Dr. Diana Payawal President Hepatology Society of the Philippines

1. Breaking Barriers in Hepatitis Vaccination, Liver
Cancer Prevention
Diana Alcantara-Payawal, MD, MSc, FPCP, FPSG, FPSDE
President , Hepatology Society of the Philippines
Executive Council, Asian Pacific Study of the Liver

2. HSP Strategic Focus
We are the lead national organization committed to the study of
the liver in health and in disease involved in research, education,
advocacy and formulation of health policies and in partnership
with the global community
membership
EDUCATION
Continuing
medical
membership
education
Government policy
FUNDING RESOURCES
Ways and Means
Global network
Research
Research education
and training
PJG
Training
program
Public health
education

3. To reduce
the
significant
health, social
and
economic
burden of
Liver
diseases in
the
Philippines
Supporting change through
policy development:
•
Advocacy – an independent
voice to
–
–
•
Call for better responses to viral hepatitis
across the region
Work in partnership with other
stakeholders, civil society and
governments
Education - knowledge
–
–
•
Build advocacy and policy knowledge and
capacity at local levels
Support local advocates with tools to help
their advocacy
Policy Development –
evidence
–
–
5/02/2014
Conduct research to address knowledge
and data gaps
Generate knowledge to inform the
development of hepatitis related public
policy

4. Major Stakeholder - WHO
• World Health Assembly
Resolution WHA63.R18 – May
2010
• WHO Implementation Strategy
– made public October 2011
• WHO Framework for Global
Action released December
2012
• HSP’s Strategic Plan closely
aligned
5/02/2014
4

5. Private Public Partnership Approach
WHO Strategic
Axis
1.
Partnership,
mobilization &
communication
2.
Data for policy
and action
3.
4.
Prevention of
transmission
HSP strategic plan:
FOCUS ON POLICY
LEVERS:
1. Advocacy
2. Education &
Capacity Building
3. Policy Development
Screening, care
and treatment
Coordination with national
government and private firms
5

6. The 4 Axes in the
WHO Framework for
Action
Raising
awareness,
promoting
partnerships
and mobilizing
resources
Evidencebased policy
and data for
action
Prevention of
transmission
Screening,
care and
treatment

7. Axis 1: Raising Awareness, Promoting
Partnerships and Mobilising Resources
Partnership,
mobilization
and
communication
Network of
collaborating
centres
Civil society
collaborations
Resource
mobilization
strategy
External
communication
strategy

8. Strengthening World
Hepatitis Day activity
Hep B and C
Screening
Fly A
Balloon
Lay Fora

9. Vaccination Project in cooperation with
Rotary Club at Juan Luna Elem. School
– Ensuring that
communities
understand and
support hepatitis
related activities
– Developing
partnerships
between clinical,
patient,
communities
– Sustainable
resourcing/funding
for hepatitis related
activity.

10. Axis 2: Evidence-Based Policy
and Data for Action
Data for
policy and
action
Disease burden
estimates
Impact
assessment
tools
Surveillance and
outbreak
investigation
standards
Country profiles
Research agenda
*

11. Axis 2 - Data for Policy and Action
– What data is
• Tap into available
available?
data banks
– What are the gaps • Establish
surveillance systems
in data?
• Cost-benefit systems
– Is this data
accessible to
everyone with a
stake in hepatitis? • 2 014 HSP
consensus guideline
– Is the data written
for Hepatitis B and C
in ways that
people can
understand and
use?

12. Axis 3: Prevention of Transmission
Guidance and tools for
immunization for A,
B
Safe health care
standards and tools
Prevention
of
transmission
Harm reduction tools for
injection drug users
Safe food and water
strategies
Safe sexual practice
guidance

13. Axis 3 - Prevention of Transmission
– While vaccination
programs are
implemented, where
are there gaps?
– Are there barriers to
needle and syringe
programs? Does
stigma affect
access?
– Is there a national
infection control
policy?
Despite Republic Act 10152 (An Act
Providing for Mandatory Basic Immunization
Services for Infants and Children:
•
timely birth dose coverage in the
Philippines was only 40%.
• no catch-up program for unimmunized
children beyond the age of 24 months
• only 57% and 70% of preterm neonates
and low-birth weight neonates were
vaccinated.
Republic Act 7719 National Blood services
Act of 1994, was enacted to encourage
voluntary blood donation, upgrade blood
donation services and facilities, and phase
out commercial blood banks to prevent
blood contamination.
• vigilant surveillance is still necessary
There are up to 18,000 injecting drug users
: high risk of needle sharing/ solution

14. Axis 4: Screening, Care and Treatment
Screening and
counseling resource
package
Diagnostic standards
Screening,
care and
treatment
Care and treatment
guidelines for B andC
Training package for
health care providers
Equity in access to
treatment and drugs

15. Axis 4 - Screening, Care and Treatment
– Are there barriers to
testing? Payment?
Confidentiality?
– Is there accessible
health promotion
information for people
with hepatitis?
– Treatment - Funding?
Limits on funding?
– What barriers are there
to people accessing
treatment?
•
•
limited up-to-date information on the
national prevalence of hepatitis B and C,
as well as its prevalence in vulnerable
groups.
Screening is currently not covered by the
PhilHealth. Stigma towards these
infections prevents at-risk individuals
from getting screened.
•
Hepatitis B and C is undertreated in the
Philippines, mostly because of the
advanced stage of disease upon
diagnosis, and the high cost of
treatment.
•
Policies against employment and
workplace discrimination are
inadequately implemented either
because many employers are not aware
of the Department Of Labor and
Employment (DOLE) Department
Advisory No. 05 (Series of 2010) or
because of the lack of punitive action on
violators.

16. Crossgovernment
approach with
industry
support
THE GREAT WALL
Barrier
•Carefully crafted
messages based
on what people
wanted/needed to
hear
LACK OF
PUBLIC
AWARENESSS
LACK OF
RESOURCES
LACK OF
PROVIDER
AWARENESS
•Policy report
galvanised political
will