• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Philippines - Current Situation in Control Strategies and Health Systems in Asia
 

Philippines - Current Situation in Control Strategies and Health Systems in Asia

on

  • 4,143 views

Current Situation in Control Strategies and Health Systems in Philippines by ERNESTO d’J. YUSON MD, Thalassemia Center of the Philippines, Balikatang Thalassaemia

Current Situation in Control Strategies and Health Systems in Philippines by ERNESTO d’J. YUSON MD, Thalassemia Center of the Philippines, Balikatang Thalassaemia

Statistics

Views

Total Views
4,143
Views on SlideShare
4,097
Embed Views
46

Actions

Likes
0
Downloads
0
Comments
0

3 Embeds 46

http://1stpanasian.tif-conference.com 40
http://www.1stpanasian.tif-conference.com 5
http://tif-conference.com 1

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Philippines - Current Situation in Control Strategies and Health Systems in Asia Philippines - Current Situation in Control Strategies and Health Systems in Asia Presentation Transcript

    • PHILIPPINES ERNESTO d’J. YUSON, M.D. Thalassemia Center of the Philippines Balikatang Thalassemia
    • DEMOGRAPHIC DATA• POPULATION - 92-95M• ETHNIC GROUPS: Chinese, Malay, y Spanish• ANNUAL BIRTH RATE:• AVERAGE INCOME: Php 14, 676 ( (USD 349.00) per capita )p p• EMPLOYMENT RATE: 39.4%• NATIONAL HEALTH BUDGET: Php 3.2T 3 2T (USD 7.27B)
    • DEMOGRAPHIC DATA (National Statistics Office)Population (August 2007) 88.57M 88 57MProjected Population (2010) 94.01MInflation Rate (Aug 2011) 4.7%Balance of Trade (June 2011) $ -376MExports (July 2011) $ 4.430BImports (June 2011)I t (J $ 4 503B 4.503BUnemployment (July 2011) 7.1%Underemployment (July 2011) 19.1%Simple Literacy (2000) 92.3%Functional Literacy (2008) 86.4%Average Family Income (2009) Php 206,000 ($4790)GNP (Q4 2010) Php 2,760.1BGDP (Q4 2010) Php 2 421 9B 2,421.9B
    • DEMOGRAPHIC DATA• POPULATION (2007) 709 people per sq k l km• Annual Population Growth rate (2000-2007): p ( ) 3.2%• Average births per woman/ total fertility rate (2003) 3.2%• N d f f il planning: 16% Need for family l i• Infant mortality rate (2006): 20 infant deaths per 1,000 live births
    • HEALTH SYSTEM• PUBLIC / GOVERNMENT:• PRIVATE SECTOR:• RE-IMBURSEMENT POLICY: PhilHealth, (HMOs, Personal & F il I (HMO P l Family Insurance) )• SPECIAL POLICIES O CHRONIC S C O C S ON C O C ILLNESS – NONE YET• ANY SPECIAL POLICIES ON Hb d/o d/o: NONE YET
    • • Incidence of Beta thalassemia in the Philippines is relatively low ( pp pp y (approx <1%). )• The most common (approx 50%) mutation is the “Filipino” deletion (b i i approximately Filipino (beginning i t l 4Kb upstream of the B-globin gene and extending beyond it)• followed by the codon 67 (-TG) 26 percent (Waye et al, 1994 K et al, 1998) (W t l 1994; Ko t l
    • EPIDEMIOLOGY (TCP/ Ba-THa) Ba THa)• Alpha carrier rate: ?• Beta thal carrier rate: ?• E-thal carrier rate: ?• S-thal carrier rate: ??
    • EPIDEMIOLOGY (TCP/ Ba-Tha Registry) Ba ThaTOTAL = 706• Alpha carrier/ trait: p 263• Hemoglobin H disease: 16• Beta thal major: 39• Beta thal minor: 348• HbE/ Beta Thal: 39• Hemoglobin E: 1• Sickle cell anemia: none
    • EPIDEMIOLOGY (TCP/ Ba-THa Registry) Ba THaTOTAL 706Alpha carrier/trait 263Hemoglobin H disease 16Beta Thalassemia Major 39Beta Thalassemia Minor 348Beta Thal – E interacting 39Hemoglobin E 1Sickle Cell Anemia none
    • EPIDEMIOLOGY (TCP/ Ba-Tha Registry) Ba ThaTOTAL 706 1,506 1 506 Extrapolate: (taking into account the parents of the index case)AlphaAl h carrier/trait i /t it 263 263 + 263 = 526Hemoglobin H disease 16 16 + 32 = 48Beta Thalassemia Major 39 39 +78 =117Beta Thalassemia Minor 348 348 + 348 =696Beta Thal – E interacting 39 39 +78 =117Hemoglobin E 1 1+1 = 2Sickle Cell Anemia none 0
    • By HPLC (2008 – June 2011)• Alpha thalassemia - 60• Hemoglobin H - H l bi 11• Beta thalassemia - 167• Beta thalassemia-E interacting – 10• Hemoglobin E – H l bi 4• Alpha Beta Thal – p a ea a 4• 463 Total samples from 2008 to June 3 2011 Institute of Human Genetics , 2011
    • Patient s Patient’s Registry• Balikatang Thalassemia• Thalassemia Center of the Philippines• PSHBT
    • National Prevention Program• Local – Balikatang Thalassemia/ pp Thalassemia Center of the Philippines - local communities NCR• R i Regional l• National at o a
    • Diagnostic Services Available• Population screening – none yet p g y• Prenatal diagnosis – none yet• Antenatal diagnosis – none yet A t t l di i t• Genetic counseling – available g• Molecular diagnostic facilities – research level only• Primary clinic level or hospital ( g y p (regional or national)
    • Diagnostic Services Available• CBC – standardization lacking• Hemoglobin electrophoresis (5) – hospital based – standardization l ki t d di ti lacking – Costly (from P3000 – 10,000)/ $71 -$238• HPLC (1) Institute of Human Genetics – cost P1 000 / $23 P1,000
    • BLOOD AND BLOOD COMPONENTS• NATIONAL POLICY ON BLOOD• NON REMUNERATED NON-REMUNERATED• REPLACEMENT• PAID DONOR (stopped since 1997)
    • BLOOD and BLOOD COMPONENTS• Philippine Blood Center (PBC) – 100% volunteer/ non-remunerated %• Philippine Red Cross (PRC) – 100% volunteer/ non-remunerated l t / t d• Hospital Blood Banks p – Volunteer/ non-remunerated 50-80% – As replacement donors 20 50% 20-50%
    • BLOOD and BLOOD COMPONENTS• Volunteer / Non- Remunerated – 44%• Replacement Donor - 45%• Both – 11% Naranjo, L. and Yuson, E., Survey of Transfusion Patterns and Practices among Thalassemia Patients in the Philippines”, Thalassemia Center of the Philippines, 2011
    • BLOOD and BLOOD COMPONENTS• NATIONAL VOLUNTEER BLOOD SERVICES PROGRAM – PHILIPPINE BLOOD CENTER (technical arm) – PHILIPPINE BLOOD COORDINATING COUNCIL (educational arm) – PHILIPPINE RED CROSS (NGO sector)
    • BLOOD and BLOOD COMPONENTS• National Blood Services Act of 1994 – To promote and encourage voluntary blood p g y donation by the citizenry and to instill public consciousness of the principle that blood p p donation is a humanitarian act – To lay down the legal principle that the provision of blood for transfusion is a professional medical service and not a sale of a commodity
    • BLOOD and BLOOD COMPONENTS- to mobilize all sectors of the community toparticipate in mechanisms for voluntary and non-profit collection of blood;- to mandate the Department of Health to establishand organize a National Blood Transfusion ServiceNetwork in order to rationalize and improve theprovision of adequate and safe supply of blood;
    • BLOOD and BLOOD COMPONENTS- to provide for adequate assistance to institutionspromoting voluntary blood donation and providingnon-profit blood services, either through a systemof reimbursement for costs from patients who canafford to pay or donations from governmental andnon-governmental entities;
    • BLOOD and BLOOD COMPONENTS- to require all blood collection units and bloodbanks/centers to operate on a non-profit basis;- to establish scientific and professional standardsfor the operation of blood collection units andblood banks/centers in the Philippines;
    • BLOOD and BLOOD COMPONENTS- to regulate ensure the safety of all activitiesrelated to the collection, storage and banking ofblood- to require upgrading of blood banks/centers toinclude preventive services an education to controlspread of blood transfusion transmissiblediseases.
    • BLOOD AND BLOOD COMPONENTS• PERCENTAGE DONATED TO THALASSEMICS – approx 2 – 5% pp• BLOOD TRANSFUSION – screening and processing fee P 1 100 00 ($ 26 19) 1,100.00 26.19)• HOW OFTEN ARE PATIENTS WITH THALASSEMIA TRANSFUSED – 3 – 12 wks
    • BLOOD AND BLOOD COMPONENTS• Pre-transfusion hemoglobin: 8.1- 9 gms (23%)• Post transfusion hemoglobin: 10 – 10.9g (33%) Naranjo, L. and Yuson, E., “ Survey of Transfusion Patterns and Practices among Thalassemia Patients in the Philippines , Philippines”, Thalassemia Center of the Philippines, 2011
    • IRON CHELATION• ALL 3 CHELATORS ARE AVAILABLE AND REGISTERED• IRON CHELATORS ARE EXPENSIVE• PURCHASED BY PERSONAL FUNDS• DFO• DEFERIPRONE O• EXJADE• DFO+ DEFERIPRONE
    • MULTIDISCIPLINARY TEAMS FORCARDIAC AND ENDOCRINE PROBLEMS• Centers with Thalassemia Units – multi- specialty clinics to handle the p y multidisciplinary approach to patients• No National Policy or Program on this yet
    • AVAILABILITY OF MRI FACILITIES• MRI available• T2* TECHNOLOGY - none T2
    • REFERENCE EXPERT CENTERS• Thalassemia Center of the Philippines ( (TCP), since 1995 ),• Balikatang Thalassemia Foundation (Ba-Tha), since 1993• Other tertiary hospitals with in-house Hematology Units / Hematologists, others gy g , established their own Thalassemia centers