Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

__
April 1, 2022

DEPARTMENT MEMORANDUM
No. 2022 - D4 ]

TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

DIRECTORS OF CENTERS FOR HEALTH DEVELOPMENT;
MINISTER OF HEALTH — BANGSAMORO AUTONOMOUS
REGION _IN MUSLIM MINDANAO; ALL LOCAL
GOVERNMENT UNITS: AND OTHERS CONCERNED

SUBJECT: Interim Guidelines for the Conduct of National Vaccination Days

(Chikiting Bakunation Days) for Catch-up Immunization

I. BACKGROUND

Outbreaks of vaccine preventable diseases (VPDs) are imminent. Partial 2021

epidemiologic data revealed that 218 measles cases were reported in the Philippines.
Among 218 cases, two-thirds were from the 0 - 59 months old cohort and majority
the
were either unvaccinated or had unknown vaccination status. Further, partial 2021
immunization coverage revealed that the Fully Immunized Child (FIC) coverage is
only at 45.9%. Consequently, approximately 1,100,000 zero dose children were
recorded last 2021. In this regard, prompt and appropriate public health action is
needed in order to close immunity gaps, achieve population protection, and avert the
possibility of VPD outbreaks within the COVID-19 pandemic.

Intensified actions through catch-up and community-based immunization were done

in the last quarter of 2021. However, despite these efforts, targets still remain unmet.
Generally, COVID-19 vaccination and childhood routine immunization have
common resources that are oftentimes diverted to promptly respond to the steep
targets and outputs needed in COVID-19 response. Innovations were seen in the
response by introducing National Vaccination Days or NVDs reach more people to
and have them vaccinated against COVID-19. One salient lesson from the NVDs is
the whole-of-government action as seen in the multi-agency policy and operational
guidelines set forth to both address the supply needs and gaps in demand generation.

The similar intensity of the whole-of-government and the whole-of-society actions

must be brought in the catch-up of under immunized vulnerable children for to have it
an impact on the immunization coverage. This issuance provides operational
guidelines in adapting NVDs approach for the conduct of catch-up immunization
based on Administrative Order No. 2021-0045.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http:/Awww.doh.gov.ph; e-mail: [email protected]
I. GENERAL GUIDELINES

A. As there are simultaneous efforts for COVID19 vaccination and non-COVID

vaccination, public and private sectors must work together in the provision of both
immunization services. It is emphasized that a whole-of-society and whole-of
government approach is needed in these endeavors. Private sectors and
government hospitals may offer assistance, may it be for service delivery or
demand generation, to any Centers for Health Development (CHDs), formalized
through a memorandum of agreement.

. The NVD-CI shall be implemented every last Thursday and Friday of April to
June 2022. This aims to vaccinate at least 80% of the remaining approximately
1,100,000 zero-dose infants who missed their routine immunization last 2021. At
the end of the last Chikiting Bakunation Days (CBDs), each province/highly
urbanized city/independent component city should have covered at least 80% of
the defaulters for each antigen. For the month of April, provinces, highly
urbanized cities, independent component cities with more than ten thousand
missed children shall be prioritized for the implementation of CBD (Annex A).

COVID-19 immunization and other program activities shall be temporarily

suspended during NVD-CI to give way for the implementation of catch-up
immunization and other related activities. All local government units and
healthcare facilities are enjoined to focus efforts and resources to augment service
delivery and promote catch-up immunization activities.

. All infants ages 0 - 23 months old who missed a dose, doses or_a series of
vaccines are eligible targets for CBD. These shall be identified from the defaulter
list of the Rural Health Units (RHUs)/Barangay Health Stations (BHS)/Health
facilities (HFs) after review of the Target Client List and/or masterlisting in all
barangays. Priority, however, is to intensify efforts to complete all primary
immunization series by the time the child reaches 12 months of age to qualify as
FIC.

All catch-up vaccines identified as per Administrative Order 2021-0045:

“Guidelines on the Conduct of Catch-up Immunization of Routine Immunization
for Children” shall be utilized during the Chikiting Bakunation Days.

All local government units and healthcare facilities shall ensure that all catch-up
vaccines that may be given to the child shall be administered upon first contact
with the succeeding doses, if applicable, given at least four (4) weeks interval in
between doses. This is to avoid missed opportunities for infants to get vaccinated.

. Minimum public health standards (MPHS) shall be observed

the conduct of CBD.
at all times during
 H. Reporting and recording shall be done through the appropriate information system
or the Target Client List (TCL) immediately or within one (1) week after each
monthly CBD.

I. SPECIFIC GUIDELINES

A. National Vaccination Day for Catch-up Immunization Targets

. The target for the CBD shall be provided by the DOH through the CHDs for
each province, city and municipality. The target will be to vaccinate at least
80% of the infants ages 0-23 months who missed their routine
immunization schedule (eg. 80% of the defaulter for measles, pentavalent
vaccine and the rest of the other antigens shall be vaccinated across the LGUs
of NCR). The 80% number of targets shall be divided among the 6 vaccination
days for catch-up immunization.

The daily target for other vaccination sites such as hospitals and private clinics
shall be set by the CHDs in coordination with the LGUs ensuring that the
targets will be equally distributed among the health facilities and other
vaccination sites.

The Disease Prevention Control Bureau (DPCB), through the National

Immunization Program (NIP) and CHDs, shall provide technical assistance to
the Local Government Units (LGUs) in their preparation for the CBD. CHDs
shall ensure that LGUs have conducted microplanning and will have the
necessary augmentation of resources which can come from private sectors,
societies, organizations and communities.

B. Allocation and Distribution of Vaccines

1. The DPCB, Supply Chain and Management Service (SCMS) and the Research
Institute for Tropical Medicine (RITM) shall ensure availability and
uninterrupted supply of vaccines and ancillaries through proper allocation and
distribution to each region according to their targets and capacities for storage.

The CHDs, through the P/CHOs, shall subsequently allocate and distribute
catch-up immunization vaccines to the LGUs based on their targets and
capacities for storage.

. The LGUs, in coordination with CHDs, may engage with other public or
private health facilities and primary care providers to provide catch-up
immunization services. LGUs may also allocate and distribute catch-up
immunization vaccines to alternative vaccination sites such as hospitals and
 clinics which shall be delivered 1 week before or depending on the
arrangement between LGUs and hospitals/clinics.

. The CHDs and LGUs shall provide vaccine forecasting to ensure the
availability of vaccine and ancillaries needed for the 2 NVD-CI each month
from April to June.

C. Social Mobilization, Advocacy and Communication

. All means of informing the community on the specific schedules and specific
sites of the vaccination campaign in each barangay shall be widely utilized and
disseminated. Communication channels and platforms shall include, but are
not limited to the following: TV ads and radio station announcements; national
and local newspaper ads; social media posts; community awareness raising
such as bandillo or ricorrida; holding of limited community assemblies with
physical distancing; by word-of-mouth, giving out flyers and use of posters in
conspicuous places in the community.

. Developed campaign plans and communication materials must ensure

distinction between the “National Vaccination Days” for COVID-19 and the
CBD to avoid miscommunication leading to the confusion of the primary
target audiences, stakeholders, and the community in general.

. The Health Promotion Bureau (HPB) and the Communication Office (COM)
shall organize briefing and advocacy meetings with different stakeholders such
as medical societies and civil society organizations and seek support both in
service delivery and in demand generation.

. Crisis communication plans must be prepared by the COM that include risk
communication strategies addressing concerns of the parents on the safety of
the vaccine, AEFI management and safety of the conduct of the campaign
during COVID-19 pandemic.

. Health Education and Promotion Officers (HEPOs) shall conduct advocacy

meetings with barangay leaders and inform them of the dates and location of
the campaign, target children and support needed from them; and

Social mobilizers shall visit the community ahead of time to ensure that every
household is informed of this campaign, the actual date and site of the
vaccination.
at
D. Vaccination Day Preparation and Process

two
1. Pre-CBD Preparations

a. A defaulter list shall be prepared before by the

RHUs/BHS/Health Facilities from the
Target Client List (TCL)
considering the targets set by the CHDs for them.

The RHUs/BHS/Health Facilities shall disseminate this defaulter list to

vaccination teams and other vaccination sites (eg. hospitals and clinics) a

least
week before the CBD.

LGUs may encourage the following as volunteers for the CBD:

weeks
The following health professionals shall be allowed to volunteer and
serve as vaccinators, provided that they undergo recommended training:
1. Medical doctors
2. Nurses
w Midwives

wae
Fourth-year nursing students
Postgraduate/undergraduate interns and clinical clerks (with
supervision)

il. All other allied health degree professionals including undergraduates as

health educators and social mobilizers; and

iii. Others as data encoders and consolidators

Volunteers shall enjoin government vaccination teams participating in the

NVD for general orientation and deployment arrangements before the start
of the campaign.

To remind the general public, especially parents or guardians with infants,

of the intensified efforts for catch-up immunization during the NVD-CI,
LGUs shall widely disseminate the availability of vaccines for infants ages
0-23 months of age through various media platforms and information
systems. These disseminated materials shall clearly state who, when, what,
where and why their children shall be vaccinated against these diseases.

2. Vaccination Site: Registration, Screening, Health Education and

Vaccination

a. The LGU shall check the following requirements (if applicable) at the
registration area:
 e Previous vaccination card of infants
e Proof of parents/guardians’ leave from work that needs to be
countersigned

b. Health Screening, health education, vaccination process and AEFI

monitoring protocols shall follow the Manual of Procedures (MOP) of the
National Immunization Program.

c. All strategies may be employed to ensure that all children will be reached.
The strategy will depend on the identified best practice strategy by the
LGUs. This may include but are not limited to:
e Fixed posts (eg. health centers, clinics and hospitals)
e Modified fixed posts
e House-to-house/Suyod Strategy

d. Catch-up immunization services may be integrated and packaged with

other health services targeted for the same age group especially among
far-flung and hard-to-reach areas.

e. As per AO 2021-0045: “Guidelines on the Conduct of Catch-up

Immunization of Routine Immunization for Children,” vaccines to be
vaccinated to defaulter children shall follow the catch-up algorithm.
However, to simplify operations, LGUs may refer to Annex B where
infants are classified to 4 types of defaulters and depending on their age at
visit during the NVD, this is the set of vaccines they should receive.

3. Logistics and Cold Chain Management

a. A vaccinator team supervisor shall be identified per RHU/BHS/HFs.

He/She shall ensure that vaccine and vaccine ancillaries which include but
are not limited to: refrigerators, vaccine carriers, vaccines, diluents,
syringes, needles and safety collector boxes are available, conditioned and
monitored.

b. The vaccinator team supervisor shall monitor and record the temperature
in the vaccine refrigerator and carrier.

c. The vaccination team supervisor shall test all electrical equipment to avoid
vaccine quality reduction.

E. Data Reporting

a. Each RHU/BHS/HF shall have a data encoder assigned to their area for the
CBD.
 b. All vaccination sites shall record officially the vaccination event and the
accomplishments to the appropriate information system or the TCL set by
the Field Health Services Information System (FHSIS) through their
connected RHU/BHS/HF. This shall be done immediately or a week after
the CBD phase.

On the submission of aggregated data, the RHU/BHS/HF assigned data

encoders shall update the CHDs in order to update the Google Sheet with
this link: https://tinyurl.com/Catch-Up2022 at the end of each CBD.

CHDs, PHOs and vaccination team supervisors shall ensure that the
aggregated data are submitted in the Google Sheet provided.

F. Monitoring and Supervision

a. Vaccination team supervisors shall ensure that for each phase of the CBD,
there are adequate resources available which includes Human Resources
for Health (HRH), vaccine logistics, ancillaries and other commodities.
They shall also ensure that submission of data be done by the data
encoders at the RHU/BHS/HF.

b, Analysis of data coverage for the CBD shall be done on a monthly basis by
the CHDs and the DPCB through the NIP. Feedback or assistance for the
identified low-performing areas for the CBD shall be done immediately.

G. Surveillance and Reporting of Adverse Events Following Immunization

(AEFD

a. All detected AEFIs, may it be classified as minor or major, shall be

reported to the nearest health facility. For this purpose, the existing AO
2016-0006 entitled, ‘Revised Guidelines and Response to Adverse Events
Following Immunization’ shall be followed.

Following AO 2016-0025: entitled ‘Guidelines on the Referral System for

Adverse Events,’ AEFI cases needing intensive care and hospitalization
shall be managed and referred to the appropriate health facility.

IV. ROLES AND RESPONSIBILITIES

A. Disease Prevention and Control Bureau (DPCB)

a. Develop the policy for the operationalization of the CBD and ensure
dissemination and implementation of these guidelines;
 Provide technical assistance and capacity building to the CHDs, MOH
BARMM, and other stakeholders on routine and catch-up immunization
services in collaboration with professional and civil society organizations;
Facilitate procurement, forecasting, and monitoring of vaccines, ancillaries
and other commodities needed for the CBD to ensure that LGUs have
continuous supply;
Monitor and evaluate the implementation of CBD in coordination with the
CHDs;
Integrate the CBD with other programs of the bureau;
Coordinate with the Health Promotion Bureau and Communication Office in
planning health promotion and advocacy activities for the conduct of the
CBD; and
Establish an efficient system of operation coordination between the national
and local NIP during the pre-, intra-, and post-implementation of the CBD.

B. Health Promotion Bureau (HPB)

a. Continuously develop health promotion and communication plans that are
responsive to the current needs of the clients and the program especially on
importance of completing basic immunization and its different components,
Cascade CBD promotional and campaign materials to the regional
counterparts for widest dissemination;
Conduct awareness building and promotion of CBD and catch-up
immunization services;
Evaluate effectiveness of health promotion and communication strategies in
promoting CBD and catch-up immunization services to guide evidence-based
research and policy making; and
Conduct of capacity building of health promotion officers at the regional level
on the conduct of promoting awareness and acceptance of CBD and catch-up
immunization activities.

C. Communication Office (COM)

a. Develop crisis management and communication plans tailored to the CBD.
b. Ensure strengthened media relations;
Cc,Revitalize partnerships from different sectors that supported the previous
campaigns of NIP; and
Engage with various stakeholders, advocate for CBD and seek formalized
partnerships with them.

D. Field Implementation and Coordination Team (FICT)

a. Oversee and coordinate the dissemination and implementation of the CBD
operational guidelines with LGUs, the private sector, civil society
organizations, and other government agencies regarding the catch-up
immunization; and
Assist in communications from LGUs, the private sectors, civil societies and
organizations and other government agencies to the Department of Health
Central Office.
E. Procurement and Supply Chain Management Team
a. Oversee and implement the procurement and distribution of vaccines and other
logistics;
b. Manages records, documents and communications with regard to the
procurement of vaccines and ancillaries; and
Coordinate with the DPCB and other offices concerned in the procurement
and logistics of vaccine supply.

F. Centers for Health Development and Ministry of Health - Bangsamoro

Autonomous Region in Muslim Mindanao
a. Conduct orientation and planning meeting for concerned stakeholders
regarding the policy and advocate for its adoption and implementation;
b. Provide technical assistance and capacity building to LGUs and other partners
on the catch-up immunization services;
Harmonize other partners to solicit support for immunization program;
Ensure intensification of health promotions regarding catch-up immunization
services together with routine immunization services within their area of
influence;
Conduct analysis of data from Local Government Units and submit timely
reports using the FHSIS reporting tool;
Evaluate and monitor the implementation of the policy by both public and
private sectors in their respective regions; and
Conduct random data quality checks on submitted reports by the LGUs.
Formalize formed partnerships between CHDs and professional institutions,
private sector and other supporting stakeholders through a memorandum of
agreement.

Local Government Units

a. Conduct of catch-up immunization services within their area of influence in
accordance to the guidelines set by DOH;
b. Ensure the supply of vaccines in their areas of jurisdiction by continuously
monitoring vaccines supply, utilizing the current stocks their area have and
requesting stock from the next higher level;
Allocate vaccine supplies and commodities to other partner stakeholders that
will provide immunization services during the CBD based on predetermined
targets for each respective immunization service partners.
Provide localized support or counterpart (i.e. resources, collaterals, others) for
the implementation of the policy;
Develop strategies for conduct of catch-up immunization specific to their area
of jurisdiction;
Conduct regular consultation and implementation reviews among respective
LGU personnel, immunization stakeholders, and other organizational partners
to improve service delivery efficiency and address implementation
issues/gaps; and
Submit timely reports to the DOH for monitoring and tracking of progress of
implementation.
 H. Professional medical and allied medical associations, academic institutions,
non-government organizations, development partners and the
private sector
a. Support the implementation of the catch-up immunization guidelines and
disseminate it to the areas of their influence;
b. Encourage volunteerism within their institutions to participate NVDs as
volunteer vaccinators, members of the vaccination team or advocates for
awareness-raising and social mobilization activities; and
c. Explore additional support to be provided such as technical assistance,
funding, human resources, logistics, and social mobilization.

Vv. EFFECTIVITY

This Department Memorandum shall take effect immediately.

By authority of the Secretary of Health:

Digitally signed by
Vergeire Maria Rosario
Singh
Date: 2022.04.13 11:12:13
08'00'
MARIA ROSARIO NGH-VERGEIRE, MD, MPH, CESO II
Undersecretary of Health
Annex A. Priority Provinces, Highly Urbanized Cities and Independent Component
Cities for the Implementation of Chikiting Bakunation Days for the Month of April

. Cavite
PWN
. Laguna
. Batangas
. Rizal
A
. Bulacan
. Cebu
OMAN
. Negros Occidental
. Camarines Sur
. Tloilo

10. North Cotabato

11. Pangasinan
12. South Cotabato
13. Quezon
14.Palawan
15. Nueva Ecija
16. Zamboanga del Sur
17. Davao del Sur
18. Negros Oriental
19. City of Manila
20. Leyte
21. Masbate
22. Cagayan
23. Oriental Mindoro
24. Pampanga
25. Bohol
26. Quezon City
27. Caloocan
28. Isabela
29. Albay
30. Sorsogon
31. Bukidnon
32. Zambales
33. Northern Samar
34. Misamis Oriental
35. Occidental Mindoro
36. Samar (Western Samar)
 Annex B

Table 1. Guide to Defaulter Vaccines

1st visit > 6 wks u > 10 wks > 14 wks to
less than 9
9 mos up
to less than
12 mos up
to 23 mos
NOTE
to 10 wks up to 14
wks mos 12 mos

Defaulter A: OPV, OPV, OPV, MCVI, MCV2 Ensure at

PENTA, PENTA, PENTA, PCV IPV2 least 4
PCV

dose)
(ist PCV
(2nd dose)
(3rd dose)
and IPV1
weeks
interval in
between
Defaulter B: OPV, OPV, OPV, MCV (2nd doses;
PENTA, PENTA, PCV PENTA, dose) If 9 mos,
PCV
(lst
dose)
(2nd dose)
and IPV (Ist
PCV (3rd
dose)
©

give MCV1

dose) IPV (2nd

dose) and Check
MCV

dose)
(ist immunizati
on history,
if given
Defaulter C OPV, PENTA OPV, prior doses,
PENTA, PCV PENTA, proceed
PCV (2nd with the
(1st dose) PCV (3rd
dose): next dose in
dose)
?

Mione
(ist
IPV and
MCV (2nd
the series.
dose)
dose)

Defaulter D OPV,
PENTA,
PCV,
MCV1 and
IPV1 (1st
dose)
Annex. Citations

Department of Health. (2021). Guidelines on the Conduct of Catch-up for Routine

Immunization for Children. Manila: DOH

Department of Health & World Health Organization. (n.d.). Manual of Operations National
Immunization Program. Manila: DOH

Department of Health. (2018). Field Health Services Information System (version 2018).
Manila: DOH

Department of Health. (2016). Revised Guidelines and Response to Adverse Events

Following Immunization. Manila: DOH

Department of Health. (2016). Guidelines on the Referral System for Adverse Events.
Manila: DOH