Julie Mart C. Rubite, MD, FPAFP, MMHA Program Manager National Leprosy Control Program Department of Health OUTLINE I. Background II. The Philippine Data III. Challenges of National Leprosy Control Program (NLCP) Implementation • 109,947,900 • (Projected Population for 2020 by PSA)

17 Regions

81 Provinces

146 Cities

1998 “Leprosy was eliminated as public health problem”

National Leprosy Control Program “Accelerating towards a leprosy-free world” NLCP Strategic Activities 1. Case Detection 2. Case Holding 3. Community Awareness Campaign 4. Drug Provision 5. Data Management 6. Drug Supply Management 7. Capacity Building/Training 8. Strengthening Referral 9. Monitoring Supervision Visit 10. Evaluation (Program Review) 11. Building and Sustaining Partnerships 12. Research The Philippine Data 2005-2019 PREVALENCE RATE AND CASE DETECTION RATE(PR: <1/10000; CDR: <1/100000)

0.5 4

0.45 3.5 0.4 3 0.35 0.3 2.5 0.25 2 0.2

Prevalence Rate 1.5 0.15 CaseDetectionRate 1 0.1 0.05 0.5 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 PR 0.36 0.43 0.25 0.36 0.29 0.3 0.28 0.25 0.3 0.4 0.25 0.41 0.39 0.43 0.31 CDR 3.66 2.88 2.83 2.62 1.95 2.18 1.91 2.22 1.75 1.65 1.6 1.66 1.81 2.03 1.92 PR CDR As of 2019 - there were 2,023 new cases both for MB and PB cases

- There were 37 adults with GD2 disabilities

CURRENT STATISTICS ON LEPROSY DISEASE MB AND PB NEW CASES 2008- 2019 2012-2019 NEW CASES AMONG CHILDREN (BELOW 15 YEARS OLD)

160 148 147 140 131 126 128 117 120 99 100 89 80

60

40

20

0 2012 2013 2014 2015 2016 2017 2018 2019 2019 National Leprosy Control Cities Prevalence Rate Program Batac City, , Region 1 2.28 Provinces and Cities with highest City, Region 12 2.24 Prevalence Rate (PR= >1/10,000) Urdaneta City, , Region 1 1.16 , Region 3 1.08 City, BARMM 1.56 Provinces Prevalence Rate

Sultan Kudarat, Region 12 1.35

Ormoc City, Leyte, Region 8 1.22 *** All regions reached the targeted PR which is <1/10,000 population Zamboanga Sibugay, Region 9 1.06 National Leprosy Control Program

Philippines 1. PRESENCE OF BARRIERS ALONG THE PATIENT’S PATHWAY

Delay in Health Lack of understanding seeking and support from the communities

Stigma Lack of community engagement 2. ACTIVE CASE FINDING AND CONTACT TRACING NOT A PRIORITY

Undiagnosed Family contacts Social contacts Should be 100% presumptive of contacts leprosy case Will be diagnose ONSET About 5 to 15 years 3. LOGISTICS

• Drug stock-out reported at some facilities • Delayed delivery of the MDTs and other supportive drugs to the districts/provinces 4. DATA MANAGEMENT ▪ Online infomation system (eg. ILIS) is available but not fully utilized ▪ Offline version of ILIS is not yet functional ▪ Paper based reporting is also used ▪ Difficult to track patients that change location or address ▪ Lack of data encoder / multitasking personnel 5. CAPACITY BUILDING/TRAINING ▪ Rapid turn over of health care workers in the facility ▪ Some new regional program managers including new health personnel need training ▪ Some Leprosy experts already retired 6. RESEARCH ▪ Limited number of research projects ▪ Only one non-government facility conducts anti-microbial resistance study ▪ Fundings are limited REMAINING CHALLENGES OF THE NLCP IMPLEMENTATION

• Zero Disease • Zero transmission of leprosy infection • Zero disability due to leprosy 1. Interim Guidelines on National Policy Development Activity Leprosy Control Program during COVID-19 (Signed, posted and disseminated to Regions, Provinces, Cities and Municipalities) 2. Updated Guidelines on the Treatment and Prevention of Leprosy (Adapting 2018 WHO Guidelines) 3. Guidelines on the Institutionalization of the Leprosy Alert and Response Network System (LEARNS) of the National Leprosy Control Program 4. Development of Leprosy Clinical Practice Guidelines (CPG)