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Program Background

     Advances in cancer diagnosis and treatment have now made long-term survival and cure a reality for many children with this disease.  This is particularly true in developed countries where survival rates for children with cancer reach as high as 80-90%.  Unfortunately, in developing countries where majority of childhood cancer are being diagnosed, less than 20% of those children survive.

     In the Philippines, it has been estimated that about 3,500 children will be newly diagnosed with cancer each year.  Childhood leukemia is the most common and accounts for about 60-70% of cancers seen among Filipino children.  Although multidisciplinary management is available and could potentially cure 80% of cases, only about 10-20% actually attains long-term survival.

     Thus, to help improve the cure and survival rates of children with Acute Lymphocytic Leukemia (ALL) and alleviate their financial hardships in paying for costly cancer treatment the Department of Health began sourcing childhood chemotherapy drugs in partnership with PITC Pharma Inc. in 2009. The Program aims to lower the mortality and increase the survival rates of children with acute lymphocytic leukemia in the Philippines. The DOH ensured the procurement of ALL medicines and allowed the access to chemotherapy drugs for free for its identified beneficiaries undergoing treatment through identified government hospitals across the Philippines. DOH targeted the most cost-effective and commonly used chemotherapy for ALL among Filipino children.

Access Sites/Identified Hospitals

  1. Batangas Medical Center (BMC)
  2. Bicol Regional Training and Teaching Hospital (BRTTH)
  3. Cotabato Regional Medical Center (CRMC)
  4. Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH)
  5. Davao Regional Hospital (DRH)
  6. East Avenue Medical Center (EAMC)
  7. Ilocos Training and Regional Medical Center (ITRMC)
  8. Jose B. Lingad Memorial Regional Hospital (JBLMRH)
  9. National Children’s Hospital (NCH)
  10. Northern Mindanao Medical Center (NMMC)
  11. Ospital ng Makati (OsMak)
  12. Philippine Children’s Medical Center (PCMC)
  13. Philippine General Hospital (PGH)
  14. Southern Philippines Medical Center (SPMC)
  15. Tarlac Provincial Hospital (TPH)
  16. Wetstern Visayas Medical Center (WVMC)
  17. Zamboanga City Medical Center (ZCMC)

Medicines Included in the CCMAP

Bleomycin 15 mg vial/amp (IM/IV/SC) (as sulfate)

Calcium Folinate (leucovorin calcium) 50 mg vial (IM,IV)

Carboplatin 150 mg vial (IV)

Carboplatin 450 mg vial (IV)

Cisplatin 50 mg powder vial (IV)

Cisplatin 10 mg powder vial (IV)

Cyclophosphamide 500 mg powder vial (IV)

Cyclophosphamide 1000 mg/1 gram powder for injection vial (IV)

Cytarabine 100 mg vial (IM/SC/Intrathecal)

Cytarabine 500 mg solution for injection vial (IV infusion)

Cytarabine 1 gram solution for injection (IV infusion)

Doxorubicin 10 mg powder for injection vial (IV) (as hydrochloride)

Doxorubicin 50 mg powder for injection vial (IV) (as hydrochloride)

Etoposide 20 mg/mL, 5 mL amp/vial (IV)

Filgrastim (G-CSF) 300 mcg/mL or 300mcg/1.2mL vial (IV,SC)

Ifosfamide 2 g (IV infusion)

Mercaptopurine 50 mg tablet

Mesna (sodium-2-mercaptoethanesulphonate) 100 mg/mL, 4 mL (IV)

Methotrexate (as sodium salt/disodium salt) 2.5 mg tablet (6 mm tablet size)                                              

Methotrexate (as sodium salt, preservative-free) 50 mg vial  (IM/IV/ intrathecal)

Methotrexate sodium 500 mg (IM, IV, Intrathecal)

Methotrexate sodium 1 gram (IM, IV, Intrathecal)

Vinblastine 10 mg powder vial (IV) (as sulfate)

Vincristine 1 mg/mL, 1 mL vial (IV)  (as sulfate)

Vincristine 1 mg/mL, 2 mL vial (IV) (as sulfate)                                                         

Program Updates/Milestones

     The program was enhanced in 2013 with the Philippine Children’s Medical Center (PCMC) designated as the National Collaborating Center for Childhood Cancer coordinating with the network of pediatric oncologists and hematologists practicing in government hospitals all over the country.    The program was also expanded to other common Solid Tumors in children and the provision of medicines to manage toxic complications of chemotherapy. In addition, the Patient Navigation Program was also incorporated to track and monitor patients in terms of treatment response, occurrence of adverse drug experiences, research, coordination with health care providers, assistance to patients and their family to overcome health barriers and provide psychosocial support.

Number of Enrollees in the DOH-Childhood Cancer Medicines Access Program (as of  December 2016)

Hospital

Cancer type

total no. of patients enrolled

Batangas Medical Center

Acute Lymphocytic Leukemia

130

Solid tumors

44

Bicol Training and Teaching Hospital

Acute Lymphocytic Leukemia

73

Solid tumors

10

Davao Regional Hospital

Acute Lymphocytic Leukemia

39

Solid tumors

8

East Avenue Medical Center

Acute Lymphocytic Leukemia

20

Solid tumors

142

Ilocos Training and Regional Medical Center

Acute Lymphocytic Leukemia

70

Solid tumors

17

Jose B. Lingad Memorial Regional Hospital

Acute Lymphocytic Leukemia

55

Solid tumors

25

National Children’s Hospital

Acute Lymphocytic Leukemia

279

Solid tumors

88

Northern Mindanao Medical Center

Acute Lymphocytic Leukemia

121

Solid tumors

26

Ospital ng Makati

Acute Lymphocytic Leukemia

33

Solid tumors

18

Philippine Children’s Medical Center

Acute Lymphocytic Leukemia

656

Solid tumors

494

Philippine General Hospital

Acute Lymphocytic Leukemia

421

Solid tumors

549

Southern Philippines Medical Center

Acute Lymphocytic Leukemia

273

Solid tumors

371

Western Visayas Medical Center

Acute Lymphocytic Leukemia

40

Solid tumors

38

Zamboanga City Medical Center

Acute Lymphocytic Leukemia

47

Solid tumors

47

Tarlac Provincial Hospital

Acute Lymphocytic Leukemia

48

Solid tumors

16

Total

4,212

About Breast Cancer Medicines Access Program

     The Department of Health in partnership with the Philippine Cancer Society Inc. (PCSI) launched the Breast Cancer Medicines Access Program-Patient Navigation Program (BCMAP-PNaP) in May 2011 which seeks to improve the survival rates of women diagnosed with breast cancer in the Philippines.

   Cancer care, however, does not end with the provision of free medicines.   Quality of care and ensuring patient adherence to treatment is also of great importance to improve cancer survival. The DOH also implemented the patient navigation scheme with the PCSI to ensure full adherence of the patients to the treatment regimen and to continuously monitor their status and health conditions. 

    The BCMAP also provides standard diagnostic procedures such as hormonal status (i.e. ER, PR, Her2 Neu) through the National Kidney and Transplant Institute (NKTI) for the eligible patients at no cost to them.

Access Sites/Identified Hospitals

     All having the capacity, facilities and multidisciplinary team of experts for managing breast cancer, DOH is currently collaborating with the following hospitals to implement the Program:

DOH Retained Hospitals:

  1. East Avenue Medical Center
  2. Jose Reyes Memorial Medical Center
  3. Rizal Medical Center
  4. Amang Rodriguez Memorial Medical Center
  5. Bicol Regional Training and Teaching Hospital
  6. Davao Regional Hospital

Non-DOH Hospital:

  1. Philippine General Hospital

List of Medicines

     The implementation of the program has been guided by a Technical Working Group (TWG) composed of specialty experts and providers in the access sites. The TWG developed a standard treatment and management protocol for early stage breast cancer for implementation in the access sites.

Cyclophosphamide 500 mg vial

Fluorouracil 25 mg/mL, 10 mL vial

Doxorubicin Hydrochloride 50 mg powder vial

Tamoxifen Citrate 20 mg tablet

Docetaxel 40 mg/mL vial, 2 mL (80 mg)

Docetaxel 20 mg vial/0.5 mL vial

Filgrastim 300 micrograms/mL vial (IV,SC)

Ondansetron 2 mg/mL, 2 mL ampule (IM, IV)

Program Updates

Number of Enrollees in the DOH- Breast Cancer Medicines Access Program (March   2011-November 2016):

Hospital

No. of Patients enrolled

East Avenue Medical Center

522

Jose Reyes Memorial Medical Center

1232

Rizal Medical Center

272

Philippine General Hospital

1833

Bicol Regional Training and Teaching Hospital

126

Amang Rodriguez  Memorial Medical Center

105

Davao Regional Hospital

85

Total

4,175

     The compliance rate of the patients to their scheduled check-up, chemo sessions were observed to be as high as 97% due to access to free medicines and diagnostic procedure as well as the patient assistance coming from the Patient Navigators. Patient Navigators are able to provide services such as patient counseling and education, program monitoring, creation of a patient registry, and other tasks needed to ensure the smooth and timely treatment of the patients.

Program Background

      While generic medicines have made the cost of treatment more affordable for patients, their reach is somewhat limited to certain areas, mostly urban settings in the Philippines.

     The BnB refers to a drug outlet managed by a legitimate community organization (CO)/non-government organization (NGO) and/or the Local Government Unit (LGU), with a trained operator and a supervising pharmacist specifically established in accordance with this Order.

Access Sites and Beneficiaries

     Access sites are established in every city and/or municipality in all 18 regions of the Philippines. Established BnB outlets reached more than eighteen thousand since 2003.

     The  location  of  the  BnB  outlet  is  identified,  evaluated and  selected by  the concerned Center for Health Development (CHD).  The establishment of a BnB outlet is approved by the PHARMA 50 Project Management Unit (PMU) and given a special license to operate (SLTO) by the Bureau of Food and Drugs (BFAD) to sell, distribute.  BnBs offer for sale and/or make available low-priced generic home remedies, over-the-counter (OTC) Drugs and two (2) selected, publicly-known prescription antibiotics drugs (i.e. Amoxicillin and Cotrimoxazole).

     The  initial  target  was  to  establish  1  BnB  to  serve  3  adjacent  Barangays. However, due to the number of Barangays all over the country, and the need for more than 1 BnB in some poor adjacent barangays to better provide for the service, the targets were changed to 1:1.  Since the absorptive capacity for the DOH-CHDs  to  establish  BnBs  is  also  limited  due  to  resource  and  time constraints, the initial phasing of the target to achieve 1:1 is being done.  Thus, for the next two (2) years, the target would be initially 1:2 except for select areas that have high poverty incidence, conflict or geographically isolated areas, and the like where the target would be 1:1.

Program Objectives and Goal

Program Objectives

Promote equity in health by:

  1. Ensuring the availability and accessibility of affordable, safe and effective, quality essential drugs to all.
  2. Prioritizing the marginalized, underserved population groups, and the critical and far-flung areas.

Goal

     To  ensure  the  accessibility  of  low- priced  generic  over-the-counter drugs and eight (8) prescription drugs as recommended by the National Drug Formulary Committee.

What are the Variants of Botika ng Barangay?

Botika Para sa Taumbayan (BPT) - A partnership with the Civil Service Commission (CSC). Establishing 300 BPT in government agencies nationwide.

Botika ng Manggagawa (BM) - A partnership with the Philippine Government Employees Association (PGEA). Establishing 100 BM in NCR.

Health Plus Outlet (HPO) - A partnership with the National Pharmaceutical Foundation (NPF). There are around 308 HPOs nationwide.

Botika Binhi (BB) - A partnership with the Kabalikat ng Botika Binhi, Inc. (KBBI). There are around 26 active BBs nationwide from the 163 established.

List of Medicines Available in BnB Outlets

  1. Aluminum hydroxide 225 mg + Magnesium hydroxide 200mg/5mL suspension (60 mL)
  2. Amoxicillin 250 mg/5 mL powder/granules for suspension (as trihydrate) (60 mL bottle)
  3. Amoxicillin 500 mg capsule (as trihydrate) (blister pack)
  4. Ascorbic acid 500 mg tablet (blister pack)
  5. Cotrimoxazole (800 mg Sulfamethoxazole + 160 mg Trimethoprim) tablet/capsule (blister pack)
  6. Ferrous sulfate tablet (equivalent to 60 mg elemental Iron) (blister pack)
  7. Loperamide 2 mg capsule (as hydrochloride) (foil/blister pack)
  8. Mefenamic acid 250 mg capsule/tablet (foil/blister pack)
  9. Multivitamins (for adults) capsule (foil/blister pack)
  10. Multivitamins per 5 mL syrup (for children) (60 mL bottle)
  11. Paracetamol 250 mg/5 mL syrup/suspension (60 mL bottle)
  12. Paracetamol 500 mg tablet (blister pack)
  13. Povidone Iodine 10% Topical Solution (15 mL bottle)
  14. Metformin 500 mg tablet (as hydrochloride) (foil pack)
  15. Glibenclamide 5 mg tablet (blister pack)
  16. Metoprolol 50 mg tablet (as tartrate) (foil pack)
  17. Captopril 25 mg tablet (foil pack)
  18. Salbutamol 2 mg tablet (as sulfate) (blister pack)
  19. Salbutamol 2 mg/5 mL syrup (as sulfate) (60 mL bottle)
  20. Lagundi 300 mg tablet (strip foil)
  21. Sambong 250 mg tablet (strip foil)

Program Updates/Milestones

     Since the BnBs served its purpose, with the increased number of drug outlets carrying generics medicines at lower cost nationwide. There is no need for the national government to establish more BnBs. The DOH will continue its support to successful BnBs by coordinating with FDA and assist the existing BnBs to comply with the standards of a regular drug outlet or an OTC or no-traditional outlet.

     Currently, there about 14,813 existing BnBs nationwide with 12,896 BnB with Special License to Operate (SLTO).  The Philippine FDA will no longer be renewing this type of drug outlet licensing. The DOH issued moratorium (Department Memorandum No. 2011-002) on the establishment of Botika ng Barangay (BnB) nationwide to address the concern on sustainable operations and financing, the lack of supervising pharmacists, and irrational dispensing of medicines.

The table below shows the number of established and existing BnB outlets per region.

No. CHD No. Total # of BnBs Established from (2003-2011) Total Number of Existing BnBs (as of December 2013)

1

CHD I - Ilocos

2,086

1,769

2

CHD II - Cagayan Valley

578

474

3

CHD III - Central Luzon

1,912

1,217

4

CHD IV-A - CALABARZON

1,884

1,497

5

CHD IV-B - MIMAROPA

1,189

992

6

CHD V - Bicol

771

690

7

CHD VI – Western Visayas

1,751

1,310

8

CHD VII – Central Visayas

621

438

10

CHD VIII – Eastern Visayas

1,052

757

11

CHD IX – Zamboanga Peninsula

788

786

12

CHD X – Northern Mindanao

1,189

1,059

13

CHD XI - Davao

933

773

14

CHD XII - SOCCSKSARGEN

557

499

15

CHD - CAR

811

736

16

CHD - NCR

929

666

17

CHD - CARAGA

897

891

18

ARMM

394

359

 

T O T A L

18,342

14,913

What is Rare Disease Medicines Access Program

      The DOH-NCPAM is embarking on a program that will provide health care access to patients with rare disease through the Rare Disease Medicines Access Program. Filipino patients born with rare disease are "orphaned" by society. They suffer social abandonment because of lack of existing network of support to aid them. Medical help is exclusive under the conditions of the country's health priority. The nature of their illness is hardly know due to lack of information and only a few medical professionals in the country are aware of these disorders and known how to diagnose and address these conditions.

Medicines Access Programs (MAPs)

The Medicines Access Programs or MAPs are public health programs that aims to improve drug availability in public sector health facilities. The MAPs are initially implemented by the Pharmaceutical Division (formerly the National Center for Pharmaceutical Access and Management) pursuant to Cheaper Medicines Act of 2008. Also, the MAPs was enshrined in the Philippine Medicines Policy: “The DOH, PhilHealth and other relevant government agencies shall employ strategies that will provide free medicines to the poor or a population of patients that addresses priority diseases (e.g. TB, HIV, malaria, NCDs, cancers).

 

The MAPs occupies the 90% of the budget allocated for the Pharmaceutical Division budget for the procurement of essential medicines for priority diseases.

 

Goals and Objectives of Medicines Access Programs (MAPs)

  1. To improve access to essential medicines in the public sector through innovative strategies which include the following but not limited to:

a. Pooled procurement
b. Consignment
c.
Price negotiation
d. Medicines Patent Pool (MPP)

e. Importation/parallel importation
f. Employing TRIPS flexibilities
g. Public-private partnerships

  1. To increase the percent availability of essential medicines addressing priority diseases in both the hospital and primary care setting
  2. To ensure the cost-effective and rational use of medicines and quality of care according to nationally accepted treatment guidelines
  3. To improve health outcomes of patients affected by priority diseases (i.e. MDGs, TB, HIV/AIDS, NCDs and other priority diseases of DOH)

Milestones of the Medicines Access Programs

      In recent years, several access programs have thus been created under the DOH-NCPAM utilizing the Php 1 billion annual appropriation to target drugs poorly available in public health facilities and which pose a significant cost burden to patients.   These drugs include basic essential drugs needed in primary care for both infectious and chronic conditions (i.e. ARI, pneumonia, UTI, hypertension, diabetes, asthma) procured in bulk and distributed in complete treatment regimens to all rural health units (RHUs) nationwide. Several access programs for in-patient and catastrophic care have also been created for breast and childhood cancers, mental health diseases and geriatric health.

 

     With the launching of MAPs, drug availability in primary health care facilities were shown to have improved according to the monitoring and drug availability studies commissioned by the DOH. Mean drug availability in rural health units increased from 24.8% to 53.5% from 2010 to 2012.  However, the percentage improvement in Level 2 to 4 hospitals was lower from 25.8% to 44.3% (See Table 11).

 

Mean availability of a basket of essential medicines in government health facilities

Facility Level

Mean availability

2010

(Mean, 95% CI)

Mean availability

2011

(Mean, 95% CI)

Mean availability

2012

(Mean, 95% CI)

Rural Health Units, Health Centers and Level I Public Hospitals

24.8 %

(21.0-28.5 %)

51.7%

(47.9-55.4%)

53.6%

(50.0-57.2%)

Level II to IV Public Hospitals

25.8%

(22.3 -29.4 %)

37.8%

(33.6-41.9%)

44.3%

(39.7-49.0%)

Drug Availability is defined as the percentage availability of a reduced list of essential drugs taken from the Philippine National Drug Formulary in samples of health facilities at the moment of the visit.

Sources:

Dichosa, M.J.,  Sarol, J., Mabulay, A.S., & Domingo, D.P.(2010) Establishment of a Baseline for the Performance Indicators of Health Sector Policy Support Program Phase II – Final Report. Philippines.

Sarol, J. (2012) Survey on Drug Availability in Public Health Facilities in the Philippines 2011. Philippines.

Sarol, J. (2013) Survey on Drug Availability in Public Health Facilities in the Philippines 2012. Philippines.