THE PHILIPPINES Work Plan FY 2017 Project Year 6

THE PHILIPPINES Work Plan FY 2017 Project Year 6 October 2016 September 2017 ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the U.S. Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance for ENVISION is September 30, 2011, through September 30, 2019. The author s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

ENVISION PROJECT OVERVIEW The U.S. Agency for International Development (USAID) s ENVISION project (2011 2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths ([STHs] roundworm, whipworm, hookworm), and trachoma. ENVISION s goal is to strengthen NTD programming at global and country levels and support ministries of health (MOHs) to achieve their NTD control and elimination goals. At the global level, ENVISION in close coordination and collaboration with WHO, USAID, and other stakeholders contributes to several technical areas in support of global NTD control and elimination goals, including: drug and diagnostics procurement, where global donation programs are unavailable capacity strengthening management and implementation of ENVISION s Technical Assistance Facility (TAF) disease mapping NTD policy and technical guideline development NTD monitoring and evaluation (M&E). At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including: strategic annual and multi-year planning advocacy social mobilization and health education capacity strengthening baseline disease mapping preventive chemotherapy (PC) or mass drug administration (MDA) drug and commodity supply management and procurement program supervision M&E, including disease-specific assessments (DSA) and surveillance. In the Philippines, ENVISION project activities are implemented by RTI International. ENVISION FY17 PY6 THE PHILIPPINES Work Plan i

TABLE OF CONTENTS Page ENVISION Project Overview... i List of Tables... iii List of Figures... iii Acronyms List... iv Country Overview... 5 1) General Country Background... 5 a) Administrative Structure... 5 b) NTD Program Partners... 5 2) National NTD Program Overview... 7 a) Lymphatic Filariasis... 7 b) Schistosomiasis... 9 c) Soil-Transmitted Helminths... 9 3) Snapshot of NTD status in the Philippines... 11 Planned Activities... 12 1) NTD Program Capacity Strengthening... 12 a) Strategic Capacity Strengthening Approach... 12 b) Capacity Strengthening Interventions... 13 c) Monitoring Capacity Strengthening... 14 2) Project Assistance... 15 a) Strategic Planning... 15 b) NTD Secretariat... 15 c) Advocacy for Building a Sustainable National NTD Program... 15 d) Social Mobilization to Enable NTD Program Activities... 16 e) Training... 16 f) Mapping... 16 g) MDA Coverage and Challenges... 16 h) Drug and Commodity Supply Management and Procurement... 17 i) Supervision... 17 j) M&E... 17 3) Maps... 18 Appendix 1. Work Plan Activities... 22 ENVISION FY17 PY6 THE PHILIPPINES Work Plan ii

LIST OF TABLES Table 1. NTD partners working in the Philippines, donor support, and summarized activities... 7 Table 2: Snapshot of the expected status of the NTD program in the Philippines as of September 30, 2016... 11 Table 3: Capacity Strengthening Interventions... 13 LIST OF FIGURES Figure 1. Administrative levels and health structure in the Philippines... 5 Figure 2. Data flow for STH MDA... 10 Figure 3. Philippines Reference Map... 18 Figure 4. Philippines Endemicity Map... 19 Figure 5. Philippines MDA Geographic Coverage Map... 20 Figure 6. Philippines LF DSA Map... 21 ENVISION FY17 PY6 THE PHILIPPINES Work Plan iii

ACRONYMS LIST ALB ARMM ASEAN CST DEC DOE DOH DQA DSA EU FOG FTS FY GSK ICT JRSM LF LGU MDA MEB M&E Mf MMDP NTD PC PHIS PreSAC PZQ Q RHU RPRG SAC SAE SCH STH STTA TAS TIPAC USAID WCBA WHO Albendazole Autonomous Region of Muslim Mindanao Association of South East Asian Nations Coverage Supervisory Tool Diethylcarbamazine Citrate Department of Education Department of Health Data Quality Assessment Disease-Specific Assessment Evaluation Unit Fixed Obligation Grant Filariasis Test Strip Fiscal Year GlaxoSmithKline Immunochromatographic Test Joint Request for Selected (PC) Medicines (WHO) Lymphatic Filariasis Local Government Unit Mass Drug Administration Mebendazole Monitoring and Evaluation Microfilaria Morbidity Management and Disability Prevention Neglected Tropical Diseases Preventive Chemotherapy Philippines Health Information System Preschool Children Praziquantel Quarter Rural Health Unit Regional Program Review Group School-age Children Serious Adverse Event Schistosomiasis Soil Transmitted Helminthiases Short Term Technical Assistance Transmission Assessment Survey Tool for Integrated Planning and Costing United States Agency for International Development Women of childbearing age World Health Organization ENVISION FY17 PY6 THE PHILIPPINES Work Plan iv

COUNTRY OVERVIEW 1) General Country Background a) Administrative Structure With a projected population of 103 million in 2015, the Philippines is the world s 12th most populous country. The Philippines consists of three island groups Luzon, Visayas, and Mindanao and 7,107 islands. Given the decentralized nature of the Philippines government system, actual implementation including operational planning, budgeting, and funding for most neglected tropical disease (NTD) field activities is the responsibility of the provincial and city/municipality health authorities (see Figure 1 for administrative levels). Figure 1. Administrative levels and health structure in the Philippines Level Health Structure Number (as of 2016) National Department of Health (DOH) 1 Region DOH Regional Office 18* Province Province Health Department 81 Cities and Municipalities Local Government Units (LGUs) City/Municipal Health Office 123 cities 1,496 municipalities *Negros Island Region was formed in 2015. The region is still in the process of setting up the regional support offices, expected to be completed in 2017. The Philippine government structure is in the process of devolving more responsibility and authority for public health program management to the provincial level. All health staff down to the municipal and barangay (village) levels report to the Local Chief Executive of their locality, and not to the Department of Health (DOH). This means that on-the-ground implementation requires interface with local government units (LGUs), whose leaders are elected locally and responsible for local agendas, budgets, and priorities. Five of the 81 provinces in the country are under the authority of the Autonomous Region of Muslim Mindanao (ARMM), which is an isolated region of the country affected by serious social and extreme security issues. This includes three lymphatic filariasis (LF)-endemic provinces, five soil-transmitted helminthiases (STH)-endemic provinces, and two schistosomiasis (SCH)-endemic provinces. ARMM health workers report to the Secretary of the DOH-ARMM, which requires well-managed coordination to implement comprehensive NTD activities in these provinces. b) NTD Program Partners The DOH has the ability to fund the majority of the NTD program activities and drug procurement needs. The funding is allocated by the Department of Budget and once allocated to a line item is reserved specifically for that line item/activity. The DOH is able to ensure the country has the resources to meet its drug requirements as well as fund activities surrounding the mass drug administration (MDA). 5

USAID s End Neglected Tropical Diseases in Asia Project (END in Asia, led by FHI360) provided support to the National NTD Program in the Philippines from October 2011 through September 2015. For LF, END in Asia supported regional training and data review workshops, surveys, and pre-dossier development. SCH support focused on updating program guidelines, data review meetings, training lower-level health workers to improve surveillance, and supporting MDA in ARMM. In regards to STH, END in Asia assisted the government in increasing MDA coverage through national review and planning meetings, regional trainings in low coverage provinces, production of training and social mobilization materials, and refresher training of teachers and health workers on school-based MDA. U.S. Agency for International Development (USAID) support to the Philippines was transferred to the ENVISION project in fiscal year 2016 (FY16). Under ENVISION, activities in the Philippines center around technical support through short-term consultants and ENVISION staff to the DOH for developing disease-specific strategic plans that will help ensure the country achieves its control and elimination targets, updating national policies, and enhancing NTD knowledge among other stakeholders necessary to ensure program sustainability. The World Health Organization (WHO) remains a major source of technical assistance to the National NTD Program, providing funding for two staff positions and financial support for data strengthening activities, such as the creation of a Philippines National NTD Database that will be easily integrated with the Philippines Health Information System (PHIS), with funding from the Bill & Melinda Gates Foundation. The database is being designed specifically for the Philippines so that the information can be collected electronically at the field level per the requirements of the knowledge management section of the DOH. The database will also be able to produce reports for the WHO system. Pilot testing of the database is scheduled to begin in December 2016. The WHO also facilitates GlaxoSmithKline (GSK) s donation of albendazole (ALB) for LF MDA and began facilitating Eisai s donation of diethylcarbamazine citrate (DEC) in 2016 for three provinces as a pilot, with the plan to roll out the donated DEC to all remaining provinces in 2017. The majority of the ALB for STH MDA for preschool children (PreSAC), older school children, and women of childbearing age (WCBA) is procured locally with funding from the DOH budget. For STH MDA in school-aged children (SAC) aged 5 14, WHO has provided ALB from GSK in the past; starting in 2017, Johnson & Johnson will be donating all mebendazole (MEB) needed for SAC. The Government of China is providing technical support to SCH elimination strategies in the Philippines. Table 1 shows NTD partners in the Philippines. 6

Table 1. NTD partners working in the Philippines, donor support, and summarized activities Partner Location (Regions/States) Activities Is USAID providing direct financial support to this partner? List other donors supporting these partners RTI/ENVISION Department of Health (DOH) Department of Education (DOE) World Health Organization Government of China Central Central, Province, District Central, Province, District, Barangay Manila with field visits to implementing provinces/districts Central Provides direct technical assistance to the DOH in strategic planning, monitoring and evaluation (M&E), advocacy. Procurement of Brugia Rapid tests. Plans and coordinates activities across the country Support in the school-based drug distributions throughout the country for soil-transmitted helminths Provides technical support for strategic planning, M&E and donation of albendazole, mebendazole and diethylcarbamazine citrate (DEC). Technical support for schistosomiasis elimination Yes No No No No No DOH DOE GlaxoSmithKline, Eisai, Johnson & Johnson, Bill & Melinda Gates Foundation Government of China 2) National NTD Program Overview a) Lymphatic Filariasis The predominant parasite causing LF in the Philippines is Wuchereria bancrofti, transmitted by Aedes poicilius and Anopheles minimus flavirostris, although nocturnally sub-periodic Brugia malayi has been found in 10 provinces and is transmitted by Mansonia uniformis and Ma. bonneae. Microfilaria rates determined by data collected during studies from 1969 2000 were used to classify 45 provinces in 12 regions as endemic for LF, with an at-risk population of 40 million people. i) Strategic planning The Philippines LF Strategic Plan 2016 2020, developed with ENVISION support, has a goal of elimination of LF as a public health problem by 2020, and is currently being adopted in the country. In addition to assisting the DOH with continued strengthening of MDA in the 14 remaining endemic provinces, it provides strategies to help the country conduct ongoing surveillance to ensure interruption of transmission is maintained by incorporating surveillance strategies with other disease programs. As the country nears elimination, this plan allows the country to be more targeted in its approaches to achieving effective MDA coverage and monitoring for recrudescence. 7

ii) Mass drug administration MDA with ALB and DEC was scaled up from 2003 to full national coverage in 2010. 2015 MDA took place between November 2015 and April 2016. National coverage, defined by WHO as the proportion of the population requiring preventive chemotherapy (PC) for LF in the country that have been treated, was 59%. Between 2015 and 2016, the DOH revised its NTD MDA schedule to integrate MDA rounds and reduce the number of separate drug distributions. Thus, in July 2016, the DOH piloted community-based LF MDA integrated with the school-based STH MDA in some provinces that had implemented 2015 MDA in November December 2015; the other provinces will implement LF MDA in October/November 2016. In 2017, the DOH plans to implement all LF MDA in one month (July) in 14 provinces. iii) Transmission assessment survey (TAS) and post-mda surveillance School-based TAS will continue to be the principal strategy to determine if MDA can be stopped (TAS1) and for post-mda surveillance (TAS2, TAS3). In FY17, 3 TAS1 will be implemented, as well as 12 TAS2 and 8 TAS3. In those provinces that have passed TAS3, ongoing surveillance is being established. Ongoing surveillance has been proposed as a passive health-facility based assessment of LF infection using Filariasis Test Strips (FTSs), with a sample size of 1000 adults per year per EU; however, this will be further explored during a FY17 regional meeting on post-validation surveillance. In FY16, Oriental Mindoro failed the first post-mda surveillance TAS (TAS2), with a majority of positive children coming from the Mangyans ethnic group, a group which migrates often among nearby provinces. The WHO Regional Program Review Group (RPRG) has recommended research to understand the compliance of this group in previous MDA and the risks of their migration to nearby provinces that are also in the post-mda surveillance phase. Based on RPRG recommendations, the DOH is deciding whether to start two more rounds of MDA in the entire province or whether to split the province into smaller evaluation units (EUs) and implement mini-tass to determine where to restart MDA. MDA will likely occur in most, if not all, of the province in 2017. ENVISION provided Brugia Rapid tests and training to the DOH to facilitate detection in co-endemic areas of the country. The DOH used the Brugia Rapids to test for B. malayi alongside immunochromatographic tests (ICT) in co-endemic areas of the country, starting with Eastern Samar and Palawan provinces in FY16. The training was conducted in Eastern Samar province in June 2016; however, implementation of the testing is at the discretion of the provincial health officers, and results have not yet been reported up to the central level. iv) Morbidity The DOH Central Office provides disability management kits to lymphedema patients and funding for hydrocele surgeries. A national database was established in 2007 with a line listing of over 700 patients; however, it has not been updated since 2012 due to lack of human resources. Case finding is generally implemented during MDA campaigns, with rural health officers going door to door to ask if cases exist and then having staff from the rural health units or hospitals validate the suspected cases. Validated cases are provided treatment services at the local health units. 8

b) Schistosomiasis In the Philippines, SCH is caused by Schistosoma japonicum transmitted through an intermediary snail host, Oncomelania quadrasi. S. japonicum is one of the most difficult parasites to control due to its zoonotic nature, as it also can be transmitted by buffalo, rats, and dogs. SCH is endemic in 28 provinces, putting a total population of approximately 12 million at risk, with about 2.3 million people directly exposed to the disease. Fifteen provinces conducted sentinel site surveys in 2015, and of those, six reported < 1% positive intestinal infection rates. Mass treatment of people aged 5 65 using community-based MDA throughout all 28 endemic provinces began in 2009, but the MDA has had low national coverage since 2010 (ranging from 43 60%), due to problems in locally procuring praziquantel (PZQ) and getting local commitment to implement MDA. While END in Asia provided an emergency supply of PZQ in 2012 and ENVISION provided 1.8 million tablets in 2016, the DOH has since been able to increase its budget allocation to include sufficient PZQ for MDA in all endemic provinces and will not need help procuring PZQ for 2017. From 2009 to 2015, SCH MDA was implemented in July, but it was shifted to January in 2016 to align with school-based MDA for STH in select pilot schools, with the remainder of SCH MDA implemented in March 2016. The DOH is planning for SCH MDA to occur in January 2017 in all endemic areas. In addition to MDA and snail surveillance, the Schistosomiasis Control and Elimination Program also focuses on environmental sanitation and engineering, and management of animals to control the spread of the disease. The DOH is consulting with Chinese experts to develop a strategy to move from control to elimination, in line with the WHO goal of elimination of SCH as a public health problem in the Philippines by 2016. c) Soil-Transmitted Helminths STH is endemic in all 81 provinces in the Philippines, with a population of 20 million SAC and 10.6 million PreSAC requiring MDA for 2016. Before the beginning of the MDA program in 2003, the prevalence rate among 6- to 14-year-old SAC was 65%, with a similar rate in PreSAC of 66%. PreSAC (1 4 years) are dewormed in Rural Health Units (RHUs) through the Garantisadong Pambata Program (a bi-annual health program supporting various health programs), while SAC 5 18 years old are dewormed by the Department of Education (DOE) in public elementary schools. Non-enrolled children aged 5 12 years are dewormed in RHUs. In 2015, the DOH moved twice-per year STH MDA to the months of July and January and integrated it with LF (July) and SCH (January). In order to assess the impact of MDA, the Research Institute for Tropical Medicine, the research arm of the DOH, implemented a nationwide STH prevalence survey in SAC (5 14 years old) in 2014 2015. Results from this study indicated overall STH prevalence is 28.4%, a decrease in the overall prevalence reported in 2004 of 62.3%. Overall, Ascaris prevalence was 17.4%, with 42.5% of these moderate to heavy intensity infections. Trichuris prevalence was 19.7%, with 18.9% moderate to heavy intensity infections. Hookworm prevalence was 0.55%, with 4.9% of these moderate to heavy intensity infections. A data quality assessment (DQA) was conducted in May 2016 based on the January STH MDA. The DQA identified some areas for improvement, such as the need for extended timing for deworming and for improved reporting forms that were immediately implemented during the July 2016 MDA. The flow of information also helped highlight the importance of strong coordination that is needed between the DOH and Department of Education (DOE) at the national level to ensure the guidelines and information flow down to the various levels and with enough notice in order to allow the provinces to plan and train the schools and health centers on the integrated MDA (Figure 2). 9

Figure 2. Data flow for STH MDA DoH Central DoH Regional City Health Office/Provincial Health Office DoE Regional District School Division Health Center School District School As the DOH moves to an integrated MDA for all PC NTDs (January for STH/SCH and July for STH/LF) this flow of information will need strong coordination at all levels to ensure accurate reporting and treatment of the three diseases. 10

3) Snapshot of NTD status in the Philippines Table 2: Snapshot of the expected status of the NTD program in the Philippines as of September 30, 2016 Columns C+D+E=B for each Columns F+G+H=C for each disease disease MAPPING GAP MDA MDA GAP DETERMINATION DSA NEEDS DETERMINATION ACHIEVEMENT A B C D E F G H I Disease Lymphatic filariasis Total No. of Districts in COUNTRY 81* No. of districts classified as endemic No. of districts in need of initial mapping No. of districts receiving MDA as of 09/30/16 USAIDfunded Others No. of districts expected to be in need of MDA at any level: MDA not yet started, or has prematurely stopped as of 09/30/16 Expected no. of districts where criteria for stopping district-level MDA have been met as of 09/30/16 45 36 0 0 14 0 32 No. of districts requiring DSA as of 09/30/16 Pre TAS: 3 TAS 1: 3 TAS 2: 12 TAS 3: 8 Onchocerciasis N/A N/A N/A N/A N/A N/A N/A N/A Schistosomiasis No. of districts classified as nonendemic Soiltransmitted helminths Trachoma 28 53 0 0 28 0 0 2 for focal surveys 81 0 0 0 81 0 0 0 N/A N/A N/A N/A N/A N/A N/A N/A *Implementation unit in the Philippines is province, not district. Currently the workbooks show 80 provinces. Dinigat Islands, which split from Surigao del Norte (Caraga Region), is in the process of being incorporated into the database and the workbooks. In the interim, it is combined with Surigao del Norte in the FY17 work planning workbooks. Please note that Dinigat Islands has stopped MDA for LF. 11

PLANNED ACTIVITIES 1) NTD Program Capacity Strengthening a) Strategic Capacity Strengthening Approach The Philippines DOH already has been strategically planning for the sustainability of their STH and SCH control programs, as well as the ongoing activities needed after LF elimination. With ENVISION support in FY16, they have developed plans for the next five years that include institutionalizing capacity for quality MDA, surveillance, and case management. ENVISION will help the DOH to efficiently operationalize these plans. Specifically: Assist in planning and forecasting activities Operationalize the disease specific sustainability plans and NTD lab network plan Monitor supply chain management for MDA drugs In consultation with the DOH, ENVISION is planning to focus capacity strengthening support on the following objectives: Objective 1: Strengthen use of data Objective 2: Improve annual plan implementation and budgeting Objective 3: Facilitate expert input into surveillance activities. These objectives have been agreed between the DOH and ENVISION as they align with ENVISION s approach in the Philippines to ensure the DOH has the capacity to use their internal resources effectively. WHO is also a key player in the Philippines and ENVISION will work closely with them on the management and use of data objective. The second objective will help the DOH implement their annual work plan and track the funding that is put towards activities at all levels. All NTD program team members at the DOH will also be kept informed of the progress the team is making against its plan, provide a timeline of when activities will be taking place and clearly identify when the preparations need to begin that lead up to field activities, and the third objective will help operationalize the disease specific plans and ensure the DOH has in place the structure that will sustain the program work beyond elimination to ensure recrudescence does not occur. Objective 1: Strengthen use of data: The DOH has identified the need for assistance to document activities, analyze data, and write reports with critical recommendations and next steps highlighted. In addition, the DOH will use the data during advocacy visits to highlight weaknesses of the programs and assist the provinces in identifying ways to improve MDA coverage. ENVISION will provide assistance through placing a full-time staff member a Program Technical Support Manager - embedded within the DOH. This position will be filled with someone who has strong analytical, writing, communication, and mentoring skills. They will be trained by ENVISION on use of key resources and tools on data use, for example the data for action facilitation guide. At the same time ENVISION is working with the DOH to determine a plan for sustainability of this support after the project ends, for example, by facilitating the creation of a full-time position within the DOH NTD department to take over these responsibilities. 12

Objective 2: Improve annual plan implementation and budgeting: Focusing on improved implementation of the NTD annual plan at the central level will help the DOH ensure that activities and budgeting are taking into consideration the adequate needs of the lower levels and putting flexible plans in place that will be able to accommodate the changes throughout the year. Through the Tool for Integrated Planning and Costing (TIPAC), ENVISION will assist the DOH in planning NTD activities over the next five years. This detailed planning captured in a central location will more easily identify where the DOH needs to provide additional support. Improved implementation and budgeting will also help the DOH to track the progress of the provinces conducting LF MDA and ensure they are planning for TAS when the time comes. Improved planning at the central level will allow the DOH to provide advanced notification to the provinces to submit TAS requests and plan surveillance activities. ENVISION will assist the DOH in monitoring the provincial progress and ensure they are tracking TAS activities in all the provinces by putting the scheduled TAS on the activity calendar, and assisting the DOH with preplanning activities using the WHO TAS planning checklist. Objective 3: Facilitate expert input into surveillance activities: As the DOH approaches elimination for LF and gets closer to control for SCH and STH, they have begun thinking about how they will ensure recrudescence does not occur. The DOH has a multi-year SCH sustainability plan, and with support from ENVISION in FY16, the DOH worked with an LF expert to draft a multi-year LF sustainability plan that includes surveillance activities to commence pre-elimination, but continue after validation. A plan for STH will be developed with ENVISION support in FY17 to close the gap for sustainability plans for the three diseases in the Philippines. In FY16, ENVISION also provided assistance through a consultant to develop terms of reference for a network of laboratories that would guide the DOH in building the capacity of RITM to fulfill its mandate of being able to address the needs of NTDs. In FY17, ENVISION will support a consultant to work with the DOH to pilot test the plan with RITM and three regional laboratories (see section k of this work plan) and will help link the DOH to appropriate tools for assessing regional laboratory capacity. In addition, ENVISION will facilitate the DOH s participation in the joint WHO-USAID post-validation surveillance meeting that is proposed in Q2 of FY17. This meeting will allow the DOH to receive advice from experts on finalizing the details of their proposed LF surveillance methodology. b) Capacity Strengthening Interventions Table 3: Capacity Strengthening Interventions Project assistance area Strategic planning Capacity strengthening interventions/activities STH strategic plan and data review, Tool for Integrated Planning and Costing (TIPAC) review and update How these activities will help to correct needs identified in situation above Proper allocation of resources to activities; ensure resources are available in a timely manner 13

Staffing Building advocacy for a sustainable NTD program Program Technical Support Manager to assist in data analysis, reporting writing and data-driven decision making Advocacy visits to 5 low performing provinces to engage with the new governments and present multi-year data analysis Hiring a full time Program Technical Support Manager will help alleviate some of the staffing constraints of the DOH and allow time for the DOH to advocate for a new position internally Advocacy visits will provide an opportunity to present multiyear coverage data to the provinces to inform and educate the newly elected officials in low performing areas of the need to allocate resources to programs that will benefit the community c) Monitoring Capacity Strengthening In order to monitor the impact of ENVISION support to capacity strengthening, the in-country ENVISION staff will track the progress during their weekly meetings with the DOH putting this as a special topic on the agenda every quarter. The ENVISION HQ staff will hold quarterly calls with the DOH to seek feedback on ENVISION's assistance. This will ensure that ENVISION assistance is targeted appropriately to assist with challenges as they arise. Objective 1: Strengthen MOH staff capacity on data use: After hiring for the new Program Technical Support Manager ENVISION will check in with the DOH on a quarterly basis to assess how this position is functioning. Note will be taken of the types of data analysis and reports that the Program Technical Support Manager has provided and of the types of interactions that they have had with DOH staff members. Conversations will focus on whether the Program Technical Support Manager s efforts are helping the DOH use its data more effectively, to think more strategically, and the progress on moving to create a permanent DOH-funded position. ENVISION will also hold a meeting with the DOH after the first advocacy visit to see how the data presented was received, what the reaction of the province was, what went well, what should be revised, and what additional data needs to be presented to bolster the NTD support from the provinces. Objective 2: Improved planning and budgeting After the first two months, ENVISION HQ will hold a call with ENVISON Philippines staff to see how planning and implementation is progressing. A call with the DOH after the first MDA (January 2017) will be held for them to provide their assessment of how the weekly meetings have helped with the preparations and how they would like to see these modified moving forward. Objective 3: Facilitate expert input into surveillance activities: ENVISION Philippines will check that the 2018 annual plan (developed June-August 2017) incorporates the activities from the disease specific plans. As activities unfold through the year, ENVISION HQ will continually check through emails and in 14

management visits with the DOH that questions from RITM and the three regional laboratories are addressed by experts and that responses are incorporated into the piloting of the network plan. 2) Project Assistance a) Strategic Planning 1st ASEAN NTD Day: During the biennial Association of Southeast Asian Nations (ASEAN) Expert Group on Communicable Diseases Meeting, ENVISION will work with the Philippines DOH, chair of the ASEAN NTDs Group, to organize a side-meeting to present and discuss the progress being made on the elimination of NTDs in the region. ENVISION will support funding for the venue and refreshments for this meeting for 100 participants, usually Secretaries (or Deputy Secretaries) of Health and Local Chief Executives as well as other committee members. The ASEAN Summit presents an opportunity for the Philippines and other ENVISION countries (Indonesia, Cambodia, Laos, Vietnam) to share experiences combating NTDs and showcase advancements made toward elimination goals. Additionally, the countries will have an opportunity to learn from each other and take best practices back to their countries and help continue the fight. This meeting was originally planned to take place in FY16; however, due to the postponement of the official meeting, the NTD Day is being requested in FY17. STH Strategic Plan and Data Review: ENVISION will support an expert to work with the DOH on the development of the STH Strategic Plan to finalize the PC NTD strategic plans for the country. The ENVISION-supported consultant will review the available data on prevalence and intensity of STH by parasite and risk group. This analysis should inform the risk groups that need priority support, the best platforms for drug delivery, and choice of drugs. This analysis will be presented at a consultative meeting, funded by the DOH, held with the DOH, DOE, and other stakeholders, to review current data and MDA coverage and ensure the plan meets the needs that will help the country reach sustainable control of STH. The consultant will then finalize the strategic plan after the consultative meeting. The consultancy will be approximately 2 weeks and will be done in Quarter (Q) 1 FY17, before the January MDA. Philippines TIPAC update and review: ENVISION trained the DOH on the TIPAC in May 2016. The participants were very interested in its use and benefit, specifically in generating the Joint Request for Selected Medicines (JRSM). The DOH has requested that ENVISION assist with updating the TIPAC in Q1 of FY17 in order to enter the final DOH budget for 2017, update the calendar of activities, and identify any gaps. This support will be part of the planned program management trips, either by the Subaward Manager or Senior M&E Specialist. b) NTD Secretariat There are no planned activities for the NTD Secretariat in FY17. c) Advocacy for Building a Sustainable National NTD Program Provincial advocacy visits: The transition of the government in July presents an opportunity for the NTD program to advocate to the newly elected mayors and provincial representatives. This will allow the NTD program to garner buy-in from the administrative levels responsible for MDA implementation (district and LGU levels included) and target the low performing provinces (those provinces not achieving the 15

required coverage per the DOH guidelines). Five provinces will be identified for planned advocacy trips for the NTD team to visit, identify the reasons for low performance, and work with on improving coverage. The DOH will adapt the ENVISION Data Action for Planning Guide to the Philippines context and use this tool to present data to the provinces and stimulate the discussions around improving low coverage. The DOH also will use the ENVISION supportive supervision checklist to guide discussions with the provinces and develop follow-up action items that will be used to monitor improvement. The costs associated with this are travel expenses (per diem, lodging, and travel) for two MOH staff for three days per province. d) Social Mobilization to Enable NTD Program Activities The END in Asia project worked closely with the DOH to update their IEC materials. These materials are being used by the DOH prior to the MDA campaigns. The DOH also relies heavily on TV and radio advertisements to inform communities about the MDA. Messages focus on the safety of the drugs being used in the MDA, help highlight the benefits to society of taking the medication, and emphasize that the drugs are free of charge. While there are no social mobilization activities planned with ENVISION funds in FY17, the ENVISION team will work closely with the DOH to ensure social mobilization activities are planned and implemented before the MDA is scheduled to occur. e) Training There are no specific trainings planned with ENVISION funds in FY17. ENVISION supported four trainings in FY16: TIPAC, DQA, TAS, and Coverage Supervisory Tool (CST) training. In FY17, ENVISION is continuing to give coaching on the use of the TIPAC and will liaise with the DOH to ensure staff have the necessary skills to implement DQA and the CST on their own. The ENVISION M&E team will be available to answer questions and provide support if necessary. For the TAS training follow-up, ENVISION will recommend that before TAS using Brugia Rapids is implemented in FY17, survey teams take a test to ensure they can correctly identify Brugia Rapid test results as positive, negative, or invalid. ENVISION will also provide online resources as they are developed to the DOH and will ensure the DOH team has access to webinars and informational resources. The DOH conducts a cascade training before each MDA. The ENVISION team will work with the DOH to ensure MDA coverage issues are highlighted in the trainings. f) Mapping There are no planned mapping activities with ENVISION funds in FY17. All 81 provinces have been mapped for LF, SCH, and STH. g) MDA Coverage and Challenges While ENVISION does not provide direct support for MDA in the Philippines, it is working closely with the DOH at the central level to ensure the program has the necessary tools and resources to achieve its elimination and control targets. 16

h) Drug and Commodity Supply Management and Procurement There are no drug requests from the DOH for FY17 under ENVISION. The DOH has requested that ENVISION procure Brugia Rapid tests in order to conduct TAS in four potentially B. malayi co-endemic provinces - Sarangani, Davao Oriental, Augusan del Norte (TAS 2), and Augusan del Sur, which passed TAS 3 however the DOH is planning to conduct another TAS using Brugia Rapid tests. i) Supervision The decentralized structure of the DOH means that the central level NTD program team is responsible for issuing guidelines and providing support when requested from the region and provincial levels. The guidelines issued by the DOH directly reflect the recommendations put forth by the WHO. The regional and provincial levels are responsible for the implementation of program activities based on these guidelines. Direct supervision of activities at the community level is the responsibility of the regional and provincial level DOH staff. The provincial level staff collect the data at community level and report up through to the regional level and then central level based on the reporting forms issued by the DOH, if they are received on time and have the resources to reproduce the forms. ENVISION will provide the DOH with supervisory tools and checklists available from the ENVISION capacity strengthening team to assist during MDA implementation. j) M&E NTD Lab Network Pilot Test: The DOH has identified three laboratories to field test the plan that was developed with ENVISION support in FY16. The lab network will provide the basis for the Philippines to build on its own infrastructure to be able to collect and examine samples, test them, and determine the prevalence of both PC and non-pc NTDs, in the country. Additionally, this will help establish them as a go-to country for laboratory testing in the region for NTDs. Updating of MDA Guidelines: The DQA implemented in FY16 provided valuable insight to the DOH central level team. Based on the results, the DOH quickly revised the integrated MDA guidelines and the reporting forms for the July STH/SCH MDA. ENVISION will assist the DOH with reviewing the new guidelines and reporting forms and incorporating further recommendations from their use in the July MDA. Coverage Survey: The DOH is planning to conduct one coverage survey in Oriental Mindoro following re- MDA round one per the WHO TAS checklist guidance. 17

3) Maps Figure 3. Philippines Reference Map 18

Figure 4. Philippines Endemicity Map NOTE: Updates have been received for STH and SCH since the preparation of these maps and workbooks. The updates will be incorporated in the future submissions. 19

Figure 5. Philippines MDA Geographic Coverage Map 20

Figure 6. Philippines LF DSA Map Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project. 21

APPENDIX 1. WORK PLAN ACTIVITIES FY17 Activities Capacity Strengthening Strategy Access to webinars, tools, information TIPAC Review and Update Post Validation surveillance meeting Project Assistance Strategic Planning ASEAN NTD Day Meeting STH Strategic Plan and Data Review Advocacy for Building a Sustainable National NTD Program Provincial Advocacy Visits Drug Supply Management and Procurement Brugia Rapid Tests M&E NTD Lab Network Pilot Test Coverage Survey 22