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Women's Health and Safe Motherhood Project


Submitted by april2011 on March 15, 2012 - 09:04 I. RATIONALE The Philippines has committed to the United Nation millennium declaration that translated into a roadmap a set of goals that targets reduction of poverty, hunger and ill health. In the light of this government commitment, the Department of Health is faced with a challenge: to champion the cause of women and children towards achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6(combat HIV/AIDS, malaria and other diseases). Pregnancy and child birth are among the leading causes of death, disease and disability in women of reproductive age in developing countries. The Philippine government commitment to the MDGs is, among others, a commitment to work towards the reduction of maternal mortality ratios by three-quarters and under-five mortality by two-thirds by 2015 at all cost. Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal mortality ratio, increasing neonatal deaths particularly on the first week after birth, unmet need for reproductive health services and weak maternal care delivery system, in addition to identifying the technical interventions to address these problems, the DOH with support from the World Bank decided to focus on making pregnancy and childbirth safer and sought to change fundamental societal dynamics that influence decision making on matters related to pregnancy and childbirth while it tries to bring quality emergency obstetrics and newborn care to facilities nearest to homes. This moves ensures that those most in need of quality health care by competent doctors, nurses and midwives have easy access to such care. Project Development Objectives and Indicators The Project contributes to the national goal of improving womens health by: 1. Demonstrating in selected sites a sustainable, cost-effective model of delivering health services access of disadvantaged women to acceptable and high quality reproductive health services and enables them to safely attain their desired number of children. 2. Establishing the core knowledge base and support systems that can facilitate countrywide replication of project experience as part of mainstream approaches to reproductive health care within the Kalusugan Pangkalahatan framework. Project Components Component A: Local Delivery of the WHSM Service Package This component supports LGUs in mobilizing networks of public and private providers to deliver the integrated WHSM-SP. In such project site, the following are currently being undertaken:

1. Establishment of Critical Capabilities to Provide Quality WHSM Services through the organization and operation of a network of Service Delivery Teams consisting of: a. Womens Health Teams b. BEmONC Teams c. CEmONC Teams d. Itinerant Teams 2. Establishment of Reliable Sustainable Support Systems for WHSM Service Delivery: a. Drug and Contraceptive Security b. Safe Blood Supply c. Behavior Change Interventions d. Sustainable financing of local WHSM services and commodities Component B: National Capacity 1. Operational and Regulatory Guidelines (Manual of Operations) 2. Network of Training Providers 3. Monitoring, Evaluation, Research and Dissemination II. INTERVENTIONS AND STRATEGIES EMPLOYED The Department of Health through the Womens Health and Safe Motherhood Project 2 introduces new strategies to address critical reproductive health concerns while confronting both demand and supply side obstacles to access for disadvantaged women of reproductive age. Among the changes that the Project introduced and has systematically mainstreamed into the current National Safe Motherhood Program are the following: Strategic Change in the Design of Womens Health and Safe Motherhood Services WHSMP2 brought about strategic changes in the way services are delivered to clients particularly the disadvantaged and underserved. These changes involve (1) a shift in emphasis from the risk approach that identifies high-risk pregnancies during the prenatal period to an approach that prepares all pregnant for the complications at childbirth this change brought about the establishment of the BEmONC CEmONC network, which is now part of the MNCHN service delivery network; (2) improved quality of FP counseling and expanded service availability, including the organization of more Itinerant Teams providing permanent methods and IUD insertion on an outreach basis and (3) the integration of STI screening into the maternal care and family planning protocols. An Integrated Package to Womens Health Services The above changes in service delivery will likewise involve a shift from centrally controlled national programs (MC, FP, STI and AH) operating separately and governed independently at various levels of the health system to an LGU governed system that delivers an integrated womens health and safe motherhood service package

. This service delivery strategy is focused on maximizing synergies among key services and on ensuring a continuum of care across levels of the referral system. At the ground level, this implies that a woman, whatever her age and specially if she is disadvantaged, who seeks care from a public health provider for reproductive health concerns, could expect to be given a comprehensive array of services that addresses her most critical reproductive health needs. Reliable Sustainable Support Systems Support Systems for WHSM service delivery include systems for (1) drug and contraceptive security, through a strategy of contraceptive self reliance; (2) safe blood supply; (3) stakeholder behavior change, through a combination of performance based grants and advocacy and communication; (4) sustainable financing, through a diversification of funding sources, principally given by the development of client classification scheme so that the poor gets public subsidies and the non-poor are charged user fees. Stronger Stewardship and Guidance from the DOH DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on WHSM services, (2) a system for accrediting providers of integrated WHSM service package training program; and (3) monitoring, evaluation and research on the new WHSM strategies. The Project is implemented in LGUs in 2 phases: Phase 1 (2006-2012): Sorsogon in the Bicol region and Surigao del Sur in the Caraga Region Phase 2 (2009-2012): Albay, Catanduanes and Masbate III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS As of December 2011, the project accomplishments via-a-vis its life of project work plan is 71%. Among the operations issues that delays accomplishments of critical inputs relates to procurement and other external factors such as LGU organizational structures. The following summarizes the over-all accomplishment of the project.

Results Matrix:

Outcome Indicators 80% Facilitybased Births 80% of the Women who gave birth have birth plans 75% of facility deliveries are financed by PHIC Increase CPR by 10 percentage points 100% of LGUs have passed an ordinance on the Contraceptive Self Reliance 100% of BEmONC have MCP accreditation Universal Social Health Insurance Coverage

Baseline (2010) Accomplishments 67% 99%

2011 2011 Target Accomplishments Values 80% 80% 77% 100%

17%

55%

27%

36%

5% 3% points increase points 39% increase 100% 70%

47%

45%

50%

52%

72%

75%

100%

Relative to the physical targets, the Project has accomplished the following in the Project sites: Year Project Milestones Status

2009 Social Preparation of Batch 2 Sites Organization of Service Delivery Teams Regional Blood Centers equipment upgrade 2009- Facility upgrade: Infrastructure 2011 and Equipment Ongoing: Albay: 90% Masbate: 80% Catanduanes: 60% Surigao del Sur: 53% Sorsogon: 84% 2009- Training Centers 2010 Insfrastructure and equipment enhancement Done Done Done

73%

Currently undergoing procurement 13 Training Centers already provided with equipment and other training logistics

20092010 Ensuring environmental Safeguards Organization of EMU in CEmONCs Designation of Waste Management Focal Persons in BEmONCs

Done

20082012

Capability Enhancement: Women's Health Teams

BEmONC Skills: 60% Sorsogon: 73% Albay: 103% Catanduanes: 55% Masbate: 73% Surigao del Sur: 63%

20082010 20082010 20112012 2010 20092013

BEmONC Teams Midwives on BEmONC Skills Module currently being finalized CEmONC Doctors (nonspecialists) Provincial Review Teams Behavior Change Interventions Performance-based Grants: Facility based Deliveries Universal Social Health Insurance Coverage Essential Drugs and Contraceptive Security Module currently being finalized Done

20102013

Advocacy for Positive Behavior Change TV Infomercials

4 Infomercials produced and aired in 2011; another 4 being produced for airing in 2012.

20092013

BEmONC Facility MCP Accreditation

52% Albay: 31% (5/16) Catanduanes: 17% (1/6) Masbate: 62% (13.21) Sorsogon: 82% (14/17) Surigao del Sur: 16% (3/19)

IV. PLANS FOR 2012 The Project intends to propose for an extension of another year to enable it to accomplish important activities as provided for by the design and loan agreement with the World Bank. These are: 1. Pilot test of an Adolescent Health Program model for the Philippines. This requires 2 years. 2. Study on the Impact of the WHSMP2 Performance Based Grant on Facility Based Deliveries is a one-year study. 3. Assessment of BEmONC Functionality is nationwide in scope and requires 1 year. If the extension is not granted, the Project implementation ends by December 2012. The activities therefore will be focused on accomplishing the remaining tasks with no new activities, except the conduct of the end of Project survey to determine its impact at the Project LGUs and its contribution to the attainment of national goals. Writing of end of project reports will be done in January to June of 2013. The project also supported the BEmONC Skills Training Program of the National Safe Motherhood Program and was instrumental in the 1. Establishment of 30 Training Centers in the country for the BEmONC Skills Training Course. Three of these training centers have efficiently partnered with academic institutions. 2. Development of training guidelines. 3. Passage of the Department Order allowing for the collection of training fees for the operation of the Training Centers. 4. Engagement of Technical Assistance (UP-Manila College of Public Health) for the development of the CEmONC Training Curriculum and Module. 5. Development of the Harmonized Module for BEmONC for Midwives in cooperation with UNICEF and UNFPA. 6. Training of BEmONC Teams nationwide; the current accomplishment is 48%. 7. Development and maintenance of a database on BEmONC Training. V. Other Significant Information Worth Mentioning

1. The Project provided assistance in the development of the Maternal Health Reporting and Review Protocol in cooperation with the National Safe Motherhood Program and WHO. 2. Publication of the Project Experience (in Sorsogon) in the November 2011 issue of the WHO Bulletin. Program Manager: Ms. Zenaida D. Recidoro National Center for Disease Prevention and Control - Family Health Office Telephone Number: 651-7800 locals 1726-1730 (As stated in the Womens Health and Safe Motherhood Project 2 Implementation Plan)

Women's Health Safe Motherhood Program 2 Safe Motherhood and Women's Health Project Copyright Department of Health All Rights Reserved

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