Dr Pacita Jay L. Lopez-Ballelos, Project Director
Dr Juliet J. Balderas, President
Philippine Foundation for the Prevention and Control of RF RHD
Council Chair RF RHD, Philippine Heart Association Quezon City, Philippines

Philippine Health Insurance (PhilHealth) was created by the National Health Insurance Act of 1995 with the objective of providing universal health coverage (UHC) for all Filipinos. The national movement for UHC has undergone several name changes and progressive amendments over the years. A Universal Health Care (UHC) Bill (Republic Act No. 11223) was signed into law by President Duterte in early 2019. Enthusiastically supported by WHO Western Pacific, this new bill automatically registers all Filipinos into PhilHealth, and rolls out popular reforms and expansion of healthcare services.

Of special interest to the RHD global community is Circular 2019 / 0005, “Outpatient Benefit Package for the Secondary Prevention of Rheumatic Fever / Rheumatic Heart Disease” that was approved by the PhilHealth Board in April 2018 and then officially rolled out for implementation in July to mandate treatment protocols and benefits for rheumatic fever (RF) and rheumatic heart disease (RHD) patients. Facilities accredited to deliver the new benefit package will provide BPG injections every 21 days and an annual echocardiogram free-of-charge for registered RHD patients, removing significant financial barriers to care.

The groundwork for this remarkable achievement is largely due to the dedicated efforts of the Philippine Heart Association- Council of RF RHD, Philippine Society of Pediatric Cardiology and Philippine Foundation for the Prevention and Control of RF RHD. Dr Juliet J. Balderas, President of the Foundation and Dr Pacita Jay “Jing” Lopez-Ballelos, Project Director, were awarded an RHD Action Small Grant in August 2018 for their project entitled, “Creation of Standardized RHD Educational Materials to Support and Promote the National Implementation of Free Secondary Prophylaxis in the Republic of the Philippines” to support their continuing advocacy for the implementation of Outpatient Benefits Package for RHD Patients.

Prior to the Small Grant award, this dedicated group worked with the Philippine Heart Center Department of Pediatric Cardiology on “Standardization of Guidelines in Treatment of RF/RHD” and created clinical pathways documentation for diagnosis, screening, and treatment. This work led to their involvement in the drafting of the national policy, which in turn, paved the way to the approval of the special RF/RHD benefits package. The main objective of their Small Grant project was to provide information and training sessions as the new PhilHealth RF/RHD standards, guidelines and benefits are introduced across the country.

The team created educational materials to cover important topics for facilities to meet the nationally required certification standards to become an approved RHD provider under PhilHealth. They formally launched their programme at the Children's Heart Foundation Grand Auditorium Philippine Heart Center in Quezon City in November 2018. From October 2018 through May 2019, using live and video conferencing, the team was able to reach over 700 doctors, nurses, other allied health professionals affiliated with school health programmes (not counting all those who attended via video link) with five presentations of their Symposium for Hospitals Accredited for FREE BPN.

These sessions were fully endorsed by the Philippine Department of Health program and more than 90 Department of Health employees attended the initial roll-out session. Sessions included important educational modules on a comprehensive array of topics covering The Magnitude of RF RHD in the Philippines; Clinical Pathways for Sore Throat Primary Prevention, and RF/RHD Screening and Echo Screening; The New Jones Criteria; Algorithm and Guidelines for BPN Injections: Duration and intervals; Valve Clinic Guidelines for Tertiary Prevention; and How to Enrol patients in the new RF RHD REGISTRY. The Implementing RF RHD Guidelines session was used to fulfill PhilHealth requirements for hospitals applying for Authorization as Providers of the new benefit package. The team is now working to implement quarterly training to ensure national coverage.

Dr “Jing” (Ballelos) expressed her enthusiasm and excitement: “This has never happened in Philippine history. After this approval, we wish to eradicate RF in the country within the next 10 to 20 years.” We at RHD Action wish them well and look forward to continuing to work together, supporting and advocating for all efforts aimed at preventing and controling RHD across the globe.