM
Filinvest Corporate City,
Alabang
1770 Muntinlupa City
Philippines
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 9
Agency/organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
Kilusan Ligtas Malaria (KLM)
Public-Private Mix
Philippine Malaria Proposal Round 6
Website
Sector
represented
Public- Private Mix
Disease Coalition (Provincial
Level)
16
3A Applicant type
People Living with the Disease Malaria
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Ray Angluben
CCM
member
since
Septebmer 2002
Title in agency
Project Director
Fax
6348 434-5202
E-mail address
[email protected]
[email protected]
Telephone
6348 434- 6346
Mailing
address
KLM PRIMM Bldg. PEO
Compound
Bgy. Bancao-Bancao
Puerto Princesa City
Palawan
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input /Proposal writing
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 10
Agency/organization
Provincial Health Office - Apayao
Website
Public Health
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Public Sector
Name of
representative
Dr. Thelma Dangao
CCM
member
since
Title in agency
Provincial Health Officer II
Fax
E-mail address
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input
Local Government Unit
Malaria
March 2002
Telephone
632 983-1052
Mailing
address
Provincial Health Office Apayao
Website
www.ncip.gov.ph
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 11
Agency/organization
National Commission for Indigenous
Peoples (NCIP)
Non-health public sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Public Sector
Dr. Ricardo Sakai
Philippine Malaria Proposal Round 6
Sector
represented
CCM
member
since
Indigenous People
Sept 2002
17
3A Applicant type
Title in agency
Medical Officer V
Fax
632 373-9534
E-mail address
[email protected]
Telephone
632 374-5554
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input /Review
Mailing
address
2nd Floor,
Dela Merced Bldg. West Ave.
Cor Quezon Ave. Quezon City
Website
www.neda.gov.ph
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 12
Agency/organization
National Economic Devt. Agency
(NEDA)
Non-health public sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Public Sector
Name of
representative
Ms. Arlene Ruiz
CCM
member
since
September 2002
Title in agency
Chief, HNPD
Fax
632 631-3558
E-mail address
[email protected]
Telephone
632 631-5435
Review
Mailing
address
12 Jose Ma. Escriva Drive ,
Ortigas Center
Pasig City
Main role in the
Coordinating
Mechanism and the
proposal
development
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 13
Agency/organization
Association of Philippine Medical
Colleges
Website
Academe
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector
Sector
represented
Name of
representative
Dr. Fernando Piedad
CCM
member
since
June 2006
Title in agency
President
Fax
63-2-4153488
E-mail address
[email protected]
Telephone
63-2-32727947
Philippine Malaria Proposal Round 6
18
3A Applicant type
Main role in the
Coordinating
Mechanism and the
proposal
development
Mailing
address
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Room 101
National Institutes of Health
Bldg.
P.Gil ST.,
Ermita, Metro Manila
Member 14
Agency/organization
Positive Action Foundation
Philippines , Inc.(PAFPI)
Website
PLWD – HIV/AIDS
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector
Name of
representative
Mr. Joshua Formentera
CCM
member
since
Sept 2002
Title in agency
President
Fax
632 404-2911
E-mail address
[email protected]
Telephone
632 832-6239
Review
Mailing
address
2361 Dian St.
Malate
1004 Manila
Website
www.dost.gov.ph
Main role in the
Coordinating
Mechanism and the
proposal
development
Sector
represented
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 15
Agency/organization
Phil. Council for Health Research
Development. Department of
Science and Technology
Health Research Sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Public Sector
Sector
represented
Science & Technology
Name of
representative
Dr. Jaime Montoya
CCM
member
since
March 2002
Title in agency
Executive Director
Fax
632 837-2942
E-mail address
[email protected]
Telephone
632 837-2942
Mailing
address
3rd Floor
DOST Bldg.
Taguig, Bicutan
Metro Manila
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Philippine Malaria Proposal Round 6
19
3A Applicant type
Member 16
Agency/organization
Samahang Lusog Baga
Website
People Living with the Disease
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Private Sector
Name of
representative
Mr. Fernando Collera
CCM
member
since
Title in agency
President
Fax
E-mail address
[email protected]
Telephone
Main role in the
Coordinating
Mechanism and the
proposal
development
TB Patient Organizaiton
Non-government organization
November 2005
Review
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 17
Agency/organization
Phil. Coalition Against Tuberculosis
(PhilCAT)
Website
Public Private Mix - TB
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Title in agency
E-mail address
Main role in the
Coordinating
Mechanism and the
proposal
development
Sector
represented
Public-Private Mix
Dr. Jubert Benedicto
Ms. Amy Sacramento
Chairman /
Executive Director
[email protected]
Tuberculosis
CCM
member
since
March 2002
Fax
632 749 - 8990
Telephone
632 781 - 9536
Mailing
address
Ground Floor RTC Bldg
Quezon Institute Compound
E. Rodríguez Ave.
Quezon City
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 18
Agency/organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
Philippine National AIDS
Commission (PNAC)
Public Private Mix
Philippine Malaria Proposal Round 6
Website
Sector
represented
Coalition – HIV/AIDS
20
3A Applicant type
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Dr. Fercito Avelino
CCM
member
since
March 2002
Title in agency
Officer in Charge
Fax
632 743-0512
E-mail address
[email protected]
[email protected]
Telephone
632 743-0512
Mailing
address
3rd Flr, Bldg 12
Dept. of Health San Lazaro
Compound
Sta. Cruz, Manila,Philippines
Website
www.pngoc.com
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 19
Agency/organization
Phil. NGO Council
NGO
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Private Sector
AIDS Advocacy Group
Name of
representative
Ms. Eden Divinagracia
CCM
member
since
March 2004
Title in agency
Executive Director
Fax
632 834-5008
E-mail address
[email protected]
Telephone
632 834-5007
Mailing
address
38-A San Luis St.
Pasay City
Manila
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input /Proposal writing
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 20
Agency/organization
Pilipinas Shell Foundation, Inc
Website
Private Corporate Foundation
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
www.shell.com
www.pilipinasshellfoundation.org
www.malampaya.com
Private Sector
Marvi Rebueno-Trudeau
Mr. Ed Veron Cruz
Philippine Malaria Proposal Round 6
Sector
represented
CCM
member
since
Malaria
2004
21
3A Applicant type
Title in agency
Program Manager/
President
E-mail address
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input/ Proposal
Writing/Review
Fax
6348 434-5202
Telephone
6348 434-5203
Mailing
address
Castillan Hall,
Asturias Hotal
Tiniguiban, Puerto Princesa City
5300 Palawan
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 21
Agency/organization
Philippine College of Chest
Physicians
Website
Professional Society
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Private Sector
Tuberculosis
Name of
representative
Dr. Renato Dantes
CCM
member
since
June 2006
Title in agency
President
Fax
9240144
E-mail address
[email protected]
Telephone
9249204
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
84-A Malakas St.
Pinahan Road, Quezon City
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 22
Agency/organization
Tropical Disease Foundation, Inc
(TDF)
Website
NGO
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector:
Sector
represented
Private non-profit science
foundation
Name of
representative
Dr. Thelma Tupasi
CCM
member
since
March 2002
Title in agency
President
Fax
632 888-9044
E-mail address
[email protected]
[email protected]
Telephone
632 893-6066
Philippine Malaria Proposal Round 6
22
3A Applicant type
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input /Proposal writing
Mailing
address
Room 2002 Medical Plaza Bldg.
Amorsolo St. Cor.
Dela Rosa St.
Makati
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 23
Agency/organization
Remedios AIDS Foundation
Website
NGO
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector
Sector
represented
Name of
representative
Dr. Jose Narciso Melchor Sescon
CCM
member
since
June 2006
Title in agency
Executive Director
Fax
(63-2) 524-0494
E-mail address
[email protected]
Telephone
(63-2) 524-0494
Review
Mailing
address
1066 Remedios St.,
Malate, Manila
Website
www.who.int
Main role in the
Coordinating
Mechanism and the
proposal
development
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 24
Agency/organization
World Health Organization –WR
(Philippines)
UN Agencies -Health
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Development Partners
Sector
represented
Name of
representative
Jean Marc Olive
CCM
member
since
Aug 2002
Title in agency
Representative (Phil)
Fax
632 731-3914
E-mail address
[email protected]
[email protected]
Telephone
632 528-9761
Mailing
address
2nd Floor , Bldg 9
DOH Compound,
Tayuman, Sta. Cruz
Manila
Main role in the
Coordinating
Mechanism and the
proposal
development
Technical Input /Proposal
writing/Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Philippine Malaria Proposal Round 6
23
3A Applicant type
Member 25
Agency/organization
World Vision Devt Foundation
(WVDF)
Website
NGO
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
www.wvi.org
Sector
represented
Private Sector
Name of
representative
Dr. Melvin Magno /
Marlon Villanueva
CCM
member
since
Sept 2002
Title in agency
National Health Advisor
Fax
632 374-7618
E-mail address
[email protected]
Telephone
632 809-7599
Mailing
address
883 Quezon Ave. Quezon City
Website
www.undp.org
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 26
Agency/organization
UN Program on HIV/ AIDS (UNAIDS)
UN Agencies -AIDS
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Development Partners
Name of
representative
Dr. Ma. Elena Borromeo
CCM
member
since
Sept 2002
Title in agency
Country Coordinator
Fax
632 840-0732
E-mail address
[email protected]
Telephone
632 901-0411
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
31st Floor RCBC Plaza
Ayala Avenue
Makati City
Philippines
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 27
Agency/organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
Dept. of National Defense
Public Sector
Philippine Malaria Proposal Round 6
Website
Sector
represented
www.dnd.gov.ph
Armed Forces
TB
Malaria
24
3A Applicant type
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
AIDS
Name of
representative
Dr. Peter G. Galvez
CCM
member
since
Title in agency
Medical Consultant
Fax
E-mail address
[email protected]
[email protected]
Telephone
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Agency/organization
Canadian International Development Agency
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Sept. 2002
632 911-4552
Office of the Undersecretary for
Policy, Plans & Special
Concerns
Dept. of National Defense,
Camp Aguinaldo, Quezon City
Member 28
Website
Bilateral Development partners
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
www.gov.ca
Sector
represented
Development Partners
Name of
representative
Ms. Myrna Jarillas
CCM
member
since
March 2002
Title in agency
Senior Program Officer
Fax
(632) 810-5142
E-mail address
[email protected]
Telephone
(632) 857-9139
Mailing
address
7th Floor
Tower II
RCBC Building
Makati City, MM
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 29
Agency/organization
Dept. of Interior & Local Govt. (DILG)
Website
Non-health public sector
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Public Sector
Sector
represented
LGU
Feb 2005
Name of
representative
Hon. Austere Panadero /
Mr. Cesar Montanses
CCM
member
since
632 925-0353
Title in agency
Assistant Secretary
Fax
632 925-0361
Telephone
EDSA cor
Mapagmahal St Quezon City
Philippines
E-mail address
[email protected]
Philippine Malaria Proposal Round 6
25
3A Applicant type
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 30
Agency/organization
United Nations International
Children Education Fund (UNICEF)
Website
UN Agencies – Children, Health,
Education
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Sector
represented
Development Partners
Name of
representative
Dr. Nicholas K. Alipui
CCM
member
since
Feb 2005
Title in agency
Representative ( Programme Officer)
Fax
632 901-0170
E-mail address
Main role in the
Coordinating
Mechanism and the
proposal
development
Telephone
Review
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
3rd Floor
Yuchengco Tower
RCBC Plaza
6819 Ayala Ave.
Makati City
Member 31
Agency/organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Kasangga Mo ang Langit Foundation
Website
NGO
Private Sector
Sector
represented
Malaria
Name of
representative
Mr. Rey Langit
CCM
member
since
June 2006
Title in agency
Executive Director
Fax
(63-2) 634-5335
E-mail address
[email protected];
[email protected]
Telephone
(63-2) 634-5335
Main role in the
Coordinating
Mechanism and the
proposal
development
Review
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member 32
Agency/organization
University of the Philippines –
College of Public Health
Philippine Malaria Proposal Round 6
Website
26
3A Applicant type
Academe
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private
Sector
represented
Name of
representative
Dr. Caridad Ancheta
CCM
member
since
Feb 2005
Title in agency
Dean
Fax
632 521-2703
E-mail address
[email protected]
Telephone
632 524-1394
Review
Mailing
address
525 P.Gil St.
Ermita, Paco
Manila
Philippines
Main role in the
Coordinating
Mechanism and the
proposal
development
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Agency/organization
Member 33
World Family of GOOD People
Foundation (WFGP)
Website
NGO
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector
Sector
represented
Name of
representative
Dr. Jocelyn Park
CCM
member
since
June 2006
Title in agency
Director
Fax
(63-2) 330-7280
E-mail address
[email protected]
Telephone
(63-2) 330-7280
Review
Mailing
address
Member No.34
Couples For Christ-Gawad
Kalusugan
Private Sector
Website
Main role in the
Coordinating
Mechanism and the
proposal
development
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Agency/organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Name of
representative
Faith-based Organizaiton
Sector
represented
Dr. Elmer Garcia
Philippine Malaria Proposal Round 6
CCM
member
since
June 2006
27
3A Applicant type
Title in agency
Director
Fax
(63-2) 522-9231
E-mail address
[email protected]
Telephone
(63-2) 522-9231
Review
Mailing
address
Main role in the
Coordinating
Mechanism and the
proposal
development
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Member No. 35
Agency/organization
Salvation Army
Website
Faith-based Organization
Type
(academic/educational sector;
government; nongovernmental
and community-based
organizations; people living with
HIV/AIDS, tuberculosis and/or
malaria; the private sector;
religious/faith-based
organizations; multi-/bilateral
development partners)
Private Sector
Sector
represented
Name of
representative
Mr. Charles Malcom Induruwage
CCM
member
since
Title in agency
President
Fax
E-mail address
[email protected]
Telephone
Main role in the
Coordinating
Mechanism and the
proposal
development
November 2005
Mailing
address
(proposal preparation, technical
input, component coordinator,
financial input, review, other)
Philippine Malaria Proposal Round 6
28
3A Applicant type
Agency/organization
Name of representative
Title
Department of Health – Health
Program Development Cluster (DOH)
Ethelyn Nieto, MD, MPH,
MHA, CESO III
Undersecretary
of Health, DOH
Positive Action Foundation Phil, Inc
(PAFPI)
Joshua Formentera
President
Philippine National AIDS Council
(PNAC)
Irene Fonacier
PNAC
Representative
Phil. NGO Council for Health and
Welfare, Inc (PNGOC)
Eden Divinagracia, PhD
Executive
Director
Pilipinas Shell Foundation, Inc (PSFI)
Marvie Trudeau/Edgar
Veron Cruz
Program
Manager
Research Institute for Tropical
Medicine (RITM)
Remigio Olveda, MD,
MPH
Director IV
Tropical Disease Foundation, Inc.
(TDFI)
Thelma Tupasi, MD
President
United States Aid for International
Development (USAID)
Aye Aye Thwin, MD
Chief, OPHN
World Health Organization Philippines (WHO)
Jean Marc Olivé, MD
WHO
Representative
United Nations Program on HIV and
AIDS (UNAIDS)
Ma. Elena Borromeo, MD,
MPH
Country
Coordinator
Department of Interior and Local
Government (DILG)
Austere Panadero
Assistant
Secretary
College of Public Health, University of
the Phil. (UP CPH)
Caridad Ancheta, PhD
Dean
Department of Labor and
Employment (DOLE)
Dulce Estrella Gust, MD,
MPH
Executive
Director
United Nations International
Children’s Education Fund (UNICEF)
Nikolas Alipui
Representative
Phil. Council for Health Research and
Development (PCHRD)
Jaime Montoya, MD
Executive
Director
DOH Center for Health Development
in Cordillera Autonomous Region
(DOH CAR)
Myrna Cabotaje, MD,
MPH
Director IV
Local Government Untit – Apayao
Province
Thelma Dangao, MD
Provincial Health
Officer
National Economic Development
Authority (NEDA)
Arlene Ruiz, MPH
Division Chief
Department of National Defense
(DND)
Peter Galvez, MD
Medical
Consultant
National Commission on Indigenous
Ricardo Sakai Jr., MD
Medical Officer V
Philippine Malaria Proposal Round 6
Date
(yyyy/mm/dd)
Signature
29
3A Applicant type
People (NCIP)
Salvation Army
Mr. Charles Malcom
Induruwage
President
Couples for Christ - Gawad
Kalusugan
Elmer Garcia, MD
Director
German Technical Cooperation
Agency (GTZ)
Michael Adelhardt, MD
Program
Manager.
European Commission (EC)
Fabrice Sergent, PhD
Individual Expert
for Health
Canadian International Development
Agency (CIDA)
Myrna Jarillas
Senior Program
Officer
Japan International Cooperation
Agency (JICA)
Mie Kasamatsu, MD
Chief Advisor
Association of Philippine Medical
Colleges (APMC)
Fernando Sanchez, MD
President
World Family of Good People
Foundation, Inc (WFGP, Inc.)
Jocelyn Park, MD
President
Kasangga Mo Ang Langit (Reyster
Langit) Foundation, Inc
Rey Langit
President
Remedios AIDS Foundation, Inc
(RAF)
Jose Narciso Melchor
Sescon, MD
Executive
Director
Kilusan Ligtas Malaria (KLM)
Ray Angluben
Project Director
Philippine Coalition Against
Tuberculosis (Phil CAT)
Jubert Benedicto/
Amelia Sarmiento
Chairperson/
Executive
Director
Philippine College of Chest Physician
(PCCP)
Renato Dantes, MD
President
Samahang Lusog Baga
Mr. Fernando Collera
President
World Vision Development
Foundation
Melvin Magno
National Health
Advisor
Philippine Malaria Proposal Round 6
30
LIST OF ANNEXES TO BE ATTACHED TO PROPOSAL
The table below provides a list of the various annexes that should be attached to the proposal. Please complete this
checklist to ensure that everything has been included. Please also indicate the applicable annex numbers on the right
hand side of the table.
Relevant item
on the
Proposal
Form
Description of the information
required in the Annex
Name/Number given to annex in
application
Section 2: Eligibility
Coordinating Mechanisms only: Country Coordination Mechanism: Country Coordinated Proposal
2.2.1 b)
Comprehensive documentation on
processes used to select nongovernmental sector representatives
of the Coordinating Mechanism.
2.2.2
Documented procedures for the
management of potential Conflicts of
Interest
between
the
Principal
Recipient(s) and the Chair or Vice
Chair of the Coordinating Mechanism.
Documentation
describing
transparent processes to:
Minutes of the Partnership Forum. /An 4,
4a
STOP TB forum /An 4b.
Guidelines of the CCM, Philippines /An 6.
Minutes of Adhoc committee on CCM.
/An 10.
Minutes of June CCM Meeting /Ann 11.
Guidelines of the CCM, Philippines /An 6.
the
2.2.3 a
- solicit submissions for possible
integration into the proposal.
Advertisement in the Philippine Daily
Inquirer/ An 1 July 18, 2006 CCM
Meeting Minutes/An 8
Consultation with the LGUs/ An 2
2.2.3 b
- review submissions for possible
integration into the proposal.
July 18, 2006 CCM Meeting Minutes/An
8
2.2.3 c
- select and nominate the Principal
Recipient (such as the minutes of the
CCM meeting at which the PR(s)
was/were nominated).
July 18, 2006 CCM Meeting Minutes An
8/ Call for nominations and election for
Principal Recipient /An 9
2.2.3 d
Call for concept proposals../An 1
Summary of the consultations undertaken
- ensure the input of a broad range of with the Local Government Units in the
stakeholders
in
the
proposal areas covered by the Round 2 GF project
development process and grant on Malaria/Annex 2.
External Evaluation of Round 2/Annex 3
oversight process.
July 18, 2006 CCM Meeting Minutes/An
8
Philippine Malaria Proposal Round 6
31
4 Component Section Malaria
PLEASE NOTE THAT THIS SECTION AND THE NEXT MUST BE COMPLETED FOR EACH COMPONENT. Thus, for
example, if the proposal targets three components, sections 4 and 5 must be completed three times.
For more information on the requirements of this section, please refer to the Guidelines for Proposals, section 4.
4.1 Indicate the estimated start time and duration of the component
Please take note of the timing of proposal approval by the Board of the Global Fund (described on the cover page
of the Proposal Form). The aim is to sign all grants and commence disbursement of funds within six months of
Board approval. Approved proposals must be signed and have a start date within 12 months of Board approval.
Table 4.1.1 – Proposal start time and duration
From (yyyy/mm)
To (yyyy/mm)
August 1, 2007
July 31, 2012
Month and year:
4.2 Contact persons for questions regarding this component
Please provide full contact details for two persons; this is necessary to ensure fast and responsive
communication. These persons need to be readily accessible for technical or administrative clarification purposes,
for a time period of approximately six months after the submission of the proposal.
Table 4.2 – Component contact persons
Primary contact
Secondary contact
Name
Dr. Jaime Lagahid
Ms. Lourdes Pambid
Title
Director III
Program Manager
Infectious Disease Office
Department of Health
Infectious Disease Office
Department of Health
San Lazaro Cpd, Manila,
Philippines
Tropical Disease Foundation
Suite 2002 Medical Plaza Makati
Amorsolo cor. Dela Rosa
Makati City 1229
Philippines
Telephone
7438301 loc. 2350/2352
63 2 8889044
Fax
711-68-08
63 2 840 2178
Organization
Mailing address
E-mail address
TUUVXW*Y[Z]\Y[^`_\a _[^b[ca d a eea f[YhgET
i ZIZ]jkgYlZ]\:Y[^`_\a _[^meca d nkoh_c[plp$q Z8p3jsr
[email protected]
4.3 Component executive summary
4.3.1 Executive summary
Describe the overall strategy of the proposal component, by referring to the goals, objectives and
main activities, including expected results and associated timeframes. Specify the beneficiaries and
expected
benefits
(including
target
populations
and
their
estimated
number).
(Please include quantitative information where possible. Maximum of one page.)
Malaria is endemic in 65 of 79 provinces in the Philippines. GF grant from the second round (GFMP2)
supports malaria control interventions in 26 highly endemic provinces categorized by an incidence of
>1,000 cases/year/province; with 339 endemic municipalities, 4407 barangays (villages) comprising a total
population of 5,530,908 rural poor. Furthermore, increasing cases have been reported in four other
Philippine Malaria Proposal
32
4 Component Section Malaria
th
th
provinces in the southern part of the country. Of the endemic areas, 60% are categorized as 4 – 6
class municipalities with the lowest income group compounded by security risks due to political and tribal
conflicts. Of this population, IPs and tribal groups constitute approximately 40%. Access to health services
is limited for the IPs, tribal groups and those socially marginalized populations due to their occupation
(forest laborers, fisher folk), place of residence, economic and social standing. Due to their mobility and
migratory habits, control of malaria is further compounded.
Malaria morbidity has actually increased from 35,185 cases in 2002 to 40,281 in 2004 due to improved
case finding in the 26 provinces. Outbreaks have been reported in seven of these 26 provinces. GFMP2
supported these interventions in these 26 provinces. The five top most endemic provinces are currently
th
being covered by the 5 round GF grant (GFMP5) with intensified control strategies such as increased
coverage of >80% with LLITNs and indoor residual spraying (IRS). The focus of this round 6 proposal is
the 21 remaining provinces plus the four emerging provinces with reported increasing number of cases.
This project is expected to consolidate the gains made by the GFMP2 in the 21 provinces, help expand
access to diagnostic and treatment services to these target groups, and to cover a substantial proportion
of the population with appropriate vector control methods, and to establish mechanisms that will ensure
the sustainability of these desired outcomes through public private partnership including in the four
emerging provinces.
The goals, objectives, strategies and activities of this proposal are consistent with the National Objectives
of Health (Annex 16) and those of the national Malaria Control Program strategies and with those of the
two projects currently being supported by the GF. The goal is the reduction of malaria morbidity by 70% in
the 21 provinces under GFMP 2 and the four emerging provinces and the achievement of zero mortality
by year 2011-2012 relative to 2005.
The objectives, strategies and activities are as follows: Objective 1: To consolidate, expand and sustain
high coverage of early diagnostic and treatment services for malaria through health systems strengthening
and public private partnership. Major strategies include early case detection and appropriate treatment,
health systems strengthening and mobilization of public private partnership following the private public mix
DOTS strategy of TB control. Capacity building on malaria diagnosis (microscopy and RDTs),
management of severe malaria will be done for both public and private health care providers, community
volunteers and health staff of nongovernmental organizations (NGOs) and faith-based organizations
(FBOs). Facilities established in GFMP 2 will be assessed and targeted for strengthening based on the
level of functionality and the need of such facilities in the target areas. Expansion of access to diagnostic
and treatment services will be achieved through partnership with private sector health facilities and
NGOs/FBOs. Commodities for diagnosis and treatment will be provided through an innovative
procurement supply management to ensure continuous supply of antimalarial drugs, laboratory supplies
and RDT kits. Integration of malaria diagnostic and therapeutic services with existing public health
programs in the area will be synergistic features of this project.
Objective 2: To scale up malaria control to interrupt malaria transmission
Promotion and distribution of approximately 962,194 long-lasting insecticide treated nets (LLITN) and
retreatment of existing nets will achieve at least 80% coverage (2-3 LLITNs/household) of the at-risk
population estimated at 4.2 million in the top endemic municipalities and barangays (villages).
Complementary strategies include indoor residual spraying once a year in 20,000 houses in selected sites
will be done to prevent outbreaks. This will help bring down malaria cases in areas that have continued
high morbidity due to inadequate net coverage in GFMP2. Epidemic control strategies at various levels of
health care will be strengthened and sustained.
Objective 3: To strengthen local capacity for stewardship through empowerment of the LGUs and
community systems strengthening for sustainable community-based malaria control. Training and
capacity building on local government unit (LGU) stewardship and leadership of the malaria control
program will include not only the health sector but also the local executives in the affected communities.
The role of malaria control not only as a public health intervention but as a part of development strategy in
the community will be emphasized to gain greater support from the local political leadership Multisectoral networking with other non-health public sector agencies and private stakeholders in the
community will be pursued to strengthen the community responsiveness and preparedness for malaria
control. In addition, harnessing the existing health providers among faith-based organizations (FBOs) and
community-based organizations (CBOs) through public private partnership will ensure sustainability. With
these interventions on hand, the ultimate goal of the potential elimination of malaria in these communities
in accordance with the flagship strategy of the Department of Health (DOH) enunciated in the FOURmula
One for Health and the national objectives of health goal of malaria-free Philippines by 2020. Integration
Philippine Malaria Proposal
33
4 Component Section Malaria
of malaria services with other public health programs including TB will lead to health and community
systems strengthening.
4.3.2 Synergies
If the proposal covers more than one component, describe any synergies expected from the
combination of different components—for example, TB/HIV collaborative activities.
(By synergies, we mean the added value that the different components bring to each other, or how
the combination of these components may have broader impact.)
Integration of microscopy and treatment services for Malaria and TB: The proposal will include integration
of diagnostic and treatment services for malaria with other public health interventions such as the TB
diagnostic and treatment services focusing particularly on the populations in hard to reach areas including
the indigenous peoples living in the mountain areas that are at high risk for malaria. This task can be
undertaken by the Barangay Microscopists (BMs) as part of primary interventions that they can implement
for them to be accredited by the Local Health Board in order for them to avail of the benefits of the
Barangay Health Workers'Benefit and Incentives Act of 1995
Capacity building for the procurement (national), distribution (national, regional, and provincial/municipal
levels) of malaria drugs and commodities will also improve the procurement, distribution of other drugs
and commodities, including TB drugs. Capacity building for monitoring and supervision of distribution at
national, regional, provincial and municipal levels can also synergies with the same needs for TB,
HIV/AIDS and other public health programs of the DOH and the LGU.
Capacity building for programmatic monitoring and evaluation and medical information systems at all
levels of health delivery including municipal and provincial levels (Local government units), regional and
national level at the NEC (Department of Health) will harmonize data quality and utilization for effective
program management.
Capacity building of the Local Government Units (LGUs) for stewardship and empowerment to undertake
and implement the Malaria Control Program will address the other primary health interventions including
TB and at the development of multisectoral networking with other agencies in government and in the
private sector will enhance community systems strengthening.
Community systems strengthening will synergize the implementation of malaria public health services and
the TB and other public health programs of the LGUs as well as the development programs of the nonhealth agencies including NEDA, LGU, DILG, and the DND.
Philippine Malaria Proposal
34
4 Component Section Malaria
4.4
National program context for this component
The information below helps reviewers understand the disease context, and which problems the
proposal will address. Therefore, historical, current and projected data on the epidemiological
situation, disease-control strategies and broader development frameworks need to be clearly
documented. Please refer to the Guidelines for Proposals, section 4.4.
4.4.1 Indicate whether you have any of the following documents (tick appropriate box), and if so, please
attach them as an annex to the Proposal Form:
X
National Disease Specific Strategic Plan (Annex 12)
X
National Disease Specific Budget or Costing (Annex 12)
X
National Monitoring and Evaluation Plan (health sector, disease specific or other)
This is project-based undertaken by the Malaria Control program of the Department of Health.
X
Other document relevant to the national disease program context (e.g. the latest disease
surveillance report)
Please specify:
Data is as of 2003 as validated by RBM, data of 2004 and 2005 still to be validated. (Annex
12)
4.4.2 Epidemiological and disease-specific background
Describe, and provide the latest data on, the stage and type of epidemic and its dynamics (including
breakdown by age, gender, population group and geographical location, wherever possible), the
most affected population groups, and data on drug resistance, where relevant. With respect to
malaria components, also include a map detailing the geographical distribution of the malaria
problem and corresponding control measures already approved and in use. Information on drug
resistance is of specific relevance if the proposal includes anti-malarial drugs or insecticides. In the
case of TB components, indicate, in addition, the treatment regimes in use or to be used and the
reasons for their use.
The Philippines records an average of 3-5 outbreaks of malaria (small epidemics) affecting an average
2000-5000 individuals in very low endemic border areas of targeted provinces. Eighty percent of
epidemics occur in the 21 and specially four emerging provinces, which will all now be covered by this
proposal. Most of the epidemics are caused by importation of cases from endemic provinces as result of
movement of migratory casual labor force.
Malaria is endemic in 65 of the 79 provinces, 760 of the 1600 municipalities and in 9345 of the 42’979
barangays (villages) of the Philippines. Approximately 96% of the malaria cases occur in the 26 highpriority provinces which are covered by the Global Fund Round 2 Malaria Project (GFMP2). The top five
of these 26 provinces are the beneficiaries of Round 5 GF Malaria project (GFMP5), thus this Round 6
proposal focuses on the remaining 21 provinces. The 21 provinces are all located either in Luzon or in
Mindanao, the large island in the south of the country where Muslims predominate and poverty is
generally more pronounced than in the rest of the country. In addition to the 21 provinces, there are four
provinces with increasing trends of malaria cases with around 1 million at risk population. These are are all
in Mindanao, the southern part of the country: Sultan Kudarat, North Cotabato, South Cotabato, and
Zamboanga del Norte. (Roll Back Malaria, Strategic Plan Philippines 2006-2010).
In 2003, a total of 530,205 people nationally were tested for malaria, and 48,411 of them were found to
have malaria (73% of them P. falciparum). Only 162 malaria-related deaths were reported. In the 21
provinces with a total population of 17 million, 5.8 million live in endemic areas, spread over 287
th
municipalities. More than half of these endemic municipalities belong to the low-income municipalities (4 ,
th
th
5 , and 6 class municipalities). A total of 5.5 million people in these provinces belong to Indigenous
people groups. It has been reported that malaria is more prevalent in indigenous people groups than
among settlers. (Ortega et al, 1998). In 2003, a total of 243,210 people from these 21 provinces were
tested for malaria, and 11,844 of them were found to have malaria (75% of them P. falciparum).
Philippine Malaria Proposal
35
4 Component Section Malaria
Compared to 2003, more malaria cases occurred in the 25 Round 6 target provinces in 2005, namely
16,409, while in 2003; this total was only 13,980 (Annex 13) In 17 of the 25 provinces, more cases were
found in 2005 than in 2003. Sporadic outbreaks take place from time to time in some of the 25 priority
provinces often in places that are mainly inhabited by IPs and internally displaced peoples.
The existing GFMP2 and GFMP5 in partnership with DOH and WHO have established eight sentinel sites
for drug resistance monitoring. Each site has a sample size of 130 individuals per line of treatment (first
line and second line). Data from over 250 such tests (2004 onwards) have revealed resistance rates of 57% against the first line combination treatment of Chloroquine and Fansidar and 0.5% to the second line
Artemisinin Combination treatment of Coartem.
Ortega LI, Joson N, Hugo C, Guballa F and Ortega D 1997. Malaria prevalence survey in a highly endemic area of Quezon,
Palawan. Unpublished report. Malaria control Service, Department of Health, Manila.
4.4.3 Disease-control initiatives and broader development frameworks
Proposals to the Global Fund should be developed based on a comprehensive review of diseasespecific national strategies and plans, and broader development frameworks. This context should
help determine how successful programs can be scaled up to achieve impact against the three
diseases. Please refer to the Guidelines for Proposals, section 4.4.3.
a) Describe comprehensively the current disease-control strategies and programs aimed at the
target disease, including all relevant goals and objectives with regard to addressing the disease.
(Include all donor-financed programs currently implemented or planned by all stakeholders and
existing and planned commitments to major international initiatives and partnerships.)
The goal as enunciated in the 2005-2010 National Objectives for Health Philippines relative to malaria is
its elimination as a public health problem in all endemic provinces and maintenance of malaria- free status
for 14 provinces. To attain these goals, the Malaria Control Program in the Department of Health aims to
reduce malaria morbidity by 70% in the 26 Category A provinces as of 2002 and by at least 50% in
Category B provinces and to reduce malaria deaths by at least 50 percent in the 26 Category A provinces.
(National Objectives for Health Philippines 2005-2010, draft). It also aims to reduce the transmission of
malaria in the general population. These goals are also consistent with the Administrative Order No.
2005-0023 issued by the Secretary of Health on “FourMULA One for Health as Framework for Health
Reforms”. The objectives of the Health Reform are 1) better health outcomes, 2) more responsive health
system, 3) more equitable healthcare financing and 4) governance. The objective is to undertake reforms
to improve the efficiency, effectiveness and equity of the Philippine health system appreciated by Filipinos,
especially the poor in order to attain the Millennium Development Goals, and the Medium Term Philippine
Development Plan (2006-2010). These goals, objectives and strategies are enunciated in the RBM
Strategic Plan for the Philippines 2006-2010 (Annex 12).
The strategies to attain the malaria-related objectives have been to increase the proportion of febrile
patients correctly diagnosed and appropriately treated for malaria within 24 hours after onset of illness and
to institute appropriate vector control. The diagnosis and treatment of malaria have been brought to the
grassroots level through the training of barangay microscopists (community volunteers including rural
health midwives teachers, etc) who are readily accessible to the population at risk, and the training of
barangay health workers on rapid diagnostic tests (RDT) for populations that are hard to reach comprising
the rural poor and indigenous populations living in the mountains. These activities in the top 26 provinces
were supported by the GFMP2 and additionally by the GFMP5 in the top five provinces among these.
Distribution of insecticide treated nets (ITNs) and indoor residual spraying (IRS) in selected communities
to prevent epidemic outbreaks, have been the strategies for the prevention of transmission through vector
control undertaken in the 26 provinces. Four zonal stockpiles have been provided with insecticides, spray
cans, RDTs and anti-malarial drugs for use in epidemic response. These strategies have been
implemented in the GFMP2 in the 26 high endemic provinces since 2004. While there has already been
evident positive impact of these interventions in the community, the quantity of distributed ITNs is
inadequate to have an impact on transmission.
Likewise there is a need to sustain the gains attained through intensified development of local capacity
Philippine Malaria Proposal
36
4 Component Section Malaria
and strengthening of health and community systems through public private partnership. There have been
preceding internationally funded grants on malaria in the Philippines: Japan International Cooperation
Agency (JICA) in Palawan in 1997 through the DOH regional center for health development (CHD) which
was eventually taken up by the Kilusan Ligtas Malaria (KLM) 1999, the Australian Agency for International
Development (AusAID) support of the malaria control program in Agusan del Sur in 1996, and the United
States Agency for International Development (USAID) funded projects through the Infectious Disease
Surveillance and Control Program (IDSCP) in Ifugao and Sultan Kudarat. More recently, in 2003, the
GFMP2 implemented Malaria control strategies in the 26 high burden provinces and the report on the
outcome is shown in Annex 14. This annex excludes the 5 top provinces covered by GFMP5. The Roll
Back Malaria (RBM)/WHO is currently implementing the same strategies for malaria control in 12
provinces: Sultan Kudarat, Zamboanga del Norte, Davao Del Sur, Davao del Norte, Zamboanga Sibugay,
Davao Oriental, Sarangani, Compostela Valley, Agusan del Norte, Surigao del Sur, Tawi-Tawi, Sulu The
GFMP5, which has just been initiated June 2006, augments the support provided by the GFMP2 in the five
top endemic provinces which include Palawan, Apayao, Quirino, Tawi-tawi, and Sulu.
b) Describe the role of HIV/AIDS-, tuberculosis- and/or malaria-control efforts in broader
developmental frameworks such as Poverty Reduction Strategies, the Highly-Indebted Poor
Country (HIPC) Initiative, the Millennium Development Goals or Sector-Wide Approaches.
Outline any links to international initiatives such as the WHO/UNAIDS ‘Universal Access
Initiative’ or the Global Plan to Stop TB or the Roll Back Malaria Initiative.
The rural poor are at greatest risk of malaria particularly the wood gatherers, forest laborers and the
indigenous peoples as well as mobile fisher folks. The recurrent infections due to malaria in these
population has led to absenteeism in school and at work, loss of economic productivity in the high-risk
provinces so that the malaria problem in these areas have serious socio-economic implications and is a
significant socio-economic burden. Through the implementation of effective malaria control activities in
these communities, these at-risk populations are protected from recurrent malaria morbidity, preventing
recurring medical expenses for their illness, and making them productive economically; thereby
responding to a number of MDG goals in addition to MDG No. 6, halt HIV/AIDs, malaria, and other
diseases by reducing mortality and morbidity and to reverse the incidence of these diseases such as No.
1 eradicate extreme poverty, 2. Achieve universal primary health education, 4. Reduce child mortality, 5.
Improve maternal health, 8. Develop a global partnership for development and provide access to
affordable and essential drugs.
The interventions in the control program of malaria in the Philippines were implemented initially as a
vertical program. Despite devolution, the malaria control program remained as a vertical program despite
the early Local government units’ (LGUs) initiatives through community-based malaria control program.
Very little is available for operational and capital needs due to limited resources with 60% of the DOH and
LGU budget funds providing salaries for personnel. The FourMULA One for Health Functional
Management is envisioned to implement critical reform initiatives into four components; namely, financing,
regulation, service delivery, and governance. “These reforms shall be implemented under a sector-wide
approach covering the entire health sector and with an investment portfolio that shall encompass all
sources”.
The goals and objectives of the proposed project are consistent with the goals of FourMULA One for
Health framework for health reforms. “The activities on early diagnosis and treatment and the prevention
of vector transmission will enhance service delivery with speed and precision and support community
systems strengthening.” Strategies for local government empowerment will be consistent with the national
reforms for financing, regulation, and governance. In addition, the major strategies of this proposal are
consistent with those of the Roll Back Malaria Initiative and will complement the interventions already
being put in by the GFMP2 and GFMP5 in high malaria endemic sites in the country.
4.4.4 National health system
a) Briefly describe the (national) health system, including both the public and private sectors, as
relevant to reducing the impact and spread of the disease in question.
The health care system in the Philippines is an extensive dual system consisting of the public sector and
the private sector for-profit and non-profit providers. The Public sector health system comprises of the
Department of Health (DOH), and local government units (LGUs).
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4 Component Section Malaria
Several strategies have been implemented to improve health care delivery including the Primary Health
Care in 1979, the integration of public health and hospital services in 1983, the devolution of health
services to the LGUs in 1993, and the National Health Insurance Act 1995. Following the enactment of
the Local Government Code in 1991, the Philippine Health Care System was reorganized. Although
intended to make health services more responsive to communities, it disrupted the district health system.
Under the devolved system, the DOH provides policy direction on health , and technical assistance and
has and in furtherance of these activities, it maintains regional field offices with representatives to the local
health boards and personnel engaged in communicable disease control in the provinces. Thus, the
National Malaria Control Program (MCP) which is based in the Infectious Disease Office, National Center
for Disease Control and Prevention, with a shrunken human resource force at the national level by virtue
of Executive Order 102, is responsible for the technical and managerial leadership of the program. The
program continues to operate in a semi-vertical structure at the regional level with building partnerships
and strengthening collaboration with LGUs and the community-at-risk in undertaking the activities required
to ensure improved access to more efficient service delivery . However, budget limitation both at the
national and regional level proved to be a constraint in fully achieving the mandate of the DOH.
Delivery of health care services was devolved to the LGUs. Local government facilities, thru the 2,355
Rural Health Units (RHUs), run by the municipalities, are the main channel for service delivery of national
public health programs. However, there are inadequate funds at the LGU level to support the local health
delivery system. Furthermore, there is inequity in public health spending among the LGUs as manifested
by the large unmet needs for health services among the poorest households and communities particularly
in the poorest localities. This is due to a lack in the capability of local chief executives to include health in
their development agenda and to mobilize resources to support it. As a result, priority health problems
such as malaria are not adequately addressed. Many LGUs continue to be dependent on the DOH and
the CHD for malaria control.
To address the weaknesses in the health system, the Health Sector Reform Agenda (HSRA) was drafted
in 1999 to institute reforms in Hospital Services, Public Health, and Local Health Systems. The latter was
aimed to improve health care delivery system, and consider possible health financing by instituting
changes in health care delivery, regulation and financing. The HSRA was institutionalized in 2000 and in
2001 was implemented in 64 provinces and cities, with the end in view that these convergence sites will
become self-sustaining and wean them from dependence on government subsidies.
In general, health expenditures have been declining both as percentage of GDP and also per capita.
Budget allocation for health by the national government has been shrinking since 1997, although from
2001-2003, the LGUs spent more in health by 2 to 2.9 percentage points than the national government.
However, 60-70% of these health resources are spent for personnel services alone, leaving very little to
provide for operational and capital needs. Overall, the country spent a total of 133.2 billion for health care,
representing a 2.9 percent GNP share for health in 2003. Total health care expenditures have been
reduced from 3.3 percent of GNP in 1999 to 2.9 in 2003. Of this, total out-of pocket health spending from
patient’s accounts for about 46% percent. (Roll Back Malaria in the Philippines A Five Year Strategic Plan
2006-2010). The fact that people would rather pay for health services in the private facilities illustrate the
inadequacy of public health facilities to provide the standard services required by the average Filipino.
The HSRA was meant to step up the quality of services offered by government facilities through the
above-mentioned areas for reform.
Health services provided by the private sector (offered by private practitioners in clinics and hospitals) are
focused on curative services. Access to these private sector services, however is limited due to high cost
and socio-cultural barriers. The private practitioners providing malaria diagnostic and treatment services
often do not adhere to the national guidelines. There is a need to integrate these private practitioners
through public private partnership. This will enhance the management of malaria cases, leading
populations at risk to have more options in accessing services for malaria diagnosis and treatment.
Civil society participation in malaria control has been in existence for many years now through private
practitioners in for-profit health facilities and non-profit
faith-based organizations, community
organizations, and people’s organization among the rural poor including the indigenous populations in the
hard to reach communities. Unfortunately, these services, with few exceptions, are minimally integrated
with the public health system mainly due to lack of networking and limited resources. A standardized
program/policy in malaria control to involve the private health care providers and other civil society
stakeholders such as non-governmental organizations in the implementation of public health programs
Philippine Malaria Proposal
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4 Component Section Malaria
does not exist and needs to be developed. There is a need to strengthen collaboration between the formal
public health sector and the private sector organizations in order to maximize the resources and technical
capacities for malaria control, thereby increasing access to services by those who are at-risk of
contracting the disease. This is one of three objectives of this proposal.
b) Given the above analysis, explain whether the current health system will be able to achieve and
sustain scale up of HIV/AIDS, tuberculosis and/or malaria interventions. What constraints exist?
The current health system is poised to fulfill and achieve the MDG targets of halving the malaria cases.
However, given the above-mentioned constraints in the structure, resource limitations and spending
pattern of the national government and LGUs for health, sustaining the control of malaria on its own may
be an uphill climb for the government sector. Unless further resources are made available and stronger
efforts from the local community and their executives is undertaken, the malaria problem will remain.
To overcome these constraints, the proposal envisions that through appropriate networking with nonhealth sectors within the public sector that have and private public partnership with the civil society
organizations that possess existing manpower and infrastructure for implementing the malaria control
program in the high endemic areas the access of the malaria control program can be broadened and
expanded. The resources being requested from the GF through this proposal should provide the
necessary training and development for such inter-sector networking and private public partnership and
more importantly provide the required anti-malarial drugs, commodities required by the Malaria Control
Program to reduce morbidity, prevent deaths, and interrupt transmission through a massive and effective
vector control.
c) Please describe national health systems strengthening plans as they relate to these constraints.
If this proposal includes a request for resources to help overcome these constraints, describe
how the proposal will contribute to strengthening health systems.
Health Systems Strengthening:
1) Human resource for health development and retention: This strategy entails training and provision of
microscopes, drugs, and commodities to the public sector health personnel as well as existing staff of
FBOs, NGOs, CBOs that are now providing health services to the rural poor, particularly the at-risk
populations (including indigenous peoples). These trainees will add to the manpower that will provide
appropriate malaria diagnostic and treatment services, thereby increasing access for those living in farflung communities and have limited capacity to pay for health services and medicines.
Staff development and retention program with appropriate incentives will be developed. Training programs
for regional, provincial and municipal level health service providers will serve to enhance their technical
and management capacity. This is also aimed at addressing the apparent brain drain the health sector is
experiencing in view of the exodus of health professionals. In addition, advocacy among LGU executives
in the implementation of existing legislation that provide incentives to barangay health workers should be
pursued to enhance resources for both human resource for health development and retention of trained
personnel in the light of aggressive recruitment for caregivers by developed countries. This include:
“Barangay Health Workers’ Benefits and Incentives Act of 1995” and the outpatient malaria Phil Health
benefits.
2) Development of infrastructure and provision of equipment: The establishment of barangay microscopy
centers, provision of microscopes for these centers, and improvement of existing warehouse and storage
facilities at various levels for better supply and distribution system for antimalarial drugs and commodities
will also have added value for other public health programs including TB.
3) Establishment of a referral network that links the microscopy centers in the community and the referral
facilities for complicated malaria cases, both in the public and private sector will increase access to
appropriate diagnostic and treatment services. This will also strengthen partnership between the two
sectors and mobilize community participation.
4) Private public partnership with all private health service providers in for-profit health facilities and CBOs,
FBOs, NGOs who render services for malaria control in hard to reach areas. With training of all health
care givers, the number of public health providers will be augmented without additional financial outlay to
government. Through their existing infrastructure, distribution of anti-malarial drugs and commodities could
be facilitated to areas of their concern, particularly in those hard to reach barangays
Philippine Malaria Proposal
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4 Component Section Malaria
5) Integration of malaria diagnostic services with other primary care interventions through an integrated
microscopy services following good laboratory practices for TB and other parasitic infections A majority of
households are unwilling to contribute to the LGU subsidies for community volunteers in malaria control, a
sign of lack of ownership of program. Notwithstanding these problems, ownership of community and
counterpart local governments will be strengthened if barangay microscopists (BMs) are molded into
versatile community health managers. Integration of microscopy services for malaria with TB and other
parasitic diseases could increase the appreciation of the community for the BMs. Households may finally
be convinced to support volunteers and pay for their services if they feel that volunteers are
“professionals” with regular services to give them and not just periodic malaria diagnostic treatment.
Strengthening procurement and supply management of anti-malarial drugs and commodities through
innovative strategies will also benefit other public health programs.
Enhancement of monitoring and evaluation at the national, regional, provincial level will all have synergies
with other disease control program including TB.
Community Systems Strengthening
1) Community-based health care financing: This can be attained from bottom up. Local health officials
should, together with their local executives, be trained in workshops on development planning with
emphasis on incorporating health concerns in the overall development agenda of the LGU (short, medium
and long-term development plans). Most of these plans particularly on the health sector are not evidence
based and are done with minimal consultation with the health stakeholders (planning office usually does
this alone). Local Health planning workshops with multi-stakeholder participation will be conducted.
Sustainability of the malaria control program could be ensured through passage of ordinances, the legal
mandates that define LGU action, to include the Local Health Code – guidelines on health implementation
including provisions on possible health financing and sustainable local malaria prevention and response
activities. This could include a special Health LGU trust or a malaria emergency response fund culled from
a percentage of the health unit’s services or the PHILHEALTH capitation particularly services that
addressed malaria services could be proposed.
2) LGU stewardship and community ownership of the Malaria Control Program: The devolved health
system with the LGUs implementing the malaria control and prevention services has posed a challenge.
The lack of evident ownership of partner LGUs and communities of the malaria control and prevention
program is evidenced by the difficulty of providing resources for the assimilation of trained Barangay
Microscopists (BMs) and Medical Technologists (MTs) into the staff of the LGUs. The main reasons for
this are: 1) lack of LGU resources – budgetary regulations on allocation of personal services, 2) too many
separate programs requiring local counterpart funds – Barangay veterinarians, Nutrition Scholars, Local
Community Organizers, Community Information Officers – these are impositions of donor agencies and
national government agencies on LGUs; 3) no community investments. Thus, in some instances, the
malaria program suffers from inadequate LGU ownership because it is not included in the overarching
local development agenda. Advocacy and capability building at the LGU (particularly at the higher levels)
on agenda setting and policy making designed to enhance the sustainability of health program including
the malaria program would improve LGU ownership, emphasizing the socio-economic benefits that could
be gained by malaria control. .
3) Social mobilization and socio-economic empowerment of the community: Through appropriate
advocacy and behavior change communications, demand generation for appropriate and early malaria
diagnostic and treatment services and preventive measures will be enhanced.
4.5 Financial and programmatic gap analysis
Interventions included in relation to this component should be identified through an analysis of the gaps in the
financing and programmatic coverage of existing programs. Such an analysis should also recognize gaps in
health systems, related to reducing the impact and spread of the disease. Global Fund financing must be
additional to existing efforts, rather than replacing them, and efforts to ensure this additionality should be
described. For more information on this, see the Guidelines for Proposals, section 4.5.
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4 Component Section Malaria
Use table 4.5.1-3 to provide in summarized form all the figures used in sections 4.5.1 to 4.5.3.
4.5.1 Overall needs assessment
a) Based on an analysis of the national goals and careful analysis of disease surveillance data and
target group population estimates for fighting the disease component, describe the overall
programmatic needs in terms of people in need of these key services. Please indicate the
quantitative needs for the 3-5 major services that are intended to be delivered (e.g. anti-retroviral
drugs, insecticide-treated bed nets, Directly Observed Treatment Short-Course for TB
treatment). Also specify how much of this need is currently covered in the full period of the
proposal by domestic sources or other donors. Please note that this gap analysis should guide the
completion of the Targets and Indicators Table in section 4.6. When completing this section, please refer to
the Guidelines for Proposals, section 4.5.1.
The findings of the WHO External Evaluation held last December 2004 (Annex 3) show the basis for
needs assessment as cited below:
(1) Need for more ITNs: “The number of nets provided by the existing GFATM2 project was grossly
inadequate, only enough to provide personal protection against the vector and in view of low coverage
rate, it will not have any impact on transmission. (Global Fund 2 project is only able to provide one net per
family of the IP population while the average requirement is between 2-3 nets per family.) In view of the
recommendations from the External Evaluation, the TWG revised the Vector Control Guidelines: ITN
distribution was refocused on the priority or top endemic municipalities and top endemic barangays (those
which contributed approximately 80% of malaria cases). Reallocation of nets was also done to cover all
family members. However, due to the limited number procured, coverage remained inadequate. The total
official malaria at risk population in the 25 project provinces was about 6 million people in 2002, therefore
at least 1 million households will need at least 1 ITN. However; using a population coverage indicator, and
assuming 2.3 persons/net, the amount of ITNs needed would be around 2.6 million ITNs;). As a result, the
amount of projected and budgeted nets and insecticides in the project are inadequate. “
Nevertheless, there have been success stories from one of the 26 provinces under GFMP2, Sarangani
province, where the local executive, the governor of the province, advocated and mobilized local private
stakeholders to raise the funds to procure more INTs in the province. Such intersectoral networking and
public private partnership is a good example how stewardship by the LGU of the malaria program could
make it sustainable and not program dependent.
st
rd
(2) Need for supplies of 1 line and 3 line drugs: “Although the diagnostic services have been noted as
having been greatly enhanced by the GFATM2 project, drug supply is insufficient and resupply of initial
st
stocks were low to almost nil to municipalities where there is chronic shortage of supply of 1 line drugs
st
rd
CQ+SP. ” To address this, the GFATM2 project provided 1 to 3 line drugs. However, in order to
ensure continued provision of prompt and appropriate treatment, provision of these drugs should be
supported further.
(3) Need to strengthen LGU stewardship and leadership in malaria control: “Most of the commitments of
st
the local government units (LGU) to purchase 1 line drugs and to absorb the personnel trained by the
existing GFATM after one year did not materialize due to budget cuts of the LGUs. The loss of these
trained microscopists has compromised the strategy on early diagnosis and prompt treatment.” In view of
the limitations of the LGU to absorb these service providers, there is a need to explore other options for
supporting them.
This project proposal will provide resources to address the above mentioned problems and will
complement existing efforts with a more focused intensified sustainable strategies in the top 25 provinces
(excluding the 5 supported by GFATM5). This will enable the program to address the gaps of GFATM2
project and will sustain the initial gains in the expected impact indicators.
b) Based on an analysis of the national goals and objectives for fighting the disease component,
describe the overall financial needs. Such an analysis should recognize any required
investment in health systems linked to the disease. Provide an estimate of the costs of meeting
this overall need and include information about how this costing has been developed (e.g.,
costed national strategies, medium term expenditure framework). (Actual targets for past years and
planned and estimated costing for future years should be included in table 4.5.1-3 [line A].)
The current budget for malaria at the National level has not increased over the last five years.
Philippine Malaria Proposal
The
41
4 Component Section Malaria
budget estimated is a total of US39,688,548 over five years to achieve the goal of 70% reduction of
morbidity and mortality for the Category A provinces in the country shown in the RBM Philippines
Strategic Plan for 2006-2010 (Annex 12). However, based on the findings of the External Evaluation, the
figures indicating the total requirements need to be revised as those figures were based on the target of 1
conventional net per household, which is only for personal protection and will not attain the necessary
coverage of >60% population covered, required to interrupt transmission. In addition, the inadequate
supply of antimalarial drugs has to also be addressed as the current budget from both the local and
national government will not be sufficient for the procurement of these essential drugs. Since the budget
did not include cost estimates based on the requirements for an intensified effort using all proven
interventions against malaria as well as innovations to ensure sustainability, i.e. scaled-up interventions to
reduce transmission by having at least 80% coverage of at-risk population with bednets through increased
bed net allocation of 2-3 LLITNs per family; yearly focal indoor residual spraying for 2 years; the use of
st
nd
rd
combo RDT; availability of 1 and 2 line drugs in all health centers and 3 line drugs in all hospitals, and
epidemic management, a revision of the budget has to be done to include all the intensified efforts
mentioned above.
The GF round 6 proposal will address these financial gaps and incorporate appropriate measures in order
to consolidate and sustain the gains achieved by the current GFATM2 project. Thus, this project will
enable the MCP to achieve its overall objectives and move well ahead of the MDG targets 1, 2, 4, 6, and
8.
4.5.2 Current and planned sources of funding
a) Describe current and planned financial contributions, from all relevant domestic sources
(including loans and debt relief) relating to this component. (Summarize such financial amounts for
past and future years in table 4.5.1-3 [line B].)
The domestic sources for the malaria budget are from the National government and the local government.
The national budget for malaria has shrunk from 0.4 percent relative to the GNP in 2002-2003 to 0.3
percent of GNP in 2004. It has been pegged at US$180,000 for the last 5 years and has been increased
to a total of US$ 10,500,000, divided equally in the next five years at US$210,000 each
The LGUs have allocated only US$100,000 annually for all the endemic provinces total of US$500,000 in
the next five years. In addition, the Pilipinas Shell Foundation, the Social Arm of the Shell Philippines,
currently the Principal Recipient of the GFMP5 is contributing and will continue to contribute significant
amounts totaling US$ 1,551,592 from 2006-2010 in support of the malaria program in the five top
provinces with the highest burden of malaria in the country.
In this proposal, contributions in kind through the personal services of private sector partners which will be
included in the private-public partnership strategy and other non-health public sector agencies in the total
amount of US$ 5,664,000 would augment the resources for health in malaria control and at the same time
expand the human resource for health by relying on the existing staff of partners, both in public and
private sector.
b) Describe current and planned financial contributions, anticipated from all relevant external
sources (including existing grants from the Global Fund and any other external donor funding)
relating to this component. (Summarize such financial amounts for past and future years in table 4.5.1-3
[line C].)
Until 2008, GFMP2 will continue to have financial support amounting to US $ 4, 584,640 (US$ 2,256,775
in 2006, US$1,614,221 in 2007; US$ 713,644 in 2008) . RBM will provide US$2,200,000 divided equally in
2006 and 2007. GFMP5 will provide the majority of funds but only targeting the five top provinces with no
fund support for the 21 remaining top provinces and the four emerging provinces which will be covered by
this proposal. The GFMP5 will total US$14,308,636 divided into US$ 7,161,436 in 2006-07; US$
3,936,092 in 2007-08; US$ 1,836,493 in 2008-09; US$ 728,345 in 2009-2010; US$ 646,270.
To augment these external funds, the proposal is requesting funding from GF totaling US$22,344,785.00
Philippine Malaria Proposal
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4 Component Section Malaria
4.5.3 Financial gap calculation
Provide a calculation of the gap between the estimated overall need and current and planned
available resources for this component in table 4.5.1-3 and provide any additional comments below.
Based on The RBM Strategic Plan for the Philippines 2006-2010 (Appendix 12) the gap for the malaria
control program in the Philippines is understated as over-all needs of US$ 39,056,766 indicated in that
document was based on the original target of 1 conventional bed net per household
This estimate needs to be adjusted to provide for: 1) the desired quantities of Long lasting insecticide
treated bed nets to attain a population coverage of >80%, 2) budget for antimlarial drugs and commodities
to provide uninterrupted supply of both for early diagnosis and treatment and vector control., 3) support for
health system and community system strengthening. The adjusted total needs is US$ 61,218,233
from 2007-2011.
Subtracting the total amount of domestic and external funds of US$ 28,509,662, for the years 2007-2011
the unmet need is US$ 32,809,570. Of this unmet need, the funding requested from GF is a total of
US$ 22,344,785.00
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4 Component Section Malaria
Table 4.5.1-3 - Financial contributions to national response
Financial gap analysis (please specify currency: Euro / US$)
Actual
2004
Planned
2005
Overall needs costing (A)
Estimated
2006
2007
2008
2009
2010
2011
23,441,039.00
27,562,277.00
13,149,054.00
8,086,742.00
6,937,739.00
5,582,421.00
Current and planned sources of funding:
Domestic source: Loans and debt
relief
GF 5 LGU Domestic Source
Pilipinas Shell Foundation, Inc.
100,000.00
100,000.00
100,000.00
100,000.00
100,000.00
100,000.00
100,000.00
100,000.00
178,020.00
356,772.00
490,080.00
389,104.00
213,064.00
228,344.00
231,000.00
210,085.00
1,330,000.00
1,289,000.00
1,085,000.00
985,000.00
975,000.00
Counterpart funds from partners in
other public sector, NGOs, FBOs
National funding resources
2,100,000.00
2,100,000.00
2,100,000.00
2,100,000.00
2,100,000.00
2,100,000.00
2,100,000.00
2,100,000.00
2,378,020.00
2,556,772.00
2,690,080.00
3,919,104.00
3,702,064.00
3,513,344.00
3,416,000.00
3,385,085.00
External source 1
GF 2Grants
2,766,831.00
4,072,934.00
2,256,775.00
1,614,221.00
713,644.00
External source 1
RBM/WHO
300,000.00
1,060,000.00
1,100,000.00
1,100,000.00
7,161,436.00
3,936,092.00
1,836,493.00
728,345.00
646,270.00
Total domestic
sources of funding(B)
External source 3
GF 5
Total external
sources of funding (C)
Total resources available (B+C)
Unmet need (A) - (B + C)
Philippine Malaria Proposal
3,066,831.00
5,132,934.00
10,518,211.00
6,650,313.00
2,550,137.00
728,345.00
646,270.00
0.00
5,444,851.00
7,689,706.00
13,208,291.00
10,569,417.00
6,252,201.00
4,241,689.00
4,062,270.00
3,385,085.00
0.00
0.00
10,232,748.00
16,992,860.00
6,896,853.00
3,845,053.00
2,875,469.00
2,197,336.00
44
4 Component Section Malaria
4.5.4 Additionality
Confirm that Global Fund resources received will be additional to existing and planned resources,
and will not substitute for such sources, and explain plans to ensure that this will continue to be true
for the entire proposal period.
This proposal will consolidate the significant gains made by the GFMP2 project and AusAID/DOH/WHO
RBM project would continue to support and compliment malaria control activities in Mindanao. The DOH is
currently initiating necessary legal framework to ensure funds earmarked for malaria control at the local
level will continue to be provided and will be increased as and when needed. This will be in the form of an
executive order from the office of the president.
4.6.1 Goals, objectives and service delivery areas
Provide a clear description of the program’s goal(s), objectives and service delivery areas (provide
quantitative information, where possible).
Goal: (1) To reduce malaria morbidity by 70% in 21 of 26 provinces covered by Round 2 (excluding the
five top provinces) and in 4 emerging provinces where malaria morbidity is increasing, and
(2) To achieve zero mortality in the 25 provinces by 2011
Objectives:
1. To consolidate, expand and sustain high coverage of early diagnostic and treatment services
for malaria through health systems strengthening and public private partnership
Since diagnostic centers are already established in the villages where the at-risk population lives, early
diagnosis and treatment of patients has been facilitated. Patients are already being managed by the most
peripheral health facilities. Round 6 will maintain the momentum achieved in Round 2. Quality assurance
of both barangay malaria microscopy centers and the RDT sites at the village level, the RHUs and district
hospitals at the municipal level and the hospitals at the provincial level will be monitored and ensured.
Public-private partnership with private for-profit providers, will further expand the services as well as
increase the number of patients diagnosed and appropriately treated early. Partnership with FBOs and
NGOs especially in the hard to reach mountain villages and in the problematic border areas which are
prone to epidemics will further increase patients served. In addition, expansion to 4 provinces (not covered
presently by Round 2) where cases are increasing will avert escalation of the malaria problem in these
areas.
To expand the coverage of early diagnosis and provision of appropriate treatment for malaria, the service
delivery areas (SDAs) are:
SDA 1) Human resources - Service providers trained
Around 661 health service providers shall be trained. Training will be extended to health care givers from
public as well as private facilities including non-profit organizations, faith-based organizations, as well as
for-profit private practitioners. The support to be provided by the project for the private facilities and nonprofit organization will include training costs, provision of equipment and laboratory supplies for
microscopy and RDT, as well as provision of medicines for uncomplicated malaria for those in the primary
health care facility level. Training and refresher courses will be on malaria diagnosis (microscopy and
RDT) , clinical management, Quality Assurance, Malaria Management and continuing education for those
who will be recipients of scholarships.
SDA 2) Treatment: prompt, effective antimalarial treatment – people receiving anti-malarial
treatment as per national policy
A total of 54,313 people are targeted to receive appropriate diagnosis and anti-malarial treatment within
the 5 years of the project.
SDA 3) Treatment: prompt, effective antimalarial treatment – patients admitted with severe malaria
receiving correct treatment at health facilities
An estimated 3,246/3,401 or 95% patients with severe malaria are expected to receive correct treatment
at the health facilities within 5 years of the project.
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4 Component Section Malaria
Prompt, effective antimalarial treatment will lead to increased number of patients treated for malaria
following the national guidelines and patients receiving correct and effective treatment of severe malaria in
referral hospitals, children <5 years within 24 hours of onset of fever. Supportive environment includes the
setting up of barangay microscopy centers and equipping laboratories with working microscopes and
providing laboratory reagents and RDTs for the diagnosis of malaria Service delivery will include the
establishment of an effective referral system and the integration of microscopy services for malaria and TB
and the provision of DOT for TB by barangay microscopists.
SDA 4) Procurement and supply management – health facilities with no reported stock out lasting
more than one week of nationally recommended anti-malarial drugs during the past 3 months.
The target is for 1,271 out of 1,412 or 90% of malaria diagnostic and treatment facilities will not report
stock out of anti-malarial drugs lasting more than a week. Procurement and supply management will
include training of logistic staff on drug forecasting, storage and inventory, and procurement from central
stores as well as distribution of drugs and supplies from the municipal storage to the household using
innovative strategies including through school children, CBOs, FBOs, corporate donors, the Philippine
Army, and through distribution in congregate settings like in market place and places of worship.
SDA 5) Information system and operations research – provinces with operationl malaria
information system
Currently, there are 10 provinces that have operational information system. The target is to have all the
th
21 GF2 provinces’ malaria information system operational by the 24 month of the project and all the 25
rd
provinces by the 3 year of the project.
SDA 6) Information system and operational research – Local government units that plan for
malaria control activities using information derived from the Malaria Information System (MIS).
Information system and operational research will include the operationalization of the Philippine Malaria
Information system (PhilMIS) with the aim of providing timely information for management decision
through the analysis and consolidation of the experiences from these facilities.
At present there is only 1 province which is able to plan for malaria control activities using its malaria
information system and by the end of the project all the 25 projects shall be using their PhilMIS for
planning and decision – making.
2. To scale up vector control to interrupt malaria transmission
The bed nets distributed in Round 2 shall be augmented as the numbers did not reach a coverage of
>80% of the population at risk to interrupt transmission. Long lasting insecticide treated nets (LLITNs) in
quantities that will allow for 80% coverage of the at-risk population is going to address the challenge
posed by retreatment of conventional nets used in Round 2. Indoor residual spraying twice a year in
selected sites shall provide the necessary support in areas where outbreaks occur and where feasible and
sustainable. Epidemic management shall be improved and the four zonal stockpiles will be expanded to
10 regions.
The SDAs under this objective will include:
SDA 7) Prevention: insecticide treated nets (ITNs) – LLITNs distributed
962,194 LLITNs will be distributed in the 25 provinces.
SDA 8) Prevention: insecticide treated nets (ITNs) – At-risk population covered by ITN
4,242,153 out of 5,302,691 or 80% of people at risk of malaria in the 25 provinces will be covered by ITN
within the 5 years of the project.
SDA 9) Prevention: insecticide treated nets (ITNs) – People who slept under an ITN the previous
night
Bednet utilization survey results would show 23,254 out of 27,358 or 85% of people surveyed slept under
insecticide – treated mosquito nets the previous night.
SDA 10) Prevention: insecticide treated nets (ITNs) – Children under 5 sleeping under an ITN
Bednet utilization survey results would show 2,996 out of 3,525 or 85% of children under five years old
among households surveyed slept under insecticide – treated mosquito nets the previous night.
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4 Component Section Malaria
SDA 11) Prevention: vector control (other than ITNs) – Outbreaks detected early
A total of 16 epidemics out of a total expected 20 epidemics or 80% will be detected early over a period of
5 years.
3. To strengthen local capacity through community systems strengthening for sustainable
community-based malaria control and management.
The HSRA and devolution of the health system has disrupted programs that have been run as vertical
programs in the past. The local government units (LGUs) need empowerment through multi-sectoral
training and policy making with their health personnel, looking at control of malaria beyond a health
problem and recognizing that it is important within the broad development strategies of the government.
The SDAs under this objective are:
SDA 12) Community systems strengthening – municipalities with established local health codes or
community – based health financing scheme
Local health codes and/or community-based health financing schemes in support of malaria control shall
be established in 169 local government units (province, municipalities or barangays).
SDA 13) Supportive environment: coordination and partnership development (national,
community, public-private – networks/partnerships involved
169 networks and partnerships shall be established and strengthened. Coordination and partnership
development will be through multi-sectoral networking with private sector stakeholders including logging
firms, mining companies, and other non-health public sector such as the department of interior and local
government, department of education and private public partnership with for-profit private practitioners and
non-profit organizations such as FBOs and CBOs that are already operating and providing health services
in the at-risk communities. Partnership with these non-profit organizations can also facilitate border
operations to prevent epidemic outbreaks.
SDA 14) Prevention: BCC – community outreach – people who know the cause, symptoms,
preventive measures and treatment of malaria
2,593 out of 3,050 or 85% of household heads or representatives surveyed know the basic facts about
nd
th
malaria and its prevention by the 2 year of the project. The target for the 4 year of the project is 2,745
out of 3,050 or 90% of household heads surveyed.
SDA 15) Service delivery – health facilties providing integrated malaria, TB and intestinal
parasitism diagnostic and treatment services
1,756 barangay microscopy centers and rapid diagnostic sites providing malaria diagnostic services will
be developed to be able to extend services for the provision of TB and intestinal parasitism diagnostic
and treatment services.
Coordination and partnership development could develop stewardship and empowerment of local
Government Units (LGUs). Workshop and evidence-based planning for local executives and their
respective Provincial Health and Rural Health Officers to entrench malaria control as a part of
development program of local government should be pursued, emphasizing on the economic burden of
malaria and the benefits that control will accrue. To motivate the trained health service providers to stay
with the government and in the country and to continue providing services, incentives through the
implementation of existing “Barangay Incentives and Benefits act of 1995” and the availment of PhilHealth
outpatient malaria benefits should be explored. In addition, incentives in the form of distance learning
education or step-ladder education shall be considered through networking with educational and other
training institutions. Operational researches shall result in the review and modification of policies on
malaria control with the aim in view of local government units adopting a proactive role with the
enunciation of local ordinances to support health programs in general as part of their developmental plans
and malaria control in particular. Community systems strengthening shall include LGUs networking with
private sector stakeholders to support malaria control and local executives passing local ordinances
including local health codes and the establishment of health financing schemes for malaria.
Implementation of the existing Barangay Health Workers Benefits and Incentives Act of 1995 will be
advocated including the recognition and accreditation of barangay microscopists as barangay health
workers by the local health board. Public-private partnership with FBOs and NGOs will be pursued.
Utilizing their infrastructure, diagnostic and curative services as well as distribution of commodities for
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4 Component Section Malaria
vector control will reach more people served. Service delivery will be improved through establishment of
referral system between community-based microscopy centers and RDT sites to referral level hospital, in
both public and private health sectors; integration of malaria and TB microscopy services and will also
expand the services available to target population and further develop the health workers’ skills in
diagnosis and treatment.
Behavior change communication using IEC tools and methods that are culturally sensitive and acceptable
will be undertaken to promote social mobilization focusing on core messages to encourage 1) early
diagnosis by knowing and using malaria diagnostic and treatment services available within 24 hours of
onset of fever 2) compliance to treatment, and 3) the use of insecticide treated nets. Proven strategies
used in Round 2 shall be applied such as Malaria School–On-Air, school-based malaria education
activities and the mobilization of malaria advocates.
4.6.2 Link with overall national context
Describe how these goals and objectives are linked to the key problems and gaps arising from the
description of the national context in section 4.4. Demonstrate clearly how the proposed goals fit
within the overall (national) strategy and how the proposed objectives and service delivery areas
relate to the goals and to each other.
The gains achieved during the implementation of round 2 served to fill the gaps in the delivery of services
for the diagnosis and treatment of malaria in the past. The increase in health facilities providing these
services will help address the problem of high morbidity due to the disease. Although trends for both
morbidity and mortality are on a decline in many provinces, these need to be maintained in order to
achieve adequate control of the disease, thereby reducing the socio-economic burden brought about by it.
The goal of reducing morbidity and mortality due to malaria by 70% in the remaining affected and even
emerging provinces is consistent with the national agenda of elimination of malaria, among seven other
diseases. Through the National Objectives for Health, this has been set as a goal for all local government
units, NGOs and the health sector to target. It is strategic to focus on elimination of diseases with cost
effective technologies and through multisectoral approach because it will result to eventual unloading of
health systems of its persistent burden of communicable diseases.
The strategies of early diagnosis and prompt, appropriate treatment complemented by the use of
appropriate vector control strategies are consistent with the major strategies of the national Malaria
Control Program. These would contribute to the attainment of decreased morbidity and mortality by
interrupting disease transmission. The facilities established in Round 2 will be consolidated and
strengthened further to provide continuous quality diagnosis and treatment services. Since nongovernment organizations, faith-based organizations and community-based organizations work among
target populations, expansion of access to health services through these organizations would ensure that
those in far-flung and economically depressed areas would be reached. Workers of these organizations
would undergo training on malaria diagnosis and treatment and would be provided with logistical support.
The social mobilization and health systems strengthening objectives would serve to support the service
delivery system already established for malaria control and to consolidate and sustain the gains in the
area of mobilizing LGU and community participation.
The lack of funds for operations of health facilities by the local government units remain a constraint not
just for the MCP but for the entire public health system. This has resulted in limited access to and use of
services by the poorest of the poor. Continuous support for the RHUs and established diagnostic and
treatment facilities is needed to ensure continuous operations. This will be done through provision of
commodities and training for the service providers not just in the RHUs but in the hospitals as well.
Private clinics and hospitals through public private partnership would also be supported so that they can
add to the facilities providing quality and standard diagnostic and treatment services for malaria.
Strengthening of local capacity to manage a community-based malaria control program would focus on
the stewardship and empowerment of LGUs so that they can include malaria control and other health
concerns in their local development agenda. This would help LGUs analyze more thoroughly the real
needs for health and their spending patterns for public health. Tapping local sources of funds (like
portions of revenues from tax collections, service fees from health facilities, etc) and mobilization of funds
through the establishment of a community-based health care financing system would also help augment
the limited funds for health services. This, in turn should bridge the inequity in public health spending
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4 Component Section Malaria
where those who have the least capacity to pay have the larger unmet needs for health services.
Although there is growing involvement of the private sector in the operations of the public health system,
there is a need to strengthen linkages and ensure effective collaboration between public and private
sector. Forging stronger links will facilitate maximization of resources (funds, manpower, technical
capacity) from various sectors including the community that can be used to improve service delivery for
malaria control.Achievement of these objectives would contribute to the attainment of the overall goal of
reduction of morbidity and mortality due to malaria to rates that it would no longer be a constraint to the
socio-economic development of the country.
4.6.3 Activities
Provide a clear and detailed description of the activities that will be implemented within each service
delivery area for each objective. Please include all the activities proposed, how these will be
implemented, and by whom. (Where activities to strengthen health systems are planned, applicants are also
required to provide additional information at section 4.6.6.)
Objective 1. To consolidate, expand and sustain high coverage of early diagnostic and treatment services
for malaria through health systems strengthening and public private partnership
Activities:
SDA 1: Human Resources: Service providers trained. Department of Health staff will provide all the
training courses. The first three quarters of Year 1 will be spent evaluating the training courses on
diagnostic and treatment that have been conducted in GFMP2. Refinement of modules and other tools
will be done during this time to ensure that capability building will be effective and appropriate.
• Training on Basic Malaria Microscopy will be conducted for public health service providers (medical
technologists of Rural Health Units and government hospitals) in the four new provinces. Target
participants will also come from private clinics/hospitals, faith-based organizations, non-government
organizations, community-based organizations in all 25 provinces covered by the project. Barangay
microscopists will be selected and trained from among the priority barangays in the four provinces.
Target trainees may be the barangay health workers or the volunteers/staff of the FBOs, NGOs and
CBOs.
For basic malaria microscopy, the training period is 35 days for barangay microscopists and 14 days
For medical technologists.
All basic malaria microscopy trainings are set for the second year. This is to allow sufficient time for
preliminary activities like validation of barangay microscopy site, proper selection of the target trainees
(Both medical technologists and barangay microscopists). Negotiations with LGUs and private sector
organizations will also take place in the early part of the project implementation to ensure that
mechanisms for sustainability will already be in place before the actual selection and training of these
Service providers. These are being done as a result of learnings from experiences in GFMP2
implementation.
• Refresher courses on Malaria Microscopy shall be given to malaria microscopists from the 21
provinces based on the results of QA monitoring. Refresher course for medical technologists will be
for one week and for barangay microscopists two weeks. These will take place in the fourth quarter of
the first year. This will give time for proper assessment of the proficiency of the microscopists and to
ensure functionality of the microscopy centers where they are assigned.
• Training on the use of Combination Rapid Diagnostic Tests (RDTs) to diagnose both Plasmodium
falciparum and Plasmodium vivax will be given to Barangay Health Workers of both public health
facilities and private sector organizations. Training on RDTs will take only 1.5 days. Trained medical
technologists will be tapped to facilitate the training at the local level.
• Basic Malaria Management Course will be given to doctors and nurses of Rural Health Units in the
four new provinces and to doctors/nurses of partner FBOs, NGOs and CBOs. Duration of training is
three days. This is targeted in the third quarter of Year 1, before the conduct of the trainings on
Malaria diagnosis (malaria microscopy and RDT). This is in correction of the oversight during the
GFMP2 where microscopists were trained ahead of the doctors. This resulted in some difficulty in
fully implementing the National Guidelines on the Chemotherapy of Malaria in several provinces.
• Course on management of severe malaria will equip service providers on the recognition of and
appropriate management of severe malaria through a case management oriented algorithmic
approach for hospital doctors of public and private health facilities. This shall be supported by an
improved referral system that will take into consideration the resources of the public and private
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4 Component Section Malaria
•
•
•
organizations. The course will take three days.
Validators’ training will be conducted in the last quarter of year 1. This is to give ample time for the
proper selection of provincial validators, particularly in the four new provinces, who will be key people
in the effective implementation of the Quality Assurance system for malaria microscopy. Training
period is one week.
QA orientations will be conducted to facilitate expansion of the QA system in all the target provinces.
Participants include microscopists and other relevant health personnel from both public health and
private sector organizations involved in the delivery of malaria diagnostic and treatment services. This
is scheduled in the third and fourth quarter of Year 2 to complement the capability building already
done in the previous quarters, specifically in the areas of malaria diagnosis.
Establishment of staff development and retention program for regional, provincial and municipal
health staff and other LGU personnel is part of the strategies for health systems strengthening.
Scholarship grants will be given in the first two years of the project, with provision of additional
beneficiaries in the second phase depending on the results of the initial venture. Deserving health
personnel can enroll in Distance Learning Program, University Stepladder Program, postgraduate
diploma and certificate courses. This will be done in collaboration with academic institutions
particularly, the state universities. Scholars will be selected based on criteria to be set by the TWG
and in consultation with the Provincial Management Committees.
SDA 2: Treatment: prompt, effective antimalaria treatment – People receiving anti-malaria
treatment as per national policy
SDA 3: Treatment: prompt, effective antimalaria treatment –Patients with severe malaria receiving
correct treatment at health facilities
•
•
•
Procurement and distribution of commodities and equipment for early case detection and
appropriate antimalaria treatment will be done in support of this SDA.
a. first-line,
second-line
and
third-line
antimalarial
drugs
(Chloroquine/Sulfadoxine
pyrimethamine/Primaquine, Coartem and Quinine, respectively) will be procured in the second
year. This is in view of the fact that there would still be adequate stocks of these drugs from
GFMP2 and that distribution to the four new provinces will only take place after the training of
doctors and microscopists.
b. Combination RDTs will be procured in the first and second year, prior to the conduct of trainings.
c. Laboratory supplies will also be procured to support the diagnostic facilities— those already
functional (in the 21 provinces) and those that will still be established (in the four new provinces).
Barangay microscopy centers run by microscopists of FBOs, NGOs and CBOs will also be
provided with laboratory supplies.
d. Microscopes will be procured and provided to public health facilities and those run/supported by
private sector organizations.
Barangay Microscopy Centers will be established in priority barangays based on guidelines set by
the TWG. Barangay Health Workers, midwives and other community volunteers may be selected to
undergo the five-week training on Basic Malaria Microscopy. The microscopist will be given a monthly
honorarium for one year, after which, support should be continued by the LGU, the community and/or
private sector organizations.
Negotiations will take place with representatives from the above-mentioned organizations to establish
a mechanism to mobilize resources for the continued support for the microscopists and the
microscopy centers.
Private-public partnership between public sector providers and private non-profit (including FBOs
and CBOs) and for-profit health facilities/providers. Following the successful model of the PrivatePublic Mix DOTS (PPMD) pioneered in the Philippines, among other countries, the steps will include
advocacy among health care providers in both private and public, and with the assistance of the NCIP,
advocacy and consultative meetings with the FBOs and other non-profit NGOs that are already
operating in the endemic areas. Support to be provided by the project will include technical assistance
through training of referring physicians, all health care workers at various levels of health care, the
provision of anti-malarial drugs and laboratory equipment and supplies. The counterpart funding from
these private partners will provide the health manpower and their facilities that are already existing.
This strategy, will harness the existing human resources for health of these private facilities and NGOs
and thereby increase the number of health care providers in the community without budgetary
allocation having to be shouldered by the LGUs that already have limited resources. At the same,
provision of the drugs and laboratory supplies will enhance the capacity of these private providers in
malaria management and control. In addition cases that are managed by the private facilities are also
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4 Component Section Malaria
•
captured in the malaria information system
Referral networking between community-based health care providers and referral health
facilities (including tertiary hospital with capacity to manage complications of malaria) will be
undertaken after appropriate training of the hospital staff on the management of severe malaria. This
follows the model of the case-management oriented classification of acute respiratory infections in
children where peripheral workers are taught simple clinical signs that minimally educated/trained
peripheral health providers can use to identify serious malaria cases that need to be referred to higher
level health care facilities (referral hospitals).
SDA 4: Procurement and supply management – Health facilities with no reported stock outs lasting
more than 1 week of nationally recommended anti-malarial drugs during the past 3 months
•
•
•
Training on procurement and supply management using innovative approaches described in
st
nd
rd
Annex 15 will be undertaken to ensure an uninterrupted supply of 1 , 2 and 3 line anti-malarial
drugs and laboratory supplies in the appropriate level of drug dispensing health care facility. LGUs can
then avail of quality drugs at low costs through pooled procurement. LGU, public health workers and
private sector health service providers will be equipped on logistics management to ensure that there
will be zero stockout of drugs and laboratory supplies in any of the health facilities. A consultant will
be providing technical assistance for the development of the training module course and the actual
conduct of the said activity.
Upgrading of warehouses in the provincial health offices will be done as part of health systems
strengthening, specifically in the area of logistics management system. This will be done in the first
two years of project implementation.
Distribution system will utilize the existing infrastructure and personnel of NGOs and FBOs working
with the communities and indigenous peoples at no additional expense to the program.
SDA 5: Information system and operational research – Provinces with operational malaria
information system
SDA 6: Information system and operational research – Local government units that plan for
malaria control activities using information derived from the Malaria Information System
Activities to scale up the Philippine Malaria Information System for program management and to
strengthen surveillance system in the provinces in a phased manner will be conducted. Inclusion of
private health service providers among the users of the system will ensure that cases from private facilities
will be reflected in the overall provincial malaria control data.
• PhilMIS orientations will be conducted for service providers from the provincial to the barangay level.
Service providers from the private sector will likewise be participating. These will be facilitated by
members of the TWG MIS Committee and staff of the National Epidemiology Center (NEC) of the
DOH. Participants will come from the four new provinces and the private sector facilities of the 21
provinces.
• Provision of computer units and peripherals for the rolling out of PhilMIS developed by GFMP2 will
be pursued in the four new provinces.
• Workshops on data utilization will be conducted not just for health staff but also decision-makers
like the local chief executives. Capacity building on data utilization would be done as part of the
agenda during Provincial Management Committee meetings and as a formal workshop conducted
separately, particularly for the four new provinces.
Objective 2. To scale up vector control to interrupt malaria transmission
Activities:
SDA 7: Prevention: Insecticide treated nets – LLITNs distributed
SDA 8: Prevention: Insecticide treated nets –At-risk population covered by ITN
SDA 9: Prevention: Insecticide treated nets – People who slept under an ITN the previous night
SDA 10: Prevention: Insecticide treated nets –Children under 5 sleeping under an ITN
• LLITN distribution will be done to achieve at least 80% coverage in highly endemic
barangay/municipalities. These shall be distributed for free for universal access to the rural poor
including indigenous peoples. This will be facilitated by public health workers, community volunteers
FBOs, NGOs and CBOs. Networking with these partners will expand coverage since they are the
ones at the frontline and have access to the at-risk populations living in far-flung communities.
• Retreatment of (conventional) bednets that were distributed by GFMP2 will also be done for
increased coverage. Retreatment will be timed before the period of peak of transmission in the area.
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4 Component Section Malaria
•
Similar to the distribution of nets, retreatment will be done by partners at the local level. The Action
Committees for malaria control that were established in GFMP2 will take the lead in planning for and
facilitating this activity.
Bednet Utilization Survey will be done to establish baselines in year 1 and to assess the outcome of
interventions midway through the project. Barangay Health Workers, FBOs, NGOs and CBOs will
form the survey team with the Provincial Malaria Control Program Coordinator as the team leader.
SDA 11: Prevention: Vector control (other than ITNs) – Outbreaks detected early
• Training on Malaria Surveillance and Epidemic Management will be conducted for health
personnel from both public health and private sector organizations. This will help facilitate efficient
and timely outbreak response.
• Establishment of regional stockpiles from the original four zonal Stockpiles for Outbreak Response
will cater to the needs of the 25 target provinces. This will facilitate better access to commodities for
vector control and outbreak response. The project will provide insecticides, spraycans and personal
protection equipment (PPEs).
• Indoor residual spraying as additional intervention through focal in outbreak prone areas shall be
undertaken in selected sites and during outbreaks. Sprayteams at the local level will be oriented on
spraying based on TWG Vector Control Guidelines.
Objective 3. To strengthen local capacity for stewardship through empowerment of the LGUs and
community system strengthening for sustainable community-based malaria control
Activities:
SDA 12: Community systems strengthening – Municipalities with established local health code or
community-based health financing scheme. Stewardship and empowerment of LGUs to lead public
private partnership as well as multisectoral networking, and resource and social mobilization to support
malaria activities in the community.
• Workshop on development planning and local health financing for local chief executives will be
conducted to equip them to include health and malaria in the general development agenda of their
municipality/barangay. A concrete output of this activity is the establishment of a Health Code that will
constitute a set of guidelines for health based on the policy agenda for health of the administration.
Partner NGOs and representatives from the Department of Interior and Local Government will
facilitate the workshops.
• Consultation and advocacy meetings at the national and provincial level will be held with LCEs,
private sector representatives to facilitate discussion on Health Financing Schemes and other health
agenda that require policy development.
SDA 13: Supportive environment: coordination and partnership development (national,
community, public-private ) – networks and partnerships involved.
LGU executives should work collaboratively with health officials to review policy and undertake evidencebased policy development for malaria control and elimination as an integral aspect of the general
developmental strategies to improve the socio-economic status of their communities
• Provincial Management Committee composed of private public stakeholders including FBOs,
NGOs and CBOs actively participating in planning meetings for community strengthening to
confront local concerns on malaria control including planning for appropriate interventions at the local
level, health financing and health staff development and retention.
• Establishment of a system of certification and accreditation for health facilities in public and
private sector in collaboration with the DOH to enable health care givers to avail of potential PhilHealth
benefits for sustainability of services.
• Public Private Partnership for Malaria (PPPM) to mainstream existing NGO, FBO health service
infrastructures and personnel following the PPMD model for TB through planning workshop,
advocacy, MOU between the local MCP and the NGOs and FBOs, training on malaria diagnosis and
treatment, provision of laboratory equipment, laboratory supplies, and medicines and monitoring and
supervision to strengthen linkages between public (health and political) and NGOs providing health
services including that for malaria in hard to reach communities where at-risk populations including
indigenous peoples live.
SDA 14: Prevention: BCC – community outreach. People who know the cause, symptoms,
preventive measures, and treatment of malaria (number and percentage) will be increased through the
use of innovative BCC that are culturally sensitive and appropriate.
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4 Component Section Malaria
•
•
•
•
•
•
School-based malaria education, interschool integrated health quiz to be sponsored by the
private sector. Modules and other teaching aids shall be developed for this purpose.
Barangay assemblies and mothers’ classes for health promotion will be held. Appropriate and
culturally sensitive IEC materials using core messages on early case detection, compliance with
treatment, and regular use of mosquito nets will enhance these activities. These activities shall be
facilitated by the trained malaria advocates from the private sector, FBOs, NGOs.
Malaria School-on-the-Air is a take-off from the pilot done in one of the GFMP2 provinces. This will
be expanded to other provinces through local radio stations. This will be done in a phased manner.
The pilot phase will be done after evaluation of the procedures and materials used.
Training of Malaria Advocates/Educators in the four new provinces and from among the
representatives of the FBOs, NGOs and CBOs will be done as part of the extension of the health
promotion role of the provincial and municipal health offices. The three-day training will be interactive
and wil include a session on action planning. This will help the participants to map out the target
areas for their community-based IEC activities.
KAP and prevalence survey will be done to establish baselines on the knowledge, attitude and
practices of target populations in highly endemic areas. This will serve as basis for the development of
appropriate IEC materials and strategies. A follow-up survey midway through project implementation
will help assess the effect, if not the impact, of the intervention for this SDA.
Production of appropriate and culturally sensitive IEC materials. Print IEC materials that will
serve as tools for the activities on health promotion will be developed. Flipcharts, in particular, will be
used by the Malaria Advocates in their one-on-one sessions with the community members. For IPs
and target groups of low literacy, materials would consist mostly of illustrations.
SDA 15: Service delivery – Health facilties providing integrated malaria, TB and intestinal
parasitism diagnostic and treatment services. Integration of Malaria with TB and Intestinal Parasitism
Diagnostic and Treatment Services through an tegrated microscopy service following good laboratory
practice principles.
• Training of barangay microscopists and RHU Medical Technologists on Integrated Microscopy
(Malaria, TB, Intestinal Parasitism and the implementation of DOT)
The one-week course will equip these microscopists with knowledge and skills to enable them to
expand the services they are offering. A separate training team at the national level will facilitate this
course.
• Training on Integrated Diagnostic and Treatment Services for Barangay Health Workers
BHWs and other local health volunteers will be equipped on specimen collection, diagnosis and
treatment (with emphasis on DOT) of the above-mentioned infectious diseases.
• Consultation meetings at the national and provincial level will be held to prepare all implementers
and stakeholders on how to facilitate the integration of these diagnostic and treatment services for
Malaria, TB and intestinal parasitism. The TWG and the DOH will facilitate these meetings.
Philippine Malaria Proposal
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4 Component Section Malaria
4.6.4 Performance of and linkages to current Global Fund grant(s)
This section refers to any prior Global Fund grants for this disease component and requests information on
performance to date and linkages to this application. For more information, please refer to the Guidelines for
Proposals, section 4.6.4.
a) Provide an update of the current status of previous Global Fund grants for this disease
component, in the table below.
Table 4.6.4. Current Global Fund grants
Grant number
Grant amount*
Amount spent
GF Grant 1
PHL-202-G02-M-00
USD 11,829,545.00
USD 9,671,357.00
GF Grant 2
PHL-506-G05-M
USD 11,097,529.00
USD 124,110.00
GF Grant 3
GF Grant 4
*
For grants in Phase 1, this is the original two year grant amount. For grants that have been renewed into
Phase 2, this is the total amount, inclusive of Phase 1 and Phase 2. For unsigned Round 5 grants this is the
two year TRP approved maximum budget.
b) Please identify for each current grant the key implementation challenges and how they have
been resolved.
The World Health Organization conducted an external evaluation of the Malaria Round 2 project after 18
months of implementation and identified key issues which needed to be addressed. The project has since
then successfully dealt with these issues but continue to be faced with challenges which the proposed
Round 6 project can help resolve.
Inadequate coordination with DOH MCP staff in the provinces: In terms of project management, the
weak coordination with the Department of Health Malaria Control Program (DOH-MCP) was identified as a
“structural problem that has the potential to negate gains made when GF funding stops”. Because of
devolution, the LGUs under tine Provincial Health Officer (PHO) and the Municipal Health Officers (MHO)
are in charge of the implementation of the Malaria Control Program, hence, and yet the Department of
Health has MCP staff working in the provincial level, in which the LGUs have developed a dependency. it
was the project’s intention to engage the LGUs to become more pro-active in running the program.
Consequently, coordination with the provincial level MCP was left out. To correct this, the project has
established stronger links through the formation of Provincial Management Committees (or Provincial
Technical Working Groups) where the key players are the PHOs, the Provincial Malaria Coordinators of
the DOH-MCP and the Provincial Project Coordinating Officers of the PR. This arrangement ensures the
capacity of the LGUs are strengthened with adequate technical guidance provided through the Provincial
Malaria Coordinators of the DOH-MCP, the national Technical Working Group and Malaria Management
Committee headed by the DOH – MCP. At present there are strong to moderate linkages with the DOH MCP in 20 out of the 26 provinces and Provincial Management Committees are fully functional in 18 out of
26 provinces. Round 6 will continue to strengthen and consolidate these structures but will provide
additional support to the LGUs by linking the public health network to the private network such as
corporations, private agencies, faith-based organizations and non-government organizations.
Retention of trained staff: For diagnosis and treatment, the project has trained medical technologists and
barangay malaria microscopists whose honoraria were provided for by the project for the first year and, as
per agreement with the LGUs, have to be integrated into the LGU staff after the first year. WHO
recommended that the medical technologists should be absorbed into the staff by the LGU. Despite the
financial difficulties of the LGUs, roughly 50% of the medical technologists and 62% of the barangay
microscopists have already been absorbed. Advocacy among the local chief executives needs to continue
to empower them to take the lead and steward and to support these health service providers since the
setting up of barangay microscopy centers and the improvement of the RHU microscopy centers have
improved case detection.
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4 Component Section Malaria
Quality assurance of barangay microscopy: The evaluation also recommended a close supervision of the
barangay microscopists by the medical technologists. In response to this, a quality assurance system to
ensure quality microcopy services and treatment of malaria patients was developed by the Department of
Health, the World Health Organization and supported by the project and has been pilot tested and is now
ready for expansion to the rest of the provinces.
Lack of appropriate ant malarial drugs: It was found in the evaluation that there was lack of quinine in the
rural health units and the provincial and district hospitals. The project procured quinine even if this was
not in the original plan. Furthermore, it also provided first line drugs (chloroquine, sulfadoxinepyrimethmine and primaquine) when it became apparent that the LGUs were still not ready to provide
enough quantity of drugs as needed.
Functionality of RDT sites for both diagnosis and early treatment :Rapid diagnostic test (RDT) sites need
more attention, monitoring and analysis to be fully functional. The remoteness of these sites has made it
difficult to visit and monitor these facilities. Submission of report by these volunteers is also difficult. They
do not receive honoraria or augmentation for transportation expenses from the project. Although the
volunteers have passed the training, some municipal health officers still require that all patients’ blood
smears, whether found to be RDT positive or negative, should be submitted to the RHU for microscopy
and choose to have treatment given by the professionals rather than the volunteers. This indicates the
need to advocate for local executives to develop policies supportive of home-based malaria care,
empowering the health volunteers to dispense first line drugs, an intervention which will be part of the
proposed activities. The project has also decided to pursue the use of combination P.falciparum and
P.vivax.
Inadequate quantity of insecticide treated nets for interruption of transmission: For vector control, the
lack of mosquito nets is a serious deficiency in the Round 2 proposal that needs to be corrected in Round
6. Funds from Phase1 were reallocated so that approximately USD 500,000 was used to procure
additional nets and insecticides. However, the 200,000 additional nets procured are still not sufficient to
provide >80% coverage of the population at-risk for effective interruption of vector transmission. In
addition, the remaining ITNs were prioritized for areas of highest transmission to be able to cover 80 to
100% of the population in line with the desire to achieve control of transmission instead of personal
protection only.
Retreatment of nets: Guidelines for retreatment have been updated following results of the bioassay and
susceptibility tests. Timing of re-treatment is now done once a year, before the peak of transmission. But,
it is still difficult to conduct retreatment because of the operational costs, the difficulty in going to the
remote areas and the timing in the availability of the logistics. WHO has recommended the use of longlasting insecticide treated nets which the project, if approved, will use for Round 6.
Harmonization of multiple GF grants: Round 5 Malaria project has just begun implementation this June
2006 and has so far harmonized activities with Round 2. The proposed project is an augmentation of the
Round 2 project much like a phase 3 for the 21 provinces that will be easy to harmonize with the existing
GFMP2.
c) Are there any linkages between the current proposal and any existing
Global Fund grants for the same component? (E.g. same activities,
same targeted populations and/or the same geographical areas.)
Yes
X
t
complete d)
t
go to 4.6.5.
No
d) If yes, clearly list such linkages and describe how this proposal builds on, but is not duplicative of
the funding provided under current Global Fund grants.
GFMP2 covers 26 provinces while Round 5 covers the 5 of the 26 which are the most endemic provinces
of Round 2. The achievements so far realized in the implementation of GFMP2 are described in Annex 13
indicating that significant progress has been made in the establishment of diagnostic facilities and
capabilities in the 26 provinces covered by the project and the impact on malaria morbidity and mortality
attained thus far. The proposal will now cover the 21 provinces left out by Round 5 plus 4 provinces that
are all in Mindanao, with very limited socio-economic resources that have been observed to have
increasing number of malaria cases. The target is to sustain the gains in the 21 provinces of GFMP2
which are not covered by the GFMP5. The new proposal will supplement in the last years of GFMP2
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4 Component Section Malaria
resources to scale up and enhance the activities of GFMP2. This will ensure that the momentum towards
malaria control gained will be sustained by GFMP5 and Round 6. The goal in Round 6 will be similar to
GFMP5, that is, morbidity will be reduced by 70% with 2003 figures as baseline so that the level of
reduction reached by the provinces in all the 26 provinces of GFMP2 is sustained. However, Round 6 will
aim for zero mortality in the 25 provinces it will cover because these provinces are less endemic compared
to the provinces covered by GFMP5. For malaria diagnosis and treatment, GFMP2 covered only public
health facilities. For Round 6, aside from the public health facilities, public-private partnership with the
private clinics/hospitals and more importantly the non-profit health facilities and services operated by the
FBOs, NGOs and other private organizations will be harnessed into the Malaria Control Program. This is a
new strategy to increase the number of patients to be diagnosed and treated within 24 hours of onset of
fever.
For vector control, the great gap in the quantity and quality of ITNs in GFMP2 will be rectified by Round 6
through the procurement of LLITNs. Distribution through innovative channels using FBOs, NGOs, CBOs,
schools, distribution booths in areas of congregation are new strategies which will be undertaken in Round
6. The targets for health system strengthening in Round 6 will benefit both the Round 2 and Round 5
projects as it consolidates the lessons from both Rounds to come up with more relevant national malaria
control policies, better procurement and logistics system for the Department of Health, linkages and
networking with public and private organizations and improvement in the malaria information system.
Round 6 will also provide an integration of malaria diagnosis and treatment with other disease
components covered by GF, particularly TB in Round 2 and other programs like Schistosomiasis and
Intestinal Parasitism as the laboratory diagnosis covered by the malaria microscopy centers expands to
provide these diagnostic services and treatment.
Focus on the leadership of the LGU, and promoting the notion that malaria control is not only a health
program but a part of a greater development program that will reap economic rewards is a new strategy
which was not included in the previous rounds. In addition, community systems strengthening through
advocacy, networking between government and other private stakeholders in the area as a means of
making the community self reliant and thereby ensuring sustainability is another new intervention that will
be included in the Round 6 proposal.
In conclusion, Round 6 will have new innovative strategies to carry out the malaria control program that
are not part of the GFMP)2 or even GFMP 5. These include public private partnership with existing health
care providers including the for-profit Private Practitioners and non-profit organizations including FBOs,
CBOs, and other NGOs that are already operating and providing malaria services to the IPs. Capacity
building of the executives of the LGUs for networking with other sectors and private stakeholders, policy
development for health, in general, and including health financing for malaria control in particular, will be
another strategy to develop stewardship and leadership of the LGU of the malaria control program and to
gain sustainability of the program beyond the project. Integration of malaria services with other public
health programs, particularly TB, is another strategy to enhance synergies between the malaria program
and TB and other primary care programs.
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4 Component Section Malaria
4.6.5 Linkages to other donor funded programs
a) Are there any linkages between the current proposal and any other
donor funded programs for the same disease
Yes
X
t
complete b)
t
go to 4.6.6.
No
b) If yes, clearly list such linkages and describe how this proposal builds on, but is not duplicative of
the funding provided by other donors, including in respect of health system strengthening
activities.
The AusAID - Roll Back Malaria Project is currently being implemented in 8 of the provinces that will be
covered by the proposal. These include 4 under the Round 2 project (Davao Del Norte, Davao del Sur,
Davao Oriental and Compostela Valley) and the 4 provinces where the proposal will expand to (Sultan
Kudarat, Zamboanga del Norte, North and South Cotabato). For LLITN distribution, the target of RBM is
only households with children under 5 years old and pregnant women. This proposal provides
complementarity with the planned distribution for a coverage of >80% of the population at-risk. Drugs
provided by RBM will be taken into consideration during planning. Only GF 2 provides laboratory
supplies. In the past, RBM specifies activities which it can fund and these are no longer duplicated by the
GF Round 2 project. RBM provides the technical expertise in the development of guidelines and systems
while Round 6 will provide the additional logistics and budget to operationalize these in the provinces
4.6.6 Activities to strengthen health systems
Certain activities to strengthen health systems may be necessary in order for the proposal to be successful and
to initiate additional HIV/AIDS, tuberculosis, and/or malaria interventions. Similarly, such activities may be
necessary to achieve and sustain scale-up.
Applicants should apply for funding in respect of such activities by integrating these within the specific disease
component(s). Applicants who have identified in section 4.4.4 health system constraints to achieving and
sustaining scale-up of HIV/AIDS, tuberculosis and/or malaria interventions, but do not presently have adequate
means to fully address these constraints, are encouraged to complete this section. For more information,
please refer to the Guidelines for Proposals, section 4.6.6.
a) Describe which health systems strengthening activities are included in the proposal, and how
they are linked to the disease component. (In order to demonstrate this link, applicants should relate
proposed health systems interventions to disease specific goals and their impact indicators. See the MultiAgency M&E Toolkit.)
Human Resource for Health Development: Training on malaria microscopy and treatment will be
conducted by the pool of trainers in the Department of Health for medical technologists and volunteer
barangay microscopists as well as physicians in the hospital facilities encompassing both the public and
private health sector facilities. In addition, quality assurance shall be provided for all trained barangay
microscopists to ensure quality service for malaria control. In addition to training on the technology of
diagnosis and treatment of malaria cases, health care workers should also be trained on program
planning, budgeting and management.
•
Early diagnosis and appropriate treatment: through public private partnership will entail capacity
building among various levels of health care givers in the private sector, providing them with
enough incentives to engage in the MCP through certification, accreditation for benefits that could
be provided by PhilHEALTH is part of capacity building.
•
Integrated Microcopy services for Malaria and TB: BMs who are already provided with
microscopes, can be harnessed into the National TB Program by providing them training on
sputum smear and staining for the detection of sputum smear positive cases that have the priority
for treatment as they are at greatest risk of communicability to all lathers living within their
household.
Infrastructure and equipment outlay for early diagnosis and treatment: Establishment of barangay
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4 Component Section Malaria
microscopy centers will be done in collaboration with the LGUs and provision of microscopes with training
on maintenance of the equipment will likewise be provided. All diagnostic facilities shall be provided with
laboratory supplies, reagents, and kits for RDT. Facilities, both diagnostic as well as for case management
shall likewise be upgraded to be able to provide the services required depending upon the health care
level of care they are in order to establish a working referral system from the community treatment
sites/barangay health centers/to referral hospitals for the management of complicated malaria cases.
Procurement and supply management system: Technical assistance with experts on this field will be
requested. Innovative strategies will be utilized to improve the procurement of anti-malarial drugs from the
LGU level as well as distribution from central stores in the provincial and municipal levels to the target
households. This HSS activity will have synergy with other programs including TB and other public health
problems.
Monitoring and evaluation and health information system: Deployment of the PhilMIS into all the provinces
to be covered by the project will make program data available in a timely fashion to provide real time data
for program management. Training on monitoring and supervision at national, regional, provincial and
municipal health care level will also enhance the quality of services as there will always be a feedback
mechanism to inform the healthcare worker about their performance and how they can improve upon it , if
any.
Policy development for a supportive policy environment: Although this are not necessarily within the realm
of the public health sector, capacity building among local executives of the LGUs to provide them with
knowledge, skills in policy development for sustainable malaria control program and the retention of the
trained human resources for health through effective financing and allocation of budget, incentives, and
recognition, will enable the LGU to exert its stewardship and leadership in the Malaria Control Program in
their area of responsibility.
Community mobilization through behavior change communication for demand generation of malaria
services will require developing skills of health care workers in communicating the core information on 1)
available diagnostic and treatment services for malaria and when to use them, 2) adherence to treatment,
and 3) sleeping under an insecticide treated net. Efforts to establish community self-sufficiency will be
pursued in collaboration with stakeholders in the community.
b) Explain why the proposed health systems strengthening activities are necessary to improve
coverage to reduce the impact and spread of the disease and sustain interventions.
(When completing this section, applicants should refer to the Guidelines for Proposals, section 4.6.6.)
Human resource for health development will be essential as there is a dearth of healthcare giver following
the Diaspora and mass exodus of health professionals to developed countries for more lucrative salaries.
The strategy of public-private partnership in undertaking human resource for health development has cost
implications, as these care givers are now existing in the areas where the program needs to expand, and
personnel costs are taken as counterparts of the sub-recipients in this category, with the project just
providing technical support through training and the provision of the necessary laboratory equipment,
supplies and the antimalarial drugs to dispense for early treatment of cases within 24 hours of onset of
fever. The impact of this activity would be reduction of malaria deaths due to early diagnosis and
appropriate treatment.
Infrastructure and equipment outlay: These are done in partnership with LGUs and may not necessarily
entail as much outlay as in the provision of equipment. Referral hospitals, however, may require a greater
investment to equip it to be able to deal with complicated cases of malaria. An effective referral network
would be the output for this activity and the impact would be the reduction of malaria deaths due to
appropriate treatment of complicated malaria cases
Procurement and supply management is a challenge in the underdeveloped rural Philippines where
malaria risk is greatest and the resources to control it are limited. Innovative procurement and distribution
strategies will ensure the uninterrupted supply of antimalarial drugs and commodities for the prevention of
malaria transmission. The impact of this is the reduction of malaria morbidity and mortality.
Monitoring, evaluation, and health Information management is essential in the development of strategies
for malaria control. Data on malaria morbidity and mortality are scarce, although there is now software
developed through the GFMP2 project to have a computerized system that could provide timely
information to be useful for program management. The outcome of this would be a more efficient and
effective control program.
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4 Component Section Malaria
Policy development, although within the context of local executives, is important in developing a
supportive policy environment to be able to effectively implement and sustain the malaria control program
in rural Philippines.
Community systems strengthening through networking, advocacy, and behavior change communication
should improve health seeking behavior of the population at risk and the impact would be reduced malaria
deaths through early diagnosis and appropriate treatment, and prevention of transmission through use of
ITNs. In addition, sustainability of the MCP can be enhanced through community empowerment and
incentives can then be provided for volunteers to retain those who have been trained.
c) Describe how activities to strengthen health systems, integrated within this component, will have
positive system-wide effects and how it is designed in compliance with the surrounding context
and aligned with government policies.
Human resource for health development, infrastructure and equipment outlay, procurement and supply
management, monitoring supervision and health information management all lead to positive system-wide
effects as the impact of these activities in health systems strengthening is to reduce malaria morbidity,
leading to improved income generation activity of the people served by the program due to increased
productivity due to improved health and less expenditure for health services due to recurring malaria. This
will eventually lead to community systems strengthening as the socio-economic development of the area
will be enhanced.
d) Are there cross-cutting healths systems strengthening activities
integrated within this component that will benefit any other component
included in this proposal?
Yes
t
complete e) and f)
X
t
go to g)
No
e) If you answered yes for d), describe these activities and the associated budgets and identify and
explain how the other components will benefit. Please refer to the Round 6 HSS Information Sheet on
http://www.theglobalfund.org/en/apply/call6/documents/ before completing this section.
f) If you answered yes for d), confirm that funding for these activities has not also been requested
within the other component. Please refer to the Round 6 HSS Information Sheet on
http://www.theglobalfund.org/en/apply/call6/documents/ before completing this section.
g) Is this component reliant on any cross-cutting health systems
strengthening activities that have been included within other
components of this proposal?
Yes
t
complete h)
X
t
go to 4.6.7.
No
h) If you answered yes for g), describe these activities and the associated budgets and identify and
explain how this component will benefit. Please refer to the Round 6 HSS Information Sheet on
http://www.theglobalfund.org/en/apply/call6/documents/ before completing this section.
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4 Component Section Malaria
4.6.7 Common funding mechanisms
This section seeks information on funding requested in this proposal that is intended to be contributed through
a common funding mechanism (such as Sector-Wide Approaches (SWAP), or pooled funding (whether at a
national, sub-national or sector level).
a) Is part or all of the funding requested for the disease component
intended to be contributed through a common funding mechanism?
Yes
t
answer questions below.
X
t
go to 4.8
No
b) Indicate in respect of each year for which funds are requested the amount to be funded through
a common funding mechanism.
c) Describe the common funding mechanism, whether it is already operational and the way it
functions. Identify development partners who are part of the common funding mechanism.
Please also provide documents that describe the functioning of the mechanism as an annex.
(This may include: The agreement between contributing parties; joint Monitoring and Evaluation
procedures, management details, joint review and accountability procedures, etc.)
d) Describe the process of oversight for the common funding mechanism and how the CCM will
participate in this process.
e) Provide an assessment of the incremental impact on projected targets as a consequence of the
funds being requested for this component, which are to be contributed through the common
funding mechanism.
f) Explain the process by which the applicant will ensure that funds requested in this application,
that are contributed to a common finding mechanism, will be used specifically as proposed in this
application.
4.6.8 Target groups
Provide a description of the target groups, and their inclusion during planning, implementation and
evaluation of the proposal. Describe the impact that the program will have on these group(s).
The project focuses on the socially and economically disadvantaged sector of the population, majority of
who live in the rural areas. Malaria mostly affects those who live in far-flung areas particularly the
indigenous peoples, subsistence upland farmers, settlers in frontier areas and forest-related workers.
These people and their families live below the poverty line and have very limited access to basic health
services due to geographic and economic constraints. The National Commission on Indigenous Peoples
(NCIP) represents the indigenous peoples groups that are being targeted by the interventions. The staff
of this body being IPs themselves has adequate knowledge on the background, needs and culture of the
target groups. The national Medical Officer of the NCIP is member of the Writing Committee and has
participated in the brainstorming and planning phase of the development of this proposal.
The NGOs and FBOs that help to expand access to social services for the indigenous peoples work with
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4 Component Section Malaria
and through these target groups. Community organizing, being strength of these private sector and
community-based organizations, would ensure that these target groups are mobilized to participate in the
implementation, monitoring and evaluation of malaria control and prevention interventions. Selection and
training of barangay malaria microscopists and BHWs who will administer RDT services from among
these target groups will ensure that the services provided will be acceptable to the target clients. This will
also give them a sense of ownership of the program. Social mobilization strategies to be employed will
include capacity-building and deployment of local (including IP) malaria advocates acting as community
health educators, and use of culturally sensitive and appropriate IEC materials for awareness-raising and
eventual behavioral modification. This would help ensure that these people would not be mere recipients
of project inputs but active participants and even managers of their own indigenous health care system.
Increasing access to malaria diagnostic and treatment services as well as provision of LLITNs would help
cut transmission among these vulnerable groups. This in turn would result in a decline in morbidity and
prevention of mortality and an eventual improvement in their health conditions. Better health would mean
increased productivity and better quality of life.
4.6.9 Social stratification
Provide estimates of how many of those expected to be reached are women, how many are youth,
how many are living in rural areas and other relevant categories. The estimates must be based on a
serious assessment of each objective.
Table 4.6.9 Social stratification
Estimated number and percentage of people reached who are:
Women
Living in rural
areas
Youth (<18)
Other* (IPs &
indigent
people)
SDA 1: Human
resources
(service
providers
trained)
523/661 (80%)
0
661/661 (100%)
112/661 (17%)
SDA 2: Prompt,
effective antimalarial tx
(total patients)
16,294/54,313
(30%)
16,294/54,313
(30%)
54,313/54,313
(100%)
32,588/54,313
(60%)
SDA 3: Prompt
effective antimalarial tx
(severe)
487/3,246 (15%)
974/3,246 (30%)
3,246/3,246
(100%)
1,948/3,246
(60%)
SDA 4: Proc & supply
mx
469,551/962,194
(48.8%)
288,658/962,194
(30%)
962,194/962,194
(100%)
577,316/962,194
(60%)
SDA 5: Info sys &
oper research
(oper MIS)
16,294/54,313
(30%)
16,294/54,313
(30%)
54,313/54,313
(100%)
32,588/54,313
(60%)
SDA 6: Info sys &
oper research
(LGUs using
MIS)
16,294/54,313
(30%)
16,294/54,313
(30%)
54,313/54,313
(100%)
32,588/54,313
(60%)
469,551/962,194
(48.8%)
288,658/962,194
(30%)
962,194/962,194
(100%)
577,316/962,194
(60%)
SDA 7: ITNs (LLITNs
distributed)
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4 Component Section Malaria
SDA 8: ITNs (at –risk
pop covered
by ITN)
SDA 9: ITNs (people
who slept
under an ITN
prev night) –
based on prop
from survey
2,070,171/
4,242,513
(48.8%)
1,759,645/
1,866,547/
4,242,513
(44%)
4,242,153/
4,242,513
(100%)
2,545,292/
4,242,513
(60%)
3,605,830
(48.8%)
1,081,749/
3,605,830/
2,163,498/
3,605,830 (30%)
3,605,830 (100%)
3,605,830 (60%)
228,754/
468,758/
468,758/
468,758/
468,758 (48.8%)
468,758 (100%)
468,758 (100%)
468,758 (100%)
SDA 11: Prevention:
Vector control
other than ITN
(outbreaks
detected
early)
34,160/70,000
(48.8%)
21,000/70,000
(30%)
70,000/70,000
(100%)
42,000/70,000
(60%)
SDA 12: Community
systems
strengthening
(municipalities
with local
health codes
on malaria)
469,551/962,194
(48.8%)
288,658/962,194
(30%)
962,194/962,194
(100%)
577,316/962,194
(60%)
SDA 13: Supportive
environment
(networks/part
nerships)
825/1,690
(48.8%)
0
1,690/1,690
(100%)
676/1,690 (40%)
1,490,523/
3,054,350
(48.8%)
916,305/
3,054,350
(30%)
3,054,350 (100%)
1,832,610/
3,054,350
(60%)
1,272,646/
4,242,153/
2,545,292/
4,242,153 (30%)
4,242,153 (100%)
4,242,153 (60%)
SDA 10: ITNs
(children
under 5
sleeping
under ITN) –
based on prop
from survey
SDA 14: BCC
community
outreach
(people who
know cause,
sx, prev) –
prop taken
from
KAP/prev
survey
SDA 15: Service
delivery
(health
facilities with
integrated dx
& tx services)
*
2,070,171/
4,242,153
(48.8%)
3,054,350/
“Other” to include target groups according to country setting, e.g. indigenous populations, ethnic groups,
underprivileged regions, socio-economic status, etc. Targets should be defined according to country
disease programs.
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4 Component Section Malaria
4.6.10 Gender issues
Describe gender and other social inequities regarding program implementation and access to the
services to be delivered and how this proposal will contribute to minimizing these gender inequities.
Pregnant women need to be protected from getting malaria because of the toll it takes on the health of
both the mother and the child. Anemia, low birth weight infants are among the risk of pregnancy-related
malaria. Increased access to malaria diagnostic and treatment services to targeted areas would ensure
coverage of this high-risk group. Likewise, provision of LLITN would also provide protection to them and
interrupt transmission in areas where they live.
4.6.11 Stigma and discrimination
Describe how this component will contribute to reducing stigma and discrimination against people
living with HIV/AIDS, tuberculosis and/or malaria, as applicable, and other types of stigma and
discrimination that facilitate the spread of these diseases.
Access to basic social services is very limited and difficult for those who are economically disadvantaged.
This is especially true for those belonging to IP groups who are often missed out by health workers in the
planning for and actual provision of health services. Often, these people are discriminated against by
health workers because of their lack of education and they themselves even shy away from seeking
proper healthcare because of this.
Increasing access to health services through public private partnership with non-profit organizations
including FBOs and CBOs for this the economically and socially marginalized will help reduce the
discrimination and ensure that they will cease to be among the neglected clients for health care.
4.6.12 Equity
Describe how principles of equity will be ensured in the selection of patients to access services,
particularly if the proposal includes services that will only reach a proportion of the population in
need (e.g., some antiretroviral therapy programs).
Barangay malaria microscopy centers and RDT sites will be established in strategic areas (far from the
main health center) to ensure access by majority of populations at risk who have economic and sociocultural and economic barriers to access health facilities. Focus on these disadvantaged groups will help
address inequity in service provision.
LLITNs will be provided to communities living in priority barangays and municipalities based on level of
endemicity. Nets will be given for free, therefore, all residents of the priority areas will have no barriers to
availment of this vector control strategy.
4.6.13 Sustainability
Describe how the activities initiated and/or expanded by this proposal will be sustained at the end of
the program term. (When completing this section, applicants should refer to the Guidelines for Proposals,
section 4.6.13.)
Empowerment and stewardship of LGUs to lead the public private partnership is key to sustaining the
interventions that will be supported by the grant. This way, there is greater LGU ownership and
strengthened community involvement. This can be done through the inclusion of the malaria interventions
in the overarching local development agenda.
In order to truly pursue private-public partnerships, advocacy and capability building at the LGU
(particularly at the higher levels) should be carried out on agenda setting and policy making designed to
enhance the sustainability of the malaria program and health program, as a whole. Capability building on
development planning with emphasis on incorporating health concerns in the overall development agenda
of the LGU (short, medium and long-term development plans) will be conducted for health officials and
Philippine Malaria Proposal
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4 Component Section Malaria
their local executives.
institutionalized.
Local Health planning workshops with multi-stakeholder participation will be
Formulation of ordinances to include the establishment of a Local Health Code would spell out guidelines
on health implementation including provisions on possible health financing and sustainable local malaria
prevention and response activities. Local Health Agenda that localizes the Govt’s HSRA with provisions
for sustainability of the malaria control program and other health programs will be incorporated in the
Health Code..
Capacity building for stakeholders will include health development planning for health workers, negotiation
skills for health workers (lobbying and providing advisory services to politicians who make the decisions),
workshops on policy and legislation with the chief executives, Sanggunian (Council) members, planning
officers, health workers, etc.
Currently, financing for local health programs is dependent on government or donor assistance.
Unfortunately, this situation has built-in weaknesses, namely the limited government funds due to current
fiscal crisis and the influence of political considerations on government budgeting. It is important that the
program does not die a natural death once the project ends. For this to happen, measures for mobilizing
local resources should be in place. There is a need for households to be involved in providing
investments on the malaria program and health in general. Health must not just be considered as a basic
need but also a developmental need requiring personal savings and investment.
The establishment of a community-based health financing scheme at the barangay level will help facilitate
this. As community organizations are strengthened and become functional malaria program committees,
as barangay microscopists evolve into health managers that oversee community involvement in the
program, as policies are set by the local officials with the strong participation of civil society, the program
can take on a higher level with the establishment of a trust fund that have been done with the GFMP2 in a
number of provinces, that can sustain the project way after the program has ceased. The Trust Fund
shall consist of contributions taken from households, initial seed funds from the program or other
alternative sources, and counterpart funds from the LGUs (if able).
The fund could be run as a cooperative with households becoming members and their contributions
treated as shares.
The fund will be used to subsidize volunteer’s honoraria, additional supplies for service delivery and be
used as seed money for either individual or group enterprises. Enterprises such as botika sa barangay,
livestock raising could be considered.
The financing scheme can evolve into a community-based insurance program as a complement and
supplement to the PhilHEALTH’s indigent insurance program with the members’ shares converted into
insurance premiums. Or it could become direct insurance premiums to the PHILHEALTH program that will
no longer be dependent on government subsidies.
Activities for capacity-building for health human resource are aimed toward staff development and
retention. With the exodus of health care professionals and service providers for greener pastures
abroad, the country’s health care delivery system is on the brink of a brain drain. To provide motivation for
health personnel to stay and continue serving in their own country, a staff development program will be
established and will explore options for distance learning education and university step ladder program.
This will ensure available manpower who is equipped to provide technical assistance and quality health
services in the years to come.
The trainings on malaria diagnosis and treatment as well as TB microscopy and other parasitic infections
will upgrade the technical competence of the service providers in the public and private sector as well as
the community.
4.7 Principal Recipient information
In this section, applicants should describe their proposed implementation arrangements, including nominating
Principal Recipient(s). See the Guidelines for Proposals, section 4.7, for more information. Where the applicant is
a Regional Organization or a Non-CCM, the term ‘Principal Recipient’ should be read as implementing
organization.
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4 Component Section Malaria
4.7.1 Principal Recipient information
Every component of your proposal can have one or several Principal Recipients. In table 4.7.1 below, you must
nominate the Principal Recipient(s) proposed for this component.
Table 4.7.1: Nominated Principal Recipient(s
Indicate whether implementation will be managed through a single
Principal Recipient or multiple Principal Recipients.
X
Single
Multiple
Responsibility for implementation
Nominated Principal
Recipient(s)
Tropical Disease
Foundation
Area of responsibility
25 provinces covered
by this project
Contact person
Address, telephone, fax
numbers and e-mail
address
Lourdes Pambid, MPH
and
Tropical Disease Foundation
Luz Escubil, MD
63 2 888 9044
4.8 Program and financial management
4.8.1 Management approach
Describe the proposed approach of management with respect to planning, implementation and
monitoring the program. Explain the rationale behind the proposed arrangements.
(Outline management arrangements, roles and responsibilities between partners, the nominated Principal
Recipient(s) and the CCM. Maximum of half a page.)
Management of the program will be centered mainly on the Local Government Unit through the Provincial
Health Offices of the target provinces who will all be involved in the planning of the implementation. The
Provincial Health Officer (PHO) being the Program Manager, will provide the general directions for
program implementation who will lead the Provincial Management Committee, which is a public-private
partnership, composed of the Provincial Malaria Coordinator and his counterpart from the provincial
branch office of the CHD/DOH, the Regional Malaria Coordinator, Municipal Health Officers of endemic
municipalities and Chiefs-of-hospitals of referral hospitals, representative from the National Commission
on Indigenous Peoples (NCIP), Health Education and Promotion Officer (HEPO) representatives from the
NGOs and FBOs working in the province as Sub-recipients. This body will drive program implementation
—analyzing data from field reports, identifying gaps and planning for appropriate measures to address the
gap and achieve the program goals and objectives. This will empower and create stewardship of the local
health officials of their own Malaria Control Program, building on their experience in the GFMP2
implementation. The inclusion of private sector organizations (NGOs, FBOs) in the Provincial
Management Committee will be in the spirit of public-private ownership espoused by the GF. Their
strengths in social mobilization and community organizing will complement the technical capabilities of the
local health officials on malaria control and prevention and their existing manpower and infrastructure will
augment the public sector resources. The diversity in the membership increases the probability that all
the three objectives will be achieved through effective collaboration of these stakeholders with varying
disciplines and expertise.
The Regional Malaria Control Program Coordinator will provide technical guidance as the Malaria Control
Technical Adviser. He will participate in the meetings of the Provincial Management Committee and will
endorse the MCP Action Plan to the Management Committee at the national level. The existing GFMP2
Project Management Team composed of a Project Coordinator and Project Assistant will provide
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4 Component Section Malaria
administrative support to the implementers and serve as link between the PR and the local implementers.
The national Program Management Committee (Mancom), a subset of the national Technical Working
Group, oversees program implementation of the GFMP 2 and GFMP 5 to ensure that the program is
achieving the set goals and objectives. The Mancom provides technical assistance through policy review
and development, trainings, monitoring and evaluation. The Country Coordinating Mechanism (CCM) will
monitor the implementation of activities of the programs, and make and/or approve major changes as
needed. The PR and Management Committee will report to the CCM about the status of program
implementation and raise issues/concerns for consideration and comment of the latter. The PR will
provide administrative and fiscal support acting as Fund Manager and Program manager for the project.
The LGUs, NGOs and FBOs will be sub-recipients with the Provincial Management Committees
exercising oversight responsibility, working on the attainment of all the objectives set forth in the project.
Please note that if there are multiple Principal Recipients, section 4.8.2 below has to be repeated for each one.
4.8.2 Principal Recipient capacities
a) Describe the relevant technical, managerial and financial capacities for each nominated Principal
Recipient. Please also discuss any anticipated shortcomings that these arrangements might
have and how they will be addressed, please refer to any assessments of the PR(s) undertaken
either for the Global Fund or other donors (e.g., capacity-building, staffing and training
requirements, etc.).
The Tropical Disease Foundation (TDF) is a non-profit, non-stock science foundation that was founded in
1984 to promote the control and management of tropical infectious diseases of public health importance.
It has been the principal recipient of five of six Global Fund projects in the Philippines. The institutional
profile of the TDF is incorporated as part of Annex 9. It has a well functioning project management unit
that includes a Program Management Division and an Administrative Division. The Program Management
Division consists of three sections including one for Malaria, TB, and HIV/AIDS, each of which have
Program Managers and Program Coordinators. All sections are assisted by a Data Management Unit. The
Administrative Division comprises of Finance Management, Accounting, Internal Auditing , Administrative
and Human Resources sections. The external auditing function for the GF projects managed by the TDF
has been done by Carlos Valdez and associates and will be undertaken by Sycip Gores Velayo (SGV) in
the next year.
The staff in the various sections of the programmatic and administrative divisions have gained extensive
experience in the management and implementation of the three GF projects, one each in TB, malaria
since 2003 and HIV/AIDS since 2004. Through the GFMP2 and GFMP6, there will be complementarity of
the function of the staff of the PR who are currently in the field and at headquarters, responsible for the
management of the GFMP2 and with the partnership with the community-based organizations, there will
be sharing of responsibilities in program implementation. Capacity building on M&E with support from the
GTZ backup initiative has been attended by the program managers in all the disease components.
The Procurement Supply Management System of the TDF is supported by the WHO, WPRO supply
management office and the UNICEF in the procurement of antimalarial drugs and commodities and
laboratory equipment and reagents. Storage system of the TDF at the present time includes facilities of
the DOH at the national and regional levels as well as with the LGU in the provincial and municipal levels.
Distribution nationally is done with the assistance of a professional forwarder, and in the provinces, it is
the responsibility of the LGUs, assisted by the TDF staff present in the provinces. Capacity building on
PMS organized by WHO and UNICEF and supported by GF was attended by the staff of the PR.
The CCM through the PR has successfully applied for phase 2 implementation of the three projects and
the PR is currently negotiating the grant signing for the GF Round 5 approved projects on scaling up TB
and HIV/AIDS. In connection with all the GF projects, the TDF has been assessed by the local fund agent,
PricewaterhouseCooper (PwC) for the first two grants on TB and malaria in 2003 and by Chemonix in
2004 for the HIV/AIDS and more recently for the GF Round 5 grants for TB and HIV/AIDS by the PwC. It is
also an accredited member of the Philippine NGO Certification Council (PCNC), a local public-private
organization that is charged to evaluate organizations for accreditation as donee institute. Capacity
building activities of the staff of the various program and administrative sections have been actively
pursued with the participation of the TDF staff in training courses on program management, proposal
development, drug procurement and management as well as in financial, accounting and auditing
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66
4 Component Section Malaria
procedures. Through GTZ back-up initiative support, an exchange program between the TDF and the
Pacific Islands Secretariat, the PR for the multi-country GF project based in New Caledonia was
undertaken in July to share the Program Information System between the two PRs. Through this
exchange program, there will be enhancement of program information management that will facilitate
monitoring of sub-recipients and submission of reports to the GF through the CCM.
By end of August, the program management capacity of the TDF as PR will be evaluated externally by the
International Union against TB and Lung Diseases and by December, the financial management systems
will likewise be evaluated by a team from the Tuck School of Business, Dartmouth College, Hanover, New
Hampshire.
b) Has the nominated Principal Recipient previously administered a
Global Fund grant?
c) Is the nominated PR currently implementing a large program funded by
the Global Fund, or another donor?
X
Yes
No
X
Yes
No
d) If you answered yes for b) or c), provide the total cost of the project and describe the
performance of the nominated Principal Recipient in administering previous grants (Global Fund
or other donor).
The total cost of GF TB, malaria and HIV/AIDS projects approved and signed is US$28,796,438. The total
cost of Round 5 GF TB and HIV/AIDS projects that is still under negotiation for grant signing is US$
53,675,704.50.
In relation to the application for phase 2 funding of the three earlier grants, the TDF has been assessed by
the CCM for GFTB round 2 as A overall in all four parameters (expected or exceeding expectations) and
was noted by the GF as follows “TDF has managed to continue services and meet expectations. The TDF
as PR disburses to sub-recipients effectively, provides high quality reporting, and has succeeded in
cooperating and coordinating activities with government agencies and other donor programs.”
For malaria, the CCM assessed the TDF as PR as “B1” overall (adequate); A exceeding expectations on
disbursement to SRs and keeping CCM informed of its progress, B1 in achieving intended results and in
managing GF grant. The GF stated that “the PR, the TDF, has managed the grant well....Despite climatic
difficulties, the PR has responded to these challenges and continued to run the program well. The PR has
conducted its procurement and monitoring and evaluation activities well, disbursed funds to sub-recipients
effectively and submits its financial reports regularly.”
For the HIV/AIDS Round 5 phase II application, the CCM rated the PR as A (expected or exceeds
expectation) in disbursement of funds to sub recipients, B1 (adequate) in relation to achieving intended
results, informing CCM of its progress, and managing GF grants. The GF stated in relation to its
performance: “The PR has demonstrated satisfactory management of the grant to date. Programmatic
delivery has been good overall, with those activities behind schedule set to accelerate and catch up with
targets early in Phase 2. Overall financial management is sound with timely and effective disbursements to
sub-recipients (SRs) and SR expenditure rates on track. The overall M & E framework is also functioning
well.”
e) If you answered yes for b) or c), describe how the PR would be able to absorb the additional
work and funds generated by this proposal.
The TDF will utilize the existing staff of the GFMP2. The workload of the new proposal will in effect be an
extension of the work currently being done in the GFMP2 project implementation. The PR staff will
coordinate and facilitate the project activities of the sub-recipients in both public and private sector
agencies. With the four year implementation of GFMP2 in the 21 provinces, the local implementers should
now be able to take on greater responsibility and ownership of malaria control in their respective
communities with the ultimate goal of intensifying the local response to the threat of malaria.
As the areas, except for the four new provinces, are going to be the same as in GFMP2, there will be no
expansion in the workforce in these provinces. There will however be minimal expansion of manpower to
the new provinces.
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67
4 Component Section Malaria
The funds generated by this proposal are mostly for the procurement of commodities, particularly LLITNs
which would all be through the assistance of the World Health Organization WPRO. In the financial
management, the usual procedures that have been established and found to be functional will be utilized.
There will be more utilization of electronic software in the preparation of reports from the field as the PIMS
becomes utilized by all the GF projects.
4.8.3 Sub-Recipient information
X
t
a) Are sub-recipients expected to play a role in the program?
Yes
complete the rest of
4.8.3
No
t
go to 4.9
1–5
b) How many sub-recipients will or are expected to be involved in the
implementation?
6 – 20
X
21 – 50
more then 50
X
t
c) Have the sub-recipients already been identified?
Yes
complete 4.8.3. d) -e)
and then go to 4.9
t
No
go to 4.8.3. f) – g)
d) Describe the process by which sub-recipients were selected and the criteria that were applied in
the selection process (e.g., open bid, restricted tender, etc.).
The sub-recipients comprise one FBO and two CBOs. Sub-recipients were chosen from those who
submitted concept proposals in response to the call. These sub-recipients were chosen based on 1)
consistency of their concept proposal with the general strategies of the country coordinated proposal, 2)
their presence in the target provinces, 3) existing health infrastructure established, 4) track record of
handling and being involved in foreign assisted grants, 5) track record of program performance in malaria
control.
Through the NCIP, more FBOs and NGOs operating in the endemic areas covered by the project will be
invited to become implementing sub-recipients. The above criteria utilized for the first four sub-recipients
will likewise be utilized. Their counterpart responsibility for the project will be their existing human
resources and health infrastructure that are already in place in the provinces covered by this proposal.
e) Where sub-recipients applied to the Coordinating Mechanism, but were not selected, provide the
name and type of all organizations not selected, the proposed budget amount and reasons for
non-selection in an annex to the proposal.
One private corporation, PYcor, applied for the inclusion of a method of larvicidal control through the
introduction of a chemical, Sumilarv, in the breeding places of the Anopheles mosquito that prevents the
emergence of adult mosquitoes from the larval stage. The screening committee did not find enough
evidence from the literature to consider this strategy as a wise investment in vector control. It was
considered to be a product testing study which was not consistent with the intent of the grant application.
f) Describe why sub-recipients were not selected prior to submission of the proposal.
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4 Component Section Malaria
g) Describe the process that will be used to select sub-recipients if the proposal is approved,
including the criteria that will be applied in the selection process.
4.9 Monitoring and evaluation
The Global Fund encourages the development of nationally owned monitoring and evaluation plans and
monitoring and evaluation systems, and the use of these systems to report on grant program results. By
completing the section below, applicants should clarify how and in what way monitoring the implementation of the
grant relates to existing data-collection efforts.
4.9.1 Plans for monitoring and evaluation
Describe how the targets and activities indicated in the Targets and Indicator Table (attached as
Attachment A to this proposal, see section 4.6) will be monitored and evaluated. Please identify any
surveys to which this proposal is contributing.
For purposes of GF reporting on the activities and targets indicated in Table Attachment A, the utilization
of the project information management system (PIMS) will be a first step in capacity building. Verification
by the PR through field visits will be undertaken in case of discrepancy or under-performance as noted
from the reporting sub-recipients. A random sample of some of the other sub-recipients will have site-visits
for verification purposes only.
For purposes of the impact indicators, the current information system, the Philippine Malaria Information
System (Phil-MIS) in the 26 malaria endemic provinces as proposed by the Technical Working Group of
the GFATM – Malaria Component. The Phil-MIS is a modified version of the software developed by the
Australian Aid (AusAID) Malaria Control Project in the province of Agusan del Sur, Mindanao.
Enhancement of the Phil-MIS to become a web-based system of reporting is expected to provide
information in a timely fashion needed for program planning, budgeting, management and evaluation of
the malaria control program at the different levels (municipal, provincial, regional and national) as well as
by other interested sectors. PhilMIS will capture indicators routinely monitored by the National MCP of the
Department of Health as well as an integrated system detecting an increased number of febrile cases as
an early warning system for possible epidemic outbreaks. The PhilMIS will be integrated into the Field
Health Services Information System (FHSIS) of the Department of Health to generate FHSIS reports.
From a pilot of four provinces using the recent version of the software, Round 6 will roll the system to all
the 25 provinces to be covered.
The system has the following characteristics: 1) use of standardized reporting forms 2) identified schedule
of data submission from barangay (village) to municipal health office to provincial health office where
computerization is done at the provincial level 3) assurance of data quality and integrity 4) manual and
electronic data validation at the municipal and provincial health levels respectively 5) electronic generation
of reports (monthly, quarterly and annually) needed by different stakeholders.
The flow of reporting will start in a paper-based format at the barangay (village) health stations or
barangay microscopy centers to be accomplished by the barangay health workers (RDT – trained and
barangay microscopists) using Phil-MIS reporting forms and consolidated at Municipal Health Offices
th
every month. Encoding of the consolidated data is done at the Provincial Health Office every 5 day of
the succeeding month for data entry in the MIS software program. Paper-based data sheets are
submitted from hospital sites by the provincial malaria coordinator and are directly submitted to the
Provincial Health Office for encoding. Through a feedback system, data is fed back to the different
Municipal Health Offices and uploaded also to the Center for Health Development and the Central Office
of the Department of Health. Health personnel from each of the Municipal and Provincial Health Office are
designated as the Phil-MIS point person under the supervision of the Phil-MIS team coming from the
National Epidemiology Center, Infectious Disease Office and Regional Health Office.
At present, 17 provinces have started implementing in 2004 the Phil-MIS. Regular field visits to monitor
Philippine Malaria Proposal
69
4 Component Section Malaria
the implementation of the system in the 17 provinces will be done, using a set of monitoring checklist. Any
problems encountered have to be resolved before expanding to the remaining 9 provinces, with the
intention of covering all the 25 provinces to be covered in this proposal, plus the five covered by the
GFMP5.
4.9.2 Integration with national M&E Plan
Describe how performance measurement for this program is proposed to contribute to and/or
strengthen the national Monitoring and Evaluation Plan for this component. If a national Monitoring
and Evaluation strategy exists, please attach it as an annex to the proposal, and provide a summary
of key linkages with the national Monitoring and Evaluation Plan and data collection methods.
Monitoring and evaluation shall consider the process, outcome and impact indicators as outlined in the
GFATM2 and GFATM5 and in this proposal. If data are not available, baseline surveys will be done.
There will be emphasis on the systematic collection and utilization of data for evidence-based actions at
the lowest implementing units. Harmonization of program data collection of all three projects supported by
GF, i.e.: TB, HIV/AIDS and malaria into the NEC systems is planned by all three components.
The National Epidemiology Center of the Department of Health is mandated to be the repository of all
health data on major public health programs as well as to manage the health information system called
the Field Health Services Information System (FHSIS) and the National Epidemic Sentinel Surveillance
System (NESSS). The FHSIS is a passive monitoring system that gathers information of notifiable
diseases and indicators of major health programs. Health information from the barangay (village) health
stations is submitted monthly to the Rural Health Unit for consolidation. The consolidated data is then
sent to the Provincial Epidemiology Surveillance Unit every quarter for provincial consolidation, then
forwarded to the Regional Epidemiology Surveillance Unit of the Centers for Health Development and then
submitted biannually to the National Epidemiology Center. However, the indicators for malaria program
are limited only to the number of cases diagnosed, treated and recorded at the barangay (village) and
municipal health facilities. FHSIS is currently very slow in consolidating the data and the reports are over
a year behind schedule. On the other hand, the NESSS is a hospital-based information system that
monitors infectious disease with epidemic potential and malaria is not recorded. The intention now is to
incorporate the malaria hospital-based NESSS to enhance the M and E plans for malaria.
Aside from the above information systems, the National Malaria Control Program under the Infectious
Disease Office requires the Regional Malaria Coordinators of the Centers for Health Development to
submit yearly malaria data on morbidity and mortality rates, annual parasite incidence, slide positivity rate,
proportion of Plasmodium falciparum cases, disease management and prevention and vector control.
Special activities such as prevalence surveys, bed net utilization surveys are conducted as a means to
gather information on malaria indicators.
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70
4 Component Section Malaria
4.10 Procurement and supply management of health products
In this section, applicants should describe the management structure and systems currently in place for the
procurement and supply management (PSM) of drugs and health products in the country. When completing this
section, applicants should refer to the Guidelines for Proposals, section 4.10.
4.10.1 Organizational structure for procurement and supply management
Briefly describe the organizational structure of the unit currently responsible for procurement and
supply management of drugs and health products. Further indicate how it coordinates its activities
with other entities such as National Drug Regulatory Authority (or quality assurance department),
Ministry of Finance, Ministry of Health, distributors, etc.
The PR is responsible for procurement of anti-malarial drugs, insecticides, equipment, and commodities,
including bed nets. This is done through the reimbursable procurement scheme through the WHO WPRO
which is responsible for QA of drugs procured. Through WHO, exemptions from tax and customs duties is
granted. Distribution is the responsibility of the PR from the National Central Warehouse to the Provincial
including Municipal levels that lie within the distribution route of the commercial freight forwarder. From
the Province to the Municipality, it is the responsibility of the SR (Province) to distribute to the Municipality,
and the Municipality is responsible for distributing to the households/end-user. No QA test of drugs is
undertaken locally, but importation through WHO provides certification of quality assurance.
The procurement and supply distribution channels to be utilized in this project are schematically shown in
the Annex 15. The TDF staff is responsible for ensuring that sufficient buffer stock is maintained in the
national and provincial stores, in forecasting drug and commodity requirements, and in initiating the
procurement process by submitting a request through channels to the WHO WPRO procurement and
supply office. Procurement is done through international tender utilizing the procurement agents of the
WHO itself. Distribution is the responsibility of the PR from the national to the provincial level and the
LGUs are responsible for the distribution in the municipal levels to the endusers.
4.10.2 Procurement capacity
Principal
Recipient only
a) Will procurement and supply management of drugs and health
products be carried out (or managed under a sub-contract) exclusively
by the Principal Recipient or will sub-recipients also conduct
procurement and supply management of these products?
Sub-recipients
only
X
Both
b) For each organization involved in procurement, please provide the latest available annual data
(in Euro/US$) of procurement of drugs and related medical supplies by that agency.
Western Pacific Regional Office of the WHO:
The following table shows procurement of drugs and related medical supplies provided for the year past
Cold Chain
Environmental and Occupational Supplie
General Laboratory Supplies
Hospital and General Medical Supplies
Informatics and Office equipment
Injection material
Microscopes
Pesticides
Pharmaceuticals, Drugs and Biologicals
Vaccines/contraceptives
Vehicles
Philippine Malaria Proposal
USD
3,672,165
11,388,679
14,774,679
12,574,907
9,540,428
811,778
199,883
4,015,570
76,021,664
4,840,637
14,227,579
Percent
2
8
10
8
7
1
0
3
50
3
8
71
4 Component Section Malaria
X-Ray Equipment
TOTAL 2005
197,324
0
152,265,293 100
4.10.3 Coordination
a) For the organizations involved in section 4.10.2.b, indicate in percentage terms, relative to total
value, the various sources of funding for procurement, such as national programs, multilateral
and bilateral donors, etc
The Principal Recipient is a private sector agency and is assisted by the WHO Western Pacific Regional
Office for its procurement functions. Hence, in relation to the procurements undertaken by the WPRO
procurement office, there is only one source of funds, the GF.
b) Specify participation in any donation programs through which drugs or health products are
currently being supplied (or have been applied for), including the Global Drug Facility for TB
drugs and drug-donation programs of pharmaceutical companies, multilateral agencies and
NGOs, relevant to this proposal.
There is no donation program for drugs or health products related to the Malaria Control Program.
4.10.4 Supply management (storage and distribution)
a) Has an organization already been nominated to provide the supply
management function for this grant?
Yes
t
continue
X
t
go to 4.10.5
No
National medical stores or equivalent
Sub-contracted national organization(s)
b) Indicate, which types of organizations will
be involved in the supply management of
drugs and health products. If more than
one of the boxes below is ticked, describe
the relationships between these entities.
(specify which one(s))
Sub-contracted international organization(s)
(specify which one(s))
Other (specify)
c) Describe the organizations’ current storage capacity for drugs and health products and indicate
how the increased requirements will be managed.
d) Describe the organizations’ current distribution capacity for drugs and health products and
indicate how the increased coverage will be managed. In addition, provide an indicative
estimate of the percentage of the country and/or population covered in this proposal.
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4 Component Section Malaria
[For tuberculosis and HIVAIDS components only:]
4.10.5 Multi-drug-resistant TB
Does the proposal request funding for the treatment of multi-drug-resistant
TB?
Yes
No
If yes, please note that all procurement of medicines to treat multi-drug-resistant tuberculosis financed by the
Global Fund must be conducted through the Green Light Committee (GLC) of the Stop TB Partnership.
Proposals must therefore indicate whether a successful application to the Committee has already been made
or
is
in
progress.
For
more
information,
please
refer
to
the
GLC
website,
at
http://www.who.int/tb/dots/dotsplus/management/en/. Also see the Guidelines for Proposals, section 4.10.5.
4.11 Technical and Management Assistance and Capacity-Building
Technical assistance and capacity-building can be requested for all stages of the program cycle, from the time of
approval onwards, including in respect of , development of M&E or Procurement Plans, enhancing management
or financial skills etc. When completing this section, applicants should refer to the Guidelines for Proposals,
section 4.11.
4.11.1 Capacity building
Describe capacity constraints that will be faced in implementing this proposal and the strategies that
are planned to address these constraints. This description should outline the current gaps as well
as the strategies that will be used to overcome these to further develop national capacity, capacity
of principal recipients and sub-recipients, as well as any target group. Please ensure that these
activities are included in the detailed budget.
Capacity building needs will be for:
Human resources for health: This will include health workers in both public and private health service
facilities. The trainers from the DOH will undertake the training of these health workers including on basic
microscopy, the training for the clinical diagnosis and appropriate treatment of uncomplicated and severe
malaria.
Procurement and supply management for drugs and commodities: A technical adviser on this matter will
be engaged to assist the program in designing the needs for training of various health workers as well as
the renovation and upgrading of physical facilities required in the storage of the drugs and commodities at
various levels of health care and a computerized system for drug forecasting, inventory, and tracking of
drugs and supplies from central stores to the peripheral facilities.
Local community response: Workshop and training of local executives on planning, policy development
through technical advisers to develop stewardship and leadership of the malaria control program of the
LGU and the community at large.
Communications for behavior change: Technical assistance in developing the IEC materials and the tools
to create awareness, and demand for services by the target beneficiaries of the project, including the
populations at risk as well as the LGU executives and the community at large to be able to increase the
local response to malaria in their respective communities.
4.11.2 Technical and management assistance
Describe any needs for technical assistance, including assistance to enhance management
capabilities. (Please note that technical and management assistance should be quantified and reflected in the
component budget section, section 5.6)
Technical assistance for the Procurement Management System of malaria commodities in particular, and
Philippine Malaria Proposal
73
4 Component Section Malaria
the procurement of drugs by LGUs as well will require a long term consultant to develop these capacities.
Technical assistance for program management both to the DOH, LGU, and PR will be required to facilitate
program implementation and timely analysis for program management. An external evaluation of the
project is required within 14 months after initiation of the project, in preparation for the phase II application.
The role of PhilMIS and debugging of the system needs Long Term Technical Assistance (LTTA) in
collaboration with the other disease components so that harmonization of the three project monitoring and
information system within the NMEC can be realized. The PR will also require LTTA in the implementation
of the PIMS which has been kindly provided by the Secretariat of the Pacific Community, PR of the multicountry GF projects in the Pacific Islands. This may need to be extended to the SRs in the 25 provinces
that are going to be covered by this project.
LTTA for quality assurance of diagnostic and management interventions implemented by the project is
likewise planned and budgeted. This includes TES, microscopy, RDTs and clinical management of malaria
at all levels.
LTTA for development and micro-finance consultants for the LGU executives to implement an overarching development strategy to include malaria control in particular will be required. These strategies will
be important in the sustainability of the malaria control program in the endemic provinces covered by the
project. In addition, STTA for BCC to empower communities to demand generation and utilization of
available malaria services will be another component for sustainability.
LTTA for governance, regulation, health financing (including PhilHEALTH) in consonance to the
FourMULA 1 flagship program of the current DOH secretary of the Philippines.
Short term technical assistance (STTA) will be obtained for program evaluation in preparation for Phase 2
application.
Philippine Malaria Proposal
74
5 Component Budget Malaria
5.1 Component budget summary
Insert budget information for this component broken down by year and budget category, in table
5.1 below.
(The “Total funds requested from the Global Fund” should be consistent with the amounts entered in table
1.2 relating to this component.)
The budget categories and allowable expenses within each category are defined in the Guidelines for
Proposal, section 5.1. The total requested for each year, and for the program as a whole, must be
consistent with the totals provided in sections 5.1.
Table 5.1 – Funds requested from the Global Fund
Philippine Malaria Proposal
5 Component Budget Malaria
Funds requested from the Global Fund (in Euro/US$)
Human resources
Infrastructure and equipment
Training
Commodities and products
Drugs
Planning and administration
Other (please specify)
Technical Assistance
Other (please specify)
Program Management
Year 1
Year 2
Year 3
Year 4
Year 5
Total
338,363.60
498,766.10
397,278.19
436,025.26
336,322.62
2,006,755.77
302,363.21
64,150.94
2,264.15
2,264.15
0
371,042.45
231,465.66
681,499.81
35,208.30
0
0
948,173.77
6,640,542.75
285,525.35
456,620.05
81,591.31
0
7,464,279.46
0
24,078.88
21,667.59
14,433.72
0
60,180.18
2,346,403.55
2,055,979.02
1,340,204.48
1,199,873.35
673,872.64
7,616,333.03
985,913.88
361,000.01
225,324.28
173,418.78
101,019.53
1,846,676.47
1,084,505.26
397,100.01
247,856.70
190,760.66
111,121.48
2,031,344.11
Other (please specify)
Total funds requested from the Global Fund
Philippine Malaria Proposal
0
11,929,557.90
4,368,100.12
2,726,423.75
2,098,367.22
1,222,336.26
22,344,785.25
76
5 Component Budget Malaria
5.2 Detailed Component Budget
The Component Budget Summary (section 5.1) must be accompanied by a more
detailed budget covering the proposal period, attached as an annex to the proposal.
The detailed budget should also be integrated with the Work Plan referred to in section 4.6.
The Detailed Component Budget should meet the following criteria (Please refer to the Guidelines
for Proposals, section 5.2):
a) It should be structured along the same lines as the Component Strategy—i.e., reflect the same
goals, objectives, service delivery areas and activities.
b) It should cover the term of the proposal period and should:
i) be detailed for year 1 and year 2 of the proposal term, with information broken down by
quarters for the first year;
ii) provide summarized information and assumptions for the balance of the proposal period
(year 3 through to conclusion of proposal term).
c) It should state all key assumptions, including those relating to units and unit costs, and should be
consistent with the assumptions and explanations included in section 5.3.
d) It should be integrated with the detailed Work Plan for year 1 and indicative Work Plan for year 2
(please refer to section 4.6).
e) It should be consistent with other budget analyses provided elsewhere in the proposal, including
those in this section 5.
5.3 Key budget assumptions
Without limiting the information required under section 5.2, please indicate budget assumptions for year 1 and
year 2 in relation to the following:
5.3.1 Drugs, commodities and products
Please use Attachment B (Preliminary Procurement List of Drugs and Health Products) in order to compile the
budget request for years 1 and 2 in respect of drugs, commodities and health products. Please note that unit
costs and volumes must be fully consistent with the information reflected in the detailed budget. If prices from
sources other than those specified below are used, a rationale must be included.
a) Provide a list of anti-retroviral (ARVs), anti-tuberculosis and anti-malarial drugs to be used in the
proposed program, together with average cost per person per year or average cost per
treatment course. (Please complete table B.1 in Attachment B to the Proposal Form.)
b) Provide the total cost of drugs by therapeutic category for all other drugs to be used in the
program. It is not necessary to itemize each product in the category. (Please complete table B.2 in
Attachment B to the Proposal Form.)
c) Provide a list of commodities and products by main categories e.g., bed nets, condoms,
diagnostics, hospital and medical supplies, medical equipment. Include total costs, where
appropriate unit costs. (Please complete table B.3 in Attachment B to the Proposal Form.)
(For example: Sources and Prices of Selected Drugs and Diagnostics for People Living with HIV/AIDS.
Copenhagen/Geneva,
UNAIDS/UNICEF/WHO-HTP/MSF,
June
2003,
(http://www.who.int/medicines/organization/par/ipc/sources-prices.pdf); Market News Service, Pharmaceutical
Starting Materials and Essential Drugs, WTO/UNCTAD/International Trade Centre and WHO
(http://www.intracen.org/mns/pharma.html); International Drug Price Indicator Guide on Finished Products of
Essential Drugs, Management Sciences for Health in Collaboration with WHO (published annually)
(http://www.msh.org); First-line tuberculosis drugs, formulations and prices currently supplied/to be supplied by
Global Drug Facility (http://www.stoptb.org/GDF/drugsupply/drugs.available.html).)
a.
st
1 line anti-malarial drugs to be procured are chloroquine, sulfadoxine-pyrimethamine and
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
77
5 Component Budget Malaria
primaquine. The average cost of treatment for an adult patient using the price of drugs procured
nd
through WHO is Php16.5. 2 line anti-malarial is Artemether-Lumefantrine (Coartem) which costs
Php126 per course of adult treatment. Third line anti-malarial drug is quinine and the average cost of
treatment is Php178.
b.
c.
NA
st
1 line drugs
nd
2 line drugs
rd
3 line drugs
Microscopes
RDTS
Lab supplies
LLITNs
Insecticides for IRS
Insecticides for retreatment
Spraycans, PPEs
Total
5,803.06
9,611.14
8,664.70
54,250.00
132,545.55
400,181.54
5,946,360.40
190,053.10
165,866.32
10,280.09
USD 6,923,615.90
5.3.2 Human resources costs
In cases where human resources represent an important share of the budget, explain how these
amounts have been budgeted in respect of the first two years, to what extent human resources
spending will strengthen health systems’ capacity at the patient/target population level, and how
these salaries will be sustained after the proposal period is over. (Maximum of half a page. Please
attach an annex and indicate the appropriate annex number.)
5.3.3 Other key expenditure items
Explain how other expenditure categories (e.g., infrastructure, equipment), which form an important
share of the budget, have been budgeted for the first two years. (Maximum of half a page. Please attach
an annex and indicate the appropriate annex number.)
Commodities and products comprise 33.4 % of the budget. This is attributed to the quantity and cost of
long-lasting insecticide treated nets that is needed to attain the target of 80% coverage. Insecticides for
retreatment of bednets distributed from the GFATM2 implementation will also be procured. The expansion
of Epidemic Response stockpiles from zonal to regional level requires corresponding logistics support.
This explains the volume of insecticides for residual spraying as well as the spraycans as personal
protective equipment (PPE) that will be procured. The expansion of diagnostic facilities in the four new
target provinces and the inclusion of the private health faciities of NGOs, FBOs, CBOs and private
practitioners and the maintenance of RDT sites and barangay microscopy centers in the 21 provinces
likewise require additional supply of RDT kits and laboratory supplies.
Planning and administration comprise 34.1% of the budget. This includes bednet utilization survey,
therapeutic efficacy surveillance (TES), production of IEC materials, workshops and meetings to establish
coordination and public-private partnership, community mobilization, administrative and operating
expenses of the Provincial Management Teams, monitoring and evalution, procurement and supply
distribution of drugs and commodities, technical assistance and program management.
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
78
5 Component Budget Malaria
5.4 Breakdown by service delivery area
Please provide an approximate allocation of the annual budget for each service delivery area (SDA). The
objectives and service delivery areas listed should resemble those in the Targets and Indicators Table
(Attachment A to the Proposal Form). It is anticipated that this allocation of the budget across SDAs
should be derived from the detailed component budget (see section 5.2).
Table 5.4: Estimated budget allocation by service delivery area and objective.
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
5 Component Budget Malaria
Budget allocation per SDA (in Euro/US$)
Objectives
Service delivery area
Year 1
Year 2
Year 3
Year 4
Year 5
Objective 1. To consolidate,
expand and sustain high
coverage of early diagnostic
and treatment services for
malaria
through
health
systems strengthening and
public private partnership
SDA 1. Human Resources
340,531.17
504,927.97
252,382.70
190,760.61
187,277.99
1.
SDA 2 & 3. Treatment: prompt,
effective antimalaria treatment
550,088.46
356,747.97
410,002.04
30,757.30
13,812.26
1
SDA 4. Procurement & Supply
Management
83,662.68
146,373.74
2,264.15
2,264.15
0
1.
SDA 5 & 6. Information System
and Operational Research
58,044.64
43,802.00
18,867.92
0
0
2 To scale up vector control
methods to interrupt malaria
transmission
SDA 7 - 10. Prevention ITNs
6,595,229.18
540,638.29
198,750.27
157,178.58
74,911.19
2
SDA 11. Vector Control other
than ITNs
335,846.16
309,046.96
136,305.42
120,195.99
112,366.79
3 To strengthen local
capacity through community
systems strengthening for
sustainable communitybased malaria control &
management
SDA 12. Community systems
strengthening
299,954.30
0
0
0
0
3
SDA 13.Supportive environment:
Coordination and partnership
development
208,867.92
201,509.44
201,509.43
201,509.43
0
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
80
5 Component Budget Malaria
Budget allocation per SDA (in Euro/US$)
Objectives
Service delivery area
3
SDA 14. Prevention: BCC –
community outreach
3
SDA 15. Service Delivery
Total:
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
Year 1
Year 2
Year 3
Year 4
Year 5
178,301.89
107,037.72
20,283.02
11,792.45
7,547.17
3,279,031.49
2,158,015.07
1,486,057.80
1,383,908.81
826,420.87
11,929,557.90
4,368,100.12
2,726,423.75
2,098,367.22
1,222,336.26
81
5 Component Budget Malaria
5.5 Breakdown by implementing entities
Indicate in table 5.5 below how the resources requested in table 5.1 will, in percentage terms, be allocated among
the following categories of implementing entities.
Table 5.5 – Allocations by implementing entities
Fund allocation to implementing partners (in percentages)
Year 1
Academic/educational sector
Government
Nongovernmental / communitybased org.
Year 2
Year 3
Year 4
Year 5
1%
1%
0%
0%
0%
11%
37%
24%
24%
24%
81%
51%
62%
62%
62%
1%
1%
1%
1%
1%
5%
9%
11%
11%
11%
1%
1%
2%
2%
2%
100
100
100
100
100
Organizations representing
people living with HIV/AIDS,
tuberculosis and/or malaria
Private sector
Religious/faith-based
organizations
Multi-/bilateral development
partners
Others.
Please specify:
Total
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82
5 Component Budget Malaria
5.6 Budgeted funding for specific functional areas
The Global Fund is interested in knowing the funding being requested for the following three important functional
areas—monitoring and evaluation; procurement and supply management; and technical and management
assistance. Applicants are required in this section to separately identify the costs relating to these functional
areas. In each case, these costs should already be included in table 5.1. Therefore, the tables below should be
subsets of the budget in table 5.1., rather than being additional to it. For example, the costs for monitoring and
evaluation may be included within some of the line items in table 5.1 above (e.g., human resources, infrastructure
and equipment, training, etc.).
Table 5.6 – Budgets for specific functional areas
Funds requested from the Global Fund (in Euro/US$)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Monitoring and
Evaluation
508,981.07
701,192.41
635,223.39
495,977.59
486,922.84
2,828,297.30
Procurement
and Supply
Management
623,728.34
609,187.87
21,669.80
23,610.37
13,812.26
1,292,008.64
Technical and
Management
Assistance
985,913.88
361,000.01
225,324.28
173,418.78
101,019.53
1,846,676.48
Monitoring and Evaluation: This includes: data collection, analysis, travel, field supervision visits, systems and
software, consultant and human resources costs and any other costs associated with monitoring and evaluation.
Procurement and Supply Management: This includes: consultant and human resources costs (including any
technical assistance required for the development of the Procurement and Supply Management Plan), warehouse and
office facilities, transportation and other logistics requirements, legal expertise, costs for quality assurance (including
laboratory testing of samples), and any other costs associated with acquiring sufficient health products of assured
quality, procured at the lowest price and in accordance with national laws and international agreements to the end user in
a reliable and timely fashion. Do not include drug costs, as these costs should be included in section 5.3.1.
Technical and Management Assistance: This includes: costs of consultant and other human resources that
provide technical and management assistance on any part of the proposal—from the development of initial plans,
through the course of implementation. This should include technical assistance costs related to planning, technical
aspects of implementation, management, monitoring and evaluation and procurement and supply management.
Philippine Malaria Proposal
83
84
Annexures
Philippine Malaria Proposal
The table below provides a list of the various annexes that should be attached to the proposal. Please complete
this checklist to ensure that everything has been included. Please also indicate the applicable annex numbers
on the right hand side of the table.
Section 4 (Component specific): Component Strategy
4.4.1
Documentation relevant to the national disease
program context, as indicated in section 4.4.1.
Annex 12: (Roll Back
Malaria Strategic Plan
Philippines 2006-2010
4.6
A completed Targets and Indicators Table
Attachment A to the
Proposal Form
4.6
A detailed component Work Plan (quarterly
information for the first year and indicative information
for the second year).
4.6.7 c)
Documentation describing the functioning of the
common funding mechanism.
NA
4.8.3 e)
(where SRs applied but
were not selected)
Name and type of all Sub-Recipients not selected, the
proposed budget amount and the reasons for nonselection.
Pryor Corp: Annex 1
4.9.2
National Monitoring and Evaluation strategy (if exists)
(if common funding
mechanism)
Section 5 (Component specific): Component Budget
5.2
Detailed component Budget
Separate Excel file
5.3.1
Preliminary Procurement List of Drugs and Health
Products (tables B1 – B3)
Attachment B to the
Proposal Form
5.3.2
Human resources costs.
5.3.3
Other key expenditure items.
5.1 - 5.6
Available annual operational plans/projections for the
common funding mechanism, and an explanation of
any link to the proposal.
(if common funding
mechanism)
NA
Other documents relevant to sections 4-5 attached by applicant:
2.1.3, 2.2.3
2.1.3, 2,2,3
2,1,3
First part: Call for concept proposals.
1
Second part: Concept Proposals that have been
considered for incorporation into the country
coordinated proposal
Summary of the consultations undertaken with the
Local Government Units in the areas covered by
the Round 2 GF project on Malaria.
External Evaluation Report of GF Malaria Project
2
3
Round 2
Philippine Malaria Proposal
84
85
Annexures
Philippine Malaria Proposal
2,2,1
Minutes of the Partnership Forum.
4
Briefer: The Philippine Partnership to fight TB,
Malaria and AIDS
4a
News Item in The Manila Bulletin picked up by Stop
4b
TB eForum
2.2.1
2.2.2
2.2.3
2.2.3
2.2.3
3A.2.1
3A.2.1
4.4.1
4.4.2
4.4.3
4.6.3
Report of the Commission on Election to the CCM
submitted in the April Meeting of the CCM
5
Updated Guidelines of the CCM, Philippines, July
6
2006
Minutes of the Malaria TWG meeting approving the
development of a Malaria Round 6 proposal
Minutes of the July 18, 2006 CCM Meeting
7
Election of the PR by referendum
9
Records of discussion of the CCM ad Hoc
10
8
Committee
Minutes of June CCM Meeting
11
The RBM Strategic Plan for the Philippines 2006-
12
2010
Malaria Status 2003 - 2005 Covering 21 GF2
provinces and 4 additional provinces with
increasing number of cases
The GF Round 2 Malaria Project Accomplishments.
13
Procurement and Distribution plan
15
National Objectives for Health Philippines 2005-
16
14
2010
FourMULA One
17
In addition to completing section 5.3.1 (Key Budget Assumptions – drugs, commodities and products)
of the Proposal Form, please outline the preliminary procurement list of drugs and health products in
tables B.1 – B.3 below. Unit costs and volumes must be fully consistent with the detailed budget. If
prices from sources other than those specified below are used, a rationale must be included.
Applicants should be aware that all procurement of medicines to treat multi-drug-resistant tuberculosis financed
by the Global Fund must be conducted through the Green Light Committee (GLC) of the Stop TB Partnership.
Proposals must therefore indicate whether a successful application to the Committee has already been made or
is
in
progress.
For
more
information,
please
refer
to
the
GLC
website
at
http://www.who.int/tb/dots/dotsplus/management/en/. Also see the Guidelines for Proposals, section 4.10.5.
Please note that the tables below should be completed for each component included within the proposal.
Philippine Malaria Proposal
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86
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Philippine Malaria Proposal
Proposal Details
Applicant:
Component:
COUNTRY COORDINATING MECHANISM PHILIPPINES
MALARIA
Table B.1: Pharmaceutical products selection
WHO
Listed in
Product (Generic Listed in STG
Name)
EML
(indicate
st nd
(Yes/No) 1 /2 line
treatment)
st
Anti-Malarials
Yes
1 line
Chloroquine
st
Yes
1 line
Sulfadoxine-
Yes
Listed in
STG
(indicate
st nd
1 /2 line
treatment)
st
1 line
Yes
1 line
st
Yes
Yes
1 line
nd
2 line
rd
Yes
Yes
3 line
rd
3 line
Product
Category
Pyrimethamine
Primaquine
Coartem
(ArtemetherLumefantrine)
Quinine tablets
Quinine
ampules
National
Yes
Yes
1 line
nd
2 line
Yes
Yes
3 line
rd
3 line
Listed in
EML
(Yes/No)
Institutional
Listed in
EML
(Yes/No)
Listed in
STG
(indicate
st nd
1 /2 line
treatment)
st
st
rd
1. Sources and Prices of Selected Drugs and Diagnostics for People Living with HIV/AIDS.
Copenhagen/Geneva, UNAIDS/UNICEF/WHO-HTP/MSF, June 2003,
(http://www.who.int/medicines/organization/par/ipc/sources-prices.pdf); Market News Service, Pharmaceutical
Starting Materials and Essential Drugs, WTO/UNCTAD/International Trade Centre and WHO
(http://www.intracen.org/mns/pharma.html); International Drug Price Indicator Guide on Finished Products of
Essential Drugs, Management Sciences for Health in Collaboration with WHO (published annually)
(http://www.msh.org); First-line tuberculosis drugs, formulations and prices currently supplied/to be supplied by
Global Drug Facility (http://www.stoptb.org/GDF/drugsupply/drugs.available.html).)
Philippine Malaria Proposal
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Annexures
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Table B.2: List of pharmaceutical products to be procured under this
component (Years 1 and 2)
Product
Category
Antimalarials
Product
Chloroquine
150 mg
base
SulfadoxinePyrimethamine
Sulfadoxi
ne 500
mg/
Pyrimetha
mine 25
mg
15 mg
base
Primaquine
Coartem
Quinine tablets
Quinine
ampules
All other
pharmace
uticals
Strength
--NA--
Artemeth
er 20 mg
+
lumefantri
ne120 mg
300
mg/tab
300
mg/ml
injection
BP
--NA--
Estimated
unit cost
(US$)
Year 1
Year 1
Year 2
Year 2
(indicate
per tablet,
per inj,
per ml,
etc)
Estimated
quantity
Total
cost
(US$)
Estimated
quantity
Total cost
(US$)
246,000
tablets
2,129.56
52,000
tablets
1,277.74
155,000
tablets
2,395.76
8.65
(canister
at 1,000
tablets/
canister)
24.72
(canister
at 1,000
tablets/
canister)
15.45
(canister
at 1,000
tablets/
canister)
88.99
(pack at
30
courses/
pack
4.94
(case at
24 tablets
/case)
18.05
(case at
12
ampules/
case
--NA--
--NA--
Procurement
to be
conducted
by¹
Procurement
method²
Tropical
Disease
Foundation,
Inc.
WHO
reimbursable
procurement
Tropical
Disease
Foundation,
Inc.
WHO
reimbursable
procurement
Tropical
Disease
Foundation,
Inc.
WHO
reimbursable
procurement
3,446
courses
9,611.14
Tropical
Disease
Foundation,
Inc.
WHO
reimbursable
procurement
62,028
tablets
3,066.67
WHO
reimbursable
procurement
31,014
ampules
5,598.03
Tropical
Disease
Foundation,
Inc.
Tropical
Disease
Foundation,
Inc.
--NA--
TOTAL
u
WHO
reimbursable
procurement
--NA--
24,078.88
(1) Indicate name of department or organization conducting procurement
(2) E.g. direct negotiation, national tender, international tender, etc.
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Table B.3: List of other health products and services to be procured under
this component (Years 1 and 2)
Prod.
Cat.
Product
Estimated
unit cost
(US$) (1)
Year 1
Year 1
Year 2
Year 2
Estimated
quantity
Total cost
(US$)
Estimated
quantity
Total cost
(US$)
29.61 (kit of
25 tests)
300 kits
8,883.75
4,176 kits
123,661.80
(varied per
lab supply)
700.00
(microscope)
(assorted lab
supplies & 78
units of
microscopes)
(400,181.54)
(54,250.00)
454,431.54
(assorted
lab
supplies)
6.18
962,194
5,946,360.40
615.22 (drum
of 148
sachets)
309
190,053.10
.74 Yr 1;
.82 Yr 2
112,392
83,349.91
219.27
spraycans
37.74 PPEs
40 spraycans
& 40 sets of
PPEs
10,280.09
QA strengthening
--NA--
--NA--
Procurement
& Logistics
consultancy
services &
software;
renovation &
improvement
of existing
warehouses(4)
--NA--
--NA--
Health
Equipment
Health Products
Rapid diagnostic
test
All other
diagnostic
products,
supplies,
equipment
Bednets (LLINs,
other)
Insecticides for
IRS (for regional
stockpiles &
house spraying)
Insecticides for
net retreatment
Spraycans &
PPEs
101,153
79,347.14
82,516.41
Procurement to
be conducted
by(2)
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
Services[3]
MIS systems
Philippine Malaria Proposal
--NA--
(22,641.51)
(30,188.68)
52,830.19
--NA-64,150.94
Tropical Disease
Foundation, Inc. thru
WHO reimbursable
procurement
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PhilMIS
enhancement;
Vehicles;
equipment,
furnitures &
fixtures for
provinces and
national office
(All non-health
products and
services(5)
--NA--
--NA--
( 8,773.58)
(98,113.21)
(37,264.15)
(51,132.08
--NA--
195,283.02
TOTAL
v
6,933,472.00
TOTAL
v
349,676.29
(1) Indicate whether PR/buyer is able to access any special prices (e.g. through Clinton Foundation, other)
(2) Indicate whether in-house or being outsourced to a procurement agent; indicate name of department or
organization conducting procurement
(3) The focus of this section is only for services related to procurement and supply management (e.g.
consultants to strengthen PSM)
(4) Indicate type of assistance segmented into categories as listed on table 1.1 (do not provide information that
is not related to PSM)
(5) It is not necessary to itemize this entry; provide a single line entry and include some large value product and
service items as examples (e.g. vehicles, computers, construction, financial consultants, etc.)
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Annex 1, first part: Call for Concept Proposals: separate file
Annex 1, second part
CONCEPT PROPOSAL 1:
th
Concept Proposals in response to 6 round GFATM call
Title: An intensified development of local capacity and health systems to sustain gains in
malaria control in rural Philippines through public private partnership and community
systems strengthening.
Background:
Since 2003, the GF malaria project was initiated in 26 provinces responsible for 90% of all malaria
cases in the country. The goal was to decrease morbidity by 70% and mortality by 50% by 2008
relative to prevailing rates in 2001.
With the activities in the global fund 2 project, there has been an impact in malaria morbidity and
mortality based on surveillance data from 2003 -2005 showing a decrease in annual parasite
incidence (7.9, 5.0, and 4.3 on the average). However, local capacity for implementation needs
further strengthening to sustain the gains made. Capacity building of the local government units is
critical, in accordance with the devolved system. In addition, health delivery system could be
expanded through public private partnership with existing private sector care givers including private
medical practitioners, academe and faith-based organizations and non-government organizations.
Objectives:
To attain the MDG goals No. , 2, 4, 5, 8, and most particularly No. 6, which is to halt and reverse the
incidence of malaria by reducing mortality and morbidity, the following objectives need to be followed:
1. Early diagnosis and appropriate treatment of malaria cases
2. Vector control with distribution of ITNs to more than 80% of population at risk.
3. Strengthen local capacity to sustain community-based malaria control.
Activities to attain the above objectives will be broadly classified under:
I. Improved health service delivery and appropriate treatment at all levels of health care: to reduce
malaria mortality by at least 50% in the 21 Cat A provinces from 0.11/100,0000 to 0.05/100,000
through:
1. Health systems strengthening which are cross cutting with other diseases including
TB and HIV:
a. Human resource for health development in LGUs through training and management
capacity development in the public sector and also in the private providers including
the private medical practitioners,
b. Health infrastructure renovation including provision of equipment and maintenance
capacity
c. Laboratory capacity building to include microscopy (integrated with TB) and rapid
diagnostic tests
d. Procurement, Storage, Distribution system for drugs and commodities including ITNs
and stockpiles for epidemic control.
e. Health information systems including Monitoring and evaluation at all levels from the
National, Regional, Provincial, and municipal levels at the point of care.
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2. Community services strengthening to engage faith-based organizations (FBOs) and nongovernment organizations (NGOs) to undertake the project on malaria services in integration
with TB
II.
To implement appropriate vector control to reduce malaria morbidity by at least 70%
in Cat. A provinces from 50/100,000 to 15/100,000 population in 2010 through
1. ITN (insecticide treated net) coverage of >80% of population at risk
2. Indoor Residual Spraying (IRS) in selected target areas.
3. Epidemic control (forecasting, stockpiling)
III Enabling policy environment including health policy, health financing, regulation and
certification
1. Evidence-based policy development for malaria control.
2. Innovative health financing systems including PhilHealth malaria package and micro
enterprise, and educational incentives
3. System of certification and accreditation of health care facilities to avail PhilHealth benefits
4. Operations research to assess effectiveness and efficiency of the program.
IV. Behaviour change communications to increase the demand for malaria diagnosis and
treatment services through
1. Innovative methods like school on the air.
2. Health information through personal sellers
3. Integration of malaria module in the school curriculum
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CONCEPT PROPOSAL 2:
Combating Malaria through Health System Strengthening
and Community-Based Health Financing
Background
The proponent intends to continue and sustain the activities in the first three years of implementation,
and plans to respond to issues arising from previous implementation and new imperatives.
In the course of the implementation, the following issues have been met:
•
•
LGU ownership of the malaria control program fell short of the expected output
Community organizations, mechanisms and structures at the barangay and municipal levels
don’t have the ability to sustain the malaria control program
Other imperatives that the proposal plans to respond include:
•
•
Strengthening the health system through establishment of community-based health financing
Economic intervention through provision of livelihood support
Methodology
Diagnosis and Treatment
The project has already trained RHU Medical Technologists, Barangay Microscopists and Barangay
Health Workers on diagnosis of malaria. Laboratory equipment and supplies has been provided for
by the project. RHUs served as the center for diagnosis, validation and consolidation of results.
Barangay Microscopy Center served those barangay far from the town centers. BHWs provide rapid
diagnostics to those in remote areas of the municipalities covered.
These activities will be sustained by the project. The 2
will also be continued.
nd
line drugs distribution, started by the project,
Vector Control
Treated bed net distribution, proven to be the most effective strategy to control the spread of malaria
will be continued. Although most of the households in the covered barangays have already received
at least one treated bed net, there are many households who expressed the need for more bed nets.
Other activities such as river and stream clearing, spraying and campaign for environmental
sanitation will also be implemented.
Strengthening Local Capacity
Most of the trained medical technologists and microscopists were not absorbed by the LGUs as
agreed, the reason being the limited resources.
The project proposes a geared up approach in sustaining these achievements of the project by
lobbying and assisting local government units to pass a health code. The health code should outline
definitive programs on health including malaria control and establishing a special health fund.
Sources of the health fund can be regular allocation and/or percentage from income of the activities
of the LGU related to health such as issuance of health permits, medical clearance, sanitary permits,
even other sources not related to health.
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The special health fund will be utilized for health programs including sustaining the malaria control
program.
Assessment of structures formed for malaria control and other health organizations will be done. This
is to determine what structures, systems and mechanisms are appropriate to respond to the malaria
problem. In essence, structures that work will be maintained and enhanced and officers and
members will be provided with organizational management skills training. Their capacity to conduct
IEC will also be enhanced.
A community-based health financing scheme at the barangay level will be established to respond to
the health needs, including malarial treatment.
Seed fund will be provided for communities to establish their community-based health financing
program. Sources of the seed fund will be the project, with counterpart from the municipal and
barangay local government units. A portion of the provincial trust fund generated from the distribution
of bed nets and provision of services will also be earmarked for the seed fund.
Members of the communities will then be encouraged to be members of the health financing scheme
and contribute an agreed amount based on the capacity of the community. After a certain period of
continuously contributing to the health fund, the member will be entitled to medical financial support
with a predetermined ceiling amount. If the entitlements will not be enough for the member’s medical
needs, he/she can apply for loan from the fund at minimal interests.
Other uses of the fund will be to provide allowances to the health personnel of the barangay.
The fund will also be used as capital for the establishment of a Botika sa Barangay to serve the
community and also generate income.
It will provide easy access to medical financial needs of communities that can complement their
existing health care system, if any, devoid of political maneuverings. It will also encourage selfreliance of the people in the community to respond to their needs.
It is a fact that malaria hits the poor and marginalized communities the most. Improving the economic
situation of the people in these communities will directly and indirectly contribute to solving the
malaria menace.
The project proposes provision of support to organizations and individuals for implementation of
viable livelihood activities. This can even be opened for health personnel since they are receiving
minimal allowances that cannot compensate the services they are providing to the communities.
Expected Output, Outcome and Impact
The project will cover the provinces of Mt. Province, Ifugao, Isabela, Cagayan and Kalinga.
Ultimately the project is expected to reduce malaria morbidity by 70% during project life and eliminate
them totally through sustained activities. It is also expected to reduce mortality by 50% in the duration
of the project, and eliminate it in the long run.
The following should have been attained in the covered provinces:
•
•
•
•
Functional and sustained microscopy centers in covered areas
Health code and special health fund in covered municipalities
Easy access to diagnosis and treatment in remotest barangays and IP communities
Increased awareness in the community leading to utilization of health services and regular
use of treated mosquito nets
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•
•
•
•
Bed net needs of household met in the covered areas
Functional structures and systems implementing malaria control program
Community-based health financing scheme established in priority barangays in the early
stages of the project and in all areas in the long term.
Individual and group livelihood projects
Sustainability
Institutionalization of health systems installed through passage of a health code would ensure
sustainability. Since the health financing is community based, sense of ownership of the program by
the people will be strong such that they would not want it to fail. Livelihood support will increase their
capacity to generate resources to maintain the health fund.
Project Management
The proponent is an NGO with in-house expertise in implementing health and community-based
projects. Personnel to be assigned to the project have been involved in community development
work, and several have been part of health projects including the malaria control program.
In most of its activities, SITMo has been establishing partnership with the various sectors, including
government organizations, people’s organizations and LGUs. The project will be a public-private
partnership among multiple stakeholders.
To implement the project smoothly a Project Management Office will be set-up composed of an Overall
Project Coordinator, Cluster Coordinators each to manage 2 to 3 provinces, an Education Officer, a
PME Officer, a Finance Officer, a Logistics/Supply Officer, and a Driver. The Provincial Management
Teams will be absorbed by the project.
Requirements of the PMO include a vehicle for mobility to manage the project effectively.
Equipments such as computer with printer and photo-video production gadgets are also needed by
the project. Basic administrative requirements are also required.
For its counterpart, SITMo will provide the office space and use of the organizations vehicle if needed
or not in use by other SITMo activities. Existing SITMo staff can also extend support services to the
project. The most crucial among SITMo’s contribution will be the expertise it will bring to the project,
with most of its core staff having more than 10 years experience in community development work.
SITMo’s office is located at Kiangan, Ifugao. It has the capacity to expand to the other provinces
given that it has partners and contacts and can easily establish linkages in the proposed covered
areas.
Brief Organizational Profile
The Save the Ifugao Terraces Movement (SITMo) is sending to you our concept paper under the
Global Fund for Malaria.
We hope you will consider it positively.
Teddy B. Baguilat Jr.
President, SITMo
SITMo is a federation of people’s organizations, institutions and individuals or other advocates. This
was formally launched in March of 2000. As an NGO its programs include the following:
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•
•
•
•
•
•
•
Sustainable Agriculture and Natural Resource Management
Renewable Energy
Community Health Management
Ecotourism
Local Governance
MDG Localization
Culture Appreciation and Integrity.
It received local and international awards to wit: ASHDEN award for renewable energy from the
British Government and the Panibagong Paraan Award, a proposal competition for innovative
projects.
Highlights of Previous and On-going Projects
SITMo evolved as a result of PRRM’s organizing work in Ifugao. During its formation, health related
programs being implemented then included the following:
• Community-Based Child Monitoring System in partnership with the National Statistical
Development Board (NSDB)
• Women’s Health and Safe Motherhood Program in partnership with the Department of
Health
• Malaria Control and Prevention.
The current PO partners of the SITMo were all involved in the implementation of the above
mentioned programs.
SITMo’s current involvements are the following programs:
•
•
•
•
•
•
Renewable Energy
Indigenous Knowledge Transmission
Systems of Rice Intensification
Environment and Rice Terraces Program
Local Governance
LGU Localization of the Millennium Development Goals
Health and nutrition cut across all these programs. One of the more active partners of the SITMo is
the Ifugao Federation of Community Health Workers.
The present pool of staff and volunteers are involved in both previous and current undertakings of the
SITMo.
CONCEPT PROPOSAL 3:
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TITLE: EXPANSION AND STRENGTHENING OF HOLISTIC COMMUNITY BASED HEALTH
AND DEVELOPMENT PROGRAM IN PALAWAN, CAGAYAN AND QUEZON TO REVERSE THE
BURDEN OF MALARIA, TB AND OTHER DISEASES AND ACHIEVE QUALITY HEALTH CARE
SYSTEM AT THE GRASSROOTS LEVEL.
BACKGROUND:
Today despite the advances in science and technology many still suffer from the lack of health care
services. This is compounded by the massive exodus of our health professionals, exporting a
minimum of 12,000 nurses per year according to research done by the group of former Health
Secretary Jaime Galvez Tan. Our top diseases are still preventable like acute respiratory infections,
tuberculosis, diarrhea and malaria. Knowing that we lack health facilities, resources and manpower,
we need to develop a strategy that would enable our people to find solutions to their own problems. A
strategy that will help “put health in the hands of the people”.
Over the years, ARP has seen changes in the health conditions of the communities served though
Holistic Community Based Health and Development Program. To date, there are 4,000 community
leaders, volunteers and students trained and more than 57,000 individuals benefited.
ARP started “Kilusang Kalusugan at Kaunlaran para sa mga Katutubo” or 4K-Project that
caters to the health and social needs of the Pa’lawan tribe, concentrated on four major components:
Malaria Control Program; Nutrition Program; Literacy Program, Livelihood Program, Water System
and Latrine Construction. After 12 months, there was 58% decrease of severe malaria cases; the
community from being ranked as No. 1 in malnutrition in 2003 – 2004, went down to rank No. 8 in
2005 – 2006; 118 households gained easy access to potable water which contributed to 48% drop of
diarrhea cases; 126 farmers were trained in natural farming method.
ARP has also established a successful innovative strategy to fight TB, where it combines the role of
both the private doctors and community health workers (Private-Public mix) approach in five
communities in Puerto Princesa City. In the one year of its implementation, it had 50 TB patients
enrolled for supervised treatment, and contributed 43.58% Case Detection Rate for the 5
communities. It also motivated 14 trained private physicians in referral to ARP DOTS center and
trained 12 community health workers in the identification, prevention, and treatment and trained in
supervision and close monitoring of enrolled TB patients. The project showed a 96.15% conversion
rate and 83% cure rate in the treatment of TB.
These on-going projects of ARP which contributes greatly to the upliftment of the quality of lives of its
beneficiaries came to realizations because of grants that are time bounded. The ARP-4K project,
funded by Geneva Global has a grant life of only one year. After the grant expires, it will be a heavy
toll financially for ARP to sustain the momentum created by these projects. It is the desire of ARP to
continue its services and to institute lasting change in selected communities of Palawan, Cagayan
and Quezon.
PROJECT DESCRIPTION:
The Agape Rural (Health) Program proposes to expand, compliment and strengthen the existing
Holistic Community Based Health Development Program that would develop local leaders and
multipliers to reduce the burden of malaria and TB as well as to contribute in achieving holistic and
quality life of indigenous communities.
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PROJECT OBJECTIVES:
1.
2.
To continue, strengthen and expand the existing 4K project, “Kilusang Kalusugan at Kaunlaran
para sa mga Katutubo” (Health and Development Movement for the Indigenous), malaria control
as the core program expanding to TB and other health & development issues.
Strengthen local capacity through continuing education and training for sustainability of
community based malaria control.
ACTIVITIES TO ATTAIN THE ABOVE OBJECTIVES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Community mobilization and capacity building
Training of Trainors for stakeholders
Establish health infrastructure/facility that would cater health service delivery, laboratory
(microscopy-TB and Malaria), treatment, and training and information dissemination.
Strengthen partnership among stakeholders through periodic reporting and dialogue.
Lobby for accreditation and or certification of workers and facility that will strengthen referral,
partnership and integration to the local health system (DOH, RHU, LGU and other agencies).
Develop and facilitate integration of malaria curriculum to tribal education and create “Sine sa
Baryo” a mobile strategy specific for detection and treatment and information campaign for hardto-reach areas.
Develop effective IEC material and or improve existing tools that are transferable and culturally
sensitive to indigenous community.
Procurement of resources needed.
Program turn-over to the community, attaining local project ownership, empowerment and
sustainability.
Monitoring and evaluation at all levels.
CONCEPT PROPOSAL 4:
BUILDING CAPACITIES OF COMMUNITIES IN THE FIGHT AGAINST MALARIA
(A Project Concept Submitted by the Council for Health and Development to the CCM-Philippines)
Background
There is a worldwide resurgence of malaria with 3 million deaths recorded annually. Southeast Asia is one of the identified
hotspots.
Malaria is the eighth leading causes of morbidity in the country, yet surprisingly, Filipinos know little about the disease.
Even in endemic communities, misconceptions on the cause, transmission, prevention and treatment of malaria still
abound. documented malaria cases have increased in recent years. In 2001, there were 34,787 cases recorded and by
2003, the figure rose to 43,664 cases – 8,877 cases higher or 25% increase.
Data averaged over ten years (1991-2000) show that more than 90% of malaria cases nationwide are found in 25 of the 65
endemic provinces. Many of the endemic areas have a high percentage (70%-90%) of indigenous peoples. Indigenous
people are the most prone to malaria epidemics. They lack knowledge on malaria. Many of them still harbor beliefs that
disease is brought about by displeased spirits.
Methodology
The Council for Health and Development has been in existence for more than 32 years using the Community-based Health
Program or CBHP approach. All over the Philippines, CHD helps in building community-managed health care system through
CBHPs. For this project, CHD will again use the experience-proven CBHP approach.
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At the core of the methodology is organizing and education. Organizing and education as a strategy recognizes the
inherent strength and the capacity of the people to manage their own health and lives as a community. To build the
capacities of communities in the fight against malaria, CHD seeks to conduct community action researches and health
education, community-propelled anti-malaria campaign and trainings on health skills and particular focus in training
mothers and mother coordinators among those who will be trained as community health workers. A community-based
health system against malaria will be set up.
Expected output
The project seeks to contribute to the fifty percent reduction of mortality and control of malaria in the 100 target barangays
in 22 endemic provinces in the Philippines. At the end of the program, the project communities should have:
w
w
w
w
Baseline data on malaria, health information and local surveillance system
Trained 100 community health teams, thousands of community health workers and mother coordinators lead the
community efforts toward detection, prevention and monitoring of treatment compliance and treatment response
to malaria.
Simple and basic health infrastructures for malaria control
A more developed indigenous health and medicinal practice of communities with respect to malaria control.
Sustainability
CHD and its member organizations take to heart the principle of community ownership in every project. This principle
defines the role of CHD and member organizations as mere facilitators in building the initiatives and capacities of
communities in managing their own health. After a certain period, when the community members are capacitated and
certain structures were built, the community will be ready to manage and sustain the malaria project.
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CONCEPT PROPOSAL 5:
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2
2.1
Background
Malaria becomes a grave threat to humans only when mosquitoes emerge from its water-borne larval
stage. Once the vector becomes airborne, a potentially expensive and intricate problem of malaria is
born. The best way to prevent the occurrence of malaria, therefore, is to inhibit the adult emergence
of the Anopheles mosquito. At its larval stage, mosquitoes pose no threat to humans, and they can
be controlled thru the application of Sumilarv.
Sumilarv is a new and innovative insect growth regulator (IGR) manufactured by Sumitomo Chemical
of Tokyo, Japan for the control of all types of mosquito larvae, including the Anopheles specie.
When applied to mosquito breeding places, Sumilarv will prevent the emergence of adult mosquitoes
from its aquatic larval stages.
Sumilarv contains the active ingredient (AI) pyriproxyfen, which has residual effect of up to six
months applied at extremely low dose (0.01 ppm). It is insect-specific and poses very minimal risks
to mammals, birds and fishes when applied at recommended doses.
The favorable safety profile of Sumilarv permits it to be applied to drinking water for the control of
mosquito larvae (WHO/SDE/WSH/03.04/113). It is recommended by the World Health Organization
(passed all stages of WHOPES – Ref: WHO/CDS/WHOPES/2001.2), pp. 50-67.
2.2
Methodology
The initial step to a successful implementation of Sumilarv as a means for malaria control is the
identification of the Anopheles breeding areas. When breeding places are pinpointed, Sumilarv can
be directly applied at the recommended dose of 1 to 2 kg per hectare of water, either thru the use of
a knapsack granule applicator, or for running water, the use of teabags filled with Sumilarv granules
dipped or submerged into the water. Integrated mosquito control programs may require the
coverage of large areas of water by means of aerial disbursement. Aerial disbursement may also be
used to treat river banks covered with abundant vegetation. These treatments will normally prevent
anopheline breeding in the treated areas.
The only other step required is the regular monitoring of the breeding places for adult emergence. If
teabags are used, it should be checked regularly for replenishment. Field trials have proven that
Sumilarv can effectively control adult mosquito emergence from a period of 3 to 6 months, depending
on the conditions in which the product is used.
2.3
Expected output/ outcome/ impact
Field trials have been conducted across the world proving that Sumilarv is an effective means of
malaria control. An example is shown below:
Sri Lanka: Field trials against malaria vectors Anopheles culicifaces and Anopheles subpictus
indicated that a single treatment of Sumilarv inhibited the emergence of adult mosquitoes in riverbed
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pools for 190 days. The treatment caused a significant reduction in mosquito populations, and the
incidence of malaria was reduced in the treatment villages by about 70%.
Control of vectors and incidence of malaria in an irrigated settlement scheme in Sri Lanka by using
the insect growth regulator pyriproxyfen. Yapabandara, AMGM & Curtis, CF. J. Amer. Mos. Cont.
Assoc. 20(4):395-400, 2004.
WHO : A full summary of laboratory and field trials of Sumilarv were reviewed by WHO before
Sumilarv achieved its WHOPES recommendation. These can be found in
WHO/CDS/WHOPES/2001.2 on pages 50-67. http://www.who.int/whopes/resources/en/
The WHOPES document lists very promising results on studies of Sumilarv for the control of the
following Anopheles species: farauti, albimanus, gambiae, balabacensis, stephensi,
quadrimaculatus, punctatus, minimus, and maculates.
Positive outcome of using Sumilarv for malaria control is expected. Existing control measures, such
as space spraying and impregnated bednets, are more reactive in nature and assumes that the
threat of malaria is already imminent. Furthermore, Sumilarv produces no chemical fumes, so it does
not pose harmful effects to the environment. Sumilarv also exerts a stronger selection pressure on
vector populations than residual spraying and the use of insecticide-treated mosquito nets, as it acts
on both sexes.
2.4
Sustainability
Field trials have shown that Sumilarv provides long residual effect at extremely low dosage. As it is
very economical to use, it is a long-term solution to malaria prevention.
Brief Organizational Profile
Pycor Inc. has been in the forefront of providing quality products for malaria control since the early
1990s. From 1995 thru 2005, Pycor Inc. was an active distributor of Bayer Environmental Science to
the Department of Health (DOH) Regional and Municipal Field Offices for products such as K-Othrine
EC/SC/WP and Deltacide E.
Beginning 2006, Pycor Inc. shifted its focus to newer innovative products for malaria and dengue
control, such as SUMILARV.
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3
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Highlights of previous and/or on-going projects
Sumilarv was the insecticide of choice used for control of mosquito-borne diseases during the recent
tsunami disaster.
Annex 2:
SUMMARY OF RESPONSES FROM LGU SURVEY
1.
KEY QUESTION
What do you need to make
the MCP sustainable in
your area?
Philippine Malaria Proposal
LGU (MAYOR)
a. honoring of the MOA; hiring of the
Medtech; creation of plantilla position
b. sustained IEC using trimedia
c. provision of adequate budget for
the program;
integration of MCP in municipal
development plan
d. Renumeration/honoraria of BMMs
(Microscopists) and RDT trained
BHWs.
e. Enactment and religious
enforcement (strong political will) of
Resolutions and Ordinances
encompassing MCP to provide a
powerful backing and reinforcement.
f. Organization/activation of
Barangay Health Emergency
Response Team.
g. Adoption of regular budget
allocation for MCP activities, such as
Mosquito Net Festival, and
integrating thereof to regular
barangay assemblies.
h. Organize and equip a
cooperative that will foster enterprise
or livelihood among health personnel,
MHOs/PHOs
- integration of MCP in municipal
development plan.
- institutionalization and/or
strengthening of Malaria Database
System for easy interpretation in
fostering swift response on urgent
malaria-related situations.
- Integration of Malaria advocacy in
other BCC projects such
incorporation to the Mother’s and
Female Functional Literacy Classes
and/or Integrated Mgmt on Childhood
Illnesses among others.
- Developing responsive strategies
such that will integrate in the
Community-Based Health Program
initiated through the interlocal health
zone concept.
- Trng for hospital doctors for severe
malaria cases (MisOr).
- Localize the MCP with the technical
supervision of the CHD and the PHO;
for LGU to provide regular budget for
MCP (Kalinga).
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KEY QUESTION
2.
What are the greatest
challenges you’ve
encountered in:
a. bednet distribution
b.
bednet retreatment
c. sustaining diagnostic health
facilities
3.
suggestions in addressing
these challenges
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LGU (MAYOR)
POs, NGOs in the municipal level
(DDN).
i. Gradual localization of the
initiatives that had been introduced
by the project (Kalinga).
MHOs/PHOs
- difficulty in collecting community
counterparts.
- Limited allocation to cater all HH in
the endemic localities; involvement of
the LGU in the decision-making of
those who shall be given/formal
information as to the area of
coverage (Kalinga).
-nomadic lifestyle and geographical
location of IPs.
- peace and order situation.
- incorrect/improper usage of
bednets; refusal usage of nets,
recipient not used of giving
counterparts (MisOr).
- Weather condition; availability of
supplies; transportation problem due
to geographical constraints (Kalinga).
- refusal of com’ty people to submit
their nets for retreatment upon
implementation of new cost recovery
scheme for retreatment
(PhP25.00/net) – MisOr.
- Limited budget for the purchase of
the insecticide for retreatment. Need
for adjustment by LGU to reconcile
needed materials for the activity
(Kalinga).
- inability of the LGU to absorb
medtech/bgy microscopist
- lack of proper laboratory space for
medical technologist
- Creation of item for the
microscopists would exceed the
allotted number of employees/casual
in the locality as per DBM
implementing rules based on the
Local Gov’t Code 7160 (Kalinga).
- hiring of a Medical Technologist to
be paid by the provincial government
and who would cater to several
municipalities on a rotation basis
- collect counterpart
contribution before actual
net distribution
- the mobility of the target
populations.
- Some barangays not covered by GF
have not undergone retreatment of
existing HH bednets due to limited
insecticide provided (Kalinga).
- lack of LGU funds to absorb
personnel.
- to involve the barangays allot fund
for the honorarium/incentives of the
microscopists (Kalinga).
- organization and mobilization of
Barangay Health Emergency
Response Team, as mandated by the
local gov’t code;
-massive BCC among residents to
get rid of passiveness eventually
encouraging them to pursue
retreatment;
-giving off of incentives to trained
BHWs to facilitating retreatment.
- follow-up implementation of
ordinances and resolutions at the
barangay level; course through ABC
for barangay counter-parting (MisOr).
- Converge efforts of the LGU –
community and the health sector plus
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KEY QUESTION
LGU (MAYOR)
4.
Innovative strategies for
health currently being
implemented
5.
What is your perception of
the MCP being
implemented in your area?
- still weak due to lack of
commitment by participating
sectors/individuals
-it is well implemented by partners
but impact is still gradual in term of
awareness.
6.
Benefits/gains from the
malaria control efforts
- protection against malaria of
families
- better access to anti-malaria drug
- increased awareness on malaria
among community members
- there is a significant reduction of
cases by 40-60% contributed by
people’s initiative to submit
themselves for blood smearing.
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MHOs/PHOs
other concern entities/individuals to
promote malaria prevention, control
and management (Kalinga).
-Social Marketing for bednets and
KOtabs which proceeds is being
deposited in the Provincial Revolving
Fund for procurement of more nets,
KOtabs, and 1st line drugs.
- Peace pact initiative among warring
tribal leaders to discuss MCP
implementation in their respective
areas which became the key entry to
boarder/highland areas thathas never
been reached by any organizations
(DDN).
- Partners forum has been enjoined
with private & business sectors and
hospitals to fill in the bednet gaps for
the identified barangays (MisOr).
- Expansion to health services with
partner NGO for absorption of health
staff and facilities (MisOr).
- Presence of PhilHealth, PESU
membership to augment health cost
of the RHU clientele (Kalinga).
- it is reaching out to people through
delivering basic services but not good
enough till it capacitate people from
delivering basic services to moving
create basic services with the people
(DDN).
- It would be more effective if
neighboring provinces such as
Agusan del Norte, Agusan del Sur
and Misamis Oriental have joint
Malaria Control Program due to
livelihood and lifestyle of IPs (MisOr).
- Great help to the community in
lowering cases especially in the far
flung areas (Kalinga).
- Significant results have been
achieved considering majority of
patients are now being treated earlier
thereby reducing health costs and
increasing productivity of the
community (DavOr).
- establishment of Revolving Fund
account for MCP has cut down the
worry for government red taping;
- Organizations’ support such as
ProvManCom, MAC, BMAC has
developed positive attitude among
gov’t officials in fighting the menace
of anopheles as a serious matter.
- establishment of diagnostic facilities
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KEY QUESTION
7.
LGU (MAYOR)
- Easy access for diagnosis/treatment
in the hard to reached/depressed
areas in the province through trained
health workers (Kalinga).
MHOs/PHOs
w/c serve people seeking treatment
other than malaria that became a
holistic health facility.
- integration of health aspect into the
cultural components.
-service delivery to unserved areas,
reaching out people who are not
reach by gov’t organizations (DDN).
- Increase bednet utilization among
com’ty HH (Kalinga).
- greater awareness among the
beneficiaries…”helping people to
take care of themselves” (DavOr).
What things could have
been done better?
- networking among potential
partners.
- Border operation with
Agusan/neighboring provinces with
meals and transportation allowance
(MisOr).
- Community organizing should have
been part of the regular health
workers activity (PHNs/RHMs) so
that funds for Cos should have been
utilized for more microscopists; and a
longer assistance to medical
technoligists under GFMC (Kalinga).
-
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Annex 3:
EXTERNAL EVALUATION OF THE GFATM-SUPPORT TO
MALARIA CONTROL IN THE PHILIPPINES
"ACCELERATING THE RESPONSE TO MALARIA AMONG
THE PHILIPPINES'REMOTE RURAL POOR"
Dr Kevin Palmer, Dr Eva Maria Christophel
Inputs from Pernille Joergensen and Stéphane Rousseau
WHO Western Pacific Regional Office
Manila
February 2004
Table of Contents
1
2
3
4
5
6
Background............................................................................................................1
Methodology ..........................................................................................................1
Findings .................................................................................................................1
3.1 Project Target Group..................................................................................................... 1
3.1.1
Design ...............................................................................................................................1
3.1.2
Implementation .................................................................................................................1
3.2 Project Objective 1: “To increase the proportion of febrile patients receiving early
diagnosis and appropriate antimalarial therapy” .................................................................... 1
3.2.1
Design ...............................................................................................................................1
3.2.2
Implementation: Diagnosis ...............................................................................................1
3.2.3
Implementation: Treatment...............................................................................................1
3.3 Project Objective 2: “To reduce malaria transmission (vector aspect)” ........................ 1
3.3.1
Design ...............................................................................................................................1
3.3.2
Implementation .................................................................................................................1
3.4 Project Objective 3: “To strengthen capacity for implementation of sustainable communitybased malaria control” ............................................................................................................ 1
3.4.1
Project Design...................................................................................................................1
3.4.2
Information Education Communication............................................................................1
3.4.3
Community Mobilization/Sustainability...........................................................................1
3.5 Project Management and Administration ...................................................................... 1
Conclusions ...........................................................................................................1
Recommendations .................................................................................................1
Acknowledgements ................................................................................................1
ANNEXES 1 and 2
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5 Background
Malaria continues to be endemic in 65 out of the 79 provinces of the Philippines; 90%
of cases are found in 25 provinces. In 2003, 44,702 confirmed malaria cases and 97
confirmed malaria deaths were reported. To raise funds for malaria control, the Philippines
submitted a proposal to the GFATM during the 2nd call for proposals in 2002 which was
accepted for funding. In 2003, a Grant Agreement was signed on USD 7,244,762 for the first
two years (Phase I) of the 5 year project (total budget USD 11,829,545). The official
program start date was 1 August 2003. It is targeted at 25 provinces, whereof 11 provinces
started implementation in Year 1 and 14 provinces in Year 2 (Maps 1 and 2, Annex 2).
The Principal Recipient (PR) of all Philippine GFATM-supported projects is a private
sector organization: the Tropical Disease Foundation (TDF). All malaria project
management is currently subcontracted to a Sub-PR: the Philippine Rural Reconstruction
Movement (PRRM), an NGO. The major implementing units are the municipalities in the
selected provinces.
TDF took the initiative and invited the WHO Western Pacific Regional Office to, in
cooperation with TDF:
1) participate in the external program evaluation of the Philippine Global Fund Malaria
Component Project; and
2) write an evaluation report.
This external assessment through WHO was part of the PR’s evaluation and final reporting
of Phase I of the project in February 2005 and the preparation of Phase II. The evaluation
results were presented during a Technical Working Group meeting on February 7 and during
a CCM meeting on February 8, 2005 (Annex 1).
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6 Methodology
The methodology of this review was agreed upon during a briefing with TDF and the
National Malaria Control Programme (NMCP): Basis of the evaluation were field visits to 4
provinces, during which progress in the implementation of the project workplan was verified
through qualitative assessments in health facilities, barangays and households. We checked
the distribution, availability, condition and use of project supplies and equipment;
interviewed health staff and observed their practices concerning training through the project,
diagnosis and treatment practices, and checked some of their slides microscopically;
interviewed villagers on their knowledge and practices concerning malaria and the project
interventions; conducted interviews with the major malaria control stakeholders in the
provinces (Project Management Team (PMT), Department of Health (DOH), local
government unit (LGU) representatives, PR and Sub-PR); visited private pharmacies to
check antimalarial drug availability and price, and markets for mosquito nets; analysed
project data and documents provided by the PR and the 4 provinces and relevant data and
documents available at WHO, and presented them in tables, graphs and maps (using
ArcView GIS software).
The main areas reviewed were: project design; implementation of interventions;
performance; operating environment; project management; and structural issues.
For selection of the provinces to be visited, the authors stratified the 11 Year 1
provinces according to the DOH 2002 and 2003 annual incidence rates of confirmed malaria
(Table 1, Annex 2). We chose both provinces with high incidence rates (Apayao/North
Luzon 17.4/1,000 population and Palawan with 21.3/1,000 in 2003), and randomly selected
two among the other provinces all of which had low incidence rates (Occidental Mindoro
1.3/1,000 and Compostela Valley/Mindanao 0.45/1,000). As a UN travel ban to Mindanao
was imposed, we replaced the latter with Isabela province/North Luzon (1.0/1000
population) which is one of the biggest provinces of the Philippines (Graph 1, Maps 3-6).
During the period December 2004 to January 2005 the teams, consisting of 1-2 WHO
staff and representatives of the PR and the Sub-PR, visited each province for one week; the
NMCP Coordinator joined for 1 province (Occidental Mindoro). Generally the evaluation
teams followed the itineraries suggested by the provinces, but tried to make at least one
change in the programme on short notice. The team visited in each province 6-8 endemic
municipalities and RHUs, 3-7 barangay microscopists (BM), 2-7 barangay health workers
(BHW) with Rapid Diagnostic Tests (RDT), and conducted households visits in several
barangays. The team paid visits to the provincial governors where possible, as well as the
DOH Region II Office in Tuguegarao and the Palawan Extension Office in Puerto Princesa
(including their Giemsa production units).
Province
APAYAO
Total
At risk
Barangays
Population Municipalities
/total
103,575
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7/7
133
Public
Hospitals
8
Confirmed Incidence
Malaria
Rate/1000
2003
2003
2,574
24.9
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MINDORO
380,250
9/11
162
9
511
1.3
PALAWAN
861,059
19/23
430
9
19,872
23.1
1,376,014
27/
35+2 cities
1,055
7
2,021
1.5
ISABELA
Source: Data provided at provincial level
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7 Findings
January 2005 was the end of Quarter II of Year 2 of project implementation. As
project activities in the provinces and municipalities started around November 2003, this
provincial evaluation captures the results of about one year of field implementation of the
project.
7.1
7.1.1
Project Target Group
Design
The project is targeted at the “Philippines’ remote rural poor”, including indigenous
population groups (IP), at risk of malaria.
7.1.2
Implementation
Especially for the insecticide-treated mosquito net (ITN) intervention, the definition of
the target group varied and the concept of targeting the poor was not always applied and
understood. For example, the Technical Working Group (TWG) guidelines on distribution of
ITNs with full subsidy only mention “50% of IP families” as recipients while all others can
only receive partially subsidized nets. This leaves out the poor non-IP at risk of malaria.
Indeed this happened in some areas (eg Isabela). There is also a potential conflict between
targeting the poor and reaching high ITN coverage in selected priority barangays (see
Objective 2).
7.2
7.2.1
Project Objective 1: “To increase the proportion of febrile patients receiving early
diagnosis and appropriate antimalarial therapy”
Design
The project aims at expanding the network of diagnosis and treatment to the grassroot
level. Existing systems were strengthened, and interventions which are new to most
Philippine provinces were introduced: barangay microsocpists (BM), rapid diagnositic tests
(RDT), and artemisinin-based combination therapy (ACT) as 2nd line drug, which had been
introduced through the revised Philippine Antimalarial Drug Policy in 2002 but which due to
its high cost so far could not be implemented on a larger scale. Objective 1 was the major
component of the project (43% of the Phase I budget).
7.2.2
Implementation: Diagnosis
Municipal microscopists
The medical technicians of most Rural Health Units (RHU) in the project provinces
received a two week training, organized by the DOH; hospital medtechs were not included.
This training is important as in the standard medtech training malaria is only very shortly
dealt with. The team had a chance to attend one of these courses in Tuguegarao: it had a tight
programme, was comprehensive (including parasite counting, the new quality assurance
system, microscope maintenance, lab biosafety, RDTs, new drug policy/treatment
guidelines), and the feedback from the participants was enthusiastic.
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Some RHUs were equipped with a new Olympus microscope. For RHUs without a
medtech, the project hired a medtech (several of them from the private sector) and provided
the salary for one year, with the provision that thereafter the LGU would shoulder the salary.
The performance of the RHU microscopists who we met was very good. Many of
them were engaged in the supervision of the BMs who they called for weekly meetings and
rechecked their slides. This project support was highly appreciated by the LGUs.
Barangay microscopists
According to the project plan, 198 barangay microscopy centers were supposed to be
established in the 25 project provinces by end of Year 2 (whereof 126 by end of Year 1).
Extensive experience with this intervention had so far only been available from Palawan,
where over 300 BM had been trained, equipped and installed with support from the Shell
Foundation in 2001-2003.
During our Palawan evaluation, we were told that around 230 of them were still
functional, although they only received a minimal incentive from the barangays. We visited
4 of them, and, impressively, they had become part of the barangay health services, against
only a small incentive from the barangay (some worked from home). However, we also
witnessed the huge challenge to maintain them, in terms of equipment maintenance,
supplies, drugs, training, supervision and quality assurance. The quality of microscopy
varied enormously between different BMs. One reason for bad performance was the
insufficient quality of the microscopes. The resupply with laboratory material and drugs
mainly happened through the KLM (Kalusan Ligtas Malaria = Movement against Malaria)
office which continues to receive Shell Foundation support, not through the municipalities
which were chronically short of supplies. For quality assurance of microscopy, Palawan has
developed its own network of validators, consisting of 9 KLM, 4 CHD and 5 municipal slide
validators, most with different geographical responsibilities (however some overlapping).
The GFATM project in Palawan did not train any new BMs but retrained a few existing
ones, and does not provide any supplies and drugs. Overall, the Palawan BMs seemed to
play an important role in increasing malaria case finding (Graphs 2 and 3, Annex 2) and in
reducing the burden of malaria patients seen at the health facilities in the Palawan high
malaria transmission situation.
In the 3 other provinces, we met 16 new BMs, all installed with GFATM project
support: several of them were already health staff with short term contracts (eg as
midwives), but some came straight from school. They were trained on microscopy for 5
weeks and equipped with a Olympus microscope, bench aids and sufficient supplies. Their
placement seemed mainly the decision of the MHO, usually in consultation with the
barangay. Sustainability played a role in this decision, at least one municipality turned down
the project offer of a BM and gave the slot to another municipality because the LGU “could
not afford” it. We tested some BMs and most performed very well; most had nice
workplaces made available by the barangay (though few had running water); their monthly
incentive (Peso 1,500) seemed adequate; and we heard lots of appreciation from the
barangay population.
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However, the established barangay microscopy centers rarely fulfilled the criteria laid
out in the TWG guidelines: usually they did less than 60 slides/week, especially in low
prevalence or low population density areas. Some were placed in the same barangay as a
BHW with RDTs. Their tasks were not always clear: some did active case detection incl.
school surveys, most not; one was placed inside the RHU but designated to be "mobile”, eg
in case of an outbreak.
The biggest issues were that most of the BMs did not have first line drugs, and that the
resupply system for drugs and supplies was not clear (see below).
RDTs
The project has the target to establish RDT diagnosis in 486 barangays at the end of
Year 2; 255 were planned for Year 1, whereof 199 were actually established – this is a great
achievement. Three of the 4 evaluated provinces had established around 20 RDT points each
(in Palawan, 2 of the BHWs who since 2 years have been part of a WHO-supported RDT
operational study have been "adopted" by the GFATM project), while Isabela had 59.
However, the design of the RDT intervention seemed experimental, and the performance and
acceptance of the 15 visited BHWs with RDTs was highly variable. We saw BHWs in very
remote and high transmission barangays with excellent performance, but we also saw BHWs
who had done no testing since May 2004 when they received the RDTs. There is a previous
Philippine experience with large-scale RDT deployment for malaria control from Agusan del
Sur province2, but it is unclear whether it was used in the design and implementation of the
GFATM project.
The selection and number of RDT barangays was made by the MHO, in coordination
with the barangay captains. According to the TWG guidelines, RDTs are a) for "extremely
remote endemic localities where microscopy services are not available within 3 hours of
travel by any form of transportation or walking" and b) places with "very low catchment
population (<60 cases per week)" – malaria endemicity is not mentioned. Most of the RDT
barangays we saw did not fulfil the first criterium (most were near a road, some were even
close to a BM); factors influencing such decisions may have been that a) very remote
barangays or sitios often do not have a BHW, and b) the project has quite rigid targets to
fulfil. However, some RDT barangays were very difficult to access but less than 3 hours
away from the nearest microscopy - which raises the question of the feasibility of this
criterium.
The training, mainly of existing barangay health workers (BHWs), was organized in
the municipalities and usually lasted one day. In one province, incorrect information seems
to have been given during this training (transfer of blood from finger directly to the RDT).
At the end of the training, the BHWs received one box of RDTs (25 tests), slides (they were
told to always do a slide in parallel to the RDT), lancets, alcohol, cotton, no timers (but none
had watches!) and a note book as well as an initial stock of 1st line drugs. The biggest issue
2
Bell David et al.: Diagnosis of malaria in a remote area of the Philippines: comparison of techniques and their
acceptance by health workers and the community. Bull. WHO, 2001, 79 (10), pp. 933-941
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was that the RDT reporting/monitoring/supervision system was not clear, and therefore a
timely and appropriate re-supply with RDTs, materials and drugs was not available in many
places (some BHWs had too many RDTs while others had run out since weeks, several had
no drugs).
There were also RDT technical issues: After the first procurement the company
changed the blood collector from a straw to a loop which was difficult to handle; some
provinces did not dare to distribute the new kits without retraining the BHWs but for which
they had no funds. Also, in some areas of the project provinces vivax malaria was largely
predominant, however the test only detects falciparum malaria; there were no instructions on
how to deal with the situation of a negative RDT result, except waiting until the result of the
slide taken in parallel became known.
Common issues in expansion of diagnosis:
x
Location: While remoteness is the major criterium for RDTs, the delineation
between an RDT point and a BMC in less remote areas was not clear: the TWG criterium of
60 slides/week is questionable (especially in low prevalence or low population density
areas). Placing both a BM and RDTs into the same barangay (eg into a far-flung sitio) may
be justified in some cases but criteria were lacking. It was not clear what role malaria
incidence rates/API and/or the DOH malaria risk stratification played for the decisions on
the selection of the barangays.
x
Drugs: Most BMs and BHWs with RDTs did not have malaria 1st line drugs (except
Mindoro), mainly because of shortages at the RHU (including lack of coordination with the
DOH supply of drugs). However, some MHOs denied BHWs or microscopists the authority
to dispense drugs and insisted that treatment be done through the existing system (mainly
midwives); in case of lack of drugs in the public system, positive patients were sent to the
private pharmacies.
x
Tasks: Some BMs and BHWs with RDTs did active case detection incl. school
surveys, particularly in low prevalence areas: this is an important task to be added to the
TOR, but which needs to be coordinated with the DOH activities. Could good microscopists
be involved in TB microscopy in the future?
x
Community awareness: Not all villagers were aware of the existence of the new
diagnostic services in their community, and some voiced astonishment about the new role of
BHWs in diagnosis and dispensing of drugs;
x
Re-Supply: Any expansion of diagnostic services leads to an increase in
consumables. However, the complex resupply system (in terms of reporting, request for
resupply, procurement/supply, stocks and distribution channels) for lab supplies (incl RDTs)
and 1st line drugs seemed not yet established and responsibilities were not sufficiently clear
(nor mentioned in the TWG guidelines). The situation was complicated through several
players involved in supply and procurement: the GFATM project (2nd line drugs, Giemsa see
below, RDTs, initial lab supplies); the provinces/RHUs who in the MoU/MoAs with the
project signed off on their responsibilities in providing 1st line drugs and other commodities,
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but many of who were not able to deliver; and DOH who is the major routine supplier but
struggling with severe budget cuts.
x
Supervision: As per TWG guidelines, the RHU medtech supervises the BM, but
procedures, checklists or standard reporting forms did not yet exist. The supervision of the
BHW with RDTs was not clear, and remote location is an inherent obstacle; currently the
Community Organizers (COs) seemed to be the link with the RHU.
x
Quality assurance: QA is obviously crucial for monitoring and maintaining the
quality of a large number of BMs. There are currently several levels of validators (DOH,
provincial, municipal), and the DOH has started the assessment of their proficiency in 2004.
A new QA system is currently under development which will use lot quality assurance
sampling; a pilot trial started in Isabela, however the danger was noted that if the provincial
validator will include the BMs and collect slides directly in the barangays, this may hamper
the RHU microscopist'
s supervisory function of the BM. QA of the RDTs on peripheral level
is currently under development and should be introduced as soon as possible as RDT storage
did not seem optimal in some cases.
x
Sustainability: The MOAs signed by most LGUs with the project include the
payment of salaries for the RHU medtechs and BMs after one year (from January 2005 in
most cases). Most mayors with who we spoke had included this in the 2005 budget. In view
of the government austerity measures and the fact that many of the target areas are poor
municipalities, it is unlikely that all will be willing and able to deliver. Several barangay
captains also assured that they would pay part of the BM incentives. In case the RHU
medtechs will not be paid, it is likely that they will go back to the private sector where many
came from. BMs who already held another health staff contract said they would continue
doing microscopy as they liked the expansion of their duties.
Zonal Giemsa supply production and distribution
The project took the initiative to ensure sufficient and continuous supplies of good
quality and reasonable priced Giemsa through establishment of 5 Zonal Giemsa Preparation
Centers within the DOH network throughout the country. Giemas solution is produced from
powder (which is cheaper) and has to ripen during 2 months with daily shaking of the stock.
A TWG guideline foresees the distribution through the CHD to the provincial CHD and
PHO, against reports on utilization; while the project would make available the Giemsa
components for free for the first 2 years, the Zonal Centres were free to determine a
“reasonable cost to cover their expenses”.
We visited the Zonal Centers in Tuguegarao and Palawan. The former seemed to work
well, had since June 2004 produced over 50 liters whereof 30 liters had been distributed for
free, and had a good workplace and book-keeping. The latter suffered from departure of a
key staff and had produced little but not yet distributed any stock because of ongoing price
discussions. However, so far there were no standardized request forms or distribution
procedures.
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Implementation: Treatment
The NMCP and/or the RHUs are in charge of providing 1st and 3rd line drugs. First
line antimalarials were available in most RHUs but were generally in short supply. Injectable
quinine was available in very few public health facilities including the hospitals (and few
private pharmacies), which is a crisis situation. This seems partially to be a supply problem
(quinine is not produced in the Philippines, and in the last years was made available by
WHO to the public sector while the private sector has to import it), and partially due to the
undefined roles of the vertical programme and the LGUs after decentralization3.
The 2nd line drug Coartem was allocated in different quantities to provinces (although
the rationale is unclear), but within provinces sometimes equally distributed the RHUs
(Apayao). Mostly it was not allocated to hospitals, against the TWG guidelines, with the
argument that hospital staff had not yet been trained. Hardly any Coartem had been used in
the 4 visited provinces, as most health staff followed the national guideline to use Coartem
only in case of proven treatment failures – and most patients did not come back. Recent drug
efficacy studies from the North (Apayao and Kalinga) showed still good (96%) efficacy of
chloroquine (CQ) in combination with sulfadoxine/pyrimethamin (SP) (despite high failures
with monotherapy: CQ 53% and SP 9% failures in 2000). However, we heard several reports
in Palawan about clinical failures during discussions with hospital colleagues: Palawan
already in 1995 had 12% CQ+SP failures, since then no further data are available. An
urgently needed monitoring study will be conducted this year with GFATM and WHO
support.
As there is an upcoming problem with Coartem expiry in Nov 2005, and the chronic
1st line drug shortage, some RHUs have started to use it as first line drug and to distribute it
to hospitals. The project only procured adult Coartem blister packs, so the blisters had to be
cut in case of treatment of children. There was no monitoring of Coartem use, so that the
new shipment of Coartem in November 2004 was again distributed not based on
consumption. The redistribution of Coartem to provinces with higher CQ+SP drug resistance
needs to be considered.
One person from each municipality, usually the MHO, participated in the training on
basic malaria management in May 2004. However, the important training on management of
severe malaria has so far has only been conducted as a TOT in Mindanao involving 2
physicians per province. Referral hospitals which lie outside of the province in a non-project
province (eg for Apayao in Ilocos Norte) and private hospitals were not planned to be
included either in case management training nor in supply of 2nd line drug.
It is interesting that some municipalities (eg in Apayao) had issued ordinances to
forbid the sale of antibiotics and antimalarial drugs from sari sari stores.
3
See Espino F. et al.: Malaria control through municipalities in the Philippines: struggling with the mandate of
decentralized health programme management. Int. J. Health Plann and Mgmt 2004; 19: S155-S166
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7.3.1
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Project Objective 2: “To reduce malaria transmission (vector aspect)”
Design
The design of Objective 2 is weak. For the project'
s goal of a 70% malaria morbidity
reduction, the five-year target of covering 679,104 households with “at least 1 ITN” (as of
the original proposal) is insufficient, because:
a) the total official malaria at risk population in the 25 project provinces was about 6 million
people in 2002, therefore at least 1 million households will need at least 1 ITN. However;
using a population coverage indicator, and assuming 2.3 persons/net, the amount of ITNs
needed would be around 2.6 million ITNs;
b) the assumed baseline of 333,000 households already having at least 1 ITN in 2002 seems
not realistic: the DOH reported only 240,000 net treatments countrywide in 2002 and
287,000 in 2003; also, the quality of these existing nets is not considered;
c) there were no replacement nets foreseen during the 5 year project life.
As a result, the amount of projected and budgeted nets and insecticides in the project are
inadequate. This lack of nets/insecticides contributes to a confusion about the objective of
the ITN intervention: Is it transmission control as stated in the proposal, which is feasible
only if risk population coverage is >60%? Or is it personal protection, and of who (see point
3.1 on target group)? The implementers had to choose.
Concerning re-treatment of nets, a target of 60% available nets to be re-treated by end
of Year 2 is questionable.
No long lasting impregnated nets (LLIN) were mentioned in the project proposal,
although they are in fact cheaper than a conventional net in the Philippine malaria
epidemiological situation where nets need to be retreated twice per year.
7.3.2
Implementation
The PR and Sub-PR only planned and budgeted 25% of the total Year1+Year2 project
budget for Objective 2, which is very low for any malaria vector control component. The
following procurement was done:
- Year 1: nets 177,920 + K-O TAB4 244,000 (means 66,080 K-O TAB for retreatment);
- Year 2: nets 114,214 + K-O TAB 313,676 (means 199,462 K-O TAB for retreatment).
As nets need to be re-treated at least twice per year, the available 265,542 K-O TAB
will only suffice to re-treat 56% of the nets distributed by the project; there is no insecticide
to treat any nets which households already had before. Given the many issues with the
revolving fund from the net revenues (see below), and uncertainties about procurement
procedures and channels from these revenues, it cannot be expected that substantial
additional quantities of insecticide will become available in time.
The 177,920 mosquito nets for the 11 Year 1 provinces arrived in Manila in several
shipments between January and March 2004 (there were 18,000 losses which are currently
still negotiated with the insurance). The quantities for each province depended on provincial
requests, although it is not clear how the municipalities estimated their needs.
4
KO-TAB is the trade name of deltamethrine insecticide in tablet form for individual net treatment
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Nets, distribution, coverage, acceptance
In the 4 visited provinces, the number of new ITNs distributed to the province was
theoretically enough to cover 12% in Palawan, 15% in Occidental Mindoro, 20% in Apayao
and 23% in Isabela of the provincial population at risk of malaria (assuming 2.3 persons/net;
DOH risk population numbers 2002, see Table 1, Annex 2). High transmission provinces
seemed to have been prioritized.
Malaria case numbers and incidence rates vary greatly within provinces (see Maps 3-6,
Annex 2). Consequently, the net allocations to the different municipalities varied except in
Apayao where each municipality received about an equal number of nets. Net distribution
within the municipalities was regulated by TWG guidelines: they stated that nets should be
targeted to malaria A+B areas (high risk areas according to the DOH stratification of
barangays), that a survey on net ownership be conducted prior to net distribution, and that
then the MHO together with the municipal DOH representative needed to prioritize the areas
for net distribution.
Implementation varied greatly. All but one province conducted the net survey to
determine needs for nets; sometimes the number of family members per household were
taken into account to determine the needs, while in other places a strict one-net-perhousehold policy was pursued. The surveys showed that in some provinces very few people
in malarious areas had nets (Mindoro), while in others most households had a net; however
this survey did not look into the quality of the existing nets. The prioritization of barangays
was mostly not done jointly with the DOH representative who has the most comprehensive
and update malaria data. This was of particular concern in Isabela province, where careful
targeting was crucial given the size of the province and its population, and the low-endemic
malaria situation with a very focal malaria distribution. Consequently municipalities were
the major decision-makers, and it seemed that sometimes political pressure also influenced
the choice. In some provinces the Provincial Management Team played an important role in
evidence-based guiding of the targeting of the ITN intervention.
At the time of the evaluation, not all nets had been distributed and not all distributed
nets had been accounted for in some provinces (distribution to the provinces only started
after the presidential election in May 2004). Based on the available data, 2 of the 4 provinces
had achieved a good targeting of ITNs to high transmission barangays (based on the
distribution of malaria cases, not on incidence rates/APIs), and thus also achieved high ITN
household coverages in these barangays. Some of these high coverage barangays had BMs,
and we could see that in several places where the nets were brought out before the malaria
season, the number of malaria cases had dropped significantly by the end of the year. In the
2 other provinces nets were given to many barangays and thus mainly achieved personal
protection for some villagers, often IPs. Map 7 (Annex 2) indicates that sometimes nets were
given to non-malarious areas while they were lacking in areas with a significant malaria
problem.
Concerning the targeting of vulnerable populations, in this project the "remote rural
poor", the net distribution records only mentioned the number of nets which had been given
to indigenous populations: the percentages (among all nets distributed) were 32% in Isabela,
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49% in Palawan and 82% in Mindoro; Apayao did not record this as most of the population
are IP.
The acceptance of the project ITNs was enthusiastic everywhere, concerning the
quality and the cheap price of the nets, and in Apayao also concerning the effect of the
insecticide treatment ("lice are killed"), and all asked for more nets. Clearly, given the large
household sizes (up to 15 family members, sometimes more than 1 family per household),
one ITN per household was not enough (the TWG guideline says "a minimum of 1 net per
household"). The project had procured two different net sizes (family and extra family), but
in several areas only one size was available; in general, people preferred larger nets. A
substantial number of malaria risk population worked in the forest and sometimes stayed
there overnight, often alone, which means that additional nets are needed.
Price
The TWG guidelines foresee a three-tier distribution system of full subsidy (defined as
up to 50 Pesos), partial subsidy and full subsidy (called "social marketing"). Pricing of nets
was a decision of the RHUs, and strategies and prices varied, between 0 and 150 Pesos (on
the markets, new nets of a similar quality as the project nets were available for around 300
Pesos). In some places the high price of the project nets prevented poor families that needed
nets from getting them, which was against the spirit of the project. Where a high coverage
approach was implemented, a differentiated pricing system was used (eg in Apayao, 17% of
nets were distributed for free and 7% were “socially marketed”).
Insecticide treatment/Retreatment
The PR had decided on procuring only K-O TAB, despite a higher price than the liquid
insecticide formulation, in order to facilitate individual net treatment. Individual plastic bags
should have been used for dipping, but except in Apayao usually the nets –also several at a
time- were dipped in bowls, while gloves were not always used. Partially too much water
was added.
Despite a significant number of pre-existing nets in households, it is unknown whether
any of them were treated as it was not clear whether the available KO-TABs could be used
for existing nets or only for the redipping of project nets, and as there were no records on
redipping (although there was a significant number of surplus KO-TABs in some provinces).
Therefore, high ITN coverage could only be achieved through distribution of new ITNs, no
matter how many nets a family already had.
In some barangays, ITNs were distributed in parallel to Indoor Residual Insecticide
Spraying (IRS) through DOH. This was justified in cases of a malaria outbreak, but
sometimes it was due to lack of coordination. There are also examples of good collaboration
with DOH, eg the use of their field auxiliary workers (FAW) for the dipping campaign, and
the coordination and pooling of the DOH and the project resources in order to be able to
redip existing nets during such a campaign, using the liquid insecticide provided by DOH.
Revolving fund
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Different provinces managed the revenues from the net sales differently: usually
municipalities kept them, either in specially opened bank accounts or in cash, and in one
province the PMT managed this money in a separate bank account. While the use of this
money for malaria control is clearly described in the TWG guidelines (which were said to
have come late), there were efforts of some municipalities to use the money differently (eg
for health facility repair). Some municipalities had already procured new nets locally; most
wanted to buy more nets and insecticide as well as quinine, but were confronted with high
local prices (eg KO-TAB was sold by a local supplier for 100 Pesos compared to ~25 Pesos
through WHO procurement) or supply problems (quinine).
7.4
7.4.1
Project Objective 3: “To strengthen capacity for implementation of sustainable
community-based malaria control”
Project Design
This project component is a particular priority and strength of the project. After the
introduction of the decentralization of health services, parts of malaria control became the
responsibility of the LGUs but many did not fulfil this task. The project, through making the
municipalities and barangays the implementing units, aimed at creating ownership and local
responsibility, leading to the integration of malaria control into local budgets and regular
community-based activities. Through making PRRM as Sub-recipient, the project intended
to draw on the long experience of this NGO in community mobilization.
7.4.2
Information Education Communication
Each PMT included an officer in charge of IEC; they were all very active, however
most of them had not been trained. All provinces had developed IEC plans during a
workshop organized by PRRM, with technical support through a consultant, however the
implementation was lagging behind due to delays in disbursement of funds. On barangay
level, "Brigada Malaria" had been established in many places and its members were about to
be trained. IEC materials had been produced, some in local languages, and notably the Tshirts for all the malaria control staff and volunteers were very visible and mostly well done.
Good flipcharts with local pictures had been developed, however due to the delay of funds
they had not been available during the net distribution campaign – instead, face to face
communication was used during the campaigns, often with the involvement of high level
politicians and health staff.
These activities need to be intensified and their impact assessed. Household interviews
showed in some areas that the population had very little knowledge about malaria
transmission, the biting time of mosquitoes, the reasons for use of nets; also net maintenance
was an issue. However in other areas the population was well informed.
7.4.3
Community Mobilization/Sustainability
Most municipalities which we visited showed a strong sense of ownership of the
project, and there were as many variations of the project implementation as municipalities
were involved. The MOU/MOAs on staff contracts (med techs, microscopists) and other
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tasks had been signed by most, but many LGUs may not adhere to the provisions mainly
because of lack of funds (compounded by new government austerity measures).
The Provincial Coordinating Committees seemed to have an important role in
coordination among the different stakeholders, notably DOH and LGUs, to involve
provincial governors, and to facilitate joint discussions on specific topics (eg the pricing of
nets). However, so far membership lists existed but it is not clear how active they were at
present.
The Community Organizers, hired by the project, were a key to the implementation of
the project. They were generally young, educated, motivated, but lacked training and
technical backup and guidelines. They were well accepted by the RHUs in case they were
residents of the respective municipality. They received a reasonable salary but no
compensation for use of own transportation or per diem for travel. However, as Phase II
foresees no funds for them, they will not be sustainable
7.5
Project Management and Administration
Project Management Teams (PMT)
In each province, the project was managed by the Provincial Malaria Coordinator, and
staffed with three other officers: one for IEC, one bookkeeper, one disbursement officer. The
PMT supervises the COs who are based at provincial and municipal levels. The staff seemed
well selected and generally handled their duties well, despite educational backgrounds which
sometimes were not related to their present functions. They appeared very motivated and
with a desire to learn more in their fields of responsibility. However, all project staff lacked
malaria training. They seeked technical support when needed from the national level
(PRRM) where there was little technical knowledge. Due to tensions with the DOH they did
not interact with the DOH technical staff who have long experience and knowledge. The
project technical knowledge is in the TWG, however PMTs seemed not to have direct access
to this group.
The workload seemed intense but well balanced between staff. Given the workload
and responsibilities, salaries seemed relatively low.
The PMTs did not have own transport; however they had a budget to hire vehicles
when necessary (which was not possible in one province where they had to use public
transport for duty travel). The PMT offices were minimally equipped, eg had no telephone
line, so communication happened via mobile phones and through internet cafes and post
offices.
On provincial level, coordination between the project and the provincial health office
was facilitated through the fact that the PHO was one signatory of the project funds. The
degree of cooperation depended on the PHO, and was excellent in 2 provinces, where the
province had appointed a provincial malaria coordinator to work closely with the project, or,
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in Palawan, to become the project coordinator. Better coordination with LGUs will be
necessary in order to harmonize planning cycles (LGUs do their planning in October).
Coordination with DOH
The DOH Malaria Control Programme is still a “semi-vertical” programme, in charge
of technical support, malaria data collection, re/supply of lab materials incl Giemsa and
antimalarial drugs (responsible for 2nd and 3rd line drugs, but supplementing 1st line drugs),
vector control (IRS, nets, insecticide for dipping, hiring of auxiliary field workers) and
outbreak control. It has a substantial network with the Regional Offices as key structures.
The issue was that the DOH role in the GFATM-supported project was not sufficiently clear
(apart from its responsibility for some training activities). It seemed that in the early project
planning and implementation phase this vital aspect of project implementation had not
received sufficient attention and the cooperation/coordination had not been formalized. As a
result, cooperation was lacking (except Palawan). The GFATM project and the NMCP
seemed like separate programmes with different objectives, however one had the technical
expertise while the other had funds.
Financial Management
While overall the financial management seemed to be well done, there were issues
with major delays in transferring funds as well as budget cuts through the PRRM without
justification. The PMTs had no buffer funds (the PRRM had 2 months of buffer funds but
did not pass these on to the PMTs) so when the PMTs ran out of money they could not
implement activities or they borrowed money (eg in Palawan from the Shell Foundation).
Currently there is no financial supervision at the provincial level, this is centralized.
Project Monitoring
The project was rated as B2 in the GFATM Grant Performance Report due to
weaknesses in monitoring. The project had no clear M&E document, with details on who
and how and when and through what means to collect indicators.
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8 Conclusions
The GFATM project has made a huge difference for the population at risk of malaria
in the Year 1 provinces. Good malaria control was implemented on a significant scale, and
malaria cases in 2004 already seemed to have decreased in some areas. Awareness about
malaria control has increased, and municipalities had ownership of the project. Overall the
project was well managed.
Major issues were the insufficient cooperation and coordination with the National
Malaria Control Programme; the shortage of 1st line and the lack of 3rd line drugs which
threaten the success of the project; and the underfunding of the ITN intervention (mainly a
project design problem) and its targeting. A number of technical issues were noted however
these can all be solved.
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9 Recommendations
Project Management and Coordination
1. Coordination with the Malaria Control Programme must be established on provincial
level. This is a structural problem that has the potential to negate all gains made by the
GF project when funding stops;
2. Stronger technical support should be provided to project staff especially related to
insecticide treated mosquito nets. This may come from NMCP or TWG;
3. A financial buffer fund should be provided to provincial management teams and there
should be some form of financial monitoring at the provincial level;
4. The role of provincial management committees should be clarified and made a part of
the overall programme management.
Diagnosis and Treatment
1.
2.
3.
4.
5.
6.
7.
8.
9.
1.
2.
3.
4.
5.
6.
7.
1.
Quinine needs to be provided to all hospitals and RHUs immediately;
Medtechs should be paid by municipalities after the first year;
Barangay microscopists should be continued under GFATM support after the first year;
Barangay microscopists need intense supervision (by med techs);
To encourage sustainability of BMs in low endemicity areas, active case detection should
become part of their work;
The RDT component of the project needs much more attention, monitoring and analysis
in order to make it fully functional;
Consideration should be given to the purchase of combined P.falciparum/P. vivax RDTs;
Health workers with RDTs should be provided with first line drugs and the authority to
administer them;
The project needs to rethink its support of Palawan: it has most malaria, but same level
of support as low endemicity areas.
Vector Control
The decision needs to be made on whether the project should be based on personal
protection or transmission control;
More nets need to be purchased and distributed so that all houses have enough nets for
all occupants;
The principle of including both IPs and rural poor needs to be followed;
Guidelines are needed for net re-treatment and replacement;
Net treatment should use the plastic bag method – nets need to be treated individually to
ensure proper insecticide dosage;
Consideration should be given to introducing long-lasting nets;
Bulk purchasing should be organized for purchase of good quality and reasonably priced
nets and insecticide using revolving funds.
Community Mobilization
Community Organizers should continue to be funded by the project in Phase II;
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2. Allowances for use of personal transport and communication should be provided to the
Community Organizers and per diem paid to encourage them to visit remote areas;
3. IEC activities need to be stepped up, and messages must reach the target populations.
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10 Acknowledgements
The authors greatly acknowledge the excellent cooperation with the Philippine
National Malaria Control Programme, Dr Mario Baquilod, and with the Tropical Disease
Foundation, Dr Thelma Tupasi. Many thanks for the good planning of the field visits and the
good travel companionship to Dr Lou Pambid. Great thanks for the open and very
constructive discussions to the Provincial Management Teams and all colleagues working
for the health of the people in the provinces we visited; their dedication to their work was
truly impressive. Special thanks to the people in the barangays who we visited who opened
their door to us and shared some of their experiences and worries with us.
Annex 4:
st
Record of Discussion of the 1 Forum of the Philippine Partnership to fight Tuberculosis,
Malaria, and AIDS
In collaboration with the
24h International Congress of Chemotherapy
4 June 2005, 9:30 AM – 12:00 Noon
Philippine International Convention Center
Participants:
Sector
Agenciy/Organization
1) Government health agencies
Department of Health
Central level
Regional level
Local level
2) Other governmental agencies
Department of National Defense
Philippine Council for Health Research
Development
3) Academe
University of the Philippines
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Representative
Secretary Francisco Duque
Director Myrna Cabotaje
Dr. Pedro Galvez
Chancellor Marita Reyes
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De la Salle University
Association of the Philippine Medical Colleges
NIH Director Galvez-Tan
Chairman, Dept. of Medicine: Charles Yu
Dr. Fernando Piedad
4) NGO community-based organization
World Vision Development Foundaiton
Alay sa Kawal
Medicos del Mundo (International NGO)
Dr. Roberta C. Romero
Jose
5) Faith-based Organizaiton
Franciscan Foundation
Foundation of our Lady of Hope
San Juan de Diyos TB Clinic
Couples for Christ Gawad Kalinga
6) Private Sector
Nutrition Center of the Philippines
Tropical Disease Foundaiton
Centers for TB in Children, Philippines, Inc,
Philippine Pediatric Society
Philippine Academy of Pediatric Pulmonologists,
Philippine College of Radiolology
Reach Out Foundation
PAL Foundation
7) People Living with Disease
PAFPI
Samahan ng Lusog Baga
8) Developmental partners
World Health Organizaiton
Japan International Cooperation Agency
9) Coalitions
Philippine Coalition against Tuberculosis
PBSP
Sr. Theresina Estalilla
Sr. Eva Maamo, MD
Dr. Marcelo
Executive Director Florentino Solon
President: Dr. Thelma E. Tupasi
Dr. Fe del Mundo
Dr. Connie Lim
Joshua Formentera
WR Ambassador Jean Marc Olive
Dr. Suchi
President: Dr. Jennifer Mendoza-Wi
Others Present:
1) Department of Health
Director Jaime Lagahid
Dr. Rosalind Vianzon
Dr. Vivian Lofranco
Dr. Mario Baquilod
Dr. Ernesto Bontuyan
Dr. Celine Garfin
2) World Health Organizaiton
\WPRO: Dr. Pieter van Maaren
WPRO: Dr. Stephane Rousseau
WR: Dr. Jayan Velayudhan
WR: Dr. Michael Voniatis
WR: Dr. Nerissa Dominguez
3) Tropical Disease Foundation:
Dr. Ma. Imelda Quelapio
Dr. Vilma Co
Ms. Nellie Mangubat
Mr. Onofre Merilles
4) Faith Based Organizaiton
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5) International Observers:
Dr. Donald Enarson: Scientific Director, International Union against Tuberculosis and Lung Disease
Dr. Lee Reichman: Director, New Jersey School of Medicine and Dentistry TB Research Unit (TBRU)
st
The 1 Forum was opened at 9:30 AM by a Welcome address by the President, International Society
st
of Chemotherapy, Dr. Jean Claude Pechere expressing his delight in having the 1 Forum
th
incorporated into the program of the 24 International Congress of Chemotherapy, making the ICC
more relevant to the host country.
The Honorable Francisco Duque III, Secretary of Health, addressed the Forum indicating his
commitment to the fight against the three diseases: TB, malaria and AIDS, and inviting the
partnership to support the efforts of the health department in its programmes.
Dr. Jaime Lagahid, Director and Officer in Charge, National Centers for Disease Prevention and
Control, presented the burden of illness due to tuberculosis, Malaria, and AIDS in the country and
presented the current targets to attain the Millennium Development Goals of the government. He
presented the current activities undertaken by the DOH and its partners in the control of the three
diseases.
Dr. Pieter van Maaren, presented the economic burden due to Tuberculosis and indicated that the
DOTS strategy was a cost-effective intervention leading to a return of investment of US$ 5 for every
US$ 1 spent in DOTS.
Mr. Stephane Rousseau, WHO WPRO regional coordinator for the GFATM presented the GFATM
background documents, describing the process of grant application and implementation, and
showing the extent of projects approved and fund disbursement to the projects in various regions of
the world.
Dr. Tupasi, representing the Principal Recipient, the Tropical Disease Foundation, presented the GF
projects in the Philippines. The highlight is that the TB and Malaria projects have been approved for
Phase II funding in view of good performance.
Dr. Myrna Cabotaje presented the Philippine Partnership to fight Tuberculosis Malaria, and AIDS and
the Country Coordinating Mechanism. The working documents are attached herewith as Annex A
and B.
st
The 9 different sectors met in breakout groups to deliberate on the Declration of the 1 Forum of the
Philippine Partnershp to fight Tuberculosis, Malaria and AIDS and to nominate amongst themselves,
a candidate for the Country Coordinating Mechanism (CCM)
The Draft Declaration was discussed and approved in principle for presentation as part of the Manila
th
Declaration of the 24 ICC. Partners were given two weeks to submit, if any, suggestions for
modification. The draft document is attached as Annex C
The following were nominated as candidates for membership to the Country Coordinating
Mechanism:
Academe.
People living with HIV/AIDS, TB &/or Malaria
UP Manila
NIH
Dela Salle University
Samahan ng Lusog Baga
Religious/Faith-Based Organizations
Foundation of our Lady of Hope
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San Juan de Dios TB Clinic
Couples for Christ Gawad Kalinga
Private Sector
Government Health Agency: Regional Level
Dr. Myrna Cabotaje (CAR)
Annex 4a
Philippine Partnership to fight TB, Malaria and HIV/AIDS
Vision:
The Partnership is a network of national partners, international organizations, public and private
donors, governmental and non-governmental organizations (NGOs) and academic institutions
committed to the vision: to fight HIV/AIDS, TB and Malaria so that they will cease to be public health
problems in the Philippines.
Mission
1. To ensure that all patients with TB, malaria and HIV/AIDS have access to effective
diagnosis, treatment, and cure.
2. To stop the transmission of TB, malaria, and HIV/AIDS.
3. To reduce the social and economic toll of TB, malaria, and HIV/AI
DS
4. To advocate for new diagnostic, therapeutic and preventive tools and strategies to eliminate
TB, malaria and HIV/AIDS
Strategic Objectives;
1. To strengthen partnerships with the Department of Health and the Local Government Units
in the control of TB, Malaria, and HIV/AIDS so that proven strategies could be effectively
implemented.
2. To expand and ensure the quality of the currently available anti-TB, anti-Malaria, and antiHIV/AIDS strategy so that all people will have access to effective diagnosis and treatment.
3. To adapt these strategies to emerging challenges like multi-drug resistant TB and Malaria
and co-infection with HIV/TB
4. To apply emerging technologies, when available, to the control of TB, malaria and HIV/AIDS.
Objective 1: to strengthen partnership:
Goals are:
1. Partnership building
a. To build a strong partnership that is inclusive, transparent, responsive to all partners,
and effective at controlling TB, malaria, HIV/AIDS.
b. To build partnerships at the local, national, and international levels
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2. To collaborate through the partnership to ensure that TB, malaria and HIV/AIDS control is
part and contributory to poverty reduction and health sector strengthening.
3. To provide effective governance so that the Partnership
a. Coordinates partner activities to maximize control of TB, Malaria and HIV/AIDS
b. Maximizes value to members and donors
c. Raises sufficient resources to diminish the threat from TB, Malaria, HIV/AIDS
i. to develop plans and raise the resourcws: human, technical and financial, to
eliminate TB, Malaria, HIV/AIDS
ii. to develop mechanisms for setting common priorities for the control and
allocation of resources to the three diseases.
iii. to coordinate with and support resource mobilization efforts of partners.
d. Provides information and communication to
i. build internal and external information and communication mechanisms to
support the partnership
ii. coordinate collection, analysis, and dissemination of information to promote
effective action to control the three diseases.
e. Generate advocacy
i. to develop and coordinate advocacy campaigns to promote effective action
to stop TB, malaria, and HIV/AIDS
ii. to assist partners and local government units in advocacy initiatives.
Obective 2: “Expand” programme implementation
Goals are:
1. To ensure that current strategies for TB, Malaria, and HIV/AIDS control are implemented
using the DOTS, RB malaria, Behavior Change Modification, respectively.
2. To ensure that all programs for TB, Malaria and HIV/AIDS control are made part and
contribute to poverty reduction strategies of the NEDA.
3. to ensure community participation in program implementation.
4. To ensure the engagement of the private medical sector in TB, Malaria, HIV/AIDS program
development and implementation.
Objective 3: Adapt program development to emerging challenges:
1. To implement DOTS-Plus for the management of MDR-TB in the DOTS program
2. To incorporate voluntary counseling and anonymous testing for HIV among select TB
patient groups as a component in the DOTS program to address the emergence of coinfection.
3. To converge DOTS implementation with Malaria Control Program activities and utilize
Barangay microscopists for DOTS implementation in hard to reach areas.
4. To converge DOTS and DOTS-Plus with PPMD in order to fully engage the private medical
sector to the TB control program.
Objective 4: To apply emerging technologies when available
Goals are:
1. To demonstrate the effectiveness and impact of rapid culture techniques and rapid DST for
rifampicin in case finding for MDR TB
2. To demonstrate the effectiveness and impact of Rapid Diagnostic Tests for case finding of
malaria in remote communities of indigenous populations.
Partnership Principles and values
•
•
•
Shared values facilitate attaining shared goal.
Challenge; To work cooperatively without losing the identity of each organization.
Opportunity: To work cooperatively is an opportunity to learn from each other and evolve
accordingly.
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Equity: TB and Malaria are diseases of the poor and HIV/AIDS is a disease of marginalized
segments of the population. These lead to social and economic inequities in a vicious cycle leading
to increased vulnerability to infection and disease, reduced access to care, and inequality of care.
The partners are committed to reduce these social and economic inequities and by providing care
and treatment, improve the health and capacity of the patient to become economically productive,
thereby alleviating poverty.
Shared Responsibility: Through collective action, goals can be attained.
Inclusiveness: All interested individuals and organizations, public and private who share the mission
and vision of the partnership are welcome to join.
Consensus: Decisions are arrived at through consensus to determine priorities and best practice.
Sustainability: The partnership is committed to sustained efforts to increase and improved the
national and local capacities to deal with TB, Malaria and HIV/AIDS
Dynamism: The partnership is dynamic and evolving and is committed to develop innovative
approaches to confront the new and emerging challenges of the three diseases in line with poverty
alleviation projects of the country.
Structure of the Philippine Partnership to fight TB, Malaria, and HIV/AIDS
1. The Partnership Forum:
Interested organizations will be invited to join the partnership and will provide information for the
database of the partnership coming from the following sectors:
1. Governmental public health agencies
a. national agency DOH
b. regional agencies CHD
c. implementing local agencies PHO/CHO/MHO
2. Other governmental agencies/corporations including those involved in economic policy
3. Academe:
4. NGOs/Community-Based Organizations
5. People living with HIV/AIDS, TB and/or Malaria
6. Private Sector and Professional Organizations
7. Religious/Faith-Based Organizations
8. Public-private coalitions
9. Multilateral and Bilateral Development Partners.
The Partners’ forum will be a biennial meeting of the Partnership which shall be held to
1. Consolidate, maintain and increase high level partners’ political commitment to the
objectives of the partnership.
2. Create and exploit opportunities for advocacy, communications activities and social
mobilization
3. Review over all progress, identify problems and new challenges, and exchange
information.
4. Nominate representatives of their sector for membership to the CCM
2. Country Coordinating Mechanism
Represent and acts on behalf of the Philippine Partnership to fight TB, Malaria, HIV/AIDS. It consists
of 31 members elected in a transparent and democratic process to represent\ different groups of
stakeholders who are members of he Partnership. It meets twice per quarter and can call for adhoc
meetings as necessary: Its functions are:
1. To develop a national proposal to the GF for the upscaling of programs to control TB,
Malaria, and HIV/AIDS
a. To monitor and provide oversight function in the implementation of the GF supported
projects on TB, Malaria, and HIV/AIDS
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134
b. To appoint, supervise and assess the Principal Recipient which shall be responsible
for the financial and program management of the GF supported projects.
c. To conduct regular meetings to review the progress of implementation, lessons
learned, challenges, and best practice.
d. To submit quarterly and annual reports on the progress of the GF supported projects
through the LFA.
2. To priorities for action by the Partnership in line with health policy and technical advice from
the WHO
3. To coordinate and promote advocacy and social mobilization in support of the partnership.
4. To identify funding gaps and mobilize adequate resources for the various activities of the
Partnership
The Manila Declaration was approved by the Forum:
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135
Annex 4b: News item from The Manila Bulletin
From STOP TB eForum:
News: RP boosts fight against malaria, TB, AIDS
The Manila Bulletin Online
25 May 2005
**************
MANILA - The Philippines intensifies its fight against
three important public health problems through the
Philippine Partnership to Fight TB, Malaria, and AIDS which
will be launched at the 1st Forum at the Philippine
International Convention Center on June 4 in collaboration
with the 24th International Congress of Chemotherapy (ICC).
Led by the Philippine Department of Health, all
stakeholders interested in the fight against the diseases
are invited to attend the first forum, which will encourage
public private partnership fostered by the Global Fund to
fight AIDS, Tuberculosis and Malaria (GFATM).
The GFATM was created in 2002 to provide additional
resources to those who can make a difference in the control
of the said diseases.
Dr. Thelma E. Tupasi, president of the Tropical Disease
Foundation Inc.(the principal recipient of the GF projects
in the Philippines) is also the president of the 24th ICC.
The first forum will highlight the health and economic
burden of these three diseases in the Philippines today and
discuss the options for possible control of these diseases
to meet the Millennium Development Goals of the government.
The goal seeks a 50 percent decline in the mortality and
morbidity of these diseases by 2015 or earlier.
Private and public partnerships to fight these three
diseases are currently being pursued by coalitions such as
the Philippine Coalition Against Tuberculosis (PhilCAT),
the Philippine National Aids Council (PNAC), the Philippine
Business for Social Progress (PBSP), and the Kilusan Ligtas
Malaria (KLM).
The program for those attending the first forum will also
include attendance in key symposia of the 24th ICC on
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tuberculosis: "Decreasing TB Morbidity and Mortality" and
"The Politics of TB Drug Development."
Particulars are available from the website: www.psmid.org.
Registration is open to all nurses, paramedical and doctors
interested in tuberculosis, malaria and AIDS.
Source: The Manila Bulletin Online
Online at: http://www.mb.com.ph/HLTH2005052635281.html
Annex 5:
CCM Secretariat Report to the CCM Election Committee
CCM Election Committee Meeting, March 29, 2006, 3-5 pm, Office of the CCM Secretariat
Executive Director
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On Site Elections (March 24, 2006, 3 pm to 8 pm, PICC) and Referendum (thru e-mail and fax
from March 27 to March 29, 2006)
NGO/CBO
Total number
Registered voters
Walk-ins
TOTAL
Academe
Registered voters
Walk-ins
TOTAL
13
1
14
Total number
9
1
10
Number voted
onsite
7
1
8
Number voted
on line
1
0
1
Total voted
Number voted
onsite
8
1
9
Number voted
on line
0
0
0
total
8
1
9
8
1
9
Private Sector (Corporate foundations, Professional Orgs and Private for Profit Corps.)
Total number
Registered voters
Walk-ins
TOTAL
15
7
22
Number voted
onsite
11
7
18
Number voted
on line
1
0
1
total
Number voted
onsite
4
1
5
Number voted
on line
0
0
0
total
12
7
19
Faith Based Organizations
Total number
Registered voters
Walk-ins
TOTAL
4
1
5
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1
5
137
CCM Election Results as counted and validated by the CCM Election Committee
Sector
Representati
on
Available
slots for
election
NGO*
3 slots
Nominated organizations
Onsite
Refer
endu
m
Total
Remarks
6
1
7
Elected
member
6
1
7
World Family of GOOD People,
Inc.
Elected
member
8
1
9
Elected
member
Association of Philippine Medical
Colleges (APMC)
5
5
Elected
member
2
2
2
2
11
11
Kasangga Mo ang Langit
Foundation
Remedios AIDS Foundation
Academe**
Private
corp./profes
sional
Orgs.**
Faith Based
Organization
s**
1 slot
1 slot
1 slot
Number of
votes
De La Salle University-Health
Sciences Campus Research
Services
University of the Philippines,
Manila
Philippine College of Chest
Physicians (PCCP)***
Philippine College of Physicians
(PCP) ***
Foundation of Our Lady of Peace
Mission
Couples For Christ-Gawad
Kalusugan
5
1
Elected
member
6
2
2
3
3
Elected
member
* 3 nominees can be voted per voting organization
** only 1 nominee can be voted per voting organization
*** for the private sector voting, 1 voting organization did not vote any nominee and 1
organization voted twice and subsequently 1 of the votes was dropped as an invalid vote as the
official representative already voted.
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Annex 6:
Philippines - Country Coordinating Mechanisms (CCM) Purpose, Structure and Composition
1. Introduction
The purpose of the Global Fund is to attract, manage and disburse additional resources
through a new public-private partnership that will make a sustainable and significant
contribution to the reduction of infections, illness and death, thereby mitigating the impact
caused by HIV/AIDS, tuberculosis and malaria in countries in need, and contributing to
poverty reduction as part of the Millennium Development Goals (MDGs).
According to its Framework Document, the Global Fund finances programs that reflect national
ownership and respect country partnership-led formulation and implementation processes that
build on and enhance, complement and co-ordinate with existing regional and national programs
in support of national policies, priorities and partnerships. In accordance with the Framework
Document approved by its Board, the Global Fund finances programs, among others, that:
a)
b)
c)
d)
e)
Focus on the creation, development and expansion of partnerships among all
relevant players within a country, and across all sectors of society, including
governments, NGOs, civil society, multilateral and bilateral agencies and the
private sector;
Strengthen the participation of communities and people, particularly those
affected by the three diseases;
Build on existing coordination mechanisms, and promote capacity building
and new and innovative partnerships where none exist;
Encourage transparency and accountability; and
Aim to eliminate stigmatization of and discrimination against those infected
and affected by these diseases, especially for women, children and
vulnerable groups.
The Global Fund recognizes that only through a country-driven, coordinated and multi-sector
approach involving all relevant partners will additional resources have a significant impact on the
reduction of infections, illness and death from the three diseases. Thus, a variety of actors, each
with unique skills, background and experience, must be involved in the development of proposals
and decisions on the allocation and utilization of Global Fund financial resources. To achieve this,
the Global Fund expects grant proposals to be coordinated among a broad range of stakeholders
through a Country Coordinating Mechanism (CCM), and that the CCM will monitor the
implementation of approved proposals. Wherever possible, CCMs should build on and be linked
to existing mechanisms for planning at the national level and be consistent with national strategic
plans. CCMs could, for example, build on national programs for the specific diseases (e.g.,
National AIDS Councils, Roll Back Malaria Committees and National TB Control Program) and
National Health Strategies and be linked to broader national coordination efforts including Poverty
Reduction Strategies (PRS) and Sector Wide Approaches (SWAP).
CCM and its members accept the following responsibilities:
1. CCM should function as a national consensus group to promote true partnership in the
development and implementation of Global Fund supported programs and be fully
transparent in its decision-making;
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140
2. All members of a CCM should be treated as equal partners in the mechanism, with full rights
to participation, expression and involvement in decision-making in line with their areas of
expertise. Voting right will be reserved to one per organization/ dept/ group.
3. CCM should be responsive to all national stakeholders. Individual members should hold
regular meetings with their constituents to ensure that representative views and concerns are
expressed in the national forum.
4. CCM should ensure that all relevant actors are involved in the process and provide
transparency to the general public. As such, it is responsible for ensuring that information
related to the Global Fund, such as Calls for Proposals, decisions taken by the CCM, and
detailed information on approved proposals for funding, is disseminated widely to all
interested parties in the country.
5. CCM should determine the details of its functioning, including organizational structure,
election procedures, frequency of meetings, terms of reference, etc
6. CCM should promote sustainability of the GFTM projects beyond the project funding period.
2. Mandate of the CCM.
The CCM emanated from the expansion of the membership and the functions and responsibilities
of the National Infectious Disease Advisory Committee (NIDAC). The Secretary of Health, Hon.
Manuel M. Dayrit, MD, on March 5, 2002, through Administrative Order No. 83-A s. 2002, granted
the authority to health personnel and non-government experts on infectious disease who are
members of the National Infectious Disease Advisory Committee (NIDAC) to assume the role of
the Country Coordinating Mechanism.with expansion of membership. (Annex 1) Currently, the
CCM is a stand alone committee composed of a broad representation from public and private
sector stakeholders.
3. Roles and Responsibilities of the CCM
As the representative of all significant stakeholders at the national level for grants received from
the Global Fund, CCMs are instrumental in developing proposals and overseeing the utilization of
Global Fund resources. The CCM is assisted by a Secretariat responsible for:
1. Coordinate the submission of proposals from all interested stakeholders consistent with
the national objectives for the control of HIV/AIDS, TB, and malaria drawing on the
strengths of various stakeholders to agree on strategy, identify financing gaps in
achieving the strategy based on existing support, prioritized needs of the Department of
Health, and identify the comparative advantages of each proposed partner by:
a. Disseminating the call for proposals to encourage all interested stakeholders to
prepare and submit plans.
b. With the guidelines from the Department of Health, prepare the Terms of
Reference for specific areas in the three diseases, which are relevant to the
national objectives.
c. Provide the mechanics for early submission to allow for an effective deliberation
on the merits of the proposals by the following:
i. Set a deadline of submission of 21 days prior to GFATM submission
ii. Mandate the Technical Working Group in each disease component to
develop, review, and scrutinize proposals following the guidelines
according to the priorities of the country and in accordance with the
policies of GFATM. If necessary, technical advisers can be engaged by
TWG to assist in this process.
iii. The TWG presents their respective recommendation to the CCM at least
10 days prior to GFATM submission deadline.
iv. The CCM makes the final decision to endorse the proposal to the
GFATM.
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141
2. Monitor the implementation of activities under Global Fund approved programs, including
approving major changes in implementation plans as necessary (including
reprogramming of budget lines);
a. Select one or more appropriate organization(s) to act as the Principal
Recipient(s) (PR) for the Global Fund grant.
b. Based on the results of the TRP/GFATM review, the CCM selects one or more
appropriate organization(s) to act as the Sub- Recipient(s) (SR) for the
Global Fund grant approved in each component, as and when necessary;
c.
Evaluate the performance of these programs, including the Principal
Recipient according to agreed upon indicators, in implementing the program,
and submit a request for continued funding six months prior to the end of the
two years of the initially approved financing from the Global Fund; and
d. Ensure linkages and consistency between Global Fund assistance and other
development and health assistance programs in support of national priorities,
such as PRS or SWAps.
4. Structure of the CCM
The CCM is a stand-alone organization headed by a Chairperson and Co-chairperson elected for
a 2-year term, in accordance with the election procedures. The CCM organizational structure is
shown in Figure 1.
CCMs should be broadly representative of all national stakeholders in the fight against the AIDS,
TB and Malaria. In particular, the Global Fund encourages CCMs to aim at a gender balanced
composition. The CCM should therefore be as inclusive as possible and seek representation at
the highest possible level of various sectors.
i)
The constituent members shall elect a Chair and a co-chair.
ii)
The CCM shall appoint an Executive Committee and other CCM committees as
required.
iii)
The CCM shall establish a Secretariat, and shall select an Executive Secretary to
lead the Secretariat
iv)
The hierarchy of authority shall be as follows: CCM; Executive Committee; Chair;
Executive Secretary.
v)
Within the hierarchy, any party can be over-ruled by parties higher in the
hierarchy.
Membership is by constituency and not on the personal capacity of the representative.
Membership matters will be regularly discussed at the CCM meetings.The constituency of the
member represents its membership or the population which it serves and are broadly classified
in the following sectors:
1) Government organization/agencies
2) Non-governmental institutions/agencies:
• Academic Institutions
• Faith-based organization
• NGO community-based organizations
• Private sector
• People living with disease
• Developmental partners.
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The members of the CCM comprise of:
1. Permanent members:
i. DOH
ii. WHO
iii. UN Theme Group on HIV/AIDS (UN/AIDS)
iv. PLWD
2. Rotating members:
i. Other government agencies
ii. Private sector representatives
1. NGO
2. Corporate foundations
3. Public private coalitions
iii. Other bilateral/multilateral development partners
Election to membership is through and open and documented transparent election by their
respective constituents according to the following steps:
1. Initial call for nomination of member organizations through the Partnership forum is the first
step in the following sectors:
• Academic Institutions
• Faith-based organization
• NGO community-based organizations
• Private sector
• People living with disease
2. A screening committee of the CCM specifically for screening nomination of members will
consider the qualifications based on specific criteria for membership, i.e. track record on
initiatives of the organization on TB, Malaria, and HIV/AIDS, transparent financial
administration and management, member of good standing with the Philippine Council for
NGO corporation (PCNC), experience with projects and established relationships with
donors.
3. All interested nominees who meet these criteria will be invited to confirm their interest to
stand for election into membership of the CCM
4. Membership to the CCM is finally selected through an open election.
5. Membership is for a term of two years, without prejudice to re-election, subject to a limitation
of two consecutive terms. An orientation process for new members to the CCM should be
undertaken.
6. The three diseases have their own private-public coalition which shall continue to be CCM
members to represent the respective organizations within their respective coalitions.
o PhilCAT (National level)
o PNAC (National Level)
o KLM (Provincial)
These coalitions are represented in the CCM. The committees are allowed to nominate and rotate
their members to the CCM. Person living with the disease should be selected by these coalitions
to be one of its members. However each group will have only one vote in the CCM. The total
number of members to the CCM should have a limit of 35 members to keep it from being too
unwieldy.
Following the election of members to the CCM in March 24, 2006, the present membership of the
CCM as of June, 2006 is shown in Table 1:
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144
Annexures
Philippine Malaria Proposal
11 CCM Organizational Chart
1 Chair/Alternate
Undersecretary of Health/Director NCDPC
Department of Health
CoChair
USAID
î ïî
11.1
11.2
îï:÷
ð'ñIò óô$ö õ
ø ö ù Iõ ú
Development
Partners
8 (23%)
Public-Private
Coalitions
3 (9 %)
Public
Sector
10 (29 %)
11.3
11.4
11.5
11.6
11.7
6 NGO
7
8
9
-- PNGOC
--TDF
--WVDF
-- Kasangga Mo ang
Langit Foundation
- Remedios AIDS
Foundation
-- World Family of
GOOD People, Inc
-UP CPH
11.8
--APMC
10 Acad
eme
---Salvation Army
UN - WHO
- UN/AIDS
Agencie
H
- UNICEF
s
PhilLCAT
Gov
Health
Agencie
s
PNAC
KLM
-CIDA
-EC
-GTZ
-JICA
-USAID
Bilateral -
Agencies
Non-Health
Agencies
2 -DOH
3
TB
4
Mala
ria
5 -me
HIV/
AIDS
-CHD
-RITM
---Gawad Kalinga
---PAFPI
---Samahang Lusog
Baga
Faith-based
Organization ---Pilipinas Shell
Foundation
---Philippine College
of Chest Physicians
4.3. Eliminating/ dropping members from the CCM:Any constituent member of the CCM can be dropped if it fails to attend three consecutive
CCM meetings or 60% of CCM meetings by either the representative organization or the
alternate organizaiton unless with valid reason. The Chairperson should review the
attendance and interest of all members every six months and is mandated to write and
inform them of their absence and propose to the CCM any action to be taken. The CCM
makes the final decision on dropping a member.
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145
4.3.. Selection of Chairperson and Co-chairperson:
The Chairperson and Co-chairperson are nominated and elected for a tenure of two years. The
two must come from different sectors. Election is by the general membership of the CCM by
secret ballot.
A search committee comprising representatives from each of the sector members: 1) private, 2)
public sector , and 3) development partner, shall perform the task of nominating two appropriate
candidates for each of the two positions to be done a month prior to the election process. They
shall decide on criteria/and qualifications prescribed and agreed upon by the CCM, for each of
the positions as basis of selection. The selected sector representative should provide a conforme
to accept the nomination and to serve the CCM once elected.
The candidates must submit their CVs for circulation to the general membership of the CCM prior
to the election. Election of the chairperson and co-chairperson should take place every
anniversary of the creation of the CCM which is March 2002. The two should be elected by close
balloting of the constituent members of the CCM.
5. The Principal Recipient:
The Principal Recipient (PR) is a legal entity that will receive and manage GFATM funds
on behalf of the country project with transparent financial systems with the capacity in place to
enable the partners to carry out the prepared activities. The PR shall be responsible to the
GFATM for the overall implementation of the program, will liaise with the LFA, coordinates with
the CCM.
The PR should be a member of the CCM and must be elected by the whole
membership of the CCM in open balloting. The PR cannot be the chairman or co-chairman of the
CCM to avoid conflict of interest.
5.1.Responsibility of the PR to the CCM/DOH: 1 The PR should comply with the national program requirements of the Department of
Health.
2 Through the Grant Agreement with the Global Fund, Principal Recipients are obliged to
keep the CCM continuously informed about proposal implementation progress.
3. PRs should provide periodic reports to the Global Fund and to the CCM with
programmatic and financial progress up-dates and an estimate of the usage of the
grant proceeds by different CCM constituencies.
5.2. Sub-Recipient
The sub-recipient is a legal entity with transparent systems of operations who shall be chosen
by the PR with the approval of the CCM to assist in the management of the program
implementation. SRs do not have a direct link to the CCM but are mandatory members in the
CCM. They are not allowed to hold any position within the CCM to avoid any conflict of interest.
All SRs should attend all the CCM meetings and participate in the proceedings. They will
have to submit their reports to the PR and can be called on by the PR to present reports and
other matters as and when necessary.
6. Meetings and Decision-making by the CCM
6.1. Meetings should be held at least twice in a quarter and ad hoc pursuant to request submitted
to the CCM Secretariat by at least 25% of the CCM members. CCM meetings should be as
informative as is possible to allow for the informed participation of all members of the CCM in
decision making.
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6.2. Accordingly, a one-day meeting of the CCM at least once a quarter, specifically on the first
month of the quarter should be organized.
• During this meeting, each membership sector shall break up into small workgroups to
deliberate on administrative and operational issues of the CCM.
• Breakout group discussions into the three disease component projects should also be done
during the one-day meeting to allow for the CCM members who are interested in the disease
component project to review reports of the implementers and to deliberate on the project
implementation and results obtained utilizing process, input, output, coverage and impact
indicators, when available.
• At plenary meeting within the one-day meeting, reports of the three disease component
projects shall be presented by the PR to the CCM.
6.3. A second meeting of the quarter in the second month shall take place to deliberate on the
quarterly report of the disease component project on the quarterly report and approve it for
submission to the GFATM by the PR through the LFA.
6.4. CCMs are expected to forward to the Global Fund minutes of their meetings as related to
Global Fund issues and information on membership changes. For the sake of transparency,
major dissents to decisions taken should be reflected in the minutes.
7. Technical Working Groups
The CCM has three subgroups which function as technical working groups (TWG) on each of the
three program components constituted through an administrative order from the Secretary of
Health. Their function is to oversee and directly guide the three disease components activities
relevant to applications, monitoring and supervision, in coordination with the Principal Recipient
and Sub-recipient, the projects. The TWGs meet on an a monthly or ad hoc basis in the
preparation of documents relevant to the application and through site visits oversees the
monitoring and supervision of the project implementation.
The TWG may also include non-CCM members who may have the expertise required. The TWG
shall be responsible for routine monitoring and supervision. Implementers of the program should
not be involved in M&E to avoid conflict of interest. Regular schedules for field visits should be
established and reports submitted to the TWG within a week after the trip. A checklist for M&E
should be developed by each TWG.
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12 CCM Secretariat :A CCM Secretariat will be established by the Chairperson and will be located within the DOH
premises. Staff to the secretariat will be seconded by the DOH and will report directly to the
Chairperson. The secretariat shall coordinate and conduct the administrative work associated
with running a CCM. The Secretariat can handle such routine tasks as:
• Coordinating the meetings of the CCM and its committees, including preparing draft,
agendas, issuing meeting reminders, making transportation arrangement to bring
CCM members to meeting, preparing draft minutes, and distributing the minutes.
• Distributing GF guidelines and other documents
• Distributing drafts of proposals and other relevant documents
• Maintaining and updating distribution lists
• Maintaining the records of the CCM
• Issuing public announcements of calls for proposals
• Preparing and submitting reports to the Global Fund
• Responding to enquiries from the GF
• Responding to inquiries from other people and organizations.
The Secretariat under the guidance of the Chairperson shall convene the CCM as and when
required.
9.CCM Executive Group: A select group of CCM members will form a core executive group in the CCM and can carry out
selected tasks as and when delegated to them by the CCM. These five- member group are
selected by the CCM and should represent the core constituents (mentioned above). The
members should not have any conflict of interest and should be technically competent to assess
and take independent decisions.
Implementing Guidelines to operationalize the CCM Principles
1. Application for GFATM Assistance:
Proposals to the Global Fund should include a description of how the CCM will oversee the PR(s)
implementation responsibilities and how the CCM will be involved in planning and decisions
during implementation.
2. Supervision of project/program implementation
The implementation of the GFATM project shall be supervised by the CCM through participation
in monitoring and supervision visits or through reports presented and submitted by the
implementers.
3. Application for Phase II funding: Before the end of the two years of initially approved funding, it
is the CCM that will assess implementation progress and submit a request for continued funding
to the Global Fund. The request for continued funding should include consolidated information for
the first 18 months of the program and the objectives, targets, and requested funding for up to
three additional years of financing from the Global Fund. The CCM should also provide
complementary information to support the request, including a country profile on key health
indicators related to the three diseases, as relevant; a description of the functioning of the CCM,
including partnerships brought about among different constituencies; linkages established
between the program and other national initiatives/programs; and the level of and distribution of
other financial resources at the country level to the three diseases and broader related purposes.
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The respective TWG of the disease component project serves as the technical and writing
committee to assist the CCM in performing this function.
4.
Capacity building of the CCM.
4.1.From the DOH:
• Office space
• Administatie Assistant support
• Seconding Staff as Executive Secretary of the CCM
4.2.Organizational Development
• NEC input
• Review of the guidelines in CCM meetings
4.3.From GF
• Allocation of budget to support the Secretariat
Adhoc Committee on CCM
Raman Velayudhan, PhD, WHO
Chair
Members
12.1
Jaime Y Lagahid, MD,
Thelma E. Tupasi, MD,
Fabrice Sergent /
Rita Bustamante,
FSFPI Marvi Trudeau,
PAFPI
Joshua Formentera/
Isidro Compuesto
IDO
TDF
EC
References:
Global fund (2004) Guidelines on the Purpose, Structure and Composition of Country
Coordinating Mechanisms.
Garmaise D and Rivers B. The Aidspan guide to buiolding and running an effective country
coordinating mechanism. 16 December 2004.
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Annex 7
7a. Minutes of the Meeting
nd
2 Project Management Committee Meeting
Boardroom 3, New World Hotel
June 14 & 15, 2006
A. Atttendance
PMC Members:
1. Dr. Mario Baquilod, DOH-IDO
2. Dra. Cristy Galang, DOH-IDO
3. Dr. Lyndon Lee Suy, DOH-IDO
4. Dr. Dorina Bustos, DOH-RITM
5. Ms. Arlene Santiago, DOH-IDO
6. Dr. Rahman Velayudhan, WHO
7. Ms. Cecil Hugo, ACT Malaria
8. Mr. Edgar Veron Cruz, PSFI
9. Marvi Rebueno-Trudeau, PSFI
10. Ray Angluben, PSFI-KLM
11. Dr. Thelma Tupasi, TDFI
12. Dra. Luz Escubil, TDFI
Finance/ Administrative Staff
13. Maris Emperado, PSFI
14. Randel, PSFI
PR Reps
15. Clyde Café, PSFI
16. Melissa Zapanta, PSFI
17. Eva Malabanan, PSFI
18. Rezeil Tugawin, PSFI
Guests: June 14
19. Meredith Gaffney, USAID
20. Delegates from Laos (4)
21. Delegates from Cambodia (6)
Guests: June 15
22. Usec Ethelyn Nieto
23. Director Yolanda Oliveros
B. Determination of a Quorum
100% attendance was recorded for the meeting on the first day. Dra. Thelma Tupasi, Mr. Edgar
nd
Veron Cruz and Ms. Maris Emperado were not able to attend the 2 day due to other
commitments.
C. Review and Approval of the Minutes of May 9 Meeting
The Minutes of the 1st PMC Meeting was sent to all members of the PMC on May 12 via email.
The members already provided their comments via email hence the Minutes was deemed
approved.
D. Minutes of the June 14 Meeting:
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The meeting was convened by Dr. Baquilod at 8:42 a.m. It was explained that due to the
harmonization agreements, the PMC of the Round 5 and the Mancom of Round 2 will be merged
and will meet monthly. This is the first meeting of the merged PMC/Mancom.
It was also explained that this meeting will be a 2 day session as there are delegates from
Cambodia and Laos who will participate in the meeting and the need to call the PR Reps for
Technical Orientation.
1. Work Plan Review
a.
Re Microscopy Training for MTs - Arlene will be point person in coordinating
activity. At least 1 training per quarter should be targeted. Maybe 1st can be done in
Palawan.
b.
c.
d.
External evaluation of trainers – Mr. Ken Lily may be available in August
Hiring of MTs – This will not be done at the moment unless there is a need in the
provinces. Only one per province will be hired, if ever. It is preferred that existing
provincial level MTs or validators be given incentives for QA responsibilities.
Personnel in the area -
û
û
û
û
Project Manager – Provincial Health Officer will be the Project Manager
Asst. Project Manager – Assists the Project Manager and Coordinates
project activities with the PMC/ PHTO. The PHO appoints and may be an
existing personnel within the PHO
Data Officer – In charge of data collation and management at the provincial
level. PhilMIS point person. Appointed by PHO and preferably an existing
personnel in the PHO
Liaison Officer (for PMN) - Regional Malaria Coordinator will act as the
Liaison Officer. They are Dr. Antonio Bautista (CAR-Apayao), Dr. Romulo
Turingan (CHD2- Quirino), Mr. Oscar Macam (CHD4-B- Palawan), Mr. Bong
Estares plus an assistant under him (ARMM- Sulu and Tawi-Tawi).
e. Incentives –
For the PMC/ ManCom members – Those with existing honorarium from Round
2 will receive additional (50%) from Round 5 but not equal to 100% of what they
are currently receiving . The total amount will be equally divided between the 2
Grants. When the money from Round 2 expires, the honorarium will be reduced
back to their original rates. Round 5 will pay 100% of this amount by then. For
newly receiving PMC members, the standard amount provided under Round 2
will be given fully by Round 5.
For the provincial personnel, the Provincial Project Manager (PHO) will also
receive an incentive of P5,000 per month. The Asst. Project Manager, if a new
person to be hired will receive 13,000/ mo., otherwise will receive an incentive
(add on to the basic pay). The Data Officer will receive 9,000/ mo. or just an
incentive if an existing employee is appointed. The Liaison Officer will receive an
incentive; the proposed amount is 5,000/ mo.
The Round 2 policy on travel expenses and honoraria for partner implementers
will be adopted by Round 5
f.
Procurement of microscopes – A comparative analysis of the microscopes intended
to be bought is needed, a matrix comparing Olympus and Nikon. The training or
teaching microscope however will be purchased from Nikon. A survey of the existing
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microscope units need to be done first so we can finalize actual number to be
purchased and not end up having a surplus. Data on the microscopes can be
derived from TDF, Dr. Ootty can facilitate. Government hospitals and facilities without
microscopes will also be provided one.
g. Basic Malaria Management – RHU personnel will be the participants.
schedules (c/o Dr. Lyndon):
July 11 to 13 – Palawan participants (30 pax)
Aug 15 to 17 – Quirino and Apayao participants (30 pax)
Sept 5 to 7 – Sulu and TawiTawi participants (30 pax)
Tentative
h. International Procurement – A letter is to be made by PSFI to DOH-BIHC informing
the Bureau of the intent and the commodities to be purchased. This letter will first be
endorsed by the IDO and then be given to BIHC.
i.
TES and Bio-asay – Instead of New Tropical Medicine Foundation, Inc, as sub-PR, it
will be the Asian Foundation for Tropical Medicine, Inc.
j.
Insecticides for IRS – Reports and recommendations from the vector control
committee will be solicited and suppliers will be asked to present their products for
the TWG to decide.
k.
Epidemic Management Training – 75 pax as target. On June 27-29, a training will be
conducted in Zamboanga. This is a WHO funded activity, but the outputs can be
considered in the accomplishments. Tentative schedules (c/o Dr. Lyndon):
Aug 22-24 (25 pax) – with WHO support
Sept 26-28 (25 pax) - ------------do----------Oct 17-19 (25 pax) - -------------do-----------
l.
COMBI Training – Curriculum for COMBI or COMBI Refresher has to be developed.
Meeting with DOH-HEPO for this purpose scheduled last week of July, 25 or 26.
provincial trainings can start Sept and run till Nov.
m. Training of teachers/ para-teachers – Round 5 targets will proceed and modules
developed under Round 2 will be utilized. Round 2 will shoulder the pilot phase/initial
batch of training of teachers (for pilot phase). Round 5 can support the expansion
phase. Outputs for both phases will be reported by the two rounds. 38 teachers
targeted for Q2.
n. Mass Media campaigns - A standard manual for media will be developed. The
existing WHO material for filaria will be re-packaged to include malaria (c/o Dr. Cristy,
Dra. Dorin and Dr. Jayan). Media engagements will be done after July by the PR
Reps.
o. Malaria in Pregnancy – An AO is being developed by Dr. Yvonne. Dr. Cristy will
follow-up status with her.
p. Barangay Based Management (is this the full title of the training course?)– Course
syllabus to be developed by Dr. Lyndon and Ray, completed by the end of August.
q. Upgrading of Warehouses – A MOA with the recipient is to be developed before
upgrading can be started. An attachment to the MOA should be the plans and cost
estimates.
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Coordination with other health programs – The manual for broadcasters/ media will
be one output of this delivery area since it is a media package containing the three
diseases – malaria, filariasis, and dengue.
2. The intention to submit a proposal for GFATM Round 6 was raised by Dr. Tupasi citing the
need to sustain control efforts and surveillance in the 21 other endemic provinces. The
development and submission of the proposal will be in accordance to the standard guidelines
as set by the GFATM and CCM. The body saw no objection to the submission of a proposal
for malaria for Round 6.
3. Guests from Laos and Cambodia visited in the afternoon. The status of malaria in the
Philippines was presented and discussed by Dr. Galang. Joining the visitors was Ms.
Meredith Gaffney of USAID.
4. The document on Harmonization of the GFATM Grant 2 and Grant 5 was discussed.
Revised document attached.
E. Minutes of the June 15 Meeting:
The Meeting was convened at 8:30 a.m by Dr. Mario Baquilod. Dra. Thelma Tupasi,
Mr. Edgar Veron Cruz and Ms. Maris Emperado could not join the meeting due to other
commitments.
Usec Nieto and Director Oliveros joined this meeting.
1. Establishment of the Project Advisory Council and meeting schedules
The PROJECT ADVISORY COUNCIL (PAC) –The PAC shall be composed of the following:
•
•
•
•
•
•
•
•
•
•
Secretary of Health
Undersecretary of the Health Programme Development Cluster,
Secretary of Health , Autonomous Region of Muslim Mindanao,
Chairman, Shell companies in the Philippines and Cluster Head for Health, Philippine
Business Society for Progress’ attainment of the Millennium Development Goal
WHO Rep to the Philippines,
Director IV, National Center for Disease Prevention and Control (NCDPC),
Director III, Infectious Disease Office
Director, Research Institute for Tropical Medicine.
Regional Directors of the CHD of 4 provinces (CAR, 2, 4-B,9)
Governors of Palawan, Apayao, Quirino, Tawi-Tawi and Sulu.
The committee shall be chaired by the Secretary of Health. The Vice Chair shall be the
Undersecretary of Health Programme Development Cluster.The Infectious Disease Office shall
serve as its secretariat. The committee shall meet at least once a year or as when necessary in
Metro Manila. A quarterly summary of the PMC monthly meeting discussions shall be provided to
the PAC to keep them updated on the progress of the project. Travel and accommodation in view
of these meetings shall be covered by the project.
The following are the functions of the PAC:
• Review the progress of the project implementation
• Ensure that project direction is relevant and consistent to the Global Fund approved
proposal.
• Ensure that project direction is in harmony with the policies of the Department of
Health and the Local Government Units.
• Explore avenues for sustainability and advocacy at the community level.
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The first meeting will be organized tentatively in August 2006 (first week). Dr. Baquilod was
instructed by Usec Nieto to coordinate with the Office of the Secretary to establish exact date of
the meeting.
2. Follow-up discussions of the meeting between Sec. Francisco Duque and Mr. Ed Chua
It was reported by Marvi Trudeau at the CCM and again during this meeting that Department of
Health Secretary Francisco Duque III and Mr Ed Chua , Chairman of the Shell companies in the
Philippines had a meeting last May 16 and discussed the following among others:
a. Declaration of Malaria Awareness Month
b. Designation of an Official Representative of DOH to the Phil Malaria Network
(PMN) and the establishment of the PMN Office in the DOH Compound
c. Endorsement of the DOH to the application of Tax Exemption of Shell Foundation for
the importation of health goods under the Global Fund Round 5 Grant.
The group discussed the above with Usec Nieto and Director Oliveros. The following are the
highlights of the discussions:
Declaration of the Malaria Awareness Day Month
Rationale:
The World Health Organization reports that approximately 3.2 billion people worldwide
are at risk of malaria and an estimated 350-500 million clinical malaria episodes occur annually.
Falciparum malaria causes more than one million deaths each year (World Malaria report 2005).
In the Philippines, malaria remains present in 65 out of 79 provinces, affecting mainly the poor
th
and underprivileged rural communities. It is the 8 overall cause of morbidity nationwide.
While malaria is a vicious disease, most Filipinos are unaware of the cause, the
methods of control, the treatments, or the magnitude of the disease. Unchecked, malaria
spreads rapidly and indiscriminately through communities. Carried by mosquitoes, malaria
infects thousands of vulnerable individuals while they sleep. However, malaria can be
significantly prevented through the use of insecticide treated mosquito nets and insecticide
sprays. Antimalarial drugs exist to treat the ill, and these need to be made available and used
with proper instruction. Malaria can kill within a few days of the onset of symptoms.
There is no organized large-scale malaria public relations effort in the country. The
problem of malaria is normally subsumed under the overall heading of poverty and not specifically
standing out on its own. In order for the disease to be controlled, malaria must be made an
independent cause. Awareness of the various issues is critical if the fight against malaria is to
succeed.
Objectives:
The Malaria Awareness Month celebration seeks to
•
•
•
Increase public awareness about malaria – magnitude, cause, symptoms, treatment, and
prevention;
Mobilize stakeholders from all sectors to participate in raising public awareness; and
Establish partnerships in the nationwide fight against malaria
(Proposed) Theme:
“Tamang Kaalaman, Malaria ay Maiiwasan”
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(options)
(Proposed) Activities:
National Malaria Conference or Congress
Intensified Case Detection and Treatment in Endemic Provinces
Intensified Vector Control activities in Endemic Provinces
Recognition of Provincial Accomplishments
Passing of a significant national policy
(Sports event) for Malaria
Tri-Media campaigns
Etc
In the discussion, the group wanted to declare April as the Malaria Awareness Month so that it
can be aligned with the World Celebration of Malaria Day in April 23. However, Usec. Nieto
reminded everyone that next year is an election year and April will be within the election period
hence people will not be able to do any activity that might be construed as electioneering. It was
agreed that the November be declared Malaria Awareness Month instead in order to prepare for
nd
the 2 peak season of the year for Malaria. The first working day of November will be the day of
the declaration of November as the Malaria Awareness Month at the meeting of the Philippine
Malaria Network. The awareness month will end with the Regional Congress on Malaria (ACT
Malaria) on November 28-30.
The Infectious Disease Office was tasked to :
1. Draft EO by June 30
2. Convene the different agencies and present the draft EO for comments
3. Functions and activities of different agencies
4. Ensure Philippine Malaria Network (PMN) is established.
Designation of an Official Representative of DOH to the Phil Malaria Network (PMN) and the
establishment of the PMN Office in the DOH Compound
Marvi Trudeau raised the need to convene the Philippine Malaria Network. It was declared by
th
Secretary Duque in the Apr 28 MOA Signing for the GF5 at the New World Hotel. TB and
HIV/AIDS have PHILCAT and PNAC respectively which are multi-sectoral coalitions that
lobby/advocate for policies and enhancements in implementation. Malaria would like to follow
suit. The proposal is for the DOH to start the ball rolling with the full support of the Round 5 GF
Project. It was requested that DOH designate an official representative to the PMN who can
organize the coalition as it was organized by PhilCAT. Usec Nieto asked Dr. Baquilod to get the
papers from PHILCAT which we can pattern the PMN. It was agreed that an Adhoc Committee
be established to draw TOR and organizational structure and linkages to institutionalize the PMN
before November.
The above should be complemented by the establishment of an office within the DOH
Compound. The proposal is for the GF5 to renovate part of the old leprosy building to house the
PMN and the malaria cluster of the IDO. This was approved in principle as long as there is an
assurance that no funds will come from DOH for the actual renovation. Usec Nieto promised to
bring this up during the next DOH-EXECOM Meeting. The funds for the renovation will come from
the budget for the upgrading of DOH capacities.
It was also discussed that part of the GF5 budget to support the CCM can also be tapped to be
able to make a big conference room where the CCM can meet regularly and then have it rented
out for others to use in order to be able to sustain the CCM Operations and to pay for the
electricity.
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It was also agreed by the body to recruit asap 2 staff for Philippine Malaria Network:
• PR Person to build network and linkages (for the interim, Charlene of Filaria).
• Administrative person.
The group agreed to meet with RMCs/ Liaison Officers to set them up for work to build key
partnerships for malaria in their areas . RMCs to convene at 1 least 1 partners’ forum per area.
Endorsement of the DOH to the application of Tax Exemption of Shell Foundation for the
importation of health goods under the Global Fund Round 5 Grant.
Marvi Trudeau explained that the Global Fund requires all its procurement to be tax and duty free.
The duties and taxes are expected to be waived by the beneficiary-country. The usual way is to
request the WHO to procure the requirement but a 6% service fee is being imposed plus the 15%
freight cost. Although we will still use this option, PSFI would like to seek other avenues to use
the funds effectively. The program will definitely gain if the Dept of Finance can be convinced to
waived this for the benefit of the program that looks into saving lives. The other benefit is that we
will be able to avoid the long queue in the WHO procurement which will make the delivery of the
goods to the beneficiary at a fraction of the time if we use the WHO option. Sec Nieto directed
Director Oliveros to prepare the endorsement letter for the Secretary to sign . The other option
will be for the DOH to make the procurement through WHO which will lessen the service fees to
3% instead of the 6% levied on PSFI.
3. Regional Malaria Congress with ACT Malaria
It was agreed that the Philippines will participate in the Regional malaria Congress of ACT
Malaria scheduled in November. The Round 5 grant has included this in the budget but will be for
the participants from the 5 target provinces and DOH Central. WHO will also participate by
funding some from their areas of coverage. The participant allotment by ACT Malaria for the
Philippines can be given to the participants from the other provinces. It was agreed that we will
continue to advocate for the Round 2 to provide for the participants from the other 21 provinces. It
was also agreed that some of the funds allocated will be for the participation in the exhibit of the
Congress. Dr. Jayan has suggested to hold the congress in PICC. It was also agreed that the
Philippine delegation should have an extra day after the Regional Congress in order to process
the learnings obtained and to present the best practices in implementation within the country.
4. Marvi announced that an email from Mr. Oren Ginzburg was received last night amending the
start of the project to June 1 instead of May and that the first reporting period will be from June
1to January 31, 2007.
5. PR Reps Update Reports
•
Training for MedTechs on Basic Microscopy: IPHO of Sulu suggested that
training be replaced with additional Barangay Microscopists since the manpower
cannot be sustained at the LGU level. The LGUs are likely to favor the absorption
of the Barangay Malaria Microscopists which entails lesser amount for incentives
(LGU counterpart). The body agreed to reassess the situation. It may be possible
to provide more RDTs in these areas hence, the allocation for Sulu for the
training for MedTthe will come from other provinces which might need it. This is
because said training is still part of the targets/deliverables of the project.
•
RDTs is best in problem spots/conflict areas and necessary for replacement of
microscopes in coastal areas (what does this mean? I think this can be stated
more clearly)
•
Distribution Plan
- Condition precedent of the Global Fund
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156
- Include time element of transfer from the province warehouse to the
municipalities
- Include number of commodities, basis would be the malaria incidence
rates (+ buffer stocks + time difference)
- Indicate transportation facilities
DOH IDO staff to adopt a province in order to ensure that presence is
maintained in all planning workshops at the provincial level.
6. Orientation of the PR Reps
•
Scope of work of 5 PR Reps:
-
•
•
clarify that PSFI Staff should introduce themselves as from Shell
Foundation which is the Principal Recipient of the Global Fund Round
5 Program.
Change of business/calling cards : Movement Against Malaria; Shell
logo with MAM
DOH can go directly to the PR Reps except when there’s costing
involved (any one from the members of the PMC should be given
utmost courtesy
If there are issues in the field, Marvi requested all members of the
PMC to call her immediately so as to avoid miscommunications.
PR role: basically logistic support to the DOH structure
Assist the RMCs who will be the Liaison Officers in each site
PR Rep to act as LFA of the program in the province, PHO is still the
team leader
Hiring of staff per province:
- discourage relatives
- ranked by PHO
- forwarded to the Execom
- TOR to be finalized by the Execom and to be communicated to the
PHOs
Technical Orientation of PR Reps
1. RDTs (Dorin),
2. Microscopy (Arlene),
3. Treatment(Lyndon),
4. Vector control -IRS (Christy),
5. ITN (Jayan),
6. COMBI (Jayan)
Documented By;
Marvi Trudeau
Ray Angluben
Reizel Tugawin.
7b. Global Fund Malaria Component
Management Committee Meeting
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5 July 2006
Conference Room
World Health Organization Country Office
DOH Compound, San Lorenzo, Manila
12.1.1 Attendance
1
2
Dr. Jaime Lagahid
Dr. Mario Baquilod
DOH-IDO
DOH-IDO
3
4
Dr. Ma. Cristina Galang
Dr. Lyndon Lee Suy
DOH-IDO
DOH-IDO
5
Arlene Santiago
DOH-IDO
6
Dr. Dorina Bustos
DOH-RITM
7
Dr. Raman Velayudhan
WHO
8
Cecil Hugo
ACT Malaria
9
Edgar Veron Cruz
PSFI
10
Marvi Rebueno-Trudeau
PSFI
11
Ray Angluben
KLM
12
Dr. Thelma Tupasi
TDF
13
Lourdes L. Pambid
TDF
14
Ianne Mencidor
TDF
12.1.2 Call to Order
The meeting was called to order at 9:15 AM and presided over by Dr. Mario Baquilod.
12.1.3 Review of and business arising from the minutes of the June 14 – 15, 2006 meeting
Page 2, D. Minutes of the
meeting
1. Work Plan Review
External evaluation of
trainers
Personnel in the area
Provincial Project
Manager &
Assistant Project
Manager
•
Dr. Velayudhan said that the external evaluation of microscopy
trainers will be done by Mr. Ken Lily in October 2006.
•
The Terms of Reference (TOR) of the 4 field personnel (Provincial
Project Manager, Asst. Project Manager, Data Officer and Liaison
Officer) shall be drafted and circulated by Marvi Trudeau for
comments before these personnel are endorsed to the PHO.
Incentives to be given to partners shall be disclosed formally to the
PHO.
The Provincial Malaria Coordinator shall automatically become the
Assistant Project Manager. If there is none, then whoever is the
LGU point person for malaria will fill in the position. Regional staff
deployed as DOH rep in the province may also be considered. Only
if necessary will a person be hired.
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Page 3, Liaison Officer
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Incentives
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Procurement of
microscopes
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Basic Malaria
Management
Page 4, TES and bioassay
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Insecticides for IRS
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Honoraria/Incentives of Regional Malaria Coordinators (RMC) under
GF5 may be a possible issue. This may not be allowed by the
Regional Directors or the Directors themselves will expect that they
will be given honoraria which are not among the plans of the GF5
project. It was agreed that upfront, the Directors will be told that the
RMCs will be given P5,000 honoraria for additional tasks as liaison
officer of GF5 Project which is not part of their job description as
malaria coordinators. This shall be tied to timely submission of
reports by the RMCs and included in their TOR.
Dr. Jayan reminded that in giving salaries to people who need to be
absorbed by the LGUs, the rates should take into consideration the
capacity of the LGU to maintain these rates.
A comparative analysis between Olympus and Nikon microscopes
was done. Basically, the advantage of Nikon YS100 over Olympus
is the oil immersion lens which is made of glass and, therefore, more
durable. Nikon also has available local service. Dr. Jayan shared
the findings of Dr. John Story with Nikon brand. If one has the
money to spend, Nikon is the better brand because it has better
resistance against fungi. Other points to consider are the following:
should have a mirror and battery operated light source, can be
secured in a box, shelf life of 15 years. But, Dr. Lagahid pointed out
that most of their microscopes for TB are Olympus (CX 31 or 41)
with available spare parts and that they have not encountered
problems with these.
Also, local service is available. The
advantages of having only 1 brand of microscope were also
considered such as managing spare parts. The body agreed that
the suppliers will be asked to attend the next Mancom meeting to
answer questions about their products to guide the members in their
decision-making.
Training in Palawan will be conducted on July 12 in collaboration
with the Filariasis Program
GF 5 is considering the Asian Foundation for Tropical Medicine as its
sub-PR for TES and bioassay activities. Requirements for a work
order to be issued by PSFI to the Foundation are the SEC
registration and the bank account. This system, however, may
create some problems with the release of funds. From the
experience of Dr. Bustos, it takes a long time for funds to be
released and she had to shell out personal money just to continue
with the implementation which had timelines to follow. In a meeting
with Dr. Lupisan, Cecil Hugo said that funds to be transferred to
government organizations will still go through local cost of the
institute and through COA. Dr. Lagahid mentioned that there is also
a DOH policy that all APWs will go through the scrutiny of BIHC
especially if the implementer is RITM.
The body decided that instead of work orders, the funds will remain
with PSFI and budget requests will just be made by the
implementers of the activities; the same system which is being
implemented by TDF for GF2.
Marvi said that she wants the procurement process for GF5 to be
done transparently. In line with this, they have secured a copy of the
DOH Department Order on the criteria for selection of IRS to have a
basis for selection of insecticides. However, Dr. Jayan pointed out
that the DO will not be very useful in helping the body decide which
insecticide to procure since all the insecticides being considered are
among those which have already passed the DOH criteria. But there
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Epidemic Management
Training
COMBI training
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Training of
teachers/Parateachers
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are other aspects to consider in deciding which to procure such as
the price and the packaging.
Suppliers for insecticides will also be asked to attend the next
Mancom meeting to present the merits of their products.
GF5 is considering procuring through local suppliers and they are
working to get tax exemptions.
It was clarified that the insecticides that have been procured by GF2
(ICON) are still effective, have passed the criteria of DOH and have
gone through a deliberation process by the TWG also.
Dr. Jayan shared that there is a new ICON in granular formulation
and in smaller packaging which will allow easier transport and less
expense.
There are 148 sachets of insecticides per sealed drum of ICON. In
Palawan, they only reported 98 – 100 sachets per drum. Other
provinces like those in Region 11 have reported 148 sachets/drum.
TDF will sample opening drums in other provinces to check if there
are similar cases. If so, this will have to be reported to WHO for
possible replacement.
1 batch of training was shouldered by WHO and another by GF2.
June 27 batch was shouldered by GF5 (?).
Dr. Cristy will invite the Health Promo staff of DOH to a meeting on
July 26 – 27. The output will be a COMBI plan in the 5 provinces of
GF5 specifying the strategies.
Marvi has stopped all IEC
activities/plans in the areas until such time that the COMBI plan has
been developed. Health Promo staff will also be involved in the
provincial activities. It was pointed out that the following should be
developed: key messages, logo and song so the program gets an
identity.
Marvi informed the body that Dr. Luz Escubil has suggested for GF5
to proceed with the proposed plan of Clyde (PSFI rep of Apayao) to
train teachers to become core of trainers. Marvi said that she has
rejected this idea since GF5, as indicated in the minutes of the last
meeting, will only fund the expansion phase and that GF2 is
supposed to be responsible for the pilot phase and the orientation for
the initial batch of teachers. It was explained by Lou Pambid that Dr.
Ooty has suggested that because in GF2, there was no plan to train
a core of trainers. The plan included only the pilot testing of
modules and the orientation of the initial batch of teachers to be
done by the PMT and the provincial partners. In the spirit of
harmonization, the team in Apayao and Clyde found that GF5’s plan
to train a core will be more beneficial if the core was trained first so
they will be utilized in the orientation of teachers already both in the
initial phase and in the expansion phase.
Marvi stated that the PMT in Apayao does not know the health
promotion plan for GF2 because it was only the National-based
staffs who know of the plan and that the field staffs just wait for
instructions for implementation. She also said that there was also no
coordination of activities citing one instance where GF5 has already
conducted a Malaria Awareness Day and then a month later GF2
conducts another Malaria Awareness Day in the same area. Lou
said that the allegation that only the national staffs know of the
health promo plan and that field staff just wait for instruction is not
true since there is even a provincial health promotion plan. Since
GF2 has already been implementing in the area and that they
already have their plans, it should be GF5 that should be adjusting
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Mass media
campaigns
Malaria in pregnancy
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Barangay-based
Malaria Control
Program Management
Training
Upgrading of
warehouses
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Collaboration with
other programs
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their plans. She also pointed out the fact that Dr. Dangao, who is a
very active Provincial Health Officer and on top of the activities, will
not allow those things to happen in her province. She said she will
clarify the facts with Dr. Dangao.
List of teachers trained by GF2 will be provided to GF5.
Standard manual for media will be drafted by August and finalized
before November.
Dr. Yvonne’s group will meet regarding the AO entitled Guidelines
for the implementation of an integrated helminthes control program.
An approved Administrative Order is needed so that anti-helminthics
nd
can be given to pregnant women during their 2 trimester as part of
the pregnancy package to be given, in addition to mosquito net and
iron pills.
There is actually no system that is picking up data to show what
proportion of pregnant women acquires malaria. This is still being
gathered.
WHO manual for health workers will be adapted to Philippine
situation with minor changes.
Soft copy of the manual was requested from Dr. Jayan.
Received budget estimates from Ray for Palawan but will be
returned because it is over the budget by P300,000. Plan will be
given to a private group for review.
Cost estimates for the DOH warehouse upgrading shall be the
responsibility of Dr. Mario (half a million pesos).
Tawi-tawi already got the estimates but PSFI has not received it yet.
Sulu is still in the process of planning.
Apayao site has already been seen and they will have a new
warehouse. PSFI will advocate for the counterpart of the governor.
Quirino will have its warehouse expanded and it will have an office
for the warehouse.
The Leprosy building that is being considered for setting up the CCM
conference room and Philippine Malaria Network office has a rotten
roof and it would be costly to repair this. The planned CCM
conference room will be rented out to other programs and the profit
will be used to sustain CCM meetings and activities and the salaries
of the secretariat. Budget for the conference room and the PhilMAN
office will be charged to the warehouse renovation budget. But if the
costs of renovation becomes higher than initially planned, then some
of the budget for CCM will also be used which was intended only for
activities and not renovation expenses.
A MOA will be drafted stating that PSFI is allowing the GF Project to
MOA with the government; goods will be allowed to be stored there
and that GF goods will have priority over the rest; that the office of
the Philippine Malaria Network will have its electricity and water
connected to the Infectious Disease Office and that IDO will provide
security and maintenance.
Filariasis Program will collaborate with GF5. On July 11 to 13, there
will be a basic malaria management training in Palawan. GF2 will
meet with the MHOs for half day and Filaria will also meet with them
for their orientation and planning. Shell has provided medicines for
filaria.
GF5 will consider collaboration on training of microscopists on TB for
the 5 provinces it covers. Resources will be shared such as
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microscopes.
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Page 5, Harmonization of
the Round 2 and
Round 5 Grants
Page 6,
7. Establishment
of the Project Advisory
Council
Schedule of
Mancom/PMC meeting
Project Advisory
Council meeting
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Page 11, Regional Malaria
Congress with ACT
Malaria
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DOH will provide information on microscopes distributed in ARMM
areas.
Ray reported that there is an on-going training on TB microscopy
sponsored by JICA and that GF microscopes were borrowed.
It is a condition precedent for GF5 and needs to be approved and
endorsed by the CCM.
GF5 will provide supplies for Zonal Giemsa Production Centers in
Palawan and Zamboanga. GF2 will provide for zonal centers in
Davao, RITM and Tuguegarao. RBM will pay for the cost of
renovation and painting of the zonal center in Zamboanga.
The schedule of ManCom/PMC meetings will be every Monday
before the CCM meeting. In months where there are no scheduled
nd
CCM meetings, it will be on the 2 Monday of the month. The next
Mancom meeting is on August 14.
Scheduled on August 3, 2006, Thursday. Governors of 5 provinces,
the DILG secretary and RITM director will also be invited. There
should also be a presentation of what GF2 had accomplished and
the governors will be asked about their commitments.
The GF5 Malaria project has already been presented to the DOH
Execom and the support of the Secretary has been assured.
Ms. Cecil Hugo presented the draft program for the congress
scheduled November 27 - 29. It is actually the 10th anniversary
celebration of ACT Malaria. Along with this, the Philippine Malaria
Forum will also be conducted.
Clarifications on the contributions of the organizations are currently
being made. ACT Malaria is now ready to launch the website.
Tentative program
st
o Opening in the 1 day – exhibits, opening ceremonies in the
evening;
nd
rd
o 2 and 3 day will be the sessions; 2 concurrent sessions in
nd
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the 2 day – vector control & diagnosis & treatment; 3 day
– local initiatives for sustainability of malaria control and info
systems. Plenary sessions.
o For presentations, innovative researches, strategies and
approaches are preferred, not basic research
Philippine presentation still needs to be discussed.
ACT Malaria takes charge of the opening ceremonies.
The
suggestion is for the Department of Health to take charge of the
closing ceremonies and this will coincide with the closing of our
Malaria Month.
Still waiting for the implementation letter for the Malaria Month
Exhibit hall; 16 booths available; side booths for sponsors
Major funder – USAID and WHO
Launching of information resource system; getting support from
Globe so participants can log on into the data base
Global and regional situationer
Global recommendations, updates and strategies
nd
2 day – Vietnam, Thailand and Malaysia – successful MCP
PM concurrent sessions – Diagnosis & Treatment; Transmission
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Prevention and Prevention and Control
Day 3 – Plenary sessions; fake drugs
RBM presentation; Malaria Awareness for Ethnic Minorities – WHO
and ADB; Issues on Decentralization and Integration of programs –
Indonesia
Other networks outside the region – Amazon region closer to
situation in Asia than Africa may be invited
Concurrent sessions in the afternoon – surveillance and information
system and IECs, local initiatives
Program for the Philippine Forum organized by the Department of
Health, 1 day
Dr. Tupasi has suggested that it may be a good idea to hold a follow
up meeting for the Forum for the Philippine Partnership to fight
AIDS, TB and Malaria. This might be done in the first day or on the
last day. However, if done on the last day, that may be more
expensive since this means another night for accommodation so that
holding it on the first day may be a better idea.
Budget of USD100 per person for registration, USD70 for Philippine
delegates; Can afford to sponsor more participants if registration can
be brought down to less than P2,000
Cecil shared that countries that host the congress usually give their
share.
Dr. Lagahid said that if the information has been
communicated to the department earlier, they could have also given
their share like the support they have given for the schistosomiasis
anniversary. Dr. Tupasi also suggested that they could also
approach PCHRD for support. Dr. Lagahid gave commitment to give
DOH counterpart in the amount of P200,000.
12.1.4 Approval of the minutes of the meeting
The minutes of the June 14 – 15, 2006 meeting was formally approved by the body.
12.1.5 Minutes of the July 5, 2006 meeting
Presentation of the
Quarter 11 Report of GF2
Trainings
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•
The Progress Update and Disbursement Request for Quarter 11 was
presented by Lou.
The weaknesses in the implementation for Q11 were brought to the
attention of the Mancom members.
Although the project has exceeded cumulative targets for number of
trainees on malaria diagnosis, targets for refresher course on
malaria microscopy for barangay microscopists in Palawan have not
been met due to the problems of counterpart funding from the LGU;
the issues on how the trainings shall be conducted (should it start
with a 3 day evaluation of the trainees first or not, etc) and the
difficulties with the synchronization of schedules of both trainers and
trainees.
Targets for clinical management training have also been exceeded.
Reports for trainings on clinical management of malaria, which
include severe malaria management, Basic Malaria Management for
RHU staff, Orientation on the National Guidelines for Malaria
Chemotherapy among RHU nurses and midwives have not been
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Diagnosis & Treatment
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Vector Control
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received since Phase 1. Dr. Lyndon has been requested previously
to submit these reports using the 1-2 page format. The LFA has
been asking for copies of these reports.
A total of 537 microscopes have already been procured of which 476
have been distributed to the provinces with 411 having MRs by end
users. Number allocated for validators will be confirmed with Athon,
the Logistics Supervisor.
There is still no combination RDT but Dr. Jayan said that we will
come up with one within year of 4 of GF2 project and meet the
targets.
Targets for number of facilities receiving drugs and number of health
facilities with malaria diagnostic and treatment centers have been
exceeded.
26,140 patients have been diagnosed and treated covering the
period August 2005 – April 2006. There is a decreasing trend in the
number of cases but in some provinces, there is an increasing trend
specially among year 2 provinces which shows that case-finding has
improved as a result of the health facilities set up.
The difficulty in reporting the indicator - number and proportion of
patients with severe malaria receiving correct diagnosis and
treatment was also reported. The members agreed that Dr. Dorin
Bustos will prepare a simple matrix which will include the following:
registry number, date of admission and discharge, sex, age, final
diagnosis and outcome.
The Provincial Project Coordinating
Officers will be asked to visit the main hospitals (provincial hospitals)
and fill out the forms on all hospital admissions for malaria. Letter to
the PHOs signed by Usec. Nieto will be prepared by DOH.
There was also difficulty in getting reports in the number of patients
treated with ACT. Palawan which is expected to have the most
number has not reported on this. Ray gave an assurance that he
will provide reports.
The project did not do too well in the areas of retreatment and
bednet distribution.
For retreatment, the problem was due to the lack of insecticides
since the procured goods from WHO are still awaiting delivery. It was
already reported in the May 4 -5 TWG meeting that there is a
problem with the amount of insecticides available so that the
question on whether a portion of the P4M bednet collection can be
used to procure insecticides locally was posed (since these were the
ones identified as urgently needed). The TWG did not decide but
instead recommended that the needs of the provinces be assessed
first. It may now be too late to procure locally since the process may
take some time and by the time the goods are delivered, the ones
ordered from WHO will have arrived already. This means that
instead of retreating before the peak season of July to September,
nd
retreatment will be done before the 2 peak season which is
November to December. (This led to a discussion on why November
was chosen as Malaria Month.) Dr. Jayan will inform TDF of the
possible time when procured goods will arrive so that we will have
an idea on whether to procure locally or not.
Dr. Lagahid pointed out that the procurement process should be
started early. It was explained that the process was actually done a
year early, however, there were some problems encountered such
as the delay of almost 2 quarters before the funds were received and
the
delay
in
the
receipt
of
cost
estimates
from
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Round 6 Malaria Proposal
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WHO.
Net distribution has slowed down due to the fact that the community
organizers which used to facilitate distribution up to the barangay
level have not been renewed. Also, distribution relies on the
capacity and availability of the LGUs to distribute since it is their
counterpart to distribute from the provincial level to the municipal
level and to the barangay level. Also, the LGUs want to recover cost
so that in some cases, this prevents households from acquiring nets.
A DOH memo/guideline will be released on Friday, June 30
containing the following:
Deadline for LGUs to distribute nets is August. It will be stated in the
directive that if they fail to distribute within the specified period, the
nets will be pulled out and will be turned over to other organizations
such as church/faith-based organizations, air force, department of
defense for distribution.
Household counterparts should not be a deterrent for poor people to
gain access of the nets so the amounts should be reduced if not
given for free
Counterparts collected shall be pooled at the provincial level and will
be used solely for procuring nets, insecticides and anti-malarial
drugs. Procurement shall be done centrally by TDF.
Dr. Mario will be responsible for the release of this memo/directive.
Letters to the other government agencies and the faith-based
organizations should be released so they will also be ready for
distribution.
Letters signed by Dr. Lagahid have been given to Kalinga and
Palawan giving instructions to account for and centralize the net
collections. There have been no actions on this by the provinces.
Dr. Lagahid requested to have a copy of the letter so that they can
follow up and reiterate the turn-over of the funds at the provincial
level.
The indicator on the number of children under 5 using ITN will be
reported using results of the bednet utilization survey which is
currently being conducted in 13 year 2 provinces. The protocol has
been coordinated with Dr. Jayan. Palawan will also conduct their
bednet utilization survey this quarter because they did not conduct
one in Phase 1.
Vector control plan will be finalized by the TWG sub-committee on
vector control. The results of the meeting on July 4 will be provided
by Mr. Oscar Macam. Lou will provide Dr. Cristy with the list of
provinces where bioassay and susceptibility tests will be conducted.
On the number of houses sprayed with insecticides, the ones
reported are houses sprayed with insecticides using those coming
from the zonal stockpiles. Reports received from zonal stockpiles
are just summaries and without a listing of the household names. It
was agreed that the reports that will be expected from the zonal
stockpiles should use the PhilMIS forms.
There will be no
replenishment for the stockpiles without the reports.
Although there were a lot of structures set up, those reported for the
quarter are the functional ones.
Background: Provinces are complaining why they were not included
in Round 5. After the end of Round 2, an upsurge in cases in the
provinces may result if the activities are not sustained; Oren said that
areas covered by GF projects should not be left high and dry after
the project and the best thing to do is ask for additional funding by
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Presentation of the draft
concept proposal
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submission of proposals in succeeding rounds.
First attempt at proposals usually do not succeed so that if we do not
succeed this round, we can still try Round 7.
In the last CCM meeting, it was pointed out that the plan to submit
proposal for Round 6 should first be consulted with the Malaria
TWG/Mancom. The Mancom meeting was attended by Dr, Tupasi
in which she asked each member present about their opinion. On
page 3, item 2 of the minutes of that meeting, there was no
disapproval. Dr. Tupasi then wrote to the CCM addressed to Dr.
Lagahid and Dr. Loloy Bontuyan, asking for the approval of the
attached advertisement calling for submission of concept proposals
for HIV and Malaria. But, when Dr. Tupasi called Dr. Lagahid she
was surprised because Dr. Lagahid asked whether it was approved
by the Malaria TWG or not.
Dr. Lagahid explained that even if it was not yet clear to him on
whether the TWG has approved it or not, he had already given the
go signal for the advertisement because if this was not released,
there will be problems later on due to the tight schedule.
Dr. Tupasi explained that she wanted to know whether the DOH is
giving its full support to the submission of Malaria Round 6 because
there is no sense in going through the whole complicated process of
application and proposal writing if it would later on be rejected by the
DOH. But, she reminded that the GF project may probably be the
only hope for the country in eradicating the 3 diseases so we should
be aggressive about applying. She assured the group that she is not
making money out of the projects. She wanted DOH to look at the
foundation as an extension of their staff in the implementation of
their programs.
The opinion of each member was asked:
Dr. Lagahid said that DOH is not opposed to a submission of
proposal as long as the TWG unanimously supports and approves it.
Dr. Jayan said that WHO supports whatever the DOH decides.
Marvi said that the TWG has already given its approval and she
agrees with Dr. Tupasi in her opinion that the opportunity that the GF
offers should be grabbed. The only thing the body wanted to see is
the gist of the approval which should be presented to the CCM.
The concept proposal that was the result of the initial consultation
with some partners was presented by Dr. Tupasi.
Proposal is entitled: Sustaining gains in malaria control in rural
Philippines through intensified development of local capacity and
health systems and through public private partnership
The goal is to sustain the gains of GF Round 2 and strengthen
surveillance to attain the elimination of malaria as a public health
problem
Focus is to empower the local government units through publicprivate ownership.
Activities will include health systems strengthening, health policy
development and behavior change communication activities.
Comments from the members were solicited. Should include the
following:
Bednets
Epidemic management
Distance Learning Program/ Step Ladder Education for BHWs/Bgy.
Microscopists, Medtechs
Category A & B provinces – justification?
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Harmonization between
GF Round 5 & Round 2
Grant Implementation
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PhilMIS Updates
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Logistics
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Data validation
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Q12 plan
•
Goal and objectives stated should be improved.
In page 3, number 2, Procurement and Supply, 2.3
Supplies for Zonal Giemsa Production Centers in Davao, RITM and
Tuguegarao will be supplied by GF2. Zonal centers in Zamboanga
and Palawan will be supplied by GF5.
In page 3, number 2, Procurement & Supply, 2.4
Lou and Ootty will provide the percentage against original target of
conventional nets to be provided to the 5 provinces.
In page 3, Monitoring, Evaluation and Reporting, 3.1
GF2 will fund monitoring activities of the national and regional
personnel for Quirino and Apayao; GF5 for Palawan, Tawi-tawi and
Sulu
The body approved the Harmonization Plan, whose final version will
include the comments above. This will be signed by the heads of
both Rounds for presentation to the CCM which will then endorse
the document to the Global Fund. Submission of this plan will lift it
from being one of the conditions precedent to disbursement for GF5.
PhilMIS has been deployed in Kalinga, Apayao, Sarangani and
Palawan; Next will be SDS, Bukidnon, Misamis Oriental, Agusan del
Norte and Tawi-tawi.
For budget covering Tawi-tawi, Dr. Jayan has requested GF5 to fund
orientation amounting to P350,000. WHO has a budget ceiling of
USD10,000 for PhilMIS.
Budget for remaining PhilMIS activities: SOG, Forms, orientation,
software deployment was clarified:
Mindanao provinces – c/o WHO
Round 5 provinces – c/o PSFI
Luzon provinces – c/o TDF
This is already included in the harmonization plan.
Centralized reproduction of forms – need to know quantity needed
then this will be canvassed and cost shared by WHO, GF2 and GF5.
Timeline is approximately 1 month form now. Information needed
shall be given to Dr. Jayan and processing will be started.
Final version of PhilMIS – the version given in Sarangani can be
considered version 1A
Change of forms for Palawan and other points of Darius shall be
addressed later.
MOA – there should be 2. One will be at the PHO level regarding
the computer set and the task of data management; the other will be
about the ownership of data. MOA drafted previously shall be
forwarded by Lou to Dr. Jayan.
Additional container van may be provided by Dr. Jayan by August for
use by GF2. There are actually 6 available. Dr. Laghid has also
offered the use of the DOH warehouse.
rd
3 line drugs have not been requested by Regions 4A and B
because Dr. Cristy has already provided them their requirements.
Dr. Cristy and GF2 will both share information on the drugs and
commodities distributed so that everyone will be kept informed on
the resources given to the provinces.
NPO have gone to the 26 provinces to validate reports that have
been submitted.
Reports on the validation are still being
consolidated.
Lou will be coordinating with Arlene, Dr. Lyndon and the vector
control group with regards to their plan.
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Financial Report
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GF5 Updates
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Period covered in the report is August 1, 2005 to June 30, 2006 (
reported expenses for June are still tentative since PMT reports are
not yet received as of reporting date)
Cumulative Utilization for year 3 (as of June 2006) as follows:
Total Revised Budget - $3,326,806 ; Total reported expenses $3,079,319 which results to a 93% overall utilization broken down
as follows: HR 106% ; Infrastructure & Equipment 92% ;
Training/Planning 69%;
Commodities
& Products
100%
(commodities are procured on May 19, 2006); M&E 93% & Admin
Cost 59%
Funds available as of June 30 (tentative) - $247,487 (this excludes
remittances from LGUs for procurement for commodities totaling
P4M) and this represents 7% of the total budget- currently and still to
be utilized in July 2000
Unspent budget for trainings shall be utilized in the following
quarters
Total PMTs liquidated expenses : P46,080,662.60
Official notice of Letter of Implementation was received on June 29,
2006.
Total funds received from GF is USD6,444,860. Reporting is biannual and will be harmonized with the reporting period of Round 2.
Social preparation activities have been started in the provinces. This
include settling of PR reps in their areas of assignment, provincial
profiling and project orientation for stakeholders.
In Sulu, meetings with local government officials including the
Governor and Patikul mayor have been conducted. A provincial
orientation for implementers was held on June 20. Other partners
like Tabang Mindanao were met. A meeting with the Regional
Malaria Coordinator of CHD9, DOH ARMM and GF2 PMT was called
on June 27. An Epidemic Management Training was held in
Zamboanga City on Juen 27 – 29, 2006 attended by 14/16
participants.
In Tawi-tawi, meetings with LGUs and RHUs were held to discuss
the project orientation, role of PSFI as PR and integration of GF5
targets in existing workplan of RHUs. Tawi-tawi warehouse has
been inspected. Orientation and planning workshop was held on
June 28 -29.
An orientation for PHO and CHD staff and MHOs was conducted in
Palawan on May 26. Media were also briefed about the project and
this was carried in the evening news of a local station, and through
radio programs.
MOA for upgrading of warehouse is being
developed.
Project orientation and courtesy calls have been done among the
ProvManCom and the local government officials and barangay
health workers. Provincial planning was one on June 7-8 with
outputs including the provincial plan, logistic management plan,
bendet allocation and distribution scheme, possible trainees and
potential sites for electrification, warehousing and MALARIA
AWARENESS DAY CELEBRATION plan.
The Malaria Network was launched in Quirino on June 6 followed by
Provincial Planning on 7 and 8. Project orientations were also done
among LGUs.
Collaboration with Filariasis Program has been forged and Shell will
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Philippine Malaria Proposal
•
•
•
•
•
•
•
provide medicines for the province of Palawan and Sulu.
Staffs for project administration have been hired.
Preparations for procurement are being made including working for
tax exemption endorsement. Software for logistic management is
being developed.
They are also working on the Declaration of the Malaria Awareness
Day.
Several meetings on Harmonization with GF2 were called.
Preparations are also under way for the Malaria Congress.
Financial updates: Expenses as of June 30, 2006
Operations: 1,554,017.09
Admin:
1,299,169.26
Total:
2,853,186.35
Malaria counterparts from KLM-SFI were also reported
It was reported that Oren has approved USD6M to be under
overnight placement earning 4%p.a – 7.5% tax or 3.7%. Interest
earned from June 7 – 30 is USD15,786.72
12.1.6 Adjournment
The meeting was adjourned at 5:10 PM.
Prepared by
Approved by
Lourdes L. Pambid
Dr. Jaime Lagahid
Dr. Mario Baquilod
Annex 8:
July 18, 2006 CCM meeting minutes
COUNTRY COORDINATING MECHANISM (CCM)
PHILIPPINES
Minutes of the Meeting
July 18, 2006
9:00AM to 12:00 PM
Tiara Oriental Hotel - Makati City
12.1.6.1.1.1
EXECUTIVE SUMMARY
The CCM meeting was held last July 18, 2006 at the Tiara Oriental Hotel from
9:00 am to 12:00 pm. This is a special meeting called specifically to look into the
proposals of HIV-AIDS and Malaria in response to the 6th Call for Proposals by GFATM.
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Philippine Malaria Proposal
The other topics presented for information/update were : Malaria Harmonization
for Rounds 2, 5 and 6; Request from the TWG of Malaria for the support of WHO and
GTZ for Technical Assistance in Proposal Writing; Request of Malaria group for the
approval by referendum of the CCM the Round 6 proposal and status report of TB for
Round 5.
The Round 6 Proposal of HIV-AIDS was presented by Mr. Joel Atienza of DOH
and that for Malaria by Dr. Luz Escubil. Both reports were approved by CCM in principle
but with revisions. The revised HIV- AIDS Proposal is due for circulation to the CCM
members on July 24, 2006 and the Malaria Proposal on July 27, 2006 .
The other items in the agenda were not discussed anymore since they are
supposed to be part of a regular meeting.
The meeting was presided by Dr. Siana Tackett of USAID, being the CCM coChair. There were 25 members in attendance, 3 were on Official Business and 9 were
not represented.
The next CCM meeting will be a regular meeting scheduled on August 8, 2006.
1.
ATTENDANCE
12.2 CCM MEMBERS
NAME
A.
1.
AGENCY
ATTEND
ANCE
DOH
P*
OB
P
P
A**
On
Leave
P
A
P
P
P
2.
3.
4.
5.
Government Sector
Usec Ethelyn P.Nieto/
Dr. Yolanda Oliveros
Ms. Arlene Ruiz
Dr. Remigio Olveda
Dr. Peter Galvez
Dr. Thelma Dangao
6.
7.
8
9.
10.
Dr. Ricardo Sakai
Dr. Dulce Estrella –Gust
Hon. Austere Panadero
Dr. Jaime Montoya
Dr. Myrna Cabotaje
B.
Private Corporate foundations and Professional
Organizations
Ms. Marvi Trudeau
PSFI
P
Dr. Renato Dantes
PCCP
A
NGO- Community-based Organization
11.
12
C.
NEDA
RITM
DND
LGU- Apayao
NCIP
OSHC-DOLE
DILG
PCHRD
CHD-CAR,
DOH
REPRESENTATIVE
Mr. Francis Ong
Dr. Fe Espino
Mr. Cesar Montances
Dr. Antonio Bautista
Mr. Ray Angluben
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Philippine Malaria Proposal
13.
14.
15.
16.
17
18
D.
19.
20.
E.
21.
Dr. Melvin Magno
Dr. Thelma Tupasi
Ms. Eden Divinagracia
Mr. Rey Langit
Dr. Jose Narciso Sescon
Dr. Jocelyn Park
People Living with the
Disease
Mr. Joshua Formentera
Mr. Fernando Collera
UN/Multilateral Agency
Dr. Jean Marc Olive
22.
23.
F.
24.
25.
26.
27.
28
G.
29.
Dr. Ma. Elena Borromeo
Dr. Nicholas Alipui
Bilateral Agency
Dr. Mie Kasamatsu
Dr. Fabrice Sergent
Ms. Myrna Jarillas
Dr. Michael Adelhardt
Dr. Aye-Aye Thwin
Academe
Dr. Caridad Ancheta
30.
H.
Dr. Fernando Sanchez
Public-Private
Collaboration
Dr. Jubert Benedicto
Mr. Ray Angluben
Ms. Irene Fonacier-Fellizar
31.
32.
33.
I.
34.
Religious Organization
Mr. Charles Malcom
Induruwage
35. Dr. Jose Yamamoto
* P- Present ; ** A- Absent
WVDF
TDFI
PNGOC
KMALF
RAF
WFGP
P
P
P
A
P
OB
PAFPI
SLB
P
P
WHO-Phil
P
UNAIDS
UNICEF
A
P
DOH-JICA
EC
CIDA
GTZ
USAID
P
A
A
P
P
UP-CPH
P
APMC
P
PhilCAT
KLM
PNAC
P
P
OB
SA
P
CFC-GK
P
Dr. Raman
Velayudhan
Ms. Ema Naito
Dr. Takeshi Kanoye
Dr. Siana Tackett
Prof. Buenalyn
Ramos
Airene Margarette
Lozada
Annexures
Philippine Malaria Proposal
13
Others present:
171
172
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Philippine Malaria Proposal
14
A.
1.
2.
3.
4.
5.
6.
7.
8.
9.
B.
1.
2.
3.
4.
5.
6.
C.
1.
2.
3.
4.
5.
6.
7.
D.
1.
2.
3.
4.
5.
DOH/TWG/CCM SECRETARIAT
NAME
TWG-TB
Dr. Jaime Lagahid
Dr. Rosalind Vianzon
Dr. Vivian Lofranco
Dr. Celine Garfin
Dr. Ernesto Bontuyan, Jr.
Mr. Onofre Merilles, Jr.
Dr. Michael Voniatis
Ms. Amelia Sarmiento
Mr. Tito Rodrigo
NAME
TWG- Malaria
Dr. Mario Baquilod
Dr. Cristy Galang
Dr. Lyndon Lee Suy
Dr. Raman Velayudhan
Ms. Lourdes Pambid
Dr. Luz Escubil
TWG-HIV-AIDS
Dr. Gerard Belimac
Dr. Nerissa Dominguez
Ms. Ruthy Libatique
Dr. Dorothy Agdamag
Dr. Aura Corpuz
Dr. Ferchito Avelino
Mr. Noel Pascual
CCM SECRETARIAT
Ms. Agnes Maria Oliva del
Rosario-East
Ms. Cirila Negad
Mr. Joel Atienza
Ms. Rose Habana
Ms. Maricel Montero
AGENCY
ATTENDANCE
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
TDFI
WHO-P
PHILCAT
PHILCAT
P
P
OB
OB
P
OB
On Leave
P
P
AGENCY
ATTENDANCE
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
WHO-P
TDFI
TDFI
OB
OB
P
P
P
P
IDO-NCDPC-DOH
WHO-P
PNGOC
TDFI
NEC-DOH
PNAC
PINOY PLUS
P
P
OB
P
P
OB
P
IDO-NCDPC-DOH
P
IDO-NCDPC-DOH
IDO-NCDPC-DOH
TDFI
TDFI
P
P
P
P
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15
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
OTHER GUESTS/PARTICIPANTS/OBSERVERS
NAME
Dr. Nobuko Yamagishi
Dr. Norito Araki
Mr. Leydo Gamiao
Dr. Meredith Gaffney
Dr. Corazon Manaloto
Dr. Joselito Vital
Dr. Elmer Garcia
Dr. Girlie Nieto
Mr. Edison Cervantes
Dr. Tomas Maramba
Ms. Norma Miranda
Ms. Jeanie Curiano
Ms. Ianne Mencidor
Ms. Maria Cristina Ignacio
Ms. Maria Catalina Roxas
AGENCY
JICA
Embassy of Japan
PHILCAT
USAID
USAID
GTZ
CFC-Gawad Kalinga
HPDC-DOH
FS-DOH
NVBSP-DOH
TDFI
TDFI
TDFI
TDFI
TDFI
COMMENCEMENT
1. Call In to Order. The meeting was called to order at 9:30 a.m. by Dr. Siana
Tackett, CCM Co- Chair from USAID. There were 25 members in attendance, 3
were on Official Business and 9 were not represented.
2. Minutes of the meeting.
Review of the minutes of the June 13, 2006 meeting.
There was also a comment that since the meeting is a Special Meeting, the CCM
Agenda, which is for a regular meeting, should not be followed anymore. The
meeting was called only to look specifically at the proposals of HIV/AIDS and
Malaria for Round 6 which is for approval of the CCM body. In the interest of the
issues at hand, therefore, the review of the minutes was dispensed with for the
regular CCM meeting in August..
Before proceeding to the review of the minutes there was a comment on the agenda.
The report on Malaria Harmonization was joined altogether for Rounds 3, 5 and 6
and was placed at the end instead of being the first item.
III. Meeting Proper
1.1. Concept proposals submitted for Malaria Round 6
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Philippine Malaria Proposal
Dr. Velayudhan on behalf of the screening committee, reported that they
received 5 concept papers for malaria. Three on Basic Concepts on Malaria
1) Building capacities for Malaria – Council for Health Development
2) Strengthening of LGU in partnership with the education Sector – SITMO
3 ) Same concepts as listed in Round 2 focus on 5 provinces –Agape
and Two operational researches
1) UP-CPH - Survey on the Burden of Malaria
2) PYCOR was rejected because the concept of using a larvicidal agent had
no evidence of efficacy in the vector control as a strategy for malaria control
The three proposals on basic concepts and 1 OR were integrated into the country
coordinated proposal for malaria in addition to the concept proposal submitted by the
writing committee.
1.2 . Proposal for HIV-AIDS Round 6
Three concept papers were received for HIV-AIDS from UP-CPH, APO- UP DILIMAN
and NOVATEK.
The HIV-AIDS proposal was presented by Mr. Joel Atienza of the Department of Health. The
proposal basically wants to address the gaps in the National Aids Program with an $11 M budget.
•
•
•
Gap Analysis: Among others, cited were:
1. Weak VCT
2. Weak Linkage between prevention and treatment and care and support
3. No PMTCT program in place
4. Limited funds for quality assurance and others
Gap Analysis: National Blood Program
1. Inadequate pre and post donation counseling
2. Lack of standard information for pre donation counseling
3. No system to trace the hidden paid replacement donors
Goals:
To maintain HIV prevalence to less than 1%
To reduce impact of HIV/AIDS among PLWHAs, their families
and significant others
Comments on the presentation :
Comments/Issues
1. Weakness in M & E ; there is a need
to focus on M&E – Programmatic,
Response
1. The proponents will consider the
suggestions as part of the final
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Philippine Malaria Proposal
Managerial, Financial
Support for CCM should also be included
2. Initially the budget was $25M but now
as per the presentation it was halved
to $11M
3. Re-think the budget, it is up to the
GFATM to cut, however the absorptive
capacity of the country should also be a
good point but should not be
underestimated.
4. As a middle income country – we need
counterpart funding – Does the
Philippines have the counterpart
funding?
5. The thrust of Round 6 should include
the RH and because the HIV/AIDS is not
an stand alone program.
6. SHC’s will have all these services. But
how about those who do not what to go
to the SHCs as stated in the earlier
meetings.
7. Are all blood donation tested for HIV?
proposal.
2. It was explained that during the
PNAC meeting – it was advised that
the proposal should focus more on
specific aspects of the proposal,
reaching the most at risk population
and build on existing activities of
Round 3
• It was also advised that reducing costs
was also based on the historical
capacity of the program :Round 3 – 6M
and for Round 5 – 7M. It might not be
acceptable to GFATM having a high
budget.
3. The project really needs the 28M
since there are issues and gaps that
need to be addressed so the
proponent should ask for what is really
needed.
• There is a need for an optimal effect
for the program. Therefore, we do
not need to limit ourselves to $ 11M.
4. In the PNAC meeting it was decided
that the group should not depend so
much on the GFATM.
• We still do not have the complete
counterpart funding. If government
counterpart is not enough, just
focus on the priority areas.
5. RH will be included in the SHCs and
in the education aspect of the outreach
component.
6. The proposal extends to the most at
risked population such as the migrant
workers.
• To address this concern, 20
migrant workers will be trained on
counseling to educate their peers.
There will be setting up of also of
VCT centers also where OFWs
would go to. Blood donors can
also go to private and public
centers.
7. Due to lack of resources not all blood
are tested but are tested sequentially.
For Round 6, there will also be a
simultaneous testing with hepatitis.
• Need to recalculate the need for
blood testing since we also need
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Philippine Malaria Proposal
8. It was cited that one of the
requirements needed for the CCM is that
the PR can’t be the CCM chair at the
same time. If DOH will be PR then they
should also not be the chair of CCM
since there is a conflict of interest.
to test for Hepa C, Hepa B,
Syphilis, HIV and Malaria
8. It was mentioned there is no conflict
since in Cambodia they are PR and
CCM Chair at the same time.
• It was stated however that a policy
really existed that the PR cannot
be the CCM chair and that it is
good to be aware because we
might be unnecessarily
disqualified.
• It was further added that what is to
be submitted is a country
coordinated proposal not a DOH
proposal.
• It was decided then that for the
deliberation of Round 6, DOH can
abstain during the votation for PR
and that there should be a written
document or guidelines that in the
event DOH becomes PR they will
relinquish CCM chairmanship.
It was moved and unanimously approved that the proposal be approved with minor
revisions.
The TWG on HIV-AIDS , which will meet on Friday, July 21, 2006, can be a good forum
for the review and revision of the proposal. It was agreed that the proposal be circulated
and reviewed by the CCM for finalization via email on the 24th .
1.3 . Malaria Proposal for Round 6 - Presented by Dr. Luz Escubil
The Malaria Program funded by GFATM in Round 2 is currently on its third year moving
on the 4th year and ending by 2008 . It covers the 26 highly endemic areas of the
country.
The goals, the activities and major strategies of the project were presented. The
challenges and constraints were cited as follows:
• Need to continue the services of the Barangay Microsciopists (BMs) in the endemic
provinces and the BMs in low endemic areas should continue to function through
active case detection
• BMs need intense supervision by medical technologists for quality assurance.
• Need for quinine to be provided to hospitals and 1st line and 2nd line anti-malarial
drugs in RHU
• Barangay (village) Health Workers need to undergo continuing monitoring and
quality assurance of Rapid Diagnostic tests (RDTS )– to make the RDT sites
functional with the introduction of combination RDT for P. vivax and P falciparum.
177
Annexures
Philippine Malaria Proposal
•
•
•
•
Health workers with RDTs should be provided with first line drugs and given the
authority to administer them to ensure early appropriate treatment
Community organizers are essential and should be maintained to facilitate
community mobilization, a major strategy for community empowerment using
appropriate and culturally sensitive information, education, and communication (IEC)
materials
Need to sustain and consolidate the gains that were attained particularly in the 21
provinces not covered by GF MP in round 5 (GFMP5) which only covers 5 of the 26
highly endemic out.
The number of cases were noted to be increasing in four emerging provinces and
epidemic outbreaks have occurred in some of the 21 provinces.
Therefore, to address these, the submission of a proposal for Round 6 was approved by
the Malaria TWG and Mancom in two meetings held June 14 and July 5, 2006 . With this
in mind, a draft proposal was presented to Mancom of the Malaria TWG was approved
for presentation to the CCM.
COMMENTS/ISSUES
It was cited that education /training /
volume of work should be considered for
the BMs in order not to lose their skills
there is a need for quality assurance.
•
•
•
The use of RDTs – some of these are not
appropriate or are they are effective for
Philippine use?
Integration of BMs work (e.g. include
parasitism etc.) network of labs happened
before, however with the local autonomy, it
did not work.
•
•
•
•
•
RESPONSE/DISCUSSION
The RP right now is an international
resource in quality assurance (QA) for
malaria miscroscopy,
It was explained that there are four
programs with QAs being piloted
globally and the RP is one of them
Checking of 120 slides per year
submitted through a randomization
scheme agreed upon by provincial
validators and BMs.
In addition, on-site visits are also made
RDTs are checked by the RITM (in the
whole Asia Pacific Region) before
being released RITM deserves the
credit for this important role they play.
Specifically, field testing is also done to
ensure the effectiveness of the kits at
field conditions.
Integration of BMs which include
BHWs, midwives who were taught and
trained for 5 weeks.
After this, they can read malaria
smears and are doing well. This has
been validated by site visits.
There is a need to advocate to
integrate with other programs so that
their services can be maximized and
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Annexures
Philippine Malaria Proposal
Would like to know how does this relate to
the proposal on HIV round 6?
Is there some kind of synergy?
•
Would like to follow the concept of PrivatePublic partnership like in TB
•
the LGUs will be more motivated to
support their services by providing
incentives.
These are two separate proposals
being submitted by the country.
Synergy is more between TB and
Malaria. The malaria services in hard to
reach areas would expand access to
TB care beyond the reach of the NTP .
The malaria group met with Faith –
based organizations (FBOs) and these
are the people working in the field will
be tapped as sub-recipients to provide
additional manpower and infrastructure
that are already in place and will
receive technical assistance and antimalarial drugs and commodities for the
services that they are currently doing .
It was agreed that the proposal can be strengthened through consultants who
have been requested to review the proposal. This has been coursed through DOH
endorsed to Bureau of International Health Concerns (BIHC).
The CCM agreed that a revised proposal should be circulated through email to the
CCM members after the TWG and Execom finalize the proposal so that CCM
could be able to give their inputs and comments.
The selection of the principal recipient (PR) will also be made through a referendum by
July 27th .
1.4. Update of TB Round 5 – by Dr. Thelma Tupasi
The objectives and impact indicators were presented which included the 2007
Nationwide Prevalence Survey. Negotiations are also on going and grant signing is
expected soon.
1.5. Update on HIV Round 3 Phase 2 and HIV Round 5 – by Dr. Dorothy Agdamag
Dr. Agdamag cited that the grant has already been signed and an implementation letter
has been received. Resolution of existing issues on the HIV Round 5 are still ongoing
and will be presented in the next CCM meeting.
IV. ADJOURNMENT
The meeting was adjourned at 12: 15 p.m. and the rest of the agenda will be discussed
in the next meeting on August 8, 2006.
Prepared By:
Annexures
Philippine Malaria Proposal
MS. AGNES MARIA OLIVA V. DEL ROSARIO-EAST, RND, MPS-FNP
Senior Health Program Officer
IDO - NCDPC DOH
CCM Secretariat
MS. CEELA D. NEGAD, RN, MAN
Supervising Health Program Officer
IDO - NCDPC DOH
CCM Secretaria
MS. MARCELA MONTERO
Program Assistant
TDFI
Approved By:
JAIME Y. LAGAHID, MD, MPH
Director III and Executive Director
CCM Secretariat
179
180
Annexures
Philippine Malaria Proposal
Annex 9:
Nomination and Election of Principal Recipient by Referendum
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Dear CCM Members
Greetings!
The deadline for submission of the Round 6 Proposals is fast approaching. With the approval of
the Round 6 Malaria proposal in the last CCM meeting, we hope to fast track all the necessary
requirements needed to ensure that we meet the deadline (August 3, 2006). As part of this
proposal, there is a need to select by nomination and election the Principal Recipient (PR) for the
Malaria component. In this regard, the CCM Chair through the CCM Secretariat is seeking
nomination for Principal Recipient (PR) of the Round 6 Malaria Component among the CCM
Members.
Due to the limited time available, may we request that the deadline be on July 27, 2006
(Thursday), 5:00 pm and that your nominations be sent via e mail in this address
([email protected]).
The nominees for PR will then be elected by referendum among the CCM members by 5:00 pm
July 31, 2006.
In the selection of PR, please consider the following criteria:
1. Track record in the management of projects with the same magnitude
2. Duly registered juridical body under the Securities and Exchange Commission (SEC)
3. Accreditation by the National Council for NGO Certification as donee institution
4. Track record of involvement in the processes of Malaria, TB and HIV implementation
Yours truly,
Dr. Jaime Y. Lagahid
Executive Director
CCM Secretariat
DR. JAIME Y. LAGAHID
Executive Director
CCM Secretariat
Office: Infectious Disease Office, 3rd Floor, Bldg 13
National Center for Disease Prevention and Control
Department of Health , Sta. Cruz, Manila
711-68-08/ 7438301 loc. 2350/2352
Annexures
Philippine Malaria Proposal
181
Dear CCM members,
As there has been a request to extend the deadline for the nomination of PR in order to review
the Malaria Round 6 proposal, we would like to inform you that the deadline has been re set to
July 28, 2006 until 5:00 pm.
The malaria round 6 proposal will be circulated before the end of the day for your reference.
We look forward to getting your nominees.
Thank you and best regards.
DR. JAIME Y. LAGAHID
Executive Director
CCM Secretariat
Office: Infectious Disease Office, 3rd Floor, Bldg 13
National Center for Disease Prevention and Control
Department of Health , Sta. Cruz, Manila
711-68-08/ 7438301 loc. 2350/2352
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Dear Dr. Tupasi,
Kindly refer to the attachment for the nominees for the PR (based on the CCM members
correspondence with the secretariat)
4 have responded and nominated TDFI.
DR. JAIME Y. LAGAHID
Executive Director
CCM Secretariat
Office: Infectious Disease Office, 3rd Floor, Bldg 13
National Center for Disease Prevention and Control
Annexures
Philippine Malaria Proposal
182
Department of Health , Sta. Cruz, Manila
711-68-08/ 7438301 loc. 2350/2352
annie" <[email protected]>
View Contact Details
Add Mobile Alert
To:
"Dr Jaime Lagahid" <[email protected]>
Subject:Nomination
Date: Thu, 27 Jul 2006 16:13:58 +0800
Dear Dr. Lagahid:
I respectfully nominate Tropical Disease Foundatioon as Principal recipient for the Malaria
component.
Sincerely
Dr. Eden R. Divinagracia
Fri, 28 Jul 2006 15:39:20 +0800
"Peter Paul Galvez" <[email protected]>
View Contact Details
Add Mobile
From:
Alert
To:
"CCM Secretariat Philippines" <[email protected]>
Subject:Re: CCM Nomination for Malaria Round 6 Principal Recipient - Deadline July 27, 5:00 pm
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"Melvin Magno" <[email protected]>
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more
To:
[email protected]
Subject:PR nominee
Dear CCM secretariat:
I apologize for this late response because of a server problem and just get this info. today. If it is
not too late, I would like to nominate the Tropical Disease Foundation as the Principal Recipient
for the Round 6 Malaria proposal.
Thank you.
Sincerely yours,
Melvin Q. Magno, MD.
National Health Advisor
World Vision Development Foundation, Inc.
Wed, 26 Jul 2006 00:17:36 -0700 (PDT)
"ricardo jr sakai" <[email protected]>
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Subject:Re: CCM Nomination for Malaria Round 6 Principal Recipient - Deadline July 27, 5:00 pm
183
Annexures
Philippine Malaria Proposal
To:
"CCM Secretariat Philippines" <[email protected]>
To CCM Secretariat
c/o Dr. Lagahid, Executive Director
CCM Secretariat
I would like to nominate Tropical Disease Foundation (TDF) to be the Principal Recipient (PR) for
Round 6 - Malaria component.
Thanks.
Dr. Ricardo Sakai Jr.
NCIP
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Dr. Jaime Lagahid
Executive Secretary
CCM Secretariat
Dear Dr. Lagahid:
We are honored that the Tropical Disease Foundation has been nominated to be the Principal
Recipient of the Malaria Global Fund Round 6 Malaria Proposal.
We respectfully accept the nomination and present herewith the brief profile of the TDF as
required by the CCM. Please see attached file.
Thank you for your kind attention and we look forward to a favorable consideration.
Yours truly,
Thelma E. Tupasi, MD
Executive Director and President
Tropical Disease Foundation
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Annexures
Philippine Malaria Proposal
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Organizational Profile
The Tropical Disease Foundation (TDF)
The Tropical Disease Foundation (TDF) is a private, non-stock, non-profit
science foundation organized in 1984. Its vision is the enjoyment of the right to health for
all. The mission of the TDF is the control and prevention of infectious diseases of public
health importance through research, training and service. The TDF’s thrusts are 1) to
conduct research, training and service in infectious diseases of public health importance;
2) to enter into partnership with public and private agencies in the implementation of
programs in the control of infectious diseases; 3) to enter into partnership with national
and international institutions involved in research to ensure technology transfer; 4) to
serve as a national and international training center for infectious diseases. Tuberculosis
has been the main focus of the research and training initiatives of the TDF. It undertook
the 1997 nationwide tuberculosis prevalence survey on behalf of the Department of
Health.1
15.1 Accreditation
The TDF is accredited by the Philippine Council for NGO Certification (PCNC) and as such, it
undergoes an external evaluation of its standard operating procedures and its financial and
management systems every 3-5 years for accreditation. As a donee institute, the TDF can accept
donations from philanthropist which could provide tax benefits to donors to the extent allowable
by law.
The TDF is also a member of the STOP TB partnership and a member of the Roll Back Malaria
Partnership. It is also an active member of the Philippine coalition against Tuberculosis.
(PhilCAT).
Global Fund to fight AIDS, TB, and Malaria:
The TDF, through Dr. Tupasi (chairman of the National Infectious Disease
Advisory Committee for the DOH, (NIDAC) initiated the organization of the Country
Coordinating Mechanism (CCM) by expanding the membership of the NIDAC. The CCM
comprises of representatives from private-public sector and multilateral and bilateral
development organizations required by the GFATM for coordinating a national
applications for GF projects and oversees the Principal Recipient (PR) and
implementation of the GF projects.
The TDF was co-chair of the CCM until November 2002 when the TDF was
elected as the the PR of the GF projects. As PR, the TDF is responsible for the fund
management and monitoring and evaluating (M&E) the implementation of the program
by its sub-recipient implementing partners.23 Clinical, operational and health systems
research to evaluate the feasibility, effectiveness and efficiency of these public health
Annexures
Philippine Malaria Proposal
185
interventions implemented in the GF projects is therefore an important component of the
M&E function of the TDF. There is therefore an urgent need to build capacity for these
activities within the TDF and for it to train future generation of scientists to sustain
evidence-based public health policy and practice review and modifications. The
objectives of the ICOHRTA Phase II respond to this need.
Since its nomination and subsequent election as Principal Recipient of the GF
projects on TB and malaria in Round 2 and HIV/AIDS in Round 3, the TDF has
successfully managed the GF projects, performing beyond the expectations of the GF as
a principal Recipient and has successfully steered all the three projects to a successful
application for Phase 2 funding. It is now negotiating through the Local Fund Agent
(LFA) for a favorable recommendation of its budget, Procurement management system,
and Monitoring and evaluation system for endorsement for favorable consideration with
the Global Fund Secretariat, through it portfolio manager. It is expected that the start up
date for the two projects will be 1 August 2006 barring more delays in the negotiations
with the LFA.
15.2
15.3 The Scope of TB Research at the TDF in the next five years
An assessment of human and resource capacities of the TDF and its research
activities and research training needs have been recently undertaken (Table 1) These
will serve as a research base for the in-country mentored proposed research training
program as well as the identification of resource development needs.
The TDF has received research funds from the Tropical Disease
Research/UNDP program of the World Health Organization for Research Capacity
Strengthening through the project: “Community-based DOTS-Plus Programme for the
Management of Multi-drug Resistant Tuberculosis (MDR-TB): Pilot Project at the Makati
Medical Center”. 13
Research support has been granted by the STOP TB at WHO Headquarters to
study adverse drug reactions in patients on DOTS-Plus and to undertake an economic
evaluation of the DOTS-Plus pilot project. A clinical trial on shortening the duration of
standard short course chemotherapy from 6 months to 4 months in HIV non-infected
patients with fully drug-susceptible, non-cavitary pulmonary tuberculosis with negative
sputum cultures after 2 months of anti-TB treatment is currently underway in
collaboration with the TBRU of Case Western Reserve University. Laboratory research
has included 1) analysis of fluoroquinolone resistance among M. tuberculosis.
Resistance to ciprofloxacin and ofloxacin was noted in 51.4% of MDR-TB strains, 25%
and 46.9%, respectively in mono- and multi-resistant strains, and 17.4% and 24.4% of
pan-susceptible strains.19 This high prevalence of resistance to the fluoroquinolones
reflects widespread use of these drugs which are added as a single agent to a failing
regimen. 2) Genetic diversity of M. tuberculosis strains isolated in the 1997 NTPS has
been undertaken to understand the epidemiology of TB in the country. 20 A similar study
on isolates from patients in the DOTS Clinic analysed through spoligotyping and
restriction length polymorphism (RFLP) show significant diversity with majority of
spoligotypes belonging to the Manila family followed by the Beijing strains which were all
MDR-TB.
Annexures
Philippine Malaria Proposal
186
More recently, the TDF has participated in a multi-country study on the
Preservation of Effective Second-Line Tuberculosis Treatment with the CDC.
Community-based TB care for MDR-TB patients has been initiated and has showed a
decrease in default rate compared to facility-based DOT-Plus.22
15.4 Training and manpower development program of the TDF
The intramural manpower program has largely been capacity building for the
TDF. At the Makati Medical Center, an active research and clinical fellowship training
program in infectious diseases has been in place since 1987. In addition, short term
training on various aspects related to the implementation of the GF TB projects have
been attended by TDF staff.
. In addition to the training undertaken in relation to the manpower development
program of the TDF, extramural training program includes a clinical fellowship training in
infectious diseases which the TDF undertakes jointly with staff of the Infectious Disease
Section, Department of Medicine, Makati Medical Center. Since 1988, there have been
twelve clinical fellows who have graduated in the training program of two years duration.
Publications have been published as a result of the manpower development
program and the clinical fellowship program. The TDF also undertakes Lecture Series
(Table 2.3) that are given by national and international leaders in various areas of
medicine. These lectures are usually attended by the Medical Staff of the Makati Medical
Center. . In addition, to be able to reach out to a bigger audience, the TDF also
undertakes circuit courses, which are done in various provincial sites outside the Metro
Manila area. . The circuit courses attended by more than 1,500 participants including
physicians, public health practitioners, nurses, and medical technologists brought
didactic teaching to various towns and cities in the Philippines to be able to gain more
participation at less cost to the practicing physicians and other paramedical health
personnel. Among the topics taken up was Tuberculosis and TB Control. In these
courses, research training was not included. However, the same format may be followed
to bring research training closer to the various provincial sites.](Table 2.4) Training for
DOTS and DOTS Plus implementation have also been undertaken for doctors, nurses,
and nursing students by the staff of the TDF
15.5
15.6 Linkages of TDF with national and international organizations
The TDF has established linkages with Philippine-based institutions including the
NTP, the Philippine Tuberculosis Society, The Nutrition Center of the Philippines. The
Philippine Tuberculosis Society also provides hospital beds for patients needing inhospital management and the Nutrition Center of the Philippines will undertake a joint
project on nutritional aspects of TB treatment. In the establishment of the MMC DOTS
Clinic, linkage has also been established with the local government unit, the Barangay
San Lorenzo (San Lorenzo Village) as well as with the Health Department of Makati City.
187
Annexures
Philippine Malaria Proposal
Through the approval of the GLC of the WHO Working Group on DOTS-Plus for the
Management of MDR-TB, links with the TB program of the World Health Organization
both at Headquarters and the Western Pacific Regional Office as well as a cooperative
agreement with the TB Elimination Division of the Centers for Disease Control and
Prevention have provided technical and logistic support to the research and training
program of the TDF in the implementation of the DOTS and DOTS-Plus pilot project.
With their support, training of staff have been undertaken at the Korea Institute of
Tuberculosis, the Institute of Tropical Medicine in Antwerp, Belgium, and an exchange
program with the staff of pilot projects in Riga and Lima, Peru. In addition, the TDF has
received a grant from the Lilly Foundation to develop a center of excellence in TB
training and a donation of the site by the Ayala Corporation is under negotiation.
Areas
Human Resources
Christian Auer
Ruben Encarnacion
Luz Escubil, MD, MPH (UP)
Lourdes Pambid, MPH (UP)
Nona Rachel Mira, MPH
(UP)
Albert Angelo Concepcion,
MHSS (DLSU)
Grace Egos, MSPH (UP)
Albert Eugenio,
MAGN(PLM)
Thelma E. Tupasi, MD
Edwin Onofre Merilles, BSN
Edwin Onofre Merilles, BSN
Virgil Belen, BSN
Vilma Co, MD,
Edwin Onofre Merilles, BSN
Maryrose Alcaneses, MD
Nellie V. Mangubat, BSFT
Nellie V. Mangubat, BSFT, Ruffy
Guilatco, BSS
Ma. Tarcela Gler, MD
Vilma Co, MD,
Lourdes Pambid, MPH
Ma. Imelda Quelapio
Lualhati Macalintal, MD
Vilma Co, MD
Ma. Imelda Quelapio, MD, Nona
Rachel Mira, MPH,
Ruth Orillaza, MD
Vilma Co, MD,
Luz Escubil, MD, MPH
Christine Asonio, BSN
Maryyose Alcaneses
Strengths
I. Postgraduate Doctorate:
a) Public Health and Epidemiology
Swiss Tropical Institute, UPCPH
b) Clinical psychology
Ateneo University
2. Masters degree:
a) Public Health
b) Health Social Sciences
c) Public Health, major in medical microbiology
d) Public Administration
3. Non-degree Training
a) Research Methodology(WHO/Kuala Lumpur)
b) Certificate on Field Epidemiology(FETP/DOH)
c) Management for International Public Health(CDC)
d) Nurse administration graduate program
e) TB/HIV Operational Research (CDC. Malawi)
f) Intensive Training in Research Ethics (UP-Fogarty,
Philippines)
f) Fundamentals on data management (Family Health
International/DMID/NIH/ Bangkok)
i) Monitoring and Evaluation Workshop
(SEAMEO/Trop Med, Bangkok)
g) Management of TB Program (Sondalo)
h) Training Course for DOTS-Plus Consultants (Riga, Latvia)
4. Workshop
a) Proposal Writing (SEAMEO/Trop Med, Lao)
b) International Clinical Research Workshop
(FHI/DMID/NIH/Bangkok)
c) Workshop on Advocacy and Technical Needs
(SEAMEO/Trop Med , Bangkok)
d) TBRU/DMID/PPD Clinical Monitoring Workshop
(CWRU, Cleveland,OH, USA_
188
Annexures
Philippine Malaria Proposal
Lourdes Pambid, MPH,
e) Monitoring
Luz Escubil, MD, MPH,
(UPCPH, Manila)
Evangeline Solivers, CPA, Gloria
Navarro, CSW
Adrian Badiable,
May Langbayan,
Carol Bautista
Vilma Co, MD
Edwin Onofre, Merilles, BSN
Ianne Mencidor
Norma Miranda
Ianne Mencidor
and Evaluation Workshop,
f) Procurement Functions and Processes(St. Benilde)
g) Procurement Supply Management (GFATM, Bangkok)
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HTML Attachment [ Scan and Save to Computer | Save to Yahoo! Briefcase ]
August 1, 2006
Dear CCM Members,
Greetings!
As previously requested for the selection of the Principal Recipient for the Malaria Round 6
Proposal, and as previously stated that due to the limited number of days remaining prior to the
deadline of submission, that a non response will be considered as a yes vote considering that
there is only one nominee, Tropical Disease Foundation Incorporated, the secretariat would like
to announce that there were 3 CCM members that voted for TDFI and that there were no
negative votes cast.
In this regard, we would like to officially close the election and announce that the TDFI has been
voted on as the PR for Malaria Round 6. Consequently a secretariat staff will be going around
your offices to get your signed endorsement of the proposal (with TDF as PR) within the next few
days.
Thank you for your continued support.
DR. JAIME Y. LAGAHID
189
Annexures
Philippine Malaria Proposal
Executive Director
CCM Secretariat
Office: Infectious Disease Office, 3rd Floor, Bldg 13
National Center for Disease Prevention and Control
Department of Health , Sta. Cruz, Manila
711-68-08/ 7438301 loc. 2350/2352
15.7
15.8
Annex 10:
CCM ADHOC Meeting
February 13, 2006
AIMHI Conference Room
Tropical Disease Foundation, Inc.
Suite 2002 20/F Medical Plaza Building, Makati City
Attendees:
Not Present:
Dr. Raman Velayudhan - WHO
Dr. Fabrice
Sergent - EC
Dr Thelma Tupasi - TDFI
Ms. Marvi Trudeau - PSFI
Dr. Ernesto Bontuyan - DOH (Representing Dr. Jaime Lagahid)
Ms. Enya Devanadera - GTZ
Mr. Joshua Formentera - PAFPI
Others:
Ms. Agnes del Rosario - DOH
Ms. Rose Habana - TDFI
Ms. Maricel Montero - TDFI
Agenda:
CCM Operational Budget
CCM Eligibility Criteria
Minutes of the Meeting:
Dr. Jimmy Lagahid CCM chairperson was unable to attend the meeting and was represented by
Dr. Ernesto Bontuyan. He however, called to recommend that Dr. Raman Velayudhan be the
chair of the ADHOC committee, this was affirmed by the members and present and Dr.
Velayudhan accepted. The meeting was thereafter presided by Dr. Velayudhan.
The operational budget for the CCM secretariat and the CCM activities were reviewed.
Discussions
Action Taken
Point
Person/s
CCM operational budget and secretariat: Global Fund can Write Mr. Oren
support the CCM for a period of two years. Thereafter,
Ginzburg for
Dr. Thelma
other sources of sustaining the CCM must be explored. Dr clarificaiton
Tupasi
Renovation cost : This may be reduced if the space
Check the actual
Dr. Ernesto
allocated is in the NCDPC office where only provision of
space allocated with
Bontuyan
additional desks is required.
Dr. Lagahid
Office equipments: The secretariat would be needing one Donors can be
desktop computer and one laptop for the meetings and the approached to donate
190
Annexures
Philippine Malaria Proposal
office. The office would also need a good printer. A minirecorder is also needed. Furniture and other fixtures can
be of minimal expense since we can get obtain these from
the PRRM – Malaria office. The Desktop/laptop computers
can be asked from donors.
Staff: It was proposed that there should be two
permanent staff (full-time) plus one messenger. Two parttime staff (CCM Secretariat staff at present) will be
supervising. It has also been suggested that at least one
of the full time staff should be a professional documenter.
Cost incurred per meeting: The cost incurred per meeting
could be donated by the donor agencies members of the
CCM on a Round-Robin fashion. The cost can be
minimized by cutting down on the excess food served
during morning and afternoon coffee break.
Travel expenses for CCM meetings CCM Members of
private or corporate foundation or those who can afford
their travel expenses should pay for their own bill (e.g.
Marvi Trudeau will be funded by Pilipinas Shell). Only the
travel expenses of the representatives of the CHD Dr.
Myrna Cabotaje and LGUs Dr. Thelma Dangao of Apayao
will be covered.
Monitoring Development partners usually are interested in
joining monitoring visits. These partners can pay for their
own travel expense.
Venue for meetings It was suggested that a bid from
various sources for CCM meeting should be obtained.
To cut down on expenses incurred each agency will be
allowed only 2 persons attending per meeting.
2. CCM Eligibility Criteria
CCM Guidelines Revisions of the CCM guidelines
presented to the Phil Partnership Forum June 2005 were
reviewed. CCM membership will be by sectoral election in
accordance to Global Fund principles to meet the eligibility
criterion for submission or proposals.
Election of CCM members: As per GF principle, the
members of the sectors should elect their own CCM
representative in an open documented and transparent
process. It was proposed that the election be held on
March 24 during the GP2 launch at the PICC to which all
members of the Philippine Partnership will be invited to
attend. This should be presented to the PhilCAT Board for
approval
Members of the CCM: Review showed the present
composigion: Public sector: 10 (28%): 2 health and 8 nonhealth government agencies Private sector: 17 (49%).: 2
faith-based, 4 NGOs/CBOs, 3 Private, 2 Academe, 3
coalitions, 3 PLWDs Development partners 8 (23%); 3 UN
Agencies, 5 bilateral agencies
The CCM was
established in March 2002 it is now appropriate to hold the
election of the members from those nominations made in
st
the 1 Forum for the Philippine Partnership to fight AIDS,
TB and Malaria in June 2005.
computer, printer and
fax machine.
Approach the donor
members of the CCM
to sponsor one
meeting per year.
Dr.
Velayudhan
Bids will be requested Ms. Rose
from Tiara, Heritage, Habana
Westin, Pan Pacific
and PICC.
CCM guidelines to be
updated
Dr. Tupasi
PhilCAT board
Dr. Lagahid
approval will be sought
to hold the elections on
the World TB
Celebration
1. Letters will be
drafted and
subsequently sent to
obtain confirmation of
their intention to be
nominated and stand
up for election to be
sent by February 20.
Confirmation of
nominations shall be
Dr. Tupasi
191
Annexures
Philippine Malaria Proposal
Of the current CCM membership sixteen shall be retained completed on March 8,
2006.
members
(Permant members): 1) DOH, 2) LGU (Public Sector:); 3). 2. Election shall
imediately follow the
Dr. Jaime
WHO, 4. UNAIDS (UN Agencies):; 5) PAFPI. (PLWD):
launch at the PICC.
Lagahid
(Principal Recipients): 6) TDF, 7) PSFI
(Sub-recipieints) :8) WVDF, 9) PNGOC, 10) PhilCAT
has to be presented for
(Newly elected members serving only 1 year) 11) DiLG;
approval by the
12) OSHC-DOLE (Public Sector); 13) UPCPH
PhilCAT board.
(Academe0:; 14) UNICEF (Development partner;) 15)
3. Ballots shall be
Salvation Army (Faith-based organization):;: 16) Samahan made per sector and
Lusog Baga (PLWD)
election shall be
Bong
19 New members in the respective sectors shall be
confined to the
Concepcion
elected from among the nominees selected in the June
members of the
st
2005 1 Partnership Forum
respective sector.
Public Sector (8): from DepEd, DSWD, DOJ , DILG,
4. This plan for the
NCIP, DND, DOST, NEDA, DOLE –OSHC
election of the CCM
NGOs/CBOs- 2 from League of Mayors, Philippine
members will be
National Red Cross, Remedios Foundaiton, Outreach
presented for approval Dr. R.
by the CCM on March Velayudhan
Foundation
Faith-based – 1 from Our Lady of Peace Mission, Couples 8, 2006
for Christ Kagawad Kalinga
Private Sector – 1 Phil. College of Chest Physicians, Tan
Yan Kee Fdtn. World Family of Good People Foundation
Academe – 1 De la Salle College of Medicine, Association
of Philippine Medical Colleges, NIH
PLWDs – 1 from Reyster Langit Foundation
Development Partners – 5 from CIDA, USAID, JICA, GTZ,
EC, AusAID, Asian Development Bank
It is proposed that this election be conducted on March 24,
2006 during the launch of the Global Plan 2 in celebration
of the World TB Day a the Philippine International
Convention Center (PICC) since all the partners will be
present in this event..
Timelines of activities: Feb 15: draft letter to nominees
February 21: Letters sent to nominees
February 28: Nominations closed
March 7: CCM approval
March 8, Press release
March 21: Accreditation of voting Partnership Members
closed
March 23: List of voters prepared
March 24: Ballots and Polling places at the PICC lobby
infront of delegates lounge.
There being no further issues to be discussed, the
Adjourned
Dr.
meeting was adjourned by 6:00 PM
Velayudhan
The Summary Table for the Election of CCM members as decided in this meeting is as follows:
Sector
1. Academe
No. to be elected
1
Candidates
UP Manila
Dela Salle University
Association of
Philippine Medical
Voting Organizations
1. UP Manila
2. Dela Salle University
Health Sciences
Campus Research
Services
3. Association of
Philippine Medical
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Colleges
Colleges
4. UERMC
5. Jonelta Foundation
School of Medicine
6. Pamantasang
Lungsod sa Manila
7. UST TB Clinic
8. UP College of
Medicine (are they
part of UP-Mla?)
Our Lady Of Peace
Mission
1. Our Lady Of Peace
Mission
Couples for Christ
Gawad Kalinga
2. Couples for Christ
Gawad Kalinga
3. Salvation Army
4. Christian Action for
Relief and
Empowerment, Inc.
2. Religious/FaithBased
Organizations
1
3. Private Sector
1
Philippine College of
Chest Physicians
1. Philippine College of
Chest Physicians
2. Andres Soriano
Foundation
3. GSK Foundation
4. Medichem
Pharmaceuticals
5. Inner Wheel Club of
QC
6. Nestle Philippines
7. Philippine Airlines, Inc
8. Philippine Pediatric
Society
9. PSMID
10. Rotary club 3830
11. Sandoz
4. NGO
3
Remedios AIDS
Foundation
Reyster Langit
Foundation
World Family of
Good People
1. Remedios AIDS
Foundation
2. Reyster Langit
Foundation
3. World Family of Good
People
4. PNGOC
5. PBSP
6. Center for
Multidisciplinary
Studies in Health and
Devt.
7. American Chamber
Foundation
8. Give Kare Health
Foundation
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9. Health Action
Information Network
10. PHAPCares
11. PhilTIPS
12. Alay sa KAwal
Foundation
13. World Vision Devt.
Foundation
14. Tropical Disease
Foundation
15. ReachOut Foundation
15.9 Annex 11:
15.10 COUNTRY COORDINATING MECHANISM (CCM) PHILIPPINES
Minutes of the Meeting
June 13, 2006
9:00AM to 3:00 PM
Tiara Oriental Hotel- Makati City
15.10.1.1.1.1
EXECUTIVE SUMMARY
The CCM meeting was held last June 13, 2006 at the Tiara Oriental Hotel from 9:00 am
to 3:00 pm. This is a regular meeting in the 2nd month of the 11th Quarter.
th
Among the important agenda of the meeting were : CCM’s approval to the 11 Quarter
Report of TB and Malaria and 7
th
Quarter Report of HIV-AIDS which are for submission to
GFATM; visit of CCM delegates from Cambodia and Laos; report of the RP delegation who
visited Cambodia; the presentation of concept paper for HIV-AIDS for Round 6 and the election of
a new CCM co-chair. USAID was automatically chosen as CCM co-chair with the withdrawal of
the two other contenders , EU and WHO.
Among the other topics presented for information were : TB and HIV-AIDS Round 5 grant
negotiation and status report of Malaria for Round 5 after the grant signing.
The GFATM-TB presentations were done by Mr. Onofre Merilles , the Malaria
component by Ms. Lourdes Pambid and HIV-AIDS by Dr. Dorothy Agdamag. Malaria Report for
Round 5 was presented by Ms. Marvi Trudeau.
For other matters, activities related to the coming National Prevalence Survey (NPS) on
TB was discussed; update of the Committee on Sustainability by Ms. Arlene Ruiz and the
discussion of the appended MOA between TDFI and the LGUs wherein TDFI assumed the role
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in handling the Malaria component from PRRM. The submission of proposal for HIV-AIDS and
Malaria for Round 6 was also discussed.
The meeting was presided by Undersecretary Ethelyn P. Nieto, CCM Chair. There were
29 members in attendance, including 4 new members and 1 was on official business.
The next CCM meeting will be a regular meeting and was scheduled on August 8, 2006.
1.
ATTENDANCE
15.11 CCM MEMBERS
A.
1.
NAME
AGENCY
ATTENDANCE
REPRESENTATIVE
2.
3.
4.
5.
Government Sector
Usec Ethelyn P.Nieto/
Dr. Yolanda Oliveros
Ms. Arlene Ruiz
Dr. Remigio Olveda
Dr. Peter Galvez
Dr. Thelma Dangao
NEDA
RITM
DND
LGU- Apayao
P*
P
P
P
A**
P
6.
7.
8
9.
10.
Dr. Ricardo Sakai
Dr. Dulce Estrella –Gust
Hon. Austere Panadero
Dr. Thelma Navarrez
Dr. Jaime Montoya
NCIP
OSHC-DOLE
DILG
HNC-DepEd
PCHRD
P
A
P
A
P
Mr. Cesar Montances
B.
1.
2.
3.
Private Sector
Dr. Thelma Tupasi
Ms. Jazmin Gutierrez
Mr. Tryve Bolante
TDFI
PBSP
PRRM
P
P
A
Mr. Eric Camacho
C.
NGO- Community Based
Organization
Dr. Melvin Magno
Mr. Raul Manikan
WVDF
PTSI
P
P
1.
2.
People Living with the
Disease
Mr. Joshua Formentera
Mr. Fernando Collera
PAFPI
SLB
P
P
E.
1.
2.
3.
UN/Multilateral Agency
Dr. Jean Marc Olive
Dr. Ma. Elena Borromeo
Dr. Nicholas Alipui
WHO-Phil
UNAIDS
UNICEF
P
P
P
Dr. Raman Velayudhan
F.
1.
2.
3.
4.
5.
Bilateral Agency
Dr. Mie Kasamatsu
Dr. Fabrice Sergent
Ms. Myrna Jarillas
Dr. Michael Adelhardt
Dr. Aye-Aye Thwin
DOH-JICA
EC
CIDA
GTZ
USAID
P
P
OB
P
Ms. Nobuko Yamagishi
Ms. Rita Bustamante
1.
2.
D.
DOH
Dr. Alan Feranil
Dr. Jeanne Valderrama
Ms. Ema Naito
Dr. Meredith Gaffney
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16
G.
CCM MEMBERS
NAME
1.
2.
3.
Academic/ Educational
Organization
Dr. Caridad Ancheta
Dr. Lulu Carandang –Bravo
Dr. Fernando Sanchez
H.
Others
H.1.
1.
2.
3.
Public-Private Collaboration
Dr. Jubert Benedicto
Mr. Ray Angluben
Ms. Irene Fonacier-Fellizar
H.2.
1.
2.
Corporation
Ms. Marvi Trudeau
Dr. Renato Dantes
H.3.
1.
2.
3.
4.
NGOs
Ms. Eden Divinagracia
Mr. Rey Langit
Dr. Jose Narciso Sescon
Dr. Jocelyn Park
H.4.
1.
Religious Organization
2.
Dr. Jose Yamamoto
Mr. Charles Malcom
Induruwage
AGENCY
ATTENDANCE
UP-CPH
NIH
APMC
A
P
A
PhilCAT
KLM
PNAC
P
A
OB
PSFI
PCCP
P
A
PNGOC
KMALF
RAF
WFGP
P
P
P
P
SA
P
CFC-GK
P
* P- Present ; ** A- Absent
REPRESENTATIVE
Mr. Raul Destura
Ms. Amelia Sarmiento
Ms. Myra Bautista
Ms. Airene Margarette
Lozada
Dr. Elmer Garcia
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17
A.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DOH/TWG/CCM SECRETARIAT
NAME
TWG-TB
Dr. Jaime Lagahid
Dr. Rosalind Vianzon
Dr. Vivian Lofranco
Dr. Celine Garfin
Dr. Ernesto Bontuyan, Jr.
Mr. Onofre Merilles, Jr.
Dr. Michael Voniatis
Mr. Marlon Villanueva
Ms. Fannie Grace Esber
Mr. Tito Rodrigo
NAME
AGENCY
ATTENDANCE
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
IDO-NCDPC-DOH
TDFI
WHO-P
WVDF
WVDF
PHILCAT
P
P
P
OB
P
P
P
P
P
P
AGENCY
ATTENDANCE
IDO-NCDPC-DOH
IDO-NCDPC-DOH
WHO-P
TDFI
TDFI
P
P
P
P
P
IDO-NCDPC-DOH
WHO-P
PNGOC
TDFI
NEC-DOH
PNAC
PINOY PLUS
OB
P
P
P
P
OB
P
B.
TWG- Malaria
1.
2.
3.
4.
5.
Dr. Mario Baquilod
Dr. Cristy Galang
Dr. Raman Velayudhan
Ms. Lourdes Pambid
Dr. Luz Escubil
C.
TWG-HIV-AIDS
1.
2.
3.
4.
5.
6.
7.
Dr. Gerard Belimac
Dr. Nerissa Dominguez
Ms. Ruthy Libatique
Dr. Dorothy Agdamag
Dr. Aura Corpuz
Dr. Ferchito Avelino
Mr. Noel Pascual
D.
CCM SECRETARIAT
1.
Ms. Agnes Maria Oliva del
Rosario-East
IDO-NCDPC-DOH
P
2.
3.
4.
5.
Ms. Cirila Negad
Mr. Joel Atienza
Ms. Rose Habana
Ms. Maricel Montero
IDO-NCDPC-DOH
IDO-NCDPC-DOH
TDFI
TDFI
On leave
P
P
P
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18
OTHER GUESTS/PARTICIPANTS/OBSERVERS
NAME
1.
2.
Ms. Khou Somatheavy
H.E. Prof. Ly Po
3.
4.
Mr. Heng Sokrithy
Dr. Kheng Sim
5.
Dr. Sok Touch
6.
Dr. Bountheuang Mounlasy
7.
NAME
Dr. Douangchanh Keoasa
8.
Dr. Nao Boutta
9.
10.
11.
12.
13.
14.
15.
16.
Mr. Isidro Compuesto
Mr. Susanne Monte
Dr. Corazon Manaloto
Dr. Norito Araki
Dr. Joselito Vital
Ms. Wilma Alaban
Mr. Joselito Sagcal
Mr. Rhandy Rowan
AGENCY
Director,Health Unlimited, Cambodia
Permanent Vice Chair, National AIDS Authority,
Cambodia
Coordinator, CPN, Cambodia
Vice Director, National Center for Malaria,
Cambodia
Director CDC and Chairman of PR, Ministry of
Health , Cambodia
Director Gen., Dept. of International Cooperation,
Ministry of Foreign Affairs, Chairman of CCM Lao
PDR
AGENCY
Director Gen., Dept. of Hygiene and Prevention,
Ministry of Health , member of CCM Lao PDR
Deputy Chief of the Cabinet, Ministry of Health,
Director of CCM Secretariat
PAFPI
PAFPI
USAID
Embassy of Japan
GTZ
TDFI
TDFI
TDFI
COMMENCEMENT
1. Call In to Order. The meeting was called into order at 9:40 a.m. by Usec. Ethelyn
P. Nieto, CCM Chair. There were 29 members in attendance, including 4 new
members and 2 were on official business.
2. Minutes of the meeting.
Review of the minutes of the March 7, 2006 meeting.
Before proceeding to the review of the minutes, Usec. Nieto asked the body for comments
and approval of the provisional agenda.
There was a comment to have a little change in the CCM Affairs portion to include : the
Status Report of Malaria for Round 5 and that the presentation of the concept paper for
HIV-AIDS for Round 6 be placed last instead of being the first item.
th
Also the Quarter Reports of TB and Malaria for the 11 Quarter and HIV-AIDS for 7
Quarter be noted as “for approval” instead of just for information.
th
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198
The minutes were then reviewed page by page and a comment was made on page 6 - on
Committee on Sustainability under Other matters wherein the last sentence should read “
…a meeting was called but they never had the chance to get together to discuss the paper
“.
Having no other comments the minutes was then moved for approval and was
seconded .
3. Business arising from the minutes.
3.1. Other Matters
3.1.1.
Committee on Sustainability
Ms. Arlene Ruiz (NEDA), mentioned that their Committee was not able to
meet last week as scheduled due to conflict of schedules and their group is
set to meet again on June 15, 2006.
4. CCM Affairs
4.1.
New CCM Members
The new CCM members who were elected last March 24, 2006 were presented to the
CCM body through their representatives. 4 out of the 6 elected organization were
present :
1) Remedios Aids Foundation – Dr. Jose Narciso Sescon
2) World Family of Good People, Inc. – Dr. Jocelyn Park
3) Couples for Christ-Gawad Kalusugan – Dr. Elmer Garcia
4) Kasangga Mo Ang Langit Foundation – Ms. Myra Bautista
Not represented were the Philippine College of Chest Physicians and the Association
of Philippine Medical Colleges.
4.2.
CCM Delegates from Cambodia and Laos
5 CCM members from Cambodia and 3 from Laos were introduced during the
meeting.
1) Ms. Khou Somatheavy- Director,Health Unlimited, Cambodia
2) H.E. Prof. Ly Po - Permanent Vice Chair, National AIDS Authority,
Cambodia
3) Mr. Heng Sokrithy - Coordinator, CPN, Cambodia
4) Dr. Kheng Sim - Vice Director, National Center for Malaria, Cambodia
5) Dr. Sok Touch - Director CDC and Chairman of PR, Ministry of Health ,
Cambodia
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199
6) Dr. Bountheuang Mounlasy - Director Gen., Dept. of International
Cooperation, Ministry of Foreign Affairs, Chairman of CCM Lao PDR
7) Dr. Douangchanh Keoasa - Director Gen., Dept. of Hygiene and
Prevention, Ministry of Health , member of CCM Lao PDR
8) Dr. Nao Boutta - Deputy Chief of the Cabinet, Ministry of Health,
Director of CCM Secretariat
They were here to observe how the CCM activities in the Philippines are conducted and to
have insights about how the GFATM projects are implemented.
They were warmly welcomed by the members and encouraged to asked questions or clarify
things during the conduct of the meeting.
The delegates were sponsored by SEAMEO-TropMed -GTZ Back Up Initiatives.
4.3.
Report of RP Delegation re : Cambodia Visit ( June 4-10, 2006)
The Philippine delegation who visited CCM Cambodia presented a report through
Dr. Ricardo Sakai of NCIP about their observations and insights.
The delegates were also sponsored by SEAMEO-TropMed -GTZ Back Up
Initiatives
Among their observations/insights between Philippines and Cambodia were:
•
The PR is the Government - Ministry of Health unlike the Philippines which
has an NGO as PR
•
They have 29 members ( public, private, bilateral partners) almost the same
composition as the Philippines
•
They meet quarterly or at least 4 times/year whereas the Philippines meets
at least 8 times/year
•
They have a CCC subcommittee that acts as CCC secretariat that meets
more regularly and reports to the CCC about decisions they come up with
•
They have TWGs not only for the GF component but for other projects
•
They have more that 50 SRs unlike the Philippines with only a handful
•
Both countries have strong CCM/CCC
•
SRs , SSRs and the PR have a standard accounting software which
facilitates monitoring and reporting to GFATM. PR also trains and retrains
finance staff of SRs/SSRs
•
Both have sustainability /support of CCM activities through funds from
GFATM and donors
4.4.
Presentation of Procurement and Supply Management Plan (PSM ) for HIVAIDS
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Dr. Dorothy Agdag was asked to present the PSM for HIV-AIDS but it was not
available yet. It will be presented to CCM again when completed. Dr. Agdamag
just presented the indicators for the Round 5 proposal of HIV-AIDS which was
reduced from 34 to18 indicators.
4.5. Presentation of Quarter Reports
4.5.1. TB Component
th
The report of TB for the 11 quarter was presented by Mr. Onofre Merilles. Basically the
indicators exceeded their target for the quarter. The Task Force approach by the World
Vision showed an increase in demand of TB Services and there was a 13% additionality
from the PPMD. For DOTS Plus there were 2 additional units to manage MDR patients .
The training on the revised Manual of Operations (MOP) for TB was also in the planned
changes in programmatic activities vis-à-vis the Grant Agreement because of various
changes such as EQA, PPMD, TBDC etc., So there is a need to disseminate it
nationwide.
Comments on the presentation :
1) Use graphs to show progress better instead of looking at numbers
2) The presentation should be simplified for the benefit of the new members and CCM
delegates
3)
Other NGOs and the community should be involved in the development of the
Monitoring and Evaluation tool
4) Technical and financial monitoring should be done in partnership with other agencies
5) Monitoring is open to all CCM members but the PR cannot support it so funding is
care of their respective organizations
After the presentation and discussion the CCM members approved the report for TB.
4.5.2.
Malaria Component
th
Ms. Lourdes Pambid presented the 11 quarter report for Malaria . among the challenges of the
project are : Needs improvement in the delivery of bednets and retreatment; Low net distribution;
delayed reporting activities; delay in disbursements from GFATM and release in costs estimates
from WHO thus delaying procurement of insecticides too; no more community organizers (COs)
because they were not absorbed by the LGUs.
Comments on the presentation :
1)There is a need to revisit the needs of the community to attain project goals so there is a need
for COs
2)Instead of paying the COs they can be given non-monetary incentives like insurance, training
for entrepreneurship, micro-credit
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3)Get workers from the community so there will be no need to give transportation allowance
4)The COs can also be given awards as incentives
5)The removal of the COs has both positive and negative effect in that the RHUs were dependent
on the COs before but now they are more involved in the RHU’s activities
There was an inquiry from one of the Cambodian delegates about the number of patients who are
receiving correct treatment ; What is the current malaria policy, ACT or Non-ACT treatment ?
Reports from clinics indicate the number of tablets given out as the indicator of how many
patients are receiving treatment. The first line drug used is Chloroquinone; 2
nd
line – Co-artem;
rd
3 line – Quinine . So far the first line drug is working well in the Philippines.
After the presentation and discussion the CCM members approved the Malaria report.
4.5.3.
HIV-AIDS Component
Dr. Dorothy Agdamag presented the 7th quarter report for HIV-AIDS. The indicators for the two
objectives on prevention and support, care and treatment of the project were met satisfactory and
most have exceeded their targets.
Comments on the presentation :
1) How do you market VCTs (Voluntary Counseling and Testing) because there is a low
demand for it? Do the SHCs have the capacity to do it?
The project gives information that drugs –ARVs are available . It is also being worked out that
Rapid testing will be done at SHCs with the results made available on the same day.
2) The patients might have the fear of being stigmatized
The health workers and NGOs are being trained on confidentiality to popularize VCTs. The
uptake of the ARVs should now be high because there is no more cost recovery. The most
important indicators are the number of VCTs and the uptake of ARVs.
3) The knowledge of doctors regarding ARVs are nil and there is a need to strengthen this
Information on ARVs and VCTs will incorporated in the basic training in PSMID.
An accreditation program can also be developed to equip doctors
After the presentation and discussion the CCM members approved the report for HIV-AIDS.
4.5.4.
Status Report of Round 5 for Malaria
Ms. Marvi Trudeau gave an update for the Round 5 activities of Malaria.
•
Received first disbursement of US$ 6,444,860.00 last June 5 , 2006 and was deposited
in a dollar account at the Citibank earning 1% per annum
•
Launched also the monthly E-news where the activities including the financial aspects
are accessed
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Comments on the presentation :
1) How will the interest be used?
The interest will be used for the project as well. We will also ask the GFATM how to use it.
2) Can TB and HIV use the same approach for transparency?
Yes for transparency the 2 projects can also follow the same approach
4.6.
Election of new CCM Co-Chair
Three organizations were nominated as CCM co-chair, the European Commission (EC), World
Health Organization (WHO ) and USAID. EC and WHO sent a letter to CCM declining their
nomination to the position. USAID accepted the nomination. Since there is no need to vote, the
group just affirmed the ascendancy of USAID as new CCM Co-Chair. The USAID was requested
to be present always since most of the time it is the co-chair who presides in the absence of the
Chair.
Dr. Meredith Gaffney of USAID sat as co-chair and assisted USEC Nieto preside over the
meeting. Being the USAID representative she was presented to the CCM as co-chair.
Dr. Gaffney mentioned that USAID is very committed to the prevention and control of infectious
diseases and committed to work closely with the CCM on this aspect.
4.7.
Status Report of Round 5 for TB
The GFATM had some comments on the Monitoring and Evaluation aspect and the TWG will
meet after the CCM meeting to discuss it. The PSM plan was re-submitted with inputs from the
TWG. The assessment from the LFA on the M & E and Program Management were also due.
The shift from quarterly to semi-annual reporting was approved by GFATM . The 11th quarter
th
th
report is due on June 15 and the 12 quarter report on September 15. The semi- annual
reporting will start on March 2007.
Grant signing target date is on June 21, 2006 and program implementation by August 1, 2006.
4.8. Presentation of Concept Paper on HIV-AIDS for Round 6
The concept paper was presented by Mr. Joel Atienza and Dr. Aura Corpuz of DOH. They
acknowledged the assistance of GTZ for the grant on proposal development.
Among the features of the concept paper are:
•
Goals : To prevent further spread of HIV infection by maintaining an HIV prevalence rate of
less than 1% ; Strengthening the national blood safety program
•
Framework for Round 6 : Experience from GF Round 3 and 5 by integrating link between
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Round 3 and 5 ; Round 5 expanded to cover 11 municipalities from the 9 high risk areas plus
an additional 2 areas ; Round 3 and 5 provides training for VCT
•
Innovations for Round 6 : Support existing GFATM projects ; pool of human resource will be
trained to provide technical support ; M & E including surveillance will be an integral
component
•
DOH will apply as PR with the COA as external auditor and will use the national government
accounting system; Funds will not be covered by DBM ; it has 3 warehouses and a separate
Project Management Office will be set up within the DOH compound
Comments on the presentation :
1) Put on more effort to new approaches
2) NGO/Community participation should be seen in the proposal
3) On the financial side the DOH might have some gaps as PR
Financial and management issues have already been discussed and will be addressed.
4) The proposal should show the commitment of the public sector
The government has always been active though may not have been highlighted. The
DOH can be a frontliner this time.
5) How will the outcomes and results of the DOH project be monitored?
There will be the TWG aside from the LFA and CCM
As a whole it was pointed out that the DOH can be a good implementor and PR
The deadline for the submission of the proposal is August 3, 2006. This will be submitted
again on the next CCM meeting sometime in July.
4.7.1.
Presentation of NPS Survey
rd
The plan to have the 3 National TB Prevalence Survey (NPS) was presented by Dr. Rosalind
Vianzon. The first NPS was made in 1983 and the 2
nd
NPS 15 years later. Since there has been
rd
a lot of changes made and initiatives done the 3 NPS is now necessary. It is slated to be
conducted in 2007.
A Steering Committee was created with Dr. Yolanda Oliveros as chair. It is composed of
representatives from the public and private sectors and the international community. The
Steering Committee will oversee the overall conduct of the survey.
An Adverstisement for a call of proposal for the NPS Survey was presented for approval by the
CCM. Letters of invitation will also be sent out from June 15-25, 2006. The CCM Secretariat will
be in charged of gathering the proposals.
The Advertisement was approved for posting by the CCM .
The deadline for the submission of proposal is on July 15, 2006.
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Philippine Malaria Proposal
204
An invitation was also given for a CCM member to be a member of the NPS Steering Committee.
The representative for CFC- Gawad Kalinga was nominated and was recognized as CCM
representative to the NPS Steering Committee.
4.7.2.
Letter from TDFI as overseer of the Malaria Project taking over PRRM’s
responsibilities
A letter was sent to the CCM through its Chair , USEC . Nieto regarding taking over
responsibilities for the Malaria Project by TDFI from PRRM. They conducted several roadshows
with the LGUs regarding the change in administration. They also restated with the LGUs of the
MOA that they have signed with PRRM before and that it still stands after it was appended with
TDFI as the new administrator of the GFATM. Some LGUS wanted a new MOA but this will go
through a tedious process again.
4.7.3.
Malaria proposal for Round 6
A need for a Round 6 proposal for Malaria was presented after considering the clamor during the
roadshow presentation of TDFI , for the Malaria project to continue after 2008. It is presently
covering 26 provinces. Though the PSFI is the PR for Round 5 for Malaria it does not cover 21
other provinces and this can be covered in Round 6.
There was a question on the absorptive capacity of TDFI and it was pointed out that TDFI does
not have to be the PR for Round 6 for Malaria because it is up to the CCM to choose the PR. The
submission of proposal should also be open to all.
It was suggested that this be included in the agenda just like the HIV-AIDS in the next CCM
Meeting.
4.7.4. Adjournment.
There being no other agenda and concerns to tackle the meeting was moved for
adjournment at 3:00 p.m. The next meeting was scheduled for August 8, 2006.
Prepared By:
MS. AGNES MARIA OLIVA V. DEL ROSARIO-EAST, RND, MPS-FNP
Senior Health Program Officer
IDO - NCDPC DOH
CCM Secretariat
MR. JOEL ATIENZA
Supervising Health Program Officer
IDO - NCDPC DOH
CCM Secretariat
MS. MARCELA MONTERO
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Philippine Malaria Proposal
205
Program Assistant
TDFI
Approved By:
JAIME Y. LAGAHID, MD, MPH
Director III and Executive Director
CCM Secretariat
18.1 Annex 12:
ROLL BACK MALARIA IN THE PHILIPPINES
A FIVE YEAR STRATEGIC PLAN 2006 – 2010
PHILIPPINES 2005
Background
The Philippines has a long history of malaria control. While significant progress was made in the
past, this was not sustained due to many factors such as lack of community participation. Roll
Back Malaria (RBM), a global movement launched in October 1998 by its founding partners
(UNICEF, UNDP, World Bank and WHO), aims to halve the burden of Malaria in 2010 and by
another half in 2015. This initiative brings to fore the burden of malaria that hinders socioeconomic development to those who are most affected – the poor. Among others, RBM
highlights the need for strong political commitments, evidence – based actions and broadening
involvement beyond the health sector for sustainable impact. Through the Department of Foreign
Affairs, the Philippines expressed to the global community its commitment to this noble cause.
RBM in the Philippines is building on and strengthening the DOH – LGU – community partnership
n malaria control. In 1999 – 2000 preparatory activities were carried out followed by small scale
implementation. Initial implementation is going on in Southern Mindanao (Region 11). There is a
need a scale up with focus in high burden areas that are mainly populated by the poor including
the indigenous people.
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This strategy document embodies the directions to be taken forward in reducing the malaria
burden in five years (2006 – 2010). It includes the estimated national needs for malaria for the
period covered. It addresses most, if not the entire key challenges facing malaria control in the
country.
Situational Analysis Summary
1. THE PHILIPPINES
Land and Climate
The Philippines is a nation of 7,107 islands located south of mainland Asia. It lies in the Pacific
Ocean off the coast of Southeast Asia with a total land area of 299,404 square kilometers.
Largest islands are Luzon in the north and Mindanao in the south with Visayas in between.
Manila is the capital city. Consisted of 12 cities ad five municipalities, Metropolitan Manila is the
biggest urban center in the country.
Country is mountainous with narrow strips of lowland along the coast and some broad inland
plains. Tropical forest used to cover most of the Philippines, but very large areas are now devoid
of forest leading to soil erosion and flash flood. The country has an extensive coastline and many
fine bays and harbors. A wide variety of tropical and plants and animals can be found in its
mountains, rivers, and lakes and along its coastal areas. Except for a few plants, the medicinal
values of this flora remain to be fully tapped.
The climate is generally hot and humid with an average temperature of 32°C. The hottest moths
are from March to June when temperatures may reach 38°C. The water from November to
February is pleasantly cool and dry with temperatures around 23°C. Rains and typhoons prevail
from July to October. The Philippines is prone to natural disasters brought about by volcanic
eruptions, earthquakes, floods, and typhoons. The tropical temperature favors the existence of
disease vectors and parasites.
Economy and Poverty
The Philippines has a population of 85 million with 40% concentrated in urban centers. Using
2005 estimates, the annual per capita GDP is about $5100 in 2004.
The Philippines was less severely affected by the Asian financial crisis of 1998 than its neighbors,
aided in part by its high level of annual remittances from overseas workers, and no sustained runup in asset prices or foreign borrowing prior to the crisis. From a 0.6% decline in 1998, GDP
expanded by 2.4% in 1999, and 4.4% in 2000, but slowed to 3.2% in 2001 in the context of a
global economic slowdown, an export slumps, and political and security concerns. GDP growth
accelerated to about 5% between 2002 and 2004 reflecting the continued resilience of the service
sector, and improved exports and agricultural output. Nonetheless, it will take a higher, sustained
growth path to make appreciable progress in the alleviation of poverty given the Philippines’ high
annual population growth rate and unequal distribution of income. The Philippines also faces
higher oil prices, higher interest rates on its dollars borrowings, and higher inflation. Fiscal
constraints limit Manila’s ability to finance infrastructure and social spending. The Philippines’
consistently large budget deficit has produced a high debt level. This as forced Manila to spend a
large portion of the national government budget on debt service. Large unprofitable public
enterprises, especially in the energy sector, contribute to the government’s debt because of slow
progress on privatization. Credit rating agencies have expressed concern about the Philippines’
ability to service the debt. Legislative progress on new revenue measures will weigh heavily on
credit rating decisions.
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The Philippines is basically an agricultural nation whose major crops include rice, corn, coconut
and tobacco. Due to recent trends in globalization, however. The present economic thrusts of
government have leaned towards industrialization. The service sector has the largest share in the
country’s output with 53.5% of the country’s GDP and around half of the employed population.
The poverty incidence fell from 49% in 1985 to 39.4% in 2000. Poverty is more widespread in the
rural areas and in some regions of the country such as Central Mindanao and the Autonomous
Region of Muslim Mindanao. Income inequality is also a problem, as the Gini coefficient has
remained high at 0.466% in 2003.
The health status of Filipinos has been progressing in the past 50 years, with vital health indices
improving consistently. Life expectancy in the Philippines has increased to 67 years for males
and 72.92 years for females, respectively. Maternal mortality rate has gone down from
209/100,000 live births in 1993 to 172 in 1998. Under-five mortality rate has also significantly from
79.6/1,000 live births in 1990 to 48 in1998 and 23.5 in 2004. Despite these gains, much remains
to be improved.
With regards to education, the functional literacy rate of the population 10 years and older is at
94%. The net elementary enrolment rate has also increased from 85% in 1991 to 96% in 2000. In
year 2000, the Philippines ranks 77th out of 174 countries in terms of the Human Development
Index.
Government Efforts
Poverty has been a major concern in the Philippines since the 1950s, but it was not until the late
1980s that poverty alleviation became the overriding goal of the country’s development plan.
Since 1986, 3 political administrations in succession have tried to address the poverty problem.
The efforts of the Aquino and Ramos administrations helped reduced the incidence of poverty
from 49% of population to 37% in 1997. Further advances in the fight against poverty slowed
down; however, when in the second half of 1997, a financial crisis occurred, engulfing East Asia.
In the Philippines, the output decline was relatively of small magnitude compared to other
countries affected, but the unemployment rate increased significantly, forcing many households to
slide into poverty.
The Arroyo Administration s committed to continue the staked war against poverty and
unemployment. The government realizes the importance of macroeconomic stability. Without
stability, sustained economic growth, vital to reducing poverty, cannot materialize. At the same
time, reliance on mere trickle-down effects of growth is not advisable. The pursuit of
development must address the needs of the poor directly. In this regard, a comprehensive set o
policies and programs must be pursued to overcome poverty and unemployment. These are
spelled out in the Medium – Term Philippine development Plan (MTPDP) for 2005-2009, the
development frame work o the Arroyo Administration.
The Main components of the 2005-2009 Medium-Term Philippines Development Plan are the
following:
a.
b.
c.
d.
e.
f.
g.
Ensuring sustained growth and macroeconomic stability.
Promoting full, decent and productive employment
Enhancing human capacities through health, education and housing
Protecting vulnerable groups
Accelerating comprehensive rural development
Gearing for international competitiveness in industry and services
Putting the Philippines on the international tourism map
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h. Strengthening government and private sector partnership in infrastructure
development
i. Bridging the digital divide through information and communications technology.
j. Reducing regional disparities through regional and spatial development
k. Creating competitive and livable cities and urban areas
l. Pursuing sustained peace and development in Mindanao
m. Improving the quality of life through good governance.
To meet poverty reduction objectives, the Philippines government will ensure that growth
accelerates on a sustained basis and at a pace sufficient to provide adequate employment. To
realize this goal, the government will pursue policies that would create a stable macroeconomic
environment and raise domestic savings to accelerate growth of domestic productive capacity,
especially in the export sector. The immediate policies that will be implemented to put economy
back on a sustained growth path are the fiscal deficit reduction program and measures that will
address corporate recovery and the banks’ non-performing loans problem.
Meanwhile, to achieve the employment goals, 4 major strategies shall continue to be adopted.
These are employment generation, employment preservation, employment enhancement and
employment facilitation. Employment generation will be done through the acceleration of the
investment levels in the country, agriculture and fishery modernization, improvement of support
systems in the agrarian reform communities, revitalization of the manufacturing and construction
sectors and the development of globally competitive industries.
In the next 4 years, the government commits itself to enhance human capacities through health,
education and housing. It will pursue the development and adoption of innovative delivery and
financing mechanism for health care, education, and housing services. It will continue to prioritize
basic social services, such as primary health care, nutrition, basic education and water and
sanitation in the allocation of resources.
The government has set its targets in the Medium-Term Philippine Development plan. Meanwhile,
it realizes that sustained growth is central to poverty reduction because in periods of economic
downturn such as the Asian financial crisis, it is the poor who are hurt the most. Not only do they
lack the assets – land, money, and technical know-how to cushion the fall in incomes arising from
unemployment and inflation, they also cut down on expenditures such as those for education,
which are essential for their long-term empowerment and their exit out of poverty, Growth should
be broad-based and equitable if the poor are to benefit from growth. Unfortunately, the poor have
not benefited as much in periods of rising economic growth as shown by the rise in income
inequality from 1994 to 1997. Thus, the reduction of poverty entails not only sustained growth in
aggregate terms but also higher growth in sectors that improve the well being of the poor such as
agriculture and small-scale industries.
Government Targets Under the MTPDP 2006 to 2010
•
•
•
•
•
•
•
•
GDP growth is expected to accelerate from 4.5% in 2004 to 7-8% by year 2009 and
2010.
Poverty incidence reduced from 34% to 17% 2010. Exports to exceed US$50 Billion by
2006.
Increase investment rate from 19% of GDP to 28% of GDP in 2006
Annual job creation exceeding 1.7 Million jobs by 2009
The consolidated public sector financial position will move towards a balance budget by
2010.
Build 3,000 classrooms a year within the public school system.
Grant college scholarship to every qualified poor family and put computers in every public
school.
Electrify 1,500 barangays and reduced the cost to become the lowest in the region.
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•
•
•
•
•
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Bring clear water to all 45,000 barangays.
Reduced b half the price of commonly used medicines.
Develop 2 million hectares of land for agri-business by 2010
Develop and support 3 million entrepreneurs
Inflation to decline from 4.8 in 2004 to 3-4% in 2006.
Life expectancy to increase to 72.8 in females and 67.53 for males in2006.
Health Expenditures
In 2000, the total health expenditure in the country amounted to P 113 billion pesos, at current
prices. This is only 3.25% of the gross national product, which is the lowest share for the health
sector in 5 years. Of the total health expenditures in the country, only minimal 6% was financed
by social health insurance, and only 18% from both National and Local Government Health
Budgets. A substantial 46% of health expenditure is still paid from out-of-pocket of individuals,
which puts Filipinos at considerable vulnerability to financial risks and its associated opportunity
loss from illness. This risk may sometimes be awesome even to the upper 60% income stratum in
the country with family savings of about 25%. However, these same risks may prove catastrophic
among the lowest 40% income stratum that have no savings, and even register a deficit from
family income as a result of expenditures (1998 Annual Poverty Indicators Survey, National
Statistics Office, Manila Philippines).
Citizen Satisfaction
Data on citizen satisfaction with services provided by the health sector has not been routinely
gathered. Glimpses of how well the country fares in these criteria of performance can be seen
from special surveys. The most recent of such surveys is the Filipino Card in Pro-Poor Services –
A Document of the World Bank done in 2000. It is a client satisfaction survey that provided
information on users’ awareness, access, use and satisfaction with public services. Its key
findings show the lack of quality as the most pressing issue against government facilities, which
are bypassed for private facilities when finances allow.
It also shows lowest access and use o health facilities by the poor who need it most. However,
government primary facilities are frequented most often by rural poor, particularly those in
Mindanao and Visayas, such that improving quality and quantity of services in these primary
facilities may well benefit the poor in the country.
2. CURRENT ACTIONS IN HEALTH
To address the observe insufficiencies in the health situation in the country, the government of
the Philippine (GOP) through the Department of Health (DOH) drafted the Health Sectors Reform
Agenda (HSRA) in1999. The agenda seeks to institute changes in the way health care is
organized and delivered, regulated and financed. Overriding concerns under each are
mechanism for incentives and inducements for service providers, as well as advocacy and
behavior change for individual clients. These involve reforms in 3 areas of Hospital Services,
Public Health and Local Health Systems.
The reforms in public health seek for more sustained financing, building of technical expertise and
revitalizing systems for efficient service delivery. The devolution of health services to local
governments intended to make service more responsive to communities, but unfortunately
resulted in the disruption of the district health system. As a result, integration of public health and
hospital systems and mechanism for cost sharing among local governments was lost. The
reforms in the area of local health systems seeks to restore these functions in local communities
and concurrently build other systems to enable them for more efficient service delivery in the
periphery.
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Health Sectors Reform Implementation Plan
After conceptualization, the HSRA was institutionalized in 2000, in plans, policies and priorities of
the DOH, the National Economic Development Authority, the Department of Budget and
Management, the National Health Planning Committee, and other agencies. In 2001,
implementations of the reforms were started with 64 provinces and cities identified as initial
implementation sites. These sites or convergence areas were selected on the basis of capacity of
LGUs to implement reforms, with emphasis on ability to pay premium counterparts for enrollment
of indigents. The reforms in the convergence sites, at the end of 4 years, is envisioned to enable
them to become self-sustaining areas, eventually weaning them off dependence I government
subsidy, which can then be shifted to other needy areas. Implementation was started in 13
convergence areas, in the previous year.
National Objectives for Health
The National Objectives for Health, which was conceptualized in 1999, sets the goals and
objectives for the health sectors in the country for the Medium term (1999-2004). It
institutionalizes the elimination of Malaria, among 7 other diseases, as goals for all local
government units, NGOs and other health providers in the whole health sector to target.
DOH Policy Thrust
The policy standpoint of the current administration in the Department of Health is good
governance in health. Good governance in health shall mean better health for all Filipinos. Good
governance in health includes the prevention of illness and early death, so that citizens avoid
illness and live out their expected lifespan; the assurance in the quality if health services so that
citizens are satisfied and confident of health services; the expansion of social health insurance so
that the family has relief from the financial burden of illness; the adequate address of the equity
issue, so that the poor in underserved areas get services at oar with both comprehensive national
performance and performance in poor and underserved areas.
3. CURRENT MALARIA SITUATION
Burden of Disease
th
Malaria ranks as the 8 leading cause of morbidity in the Philippine (HIS, 1997). The 2003
DOH/WHO shows that there were 588,836 suspected malaria cases with 48,441 confirmed cases
and 162 deaths. The reports show a significant reduction in malaria cases from 89,047 in 1991.
The reduction in cases may reflect successes in control efforts. However, the present figure more
likely underestimates the true number of cases by 50%.
Malaria in the country hits the poor and underserved areas the hardest. Malaria occurs in 65 of
the 78 provinces 760 of 1,600 municipalities and 9,345 of 42,979 barangays (villages) in the
Philippines. Data on the 10 year average of malaria shows that 81% of cases nationwide are
found in only 25 of these provinces. These 25 provinces have 339 of endemic municipalities,
4,407 barangays, with a total endemic population of 5,530,908 (refer to table 1 and figure 1). The
IPs constitutes about 20% of this population. These 25 provinces number among the poorest,
th th
with 50-60% of endemic areas categorized under the lowest income group (4 -6 class
municipalities).
Within these poorest areas, where low socio-economic development
opportunities are compounded by political conflicts, lives the highest population of indigenous
tribal communities or IPs. The IPs constitutes a specially underserved subgroup among the poor
in the Philippines, resulting from difficulties in geographic and cultural access.
In terms of mortality, deaths due to malaria has gradually declined from the 1950’s to 70’s and
has remained low since then at less than1/100,000 population or an average of 658 deaths/year
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(based on average from 1990-1997, HIS). However, deaths in the same 25 provinces are
significantly higher than the national average of 0.8/100,000 or 65% of the total deaths come from
these provinces. This has largely been in part due to delayed consultation (PHDP Evaluation
Report, 1993), and also as a consequence of irregular delivery or unavailability if necessary drugs
for treatment of severe malaria. At present, there is no available data regarding rate of mortality
amongst indigenous communities. However, the strategic planning workshop with organizations
working with IPs indicated malaria as among the leading cause of mortality in these communities.
A challenging complication to the need to reach out to those indigenous and marginalized groups
is the need to face a serious threat from drug resistance. In the last 6 years, a systematic
evaluation of Chloroquine (CQ) and Sulfadoxine-Pyrimethamine (SP) efficacy in the treatment of
malaria by the Malaria Control Service and Research Institute for Tropical Medicine (RITM)
Malaria Study Group, has shown CQ treatment failure rates to range from 45 to 70% in different
parts of the country: in Palawan (1995 to 2000), Agusan del Sur (1997 to 2000), Kalinga-Apayao
(1998 to 2000) and Davao Norte – Compostela Valley (2000). Likewise, limited studies on
treatment response to SP monotherapy also shows declining efficacy in selected areas from
1995-2000, i.e. 12.5-20% SP treatment failures in Palawan and Kalinga-Apayao, and as high as
51% in Davao Norte-Compostela Valley (Bustos et al, 1999 and 2000). Clearly, the continued use
of monotherapy threatens an increase in morbidity and mortality in this underserved population,
as these were the areas and provinces where drug resistance was documented.
Organizational Structures
In the light of the new organizational structure implemented by virtue of Executive Order 102, the
Malaria Control Program at the central office has forced itself to adapt to the changes that
ensued. Meeting the challenge of maintaining technical and managerial leadership over the
national program with a shrunken human resource at the national level is the priority area
pursued since 2001. Under the new set – up, the National Program is under the Center for
Infectious Disease of the National Center for Disease Prevention and Control. The MCP in the
regions continues to operate within a semi-vertical structure and implementation is still through
the primary health care approach. More than ever, identifying and building partnerships within
and outside of the health sector and strengthening collaboration with the Local Government Units
and the community-at-risk through the Center for Health Development (CHD) are the areas of
emphasis for improved access and more efficient delivery of services.
Budgetary Needs for Malaria Control
Budgets allocated by the national government which is experiencing sectoral spending, have
been shrinking since 1997. Health budget has been experiencing downward cuts I relation to the
Gross Domestic Product (GDP) of the country. In 2004, budget from the national government for
health went down to 0.3 percent of GDP from 0.4 percent in 2002 and 2003. The national budget
allocation for malaria has been pegged at US$180,000 for the last 5 years and does not foresee
any increase. It is fortunate that the external sources such as the Roll Back Malaria Program and
the Global Fund have been made available for the program to sustain and strengthen the
National Malaria Control Program of the country.
It is estimated that a total budget of US 39 Million will be needed over 5 years to achieve the goal
of 70% reduction of morbidity and mortality for the Category A provinces in the country. The
assumptions for these cost estimates were based in the requirements for an intensified effort
using all proven interventions against malaria as well as innovations to ensure sustainability, i. e.
scaled up interventions to reduced malaria transmission by having at least 90% coverage of
bednets and increased bed net allocation of 2-3 LLITNs per family; twice a year focal indoor
residual spraying for 2 years: the use of combo RDT; a separate allocation of combo RDTs and
st
nd
rd
drugs for the military; availability of 1 and 2 line drugs in all health centers and 3 line drugs in
all hospitals. This is complemented by an extensive Information and Education Campaign using
tri-media exposures.
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National Needs for Malaria, Philippines 2006 to 2010
Strategies
Activities
EDPT
Drugs
Cat A
Other Provinces
Sub-total
Commodities and
Product
Cat A
Other Provinces
Subtotal
Training
Cat A
Other Provinces
Sub-total
Infrastructure and
Equipment
Cat A
Other Provinces
Sub-total
Human Resource
Cat A
Other Provinces
Sub-total
Planning
and
Administration
Total
2005
168,225.00
930,803.63
588,071.05
1,518,874.68
*based on
0.10
0.10
0.10
1,687,099.68
2006
2007
173,481.00
86,740.95
260,222.85
2008
2009
2010
114,679.44
57,339.50
172,018.94
Total
288,161.34
144,080.45
432,241.79
5,207,489.78
6,200,000.00
172,500.00
11,579,989.79
original tar
4,686,740.00
4,400,000.00
172,500.00
9,259,240.00
get of 1 net
5,000.00
4,400,000.00
172,500.00
4,577,500.00
per hh.
5,000.00
2,800,000.00
172,500.00
2,977,500.00
5,000.00
2,500,000.00
172,500.00
2,672,500.00
9,909,230.58
20,300,000.00
862,500.00
31,071,730.58
850,897.00
425,448.50
1,276,345.50
373,427.00
186,713.50
560,140.50
192,677.00
96,338.50
289,015.50
99,287.00
49,643.50
148,930.50
25,213.00
12,606.50
37,819.50
1,561,501.00
770,750.50
2,332,251.50
746,132.00
373,066.00
1,119,198.00
28,000.00
14,000.00
42,000.00
28,000.00
14,000.00
42,000.00
28,000.00
14,000.00
42,000.00
28,000.00
14,000.00
42,000.00
858,132.00
429,066.00
1,287,198.00
85,089.50
111,089.60
76,089.60
76,089.60
116,089.60
464,448.00
85,089.50
1,958,757.27
111,089.60
394,156.10
76,089.60
498,836.96
76,089.60
302,452.90
116,089.60
339,692.90
464,448.00
3,493,896.13
16,279,803.00
10,366,627.00
5,655,461.00
3,546,973.00
3,208,102.00
39,081,768.00
The Malaria Control Program – (A SWOT analysis)
After the DOH streamlining plan at the Central Office was implemented in November of 2000, the
National Malaria Control Program examined its position in the light of the current changes. From
this self-assessment, internal strengths and weaknesses have been recognized; external
opportunities and threats identified. The findings of this SWOT analysis indicate the state of the
country’s National Malaria Control Programme and its capacity to pursue RBM initiatives towards
equity and sustainability of service delivery to prevent and control malaria in the Philippines.
Strengths of MCP
A well-organized, functional structure at the regional level with potential for capacity
development;
A core of civil service professionals and non-professionals with a well-entrenched
orientation towards quality service delivery and wide experienced in the control of malaria
in the Philippines.
A milieu open to technological innovations, reforms, new knowledge, collaboration with
other organized groups within and outside the health sector.
Weakness of the MCP
Changing malaria disease pattern and changing understanding of these patterns require
adaptation of strategies as appropriate to the existing situation necessitating a more proactive mindset to control operations;
Documentation of MCP actions, service delivery experiences, standard operating
procedures for quality assurance has been inadequate or absent;
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Surveillance and information system inability to provide relevant information-on-demand
for a more effective and immediate action;
Most public hospitals have been trained on the management of malaria;
Lack of resources limits the expansion and regular upgrading of managerial and technical
capacity of the regional centers as the arm of the program for ensuring quality services
for control and the local government as the implementing unit;
System for tracking progress that will allow immediate resolution of problems or planning
for alternative actions is almost nil.
Opportunities and Threats
The ease of use of new technology will allow the program to pursue a wider coverage of
more prompt and accurate malaria diagnosis.
The availability of new drug that will enable the program to revise policy is a prospect for
the provision of more effective treatment against malaria;
The abundance of allies within and outside of the health sector and government in the
common pursuit of better health will create greater momentum in improving malaria
status;
The positive environment and new determination in getting things moving at the Center
for Health Development which is the center of gravity for ensuring quality in service
delivery are conducive in placing malaria as a priority in regions and provinces where the
problem persists;
Capacity development for malaria control in support of the local health systems
development will accelerate integration of the program in all endemic areas.
Threats to RBM initiatives
Deteriorating peace and order situation in border areas as a constraint in delivering
services to the people who are mostly affected by the disease;
Limitations of public funds to solve the problem of malaria and other diseases due to
competing priorities at the local level;
Increasing costs of inputs (with no corresponding increase in budget allocation) such as
wages for casual personnel, insecticides, drugs, equipment, and other operating
expenses constrained the program in maintaining an adequate level of coverage.
In conclusion, the major challenges in sustaining the reduction of malaria burden in the country
are;
Improving the managerial and technical capacities in malaria control program
Working beyond the health sector to reach out to remote communities
Empowering the communities at risk, including the indigenous peoples, to become active
partners and not just passive recipients of health services.
Detecting and responding early to control outbreaks and preventing its occurrence.
Combating drug resistance.
4. VISION
The partner of the Malaria Control Program in the Philippines envisions that, in 2020 and beyond
the program is no longer relevant as it is today. The malaria burden would have been eliminated
through the concerted efforts of the various partners including the communities at risk. In the
medium term, the high-risk groups who are the poorest of the poor and include the indigenous
peoples in malaria endemic areas-improving equity and sustainability in health care.
5. MISSION
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The National Malaria Control Program will broaden and sustain the existing DOH-LGUcommunity partnership to empower the populations at risk, further enhance the delivery of health
services in malaria endemic areas in the context of the on going health sector reform and ensure
sustainable malaria control.
6. GOAL
To significantly reduce the malaria burden so that it will no longer affect the socio-economic
development of individuals and families in endemic areas.
7. OBJECTIVES
Health Status Objectives
Reduce malaria morbidity rate by 70% by the end of 5 years.
Reduce malaria mortality rate by 50% by the end of 5 years.
Eliminate indigenous cases of malaria in 18 provinces by the end of 5 years.
Prevent the re-establishment of malaria transmission in 13 provinces.
Service/Intervention Objectives
At least 75% of endemic municipalities have microscopy service capable of confirming
malaria diagnosis by the end of 5 years.
At least 50% of BHWs and 50% of RHMs Category A provinces use RDTs to diagnose
malaria by end of 3 years.
All confirmed P. falciparum cases are treated with combination drugs beginning of year 3.
All outbreaks are detected within two weeks and managed properly.
Risk Protection Objectives
At least 80% of households have at least 1 insecticide-treated mosquito net by end of 5
years.
At least 60% of indigenous population has at least one treated mosquito nets by the end
of 5 years.
8. GUIDING PRINCIPLES
The development and implementation of strategies to attain the above goal and objectives are
guided by the following principles:
8.1 Focus on the disadvantaged groups to help address inequity.
Malaria is not just a health problem; it is also a socio-economic development issue. The high
burden of malaria persists among the poorest of the poor particularly the indigenous peoples,
subsistence upland farmers, settlers in frontier areas and forest-related workers where access to
basic social services is difficult. This being the case, subsidies from the national and local
governments and their partners’ essential in reaching out to make the services available to the
disadvantaged groups. Reducing the burden of malaria as integral part of socio-economic
development objectives in rural areas will help address inequity.
8.2 Positioning the MCP to improve its performance.
So much had been gained during the eradication period but was lost in 1980s mainly due to
complacency and lack of sustained political support. Having gained much ground in the 1990s,
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the MCP continues to position itself to maintain its status as one of the priority health programs in
the country that is backed with strong political support at national and local levels. It reinvents
itself to suit the changing national and local socio-political environments while strengthening its
technical integrity. The management and technical support systems shall be further improved to
help ensure the program’s efficiency and effectiveness. It takes into account the decentralized
public health system and the on going health sector reform in the country in order to contribute to
the attainment of the National Objectives for Health.
8.3 Ensure sustainability through community and multi-sectoral involvement.
While the DOH, LGUs and many endemic communities have established strong partnership that
sustain the gains in the past 6 – 8 years, much more can be achieved by strengthening this
partnership in all endemic areas. Further, involving more committed partners, particularly those
that can add value in terms of financial resources, technical expertise, community mobilization
and service delivery to high risk communities can scale up the program’s performance and further
roll back malaria.
8.4 Evidence-based approaches.
The strategic plan builds on the considerable lessons learned from experiences on malaria
control in the country. It takes into account the results relevant studies from local and
international settings. Key challenges identified through review of documents or reports, experts’
opinion and consultation with partners are taken into consideration. The “epidemiological
approach” to malaria control is once again emphasized in defining key interventions applicable to
a particular area.
9. STRATEGIES
STRATEGIC FRAMEWORK: Reducing the Burden of Malaria in the Context of Health
Sector Reform to Help Address Equity
TECHNICAL STRATEGIES
The technical strategies to prevent and control malaria in the country are in accordance with the
global Roll Back Malaria (RBM) strategy. It takes into account the local epidemiological situation,
the health systems and evidence in the country. It builds on the lessons learned from decades of
anti-malarial campaign in the country but more particularly from 1993 onwards when the Global
Malaria Control Strategy was adopted in the country. The current strategy takes into account the
important roles of the implementing partners, particularly the local public health system, NGOs
and the communities at risk.
EARLY DIAGNOSIS AND EFFECTIVE TREATMENT
Early diagnosis, either by clinical, RDT or microscopy, and treatment with effective drugs near the
home or at health facilities aims to reduce morbidity days, minimize complications and reduce the
risk of deaths due to malaria. With the use of gametocytocidal drug, it will also help reduce
transmission.
The key approaches to improve access and quality to early diagnosis and effective treatment are:
(a) Strengthen confirmed diagnosis-based treatment
While P. vivax is still sensitive to chloroquine, in several provinces there is high resistance of P.
falciparum to chloroquine and sulfadoxine-pyrimethamine given as monotherapy. Surprisingly
when these are given together the efficacy improves. The efficacy may not last long and this
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necessitates the use of expensive drugs such as artemisinin-based combinations. In view of this,
the confirmation of diagnosis is becoming more essential.
Improving integrated microscopy services at RHUs and hospitals
Recent preliminary needs assessment covering RHUs in endemic municipalities indicates that
only 160/369 (45%) has microscopy services, and only 90/160 (58%) has staff trained on malaria
microscopy. Assessment in all endemic municipalities will be completed before the end of 2002.
In malaria endemic areas where there are no microscopy services, advocacy will be done to
LGUs for them to support the establishment of integrated microscopy services for malaria, TB,
soil transmitted helminthes and schistosomiasis. In class 5 and 6 municipalities (poor income
municipalities) microscopes and essential supplies that may be secured from partners will be
provided on the condition that the LGU would hire the staff (Medical Technologies or Medical
laboratory Technical) that will be trained on integrated microscopy.
Key Targets:
1. At least 100 RHUs have established a functional integrated microscopy in 5 years.
Establishment of the Barangay Malaria Microscopy (BMC) in strategic locations
Recent experience in several projects in: (a) Palawan (supported by Shell Philippines, Kilusan
Ligtas Malarya (NGO), and the LGUs), (b) El Nido, Palawan (supported by El Nido Foundation,
and (c) in Southern Mindanao (supported by LGUs and WHO as part of the RBM initiative)
showed that the volunteers at barangay level can be trained to do malaria microscopy. In
Palawan 340 BMCs are being established and 6 in Southern Mindanao. The initial evaluation on
the accuracy of diagnosis is very encouraging – it ranges from 80 to 97%. The MCP envisions
replicating this in other parts of the country to gain more experience. Further expansion will be
done depending on the outcomes in the current projects in Palawan and Mindanao as well as
those that will be established soon. LGUs and barangay councils will be mobilized to support the
establishment of BMCs, and they will be assisted to define mechanisms to sustain the services.
Key targets:
1. At least 20 BMCs are established in two years
2. Evaluation of the performance and sustainability of BMCs done by the end of year 2.
Strategic deployment of rapid diagnostic tests
In areas where access to microscopy services is difficult and where combination therapy will be
used, RDTs will be provided for use by BHWs, other volunteers and by the health center staff.
The users will be trained on the use of RDTs. To help sustain the BHWs and the volunteers,
minimal user free will be charge. The amount will be determined through consensus by the
barangay council, BHWs, other volunteers and the RHU staff. The lessons to be learned from the
current RBM initiative in Southern Mindanao where RDTs are being used will be taken into
account in scaling up the operational use of this tool.
Key targets:
1. At least 50% of all endemic municipalities in Category A provinces are using RDTs
according to NMCP guidelines by year 2 and 100% by year 5.
2. At least 25% of all endemic municipalities in Category B provinces are using RDTs
according to NMCP guidelines by year 2 and 100% by year 5.
(b) Mobilization of BHWs and other volunteers and strengthening their capacity
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The Barangay Health Workers (BHWs) are now fully institutionalized and supported mainly by the
LGUs as mandated by Law. They are now well organized and empowered, and their
organizations are federated at provincial level. Many federations are registered with the
Securities and Exchange Commission. In a project in El Nido, Palawan, active involvement of
trained BHWs increased three-fold the number of cases detected, and they contributed 50 – 60%
of the total confirmed cases detected and reported by RHUs in 1999 to 2001. In Bicol region,
massive involvement of malaria surveillance and vector control (MASUVECCO) volunteers
contributed to marked and sustained reduction of malaria cases from 7,206 in 1991 to 158 in
1996, and further down to 25 in 1999 and 21 in 2000. They were also instrumental in the
implementation of ITNs even before the use of ITNs was institutionalized nationwide. There are
other experiences that BHWs can be trained and sustained to support the implementation of
malaria interventions.
The MCP will further build up the BHWs particularly those in remote endemic barangays to
massively increase coverage of early diagnosis and effective treatment and insecticide treated
nets. They will be trained and provided with first line drugs and RDTs in accordance with the
national guidelines (to be developed).
Key targets:
In malaria endemic barangays:
1. All BHWs in endemic barangays in Category A and B provinces are able to treat
uncomplicated malaria according to MCP guidelines by year 3.
2. All BHWs in endemic barangays in Category A and B provinces are able to treat
mosquito nets with insecticide by year 3.
(c) Improve case management at health centers hospitals
Malaria case management at health facilities will be strengthened through training and provision
of anti-malarial drugs and user-friendly treatment guide.
The RHU staff (RHMs, PHNs, MHOs) will be re-oriented on case management of malaria as part
of the overall refresher course on MCP. Practically almost all RHU staff in Category A provinces
had been trained in the past 2 – 6 years. In Category B and C provinces training coverage is
about 75%. They need re-training in view of the planned change in drug policy within this year as
well as to train them on the use of RDTs. Re-training with total coverage in 3 – 5 years is being
envisioned. A core group of trainers at regional level that is already established will be supported
with trainers from the provincial health offices.
In endemic areas where is on going IMCI training that the MCP has supported since the
adaptation of training materials, no other malaria specific training on case management will be
conducted other than IMCI.
The coverage of training for resident physicians is very low. In the past four years, only about
100 resident physicians at provincial and district hospitals and about 10 private practitioners (in
Kalinga province) were trained on case management. More investments are needed in this area
particularly in training those in the public sector. For private practitioners, the medical society will
be tapped to improve the knowledge and skills of their own ranks. Support will be provided in
terms of technical resource such as national guidelines and the handbook on case management
of severe malaria (WHO publication).
Key targets:
1. All RHU staff (RHMs, PHNs, MHOs) in all endemic municipalities is able to treat
uncomplicated malaria according to MCP guidelines by year 5.
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2. All resident physicians in provincial and district hospitals in Category A and B provinces
are able to treat malaria cases according to MCP guidelines by year 5.
(d) Ensure the availability of anti-malarial drugs and essential supplies
The DOH and LGUs, working with their resource partners, will ensure the availability of
antimalarial drugs and essential supplies at the health centers, barangay health stations and
closer to home. In the latter, it means providing them to trained BHWs and other volunteers in
the barangays so that people will have easy access.
Key targets:
1. All RHUs in endemic municipalities have first and second line drugs at any given time
starting year 2.
2. No BHS with endemic area in Category A and B provinces will have no stock out of first
line drug for more than two weeks starting year 2.
3. No trained BHW in Category A and B provinces will have stock out of first line drug for
more than 3 weeks starting year 2.
(e) Improve treatment seeking behavior and compliance
Aside from improving the availability and quality of services as described above, culturally and
technically appropriate health education strategy will be developed to significantly improve
treatment-seeking behavior and compliance. The first dose treatment will be supervised either by
the health worker or by the BHWs immediately upon establishment of diagnosis (either clinical or
confirmed). The caregivers or the adult patients will be given appropriate instructions to complete
the treatment. In situations wherein the patient is no longer around when the diagnosis is
established, the caregiver to whom the drug and instruction were given will ensure the completion
of treatment. Other details will be included under the section “Communications for Behavior
Change”
Key targets:
1.
At least 40% of malaria suspects seek treatment from either BHW or health staff (either
RHM, PHN, MD or microscopist) within 24 hours of onset of fever, and 80% seeks
treatment within 72 hours by year 3.
SELECTIVE APPLICATION OF VECTOR CONTROL
(a) Insecticide-treated mosquito nets (ITNs)
The use of ITNs shall be massively scaled up as the main tool to reduce transmission. The aim is
to have at least one bednet per household. For indigenous peoples and the very poor, long
lasting treated bednets will be given free. In other areas, cost sharing as implemented in the past
will be strengthened. In this approach, 60 per cent of the needs in the barangay will be provided
by the government/partners on the condition that the community themselves will provide the
remaining 40%. The health workers, NGOs and POs will be tapped to mobilize the communities
for the latter to come up with their own mechanisms in providing the remaining 40%. In the past,
most communities agreed to charge some amount from each recipient to buy additional nets to
cover the 40% counterpart. In other areas, either the barangay or municipal councils provided
the counterpart.
The insecticide for treating bednets will be provided free of charge.
workers shall do the treatment.
The BHWs and health
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Key Targets:
1. At least 90% (national average) of households in malaria endemic areas have at least
one bednet in year 5 (baseline: 65%).
2. At least 75% of households of indigenous people have at least one permanently treated
nets (baseline: to be established)
3. At least 90% of all bednets in endemic barangays in Category A and B provinces is
treated at least once a year in year 3 onwards (baseline:xxx)
(b) Indoor residual spraying (IRS)
IRS is still very effective against the main malaria vector in the country and acceptable to the
people. However, the wide scale use as practiced in the past is constrained by the very high
costs of insecticides and labor. Its use has been judiciously scaled down, and this is mainly for
containment of outbreaks that the current strategy also espouses.
Key target: At least 90% of target houses are sprayed to control outbreak.
(c) Other vector control measures
Reports indicate that environmental management has been utilized with success in the country in
1920’s and 1930’s in the country. And even when DDT was widely used, environmental
management, as well as biological control, is being advocated as a supplemental vector control
measure whenever appropriate.
(d) Chemoprophylaxis
Chemoprophylaxis will be limited only to travelers from non-endemic areas that would stay / work
for short period in moderate to high endemic areas. The drugs to be used will be determined
soon in view of the recent confirmation that chloroquine is no longer effective against P. vivax.
Unlike in Africa with high malaria transmission, there is no evidence yet on the value of giving
intermittent preventive treatment for malaria in pregnancy in relatively low endemic areas such as
the Philippines.
Key target: all those who request for chemoprophylaxis and qualify as per national guidelines
shall be provided with chemoprophylaxis
EPIDEMIC PREPAREDNESS AND RESPONSE
Significant gains were achieved in malaria control that wide areas of the country had been clear
or almost cleared of malaria transmission but some are still receptive to transmission. There is
an ever-present risk of outbreaks due to many factors such as population movement and
breakdown of control services. Surveillance/vigilance needs to be intensified so that outbreak
could be detected and properly controlled within two weeks of onset. The DOH and LGU are now
strengthening the national, regional, provincial and municipal (some) epidemiology centers and
the MCP is banking on this system for early detection of outbreaks. Areas that are still receptive
to outbreaks will be identified and the concerned health workers will be informed of the potential
for malaria transmission. In every region (except NCR), a rapid response team will be
established to investigate and coordinate the proper control of malaria outbreak.
Key target: All outbreaks are detected within two weeks of onset and properly controlled.
ELIMINATION OF INDIGINOUS CASES IN CATEGORY C PROVINCES
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Category C provinces are those with either few indigenous cases (less than a hundred cases) or
no more indigenous case within the past three years. There is potential to eliminate the
indigenous cases in these provinces. If there is no more indigenous case detected for more than
three years after intensive investigation, a province shall be declared “malaria free”. However,
the presence of the vector will be determined in order to know if there is still potential for
transmission. The broad activities include:
Delimitation of foci transmission.
Intensive surveillance, case investigation and foci investigation.
Radical treatment of cases and follow-up
Elimination of breeding sites through environmental management wherever feasible.
Continued vigilance in areas with potential for transmission (with vectors).
Evaluation to determine the status of the province.
The current strategy strongly re-iterates multi-sectoral partnerships, with DOH, LGU and
communities at risk as the core partners. Targeted advocacy will be done to broaden the
partnerships, and the partners find appropriate mechanisms strengthen the partnership.
Depending on the scale of partnership activities and/or geographic coverage, the partnership will
be coordinated either at barangay, municipal, regional and/or national levels.
Key targets:
1. Key partners reached consensus on the drug policy by year 2002.
2. There is a functional multi-sectoral partnership in at least 50% of Category A provinces
by 2003 and 100% by 2005.
STRENGTHEN THE MANAGEMENT AND TECHNICAL CAPACITIES
(a) Human resource development
A right mix managerial and technical expertise is required for effective and sustainable malaria
control. The focus will be on improving the managerial and technical capacities of the RHU staff
since they are the front line health care providers and they have some degree of autonomy due to
the decentralized health system. Equally important is to address the training needs of Medical
Officers both in the private and public sector on case management of malaria. In the face of
worsening drug resistance, accuracy of diagnosis is essential than ever and therefore improving
the skills of microscopists on malaria diagnosis need to be accelerated. Depending on the
category of trainees, social mobilization will be part of the training.
Key targets:
1. 100% of regional malaria coordinators and 50% provincial coordinators from Category A
provinces trained/refreshed on malaria program management by 2002; and 100% PMC
by 2003;
2. 100% of regional and provincial hospitals in endemic provinces trained on case
management by 2003.
3. 75% of malaria microscopist at the regional/provincial from Category A provinces trained
as validators by 2002; 100% for Category A and 50% for Category B by 2003; 100% for
Category B by 2004
(b) Improve Supervision
Supervision is an essential management tool to ensure implementation is carried out effectively
and efficiently in accordance to policies and set standards. In the context of the current structure,
the Regional Offices is still directly responsible for supervising the malaria control program
personnel through the Provincial Health Team Leader and the Malaria Control Program
Coordinator. Regular supervisory visits must be carried out to ensure guidelines are followed
accordingly. However, at the municipal level, the MCP needs to coordinate all activities of the
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program with the MHOs, who is the manager of the program at this level. This is to harmonize
the control program at this level. This is to harmonize the control program activities with that of
the RHU, enabling them to include malaria control in the over-all health plan of the area.
(c) Strengthen technical support
Establish/strengthen technical support groups
Technical Support Groups at national and regional levels will be institutionalized to service the
partnerships and to reinforce the project based TWGs. The recently created National Infectious
Diseases Advisory Council under the auspices of the Department of Health is mandated to
provide technical advisory services to partners dealing with infectious diseases including malaria.
The Malaria Task Force that exists since 1995 and comprised of malaria experts from different
institutions and spearheaded by the Philippine Council for Health Research and Development will
be further strengthened. At regional level, Region 11 (Southern Mindanao) has already RBM
TWG to support planning and implementation, monitoring and evaluation.
Key Targets:
1. A TSG is functional at national level.
2. At least 6 regional TSG (3 in Luzon and 3 in Mindanao) are functional by the end of
year 2.
Strengthen the collaborating centers
Through the support from the Japanese Grant Aid for Child Health and US-NAMRU-2 a
collaborating center on malaria and other vector borne diseases was established and
operationalized in Mindanao and Cordillera Administrative Region in 2001. Its functions include:
to provide services for training, research, resistance monitoring on insecticides and drugs and
quality assurance on diagnosis and to serve as reference center in the zones where they are
located.
Key targets:
1. At least one operational research completed every 2 years starting year 1.
2. At least one sentinel site each is maintained for monitoring resistance to drugs and
insecticide.
(e) Improve surveillance and the use of evidence
Surveillance, which means continuous collection, collation and analysis of information for action,
is fragmented in most instances. Data collection may be good in some instances but data
analysis is done at the level where planning and implementation of the program. Data are
collected for the sake of reporting to higher level, and not for use as evidence in the management
of the program at the lowest level. The managers of the local public health system should be
reminded that they should collect data primarily for there own use to improve health programs.
This shifting of paradigm will be done through advocacy and during training of health staff.
To enhance surveillance coverage, the BHWs will be utilized. Documentation of projects in
recent years indicated that when BHWs and other volunteers are trained and provided with
logistics, case detection markedly improved, sometimes threefold. Cases that would have been
otherwise missed were detected and treated by trained BHWs. It is therefore essential to support
the BHWs and other volunteers.
The DOH and LGU are strengthening the epidemiology centers (national, regional, provincial and
in some municipalities. The MCP program shall position to make use of this important resource.
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In some areas, there is already community-based surveillance going on. This will be evaluated,
and if it is feasible and useful, it will be replicated in other areas.
(f) Epidemiological stratification
In order to guide management decisions and the planners so that interventions are best targeted
to a particular epidemiological setting, macro- and micro- stratification of areas is being carried
out.
(g) Resource Mobilization
Several approaches shall be done to mobilize resources. This shall include targeted advocacy to
key resource partners (bilateral and multilateral agencies, international NGOs, etc) as well as to
LGUs in order to generate financial and technical support. Communities are important resource
so they will be mobilized so that they are more than just passive recipients but active partners
that can contribute resources (e.g., support to their own volunteers).
(h) Innovative actions
RBM calls for innovation based on evidence and not working as usual. There is a need to put
into practice the epidemiological approach in malaria control, and to adapt or develop package of
interventions directed towards key target population to address specific situations.
Since the burden of malaria is high among indigenous peoples (IP), and in order to engage the IP
in a culture sensitive way, there is a need to develop with them a holistic intervention package.
MCP may learn from experience of non-health sector particularly from NGOs to deal with them.
An example is the Community Health Initiatives for Indigenous Peoples (CHIIP) that was recently
initiated. CHIIP aims to effectively deliver a comprehensive package of health interventions for
indigenous people in malaria endemic areas. It is building on non-health projects of NGOs and/or
LGUs such as adult literacy program, livelihood program and others in order to develop
“indigenous tools” that will help empower the IP and improve the delivery and sustainability of
health care interventions. Initially the package will comprise of ITNs, RDTs, drugs and
community health education. Other interventions against other common health problems of the
IP will be included.
(h) Monitoring and evaluation
Monitoring and evaluation shall consider the process, outcome and impact indicators as outlined
in the RBM Framework for Monitoring Progress and Evaluating Outcomes and Impact. Also, the
indicators adopted during the WHO Bi-regional Meeting in Kunming, China in 1999 will be
considered. If data on important indicators are not available, baseline surveys will be done.
There will be emphasis on the systematic collection and utilization of data for evidence-based
actions at the lowest implementing unit.
18.2
223
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Philippine Malaria Proposal
Annex 13: Malaria Status, years 2003 to 2005
Malaria Status 2003 - 2005 Covering 21 GF2 provinces and 4 additional
provinces with increasing number of cases (Philippines)
Source: Department of Health - Malaria Control Program Special Report
Region
II
Batch
Round 2
2
II
III
IVA
IVB
IX
IX
X
X
XI
XI
XI
XI
XI
CARAGA
1
1
1
1
2
2
2
2
1
1
2
1
2
2
CARAGA
CARAGA
CAR
CAR
CAR
ARMM
Total 21
Provinces
2
1
1
2
1
2
XII
XII
XII
IX
Total 4 new
provinces
Total 25
provinces
New
New
New
New
Province
Cagayan
Isabela
Zambales
Quezon
Occ. Mindoro
Zambo del Sur
Zambo Sibugay
Misamis Or.
Bukidnon
Davao del Norte
Davao del Sur
Davao Or.
Compostela Val.
Sarangani
Surigao del Sur
Agusan del
Norte
(including cases
in Butuan City)
Agusan del Sur
Ifugao
Mt. Province
Kalinga
Basilan
North Cotabato
South Cotabato
Sultan Kudarat
Zambo del Norte
2005 Population
993'
580
Total Cases
2003
2004
2005
2'
193
1496
1'
593
API
2005
1.60
1'
432'
427
483'
833
1'
621'
611
426'
831
1'
464'
801
552'
433
753'
027
1'
198'
799
826'
374
852'
513
482'
779
649'
003
460'
513
535'
680
1'
408
414
174
511
161
53
104
97
475
2370
301
279
492
237
1'
355
455
99
489
439
40
206
38
738
482
125
134
815
306
1'
638
988
594
419
604
70
388
330
203
223
398
140
1'
439
1'
320
1.14
2.04
0.37
0.98
0.41
0.13
0.52
0.28
0.25
0.26
0.82
0.22
3.12
2.46
285'
773
609'
351
175'
119
151'
253
196'
907
375'
763
579
818
53
99
830
196
451
272
121
191
671
75
1'
338
718
66
308
987
80
4.68
1.18
0.38
2.04
5.01
0.21
14'
528'
370
11'
844
8'
998
13'
844
0.95
1'
068'
408
770'
162
660'
405
881'
572
221
174
1'
729
12
199
255
1'
424
not available
125
441
1'
914
85
0.12
0.57
2.90
0.10
3'
380'
547
2'
136
1'
878
2'
565
0.76
17'
908'
917 13'
980
10'
876
16'
409
0.92
Annexures
Philippine Malaria Proposal
224
Annex 14: GFMP2 Accomplishments
Provinces
Total
Population
Agusan del Norte
289'736
Agusan del Sur
615'071
Basilan
452'193
Bukidnon
933'255
Cagayan
973'681
Compostela Valley
658'930
Davao del Norte
529'833
Davao del Sur
535'536
Davao Oriental
378'961
Ifugao
175'577
Isabela
1'002'851
Kalinga
193'522
Misamis Oriental
832'613
Occidental Mindoro
432'754
Mountain Province
973'681
Quezon
1'607'598
Sarangani
500'189
Surigao del Sur
439'308
Zambales
642'407
Zamboanga del
Sur
206'656
Zamboanga
Sibugay
555'087
Total (21 provinces) 12'929'439
Profiles of the 21 Provinces
Diagnostic Facilities
Pop'n of
Ave.
Priority
No.
Cases/Month
Municipalities
BMMCs
HH
served
RDT
sites
Net and insecticide distribution
HH
served
Nets
distributed
HH
served
Local
Malaria
Insecticides policies advocates
distributed established
231'467
322'716
161'226
235'377
518'977
387'237
146'581
220'774
215'332
90'751
619'590
147'948
277'329
304'523
32'900
66'374
228'563
254'871
348'077
58
39
36
37
86
15
25
22
25
9
112
120
89
38
34
23
180
119
132
7
39
6
6
11
9
11
11
9
4
20
10
4
11
5
10
5
5
6
3'352
79'264
990
7'936
7'050
11'833
9'758
12'352
16'550
6'461
9'234
6'362
3'888
29'269
4'217
1'712
9'532
5'820
5'779
16
0
11
14
32
28
10
3
12
14
29
86
26
22
8
18
17
27
8
1'313
0
2'423
3'644
9'963
10'073
3'577
1'063
4'987
3'169
5'955
16'178
7'918
84'456
3'402
200
10'175
7'849
3'021
5'573
11'103
8'878
10'090
19'922
14'494
5'669
19'667
6'556
10'074
36'545
10'164
4'963
11'477
2'970
3'402
7'314
5'167
1'960
5'573
2'221
8'585
10'090
19'105
15'641
8'905
21'573
6'571
10'074
36'545
10'437
4'963
11'505
2'970
3'402
7'314
5'167
1'960
15'180
15'918
20'980
20'090
49'316
57'249
24'629
42'344
12'765
25'468
94'483
32'674
8'575
27'911
3'210
8'245
10'260
12'243
4'070
7
12
0
30
13
1
22
7
2
1
110
8
2
6
1
4
0
3
2
96
0
18
90
15
100
80
28
36
0
0
106
16
17
19
47
18
28
30
75'111
31
4
1'375
12
2'305
4'586
4'586
16'560
3
0
120'766
5'006'490
11
1'241
0
193
0
232'734
11
404
9'230
190'901
3'100
203'674
620
197'807
7'712
509'882
1
235
46
790
225
Annexures
Philippine Malaria Proposal
Annex 15
Anti-malarial Drug and Commodities Procurement, Supply
and Distribution Management System
Drug supply
An uninterrupted supply of anti-malarial drugs to ensure early treatment of cases to prevent
malaria mortality is one of the objectives of this proposal. In the 2nd Round GF Malaria project, the
first line drugs: chloroquine and pyrimethamine plus solfadoxine were the undertakings of the
LGUs, the second line drugs, Coartem (combination between artemesinin plus lomofantrine) was
rd
supported by the GF project, and 3 line drugs: quinine plus was to be supported by the
st
nd
Department of Health. All out-patient facilities should have the 1 and 2 line anti-malarial drugs
rd
for the treatment of uncomplicated malaria, and the hospital facilities should have the 3 line
drugs for complicated malaria cases.
st
An assessment of the capacities of the LGUs to provide the 1 line drugs and the DOH to provide
the 3rd line drugs during the project indicated that funds were not available for them to provide
these medications. In addition, there was no effective drug management system in place to
inventory stocks, forecast needs, procure these needs, and rely on an effective distribution
system to ensure that all levels of health care are provided with uninterrupted supply of these
anti-malarial drugs, based on their level of health care facility. The project aims to develop an
efficient and effective drug procurement and distribution system with the help of a technical
expert, which should have synergies with the other programs including TB and STD and other
primary health care programs. Until that is established, the scheme which is attached as the
current drug and commodities procurement and supply management system will be utilized.
(Figure)
The project aims to ensure the availability of antimalarial drugs and commodities at the health
centers, barangay health stations and at the grassroots close to the homes of the at-risk
st
nd
population. The latter would require that trained BHWs should be provided with the 1 line and 2
line drugs to dispense immediately after establishing the diagnosis by microscopy or by RDTs. All
health care providers will be given sufficient training on the appropriate treatment of malaria. For
st
nd
BHWs and care-givers in public and private out-patient facilities, 1 and 2 line anti-malaria
drugs for uncomplicated malaria shall be provided. Utilizing a simple case-management oriented
algorithm, simple and easily recognized signs such as confusion, diarrhea, and severe
drowsiness or coma, shall be indications for the first line workers to refer to the hospitals for the
treatment of complicated malaria. Hospital personnel, both in public and private institutions shall
be given training on the appropriate management of complicated malaria.
Commodities for Vector Control
From the identified challenges in the GF Round 2 project of retreating with insecticide the
conventional nets procured in GF Round 2 project, and the shortfall in the distribution that did not
attain the desired coverage for vector control, the use of Long Lasting Insecticide Treated
Bednets at an average of 2 bednets (range of 1-5, depending upon the household size) is
planned for this proposal. Distribution will ensure universal access so that recovery scheme will
not be implemented in this project as it became a barrier to access for the rural poor, particularly
the indigenous peoples.
Innovative methods to improve Anti-malarial Drug and Commodity Procurement and Distribution
System
226
Annexures
Philippine Malaria Proposal
Objective:
Uninterrupted Supply of
Quality Anti-Anti-malarial
drugs
Activities: innovative
methods to attain the
outputs/impact desired
Radio frequency
identification (RFID)
method
PhilMIS drug
consumption database
Local ordinances to
ensure pooled provincial
or regional procurement
Enhancement of
monitoring and
supervision capacity of
the National and Regional
Malaria Control Program
Capacity building for QA
methods of assaying
drugs through GPHF
minilab
>90% coverage of at-risk
population with LLITNs
Efficient distribution
Universal Access
Outputs
Adoption of information system
that enables the provincial
health offices tract the type and
quantity of anti-malarial drugs
delivered, stocked and
consumed in RHUs
DOH and/or LGUs adopt a drug
requirement forecasting,
distribution and utilization model
Improved drug procurement
system, such as pooled
procurement or direct
participation, at the local level
and in the private sector
Strengthened DOH and LGU
capacity for monitoring and
evaluating the anti-malarial drug
management system
Strengthened
DOH/BFAD/PhilHealth capacity
for monitoring drug quality,
especially those available in the
open market
Networking with FBOs, NGOs,
and CBOs with existing
infrastructure in the hard to
reach populations
Cost recovery will not be part of
the strategies for sustainability
as a first step, until
socioeconomic improvement
has been attained in the
community, commodities will be
distributed free of charge to all.
Impact
No stock out of antimalarial drugs
Appropriate forecasting
Lower cost of antimalarial drugs
Uninterrupted supply of
antimalarial drugs and
prevention of drug
resistance
Prevent drug resistance
from emerging
Interrupt vector
transmission
Interrupt vector
transmission
227
Annexures
Philippine Malaria Proposal
Figure 1. Current system of procurement and distribution of anti-malaria drugs
Drugs:
st
1. 1 line (Chloroquine and Pyrimethamine-sulfadoxine)
nd
2. 2 line (Coartem)
rd
3. 3 line (Quinine Plus) now channeled through the CHDs,
IDO and TWG Malaria
Reimbursable Procurement Scheme
PR (TDF)
WHO
Procurement Cycle
21 Provincial Health Offices
(Warehouses)
City Health Offices (Warehouses
)
DOH
Central Office / Central
warehouse
Distribution channels
RHUs/
Provincial
Hospital
BHSs
BarangayMicroscopy
Places
FBOs/
CBOs in
hard to
reach areas
DOH retained hospitals
in the 21 provinces
228
Annexures
Philippine Malaria Proposal
Figure 2. Procurement and Distribution channel for Antimalarial commodities
IDO and TWG Malaria
Reimbursable Procurement Scheme
PR (TDF)
WHO
Procurement Cycle
Forwarder
21 Provincial Health
Offices (Warehouses)
City Health Offices
(Warehouses )
Distribution Channels
NGO/FBO
RHUs/ Barangay
Microscopy Ctrs
Hard to
reach
areas
BHSs /Basic Malaria
Microscopy Places
Municipal Health Offices
along distribution route
of forwarder
Annexures
Philippine Malaria Proposal
229
Models of Pooled Procurement
Label
Description
•
Group
Country delegates meet to
jointly conduct price
negotiation and supplier
selection on behalf of
Members. Alternatively, an
agency may be contracted
for this purpose
•
Contracts with a jointly
designated central buying
unit to conduct and
adjudicate tenders
•
•
Provide accurate and
reliable quantification of
needs for selected items
Provide funds to
procurement unit/agency
for supplier payment
Provide accurate and
reliable information on
product quality monitoring
•
Individual
•
Individual
•
•
Facilitate the
gathering and
dissemination of
supplier and price
information among
Members
(Clearinghouse)
Simple sharing of
information
•
Share procurement
information for
selected items
•
Forum for harmonization
of information
requirements and
systems; mechanism
for market research,
dissemination of findings
among Members, and
potentially provision of
drug information
Focus on coordination of
information gathering
and sharing
Collect information
related to pricing and
supplier performance
based on harmonized
requirements; provide
resources to conduct
joint market research
activities for selected
items
•
Central Unit (MOH or
more regional) roles &
responsibilities
Group
Members share
information about
prices and suppliers
Members conduct
procurement
individually
•
•
Supplier Selection &
Price Negotiation
Regional group roles &
responsibilities
Members jointly
negotiate prices and
select suppliers.
Members agree to
purchase from selected
suppliers
Members conduct
purchasing individually
Central Contracting and
Purchasing
• Members jointly conduct
tenders and awards
contracts through an
organization acting on
their behalf
• Central buying unit
manages the purchase on
behalf of Members
Coordinated Informed
Buying
• Members undertake
joint market research,
share supplier
performance
information, and monitor
prices
• Members conduct
procurement individually
Informed Buying
•
•
Group Contracting
•
•
•
•
•
Provide accurate and
reliable quantification of
needs for selected items
Provide timely payment
to suppliers
Provide accurate and
reliable information on
supplier performance
and product quality
•
•
ðò ç
ñè
ò
é
ç
ê
Group Contracting
òè öë
æÿ
Coordinated Informed
Buying
ëù
îò ö
Informed Buying
Label
ñ÷ àß
ôø áâã
ùë åä
òö
ñè èé æç
ö ê
ë õ íëì ê
ñï
î æ
ôë #
ë ð ïë çñ
ëè êê é
ñ òé ê
ø
éò óèñéó
÷
ñ öç
ô
òì ëì õ
ë
ýè ñ ö
ç
ôëé éë õ
ð ê
è ì öõ
ëë ë
ñô ö
í ùëò èð
ö ñ
ø ñ
í òë ì ÷
èóñ
î ôøèë
ùë
ò öú
èû
ë
çê
éù ç
òè
üýé
ç
çç þê
éü ö
ìì
ëìì
Annexures
Philippine Malaria Proposal
230
Central Contracting and
Purchasing
monitoring
LIST OF ANNEXES TO BE ATTACHED TO PROPOSAL Malaria
II - Distribution of Drugs and Commodities:
Distribution of drugs and commodities occur in three planes: 1. from the National warehouse to the
Provincial/Municipality; 2. From the Provincial to the Municipality,
2) from the Municipality to the households.
In the first level: a commercial freight forwarder is responsible to collect the commodity from the
point of entry in the port to the provincial capitol and municipalities along the way..
From the Province to the municipality, resources need to be generated to pay for the transport cost
of the commodities. Pooled distribution of adjoining municipalities or those that fall along the route of
distribution could be considered. To fund this, each municipality could contribute, pro rata according to the
distance traveled. Another means of dealing with this problem is for municipalities to pass local ordinances to
allocate a per cent of their budget for this purpose. Corporate donors or donations from local businesses
could be tapped to fund distribution. Additionally, advocacy for corporations with distribution systems for their
own products and commodities should be undertaken for them to include malaria commodities in their
distribution routes.
Since the Philippine Armed forces are also at risk, and have very effective distribution system,
coordination with the army should be pursued, in the spirit of winning and minds and hearts of the population.
3. From the municipality to the households:
A mapping of the distribution and population size of peoples at risk through GIS should be
considered. Information from the population to determine the most efficient means of transportation to reach
them should be obtained. Project investment for acquiring these means of transportation, whether a bicycle,
motorbike, truck, jeep, or horse, or banca (boat) should be considered with the end in view of leaving these
to the community for the sustainability of the distribution system. These vehicles could be utilized by the
community for other purposes to generate income in order to make the transport system maintenance and
operation sustainable.
Distribution utilizing the existing infrastructure of CBOs, FBOs who are already providing health
services in the area will be explored. Distribution booths in areas of congregation such as in market place, in
churches or places of worship where the at-risk population visit, or through school children, could also be
another system. To avoid duplication of supply, a master list should be updated and consulted. A web-based
master list (connected through SMS) could be utilized for easy access of this information.
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
231
LIST OF ANNEXES TO BE ATTACHED TO PROPOSAL Malaria
ACRONYMS
AUSAID
BMs
BCC
BHW
BMMC /BMC
CBOs
CCM
CHD
CQ
CRIS
DILG
DND
DOH
ETR
FBOs
FHSIS
GF / GFATM
GDP
GFMP2
GFMP5
GTZ
HH
IEC
IPs
IRS
ITNs
JICA
KLM
LLITNs
LCE
LGUs
LTTA
MCP
MTPDP
NCIP
NEC
NEDA
NESSS
NGOs
P.
PAFPI
PhilMIS
PLWHA
PLWT
PPE
QA
SESS
SP
STTA
PIMS
TB
TDF
TWG
USAID
WHO
Prop_R6_EAsP_CCMPhillipines4285M_PF_28Aug06.doc
Australian Assistance for International Development
Barangay Microscopists
Behavior Change Communication
Barangay Health Worker
Barangay Malaria Microscopy Center
Community-based organizations
Country Coordinating Mechanism
Center for Health Development (Regional Health
Office of the Dept. of Health)
Chloroquine
Country Response Information System
Department of Interior & Local Government
Department of National Defense
Department of Health
Electronic TB Register
Faith-based organizations
Field Health Services Information System
Global Fund to Fight AIDS, TB and Malaria
Gross Domestic Product
Global Fund Malaria Project 2
Global Fund Malaria Project 5
German Technical Cooperation Agency
Households
Information, Education, Communication
Indigenous Peoples
In-door residual spraying
Insecticide treated nets
Japanese International Cooperating Agency
Kilusan Ligtas Malaria
Long-lasting insecticide treated nets
Local Chief Executive
Local Government Units
Long Term Technical Assistance
Malaria Control Program
Medium-Term Philippine Development Plan
National Commission For Indigenous Peoples
National Epidemiology Center, DOH
National Economic Development Agency
National Epidemic Sentinel Surveillance System
Non-government organizations
Plasmodium
Positive Action Foundation Philippines, Inc.
Philippine Malaria Information System
People Living With HIV/AIDS
People Living With TB
Personal Protection Equipment
Quality Assurance
STD Etiologic Surveillance System
Sulfadoxine-Pyrimethamine
Short Term Technical Assistance
Project Information Management System
Tuberculosis
Tropical Disease Foundation
Technical Working Group
United States Assistance for International
Development
World Health Organization
232