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Philippines
>> Regional Overview >> Philippines Overview ACTIVITY DATA SHEET
PROGRAM: Philippines
TITLE AND NUMBER: Threat of HIV/AIDS and Other Selected Infectious Diseases Reduced, 492-007
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $4,950,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: None.
INITIAL OBLIGATION: FY 1992 ESTIMATED COMPLETION DATE: FY 2004Summary: Infectious diseases (IDs) continue to be the leading cause of morbidity and mortality in the Philippines. Seventy-five Filipinos die of tuberculosis (TB) every day. The Philippines has the highest tuberculosis burden in the Western Pacific region, with an estimated 30 million people (32% of the entire Philippine population) infected with TB bacilli. Sixty-six of the seventy-nine provinces in the Philippines are considered endemic for malaria, with malaria infection rates of 40%-60% widespread in rural areas. Widespread dengue epidemic outbreaks occur every 2-3 years in the urban areas. Because of the dismal health situation, prevention and control of major infectious diseases have become key goals for the Philippines Department of Health (DOH). In 1999, the Government of the Philippines (GOP) and USAID, working closely with the U.S. Centers for Disease Control and Prevention (US-CDC), developed an activity to respond to the emergence of resistant varieties of tuberculosis and malaria in epidemic proportions and to periodic occurrences of dengue epidemics.
AIDS has caused deaths by the hundreds of thousands in many parts of the world, including Southeast Asia, and the Philippines has had its share of deaths caused by AIDS. While the Philippines has so far been successful in keeping a widespread AIDS epidemic at bay, an active sex industry and a sizable population of injecting drug users serve as constant reminders that complacency is not an option. Focused prevention activities and very strong surveillance are the keys to keeping the disease under control and preventing the need for the high cost, national scale interventions that have become necessary in many other Asian countries. The GOP, with USAID assistance, is implementing a program that is aimed at: 1) controlling HIV/AIDS transmission through focused education programs that will encourage behavior change among target groups, both to reduce the individual risk of becoming infected with or transmitting sexually transmitted diseases and HIV; and 2) institutionalizing the HIV Sentinel and Behavioral Surveillance Systems to monitor HIV prevalence and high risk behaviors.
The activities described above complement USAID's global infectious diseases and HIV/AIDS strategy. The primary beneficiaries of the HIV/AIDS program are high-risk individuals (i.e., registered female commercial sex workers and injecting drug users). The general population will also benefit from the HIV/AIDS program since increased public awareness about HIV/AIDS will enable them to adopt practices that will prevent a rapid increase in HIV/AIDS infections. Direct beneficiaries of the ID activities are the general population of the Philippines; other countries, including the U.S., benefit indirectly by control of the cross-border spread of IDs.
Child Survival and Disease (CSD) funds, particularly those that fall within the HIV/AIDS and IDs directives, will be used to support activities under this special objective.
Key Results: The HIV Sentinel Surveillance System operating in eight sites continued to detect low HIV prevalence (<3%) in the high-risk groups. The 3% level is critical because international experience shows that rates higher than 3% among high-risk populations indicate a spread of HIV into the general population and, hence, the need to expand prevention activities from the high-risk group to the entire population. On the new ID initiative, systems required to fully move the program forward have been established. In addition, USAID-supported advocacy resulted in two of eight local governments passing ordinances ensuring funding for HIV/AIDS education activities in those cities, and three other local governments are beginning to assume the costs associated with surveillance and education activities.
Performance and Prospects: There has been no explosion of HIV infection thus far in the Philippines. The HIV Sentinel Surveillance System operating in the eight sentinel sites continues to indicate that HIV seroprevalence rates remain below 3% among the sentinel group of registered female commercial sex workers (RFCSWs). In addition, data from the Behavioral Surveillance System shows that the proportion of RFCSWs using condoms with non-regular partners/clients steadily increased from 74% in 1997 to 83% in 1999, as a result of intensive condom promotion. The 2000 data show a general trend of increasing condom use in majority of the sites. Average condom use in five of the sites increased to 87% in FY 2000. In 3 of the sites, however, average condom use decreased to 38%, thus pulling down the national average to 69%. These sites are Davao City and General Santos City, both located in Mindanao, and Iloilo City, which is located near Mindanao. The presumed reason is the migration of people caused by the war between the Philippine government and the secessionist Moro Islamic Liberation Front, and also the kidnappings by the terrorist group Abu-Sayyaf. Many internally displaced people could have traveled to the nearby metropolitan areas. With such a large turnover and increase in the number of commercial sex workers as a whole, the programs were not able to meet the same impact levels as the other five surveillance areas. USAID is confirming the reasons for the decline in condom usage.
Sustaining the HIV/AIDS Program: The FY 2001 planned obligation for sustainability activities is $1.5 million CSD. USAID's HIV/AIDS surveillance and education activities have made it possible for the Philippines to continue to remain a low prevalence country through early and effective targeting of HIV prevention interventions to high-risk groups. The HIV Sentinel Surveillance and Behavioral Sentinel Surveillance systems that have been established are cost effective models for countries with low HIV/AIDS prevalence to monitor the disease and associated behavioral change among the high-risk groups. Prospects that HIV prevalence rates for the target groups will remain below 3% through the year 2002 are good, indicating that threat of a major HIV/AIDS epidemic among the general population is still contained.
At this point, there is a need to ensure the sustainability of gains achieved under the HIV/AIDS program, particularly in the areas of surveillance and education. Ongoing and future USAID technical assistance is now focused on strengthening the capability of local governments to fund and manage activities to maintain the low prevalence of HIV/AIDS in their communities themselves. Two sentinel sites (General Santos and Angeles cities) have enacted local ordinances promulgating policies and measures for the prevention and control of HIV/AIDS/STD, such as the 100% condom use policy, institutionalization of multi-sector AIDS councils, and appropriation of funds to support their HIV/AIDS prevention activities. A system for policy compliance monitoring for implementation in all sites has also been developed to improve their capacity to monitor the local sex industry's compliance with labor laws prohibiting employment of minors. A barangay (i.e., smallest unit of government at the local level) legal action against child prostitution advocacy strategy has been developed to protect children against possible sexual exploitation in and around entertainment establishments in the sentinel sites. Reproductive health services have been expanded to involve not only physicians but also drugstore sellers, nurses, midwives and other health service providers.
Establishing ID Surveillance and Control Systems: The FY 2001 planned obligation of $3.45 million CSD will allow USAID to accelerate implementation of its ID activities as mobilization activities have been completed. The ID Activity Management Office and the DOH technical working groups have been established. Baseline assessments have been completed, and plans have been developed to improve infectious disease control in the target areas. Training activities (Directly Observed Treatment Short Course for TB, malaria diagnosis, surveillance, basic epidemiology, etc.) are underway. The strengthening of laboratory systems is also taking place. In addition, the increased level of resources that USAID is receiving will support activities aimed at directly improving TB diagnosis and treatment in the private sector, a new area of focus worldwide. This is especially important as almost 40% of Filipinos with TB seek treatment from the private sector.
Possible Adjustments to Plans: As articulated in USAID's 1999 strategy, USAID will integrate the HIV/AIDS and ID special objective (492-007) into the Population and Health Strategic Objective (492-003). An assessment of the HIV/AIDS program will be conducted in April 2001 to determine areas of integration. Based on the recommendations of the assessment, appropriate adjustments to the objective will be made early in FY 2002, resulting in a well-targeted results framework. Future funding for HIV/AIDS and ID activities will be requested under objective 492-003.
Other Donor Programs: USAID continues to be the largest contributor to the Philippine National HIV/AIDS/STD Prevention and Control Program, although other donors are now showing a high level of interest in the program. The US-Japan Common Agenda was critical in leveraging resources from Japan. USAID provides technical assistance to the HIV sentinel surveillance system, while Japan provides laboratory, office, and communications equipment. Both Japan and the Netherlands contribute STD drugs that complement USAID-supported training activities on STD syndromic case management. USAID's focus on HIV/AIDS education for high-risk groups is complemented by other donors' educational activities aimed at the general population. Both Australia and the European Union (EU) support NGO projects to strengthen community-based responses to AIDS. The World Bank and the United Nations Fund for Population Activities are supporting programs to diagnose and treat sexually transmitted diseases. The TB program receives funding from Japan, the World Health Organization (WHO), the World Bank and Canada. Australia, the EU and WHO provide limited support to the DOH Malaria Program. CDC and WHO are providing partial funding for polio surveillance. The U.S. National Institutes of Health provide funding to support various activities pertaining to infectious diseases.
Principal Contractors, Grantees, or Agencies: USAID implements the program through the GOP's Department of Health and selected local government units; the U.S. Centers for Disease Control; the World Health Organization/Western Pacific Regional Office; the Program for Appropriate Technology in Health, Family Health International; and the New Tropical Medicine Foundation, Inc.
FY 2002 Performance Table
Philippines: 492-007
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Percent of RFCSWs reporting condom use during last sex with non-regular (commercial) partner 74 71 83 69 80 82 84 Indicator 2: Number of HSS sites with HIV seroprevalence rates among RFCSWs < 3% 8 8 8 8 8 NA NA Indicator 3: Cure rate for new TB smear-positive cases in project sites NA NA TBD NA NA NA 85 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent HIV Sentinel Serologic Surveillance and Behavioral Sentinel Surveillance (BSS) technical reports RFCSW = registered female commercial sex workers working in establishments, who exchange sex for money, and have health cards/permits. Data reported is aggregate for eight sentinel sites. BSS sites include the cities of Pasig, Quezon, Cebu, Davao, Angeles, Iloilo, Gen. Santos and Zamboanga. Non-regular partner is a person who has been a sex partner for less than 6 months. Indicator 2: IR No. of HIV sentinel surveillance sites HIV Sentinel Serologic Surveillance technical reports RFCSW = registered female commercial sex workers working in establishments, who exchange sex for money, and have health cards/permits. HSS sites include the cities of Pasig, Quezon, Cebu, Davao, Angeles, Iloilo, Gen. Santos and Zamboanga. Indicator 3: IR Percent Service data provided by local health centers TB= Tuberculosis. TB smear-positive cases are from LGU project sites (cities of Baguio, Calbayog and Cotabato; provinces of Samar, Ifugao and Sultan Kudarat). Cure rate = % of TB-smear positive cases who receive appropriate chemotherapy and are cured. This is a national rate. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 11,100 DA 10,249 DA 851 DA 8,700 CSD 3,202 CSD 5,498 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA 0 MAI 0 MAI 0 MAI 0 DCA 0 DCA 0 DCA Fiscal Year 2000 0 DA 851 DA 3,500 CSD 1,854 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA 0 MAI 0 MAI 0 DCA 0 DCA Through September 30, 2000 11,100 DA 11,100 DA 0 DA 12,200 CSD 5,056 CSD 7,144 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA 0 MAI 0 MAI 0 MAI 0 DCA 0 DCA 0 DCA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Planned Fiscal Year 2001 NOA 0 DA 4,950 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Total Planned Fiscal Year 2001 0 DA 4,950 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 11,100 DA 0 CSD 0 CSD 17,150 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA 0 MAI 0 MAI 0 MAI 0 DCA 0 DCA 0 DCA
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Last Updated on: May 29, 2002 |
