Administrative Order No. 2013 - 0007

February 15, 2013

ADMINISTRATIVE ORDER

No. 2013 – 0007

GUIDELINES ON THE ESTABLISHMENT OF MALARIA ELIMINATION HUBS

I.     RATIONALE

Malaria remains a public health that continues to threaten the lives of about 14 million Filipinos in the 53 million malaria endemic provinces, while 27 provinces have been declare malaria–free.

The 2011–2016 Malaria Program–Medium Term Development Plan (MP–MTDP) embodies a new policy direction of the Malaria Program from control to elimination. Its goal to accelerate the transition from control to sustained elimination ensures universal access to reliable diagnosis, highly effective and appropriate treatment and preventive measures to have a malaria–free Philippines.

One of the strategies to attain this in the establishment of elimination hubs in epidemic–risk and malaria–free provinces/cities which will be responsible for overseeing and sustaining malaria– free status of different respective provinces and cities. The number of hubs would depend on the population size, geographical spread and location of endemic barangays and the accessibility of clients to these hubs.

This Order is hereby issued as a guideline on the establishment of malaria elimination hubs and how the elimination hub will carry out a mix of interventions to prevent the re–introduction of malaria equally requiring local government unit commitment, policy support and resources.

II.    OBJECTIVE

This order shall set the guidelines in the establishments of malaria elimination hubs in all epidemic–risk and malaria–free provinces and chartered cities.

III.  SCOPE AND COVERAGE

These guidelines shall apply to all health workers in the national, regional, provincial and city health offices whose functions and activities contribute to the establishment and operations of malaria elimination hubs in all epidemic–risk and malaria–free provinces and chartered cities.

IV.   DEFINITION OF TERMS

1. Malaria control is reducing malaria disease burden to a level where it is no longer a public health problem.

2. Malaria elimination is permanent reduction to zero on the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts.

3. Malaria prone areas are areas with no indigenous case in the last five year even in the presence of the vector

4. Malaria–free areas are province or a set of contiguous provinces where there is no on– going local mosquito–borne malaria transmission, and the risk of acquiring malaria is limited to introduced cases only.

5. Disease surveillance is the regular collection, monitoring and analysis of information in a given population or sub–population to detect the presence and any epidemiological changes of malaria.

6. Vector surveillance is the regular collection of vector mosquitoes in a given area to determine the presence /density and or absence of the malaria vector

7. Malaria elimination hub refers to a structure/hub equipped with diagnostic capabilities and laboratory equipment and supplies, anti–malaria drugs, vector control commodities established in areas with sporadic transmission and those already classified as malaria–prone and malaria–free areas to prevent the re – introduction of malaria.

8. Epidemic–risk area are low endemic areas where factors which may cause the occurrence of epidemic are present such as influx of laborers in developmental projects, local or foreign tourists, movement of indigenous people, military personnel and displaced populations from malaria endemic provinces or countries and or in areas bordering endemic areas.

V.     GENERAL GUIDELINES

1. To achieve universal access to anti–malaria services, strategy 1.1 of objective 1 of the MP–MTDP, shall level–up focal of anti–malaria interventions in areas with stable and unstable transmission of malaria. Strategy 1.2 shall sustain provisions of anti– malaria diagnostic, treatment and preventive measures in epidemic risk, malaria– prone and malaria–free areas.

2. To ensure that anti–malaria services are accessible to all clients and community members even in malaria–prone or malaria–free areas, malaria elimination hubs shall be established to oversee and sustain the malaria–free status in these respective provinces or cities.

3. Elimination hubs shall have to carry out multiple interventions to prevent the re– introduction of the disease which equally requires local government commitment, policy support and resources.

4. The presence of elimination hub shall be considered additional criteria in declaring provinces and cities as malaria–free.

VI.  SPECIFIC GUIDELINES

A. Implementing Guidelines in the Establishment of Malaria Elimination Hubs

1. The elimination hubs shall be managed by:

(a)   A team of local malaria personnel and other provincial/city health staff with expertise in malaria surveillance and response to be designated by the LCE.

(b)   An entomologist/entomologist–trained designate from CHDs

(c)    A medical doctor trained in malaria case management and treatment

(d)   The existing malaria program coordinator or point person and

(e)   A person to be in–charge of health promotion, social mobilization and advocacy activities, preferably the designated Health Promotion Officer (HEPO) of the LGU

2. Key interventions to be made available by the elimination hubs shall include the following:

(a)   Intensified malaria disease surveillance by the RESU, PESU, MESU.

(b)   Pro–active vector surveillance. Larval collection through larval dipping and adult mosquito collection through carabao–bait trapping to be done in May –June, two months before the main (July–August) transmission and in September before the second (October–November) transmission season.

(c)    Establishment of an epidemic detection and response mechanism to compose a case investigation, diagnostic and vector control team. To include stockpile of necessary anti–malaria drugs, insecticides and laboratory reagents and diagnostic equipment and supplies

(d)   Measures to modify the environment, like stream clearing

(e)   Focused health promotion towards target clients for a desired new behavior and intentional health promotion like local policies supported by resolutions/ordinances, networking and inter–agency committees to increase number of people promoting health actions, community action ensuring target clients are fully covered and development of personal skills through interpersonal communications, event launching and mentoring/coaching to prevent complacency among community members. Production of IEC materials.

(f)    Technical updating of knowledge and skills of service providers through trainings

(g)   Institutionalization of appropriate policies and local ordinances to support and maintain malaria–free status in each area

(h)   The installations and operations of a functional referral system to ensure that clients will have access to the aforementioned interventions. Advocate immediate consultation of transient fever cases to prevent re–introduction of cases.

(i)     All declared malaria–free areas shall be able to establish their respective elimination hubs by 2013.

(j)     Provinces and cities currently classified as epidemic–risk and malaria–prone areas shall also establish their respective elimination hubs.

(k)   The elements of elimination hubs shall guide the allocation and utilization of grant assistance from the DOH as a reward in recognition to have reached zero case in their area or locality.

3. Reporting Mechanism

(a)   The Municipal Health Office shall submit report of cases detected or even zero cases every month to the Provincial Health Office. The spraying operations conducted shall likewise be reported to the Provincial Health Office every six months.

(b)   In case of outbreak occurrence, a report of epidemiological investigation shall be reported immediately to the Provincial Health Office for immediate assistance.

(c)    The Provincial Health Office shall report the number of hubs established to the Center for Health Development after the establishment.

(d)   Vector surveillance activities such as larval surveys and adult collection done by the vector surveillance team at the province shall be consolidated and submitted to the Center for Health Development Office at the end of the year.

(e)   The Center for Health Development Office shall submit to the NCDPC – IDO reports of malaria cases and vector surveillance activities at the end of the year or during Program Implementation Reviews.

VII.  ROLES AND RESPONSIBILITIES

A. NATIONAL CENTER FOR DISEASE PREVENTION AND CONTROL – INFECTIOUS DISEASE OFFICE

1. Develop criteria for the development of elimination hubs

2. Develop guide on the establishment and operations of elimination hubs

3. Orient CHDs on the guide to establishment of elimination hubs

4. Provide the hubs with microscopy units.

5. Allocate and augment the hubs with anti–malaria drugs, vector control commodities such as insecticides, spray cans, spare parts and PPEs

6. Allocate and provide guide on the utilization of grant assistance from the DOH as a reward for recognition for having reached zero case.

B. CENTERS FOR HEALTH DEVELOPMENT

1. Orient LGUs (Provincial Health Office, Municipal Health Office) on the establishment of elimination hubs. Integrate to existing RESU (Regional Epidemiology Surveillance Unit)

2. Assist the provinces in forming the hubs in epidemic –risk provinces/chartered cities and in malaria prone/malaria–free areas.

3. Allocate/augment anti–malaria drugs and vector control commodities

4. Equip/provide the elimination hub with diagnostic equipment and laboratory supplies

5. Establish surveillance units or intensify existing surveillance system, the Provincial Epidemiology Surveillance Unit (PESU) and Municipal Epidemiology Surveillance Unit (MESU)

6. Conduct health promotion activities to increase awareness on prevention and control of malaria

7. Conduct training for spraymen, BHWs, midwives and other health providers of the LGU level

8. Conduct vector surveillance training with the assistance of an entomologist or invite the Research Institute for Tropical Medicine, Entomology Division for technical assistance

9. Establish/integrate QAS (Quality Assurance System) for malaria microscopy.

10.  Collaborate with other stakeholders like the DILG, DSWD, private sectors, media, etc., applying the Integrated Vector Management principle.

C. PROVINCIAL HEALTH OFFICE

1. Integrate surveillance activities of the elimination hub to the existing PESU (Provincial Epidemiology Surveillance Unit)

2. Allocate funds for hiring of spraymen

3. Form the hubs in epidemic–risk areas and in (malaria prone/malaria–free areas)

4. Intensify malaria disease surveillance, and facilitate trainings to PESU, MESU.

5. Establish vector surveillance team (trained provincial sanitary engineers/inspectors).

6. Conduct vector surveillance in malaria–prone areas. Larval surveys through larval dipping and adult collection through carabao–bait trapping once in May–June during two months before the first peak of transmission (June–July) and in September before the second peak of transmission (October–November)

7. Advocate for immediate consultation of transients possibly carrying malaria parasites to prevent re–introduction in malaria prone/malaria–free areas

8. Develop Quality Assurance at the PHO/PHTL Office.

D.    MUNICIPAL HEALTH OFFICE

1. Identify designated MESU (Municipal Epidemiology Surveillance Unit)

2. Intensify malaria disease surveillance

3. Maintain a microscopy diagnostic facility equipped with functional microscopy unit, medical technologist trained in malaria microscopy and laboratory supplies

4. Maintain stockpile of anti–malaria drugs for immediate treatment of any imported case to prevent occurrence of secondary cases and outbreak

5. Establish a vector control team to undertake spraying of houses in barangays in case an outbreak occurs.

6. Establish a diagnostic and surveillance team to carry out epidemiological investigation in case an outbreak occurs.

7. In case of an imported case, carry out follow–up blood smear on day 3, 7, 14, 21 and 28 days.

8. Continue to carry out advocacy on immediate consultation of any fever case and treatment compliance of any imported case detected.

9. Establish a vector surveillance team

10.  Conduct health promotion activities to prevent complacency among community members

11.  Do zero reporting even if there is no indigenous case detected

VIII.  REPEALING CLAUSE

Provisions from previous and related issuances inconsistent or contrary with the provisions of this Administrative Order are hereby revised, modified, and rescinded accordingly. All other provisions of existing issuances which are not affected by this Administrative Order, shall remain valid and in effect.

IX.   EFFECTIVITY

This order shall take effect immediately

ENRIQUE T. ONA, MD

Secretary of Health