Newborn Screening in the Philippines: Experiencing the Promise of

Precision Public Health

The Philippines

Composition (7,107 Islands)

Population (100 M)*

Livebirths (1.7M)*

Infant Mortality Rate (22 per 1000)**

Neonatal Infant Mortality Rate (13 per 1000 )**

Sources:

* https://psa.gov.ph/content/births-philippines-2016

**https://data.unicef.org/country/phl/

Newborn Screening Pilot Implementation in 1996

NCR

Capitol Medical Center

Cardinal Santos Medical Center

Chinese General Hospital and Medical Center

De Los Santos Medical Center

Dr. Fe Del Mundo Memorial Medical Center

Foundation Philippines, Inc.

Dr. Victor R. Potenciano Medical Center

FEU-Nicanor Reyes Medical Foundation Hospital

Mary Chiles General Hospital

MCU-FDT Medical Foundation Hospital

Medical Center Manila

Metropolitan Medical Center

Our Lady of Lourdes Hospital - Manila

University of Perpetual Help Rizal Medical

Center-Las Piñas

Philippine General Hospital

Quezon City General Hospital

Rizal Medical Center

St. Luke's Medical Center

UERM Memorial Medical Center Hospital

United Doctors Medical Center

Manila Doctors Hospital

Ospital ng Maynila

Philippine Children's Medical Center

Quirino Memorial Medical Center

St. Martin De Porres Hospital - San Juan

24Hospitals

InMetro Manila

Newborn Screening Study Group

The Philippine Newborn Screening Project was born

Spirit of Voluntarism

Landmark Publications

Padilla, CD and Domingo, C for the Newborn Screening Study Group. Implementation of newborn screening in the Philippines. Philippine J

Pediatr. 2002;51:2-10.153 hospitals

1) to establish the incidence of CH, CAH, Gal, PKU, HCY, G6PD def; and

2) to make recommendations for adoption of nationwidenewborn screening.

Landmark Publications

Acta Medica Phililppina, Vol 43 No 2. 2009

If screening coverage is 100%, there is a net benefit of US$11.42M every year.

With the current exchange rate, the net benefit is P593M every year.

Slow expansion of NBS

1996 24 hospitals

1999 69 hospitals

2000 153 hospitals

2001 153 hospitals

2002253 hospitals

2003323 hospitals

Target: 7000 hospitals and birthing centers

Newborn Screening Bill filed in Congress

The life of the Newborn Screening Study Group ended with the passage of the Newborn screening Law (RA9288).

Enactment of the

RA 9288

(April 6, 2004)

Signing of the

Implementing Rules and Regulation

of RA 9288

(October 5, 2004)

Highlights of Newborn Screening Law (RA9288)

Sec 2. Declaration of Policy:• Institutionalize a National Newborn Screening System that is…

- Comprehensive- Integrative- Sustainable- Collaborative

• Opportunity of every baby born in the Philippines to undergo NBS

Highlights of Newborn Screening Law (RA9288)

• Sec 5 Obligation of Health Workers to inform parents or legal guardians of the newborn about newborn screening

• Sec 9 DOH and PHIC shall require health institutions to provide newborn screening services as condition for licensure and accreditation

• Sec 10 Defining DOH as the lead agency

• Sec 11 Creation of an Advisory Committee

• Sec 13 Creation of the Newborn Screening Reference Center

• Sec 16 PHIC will include newborn screening in benefits package*PHIC – NATIONAL INSURANCE

Governance

Department of Health Lead Agency

University of the Philippines Technical Partner

Philippine Health Insurance Corporation Funder of the program

Landmarks and Coverage

2016-2018 Based on the estimated population provided by the Department of Health with birth rate of 22/1000 population.1996-2015 Based on PSY 2015 | 2018 screening as of July

Research

DOH

Pres Proclamation

RA 9288 (law)

90% NBS fee covered by insurance

100% NBS fee covered by insurance

Expanded NBS started

Expanded NBS considered

0.7% 1.9% 2.1% 1.5% 2.3% 2.7% 3.5% 3.9% 5.2% 7.6% 10.7%

15.5%19.7%

26.9%

33.2%

39.6%

49.6%

57.3%

65.0%

77.0%

67.9%70.4%

78.6%

2.8% 6.9% 10.2%12.5%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

NBS vs. Est. Live Birth ENBS vs Est. Live Birth

Conditions covered

Covered by insuranceBasic Panel of 6CHCAHGaLMSUDPKUG6PD def

Will soon be covered by insuranceExpanded Newborn Screening

29 conditions

OPTIONS

From 24 hospitals in 1996 to 6800+ hospitals in 2018

This is the product of a PUBLIC HEALTH

APPROACH!

Newborn Screening Laboratories

NSC – MINDANAOSouthern Philippines

Medical Center (Davao City)

NSC - CENTRAL LUZONAngeles University Foundation

Medical Center (Angeles, Pampanga)

NSC – NIHUP Manila

NSC – VISAYASWest Visayas State University

Medical Center (Iloilo City)

NSC – SOUTHERN LUZONDaniel Mercado Medical Center

(Tanauan City, Batangas)

NSC - NORTHERN LUZONMariano Marcos Memorial Hospital

and Medical Center (Batac Ilocos Norte)

Future NSCs

Societal effort

Neonatologist Nurse

Nursery Team

Community Health Workers Midwives Organizations

Families of Saved Babies

Twin Legislation

Rare Disease Act of 2016Newborn Screening Act of 2004

Newborn ScreeningThe Largest Precision Public Health Program

Medicine Public Health

Individuals

Healthcare

Clinical

Treatment

Genomics/Biology

Population

Health

Community

Prevention

Social/Environmental

Critical role of the PUBLIC HEALTH APPROACH in bringing precision medicine to the people

Population Screening

Total Health

Community Engagement

Prevention of complications

Social effort/Environmentalpoverty – national insurance

Newborn ScreeningThe largest Precision Public Health Program in the Philippines

Newborn Screening in the Philippines: Experiencing the Promise of

Precision Public Health