Transcript Summary of Agreements

Country Team
Report - Philippines
Outline
 Current Situation vis-à-vis MDGs
 Status on Commitments in last MCH/FP
Upscaling Meeting in 2007
 Challenges & Issues
 Target/ Objectives
 Action Plan
 Country Team Members
Philippines
Facts:
• 88.4 Million (2007)
• Growth Rate = 2.04%
•
•
•
•
Population Density = 255/sq km
Median Age = 21 years old
Dependency Ratio = 69
TFR = 3.5 (2003)
• Women’s Education = 98.6%
• 55/45 urban/rural
Where are we now?
Population of over 88 million will
double in 30 years at current
growth rate of 2.04%
Rice production in 2004 grew by an
average of only 1.9% -- more
hungry people competing for a
decreasing volume of rice
Under-five mortality rate
Deaths per 1,000 live births
90
80
70
80.0
60
34.0
50
26.7
40
30
20
10
0
’90 ’91 ’92 ’93 ’94 ‘95
1998
2003
2008
2015
Sources: National Statistics Office - 1998, 2003 & 2008 data: NDHS; 1990 to
1995 data: TWG on Maternal and Child Mortality-National Statistical
Infant mortality rate
Deaths per 1,000 live births
60
50
57.0
25.0
40
19.0
30
20
10
0
’90 ’91 ’92 ’93 ’94 ‘95
1998
2003
2008
2015
Sources: National Statistics Office - 1998, 2003 & 2008 data: NDHS; 1990 to
1995 data: TWG on Maternal and Child Mortality-National Statistical
Child Mortality Trends
80
70
72
60
54
50
48
46
40
30
40
34
35
29
28
20
18
17
17
32
34
24
25
15
10
0
1988 1993 1998 2003 2006 2008
UFMR
IMR
NMR
 Downward trend in
childhood deaths
but,
 Slowed down in
the past decade
 Neonatal mortality
becoming higher
proportion of total
under 5 deaths
 Need statistician’s
understanding of
2006 vs 2008
Neonatal mortality indicators
20
18
16
14
12
17
2003
2008
16
12
9
10
8
6
4
2
0
Neonatal mortality
Postneonatal mortality
Sources: 2003 & 2008
NDHS
52
Maternal health
 91% received antenatal
care (ANC) from skilled
provider
 3.8 months pregnant at
the time of the first visit
 Lowest level of antenatal
care among




Rural women: 88%
Residents of ARMM: 47%
No education: 44%
Lowest quintile: 77%
Antenatal care providers
Doctors
51%
Midwives
51%
Unskilled
provider
9%
Nurses
1%
Wanted fertility by poverty
status
7
Wanted TFR
TFR
6
5
3.5
4
2.5
3
2
1
0
Lowest
Second
Middle
Fourth
Highest
Total
Increasing unmet need for FP
 Unmet need for FP is
highest among




15-19 (35.8%)
Rural women (23.7%)
ARMM (32.7%)
No education (28.6%)
Lowest quintile (28.2%)
 Total demand for FP is
73% (compared to 69% in
2003)
 Increase may be due to
difference in methodology
used in 2003 &2008
20
Percent

25
Trends in unmet need for
family planning
13
15
Limiting
Spacing
9
10
5
8
9
2003
2008
0
Priority Action in 2007
Major Activity
Action Taken
Status as of Jan 2010
1.
DOH AO 2008-0029
on Rapid Reduction
of MMR & NMR
Full implementation with
establishment of
BEmONC/CEmONC
nationwide
MOP for Maternal
Care & MOP for
Newborn Care
MCH MOP for
dissemination
NBC MOP in progress
Policy for MCH/FP
Scaling-Up
2. Guidelines for
Integration of MCH/FP
3. Advocacy tools for target Advocacy/IEC Matl
stakeholders
developed
Implementation ongoing
Media Campaign
4. Family Health Book
Demo site
Pilot implementation for
evaluation & subject to
expansion
ComVal Province
Priority Action in 2007
Major Activity
Action Taken
Status as of Jan 2010
5. Pre-service & In-service
training integration of
MCH/FP
IMCI integrated in
MW, RN, MD
Curriculum
Institutionalized 67, 42,
37% trained faculty in
MD, RN, MW schools
New initiatives ENBC in
progress
6. Updating training
materials and CMMNC
Manuals
CMMNC Manual only Full implementation
used in ARMM
Other training
On going
materials updated
7. Upgrading Health
Facilities
Budgeted in 20082010
50% of target BEmONC/
CEmONC upgraded
8. Integrated supervisory
M&E Tools for MCH/FP
QA & M/E tools for
MW practice
MDR Manual
Used by private MWs,
for adaptation to DOH
100% provinces using
Priority Action in 2007
Major Activity
Action Taken
Status as of Jan 2010
9. Advocacy for
amendment of the
MW Law
Many meetings conducted
(PRC,IMAP)
Congressional lobbying
done
PRC not convince that
Law needs amendment
Cong Hearings
undertaken but Bill not
passed
10. Advocacy for
inclusion of AMTSL
in Maternity Care
Package of PHIC
Lobbying for integration
done
Not included in pre-service
trainings/ curriculum
Not done
MW under the
supervision of MDs but
MDs not trained on
AMTSL
Issues & Concern
 Eliminating ineffective MNCHN practices
(ex. Episiotomy, use of HBMR, use of
delivery table, prophylactic anti-biotics)
 Major shift to improving pre-service
training rather than in-service
 Document quality of care of private
sector facilities esp. supervision/ govt
regulation of “midwife ran clinics”
Issues & Concern
 Define Skilled attendant as oppose to
skilled care
 Move stakeholders from well-intended to
well-aligned
 Supporting home deliveries
 Protecting the Rights of Skilled Providers
(Compensation & access to quality
training/ updating)
Goals & Targets for
MNCH/FP Scaling up
 Increase the proportion of Birth Attended
by skilled attendants from 64% in 2008 to
100% by 2015
 Increase the proportion of Health FacilityBased delivery from 44% in 2008 to 90% by
2015
 Increase CPR from 36% in 2007 to 70% by
2015
 Reduce unmet need for FP from 22% in
2008 to 11% by 2015
Country Team Action Plan
Objectives 2010
 Reduce the Neonatal Mortality Rate
(NMR) from 17/1,000 LB to 9/1,000 LB
by 2015 through 90% coverage of ENC
 Reduce Maternal Mortality Ratio
(MMR) from 162/100,000 to 52/100,000
LB by 2015 through increasing CPR to
60% by implementing 100% Post
Partum & Post Abortion Family
Planning Coverage
Best Practices to Scale
Up
Essential Newborn Care
Package
Includes:
 Immediate Drying
 Skin to Skin Contact
 Delayed Clamping of the Cord
 Early Initiation to BF
WHY Essential Newborn
Care (ENC)?
 Credible : there’s a study in 51 tertiary
hospitals in the country that showed that ENC
is not being practiced in these basically
teaching hospitals
 Observable : decrease in UFMR but NMR has
not changed much, it shows over 1/3 of UF
Deaths
 Advantage : evidenced-based, cost-effective;
very simple; not technology based
WHY ENC?
 Easy to install : not medical/ technical based;
has IEC materials “unang yakap”
 Is it Compatible: difficult to unlearn traditional
practices esp. in the Hospitals; its more costeffective; better implementation of rooming-in &
BF policies
 Testable : it can be done in phases starting
with Tertiary Hospitals first.
The Evidence
 Essential Newborn Care (ENC)
is not practiced in most Tertiary
Hospitals in the Philippines
 ENC was piloted in one DOH
Tertiary/ Training Hospital in
2009, showed reduced Neonatal
Sepsis in this hospital
A Minute-by-Minute Assessment of Newborn Care
within the First Hour of Life in Philippines Hospitals (2009)
Intervention
Percentage and
Median Time
WHO Standard
Cord Clamp
12 sec
99% in < 1 min
Until pulsations stop (1-3
mins)
Drying
97% at 1 min
100% Immediately
Immediate Skin to skin 9.6% at 5 min
>90% (except those needing
resuscitation)
Put on cold surface 12%
None
Not dried
2.5%
None
Head not dried
6.2%
None
84% at 8 min
>6 hours
17%
All
Wash
Temp taken before
A Minute-by-Minute Assessment of Newborn Care
within the First Hour of Life in Philippines Hospitals (2009)
Intervention
Median Time or
Percentage
WHO Standard
Breast feed
69.3% at 10 min
Within 1 hour (but when
baby shows signs)
Separated from
mother
92.9% at 12 min
>1 hour
Weigh
100% at 13 min
> 1 hour
Exam
75.7% at 17 min
> 1 hour
Hepatitis B Vaccine
69.4% at 20 min
>1 hour
Nursery
52% at 19 min
Never
Rooming in
83% (155 min)
Immediately with mother
Stakeholders in ENC
Scaling Up –the Users
 DOH Hospitals
 Professional
Organizations
(PPS,POGS, IMAP,
FPAP, etc)
 Local Government
Units (LGUs) =
Hospitals & RHUs
 Resource Group
 Technical Resource
 Implementors of the
Guidelines
 Implementors
Stakeholders in ENC
Scaling Up – the Users
 Non-Government
Organizations
 Women’s Health
Teams (BHWs,
TBAs, Midwives)
 Health Workers
(Hospitals, Clinics,
RHUs)
 Academe
 Advocacy
 Implementors
 Pre-service Training
Mainstreaming
The Resource Group to Promote &
Facilitate the Expansion of ENC
Group
 Department of Health
(National & Regional)
and its attached
agencies
 Local Governments
 Development Partners
Role/Responsibilities
 Primary Support:
 Policy Development
& Dissemination
 Human Resource
Development (Inservice Trainings)
 Funding Resource
The Resource Group to Promote &
Facilitate the Expansion of ENC
 Professional
Organizations
 Other National
Government
Agencies (ex.
CHED, PRC, DILG,
PIA)
 Medical/ Allied
Professionals &
their schools
 Secondary Support:
Technical & Financial
Assistance
 Advocacy
Are there Champions/
Advocates in the Organizations?
 Participants of Reconvening Bangkok
2010
Role: Policy Dissemination & Advocacy
 Public-Private Partnerships as
implementors of ENC
Opportunities
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Existing Policy on ENC
Protocol & MOP for ENC
ENC is non-controversial
Government is committed to meet MDG 4
Increased DOH budget for IMNCH
Active Participation of many Devt Partners
Health Sector Reform is in place esp.
Governance
 Upcoming Elections may see Supportive Govt
Officials
Constraints
Action Needed
Well entrenched practices in
the Hospitals ex Immediate
Bathing, Suctioning
Optimize Role of
Professional Orgs to
Disseminate new ENC
Policies, BCC
Identify Champion to
oversee actual
implementation
Organize a training team
(c/o DOH)
Start in critical facilities
Timeliness of Scale Up (it
could take long…)
Constraints
Action Needed
Timeliness of Scale Up (it
could take long…)
Phased Scale-up, start
with training hospitals per
Region & Devt the ME to
track progress
Train/ Inform the
mothers during ANC
Make ENC part of the
training for WHTs
Increase SBAs esp. in
GIDA (DOH/ LGUs)
Integrate the new ENC
policy in the CPGs of SHI
56% of deliveries are at
home
30% are attended by nonSBAs
New ENC not part of the
package for Social Health
Insurance
Action Plan for 2010 onwards
Priority Action
Time Frame
Agency
Responsible
National
Dissemination
Forum for ENC
Policy
Region Level
Orientations
Phased Scale-up,
start with One
training hospital per
Region
April 2010
DOH,
Professional
Orgs.
May 2010
DOH CHDs
June- December DOH, CHDs
2010
Action Plan for 2010 onwards
Priority Action
Time Frame
Agency
Responsible
Organize a training
team (c/o DOH)
Start Trainings in
critical facilities
March – April
2010
May – Dec
2010
DOH
Modification of the
Curriculum (ex. PRC,
CHED, APMC,
Academe)
April –
December
2010
DOH, Partners,
LGU, NGAs
Advocacy & Align to
Professional Orgs
June 2010
DOH, Partners
DOH Regional
Directors
Action Plan for 2010 onwards
Priority Action
Time
Frame
Agency
Responsible
Develop Information
materials for the mothers
during ANC
Make ENC part of the
training for WHTs
Increase SBAs esp. in
GIDA (DOH/ LGUs)
Integration of ENC
standards in the TCL
March –
December
2010
DOH, IMAP,
LGUs
2010-2012 LGUs
Ongoing
DOH
Methods for M & E
 Monitoring Tools for Midwife being
developed --- Self Assessment &
Supervisory Tools
 Include in the FHSIS through inclusion
in the Target Client List
 Baseline Data Collection c/o DOH &
LGU
Costs of IMNCHN w/ ENC
 ENC Policy Dissemination --- P1M per
Region = P17M
 Capacity Building Activities ---P25 M
(WHO/ UNICEF/UNFPA/ DOH)
 Technical Assistance – P50M (USAID)
 Supplies & IEC Materials – P10M (DOH)
Cost for IMNCHN
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


DOH --P3,150M
UNICEF/ UNFPA/ WHO --- P 25M
USAID --P 50M
LGU --P 81M
-------------------TOTAL ---P3,306M
OR $ 66M
Cost specific for ENC to be determined.
Country Team Members
 DOH
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Assistant Secretary – Dr. Paulyn Jean B. Rosell-Ubial
NCDPC Director – Dr. Eduardo Janairo
CHD CARAGA Regional Director – Dr. Leonita Gorgolon
CHD Bicol, MCH/FP Coordinator – Dr. Alejo Aralar
 LGU
 Tawi-Tawi PHO,Head – Dr. Sukarno Asri
 Compostela Valley PHO, Medical Officer – Dr. Kay
L. Rodriguez
 MHO Penablanca, Cagayan & AMHOP President
Region II – Dr. Mila Lingan-Simangan
Country Team Members
 LGU
 PHO – Saranggani – Dr. Antonio Ysana
 APHO – North Cotabato – Dr. Eva Rabaya
 PHO Eastern Samar – Dr.Marcia Indencio
 NGO
 IMAP, Bohol – Ms. Corazon Paras
 Development Partners
 UNICEF – Dr. Matha Cayad-an
 USAID, HPDP – Ms. Cheryl Bernadita S.
Osorio
Country Team Members
 Development Partners
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USAID – Ms. Marichi de Sagun
USAID – Ms. Nilda Perez
USAID – Dr. Padmaja Shetty
SHIELD – Dr. Leo Alcantara
A2Z – Dr. Corazon Barba
PRISM – Dr. Lemuel Marasigan
World Vision – Dr. Yvonette Duque
World Vision – Ms. Mary Grace Gayoso
World Vision – Dr. Cerilo N. Diesmas
Thank You…See you in 2012