Situated in Southeastern Asia between the Philippine Sea and the South China Sea, the Federal Republic of the Philippines is a group of more than 7,100 islands that comprise and area slightly larger than Arizona. Home to 104.2 million people, the Filipino population is concentrated where good farmlands lie, including in northwest and south-central Luzon, the southeastern extension of Luzon, and the islands of the Visayan Sea, particularly Cebu and Negros. Manila is home to one-eighth of the entire national population.
The Philippines is one of the countries along the Ring of Fire, a belt of active volcanoes and earthquake epicenters bordering the Pacific Ocean where up to 90 percent of the world’s earthquakes and 75 percent of the world’s volcanic erruptions occur; it also sits astride the Pacific typhoon belt. Consequently, natural disasters pose a significant public health threat.
With a GDP of $383 billion USD (2020), the Philippines is primarily considered a newly industrialized country, which has an economy in transition from one based on agriculture to one based more on services and manufacturing.
As of 2015, maternal mortality was estimated at 114 deaths per 100,000 live births and the infant mortality rate was 21.4 deaths per 1,000 live births. The country reports a low adult HIV prevalence rate, with and estimated 68,000 people living with HIV as of 2018 and fewer than 1,000 deaths. The risk of food and water-borne infectious diseases is high, particularly for bacterial diarrhea, hepatitis A, and typhoid fever, while major vector-borne diseases include malaria and dengue fever. The water contact disease leptospirosis is also a concern.
Recent reports from the UN and WHO estimated that close to one in three people in the Philippines will die before the age of 70 from a noncommunicable disease such as cardiovascular diseases, stroke, diabetes, cancers, or chronic respiratory diseases.
In 2020, AIHA began assisting the CDC at the global and country level in the Philippines under the CDC1950 grant, as described below. AIHA previously supported USAID’s HRH2030 program in the Philippines as a member of a broad-based consortium led by Chemonics International.
Targeted Programmatic Support Across Countries (CDC1950)
(2020 – Present)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant, providing a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. So far, this project has operated in 10 countries including Thailand, Laos, Kenya, Tanzania, Nigeria, Zambia, the Dominican Republic, Haiti and Guatemala, as well as the Philippines.
In Southeast Asia, AIHA started project implementation in the Philippines in 2021. In 2022/3, the Philippines has been the focus of AIHA’s activities under CDC1950.
The Philippines has the fastest growing HIV epidemic in the Southeast Asia/Pacific region, with a sevenfold increase in newly diagnosed cases from 2010 to 2018 with HIV/AIDS transmission the highest and most rapidly growing among Key Populations (KP). In the Philippines, initiating testing, especially among KP, has lagged other countries, and thus achievement of the 95-95-95 goals has been elusive in that country.
Key to overcoming this is to build capacity of and partner with Filipino HIV/AIDS and KP-led Civil Society Organizations (CSOs) and to deploy improved techniques to enhance targeted case finding such as community-based index testing, self-testing, and social network strategies with linkage to treatment. Stigma and discrimination also play an important role and AIHA is working with KP and CSO-led organizations along with other stakeholders to combat that. And finally, AIHA is helping to enhance the technical and organizational skills of CSOs and KP groups in order to be more effective at their work. AIHA is working in two of the most challenging regions of the Philippines to implement its activities: region 6 (Western Visayas) and Region 7 (Central Visayas).
In the first year of the project, AIHA focused our efforts on Organizational Capacity Assessments (OCA) of relevant HIV/AIDS and/or KP-led CSOs in the Philippines. That led to the development and deployment of OCA-based Training and Mentorship programs for HIV and KP-led CSOs in the country.
In the second year of the project, AIHA reviewed existing systems with the goal to improve case finding at the community level, linking to care and initiation of treatment in Regions 6 and 7. To better understand current barriers and perspectives from community and Key Populations’ points of view, in September 2022, AIHA organized a series of consultations facilitated by the CDC team including:
- Social Networks Strategy Consultation
- Community Engagement Consultation
- Listening Session with Men having Sex with Men (MSM) in Iloilo
- Listening Session with People Who Inject Drugs (PWID) in Cebu
- Listening Session with Transgender Women in Cebu
AIHA also assessed the skills and competencies of Peer Navigators and Community-Based Screening Motivators from CSOs with whom AIHA collaborated to determine the gaps and to develop targeted training and mentorship interventions.
In the third and current year of the project, in close collaboration with CDC and DOH, AIHA is working on the following strategic priorities:
- Enhancing targeted case finding
- Ramping up of rapid HIV diagnostics algorithm
- PreP demand-creation and scale-up
- Enhancing KP competencies
AIHA supports community-based index testing and self-testing with local CSOs in regions 6 and 7, peer navigation for linkage to care from CSO community-based testing sites, and community messaging for U=U and stigma reduction. AIHA identified 10 CSOs and KP-led or KP-competent CSOs from Region 6 and 7 with whom to partner on HIV case finding and linkage to care.
Region 6 (Western Visayas):
- FPOP Iloilo (Iloilo City)
- Capiz Shells (Roxas City)
- Aklan Butterfly Brigade (Kalibo, Aklan)
- Antique Red Sea Horse (Antique)
- Boracay Red Lace (Boracay Island)
- Kabankalan (Kabankalan City)
- Cadiz (Cadiz City)
Region 7 (Central Visayas):
- LoveYourself Whitehouse
All activities implemented by the AIHA and our partners in both regions are coordinated with and supported by the Department of Health and Provincial Health Offices in both regions.
Meeting with DOH team (AIHA, LoveYouself, CDC)
Meeting with the Provincial Health Office and CSO Capiz Shells in Roxas City, Region 6
Outreach activities at the community level are provided by all 10 CSOs and include brief HIV101 training, Questions and Answers sessions and HIV testing.
Pictures below are from one of the community outreach activities conducted by the IDUCARE in Region 7.
Outreach activities in Region 6 conducted by Capiz Shells in Roxas City:
HIV testing is an essential gateway to HIV prevention, treatment, care and support services, in order to reach 95-95-95 targets among All People Living with HIV in PEPFAR-Supported countries by 2025. However, traditional HIV testing may not be enough to reach this goal. Social network testing is a strategic case finding method that has been proven to increase HIV testing yield. The CDC team recently conducted a set of trainings aimed at increasing the capacity of CSOs to fully execute and manage the social network strategy (SNS) to increase HIV case identification and linkage to PrEP, HIV treatment and care among key populations and those at elevated risk for HIV. This training equipped healthcare workers and CSOs to implement social network testing with fidelity to maximize limited resources and identify new cases of HIV infection. AIHA launched SNS in April 2023 in both regions.
In March 2023, AIHA conducted a survey at several project sites to understand key priority issues for the KPs in terms of safety and security, stigma and discrimination, community engagement and the quality of services. A total of 50 respondents answered the survey. 41 of them are members of KP and are PLHIV, while the remaining are clients who are accessing the facility for other HIV related services (testing, and PrEP).
About 46% of KPs and clients cited having experienced safety and security incidents because of their HIV-status. This included sexual assault (including rape) and verbal abuse and intimidation, both on-line and at their home. Furthermore, KPs and clients reported that this discourages them from seeking HIV related services (testing, treatment, counseling, etc.). That in turn will increase the risk for HIV infection, and, for some, long term complications associated with HIV such as opportunistic infections and the development of deleterious mental health problems (e.g., anxiety).
In response, KPs and clients recommended steps on how to better address safety and security issues such as: advocating to decision makers about the impact of safety and security challenges and the changes needed; sensitizing key stakeholders; providing legal assistance; establishing a system (i.e. databases) to document safety and security incidents and trauma; and counseling/psychiatric debriefing.
At least 74% of the KPs reported having experienced HIV-related stigma. Most commonly cited was people becoming fearful of them (because of their HIV status) and persistent anxiety that people will be gossiping about their HIV status. On the other hand, the prevalence of HIV-related discrimination is lower (32%) among KPs. Most common forms of discrimination experienced by KPs were: people avoided physical contact with them; being refused admission to a healthcare facility/school; and being deprived employment opportunities.
They shared recommendations on how HIV-related stigma and discrimination can be reduced, including: talking openly about HIV to normalize the subject; providing HIV-related legal services; legal literacy (“know your rights”); educating/sensitizing law makers and law enforcement officials; and strengthening the ongoing media campaign against HIV-related stigma and discrimination.
85% of KPs and clients still believe that the creation of a Community Advisory Board (CAB) will be instrumental in putting forward the needs of people affected by HIV/AIDS.
Ultimately, KPs and clients were asked for their suggestions on how they think the delivery of HIV-related services can be improved. They provided recommendations that will be shared with stakeholders and implemented.
In 2023, AIHA, in collaboration with its partners, will focus on delivering Community Based Screening and Testing with the goal to help HIV- positive to know their status, initiate treatment and improve quality of life, and reduce stigma and discrimination.
Advancing Human Resources for Health in Philippines through eLearning
(2018 – 2020)
As in many other countries, the Philippine health system faces challenges in the development and distribution of health workers. Ten percent of the country’s human resources for health (HRH) serve geographically isolated and disadvantaged rural areas, leaving some islands and barangays without adequately prepared medical professionals. HRH shortages limit the quality and availability of care, resulting in disparities in health outcomes.
USAID’s HRH2030 program began partnering with the Philippines Department of Health in 2018 to strengthen the deployment, training, and management of the health workforce to improve access to and quality of tuberculosis, family planning, and maternal and child health services in the Philippines. Key objectives were to:
- Improve the skill mix, competency, and distribution of the health workforce at the primary level
- Strengthen human resources for health leadership, governance, and performance management
- Advance the use of data for human resources for health decision-making at central and regional levels
In keeping with these objectives, AIHA developed The Health Academy available via e-Learning portal for the Department of Health in the Philippines.. USAID considers the portal we developed and training we provided as one of best practices for utilization of e-Learning on a national level for user-friendly continuous professional education courses to strengthen the knowledge and skills of the country’s health workforce, specifically physicians, nurses, midwives, and medical technologists. Targeted learning focus areas were tuberculosis, family planning, and maternal and child health.
AIHA designed the platform and materials to be a publicly available resource for more than 100,000 people. The DOH e-Learning Academy is delivered on the Moodle open-source platform. Content for one-hour content modules continue to be prepared by local experts. This ensures all training is of high quality, evidence-based and consistent with local procedures. AIHA tested and disseminated these modules in mobile smart phones, laptops, tablets, or desktop devices. The modules are accessible for instruction completely off-line by downloading with Wi-Fi onto any device. The offline version can be delivered in small groups of trainees in face-to-face training or can be completed by an individual.
Since its launch in October 2019, the e-learning portal now serves as a platform for additional coursework, including courses developed in 2020 to address COVID-19 related issues. 4 out of the 18 DOH Academy courses were developed with HRH2030, running from October 2019-January 2021, with more than 5,000 participants in a single course since its launch.
To learn more about this project, including project accomplishments, please read:
- Three Questions with Roxanne Zaghab: Innovating for Improved Health Worker Training
- Elated About e-Learning: A Critical Tool for Advancing UHC
- Introducing Online Training for Health Workers in the Philippines