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Assurance exercise. The DOH also requires external review assessment as part of its NSC licensure
requirement, and a review team of international experts (Dr. Bradford Therrell from the USA and Dr.
Veronica Wiley from Australia), a local pathologist, and representatives from the DOH and NSRC provide
periodic expert reviews as part of this process.

Oversight issues
Despite the overall success of the program, there are continuing national challenges yet to be fully addressed
by the NSRC [Table 2]. Policies must be developed to address the timeliness of specimen submission and
recall of screen-positive patients, which pose a particular challenge for patients from remote communities in
the mountains or on remote islands. For screen-positive patients already presenting with symptoms upon
recall, coordination with the needed subspecialist must be done to initiate acute care management. When a
remote patient is confirmed, arrangements for follow-up and delivery of metabolic food (for metabolic
patients) and drugs pose a logistical issue. In some instances, collaboration with the military has been
necessary as the only viable alternative to accomplish this task. The presence of these geographically isolated
and disadvantaged areas (GIDA) also presents a challenge in delivering continuing education to NBS
frontliners. Telecommunications technology is currently being used to keep the program implementers
updated. A locally developed ENBS mobile app now provides a one-stop communications hub for NBS
information. The app streamlines messages to all healthcare workers about program activities and monitors
compliance of newborn screening facilities.

Table 2. Summary of challenges and possible solutions
Challenges Possible solutions
Quality of specimen submission during NBS Re-training screeners at the NSFs
initial test
Efficiency of recall of screened positive Collaborations with LGUs and DOH-CHDs for reaching patients living in difficult-to-reach
newborns places, i.e., islands and mountains
Training healthcare workers in communities to perform heel prick and to help in the recall of
patients
Prompt treatment of diagnosed patients Early coordination with the needed subspecialist to initiate management of patients who
already present symptoms on recall
Presence of geographically isolated and Collaborations with LGUs in education and implementation of the program
disadvantaged areas Use of telecommunications technology to keep the program implementers updated
Maintain quality testing in the NBS laboratories Initiate and ensure compliance with standards among the NSCs through ISO 15189 certification
Expansion of the treatment network Coordination with DOH regional offices and provincial offices in identifying new sites for the
continuity and satellite clinics

DOH-CHD: Department of Health-Centers for Health Development; ISO: International Organization for Standardization; ISO 15189: international
standard specifying requirements for medical laboratory competency; LGU: local government unit; NBS: newborn screening; NSC: newborn
screening center (screening laboratory and follow-up); NSF: newborn screening facility (hospital or birthing facility).

CONCLUSION
The challenges to implementing sustainable national newborn screening in developing health systems have
[38]
been previously outlined . The implementation of NBS in the Philippines has been successful because of
attention to overcoming these challenges that we have discussed in this paper. The success of the PNBSP has
been attributed to a mix of actions and activities, including national policies, local health ordinances,
dedicated program partners, health professionals, policymakers, and civil organizations (professional health
societies, NGOs, parent support groups, etc.). The inclusion of a funding mechanism in the law was a

environment.