Part II: Context and Resources of the
National Response

The National Response

Wary of the unfolding epidemic in neighboring Thailand in the late 1980's, the Philippines was quick to recognize its own vulnerabilities to HIV/AIDS. Early responses included:

• Creation of the National AIDS and STI Prevention and Control Program (NASPCP) in 1988 within the Department of Health (DOH).

• Issuance of Executive Order No. 39 in 1992 by the President of the Philippines that created the Philippine National AIDS Council (PNAC), a multi-sectoral body tasked to advise the President on policy issues regarding HIV/AIDS. Members of PNAC are government agencies, non-government organizations, professional groups and representatives of people living with HIV/AIDS.

• Establishment of HIV/AIDS Surveillance System established to keep track of the infection and guide program planners and implementers.

• Enactment of Republic Act 8504, or the Philippine AIDS Prevention and Control Act of 1998 by Congress (AIDS Law). The Law mandates the promulgation of policies and prescription of measures for the prevention and control of HIV/AIDS in the Philippines, institutionalization of a nationwide HIV/AIDS information and educational program, establishment of a comprehensive HIV/AIDS monitoring system, and strengthening of PNAC.

• Development of AIDS Medium Term Plans (AMTP) to strategically guide policymakers and programme planners and determine where resources for HIV/AIDS could make the most impact and what strategies and interventions were needed given the prevailing situation.

• Development of Guidelines, Standards and Protocols for reporting, treatment, care and support.

• Piloted community-based interventions, ranging from information dissemination to behaviour change strategies targeted at most at risk groups.

• Building the capacities of health care providers to offer quality prevention, care and support services, and the creation of the HIV/AIDS Core Team (HACT), made up of doctors, nurses, medical technicians and social workers in government-retained hospitals, together with NGOs based in the community.

• Creation of Local AIDS Councils (LACs) in some cities, institutionalizing partnership of Local Government Units (LGU) and NGO at the city level. Local AIDS ordinances including budgetary allocations for STI/HIV/AIDS program were also enacted.

• Development of modules to integrate HIV/AIDS in the school curricula at all levels, including non-formal education. Training of trainors has been conducted on the use of these modules.

• Development of HIV/AIDS Policies in the Workplace by the Department of Labor and Employment (DOLE). A tripartite committee has been formed to ensure full implementation of this policy. The involvement of the business sector and trade unions facilitate the establishment of HIV/AIDS programs in the workplace.

• Integration of HIV/AIDS and Migration in the curriculum of the Foreign Service Institute (FSI) of the Department of Foreign Affairs (DFA).

Although the early and proactive response to HIV/AIDS has contributed to the low prevalence, the overall momentum in the national HIV/AIDS response has slowed down. Resources for HIV/AIDS prevention, care and support programs have significantly decreased. R.A. 8504 and other policies, guidelines and protocols are yet to be fully disseminated and implemented nationwide, and pilot interventions that have shown promising gains are not sustained or scaled up, some of which have even ceased.

AIDS Financing

Total AIDS spending over the last five years (2000-2004) is estimated at PhP1.4 billion. Spending peaked in 2001 largely because of the huge amounts of resources provided by donor agencies-United States Agency for International Development (USAID) and Japan International Cooperation Agency (JICA). During this year, USAID poured resources leading to the completion of the AIDS Surveillance Education Project (ASEP, 1993-2003). On the other hand, JICA provided funding assistance for infrastructure including the establishment of the STI/AIDS Central Cooperative Laboratory (SACCL) at the San Lazaro Hospital (1993-2001). Total expenditures slowly declined in the succeeding years. (Figures 3 and 4)

Figure 3. Total HIV/AIDS spending, 2000-2004 (in thousand Pesos)

Figure 4. Total HIV/AIDS spending by source, 2000-2004 (in thousand Pesos)

The share of public sector spending on AIDS in the last five years is relatively small (15.58% in 2000, 6.47% in 2001 and 21% in 2004). It should be noted that in recent years, the Philippines has been experiencing fiscal constraints resulting in limited budget appropriations in nearly all government agencies. A large share of total spending therefore came from external sources (84% in 2000, 85% in 2002, and 79% in 2004). (Figure 5)

Figure 5. Distribution of spending by source, 2000-2004 (in %)

Public sector sources include national government agencies and the LGUs. National government spending is mainly from the DOH's NASPCP and its Centers for Health Development (CHDs), the PNAC Secretariat, DepEd and DOLE-OHSC, among others. On the other hand, external sources of financing include: USAID, JICA, Joint United Nations Programme on AIDS (UNAIDS), United Nations Population Fund (UNFPA), the German Development Bank (Kreditanstalt fur Wiederafbau or KfW), among others.

The NGOs usually get funding from external sources as well. In terms of financing agents, more than half of total financing went to non-public agents or NGOs (71% in 2002, 79% in 2003, and 57% in 2004).

With regard to specific activities, resources were poured mostly on prevention activities (77.7% in 2000, 65% in 2002 and 62% in 2004) which include: behavior change initiatives, IEC, condom social marketing, counseling and testing, STD management, among others. (Figure 6)

Resources were also spent on program costs, which include: advocacy activities, capability building, monitoring and surveillance, laboratory infrastructure, research, and management costs.

Although the share of spending for treatment is very low, it has been relatively increasing since 2002 (1% in 2002, 1.14% in 2003 and 2.4% in 2004). These services are limited only to laboratory tests, prophylaxis for OIs and treatment of opportunistic infections (OIs). In the past, cost of ARV is usually borne by the AIDS patient. There are however ongoing efforts now to make ARV accessible and affordable.

Figure 6. Distribution of spending by nature, 2000-2004 (in %)

The Philippine AIDS Medium Term Plan IV 2005-2010

The 4th AIDS Medium Term Plan, which is the fundamental basis for setting country-specific targets for Universal Access, has set out the following policy directions for 2005-2010:

1. Efforts must be geared towards the prevention of the further spread of the HIV infection and to reduce the impact of the disease on individuals, families and communities;

2. It must ensure that measures and programs undertaken are responsive to the identified needs of concerned sectors, individuals and groups;

3. Priority must be given to the infected and affected as well as to existing and emerging highly-vulnerable groups, especially those not covered in the AMTP III, which include OFWs, youth, infected and affected children;

4. Quality improvement in the design and implementation of STI/HIV/AIDS interventions must be given due attention. Systems to monitor and measure quality of every intervention must be put in place;

5. Scaling up and expansion of effective intervention measures must be pursued and given ample resource support;

6. It shall embody all on-going assisted projects and programs on HIV/AIDS to ensure integration, harmony of purpose and direction and avoid overlaps;

7. It must include mechanisms to ensure a protected level of funding support to pursue its goals and objectives;

8. The implementation, coordination, monitoring and evaluation mechanisms of the AMTP IV should build on existing structures and systems, particularly those provided by the Local Government Code; and,

9. The directions and goals shall be aligned with the vision, goals and purposes of the Medium Term Philippine Development Plan (MTPDP), the Millennium Development Goals (MDGs), UNGASS Declarations, and the Joint Ministerial Statement and other international commitments that are considered applicable to the country.

GOAL

To prevent the further spread of HIV infection and reduce the impact of the disease on individuals, families and communities

OBJECTIVES

1. To increase the proportion of population with risk-free practices;

2. To increase the access of people infected and affected with HIV/AIDS to quality information, treatment, care and support services;

3. To improve accepting attitudes towards people infected and affected by HIV/AIDS; and,

4. To improve the efficiency and quality of management systems in support of HIV/AIDS programs and services.

KEY STRATEGIES

Strategy 1	Scaling-up and quality improvement of preventive interventions targeted to identified highly vulnerable groups (sex workers and their clients, IDUs, MSMs and OFWs)
Strategy 2	Strengthening institutional and general public preventive interventions
Strategy 3	Scaling up and quality improvement of treatment, care and support services for people infected and affected with HIV/AIDS
Strategy 4	Integrate stigma reduction measures in the preventive treatment, care and support services and in the design of management systems
Strategy 5	Strengthening and institutionalization of management systems in support of the delivery of HIV/AIDS information and preventive services

INDICATORS

IMPACT INDICATORS
GOAL To prevent the further spread of HIV/AIDS infection and reduce the impact of the disease on individuals, families and communities.	HIV prevalence at 1% for MARP and less than 1% for VP and general population 50% decrease in STI prevalence among MARP
OUTCOME INDICATORS
Objective 1 To increase the proportion of the population with risk-free practices	1.1 60% of MARP use condoms correctly and consistently (60% PIPs, 60% MSMs, 40% IDUs, 60% VPs) 1.2 30% increase in the proportion of IDUs with safe injecting practices 1.3 Maintain at 18 years old the median age of penetrative sexual intercourse among 15-24 years old
Objective 2 To increase the access of people infected and affected by HIV/AIDS to quality information, treatment, care and support services	2.1 Increase proportion of PLWHAs seeking medical treatment 2.2 % increase of families caring for PLWHA members/relatives 2.3 Decrease in the incidence of OI among PLWHAs taking ARVs 2.4 Enhanced capability of affected families of PLWHAs in providing home-based care
Objective 3 To improve accepting attitudes towards people infected and affected by HIV/AIDS	3.1 Decrease in the number of PLWHAs with no community/family support 3.2 % of health providers to have positive attitudes in accepting the PLWHAs 3.3 % of general public with accepting attitudes towards PLWHAs 3.4 % of workplace with accepting attitude towards PLWHAs 3.5 % general population with accepting attitudes towards PLWHAs (employers - 60%; general public - 50%)
Objective 4 To improve the efficiency and quality of management systems in support of HIV/AIDS programs and services	4.1 Increase in the number of identified risk zones with functional LACs 4.2 Increase in funding support for HIV/AIDS from the national and local government 4.3 Increase in the number of LGUs implementing 100% CUP 4.4 100% of PNAC member agencies are implementing HIV/AIDS program 4.5 100% functional M&E system in place 4.6 100% functional resource tracking system for HIV/AIDS in place

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