School-Based Immunization Program
School-Based Immunization Program (PAO-2017-04)
Delayed procurement of Td vaccines and low parental consent resulted in the non-immunization of 1.065 million or 64% of enrolled Grade 1 students and 0.998 million or 63% of enrolled Grade 7 students in 2016
What COA Found
The SBIP intends to provide all public school students enrolled in Grades 1 and 7 nationwide with booster doses of routine vaccines to ensure that high level of protection is maintained against measles, rubella, diphtheria and tetanus. Only students with parental consent are vaccinated. While the program aims to immunize all students in the said grade levels, achieving a 95% immunization target was already considered a success following the principle of herd immunity.
For 2015 and 2016, the SBIP failed to achieve the immunization rate target in both Measles Rubella (MR) and Tetanus Diphtheria (Td) vaccines for Grades 1 and 7. While there was an increase of 12% in MR for Grade 1 from 60% in 2015 to 72% in 2016, the rates for Grade 7 did not change at 72%. The Td vaccination rates of 73% and 72% in 2015 for Grades 1 and 7, respectively, dropped to 36% and 37% in 2016.
The decline in immunization rates for Td was caused by lack of Td vaccines during the campaign period in 2016. The gap of at least 20% between actual immunization rate and the target rate was mainly attributable to students not vaccinated in the absence of parental consent.
Increasing awareness on the benefits of the program particularly for the parents and guardians will lower the number of students without consent. Apparently, the absence of communication plan and lack of coordination efforts among partner agencies and appropriate information materials to ensure high coverage impacted the attainment of the target.
The timely procurement of vaccines aimed at ensuring their availability in time for the vaccination period was not achieved in 2016 for Td vaccines due to late initiation of procurement activity and failure to address the issues that caused delay in the procurement. In addition, no policy on maintenance of buffer stock was enforced to answer for delay in the procurement of vaccines.
The noted deficiencies in the reporting system for the Nationwide Accomplishment Report (NAR) particularly on completeness of submission, accuracy of data reported and consistency in reporting impacted the efficiency and accuracy of data and information needed for decision-making.
Control on the utilization of resources could not be maximized in the absence of separate inventory management and financial recording for the program. The challenges noted did not contribute to the efficient, economical and effective implementation of the SBIP.
Why COA did this study
The Department of Health (DOH) launched the School-based Immunization Program (SBIP) in 2013 to ensure prevention of morbidity and mortality of school age children due to vaccine-preventable diseases. Government funds amounting to at least ₱330 million and ₱282 million were allocated for the nationwide immunization campaign in 2015 and 2016, respectively. DOH claims success at 95% immunization coverage of public school students enrolled in Grades 1 and 7. Thus, the need to determine whether DOH is making progress in achieving its goals for the program.
In order to confirm the aforementioned assumptions, COA (1) identified the program’s goals and objectives and the extent these goals can be measured; (2) determined the fund allocation, extent of utilization and whether these were enough to procure the required type and quantity of vaccines; and (3) determined the extent the program achieved its immunization goals and the extent of participation of partner agencies in achieving these goals.
COA reviewed relevant guidelines, reports and regulations to determine the program goals, objectives and implementation processes. To assess the extent of program’s success, program implementation for 2015 and 2016 was reviewed taking into consideration the principles of efficiency, economy and effectiveness. Areas that were looked into included, among others, procurement of vaccines, inventory management, participation of partner agencies, fund utilization and reporting of accomplishment.
What COA recommends
To increase the immunization coverage and attain the herd immunity target, DOH in coordination with DepEd need to minimize students without parental consent by adopting and implementing, among others, an appropriate communication plan and strengthening coordination efforts among partner agencies. DOH needs to undertake its procurement plan as scheduled and address immediately any issue that may hinder the availability of vaccines in time for the vaccination period. There is also the need to improve procurement planning and inventory management, accomplishment reporting and financial recording to promote efficient, economical and effective program implementation and accountability of program managers.