YOLANDA E. OLIVEROS, MD, MPH Director IV National Center for Disease Prevention and Control, Department of Health 33rd Annual International Conference on Global Health May 30-June 2, 2006 Supported in part by USAID under the Local Enhancement and Development (LEAD) for Health Project and Management Sciences for Health Contraceptive Self Reliance (CSR) Strategy The Philippine Experience

Profile Tropical country: 7,107 islands Population: 84M Annual Growth Rate: 2.32% (2003) Urban = 47.6% Rural = 52.4% Total Fertility Rate: 3.5 children/woman Total Contraceptive Prevalence Rate: 49% (2003 NDHS)

Maternal Mortality Rate: 172/100,000 LB Neonatal Mortality : 17/1,000 LB Infant Deaths : 29/1,000 Live births Under Five Mortality Rate: 40/1,000 LB Situation

Unmet Need for Family Planning: 17.3% of married women of reproductive age (about 2 million) 9.4% wanted to limit 7.9% wanted to space pregnancies 1 in 6 pregnancies ends up in abortion because they are unplanned or unwanted Incidence of abortion rising from 320,000 to 400,000 annually Need for Family Planning

All modern methods (artificial and natural FP) will be provided to clients based on informed choice Family Planning is a health intervention initiative by: preventing high risk pregnancies reducing maternal deaths responding to unmet needs Policy Statements

Implementation of Family Planning program shall abide by the following principles: Responsible Parenthood Respect for Life Birth Spacing Informed Choice General Principles: 4 Pillars of FP

To address the need to help couples and individuals achieve their desired family size within the context of responsible parenthood and to improve their reproductive health to attain sustainable development Objective of FP Program

Focus service delivery to the urban & rural poor Re-establish the FP Outreach Program Strengthen FP provision in regions with high unmet need Promote frontline participation of hospitals Mainstream modern natural FP Promote Contraceptive Self Reliance Strategy Program Strategies

FP program dependence on contraceptive donation for 30 years Contraceptive Independence Initiative (July 1999) January 2000: unified plan formulated November 2000: Contraceptive Interdependence Initiative 2001: Contraceptive Self Reliance (CSR) Background/Rationale for CSR

Policy Project conducted the Market Segmentation to ascertain if the clients who use FP commodities are willing and able to pay Findings: 60% are capable to buy their own supply 22% are getting supply from private sector (13.2% are from low income group) Methodology

Phase down of donated contraceptive supplies Condom supply - April 2003 Pills and injectables - gradual phase down from 2004 – 2008 Government Response: formulation and implementation of a Contraceptive Self Reliance (CSR) Strategy Methodology

At the national level: formulation of the national policy and implementing guidelines coordination with Local Government Units develop complementary means of financing expands complementary privates sources Because basic health services in the Philippines were devolved in 1991, the Phil. Gov’t. response to CSR has been two fold:

At Local Government Level: Empower local government units (LGUs) to meet the needs of the poor while segmenting the market with those who can afford to pay and refer to the private sector

The contraceptive donation phase down process: Batch 1 (accelerated phase): cities & provinces with lowest poverty incidence Batch 2 (longer phase-out period): LGUs with higher rates of poverty incidence Batch 3 (last, longest phase-out period): LGUs with highest rates of poverty incidence Administrative Order #158. s. 2004

DOH, MSH-LEAD, JSI & Project Deliver assisted the roll-out of CSR Initiatives in the LGUs\ Series of orientation workshops on AO 158 Training on CSR logistics policy guidelines formulation Planning activities capacitating LGUs to forecast, mobilize resources, procure and deliver/distribute good quality, & affordable contraceptive supplies

Survey of 892 LGUs Findings: 15% LGUs intend to fully cover the gap in contraceptive requirements 58% of LGUs intend to partially cover the gap 0.5% LGU opt the DOH commodity swap scheme 26.5% LGUs w/o any plan of covering the gap Results

Financing options for contraceptives identified during the CST strategic planning activities:

Procurement options of LGUs: Results

The success of the Philippines Contraceptive Self Reliance Strategy relies heavily on the synergy, coordination & cooperation of the DOH, the LGUs, donors, private sector/NGO providers and media The varied socio-economic conditions and priorities of LGUs will influence the options chosen by the LGU to operationalize CSR. Conclusion

There is still much to be done: National level policies & services that would enable LGUs to succeed in CSR responses (e.g. procurement guidelines, M & E of LGUs responses to CSR, etc.) Continuous advocacy effort Strengthen community support Conclusion

Commitment, systems & capacities of provinces, cities and municipalities as managers of local FP services Commitment, systems & capacities of employers to facilitate FP provision in the workplace Private sector players replace donated supply and expand domestic market Conclusion