Expanded Immunization Program

A. Brief Description

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines.
Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. Vaccines under the EPI are BCG birth dose, Hepatitis
B birth dose, Oral Poliovirus Vaccine, Pentavalent Vaccine, Measles Containing Vaccines
(Antimeasles Vaccine, Measles, Mumps, Rubella) and Tetanus Toxoid. In 2014, Pneumococcal
Conjugate Vaccine 13 was included in the routine immunization of EPI. This 2016, the
Expanded Program on Immunization will transition to become the National Immunization
Program. It will include immunizations of other populations such as senior citizen immunization,
school-age immunization, and adolescent immunizations.

B. Objectives and Program Goals.

Vision: Enabled and strong immunization system for everyone, everywhere at every age to attain
a vaccine-preventable disease-free and a healthier Philippines

Mission: Guided by the Universal Health Care Law, the program commits to ensure that every
Filipino is fully immunized from vaccine-preventable diseases by building a strong and well-
supported immunization system that is equipped for routine immunization service delivery and
backed with contingencies for and response to public health crises related to VPDs, vaccines and
immunization programs.

Over-all Goal:

To reduce the morbidity and mortality among children against the most common vaccine-
preventable diseases

Specific Goals:

1. To immunize all infants/children against the most common vaccine-preventable diseases;

2. To sustain polio-free status of the Philippines;
3. To eliminate measles infection;
 4. To eliminate maternal and neonatal tetanus;
5. To control diphtheria, pertussis, hepatitis b and German Measles;
6. To prevent extra pulmonary tuberculosis among children.

C. Legal Basis of the Expanded Program on Immunization:

The Philippine Immunization Program is mandated and supported by the following laws and
policies.
1. Presidential Decree 996. Immunization of School Entrants.
It shall be the duty of all schools, public and private, to provide basic immunization
services to all pre-school and primary school entrants who have not received such
immunization, subject to rules and regulations as the Secretary of Health may
promulgate.
2. Republic Act 10152. Mandatory Infants and Children Health Immunization Act.
An act providing for mandatory basic immunization services for infants and children,
repealing for the purpose Presidential Decree No. 996.
3. Republic Act 7846. Compulsory Immunization Against Hepatitis B.
An act requiring compulsory immunization against Hepatitis-B for infants and children
below eight (8) years old, amending for the purpose Presidential Decree No. 996.
4. P.D. No. 6 (1966). Wednesdays as Immunization Day.
5. Proclamation No. 46. Reaffirming the Commitment to the Universal Child
and Mother Immunization Goal by Launching the Polio Eradication Project.
6. DOH AO No. 39, s. 2003 (April 21, 2003) guided the nationwide implementation of the
EPI.
D.   Evaluation based on the 6 principles of PHC.  Discussion can be brief and direct to the point
a. 4A's of health services (Is the program adhering to the principle of affordability?
accessibility? acceptability - in terms of culture and tradition? availability- is it constantly
present in the health institution or assigned institution?
 Affordability- The vaccines are provided freely to the general public, thus adheres to
the principle of affordability
 Accesibility- The DOH introduced the Reaching Every Barangay (REB) plan in 2004
with the intention of improving access to regular vaccines and reducing program
drop-out rates. The REB is only one of several strategies the Philippine government's
health office has employed to ensure that every child has received their vaccines.
With the help of this plan, vulnerable people and hidden slums would be reached by
the provision of special health services. The Reaching Every Purok (REP) Strategy
was also launched in 2013 as a follow-up to the Reaching Every Barangay (REB)
Strategy with the aim of reducing significant vaccination gaps among poor puroks or
sitios in a barangay. Given these efforts, they were able to provide easy access to the
public by having it available to every barangay health centers.
 Acceptability- The Philippines' culture is said to be both rich and diverse. Rural folk
are more prone to interpret cultural references incorrectly, especially  those that relate
to health. As a result, providing health care to rural communities could sometimes  be
complicated.
  Availablity- Since there is no official distribution system, vaccination delivery to
LGUs is frequently ineffective. The stocks and inventory of vaccinations (or other
DOH supplies) in healthcare institutions are not electronically monitored. Due to this,
LGUs always have the tendency of stocking either an excessive or inadequate amount
of vaccines. Therefore, the availability of the vaccinations is not assured and
consistent.
b. Support Mechanism and Multi-sectoral approach (Does it utilize a support mechanism in
terms of implementation? What sectors are involved? What form of support is provided by
these sectors?) Are the 3 C's observed?
- The NIP is in charge of controlling the demand for vaccines and other immunization
supplies as well as the prompt delivery of such goods to regional health facilities. The
mechanism of self-procurement is used to buy vaccines, along with a local bid procedure
and UNICEF's supply division. Through a decentralized system of health care delivery,
vaccination services are provided. The Local Government Code (LGC), which was
implemented in 1991, gave local governments primary responsibility for providing
healthcare (LGUs). The following obligations related health services are imposed on local
governments by the LGC at each level:
● The Department of Health (DOH) continues to play the roles of formulating policy,
enforcing legislation, offering technical advice, providing training and orientation, and
conducting planning and assessment. It will carry out advocacy, surveillance, monitoring,
and research while continuing to establish strategic strategies. The DOH will be in charge
of managing specialist and local hospitals and medical facilities through its 18 Regional
Offices (ROs).
● In accordance with national policies and standards, LGUs act as stewards of the local
health system by developing and enforcing municipal laws and ordinances pertaining to
health, nutrition, sanitation, and other health-related issues. They must also foster a
favorable environment for forming alliances with all sectors. In a devolved system, the
municipal and city governments are in charge of managing community hospitals as well as
rural health units, main health centers, health centers, and barangay health stations. The
provincial governments are responsible for managing provincial and district hospitals.
● A network of community-based health volunteers supports midwives in providing
medical care at the local level. Barangay Health Workers (BHWs) and other support
organizations are examples of these volunteers.

Immunization providers are composed of those coming from both the public and private
sectors:

● The public sector network of health care providers consists of those from the national
and sub-national, provincial and municipal or city levels.
● The private sector consists of privately-operated facilities, physicians in solo or group
practice, hospitals and maternity centers, diagnostic centers, employer-based out-patient
facilities, secondary and tertiary hospitals, as well as traditional birth attendants and
indigenous healers.

The reach of the service delivery network for immunization is expanded by partnerships
 with: (i) private sector partners like professional societies, private clinics and practitioners
and NGOs during special immunization campaigns; and (ii) public sector partners like the
Department of Education (DepEd) in providing immunization to all public school children
in Grades 1 and 7 annually and the Department of Social Welfare and Development
(DSWD) through its Conditional Cash Transfer (CCT) Program.
c. Community participation - How is this initiated or promoted by the program? Are the
people in the community encouraged or given the opportunity to participate or just passive
recipients of the program/health care?
- Different communication can reach parents and other target audiences with key
immunization message. These include radio, television, folk media, community events,
and counselling sessions at health facilities. The general public has a high level of
acceptance for immunization as a public health intervention and as a practical medical
procedure. In the first year of a child's life, immunization only necessitates parental
intervention around six times, and it is typically accepted by families and communities.
Making accessible immunization sessions is only half the battle; clients must actually use
the services. People will use immunization services at least once, according to research
from numerous nations, if they are aware of the services that are provided and where and
when they may be obtained. They will return if: They know when to come back, they have
been treated respectfully, they are confident they will receive the vaccinations they come
for. I believe that people in the community are encouraged to actively participate through
different strategies that focus on reaching the unreached, reducing drop-outs, and limiting
missed opportunities.

d. Equitable distribution of health resources - Are the resources required in this program
readily available? What about budget allocation? Is it appropriate for the program (may
include this if data is available) What about the health personnel needed to carry out this
program? What is the reach or extent of availability? Is it made available to majority of
the people?
- The majority of the financing for regular children vaccination was given by the public
sector, particularly the national government through the DOH. Without a doubt, the EPI
receives priority funding from the Department of Health. The DOH allotted 
approximately 7.3 billion pesos allocation for DOH, or 7.2% of its PHP 100.56 billion
yearly budget. From 2005 to 2020, public spending on EPI increased dramatically, and
when the Sin Tax Law was passed in 2012, the program got a considerable infusion of
funds (RA 10351). Public funding nearly quadrupled from PHP 2 billion in 2013 to PHP 7
billion in 2020. Less than 1% of the budget was allocated for "soft" components, such as
research, media, and capacity building, whereas between 1% and 1.5% was set up for the
cold and supply chain.  Approximately 95% of children had their most recent
immunization at a facility, according to a study of NDHS data. Particularly for subsequent
doses in a series, immunization rates in the private sector were higher for wealthier
households. This indicates that routine vaccination appears to be provided primarily in the
public sector.
e. Appropriate technology? - It is what the community needs? reflect on the different
criteria? Does the program adhere to these criteria?
- The EPI's implementation of the recommended vaccination protocol is a key component.
The greatest standard of professional care must be taken by vaccination providers to
ensure the optimal level of recipient's immunological response.   It is imperative that
vaccines save lives hence, immunization programs must safely provide potent vaccines to
all eligible children and women before they are exposed to diseases that can be prevented
by vaccines.  Therefore, it is essential to carry out vaccination sessions that satisfy quality
standards and adhere to authorized procedures, whether this is done in a permanent
location, through outreach, or in special campaigns. High-quality immunization sessions
will be most advantageous to the targeted consumers and will encourage them to return for
additional immunizations.

References
Department of Health. (n.d.) Expanded Program on Immunization (EPI). Retrieved from
https://caro.doh.gov.ph/expanded-program-on-immunization/#:~:text=The%20Expanded
%20Program% 20on%20Immunization,%2C%20tetanus%2C%20pertussis%20and%20measles.

Department of Health. (n.d). Immunization Program. Retrieved from https://doh.gov.ph/health-

programs/immunization-program/implementation-support-materials

https://caro.doh.gov.ph/expanded-program-on-immunization/#:~:text=The%20Expanded%20Program
%20on%20Immunization,%2C%20tetanus%2C%20pertussis%20and%20measles .