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Pandemic in 2021: How the Philippines responded to COVID-19

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Pandemic in 2021: How the Philippines responded to COVID-19

The second year of the coronavirus pandemic in the Philippines was, in a number of ways, similar to the first. 

Lockdowns remained for the most part of the year as two waves of COVID-19 ravaged the country. While several millions of Filipinos were able to get vaccinated throughout the year, experts flagged the vaccination campaign’s sluggish pace. 

In the middle of it all, lawmakers investigated alleged anomalies involving billions of pesos in the Duterte administration’s pandemic contracts. These were probed in marathon Senate hearings that went on for months on end.

It was not until the latter part of the year until new daily coronavirus cases were reported only in the hundreds, restrictions were eased, and mandatory face shield policies were dropped – finally giving some kind of sense that, perhaps, the Philippines was getting out of the woods. (READ: Does wearing a face shield protect against COVID-19? )

While the holidays may be looking up for many Filipinos, the threat of a new variant of concern looms, and experts say that there is still a need to practice “risk-based” decisions when choosing activities and engagements despite the relatively low cases.

Here’s a list of stories reviewing what happened during the COVID-19 pandemic in 2021.

As the Philippines’ vaccination campaign began in March, one of the government’s main goals was to get as many Filipinos vaccinated. We monitored the arrival and rollout of the vaccines in these trackers, as well as where COVID-19 cases were most prevalent. We also chronicle the significant events in the pandemic in a running timeline.

  • TRACKER: The Philippines’ COVID-19 vaccine distribution
  • TRACKER: Status of vaccination in Metro Manila
  • TRACKER: The Philippines’ plans for COVID-19 boosters, third doses
  • MAPS: COVID-19 in the Philippines
  • TIMELINE: The novel coronavirus pandemic

Things we learned about COVID-19

These stories and explainers explore new information about the virus as they came.

Why did we need to pay attention to the virus when it mutated?

  • EXPLAINER: Ano ang pagkakaiba ng mutation, variant, at strain?
  • What we know so far about new COVID-19 variant found in PH
  • FAST FACTS: The coronavirus Lambda variant
  • What the surge fueled by the Delta variant taught us
  • Beyond the Stories: Ano’ng dapat malaman tungkol sa Omicron variant?

How did the public and health experts tackle the ivermectin debate, when it was floated as a possible alternative treatment to COVID-19?

  • COVID-19: The Philippines’ race for a cure
  • Are we missing out on alternative treatments for COVID-19?
  • EXPLAINER: Myths and facts about ivermectin
  • In fierce Ivermectin debate, doctors remind: ‘Do no harm’

How did we learn to understand the dynamics of new variants and vaccines, and was herd immunity the only goal? 

  • Can COVID-19 vaccines in the Philippines beat Delta?
  • 5 myths about COVID-19 vaccines debunked
  • EXPLAINER: COVID-19 patients at PGH mostly unvaccinated
  • In COVID-19 battle, herd immunity isn’t the only goal the PH needs to reach
  • COVID-19 holiday plans: What would experts do?

Plight of health workers

Two deadly surges took an unprecedented toll on health workers employed in a healthcare system which had problems spilling over from before the pandemic began. 

The release to workers of their benefits mandated by law was also a rocky discussion as the Department of Health’s spending was put under scrutiny.

  • Overworked, underpaid health workers are walking away as Delta ravages PH
  • Are the doctors alright? Frontliners in remote areas feel Manila’s neglect
  • Doctors plead with gov’t: ‘We can’t fight this virus with antiquated methods’
  • How Philippine contact tracers lost track of the virus
  • Philippine contact tracers: The forgotten frontliners
  • Underpaid health workers walk out, call for Duque resignation at mass protests
  • What you should know about COVID-19 hazard pay, special risk allowance

The Duterte COVID-19 response

The pandemic response of President Rodrigo Duterte was not without criticism on matters of public health policy, public funds management, and governance.

  • PH scores lowest among ASEAN countries in gov’t pandemic response – survey
  • ‘NCR Plus’ bubble vs COVID-19 pointless with lax LGU borders
  • PH may be among last in Southeast Asia to reach herd immunity
  • What you need to know about Duterte’s COVID-19 loans
  • Many unknowns in Duterte’s COVID-19 jab as PH fights vaccine hesitancy
  • EXPLAINER: What went wrong with Duterte’s pandemic response?
  • EXPLAINER: The Philippines’ fight vs vaccine hesitancy
  • Hesitancy not a major driver for PH’s low vaccination rates
  • President Duterte, you can still get COVID-19 under control
  • Duterte’s longest SONA leaves Filipinos hanging on pandemic recovery
  • Often-ignored COA fuels pandemic outrage vs Duterte gov’t
  • DOH’s poor use of P67 billion COVID-19 funds led to ‘missed opportunities’ – auditors
  • DOH failed to spend P2.07 billion after parking it in PS-DBM in 2020
  • How the Duterte gov’t shut out local PPE producers during a pandemic
  • PH’s last-minute quarantine changes force travelers to spend thousands

Jobs and economy

The health crisis coincided with an economic crisis that was experienced locally and globally. Here’s what it was like for Filipinos in 2021.

  • Philippines offers nurses in exchange for vaccines from Britain, Germany
  • Labor secretary Bello aims to deploy more nurses, healthcare staff overseas
  • With fresh lockdowns, 3.88 million Filipinos jobless in August 2021
  • Philippines lowers 2021 economic growth target over fresh lockdowns, Delta
  • Delta variant puts Philippine economy among most vulnerable in Asia
  • COVID-19 pandemic to cost PH P41.4 trillion over next 4 decades – NEDA
  • Philippine GDP growth slows but beats forecasts at 7.1% in Q3 2021
  • Philippines raises deployment cap of healthcare workers to 7,000

Despair, ‘bayanihan’ amid crisis

The Philippines recorded millions of positive cases and tens of thousands dead – with more added to the health department’s daily tally. These are stories of people behind the numbers, as well as how Filipinos in the country and abroad banded together in times of crisis. 

  • Philippines’ COVID-19 surge tears through families
  • Facebook as lifeline: Desperate Filipinos turn to strangers for help
  • Community pantries: Is it a ‘revolution’ when Filipinos just want to give?
  • ‘Take care of your neighbor’: Communities battle doubts about COVID-19 vaccines
  • Healthcare professionals turn to TikTok to fact-check, debunk health myths
  • Through virus surge and separation, Filipinos in Indonesia closer than ever
  • ‘Last year was nothing compared to now’: Learning from India’s second wave

The Pharmally controversy

As Filipinos struggled to survive, lawmakers investigated allegations of misspending in the government’s pandemic funds. These anomalies, which sprung from irregularities found by the Commission on Audit, had ties to the President himself.

  • Biggest pandemic supplier has links to ex-Duterte adviser Michael Yang
  • Pharmally had P625,000 capital before bagging P8 billion in COVID-19 contracts
  • Pharmally bags P2 billion more deals in 2021
  • PANOORIN: Bakit kahina-hinala ang pagkakuha ng Pharmally ng mga kontrata sa pandemya?
  • ‘We swindled gov’t’: Pharmally changed expiry date of medical-grade face shields
  • 2 days after bombshell testimony, Pharmally exec can’t be contacted by Senate panel
  • Furious Duterte seeks to block Cabinet, witnesses from appearing in Senate probe
  • Rigged favors for Pharmally, substandard supplies are graft – senators
  • Pharmally’s Krizle Mago recants Senate testimony: ‘It was a pressured response’
  • ‘Sue us instead’: Jailed Pharmally execs still won’t budge over missing documents

– Rappler.com

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  • Open access
  • Published: 21 September 2021

Local government responses for COVID-19 management in the Philippines

  • Dylan Antonio S. Talabis 1 , 2 ,
  • Ariel L. Babierra 1 , 2 ,
  • Christian Alvin H. Buhat 1 , 2 ,
  • Destiny S. Lutero 1 , 2 ,
  • Kemuel M. Quindala III 1 , 2 &
  • Jomar F. Rabajante 1 , 2 , 3  

BMC Public Health volume  21 , Article number:  1711 ( 2021 ) Cite this article

547k Accesses

24 Citations

6 Altmetric

Metrics details

Responses of subnational government units are crucial in the containment of the spread of pathogens in a country. To mitigate the impact of the COVID-19 pandemic, the Philippine national government through its Inter-Agency Task Force on Emerging Infectious Diseases outlined different quarantine measures wherein each level has a corresponding degree of rigidity from keeping only the essential businesses open to allowing all establishments to operate at a certain capacity. Other measures also involve prohibiting individuals at a certain age bracket from going outside of their homes. The local government units (LGUs)–municipalities and provinces–can adopt any of these measures depending on the extent of the pandemic in their locality. The purpose is to keep the number of infections and mortality at bay while minimizing the economic impact of the pandemic. Some LGUs have demonstrated a remarkable response to the COVID-19 pandemic. The purpose of this study is to identify notable non-pharmaceutical interventions of these outlying LGUs in the country using quantitative methods.

Data were taken from public databases such as Philippine Department of Health, Philippine Statistics Authority Census, and Google Community Mobility Reports. These are normalized using Z-transform. For each locality, infection and mortality data (dataset Y ) were compared to the economic, health, and demographic data (dataset X ) using Euclidean metric d =( x − y ) 2 , where x ∈ X and y ∈ Y . If a data pair ( x , y ) exceeds, by two standard deviations, the mean of the Euclidean metric values between the sets X and Y , the pair is assumed to be a ‘good’ outlier.

Our results showed that cluster of cities and provinces in Central Luzon (Region III), CALABARZON (Region IV-A), the National Capital Region (NCR), and Central Visayas (Region VII) are the ‘good’ outliers with respect to factors such as working population, population density, ICU beds, doctors on quarantine, number of frontliners and gross regional domestic product. Among metropolitan cities, Davao was a ‘good’ outlier with respect to demographic factors.

Conclusions

Strict border control, early implementation of lockdowns, establishment of quarantine facilities, effective communication to the public, and monitoring efforts were the defining factors that helped these LGUs curtail the harm that was brought by the pandemic. If these policies are to be standardized, it would help any country’s preparedness for future health emergencies.

Peer Review reports

Introduction

Since the emergence of the COVID-19 pandemic, the number of cases have already reached 82 million worldwide at the end of 2020. In the Philippines, the number of cases exceeded 473,000. As countries around the world face the continuing threat of the COVID-19 pandemic, national governments and health ministries formulate, implement and revise health policies and standards based on recommendations by world health organization (WHO), experiences of other countries, and on-the-ground experiences. Early health measures were primarily aimed at preventing and reducing transmission in populations at risk. These measures differ in scale and speed among countries, as some countries have more resources and are more prepared in terms of healthcare capacity and availability of stringent policies [ 1 , 2 ].

During the first months of the pandemic, several countries struggled to find tolerable, if not the most effective, measures to ‘flatten’ the COVID-19 epidemic curve so that health facilities will not be overwhelmed [ 3 , 4 ]. In responding to the threat of the pandemic, public health policies included epidemiological and socio-economic factors. The success or failure of these policies exposed the strengths or weaknesses of governments as well as the range of inequalities in the society [ 5 , 6 ].

As national governments implemented large-scale ‘blanket’ policies to control the pandemic, local government units (LGUs) have to consider granular policies as well as real-time interventions to address differences in the local COVID-19 transmission dynamics due to heterogeneity and diversity in communities. Some policies in place, such as voluntary physical distancing, wearing of face masks and face shields, mass testing, and school closures, could be effective in one locality but not in another [ 7 – 9 ]. Subnational governments like LGUs are confronted with a health crisis that have economic, social and fiscal impact. While urban areas have been hot spots of the COVID-19 pandemic, there are health facilities that are already well in placed as compared to less developed and deprived rural communities [ 10 ]. The importance of local narratives in addressing subnational concerns are apparent from published experiences in the United States [ 11 ], China [ 12 , 13 ], and India [ 14 ].

In the Philippines, the Inter-Agency Task Force on Emerging Infectious Diseases (IATF) was convened by the national government in January 2020 to monitor a viral outbreak in Wuhan, China. The first case of local transmission of COVID-19 was confirmed on March 7, 2020. Following this, on March 8, the entire country was placed under a State of Public Health Emergency. By March 25, the IATF released a National Action Plan to control the spread of COVID-19. A community quarantine was initially put in place for the national capital region (NCR) starting March 13, 2020 and it was expanded to the whole island of Luzon by March 17. The initial quarantine was extended up to April 30 [ 5 , 15 ]. Several quarantine protocols were then implemented based on evaluation of IATF:

Community Quarantine (CQ) refers to restrictions in mobility between quarantined areas.

In Enhanced Community Quarantine (ECQ), strict home quarantine is implemented and movement of residents is limited to access essential goods and services. Public transportation is suspended. Only economic activities related to essential and utility services are allowed. There is heightened presence of uniformed personnel to enforce community quarantine protocols.

Modified Enhanced Community Quarantine (MECQ) is implemented as a transition phase between ECQ and GCQ. Strict home quarantine and suspension of public transportation are still in place. Mobility restrictions are relaxed for work-related activities. Government offices operates under a skeleton workforce. Manufacturing facilities are allowed to operate with up to 50% of the workforce. Transportation services are only allowed for essential goods and services.

In General Community Quarantine (GCQ), individuals from less susceptible age groups and without health risks are allowed to move within quarantined zones. Public transportation can operate at reduced vehicle capacity observing physical distancing. Government offices may be at full work capacity or under alternative work arrangements. Up to 50% of the workforce in industries (except for leisure and amusement) are allowed to work.

Modified General Community Quarantine (MGCQ) refers to the transition phase between GCQ and the New Normal. All persons are allowed outside their residences. Socio-economic activities are allowed with minimum public health standard.

LGUs are tasked to adopt, coordinate, and implement guidelines concerning COVID-19 in accordance with provincial and local quarantine protocols released by the national government [ 16 ].

In this study, we identified economic and demographic factors that are correlated with epidemiological metrics related to COVID-19, specifically to the number of infected cases and number of deaths [ 17 , 18 ]. At the regional, provincial, and city levels, we investigated the localities that differ with the other localities, and determined the possible reasons why they are outliers compared to the average practices of the others.

We categorized the data into economic, health, and demographic components (See Table  1 ). In the economic setting, we considered the number of people employed and the number of work hours. The number of health facilities provides an insight into the health system of a locality. Population and population density, as well as age distribution and mobility, were used as the demographic indicators. The data (as of November 10, 2020) from these seven factors were analyzed and compared to the number of deaths and cumulative cases in cities, provinces or regions in the Philippines to determine the outlier.

The Philippine government’s administrative structure and the availability of the data affected its range for each factor. Regional data were obtained for the economic component. For the health and demographic components, data from cities and provinces were retrieved from the sources. Due to the NCR exhibiting the highest figures in all key components, an investigation was conducted to identify an outlier among its cities. The z -transform

where x is the actual data, μ is the mean and σ is the standard deviation were applied to normalize the dataset. Two sets of normalized data X and Y were compared by assigning to each pair ( x , y ), where x ∈ X and y ∈ Y , its Euclidean metric d given by d =( x − y ) 2 . Here, the Y ’s are the number of COVID-19 cases and deaths, and X ’s are the other demographic indicators. Since 95% of the data fall within two standard deviations from the mean, this will be the threshold in determining an outlier. This means that if a data pair ( x , y ) exceeds, by two standard deviations, the mean of the Euclidean metric values between the sets X and Y , the pair is assumed to be an outlier.

To identify a good outlier, a bias computation was performed. In this procedure, Y represents the normalized data set for the number of deaths or the number of cases while X represents the normalized data set for every factor that were considered in this study. The bias is computed using the metric

for all x in X and y in Y . To categorize a city, province, or region as a good outlier, the bias corresponding to this locality must exceed two standard deviations from the mean of all the bias computations between the sets X and Y .

Results and discussion

The data used were the reported COVID-19 cases and deaths in the Philippines as of November 10, 2020 which is 240 days since community lockdowns were implemented in the country. Figure  1 shows the different lockdowns implemented per province since March 15. It can be seen that ECQ was implemented in Luzon and major cities in the country in the first few weeks since March 15, and slowly eased into either GCQ or MGCQ as time progressed. By August, the most stringent lockdown was MECQ in the National Capital Region (NCR) and some nearby provinces. Places under MECQ on September were Iloilo City, Bacolod City, and Lanao del Sur, with the last province as the lone community to be placed under MECQ the month after. By November 1, 2020, communities were either placed under GCQ or MGCQ.

figure 1

COVID-19 community quarantines in Regions III, IVA and VII

Comparison of economic, health, and demographic components and COVID-19 parameters

The economic, health and demographic components were compared to COVID-19 cases and deaths. These comparisons were done for different community levels (regional, provincial, city/metropolitan) (See Tables  2 , 3 , and 4 ). Figure  2 summarizes the correlation of components to COVID-19 cases and deaths at the regional level. In all components, correlations with other parameters to both COVID-19 cases and deaths are close. Every component except Residential Mobility and GRDP have slightly higher correlation coefficient for COVID-19 cases as compared to COVID-19 deaths.

figure 2

Correlation of components to COVID-19 cases and deaths at the regional level

Among the components, the number of ICU beds component has the highest correlation with COVID-19 parameters. This makes sense as this is one of the first-degree measures of COVID-19 transmission. Population density comes in second, followed by mean hours worked and working population, which are all related to how developed the region is economy-wise. Regions having larger population density also have a huge working population and longer working hours [ 24 ]. Thus, having a huge population density implies high chance of having contact with each other [ 25 , 26 ]. Another component with high correlation to the cases and deaths is the number of doctors on quarantine, which can be looked at two ways; (i) huge infection rate in the region which is the reason the doctors got exposed or are on quarantine, and (ii) lots of doctors on quarantine which resulted to less frontliners taking care of the infected individuals. All definitions of mobility and the GDP are not strongly correlated to any of the COVID-19 measures.

In each data set, outliers were identified depending on their distance from the mean. For simplicity, we denote components that are compared with COVID-19 cases by (C) and with COVID-19 deaths by (D). The summary of outliers among regions in the Philippines is shown in Figs.  3 and 4 . Data is classified according to groups of component. In each outlier region, non-pharmaceutical interventions (NPI) implemented and their timing are identified.

figure 3

Outliers among regions in the Philippines with respect to COVID-19 cases

figure 4

Outliers among regions in the Philippines with respect to COVID-19 deaths

Region III is an outlier in terms of working population (C) and the number of ICU beds (C) (see Fig.  5 and Table  5 ). This means that considering the working population of the region, the number of COVID-19 infections are better than that of other regions. Same goes with the number of ICU beds in relation to COVID-19 deaths. Region III is comprised of Aurora, Bataan, Nueva Ecija, Pampanga, Tarlac, Zambales, and Bulacan. This good performance might be attributed to their performance especially on their programs against COVID-19. As early as March 2020, the region had been under a community lockdown together with other regions in Luzon. Being the closest to NCR, Bulacan has been the most likely to have high number of COVID-19 cases in the region. But the province responded by opening infection control centers which offer free healthcare, meals, and rooms for moderate-severe COVID-19 patients [ 27 ]. They have also implemented strict monitoring of entry-exit borders, organization of provincial task force and incident command center, establishment of provincial quarantine facilities for returning overseas Filipino workers, mandated municipal quarantine facilities for asymptomatic cases, and mass testing, among others [ 27 ]. Most of which have been proven effective in reducing the number of COVID-19 cases and deaths [ 28 ].

figure 5

Outliers among the provinces in Luzon with respect to COVID-19 cases and deaths

figure 6

Outliers among the provinces in Visayas with respect to COVID-19 cases and deaths

figure 7

Outliers among the provinces in Mindanao with respect to COVID-19 cases and deaths

Region IV-A is an outlier in terms of population and working population (D) and doctors on quarantine (D) (see Fig.  5 and Table  5 ). Considering their population and working population, the COVID-19 death statistics show better results compared to other regions. Same goes with the number of doctors in the region which are in quarantine in relation to the reported COVID-19 deaths. This shows that the region is doing well in terms of decreasing the COVID-19 fatalities compared to other regions in terms of populations and doctors on quarantine. Region IV-A is comprised of Batangas, Cavite, Laguna, Quezon, and Rizal. Same with Region III, they have been under the community lockdown since March of last year. Provinces of the region such as Rizal have been proactive in responding to the epidemic as they have already suspended classes and distributed face masks even before the nationwide lockdown [ 29 ]. Despite being hit by natural calamities, the region still continue ramping up the response to the pandemic through cash assistance, first aid kits, and spreading awareness [ 30 ].

An interesting result is that NCR, the center of the country and the most densely populated, is a good outlier in terms of GRDP (C) and GRDP (D). Cities in the region launched various programs in order to combat the disease. They have launched mass testings with Quezon City, Taguig City, and Caloocan City starting as early as April 2020. Pasig City started an on-the-go market called Jeepalengke. Navotas, Malabon, and Caloocan recorded the lowest attack rate of the virus. Caloocan city had good strategies for zoning, isolation and even in finding ways to be more effective and efficient. Other programs also include color-coded quarantine pass, and quarantine bands. It is also possible that NCR may just have a very high GRDP compared to other regions. A breakdown of the outliers within NCR can be seen in Fig.  8 .

figure 8

Outliers in the national capital region with respect to COVID-19 cases and deaths

Region VII is also an outlier in terms of population density (D) and frontliners (D) (see Fig.  6 and Table  5 ). This means that given the population density and the number of frontliners in the region, their COVID-related deaths in the region is better than the rest of the country. This region consists of four provinces (Cebu, Bohol, Negros Oriental, and Siquijor) and three highly urbanized cities (Cebu City, Lapu-Lapu City, and Mandaue City), referred to as metropolitan Cebu. This significant decline may be explained by how the local government responded after they were placed in stricter community quarantine measures despite the rest of the country easing in to more lenient measures. Due to the longer and stricter quarantine in Cebu, the lockdown had a greater impact here than in other areas where restrictions were eased earlier [ 31 ]. Dumaguete was one of the destinations of the first COVID case in the Philippines [ 32 ], their local government was able to keep infections at bay early on. Siquijor was also COVID-19-free for 6 months [ 33 ]. The compounded efforts of the different provinces in the region can account for the region being identified as an outlier.

Among the metropolitan cities, Davao came out as a good outlier in terms of population (C) and working population (C) (see Figs.  7 , 9 , and Table  5 ). This result may be attributed to their early campaign on consistent communication of COVID-19-related concerns to the public [ 34 ]. They were also able to set up transportation for essential workers early on [ 35 ].

figure 9

Outliers among metropolitan areas in the Philippines with respect to COVID-19 cases and deaths

This study identified outliers in each data group and determined the NPIs implemented in the locality. Economic, health and demographic components were used to identify these outliers. For the regional data, three regions in Luzon and one in Visayas were identified as outliers. Apart from the minimum IATF recommended NPIs, various NPIs were implemented by different regions in containing the spread of COVID-19 in their areas. Some of these NPIs were also implemented in other localities yet these other localities did not come out as outliers. This means that one practice cannot be the sole explanation in determining an outlier. The compounding effects of practices and their timing of implementation are seen to have influenced the results. A deeper analysis of daily data for different trends in the epidemic curve is considered for future research.

Correlation tables, outliers and community quarantine timeline

Availability of data and materials.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

JFR is supported by the Abdus Salam International Centre for Theoretical Physics Associateship Scheme.

This research is funded by the UP System through the UP Resilience Institute.

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Dylan Antonio S. Talabis, Ariel L. Babierra, Christian Alvin H. Buhat, Destiny S. Lutero, Kemuel M. Quindala III & Jomar F. Rabajante

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S. Talabis, D.A., Babierra, A.L., H. Buhat, C.A. et al. Local government responses for COVID-19 management in the Philippines. BMC Public Health 21 , 1711 (2021). https://doi.org/10.1186/s12889-021-11746-0

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150 words essay about philippine covid 19 response

Supporting the Philippines’ COVID-19 Emergency Response

Beneficiaries

For Vilma Campos , a Quezon City resident and mother of five, life has improved since her family received their vaccinations. “My daughter has resumed working, so has my husband,” she said. “Life is no longer that difficult.”

Before COVID-19 hit, Vilma’s job was taking care of children. When the authorities started implementing quarantine restrictions, she, her daughter, and her spouse lost their jobs. Vilma said her family was always wondering where to get the next meal.  “What gave us hope was the arrival of vaccines,” she said. “Things have improved and I really wish we can all overcome this pandemic.”   

The Philippines was one of the countries hit hardest by COVID-19 in the East Asia and Pacific region. To manage the spread of the virus, authorities implemented strict quarantine restrictions and health protocols, restricted mobility of people as wells as the operational capacity of businesses. As a result, the Philippine economy suffered. In 2020, GDP contracted 9.5 percent, driven by significant declines in consumption and investment growth, and exacerbated by the sharp slowdown in exports, tourism, and remittances. Many Filipinos lost jobs and experienced food shortages and difficulties accessing health care. Due to global shortages, procurement of COVID-19 vaccines, medical supplies, personal protective equipment (PPE), reverse transcription polymerase chain reaction (RT-PCR) test machines, and test kits proved challenging in the early phases of the pandemic.

The project supported the country’s efforts to scale up vaccination across the national territory, strengthen the country’s health system, and overcome the impact of the pandemic especially on the poor and the most vulnerable. Besides vaccines, the project supported procurement of PPE, essential medical equipment such as mechanical ventilators, cardiac monitors, portable x-ray machines; laboratory equipment and test kits; and ambulances. The project also supported construction and refurbishment of negative pressure isolation rooms and quarantine facilities, as well as the expansion of the country’s laboratory capacity at the national and sub-national levels for prevention of and preparedness against emerging infectious diseases. It funded retrofitting of the national reference laboratory – the Research Institute for Tropical Medicine (RITM) – as well as six sub-national and public health laboratories in Baguio, Cebu, Davao, and Manila, and the construction and expansion of laboratory capacity in priority regions without such facilities.

During year1 to year 2, the following results were achieved:

  • The project supported the procurement and deployment of 33 million doses of COVID-19 vaccine across the country. The project supported pediatric vaccination for 7.5 million children. With the support of development partners including the World Bank, Asian Development Bank, and Asian Infrastructure and Investment Bank, the Philippines administered more than 137 million vaccines (more than 126 million first and second doses, and more than 10 million booster doses) by March of 2022.
  • The project helped scale up testing capacity from 1,000 RT-PCR tests per day to 24,979 per day.
  • The project supported the procurement of 500 mechanical ventilators, 119 portable x-ray machines, 70 infusion pumps, 50 RT-PCR machines, and 68 ambulances.
  • As a result of the strong vaccination rates and strengthened health response capacity, the Philippines is now much better able to manage the pandemic.

The Philippines COVID-19 Emergency Response Project supported the procurement and deployment of 33 million doses of COVID-19 vaccine across the country. The project also supported pediatric vaccination for 7.5 million Filipino children.

Bank Group Contribution

The World Bank through the International Bank for Reconstruction and Development (IBRD) provided $900 million of funding in total for the emergency response project. The project provided $100 million for medical and laboratory equipment and supplies; $500 million for primary vaccine doses, ancillaries, and end-to-end logistics; and $300 million for boosters and additional doses, and end-to-end logistics.

The World Bank collaborated with the Asian Development Bank (ADB) and the Asian Infrastructure and Investment Bank (AIIB) on project preparation and vaccines financing. The Bank worked with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID) on the Vaccine Introduction Readiness Tool (VIRAT) and Vaccine Readiness Assessment Tool (VRAF) Tool 2.0, which is used to assess status, gaps, and issues in four domains: planning and management, supply and distribution, program delivery, and supporting systems and infrastructure. Australia, through the AGaP Trust Fund, provided a US$300,000 grant to support implementation. The World Bank also collaborated with UNICEF to address vaccine hesitancy and with the WHO to procure RT-PCR machines and test kits.

Looking Ahead

The Philippine government is considering additional support for scaling up testing capacity. Equipment has been acquired and civil works commissioned through the project are now in use. An action plan is being developed for continued implementation of environmental and social safeguards employed in the project, such as COVID-19 waste management and assessment of accessibility of vulnerable groups to health care services. These will be institutionalized using the manuals developed and through directive issuances by the Department of Health. The project also supports the development of National Action Plan Towards Increased Accessibility of Health Care Facilities for Vulnerable Groups. The World Bank is also supporting the Department of Health and priority LGUs in strengthen local health systems for Universal Health Coverage.

Philippines Covid-19 Emergency Response Project

Philippines Covid-19 Emergency Response Project Additional Financing

Philippines COVID-19 Emergency Response Project – Additional Financing 2

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100 days of COVID-19 in the Philippines: How WHO has supported the Philippine response

WHO staff visits RITF in the Cordillera Region

9 May 2020 marked 100 days since the first confirmed COVID-19 case was announced in the Philippines. Here is how WHO has supported the Philippine response.

Last 9 May 2020, exactly 100 days had passed since the first confirmed COVID-19 case was announced in the Philippines on 30 January 2020, with a 38-year old female from Wuhan testing positive for the novel coronavirus. On the same day, on the other side of the world at the WHO headquarters in Geneva, WHO activated the highest level of alert by declaring COVID-19 as a public health emergency of international concern. The Philippine government mounted a multi-sectoral response to the COVID-19, through the Interagency Task Force (IATF) on Emerging Infectious Diseases chaired by the Department of Health (DOH). Through the National Action Plan (NAP) on COVID-19, the government aims to contain the spread of COVID-19 and mitigate its socioeconomic impacts. The Philippines implemented various actions including a community quarantine in Metro Manila which expanded to Luzon as well as other parts of the country; expanded its testing capacity from one national reference laboratory with the Research Institute of Tropical Medicine (RITM) to 23 licensed testing labs across the country; worked towards ensuring that its health care system can handle surge capacity, including for financing of services and management of cases needing isolation, quarantine and hospitalization; and addressed the social and economic impact to the community including by providing social amelioration to low income families. The World Health Organization (WHO) has been working with Ministries of Health worldwide to prepare and respond to COVID-19. In the Philippines, WHO country office in the Philippines and its partners have been working with the Department of Health and subnational authorities to respond to the pandemic. The country level response is done with support from the WHO regional office and headquarters.

Surveillance

Surveillance is a critical component and is used to detect cases of COVID-19 as well as to understand the disease dynamics and trends and identify hotspots of disease transmission. The Department of Health included COVID-19 in the list of nationally notifiable diseases early in the outbreak to ensure that information was being collected to guide appropriate response actions. Existing surveillance systems were capitalized upon to speed up identification of cases as well as identify unusual clusters. Laboratory confirmation is a critical component of the surveillance system but cannot be the only sources of information. The non-specific symptoms and the novel nature of the disease means that the DOH, with support from WHO, are looking at all available information sources to guide response decision making. WHO also provided technical assistance to selected local government units to strengthen field surveillance for timely data for action at the local level.

Contact tracing

Contact tracing is crucial to the response. It is a system to detect and isolate cases and identify close contacts who will be advised for quarantine. It allows the investigation the system to tracjk the chain of infections as well as the settings, places, events or other avenues that where transmission have occurred or may have been amplified. A major bottleneck to doing this is the availability of timely and complete information from the hospitals for suspected, probable and confirmed COVID-19 cases. WHO assisted the DOH Epidemiology Bureau in developing  COVID KAYA , a case and contact tracing reporting system for epidemiology and surveillance officers, health care providers and laboratory-based users, expanding the capacity of the previous COVID-19 information system. WHO also continued to support the government to establish the system and improve capacity for contact tracing at the city and municipal levels.

COVID app

Infection prevention and control

Patients and health workers must be protected from the possible transmission of COVID-19 inside health facilities. Infection prevention and control (IPC) is vital in minimizing the harm caused by the spread of infection in these facilities. In the early part of the response, WHO supported the DOH with the provision of personal protective equipment (PPE) for health workers. To strengthen IPC, WHO and DOH developed modules and conducted online IPC training of trainers for frontline health workers in health care and community settings. The training has since been rolled out more widely by partners USAID-MTaPS and UNICEF to cover over 5,500 health workers to date.

Laboratory and therapeutics access

Laboratory testing for COVID-19 is critical to be able to rapidly identify, treat and isolate the positive patients, and be able to see the bigger picture of how many people are infected and ultimately stop the transmission of the virus. Since the beginning of the response, WHO provided support to the DOH’s Research Institute for Tropical Medicine with laboratory supplies and extraction kits. WHO also assisted the DOH in the accreditation of COVID-19 testing laboratories. To date, 23 real-time reverse transcription polymerase chain reaction (rRT-PCR) laboratories nationwide are now conducting COVID-19 diagnostic tests. The Philippines has also  recently joined the WHO Solidarity trial  to find effective COVID-19 treatment.

RITF lab worker

Clinical care

With a new disease, there are a lot of unknowns regarding the proper clinical management of suspect and confirmed cases. But when clinicians are armed with the necessary knowledge and skills to care for sick patients, the more the patients are likely to recover. WHO supported the frontline health workers through a webinar series on clinical management, providing up-to-date WHO clinical perspectives. At the same time, WHO also supported the DOH and the Department of Interior and Local Government in preparing policies to form health care provider networks for COVID-19, from primary care that includes telemedicine and community management, to tertiary care linking to referral hospitals.

Non-pharmaceutical interventions and mental health

Non-pharmaceutical interventions (NPIs) refer to public health measures, which are not related to medicines or vaccines, that people and communities can do to prevent the spread of infections like COVID-19. These interventions involve personal protective measures, environmental measures, physical distancing measures and travel-related measures. WHO supported the DOH in the development of a policy on NPIs as well as assisted in rapid assessment on local government capacity on NPIs and policy-gap analysis. In times of extreme experiences brought by COVID-19, it is likely that people feel fearful and anxious. Providing mental health and psychosocial support (MHPSS) during the time of COVID-19 pandemic is important. WHO assisted the DOH in developing policy guidance and advice on integrating MHPSS within health and social services and increasing access to care to these services.

Risk communication and community engagement

Effective communication and engagement with communities is essential for people to understand the situation, know the situation and practice protective measures to protect their health, their family and the larger community. WHO supported and amplified DOH messaging by releasing various communication materials on the risk of COVID-19 and how people can protect themselves through social media and traditional media. WHO also worked with partners such as UNICEF and OCHA in reaching vulnerable groups, getting their feedback and understanding their information needs.

CFSI worker visits communities

Logistics support

With lots of moving equipment and supplies required for COVID-19, logistics support is an important part of the response. WHO provided technical support to the DOH in the recalibration of PPE requirements by using WHO projection tools, provided cost estimates, and advised on streamlining the distribution flow of PPEs and other essential supplies. WHO also supported DOH in the development of a commodities dashboard that provides real-time PPE stocks at the facility level, as well as assisted in building an information system for tracking essential COVID-19 commodities.

Subnational operations support

Aside from national support to the DOH, WHO is also providing subnational support in the Philippines by working with the DOH Field Implementation and Coordination Team (FICT) and the Centers for Health Development (CHDs) at the regional level. WHO conducted scoping missions in 10 out of 16 regions outside the National Capital Region to assess the needs and capacity of CHDs in responding to COVID-19. WHO staff have also been deployed in specific high-risk subnational areas in the country to provide technical support for the response. At the same time, contact tracing in subnational areas is also being strengthened with WHO, DOH Epidemiology Bureau, and UP College of Nursing developing a training programme and learning resource materials on contact tracing to build the capacity of epidemiology and surveillance officers and local contact tracing teams.

Responding to outbreaks in high risk areas

Closed settings like prisons and hospitals have seen clusters of confirmed cases. WHO, the DOH Epidemiology Bureau and the International Committee of the Red Cross (ICRC) worked with prison authorities and hospitals in joint contact tracing and infection prevention and control investigations. The teams provided them with guidance to prevent the further spread of infection to ensure the protection of persons deprived of liberty, hospital patients and people with mental health conditions.

WHO also supported the strengthening of community-based interventions and social support and addressing the needs of specific populations such as people with pre-existing mental and substance use disorders.

WHO visit to detention facility

Moving forward with the response

Much more needs to be done to break the chain of COVID-19 transmission. Some of the challenges that the Philippines continues to face are containing transmission of infection, mitigating the impact in high risks communities and confined settings, as well as ensuring the uniform enforcement of non-pharmaceutical interventions that are already in place. The continuation of the community quarantine will have substantial social and economic impact and thus a heightened effort to control  transmission of infections through rigorous contact tracing, isolation of cases, quarantine of contacts while ensuring timely and adequate treatment to save lives will continue to be the primary public health measure. In addition, while the government is exerting all its efforts in this current situation, it also needs to prepare its health systems for surge capacity in the event that a wide-scale community transmission occurs.

In the next few days, the government will carefully consider the next steps, especially on deciding whether or not the communty quarantine will be lifted or levels of quarantine will be differentiated based on the situation of provinces. WHO strongly recommends that when the government considers  adjusting public health and social measures in the context of COVID-19  the following requirements must be in place:

  • COVID-19 transmission is controlled through two complementary approaches – breaking chains of transmission by detecting, isolating, testing and treating cases and quarantining contacts and monitoring hot spots of disease circulation
  • Sufficient public health workforce and health system capacities are in place
  • Outbreak risks in high-vulnerability settings are minimized
  • Preventive measures are established in workplaces
  • Capacity to manage the risk of exporting and importing cases from communities with high risks of transmission
  • Communities are fully engaged.

View an infographic on WHO Philippines' support to the COVID-19 response in the Philippines  here.

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COVID-19 vaccines in the Philippine context

Several months and over 400,000 COVID-19 cases later, the Philippines has begun its long-awaited and promised process of acquiring vaccines as a means to end the pandemic. As early as April, President Duterte spoke optimistically of the prospects of a vaccine. Realistically, however, we must be aware of the realities of vaccination in the recent past in order to truly ensure its success.

Before looking at the advances of COVID-19 vaccine technology, it is important to look at the role immunization has played in the Philippine health care system. Indeed, this has been one of the cornerstones of preventive care for disease not just of childhood (mumps, chickenpox) but eventual adult concerns (HPV, pneumonia) as well. Yet despite the government’s Expanded Program on Immunization (EPI) and the National Immunization Program (NIP), the country has seen a drop in population coverage, leading to the resurgence of vaccine-preventable illnesses such as measles, diphtheria, and even poliomyelitis in the past decade. The Philippines’ circulating vaccine-derived polio cases in 2019-2020 placed us on a list with African countries struggling to end the transmission of this disease.

Many attribute the dismal immunization coverage to the dengue vaccine scandal, but while it doubtless eroded vaccines confidence in the Philippines, our immunization programs have actually been problematic long before Dengvaxia, failing to reach the coverage goal of 95 percent for many years now. The scandal only represented the nadir of what’s already been an alarming trend.

In fact, when it comes to timeliness of vaccination, the 2017 National Demographic and Health Survey showed only a 10.6 percent rate for all vaccines (ranging from 38 to 67 percent per vaccine). The gaps in delivery boil down to the quality and accessibility of our public health system, which, during the recent polio vaccinations, for instance, relied heavily on private sector support. It also faces a lot of challenges when it comes to maintaining the cold chain.

Looking forward to the COVID-19 vaccines, there have been major breakthroughs, the speed and complexity of which have never been encountered before. Of those nearing approval, there are two mRNA vaccines from Moderna and Pfizer—both requiring negative temperatures in their delicate handling. There are also the vector-based vaccines from Astra-

Zeneca and Gamaleya’s Sputnik V, as well as China’s inactivated vaccines developed by Sinopharm and Sinovac, all of which will only need normal refrigerated temperature.

Beyond the vaccine type, its corresponding handling, and the limitations of our health infrastructure, a major concern is the potential politicization of the acquisition, prioritization, and distribution protocols that will be put in place. There have been conflicting reports on who will be vaccinated first—health workers, vulnerable individuals, the poor, and uniformed personnel—according to different government agencies. There is also a need to address people’s concerns about the vaccines, from fears of being made “guinea pigs” to misconceptions about side effects and efficacy.

Surprisingly, there are reports of politicians having already received the vaccine, even if no emergency use authorizations have been granted by the local FDA. The vaccine “czar,” Gen. Carlito Galvez Jr., also mentioned that equitable access to the vaccine will only be achieved by 2022—an election year, which may bring about a predicament not unlike that of Dengvaxia in 2016, which some quarters allege was funded and launched for political considerations. These issues once again raise the danger of politicizing vaccination, especially if the process for prioritization will have potential interference from vested interests. With the urgency called for by the still uncontrolled pandemic, the success of not just the COVID-19 vaccine, but also of the entire vaccination institution in our country, hangs in the balance.

In the end, however, the solution for COVID-19 goes beyond vaccination. The World Health Organization reminds governments of the continuous need to strengthen their countries’ health system to provide for adequate testing, tracing, quarantine, treatment, and monitoring, aside from the provision of essential services. States must invest in public health to strengthen the infrastructure for pandemic preparedness, and to ensure the well-being of all, now more than ever.

Joshua San Pedro, MD, and Gideon Lasco, MD, PhD, are both physicians and anthropologists.

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COVID-19 response, NICE and community participation in the Philippines

Ma marilou s ibita.

Theology and Religious Education Department, De la Salle University, Metro Manila, Manila 1004, Philippines

Faculty of Theology and Religious Studies, Katholieke Universiteit Leuven, Vlaams-Brabant, Leuven 3000, Belgium

Ma Maricel S Ibita

Department of Theology, Ateneo de Manila University School of Humanities, Quezon City, Manila 1108, Philippines

Dear Editor,

Hannah Maiden et al . underlined the importance of community engagement and the use of National Institute for Health and Care Excellence (NICE) resources in responding to Corona Virus Disease 2019 (COVID-19). They emphasized the role of ‘community engagement: improving health and wellbeing’ as NICE’s ‘quality standard on evidence-based approaches to identify, mobilise and build on the existing strengths unique to every community’. 1 They highlighted the inadequate patient and public involvement in the decisions directly impacting their care and the under-realization of lay expertise. The authors enumerated what NICE does in providing quality standards for community engagement, identifying community assets, proposing quality metrics and have enumerated a list of support that champion shared learning, implementation and public involvement.

This kind of community engagement promoted by NICE could be utilized in the Philippine setting where the deficient COVID-19 response has been mainly military-led. 2 The inadequacy of this top-down style and the tactics of scare are glaring as the country’s number of cases and deaths have worsened from mid-March 2021. There is a continued under-utilization of community-based response on building back better amid the pandemic and envisioning a post-COVID era. The participation of people’s organization and faith-based groups could be tapped for a more integrated and holistic response that can yield better compliance in mitigating and responding to the physical–mental health consequences and the other collateral damage of the pandemic, such as children’s education. 3 For instance, the Urban Poor Women and Children with Academics for Reaching and Delivering on UNSDGs in the Philippines—(UPWARD-UP) project promotes community engagement among the Alliance of Peoples Organization Along the Manggahan Floodway community in Pasig City, the Community Organizers Multiversity and the academic researchers to help build back better with community ownership of the pandemic response. They use their community-articulated assessment criteria based on the United Nations Sustainable Development Goals as metrics and citizen journalism as a tool for their measurement. In the UPWARD-UP project, their community-articulated five priorities include: UNSDG #1 No Poverty (due to pandemic-induced job loss), #3 Good Health and Well-being (physical and mental health of members as families become infected), #4 Quality Education (diminished due to the lack of online tools and internet connection), #5 Gender Equality (given the triple burden of women as house managers, health care providers and education guide) and #16 Peace, Justice and Strong Institution (managing community peace and COVID-19 health compliance). The Philippines’ COVID-19 response could be more effective when initiatives like NICE and UPWARD-UP are incorporated in the ongoing local and national strategies.

Contributor Information

Ma Marilou S Ibita, Theology and Religious Education Department, De la Salle University, Metro Manila, Manila 1004, Philippines. Faculty of Theology and Religious Studies, Katholieke Universiteit Leuven, Vlaams-Brabant, Leuven 3000, Belgium.

Ma Maricel S Ibita, Department of Theology, Ateneo de Manila University School of Humanities, Quezon City, Manila 1108, Philippines.

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Philippines

Supporting the Philippines’ COVID-19 Emergency Response

When the COVID-19 pandemic struck in the Philippines, the World Bank supported the country's efforts to scale up vaccination, strengthen its health system, and counter the impact of the pandemic, especially on the poor and the most vulnerable. In addition to support for procurement and deployment of 33 million doses of vaccines, the project funded purchases of emergency medical/laboratory equipment and supplies, ambulances, and civil works, including the construction of negative pressure rooms for frontline health facilities.

Beneficiaries

For Vilma Campos , a Quezon City resident and mother of five, life has improved since her family received their vaccinations. "My daughter has resumed working, so has my husband," she said. "Life is no longer that difficult."

Before COVID-19 hit, Vilma's job was taking care of children. When the authorities started implementing quarantine restrictions, she, her daughter, and her spouse lost their jobs. Vilma said her family was always wondering where to get the next meal. "What gave us hope was the arrival of vaccines," she said.* "Things have improved and I really wish we can all overcome this pandemic."*

The Philippines was one of the countries hit hardest by COVID-19 in the East Asia and Pacific region. To manage the spread of the virus, authorities implemented strict quarantine restrictions and health protocols, restricted mobility of people as wells as the operational capacity of businesses. As a result, the Philippine economy suffered. In 2020, GDP contracted 9.5 percent, driven by significant declines in consumption and investment growth, and exacerbated by the sharp slowdown in exports, tourism, and remittances. Many Filipinos lost jobs and experienced food shortages and difficulties accessing health care. Due to global shortages, procurement of COVID-19 vaccines, medical supplies, personal protective equipment (PPE), reverse transcription polymerase chain reaction (RT-PCR) test machines, and test kits proved challenging in the early phases of the pandemic.

The project supported the country's efforts to scale up vaccination across the national territory, strengthen the country's health system, and overcome the impact of the pandemic especially on the poor and the most vulnerable. Besides vaccines, the project supported procurement of PPE, essential medical equipment such as mechanical ventilators, cardiac monitors, portable x-ray machines; laboratory equipment and test kits; and ambulances. The project also supported construction and refurbishment of negative pressure isolation rooms and quarantine facilities, as well as the expansion of the country's laboratory capacity at the national and sub-national levels for prevention of and preparedness against emerging infectious diseases. It funded retrofitting of the national reference laboratory -- the Research Institute for Tropical Medicine (RITM) -- as well as six sub-national and public health laboratories in Baguio, Cebu, Davao, and Manila, and the construction and expansion of laboratory capacity in priority regions without such facilities.

During year1 to year 2, the following results were achieved:

The project supported the procurement and deployment of 33 million doses of COVID-19 vaccine across the country. The project supported pediatric vaccination for 7.5 million children. With the support of development partners including the World Bank, Asian Development Bank, and Asian Infrastructure and Investment Bank, the Philippines administered more than 137 million vaccines (more than 126 million first and second doses, and more than 10 million booster doses) by March of 2022.

The project helped scale up testing capacity from 1,000 RT-PCR tests per day to 24,979 per day.

The project supported the procurement of 500 mechanical ventilators, 119 portable x-ray machines, 70 infusion pumps, 50 RT-PCR machines, and 68 ambulances.

As a result of the strong vaccination rates and strengthened health response capacity, the Philippines is now much better able to manage the pandemic.

33 million vaccines

The Philippines COVID-19 Emergency Response Project supported the procurement and deployment of 33 million doses of COVID-19 vaccine across the country. The project also supported pediatric vaccination for 7.5 million Filipino children.

Bank Group Contribution

The World Bank through the International Bank for Reconstruction and Development (IBRD) provided $900 million of funding in total for the emergency response project. The project provided $100 million for medical and laboratory equipment and supplies; $500 million for primary vaccine doses, ancillaries, and end-to-end logistics; and $300 million for boosters and additional doses, and end-to-end logistics.

The World Bank collaborated with the Asian Development Bank (ADB) and the Asian Infrastructure and Investment Bank (AIIB) on project preparation and vaccines financing. The Bank worked with the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the United States Agency for International Development (USAID) on the Vaccine Introduction Readiness Tool (VIRAT) and Vaccine Readiness Assessment Tool (VRAF) Tool 2.0, which is used to assess status, gaps, and issues in four domains: planning and management, supply and distribution, program delivery, and supporting systems and infrastructure. Australia, through the AGaP Trust Fund, provided a US$300,000 grant to support implementation. The World Bank also collaborated with UNICEF to address vaccine hesitancy and with the WHO to procure RT-PCR machines and test kits.

Looking Ahead

The Philippine government is considering additional support for scaling up testing capacity. Equipment has been acquired and civil works commissioned through the project are now in use. An action plan is being developed for continued implementation of environmental and social safeguards employed in the project, such as COVID-19 waste management and assessment of accessibility of vulnerable groups to health care services. These will be institutionalized using the manuals developed and through directive issuances by the Department of Health. The project also supports the development of National Action Plan Towards Increased Accessibility of Health Care Facilities for Vulnerable Groups. The World Bank is also supporting the Department of Health and priority LGUs in strengthen local health systems for Universal Health Coverage.

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