title: Findings from a hepatitis B birth dose assessment in health facilities in the Philippines: opportunities to engage the private sector.
abstract: BACKGROUND
  Hepatitis B vaccination in the Philippines was introduced in 1992 to reduce the high burden of chronic hepatitis B virus (HBV) infection in the population; in 2007, a birth dose (HepB-BD) was introduced to decrease perinatal HBV transmission. Timely HepB-BD coverage, defined as doses given within 24h of birth, was 40% nationally in 2011. A first step in improving timely HepB-BD coverage is to ensure that all newborns born in health facilities are vaccinated.
  
  
  METHODS
  In order to assess ways of improving the Philippines' HepB-BD program, we evaluated knowledge, attitudes, and practices surrounding HepB-BD administration in health facilities. Teams visited selected government clinics, government hospitals, and private hospitals in regions with low reported HepB-BD coverage and interviewed immunization and maternity staff. HepB-BD coverage was calculated in each facility for a 3-month period in 2011.
  
  
  RESULTS
  Of the 142 health facilities visited, 12 (8%) did not provide HepB-BD; seven were private hospitals and five were government hospitals. Median timely HepB-BD coverage was 90% (IQR 80%-100%) among government clinics, 87% (IQR 50%-97%) among government hospitals, and 50% (IQR 0%-90%) among private hospitals (p=0.02). The private hospitals were least likely to receive supervision (53% vs. 6%-31%, p=0.0005) and to report vaccination data to the national Expanded Programme on Immunization (36% vs. 96%-100%, p<0.0001).
  
  
  CONCLUSIONS
  Private sector hospitals in the Philippines, which deliver 18% of newborns, had the lowest timely HepB-BD coverage. Multiple avenues exist to engage the private sector in hepatitis B prevention including through existing laws, newborn health initiatives, hospital accreditation processes, and raising awareness of the government's free vaccine program.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-04, Atlanta, GA, United States. Electronic address: hgo9@cdc.gov.
authors.forename: Minal K
authors.initials: MK
authors.lastname: Patel
authors.affiliation: Research Institute of Tropical Medicine, Department of Health Compound, Filinvest Corporate City, Alabang, Muntinlupa City 1781, Philippines. Electronic address: lerosecap@yahoo.com.ph.
authors.forename: Rosario Z
authors.initials: RZ
authors.lastname: Capeding
authors.affiliation: Expanded Programme on Immunization, Department of Health, San Lazaro Compound, Tayuman, Sta. Cruz, Manila, Philippines. Electronic address: juducusin@yahoo.com.
authors.forename: Joyce U
authors.initials: JU
authors.lastname: Ducusin
authors.affiliation: Expanded Programme on Immunization, World Health Organization, Office of the WHO Representative in the Philippines, Department of Health, San Lazaro Compound, Building 3 G/F, Tayuman, Sta. Cruz, Manila, Philippines. Electronic address: castroma@wpro.who.int.
authors.forename: Maricel
authors.initials: M
authors.lastname: de Quiroz Castro
authors.affiliation: Expanded Programme on Immunization, Department of Health, San Lazaro Compound, Tayuman, Sta. Cruz, Manila, Philippines. Electronic address: luzcgarcia@gmail.com.
authors.forename: Luzviminda C
authors.initials: LC
authors.lastname: Garcia
authors.affiliation: Expanded Programme on Immunization, Western Pacific Regional Office, World Health Organization, P.O. Box 2932, UN Avenue, Manila 1000, Philippines. Electronic address: hennesseyk@wpro.who.int.
authors.forename: Karen
authors.initials: K
authors.lastname: Hennessey
mesh_terms: D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007231:Infant, Newborn; D010679:Philippines; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D017325:Hepatitis B Vaccines
keywords: Birth dose; Hepatitis B vaccine; Perinatal transmission; Philippines; Private hospitals