Republic of the Philippines Department of Health Philippines COVID-19 Emergency Response Project (P173877) and Additional Financing Project (P175953) STAKEHOLDER ENGAGEMENT PLAN (SEP) 17 MARCH 2021 1 Contents 1. Introduction/Project Description .................................................................................................... 4 2. Stakeholder identification and analysis .......................................................................................... 8 2.1 Methodology ................................................................................................................................. 9 2.2. Affected parties ...................................................................................................................... 10 2.4. Disadvantaged / vulnerable individuals or groups................................................................. 17 3. Stakeholder Engagement Program ............................................................................................... 18 3.1. Summary of stakeholder engagement done during project preparation .............................. 18 3.2. Summary of project stakeholder needs and methods, tools, and techniques for stakeholder engagement .................................................................................................................................. 26 3.3. Proposed strategy for information disclosure ....................................................................... 28 Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines (NDVP) ................... 30 3.4. Stakeholder Engagement Plan – Project Implementation ..................................................... 31 3.5. Proposed strategy to incorporate the view of vulnerable groups ......................................... 33 4. Future of the project ......................................................................................................................... 34 5. Resources and Responsibilities for implementing stakeholder engagement activities ............... 34 5.1. Resources ............................................................................................................................... 34 5.2. Management functions and responsibilities .......................................................................... 34 6. Grievance Mechanism ................................................................................................................... 43 6.1. Description of GRM ................................................................................................................ 43 7. Monitoring and Reporting............................................................................................................. 50 7.1. Involvement of stakeholders in monitoring activities ........................................................... 50 7.2. Monitoring indicators............................................................................................................. 50 7.3 Monitoring of Adverse Events Following Immunization (AEFI) ............................................ 53 7.4. Reporting back to stakeholder groups ................................................................................... 58 Annex A. Results and summary of key feedback in the National Stakeholders Consultation on the Parent Project conducted on August 18-19, 2020 ................................................................................ 59 Annex B. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment on December 7, 2020 ......................................................................... 67 Annex C. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment on January 8, 2021 ............................................................................. 69 Annex D. Results and summary of key feedback of the Consultation with Persons with Disabilities on the PCERP held last 5 October 2020 ..................................................................................................... 77 Annex E. Results and summary of key feedback of the Consultation with Gender- Based Groups on the PCERP held last 30 October 2020 ......................................................................................................... 78 Annex F. Results and summary of key feedback of the Consultation with Indigenous Peoples on the PCERP held last 23 February 2021 ........................................................................................................ 81 Annex G. Results and summary of key feedback of the Community Consultation on the Retrofitting and Refurbishing of the Research Institute for Tropical Medicine (RITM) held on 27 October 2020 .. 83 2 Annex H. Results and summary of key feedback Retrofitting of the Isolation Rooms of Fourteen (14) Hospitals in the National Capital Region (NCR) held on 28 October 2020 ........................................... 84 Annex I. Results and summary of key feedback Building Completion of the Quirino Memorial Medical Center (QMMC) held on 9 February 2021 ............................................................................................ 84 Annex J. Results and summary of key feedback of the Townhall Consultation with Indigenous Peoples conducted by the DOH HPB last 16 March 2021 .................................................................................. 85 Annex K. Grievance resolution process of grievances within the jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinarv Complaints in the Department of Health .......................................................................... 89 Annex L. Grievance Resolution Process for DOLE- Related Cases ........................................................ 95 Annex M. Grievance Monitoring Forms and Online Dashboard ........................................................... 96 3 1. Introduction/Project Description An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV- 2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. As of March 26, 2020, the outbreak has resulted in an estimated 416,686 cases and 18,589 deaths in 197 countries and territories. COVID-19 is one of several emerging infectious diseases (EID) outbreaks in recent decades that have emerged from animals in contact with humans, resulting in major outbreaks with significant public health and economic impacts. The last moderately severe influenza pandemics were in 1957 and 1968; each killed more than a million people around the world. Although countries are now far more prepared than in the past, the world is also far more interconnected, and many more people today have behavior risk factors such as tobacco use and pre-existing chronic health problems that make viral respiratory infections particularly dangerous. With COVID-19, scientists are still trying to understand the full picture of the disease symptoms and severity. Reported symptoms in patients have varied from mild to severe, and can include fever, cough, and shortness of breath. In general, studies of hospitalized patients have found that about 83% to 98% of patients develop a fever, 76% to 82% develop a dry cough and 11% to 44% develop fatigue or muscle aches. Other symptoms, including headache, sore throat, abdominal pain, and diarrhea, have been reported, but are less common. While 3.7% of the people worldwide confirmed as having been infected have died, WHO has been careful not to describe that as a mortality rate or death rate. This is because in an unfolding epidemic it can be misleading to look simply at the estimate of deaths divided by cases so far. Hence, given that the actual prevalence of COVID-19 infection remains unknown in most countries, it poses unparalleled challenges with respect to global containment and mitigation. These issues reinforce the need to strengthen the response to COVID-19 across all IDA/IBRD countries to minimize the global risk and impact posed by this disease. The Philippines COVID-19 Emergency Response Project (P173877), in the amount of US$100 million, was approved by the World Bank on April 22, 2020. It was prepared under the global framework of the World Bank COVID-19 Response financed under the Fast Track COVID-19 Facility, which provided up to US$14 billion in immediate support to assist countries coping with the impact of the global outbreak. The objectives are aligned with the results chain of the Bank’s COVID-19 Strategic Preparedness and Response Program (SPRP). The Project Development Objective (PDO) is to strengthen the Philippines’ capacity to prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Despite recent progress, the Philippines remains one of the countries most affected by the COVID-19 in East Asia and Pacific, rendering vaccine purchase and deployment a national priority. With the availability of vaccines, the Philippines has now an opportunity to add a significant new layer to its COVID-19 emergency response. Procuring and administering vaccines is critical to reducing mortality from COVID, opening the economy in earnest and arresting the decline in GDP, employment and incomes. Hence, Additional Financing (AF) was sought by the country. The Additional Financing will form part of an expanded health sector response to the COVID-19 pandemic. The AF which is the amount of additional US $ 500 million will support the costs of expanding activities of the Philippines COVID-19 Emergency Response Project (P173877, the Parent Project) to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in the country through enhanced vaccination system strengthening and to further strengthen preparedness and response activities under the parent project. The project development objective of the Parent Project “to strengthen the Philippines' capacity to prevent, detect and respond to the threat posed by COVID- 4 19 and strengthen national systems for public health preparedness”, and the project’s component structure will remain unchanged but new activities will be included to scale-up the support related to COVID-19 vaccines procurement and deployment with the additional financing. The Parent Project SEP has been updated to reflect the activities under the Additional Financing and the additional issues noted in line with the template provided by the Bank. The proposed additional US$500 million IBRD loan will support the scale-up of activities for vaccination. The changes proposed for the AF entail expanding the scope and scale of activities under the PCERP, and there will be no changes to the overall design. However, there will be changes to sub- components under Component 1 to include activities on deployment of vaccines. The PDO will remain unchanged as the proposed activities to be funded under the AF are aligned with the original PDO. The closing date of the AF will remain aligned with the closing date of the parent project, i.e., December 29, 2023. The following are the Project Components: Component 1: Strengthening Emergency COVID-19 Health Care Response (Total US$ 581,000,000): The aim of this component is to strengthen essential health care service delivery system to be able to respond to a surge in demand as a result of anticipated rise in the number of COVID-19 cases in the coming months. As COVID-19 will place a substantial burden on inpatient and outpatient health care services, support will be provided to equip selected health facilities prioritized by DOH for the delivery of critical medical services and to cope with increased demand. Health system strengthening efforts will therefore focus on provision of medical and laboratory equipment, PPE, medical supplies as well as essential inputs for treatment such as oxygen delivery systems and medicines to selected hospitals and health facilities. Local containment will be supported through the establishment of local temporary isolation units. The component will also finance requirements of infrastructure of quarantine facilities. It is anticipated that any construction involved under this component will be conducted at existing facilities; activities requiring land acquisition or involuntary resettlement are not eligible. This component also supports the Department of Health in preparing a guidance note on standard design for hospital isolation and treatment centers to manage Severe Acute Respiratory Infections (SARI) patients that will be used in health facilities across the country to ensure standard and quality of COVID-19 health care services. The component has three sub-components. The scope of Component 1: Strengthening Emergency COVID-19 Health Care Response (current allocation: US$95.5 million; revised allocation: US$581 million) will be scaled up to support COVID-19 vaccines purchase. Component 1 will be revised as follows: (a) Sub-component 1.1. Provision of medical and laboratory equipment and reagents1 (current allocation: US$34.3 million; revised allocation: US$ 34.5 million): This sub-component will support selected DOH hospitals and provincial hospitals with laboratory equipment (e.g. Polymerase Chain Reaction machines), test kits, reagents, as well as to upgrade diagnostics and treatment of COVID-19 infection capacity through procurement of such intensive care unit equipment and devices as mechanical ventilators, cardiac monitors, portable x-ray, extracorporeal membrane oxygenation (ECMO) machine, portable oxygen generator machine, and continuous positive airway pressure (CPAP). The sub-component will also support provision of oxygen, emergency beds, laboratory reagents, and waste management facilities. This subcomponent will also support short trainings on the use of equipment, 1 Laboratory support under Sub-Component 1.1 is short-term and includes PCR machines and test kits for selected DOH hospitals and provincial hospitals. Component 2 supports strengthening of reference laboratories at both national and sub-national levels to address EIDs in the short and medium term. 5 devices, and tests for health providers and technicians; and to support the necessary logistics and supply chain to ensure that the equipment will reach frontline health facilities without delays. No new additional activities are proposed but the amount has been revised to be aligned with updated costing of activities by the DOH. (b) Sub-component 1.2. Provision of medical supplies, including Personal Protective Equipment (PPE), COVID-19 vaccines, medicines, and ambulance (current allocation: US$46.6 million; revised allocation: US$521.3 million) : This subcomponent will support the health system with supplies including PPE such as masks, goggles, gloves, gowns, etc. It will also support medical counter measures and medical supplies for case management and infection prevention, through the procurement of COVID-19 vaccines, drugs such as antivirals, antibiotics, and essential medicines for patients with co-morbidity and complications such as CVDs and diabetes, as well as assistance to support the Borrower’s advance purchase mechanisms. This subcomponent will also support short trainings on the use of medical supplies for health providers and technicians as needed; and support to the necessary logistics and supply chain to ensure that the medical supplies and PPE will reach frontline health facilities without delays. Small part of this sub-component may also support ambulance vehicles to address COVID-19 response, as needed. The AF supports COVID-19 vaccines purchase through this sub-component. (c) Sub-component 1.3. Enhancing isolation/quarantine facilities (current allocation: US$14.5 million; revised allocation: US$25.2 million) : This sub-component will support the establishment, construction, retrofitting/refurbishment of quarantine facilities in major points of entry, increase number of regular isolation rooms in DOH and provincial hospitals as well as establishment of negative pressure isolation rooms in DOH and provincial hospitals. It will also support setting up of first line decontamination facilities in international airports (holding areas) as well as establishing isolation tents for triaging in health facilities. The increased amount for the component restores financing which had been re-allocated to sub- component 1.2 to finance COVID-19 vaccines during the December 2020 restructuring. (d) Sub-component 1.4. Deployment of COVID-19 vaccines (new sub-component, financed by counterpart funding from the GOP: US$155.5 million). The sub-component is financed primarily through the GOP's counterpart funding to support the deployment of World Bank- financed and eligible COVID-19 vaccines. The sub-component will finance planning and management of the COVID-19 vaccines procured by loan proceeds from the AF and deemed eligible by the World Bank, as part of the national COVID-19 vaccination campaign, through enhancing systems and capacity for planning, regulation, and M&E. In addition, the sub- component will finance safe and effective deployment of COVID-19 vaccines procured by loan proceeds from the AF and deemed eligible by the World Bank, including delivery, cold chain and logistics system, disposal of healthcare wastes, risk and communication, as well as surveillance and adverse events monitoring. Component 2: Strengthening laboratory capacity at national and sub-national level to support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response (Total US$ 11,500,000): The component will support the establishment of national reference laboratories as well as selected subnational and public health laboratories. It will include improving, retrofitting, and 6 refurbishing national reference laboratory – Research Institute for Tropical Medicine (RITM) as well as six sub-national and public health laboratories in Baguio, Cebu, Davao, Surigao City, and Manila.2 The sub-component may also support constructing and expanding laboratory capacity in priority regions that currently do not have necessary laboratory capacity. The sub-component will also support necessary laboratory equipment, laboratory supplies, reagents, as well as capacity building for relevant laboratory staff. It is anticipated that any construction involved under this component will be conducted at existing facilities, and that no new land acquisition or involuntary resettlement are expected. Component 3: Implementation Management and Monitoring and Evaluation (Total US$ 7,500,000): Project Management. The component will support the Department of Health (DOH) as the implementing agency of the project. DOH will be responsible for the coordination, management, and implementation of the project at the national and sub-national levels, financial management and procurement. The project will be implemented through mainstream DOH processes and will not involve a parallel project implementation unit or secretariat. This will be strengthened by the recruitment of additional staff/consultants responsible for overall administration, procurement, and financial management under country specific projects. To this end, the Project would support costs associated with project coordination, management, and implementation. This component will also support costs related to the management of environmental and social risks under the Bank’s ESF, including the implementation of this ESMF and Stakeholder Engagement Plan (SEP). The implementation arrangements of the Parent Project will be adjusted to enhance the capacity of DOH for implementation related to vaccine procurement, cold chain strengthening, and vaccination delivery support, as well as human resource strengthening in risk communication and community mobilization and M&E. Additional expertise and capacity will also be added as required by the additional financing. Specifically, the COVID-19 vaccination initiatives will be strengthened by the development of the Vaccine Delivery and Distribution Manual and National Deployment and Vaccination Plan (NDVP) and the hiring of a (i) Vaccine Specialist, (ii) M&E Specialist, and a (iii) second Procurement Specialist. Monitoring and Evaluation (M&E). This component would also support monitoring and evaluation of project implementation, prevention and preparedness, building capacity for clinical and public health research, and joint learning across and within countries. Furthermore, the M&E includes a mechanism to review the capacity of the national health systems to deploy vaccines universally and to reach isolated and marginalized communities and those difficult to reach. It will include the maintenance of daily records documenting who received the vaccine from which vial as well records of any adverse vaccination effects. The M&E system will include data and information disaggregated by gender, demography, race-ethnicity, location-residence, socioeconomic status, and disability. As may be needed, this component will also support third-party monitoring of progress and efficient utilization of project investments. The Philippines COVID-19 Emergency Response Project (the Project) has beenprepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard (ESS) 10 Stakeholder Engagement and Information Disclosure, the implementing agencies should provide stakeholders with timely, relevant, understandable, and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination, and intimidation. 2 Subnational and public health laboratories include (i) Lung Center of the Philippines (QC); (ii) San Lazaro Hospital (Manila); (iii) Baguio General Hospital (Baguio); (iv) Vicente Sotto Memorial Medical Center (Cebu); (v) Caraga Regional Hospital (Surigao City); (vi) Southern Philippines Medical Center (Davao). 7 Component 4: Contingent Emergency Response Component (CERC) (US$0): In the event of an Eligible Crisis or Emergency, the project will contribute to providing immediate and effective response to said crisis or emergency. A zero-value component has been included to ensure funds. The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and it includes a mechanism by which they can raise concerns, provide feedback, or make complaints about the project and its related activities. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between the project staff and local communities and to minimize and mitigate the environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. For COVID-19 vaccination programs, stakeholder engagement is key to communicating the principles of prioritization of vaccine allocation and the schedule for vaccine rollout, reaching out to disadvantaged and vulnerable groups, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, cultural hesitancy), and creating accountability against misallocation, discrimination, and corruption. 2. Stakeholder identification and analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e., the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project- related information and as a primary communication or liaison link between the Project and targeted communities and their established networks. Community representatives, cultural leaders and women leaders may also be helpful intermediaries for information dissemination in a culturally appropriate manner, building trust for government programs or vaccination efforts. For Indigenous People, stakeholder engagement should be conducted in partnership with Indigenous Peoples’ organizations and traditional authorities. Among other things, they can provide help in understanding the perceptions of Indigenous Peoples’ on the causes of the virus, which will influence their opinions around the vaccination campaigns as a proposed solution. Women can also be critical stakeholders and intermediaries in the deployment of vaccines as they are familiar with vaccination programs for their children and are the caretakers of their families. 8 Verification of stakeholder representatives, i.e., the process of confirming that they are legitimate and genuine advocates of the community they represent, remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. With community gatherings limited or forbidden under COVID-19, it may mean that the stakeholder identification will be on a much more individual basis, requiring different media to reach affected individuals. 2.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the Project will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the Project is inclusive. All stakeholders are at all times encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth, elderly, persons with disabilities, displaced persons, those with underlying health issues, and the cultural sensitivities of indigenous peoples and diverse ethnic groups. For the purposes of effective and tailored engagement, stakeholders of the proposed Project can be divided into the following core categories: • Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the Project and/or who could affect the Project and the process of its implementation in some way; and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the Project as compared with any other groups due to their vulnerable status3 and that may require special engagement efforts to ensure their equal representation in the consultation and decision- making process associated with the project. 3Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. 9 2.2. Affected parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: • COVID-19 patients and infected people • Communities with COVID-19 infected people • People under COVID-19 quarantine • Family members of COVID-19 infected people or people under COVID-19 quarantine • Frontline health workers particularly those dealing with COVID-19 patients • Local government units where isolation/quarantine/screening facilities will be located and the vaccination activities will take place • Health facilities where vaccines will be administered • Security/uniformed personnel or local government unit-designated officers tasked to maintain peace and order during the vaccination activities • Security/uniformed personnel involved in ensuring the proper and safe logistics and distribution of the vaccines • Communities around proposed isolation/quarantine/screening facilities • Municipal waste collection and disposal workers • Waste transporters and transport, storage, and disposal (TSD) service providers handling hazardous healthcare wastes • Workers supporting the renovation/rehabilitation/construction of health care facilities, quarantine centres and screening posts. • Department of Health (DOH) and other public health agencies • Workers coming back to the Philippines from abroad; and • Business entities and individual entrepreneurs supporting and/or supplying key goods and services for prevention of and response to COVID-19 • Pharmaceutical companies particularly those involved in the COVID-19 vaccine development and supply Private companies with cold storage facilities and transport and/or engaged in dry storage and cold chain services The affected parties of the COVID-19 vaccination activities are consisted mostly of the preliminary identified priority eligible population for vaccination, based on existing ethical principles and recommendations of the World Health Organization’s Strategic Advisory Group of Experts (WHO SAGE) Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply and the WHO SAGE Values Framework for the Allocation and Prioritization of COVID-19 Vaccination, and the recommendations of the recommendations of the National Immunization Technical Advisory Group (NITAG): The DOH Administrative Order No. 2021-0005 entitled “National Strategic Policy Framework for COVID-19 Vaccine Deployment and Immunization” provides the Decision Matrix in determining priority eligible population groups based on the principles of the abovementioned WHO SAGE Guidelines and NITAG recommendations. Table 1 below outlines the priority groups based on the said principles. 10 Table 1. Decision Matrix in determining priority eligible population groups Principles Objectives Population Groups Human well- ● Reduce deaths and disease ● Health workers being burden ● Older adults (senior citizens with or ● Protect those in the health without comorbidities) services and essential services ● Persons with comorbidities ● Personnel in government agencies providing essential services (DSWD, DeEd, DILG, BJMP & Bureau of Correction, PNP, AFP, PCG, BFP, CAFGU) ● Government workers, teachers and students, essential workforce (agriculture, tourism, transportation, food industry, tourism, manufacturing, construction, among others) ● All workforce Reciprocity ● Protect those who bear ● Health workers (all) significant additional risks and ● Essential workers outside the health burdens of COVID-19 to sector, those with high-risk of safeguard the welfare of others exposure, such as contact tracers, social workers providing social services, among others Equal respect ● Treat the interest of all ● All citizens based on the availability individuals and groups with of vaccines equal consideration as allocation and priority setting ● Vaccinate all citizens National equity ● Ensure that vaccine ● People living in poverty (indigent prioritization takes into account population) vulnerabilities, risks and needs ● Disadvantaged groups (PWD, PDLs, groups because of underlying among others) societal, geographic or ● Low-income workers biomedical factors ● Hard-to-reach areas ● Overseas Filipino Workers Using the Decision Matrix, the National Government has determined that below will be the priority eligible groups for COVID-19 vaccination: Table 2. Priority eligible groups for COVID-19 vaccination Priorities Population Group Definition of Terms Priority Eligible Group A* 11 1 Frontline Health Workers All health workers from the PRIVATE and PUBLIC sector currently on ACTIVE practice/service, whether they are permanent, contractual, job-order and/or outsourced employees or staff: a) Public and private ● All those are working in medical centers, health facilities hospitals, clinics, laboratories, Temporary [hospitals, medical Treatment and Monitoring Facilities (TTMFs), centers, laboratories, and Treatment Rehabilitation Centers (TRCs). If infirmaries, the vaccine supply is limited, priority shall be Treatment given to hospitals and medical centers directly Rehabilitation catering to COVID-19 patients, including Centers (TRCs) and suspects, probable and confirmed COVID-19 Temporary cases. Treatment and ● Specifically, all those who are assigned in the Monitoring Facilities triage areas, out-patient departments, (TTMFs)] emergency rooms, wards, intensive care units, operating rooms, delivery rooms, laboratory, radiologic and pathology areas, rehabilitation units, among others. ● Medical and allied health students who are serving as clerks or interns in hospitals ● Those who are assigned as part of the disinfection or decontamination teams, medical social workers, admin personnel, and security guards of the above-mentioned facilities. b) Public health workers All workers in the public health sector: (all RHU/CHO ● All employees in the public primary care personnel, PHO, facilities (Rural Health Units, City Health Offices PDOHO, CHD and CO) (whether LGU-hired or DOH-hired/deployed) and LGU contact ● All health workers employed/deployed/ tracers detailed in Provincial Health Offices, Center for Health Development and Department of Health Central Offices, including Food and Drug Administration and Bureau of Quarantine ● All health workers employed/deployed/ detailed in DOH-attached agencies such as Philippine Health Insurance Corporation, Philippine National AIDS Council, Philippine Institute of Traditional Alternative Health Care, Dangerous Drugs Board, and National Nutrition Council ● LGU-deployed/designated/hired contact tracers [those with appropriate documents stating deployment/designation of government employees as contact tracers either through an Executive Order (EO), resolution and/or ordinance] ● Note: If the vaccine supply is limited, among 12 workers in public health, priority shall be given to those who are providing direct health services. c) Barangay Health ● All Barangay Health Workers in active service Workers including ● All active members of the BHERTs (based on Barangay Health appropriate documents stating designation Emergency Response either through an LGU EO, resolution and/or Teams (BHERTs) ordinance) d) Other NGAs (DSWD, ● DSWD, and its regional and local counterparts DepEd, DILG, BJMP ○ All employees manning close-setting and Bureau of facilities and long-term care facilities, e.g. Correction) orphanage, home for the aged, women’s crisis centers. ○ Social workers providing social amelioration, and social services in the communities ● DepEd ○ Health and nutrition personnel ● DILG ○ Those hired by DILG as contact tracers (active service) ● BJMP (under DILG) ○ All employees and health workers assigned in direct contact with Persons Deprived of Liberty (PDLs) such as jail officers, wardens, and/or guards ● BuCor (under DOJ) ○ All employees and health workers assigned in direct contact with Persons Deprived of Liberty (PDLs) such as jail officers, wardens, and/or guards 2 Indigent Senior Citizens All indigent senior citizens registered and as determined by DSWD 3 Remaining Senior Citizens All senior citizens (not categorized as indigent) registered and as determined by DWSD 4 Remaining Indigent All indigent population as determined by DSWD Population 5 Uniformed Personnel All enlisted uniformed personnel in active services under the: ● Armed Forces of the Philippines ● Philippine National Police ● Philippine Coast Guard 13 ● Bureau of Fire Protection ● Citizen Armed Force Geographical Unit Priority Eligible Group B** 6 Teachers and school ALL teachers and school workers, whether workers permanent, job-order, contractual or out-sourced in all educational levels, from primary, secondary and tertiary, and vocational educational institutions, both private and public 7 All government workers All government workers, whether permanent, job- (national and local order, contractual or out-sourced, in national government) government agencies, government-owned and controlled corporations (GOCCs), government financial institutions (GFIs), local government units, among others. 8 Essential workers ● All workers providing basic services during this time of pandemic and essential to the growth of the economy as determined by DTI and DOLE ● These workers may come from the following sectors: agriculture, forestry and fisheries; transportation; construction; food industries; manufacturing of essential goods; tourism; essential retail; water-refilling stations; laundry services; logistics service providers; delivery and courier services; water supply and sanitation services; telecommunication services; energy and power companies; gasoline stations, among others 9 Socio-demographic groups ● All Persons Deprived of Liberty as determined by at significant higher risk BJMP and BuCor other than senior citizens ● All Persons with Disability as determined by and indigent populations DSWD, and National Council for Disability Affairs [e.g. Persons Deprived of (NCDA) and LGUs Liberty (PDLs), Persons ● All Indigenous Peoples as determined by the with Disabilities (PWDs), National Commission on Indigenous Peoples Indigenous Peoples, (NCIP). This may include: the Lumads of Filipinos living in high- Mindanao, the Peoples of the Cordillera, and density areas) scattered tribal peoples of the hinterlands of Central and Southern Luzon, Viasayas, Mindoro and Palawan ● All Filipinos living in high-density areas as determined by the LGUs (as documented in the LGU’s Comprehensive Land Use Plan) such as in slums and temporary shelters, among others; including those who are homeless and living in temporary shelters and homes 14 Eligible Students ● All students in primary, secondary and tertiary and vocational educational institutions. However, vaccination of students below 18 y.o. will depend on the recommendations of WHO and NITAG, with the concurrence of the COVID-19 Vaccine Cluster. 10 Overseas Filipino Workers Filipino migrant workers who reside in another (OFWs) country for a limited period of employment that were not yet vaccinated 11 Other remaining All remaining Filipino workforce as determined by the workforce DOLE, DTI and CSC Priority Eligible Group C** 12 Remaining Filipino Citizens All Filipino Citizens that were not mentioned in priority A and B * Persons with co-morbidities are being taken into consideration as part of Priority Eligible Group A depending on the latest development and scientific evidence. This is being discussed by the NITAG. **The Priority Eligible Group B and C may change as these categories will still undergo review of the NITAG and final approval of the COVID-19 Vaccine Cluster and the IATF. It should be noted that the prioritization of population groups are based on the following goals: Primary Goals ● Direct reduction of morbidity and mortality. ● Maintenance of most critical essential services. Secondary Goals ● Substantially control transmission ● Minimize disruption of social, economic and security functions. Tertiary Goal ● Resumption to near normal. Table 3. Priority groups per population with size Ranking of vulnerable group, Number of % of Population group or inclusion in people population which phase Stage 1 1st Priority: Frontline Health Workers 1,762,994 1.6% (2021) a) Public and private health facilities (Hospitals, 612,975 0.6% Treatment and Rehabilitation Centers, and 15 Ranking of vulnerable group, Number of % of Population group or inclusion in people population which phase Temporary Treatment and Monitoring Facilities) b) Public health workers (all Rural Health 602,982 0.6% Units/City Health Office personnel; Provincial Health Office, Provincial DOH Officer, CHD, and Central Office field workers) and LGU contact tracers c) Barangay Health Workers including Barangay 414,640 0.4% Health Emergency Response Teams d) Other National Government Agencies 132,397 0.1% (Department of Social Welfare Development, DepEd, DILG, BJMP & Bureau of Correction) nd 2 Priority: Indigent Senior Citizens 3,789,874 3.5% 3rd Priority: Remaining Senior Citizens 5,678,544 5.3% 4th Priority: Remaining Indigent Population 12,911,193 12.0% 5th Priority: Uniformed personnel – Philippine National 525,523 0.5% Police (PNP), Armed Forces of the Philippines (AFP), Philippine Coast Guard (PCG), Bureau of Fire Protection (BFP), Citizen Armed Force Geographical Unit (CAFGU) Sub-total Sub-Total 24,668,128 23% Stage 2 a. Teachers and school workers (public and private) 44,628,902 40% (2022) b. All government workers (National and Local Government) c. Essential workers in agriculture, food industry, transportation, and tourism d. Sociodemographic groups at significantly higher risk other than the senior citizens and indigent population (PDLs, Persons with Disability, Filipinos living in high-density areas) e. Overseas Filipino Workers (OFWs) f. Other remaining workforces g. Students Stage 3 All remaining Filipino citizens 41,770,329 37% (2023) Total 111,067,422 100% 2.3. Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including: • General public who are interested in understanding the Government’s prevention and response to COVID-19; • Government officials, permitting and regulatory agencies at the national, regional, and community levels, including environmental, technical, social protection and labor authorities; • National Commission for Indigenous Peoples (NCIP); 16 • Development partners and civil society organizations at the global, regional, and local levels that may become partners of the project, including organizations representing indigenous peoples and peoples with disabilities; • Business owners and providers of services, goods and materials that will be involved in the project’s wider supply chain or may be considered for the role of project suppliers in the future; and • Mass media and associated interest groups, including local, regional, and global printed and broadcasting media, digital/web-based entities, and their associations. • Religious groups and other faith- based organizations which may disseminate information to their members regarding COVID-19 and vaccines. • The academe and professional organizations with interest in COVID-19. 2.4. Disadvantaged / vulnerable individuals or groups It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project. It is important to ensure that awareness raising (on infectious diseases and medical treatments in particular) and stakeholder engagement with disadvantaged or vulnerable individuals or groups be adapted to take into account such groups’ or individuals’ particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from person’s origin, gender, age, ethnicity, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g. minorities or fringe groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project- related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: • elderly; • children, particularly those who are malnourished and have high susceptibility to diseases; • those with underlying health conditions e.g., diabetes, cancer, hypertension, coronary heart diseases, and respiratory diseases, among others; • persons with disabilities including physical and mental health disabilities; • poor, economically marginalized, and disadvantaged groups including women and ethnic minority groups; and • indigenous peoples. There is an indirect risk of social exclusion, in particular, the most vulnerable and marginalized groups such as the indigenous peoples in remote areas from access to the COVID-19 vaccines. The elderly, those with underlying medical conditions, and people living with disability, though included in the priority populations to be vaccinated as identified in the WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply, may have limited access to the vaccines due to reduced mobility. The information materials on the COVID-19 vaccine to be developed could exclude the most vulnerable or be developed in a way that is not sensitive to the needs and access of these different groups. These will be addressed through the identification of strategic locations for vaccine administration or transport assistance for vulnerable groups for increased access to vaccination sites. Risk 17 communication materials to be developed will also be clear and concise and in a format or language that is understandable to all people, in particular the most vulnerable. This may require different types of media (print, broadcast, and digital or new media) as well as engaging existing formal and informal public health and community-based networks (schools, healthcare service providers at local level, etc.). Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. In the COVID-19 vaccination, the risk profiling of the vaccinees will include data collection and disaggregation based on sex, age, indigent status (per DSWD guidelines), indigenous group or community (IP), and presence of any disability. Description of the methods of engagement that will be undertaken by the Project is provided in the following sections. 3. Stakeholder Engagement Program 3.1. Summary of stakeholder engagement done during project preparation Given the urgency of this COVID-19 operation there were no stakeholder engagements conducted in the preparation of the first draft of the SEP. Discussions on project design and the SEP were only held between representatives from DOH and the World Bank. Stakeholder engagements were conducted after project approval to inform a revision of the SEP during implementation. The Environmental and Social Commitment Plan (ESCP) and the first draft of the SEP were disclosed on April 2, 2020 at the DOH website at https://www.doh.gov.ph/sites/default/files/health_advisory/ Environmental%20and%20Social %20Commitment%20Plan%20(ESCP).pdf. They were disclosed on April 8, 2020 at the World Bank’s external website (www. http://documents.worldbank.org/ curated/en/home). The ESMF, ESCP, and SEP were disclosed in the DOH website on 4 August 2020, 09 October 2020, 25 November 2020, 8 January 2021, and 4 February 2021 at https://www.doh.gov.ph/COVID-19/emergency-response-project and disclosed at the World Bank’s website. The ESF documents, i.e. ESMF, ESCP, and SEP, updated for the Additional Financing had been disclosed in the DOH website on 8January 2021. Updated versions of the SEP, ESCP, and ESMF will be disclosed on the same website during project implementation. The National Stakeholders Consultation on the Parent Project was conducted on August 18-19, 2020 and the results and key feedback are provided in Annex A. Due to the physical distancing and large gathering restrictions, the engagement process was conducted virtually through a series of meetings. Local consultations with affected and interested stakeholders at recipient health facilities will be conducted during implementation, including for the civil works components. Further information on the approach for the said consultations is provided in Section 3.4. The DOH DPCB has conducted the online Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment and Immunization last December 7, 2020 and January 8, 2021 which was participated by national government agencies, DOH CHDs, health care facilities, professional organizations, the academe, civil society organizations, private sector (health insurance corporation), and development partners. These had also been an avenue for orientation and policy advocacy to the Local Chief Executives and local leaders in line with the cascading of policies from the national to regional level to local levels. The proceedings of the open forum of these consultations are in Annexes B and C. The DOH HPB is also conducting Town Hall Meetings (https://doh.gov.ph/press- 18 release/DOH-AND-PHILIPPINE-NURSES-ASSOCIATION-HOLD-TOWN-HALL-TO-PROMOTE-VACCINE- CONFIDENCE). The proceedings of which will be requested. Consultations with PWD and gender- based groups on the PCERP were also conducted on 5 and 30 October 2020, respectively. The proceedings of which are in Annexes D and E. The consultation with the NCIP, NCIP Health Workers in Community Service Centers (nurses, midwives), IP Mandatory Representatives (IPMR), and IP leaders on the PCERP was held last 23 February 2021 which was attended by 300 participants nationwide (Annex F). Town hall consultations with the uniformed personnel for the security of the vaccines and vaccine implementation and with Indigenous Peoples and their representatives, the National Commission Indigenous Peoples (NCIP), and other relevant CSOs has been conducted by the DOH HPB in March 2021. The IP Townhall consultation held last 16 March 2021 included NCIP- hired nurses and midwives in the community service centers (LGUs), doctors in the NCIP Regional Offices, IP regional representatives, IP Mandatory representatives (IPMR), IP leaders, and communities. Moreover, community consultations on the construction activities for the RITM, 14 NCR hospitals, and Quirino Memorial Medical Center were participated by the DOH Central Office (BIHC, DPCB, HFEPMO); Metro Manila Center for Health Development - HFEP Counterpart; health facilities’ administrative and planning department, engineering department, and infrastructure committee; local government units (Building Official, Engineering Department, City Health Office, City Environmental and Natural Resources Office [CENRO], Barangay Officials); and the World Bank. These community consultations were held on 27 October 2020, 28 October 2020, and 23 February 2021, respectively. The proceedings of the consultation are in Annexes G to I. The DOH through the Health Promotion Bureau (HPB), as member of the National Task Group on Demand Generation and Communications headed by the Presidential Communications Operations Office (PCOO), together with the Philippine Information Agency (PIA), the National Telecommunications Commission (NTC), and the Department of the Interior and Local Government (DILG), will develop key messages and materials for public communications and advocacy aligned with demand plan. The developed materials will be pre-tested in communities and will be subsequently rolled-out to the regional and local levels through training of the Health Education and Promotion Officers (HEPOs). The National Task Group on Demand Generation and Communications has the following functions: (a) design a demand and risk communication plan, (b) implement social mobilization and community engagement activities, and (c) ensure social preparation of target population groups and geographical areas prior to vaccination. Data collection systems including (a) social media listening and rumor management and (b) assessment of behavioral and social data will be established. Currently, the frequently asked questions (FAQs) on COVID-19 and the vaccines are being reviewed and updated based on possible scenarios. Using the revised information, the KIRA ChatBot backend will be updated. To be able to effectively develop and implement the above data collection systems, the following will human resource strengthening, and re-enforcement activities will be conducted: (i) contracting of third party for the conduct of surveys, (ii) hiring of regional staff, at least 1 per region, (iii) contracting of technical assistance provider on infodemic management, (iv) contracting of technical assistance provider on in- house social listening, and (v) training of regional and local HEPOs. The Government of the Philippines, with the lead of the DOH and guidance of the COVID-19 Vaccine Czar’s Office, will design and distribute a social mobilization and engagement strategy/demand plan and information awareness program, such as through advocacy, communications, social mobilization, risk and safety communications, community engagement, and training, to generate confidence, acceptance and demand for COVID-19 vaccines, including for engaging with national and local media, NGOs, social platforms, etc. and human resources for community outreach and risk 19 communication management that also explains how complaints may be lodged and how they will be resolved, are available at all levels. This is currently being discussed by the DOH- HPB with the Philippine Information Agency (PIA) and private sector partners. In response, community organizers will be hired and technical assistance on crisis communications and preparedness planning will be sought. In response to the above needs for risk communication and community engagement for the effective delivery and deployment of the COVID-19 vaccines, the DOH HPB has developed the National Demand Generation and Communications Plan for COVID-19 Vaccines, with the following objectives for the citizens: ▪ Understand, feel confident in the government’s approach to roll-out COVID-19 vaccines, and believe that it is fair; ▪ Maintain trust in, and demand for, COVID-19 vaccine and routine immunization; ▪ Understand the importance of physical and mental resilience and continued practice of other preventive health behaviors (hand washing, mask wearing, and physical distancing); and ▪ Rely on government-initiated platforms as the authoritative source of information on COVID-19 vaccines deployment. The specific objectives are as follows: ▪ Adults, caregivers, and parents understand the threat of COVID-19 and the need for herd immunity to protect their families; ▪ Eligible Filipinos are aware of the COVID-19 deployment plan (authorization for safety and efficacy, prioritization of recipients) and implementation plan (schedule, venue, and requirements for safe vaccination before the deployment start date); ▪ All Filipinos understand the key difference of the COVID-19 vaccine clinical trials and the government-led roll out of the COVID-19 vaccines; ▪ Health workers, community volunteers, and other frontline workers are able to communicate key messages of the campaign, respond to concerns regarding the campaign, and verify information appropriately; and Private sector, civil society organizations, Local Chief Executives, and other key stakeholders are engaged to champion the immunization activities through provision of accurate and timely information and of resources for community mobilization. The approaches and strategies will include the following: ▪ Raising awareness and engagement through unified messaging across multiple but streamlined communication platforms or spokespersons. ▪ Ensuring feedback loops from monitoring of platforms to inform calibration of messages. ▪ Strengthening capacities of health workers and other frontline workers on communication and engagement ▪ Advocacy and engagement of partners and influencers, including Local Chief Executives (LCEs) ▪ Media engagement and management 20 Table 4. Overview of the key messages per phase Social listening allows the COVID-19 vaccine communication team to prioritize and evaluate feedback from the different sources of information in order to create messages with relevant content for target audiences. Through this, communication can be adjusted based on trends and continuously shift strategies to fit the current needs of the target audiences. Social listening activities will generate insights and recommendations that will guide the development of policies, demand generation plans, creation, and dissemination of frequently asked questions (FAQs) and other communication materials regarding COVID-19 vaccines, and the overall COVID-19 vaccine deployment plan and strategies. Figure 1. Social listening framework for the COVID-19 vaccination 21 The social listening activities per geographic areas will be based in Table 5. Table 5. Social listening strategy per geographic area level The following table shows critical topics that are recommended to be covered per target group of stakeholders (Table 6). 22 Table 6. Topics for targeted stakeholders for demand generation of the COVID-19 vaccines The DOH Health Promotion Bureau (HPB) regularly convenes with the Office of the Vaccine Czar, with the following schedule: • Mondays at 8:00 AM, with the Boston Consulting Group, Vaccine Czar, and leads of the Task Group (TG) Demand Generation and Communications • Tuesdays at 6:00 PM, the Vaccine Cluster Meeting with other Task Groups (TGs) and Sub-task Groups (STGs) Together with the Office of the Vaccine Czar, the DOH HPB holds the ‘Laging Handa: COVID-19 Vaccines Explained’ as information and demand generation campaign for the COVID-19 vaccines. The other platforms of interface include chat group with NTF, PIA, and DOH for issues management. The health 23 promotion campaign of the HPB for the COVID-19 response (Figure 2) and the vaccination (Figure 3) may be summarized in the following figure: Figure 2. Health promotion campaign strategy of DOH for the COVID-19 response Figure 3. Health promotion campaign strategy of DOH for the COVID-19 vaccination The PulseAsia has conducted a survey last December 2018 on who can get an individual vaccinated and it is shown that health care providers, relatives, and local government units play a crucial role, considering 24 the devolved nature of health care in the country (Figure 4). It is important to note that this survey is not in the context of COVID-19. Figure 4. Pulse Asia survey on vaccination positive influencers (2018) The HPB also has been conducting a series of Town Halls wherein various stakeholder groups are invited to consult on the COVID-19 vaccination. Consultations with the Philippine Medical Association (PMA) last 14 January 2021, Philippine Nurses Association (PNA) last 16 January 2021, with pharmacists last 23 January 2021, and with midwives last 30 January 2021 show the vaccine acceptance of these groups, upon the poll on the question “How likely are you to get the COVID Vaccine if available, with safety and effectiveness comparable to other common vaccines, and with FDA approval for public use?”. Table 7. Vaccination acceptance results during the Town Halls led by the HPB (2021) 25 Various health trainings on COVID-19 and vaccination are also made available at the DOH Academy E- Learning Platform (https://learn.doh.gov.ph/). The module on health promotion for COVID-19 vaccines includes the following topics: Table 8. Health promotion module for COVID-19 vaccines in the DOH Academy E-Learning Platform Topic Target Audience 1: Overview of the Vaccine Deployment Plan: Communicators, General Public 10 Things You Need to Know 2: Demand Generation: Framework for Action Communicators 3: Demand Generation: Playbook Communicators 4: Feedback Mechanisms and Social Listening Communicators 5: Vaccine Reportage and Communications Communicators 3.2. Summary of project stakeholder needs and methods, tools, and techniques for stakeholder engagement Different engagement methods are proposed and cover different needs of the stakeholders: • Online formal meetings • Through social media • Community consultations where physical distancing measures are practiced in respective LGUs/areas • One-on-one interviews through phone or available local apps (i.e., Viber, Messenger) • Site visits with personal protective equipment and physical distancing measures (when appropriate) • Use of existing or new community communication mechanisms Targeted consultations with special interest groups will be undertaken. These include the organizations representing and supporting people with disabilities (PWDs), such as the Alyansa ng may Kapansanang Pinoy, Inc. (AKAP-Pinoy), which is a 415-strong federation of local and national organizations and 900 individual members dedicated to advocate for the rights and promote the interests of persons with disabilities), the Life Haven Center for Independent Living, Regional Association of Women with Disabilities, the Philippine Federation of the Deaf, Inc. (PFD), and the Philippine Coalition on UNCRPD. Targeted consultations with indigenous peoples’ representatives and organizations including the National Commission on Indigenous Peoples (NCIP) will also be undertaken during project implementation. This will include, inter alia: 26 • Identification of indigenous peoples’ organizations for stakeholder engagement; • identification of potential affected groups and communities, their representative bodies and organisations; • engagement approaches that are culturally appropriate that allow for sufficient time for feedback and decision-making processes; and • measures to allow for their effective participation in the design of project activities or mitigation measures that could affect them either positively or negatively including relevant mechanisms and procedures of the Joint Memorandum Circular “Guidelines on the Delivery of Basic Health Services for Indigenous Peoples/Indigenous Cultural Communities (IPs/ICCs)” agreed to between DOH, NCIP, the Department of Interior and Local Government (DILG) on June 3, 2013. An adaptive approach may also be needed for engaging stakeholders in Bangsamoro Autonomous Region of Muslim Mindanao (BARMM) due to the fragile political situation and security context. Particularly if the project will finance site-specific investments in BARMM (in addition to awareness raising), the SEP will be revised to include specific provisions for stakeholder engagement. Moreover, community consultations with the affected stakeholders in the civil works project sites and other project activities will be conducted. A precautionary approach will be taken to the consultation process to prevent contagion, given the highly infectious nature of COVID-19. The following are some considerations for selecting channels of communication, in light of the current COVID-19 situation: • Avoid public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings; • If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels; • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, and mail), particularly to target stakeholders who do not have access to online channels or do not use them frequently. Traditional channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators; • Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. • Identify trusted local civil society, ethnic organizations, community organizations and similar actors who can act as intermediaries for information dissemination and stakeholder engagement; engage with them on an ongoing basis. For effective stakeholder engagement on COVID-19 vaccination, prepare different communication packages and use different engagement platforms for different stakeholders, based on the stakeholder identification above. The communication 27 packages can take different forms for different mediums, such as basic timeline, visuals, charts and cartoons for newspapers, websites, and social media; dialogue and skits in plain language for radio and television; and more detailed information for civil society and media. These should be available in different local languages. Information disseminated should also include where people can go to get more information, ask questions, and provide feedback. During the implementation of the Project, the ESMF and the SEP will be regularly updated and the alternative tools for stakeholder engagement will be assessed, as needed. This may include: establishing community feedback mechanisms for healthcare providers to support two-way communications, for example to build vulnerability profiles in the community and to counter misinformation and misperceptions; use of community facilitators and leaders to provide two-way information channels to healthcare providers in identifying who is most vulnerable or at high risk, and who may require support; use of global and local tools developed to address COVID-19, such as the WHO COVID19 Alerts via WhatsApp, HealthBuddy, and Covid19Info App (a tracking and educational platform with mobile phone alerts). 3.3. Proposed strategy for information disclosure Table 9. Strategies for information disclosure per project stage List of Methods and timing Project stage Target stakeholders information to be disclosed proposed Preparation, Government agencies Project objectives and Disclosure on World Bank prior to including DENR, Office of activities and DOH websites in April effectiveness the President, and 2020 NDRMMC Environmental and Social Health agencies Management Framework NCIP (ESMF). General public Civil society organizations Stakeholder Engagement IP organizations Plan (SEP) and Grievance Development partners Redress Mechanism (GRM). Mass media Environmental and Social Commitment Plan (ESCP). 28 Project Government agencies Updated ESF instruments. Updated ESF documents Implementation including DENR, Office of were disclosed by DOH on the President, and Feedback of project August 4, October 9, and NDRMMC consultations. November 25, 2020. Final Health agencies documents disclosed by NCIP Information about project DOH and World Bank. Any Local government units activities in line with the subsequent updated Local communities World Health Organization versions will also be particularly those around (WHO) COVID19 guidance disclosed proposed on risk communication and isolation/quarantine community engagement. Locality’s ways of centers disseminating information Health facilities and their workers Information leaflets and Municipal waste collection brochures to be and disposal workers distributed with sufficient Business owners and physical distancing providers of services, goods measures and materials General public Civil society organizations, including organizations representing people with disabilities, IP organizations / representatives Development partners Mass media In line with WHO guidelines on prioritization, the initial target for vaccination under the World Bank COVID-19 Multi Phase Programmatic Approach financing of the Philippines COVID-19 Emergency Response Project is to reach 20% of the population in the first year in each country, prioritizing health care workers, other essential workers, and the most vulnerable, including the elderly and people with underlying co-morbidities. As all people will not receive vaccination all at the same time, inadequate or ineffective disclosure of information may result in distrust in the vaccine or the decision-making process to deliver the vaccine. Therefore, the government will ensure that information to be disclosed: ▪ Is accurate, up-to-date and easily accessible; ▪ Relies on best available scientific evidence; ▪ Emphasizes shared social values; ▪ Articulates the principle and rationale for prioritizing certain groups for vaccine allocation; ▪ Includes an indicative timeline and phasing for the vaccination of all the population; ▪ Includes explanation of measures that will be used to ensure voluntary consent, or if measures are mandatory that they are reasonable, follow due process, do not include punitive measures and have a means for grievances to be addressed; 29 ▪ Includes explanation of vaccine safety, quality, efficacy, potential side effects and adverse impacts, as well as what to do in case of adverse impacts; ▪ Includes where people can go to get more information, ask questions and provide feedback; ▪ Includes the expected direct and indirect economic costs of the vaccines and addresses measures should there be serious adverse impact on stakeholders due to the vaccine, such as serious side effects; and ▪ Is communicated in formats taking into account language, literacy and cultural aspects. Over time, based on feedback received through the Grievance Mechanism and other channels, information disclosed should also answer frequently asked questions by the public and the different concerns raised by stakeholders. • Misinformation can spread quickly, especially on social media. During implementation, the government will assign dedicated staff to monitor social media regularly for any such misinformation about vaccine efficacy and side effects, and vaccine allocation and roll out. The monitoring should cover all languages used in the country. In response, the government will disseminate new communication packages and talking points to counter such misinformation through different platforms in a timely manner. These will also be in relevant local languages. • If the engagement of security or military personnel is being considered for deployment of vaccines, ensure that a communication strategy is in place to inform stakeholders of their involvement and the possibility of raising concerns and grievances on their conduct through the Grievance Mechanism. Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines (NDVP) The Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines was drafted for the purpose of providing operational guidance in the implementation of the COVID-19 vaccine deployment and vaccination program. It is a living plan to be updated as more information becomes available or as recommendations are provided by international and national organizations. Its development has involved the participation of various government agencies to ensure alignment of policies and plans among agencies and integration of the said plans into national governance mechanisms. The development process for this Plan was participatory and involved various stakeholders led by the COVID-19 Vaccine Cluster and its Task Group (TG) and Sub-Task Group (STG) members. These TGs and STGs were composed of various Departments and Agencies as outlined in the section of Governance. The TGs and STGs under the COVID-19 Vaccine Cluster developed briefs to guide the implementation of the vaccine. Key Informant Interviews were also conducted to understand various perspectives in addition to various rapid assessments. A short-term technical assistance staff was hired to collate the briefs/guides developed by each of the TGs and STGs. A series of meetings were held to review and enrich the plan. The final draft of the NDVP was presented to the DOH Executive Committee, COVID-19 Vaccine Cluster of the National Task Force for endorsement. The target audience includes policy makers, planners, program and project implementers, development partners, health service providers, partners in public and private sector, civil society organizations, health consumers, and the general public. The NDVP was approved and ratified by the IATF Resolution no. 95 and further reinforced by the NTF Against COVID-19 Memorandum Circular no. 5 series of 2021. 30 Disseminating the NDVP to the different audiences in a meaningful way that will engage the audience and enable action will require that there are different versions and formats of this plan. Table 10 below summarizes the proposed dissemination of the NDVP. Table 10. Proposed dissemination strategy for the NDVP Users Needs Dissemination Government at all levels Taking stock Contents (what) Development partners Any changes / updates in the Tables International agencies plan Graphs and maps Private Sector Follow-up Analysis Academic and Research Planning and Projections Policy briefs and briefers Institutions Sector analysis Powerpoint presentations General Public Buy-in Media (How) Hard copy of the plan Soft copy of the plan Media (TV, newspapers) Workshops and seminars Government ’ s knowledge management website. 3.4. Stakeholder Engagement Plan – Project Implementation Table 11. Stakeholder engagement strategy Topic of consultation/ Method used Target stakeholders Responsibilities message The Project, its Virtual consultations Affected people, priority eligible DOH activities and locations, population for vaccination,and potential impacts and Correspondence by other interested parties as mitigation measures. phone/email appropriate. Introduce the project’s Official communication / Relevant government agencies ESF instruments. transmittal letters o local, working in, or with an interest in provincial, and national health sector and COVID-19. Present the SEP and authorities the Grievance Redress IPOs, NGOs and CSOs may also be Mechanism. Consultations with included. indigenous peoples in a Community culturally appropriate and Local government units consultations for the health-conscious manner civil works components Local communities particularly Locality’s ways of engaging those around proposed with constituents isolation/quarantine centers 31 Consultations with vulnerable groups Health facilities and their workers Updated project’s ESF Municipal waste collection and instruments. disposal workers Feedback of project Business owners and providers of consultations services, goods and materials Validation of the GRM General public steps/process CSOs and NGOs Information about project’s activities in IP organizations / representatives line with the World Health Organization Development partners (WHO) COVID19 guidance on risk communication and community engagement. The National Demand Generation and Communications Plan for COVID-19 Vaccines has been developed and will be updated by the DOH Health Promotion Bureau (HPB) for the COVID-19 immunization program which will be integrated in the National Deployment and Vaccination Plan and the Vaccine Delivery and Distribution Manual. It will have a whole-of-government, whole-of-system, and whole-of-society approach which will encompass general information on (i) COVID-19 and the need for sanitation and hygiene practices, (ii) COVID-19 vaccine basic information, (iii) trials results and procurement, and (iv) vaccine program roll-out. The WHO Risk communication and community engagement readiness and response to coronavirus disease (COVID-19) released on 19 March 2020 will also be used as reference in the development of messages and planning of risk communication and community engagement (RCCE) activities. A series of consultations will be conducted with the implementers of the GRM and with the implementers and stakeholders of the COVID-19 vaccination activities, in consultation with and per directive of the COVID-19 Vaccine Cluster Organizational Structure. Targeted consultations directed at relevant key industry stakeholders such as private sector engaged in cold chain storage and transportation, health care waste management (e.g., waste transport, storage and disposal service) and others, will be conducted to ensure understanding of the quality of service required consistent with government regulations and the environmental and social standards of the Banks’ ESF. These consultations should involve the Centers for Health Development, the Food and Drug Administration, local government units (LGUs), the recipient health facilities, and priority eligible population for vaccination, and the private sectors involved in cold chain management. 32 3.5. Proposed strategy to incorporate the view of vulnerable groups The project will carry out targeted stakeholder engagement with vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and other challenges they face at home, at workplaces and in their communities. Special attention will be paid to engage with indigenous peoples and women as intermediaries. The details of strategies that will be adopted to effectively engage and communicate to vulnerable group will be considered during project implementation4. Where the SEP and the ESMF are used to address Indigenous Peoples, the SEP will be prepared in a manner consistent with the ESS7 to enable targeted meaningful consultation, including identification and involvement of Indigenous People communities and their representative bodies and organizations; culturally appropriate engagement processes; providing sufficient time for Indigenous Peoples decision making processes; and allowing their effective participation in the design of project activities or mitigation measures that could affect them either positively or negatively. For any vaccination program where Indigenous Peoples are beneficiaries, the SEP will include targeted, culturally- appropriate and meaningful consultations before any vaccination efforts begin. Consultations and vaccination campaigns will be conducted through partnership with relevant Indigenous Peoples organizations and traditional authorities. Consultations will clearly communicate that there are policies ensuring that there is no forced vaccination. 5 If the Borrower has mandatory vaccination regulations applicable to IP/SSAHUTLC, targeted, culturally appropriate and meaningful consultations should be conducted for applicability of these regulations to IP/SSAHUTLC communities. Lastly, stakeholder engagement and vaccinations will be conducted with extra precautions to minimize COVID-19 transmission risks, especially for Indigenous Peoples living in more remote areas or in voluntary self- isolation. This may require testing or vaccinating intermediaries conducting consultations who may travel in and out of communities. The GRM will be culturally appropriate and accessible for IPs taking into account their customary dispute settlement mechanism. 4 Examples may include (i) women: ensure that community engagement teams are gender-balanced and promote women’s leadership within these, design online and in-person surveys and other engagement activities so that women in unpaid care work can participate; consider provisions for childcare, transport, and safety for any in-person community engagement activities; (ii) Pregnant women: develop education materials for pregnant women on basic hygiene practices, infection precautions, and how and where to seek care based on their questions and concerns; (iii) Elderly and people with existing medical conditions: develop information on specific needs and explain why they are at more risk & what measures to take to care for them; tailor messages and make them actionable for particular living conditions (including assisted living facilities), and health status; target family members, health care providers and caregivers; (iii) People with disabilities: provide information in accessible formats, like braille, large print; offer multiple forms of communication, such as text captioning or signed videos, text captioning for hearing impaired, online materials for people who use assistive technology; and (iv) Children: design information and communication materials in a child-friendly manner & provide parents with skills to handle their own anxieties and help manage those in their children. 5 See the Project Appraisal Document for the COVID-19 Multi Phase Programmatic Approach Additional Financing, which can be found here and states that the Bank will provide assistance to Borrowers for the “establishment of policies related to ensuring that there is no forced vaccination.” Forced vaccination refers to a government mandate requiring vaccination of everyone or everyone in a defined group, without any exceptions or due process for refusing to be vaccinated. Refusal to be vaccinated may result in punitive measures such as criminal sanctions. 33 4. Future of the project Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the ESMF, Stakeholder Engagement Plan, and Grievance Redress Mechanism (GRM). 5. Resources and Responsibilities for implementing stakeholder engagement activities 5.1. Resources The DOH will be in charge of stakeholder engagement activities. The budget for the SEP is estimated to be USD $200,000 and is included in Component 3 Implementation Management and Monitoring and Evaluation of the Project. 5.2. Management functions and responsibilities The DOH will be the implementing agency for the Project. The DOH has appointed a Project Director (Undersecretary level), and a Project Manager (Director level), with two Project Co-Directors for the implementation of the Project and the Additional Financing. The DOH will appoint a Project Manager. The Project Manager will be acting through DOH’s technical departments and national programs, as well as the regional health units, Local Government Units (LGUs), referral hospitals, and health centers. Within the DOH, the Project will be implemented through the following Departments, using mainstream DOH processes and will not involve a parallel project implementation unit or secretariat: Bureau of International Health Cooperation (BIHC), Health Facility Enhancement Program Management Office (HFEPMO), Disease Prevention and Control Bureau (DPCB), Health Emergency Management Bureau (HEMB), Procurement Service (PS), Finance Management Service (FMS), and relevant units, with BIHC as the main project focal point. However, the project will have a provision to strengthen these departments’ capacity and skills through additional consultants or advisors. 34 Figure 5. Institutional Set Up for the Philippine COVID-19 Emergency Response Project (PCERP) DOH will be responsible for the implementation of the SEP, as well as the ESMF and the Environmental and Social Commitment Plan (ESCP). DOH will appoint an Environmental and Social Risk Management Specialist to manage environmental and social risks of the Project and the engagement with stakeholders. Consultants may be hired as necessary. The DOH Environmental and Social Safeguards Team will provide technical and administrative support to the DOH DPCB, HPB, and other offices as advised for the risk communication and community engagement activities, mainly for information, communication, and consultation of the COVID-19 vaccine deployment and delivery activities, as necessary. The COVID-19 Vaccine Cluster Organizational Structure The COVID-19 Vaccine Cluster shall serve as a unified command, control, coordination, communication, and cooperation mechanism that ensures the procurement, deployment of COVID-19 vaccine and the vaccination of identified eligible populations. 35 Figure 6. COVID-19 Vaccine Cluster organizational structure The organizational structure and line of command for COVID-19 vaccines is as follows: 1. The Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID, or merely the IATF) is a task force created through Executive Order No. 168 s. 2014 by the Philippine President to respond to affairs concerning emerging infectious diseases in the country. For COVID-19 vaccines, the IATF-EID shall serve as the National Coordinating Committee. 2. For the COVID-19 pandemic response, President Rodrigo Roa Duterte established the National Task Force (NTF) Against COVID-19 to oversee the operations of the national response. Detailing the strategic framework of the pandemic response, the National Task Force drafted the National Action Plan Against COVID-19 (NAP) to guide the operations of the pandemic response anchoring on the principle that the response should be national-government-enabled, local government unit (LGU)-led, and people- centered. 3. Under the NTF Against COVID-19, there are three clusters namely, the Response Cluster, the Recovery Cluster and the COVID-19 Vaccine Cluster. As mentioned above, seeing the need for an organizational structure to support the strategic directions of the national government, the COVID-19 Vaccine Cluster was added based on the guidance stipulated in the NAP Phase III. In line with the directions of the VIRAT, the COVID-19 Vaccine Cluster shall serve as the National Technical Working Group. The COVID-19 Vaccine Cluster is led by Secretary Carlito G. Galvez, Jr., who was designated by President Rodrigo Roa Duterte as the COVID-19 Vaccine Czar. The President of the Philippines appointed a Vaccine Czar for the purchase of vaccines and negotiate with manufacturers. To support the Vaccine Czar, the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID) created a structure that would manage and distribute COVID- 19 vaccines once they become available to the Philippines. The vaccine task group is led by the Department of Health. 36 4. Under the COVID-19 Cluster are six Task Groups, and based on the direction of the VIRAT, shall serve as the Sub-Technical Working Groups. Each TGs is represented by the designated lead in the COVID-19 Vaccine Cluster Executive Committee. The Committee, in turn, advises and updates the COVID- 19 Vaccine Cluster Chair. The six Task Groups are: a. Scientific Evaluation and Selection b. Diplomatic Engagement and Negotiation c. Procurement and Finance d. Cold Chain and Logistics Management e. Immunization Program f. Demand Generation and Communications. The COVID-19 vaccination activities will be implemented in accordance with the directives of the COVID- 19 Vaccine Cluster Organizational Structure. The Inter-Agency Task Force on the Management of Emerging Diseases is Chaired by Secretary Francisco Duque IIII of the Department of Health while the National Task Force Against COVID-19 is Chaired by Secretary Delfin Lorenzana of the Department of Defense. Secretary Carlito Galvez, Jr., Presidential Adviser on the Peace Process, is the Chairperson of the National Incident Command and COVID-19 Vaccine Cluster (Philippine National Vaccine Roadmap or PNVR). Undersecretary Leopoldo Vega of the Department of Health is the Chairperson of the Response Cluster while the National Economic and Development Authority (NEDA) is the Chair of the Recovery Cluster. 37 The Task Groups are composed of various government agencies and participated by diverse experts and professionals: Table 12. Summary of task groups (TGs) Task Group (TG) Lead Members Roles and Responsibilities Scientific Department of Department of Health (DOH), Food and Drug Provide oversight on the evaluation of applications and Evaluation and Science and Administration (FDA), Research Institute for conduct of COVID-19 vaccine clinical trials in the country. Selection Technology Tropical Medicine (RITM), Department of (DOST) Trade and Industry (DTI), Department of Evaluate results of COVID-19 vaccine clinical trials as part of Foreign Affairs (DFA), National Development the inputs on the criteria for COVID-19 vaccine selection. Company (NDC), and the Vaccine Expert Panel (VEP) Develop criteria and provide recommendations of the evaluation and selection of COVID-19 vaccines that will be considered for procurement. Continue engagement with bilateral partners for clinical trials interested in pursuing local manufacturing and technology transfer. Diplomatic Department of Department of Finance (DOF), DOH, National Initiate diplomatic engagements with other governments, Engagement and Foreign Affairs Task Force, DOST, Office of the President international bodies, international non-government Negotiation (DFA) (OP) organizations, international financial institutions, and international cooperation agencies. Provide feedback and updates to the other respective TGs pertaining to vaccines in the global market. Coordinate and collaborate with TG Procurement and Finance in identifying viable global market vaccine manufacturers and entities. Negotiate agreements for the provision of technical and financial assistance. Procurement and DOF Department of Budget and Management Facilitate procurement through various mechanisms Finance (DBM), DOH allowed under existing laws, rules and regulations through 38 bilateral, multilateral and other financial modalities (e.g. COVAX Facility and etc.). Activate price negotiation board subject to HTA’s cost- effective price, if applicable. Coordinate with legislators, as may be necessary on budget and co-payment ceilings. Explore local vaccine production and supply, if applicable. Cold Chain and DOH, Co-Lead: DBM; Department of Interior and Local Map the potential port(s) of entry, points of storage Logistics Task Group Government (DILG), specifically, the (stores), and fallback facilities in the country with their Management Resource Philippine National Police (PNP); respective cold chain and transportation/distribution Management and Department of National Defense (DND), capacity for vaccines and ancillary products and assess dry Logistics (TGRML) specifically the Armed Forces of the storage and cold chain capacity at all levels. under the Philippines (AFP) and the Office of Civil Response Cluster Defense (OCD), Department of Information Facilitate acceptance and inventory of vaccines and and Communications Technology (DICT), logistics. Department of Transportation (DOTr), RITM, FDA, and DTI Facilitate and ensure storage, distribution and delivery of vaccines and logistics to target areas. Monitor cold chain practices and ensure that vaccines are handled and disposed correctly and properly. Develop a distribution plan down to the local level; adapt needs of vaccines, syringes and safety boxes to planning of stages or phases according to vaccine availability. Schedule transportation of vaccines and other supplies at all levels. Implement monitoring systems for vaccine distribution and conduct inventories using logistics information software 39 integrated into existing systems and technology development (barcodes, electronic tracking, etc.). Define indicators to evaluate the supply chain from the international up to the service delivery points. COVID-19 DOH DILG, DND, Office of the Chief Presidential Plan and craft policies, guidelines and standard operating Immunization Legal Counsel (OCPLC), Bureau of procedures related to the COVID-19 vaccine deployment Program Corrections (BuCor), Philippine Coast Guard and program implementation. (PCG), Department of Social Welfare and Development (DSWD), Department of Estimate potential numbers of target populations that will Justice (DOJ), Department of Education be prioritized for access to vaccines stratified by target (DepEd), AFP, PNP, BJMP, DICT, FDA, group and geographic location. Department of Labor and Employment (DOLE) Identify potential COVID-19 vaccine delivery strategies. Create a data information system for all vaccine recipients Provide capacity building and trainings to implementers Develop or adapt existing and implement AEFI/Post- marketing surveillance and monitoring framework Ensure or craft guidelines, procedures and tools for planning and conducting vaccine pharmacovigilance activities Demand Presidential DOH, National Telecommunications Design a demand and risk communication plan. Generation and Communications Commission (NTC), Philippine Information Communications Operations Office Agency (PIA), DILG Implement social mobilization and community engagement (PCOO) activities. Ensure social preparation of target population groups and geographical areas prior to vaccination. 40 Under the TG COVID-19 Immunization Program, are four Sub-Task Groups (STGs), namely: STG Planning, Policy & Technical Support, STG Program Implementation, STG Registry, Data Management and Monitoring & Evaluation, and STG Safety Surveillance & Response. The STGs are composed of the following: a. STG Planning, Policy & Technical Support i. Lead: DOH [Disease Prevention and Control Bureau (DPCB)] ii. Members: DOH [Epidemiology Bureau (EB), and Health Policy Development and Planning Bureau (HPDPB)], OCPLC, DepEd, DILG b. STG Program Implementation i. Lead: DOH (DPCB) ii. Members: DOH [Health Emergency Management Bureau (HEMB) and Health Human Resource Development Bureau (HHRDB)], DILG (BFP, PNP, BJMP), DSWD, DepEd, DND (AFP), DOJ (BuCor), DOTr (PCG) c. STG Registry, Data Management & M&E i. Lead: DOH (EB) ii. Members: DOH [Knowledge Management and Information Technology Service (KMITS) and DPCB], DICT, DWSD, DepEd d. STG Safety Surveillance & Response i. Lead: FDA ii. Members: DOH [EB, Field Implementation and Coordination Team (FICT), DPCB, HEMB] The COVID-19 Vaccine Cluster is supported by several independent bodies. These are: a. The National Immunization Technical Advisory Group (NITAG) for COVID-19 Vaccines is a multidisciplinary group of national experts responsible for providing independent, evidence-informed advice to policymakers and program managers on immunization and vaccine policy issues. The Philippine NITAG was organized and created through a Department Personnel Order as issued by the Secretary of Health of the Republic of the Philippines. The NITAG shall serve as an independent body that provides recommendations to the DOH and COVID-19 Vaccine Cluster, ensuring transparency, credibility, and technical soundness to the decision-making process and contributes to building public confidence COVID- 19 vaccination program. b. The National Adverse Event Following Immunization Committee (NAEFIC), comprises representatives from different medical societies and vaccine experts. It reviews, analyzes, and comes up with causality assessment as the basis for the Food and Drug Authority (FDA) action and appropriate DOH bureaus/offices on Adverse Events Following Immunization (AEFI) and Adverse Events of Special Interest (AESI). c. The Health Technology Assessment Council (HTAC), whose mandate is to undertake technology appraisals by determining their clinical and economic values in the Philippine healthcare system, with the aim to improve overall health outcomes and ensure fairness, equity and sustainability of coverage for all Filipino citizens. The National COVID-19 Vaccination Operations Center shall be headed by the COVID-19 Vaccine Cluster Chair, The Regional COVID-19 Vaccination Operations Center shall be led by the Centers for Health 41 Development with the participation of other government agencies and the Regional Task Forces Against COVID-19. And lastly, the Local COVID-19 Vaccination Operations Center shall be led by the Local Government Units. The Provincial Vaccination Operations Center shall oversee the Municipal and City Vaccination Operations Center (component cities). To avoid overlapping of functions and oversight, the COVID-19 Vaccination Operations Centers shall be distinctly separated from the EOCs of the COVID-19 Response Clusters which are headed by the Regional/Local Task Forces Table 13. Functions of the support groups to the COVID-19 Vaccine Cluster Group Function National Immunization ● Review the latest position papers, studies, international Technical Advisory Group guidelines and recommendations from internationally (NITAG) acknowledged resources [i.e., World Health Organization (WHO), Strategic Advisory Group of Experts for Immunization (SAGE)] for possible adoption in the country policies and plans for the National Immunization Programme. ● Conduct existing policy analysis, review of the program data and evidence in order to provide evidence-based technical advice and recommendations for the development of appropriate and sustainable immunization policies, guidelines, strategies and approaches related to immunization program. ● Advise the DOH in the formulation of policies, plans and strategies for research and development of existing and new vaccines and the vaccine delivery technology. National Adverse Events • Review all reported serious and cluster of AEFI cases presented for Following Immunization expert opinion and provide a final causality assessment of the AEFI Committee cases as well as the cases that were not classified by the Regional AEFI Committee. • Ensure evidence-based causality assessment by recommending further investigation and data collection as needed. • Make final decisions on causality assessment of inconclusive investigations. • Ensure standard protocols for AEFI surveillance and investigation are correctly followed. • Engage with other national and international experts when requirements arise in establishing causality and vaccine quality issues. • Provide recommendations to the National Immunization Program, EB and National Cold Chain Manager on improving immunization service delivery, compliance with injection safety and effective vaccine management based on lessons from the AEFI cases. • Serve as technical advisory group on vaccine and immunization safety-related issues of highest consideration such as immediate recall of vaccine from the market or temporary/permanent withdrawal of a vaccine from the immunization program. 42 • Serve as resource person in other AEFI related meetings, conferences or capacity building activities as requested. Health Technology Assessment • Oversee and coordinate the health technology assessment Council process of candidate COVID-19 vaccine. • Review and assess existing evidences of COVID-19 vaccines undergoing/undergone clinical trials. • Coordinate and provide recommendations to the TG Vaccine Evaluation and Selection. The Focal Points will support implementing entities and partners, including LGUs and other government entities, in implementing the SEP. The stakeholder engagement activities will be documented through minutes of stakeholder engagements, minutes of monthly and quarterly meetings with implementing partners as well as in the Project’s semi-annual reports. Consultation reports will be prepared by DOH after project-related public engagement activities have been carried out. These reports will be widely shared with the stakeholders and reported to the World Bank as defined in the ESMF and ESCP. 6. Grievance Mechanism The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective, and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of the Project; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. 6.1. Description of GRM The Grievance Redress Mechanism is open to all Project stakeholders, including the DOH personnel, health workers, communities nearby Project construction areas, vaccine candidates and vaccinated individuals, and civil society organizations to name a few. The Grievance Redress Mechanism is based on existing national policies such as the DOH’s Citizen Charter 2nd edition (2020), Civil Service Commission (CSC) Resolution no. 1701077 – 2017 Rules on Administrative Cases in the Civil Service (2017 RACCS), Department of the Interior and Local Government (DILG) Memorandum Circular no. 2017-109 – Designation of a Permanent Action Team for the Implementation of Citizen’s Complaint Hotline 8888, and the Labor Code of the Philippines (Presidential Decree no. 442 of 1974 as amended and renumbered). A. Reporting of Grievances to Authorities 43 The grievances may occur in health facility or community settings and may be relayed through the following medium/channel: physical or walk-in, mail and e-mail, and phone call. Below are the grievance reporting mechanisms per medium/channel: Grievance Reporting Grievance Reporting Mechanism Grievance Receiver Medium or Channel Physical or Walk-In Complainant files grievance through the DOH CHU or similar unit in the DOH Complaints Handling Unit (CHU) or CO, CHDs, or health facilities similar unit in the DOH Central Office Civil Service Commission and its (CO), DOH Centers for Health Regional Offices Development (CHDs), DOH health facilities, Civil Service Commission and DILG Central and Regional Offices its Regional Offices, DILG Central and Regional Offices, DOLE Central and DOLE Central and Regional Offices Regional Offices, and the Local LGU (Provincial/City/Municipal) Government Unit (LGU) Mail, Online, and Complainant files grievance through DOH CO and CHD CHU, health snail mail, email, Complaint Centers facilities, and Complaint Centers E-mail (e.g., Contact Center ng Bayan Civil Service Commission and its Presidential Complaint Center, and Anti Regional Offices Red Tape Authority) DILG Central and Regional Offices DOLE Central and Regional Offices LGU (Provincial/City/Municipal) Phone Call Complainant files grievance through DOH CO and CHD CHU and health DOH Call Center/ Hotline (COVID-19 and facilities vaccines) or through hotline of DOH CSC Central and Regional Offices health facilities DILG Permanent Action Unit Citizens’ Complaint Hotline 8888 LGU Permanent Action Unit DOLE Hotline 1349 DOLE Complaints Unit Below are the designated mail and email addresses for the DOH, DILG, and CSC Central Offices: Office Physical Address E-mail Address Hotline DOH Complaints Handling Unit, Bldg. 1, dohpau.chu@gmail.com 1555, (02) Department of Health, San Lazaro 894COVID Compound, Rizal Avenue, Sta. Cruz, Manila (26843) DILG DILG-Napolcom Center, EDSA Cor. Quezon dilgmail@dilg.gov.ph 89251135, Avenue, Quezon City 1104 89250343 44 DOLE Department of Labor and Employment laborcommunications@gmail.com, 1349 (DOLE) Building, Muralla Wing cor. General administrativeservice@gmail.com, Luna St., Intramuros, Manila, 1002 dolecentralrecords@gmail.com CSC Civil Service Commission, Constitution Hills, email@contactcenterngbayan.gov.ph 89318092, Batasang Pambansa Complex, Diliman, 89317939, Quezon City 1126 89317935 Grievances on the concerns below may be coursed through the following appropriate authorities: Concern Authority Complaints against DOH Hospitals DOH Central Office, CHD, HCF Complaints against LGU Hospitals LGU, DILG Complaints against any public/government CSC official/institution Complaints against construction activity in health HCF, LGU facility Complaints of personnel against contractor Contractor, DOLE Complaints on COVID-19 vaccination and other DOH Central Office, CHD, HCF, DILG, LGU related services Grievances may be raised by individuals or institutions who wish to be anonymous and the receiving authority should strictly observe and protect the confidentiality of the complainant. Per the 2017 RACCS of the CSC, no anonymous complaint shall be entertained unless the act complained of is of public knowledge or the allegations can be verified or supported by documentary or direct evidence. B. Reporting of Grievances to DOH on the COVID-19 Vaccination through the DOH Hotline For the COVID-19 National Immunization Program, the DOH will ensure a mechanism with multiple intake points has been designed and is in place and is operational for feedback and grievances in relation to the vaccine program. The National Emergency Operations Center with complete data management systems and tool will be established starting on January 2021. The EOC will also be established in the regional and local levels. The DOH COVID-19 hotline, which has been established last 17 March 2020, has also been an avenue for receiving grievances or complaints. The toll free numbers accessible to the public are 1555 or (02) 894COVID (26843). The Complaints Handling Unit (CHU) of the DOH- AFMT is the central receiving body of complaints. The complaints received in the DOH hotline are also forwarded to the CHU. In view of the upcoming COVID- 19 vaccination, there is a proposed hotline in support of the Vaccine Cluster. The DOH COVID-19 Hotline agents may be trained for basic protocols or provided with information guide or FAQs or basic troubleshooting steps to augment available support to vaccination teams. This will filter calls which 45 require more advanced support and may eventually be forwarded to the appropriate team for immediate assistance. Figure 7. Call algorithm of the DOH COVID-19 hotline In view of the upcoming COVID-19 vaccination, there is a proposed hotline in support of the Vaccine Cluster. The objectives are as follows: • Risk Communication - Provide a consistent, accurate information on COVID-19 vaccine to all COVID-19 Hotline callers • Serve as a first level of technical support for vaccination teams for technical concerns concerning the registry • Serve as a help desk to vaccination teams for any concerns regarding the deployment (supply request, program-specific questions, etc.) • Serve as a source of real-time surveillance data to Epidemiology Bureau for COVID-19 Hotline callers with AEFI The DOH COVID-19 Hotline agents may be trained for basic protocols or provided with information guide or FAQs or basic troubleshooting steps to augment available support to vaccination teams. This will filter calls which require more advanced support and may eventually be forwarded to the appropriate team for immediate assistance. The hotline may provide the following support: Table 16. Possible support area of the COVID-19 vaccine hotline Area Activities Supported Information Technology QR Code generation Record inaccessibility Registration concern Implementation Vaccine handling guide Basic counseling Coordination LGU to LGU 46 LGU to national government and other agencies The DOH COVID-19 Hotline may provide real-time information via email (or any provided platform) of collected epidemiologic information as it receives it from callers with AEFI ensuring immediate monitoring and follow-through of case as it is being investigated. The DOH COVID-19 Hotline will not replace, but simply augment existing communication channels. Below is the proposed process flow of the COVID-19 vaccine hotline. Figure 8. Proposed process flow of the DOH COVID-19 vaccine hotline The Grievance Redress Mechanism for the COVID-19 vaccination will be further discussed and consulted by the DOH, not only involving concerns on AEFI but also on other vaccination-related complaints, such as but not limited to forced vaccination. C. Receiving of Grievances by the Authorities The DOH Administration and Financial Management Team (AFMT) CHU personnel interviews the complainant to obtain all possible information. The CHU then evaluates if the grievance is within the jurisdiction of DOH. If complaint is within the jurisdiction of DOH, the CHU personnel will explain to the client which concerned office/agency has the jurisdiction of the complaint. Meanwhile, if complaint is within DOH jurisdiction, the CHU personnel will explain to the client that the complaint shall be properly endorsed to the concerned office and will be notified on. Grievances/complaints received by the DOH CHU are documented accordingly at the national level. The Department of Health will be in charge of keeping a database of grievances and monitoring of resolutions. This is also in line with the guidelines prescribed by the Memorandum from the Executive Secretary dated 28 January 2021 on the Updated Freedom of Information Manual of the Office of the President Proper. Similarly, the Civil Service Commission, DILG, DOLE and LGU, upon, receipt of a complaint which is sufficient in form and substance, will conduct preliminary investigation through the disciplining authority and may create an investigating committee or designate an investigator for such purpose, per Section 17- Action on the Complaint of the CSC 2017 RACCS. Further, the DILG cascades to the LGU the responsibility 47 to create a Permanent Action Team through DILG Memorandum Circular no. 2017-109, to answer queries, concerns, and complaint received through Hotline 8888. D. Resolution/Investigation Process of the Grievance For DOH, CHD, and Health Care Facilities (DOH- Owned/Managed) The grievance resolution mechanism for grievances within the jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinarv Complaints in the Department of Health are in Annex K. These grievance resolution mechanism flowcharts provide the processes depending on the category of DOH services jurisdiction (i.e., Central Office, CHD, health facility), rank of personnel complained about, and the service capacity of the health facility concerned. Grievances will be handled at the local level by the respective health facility or LGU, by the Centers for Health Development (CHDs) at the regional level, and at the national level by the Department of Health which will also be in charge of keeping a database of grievances and monitoring of their resolution. The DOH Health Facilities and Services Regulatory Bureau (HFSRB), together with the Centers for Health Development, will conduct investigations, fact-finding on complaints against health facilities, and action complaints against hospitals and other health facilities through the HFSRB- Regulatory Compliance and Enforcement Division. The said unit will streamline the process of handling complaints and hasten its resolution, in coordination with the Regulation, Licensing and Enforcement Division (RLED) of the DOH Centers for Health Development (CHD), where the latter is in-charge of the renewal of licenses of operating health facilities. According to DOH Administrative Order 2012-0012 – Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines, the HFSRB or the Director of the CHD and/or the authorized representative/s shall investigate the complaint and verify if the hospital or other health facility concerned or any of its personnel is liable for an alleged violation and may suspend, cancel or revoke License to Operate (LTO) of the HCF after investigation if found that the provisions of the AO 2012-0012 and related issuances are violated, without prejudice to taking the case to judicial authority for criminal action. For CSC, DILG, LGUs, and LGU-Owned Health Care Facilities The CSC RACCS of 2017 states that a preliminary investigation will be undertaken as a mandatory proceeding whether a prima facie case exists to warrant issuance of a formal charge or notice of charge. The preliminary investigation may be conducted in any of the following manner: • Requiring submission of counter affidavit or comment and/or other documents from person complained of within 5 days from receipt of complaint which is sufficient in form and substance • Ex- parte evaluation of records • Clarificatory meeting with the parties to discuss merits of cases When complainant is initiated by disciplining authority, it or its authorized representative shall issue a show- cause order directing the person complained of to explain within the same period why no administrative case should be filed against the person. The failure to submit a comment, counter affidavit, or explanation shall be considered a waiver thereof and the preliminary investigation may be completed even without the comment, counter affidavit, or explanation. The right to counsel may be exercised even during the preliminary investigation. 48 Preliminary investigation shall commence within non-extendible period of 5 days upon receipt of complaint by disciplining authority and shall be terminated within 20 days thereafter. Disciplining authority may extend such period in meritorious cases. Within 5 days from termination of the preliminary investigation, the investigating body shall submit the Investigation Report with recommendation and complete records of the case to disciplining authority, subject to treatment with confidentiality. If a prima facie case is established after preliminary investigation, the disciplining authority may issue either a formal charge or notice of charge in accordance with Rule 5 or the 2017 CSC RACCS. In absence of a prima facie case, the complaint/grievance shall be dismissed. For Construction- Related Grievance of the Workers A Contractor’s Personnel Grievance Redress Mechanism will also be developed by the contractors for the civil works components, in compliance with the ESF requirements in the Contract. The monitoring and reporting of this GRM will also be the same as that of the main Project GRM. Resolution of the worker’s grievance will follow the Contractor’s Personnel Grievance Redress Mechanism. In case the worker’s complaint is not resolved, it may be elevated to the DOLE, with the resolution process in Annex L. D. Closing of Grievance Once all possible redress has been proposed and if the complainant is still not satisfied, they should be advised of their right to legal recourse. E. Operationalization of the GRM The operationalization of the GRM will similarly consider the multiple sources of GRM, such as those of relevant key agencies, as it links to the dedicated GRM in the DOH established as part of the Project. The GRM is monitored by all project recipient facilities with the report submitted online monthly to the DOH, through the PCERP Team. The monitoring forms and online dashboard is in Annex M. Following engagement and feedback, the GRM and its operationalization takes into account the needs of various affected groups including from indigenous peoples and ethnic minority representatives and organizations to ensure that methods are culturally appropriate and accessible and take account of their customary dispute settlement mechanisms, as appropriate. Consultations on the GRM will be conducted with the implementers and stakeholders as participants, such as the project recipient facilities, DOH CHDs, LGUs, professional organizations, and civil society organizations. Below is the proposed online GRM consultation schedule: Session 1 Session 2 Session 3 th 4 Week of March or 1st th 4 Week of March or 1st Week st nd 1 or 2 Week of April 2021 Week of April 2021 of April 2021 • DOH Central Office NCR to Region V: Region VI to BARMM: • DOH Regional Offices/ Centers for Health • Hospitals • Hospitals Development (CHDs) • Isolation/ Quarantine • Isolation/ Quarantine facilities facilities 49 • National Government • National, regional, and • Local Government Units Agencies (NGAs)- DILG, subnational laboratories (LGUs) DOLE, CSC • Local Government Units • Associations for (LGUs) Vulnerable populations (PWDs, IPs, Gender- Based Groups) • Association of Medical Professionals (doctors, nurses, medical technicians) • CSOs involved in COVID- 19 response Further queries, concerns, or grievances on the project may be relayed to the Project Management Team through https://bit.ly/CERPFeedback. 7. Monitoring and Reporting 7.1. Involvement of stakeholders in monitoring activities The DOH may consider involving particular stakeholders in the monitoring of project activities and the implementation of the SEP and ESMF during the project implementation. 7.2. Monitoring indicators The Implementation Status and Results Report (ISR) indicator for the COVID-19 Investment Project Financing (IPF) will be observed to ensure that there is a feedback loop for citizens and stakeholders that will allow their grievances to be heard and resolved. The ISR will include the percentage of grievances resolved within the timeframe specified in the GRM for stakeholders. The ISR indicator will be monitored throughout the life of the project. Promotion and awareness on the GRM will be done continuously. Coordination with relevant LGUs/DOH offices will be conducted to record grievances and their resolutions, and to ensure that the GRM is part of the monitoring and evaluation database and system. The Key Performance Indicators (KPIs) will also be monitored by the Project monthly including the following parameters: • Number of public hearings, consultation meetings and other public discussions/forums conducted annually (even if virtually); • Number of grievances received monthly and number of those resolved within the prescribed timeline • Number of press materials published/broadcast in the local, regional, and national media 50 The template below will be used for the monthly monitoring of the SEP: Month/Year: ______________________________________________________________________ Monitoring of Public Discussions/Forums Date Activity Target Issues and Actions to be Status/Remarks Stakeholder Feedback of Taken Stakeholders Total no. of public discussions/forum for the month: _________________________________________ 51 Monitoring of Published/Broadcasted Materials in the Local, Regional, and National Media Date Type of Material Level of Target Issues Raised Actions to be Status/Remarks (News Article, Org Publication/Broadcast Stakeholder and Feedback Taken on Actions to Press Release, (National/Regional/Local) be Taken Annual Report, etc. ) 52 7.3 Monitoring of Adverse Events Following Immunization (AEFI) The WHO defines Adverse Event Following Immunization (AEFI) as any untoward medical occurrence which follows immunization, and which does not necessarily have a causal relationship with the usage of the vaccine. If not rapidly and effectively dealt with, AEFIs can undermine confidence in a vaccine and ultimately have dramatic consequences for immunization coverage and disease incidence. Based on consultations with experts and the latest data from published clinical trials as of 16 January 2021, the following are the identified AEFI from various brands of COVID-19 vaccination and must be reported. The National Adverse Events Following Immunization Committee was created to monitor and assess the possible adverse effects of the COVID-19 vaccine on individuals. The roles and responsibilities of the Committee include the following: • Review all reported serious and cluster of AEFI cases presented for expert opinion and provide a final causality assessment of the AEFI cases as well as the cases that were not classified by the Regional AEFI Committee. • Ensure evidence-based causality assessment by recommending further investigation and data collection as needed. • Make final decisions on causality assessment of inconclusive investigations. • Ensure standard protocols for AEFI surveillance and investigation are correctly followed. • Engage with other national and international experts when requirements arise in establishing causality and vaccine quality issues. • Provide recommendations to the National Immunization Program, EB and National Cold Chain Manager on improving immunization service delivery, compliance with injection safety and effective vaccine management based on lessons from the AEFI cases. • Serve as technical advisory group on vaccine and immunization safety-related issues of highest consideration such as immediate recall of vaccine from the market or temporary/permanent withdrawal of a vaccine from the immunization program. • Serve as resource person in other AEFI related meetings, conferences or capacity building activities as requested. The draft DOH training modules on the COVID-19 vaccine administration provides guidelines on the Adverse Events Following Immunization (AEFI). The working objectives of the module are as follows: Objectives: 1. To know the overall safety surveillance framework 2. To identify, manage, report and communicate effectively all adverse effects following immunization (AEFI) concerns 3. To be oriented on the basics of Immunization Safety 4. To be able to discuss AEFIs to patients and vaccine-recipients By the end of this module, the health care worker should be able to: 1. Understand the safety surveillance framework and activities 2. Rapidly identify AEFI signs and symptoms for COVID-19 vaccines 3. Administer initial management of AEFI 53 4. Report AEFI cases to the national database timely and accurately 5. Able to discuss AEFIs to patients and vaccine-recipients 6. Vaccinator should be able to discuss Immunization Safety 7. Vaccinator should be able to discuss Injection Safety The content of the module will include: I. COVID-19 Vaccines: Safety Surveillance Manual by WHO Source: https://www.who.int/vaccine_safety/publications/Global_Manual_on_Surveillance_ of_AEFI.pdf II. Overview of COVID-19 vaccines clinical trial results III. Basics of what to look out for vaccine-recipients suspected for AEFI Source: https://www.doh.gov.ph/sites/default/files/publications/AEFI_MOP%202014%20Final.pdf, Recognition and Treatment of Anaphylaxis from AEFI MOP (2014) IV. AEFI case management protocols (experiences from previous campaigns) V. Significance of AEFI reporting (minor, serious, minor clusters) VI. Procedural reporting of AEFI cases VII. Procedural follow-up of vaccination cohort (with and with AEFI case) VIII. FAQs on AEFI IX. Counselling techniques on AEFI risk communications X. Importance of Immunization Safety XI. Ultra-Cold Chain Management XII. Personnel and Equipment XIII. Procedures, Vaccine Schedule and Storage XIV. What is injection safety? XV. Injection equipment XVI. Effects of unsafe injection practices XVII. Expired vaccines XVIII. Practices that can harm recipient, health worker, and the community (in the context of COVID-19 pandemic) As part of the module, it is preliminarily envisioned in the working plan that the vaccinators/program implementers should be able to develop a final operational plan for the COVID Vaccine Program Implementation, including a system or plan for AEFI monitoring with the AEFI Monitoring Protocol/Plan as an output with the identified persons responsible for AEFI Monitoring. In the context of the COVID-19 vaccination program, any health event that has occurred after vaccination must be reported and considered as AEFI, pending proper professional consultation/case classification. AEFI surveillance shall be performed by the Surveillance Officer (stimulated passive surveillance) every two (2) weeks for the first two (2) months, then monthly for one year. This is to ensure that no health event relevant to COVID-19 shall be experienced by the recipient per incubation period of the disease. 54 Figure 9. Process flowchart for AEFI surveillance and response in the context of COVID-19 vaccine administration Figure 10. Process flowchart for responding to serious AEFIs of COVID-19 vaccine Table 15. WHO-recommended safety surveillance activities for all countries introducing COVID-19 vaccine regardless of AEFI surveillance capacity 55 Objective Recommended AEFI surveillance activities Strengthen routine passive ● Conduct training on identification and reporting of AEFI for AEFI surveillance reporting health care professionals. systems for the management ● Update, print and distribute AEFI surveillance tools. of increased frequency or ● Use both vaccine tracking information and passive AEFI severity of AEFI reports (mild, reporting information to perform vaccine-specific safety moderate and severe) analyses. ● Review and adapt processes for timely reporting, review and data sharing nationally, regionally and globally (e.g. uploading data to global databases such as the WHO VigiBase) ● Develop clear standard operating procedures (SOPs) for the coordination process between the NRA, NIP/EIP, and other institutions with responsibilities for AEFI surveillance. ● Consider coordination of activities with Public Health Emergency Units. ● Consider setting up AEFI committees at subnational as well as national level, particularly in large countries Investigate potential AEFIs ● Prepare investigation teams and train them for AEFI causing concern, such as investigation activities that are relevant in the population being clusters, serious events, vaccinated. programmatic errors, ● Update, print and distribute AEFI investigation tools to obtain community concerns information on specific outcomes. ● Ensure the collection and storage of all relevant data to help make a causality assessment (AEFI reporting and investigation forms, clinical case record, laboratory reports, autopsy reports, etc.) Perform systematic causality ● Constitute an National AEFI committee to review and respond to assessment of AEFIs causing AEFI safety signals and public concerns or contact the WHO concern Country or Regional Office or send email to gvsi@who.int for assistance. ● Provide training on causality assessment processes using WHO causality assessment guidelines for members of the National AEFI committee. ● Ensure regular updates to the Committee members on COVID- 19 vaccine development and safety data, including safety reports from ongoing phase III clinical trials or any events reported in clinical trials. ● Foster and use the committee’s expertise to identify AEFI cases in need of further investigation, such as AESIs. 5. Anticipate an increased number of AEFI reports that will need to be reviewed and consider including AEFI committees at subnational as well as national level, particularly in large countries. Use AEFI and disease ● Regularly review and report AEFI surveillance data, particularly surveillance data to detect those relevant to AESIs or other conditions identified during pre- potential safety signals or licensure COVID-19 vaccine clinical trials. clustering of events ● Explore the use of disease surveillance data to complement AEFI surveillance systems for the detecting of AESIs, if indicated. ● Consider use of early signal detection methods, especially for certain AESIs. 56 Prepare comprehensive plans ●Outline roles and responsibilities of key stakeholders (including to respond rapidly to any the private sector) for the implementation of safety surveillance COVID-19 vaccine-related activities and responding to vaccine-related events. event ● Keep stakeholders up to date with COVID-19 vaccine safety information. ● Communicate with WHO regions and globally and share data on outcomes of AEFIs and AESIs in a rapid, timely and regular manner. Address concerns of ● Create and share a COVID-19 vaccine safety communication plan healthcare professionals and with relevant stakeholders. maintain community ● Train and support personnel at all levels to address concerns confidence. (Link to that may arise before, during and after COVID-19 vaccine communication module to be introduction. added) ● Develop, print, and distribute messages concerning the safety COVID-19 vaccines Note: Objectives and Recommendations were adapted from the WHO COVID-19 Vaccines Safety Surveillance Manual: Module on Establishing surveillance systems in countries using COVID-19 vaccines, 2020. Figure 11. AEFI surveillance cycle The DOH has also been developing the ‘Standard Operating Procedure (SOP) in Handling Serious AEFI Cases in the Region’ with the aim of providing a standardized guideline to all epidemiology and surveillance units towards a robust implementation of safety surveillance and in order to maintain the public confidence in the national immunization program of the Department of Health. This SOP covers the general parameters in pursuance of AEFI surveillance and response across the private and government health facilities, with reference to the following guidelines: 57 • World Health Organization. (2014). Global manual on surveillance of adverse events following immunization. • Department of Health – National Epidemiology Center. (2014). Adverse events following immunization (AEFI): A manual of procedure for surveillance and response to AEFI. • DOH Administrative Order no. 2016-0006: Revised Guidelines on Surveillance and Response to Adverse Events Following Immunization Currently, the AEFI guidelines stated in the NDVP has been communicated to the implementers and the public through the series of consultations on the NDVP and the training for vaccinators and DOH CHDs conducted by the DPCB. Once the said SOP had been finalized, consultations and trainings will be conducted by the DOH. 7.4. Reporting back to stakeholder groups The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Monthly summaries and internal reports on public grievances, enquiries, and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The monthly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: • Reporting on the status of KPIs and ISR indicators • Publication of a stand-alone annual report on the Project’s interaction with the stakeholders • The monthly and yearly monitoring forms will be used for the reporting to stakeholders. 58 Annex A. Results and summary of key feedback in the National Stakeholders Consultation on the Parent Project conducted on August 18-19, 2020 Topic Stakeholder Comment / Feedback Response Stakeholder Save the Children Query on the difference in the engagement among The SEP is a guide for stakeholder engagement Engagement Philippines groups or if the groupings were made to facilitate throughout the project implementation. It is a consultation living document which will be revised as appropriate, considering the feedback of the In view of the prolonged pandemic and its wide stakeholders. The SEP distinguishes between impact, it may also be necessary to review who are affected and interested stakeholders and affected. identifies vulnerable stakeholders that may require special attention. Philippine VAWC is an important issue. We should raise VAWC and GBV are highlighted in the ESMF Coalition on the awareness, provide information on how to access, and SEP and awareness will be integrated in the UNCRPD and provide help desks. project activities. Saint Anthony Risk of transmission is high for patient watchers The patient watchers are covered by the Mother and Child within hospitals. Guidelines for control and mitigation guidelines on the rational use of personal Hospital measures of transmission and accommodation for protective equipment (PPE). There are no them for social distancing is recommended to be accommodations for them due to the high provided. number of cases needed to be catered and the risk of infection. Strengthening MIMAROPA Health care manpower is the main challenge, The project activities include mostly provision capacity in the Center for Health especially in geographically isolated and of equipment to build COVID-19 response regions Development disadvantaged areas (GIDAs). Health care facilities are capacity and some repairs of health care (CHD) existing but there are no applicants. facilities and laboratories, including the isolation rooms. CARAGA CHD The locally stranded individuals or LSIs are major sources of COVID-19 infection (56%) in the There will also be a capacity building MIMAROPA region. Ways in which the project can component for health care workers. help address this problem are sought. Moreover, ways to strengthen capacity at the regional Project consultations and trainings will be and facility levels are sought. provided. These will mostly be online due to challenges in the implementation of the project due to the pandemic. 59 Services for National The accessibility of services and infrastructure (e.g. The DOH Health Facilities Development Bureau persons with Commission on ramps) and hospitalization support for PWDs who will (HFDB) has reported that there are 10 disabilities Disability Affairs contract COVID-19 should be provided. It was also provincial hospitals which currently have (PWDs) and (NCDA) pointed out that each type of disability has specific Filipino sign language interpreters (FSL) who children needs and support services which may need capacity are mostly social workers employed by the Filipino Sign building of health care personnel. hospital. They are as follows: Language Access Team for COVID- There is a need for virtual sign language interpretation Region Hospital 19 services in health care facilities, testing centers, and NCR Jose Fabella Memorial Hospital, quarantine/isolation areas. There are networks who Lung Center of the Philippines Philippine Alliance may be able to provide sign language interpreters but I Mariano Marcos Memorial Medical of Persons with they are mainly based in Manila. TFSL interpretation Center, Chronic Illness in health facilities through video calls provided by Ilocos Training and Regional (PAPCI) service providers is recommended. It was also pointed Medical Center, out that the DOH and DILG should comply with RA Region I Medical Center Philippine 11106 or the Filipino Sign Language Law by providing IV Batangas Medical Center Federation of the such services in health facilities, workplaces, and the VI Corazon Locsin Montelibano Deaf media. Memorial Regional Hospital, Guidelines on FSL interpreter qualifications, including Don Jose Monfort Memorial Philippine skills and ethical considerations is needed. Medical Center Extension Hospital National VII Vicente Sotto Memorial Medical Association of Access to information for PWDs is also a main concern Center Sign Language as sign language interpretation is still very limited. XII Cotabato Regional Medical Center Interpreters Unlike national TV news, regional TV news do not (PNASLI) have sign language interpretation. Grassroots According to the Degenerative Disease Office organizations have turned to social media to of the Disease Prevention and Control Bureau Live Haven, Inc. disseminate information. They requested that the (DPCB-DDO), the new education curriculum of project stress the importance of access to information social workers has integrated basic FSL. It Philippine through DOH, even if the COVID IEC funds come from should be noted that hospitals have at least 1 Coalition on the a different donor source. social worker. It would be ideal if the employed UNCRPD social worker has background on FSL. Assistance to the deaf in finding hospitals which are The Metro Manila and CALABARZON Centers deaf- accessible and providing counseling services for Health Development (CHDs) are conducting should be given. community- based trainings on FSL. It is 60 planned to cascade the training to the other There is a need to accommodate and entertain regions in 2021. carers/personal assistants of PWDs and children in health care facilities, testing centers, and The Congress is also discussing the provision of quarantine/isolation areas. FSL interpreters in health facilities. However, the timeline for this is not yet known. Vaccination for children and other vulnerable sectors should be provided. The Project will be conducting a baseline assessment on the capacity of the recipient The PWD groups have expressed their interest in hospitals to provide accessible health services being engaged and involved in the project to vulnerable groups, including provision of implementation. The need to recognize vulnerable virtual FSL services based on parameters such groups, e.g., PWDs and IPs, were pointed out. as availability of devices and internet connection. The baseline assessment will also cover GBV, VAWC, and IPs. Based on the results of this assessment, the Project in coordination with HFDB and DPCB- DDO, will determine the feasibility of the virtual FSL services which would be in partnership with the FSL interpreters and PWD representatives to be financed by the Project. The DOH Health Promotion and Communication Services (HPCS) has no COVID- 19 health promotion materials for the PWDs. Currently, they only have the 30- second video with FSL interpretation for polio. The HPCS and the DPCB- DDO have included PWD- accessibility in their Communication Plan for 2021 which will include printer materials with Braille and videos with sign language. The DPCB- DDO in partnership with the Philippine Information Agency (PIA), have previously 61 developed a Communication Plan for PWDs which was also presented to the PWD CSOs. The concerns of PWDs, particularly accessibility, will be considered in the activities under Component 3, Project Management and Monitoring and Evaluation, of the project by integrating into the prevention and preparedness activities. Project management and monitoring should ensure that the improved capacity of the health care facilities results in improved access for PWDs. The PWDs and other vulnerable sectors will be highly considered in the project. The ESMF will also be revised to include Republic Acts 11106 and 7277 and Batas Pambansa 344 to further strengthen the framework. The request for vaccination of children and Philippine other vulnerable groups as well as the Pediatric Society guidelines for carers/personal assistants of (PPS) PWDs and children will be relayed to the DOH DPCB, HFDB, and the DOH IATF Focal Team. Pediatric The PWD CSOs will be requested to submit a Infectious Disease formal request to the IATF Society of the (iatfsecretariat@gmail.com) and DOH Philippines regarding the grievances of the carers / (PIDSP) personal assistants. The HFDB, with assistance from the Project, will develop a policy issuance to consider the carers of PWDs and children in health facilities. 62 Indigenous Tebtebba It was recommended to include disaggregated data The DOH Epidemiology Bureau (EB) which is in- Peoples Foundation for Indigenous Peoples related to the COVID-19 charge of the data management on COVID-19 response. does not have disaggregated data for IPs. The group also relayed that they have conducted an The request has been communicated to EB. assessment on IPs and COVID-19 which they may The Tebtebba Foundation has submitted their share with the Project Team. request for data on Indigenous Peoples (identified as to their ethnicity) infected by COVID-19 and history of infection aside from the usual data provided to the EB. The Project will further assist Tebtebba Foundation on this request. To ensure that IPs will have access to the COVID-19 related health services, the DOH Bureau of Local Health Systems Development (BLHSD) has issued Department Circular 2020- 0192 last April 2020 entitled ‘Ensuring that people in GIDAs, Indigenous Cultural Communities/Indigenous Peoples are well- informed on COVID-19 and have access to Temporary Treatment and Monitoring Facilities and Referral Hospitals.’ BARMM Community and Coordination with BARMM MOH and project BARMM is covered by the project. The Amai Family Services coverage inclusion was asked. Pakpak Medical Center is included in the International tentative list of recipient facilities. Coordination with BARMM MOH will be done through the Field Implementation and Coordination Team- Visayas and Mindanao Grievance Save the Children It was raised that if the grievance pertains to the It would be good if the issue will be resolved at Redress Philippines service received from a local health facility or LGU, the local level. Grievance may be elevated to Mechanism submitting the grievance to them may prevent the regional and national levels, following the GRM community to raise concern. process. 63 ESMF Philippine The provision of pneumococcal, flu, and hepatitis B This will be considered in the project activities. Medical vaccines for health workers was recommended. It has also been relayed to DOH DPCB, as it is Association in-charge of vaccination initiatives (not financed by the Project). It should be noted that these vaccines are covered in the Expanded Program on Immunization (EPI) of DOH. There is a need to address health hazards brought The infectious waste- generating about by the improper disposal of face masks. establishments as well as the waste service providers or treatment, storage and disposal facilities (TSDs) should comply with the DENR EMB guidelines for waste generators. The ESMF includes measures to improve waste management and will be further enhanced through an ongoing audit of current infectious waste management at health facilities. The audit tool developed by the Project will provide the health facilities self- assessment tools to monitor waste disposal. Education campaigns and information materials on infectious wastes and proper disposal will be further promoted. Occupational safety and health risks during The project will not develop additional construction should be addressed. It was inquired guidelines as there is limited construction whether specific guidelines will be issued due to the activities involved. Workers will be provided COVID-19 pandemic, aside from the usual OHS and with face masks by the contractors and social DOH issuances. distancing measures for construction will be adhered to. The contractors will also be asked to prepare the Environmental and Social Management Plan (ESMP), Environmental Codes of Practice (ECOP), Labor Management Procedures (LMP), and Contractor’s Personnel 64 Grievance Redress Mechanism to minimize occupational risks in the civil works components. Cebu The Republic Act 11058, Department Order South The coverage of medical bills and wages of workers Medical Center 198, and the IATF issuances set liability on the who will contract COVID-19 was queried. Experience contractor. To further highlight the on symptomatic workers in which the hospitalization contractor’s responsibility, the liability clause costs and compensation were covered by the hospital was relayed. will be explicitly stated in the contract. The ESMF includes Labor Management Procedures. Recipient Pangasinan The health facilities which will be covered by the The hospitals to be included as recipients of the hospitals and Provincial Health project and the equipment to be given were asked. World Bank loan are the 70 retained DOH equipment Office hospitals and the 30 hospitals part of the Universal Health Care implementation sites which were first approved by the NEDA. Luis Hora The hospitals invited in the National Stakeholders Other hospitals not part of the project may be Memorial Consultation are included in the initial list of covered by other projects such as that of ADB. Regional Hospital recipients recommended by the HFEPMO. The local government units through the provincial, city, and The recipient facilities were selected based on municipal health offices were invited for their capacity to test, i.e., ongoing application for information and guidance on the project. accreditation. Mariano Marcos It is envisioned to expand the testing in the rural areas The local government units through the Memorial also. However, the project recipients are chosen provincial, city, and municipal health offices Hospital and based on the ongoing application for testing were invited for their information and Medical Center accreditation. guidance on the project. It was also clarified that the project is different from the existing project of HFEPMO. The HFEPMO will finalize the list of hospitals and equipment to be distributed. 65 Project Mariano Marcos The project requirements and expectations from There will be no project proposal required as Implementation Memorial recipients, e.g., proposal, timelines, funding approval, the health care facilities are chosen Hospital and project termination, and monitoring and evaluation. beneficiaries of the project. It will follow the Medical Center usual protocol on accepting donations from the DOH Central Office, such as accomplishing the Deed of Donation, i.e. formal transfer of ownership and acceptance from DOH to the recipient hospital. The recipient is expected to maintain the equipment for its sustainability. Post- evaluation and monitoring may also be conducted by the Project Team. The HFEPMO clarified that there will be mostly retrofitting/upgrading of the existing hospitals and that currently, only the National Center for Mental Health and Dr. Jose Rodriguez Memorial Hospital will have new constructions. The list of construction works will be sent by the HFEPMO. It was queried if the civil works component of the Corazon Locsin project will cover only the existing facilities. For the safety of the workers, PPEs will be worn Montelibano and the hierarchy of controls will also be Memorial observed. Engineering controls and Regional Hospital substitution will also be observed. Project Tebtebba The COVID-19 recovery will take a “heal as one” To extend the benefits of the project, the Sustainability Foundation approach, aside from the direct results of the project, recipient hospitals will have to and are entailing community mobilization. expected to take good care of the project donations, such as the equipment. Training of It was asked if there would be an exit strategy to personnel will also be part of the sustainability guaranteed sustainability of project benefits. It was initiatives. also inquired how the exit strategy ensure that indigenous health care, knowledge and management In areas with IP, the ESMF includes measures to systems, as well as traditional health care providers coordinate with traditional health care providers, consistent with DoH’s Guidelines on 66 would be acknowledged and recognized, given their the Delivery of Basic Health Services for significant roles in community health. Indigenous Peoples/Indigenous Cultural Communities. Annex B. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment on December 7, 2020 Topic Stakeholder Key Agreement/ Recommendation General Guidelines UP College of Medicine To include communication and health education in the specific objectives (UPCM) To include and to prioritize the widespread communication and understanding of COVID burden and its prevention To include and prioritize the widespread communication and understanding of COVID burden and its prevention DOH Reconsider statement that COVID-19 vaccine is a ‘public good’ as this term is different in economics UP College of Public To consider the reciprocity Principle under WHO SAGE framework Health (UP CPH) Financing and Funding UPCM To specify the establishment of plans and strategies to make the country vaccine Mechanisms ‘resilient’ able to address setbacks, disruptions, crises that could destroy the immunization programme with a view to ensure programme continuation Identification of UNICEF To identify the minimum list of the priority population Eligible Population DOH Epidemiology Inclusion of the term 'herd immunity' Bureau (EB) Coalition for People's Exclusion criteria must also be mentioned apart from eligibility Right to Health (CPRH) 67 Supply Chain and UNICEF To have the supply chain management plan linked to the overall EPI cold chain Management of management plan and to use the evidences from the VRAT/VRAF assessment and EVMA Health Care Waste and recommendations Injection Safety Office of the Presidential Inclusion of the statement ‘Facilitate procurement through various mechanisms allowed Adviser on the Peace under existing laws, rules, and regulations through bilateral, multilateral and other Process (OPAPP)/ financial modalities (e.g., COVAX Facility, etc.)’ National Incident Command- Emergency Operations Center (NIC- EOC) Human Resource Philippine Pharmacists To include a provision for the active involvement of the barangay health workers at the Management and Association (PPhA) level of the community Training To include training of uniformed men to understand the proper handling and storage of these vaccines DOH EB To include 'health care waste' management plan DOH DPCB Occupational Consider to include in the definition of terms who are the members of the committees Diseases Division (ODD) such as NITAG, etc. Vaccine Acceptance UP CPH To identify and consult the end-users of the data management system with the other and Uptake stakeholders in the process of developing the information system (IS) to come up with a user-friendly digital system To train end-users in the functionality of the IS to minimize use of parallel (often paper- based) technologies which arise with non-familiarity with the new system Vaccine Safety UPCM To have an active surveillance system rather than just a passive surveillance system Monitoring, Management of AEFI and Immunization There is a need for media management when it comes to AEFI reporting Safety Immunization CPRH There should be communication of exclusion criteria to be specified apart from eligibility. 68 Registration, DOH EB A phased-in profiling of eligible populations based on areas with high burden of disease Monitoring and Data and priority population groups shall be conducted. Management Systems Roles and OPAPP/NIC-EOC Task Group on Procurement and Finance be led by the Department of Finance with DBM Responsibilities and DOH as members One of the Task Groups to develop a strategic map with necessary indicators and targets for easy monitoring To include the number and general description of the NITAG’s composition DOH EB To include FDA in the agencies/ offices to be provided with recommendations by the NAEFIC PPhA Task Group on Cold Chain and Logistics to consider mobilizing pharmacies to be center for pharmacy-based immunization CPRH To review the implications on the implementation if Phase III clinical trials and the implementation of the vaccines with EUA will overlap Annex C. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment on January 8, 2021 Topic Stakeholder Queries/Recommendations DOH Responses Presentation of the Dr. Quizon Why are indigent populations among priority groups? Their DPCB answered that it will be discussed National COVID-19 risk is no greater than a rich person. Is there evidence that during the next NITAG meeting to Deployment and those who got infected so far, are indigents? discuss the order of priority Vaccination Plan League of Will the National Government's purchase of vaccines be DPCB said yes and all vaccines will be Provinces of provided to the LGUs, as identified according to the IATF's coursed through the LGUs. the Philippines priority plan? Mr. Jose, Jr. Dir. Sudiacal of DPCB responded that Order of priority for non- medical government officials such Government workers aside from those as Mayors; local Gov’t officials and Government workers in Government offices? Also Congressmen and Senators? mentioned in Priority A area under Priority B. Far Eastern How will the vaccinees be notified of their vaccination The LGU and the implementing unit University - schedule? such as the health facility will Nicanor Reyes determine your schedule. On the other 69 Medical hand, a digital system will notify you of Foundation your vaccination schedule date. School of What is the implication of the vaccine pre-registration already Medicine being done by various LGUs (i.e., online registration via As of now, DOH is working closely with Google Forms) with the proposed plan of vaccine the LGU to marry existing information deployment? systems and the COVID-19 Vaccine Electronic Immunization Registry (CEIR). Ideally, only those registered in the CEIR will be provided with a unique QR Code, and thus, eligible to be vaccinated. Ms. Ramos In the vaccination program and asked if the HCWs will be The DOH is requiring each prioritized. However, this will impact the resources needed implementing unit to do micro for the vaccination program as well as continuous health planning to ensure that contingency services. In particular for the first round of 1.7M HCWs, they plans are available if a health worker is will need time off after vaccination due to the expected side not able to report due to adverse effects. Will there be a number of people who will reactions. And the vaccination activity supplement the HCWs while they are recuperating? How is done through a determined schedule long will they be given time off? basis. Thus, the health facility should be able to allocate adequate human resources for the conduct of continuous health services. Ms. Kraft If remaining indigent population has been indicated as a The vaccines will be given to eligible priority population group, will this group include those who population groups. As of now, data are below 17 years old? I ask because some of the vaccines shows that COVID-19 vaccines can only have not been tested on children. be administered to >16 years old and above. Ms. Rabe Can the LDRRM Fund or Quick Release Fund be used for the Unfortunately, we do not have any purchase of vaccines? jurisdiction on this. We will forward your concern to DBM. As reiterated by Usec. Cabotaje, the vaccines will not be available commercially until late 2022. 70 Procurement will be coursed through DOH. Ms. Nievera Will there be instances where vaccines will be used The vaccines will be given to eligible interchangeably - meaning another vaccine is used for the population groups. As of now, data 2nd dose? How do we monitor/manage/avoid such cases? shows that COVID-19 vaccines can only be administered to >16 years old and above. Mr. Songco Who is allowed to vaccinate? Doctors and nurses. Ms. Luzande What kind of distribution model will the government employ? It will be a centralized hub. Centralized, Hub and/or Decentralized? HTAC Evaluation Mr. Ybiernas What type and brand of vaccine to be given to the Filipino Dr. Guerrero mentioned that there is a Framework for People?Do we have a list of brands to consider? need for EUA before we can use and COVID-19 Vaccines administer the vaccine. The FDA has yet to issue EUA to any vaccine but they have received at least 2 applications as of the moment. Ms. Villa Regarding prioritization of vaccines to be given, will it be Yes, we are adhering to the principles considered to prioritize giving to those LGUs who have not of equity and reciprocity. The national manifested procurement of their own vaccines? government will provide vaccines to all LGUs/areas, following the priority eligible population. Cotabato If the individual has already been infected,what priority level Dir. Arevalo mentioned that DOH Regional will they belong to? through the Health Promo Bureau has Medical done social listening and surveys. Center Demand Generation is headed by the Ms. Maderazo If the EAU will be given to DOH only for purposes of intense PCOO along with DOH, DICT and PIA. side effect monitoring, does it mean that the LGUs with alleged budget allocation for their own vaccine procurement Conduct of a series of townhall is not necessary? meetings have started to increase Laban The acceptability of vaccination among Filipinos is only 50% awareness about the vaccination. Consumer as a result of the surveys. Therefore, what is the plan of the government to increase acceptance of the vaccine? US experience: Vaccination sites were not prepared so the DOH has started the capacity building and other 71 strategies including communication before the vaccination. Ms. Kapunan Will the LGUs be able to independently procure vaccines or The LGU can procure vaccine will the EUA be granted only to DOH? Health How will the government certify that a person has been The DPCB will coordinate with HFSRB Technology vaccinated? Will this certificate be recognized abroad? Are and LGUs. Assessment there internationally accepted formats right now? Council (HTAC) Philippine What is the role of hospitals in this immunization program? Dir. Arevalo answered that Hospitals Hospital will be vaccination sites. Further, Association capacity building through e-learning will be done starting next week. Hence, both the Public and private hospitals are included in the training. Contact details of hospitals and LGUs where they are located were requested for succeeding trainings. Ms. Tiamzon In the news there are private companies who are saying that The DPCB will still coordinate with the they will also be procuring COVID-19 vaccine. How is this in private sectors. sync with the government's procurement of the vaccine? League of On the EUA/FDA Approval: FDA will provide information on the Provinces of Can LPP get the contact information of the FDA approved vaccines approved by January 15, only the Philippines supplier? one applied is currently being assessed. Usec. Myrna Cabotaje added that all vaccine trials are on Phase III, they have not finished Phase III and Phase IV yet. The DOH cannot introduce vaccines unless they are in Phase IV of the clinical trial. 72 The EUA is an authorization not a marketing authorization so this will not make the vaccine commercially available for procurement of individuals, private entities and the government. Acquisition and access are done through Sec. Galvez. Consignee designation through Sec. Duque. Hence, we always have tripartite agreements. Ms. Delos Is the vaccination program on a voluntary basis? How do we Vaccination will be based on vaccine Reyes handle persons in the Priority Group who will not allow availability. If they miss their themselves to be vaccinated? opportunity to be vaccinated the first time they will have to wait for the second round based on the available vaccine. Dir. Arevalo said that it depends upon the LGUs, Hospitals and Priority group heads to encourage them to be vaccinated. If they refuse, it will be given to other priority groups. Dir. Arevalo encouraged them to be the champion among their organization to increase the uptake of COVID-19 vaccination. Mr. Salacut Under Eligible Population in the presentation, No. 5 is This has been duly noted. Uniformed Personnel. For its Definition of Term, recommend the following: All Officers and Enlisted Personnel 73 Dr. Dy Which Priority Group would non-senior citizen patients with If they are healthcare workers they will underlying medical conditions (such as DM, with Congestive be prioritized but there will be Heart Failure) belong to? intersectoral prioritization for those with co-morbidities will be prioritized. The WHO SAGE recommendation does not include the co-morbidities. Ms. Ciriaco In this program, the vaccine will be given to the priority population for free, be it private or government? Philippine How to register personnel to attend the TOT? The secretariat will contact them. Coast Guard Medical Services Ms. Tinio What about the private clinics or physicians in private practice? Mr. Faraon Will there will be a geographic prioritization based on local It will be determined based on the context and epidemiologic setting? how will allocation be eligible population done? NCR will have more allocation compared to Batanes? Mr. Cruz What if, for example, a frontliner works in Quezon City but The vaccinee will be vaccinated in his resides in San Juan City, which LGU will vaccinate this workplace as a frontliner frontliner? Mr. Yudelmo What interventions are done to ensure that people will get Dir. Arevalo said that there are vaccinated? communication handles to have greater uptake on COVID19 immunization. Training for navigators, community mobilizers will also be conducted especially those affected by previous vaccination initiatives. Dir. Arevalo enjoined all attending the forum to help promote the vaccination program of the government. 74 Videos are being disseminated to Health Promotion Officers to be popularized. Dr. Anthony Will NCR be prioritized? Dir. Arevalo said that Eligible Faraon population is based on the burden Family Considering the portfolio of medicines ( 5 to 6) how will this (sectoral) and geographical (based on Foundation be allocated? What if an LGU has preference over a certain prevalence). The NITAG will discuss the vaccine other than what is allocated to them? priority population based on certain criteria (attack rate, case fatality, readiness of the LGU) tomorrow and give the recommendation to DOH and the vaccine czar. In terms of vaccine portfolio, the vaccines that will come based on the prioritization based on the specific guidelines that will not be based on preference . It will be administered as prioritized and not on preference. If they waive their opportunity to be vaccinated, there will be a second round still based on availability. Health Care After the use of EUA, will they still undergo HTAC review? Dr. Guerrero said that LGUs can not Professional Timeline after EAU to HTAC recommendation? procure without the clearance of Alliance on HTAC. COVID-19 Is there guidance for LGUs who already set aside their budget for procurement of vaccines? Even without the EAU, the HTAC are already reviewing the evidence for the vaccines for publication. It is easier to issue the recommendation. Per Bayanihan Law, only Phase IV was waived. 75 The second question was already answered by Usec. Cabotaje earlier based on specific guidelines to be released thru Sec. Galvez and Sec. Duque. Mr. Dimagiba After all requirements have been complied, what is the The vaccine will not be available yet in procedure for the vaccination? Will this be a prescriptive the market and will not be available on vaccine or available in the market for consumers? prescription basis. We are still waiting for the EUA to vaccinate the priority population. The LGU preparation will follow the usual campaign of the National Immunization Program except that the vaccine is not yet available in the market but through EUA. Ms. Paredes It was suggested that the DOH and HTAC can be invited in Noted. their meeting for the Governors which they will schedule soon, to discuss the COVID-19 vaccines. Please communicate through sandy.paredes.lpp@gmail.com 09167528005 When will the vaccine be commercially available? The vaccine after clinical phase IV, will be given CPR and only then can it be commercially available. The Director General of FDA predicts that it might be commercially available by late 2022. Depending on the supply of the vaccine, all will be vaccinated on a phased implementation. 76 Ms. Rabe What will be the guidelines/process for securing the consent The STG on registry and data of patients for the administration of the vaccine? what is the management is in close coordination timeline for the release of the national roadmap on vaccine with the Legal service. availment? LPP How does DOH/IATF intend to allocate the limited vaccines to Distribution will be primarily based on 82 provinces? sectoral prioritization. Followed by geographical prioritization,(based on disease burden - attack rate, incidence rate/active cases and readiness of LGU. UP Diliman Recently, there has been news that Taiwan has found 73 side DPCB answered that the vaccines are effects of China's Sinopharm, while Sinovac's vaccine evaluated regularly based on a set of appeared to have efficacy of less than 80% in other countries, guidelines. notwithstanding the more expensive price of these vaccines compared to other Western-made. Considering that the Duterte administration prefers vaccines from China and that the DOH prioritizes efficacy, how would the DOH (particularly the COVID-19 Task Force) compromise? Ms. Belen Makati LGU announced that they can include the vaccine The IATF will still have to determine the purchase of businesses around Makati if these companies process would like to buy the vaccine. Is this allowed? Also, Red Cross, as mentioned by Sen Gordon the other day, can procure vaccines for the country, and sell these to those who can pay. Is this allowed as well? PHPSP Will the vaccine procurement undergo HTAC review? HTAC recommendations can only be issued after an EUA is issued by the FDA Will the review happen before or after issuance of EUA? to ensure that basic safety and efficacy standards are met. Annex D. Results and summary of key feedback of the Consultation with Persons with Disabilities on the PCERP held last 5 October 2020 Topic Discussion Action Points/ Clarifications/ Key Agreements Competency Ms. Agbay of the Philippine Federation of the Deaf raised that the The level of knowledge/ competency of the and guidelines FSL interpreters in the health facilities are knowledgeable on the interpreters on FSL will be added in the indicator. 77 on the FSL medical terms, especially for COVID-19, and not just the interpreters background on basic sign language such as hand signals for letters. The ethic and previous work experiences of FSL interpreters will be considered in the drafting of the Aside from the competencies of the FSL interpreters, Ms. Dagani said guidelines. of the Filipino Sign Language Access Team for COVID-19 pointed out that previous health- related experiences and ethic guidelines are necessary in the qualifications of the interpreters. It was noted that the civil society organizations (CSOs) are providing virtual FSL services during the COVID-19 pandemic. Moreover, it was noted that they will be charging fee from the government if their services will be contracted. Health The PWD representatives concurred that the health promotion Inclusivity and accessibility of PWDs in the health promotion materials, especially for COVID-19, should be sensitive to the promotion materials was communicated to DPCB- materials for needs of all PWDs, covering all types of disabilities, as set forth in DDO and HPCS. This will also be included in the PWDs the Batas Pambansa 344. indicators of the proposed HCF capacity assessment for services for vulnerable groups. Ms. Rabino of the NCDA recommended to include accessible website/s or ‘web accessibility’ for visual impairment in Ms. Rabino of NCDA will share to DOH and the PWD coordination with the Department of Information and groups the information on web accessibility for Communications Technology (DICT). better access for the blind. Infrastructure Mr. Bernandino and Mr. Manlapaz of the UNCRPD stressed the The structural requirements of the BP 344 and needs of PWDs importance of the compliance of health facilities to the Building Building Code for PWDs, such as the PWD- Code with regard to the needs of PWDs. accessible CRs. will also be included in the indicators of the proposed HCF capacity assessment for Ms. Agbay also added that the elevators of the health facilities services for vulnerable groups. should also be accessible to the PWDs and their assistants/carers. Ms. Rabino raised that the comfort rooms (CRs) of some health facilities do not fit wheelchairs. Annex E. Results and summary of key feedback of the Consultation with Gender- Based Groups on the PCERP held last 30 October 2020 78 Topic Discussion Action Points/ Clarifications/ Key Agreements Accessibility of Ms. Jennifer Garcia of the Regional Association for Women Engr. Joselito Riego de Dios responded that the DOH has existing services for with Disabilities raised that women with disabilities may strategies and programs for the PWDs to provide COVID-19 women PWDs have difficulty in accessing WCPU services due to services as well as gender- related concerns. These strategies decreased mobility during the pandemic. were also discussed in the meeting with the PWD representatives last October 5, 2020. To further improve the services for PWDs, GAD, and WCPU, the Project will conduct a health facility assessment to evaluate the services for vulnerable groups and identify areas for support and improvement. Coordination Ms. Giceline Artuyo of DOH-HPDPB recommended the Ms. Gaylan reiterated that the ESMF, ESCP, and SEP of the with other Project to coordinate with the Office of Undersecretary Project are submitted to the Office of Usec. Bayugo for clearance DOH Bureaus Bayugo (FICT) to harmonize the environmental and social as the Chief Incident Commander for COVID-19. risks identified in the Project with the National Action Plan of DOH for COVID-19. She also suggested to coordinate Further coordination with FICT and HEMB will done succeedingly with DOH- HEMB for other gender- related initiatives with by the Project. regard to emergency response. Importance of According to Atty. Rubin, the Commission on Human The suggestions of the CHR will be forwarded to the GAD TWG gender- based Rights appreciates that gender is mainstreamed in the for consideration and further discussion. initiatives and DOH programs and that GBV response is a component. gaps on the The CHR has emphasized the need for gendered and current intersectional response to the crisis, particularly implementation emphasizing that GBV should be a part of COVID response of services and special focus should be provided for marginalized groups, hence a Joint Memorandum Circular with DILG was developed to also address the risks posed, especially for marginalized groups. As we agree with the finding of WCPUs that there has been decrease in reporting of GBV, and that there are breakdown/gaps in referral mechanisms, we support programs that increase the number and enhance the functionality of WCPUs in the country. WCPUs are crucial to GBV response with their multi-sectoral teams, and it is distressing to hear the assessment that some were unable to provide the same services during the pandemic. Ensuring continued 79 functionality, coupled with updated and community/LGU based functional and updated referral mechanisms is important. As part of the program's risk management, Atty. Rubin noted that it is good that gendered responses are included for health service providers. It was suggested to consider the need to protect and address as well the multiple burden of community health service providers (BHWs that are on allowance basis with LGUs), and contractual health workers engaged under the project. There is also a need to recognize unpaid care work at home of these workers, as well as adopting strategies that recognize flexible working hours, recognition of different vulnerabilities for workers who are solo parents, taking care of the ill or elderly, etc. Protocols and procedures should also remain in place for availment of maternal and paternal leaves, VAWC leaves for victims of violence and a clear reporting procedure not only among plantilla officers but also among contractuals, and communities engaged with. The CHR echoes the need to include in the GBV response the focus on strengthening community referral mechanisms, including sessions that connect WCPUs not only with women's desks, social welfare officers, prosecutors, but also with barangay VAW desks officers, civil society organizations, and regional offices of the CHR. This will fast track referral of cases and address issues of limited mobility and resources of women and girls reporting GBV. The program could also look into influencing DOH units to adopt protocols specific to marginalized groups including PWDs who often lack access to information and who face 80 physical and social barriers; IDPs, IPs, LGBTQIs, and the incarcerated women. The vulnerable groups and their vulnerabilities were included in the JMC of CHR and DILG. Annex F. Results and summary of key feedback of the Consultation with Indigenous Peoples on the PCERP held last 23 February 2021 Topic Comment/Query Stakeholder Response Discrimination In other provinces, Indigenous IP Mandatory DOH BLHSD has responded that the DOH has a joint against IPs in Peoples are not accommodated Representative Memorandum Circular with DILG on the health service health properly or discriminate against in (IPMR) of delivery for IPs. The IPs may opt to visit a nearby hospital and facilities hospitals. This leads to the increased Olongapo file a complaint against the hospital where they were not hesitation of IPs to seek medical care catered as appropriate. The complaint should be coursed in health facilities. through proper channels such as through DOH Centers for Health Development or Provincial DOH Office. It was also reiterated that due to the devolved health system in the country, not all health facilities are owned by the DOH. Some facilities are run by the local government unit. To further prevent discrimination Municipal IPMR The BLHSD has an ongoing medical scholarship program to against IPs and considering the - General capacitate IPs and absorb them in the government health ‘reserved’ nature of IPs, it was Nakar, Quezon facilities for professional practice. suggested to (1) designate a focal In response to the query on the maintaining grades of IP person in hospitals who are also IMPR North scholars in midwifery, the BLHSD reiterated the need to meet members of the IP community, (2) Cotabato the grade cut-off to ensure the quality of future professionals provide a separate lane for IP and their capacity to provide proprt medical services. services, and (3) designate an IP helpdesk in all health facilities. Lack of financial Some COVID-19 positive IPs are IPMR Under the current assistance of the Philippine Health resources for staying at home for monitoring of the Camarines Sur Insurance Corporation (PhilHealth) and with the upcoming health care NCIP nurses and barangay health implementation of the Universal Health Care (UHC), the IPs workers as they cannot afford may avail free health services. The Medical Social Units and 81 treatment in hospitals. It was asked if Malasakit Centers of health facilities may also be approached the DOH could provide free medical for medical assistance to indigent IPs. services for IPs who have COVID-19. Referral pathway It was asked what the IP should do if IPMR It was advised to seek treatment or isolation services from for health the health facility, including isolation another nearby facility in other municipalities. Referral of the services for IPs area, closest to their home cannot health facility may be sought, and there should be LGU to LGU accommodate them as its full coordination, as prescribed in the DOH-DILG Joint capacity has been reached. Memorandum Circular for the health service delivery for IPs. It should also be noted that most health facilities have no IP dedicated helpdesk and has no existing referral pathway, based on the health care facility assessment for services to vulnerable groups that the PCERP has conducted. Access to The access of IPs to health NCIP health The DOH through the Health Promotion Bureau develops information on information, especially on COVID-19 worker – health information and campaign materials for COVID-19. The COVID-19 and and vaccines, is limited. The need for San Jose dissemination is through the CHDs and also through LGU. It other health further information dissemination Community was recommended to further communicate with the NCIP, issues and communication with the IP Service Center IPMR, and IP Leaders to assure that information is disseminate communities was expressed. They to all communities. asked in which channels the DOH IPMR Libungan For the PCERP, it was reiterated that there is an online could further communicate with feedback form (http://bit.ly/CERPFeedback) and the GRM. them. IPMR Olongapo The HCF assessment done by PCERP also shows that most information materials are not in the language understood by It was also suggested to designate an local and IP communities. The assistance of the CHDs may be IP focal person per sitio or barangay sought for translation in the development of appropriate for dissemination of health materials. The HEPOs in the CHDs may also assist to laymanize information. the medical terms. According to the IPMRs, radio is the most effective way of Some health information in the providing health information to IP communities due to the mainstream media are not in the absence of internet connection. language used by the IP groups. Health care It was asked whether it is proper IMPR It was clarified that burning of wastes is not allowed based on waste practice to burn health care waste in Camarines Sur the Philippine Clean Air Act and other laws of the DENR. 82 management in health facilities and how to ensure Health care wastes are disinfected as appropriate based on the health care that these wastes will not pose threat DOH and DENR guidelines, such as the use of chlorine solution. facilities to communities especially during Proper PPEs should also be used by the waste handlers. collection and transport. Infectious wastes are segregated from general wastes using yellow plastic bags. It is delineated from the municipal wastes in black bags using the yellow color for infectious. Some facilities also practice disposal of wastes by the use of a septic vault in the facility. COVID-19 Issues on the COVID-19 vaccines were IPMR It was clarified that the COVID-19 vaccines is not part of the vaccination raised such as safety of the vaccines Occidental scope of this consultation. However, issues on the vaccination and various brands, safety of Mindoro, had been raised in relation to COVID-19. It was advised that a vaccination for senior citizens and Libungan, separate consultation will be conducted by the DOH dedicated individuals with co-morbidities, Filimon, and for the IP groups. access to vaccines considering the others distance of health facilities, and the need for support on resources to access vaccines, e.g., organized transportation for IPs. Annex G. Results and summary of key feedback of the Community Consultation on the Retrofitting and Refurbishing of the Research Institute for Tropical Medicine (RITM) held on 27 October 2020 Topic Discussion Action Points/ Clarifications/ Key Agreements Risk of Coinciding Director Sudiacal of DOH– DPCB queried on the The RITM will accomplish an ESMP in relation to with DOH COVID-19 timeline of the construction activities in RITM as it the possible simultaneous construction and vaccination activities might coincide with the vaccination activities of DOH vaccination. in 2021 in the 2nd quarter of 2021. According to Arch. Magbanua, the construction activities might extend The RITM would possibly develop re-routing until the Q2 of 2021 as the bidding has not yet schemes and designate areas once its started. 83 engagement in the vaccination activities has According to Engr. Calma of the RITM Planning Office, been finalized. the RITM is considered as a warehouse of the COVID- 19 vaccines. Survey for It was confirmed by the RITM Planning Office that a DOH– DPCB to request the officials of Barangay Community community survey is needed for the residents of Alabang to facilitate the survey which may be Residents Barangay Alabang, specifically the residents of done accomplished online or printed Pleasant Village and Camella III which are nearby the questionnaires, in English (Annex F) and Filipino RITM compound. (Annex G) versions. Annex H. Results and summary of key feedback Retrofitting of the Isolation Rooms of Fourteen (14) Hospitals in the National Capital Region (NCR) held on 28 October 2020 Action Points/ Clarifications/ Key Topic Discussion Agreements Burning of wastes It was clarified upon the query of Barangay Central, Quezon produced in the City that wastes will not be burned as a disposal method in construction site the construction sites. Permits required by The Implementation Arrangements of the Ms. Villaluz of the World Bank and Engr. Marayag of the Dr. LGUs for the Project will include the MOA with LGUs for Jose N. Rodriguez Memorial Hospital reiterated that there is construction the construction activities. The HFEPMO will a need for support from the LGUs as regards the securing of activities permits and clearances for the construction activities.be conducting a meeting with the project recipients and other stakeholders regarding this matter. Public hearing for Representatives of Barangay Bagong Ilog- Pasig City asked if The Project will be requesting the barangay communities there should be a public hearing for nearby residents. officials to facilitate the survey to be answered by the barangay residents, preferably those nearby, regarding the environmental and social risks of the minor construction activities. Annex I. Results and summary of key feedback Building Completion of the Quirino Memorial Medical Center (QMMC) held on 9 February 2021 84 Topic Comment/Query Stakeholder Response Number of For the completion of the 4th floor of the Phase 9 Quirino Memorial According to the HFEP Central Office, workers and Building of the QMMC, the number of workers to be Medical Center- the number of workers cannot be health deployed in the construction area should be Engineering Department determined at this point and it will protocols identified, considering the possible influx of workers depend on the number to be deployed and the need for observance of physical distancing, in by the contractor. compliance with minimum public health standards. Housing of the Based on the number of construction workers, it Quirino Memorial In the latest DPWH guidelines for the construction should be determined if the workers will be housed Medical Center- COVID-10 pandemic, transient workers inside the QMMC premises or not. Engineering Department accommodation should be provided for the construction workers. The QMMC will find a suitable location in their facility to house the workers. This will be discussed with the contractor and the HFEP. Annex J. Results and summary of key feedback of the Townhall Consultation with Indigenous Peoples conducted by the DOH HPB last 16 March 2021 Stakeholder Query/Comment Respondent Response Is it necessary that same brand of Philippine Society for Yes, it is recommended that we take the same brand. Reason being, there is no study vaccine that we are going to use for the Microbiology and that involves intermixing different brands of the vaccine. 1st and 2nd dose? Infectious Diseases Philippine Society for How old is the target age (for Target population for the vaccines is 18 years old and above. That is the reason why Microbiology and vaccines)? we give them to adults. Even 60, 70 or 80 years old will also be given the vaccine. Infectious Diseases 85 Any comment on the numerous EU FDA clarified with Astrazeneca that the ones that were deployed to the EU countries countries that suspended the use of DOH have a different batch or lot number. It is not the same batch that we will be getting the Astrazeneca due to the blood from Astra right now. It is a different batch was deployed in those EU countries. clotting side effects and death? Even if you have a lot of allergies, you can still accept the vaccine. Unless you are I have allergies. Is there a specific Philippine Society for proven to have an allergic reaction to the specific components of the vaccines. You brand that cannot trigger anaphylactic Microbiology and can still get the vaccine, but what will happen is you would be closely monitored after shock? Infectious Diseases you receive the vaccine. Before leaving the vaccination site, you will be advised on the specific signs and What would the action be if you symptoms to watch out for. And if you start having those symptoms, you will be started to have symptoms after DOH informed of where to go and who to call. Even if they are minor, you are supposed to receiving the vaccine? report this. In case you need medical attention, you will be referred to a proper facility for proper management. There’s no specific study with the vaccine per se with pregnant women. But there are Philippine Society for Is the vaccine safe for breastfeeding recommendations that pregnant women still get vaccinated with consent. Reason Microbiology and women and what are the side effects? being, there would still be more benefits to getting vaccinated. Antibodies could be Infectious Diseases transferred to the babies. They are usually asked to sign a waiver. Philippine Society for How long will the protection from the That is unknown to this point. We are still waiting for data that would specifically tell Microbiology and vaccine last for? us on how long the antibodies would last. Infectious Diseases There is news that we would have to be Philippine Society for There is a possibility. But as of now, we don’t know yet. We don’t know yet on how vaccinated for COVID every year. Is this Microbiology and long the antibodies would last. There are data that suggests that it would be like a flu true? Infectious Diseases vaccine, that would be annually. Will you get the protection from the Philippine Society for Average it would take 15 days before you start forming antibodies from the COVID-19 right after the vaccine? Or Microbiology and vaccination. Chances for your protection will increase as the days go by and you after a few more days? Infectious Diseases receive your booster shot. Can a recipient choose on what brand DOH The vaccination is not mandatory. But we are doing everything we can to convince of vaccine he/she want? Or will they people to get vaccinated to enable herd immunity. Target is 75% of the population. 86 just have to settle for whatever is Yes, you can turn down a specific vaccine, but you will now be included on the next available? round of vaccines. Is it safe to get the COVID vaccine with Philippine Society for other vaccines like the flu vaccines or Microbiology and There are no studies on whether it is safe, or not safe yet. pneumonia vaccines? Infectious Diseases It would be highly encouraged for those with co-morbidities to take the vaccine. On co-morbidities. What would be the Philippine Society for Reason being, studies show with those with diabetes or hypertension who got side effects to those with co- Microbiology and infected with the virus, their symptoms are more severe. You would benefit from it, morbidities? Infectious Diseases and there’s no documented side effects. If you tested positive for COVID, when Philippine Society for If you’re a patient who got infected by COVID, you could wait for up to 90 days to get can you get vaccinated for it? Will you Microbiology and vaccinated. But if you wish to get vaccinated to be earlier, you may do so. Provided, have to wait after 14 days of Infectious Diseases that you are recovered from the COVID-19 virus. quarantine? The IP is under the prioritization group B.4. Socio-demographic groups at significant Profiling & masterlisting. For the higher risks. When can they get vaccinated? Focus is on the 3rd quarter, where millions prioritization of the vaccines, what DOH of doses will come. It will be the local government unit who will initiate the category does the IP fall under? vaccination of our IP groups. Do all the suppliers of the COVID Philippine Society for There are different platforms of vaccine. There are those who use vector like vaccine have the same elements? Microbiology and Astrazeneca so it uses a viral vector. There are also inactivated virus like Sinovac. What are the elements of the COVID- Infectious Diseases There are different platforms, but they all have the same goal. 19 vaccine? What about for those undergoing Philippine Society for dialysis treatment? Can they still get Microbiology and You can still take the vaccine even if you are undergoing dialysis treatment. vaccinated? Infectious Diseases Philippine Society for DOH: Besides the NCIP advocating for our IPs to get vaccinated, aside from them Regarding the role of NCIP on Microbiology and helping us disseminate information, the team is composed of 6-8 members. They can information dissemination. Infectious Diseases also volunteer as part of the vaccination team to take on several roles. 87 May we know the difference between Philippine Society for Studies nowadays are on their behavior. The UK variant is more infectious. Regarding Philippine variant and UK or Brazil or Microbiology and the effectiveness of the vaccines on them, there are still ongoing studies. Some of the African variants? Infectious Diseases vaccines may still provide some amount of protection against these variants. Do we already have an initial report on We already have data, but they are still incomplete. The immunization program we the healthcare workers injected with DOH have is government facilities. We cannot divulge that information yet, since they are the vaccine? still incomplete. I think the campaign is not directly attacking the anti-vaxxers. This campaign is trying Philippine Society for Is there an active anti-vaxxers to correct misinformation and set the facts straight as well as encouraging people to Microbiology and campaign in the Philippines? take the vaccine. In the hopes of when the anti-vaxxers hear this, they would Infectious Diseases eventually become advocates for vaccines as well. 88 Annex K. Grievance resolution process of grievances within the jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinarv Complaints in the Department of Health Figure A. Grievance Resolution Process for Complaints Against the Personnel with Rank Lower than the Chief Departments under DOH CHDs 89 Figure B. Grievance Resolution Process for Complaints Against the Chief of Departments under DOH CHDs Figure C. Grievance Resolution Process for Complaints Against the Chief of Health Facility under DOH CHDs 90 Figure D. Grievance Resolution Process for Complaints Against Personnel with Rank Less than the Assistant Director under DOH CHDs Figure E. Grievance Resolution Process for Complaints Against the Personnel with Rank Lower than the Chief Departments under DOH Central Office 91 Figure F. Grievance Resolution Process for Complaints Against the Chief Departments under DOH Central Office Figure G. Grievance Resolution Process for Complaints Against the Chief of Health Facility under DOH Central Office 92 Figure H. Grievance Resolution Process for Complaints Against the Rank of Division Chief and Below under DOH Central Office and Attached Offices Figure I. Grievance Resolution Process for Complaints Against All Presidential Appointees in the DOH except Undersecretaries and Assistant Secretaries 93 Figure J. Grievance Resolution Process for Complaints Against Undersecretaries and Assistant Secretaries 94 Annex L. Grievance Resolution Process for DOLE- Related Cases 95 Annex M. Grievance Monitoring Forms and Online Dashboard Monitoring of Grievances Grievances received within the month will be recorded in this form. Each grievance received will be counted as one item in the monitoring. Grievance Grievance Date Level at which Stakeholders Status Next Steps Level at which Description ProponentReceived Grievance was Involved (resolved/ Action In- Timeline Grievance was Received pending) Taken Charge Resolved (facility/ (facility/ LGU/regional/ LGU/regional national) / national) Note: Grievance proponent may or may not provide personal details Monitoring of Grievance Resolution No. of Grievances No. of Grievances Percentage of Grievances Resolved Received Resolved (No. of Grievances Resolved / No. of Grievances Received) Health Care Facility (Project Recipient) GRM Monitoring Dashboard (https://ee.kobotoolbox.org/single/GairVkZg) 96 The same monitoring mechanism will be observed for the Contractor’s Personnel Grievance Redress Mechanism for the civil works components monthly: Monitoring of Grievances Next Steps Grievance Grievance Date Stakeholders Status Action to In- Description Proponent Received Involved Timeline be Taken Charge Monitoring of Grievance Resolution No. of Grievances No. of Grievances Percentage of Grievances Resolved Received Resolved (No. of Grievances Resolved / No. of Grievances Received) 97