Dr. Irma Asuncion NCDPC, Department of Health

1. DOH Program Directions and
Priorities Towards MDG 4 and 5

2. Outline of the
Presentation
 Current efforts
 Status of MDG 4 and MDG 5
 Policy and program directions on public health
programs using the Maternal Newborn, Child Health
and Nutrition strategy
 Challenges and plan of action

3. What have been done. . .

4. Established Emergency Obstetric
and Newborn Care in select facilities
 identified 1784 facilities
 1443 RHUs (476 BHSs)
 341 hospitals
 1232 (69%) are staffed by a trained team of health
professionals
 identified 252 facilities to provide Comprehensive
Emergency Obstetric and Newborn Care, mostly
Regional Hospitals and Medical Centers, including
provincial hospitals

5. Integrated Service Package for Women, Mothers
and Newborns
•Integration of FP with other MNCHN services
eg. FP- ANC/ EPI integration
Postpartum IUD insertion
• Facility based deliveries

6. Developed a system for training health
providers
DJFMH
University Hospital
Training Unit Administrative
Unit
TRAINING INSTITUTIONS
RH WOMEN
NB
SERVICE PROVIDERS
CLIENTS
NCDPC HHRDB
Established 29
Training Centers
Trained 1445 of
2444(59%)
Health Teams
on BEmONC
Skills

7. Developed a system for monitoring
and evaluation

8. Developed a system for maternal death
reporting and review
Reporting
System
Review
System
Community: C/WHT
Facility: BEmONC and
CEmONC Teams
PHO: PRT Secretariat
PROVINCIAL REVIEW
TEAM
PHO: PRT Secretariat
Assuring Data Quality to Improve the System
*MNDRS

9. • Maternal and Neonatal Death Reporting
System (with IMS-DOH)
• submission of data thru the use of SMS technology
• The system aims to address immediate reporting of
maternal and neonatal death.
• Initial sites : Centers for Health Development
o Metro Manila
o CALABARZON
o MIMAROPA (Marinduque, Oriental and Occidental Mindoro

10. Adolescent Health
•Training of Trainers on comprehensive management on adolescent health(13
regions started rolling out, regions need trainings);
•Leaders for health and health advocates training for out of school youth (street
children of Metro Manila (86) and indigenous people (Mangyans, 100) and
(Dumagat,100)) (total px -286);
•Peer educators training for in-school adolescents (NCR 300px)
•Program implementation review integrating catch up immunization program for
adolescents (using MMR and Td) nationwide; Joint Memorandum Circular
signing(DOH, DepEd and NYC) on CSE and Adolescent immunization program
•National Adolescent Immunization Program (August. 2013)
•Drafting Guidelines for Adolescent Health Package with Philhealth and other
partners.
•National Awareness Campaign on Preventing Teen Pregnancy

11. Expanded Program on
Immunization / Vaccines
2,011,194 fully immunized children
(given complete doses of
BCG+OPV+DPT+Hepa+Measles)
Rotavirus vaccination for diarrhea
for 700,000 poor children
Pneumonia vaccines for 700,000
poor children
Influenza and Pneumococcal
vaccines for 1.1 million Senior
Citizens
What has DOH accomplished?

12. Family Health
17 CHDs; 33 DOH Hospitals, 81 provinces and
41 independent cities accessed grants for
MNCHN activities worth PHP167 million
Procured P400M worth of FP commodities
37 Hospitals provided with Voluntary Surgical
Contraception funding worth PHP37 million
PHP 11,836,000 was used to procure FP Kits
(BTL, NVS) for FP training
Vit A supplement provided to 1,186,356 infants;
9,450,553 children; and 2,616,000 postpartum
women
Provided iron to 586,811 low birthweight infants
and 2,655 children
Provided micronutrient powder to
182,951 infants and 365,902 children
Trained providers on FP CBT 1, FP CBT 2 etc.
What has DOH accomplished? 2

13. Family Health
50% of hospitals providing maternity and
child health services are certified MBFHI
60% of municipalities/cities have at least
one functional IYCF support group (4,010
BF/IYCF support groups at the
municipal/city/barangay level);
50% of workplaces have lactation units
and/or implementing nursing/lactation
breaks
55% (71/129) cities, 17% mun.
(263/1522), 28% provinces (23/80)
passed local ordinance/resolutions that
adopts IYCF recommendations
(23/80)provincial governments
What has DOH accomplished? 2

14. Community Health Teams
(CHTs)
44,009 CHTs (164,456
members) trained and deployed
2,999,707 NHTS households
nationwide visited
What has DOH accomplished? 3

15. Specific Policies Issued in Support
of FP/MNCHN
• AO 2008-0036 (MNCHN AO)
• AO 2009-0025 (ENC Protocol)
• DM 2011-0117 (MNCHN MOP)
• AO 2012 – 009 (FP AO)
• AO2013-0013 (Adolescent Health Policy)
• RPRH Law and IRR - under SQAO by SC
• Various PHIC circulars on accreditation and FP/MNCHN
benefit packages
• AO No. 2010-0010 – Micronutrient Supplementation Guidelines;
AO No. 2007-0045 – Zinc Guideline; DM No. 2011-0303 –
Micronutrient Powder

16. What do we want to achieve?
• Reduce unmet need for modern FP affecting 6M women, of which
2M are poor
• Reduce unmet need for FBD affecting 850,000 women of which
722,000 are poor
• Reduce unmet need for full immunization affecting 367,000 children
of which 21, 232 are poor
• Reduce unmet need for Vit A supplementation affecting 981,000
children of which 394,353 are poor
• Ensure that newborns are given EINC
• Upgrade health facilities to improve quality of care for at least 5.2M
NHTS poor families
• Sustain the deployment of at least 50,000 CHTs to serve poor
families
• Train all midwives etc

17. Where are we. . .

18. Antenatal Care Coverage hardly increased in
the past five years
78% of pregnant women have at least 4
ANC visits.
2015
TARGET:
85%

19. Skilled attendance and facility based births
increased , but why is MMR still increasing?
11 percentage points
increase in Facility
Delivery
2015
TARGET:
85%

20. Facility Delivery and Skilled Health Professional
Assistance at Birth
as of end 2012, PHO Reports

21. Facility Based Deliveries

22. Skilled Health Professional Assistance
at Birth

23. Frequency of Postnatal Care Received by Mothers within first
week of delivery
FHS 2011: NSO, DOH, USAID
84% of women received postnatal care
during first week after delivery.
2015 TARGET: 85%

24. INFANT AND UNDER-FIVE MORTALITY
(2003 – 2011)
FHS 2011: NSO, DOH, USAID
MDG Targets
for 2015
(26.7 and 19)
are
ACHIEVABLE

25. FIC, 2012, CHD data

26. TEENAGE FERTILITY HAS INCREASED TO
10 PERCENT IN 2011 FROM 6 PERCENT IN
2006.
4.8
7.4
6.3
9.5

27. Contraceptive use rates have barely
changed in the past decade

28. Unmet need for modern FP continues to
persist

29. Family Planning Method FPS 2006 FHS 2011
Any Method 50.6 48.9
Any Modern Method 35.9 36.9
Pill 16.6 19.8
Female Sterilization 10.4 8.6
IUD 4.1 3.1
Injectables 2.8 3.4
Male condom 1.6 1.2
Other Modern 0.3 0.8
Any traditional 14.8 12
OCPs are most preferred method; LAPM use declined

30. CHALLENGES. . .

31. As of Dec 2012
Less than a third of RHUs are MCP
accredited

33. SUSTAINABLE FINANCING CALLS FOR:
1. Rationale investments to cause the
PHILHEALTH ACCREDITATION of
facilities
2. Revenue retention – share for health
workers, CHTs
3. Allow user fee collection from non-poor
clients.

34. Make Safe Blood Available
• Implement fully the National Voluntary
Blood Program.
• Establish a Safe Blood Supply Network in
every city and province.
• Make blood easily, readily accessible

35. Referral Network
 Set up an Efficient Referral Network within ILHZs
and Province with the following in place:
› Emergency Transport on stand-by in every facility that
provide BEmONC 24/7.
• Can be for free or fee
– Properly maintained government owned ambulance
– Privately owned vehicles : MOA with public transport groups
for conveyance of referred cases
› Efficient Communication System to allow the referring
doctor to make endorsements to the referral hospital
› National Referral Manual of Operations

36. Ensure health teams competence
• Encourage LGUs to allow their staff to
undergo training on basic emergency
obstetrics and newborn care .
• post training evaluation

37. Conduct Maternal Death Reviews
• Strengthen and support Provincial and
City Review Teams.
• Conduct MDR at least once per 3
months
– Assist LGUs identify systemic gaps
– Assist LGUs address these gaps

38. And. . .

39. Connect the CHTs. . .
• Data
•Supervision
• Monitoring
• Members

40. Extent of CHT deployment varies widely
across areas
I II
III
IV
Source: CHDs as of August 2012

41. Access to safe deliveries in RHUs is
uneven across areas
I II
III IV
Source: HPDP Survey of Selected Government Health Facilities as of
August 2012

42. Access to surgical services in district and sub-provincial
hospitals is inadequate
I II
III IV
Source: HPDP Survey of Selected Government Health Facilities as of

43. Other Challenges
• Logistics management capacity that needs to be
strengthened
• Inadequate number of trained providers on
FP/MNCHN
• Delay in CHT deployment; limited effect on health
care use
• Limited functionality of service delivery networks;
mechanisms to formally engage private sector
providers need to be established

44. Proposed Approach to Scaling up
FP/MNCHN under KP
• Focus on poor households, starting with CCT/4Ps
• Tap Family Development Sessions (FDS) as entry point to
reach families
• Utilize Parent Leaders (PLs) and other volunteers to engage
families
• Conduct needs assessment and planning by making use of
available survey data and local information
• Estimate and match demand with supply of services,
including partnering with private sector
• Introduce innovations (health vouchers, outreach)to facilitate
use of services by families
• Engage local technical assistance partners (i.e. NGOs) to
help the LGUs and CHD execute the scale up strategy

45. Proposed collaboration with partners
• Updating of clinical standards and protocols
• Capacity building of health providers on IPCC, FP CBT 1 and
2
• Capacity building for midwives, nurses etc , including
mechanism for certification
• Strengthening logistics and supply-chain management
• Enhancement of CHT functions and support to deployment
• Improving monitoring and evaluation of programs including
compliance of facilities to EINC implementation
• Development of policies and guidelines including
management of prematurity and prevention of prematurity
complications
• Conduct of implementation research

46. Thank you. . .