ADMINISTRATIVE ORDER No. 129–A s. 2002

June 19, 2002

ADMINISTRATIVE ORDER

No. 129–A series 2002

NATIONAL POLICY ON DIAGNOSIS AND CHEMOTHERAPY FOR MALARIA

I.     RATIONALE

Drug resistance has become a major problem hampering current efforts in the control of malaria in the Philippines. Results of recent studies show that in vivo determinations of treatment failure rates for Chloroquine (CQ) and Sulfa–Pyramethamine (SP) monotherapy in sampled population from different regions in the country far exceed the 25% WHO benchmark for clinical failures (MCS, 1996 – 1997, Preliminary Report ENHR, 2000, ADS – MCP, 1997 – 2000 and WHO/RBM, 2000 – 2001). These high treatment failure rates provide a very strong evidence of the Department of Health to immediately review and change existing anti–malarial drug policy in the country (WHO Guidelines, 2000).

In such cases as monotherapy failure, combination therapy becomes the more viable alternative in improving efficacy of available drugs. Therapeutic efficacy studies done in Compostela Valley showed 100% efficacy of artemether–lumefantine combination, which would make it the better choice in terms of efficacy, safety and tolerance profile and availability as a fixed dose formulation (WHO, 2001). However, this combination has been restricted to be used as a second – line drug in view of these reasons: limited findings of its safety for very young children, pregnant women and breastfeeding mothers and their babies and the inadequate capability of the current health infrastructure in many endemic areas to provide confirmatory diagnosis. The DOH therefore has to be given time to explore and further study the use of artermisin–based combination before it is adopted as a first–line treatment.

On the other hand, CQ+SP combination showed lower treatment failure rates of >15% in the sampled population studied in Agusan and Compostela Valley (ADS – MCP 2001 and WHO/RBM, 2001). To ensure that there is always safe, effective and affordable treatment which is accessible to the population at risk, the CQ+SP combination offers a better and more practical anti–malarial option in the short term.

This administrative order prescribes policies and guidelines for diagnosis and combination chemotherapy for malaria, with the objective of reducing further development of drug resistance and ultimately towards reducing morbidity and transmission and preventing complications and mortality due to malaria.

II.   COVERAGE

This order shall apply to all government (national and local) and private health facilities nationwide.

III. GENERAL POLICIES

A. The new anti–malarial drug policy as prescribed herein and its implementation shall be subject to continuous review and evaluation by technical experts.

B. Implementation of this diagnosis and chemotherapy in the control of malaria shall always be within the context of primary health care approach. Provision of services shall be integrated with other health services available at the different levels of health care in endemic areas.

C. Implementation shall be done in phases. This is to allow the National Malaria Control Programme to manage the increase in cost of diagnosis and treatment and for the regions to strengthen and expand its capacity for implementation. Areas shall be prioritized as follows:

1. Priority 1 – pilot areas for implementation will consist of project sites where capacity building for drug policy implementation has already been carried out or underway, malaria microscopy centers at the Rural Health Units are already established or upgraded and tools and system for monitoring is being developed, i.e. Palawan, Agusan del Sur, Roll Back Malaria sites in Compostela Valley, Davao del Sur and Kalinga;

2. Priority 2 – category A provinces and areas who had epidemics in last 2 years.

3. Priority 3 – category B provinces

4. Priority 4 – all other endemic provinces

D. Advocacy, training of health workers have to be conducted, systems need to be in place and funding requirements need to be secured prior to the full implementation of this policy.

E. Support from and collaboration among government, non–government and private organizations shall be a necessary requisite for its successful implementation.  

IV.  PROGRAM POLICIES

A. Combination treatment for malaria

B. Diagnosis

1. Microscopy shall remain as the “gold standard” for diagnosing malaria. All area with a functional laboratory shall at all times employ this standard.

2.  To ensure quality, a quality assessment and assurance system shall be put in place. Specifically, slide validation of all confirmed positive and proportion of negative smears shall be done by designated provincial/regional validators at least once a year.

3. Diagnosis through Rapid Diagnostic Test (RDTs) shall initially be implemented in pilot areas until operational experience in its use has already been gained. Eventually, its deployment will be limited to the following areas:

a. Areas with no microscopy centers

b. Areas which require two (2) hours travel to the nearest microscopy centers.

C. Treatment

D. Treatment during emergency situations or epidemics

V.   SUPPORT SYSTEMS

A.  Health Human Resource Development

B.  Logistics Management System

C.  Reporting and Surveillance System

VI.   ROLES AND RESPONSIBILITIES

A.  The Center for Infectious Diseases

B.  Centers for Health Development

C. Local Government Units

1.  Provincial Health Office (PHO)

2.  Rural Health Unit (RHU)

3.  BHWs/FAWs/other Volunteers

D. Non–Government Organizations

VII. REPEALING CLAUSE

Administrative Order No. 19 series 1996, all other orders and related issuances inconsistent with the provisions of this issuance are hereby rescinded.

VIII.  EFFECTIVITY

This order takes effect immediately.

MANUEL M. DAYRIT, MD, MSc

Secretary of Health  

This order was deliberately shortened to only highlight responsibilities inherent to a medical technologist.