1. state of Filipino mothers
The National safe motherhood program

2. Presentation outline Our Mandate What we have done? The Results
The Challenges that we need to face

3. Improve Maternal Health Outcomes
Our Mandate
Improve Maternal Health Outcomes
Reduce Maternal and Newborn Mortality

4. What it takes to improve maternal health outcomes?
DOH initiatives
What it takes to improve maternal health outcomes?

5. reforms in the system Health Sector Reform Agenda
> Health Service Delivery
> Health Financing
> Health Regulation
> Health Governance
FOURmula One for Health
> Ensured access and availability of foods and services
> Increased, better and sustained service delivery
> Assured quality and affordability
> Improved health system performance
Universal Health Care
> Health Service
> Policy, Standards and Regulation
> Governance for Health
> Health Human Resource
> Health Information

6. Health Service Delivery
Reforms Areas
Health Service Delivery
Quality women’s health and safe motherhood service package
Health Regulations
Licensing requirements
PhilHealth accreditation
Clinical protocols
Human resource training and development and deployment
Health Facility Enhancement Program
Health Financing
Revenue generation
Rational use of resources
Equitable health service provision
Health Governance
Health system operations : ensuring that MONEY and STANDARDS are in place for the DELIVERY OF QUALITY HEALTH SERVICE.
Health Leadership
Reporting of vital events

7. Health sector reforms programs
Health Sector Reform Agenda
FOURmula One for Health
UHC
> Better Health Outcomes
> Responsive Health System
> Equitable Health Financing

8. UNIVERSAL HEALTH CARE as an operational solution
Convergence of three strategic thrusts to serve poor families.
Poor Families
NHIP Benefit Delivery
Access to Quality IP and OP care
Public Health Services

9. All pregnancy is a risk…
The Paradigm Shift in Maternal Health

10. Considers ALL pregnant to be at risk of complications at childbirth
The Paradigm Shift
From
Risk Approach To
EmONC Approach
Aims to identify high risk pregnancies for referral during the prenatal period
Considers ALL pregnant to be at risk of complications at childbirth
The goal of rapidly reducing maternal and neonatal mortality shall be achieved through effective population-wide provision and use of integrated MNCHN services as appropriate to any locality in the country. The strategy aims to achieve the following intermediate results

11. Maternal and newborn mortality reduction: WHAT WORKS
IN FACILITIES WITH CAPABILITY TO PROVIDE BASIC EMERGENCY OBSTETRICS AND NEWBORN CARE (BEmONC).
ASSISTED BY SKILLED HEALTH PROFESSIONALS
WOMEN DECIDING TO GIVE BIRTH …
To make this happen …

12. Improved Access of women to:
Emergency Obstetrics and Newborn Care (B/CEmONC) –
Birthing Centers with BEmONC capability nearest to homes
Designated referral hospitals for women needing CEmONC
Safe Blood
Efficient emergency transport service during referral
At least 4 Antenatal Care visits
At least 2 Postnatal Care check-ups

13. Administrative Order : Implementing Health Reforms to Rapidly Reduce Maternal and Newborn Mortality N
Maternal Newborn Child Health and Nutrition (MNCHN) as a National Strategy

14. MNCHN STRATEGY:
INTERMEDIATE RESULTS
Every pregnancy is wanted, planned and supported
Every pregnancy and delivery is appropriately managed in health facilities and by skilled health professionals
Every mother and newborn pair secures proper postnatal care

15. Women should GIVE BIRTH IN A HEALTH FACILITY
Our Advocacy
Women should GIVE BIRTH IN A HEALTH FACILITY

16. Improve women’s health and ensure safe pregnancy and childbirth
Access
Capability or means of entry into the health care system
Availability
Presence/ “obtainability” of the product or service
Equity
Increase access of the poor and disadvantaged
Integrate
Provide services as one single package to Optimize resources and Improve service delivery and utilization

17. Capability or means of entry into the health care system
ACCESS
Capability or means of entry into the health care system

18. Access means … Goods and services are AVAILABLE
Goods and services are AFFORDABLE
Health providers are APPROACHABLE
Health facilities are REACHABLE
Clients are able to GET the GOODS AND SERVICES that they need whenever they need them.

19. Our Framework Women Integrated WHSM service package
Health Facilities
Better Service Delivery
Women
Make pregnancy and childbirth safer
Enable couples to attain their desired spacing and number of children
Improve reach to adolescents
Control the spread of STIs and prevent infection
Sustainable autonomous operation of the public health facilities

20. Appropriate Intervention to Reduce Maternal and Newborn Death
BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE (BEmONC)
at facilities nearest to homes.

23. This is where we refer cases that cannot be managed at primary level
Cemonc provider
Public and Private Secondary and Tertiary Hospitals
Provincial Hospitals
Regional Hospitals
Medical Centers
Health Specialists
Obstetric specialists
Pediatric specialists
Anesthesiologists
DR Nurses
OR Nurses
This is where we refer cases that cannot be managed at primary level

24. BEmONC Defined

25. What is BEmONC? BASIC EMERGENCY OBSTETRICS AND NEWBORN CARE (BEmONC)
Refers to life saving services for emergency and newborn conditions/complications being provided by a health facility or professional to include the following services:

26. The Six BEmOC Signal Functions: (International Definition)
Parenteral administration of antibiotics
Parenteral administration of anticonvulsant
Parenteral administration of uterotonics
Manual removal of the placenta
Manual removal of the products of conception
Assisted vaginal delivery using low outlet forceps

27. Parenteral administration of loading dose of antibiotics
Basic Emergency Obstetrics and Newborn Care in the Philippines include the following functions:
Parenteral administration of loading dose of antibiotics
Parenteral administration of loading dose of anticonvulsants
Parenteral administration of uterotonics
Imminent breech delivery
Parenteral administration of loading dose of maternal steroids for preterm labor
Essential newborn care to include newborn immunization and newborn screening
Newborn resuscitation
Blood transfusion services in hospitals

28. At primary level…
BEmONC services must be made available 24 hours a day, 7 days a week in a single facility or in a network of facilities.
FP services provided
Counselling
Contraceptives provision

29. At secondary and tertiarry level…
Provision of all the BEmONC functions as internationally defined
Perfomance of Surgical delivery (caesarian section)
Blood transfusion
Management of all maternal and newborn complicatons
For FP
All services provided at BEmONC level
Surgical contraception

31. our health service delivery system
The current health system is characterized by….

32. 1735 facilities designated to provide BEmONC:
Basic Emergency Obstetrics and Newborn Care is provided in selected facilities nearest to homes.
1735 facilities designated to provide BEmONC:
1418 RHUs (477BHSs)
315 hospitals
1636 (94%) are staffed by a team of health professionals trained on the provision of Basic Emergency Obstetrics and Newborn Care.
There are 253 hospitals that provide Comprehensive Emergency Obstetrics and Newborn Care (CEmONC)
1. In keeping with the pradigm shift in maternal health service delivery and the call for facility delivery, Basic Emergency Obstetrics and Newborn Care (BEmONC) are now provided in facilities nearest to homes.

33. 30 minutes away from homes
The BEMONC-CEmONC NETWORK is established in all provinces for Maternal & Newborn Health SERVICE DELIVERY
BEmONC –CEmONC
CEmONC
RHU
BEmONC
1 hour away from BEmONCs
BHS
Hospital
BEmONC
2. To improve service delivery and save lives, a BEmONC-CEmONC network has been established to allow for easy referral. The network in most instances followed the Inter-local Health Zone configuration. Thus, wherever complications occur that is beyond the BEmONC signal function, a woman can be referred directly to a tertiary hospital that provides Comprehensive Emergency Obstetrics and Newborn Care (CEmONC). E.g. a woman having ANC at the BHS need not consult a hospital BEmONC when such complications occur…she can be referred immediately to a Provincial or Regional Hospital.
30 minutes away from homes

34. Maternal and Newborn Health (BEmONC) STI Screening during ANC
Integrated Women’s Health and Safe Motherhood Service Package for Women, Mothers and Newborns in all health facilities
Maternal and Newborn Health (BEmONC)
STI Screening during ANC
Adolescent Health
Family Planning
3. Health services are likewise delivered in an integrated manner to ensure that no opportunity is lost in health service provision. Thus a woman who comes for antenatal care should be provided with an array of services that she needs: she should be screened for STI, given counseling on responsible parenthood and post-partum contraception, etc. An adolescent whether pregnant or non-pregnant shall be provided with RH counseling, and other services.

35. Trained 1,996 of 1735 (115%) Health Teams on BEmONC Skills
Health Workers Competence is assured through the BEmONC Skills Training Program offered in 31 Training Centers
Family Health Office
Trained 1,996 of 1735 (115%) Health Teams on BEmONC Skills
Regional Hospitals RH
WOMEN NB
Hospital
Training Center
4. 29 Training Centers has been established all over the country to provide for RH training needs of health workers. Currently, these training centers only offer BEmONC Skills Training Course as this was the priority of the health sector given the commitment to accomplish MDG 5. But the ultimate plan is for these Training Centers to handle all in-service training needs of health workers. This reform in human resource capacity building is to ensure that health teams are appropriately trained by the specialists on the clinical skills required.
Training Unit
Administrative Unit

36. The Bemonc skills Training Centers
Luzon
Metro Manila
Ilocos Regional Training and Teaching Hospital
Mariano Marcos Memorial Medical Center
Region 1 Medical Center
Cagayan Valley Medical Center
Veterans Regional Hospital
Jose B. Lingad Memorial Hospital
Dr. Paulino J. Garcia Memorial Research and Medical Center
Batangas Regional Hospital and Medical Center
Ospital ng Palawan
Bicol Medical Center – Naga College Foundation Inc.
Bicol Regional Training and Teaching Hospital – Bicol University
Baguio Regional Hospital and Medical Center
Amang Rodriguez Memorial Medical Center
Dr Jose Fabella Memorial Hospital
East Avenue Medical Center
Quirino Memorial Medical Center
Rizal Medical Center
Tondo Medical Center

37. The Bemonc skills Training Centers
VISAYAS
Mindanao
Corazon Locsin Montelibano Memorial Medical Center
Western Visayas Medical Center
Saint Anthony Mother and Child Hospital
Governor Celestino Gallares Memorial Medical Center
Vicente Sotto Memorial Medical Center
Eastern Visayas Regional Medical Center
Zamboanga City Medical Center
Mayor Hilarion Ramiro Sr Memorial Medical Center
Northern Mindanao Medical Center
Cotabato Medical Center
Southern Philippines Medical Center
Davao Regional Hospital
Caraga Regional Hospital

38. maternal deaths are reported, reviewed and ACTED
Reporting System
for Safe Motherhood Program Indicators
Review System
to identify any gap in the health system that results to maternal death and address this gap
PROVINCIAL REVIEW TEAM
CITY REVIEW TEAM
Community: Midwives
Public and Private Health Facilities
5. A Maternal Death Surveillance and Response System is in place in all Provinces to ensure that every maternal death is reported and reviewed. The Review System is meant to identify and address gaps in the health system that contributed to death. This initiative shall prevent future deaths from occurring.
The Reporting System makes use of the CHTs and the Facility Teams. Community deaths (e.g. women delivers at home and die) are reported by the CHTs to their team leaders (the midwives) and validated by their respective MHOs. These reports are submitted to the Provincial Review Team (PRT) Secretariat at the PHO.
The Review Team is organized in every province (1 PRT per province) to ensure integrity of information and confidentiality. The review is done not to blame anyone but merely to identify and respond to system’s gaps.

39. Conduct of Annual Program Implementation Reviews:
Safe Motherhood Program Indicators are monitored and appropriately evaluated
National Safe Motherhood Program
BEmONC Skills Training Program
Maternal Death Surveillance and Response
Conduct of Annual Program Implementation Reviews:
6. A system for quick monitoring of important indicators is done through the Program Implementation Reviews which are done annually per cluster. The implementation reviews is a venue for discussion and resolution of important program implementation issues.

40. The RESULTS

41. Current State of Filipino Mothers and Newborns
This presentation shall cite the Family Health Survey of 2011 and the 2012 Reports submitted by the PHOs and validated by the CHDs.

42. EmONC and Maternal Health Outcomes
Indicator
2013 Target (NOH)
2013
NDHS Result
4 ANC
75%
84%
FBD
60%
SHP (SBA)
73%
2 PNC
72%
1,735
253
Indicator
2013 Target
2013 PHO /CHO Reports
4 ANC
75%
72%
FBD
77%
SHP (SBA)
87%
2 PNC
Our data provides the evidence that our investments in upgrading the health system (health facility enhancement and health staff training on BEmONC) benefits not only the mothers and the newborns but the whole population in general.

43. PHO and CHO Reports Actual Counts, 2012-2014
Outcome Indicators
2012
2013
2014
Target
Achieved
TOTAL DELIVERIES
1,820,212
1,761,414
1,807,482
1. % women with 4 ANC
70%
57%
75%
72%
80%
78%
2. % FBD
77%
3. % SHP
81%
87%
86%
4. % women with 2 PNC
67%
76%

44. Safe Motherhood Indicators 2012-2014, PHO and CHO Reports

45. ANC 4 Visits by Education and Wealth
While the trend of inequity in 4 ANC visits is decreasing at the rate of 13% - 7%, the gap is noted at 32%.
Education and wealth cause great disparity in a client’s compliance to 4 ANC with a 32% difference between Q1 and Q5. For education the gap is 51%.

46. Access to SBA by Education and Wealth
The trend in disparity is changing very slowly at the rate of 4.5% with a gap of 68.7% (25.7 vs 94.4) The gap is highest in education with 61% difference.

47. Program Response Focus on: Education Client
Awareness on ANC service in health facilities
Awareness on importance of ANC
Awareness on the benefits of professional care in a health facility
Health Workers
Enhance counseling services to motivate clients to utilize the services offered
Awareness on the importance of ANC and provision of quality care

48. Program Response Cost PhilHealth accreditation of facilities
PhilHealth membership of clients
Membership at the point of care

49. PHO and CHO Reports Actual Counts 2012-2014
Impact Indicator
2012
2013
2014 #
Ratio
Total Live births
1,842,167
1,773,468
1,796,821
MMR (per 1,000 LB)
1,262 69
(104)
1,109 63
(95)
1,374 76
(114)
National Surveys of MMR
2006 FPS: 162
(UN adjusted MMR: 130)
2011 FHS: 221
(UN adjusted MMR: 180)
UN Estimate
2005:
2010:
129
2015:
114
Note: MMR in parenthesis is the adjusted MMR based on UN adjustment factor of 1.5.

50. National Safe Motherhood Program
SUMMARY OF ACCOMPLISHMENTS
2014
IMPACT INDICATORS
Region
Live births
Maternal Death
Number
Ratio/100,000 LB
DOH CARO
36,259 18 50
DOH NCR0
294,296
173 59
DOH RO 1
87,815 37 42
DOH RO 2
55,044 23
DOH RO 3
169,995 79 46
DOH RO 4A
193,556
126 65
DOH RO 4B
59,106 58 98
DOH RO 5
117,578
117
100
DOH RO 6
80,792 80 99
DOH RO 7
142,784
132 92
DOH RO 8
79,619 77 97
DOH RO 9
75,654 61 81
DOH RO 10
92,603 74
DOH RO 11
92,389
134
145
DOH RO 12
90,643 54 60
DOH RO 13
50,102 75
150
DOH ARMM
78,586 56 71
National Average
1,796,821
1,374 76

51. MMR in the ASEAN Region

52. Challenges Quality of Care needs improvement
> Referral protocol
> Admission protocol
> Clinical Practice Guides
> Nursing Care Protocol
> Attitude of Health Workers
Human Resource needs to be increased
Safe Blood needs to be made available 24/7 and with clients given stress-free access
Improve access to contraceptives
Improve on data management
While investments are huge to improve the health system, there are still few remaining challenges…

53. How Can Pogs help?
Establish a functional Expert Panel to review clinical causes of death:
How cases were diagnosed and managed at the hospitals/health facilities.
Make this a venue for attending physicians to learn.

54. Thank you…