Republic of the Philippines

Province of Leyte

SANGGUNIANG PANLALAWIGAN

EXCERPT FROM THE MINUTES OF THE FIFTH REGULAR SESSION OF THE

SANGGUNIANG PANLALAWIGAN OF LEYTE, AT THE SESSION HALL,
LEGISLATIVE BUILDING, PROVINCIAL CAPITOL COMPOUND, TACLOBAN CITY
HELD ON 02 AUGUST 2019.

PRESENT:

ABSENT:

RESOLUTION NO. ____ - 2019

AUTHOR: ATTY. CARLO P. LORETO

CO-AUTHORS: HON. FLORANTE A. CAYUNDA
HON. RAISSA J. VILLASIN
HON. RANULFO S. ABELLANOSA
HON. TRINIDAD G. APOSTOL
HON. ANNA VICTORIA M. VELOSO-TUAZON

WHEREAS, it is the policy of the state to ensure the health and wellbeing of all
Filipinos at all ages;

WHEREAS, it is the aim of the state to end the epidemics of AIDS, tuberculosis,
malaria and neglected tropical diseases and combat hepatitis, water-borne diseases
and other communicable diseases by 2030 [Sustainable Development Goal (SDG) No.
3.3];

WHEREAS, Malaria and Dengue remain as public health problems that threaten
the lives of Leyteños and continue to be an impediment to human and economic
development if not prevented, controlled or eliminated;

WHEREAS, the Department of Health’s Malaria Program’s new direction veers

away from malaria control to malaria elimination to achieve a world free of malaria as
envisioned in the Global Technical Strategy for Malaria 2016-2030, wherein the
Philippines is targeted to eliminate malaria by 2030;

WHEREAS, Section 16 of Republic Act 7160, otherwise known as the Local

Government Code of 1991 mandates every Local Government Unit to exercise the
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

powers expressly granted, those necessarily implied therefrom, as well as powers

necessary, appropriate, or incidental for its efficient and effective governance, and those
which are essential to the promotion of the general welfare, in this case the promotion of
health and safety within the Province of Leyte;

WHEREAS, Section 17 of the Local Government Code of 1991 further mandates

Local Government Units to discharge the functions and responsibilities of national
agencies devolved and provide basic services and facilities for health services such as
disease prevention, treatment, control and elimination, and maintenance of hospitals;

WHEREAS, the Province of Leyte has been declared and certified malaria-free in
the 1990’s but potential re-establishment of malaria is probable because the province is
the gateway of human traffic going to Luzon from Mindanao and vice-versa where
malaria endemic provinces are located.

WHEREAS, dengue has grown dramatically around the world in recent decades.
A vast majority of cases are asymptomatic and hence the actual numbers of dengue
cases are underreported and many cases are misclassified and is a leading cause of
serious illness and death among children and even adults in the Province.

WHEREAS, there is no specific treatment for dengue, but early detection and
access to proper medical care lowers fatality rates below 1% according to the World
Health Organization (WHO) however dengue prevention and control depends on
effective vector control measures.

WHEREAS, there has been a determination by the Department of Health (DOH)

that the incidence of dengue in Leyte has exceeded the epidemic threshold as of 12
July 2019;

WHEREAS, the Sangguniang Panlalawigan declared the Province of Leyte in a

State of Calamity pursuant to Resolution No. 2019-310 dated 2019.

WHEREAS, the Department of Health has declared a National Dengue Epidemic

in the wake of 146,062 cases recorded since January to July 20 this year.

NOW, THEREFORE, on motion of Board Member, Hon.

_______________________, duly seconded by _______________________________,
be it

RESOLVED TO ENACT, as it is hereby ENACTED, the following:

Ordinance No. 2019 - _____

AN ORDINANCE CREATING AND ESTABLISHING

THE MALARIA AND DENGUE ELIMINATION
RESPONSE HUB IN THE PROVINCE OF LEYTE,
PROVIDING FUNDS FOR ITS COMPOSITION AND
FUNCTIONS AND OTHER PURPOSES

The Sangguniang Panlalawigan of Leyte, hereby ORDAINS, that:

TITLE OF THE ORDINANCE

 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

Section 1. Title – This Ordinance shall be known as “The Anti-Malaria and

Dengue Ordinance of the Province of Leyte”

Section 2. Definition of Terms

Active Surveillance – refers to public health officers either collect the data
themselves or seek reports from participants in the surveillance system on
a regular basis, rather than waiting for the reports.

Alert Threshold – refers to the level of occurrence of disease that serves as an

early warning for epidemics. An increase in the number of cases above
the threshold level should trigger an investigation, check epidemic
preparedness and implement appropriate prevention and control
measures.

Case-based Surveillance - refers to the collection of specific data on each case

(e.g. collecting details on each case of acute flaccid paralysis [AFP]) as
determined by the national coordinating body.

Cluster – refers to the aggregation of relatively uncommon events or diseases in

space and/or time in magnitude that is believed or perceived to be greater
than could be expected by chance.

Disease – refers to a specific illness or medical condition, irrespective of origin or

source that directly presents or has the potential to present significant
harm to humans.

Dengue – is a viral infection caused by four types of viruses (DENV-1, DENV-2,

DENV-3, DENV-4) belonging to the Flaviviridae family. The viruses are
transmitted through the bite of infected Aedes aegypti and Aedes
albopictus female mosquitoes that feed both indoors and outdoors during
the daytime (from dawn to dusk). These mosquitoes thrive in areas with
standing water, including puddles, water tanks, containers and old tires.
Lack of reliable sanitation and regular garbage collection also contribute to
the spread of the mosquitoes. This mosquito also transmits chikungunya,
yellow fever and Zika infection. Dengue is widespread throughout the
tropics, with local variations in risk influenced by rainfall, temperature and
unplanned rapid urbanization.

Entomological (Vector) surveillance – is used to determine changes in the

geographical distribution and density of the vector, evaluate control
programmes, obtain relative measurements of the vector population over
time and facilitate appropriate and timely decisions regarding
interventions.

Entomologist – is a scientist who studies insects. Entomologists study the

classification, life cycle, distribution, physiology, behavior, ecology and
population dynamics of insects. Entomologists also study urban pests,
forest pests, agricultural pests and medical and veterinary pests and their
control.
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

Epidemic – refers to the occurrence in a community or region of cases of an

illness, specific health-related behavior, or other health-related events
clearly in excess of normal expectancy. The community or region and the
period in which the cases occur are specified precisely. The number of
cases indicating the presence of an epidemic varies according to the
agent, size, and type of population exposed; previous experience or lack
of exposure to the disease; and time and place of occurrence. (Adapted
from Last JM, Ed. A Dictionary of Epidemiology, 1997). A community may
refer to specific groups of people (e.g., those attending a social function
and got ill from food poisoning).

Epidemic threshold – refers to the level of occurrence of disease above which

an urgent response is required. The threshold is specific to each disease
and depends on the infectiousness, other determinants of transmission
and local endemicity levels. For some diseases, such as poliomyelitis or
SARS, one case is sufficient to initiate a response.

Epidemiologists – are scientists who study diseases within populations of

people. In essence, these public health professionals analyze what
causes disease outbreaks in order to treat existing diseases and prevent
future outbreaks. Epidemiologists are considered “disease detectives” of
the public health world.

Epidemiology – is a discipline that considers the distribution of disease, and

focuses on questions, such as: who is getting the disease within a
population, as well as when and where it is occurring.

Larvicide – (alternatively larvacide) is an insecticide that is specifically targeted

against the larval life stage of an insect. Their most common use is
against mosquitoes.

Malaria – Malaria is caused by Plasmodium parasites. The parasites are spread

to people through the bites of infected female Anopheles mosquitoes,
called "malaria vectors." There are 5 parasite species that cause malaria
in humans, and 2 of these species – P. falciparum and P. vivax – pose the
greatest threat. Children with severe malaria frequently develop one or
more of the following symptoms: severe anaemia, respiratory distress in
relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ
failure is also frequent.

Neglected tropical diseases (NTDs) – a diverse group of communicable

diseases that prevail in tropical and subtropical conditions in 149 countries
It affect more than one billion people and cost developing economies
billions of dollars every year. Populations living in poverty, without
adequate sanitation and in close contact with infectious vectors and
domestic animals and livestock are those worst affected.

Passive surveillance – refers to a surveillance system in which reports are

awaited and no attempt is made to seek reports actively.

Philippine hemorrhagic fever – is a syndrome due to the dengue virus that

 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

tends to affect children under 10, causing abdominal pain, hemorrhage

(bleeding) and circulatory collapse (shock). Known also as dengue
hemorrhagic fever (DHF), it starts abruptly with high continuous fever and
headache plus respiratory and intestinal symptoms with sore throat,
cough, nausea, vomiting, and abdominal pain. Shock occurs after 2 to 6
days with sudden collapse, cool clammy extremities, weak thready pulse,
and blueness around the mouth (circumoral cyanosis). There is bleeding
with easy bruising, blood spots in the skin (petechiae), spitting up blood
(hematemesis), blood in the stool (melena), bleeding gums and
nosebleeds (epistaxis). Pneumonia and heart inflammation (myocarditis)
may be present. The mortality is appreciable ranging from 6 to 30%. Most
deaths occur in children. Infants under a year of age are especially at risk
of death. It is also called Thai or Southeast Asian hemorrhagic fever and
dengue shock syndrome.

Public Health Surveillance – refers to the ongoing, systematic collection,

analysis, interpretation and timely dissemination of health data for the
planning, implementation and evaluation of public health program. The use
of information based from these data to disease prevention and health
promotion program completes the surveillance cycle in public health.

Severe dengue – is a potentially deadly complication due to plasma leaking,

fluid accumulation, respiratory distress, severe bleeding, or organ
impairment. Warning signs occur 3–7 days after the first symptoms in
conjunction with a decrease in temperature (below 38°C/100°F) and
include: severe abdominal pain, persistent vomiting, rapid breathing,
bleeding gums, fatigue, restlessness and blood in vomit. The next 24–48
hours of the critical stage can be lethal; proper medical care is needed to
avoid complications and risk of death.

Surveillance Report – refers to the regular publication with specific information

on the disease under surveillance. It contains updates of standard tables
and graphs as well as information on epidemics. In addition it may contain
information on the performance of participants using agreed performance
indicators.

Vector – an organism, typically a biting insect or tick that transmits a disease or

parasite from one animal or plant to another.

Vector control – is any method to limit or eradicate the mammals, birds, insects
or other arthropods (here collectively called "vectors") which transmit
disease pathogens. The most frequent type of vector control is mosquito
control using a variety of strategies. Several of the "neglected tropical
diseases" are spread by such vectors.

Zero Case Reporting – refers to the reporting of “zero case” when no cases
have been detected by the reporting unit.

Section 2. The Malaria and Dengue Elimination Response (MADER) Hub – is

a facility equipped with diagnostic capabilities, laboratory equipment and supplies, anti-
malaria and anti-dengue drugs and vector control commodities located at the Leyte
Provincial Hospital (LPH), Pawing, Palo, Leyte.
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

Section 3. The Malaria and Dengue Elimination Response (MADER) Hub

shall be managed by a team headed by the Governor of Leyte and composed of the
following:

a.) Provincial Health Officer

b.) Provincial DOH Officer
c.) Chief of Hospitals – LPH and District Hospitals
d.) Malaria-Dengue Doctor trained on Malaria Case Management and Treatment
e.) Provincial Malaria-Dengue Coordinator
f.) Provincial Malaria-Dengue Entomologist
g.) Provincial Epidemiologist Surveillance Unit Officer
h.) Provincial Sanitation Officers
i.) Provincial Health Education and Promotions Officer
j.) SP Chairman, Committee on Health
k.) SP Chairman, Committee on Disaster Risk Reduction Management
l.) DOH Regional Office 8 Representative
m.)Malaria Microscopist

Section 4. The Malaria and Dengue Elimination Response (MADER) Hub

shall make the following interventions available in coordination with DOH Regional
Office 8 Medical Health Officer and other stakeholders.

a.) Malaria and Dengue Disease Surveillance

b.) Pro-active Vector Surveillance
c.) Establish an epidemic detection and response mechanism composed of case
investigation, diagnostic and vector control team. It also includes stockpile of
necessary anti-malaria and anti-dengue drugs, insecticides and laboratory
reagents and diagnostic equipment and supplies.
d.) Focused health promotion like local policies supported by resolution or
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 and coaching to prevent
complacency among community members. Production of Information and
Education Communication (IEC) materials.
e.) Technical updating of knowledge and skills of service providers through
trainings.
f.) Institutional policies and local ordinances to prevent re-establishment of
malaria and eliminate vector-borne disease such as dengue, zika and
chikungunya.
g.) Installation and operation of a functional referral system to ensure that clients
will have access to the aforementioned interventions. Advocate to stakeholder
immediate consultation of transient fever to prevent re-introduction of cases.

Section 5. Creation of the Provincial Vector Surveillance and Control Team.

The Provincial Vector Surveillance and Control Team is tasked to undertake pro-active
vector surveillance such as larval dipping, carabao-bait trapping, indoor residual
spraying, fogging or misting, larviciding, IEC and dengue vector surveillance and shall
be composed of the following:

a.) Team Leaders – Provincial Sanitary Engineer

 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

Provincial Sanitation Inspectors

b.) Members – Sanitation Inspectors

c.) Advisers – Regional Sanitary Inspectors

Regional Entomologist

Section 6. Reporting Mechanism: All activities conducted by the team shall be

consolidated at the Provincial Health Office (PHO) and through the Governor, reported
to the Department of Health Regional Office 8 (DOH RO8).

The Municipal Health Office (MHO) shall submit their report of malaria and
dengue cases detected within 24 hours and report even zero cases to the Provincial
Health Office. The spraying operations conducted shall likewise be reported to the
Provincial Health Office (PHO) after each activity.

a.) In case of outbreaks, a report of the epidemiological investigation shall be

reported immediately to the PHO for immediate assistance.
b.) Immediately after the Malaria and Dengue Elimination Response Hub has
been established, it shall be reported to the DOH RO8 for proper notification
and documentation.
c.) Vector surveillance activities such as larval surveys and adult mosquito
collections done by the Vector Surveillance Team shall be consolidated and
submitted to the DOH RO8 every quarter.
d.) The DOH RO8 shall submit to the National Center for Disease Prevention and
Control-Infectious Disease Office (NCDPC-IDO) of malaria and dengue
cases, and vector surveillance activities every quarter or during Program
Implementation reviews.

Section 7. Epidemic Detection and Response Team

The Epidemic Detection and Response Team is hereby created. It is a readily

deployable team of public health experts coordinated from the Malaria and Dengue
Elimination Response (MADER) Hub. The Epidemic Detection and Response
Mechanism is composed of case investigation, diagnostic and vector control team to
include stockpile of necessary anti-malaria and anti-dengue drugs, insecticides and
laboratory reagents and diagnostic equipment and supplies. It shall be composed of the
following:

a.) Provincial Epidemiological Surveillance Unit – The role of the Unit is to

support the public health system by monitoring, analyzing and reporting on
the occurrence, spread, and severity of communicable and non-
communicable diseases and conditions in the Province of Leyte. It shall
systematically receive and manage reportable communicable disease data.
The Unit is involved in notifying public health offices across the Province of
cases of communicable disease, and manages the flow of information to and
from these offices in support of regional public health investigations. Working
in close collaboration with the Surveillance Unit, the epidemiologists analyze
the case-based data collected by the Surveillance Unit to create reports and
updates that can be used for planning, implementing, and evaluating public
health interventions and programs. Epidemiologic information can be used to
detect and monitor trends or changes in the population’s health, as well as
monitor health events (such as disease outbreaks) and determinants of
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

health.

b.) Municipal Epidemiological Surveillance Unit – Monitors, analyze and

report the occurrence, spread, and severity of communicable and non-
communicable diseases and conditions of the municipality. It shall
systematically receive and manage reportable communicable disease data.
The Unit is involved in notifying the barangays of the municipality, and public
health offices across the Province of cases of communicable disease, and
manage the flow of information to and from these offices in support of
provincial public health investigations. Working in close collaboration with the
Surveillance Unit, the epidemiologists analyze the case-based data collected
by the Surveillance Unit to create reports and updates that can be used for
planning, implementing, and evaluating municipal public health interventions
and programs. Epidemiologic information can be used to detect and monitor
trends or changes in the population’s health, as well as monitor health events
(such as disease outbreaks) and determinants of health at the municipal
level.

c.) Vector Control Team – Vector control is crucial to reduce the incidence of
infection from diseases; this is especially important for those for which there is
currently no effective cure or preventive medical measures available, such as
Dengue, West Nile virus and Chikungunya virus. Even for vector-borne
diseases for which effective and targeted medical treatment exists, such as
malaria, however issues such as cost, delivery, correct diagnosis, drug
resistance and other challenges make disease control through the use of
medical drugs alone an unrealistic alternative to disease prevention by vector
control. Both prevention and treatment are needed. Vector control involves
using preventive methods to eradicate or control vector populations, in order
to limit the transmission and spread of diseases. Preventative measures
include:

• Habitat control: Removing or reducing the number of places where the

vector can breed helps to limit populations from growing excessively. For
example, by removing stagnant water, removing old tires and empty cans
which serve as mosquito breeding habitats and through good
management of used water.

• Reducing contact with vectors: Reducing the risk of exposure to insects

or animals that are vectors of diseases can limit the risk of infection. For
example, using bed nets, adding window screens to homes, or wearing
protective clothing can help reduce the likelihood of coming into contact
with vectors. An important component of exposure reduction is also the
promotion of health education and raising awareness of risks. Bed nets
treated with insecticide can reduce the risk of insect bites and infection.

• Chemical control: Insecticides, larvicides, rodenticides and repellents are

used to control pests and can be used to control vectors. For example,
larvicides can be used in mosquito breeding zones; insecticides can be
applied to house walls (indoor residual spraying); bed nets treated with
insecticide and use of personal skin repellents can reduce the risk of
insect bites and thus infection. The use of pesticides for vector control is
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

supported by the World Health Organization (WHO) and has proven to be

highly effective.

• Biological control: The use of predators (natural enemies of the vectors),

bacterial toxins or botanical compounds can help control vector
populations. For example, using fish that eat mosquito larvae or the
introduction of sterilized male tsetse flies in order to reduce the breeding
rate of these flies are methods to control vectors and reduce the risk of
infection.

All these measures are important elements for an integrated approach to

control the spread of vector borne diseases. The choice of the most
appropriate method(s) to use depends on the disease pattern and behavior of
the vector.

The Vector Control Team shall be composed of the (a) Provincial Sanitary
Engineer and the (b) Sanitation Inspectors.

Together, the Epidemiology and Surveillance Unit works to support the public
health system and the health of Leyteños.

Section 8. Appropriation. Funds shall be allocated for the operationalization of

the Malaria and Dengue Elimination Response Hub.

a.) The Provincial Government of Leyte through the Provincial Health Office shall
allocate an amount every year for the operationalization of the Malaria and
Dengue Elimination Response Hub for malaria and dengue border operations,
integrated vector control management, transportation, insecticides, trainings,
meetings, IEC materials, forms, surveillance and outbreak response.
b.) Component City and Municipalities shall shoulder expenses incurred during
indoor residual spraying operations such as but not limited to labor cost of
spraymen.

Section 9. Separability Clause. If for any reason, any section or provision of this
ordinance is declared unconstitutional, or inconsistent with any national law, sections or
provisions thereof, which are not affected, shall continue to be in full force and effect.

Section 10. Repealing Clause. All ordinances, resolutions, rules and

regulations, or parts thereof, in conflict with, or inconsistent with any provision of this
ordinance are hereby repealed or modified or modified accordingly.

Section 11. Effectivity. This ordinance shall take effect in accordance with the
provisions of the Local Government Code of 1991.

APPROVED.

………
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

ATTESTED

ATTY. CARLO P. LORETO

Vice Governor and Presiding Officer

HON. GINA E. MERILO HON. MESIAS P. AREVALO

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member

HON. RANULFO S. ABELLANOSA ATTY. FLORANTE A. CAYUNDA JR.

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member

HON. RAISSA J. VILLASIN HON. EMMANUEL L. GACIS

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member

HON. TRINIDAD G. APOSTOL HON. EDWIN F. FALLER

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member

HON. MA. CORAZON M. REMANDABAN HON. NOLIE C. CAÑA

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member

HON. ANNA VICTORIA M. TUAZON-VELOSO HON. JO VANILLE CHUA-MERILO

Sangguniang Panlalawigan Member Sangguniang Panlalawigan Member
 Republic of the Philippines
Province of Leyte

SANGGUNIANG PANLALAWIGAN

HON. MARIA CARMEN JEAN TORRES-RAMA

Sangguniang Panlalawigan Member