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Padilla et al. Rare Dis Orphan Drugs J 2023;2:27 https://dx.doi.org/10.20517/rdodj.2023.38 Page 7 of 13

In 2020, the COVID-19 pandemic challenged healthcare systems worldwide. In the Philippines, strict
border controls were enacted between provinces, challenging the way in which NBS samples, medical foods,
supplies, and medicines could be transported. The ingenuity and dedication of the staff at the NSFs, NSCs,
NBSCCs, CHGSs, NSRC, and DOH regional offices led to the successful continuation of NBS despite the
COVID-19 pandemic. Disaster contingency plans for overcoming the resulting challenges (operations,
transportation, supply chain, communication, safety, etc.) were enacted by all groups. The NSFs, in
collaboration with the DOH regional offices, sent samples with personnel who were allowed to cross the
borders (policemen, firemen, military, navy, etc.). NSCs are divided internally into two cross-trained
laboratory teams to enable continued laboratory services should COVID-positive cases arise in team
members. Follow-up of patients shifted to teleconsultations as the main mode of patient contact [24-27] . As a
result, the PNBSP is developing updated contingency plans to respond not only to pandemics but also to
natural and man-made disasters. Being located in the Pacific Ring of Fire, the NBS program must be able to
respond effectively in emergency situations.

DISCUSSION
FACTORS CONTRIBUTING TO SUCCESSFUL NBS IN THE PHILIPPINES
Policy development
With the poor uptake of NBS in the early years, national policy development became the major thrust of
NBS champions. When NBS uptake failed to increase significantly, NBS champions moved forward with a
request for a national law requiring that NBS be offered to all parents of newborns. The 2004 NBS law also
integrated NBS into the public healthcare system. The Newborn Screening Act of 2004 has had the most
significant impact on national implementation. The law included five key elements: (1) DOH was made the
lead agency for NBS implementation; (2) NBS was covered by government insurance; (3) a Newborn
Screening Reference Center (NSRC), a university-based technical implementation partner, was created; (4)
health workers were required to inform parents and guardians about NBS; (5) NBS was required to be
[18]
offered for issuance of a birthing facilities’ license to operate and accreditation .
The full engagement of the DOH contributed to the progressive success of the PNBSP by increasing the
number of NSFs (from 24 hospitals in 1996 to 324 at the time the law was passed, 5,616 in 2014, and 7,200+
until now), and by increasing NBS coverage (from less than 1% in 1996 to 93.5% in 2019). The NBS law has
been used as the basis for target setting at the DOH. In 2018, the “National Policy and Strategic Framework
on Expanded Newborn Screening for 2017-2030” was formulated, which details the NBS targets by 2030:
95% newborn screening coverage; 90% of health facilities with maternity and newborn services include
expanded NBS (ENBS); 100% PhilHealth coverage of the newborn care package including ENBS; 95% of
facilities maintaining a greater than 99% satisfactory specimen rate; 95% of monitoring data generated from
DOH regional offices and NSFs through an online monitoring system; and 85% of identified strategically-
located provinces with established long-term management system for confirmed positive NBS patients .
[28]

Funding
The NBS law included payment for NBS in the benefits package of the Philippine Health Insurance
Corporation (PhilHealth), which oversees the National Health Insurance Program [19,20] . Program costs to be
reimbursed included stakeholder education, laboratory testing, sample transport, short-term follow-up, and
overhead expenses, among others. The law provided for administrative support by including that at least 4%
of the NBS fee go to the DOH Centers for Health Development (CHD) for follow-up services, education,
and other relevant activities. At least 4% was also allocated to the NSCs for human resource development,
equipment maintenance, and equipment replacement. At least 4% was also allocated to the Newborn
Screening Reference Center (NSRC) for overall program supervision, training, continuing education,