BACKGROUND

The Department of Health (DOH) was mandated under Presidential Decree No. 996 dated September 16, 1976 to provide free basic immunization to eligible population. To operationalize this function, parents, guardians or persons having custody of the infant or child are duty-bound to present the child for basic immunization at the time and place specified by the DOH.

Recognizing the importance of immunization to address preventable diseases, the DOH, even before the passage of this decree, had launched the Expanded Programme on Immunization (EPI) on July 12, 1976. The program covers immunization for BCG (for extrapulmonary tuberculosis), DPT (Diphtheria, Pertussis and Tetanus), oral polio vaccine (OPV) (for poliomyelitis), Hepatitis B (for hepatitis infection), and measles (for measles infection). The DOH is assisted by Local Government Units (LGUs) and government hospitals in the implementation and administration of this program.

The immunization program is intended to reduce the morbidity and mortality of children nationwide against the seven (7) vaccine-preventable diseases through the following strategies:

• Routine immunization services or in combination with supplementary immunization activities in all areas nationwide covering 95% of eligible population;

• Disease surveillance to the extent that the impact of immunization interventions can be evaluated, outbreaks rapidly identified, investigated and controlled, epidemics predicted and prevented, and importations rapidly identified and controlled;

• Special immunization on declared national immunization days (NIDs) covering the entire country or in cases of reported outbreak of disease covering selected areas where the polio virus outbreak was suspected; and

• Maintenance of high level preparedness to various derived polio virus or wild polio virus importation.

In view of these initiatives, in October 2000, the Philippines was certified by an international certifying body authorized by the World Health Organization (WHO) as a polio-free country.

For the continuous implementation of the program, a total of 683,511,000 was allotted from January 2001 to December 2002, of which 132,555,500 was allocated for the procurement of OPVs. From this allocation, 1,614,817 vials equivalent to 32,296,340 doses of vaccines were procured and received within the year for distribution to the different DOH Regional Offices/LGUs.

Another 229,400 vials equivalent to 4,588,000 doses of vaccines were received during the period out of previous years procurement. Of these vaccines, 999,543 vials equivalent to 19,990,860 doses were distributed during the period under audit leaving 844,674 vials in the custody of the DOH Central Office as of December 31, 2002. For the City of Valenzuela, the DOH issued 3,150 vials equivalent to 63,000 doses in 2001 and 3,460 vials equivalent to 69,200 doses in 2002.

The quantity of vaccines to be procured is determined on the basis of the targeted eligible polio population which is equivalent to 3% of the total projected population of the National Statistics Office (NSO). For CYs 2001 and 2002, the DOH targeted 2,271,096 (excluding ARMM) and 2,398,914 eligible polio population and reported that 1,632,652 and 1,729,229 children, respectively, were immunized with three doses of OPV, both equivalent to 72%.

In the City of Valenzuela, of the total eligible population of 15,992 and 16,460 for CYs 2001 and 2002, 82.5% and 75.3% were reported immunized with three doses of the same vaccine during the period, respectively. The City of Valenzuela is composed of 39 Health Centers distributed throughout the City.

AUDIT OBJECTIVE

The audit was conducted to determine whether existing policies and procedures implementing the Polio Immunization Program were adequate and effective to sustain a polio-free status of the Philippines taking into consideration the following:

• Identification of eligible population;
• Management of vaccines; and
• Monitoring and evaluation of the implementation of the program.

AUDIT SCOPE AND METHODOLOGY

The audit covered the implementation of the Polio Immunization Program of the government through routine immunization undertaken from January 2001 to December 2002. The implementing agencies included in the evaluation are as follows:

• DOH Central Office
• National Capital Region (NCR)
• Selected Cities & Health Centers within Metro Manila
• Manila
• Quezon
• Kalookan
• Valenzuela
• Selected Hospitals within Metro Manila
• Jose R. Reyes Memorial Medical Center
• uezon City General Hospital
• Valenzuela General Hospital

The audit was confined to selected cities and hospitals within Metro Manila due to limited audit period.

The performance of the implementing agencies was assessed using the following criteria:

• Sound identification of eligible population
• Efficient management of vaccines
• Effective performance monitoring and evaluation system

During the audit, the team performed the following procedures, among others:

• Reviewed existing policies and procedures on the identification of eligible population, management of OPVs, and monitoring and evaluation of accomplishment / program;

• Interviewed personnel involved in the implementation of the program;

• Obtained and reviewed records, accomplishment reports, work plans and other relevant records and reports pertaining to the implementation of the program;

• Reviewed and evaluated the roles and responsibilities of agencies involved in the implementation of the program;

• Inspected selected health centers and district health centers within the jurisdiction of the LGUs covered in the audit; and

• Assessed the extent of the achievement of the program objectives.

For validation of program implementation, the team visited the Health Centers of Malinta, Karuhatan, Dalandanan and Gen. T. de Leon, all under the jurisdiction of the City of Valenzuela.

The audit was conducted from November 18, 2002 to March 31, 2003 pursuant to COA Assignment Order No. 2002- 514 and 514A dated November 15, and 26, 2002, respectively, and Memorandum dated February 13, 2002. The results of the audit were discussed with the concerned officials and employees of Valenzuela City and NCR on November 6, 2003.

AUDIT CONCLUSION

Generally, the existing policies and procedures for the implementation of the Polio Immunization Program can be considered adequate. However, these were not effectively implemented by the City Government of Valenzuela resulting in overall accomplishments for CYs 2001 and 2002 of only 82.5% and 75.3%, respectively, out of the targeted 95% coverage. This condition would affect the government's objective of ensuring the sustainability of a polio-free status of the country.

The deficiencies in implementation are manifested in the following cases:

• The target setting of eligible polio population was not revised to a more realistic projection as required under the EPI Manual. The DOH maintained the historical 3% projection at all levels. Based on this projection however, the reported accomplishment per Health Center in Valenzuela City ranged from as low as 42.26% to as high as 206%. Had projections been revised, the reported accomplishments could be properly assessed which would warrant the determination of whether or not the targeted coverage is achieved. The identification of eligible population is crucial not only in attaining the targeted coverage but also in determining the quantity of vaccines to be procured and distributed to Regional Offices and LGUs to effectively sustain the implementation of the program.

• The distribution of vaccines to the Health Centers of Valenzuela City was not based on needs. Vaccine distribution to Health Centers which should be 167% of the basic requirements ranged from 46% to 377%. These vaccines were, however, not fully utilized by the end-users. There were Health Centers with vaccine utilization of only 33% to 90 % of the total vaccines received. This practice might expose the vaccines to outright expiration before the same were effectively utilized.

The performance of the participating agencies was not effectively monitored. It was noted that the required monitoring and evaluation process were not undertaken. The LGU then does not have an opportunity to assess the progress of the implementation of the program in the Health Centers and to address the risks associated in the implementation of the program.

The audit further disclosed that in CYs 2001, the overall EPI accomplishment covering six immunizable diseases of the City was not accurately reported. The number of fully immunized children in 16 Health Centers exceeded the highest accomplishment per antigen for the same period.

The inaccurate reporting affects the validity of the report and the results of the evaluation of the program implementation which is crucial in sustaining the country's status as a polio-free country.

As the Polio Immunization Program is a continuing activity of the Government and deficiencies in program implementation would greatly affect the ability of the government to protect the intended coverage, the team recommended measures to address these concerns for consideration by the City of Valenzuela.

MANAGEMENT’S REACTION TO AUDIT OBSERVATIONS

The team forwarded the audit highlights to the City Mayor for comments on September 22, 2003. For clarification of certain issues, exit conference with the concerned officials and staff of the City and NCR was conducted on November 6, 2003.

Generally, the City recognized the existence of the problems raised in the report and resolved to initiate appropriate steps to improve its performance. The concerned City officials submitted explanations and constraints surrounding the implementation of the program which were incorporated in the report, together with the team’s rejoinder.