Mindanaohealth Project Program Year 5 Accomplishment Report

MindanaoHealth Project Program Year 5 Accomplishment Report

(October 2016-September 2017)

Submitted: October 30, 2017

Submitted by: Dolores C. Castillo, MD, MPH, CESO III Chief of Party MindanaoHealth Project E-•‐mail: [email protected] Mobile phone: 09177954307

On the cover:

Top left: Jhonylyn Areja (extreme right), one of the women listed in the CARAGA Health Information System as having FP unmet need, call in her husband, Eugenio Areja (2nd from right) to listen and learn from Rural Health Midwife Suzzette Despi (extreme left) as she provides them with FP information and counseling services. (ALachica/Jhpiego)

Bottom left: Buenavista National High School Head Mr. Apolinario Felias (2nd from right) holds the official Teen Safe Place signage endorsed by MindanaoHealth Project representatives Caraga Technical Team Leader Arlys D. Demata (extreme right) and Project MNCHN and FP Specialist Dr. Hendry Plaza (extreme left) together with Provincial Youth Coordinator Mary Grace E. Wang (2nd from left). This signage will be posted so students with reproductive health issues needing counseling would know where to go. (Photo: DepEd Agusan del Norte)

Top right: Nurse Amy Joy Abaday (right), Public Health Nurse of Tabina Rural Health Unit in Zamboanga del Sur, meets Frelie Navaja, 30-year old mother of 3 and a satisfied acceptor of Bilateral Tubal Ligation who was initially profiled as having unmet need for family planning using a masterlist reviewed together with the Municipal Link Officer of the Department of Social Welfare and Development and the Provincial Population Office in Zamboanga del Sur. (MCossid/Jhpiego)

Bottom right: A health service provider from Lanao del Sur distributes Family Planning fans to mothers attending a Family Planning lecture during a medical mission in one of the evacuation sites for persons displaced by the conflict in Marawi City. In this same activity, USAID also distributed jerry cans to ensure families have clean water containers/storage. (MAbdulwahid/Jhpiego)

This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-492-A-13-00005. The contents are the responsibility of the Maternal, Neonatal, Child Health/Family Planning (MNCHN/FP) Regional Projects in Luzon, Visayas, and Mindanao and do not necessarily reflect the views of USAID or the United States Government.

Contents

List of Acronyms and Abbreviations...... 1 Executive Summary ...... 1 Introduction ...... 4 Progress in Key Program and Project Indicators ...... 5 Narrative of Key Achievements and Recommended Measures by Strategy ...... 18 Strategy 1: Increasing the Supply of FP/MNCHN/AYRH Services at Fixed Facilities and through Outreach ...... 18 Strategy 2: Increasing the Demand for MNCHN/FP Services...... 31 Strategy 3: Removal of policy and systems barriers to service delivery and its utilization ...... 40 Strategy 4: Strengthening the Capabilities of DOH Regional Offices and Provincial Health Offices in Program Development, Management and Oversight ...... 46 Program Management ...... 48 Challenges and Mitigation Measures ...... 53 Financial Expenditure and Cost Share ...... 55 Annex A: List of AY-Friendly RHUs ...... 58 Annex B: Summary of Demand Generation Activities (All Project Sites, As of September 30, 2017) ...... 61 Annex C: Cumulative Number and Distribution of FP Acceptors and Referrals by Type of USAPAN and FP Method (as of September 30, 2017) ...... 62 Annex D: Status of FP Commodity and Logistics Management System, as of end of PY5 ...... 64 Annex E: SDN Establishment: Towards Achieving Functionality, Status as of end of PY5...... 67 Anenx F: PY5 Status of PHIC Accreditation and Reimbursement Policy by Province/City ...... 71 Annex G: Success Stories and Evolving Initiatives ...... 75 Annex H: Abridged Compendia of Emerging Good FP/MNCHN/AHD Models ...... 83 Annex I: Safety and Security (July 2017 – September 2017) ...... 96 Annex J: Summary of Capacity Building Activities ...... 101 Annex K: Summary of Documented Good Practices by Component ...... 103 Annex L: Informed Choice and Voluntarism Compliance Monitoring Activity ...... 105

List of Acronyms and Abbreviations

ABC Association of Barangay Captains ADNPH Agusan del Norte Provincial Hospital ADPCN Association of Deans of Philippine Colleges of Nursing AJA Adolescent Job Aids AMTSL Active Management of the Third Stage of Labor ANC Antenatal Care AOP Annual Operational Plan APSOM Association of Philippine Schools of Midwifery ARMM Autonomous Region of Muslim Mindanao AY Adolescent and Youth AYRH Adolescent and Youth Reproductive Health BCS + Balanced Counseling Strategy Plus BEmONC Basic Emergency and Obstetric Newborn Care BH Birthing Homes BHS Barangay Health Station BHW Barangay Health Worker BMC Butuan Medical Center BTL Bilateral Tubal Ligation CA Cooperating Agencies CAA Conflict Affected Areas CCT Conditional Cash Transfer CDI Cities Development Initiative CDO Cagayan de Oro CDOHO Cagayan de Oro Health Office CECAP Cervical Cancer Prevention Program CEmONC Comprehensive Emergency Obstetric and Newborn Care CHANGE Communication for Health Advancement through Networking and Governance Enhancement CHO City Health Office CHT Community Health Team CHT-IS Community Health Team–Information System CMNC Caring for Mothers and Newborns in the Community COE Center of Excellence CYP Couple Years of Protection EBF Exclusive Breastfeeding EOP End-of-Project IEC Information, Education, and Communication ILHZ Inter-Local Health Zone IPHO Integrated Provincial Health Office LAM Lactational Amenorrhea Method LAPM Long Acting and Permanent Method LARC Long Acting Reversible Contraception LGUs Local Government Units LIPH Local Investment Plan for Health LMT Lactation Management Training M&E Monitoring and Evaluation MCP Maternity Care Package MH MindanaoHealth MLLA Mini Laparotomy using Local Anesthesia

MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement MSH Marawi Specialist Hospital MSI Marie Stopes International NCP Newborn Care Package NDP Nurse Deployment Program NHTS National Household Targeting System NSV No Scalpel Vasectomy OSCE Objective Structured Competency Evaluation PHO Provincial Health Office PHN Public Health Nurse PMP Performance Monitoring Plan POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device TCL Target Client List

Executive Summary The MindanaoHealth (MH) Project, a five-year (2013–2018) initiative funded by the United States Agency for International Development (USAID), is primed by Jhpiego in partnership with RTI International. The Project’s goal is to improve family health by dramatically increasing the quality and uptake of integrated maternal, newborn, and child health and nutrition/family planning (MNCHN/FP) services at the household level, in communities, and at public and private health facilities, thereby resulting in improved child health and nutrition, reduced maternal and infant deaths, and decreased unmet need for FP services—especially among the population belonging to lowest wealth quintiles and in conflict-affected areas in Mindanao. The Project actively works and collaborates with the Department of Health (DOH)-led scale-up of high-impact services and client-centered information for Mindanao, the southernmost of the three island groups in the Philippines. MH works directly with six (6) DOH-regional health offices (RHOs) of Zamboanga Peninsula, Northern Mindanao, Davao Region, SOCCSKSARGEN, and CARAGA as well as the DOH for the Autonomous Region of Muslim Mindanao (ARMM). The MH partnership involves provincial/municipal/city local government units (LGUs) in 19 provinces, two (2) cities, and 368 municipalities and component cities. This report describes the performance progress made from October 1, 2016 to September 30, 2017 including Q4PY5 of project implementation and is organized as follows: a) the “Progress in Key FHSIS MNCHN/FP Indicators” which provides a holistic picture of the MNCHN/FP situation in the Mindanao region from 2012 to 2017; b) Progress of MindanaoHealth by Indicator Against Performance Targets” section which summarizes the achievements in this reporting period against the “MUST” indicators; c) “Analysis of CYP and FP Users, Overall and by Region” which strengthens the analysis of progress against the Project’s two foremost indicators; d) the “Narrative of Key Achievements and Recommended Measures by Strategy” which describes the accomplishments of the three (3) project strategies and objectives against the workplan and proposed measures for the next PY to move MH forward; e) “Program Management” which summarizes progress in Monitoring, Evaluation and Research (MER), Communications, Human Resources, Administrative and Financial Management; f) “Challenges and Solutions”; g) “Success Stories and Evolving Initiatives”; and g) Annexes. Building on the commitment of the DOH, MH made key achievements in Project Year 5 (PY5) or October 1, 2016 to September 30, 2017: Contribution to Program Outcomes • Increased CYP. PY 5 accomplishment is at its highest at 520,473 – a 56% increase from the previous year and an overall accomplishment of 93% of its target with increases in all LAPM acceptors. • An additional 134,831 Current Users of modern FP methods. Improving the Suppy of MNCHN/FP Services • Reached an additional 11,026 LAPM acceptors through outreach and 20,162 in fixed facility family planning services; this represents a contribution of roughly 35% of all LAPM cases reported in the FHSIS for the period Q4PY4-Q3PY5; • Improved the coverage of supportive supervision in USG sites with 228 BTL, PPFP/PPIUD, and LARC-PSI, trained providers leading to the certification BTL-MLLA at 62 (50% of 125 trained) BTL-MLLA, 344 (36% of 955 trained) of PPFP/PPIUD, and 125 (18% of 688 trained) LARC-PSI trainees

1 • Expanded the number of SDPs providing adolescent and youth reproductive health (AYRH) services from 25 as of the end of PY4 to 61 as of this reporting period; 23 LGUs have passed policies to sustain these initiatives. • Conducted a total of 334 outreach activities in CAA areas in PY5 that reached 23,594 women, children, and youth. This is more more than quadruple the target of 70 for PY5; • Supported efforts to mitigate the effects of the Marawi siege through the donation of 6,000 Jerry cans, 12,000 chlorine tablets, and 2,000 FP fans through the DOH ARMM Health Emergency Command Center in Iligan City. These donation have reached and benefitted some 3,000 families displaced by conflict; Increasing Demand for MNCHN/FP Services . 853 USAPAN sessions conducted reaching 17,123 women, children and men yielding 4,520 acceptors . Eighty (80) FP providers from the private sector and 43 from public sector trained on providing client-centered counseling on family planning and safe motherhood in one-on- one consultation or in a group setting; . Various types of IEC materials produced, disseminated and spot-checked throughout the project sites . Expanded reach to some 30,200 women pregnant and postpartum women on information on exclusive breastfeeding through health events, information materials and group education. . Engaged and mobilized 60 faith-based leaders for community local dialogues (health events, USAPAN sessions) on the permissibility of modern family planning and RH programs and services in the Islamic context. Removing Policy and Systems Barriers to Service Delivery and Its Utilization  Maintained the low number of SDPs with stock-outs of FP commodities. Stock out rates for pills, DMPA, and IUD remained at 4% or less since Q1PY5;  Increased by 16% (258 in PY4 to 300) the number of public facilities that attained MCP/NCP re-accreditation by end of PY5 ;  Increased by 18% (315 in PY4 to 327) the number of LGUs utilizing PhilHealth reimbursements as per PHIC guidelines;  Sustained the rollout of SDN establishment in 21 SDN sites in 13 provinces and three (3) cities involving 79 LGUs with established TWGs and referral pathways for MNCHN/FP and AY servicesp  Data quality checks implemented in 77% (282) of the 368 USG-assisted LGUs. Efforts to institutionalize DQC activity were demonstrated in 13 provinces and 28 individual LGUs in Region 12 through the issuance of either an Executive Order (EO) by the LCE or an Office Order by the P/CHO; Strengthening DOHRO and PHO capacities • Completed four (4) compendia, namely: i) Service Delivery Network, ii) Integration of Family Planning Program in Hospital Settings, iii) Adolescent and Youth Reproductive Health (AYRH) and the iv) USAPAN approach to FP demand generation;

2 • Conducted two (2) dissemination forums in Northern Mindanao and the CARAGA regions aimed at highlighting and showcasing emerging good practices, innovations and accomplishments that have surfaced as a result of the collective efforts and initiatives not only of public and private partners at the local levels. Overall, MindanaoHealth’s performance in PY5 shows that most indicator values are either on track, or within range of this year’s expectations. The topline indicator - Current Users (CU) – show continued expansion when compared to the previous year period although ARMM experienced a slight decline by the end of the last quarter due to the on-going conflict in Marawi, Lanao Del Sur. Target for this indicator, however, has been surpassed. The CYP performance of 93%, on the other hand, is slightly below the planned level but it is the highest achieved since the Project started. DQC coverage has significantly improved and is a little lower than previous years’ performances but more LGUs have passed policies to institutionalize the process. Targets for CAA indicators show remarkable improvement as well from the previous year with more outreach activities conducted and clients reached. Several key challenges confronted project implementation, the most notable of which includes: the on-going armed conflict in Marawi and sporadic terroristic activities have caused the disruption of operations in ARMM including its corridors; this conflict and the inadequate availability of skilled practitioners have posed continuing limitations in the conduct of outreach activities and supportive supervision visits; the mechanisms to improve uptake in demand generation activities needs further strengthening; and the paradigm shift from mere inputs to systems is taking too long like in SDNs. At the project management level, large performance variances across regions and provinces/cities need to be managed while putting in place the needed mechanisms to sustain gains. MH will amplify corresponding measures and specific strategies consistent with the Health Agenda of the current administration and packaged the same into a sustainability plan for any extension or successor project to MindanaoHealth. The total financial support to bring these gains of the project implementation in its Year 5 is $4,340,489.62. The total commulative expenses as of end of year 5 is $21,533,275.08 from the obligated funding of $24,229,521.35

On the cost share, MH has been successful in capturing $1,294,865.97 of the total required $1,211,467.07 (5% of the obligated amount) which is $83,389.90 more than the required.

3 Introduction

This report covers the period from October 1, 2016 to September 30, 2017 of project implementation. During the year in review, MindanaoHealth (MH) Project:  Strengthened service delivery with a purposive link between demand generation and high- impact activities which directly contributed to the achievement of long-term results, with priority focus on increasing CY87P, current users, and reduction of first births among women 18 years old and younger;  Collaborated closely with the reactivated Office of the Field Implementation in Mindanao- (OFIM), DOH-ROs, Centers of Excellence (COEs), non-governmental organizations (NGOs), and LGUs in building a critical mass of certified, trained health service providers (HSPs) delivering FP/MNCHN/AYRH services with confidence, through fixed and ambulatory approaches;  Worked closely with the newly re-activated Office for Field Implementation in Mindanao in partnership with DOH-ROs, Population Commission (POPCOM), and LGUs, in moving forward gains that supported the creation of an enabling systems and policy environment for FP/MNCHN/AYRH services, such as the establishment of service delivery network (SDN), data quality check (DQC), routine use of dashboards, and the formulation of an LGU ordinance on PhilHealth reimbursement utilization, localization/adaptation of national policies on FP/MNCHN/AYRH by LGUs, among others; also closely worked with the Zuellig Family Foundation (ZFF)-Health Leadership Governance Project (HLGP), Health Planning and Development Project – Phase 2 (HPDP2) and CHANGE project.  Built capacities of key partners at DOH-RO, LGUs on DQC, SDN and in engaging the private sector as their partners in health service provision;  Sharpened project’s evidence-based advocacy works through improved documentation of lessons learned, high-impact interventions, and good practices geared toward strengthening DOHRO and LGU ownership, both for technical and financial accountabilities; and  Intensified and enhanced its communications activities through the documentation of emerging good practices on FP/MNCHN, publishing them into separate compendium, and hosting regional dissemination forums to impart to and share with various audiences and partners messages of said practices.

This report is organized as follows: a) the “Progress in Key FHSIS MNCHN/FP Indicators” which provides a holistic picture of the MNCHN/FP situation in the Mindanao region from 2012 to 2017; b) Progress of MindanaoHealth by Indicator Against Performance Targets” section which summarizes the achievements in this reporting period against the “MUST” indicators; c) “Analysis of CYP and FP Users, Overall and by Region” which strengthens the analysis of progress against the Project’s two foremost indicators; d) the “Narrative of Key Achievements and Recommended Measures by Strategy” which describes the accomplishments of the three (3) project strategies and objectives against the workplan and proposed measures for the next PY to move MH forward; e) “Program Management” which summarizes progress in Monitoring, Evaluation and Research (MER), Communications, Human Resources, Administrative and Financial Management; f) “Challenges and Mitigation Measures Implemented”; and g) Annexes.

4 Progress in Key Program and Project Indicators

A. FHSIS MNCHN/FP Indicators This section of the annual report depicts a holistic picture of the MNCHN/FP situation in Mindanao by region and by province from 2012 when MindanaoHealth was just about to take off to 2017. It provides a six-year trend of MNCHN/FP impact indicators (e.g., maternal, infant and under-5 mortalities) as well as outcome indicators (e.g., contraceptive prevalence, facility-based deliveries, skilled-birth attendance, etc.) deemed to directly influence the long-term results of any MNCHN/FP intervention. The available FHSIS-based regional reports showed a generally increasing trend in key MNCHN/FP indicators across all regions as shown in Table1. For contraceptive prevalence rate (CPR), the regions of Zamboanga, Davao and Caraga increased from the previous year. ARMM, Northern Mindanao, and SOCCSKARGEN however reported lower than previous year figures. Both CARAGA and SOCCKSKARGEN are within the 65% target for CPR. For other indicators, 4ANC, PPV2, and FIC show general declines compared to the previous year. SBA and FBD figures remain high but show variable performance across the different regions. Across the USG provinces and cities, 19 out of the 22 project sites show slight to high increases from the previous year. Ten (10) provinces have achieved CPR figures higher than the national target of 65% compared to none during baseline. In ARMM, the provinces of Basilan and Maguindanao show slight declines while the other provinces show continuous increases in the CPR. At the regional level, however, only CARAGA, Zamboanga Peninsula and SOCCSKARGEN have reached the national CPR target. The major factors noted to have continuously influenced these general improvements in key MNCHN/FP indicators in the last four years include: i) DOH investments in health facility improvements through the Health Facility Enhancement Program (HFEP) of the DOH ,deployment of nurses under the Nurses Deployment Program (NDP), midwives under the MECCA program in ARMM, ii) centralized distribution of FP commodities at the DOH starting 2015; iii) the issuance of various DOH policies that tended to enhance the nationwide implementation of the MNCHN/FP program of the government, as well as the Responsible Parenthood and Reproductive Health (RPRH) Law; iv) ) increasing numbers of LGUs complying to Philhealth accreditation of its health providers and facilities and implementing reimbursement policies; v) increasing outreach services in partnership with CSOs and private providers; and vi) the sustained collective technical support of development partners on FP/MNCHN service delivery and health systems strengthening.

5 Table 1: Mindanao Performance in Key MNCHN/FP Program Indicators

6 B. Project MNCHN/FP Indicators

1. Increased number of current FP users As of the end of PY5Q3 of this year, the number of current FP users posted an increment of 134,831 over the previous year’s level representing an increase of about ten percent (10%). The end of the period current user figure of 1,468,220 is the highest achieved since PY1 and is thirty-seven percent (37%) higher than the 2012 baseline figure of 1,070,486. By region, all except ARMM show increases from the same period of last year. The current report of ARMM excludes Lanao del Sur where the reporting system has been disrupted by the on-going conflict. On the average, Lanao del Sur accounts for more than 40,000 current users per year which when included could have shown similar increases in the ARMM region. Davao region shows the biggest increment in current users for the year – a large turnaround from the last year as the more than 65,000 current users delisted from during the conduct of DQC from FP records have mostly been recovered this year. Compared to baseline figures, the highest increase in current users comes from Pills (81,340) and DMPA (29,944) followed by implants (14,695) and IUD (9,967). Most of the NFP methods show declines with LAM (18,413) figures showing the biggest reduction.

Figure 1: Summary of Accomplishments and Trends in Current Users

2. Increased CYP from PY4-PY5 From a PY4 figure of 334,079, CYP increased by fifty-six percent (56%) to 520,473 in PY5. When compared with the 2012 figure, this represents a 128% increase from the baseline estimate of 228,438. Reported CYP figure only covers LAPM/LARC methods (BTL, NSV, IUD, and Implants). Comparing the PY4 and PY5 sources of acceptors where CYP is computed, all methods increased significantly (BTL – 58%, PPIUD/IUD – 36%, and SDI – 183%). The method mix however changed significantly. From a 13% share in PY4, SDI acceptors accounted for 23% in PY5. This was due to a large extent on the increased contribution of private sector including NGOs and outreach providers who provided SDI despite the Temporary Restraining Order (TRO) issued by the Supreme Court disallowing the distribution by DOH of Implanon. This increase however was offset by the decline in the reported IUD/PPIUD acceptors from a 58% share in PY4 to 48% in PY5. BTL and NSV acceptors’ shares to the total number of acceptors did not change at 28% and 1%, respectively.

Figure 2: Summary of Trends in CYP

While CYP figure for the last quarter declined, the Project achieved 93% of its total CYP target for the year of 558,678. It must be noted that the target included previous year deviations from the EOP commitments. Among the factors that facilitated the continuing rise in CYP include: i) the expansions in the availability of fixed facility and outreach services for LAPM; ii) the increasing practice of collecting reports of private clinics and hospitals both public and private; and iii) increased supportive supervision by more than 280% particularly on PPIUD. Figure 3: PY5 CYP Accomplishment vs Target

8 Regional CYP Performance There are variations in the performance across regions, with CARAGA (149%), Davao (12%), and Northern Mindanao (110%), performing better or within range of their targets, while the other regions’ performances posted lower than planned with ARMM reaching only 44% of its target, SOCCSKSARGEN at 74%, and Zamboanga Peninsula at 72%. In PY5, all regions (Figure 4) show increases compared to PY4 with Davao showing the biggest increase particularly in BTL. This is the result of including SPMC data which mostly unreported in the FHSIS reports of Davao City and referring provinces. In Northmin, the inclusion of private sector reports particularly in Misamis Oriental, Lanao del Norte and Cagayan de Oro were one of the significant factors contributing to higher CYPs.

Figure 4: Couple-Years of Protection (Number by Region PY5)

In the Autonomous Region of Muslim Mindanao (ARMM) in particular, all provinces except Lanao del Sur show slight increases in CYP performance during the year. Progress remains constrained by recurring conflict, lately in Lanao del Sur. During the year, partnerships were intensified with local CSOs like UNYPHIL in Maguindanao, Tarbilang Foundation in Tawi Tawi, Pink Pinay in Basilan, Likhaan Foundation in Sulu, and Al Mujadillah in Lanao Del Sur, and also NGOs like MSI intensified their collaboration with private hospitals in Basilan such as the Juan S. Alano Memorial Hospital and Amor Mclintock Isma, a private clinic. Mindanalano Hospital, a private hospital based in Lanao del Sur, that was previously capacitated by MH on LAPM provision, in addition to non-ARMM public facility (APMC), have likewise been receiving clients from Marawi and Lanao del Sur.

MindanaoHealth Contribution to Total CYP Figure 5: Total Number of LAPM Acceptors (FHSIS) and MH Figure 5 shows the overall contribution of Contribution MH-supported LAPM activities for comparative quarters where FHSIS data is available. For the period Q4PY4 – Q3PY5, MH contribution when compared to the total LAPM acceptors reported in the FHSIS for the same period, is at 35%. Project contribution drastically dropped in the previous period during the TRO on implants which was becoming a major choice of contraception among women.

9 C. Project Level Accomplishments

This section summarizes progress towards the seven (6) of the remaining eight (8) PY4 “MUST” indicators and 2 custom indicators in the Performance Monitoring Plan (PMP) including four (4) indicators for the CAAs. The sub-headings of the “MUST” indicators summarize the progress in the reporting period. Indicators based on the Field Health Service Information System (FHSIS) data, such as CYP and CU, present progress for Q4PY4 to Q3PY5 while indicators using project databases present actual accomplishments for Q1PY5 to Q4PY5.

1. Grew the network of SDPs providing FP/RH services From a total number of 630 SDPs providing FP/RH services in PY4, its total as of PY5 reached 718 public and private facilities, representing a 14% increase from the previous year and an achievement rate of 97% of the total targeted 737 SDPs for the year. These figures are cumulative accomplishments to date that include the baseline of 244 (this was adjusted from the previous figure of 225 as SDPs assisted in the last 5 years not in the baselines were included). The latest report also highlights the significant expansion in the private sector with 20% of SDPs accounted for by private clinics or hospitals. It should also be noted that MH technical assistance, through the DOH ROs, led to the capacitation of 83 SDPs in non-USG sites. Comparing regional performance, the four regions of Northern Mindanao, Davao, SOCCSKSARGEN and CARAGA achieved more than their targets, while Zamboanga Peninsula remained within range of its planned SDPs targets. ARMM on the otherhand has achieved its targeted public SDPs but falls short on targeted private providers despite training of some 150 health workers in the region during the year.

Figure 6: Summary of Accomplishments and Trends in FP/RH SDPs

The influencing factors for this positive growth include: a) the complete buy-in and cost-sharing between MH and DOH-ROs and b) the introduction of the more acceptable four-day staggered FBCBT1/ balanced counseling strategy plus (BCS+) training module/design for medical doctors in lieu of the five-day FPCBT1 course. The call of the new administration for a serious review of approaches to limiting family size, addressing teen-age pregnancies, and increasing involvement of private sector providers will likely sustain this level of performance. 2. Scaled-up institutionalization of DQC Coverage of DQC activities across project sites reached 76% (280/368). Coverage across regions differ with Northmin, Davao, and CARAGA achieving their targets while ZamboPen,

10 Figure 7: Summary of Accomplishment and Trends in the Coverage of Data Quality Checks

SOCCSKARGEN, and ARMM were less than planned. Lanao del Sur in ARMM was unable to conduct its usual DQC activities although this has been relatively high in previous years. ARMM adopts a “no report, no MOOE” policy hence compliance to reporting and DQC is usually high. A major tack in PY5 was the institutionalization of DQC through advocacy in passing local ordinances/office orders for the regular conduct of DQC. Strengthening of health information system through the institutionalization of DQC implementation was demonstrated in 13 provinces and 28 individual municipal LUs in SOCCSKSARGEN through the issuance of DQC policies either Executive Order (EO) by the Local Chief Executive (LCE) or an Office Order by the Provincial of City Health Officer mandating that resources such as DQC team, equipment, logistics, and budget support be provided for onsite data cleaning and validation activities. Emerging good practices on DQC implementation were documented in Compostela Valley and Agusan del Sur which were shared during the Regional Dissemination Forums in Northern Mindanao and CARAGA Regions in Q4PY5. The generation of DQC’d data allowed the local health managers and LCEs to develop context- and site-specific health programs that will benefit the underserved population. 3. Grew the network of SDPs providing AY/RH services

As of the end of PY5, the total hospital or RHU based Teen Centers reached 60 accomplishing 105% of the 58 targeted for the year. This is an additional 34 SDPs from the previous year cumulative total of 26. The SDPs providing AY/RH services as of PY5 are from ARMM (15), SOCKSKARGEN (16), NorthMin (10), CARAGA (4) and Davao (15). For ARMM, 7 out of the 11 additional SDPs were installed in Sulu. Across all USG sites, the 61 Teen Centers represent 8% of the 737 total SDPs. In PY5, an additional 50 health personnel from Agusan del Norte, South Cotabato, and General Santos were trained on AJA brining the total to 1,029 health workers in about 183 LGUs. The full installation of the program coupled with buy-in of the LGUs to establish youth-friendly services howeve r was a gradual process, thus, only 37 RHUs in both SDN and non-SDN sites who met the minimum criteria were qualified. MH has developed a prototype Operational Guide and executive order/policy for the LGUs to adapt within the local setting/context. The SDPs’ AY-friendly

11 Figure 8: Summary of Accomplishment in Establishing AYRH SDPs services will also be strengthened by establishing referral linkages, firming-up recording and reporting mechanisms and assisting the DOH-ROs/PHOs in the conduct of support mentoring.

4. Reduced stock-outs on FP commodities in USG-Assisted SDPs Over-all stock-out rate on FP commodities in USG-assisted SDPs in the past two programming years remains at less than EOP target of 3%. The continuing delivery of commodities from DOH Central, availability of buffer stock at regional offices, and effective coordination and reporting mechanisms at the local level with the Regional Implementation Team (RIT) at the helm played a key role in this accomplishment. PopCom has been tasked to track and monitor FP commodities while the DOH-ROs perform inventory management through its Pharmacist deployed in the provinces. Further, the wider use of simplified FP Commodity Inventory and Order Form and other existing commodity tracking tool such as SMRS, SIMS, and CDLMIS in more than 85% of RHUs and CHOs strengthened the recording and reporting of actual consumption reports to the FP Logistics Hotline and FP Commodity Online Monitoring using the Facebook platform. In this period, stock outs were only reported in seven out of 737 SDPs while 324 SDPs have in place logistics management system (LMS) while five (5) provinces involving 44 SDPs have reported not using any form of FP commodity tracking and reporting tool. 5. Exceeded the target number of LGUs utilizing PhilHealth reimbursements per guidelines As of the end of PY5, the number of LGUs utilizing PhilHealth reimbursements for MCP/NCP services reached 327 from 315 in the previous year. This number corresponds to 118% of the PY5 target of 277 LGUs out of the 368 USG-assisted LGUs and 105% of the EOP target of 311 LGUs. Relatedly, the number of LAPM providers supported by the Project who obtained PhilHealth accreditation through supportive supervision and coaching on the ways to comply with accreditation requirements reached 380. Of this number, 94 are BTL/MLLA providers, 281 PPFP/PPIUD providers, and five (5) NSV providers. 6. Expanded outreach in Conflict Affected Areas and Support to the Marawi Crisis During the fiscal year, a total of 547 outreach activities (108 LAPM and 226 REACH) were conducted in the 8 CAA areas. This is three times more than the 110 reported in the previous year. Among the CAA provinces and cities, Cotabato City (30) reported the most number of LAPM outreach followed by Maguindanao (20) and Basilan (17). On the other hand, REACH activities were conducted mostly in Tawi-Tawi (73), Zamboanga City (62) and Basilan (28). Total clients

12 reached were 23,734 women of reproductive age, children, and pregnant women. Annual targets for both number of outreach conducted and clients reached have been exceeded at 477% and 158%, respectively. The higher coverage compensated for previous year’s variance and reflected MH response to the request from CAA areas for support. During the period, MH supported the IPHO Lanao del Sur who led the Marawi Crisis Team. Four (4) municipalities hosting home- based IDPs (total of 4, 613 families or 22,501 individuals) in Calanugas, Binidayan, BuadiPusu and Taraka were visited together with other USG CAs and development partners for the distribution of hygiene kits (UNFPA), pregnancy kits (ZFF) and jerry cans and aquatabs (USAID's MindanaoHealth Jhpiego). In June this year, 4,000 jerry cans and 8,000 aquatabs were donated by MindanaoHealth to DOH ARMM Command Center while additional 2,000 jerry cans and 4,000 aquatabs were delivered and used by Marawi Crisis Team led by IPHO Lanao del Sur. In addition, MH also provided this July to IPHO Lanao del Sur and CHO Marawi 14,400 FP fans, 30 pcs FP flipcharts, 43 USAPAN flipcharts, 50 ICV wallcharts, 20 EINC (preparing for birth charts), 342 FP placemats, 37 FP stamps and 2 boxes Easel sheets for them to use during regular and outreach activities.

13 Table 2: MH’sPY5 Progress Against Performance Targets by Indicator –Fidel, please reconcile this Doc Martha’s Table 2 % Cumulative Accomplishment TARGET Q4PY5 Accomplishments by Region PY 5 Accom‐ (i.e., running total as applicable) Annual IND. plishme Indicator Baseline Accomplis REF. nt vs. As % NORTH SOCCKSAR hment to PY1 to As of end PY5 EOP ARMM CARAGA DAVAO ZAMBO TOTAL PY5 of MIN GEN Date PY4 of PY5 Target eop (o) = i+j+ (q)= (s) = (p + t = (a) (b) © (d) (e) (i) (j) (k) (l) (m) (n) (p) (r) k+l+m+n) (p/d) r) [(s/e) FP 1 Current Users of 147,075 120,892 296,225 290,047 341,376 272,605 1,468,220 105% 105% Modern FP 1,070,486 1,399,564 1,399,564 1,468,220 1,369,053 1,468,220 Methods Q4PY5 reported figures are from July- Sept. 2017 reports as per M&E TWG agreement of one quarter back reporting. ARMM report is exclusive of Lanao del Sur where no report has been consolidated by the PHO due to Marawi seige. Lanao del Sur accounts for at least 40,000 current users. HL.7. Couple Years 520,473 93% 97% 1.1 Protection (CYP) in 228,438 558,678 1,232,995 4,849 20,877 26,879 28,135 16,830 15,310 112,881 674,317 1,194,790 USG‐ supported sites Reported percentage accomplishment for this quarter are the proportion of the totals for Q4PY4, Q1PY5 and Q2PY5 reports of provinces to total target inclusive of unmet targets from previous years. HL.7. Average stockout 1.2 rate oof contraceptive

commodities at family planning SDPs Pills 3% 3% 0% 0% 3% 0% 2% 2% 1% 1% 1% 1% Numerator 22 22 0 0 5 0 2 3 10 10 -55% 10 10 Denominator 737 737 155 59 154 125 111 133 737 737 737 737 DMPA 3% 3% 0% 0% 5% 0% 1% 1% 1% 1% 1% 1% Numerator 22 22 0 0 8 0 1 1 10 10 -55% 10 10 Denominator 737 737 155 59 154 125 111 133 737 737 This is the 737 737 first IUD 24% 3% 3% 0% 5% 0% 0% 1% 1% 1% 1% 1% 1% reporting Numerator 302 22 22 0 3 0 1 1 5 5 -77% period for 5 5 this Denominator 1,270 737 737 155 59 154 125 111 133 737 737 737 737 revised SDM Beads 5% 5% 0% 0% 0% 0% 0% 56% 10% 10% indicator 10% 10% Numerator 37 37 0 0 0 0 0 74 74 74 100% 74 74 Denominator 737 737 155 59 154 125 111 133 737 737 737 737 Condom 3% 3% 0% 2% 2% 0% 1% 0% 1% 1% 1% 1% Numerator 22 22 0 1 3 0 1 0 5 5 -77% 5 5 Denominator 737 737 155 59 154 125 111 133 737 737 737 737 % Cumulative Accomplishment TARGET Q4PY5 Accomplishments by Region PY 5 Accom‐ (i.e., running total as applicable) Annual IND. plishme Indicator Baseline Accomplis REF. nt vs. As % NORTH SOCCKSAR hment to PY1 to As of end PY5 EOP ARMM CARAGA DAVAO ZAMBO TOTAL PY5 of MIN GEN Date PY4 of PY5 Target eop (o) = i+j+ (q)= (s) = (p + t = (a) (b) © (d) (e) (i) (j) (k) (l) (m) (n) (p) (r) k+l+m+n) (p/d) r) [(s/e) 3 LGUs in ZN (pills); 26 LGUS (SDM Beads); 1 in ZSib (condom); ZSur (27 LGUs w/o beads), ZC (16 w/o beads); 5 LGUs (SDM Beads in ZSib); 2 LGUs in NC (Pills), 1 DMPA (NC), LGU 1 IUD (NC), 1 condom (NC); NORTHMIN (nearing stockout in Bukidnon for

COC, CDO providing; 3 LGUs with IUD, 1 LGU with condom; overstocking in ADS for all supplies); 9 LGUs overstocked in pills, 13 DMPA, 9 IUD, 11 condom ; ADN stockout in IUD (3), condom 1; stockout of Pills reported in 5 LGUs in Davao Sur. FP 4 Percent of USG‐ assisted service delivery points 25% 93% 93% 81% 102% 101% 102% 110% 97% 97% 97% 93% 97% 105% (SDPs) providing FP counseling and 105% services Numerator 198 685 685 125 60 155 127 122 129 718 718 712 718

Denominator 777 737 737 155 59 154 125 111 133 737 737 764 737

No additional SDPs for Q4. Although there were additional trainings during the period

for midwives and/or NDP nurses that have not received training in the last three years Percent of USG‐ assisted SDPs providing FP/RH 8% 8% 10% 7% 10% 8% 14% 0% 8% 8% 4% 8% services for adolescents and 97% 97% youth Numerator 62 62 15 4 15 10 16 0 60 60 26 60 Denominator 737 737 155 59 154 125 111 133 737 737 737 737

Additional 4 facilities added during the quarter from 2 from Agusan del Norte (Butuan Medical Center and Buenavista RHU), Davao del Sur Provincial Hospital. JR Borja). RTR was removed as their RHU is currently being renovated.

NEW Percent of LGUs conducting data 73% 85% 85% 64% 96% 100% 99% 60% 66% 77% 77% 80% 77% 90% quality checks (DQC) annually 90% Numerator 268 313 313 76 25 38 70 26 47 282 282 294 282 Denominator 365 368 368 119 26 38 71 43 71 368 368 368 368 No DQC reports were obtained from Lanao del Sur due to the armed conflict. NEW Number of USG‐ 2,330 1780 1780 New assisted CHWs 319 217 484 302 556 157 2035 2035 114% indicator 2035 114% providing FP in PY5

15 % Cumulative Accomplishment TARGET Q4PY5 Accomplishments by Region PY 5 Accom‐ (i.e., running total as applicable) Annual IND. plishme Indicator Baseline Accomplis REF. nt vs. As % NORTH SOCCKSAR hment to PY1 to As of end PY5 EOP ARMM CARAGA DAVAO ZAMBO TOTAL PY5 of MIN GEN Date PY4 of PY5 Target eop (o) = i+j+ (q)= (s) = (p + t = (a) (b) © (d) (e) (i) (j) (k) (l) (m) (n) (p) (r) k+l+m+n) (p/d) r) [(s/e) information, Regional figures are cummulative. More than 16,000 clients benefitted from FP info, referrals and/or referrals, and services. There were more CHWs reported compared to the target as services during the the implementaiton of EO 12 on unmet need was vigourously intensified. year NEW Number of women 108,005 1884 1884 giving birth who 1156 157 246 283 476 246 2564 2564 261% received uterotonic New in the 3rd stage of indicator 4448 261% labor Figures are new clients seen during the period. There was higher than expected reports among the selected in PY5 sites included in the target. No reports for April for 3 facilities, and for May and June for 7 facilities in SOCCKSKARGEN.

HL‐1 Number of Level 5 Level 5 Level 5 (new Universal Health • Strengthening essential package of health services (1=Yes): 986 trained on FPCBT1, 64 trained on FPCBT2,167 ) Coverage (UHC) trained on LARC-PSI,183 trained on FP/PPIUD, 34 trained on BTL, 27 trained on LMT, 160 trained on AJA, 482 areas supported by outreach activities conducted reaching 12,076 LAPM clients USG investment • TA provided for improving quality of health services (1=Yes): 584 supportive supervision visits (378 on PPFP/PPIUD, 98 for LARC-PSI, 86 for EINC) • TA provided to strengthen pharmaceutical system and making safe, quality and affordable medicines and

vaccine available, reducing adverse reactions and antimicrobial resistance (1=Yes): Commodity tracking and reporting of stockouts, Advocacy for use of consumption reporting, Linkage to PRSP for supply of implants • TA provided in financial risk reduction (1=Yes): Development and roll-out of unmet need data sharing system among DSWD, POPCOM, DOH; reporting system), support for accreditation of facilities for MCP/NCP o Advocacy for resource allocation for health systems strengthening during PIPH/CIPH) o 998 USAPAN sessions conducted mostly among NHTS/CCT populations reaching 18,821 participants.

HL‐2 Presence of the Yes Yes Yes Mission support to • Rolling out of the national health workforce account (or database) to be utilized for decision-making : Strengthen Human Advocacy and installation of a training information management system at DOHRO, use of TIMS to identify Resources for clinical practice sites in NORTHMIN, ZAMBOPEN, CARAGA: • Advocating for increase in funds allocated for HRH: Assistance to DOHROs in preparing strategic plans, Health (HRH) Participation in program implementation reviews and PIPH/CIPH/Operation planning • Upgrading skills mix (various types and level of skills required in reference to type of health provider: 986 trained on FPCBT1, 64 trained on FPCBT2, 167 trained on LARC-PSI, 183 trained on PPFP/PPIUD, 34 trained on BTL, 27 trained on LMT, 160 trained on AJA, 482 outreach activities conducted reaching 12,076 LAPM clients.

CAA INDICATORS CAA Number of health 336 70 265 12 NA* NA* NA* 5 9 26 334 477% 336 670 253% 1 outreach conducted There have been requests for more MH support for the conduct of REACH in Tawi-Tawi and support for CATCH and CHANGE in Sulu. There was more than expected medical outreach conducted by Zamboanga City in

transitory and permanent sites for Zamboanga siege victims. These were accommodated to off-set lower performance in previous years. Also contributory were the support provided by CSOs in the conduct of outreach.

16 % Cumulative Accomplishment TARGET Q4PY5 Accomplishments by Region PY 5 Accom‐ (i.e., running total as applicable) Annual IND. plishme Indicator Baseline Accomplis REF. nt vs. As % NORTH SOCCKSAR hment to PY1 to As of end PY5 EOP ARMM CARAGA DAVAO ZAMBO TOTAL PY5 of MIN GEN Date PY4 of PY5 Target eop (o) = i+j+ (q)= (s) = (p + t = (a) (b) © (d) (e) (i) (j) (k) (l) (m) (n) (p) (r) k+l+m+n) (p/d) r) [(s/e) CAA Number of civil 2 society organizations (CSOs) trained to 0 8 8 9 NA* NA* NA* 5 9 23 23 288% 7 23 288% effectively engage with local governments

No additional CSOs during the period. CAA Number of youth 0 175 175

3 trained as peer 144 NA* NA* NA* 15 14 173 173 99% 99% 77 173 educators

No additional peer educators trained during the period. Figures are cumulatives

CAA Number of clients 53,448 15000 47380 242 NA* NA* NA* 0 305 547 23,734 158% 63,737 135% 4 reached during 40,003 health outreach There have been requests for more MH support for the conduct of REACH in Tawi-Tawi and support for CATCH activities and CHANGE in Sulu. There was more than expected medical outreach conducted by Zamboanga City in

17 Narrative of Key Achievements and Recommended Measures by Strategy

This section highlights the progress achieved in PY5 by the Project on key milestones by component and/or strategy, and also the recommended measures to move MH forward.

Strategy 1: Increasing the Supply of FP/MNCHN/AYRH Services at Fixed Facilities and through Outreach

Key Achievements:

 Increased by 395 the number of LARC/PM outreach services undertaken in partnership with the private sectors for a total of 11,026 for PY5, and the tripartite approaches of DOHRO, POPCOM and LGUs on the identification of clients with unmet need. Twenty seven percent (27%) or 109 of LARC/PM outreaches supported were conducted in Conflict Affected Areas (CAAs).  Increased the provision of fixed FP services with 20,162 clients served. There are now 353 service delivery points with an MH trained PPIUD provider and 81 for BTL-MLLA.  Supportive supervision intensified reaching a total of 228 trained providers on BTL. PPFP/PPIUD and LARC-PSI in PY5. This brings the total of certified providers for BTL-MLLA at 62 (50% of 125 trained), 344 for PPFP/PPIUD (36% of 955 trained), and 125 for LARC-PSI (18% of 688 trained)  Thirteen (13) hospitals have been formally assisted by MindanaoHealth developed their Operational Guides (OpGuide) and the other essentials requisites for integrating FP program in hospitals. On their own initiative, twenty-six (26) other hospitals have been exerting efforts to replicate the scheme.  DOH certified six (6) health facilities as FP Training Providers and Clinical Practice Sites. In addition 39 were certified as Clinical Practice Sites on PPFP/PPIUD,and 18 designated as Coaching and Mentoring sites, including 42 birthing facilities. 1.1 Assisted the DOHROs and LGUs in mobilizing FP outreach services providers A total of 395 outreach activities in different regions were undertaken in PY5 yielding 11,026 LARC/PM acceptors of which 90% are PSI, and the rest are BTL. These outreaches were made possible by the partnership with several NGOs/CSOs such as PSPI, MSI, UNYPHIL, ARCHESS and FPOP mostly serving as co-service providers of the host LGUs and DOH-ROs.Post outreach meetings were conducted to ensure that the key gaps identified were responded to like improving the tracking and navigation of the identified WRA with unmet needs by the community volunteers to improve the yield. Other services included counseling, immunization, vitamin supplementation, medical consultations, etc.

18 Table 3: Number of FP Outreaches Conducted and Acceptors by Region and by Type of FP Method for PY5

19 NO. OF CLIENTS REACHED DURING OUTREACH REGION PROVINCE/CITY BTL NSV IUD PPIUD LARC-PSI TOTAL USG SITES ARMM Basilan - - - - 318 318 Lanao del Sur - - - - 237 237 Maguindanao 48 - - - 342 390 Sulu 3 - - - 168 171 Tawi-Tawi 16 - 3 - 159 178 REGION IX: ZAMBO PEN ------Isabela City 9 - - - 309 318 Zamboanga City 144 - - - 831 975 Zamboanga del Norte 141 - - - 208 349 Zamboanga del Sur 20 - 7 - 2,294 2,321 Zamboanga Sibugay - - - - 1,011 1,011 Region X: Northern Mindanao ------Bukidnon 22 - 3 - 155 180 Cagayan de Oro City 56 - - - 73 129 Lanao del Norte 7 - 7 - 370 384 Misamis Oriental 184 - 8 - 160 352 Region XI: Davao Region ------Compostela Valley - - 4 - 762 766 Davao City - 9 - - - 9 Davao del Norte - - - - 11 11 Davao del Sur 35 7 - - 667 709 Davao Occidental - - 1 - 297 298 Davao Oriental 53 1 - 3 376 433 Region XII: SOCCSKSARGEN ------Cotabato 73 - 18 - 190 281 Cotabato City - - - - 8 8 General Santos City 6 - - - 16 22 South Cotabato 88 - - - 25 113 Sultan Kudarat 12 - - - 41 53 Region XIII: CARAGA Region ------Agusan del Norte 114 20 - - - 254 368 Agusan del Sur 51 - - - 591 642 SUB-TOTAL (USG SITES) 1,082 17 51 3 9,873 11,026

Compared to previous years, the number of outreach activities in PY5 is the highest and more than double the figure in PY4. The proportion of outreach conducted in CAA areas in PY5 compared to project-wide figure is also the highest at 27% (109/395). Figure 9: No. of Outreach Activities by Year

1.2 Expanded support to both public and private fixed facilities to provide FP services (LARC/PM+)

21 The Project’s sustained support in Table 4: Number of FP Acceptors Served in Public and Private building the capacities of service providers in hospitals, private and Health Facilities by Region and by Type of FP Method, PY5. public, as well as non-hospitals or NO. OF CLIENTS SERVED IN FIXED FACILITIES birthing facilities outside the highly REGION PROVINCE/CITY urbanized areas has been a continuing effort to bring LARC/PM/FP services BTLNSV IUDPPIUD LARC-PSI TOTAL nearer or more accessible to the USG SITES communities and its people. The support ARMM varies from actual training for various specific skills, provision of anatomical Basilan -- - 128- 128 models, supportive supervision sessions Lanao del Sur 15- - - - 15 with actual clients to mentoring and Maguindanao 171- - 5- 176 coaching. During the entire PY5, 20,162 clients availed of LARC/PM services in Sulu 48- - 11- 59 both public and private facilities broken Tawi-Tawi 12- 2- - 14 down as follows: 4,757 opted for BTL REGION IX: ZAMBO PEN -- - - - services; 11,291 clients had PPFP/PPIUD; 2,534 acceptors went for LARC/PSI and Isabela City 65- - - 28 93 10 clients received NSV service. Unlike Zamboanga City 149- 5 880- 1,034 outreach where LARC/PSI was the most Zamboanga del Norte 87- 505 546 151,153 preferred method, PPIUD was the method Zamboanga del Sur 755- 671,113 -1,935 of choice (56%) followed BTL (24%), Zamboanga Sibugay 26- - 198- 224 LARC-PSI (13%), and IUD (Interval) at 8%. Region X: Northern Mindanao- - - - - Bukidnon 337- 3 123 165 628 Cagayan de Oro City 634- 1582,019 3413,152 Lanao del Norte 351- 103 256 3411,051 Misamis Oriental 214- 541 814 901,659 1.3 Integration of FP Program in Region XI: Davao Region -- - - - the 13 targeted hospitals Compostela Valley 15- - 31 80 126 Davao City 739 16 137 174 409 Davao del Norte 7- 123 - 22 Davao del Sur 43- 1 193 86 323 Davao Occidental -- 9 12- 21 Davao Oriental 146- 76 46- 268 Region XII: SOCCSKSARGEN -- - - - Cotabato 111 - 148 46 206 Cotabato City 328- 661,996 1762,566 General Santos City 382- 6 460 7721,620 South Cotabato 312- - 968 6 1,286 Sultan Kudarat 155- - 529 13 697 Region XIII: CARAGA Region -- - - - Agusan del Norte 181- - 319 33 533 Agusan del Sur 240- - 356 168 764 SUB-TOTAL (USG SITES) 4,757 101,570 11,291 2,534 20,162

22 In 2016 and early part of 2017, guided by the 2014 DOH Memorandum on the Establishment of FP Programs in Hospitals, and picking up from the gains of MCHIP in the establishment of and other USAID-supported projects and development partners’ support to establishing Center for Excellence on PPFP/PPIUD, the Project consulted DOHROs and LGU-assisted sites. This resulted in the identification of 13 DOH and LGU-managed hospitals, whose current FP services need to be strengthened/established. These 13 public hospitals have been assisted, closely followed-up and formally supported in developing their Operational Guides (OpGuide), implementation plans and enabling orders for integrated FP services. An additional 26 hospitals are exerting efforts to replicate this effort in their own hospital settings.1 This brings to 39 the hospitals with varying efforts at FP integration. FP Hospital Opera- FPCBT1/ W/ W/ FP BTL Center W/ Coordin Order tional BCS+ Regular Clinic Provider for Recordi Region/Name of ator/ Guide or Provider FP Clinic Dedicated Teens ng and Hospital Tech. Policy Hours Space started Reporti Team ng on FP ARMM: IPHO- √ √ √ (Final) √ √ √ 3 __ √ MaguindanaoTable 5: Status of Integration of Family Planning in Hospitals as of September 2017. Hospital (IPHO-MH) ARMM/Zambo Pen: √ √ √ √ √ -- 2 √ √ Basilan General Hospital-Isabela City Zambo Pen: √ √ √ √ √ √ 5 √ √ Zamboanga City Medical Center (ZCMC) Northern Mindanao: √ √ ISO √ √ √ 3 __ __ N. Mindanao review Medical Center (NMMC) Northern Mindanao: √ √ √ √ √ √ 2 √ √ J.R. Borja Memorial Hospital-CDO City Northern Mindanao: √ __ √ (Final) __ √ __ 2 __ __ Gregorio Lluch Medical Center-Iligan City Davao Region: √ √ √ √ √ √ 5 √ √ Southern Philippines Medical Center Davao Region: √ √ √ √ √ √ 3 √ √ Davao Regional Medical Center- Tagum City Davao Region: __ __ √ (Final) __ √ √ 2 __ __ Davao del Sur Provincial Hospital SOCCSKSARGEN: √ √ √ (Final) √ √ √ 3 Ongoin √ Cotabato Regional g Medical Center (CRMC)

1 These hospitals are located in Zamboanga Peninsula (ZDSPMC, Margostubig Regional Hospital, Zamboanga Sibugay Provincial Hospital and Dr. Jose Rizal Memorial Medical Center); in Northern Mindanao (16 more facilities with 8 in Misamis Oriental, 7 in Bukidnon and 1 from Camiguin); in Davao Region (Brokenshire Memorial Medical 23 As a continuing effort, their core hospital staffs have undergone trainings on FPBCT1/BCS+, in addition to the trainings on FPCBT2, BTL- MLLA and PPIUD which were identified as gaps during the initial and follow-up assessments. These hospitals usually have their FP services concentrated or anchored in their Obstetrics and Gynecological (Ob-Gyne) departments especially those with high volume of deliveries for possible postpartum family planning (PPFP) regardless of the age group. The ongoing efforts on systems development are intended to capture the participation of other departments and disciplines especially in identifying potential clients, generating demand by providing group information/education on FP, individualized counseling sessions and direct, interdepartmental referral or outreach services with itinerant teams on modern FP. The progress of integrating family planning in the assisted hospitals in terms of technical committee formation and designation of a full- time FP/RH coordinator, establishment of a dedicated FP clinic with regular clinic hours, establishment of a Center for Teens and presence of a recording and reporting system on FP is shown in the Table 5. Eleven (11) SDPs to date are advanced at FP integration, while two (2) other hospitals (i.e., Gregorio Lluch Memorial Hospital and DDSPH) remain in need of technical support in finalizing their OpGuides despite making some progress on the other elements of FP integration like regularizing FP clinic hours. Among the 13 SDPs assisted, only four (SDPs) have no recording and reporting system in place that captures entries from the FP Registry, encoded in I-HOMIS and could retrieve such records to come up with a summary report of encoded entries (i.e., NMMC, GTLluch, DDSPH and CRH). Of the 13 targeted hospitals, only South Cotabato Provincial Hospital, is already implementing fully the FP program in the hospital with LAPM/LARC and PPFP services on a 24/7 basis including the short acting methods and good reporting and recording as all the related information/data are in HOMIS. This I-HOMIS is being advocated in other hospital facilities. In summary, the challenge for MH is how the existing range of FP methods and services in currently assisted SDPs and SDPs which are moving gradually towards FP integration could be broadened and strengthened. The need to seamlessly integrate in hospitals other services on safe motherhood, adolescent youth health and other RH services in a continuum with an improved recording and reporting system of HOMIS in tracking the pregnancy status, provision of FP information, counseling, delivery, active management and/or use of uterotonics, neonatal and postnatal or postpartum care with FP services remains evident. MH needs to consider the priority TAs moving forward. 1.4 Sustained support to capacitate SDPs providing FP/MNCHN services in 21 SDN sites as well as non-SDN sites through supportive supervision, coaching and mentoring

1.4.1. Service Delivery Points (SDPs) providing FP Counseling and Services The Project continued to expand the number of service delivery points (SDPs) providing FP counseling and services for Mindanao. With the addition in PY5 of 11 more SDPs providing FP counseling services coming from Zamboanga del Norte (4), Maguindanao (1), Cagayan de Oro City (1), Davao City (2), Davao Occidental (1), and Davao Oriental (2), the number has now reached 718. SDPs from the 2013 baseline of 239 or an additional 479 public and private health facilities that are able to provide FP/RH services. This translates to a 97%

Center and the Davao Oriental Provincial Hospital); in SOCCSKSARGEN (Dr. Jose Royeca Memorial Hospital and Dr. Amado Diaz Foundation Provincial Hospital); and in CARAGA (the 2 Agusan Provincial Hospitals, Cabadbaran District and Adela Serra Ty Hospital).

24 accomplishment of the EOP target of 737 SDPs. This figure only covers USG sites and does not include an additional 83 SDPs in non-USG sites that were provided TA through DOH ROs. Specifically in ARMM, FP Counseling has been sustained in almost all of the facilities including one (1) private hospital (Juan S. Alano Hospital) in Basilan and Isabela City. Due to the recent armed conflict in Marawi, these services has also been disrupted. However, in the entire ARMM, of the 600 MECAs and 600 NDPs deployed in identified GIDAs only around 40% have the capacity to provide counseling. The MH project have started the conduct of the planned 5 batches of FPCBT Level 1 training to capacitate these untrained HSPs providers .

1.4.2 Support to the conduct of supportive supervision to trained HSPs and trainers The focus of Project support is to help build the confidence of non-performing trained HSPs by supporting DOH-led supportive supervision/post-training evaluation activities and facilitating their certifications by the DOH. As of this reporting period, the number of trainers trained in PPIUD/BTL-MLLA is at 126 with 88 or just 70% of them having been already supportively supervised and among these 80 have been certified as either PPIUD or BTL-MLLA trainers as shown in the following table. The number of HSPs, on the other hand, trained in various FP methods as of the same period has reached 5,664 with most, about 3,008 of them, are trained in FPCBT1. Among the 955 trained on PPIUD in USG sites 36% or 344 have been certified by DOHROs. For BTL, 125 have been trained and 62 (50%) were visited for supportive supervision and certified by DOH. Also, a total of 125 out of 688 LARC/PSI trained providers were supportively supervised and certified. The response of DOHROs to MH recommendations for the need to address the high proportion of non-practicing providers and the importance of prompt supportive supervision to sustain investments have been met with month-long post-training evaluation activities in Northern Mindanao, mobilization of trainers in SOCCSKARGEN, and , increased in the number of DOH-certified HSP was due to DOHROs. In ARMM and Davao Region, the proportion of certified PPIUD trainees remain low at 11% and 4% respectively, as the regions are still in the process of strengthening their certification procedures and mobilization of teams to do supportive supervision. Davao City, provinces of Davao Oriental, Maguindanao, Tawi-Tawi and Lanao del Sur have zero certified PPIUD providers despite 99 trained providers supportively supervised. Table 6: Status of Supportive Supervision Activities as of September 2017 (USG Sites) FP Trainer Health Service Provider % % Certified/ Certified/ Methods Trained Supportively Certified Trained Supportively Certified Trained with SS Supervised supervised

FPCBT1 10 3,008 72 60 2% 83% FPCBT2 702 122 99 14% 81% LARC-PSI 24 8 2 688 262 125 18% 48% PSI 167 Removal PPIUD 83 64 56 955 584 344 36% 59%

25 BTL- 50% 77% 43 24 24 125 81 62 MLLA NSV 19 4 0 Total 160 96 82 5664 1125 690

1.4.3 Development of Clinical Practice Sites (CPS) for postpartum family planning Guided not only by baseline assessment results but also by a modified version of performance standard checklist, MH and its partners intensified the validation visits to complete the certification of 6 facilities as both PPFP Training Providers and Clinical Practice Sites (CPS).These facilities are almost evenly distributed in five (5)-assisted regions excluding ARMM. In addition, there are 39 facilities certified as Clinical Practice Sites and 18 health facilities recognized/certified as coaching and mentoring sites for PPFP/PPIUD, Details are captured in Table 7 below. Table 7: PPFP/PPIUD Training Providers and Clinical Practice Sites, as of June 2017

Region/ Areas PPFP Training Clinical Practice Sites alone Coaching and Mentoring Covered Providers and Clinical Sites Practice Sites Zamboanga 1 – ZCMC 6 - Margosatubig RH, ZDSPH, 5 - Rotary Birthing Center of Penisula ZSPH, Dr. Jose Rizal Memorial Upper Calarian, Ipil RHU, Hospital the Leon Postigo RHU Imelda RHU, Aurora RHU and Tukuran RHU and Sindangan DH Northern Mindanao 1 – NMMC 10 – JRBGH,CHO, Bulua HC, 0 GTLMH, Kapatagan PH, Maramag RHU, Pangantukan RHU, Tagoloan RHU, Happy Midwife Clinic of Jasaan and MOPH Davao Region 2 – SPMC and DRMC 4 - Bansalan RHU, DDSPH, 7 - Sta. Maria BC, Brokenshire Memorial Hospital Magsaysay BC, Berato BC, (BMH) and Mercy Birthing Center DOPH, Lupon RHU, Maco (MBC). RHU and Nabunturan RHU SOCCSKARGEN 1 – CRMC 9 - SKPH, SCPH and Dr. Royeca 4 – Isulan RHU, Lambayong Tacurong, CHO, Bagumbayan RHU, Sto. Nino RHU and RHU, Esperanza RHU, Dr. Kalamansig-RHU Amado Diaz MPH, Mlang District Hospital and Kidapawan CHO. CARAGA 1 - CRH 8* - Agusan del Norte Provincial 2 - WFMC-Doongan and Hospital (ADNPH), Cabadbaran WFMC-Bayugan DH, Agusan del Sur PH (DOPMH), CRH-Surgao City, Bayugan City HO, Adela Serra Ty and Bislig CHO) and one (1) from 26 Region/ Areas PPFP Training Clinical Practice Sites alone Coaching and Mentoring Covered Providers and Clinical Sites Practice Sites Surigao Del Norte, the Caraga Regional Hospital ARMM None 2 – BGH and Limook BHS 0 Total 6 39* 18 Note: *DOH-Caraga certified 8 CPS but 2 of these (Adela Serra Ty and Bislig CHO) are non-USG sites.

1.4.4 Refreshing HSPs on PSI removal and counseling In preparation for the removal of SDI from about 5,070 PSI clients this year, a total of 167 trained health service providers from the private and public health sector across six (6) regions were capacitated by the Project to ably perform this task as well as to guide and counsel clients who might opt either for re-insertion or any FP methods of their choice. As of the end of the year, 142 health workers mostly in Maguindanao, South Cotabato, Sultan Kudarat, Sulu, Gen. Santos City, and Basilan have underwent supportive supervision on PSI removal and counseling. Indirectly, these supported refresher trainings also necessitated the need for more supportive supervision visits for PSI removal as well as re-insertion. Given the bulk of SDI clients, the Project will continue to identify and capacitate among SDI providers a pool of trainers on LARC/PSI with specialty on SDI removal, including coordination with LGUs and DOHROs to track PSI clients due for removal.

1.5 Expanded AYRH services Seventy-seven (77) health facilities, both private and public hospitals and RHUs in SDN and non-SDN sites were assisted to ensure adolescent–youth clients receive FP/SRH preventive guidance and access to continuity of care resulting in the establishment of 10 hospitals providing adolescent/youth friendly facilities and 50 AY-friendly RHUs that meets minimum DOH standards. Eleven (11) schools and one DepEd Division were capacitated to integrate risks assessment, guidance and referral in the schools’ youth formation services program, which include guidance and counseling, and health and nutrition programs. One hundred-sixty (167) CSO youth peer educators also underwent training as facilitators of USAPANG TeenMoms. These were collective project interventions focused on expanding the access of AYs to a continuum care for RH/FP-MCH information, counselling, and services in public and private hospitals and RHUs, and working with schools and civil society organizations to reach in-school and out-of-school youths with information, risks assessment, guidance and referral. Hospital-based Center for Teens In PY5, four (4) hospitals, namely: Agusan del Norte Provincial Hospital and D.O.Plaza Medical Center in CARAGA Region; J.R. Borja Hospital in Northern Mindanao, and Sultan Kudarat Provincial Hospital in SOCCSARGEN, were mentored to establish protocols for respective Centers for Teens to ensure that AY clients receive preventive counseling. Guided by the DOH- HEEADSS risks assessment and standards on “youth-friendly” service, a core team of health service providers involved in AY care, including nurses, midwives and physicians, was mentored to ask about risk-taking behaviors such as unprotected sex, substance use as well as about issues like violence victimization. Management, stewardship, and arrangements for internal collaboration with different clinical departments like OB- 27 Gynecology, Pediatrics, Women and Children Protection Unit, STI/HIV-AIDS were part of soft technical assistance to ensure continuing care for provision of FP-MCH/SRH care. To date, a total of ten (10) public-private hospitals (i.e., Brokenshire; Southern Philippines Medical Center; Davao Regional Medical Center; Dr J.P Royeca Hospital; South Cotabato Provincial Hospital; Cotabato Regional Medical Center; Agusan Del Norte Provincial Hospital; Sultan Kudarat Provincial Hospital, JRBorja General Hospital, D.O.Plaza Medical Hospital) were assisted by the Project to provide FP/RH services to adolescents-youth . CAA area Name of CSO/NGO AY-friendly Ready RHUs 1. Cotabato City DSWD Pag-asa Youth Association of the Philippines (PYAP) In PY5, the Project focused on accelerating the functionality of 67 RHUs to provide 2. Lanao del Sur Bubong Youth Council youth-friendly services that meet the following minimum criteria: a) available private counseling room; b) available AJA-trained providers; c) use of HEEADSS and consent 3. Marawi City Almujadilah forms; and d) use of service records logbook. TA through training of RHU nurses, 4. Maguindanao UNYPHYL (United Youth of the midwives and physicians on AJA protocol and risks assessment, development of RHU Philippines- Women, Inc) Upi guidelines, and provision of job aid tools, as well as issuance of local policy supportive Youth Governance Program; of youth-friendly programs implementation helped LGUs and health providers in Bangsamoro for Women & Child institutionalizing ASRH service programs for young people. 5. Zamboanga HDES (Human Development and City Empowerment Services) The 67 assisted RHUs (Region X-11; Region XI-12; Region XII-11; Region XIII-3; and ARMM-15) are in different levels of AY-friendly readiness (Annex: A). These RHUs are 6. Basilan Isabela Foundation located where there are hospital-based Centers for Teens, or BEmONC/CEmONC 7. Sulu Kalimayaan Foundation hospitals as referral points. Being the most common first-contact SDPs for young mothers seeking ANC, MCH and FP, MH assisted the training of 445 frontline providers 8. Tawi-Tawi TarbilangFoundation and provincial program coordinators on Use of Adolescent Job Aid Manual. Fifty (50) of the RHUs, both in SDN and Non-SDN sites, moved to meet the minimum criteria while 23 have issued local Executive Orders in support of youth-friendly programs.

Campus-based AYRH The Project assisted the DepEd Division of Table 8: List of CSO Partners in AYRH Agusan del Norte implement campus- based AYRH programs in 11 national high schools under the DepEd Division of Agusan del Norte its youth formation programs and transform them into one cohesive platform called the YOLO (Youth Optimizing Life Opportunities) Program was launched last July 2017. Youth formation programs are learner support services that complement and reinforce a student’s performance in school through co- curricular and non-curricular interventions and initiatives. Guidance Counseling and Health and Nutrition are part of these support services that look into the health and well-being of a learner. To ensure that AYs receive SRH preventive guidance and referral, MH in collaboration with DOHRO CARAGA built the capacities of 40 frontline staff like guidance counselors in the schools under this Division in integrating HEEADSS risks assessment in the profiling that they perform among all students during enrolment in respective schools, and in regular consults that they receive daily.

28 Also MH built the capacities of division health nurses tasked to implement DepEd’s Health and Nutrition program whose functions opens the space to ask about risk-taking behaviors, like unprotected sex, substance use, as well as about issues like violence victimization and provide guidance. Findingss are discussed with heads and guidance counselor for follow-through intervention. ASRH Peer Education in CAAs In PY5, the Project strengthened the capacities of 167 youth peer educators from engaged SRH-focused civil society organizations in eight (8) CAA areas. Youth peer educators were trained to facilitate USAPANG Barkadahan/USAPANG TeenMoms to reach out to OSYs and young parents with SRH/FP information, and facilitate their access to RH/MCH-FP services through referral and outreach, and access to livelihood skills development opportunities through partnership with TESDA, DepEd-ALS, and DOLE. CSO youth peer educators worked in close collaboration with the barangay LCEs, the Mayor, and with the RHUs-BHSs during the conduct of USAPANG TeenMoms for support, co-facilitation and provision of FP/MCH services inclose collaboration with respective health offices/facilities, IPHO, TESDA, DepEd ALS and comes in varied forms such As partner of ADNPH, Mr Romeo Aprovechar, Superintendent of ADN- as Usapang Teen Moms in the community, in transitory sites, multi-social DepEd Division addressed Guidance Counselors and Nurses during the AJA services caravan such as ROSE of Lamitan; and in Maguindanao especially in training and school campus guidelines development on May22-26, 2017 Upi, CSO’s partnership with schools in in Butuan City. the conduct of Usapang Barkadahan have greatly influenced the declining trend in teen pregnancy. For PY5, a total of 1,429 young mothers received FP/MCH information and preventive counseling; 353 of them were provided with FP-MCH services and products.

UsapangTeenMoms co-facilitated by HDES peer educators held at TarbilangFoundation youth peer educator with Bongao RHU in Buggoc transitory site in Zamaboanga City on February 17,2017 Tawi-Tawi co-facilitate Usapng TeenMoms held on March 6, 2017, during the launch of Bongao RHU AY friendly facility. 29

Teen Hotline The Teen Hotline implemented by the Brokenshire Program for Teens recorded a total of 125 inquiries on menstruation, available services, sexually transmitted infections, and family planning options in PY5 majority of which were made by young individuals. As part of the technical assistance of the Project, an electronic excel-based recording tool was also implemented to properly document (Left photo) Participants of the Usapang Barkadahan session during the 12th Youth Month celebration in Cagayan de Oro City the calls and texts received through the engage in conversations with fellow youths about relationships and reproductive health. (Right photo) One of the participants of hotline. To formalize the processes and the Usapang Barkadahan found to be engaged in risky behavior undergoes one-on-one counseling with a trained health provider structure, the Project also assisted from Cagayan de Oro City Health Office. (Photo: City Government of Cagayan de Oro) Brokenshire hospital in developing the “Teen Hotline Protocol and Guide” which was eventually adopted. Coming from the documented conversations, the Project also provided support in compiling and writing of an FAQ document. Both documents will aid Brokenshire as it deploy resident doctors and enable them to transition in handling the hotline. Resident doctors of the OB-GYNE department and the members of the Brokenshire WomenCenter team were oriented in using the said tool.

#SoMe4AYRH In PY5, the Project trained 13 representatives from the Zamboanga City Health Office, Commission on Population, Zamboanga City Public Information Office and IGNITE youth organization in using social media and social networking sites in providing information on sexuality and reproductive health. The initiative takes on the existing Speak Out! Zamboanga accounts and pages. Based on the key performance indicators, engagement rate increased from the baseline of 0.19% to 0.38% in Y5Q2. Frequency of posts have also increased from 0.3 to 0.7 per day. However, the engagement rate dropped down in the succeeding quarters. One of the reasons identified is the variety of AY issues/problems being catered by the Speak Out! Zamboanga and engagement of the Public Information Office in the various activities of the local government. Moreover, a number of political issues were also raised during the implementation because the pages and accounts used were strongly linked to the local government unit of Zamboanga City. As a response, the Project recommended the creation of new pages and accounts solely for campaign’s use and the transfer of management to the City Health Department.

Strategy 2: Increasing the Demand for MNCHN/FP Services

Key Achievements:

. Intensified the convergence between demand generation and service delivery to increase FP acceptance through social preparation and client generation for LARC/PM services (outreach or fixed facility service delivery); . Eighty (80) FP providers from the private sector and 43 from public sector trained on providing client-centered counseling on family planning and safe motherhood in one-on-one consultation or in a group setting; . Various types of IEC materials produced, disseminated and spot-checked throughout the project sites to promote increased use of modern FP methods, addressing fear of side effects and correcting rumors and misconceptions on FP, promote safer motherhood and exclusive breastfeeding; and . Expanded reach to some 30,200 women pregnant and postpartum women on information on exclusive breastfeeding through health events, information materials and group education. 2.1 Improved FP service uptake from profiling activities and health events

To support the Philippine Health Agenda especially on reaching Zero Unmet Need for family planning, MH during PY5 facilitated initiatives to analyze unmet need data at the regional and provincial levels, provided tools for reporting, profiling and mentored partners on using data for demand generation and service delivery. MH advocated for harmonizing data sets used by government sector partners, recognizing that various agencies tasked to achieving the goals of Zero Unmet Need – DOH, POPCOM and DILG – are using varied data sets while essentially targeting the same population: the CCT/NHTS beneficiaries. While regional actions and results vary, there are notable responses at the regional level. In Davao for example, it is reported that only 48,786 (19%) of the estimated 250,278 women with unmet need were profiled and reported, while only 17% were served. SOCCSKSARGEN region is one region that consistently uses and follows the tracking and reporting format and tools recommended by MH. FP services provision accomplishments though varies: Cotabato and Sultan Kudarat provinces performed below 35% of their respective targets. General Santos City did not fare any better at 15%. Meanwhile, Cotabato City (82.5%) and South Cotabato (81%) were the regional topnotchers. Zamboanga Peninsula (Region 9) on the otherhand logged in an accomplishment rate of 47% of its baseline estimate of CCT/NHTS clients with unmet FP need. Zamboanga City in turn reported a 62% accomplishment rate as of the end of PY5 having provided 4,439 CCT/NHTS clients with FP services out of the 7,192 CCT WRA profiled with unmet needs. For ARMM, coordination at the regional level to achieve Zero Unmet Need remains sluggish. Provincial initiatives to profile and track unmet need is the norm. Available reports places Sulu at 64% achievement of its target from 2016 baseline. The rest of the provinces are still consolidating their respective data. 2.2 Supported Expansion of LARC/PM Outreaches and Fixed-facility Services through USAPAN

31 One of the primary demand generation approaches of MH is to intensify group education and Table 9: Summary of Demand Generation counselling by supporting the conduct of USAPAN Activities in PY5 sessions. In PY5, these sessions were held primarily as social preparation activities for LARC and USAPAN SESSIONS PY5 LAPM outreach activities as well as to generate clients for fixed facility LARC/LAPM services. Usapan Sessions 853 A total of 853 USAPAN sessions with 17,123 particiapants were conducted during the period, Usapang Buntis 104 644 (75%) of which were the Usapang 644 Kuntento na/Puwede Pa variants in preparation for Usapang Kuntento Na/Puwede Pa outreach activities. Usapang Maginoo 8 Over a four-year period that this FP demand generation Usapang Barkadahan 90 approach has been undertaken, the total number of USAPAN sessions conducted as of the end of Total Participants in Usapan Sessions 17,123 PY5 has already reached 5,291 with a corresponding number of participants totaling to Total Acceptors 4,520 95,737. By integrating health events and outreach activities into this approach, the conversion New Acceptors 2,983 rate or percentage of acceptors to the total 1,537 number of participants has been improving as shown in Other Acceptors Table 10. From a low of 3.9% in PY2, the % of Acceptors to Total USAPAN 26.4% conversion rate jumped to 51% in PY5. The four-year session participants average stands at 18%. In terms of efficiency of the approach, where each USAPAN session Women provided with information on 30,238 generated less than one acceptor/session EBF from health events and Usapang in PY2, this number went up to 10.2 acceptors/session Buntis in PY5. The four-year average is computed at three (3) acceptors/session. Admittedly, Clients reached by profile much work has still to done to improve these numbers. Improvements could come enhanced Pregnant women 4,603 client identification and selection, intensified convergence between demand generation Women of reproductive age 31,891 and service delivery through social Adolescents and youth reached 11,122 preparation and client generation for LARC/PM 3,288 services (outreach or fixed facility service delivery), shortened durations of the sessions, and Men intensified support to improve the skills of USAPAN facilitators through mentoring visits, job aids and collaterals. Annex B provides a summary of demand generation activities in all Project sites as of September 30, 2017 while Annex C tabulates the total women reached and provided FP services by type of USAPAN.

Table 10: USAPAN Activities and Efficiency Year 2 Year 3 Year 4 Year 5 Total No. of USAPAN sessions (a) 645 2,606 1,187 853 5291 No. of USAPAN Participants 12,609 45,104 20,901 17,123 95,737 (b) Total Acceptors (c) 494 4,071 3,753 8,682 17,000 % Acceptors to Number of 3.9 9.0 17.9 50.7 17.8 USAPAN Participants (d) = c/d Efficiency rating (d) = c/a; # 0.77 1.56 3.16 10.18 3.2 of acceptors per USAPAN session

Capacity-building on USAPAN for partners

MH has trained from the six (6) regions 1,244 HSPs from 479 service delivery points (SDPs) either as USAPAN facilitators or trainers as shown in the table below.

Table 10. Number Trained on USAPAN as Facilitators and Trainers Region Facilitators Trainers Autonomous Region of Muslim Mindanao (ARMM) 141 26 Zamboanga Peninsula (Region IX) 255 14 Northern Mindanao (Region X) 251 19 Davao Region (Region XI) 256 9 SOCCSKSARGEN (Region XII) 304 8 CARAGA (Region XIII) 37 37 Total 1,244 113

Because of this assistance, 274 of the 366 LGUs or 75% of the MH-assisted LGUs have been enabled to conduct USAPAN as a demand generation approach, especially as a social preparation activity for LARC outreach. This number is expected to grow with the training and orientation on USAPAN processes provided to the following: (i) Orientation on the Usapan Process for Nursing and Midwifery Clinical Instructors of Davao Doctors College and Tecarro College (26); (ii) USAPAN Orientation of Newly-hired Zamboanga Del Sur Family Health Associates (27); (iii) IPCC Training for Population Program Officers of Surigao Provinces with PopCom CARAG (29); (iv) USAPAN Orientation among CMSU-IMAP in Cagayan de Oro City and Misamis Oriental (17 midwives).

2.3 Increased effectiveness of community volunteers to identify and motivate WRA with unmet need during profiling activities Reporting for this indicator must meet the following criteria: i) receiving USAID assistance coupled with ii) “active” status or evidence of participation in referrals/provision of information on FP. To meet the “active status” criteria, proof of referrals/FP services including information giving using completed referral forms or logbooks showing CHW is still active and providing services need to be submitted as MOVs. In PY5, MH provided technical assistance to 2,014 community health workers (CHWs). These health workers mobilized and provided family planning (FP) information to 8,413 women and men of reproductive age, provided referrals for family planning to 6.955 probable clients, as well as provided other services such as providing information and referrals for other health services available in the health facilities to 1,304 probable clients with health needs. They are also mobilized by partner agencies such as organizers for LARC/LAPM outreach activities, profiling activities and to monitor compliance to ICV.

Table 11. USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services in PY5 CHWs FP Services Provided REGION Total FP Info Referrals Others Autonomous Region of Muslim Mindanao 134 3221 3186 218 Zamboanga Peninsula (Region IX) 115 556 669 481 33 Northern Mindanao (Region X) 302 1217 326 605 Davao Region (Region XI) 622 560 560 0 SOCCSKSARGEN (Region XII) 691 2183 2214 0 CARAGA (Region XIII) 150 676 0 0 Total 2,014 8,413 6,955 1,304

The TA provided included job aids to help in motivating probable clients for FP/MNCHN services such as the CHW Tool Kit, FP/MNCHN Motivational Tool, and IEC materials/collaterals such as FP Fan and FP methods brochures/leaflets. Orientation sessions were also conducted in various regions to familiarize the health workers on the use of job aids, and how to effectively motivate and navigate probable clients with unmet needs for modern family planning. MH also provided technical resource to PopCom during training activities for CHWs on interpersonal communication. There are now approximately 1,200 Barangay Population Volunteers (BPVs) that were trained by PopCom Region X for the entire Northern Mindanao region, 302 of which received TA from the Project. One of the tasks of BPVs is the conduct of home visits to households with women of reproductive age (15 – 49 years old). Home visits are done to follow-up couples with unmet need for modern FP that have been identified during the conduct of FDS, USAPAN Series and/or Pre-Marriage Counseling. These couples are linked by the BPVs to the nearest health facility wherein the midwives provide FP counselling to help them decide which FP method to use. ICV compliance is strictly monitored by the population officers. 2.4 Improved counseling skills of MWs on addressing fears of side effect, and myths and misconceptions on FP A. Cohort Midwives A total of 246 RHMs from 29 municipalities and one city covering six provinces in Mindanao were involved in the conduct of a “Descriptive Survey of Rural Health Midwives’ Knowledge and Experience on Modern Family Planning Counseling and Addressing Fears, Rumors, Myths and Misconceptions.” Specific study sites are LGUs under the following Service Delivery Networks (SDNs): (i) Cluster 1 SDN of Zamboanga del Sur; (ii) ClaJaViTa ILHZ of Misamis Oriental; (iii) District 3 SDN of Davao City; (iv) CoMMMoNN ILHZ of Compostela Valley; (v) DOP ILHZ of Agusan Del Sur; (vi) BITES SDN of Sultan Kudarat; and (vii) Iranun Cluster SDN of Maguindanao. The study assesses the cohort RHMs’ current knowledge of modern FP methods and their confidence to provide the different FP services. It also assesses the midwives’ confidence to respond to client’s fear of side effects, their ability to counsel clients by addressing common myths and misconceptions associated with modern FP use as well as assess personal barriers that prevents them from responding adequately to their client’s needs and concerns. The results of the study include the following: 1. Significant difference in the knowledge, confidence and practice among midwives trained on FPCBT1 as against not yet trained, demographic differences according to seniority, years of service, and education, among other factors; 2. Knowledge of modern FP methods and confidence to counsel clients are generally high (75.5% average score), but varies per specific method. Of the top question answered incorrectly, when asked which of the listed contraceptive methods are most effective, 61%

34 said BTL, 13% said IUDs, 13 % DMPA/Depo-Provera, 6% for oral contraceptive pills, and 2% said LAM. Of the correct responses, only 2% said PSI and 0.41% said NSV; 3. Respondent-midwives are generally confident in counseling clients on FP (92%), and describe themselves as facilitating the client’s decision to choose a method (94.7%). Pills (94.3%) is the most commonly offered method, followed by injectables (88.6%), condoms (88.2%), LAM (82.1%), IUD (78.9%), BTL (72.4%), Standard Days Method (56.1%), PSI (52.8%), and NSV (38.2%) as the method least offered; 4. There are four (4) key misconceptions examined in this survey: fear of side effects, pills enhances appetite so you gain weight, contraceptives lead to abortion, and proof of a man’s manhood is his having many children. About 42% of respondents say that they are Very Confident in answering method-specific fears of side effects, same level as those who identify that they are only Somewhat Confident, while 16% are Not Confident at all. On the question of pill enhancing appetite that leads to weight gain, 57% are Very Confident that they can counsel women on this concern, 35% are Somewhat Confident and 9% are Not Confident. On the statement that contraceptives lead to abortion, more than half (52%), say they are Very Confident, 25% are Somewhat Confident and 23% are Not Confident that they can address the misconception. Half of the respondents are Very Confident that they can address client’s misperception that having many children is proof of a man’s manhood, 30% feel that they are only Somewhat Confident and 20% are Not Confident at all; 5. Expanding on the question regarding fear of side effects by asking on method-specific side effects, the respondents expressed high confidence in answering client’s questions on side effects of pill use with an aggregate confidence level of 95%, followed by IUD (92%), DMPA (89%), BTL (88%), and NFP (85%). The methods the respondents are least confident providing counseling on are NSV (31%) and SDI (30%); and 6. Lacking certification to provide or prescribe a method is the most common reason cited not to provide a modern FP method to a client (27%) followed by client’s medical ineligibility (18%), spousal or partner disapproval (17%), discomfort in providing or prescribing the method (16%), and 13% not enough knowledge about the method. Only 3% say they do not know where to refer the client. Apart from the survey, a job aid on FAQs on Modern Family Planning was developed, pre-tested and distributed to the midwives as support to the midwives’ needs in addressing the common myths and misconceptions on FP (left). B. Client-centered Counseling for Hospital-based Family Planning Providers MH capacitated 256 doctors, nurses and FP program staff from 82 SDPs on BCS+, a support initiative to institutionalize FP Programs in private and public hospitals by enhancing the DOH-required FPCBT1 training. BCS+, an FP counseling strategy that comprises a series of steps to determine the contraceptive method that best suits the client according to her/his preferences and needs. The Plus refers to the need for counseling, screening and services for sexually transmitted infections including HIV within the routine FP consultations. In Zamboanga Del Sur, 26 hospital-based FP providers of Margosatubig Regional Hospital (MRH) attended the training on Family Planning Competency-based Training Level 1 with BCS+ (FPCBT1 with BCS+). FPCBT 1 is a DOH-certified training activity on family planning to 35 enable health service providers to safely administer and dispense FP services, and share accurate information on the different modern FP methods with clients. CBT1 is enriched with modules on BCS+. The participants comprised 15 Nurses, 10 Midwives and 1 HEPO of which 20 are females and five are males. The training activity is also an on-going technical assistance to MRH to prepare the hospital as a Clinical Practice Site for PPIUD, and in the installation and strengthening of FP Program in the Hospital, eventually strengthening MRH as a referral facility for the SDN in the province. MH also provided trainees the Learning Resource Package such as: (i) BCS+ Algorithm (2015 edition); (ii) BCS+ Counseling Cards; (iii) 2015 MEC (electronic version); (iv) FP methods brochures; (v) E-copies of training presentations; and (vi) Counseling Checklist. The trainees displayed effective counseling knowledge, skills and behavior during their return demonstration, and had utilized the techniques and processes inherent in the BCS+ technique. Because of this, the hospital staff were certified as FP counselors and providers. DOH-RO IX immediately granted them certification as FP providers since the trainees are regular hospital staff and had been providing FP services for some time, albeit without the benefit of training on FP counseling. Meanwhile, in Sultan Kudarat, 33 hospital staff of Sultan Kudarat Provincial Hospital attended the same training activity. The training is part of SKPH’s strengthening of FP service provision in the hospital. During the return demonstration stage, the participants showed improvement in skills to communicate effectively during the counseling process. They are able to effectively use the job aids of the BCS+ for counseling during return demonstration. MH also provided technical support in the conduct of two training activities in SPMC in Davao City for in-house roll-out among hospital staff implementing the FP in the Hospital Program. A total of 41 SPMC staff were trained. Meanwhile, supportive supervision on FP counseling was conducted at DRMC for 22 service providers out of the 32 trained in August 2016. These staff are assigned in the OB/DR, Emergency Room, Family Medicine, and OPD. Job aides used in counseling were the cue cards of the BCS. Another round will be conducted three (3) months after for their subsequent certification as FP counselors and S/LARC providers.

2.4 Mobilized nursing and midwifery student-affiliates in hospital-based counseling on FP/MNCH MH collaborated with the ADPCN- and APSOM-affiliated colleges and universities in Davao Region to mobilize student affiliates in information giving and counseling on FP and safe motherhood. In the previous year, 16 Schools of Nursing and 11 Schools of Midwifery attended an MH-sponsored IPCC Training while 15 schools participated in the Training of Trainers on IPCC. Seven (7) Schools of Nursing have enhanced their resource unit in Nsg 101 on the 2nd year 1st semester and in Midwifery on M102 1nd year 2nd semester and on Mid 101. To monitor implementation of initiatives, visits were conducted in four schools – three in Tagum and one in Davao City. St. Mary’s College of Nursing has enhanced its resource unit in Nsg 101 for 2nd year students in the 1st semester. Forty-eight (48) hours is devoted to community exposure doing house to house visits, mother’s classes and one on one counseling under the supervision of a trained Clinical Instructor on IPCC, while 96 hours exposure in the hospital, in DRMC and in Bishop Regan Memorial Hospital. Arriesgado School of Midwifery enhanced its curriculum in Mid 101 for 2nd year students in the 1st semester. Its community exposure enhanced the resource unit in PHC 1&2 with 53 hours. In Tagum Doctors School of Nursing, the trained CI trained was no longer employed in the hospital and did not conduct the roll out among CIs. Secondly, there were no enrollees for nursing this year. MH also facilitated a series of meetings between partner nursing and midwifery schools affiliating in Southern Philippines Medical Center (SPMC) with the end in view of improving the role of student affiliates (SAs) in generating demand for FP and MCH services. As a result, in the current school year, SPMC required student affiliates to perform tasks related to FP promotion, education, and counseling such as master 36 listing of probable clients, conduct health classes, and referral of probable clients for counseling and service provision, especially in their rotation in the OB, DR, and Family Medicine/Pedia wards and in the OPD section.

2.5 Engaged MRLs to address gender and cultural barriers to FP use in ARMM MH engaged and mobilized 60 faith-based leaders for community local dialogues (health events, USAPAN sessions) on the permissibility of modern family planning and RH programs and services in the Islamic context. The MRLs in turn engaged women and men in the community. For example, in Basilan, 60 males were reached during group-level USAPAN sessions, along with 30 women and 30 men in local mushawara (dialogue). In Marawi City, an MRL spoke in front of 295 men and women during a local health event. In Maguindanao, 30 men participated in a mushawara on FP, RH, benefits of EBF, and ideal marrying age in Islam, and in Tawi Tawi, 200 males attended USAPANG Maginoo conducted during outreach activities. Finally, in Sulu 10 MRLs addressed 25 couples and 25 adolescents on FP/RH in Islam. The Regional Darul-Ifta of ARMM, with technical assistance from MH, has developed a sermon guide or khutba that will help imams when they lead Islamic worship services at the masjid. The guide was pre-tested and submitted for USAID review and approval. Currently, MH has secured the commitment of the Bureau of Madaris Education to sponsor the khutba as co-author with the Regional Darul-Ifta. While waiting for USAID approval, MH proposed to explore other means of distribution for the khutba with the CHANGE Project. CHANGE has agreed to use the khutba as resource material and outline for its planned radio program in the ARMM, with one or two MRLs and DOH- ARMM on board. The “Khutba on Air” will be a paid radio program sponsored by CHANGE Project, with MH providing technical support through its sermon guide and MRL contacts.

2.6 Facility visits/spot checks of IEC materials To promote and sustain health behaviors on family planning and safe motherhood, MindanaoHealth distributed USG-approved IEC materials and job aids in various project sites.

37 Number and type of USG-approved IEC materials distributed to promote and sustain healthy behaviors

ICV ICV Nanay FP Wallchart FP CHW Ink Wallchart FP FP Fans Bookle Stam s Flipta REGION Toolkit Bottles s Placemats t p (Cebuano rps (Tagalog) )

Zamboanga 67,860 410 10,268 104 52 6 23 74 541 Peninsula

Northern 47,390 369 6,000 61 66 403 100 70 896 Mindanao

Davao 39,372 735 6,000 53 53 53 53 70 1,058 Region

SOCCSKSAR 44,400 571 3,000 39 39 138 271 70 1,029 GEN

Caraga 26,520 390 4,000 28 28 0 100 70 539

ARMM 66,648 627 3,000 114 114 0 100 70 986

Total 292,190 3,102 32,268 399 352 600 647 424 5,049

Facility visits/spot checks of IEC materials utilization

To ensure that IEC materials are properly utilized and their uses maximized, MH conducted several spot checks in the following sites:

Site/Facility and Location FP IEC Materials Utilized 1. Ungkaya Pukan RHU, Basilan FP Flipchart available and displayed properly; CHW Tool Kit available and used to orient BHW President on how to use the material during household visits 2. Sultan Kudarat Provincial ICV wallchart displayed at the door of the Teen Center Hospital, Isulan, Sultan Kudarat 3. Calinan, Davao City ICV wallcharts are displayed and FP flipcharts available and used during client counseling 4. Brgy. Tapian BHS, Datu Odin There are five (5) FP posters (two are recent; three are from a previous USG- Sinsuat, Maguindanao assisted Project) and an FP desk chart displayed in the BHS’ FP corner. 5. RHU Sultan Kudarat, IEC materials and job aids present in the RHU include ICV wallchart, FP fans, Maguindanao FP posters and desk chart, and BCS algorithm placemat. They are found in the waiting area, FP room and in the delivery room. 6. Sta. Maria Rural Health Unit The following materials are available in the facility: a. Planadong Buhay Poster (CHANGE/USAID) b. Methods Poster (CHANGE/USAID) c. ICV Wall Chart (CHANGE/USAID) 38 d. FP fan (CHANGE/USAID) e. FP Flip chart (CHANGE/USAID) f. USAPAN tool kit/box – Provided by MH to the health workers province- wide. This box is used to store all the documents/materials during USAPAN classes such as: USAPAN card, sample FP commodities, IEC materials and others. 7. Lower Poblacion Health Materials available include: Station (Sta. Maria, Davao del a. I love you nanay poster for FP (USAID) Sur) b. 3-5 agwat poster (USAID) c. Safe motherhood poster (USAID) d. Breastfeeding TSEK (MH/USAID) e. CHW tool kit(MH/USAID) f. Planadong Buhay poster (CHANGE/USAID) g. FP desk flip chart (CHANGE/USAID) h. FP placemat (CHANGE/USAID) i. Nanay and Baby Book (CHANGE/USAID) j. FP fans (CHANGE/USAID) 8. Bansalan Rural Health Unit, This facility is the recipient of the following materials: Davao der Sur a. FP Brochures, violet and orange (CHANGE/USAID) b. FP fan (CHANGE/USAID) c. Nanay and baby book (CHANGE/USAID) d. FP placemat (CHANGE/USAID) e. MCH brochure (CHANGE/USAID) f. ICV wall chart (CHANGE/USAID) 9. Villar-Cagas Barangay Health IEC Materials in the facility include: Station a. CHW tool kit (MH-USAID) b. FP flip chart CHW tool kit (MH-USAID reprint) c. FP methods poster d. FP Brochures, green and orange CHANGE/USAID) e. ICV wall chart (CHANGE/USAID) f. FP flip tarp (CHANGE/USAID) g. FP fans (CHANGE/USAID) h. FP placemat (CHANGE/USAID)

These spot checks also provided feedback on the relevance of these materials. Generally, the local partners find the IEC materials and collaterals very helpful, especially in bringing key messages on FP and MNCHN to the clients. The FP fan for example, although very limited in quantity, was useful in spurring client interest on FP because they could bring the material home and the mothers find them attractive and useful as well. The Nanay Booklet is useful in reminding the mothers on key behaviors they need to do to remain safe during pregnancy as well specific things to do for the health of their babies as well. When they give mothers the Nanay booklet, they remind the mothers to read them carefully, pointing out the messages found page by page. The CHW Toolkit helped a community health volunteer provide information on FP on two walk-in clients in Lower Poblacion BHS.

2.7 Pregnant Women Reached with Individual or Small Group Level Education on the Benefits of EBF

39 For this reporting period, MH has already reached 30,238 women with individual or small group level education on the benefits of exclusive breastfeeding (EBF) through various health events, small group and individual discussions. This brings the five-year total to 153,151 women reached. Facility-level discussion on EBF among women who gave birth at the facility reached 141,881 women, reaching a five-year total of 1,195,032 women reached with information on the benefits of EBF.

Strategy 3: Removal of policy and systems barriers to service delivery and its utilization

Key Achievements:

For the year in review, the Project achieved the following:  Overall stockout rate of FP commodities reported during the four quarters of PY5 remains at less than 4% as the strengthened implementation of demand generation and tracking of commodities by PopCom at the ground played a positive role in accomplishing this feat. Continuing delivery of commodities from DOH Central Office coupled with inventory alert mechanisms installed at the provincial and regional DOH offices likewise accounted for this positive development;  The number of public facilities that attained MCP/NCP re-accreditation by end of PY5 reached 300 representing a 16% increase over the previous quarter accomplishment of 258 while the number of LGUs utilizing PhilHealth reimbursements as per PHIC guidelines slightly increased from 315 in PY4 to 327 surpassing by 18% the PY5 target of 277 LGUs;  Sustained the rollout of SDN establishment in 21 SDN sites in 13 provinces and three (3) cities involving 79 LGUs with established TWGs and referral pathways for MNCHN/FP and AY services. These LGUs comprise 341 GIDA barangays, 473,388 NHTS families, and approximately 70,525 women of reproductive age (WRA) with unmet need for contraception. The roll out was supported by the endorsement of the SDN Operational Guide developed by MH in 2015 in collaboration with the five (5) DOH-RO Directors and the Secretary of DOH-ARMM, and with corresponding fund support;  Through the technical support of MH, Davao City passed into law an ordinance establishing systems and mechanisms for the implementation of maternal, newborn, child health and nutrition (MNCHN) strategy for the city that would reduce and cprevent maternal and child deaths;  282 LGUs conducted DQC in PY5, a 90% accomplishment rate over the PY5 target of 305 LGUs and 77% of the 368 USG-assisted LGUs. Efforts to institutionalize DQC activity were demonstrated in 13 provinces and 28 individual LGUs in Region 12 through the issuance of either an Executive Order (EO) by the LCE or an Office Order by the P/CHO.

3.1 Linking SDPs to the commodity distribution and tracking network (towards a “pull” system) The overall stockout rate of FP commodities reported during the four quarters of FY2016-2017 remains at less than 4%. This could be attributed to the continuing delivery of commodities from DOH Central Office coupled with inventory alert mechanisms installed at the provincial and regional DOH offices that quickly identify SDPs with commodity inventories breaching the buffer stock level and respond appropriately by linking them with the regional and DOH Central FP logistics hotline and the online FP commodity monitoring through Facebook. The strengthened implementation of demand generation and tracking of commodities by PopCom at the ground have played a role for accomplishing this. MH supported the LGU by informing ahead the PHO and Population Offices of the stock level inventory of the 40 SDPs and coached SDP personnel on recording and reporting of consumptions to PopCom and DOH Central Office via the FP commodity monitoring network. The PHOs, on the other, conduct quarterly stock-out monitoring and facilitate redistribution of FP commodities from facilities with either slow moving, overstock, or commodities approaching their expiry dates to facilities with reported stock-outs. In the CARAGA region, through the approval of the Regional Implementation Team (RIT), PopCom established a regional FP logistics hotline with a dedicated personnel assigned to track and monitor FP commodity inventory status in all health facilities. The stock monitoring reports are accordingly communicated to the DOH-RO and DOH Central FHO for re-supply. DOH-CARAGA, for its part, agreed to inventory all drugs and medicines including FP commodities through its Pharmacist and furnish inventory reports to provincial program coordinators and RHUs. To immediately address stock-outs, a stop-gap measure was initiated by the PDOHO, PHO, and DOH-RO with MH support to pull out stocks from SDPs with sufficient inventory level, facilitate its redistribution to facilities with reported stock-out, and replenish the same from the DOH-RO’s buffer stock. In Cotabato City and some CARAGA SDPs, for instance, where IUD was not moving because of low service provision, these commodities where transferred to hospitals with high volume of PPIUD clients. So that a stock-out in Q1PY5 would not recur and to stabilize buffer stock level, the DOH-RO-11 Davao allocated P3M from its supplemental budget for the procurement of supplies of POP and DMPA from DOH central since these two types of FP commodities are always in demand. Said procurement was intended to cover the FP commodity needs of government hospitals and CSOs in the region. In terms of logistics management system, 324 RHUs and CHOs reported using either the supply management and recording system (SMRS) or the simplified FP Commodity Inventory and Order tools introduced by DOH and PopCom. These tools track and monitor inventory levels through issuance and dispensing, and recording and reporting/submission of actual consumption reports. The latter could be coursed through the FP Logistics Hotline or the FP Commodity On-line Monitoring o Facebook. Annex D shows a summary of the status as of end of the period. In PY5, 20 MLGUs of Lanao del Norte underwent training on simplified logistic management system (LMS) of recording, reporting and tracking FP commodity inventories and consumptions as part of the campaign to shift from a “push” to a “pull” system of inventory management. This technical assistance package, jointly provided by DOH-RO X, POPCOM X, and MindanaoHealth, was in response to a DOH memorandum mandating all DOH-ROs to submit a quarterly one-pager FP commodity inventory and order report form to be accomplished by the PHNs of RHUs/CHOs and the PHO FP Coordinator to the DOH-RO every 3rd week of the succeeding month of each quarter and supported by emails to DOH Central Office. Subsequently, this initiative was replicated in all provinces of Northern Mindanao and later in CARAGA region and then in the rest of Mindanao led by the regional offices of DOH and PopCom. MH, on the other hand, supported this initiative by integrating the simplified logistics management system in all SDN activities to ensure availability of FP commodity especially in primary health care facilities.

3.2 Improved financing through PhilHealth MNCHN/FP packages The number of public facilities that attained MCP/NCP re-accreditation by end of PY5 reached 300 representing a 16% increase over the previous quarter accomplishment of 258 while the number of LGUs utilizing PhilHealth reimbursements as per PHIC guidelines slightly increased from 315 in PY4 to 327 surpassing by 18% the PY5 target of 277 LGUs. The remaining 42 LGUs without reimbursement policy, majority of which are in Misamis Oriental and Lanao del Norte provinces, are unable to pass a PhilHealth reimbursement ordinance due to the slow completion of HFEP-funded facilities, absence of BEmONC trained personnel, and non-compliance of health facility design to PHIC’s building specifications. Basilan RHUs, on the other hand, are limited by the lack of organic local health officers and as such are 41 unable to comply with PHIC’s major accreditation requirement and thereby forced to regularly renew their MoAs with private physicians as well. Out of 67 non-accredited facilities, 36 have on-going accreditation applications while the remaining 31 facilities expressed disinterest in applying for accreditation as MHO positions in these LGUs remain vacant. The geographic isolation of the RHUs in the case of island municipalities in BaSulTa, security situation in Lanao del Sur and portion of Lanao del Norte, and proximity of public hospitals to the main health centers continue to pose as a strong discincentive to prospective applicant-doctors. Annex F provides a detailed status of PHIC Accreditation and Reimbursement Policy by Province/City On PhilHealth accreditation in modern Family Planning, there are 380 LAPM accredited providers across USG-assisted sites in Mindanao, of which 94 (25%) are BTL/MLLA accredited providers, 281 (74%) PPFP/PPIUD accredited out of 558 DOH certified providers, and 5 (1%) NSV accredited out of six (6) certified providers. The accredited PPFP/PPIUD and NSV providers represent 50% and 83% of the certified PPFP/PPIUD and NSV providers, respectively. These PhilHealth-accredited LAPM providers have been filing claims for PhilHealth reimbursements for FP services rendered. On BTL/MLLA, the three (3) provinces of Zamboanga del Sur, South Cotabato and Agusan del Norte as well as the four (4) cities of Zamboanga, Cagayan de Oro, Davao, and Cotabato have the most number of available BTL/MLLA PHIC-accredited providers. In contrast, there are only five (5) NSV PHIC-accredited providers across USG sites, of which three (3) are in Davao City CHO, one (1) in Zamboanga del Sur Medical Center and another one (1) based at the Maguindanao Provincial Hospital. An NSV non-accredited but DOH-certified provider is based at the Agusan del Norte Provincial Hospital. SOCCSKARGEN and Northern Mindanao are the regions with the most number of accredited PPFP/PPIUD providers representing 74% (209) of the total PPIUD accredited providers. As of January 1, 2017, PhilHealth mandates the use of validated electronic medical record (EMR) system for re/accreditation by PCB providers,2 MH conducted an EMR assessment in the RHUs in the first quarter of PY5 and linked them with appropriate service providers. The survey conducted by the Project in Agusan del Norte, Agusan del Sur, Bukidnon, Lanao del Sur and Cotabato City revealed that only 37% out of 41 RHUs covered have use or implement EMR. The system commonly installed in the RHUs is iClinicSys, which is also the most preferred system by those who are not implementing the EMR. Others are using the Wireless Access for Health (WAH) and “eHatid LGU”. In response to this, MH closely coordinated with PhilHealth and DOH-RO as they are aggressively conducting orientation sessions on various accredited EMR systems. As of the end of PY5, the number of RHUs and main health centers with EMR systems installed increased from 223 during the previous quarter to 247. Majority of these health facilities are using iClinicSys developed by DOH while SDPs in Zamboanga Peninsula particularly Zamboanga del Sur and Zamboanga Sibugay and a few RHUs in Maguindanao are using the Wireless Access for Health (WAH).

3.3 Accelerated the Functionality of Established SDNs The Project has so far established 21 SDN sites in 13 provinces and three (3) cities involving 79 LGUs with established TWGs and referral pathways for MNCHN/FP and AY services. These LGUs comprise 341 GIDA barangays, 473,388 NHTS families, and approximately 70,525 women of reproductive age (WRA) with unmet need for contraception. The roll out was supported by the endorsement of the SDN Operational Guide developed by MH in 2015 in collaboration with the five (5) DOH-RO Directors and the Secretary of DOH-ARMM, and with corresponding fund support. Six (6) regional teams were trained and deployed as trainers on the use of SDN operational guide, and who subsequently took the lead in rolling out SDN establishment across USG-assisted project sites. DOH-RO 9 and 10 trained five (5)

2 The implementation of PhilHealth advisory on the use of the EMR system was moved to January 2018. 42 provincial teams to spearhead the SDN rollout in the provinces. Good practices emerged on public and private partnership (PPP) such as the unified reporting system in Iligan City, the enlistment in the SDN of six (6) private hospitals in BITES SDN, Sultan Kudarat; the community-based transportation and communication support for referral in DOP SDN, Agusan del Sur, and the PPP on health in Davao City District 3 to better serve the health needs of the IP community. These good practices were documented and later shared during the regional dissemination forums in Northern Mindanao and CARAGA regions. To date, there are four (4) functional SDNs (BITES in Sultan Kudarat, Iligan & Sanlakass in Lanao del Norte, and DOP SDN in Agusan del Sur), eight (8) operational and nine (9) organized SDNs. Sanlakass SDN operation, however, is currently affected by the on-going armed conflict in Marawi City being one of its corridor areas. The TA support to SDN management structures led to LGU health policy issuances related to the RPRH law, PHIC reimbursement, LGU cluster pooling of resources to fund hospital operation, legitimization of SDN area designation, availability of safe blood, cross border referral accommodation of clients, among others. Referral mechanisms and protocols were documented in eight (8) SDN sites while 10 SDNs initiated the integration of modern FP program in hospitals serving as end referral facilities for LAPM services in 14 hospitals. The two SDNs (DOP and BueNasCar) of CARAGA region incorporated AYRH protocols in their respective referral manuals. Currently, there are five (5) referral mechanisms being documented. These are in the provinces of Zamboanga del Sur (Distircts 1 & 2), South Cotabato (province-wide), Sultan Kudarat (province wide), Bayugan SDN in Agusan del Sur, and Iranun SDN in Maguindanao. Each referral mechanism essentially puts in detail the following: (i) FP/MNCHN/AY protocols at each level of care within the network; (ii) the referral guiding principles and disciplines; (iii) the roles and responsibilities of all stakeholders down to the community level; (iv) the blood service referral system; and (v) the monitoring and evaluation system that tracks SDN contribution to achieving health outcomes and service coverage indicators, its functionality based on the 10 elements, and efficiency of referral services. In the course of formulating referral principles, protocols and agreements, MH facilitated the formulation of nine (9) public-private partnership (PPP) agreements with private hospitals as core referral facilities for maternal, LARC/PM and AYRH services; community transport group to provide the much needed transportation in GIDAs; inclusion of 911 services in the referral system; sub-specialty services, among others as integral component of SDN services. Inherent in these agreements is a basic recognition that neither the public sector nor private sector alone is in the best interest of the health system. Some 1,013 HSPs from public and private sectors and spread across all SDN sites were capacitated on LARC, BTL-MLLA and PPIUD services thereby benefiting some 17,600 (PSI - 8,665 and LAPM - 8,935) clients from MH-assisted sites. As of this reporting period, there are five (5) PPP and service level providers’ agreements under formulation in Zamboanga del Sur, Lanao del Norte, Agusan del Norte, Agusan del Sur and Maguindanao. MH also provided technical support to enable LGUs and HSPs comply with PhilHealth accreditation requirements; implement reimbursement and sharing policy to ensure that the PHIC reimbursements from MCP and FP are plowed back to health services via a trust fund in the form of incentives to HSPs, staff, Community Health Team (CHT) members, and traditional birth attendants (TBAs); and procure FP commodities and supplies. As a result, 43 out of 49 non-accredited SDPs secured MCP/NCP accreditations. Accordingly, these accreditations translate to more revenues for the SDPs. Also, out of 79 LGUs in 21 SDN sites, 56 LGUs (70%) adopted reimbursement policies as per PhilHealth guidelines. Annex E shows the status of SDN establishment in USG-assisted as they move towards achieving functionality with respect to the three core activities supported by the Project.

3.4 Institutionalization of Data Quality Check and Use of Health Information 43 Efforts to institutionalize DQC activity were demonstrated in 13 provinces and 28 individual LGUs in Region 12 through the issuance of either an Executive Order (EO) by the LCE or an office order by the P/CHO with corresponding budget support and DQC team mobilization. As a result, the number of LGUs conducting DQC regularly declined from 294 in PY4 to 321 in PY5 to 282 in PY5, a 90% accomplishment rate based on the PY5 target of 305 LGUs and 77% of the 368 USG-assisted LGUs. As a percentage of the EOP target of 309 LGUs, the accomplishment in PY5 corresponds to 90% of the EOP target. The Project trained 340 DQC trainers who in turn have so far capacitated during the DQC roll out a cumulative total of 4,132 DQC LGU staff across 19 provinces and two (2) cities as of the end of PY5. The latter number represents roughly 13% increase over the 3,669 health workers trained at the end of PY4. To date, there are only four (4) remaining provinces and three (3) cities without DQC policies. During the year, good practices on the use of clean and validated health data were documented in the provinces of Compostela Valley and Agusan del Sur by demonstrating the following: a) data completeness and accuracy enhanced afters errors were detected and then reduced/corrected/managed within the RHUs before reaching the PHO; b) data reporting and retrieval time shortened from seven to 10 days to one to two days at the RHU level and from the usual three to four months to a month or less to consolidate and complete the annual reports at the PHO level; c) percentile rates increased through improved health indices from 2012 to 2016 where DQC data are used as reference to constantly monitor and update the Target Client List (TCLs) coupled with intensified demand generation activities linked with direct service provision; d) health programming got better through the use of clean and validated data in the formulation of local investment plan for health (LIPH), annual operational planning (AOP) and project implementation review (PIR). In Agusan del Sur, DQC’d data helpful to develop evidence-based programming that is responsive to community needs such as the Toktok Planadong Pamilya – a household level family planning campaign to swiftly address modern FP unmet needs; Bay Mo Ampingan Ta (BMAT) of Talacugon RHU that provides accurate and updated monthly health profiling of households reflecting the 13 primary health indicators; and integration of MNCHN/FP with Family Develoipment Sessions (FDS) for 4Ps beneficiaries; e) budget allocation for health became more deliberate, and leveraging and use of resources became more efficient due to focused interventions; and f) institutionalization of DQC through the issuance of executive/office order facilitated the creation and mobilization of DQC teams at the provincial and municipal levels, and budget allocation to fund on-site DQC activities. In some regions like Northern Mindanao, the use of DQC data allowed the local health managers to deliver health services that are context- specific by taking into account the socio-cultural and economic determinants of health. Iligan City, on the other hand, demonstrated the importance of putting in place a unified recording and reporting system across public and private health care facilities which track and capture the true health situation of the city. In the course of implementing DQC, the Project encountered varied challenges in the early part of the year but was eventually able to overcome them. These included the non-universal commitment and action by LGUs to conduct DQC at all SDPs down to the barangay level; issues with data quality resulting from the growing scale of the DQC implementation; and the current DQC methodology which excludes hospitals and private sector facilities. MH addressed these challenges by: (i) imparting to LCEs and local health managers the benefits of 44 DQC in LGU planning, implementation, monitoring and evaluation processes; (ii) capacitating the RHMs, FHAs and PHNs on DQC and mainstreaming the activity so that DQCs are conducted at least every quarter and cover most facilities under each municipality/city; (iii) supporting LGUs and facilities to better understand the DQC methodology via on-site coaching through MH LGU Advisors (LGUAs); (iv) engaging current non-reporting hospitals and private sector facilities to participate in DQCs; and (v) continue collaborating with the Zuellig Family Foundation (ZFF) to become another active proponent of DQC. To sustain the gains on DQC implementation, the issuance of DQC policy with dedicated resources (staff, equipment, logistics, and budget) is imperative to ensure its institutionalization. This serves as an imprimatur that directs and guides local health managers and staff on both administrative and operational matters. The presence of functional technical team at the provincial level tasked to monitor, validate and analyze, and provide technical support and updates to the RHU/CHO DQC teams is key to regularize on-site DQC activities. In support to these teams, the provision of incentives in whatever form could motivate them to work as a committed team. Further, the inclusion of DQC budget in the LIPH and AOP helps ensures the success of the initiative in the succeeding years as demonstrated by the LGUs regularly conducting DQC activities. The table below features the state of DQC implementation in USG-assisted sites. Table 12: Status of LGU DQC Implementation as of end of PY5. Core Activity Status as of end of PY5

 Northern Mindanao: All 3 provinces of MisOr, LDN and Bukidnon and Iligan City issued Memo on DQC to C/MHOs through the C/PHOs while CDO City issued an EO thru the City Mayor

 Davao Region: Only Compostela Valley with EO on DQC  SOCCSKSARGEN: Sultan Kudarat thru PHO Office Order and 28 LGUs issued EOs (Cotabato City, North Cotabato – 18, SC-9/11)

DQC Institutionalization through the issuance of Executive Order  Caraga: Agusan del Sur province issued an EO on DQC while Agusan del Norte has province-wide office order or Office Order  ARMM: Regional government’s memorandum order backed by province-wide office orders of the 5 provinces  Zamboanga Peninsula: Only Zamboanga del Sur with policy Summary:

13 Provinces issued policy on DQC institutionalization; and 28 individual LGUs in R12. Remaining 4 Provinces and 3 Cities without policy (Zamboanga del Norte, Zamboanga Sibugay, Davao Oriental, Davao del Sur, Zamboanga City, Koronadal City, and Davao City)

 ZamboPen: All 70 (100%) LGUs are conducting DQC regularly (ZC, ZDS-26, ZS-16, ZDN-27)  Northern Mindanao, All 73 (100%) LGUs are conducting regular DQC (Bukidnon- 22; MisOr- 26; LDN- 23; CDO and Iligan City)

LGUs regularly conducting DQC  Davao Region: 31 (82%) out of 38 LGUs (ComVal- 11, DO-11, DDS- 9/15) out of 38 LGUs conducted DQC  SOCCSKSARGEN: All 42 (100%) LGUs conducted DQC (SK 12; SC-11 NC-18, GenSan-1, Cotabato)  Caraga: All 26 (100%) LGUs of the provinces conducting DQC quarterly  ARMM: 79 (66%) out of 119 LGUs (36 in Maguindanao; 12/12 Basilan; 19/19Sulu; 12/12 Tawi-Tawi; LDS – No data

45 Core Activity Status as of end of PY5

Summary: 321 (105%) out of 305 target LGUs for PY5 reported conducting DQC regularly either monthly or quarterly. LGUs not conducting DQC regularly are Davao City, Davao del Sur and Lanao del Sur without data due to ongoing Marawi siege.

Strategy 4: Strengthening the Capabilities of DOH Regional Offices and Provincial Health Offices in Program Development, Management and Oversight

Key Achievements:

 Trained program staff of the Davao Regional Medical Center, DOH Northern Mindanao, Zamboanga Peninsula, SOCCKSARGEN and CARAGA on Training Information and Management System (TIMS);  Harmonized FP training data for TIMS installation in CARAGA, Northern Mindanao, SOCCKSARGEN and Misamis Oriental Province;  Strengthened public and private facilities recording and reporting;  Unmet need validation and FP provision to CCT families of Zamboanga Peninsula, Davao and SOCCKSARGEN regions;  Approved the creation of regional ICV committees of Davao and Northern Mindanao via DOH Regional Orders No. 2016-2777 and 2017-1295, respectively;  Approved DOH Regional Order No 2017-0215 supporting the establishment of Regional Training Committee in CARAGA; and  Facilitated the finalization of six (6) plans for 2017-2018 for the Accelerated and Sustained Campaign on Reduction in Unmet Needs for Modern FP Methods.

4.1 Assisted the DOH-ROs implement DOH AO 2014-0041 - “Guidelines on the Recognition of FP Training Providers” Institutionalizing DOH AO 2014-0041 which mandates the establishment of a Regional Family Planning Training Recognition Committee as a critical step towards building the capability of the DOH-ROs in expanding their respective FP program training functions drew in DOH CARAGA. This DOH-RO responded to the AO by issuing MC No. 2017-215 providing TA support to enable the CARAGA Regional Hospital and the Butuan Medical Center to work for their respective recognition as FP training institutions for PPIUD. As the DOH tightens its support to RPRH implementation, the Project continued to strengthen the DOH-ROs’ health human resource capability through MNHCN/FP post-training evaluation (PTE) support. This is justified as data shows the low proportions of HSPs actually practicing the FP skills they acquired through training, i.e., only 22 % (160/742) for FPCBT2, 7% (55/796) for LARC PSI, 34 % (355/1035) for PPIUD, and 49% (61/125) for BTL-MLLA. The lack of providers’ confidence to practice and the lack of systematic way of planning PTE/supportive supervision and tracking potential trainees for supportive supervision are just some of the reasons for the poor turnout. The Project continued to enhance and advocate with the DOH Central Oiffice and DOH-ROs for the installation and adoption of the Training Information Management System (TIMS) - a web-based training database tool that aims to support training management at the DOH-RO level and systematically track/flag the status of training, post-training, and certification of HSPs. It equips program managers with Mindanao-wide and regional information on cadres of trainers and training institutions. Initially built on the FP/MNCHN training framework, the system has been expanded to cover all health training programs on the clamor of the DOH-ROs for SOCCKSARGEN, Davao, 46 Northern Mindanao and CARAGA. TIMS was live-tested in Q2PY5. To date, it holds data on around 3,687 registered trainees from 86 FP trainings and 33 PTEs conducted. Moving forward, MH started to strengthen TIMS further by adding features such as SMS-alert system for PTE evaluation that could prompt initiate supportive supervisory visits, and a redesigned matrix that includes supportive supervision checklist, PTE score results among others. Consultations and orientations were made in Q3PY5 to: (i) generate buy-in at the Regional, Program and Mindanao Cluster levels; (ii) prompt the DOH Mindanao Cluster and the DOH-ROs to policy supporting the implementation of TIMS; 3) establish a structure to support training management; and (iv) migrate 2013-2017 FP training data to TIMS and build the capabilities of the regional health offices of ARMM, Northern Mindanao, Davao, SOCCKSARGEN and CARAGA. These offices committed to implement TIMS and install a Regional Training Recognition Committee to implement DOH AO 14-0041. In Q4PY5, Zamboanga Peninsula initiated its data harmonization for TIMS. In Davao Region in partnership with Davao Regional Medical Center, MH facilitated a brief orientation and consultation among program managers (FP, training, and public health) on TIMS. As a result, the hospital management agreed to conduct data migration and installation of the TIMS. This was completed in January 2017 and training supervisors and program managers under the public health office have been actively using and maintaining the database.

4.2 Assisted the DOH-ROs implement DOH AO 2017-0005 – “Guidelines in Achieving Desired Family Size through Accelerated and Sustained reduction in Unmet Need for Modern Family Planning Methods” Aside from developing tools for recording and reporting on the ground and facilitating inter-agency collaboration, MH works through Regional Implementation Teams to institutionalize improvments in the system. In Davao Region, the Regional Implementation Team was reconvened and expanded to include active CSOs. An M&E framework was also presented and TWG memberships were identified. MH provided the DOH Davao leadership with a draft of the TWG functions for finalization. At the Cluster level, MH reiterated the importance of tracking unmet needs to be reported every quarter to the OFIM where Mindanao-wide interventions could henceforth be planned. Zamboanga Peninsula’s experience in reducing the unmet need was strengthened due to the collaborative partnership of POPCOM, DSWD and DOH that was initiated in Q1PY5. This resulted in a 38% increase in the number of couples reached with unmet needs. From December 2016 to date, 2,585 couples out of the identified 6,697 couples with unmet needs were provided with FP services, a number much higher than was reported during the previous two-year period. In the same reporting period, the distribution of the aggregate number of FP acceptors is as follows: (i) pills (18,283); (ii) IUD (3,480); (iii) DEPO (3,278); and (iv) BTL (2,510). While ARMM agencies such as DOH ARMM, POPCOM and DSWD reconciled data on on unmet needs, provinces/ cities updated and validated the status of unmet needs per SDP. The RIT was reconvened during RPRH Law workshop in November 2016 and tasked to track and follow-up the status of Zero Unmet Needs implementation based on the reconciled records and estimates of unmet needs facilitated by the Project.

4.3 Assisted the DOH-ROs foster inter-agency collaboration with coordination bodies In Q4PY5, MH continuously worked to strengthen collaboration with and among DOH-ROs, PopCom and other regional partners through: (i) attendance to the RICT/RIT and AYRH TWG meetings; (ii) sustained participation in DOH and PopCom-initiated activities like training on FP-MNCHN, PTE, USAPAN, AYRH, and Unmet Need Identification, among others. These meetings provided MH the opportunity to assist DOH identify strategies to improve demand generation utilizing the list of unmet need and link the former to service delivery and 47 expedite supportive supervision for trained PPFP providers. The meetings also became venues where DOH updated P/C LGU Health Officers, Chiefs of DOH-managed and LGU hospitals and Heads of DOH-attached agencies on DOH’s new directions, and current policies and projects. In Northern Mindanao, DOH Regional Order No. 2016-2777 creating ICV committees in the provinces resulted in the conduct of nine (9) ICV orientations for: (i) three batches of 106 BHWs; (ii) 15 mentor-mentee midwives during the FPCBT2 Training for CMSU-IMAP; and (iii) 98 clients during the five LAPM+/LARC Outreaches. Interviewed were 29 clients, 35 service providers and two (2) non-FP clients in 20 health facilities. All facilities monitored were ICV compliant, i.e. providing comprehensible information and broad range of FP methods and services to FP clients, were not setting quotas and were not declining services to non-FP clients. The RIT convened in Cagayan de Oro to confront the alarming increase in teenage pregnancy. PhilHealth reported that 12% of the total MCP reimbursements in 2016 were deliveries by women aged 14-19 y/o, not counting the non-PHIC members, hence the figures may jump to 20% if captured. Overall progress in Northern Mindanao in terms of RPRH implementation are as follows:  Assisted the Regional DOH-PopCom in holding a training/workshop on Moving Towards Zero Unmet Need for Provincial and City FP Unmet Need Core Team composed of the PHO/CHO FP Coordinators, Provincial/City Population Officers, Provincial/City Social Welfare Officers and DMOs;  Enjoining all public health facilities (RHUs) to be AY-friendly in compliance with RDC Resolution No. 36 s. 2016;  Mobilization of BHWs through their Federation Presidents to generate unmet need data, with POPCOM providing some form of incentives for the BHWs. Bukidnon will be piloted due to its high unmet need;  Purple Ribbon Provincial Screening Committees organized for the Purple Ribbon awards this December 2017. Each committee has the DOH (PDOHO), PopCom (Provincial PopCom Officer), DILG (PLGOO), PhilHealth and the DSWD as sitting members. MH was requested to help draft a memorandum for the provinces/cities on their participation in this competition. The criteria and processes for award will be finalized during the regular quarterly RIT meeting scheduled in October 2017. In SOCCKSARGEN, the RIT convened to tackle the RPRH M&E tool including the key results areas, indicators, and revised data capture forms. The DOH-RO12 and PopCom-12 are facilitating the rollout orientation activities to the LGUs as strategies and interventions on the ground need to be harmonized and contextualized. Results varied across the region. In Sultan Kudarat province, the PHO and POpCom have not met yet and levelled off as neither the PPO have attended the orientation nor undertook any activity related FP demand generation. The PHO, PDOHO and MHOs already directed their NDPs to focus on the unmet need identification and tracking such that concrete plans for methodically identifying, navigating, counseling and ultimately providing services to the WRAs with unmet needs were developed. They have focused initially on the CCTs, but also served the non-NHTS. The SKPH, which is the BITES referral hospital, also did its part in providing regular schedules of BTL services to serve clients opting for this permanent FP method. In General Santos City, there are numerous active partners working on FP, which MindanaoHealth has also build alliance with like the FPOP, both on demand generation (USAPAN sessions) and service provision through their trained HSPs. The CHO had forged agreements with these private facilities to capture their FP accomplishments by requiring them to submit reports to the CHO for eventual integration into the FHSIS.

Program Management

48 Monitoring, Evaluation and Research During the year under review, Monitoring, Evaluation and Research (MER) activities focused on providing more substantive support for the implementation of the Zero Unmet Need policy of the DOH, the development and roll out of the Training Information Management System (TIMS), and conduct of internal data quality checks as well as project implementation review.

Updates on Indicators In October 2016, an inter-CA meeting was conducted to get updates on status of USG indicators. It was noted that for EBF, several data quality issues were identified during the evaluation particularly on difficulty to track how many clients have been provided information as there were various sources that needed to be aggregated. CYP reports are also under reported as IMS data is not available to provide commodity-based methods as DKT which represents 85% of the market has not recently been a subscriber. A follow-through meeting in December 2016 in USAID resulted in the review of USG performance indicators. The following new, modified or restored indicators were agreed upon and reported quarterly, namely:

1. Average stock-out rates (revised to include condoms and SDM beads) 2. Number of USG-assisted CHWs providing FP information, referrals and/or services during the year (restored from PY 3) 3. Number of women giving birth who received uterotonic in the 3rd stage of labor 4. Number of newborns not breathing at birth who were resuscitated 5. Number of Universal Health Coverage (UHC) areas supported by USG investment 6. Presence of the Mission support to Strengthen Human Resources for Health (HRH)

The project indicator system along with a revised M&E plan Key USG performance indicators for FY 2017 were finalized in May 2017.

TIMS Development and Installation In PY5, MH continued its advocacy for the adoption of and roll out of a Training Information Management System (TIMS) in all DOHROs by using the current year’s database of all capacity building activities including information on supportive supervision and certification of providers. All the six (6) DOHROs visited have signified interest in using the system. MH then drafted a Regional Order describing proposed policies on the adoption of TIMs as well as the roles of personnel in the regions to update, analyze, and use of the information for tracking training activities, identifying trainees due for supportive supervision, and identifying those due for certification in the regions. The initial consultation meetings also became a venue for MH to advocate for better coverage of supportive supervision activities, the identification of potential clinical practice sites, and the implementation of systems that would facilitate these activities given the limitations of DOHROs and their training arm the Centers of Excellence. A web-based system complete with manuals has been installed in all DOHROs. MH is awaiting the passage of the regional orders for the final roll-out of the systems.

49 Discussions with DOH Central Office in the middle of the year, particularly the Health Human Resource and Development Bureau (HHRDB) and the Knowledge Management and Information Technology Service (KMITS) concluded with the following agreements:  HHRDB expressed openness to the idea of adopting TIMS to complement existing systems they are developing. DOH is moving towards competency-based identification of capacity building needs. MH proposed the adoption of a coding system for the different training programs of the department using the Learning and Development Intervention framework.  In terms of integrating TIMS to other existing systems, Training Codes and Trainee IDs for Trainees/Health workers need to be standardized.  TIMS may be turned over as an open source system because of its features and potentials for implementation in Luzon and the Visayas.  Currently KMITS has the Training Information System (TIS) but it only covers local trainings. KMITS indicated readiness to use other systems that have offline versions since not all RHUs have access to reliable internet connections.  KMITS standards for turnover of databases and compliance with DOH security protocols in accordance to the Data Privacy Act need to be followed. KMITS will provide a checklist of these requirements.  KMITS signified willingness to host TIMS for Mindanao regions provided that it conforms to technical requirements such as programming language used, bandwidth, and size. Internal Data Quality Checks In June 2017 and in compliance with the Project M&E Plan, MH’s M & E Officers were deployed to the regions to conduct DQCs and reconcile performance field data with the project database. This deployment revealed the following:  Some training activities have not been submitted and/or encoded in the database;  Significant number of retirees, transferred, and inactive participants;  Missing participants/activities due to non-submission of MOVs; and  Misspelled participants’ names These data quality issues have been identified in all USG-assisted provinces. Adjustments to database entries to address issues found during the review are being conducted.

Compendia Development In October 2016, USAID Manila directed all CAs involved with the health sector to document in a compendium various TA initiatives already achieved. In PY5, MH developed into compendia its experiences with: (i) SDN establishment in USG-assisted sites in Mindanao; (ii) enhancing modern family planning (FP) program in a hospital setting involving 13 health facilities; (iii) initiatives to expand the access of young people to a continuum of RH/FP-MCH care, services and products by the strengthening the capacities and operating systems of hospitals and RHUs to provide youth-friendly services and link these facilities with other institutions in the non-heath sectors; and (iv)

50 improving demand for modern FP through the USAPAN series. The SDN compendium, in general, offers an analysis of the common and unique features that are working well, the challenges faced and overcome, lessons learned, and recommendations to a way forward. It also features specific SDN initiatives as strategic innovations, which indicate “what works”, what the key lessons and experiences in operationalizing SDN are, and challenges and policy recommendations. To capture all these elements, the Project developed six (6) case studies to supplement its main document, viz.: CLAJAVITA (Misamis Oriental), DO PLAZA (Agusan del Sur), BITES (Sultan Kudarat), PALMA+PB (North Cotabato), Bayugan (Agusan del Sur) and Marilog (Davao City). Given that only a limited number of hospitals in Mindanao to date offer a broad menu of FP information, services and products, MH documented in a compendium its investments in strengthening 13 Mindanao-based health facilities through various capacity building and advocacy measures where the seamlessly integration of the DOH-prescribed FP services with existing hospital programs could be effected. The compendium on AYRH tracks the Project’s engagement with seven (7) hospitals in piloting the establishment of Centers/Programs for Teens and eventually integrating the same in the hospitals’ daily routine operations, and with 34 community–based SDPs in transforming them to become youth-friendly facilities, integrate risks assessment in their routine clinical operations, provide youth-friendly RH/FP- MCH information, counselling, and services for adolescents –youth and teen mothers, and make the needed referrals to higher facilities. One of the key challenges in family planning is the weak linkage between demand generation and service provision. To address this, MindanaoHealth in collaboration with the DOH scaled up the Conversation (USAPAN) Series developed by PRISM2 – a previous USAID Project. In this compendium, MH views USAPAN not as a stand-alone activity but as a process to improve the interpersonal communication and counseling (IPCC) subsystem in FP delivery. Appreciation of USAPAN in this context means improving the IPCC sub-system within the facility, not just the actual conduct of the health class and counseling sessions, such that the technical processes of increasing demand are ingrained in the health facility operations itself which should lead to technical sustainability. Along with the TA initiatives of LuzonHealth and VisayasHealth on SDN, FP Program in Hospital Setting, AYRH and USAPAN, MH’s four completed compendia are separately being consolidated for publication as lessons and experiences on these interventions of USAID implementing partners in the Philippines, to wit: “Service Delivery Network: Policies, Resource-Matching and Monitoring”, “Family Planning in Hospitals: A Case for Localization, Integration and Cohesion”, “Adolescent and Youth Health and Development: The Path for Innovations and Meaningful Participation” and“The USAPAN – A Behavioral Change and Communication Strategy to Help Achieve Zero Unmet Need for Family Planning”. Intended as “living” knowledge resources, each compendium envisions to guide and inspire LGUs, health workers, decision-makers and policy makers build healthier families and communities.

Project Communications Communications and knowledge management efforts of the Project in PY5 focused on continually capturing successes, experiences and lessons obtained from technical interventions provided to partners and beneficiaries in USG-assisted sites. One of these was the documentation of good practices. In August 2016, MH documented six (6) good practices and consolidated them into a compendium shared with partners from the DOH-ROs in time for the FP and MCHN Program Implementation Assessment and Strategic Planning. In the last quarter of PY5, MH documented 22 more good practices. They are now in the process of finalization as presentation materials in the upcoming Second National Family Planning Conference in November 2017.

51 As a way of sharing these practices to open prospects for learning and adoption, eight (8) of these documented good practices were presented during the Regional Dissemination Forums for Northern Mindanao in August 2016 and CARAGA in September 2016. These forums were envisioned to underscore MH’s ongoing commitment to its partners by highlighting and showcasing emerging good practices, innovations and accomplishments that have surfaced as a result of the collective efforts and initiatives not only of public and private partners at the local levels and of the DOH but also of the significant technical assistance (TA) provided by the Project. In pursuit of the plan to expand communication channels to disseminate and highlight prominent experiences and stories, the Project maximized the use of social media. Riding on its current popularity, MH took to Facebook to convey its brand and heighten its visibility as well as to get through to the public, its partners/stakeholders and especially the donors. The reach of social media cannot be over emphasized. Social media could be an effective vehicle to communicate project stories and accomplishments because it has a broader reach and offers an opening venue for interactive engagements. Hence, MindanaoHealth makes every effort to continue populating its own Facebook page with posts of its stories and experiences. It currently has more than 880 followers. The Project started its Facebook page in October 2015. In December of same year, the Project’s FB page generated 433 likes. Even USAID Philippines and Jhpiego use this medium to communicate results or impact of their respective technical interventions or assistance. The USAID Philippines Facebook Page, which has more than 19,000 followers, featured five (5) MH highlights in Year 5. In addition, Jhpiego’s Facebook Page, which has already been seen by close to 54,000 followers, also featured some of the Project’s milestones usually through photo stories as its way of letting its network and donors know the faces of its beneficiaries and also of the people who are helping improve the global health situation particularly in the areas of Maternal and Child Health, and on Family Planning. For instance, in celebration of the World Health Workers Week, DOH-awardee and Basilan midwife Virginia Cadano was presented as one of the banner photo stories that Jhpiego posted on its website. Such photo story shows how she continues to serve the people amidst constant security threats surrounding her community. Additionally, the USAID Philippines’ Office of Health Bulletin published 12 stories from MindanaoHealth on its Weekly Highlights: (i) “Integrating Private Sector Data into Public Health Information System in Misamis Oriental” - October 3, 2016; (ii) “USAID Supports Expanded Access to Family Planning Services in Cagayan de Oro” - November 11, 2016; (iii) “USAID-Supported Health Facilities Recognized as Family Planning Clinical Practice Sites in SOCCSKSARGEN” - November 25, 2016; (iv) ‘Women and Children in One of Philippines’ Farthest Islands Reached with Health Services’ - 23 December 2016; (v) “Davao City Passes Ordinance to Improve Maternal and Child Health” – January 6, 2017; (vi) “A Newfound Purpose for a Traditional Birth Attendant” – February 3, 2017; (vii) “USAID Empowers Community Health Workers” – February 17, 2017; (viii) “Agusan del Sur Generates More Family Planning Users” – March 17, 2017; (ix) “USAID Supports Teen Moms in Mindanao - April 21, 2017; (x) Young Mom Makes Tough Decisions for Self and Child” – June 30, 2017; (xi) “USAID Helps Province Strengthen Adolescent-Friendly Reproductive Health Programs in Schools” - August 11, 2017; and (xii) “Hospital-based Centers for Teens Help Empower Adolescents” - September 29, 2017. Six (6) of these stories are featured in this annual report. Underscoring the results of our partnership with the various stakeholders in USG-assisted sites are stories about MH beneficiaries, which is one focus of the Jhpiego Newsletter. For the month of July 2017, the newsletter featured a story of a teen mom from the SOCCSKSARGEN Region who was assisted during and after delivery by one of the Project’s AJA-trained providers from Dr. Jorge P. Royeca Hospital’s Center for Teens (General Santos City), and now also an FP acceptor. This is now also posted on Jhpiego Website. In PY5, some knowledge products were also produced and distributed to Project partners in order to support the continuity of initiatives beyond Project’s life. These knowledge products consisted of manuals, guides, checklists, job aids and IEC materials, among others. The first 52 batch of these materials was distributed in CARAGA region during the regional dissemination forum. As is the custom, the Project also produced the Project Magazine covering the accomplishments in PY4 for circulation among partners/stakeholders in the LGU, private sector, Jhpiego and USAID Philippines.

Project Response to the Marawi Crisis In the aftermath of the unfortunate Marawi siege, the Project was one of the first key responders providing FP IEC materials, 12,000 jerry cans and 24,000 chlorine tablets to some 4,200 families displaced by conflict.

Challenges and Mitigation Measures

Table 13: Challenges faced by MindanaoHealth in PY5 and mitigation measures implemented.

Challenges Encountered Mitigation Measures Implemented Improving the supply of MNCHN/FP services The on-going armed conflict in (1) Despite the issuances of DOH memoranda and directives, the Marawi and the declaration of efforts to be selective in pursuing activities with local clearances Martial Law in Mindanao obtained helped in realizing scheduled, postponed or delayed continue to pose threats to the activities in areas not directly affected with the armed conflicts in safety and security of health Marawi City; (2) Prioritized and fast-tracked the implementation of personnel, families and doable high-impact activities during the last two quarters of PY5 to communities in Marawi City, improve chances of closing the gaps between accomplishments and Lanao del Sur, Lanao del Norte prescribed performance targets; (3) Ensured that TA activities were and Misamis Oriental. properly and regularly coordinated with the DMOs for co-ownership, accountability and sustainability; and (4) Continued to involve regional and local colleagues who know the situation well in the execution of plans such as the conduct of trainings, supportive supervision and regional dissemination forums. Difficulty in effecting adequate DOH and LGU partners took the lead in organizing, executing and and equitable distribution and monitoring FPCBT1 in most regions. ARMM has still more than 30 reach of services by service SDPs where FPCBT1 has not been delivered yet. Thus, the ARMM team delivery points (SDPs) for FP lobbied, identified and sought management approval for 5 batches of especially in ARMM. FPCBT1 in the region. MH continued the conduct of FPCBT1 in ARMM but remained mindful of the need to prioritize facilities that have to date no providers (preferably, regular, hospital-based or birthing facilities—both public and private).

53 Challenges Encountered Mitigation Measures Implemented Difficulty in scheduling and MH engaged a BTL trainer to conduct supportive supervision for implementing TA activities due additional batch of local providers enabling them to obtain BTL/MLLA to numerous and simultaneous certification. While irregularly conducted, PPIUD supervision has DOH-initiated activities that been done by adjusting the schedules of trainers while its practicum oftentimes conflict and/or component slowly evolves in clinical practice sites. On PSI removal, compete for time and one batch of TOT was conducted in Davao with poor attendance from manpower at the PHO and the affected regions. A series of supportive supervision trainings RHU-CHO levels especially on (FPCBT2 and FPCBT1) was subsequently scheduled with DOH. supportive supervision and the MH engaged STTAs to oversee PPIUD supportive supervision in regional dissemination forum. Clinical Practice Sites or Coaching/Mentoring sites (CP/CMS), as well as the DOH and LGUs for FPCBT1, FPCBT2 and other FP supportive supervision. Seemingly unreasonable CYP MH initiated vigorous review of FHSIS data and continues to engage performance targets civil society organization (CSO) partners, such as Marie Stopes, FPOP and FriendlyCare, to be able to meet performance targets. Furthermore, MH engaged CSO partners in areas still challenged with access, and supported the engagements of fixed providers in the conduct of LARC/PM services while ensuring the distribution and availability of FP commodities Increasing the demand for MNCHN/FP services Meeting Unmet Need Harmonized FP unmet need databases among agencies tasked to implement EO 12 and demand generation initiatives. Perceived poor knowledge and Descriptive survey conducted on RHMs in seven (7) SDN sites showed skills of RHMs to address wide disparity in terms of knowledge and counseling skills of midwives client’s fears of side effects and with and without training on FPCBT1 among senior and newly-hired misconceptions on modern RHMs (about a third are newly-hired) and across regions. Intensifying family planning. the distribution of job aids (FAQs, MEC Wheel) to address frequently asked questions on mFP, including method-specific fears and misconceptions remains an option to address this challenge. Sustaining the implementation Pursued advocacy for affiliate hospital facilities to provide of enhanced pre-service opportunities for FP counseling to student affiliates for Teccaro education curricula and College of Midwifery, Ateneo De Davao CON and Davao Doctors resource units for FP/MCH College to monitor the implementation of enhanced resource units, counseling among nursing and orient CIs on the enhanced resource units, and orient CIs and student midwifery schools due to fast affiliates on the Usapan group counseling process; and for deans of turnover of clinical instructors; these schools and program managers to continue implementing monitoring group education agreed enhancements in the curriculum/resource units. and one-on-one counseling skills of student

54 Annex A: LIST OF AY-FRIENDLY RHUs

Minimum Criteria Region Name of RHU Functional Private AJA-trained Use of Service Operational LGU (Yes/No) Counseling Provider HEEADSS Record Guide Policy Rm Risks Assess Logbook ARMM 1. Upi RHU (Maguin) Yes Yes Yes Yes Yes Yes Yes 2. Buluan RHU (Maguindanao) Yes Yes Yes Yes Yes Yes Yes 3. DatuPiang (Maguindanao) Yes Yes Yes Yes Yes None None 4. Bubong RHU (LDS) Yes Yes Yes Yes Yes Yes None 5. Bongao RHU (TawiTawi) Yes Yes Yes Yes Yes None Yes 6. Patikul (Sulu) Yes Yes Yes Yes Yes None None 7. Luuk (Sulu) Yes Yes Yes Yes Yes None None

8. Pangutaran (Sulu) Yes Yes Yes Yes Yes None None 9. Talipao (Sulu) Yes Yes Yes Yes Yes None None 10. Parang(Sulu) Yes Yes Yes Yes Yes None None 11. Indanan(Sulu) Yes Yes Yes Yes Yes None None 12. Panamao (Sulu) Yes Yes Yes Yes Yes None None 13. Jolo (Sulu) Yes Yes Yes Yes Yes None None 14. Maluso (Basilan) Yes Yes Yes Yes Yes None Yes 15. Lamitan(Basilan) Yes Yes Yes Yes Yes None Yes R - 10 16. Kolambugan (LDN) Yes Yes Yes Yes Yes None None 17. Baroy LDN Yes Yes Yes Yes Yes None None

18. Tagoloan (MisOr) Yes Yes Yes Yes Yes None Yes

19. Jasaan (MisOr) Yes Yes Yes Yes Yes None Yes 20. Pangantukan (Bukidnon) Yes Yes Yes Yes Yes None None

21. Maramag (Bukidnon) Yes Yes Yes Yes Yes Yes Yes

22. San Fernndo (Bukidnon) Yes Yes Yes Yes Yes None None 23.Puntod HC (CDO) Yes Yes Yes Yes Yes None None 24.Gingoog Yes Yes Yes Yes Yes None None R - 13 25. Rosario ( Agusan delSur ) Yes Yes Yes Yes Yes None Yes 26. SanFrancisco (AgusandelSur) Yes Yes Yes Yes Yes None None

Minimum Criteria Region Name of RHU Functional Private AJA-trained Use of Service Operational LGU (Yes/No) Counseling Provider HEEADSS Record Guide Policy Rm Risks Assess Logbook 27. RTR (ADN) Yes Yes Yes Yes Yes None None R - 11 28. Barangay 21-C (DavaoCity) Yes Yes Yes Yes Yes Yes None 29. District C (Davao City) Yes Yes Yes Yes Yes Yes None 30. Buhangin(Davao City) Yes Yes Yes Yes Yes Yes None

31. Calinan(Davao City) Yes Yes Yes Yes Yes Yes None 32. Sasa(Davao City) Yes Yes Yes Yes Yes Yes None 33. Toril (Davao City) Yes Yes Yes Yes Yes Yes None 34. District A(Davao City) Yes Yes Yes Yes Yes Yes None 35. District D(Davao City) Yes Yes Yes Yes Yes Yes None 36. Talomo Central (Davao City) Yes Yes Yes Yes Yes Yes None 37. Bansalan (DDS) Yes Yes Yes Yes Yes Yes Yes 38. Sta Cruz ( DDS) Yes Yes Yes Yes Yes Yes Yes 39. New Bataan (ComVal) Yes Yes Yes Yes Yes Yes Yes R - 12 40.Polomolok (SoCot) Yes Yes Yes Yes Yes Yes Yes 41. Surallah (SouthCot) Yes Yes Yes Yes Yes Yes Yes 42. Tboli (SouthCot) Yes Yes Yes Yes Yes Yes Yes 43. Tupi (SouthCot) Yes Yes Yes Yes Yes Yes Yes 44. Bula (GSC) Yes Yes Yes Yes Yes Yes Yes 45. Calumpang (GSC) Yes Yes Yes Yes Yes Yes Yes 46. Fatima (GSC) Yes Yes Yes Yes Yes Yes Yes 47. Rosary Hghts Cot City) Yes Yes Yes Yes Yes Yes Yes 48. Pob Mother CotCity) Yes Yes Yes Yes Yes Yes Yes 49. Tamontaka (CotCity) Yes Yes Yes Yes Yes Yes Yes 50.Bagua (CotCity) Yes Yes Yes Yes Yes Yes Yes

R9 51. Ayala Health Center and lying None Yes Yes None None None None 52. Labuan None Yes Yes None None None None 53. Calarian; None Yes Yes None None None None 54. Baliwasan; None Yes Yes None None None None 55. Dona Isabel C. Climaco None Yes Yes None None None None 56. Canelar; None Yes Yes None None None None

Minimum Criteria Region Name of RHU Functional Private AJA-trained Use of Service Operational LGU (Yes/No) Counseling Provider HEEADSS Record Guide Policy Rm Risks Assess Logbook 57. Tetuan; None Yes Yes None None None None 58. )Sta. Catalina None Yes Yes None None None None 59. Talon-Talon None Yes Yes None None None None 60. Tumaga None Yes Yes None None None None 61. Mercedes None Yes Yes None None None None 62. Manicahan; None Yes Yes None None None None 63. Sangali Main Health Center None Yes Yes None None None None 64. Curuan None Yes Yes None None None None 65. Vitali Health Center and Lying in None Yes Yes None None None None 66. ) Guiwan None Yes Yes None None None None 67. Rotary Lying in Clinic None Yes Yes None None None None TOTAL 50 67 67 50 50 27 23

Annex B: Summary of Demand Generation Activities (All Project Sites, As of September 30, 2017)

Indicators Y2 Total Y3 Total Y4 Total Y5 Total Grand Total

Total No. of Health Events (Sessions) 748 2,843 1,350 1,250 6,191 Total No. of Participants in Health Events 26,959 62,821 34,543 36,814 161,137 No. of Sessions (USAPAN) 645 2,606 1,187 863 5,301 USAPAN - Buntis 180 583 206 104 1,073 Buntis Event 31 47 214 7 299 USAPAN – Kontento Na/Pwede Pa 318 1,391 516 653 2,878 USAPAN - Maginoo 67 327 77 8 479 USAPAN - Barkadahan 49 258 174 91 572 REACH 87 127 79 248 541 No. of Participants (USAPAN) 12,609 45,104 20,901 17,376 95,990 USAPAN - Buntis 2,516 9,015 3,036 3,205 17,772 Buntis Event 3,771 5,602 5,859 71 15,303 USAPAN – Kontento Na/Pwede Pa 4,496 19,503 8,140 11,865 44,004 USAPAN - Maginoo 927 4,364 1,098 104 6,493 USAPAN - Barkadahan 899 6,620 2,768 2,131 12,418 REACH 11,853 5,748 7,023 16,425 41,049 Clients Reached by Profile - Pregnant women served 5,846 18,654 9,797 4,609 38,906 Women of Reproductive Age 23,406 48,753 27,966 32,151 132,276 Adolescents and Youth (15-24) 6,420 22,493 15,323 11,243 55,479 Men 3,452 12,408 5,560 3,288 24,795 Women Provided Information on EBF from Health Events 20,940 45,156 26,427 30,062 122,585 Total Acceptors 494 4,056 3,710 8,743 17,003 New 229 2,618 2,829 5,011 10,687 USAPAN Sessions 41 1,898 2,233 2,988 7,160 Other Health Events 188 720 596 2,023 3,527 Others 265 1,438 881 3,732 6,316 USAPAN Sessions 243 1,169 472 1,517 3,401 Other Health Events 22 269 409 2,215 2,915 Total Acceptors/Total Participating in 2% 6% 11% 24% 11% Health Events

Annex C: Cumulative Number and Distribution of FP Acceptors and Referrals by Type of USAPAN and FP Method (as of September 30, 2017)

USAPAN – USAPAN USAPAN - USAPAN - FP Method Kontento TOTAL - Buntis Maginoo Barkadahan Na/Pwede Pa

BTL New Acceptors Others (Shifters, Restarters) 0 0 68 0 68 Referred 54 22 816 1 893 NSV New Acceptors 0 Others (Shifters, Restarters) 0 0 0 0 0 Referred 0 2 8 0 10 IUD Interval New Acceptors 15 7 198 0 220 Others (Shifters, Restarters) 34 2 292 0 328 Referred PPIUD Interval New Acceptors Others (Shifters, Restarters) 0 0 0 0 0 Referred 10 1 53 0 64 Pills New Acceptors 96 32 2898 65 3091 Others (Shifters, Restarters) 40 21 914 3 978 Referred Injectables New Acceptors 75 30 1677 51 1833 Others (Shifters, Restarters) 15 6 578 2 601 Referred Implants New Acceptors 27 7 1212 8 1254 Others (Shifters, Restarters) 112 1 1964 0 2077 Referred NFP-LAM New Acceptors 6 1 153 208 368 Others (Shifters, Restarters) 3 0 16 0 19

Referred NFP-SDM New Acceptors Others (Shifters, Restarters) 0 0 2 0 2 Referred 0 2 61 0 63 NFP-CM New Acceptors Others (Shifters, Restarters) 0 0 0 0 Referred 0 0 0 0 NFP-BBT New Acceptors Others (Shifters, Restarters) 0 0 0 0 Referred 0 0 0 0 CONDOM New Acceptors 11 237 434 10 692 Others (Shifters, Restarters) 1 64 118 0 183 Referred

SUMMARY By User Type 499 435 11462 348 12744 New Acceptors 230 314 6572 342 7458 Others (Shifters, Restarters) 205 94 3952 5 4256 Referred 64 27 938 1 1030 By FP Method - Total Acceptors (New and Others) 435 408 10524 347 11714 BTL 0 0 68 0 68 NSV 0 0 0 0 0 IUD 49 9 490 0 548 PPIUD 0 0 0 0 0 PILLS 136 53 3812 68 4069 INJECTABLES 90 36 2255 53 2434 IMPLANTS 139 8 3176 8 3331 NFP-LAM 9 1 169 208 387 NFP-SDM 0 0 2 0 2 CONDOM 12 301 552 10 875 Total Referrals 64 24 824 1 913 BTL 54 22 816 1 893 NSV 0 2 8 0 10 IUD 0 0 0 0 0 PPIUD 10 10

Annex D: Status of FP Commodity and Logistics Management System, as of end of PY5

LGU FP Commodity Status LMS Status Remarks 44/71 RHUs/CHOs with FP Zamboanga Peninsula commodity inventory tool  All 27 LGUs with FP commodity  PHO and DOH-RO IX 1. Zamboanga del Stockout of pills in Siocon & inventory, recording & reporting tapped buffer stocks to Norte Leon Postigo system replenish stocks 2. Zamboanga del No reported stock-out of  No issues/ concerns  No system in place Sur commodities reported  All 16 LGUs with FP commodity 3. Zamboanga No reported stock-out of  No issues/ concerns inventory, recording & reporting Sibugay commodities reported system No reported stock-out of  With FP commodity inventory,  Coordinated with CSOs/ 4. Zamboanga City commodities except for SDM forecasting, storage, distribution & religious groups to Beads recording & reporting access supply of beads  Uses the FP commodity and inventory tracking tool and FP No reported stock-out of  No issues/ concerns 5. Isabela City coordinator submits consumption commodities reported reports via FB and FP logistics hotline 68/71 RHUs/CHOs with FP Northern Mindanao commodity inventory tool  The FP commodity Inventory and Consumption report  Uses the simplified logistics form is submitted every management inventory tool with No stock-out in all SDPs. 3rd week of the 6. Cagayan de Oro forecasting, recording & reporting succeeding month of to FP logistics hotline and online each quarter to the DOH reporting CO, FHO-FP Service and emailed to [email protected].  Uses simplified FP inventory &  Regularly provides FP order form. CHO FP coordinator is commodities to 6 private No stockout reported for the incharged of consolidating hospitals and 3 birthing quarter quarterly FP inventory for clinics

submission to DOH-RO and  Consumption report is 7. Iligan City Central. submitted every 3rd

 Buffer stock reaches 25% level will week of the succeeding

alert CHO and Popcom FP month of each quarter to

logistics hotline the DOH CO, FHO-FP logistics hotline  Uses simplified FP inventory &  Consumption report is order form introduced by DOH and submitted every 3rd No stockout reported for the Popcom and submits consumption week of the succeeding 8. Bukidnon quarter reports to DOH and FP logistics month of each quarter to hotline the DOH CO, FHO-FP logistics hotline  Uses simplified FP inventory & order form introduced by DOH and No stockout reported for the  No issues/concerns 9. Misamis Oriental submits consumption reports to quarter reported DOH and FP logistics hotline Popcom No stockout reported for the  19 out of 22 RHUs use the  No issues/concerns 10. Lanao del Norte quarter simplified logistic inventory tool. reported

LGU FP Commodity Status LMS Status Remarks All 38 RHUs/CHOs with FP Davao Region commodity inventory tool  Delivery of commodities to SDPs arrived from  Simplified inventory, recording and DOH Central. reporting tool managed by the FP No stockout reported for the  Slow moving IUD was 11. Davao City Coordinator. The DOH-RO quarter pulled out from CHO Pharmacist and Popcom collect and district health the reports centers and distributed to SPMC  All LGUs are using either SIMS or CDLMIS and regularly submitting  FP commodities from No stockout reported for the report to FP logistics hotline and 12. Davao del Sur DOH Central delivered quarter DOH-Central with support from to SDPs. DOH-RO XI assisgned Pharmacist per SDN/ILHZ area  Uses simplified the FP Commodity No stockout reported for the and Inventory Form for recording  FP commodities from 13. Davao Oriental quarter and reporting to DOH Central, FP DOH Central delivered Logistics Hotline, PDOHO and to SDPs. Popcom  Uses simplified the FP Commodity and Inventory Form for recording and reporting to DOH Central, FP Logistics  FP commodities from No stockout reported for the 14. Compostela Valley Hotline, PDOHO and Popcom. DOH Central delivered quarter Reports on a monthly basis. to SDPs. LGUs are using stock-cards and logbooks in monitoring their FP commodities 29/43 RHUs/CHOs with FP SOCCSKSARGEN commodity inventory tool  No issues/concerns 15. Cotabato City No stockout was reported  No system in place reported 16. General Santos  With functional LMS/ SIMS  No issues/concerns No stockout was reported City reported  The stockout was addressed immediately by PHO FP Coordinator  13/18 GLUs with functional LMS and DOH-RO with inventory, forecasting,  All SDPs were warehousing, recording and instructed to coordinate Stockout of DMPA, IUD, COC reporting of consumption reports with FP Coordinators and POP was reported in 17. North Cotabato (Arakan Magpet, Kidapawan City, when inventory has Kidapawan and COC and Makilala, Midsayap, Pikit, Pres. reached buffer level POP in Matalam RHU Roxas, Carmen, Libungan,  Introduce simplified FP Alamada, Pigcawayan, Tulunan Commodity Inventory & and Mlang) Order Tool to 5 RHUs: Aleosan, Antipas, Banisilan, Kabacan, & Tulunan  8/11 with functional LMS (except  No issues/concerns 18. South Cotabato No stock-outs in all 11 RHUs Lake Sebu, Sto. Nino & reported Koronadal)  7/12 have functional LMS with  Introduce the simplified No stock-outs in 12 RHUs inventory management, SMRS to RHUs without 19. Sultan Kudarat and two hospitals (SKPH and forecasting, storage, utilization the system (Columbio, Lambayong District Hospital) reports, procurement plan, & Lambayong, Lutayan, reporting of consumption reports. Palimbang, Pres.

LGU FP Commodity Status LMS Status Remarks BITES SDN hired Pharmacist to Quirino) manage their LMS.  DOH-RO funded the construction of storage in all LGUs CARAGA All 26 RHUs/CHOs with FP commodity inventory tool  Implements the simplified FP  Reported low POP Commodity and Inventory stocks in Santiago, monitoring tool of DOH and Santa Josefa & Veruela Popcom but was immediately No stock-out reported in all  Popcom established Regional FP addressed 20. Agusan del Norte facilities but there is Hotline and online monitoring / FB  Private SDPs were understocking of IUD linked to DKT for IUD procurement  Popcom Caraga is incharge of stockout monitoring  Uses the simplified FP commodity  La Paz RHU procures and inventory monitoring tool. FP commodity based on  PHO conducts quarterly stockout its CSP policy monitoring and facilitates re-  Popcom Caraga is No stockout reported for the distribution of FP commodities for incharge of stockout 21. Agusan del Sur quarter those with overstock monitoring  Bayugan City with low stocks on IUD but this was immediately replenished by DOH-RO All 119 RHUs use the FP ARMM Commodity Inventory Tool  Uses the FP commodity and inventory tracking tool and FP coordinator submits consumption  Lamitan District Hospital Only 2 Lamitan RHUs reports via FB and FP logistics through the CHO 22. Basilan reported stock out of COC hotline replenished the COC

 FP Coordinator coordinates with stocks of the 2 RHUs RHUs with overstock/ near expiry and facilitates redistribution No stock-outs in 36 RHUs for  All 36 uses SMRS with regular  IPHO maintains buffer the last 3 months. All FP reporting of consumption reports to stocks 23. Maguindanao commodities are available DOH and Popcom  Regularly submits report and sufficient  All RHUs have stock rooms; PHO to DOH Central manages a Supply Room  Uses stock cards (Stock Issue No stock-outs in 40 RHUs. All Card and Dispense to User  Stopped operation in 24. Lanao del Sur FP commodities are available Record to track FP commodity Marawi City except in Marawi City inventory No stock-outs of FP  Uses the simplified FP commodity commodities in all public inventory and monitoring tool. FP facilities including the Sulu focal person conducts quarterly  Regularly submits report 25. Sulu Provincial Hospital (SPH). All meeting to monitor FP inventory to DOH Central FP commodities are available with sufficient supply  Uses the simplified FP commodity No stock-outs of FP inventory and monitoring tool. FP  Regularly submits report 26. Tawi-Tawi commodities in all RHUs focal person conducts quarterly to DOH Central including the public hospitals meeting to monitor FP inventory

Annex E: SDN Establishment: Towards Achieving Functionality, Status as of end of PY5. Accomplishment for the Core Activity Status as of end of PY5 Quarter (Q4PY5)  Four (4) Functional SDNs: Iligan City and SANLAKASS in Lanao del Norte, BITES SDN in Sultan Kudarat, and DOP SDN in Agusan del Sur;  Six (6) regional SDN core teams trained as trainers on the use of SDN operational guide. 60 trainers trained on SDN Operational Guide;  The six (6) DOH- regional offices including ARMM rolled out the SDN establishment in Mindanao using MH Operational Guide. DOH-RO 10 trained 19 trainers on the use of SDN Operational Guide;  DOH-RO9 through the Zamboanga del Sur PDOHO  21 SDN management structures at the city/provincial levels rolled out SDN with clear roles and responsibilities have been capacitated/ establishment in the mentored in formulating SDN related policies; guided in province. Led the SDN formulating and implementing SDN plans and next steps; and activities in the two (2) coached to monitor and evaluate achievement of health Clusters of District 1 and indices; monitor SDN functionality through scorecards, and Strengthen the District 2; M&E for referral activities; and SDN Management  Established the SDN TWGs  SDN-related Policies/Ordinances under implementation: Structure of the two SDNs (District 1 1. Davao City FP/MNCHN Ordinance; and 2) in Zamboanga del 2. Iligan City Executive Order designating the SDN; Sur; and 3. ClaJaViTa MOA among SDN LGUs to share resources; 4. Cagayan de Oro City Executive Order designating the  DOP and BueNasCar SDNs SDN for MNCHN/FP services and FBD Ordinance; formally adopted and 5. CoMMMoNN MOA among SDN LGUs to share approved their SDN referral resources; manuals. 6. BITES MOA among SDN LGUs to share resources and FBD Ordinance; 7. SaMaDoMJAS: JAS MoA with Glan, Sarangani for Glan district hospital to accommodate clients from six barangays of JAS; 8. Agusan del Sur Province Reproductive Health; 9. BueNasCar pooling of resources to support the operation and human resource requirements of Buenavista Infirmary District Hospital; and 10. Agusan del Norte ordinance on securing availability of safe blood for its constituent with P1M budget appropriation and mobile blood donation team.  Nine (9) existing SDN with PPPs:  DOP and BueNasCar SDNs 1. Iligan City with six (6) private hospitals (Adventist Medical facilitated the approval of Center, Dr. Uy Hospital, Inc., Iligan Medical Center their Service Providers’ Build and Hospital (IMCH), St. Mary Maternity and Children’s Agreements while Enhance PPP: Hospital, and E&R Hospital) and 3 Private Birthing Zamboanga del Sur, Homes (Grospe Polyclinic, Danz Fatimah Birthing Clinic Sanlakass SDN, Bayugan & JM Claire Birthing Clinic; SDN, and Iranun SDN in Maguindanao are still 2. BITES in Sultan Kudarat with six (6) Private Hospitals as working for the concurrence CEmONC referral facilities (Sandig Medical Clinic and Hospital, Quijano Medical Clinic and Hospital, Salayog

Accomplishment for the Core Activity Status as of end of PY5 Quarter (Q4PY5) and approval of concerned Medical Clinic and Hospital, Domingo T. Tamondong stakeholders. Memorial Hospital, St. Loius Medical Clinic and Hospital, and Matias Medical Clinic and Hospital); 3. Three (3) PPPs in Davao City District 3 SDN (DMSF- Davao Medical School Foundation (Operation of Marilog District Hospital, Brokenshire Hospital on AYRH, & Partnership with Robillo Medical Hospital, Davao Mediquest Hospital, Malita Medical Center and German Doctors (Bukidnon) as CEmONC end referral facility; 4. SaMaDomJAS partnership with South Davao Medical Hospital, Padada and Gonzales-Maranan Satelite Hospital, Hagonoy – Cross-sector and cross border partnership; 5. CoMMMoNN in Compostela Valley with 6 private hospitals (St. James, Aquacor, Nabunturan Doctocs, Cabrera Memorial, Jampayas hospital & Flordeliz) and 5 private lying-in clinics (Andan, Well Family, MOMIDCO, Well Family – Durano, JRB birthing clinic); 6. ClaJaViTa in MisOr partnership with Tagoloan Polymedic General Hospital as CeMONC end referral facility; and 7. DOP SDN in Agusan del Sur with community-based transport group.  Five (5) on-going PPP/SPA agreements in 2 SDN clusters of Zamboanga del Sur; SANLAKASS Lanao del Norte; and Bayugan SDNs in Agusan del Norte; and Iranun SDN in Maguindanao  Three (3) approved SDN referral guidelines (BueNasCar,  Two (2) SDNs (DOP and DOP, and Sanlakass); BueNasCar approved SDN  Six (6) on-going and for Approval: 2 SDN clusters of referral manuals; Zamboanga del Sur; ClaJaViTa in Misamis Oriental; Sultan  Further enhanced six (6) Kudarat (province-wide composed of 3 ILHZs); Bayugan SDN SDN Referral Guides in two in Agusan del Norte; South Cotabato (province-wide (2) SDN clusters of composed of 4 ILHZs); and Iranun SDN in Maguindanao; and Zamboanga del Sur (District Documentation  Initiated the integration of 14 Hospitals with FP 1 & 2); Sultan Kudarat of SDN Programs/Services in 10 SDNs: (province-wide); South Referral Cotabato province-wide 1. District 1, ZDS with Zambaonga del Sur Medical Center System SDN; Bayugan SDN in (ZDSMC) and MHARS Medical Center in Ozamiz City as Agusan del Sur; and Iranun LARC/PM and MCH core referral facilities; SDN in Maguindanao; and 2. District 2, ZDS with ZDSMC and Margosatubig Regional  Integrated the AYRH Hospital (MRH) as core referral facilities for MFP and protocols and standards in MNCHN services; the referral guidelines of 3. Sanlakass SDN including Iligan City with MHARS and BueNasCar and DOP SDN Kapatagan Provincial Hospital as core referral facilities for maternal and MFP services;

Accomplishment for the Core Activity Status as of end of PY5 Quarter (Q4PY5) 4. ClaJaViTa SDN with JR Borja and NMMC as end referral facilities for LARC/PM; 5. DOP SDN, Agusan del Sur with Davao Regional Medical Center (DRMC) in Tagum City as apex hospital and Agusan del Sur Provincial Hospital as LARC/PM referral facility; 6. Bayugan SDN, Agusan del Sur with DRMC in Tagum City as apex hospital and Agusan del Sur Provincial Hospital as LARC/PM referral facility; 7. BueNasCar in Agusan del Norte with Agusan del Norte Provincial Hospital (ADNPH) and Butuan Medical Center (BMC) as referral facilities for MFP, AYRH, and MNCHN services; 8. South Cotabato SDN (4 LHADZ) with Cotabato Regional Medical Center (CRMC) in Cotabato City as its apex hospital and South Cotabato Provincial Hospital (SCPH) as core referral for maternal and MFP services; 9. Sultan Kudarat SDN (3 ILHZs) with CRMC and Southern Philippines Medical Center (SPMC) in Davao City as apex facilities and SK Provincial Hospital as core referral for LARC/PM services; and 10. Iranun SDN in Maguindanao with CRMC as its apex facility and Maguindanao Provincial Hospital (MPH) for LARC/PM services.

Anenx F: PY5 Status of PHIC Accreditation and Reimbursement Policy by Province/City

FP PHIC Accredited MCP Accredited Reimbursement Area Remarks LAPM Providers Facility Policy BTL-MLLA PPFP/PPIUD NSV 5 facilities non-accredited; Zamboanga 47 (51%) out of 66 (93%) out of 71 67 (94%) / 71 18 1 2 with ongoing application; Peninsula 93 certified RHUs/CHO LGUs 4 LGUs without policy Zamboanga del 11 out of 15 25 out of 27 RHUs Sirawai, and Baliguian; No MHO and no 3 None 25 Norte certified accredited policy Zamboanga del Sur 25 (20 public, 5 Dumalinao and Ramon Magsaysay with 1 MLLA; 6 25 out of 28 RHUs/City 25 (24 RHUs & private) out of 1 on-going application. LGUs without policy: BTL accredited city) 40 certified Guipos,Dinas, & Josefina RHU Kabasalan and Pathfinder General Hospital are adjacent to each other and 5 with 2 certified 15 out of 16 RHUs owned by the LGU, thus the MHO who is Zamboanga Sibugay 2 trainers out of None 16 accredited also the concurrent Chief of Hospital 27 certified expressed disinterest in applying for RHU’s accreditation. 6 (ZCMC) out of 6 ZCMC OB All 16 district health Zamboanga City 11; remaining 5 None 1 With policy doctors centers are accredited from CHO 21 non-accredited, 86 (52%) out of 50 (70%) out of 71 50 (71%) / 70 Northern Mindanao 12 None 8 with on-going application; 165 certified RHUs/CHOs LGUs 21 LGUs without policy 12 non-accredited RHU facilities are: 14 RHUs/CHO are Balingasag, Balinogan, Binuangan which accredited out of 26 are undergoing construction; RHU Initiao health centers (Opol, El not interested because the MOPH-Initao is 4 (MOPH Salvador, Alubiijid, just 20 steps away; RHU Jasaan not Initao, Laguindingan, Lugait, interested- Jasaan Municipal Hospital few 22 out of 43 Misamis Oriental Manticao, None Tagoloan, Villanueva, 14 meters away; RHU Lagonglong certified Gingoog & Claveria, Kinoguitan, undergoing construction; RHU Libertad, Talisayan) Sugbongcogon, Salay, septic tank under construction; RHU Medina, Magsaysay Manticao undergoing construction; RHU and Gingoog City and Naawan undergoing construction and its 2 BHS) RHU Talisayan not interested (MOPH- Talisayan is within 500 meters away) Only Malaybalay is not accredited, non- 4 (hospital 17 out of 27 21 out of 22 RHUs functional birthing facility. RHU Baungon Bukidnon None 21 HSPs) trained accredited has no policy. For the rest, each RHM is given an equitable share of the

FP PHIC Accredited MCP Accredited Reimbursement Area Remarks LAPM Providers Facility Policy BTL-MLLA PPFP/PPIUD NSV reimbursement based on their policy issued 14 out of 22 RHUs accredited (Linamon, 8 RHUs with on-going HFEP building Kauswagan, Bacolod, construction or renovation (Magsaysay, 14 (4 hospitals; Kolambugan, Tubod, Maigo, Nunungan, Pantao Ragat, Pantar, 2 (LDNPH & 10 RHU Lanao del Norte None Baroy, Lala, Kapatagan, 14 Poona Piagapo, Tagoloan, and Tangcal). KPH) providers) out of Sultan Naga Dimaporo, Four of these LGUs have security issues 28 Baloi, Matungao, (Nunungan, Pantar, Pantao Ragat & Munai, Sapad and Tagoloan). Salvador) 6 BHS with on-going accreditation. City 2 (NMMC & Cagayan de Oro 48 out of 54 BHS Government signed MOAs with 48 JR Borja 33 out of 67 None 1 City accredited Barangays. The barangays receive P500 Hospital) share for every delivery in the BHS. 10 non- accredited; 7 (54%) out of 28 (74%) out of 38 30 (79%) / 38 Davao Region 19 3 8 with on-going application; 13 certified RHUs/CHO LGUs 8 LGUs without policy Hagonoy, Kiblawan and Matanao with on- 2 out of 7 2 BTL 10 out of 15 RHUs going accreditation while JAS and Don Davao del Sur (Bansalan & None 10 (hospitals) accredited Marcelino RHUs are undergoing Magsaysay) construction 2 BTL (DOPMC & 9 out of 11 RHUs Cateel and Gov. Generoso with LTO and Davao Oriental 1 (Lupon) None 9 DOPH- accredited pending approval of sharing scheme Lupon 4 BTL (4 8 out of 11 RHUs Laak, Monkayo, and Maragusan with on- Compostela Valley 1 Nabunturan None 11 hospitals) accredited going accreditation 4 BTL Only 4 are accredited out of 17: (Tibungco, (SPMC) 4/17 district health Toril, Bunawan and Agdao). Policy is Davao City 7 MLLA 3 out of 4 3 CHO centers pending upon IRR formulation on MNCHN (private ordinance hospitals) 7 non-accredited; 123 (57%) out 36 (84%) out of 43 39 (91%) / 43 SOCCSKSARGEN 21 None 6 with on-going application; of 215 certified RHUs/CHO LGUs 4 LGUs without policy General Santos City has 26 barangays General Santos City 3 out of 3 29 out of 29 None 7/12 RHUs accredited 1 clustered into 12 RHUs and 7 RHUs have attached birthing clinics

FP PHIC Accredited MCP Accredited Reimbursement Area Remarks LAPM Providers Facility Policy BTL-MLLA PPFP/PPIUD NSV 17 out of 17 10 out of 10 1 out of 7 (Poblacion The CHO has 37 BHS in 37 Barangays, Cotabato City (CRMC 15, None 1 (CRMC) Mother Birthing Clinic) and grouped into 7 Clusters CHO, Blue Star) 10/11 accredited 10 MLLA 10 (SCPH) out South Cotabato None RHUs/CHO; and SCPH 10 Koronadal City CHO is not accredited and 5 BTL of 33 and DJPRH 13 out of 18 RHUs/CHO 5 non-accredited: Alamada, Aleosan, Cotabato Province 5 out of 5 11 out of 57 None accredited; DADFPH in 16 Antipas, Kabacan and Matalam; with Midsayap ongoing application 11 out of 12 RHUs/CHO 56 (22 from Palimbang RHU with MCP application and Sultan Kudarat 3 out 3 None accredited; Kapingkong 11 SKPH) out of 79 complying with infrastructure requirements BHS in Lambayong 3 non-accredited; 13 (27%) out of 23 (88%) out of 26 22 (85%) / 26 CARAGA 10 None 3 with ongoing application; 48 certified RHUs/CHO LGUs 4 LGUs without policy 8 out of 31 (5 1 ADNPH Tubay RHUs on-process accreditation; Las 6 (ADNPH & 11 out of 12 RHUs Agusan del Norte public, 3 but not 11 Nieves LHB endorsed the PHIC BMC) accredited private) accredited reimbursement policy 5 out of 17 (4 Bunawan and Loreto RHUs on-process 4 BTL (OB private, 1 12 out of 14 RHUs accreditation. LGUs with no policy: San Agusan del Sur None 11 Gyne) public- Trento accredited Francisco (for SB deliberation), Bunawan Infirmary) & Loreto 5 (21%) out of 21 non-accredited; ARMM 14 None 98 (82%) out of 119 Region-wide 24 9 with on-going application Akbar, Tuburan, Sumisip, Lantawan, 5 out of 12 RHUs 3 out of 3 Ungkaya Pukan, Albarka, H.Muhtammad & 2 out of 9 accredited (Maluso, Basilan (BGH & None Region-wide Policy Mohammad Ajul need appointment letters (Lamitan) Tipo-Tipo, Lamitan, LDH) to contract out Physicians or renew MOA Isabela) with private OBGyne 11 out of 12 RHUs, 5 hospitals (2 districts & 3 municipal) Datu Halun Sakilan Mem Hospital, Turtle Island RHU failed to comply with Tuan Ligaddung Lipae PHIC facility specifications. No Doctor on Tawi-Tawi 1 DHSMH 0 out of 12 None Mem Hospital, Mapun Region-wide Policy board. Position remains vacant because of District Hospital, Datu its geographic isolation. Also, 5 hospitals Alwaddin Bandon Sr are MCP accredited Memorial Hospital and Languyan Municipal Hospital

FP PHIC Accredited MCP Accredited Reimbursement Area Remarks LAPM Providers Facility Policy BTL-MLLA PPFP/PPIUD NSV 13 out of 19 facilities accredited (RHUs of 3 (Parang, Maimbung, Pata, 6 not accredited: Tapul, Lugus, Pandami, Sulu 2 out of 4 None Region-wide Policy Talipao, SPH) Parang and Jolo are HP Tahil, K. Caluang, and Tongkil receiving Philhealth reimbursements) 35 out of 40 RHUs 4 out of 5 accredited and 4 district 5 RHUs of Bayang, Pagayawan, Tuburan, (Wao, Lanao del Sur None None hospitals of Malabang, Region-wide Policy Tugaya & Lumbaca Unayan are not Tamparan, Balindong, Wao and accredited Marawi) Tamparan Maguindanao 4 out of 5 None 1 MPH 34 out of 36 RHUs are 2 RHUs R. Buayan & DBS with on-going Region-wide Policy accredited; 5 BHS accreditation 67 RHUs/CHOs non-accredited; 94 281 (50%) out 301 (82%) out of 368 327 (89%) out of 36 with on-going applications; and Total 5 out of 6 BTL/MLLA of 558 certified RHUs/CHOs 368 LGUs 42 LGUs without PHIC Reimbursement Policy

Annex G: Success Stories and Evolving Initiatives

USAID-supported Local Government Unit Passes Ordinance for Mother and Child Health Care

Maternal mortality in Davao City significantly improved as the number of maternal deaths in 2015 decreased to 25 from 37 in 2014. Infant mortality, on the other hand, remains at an alarming level with 387 and 433 infant deaths being reported in 2014 and 2015, respectively (Field Health Service Information System). Still, the situation necessitated a sound legislation that will ensure the sustained delivery of quality maternal and child health services and allow for the poorest quintile of the community to have free access to said services. Under the leadership of the Davao City Council’s Committee on Health, an Ordinance on Maternal, Neonatal, Child Health and Nutrition (MNCHN) was drafted and eventually approved by said legislative body in October 2016; thus, ensuring support to strategies and activities that will be conducted to address problems faced by pregnant women, mothers and their children when it comes to health care. The ordinance guarantees the availability and delivery of the “MNCHN core package of services to all the people of Davao City who need them”. In support, USAID through its MindanaoHealth Project with Jhpiego, engaged in a series of discussions and meetings with the City Council Committee on Health to discuss the contents and required provisions of the MNCHN Ordinance. These provisions include, but are not limited to, the establishment of licensed and accredited birthing homes, prohibition of unskilled or non- health (unlicensed) birth attendants during the birthing process, and the availability as well as accessibility of MNCHN products and commodities through the prescribed funds/budget appropriated for the purpose. The Davao City Health Office will be the forerunner in the implementation of the ordinance, and is now in the process of drafting the Implementing Rules and Regulations. Just in time for the passage of the Davao City MNCHN Ordinance, the Toril Health Center Birthing Home was opened and is currently the first 3-in-1 Accredited Facility by the Philippines Health Insurance (PhilHealth), established with assistance from the Department of Health. Toril District Health Officer Dr. Margie Roa - Rubio said it took strong commitment and political will to lobby with the City Government for the setting up of the birthing home so that more pregnant women, especially the indigents, in the area will have access to a nearby birthing facility with capable health providers. PhilHealth members can also avail of free health services and deliveries while non- members can have on-the-spot Toril District Health Officer Dr. Margie Roa - Rubio addresses enrolment with the presence of the pregnant women-attendees of the facility’s opening and blessing. PhilHealth Express Office within the (Photos by: MCossid/Jhpiego) facility complex. One of the pregnant women who were invited to the Opening and Blessing of Toril Health Center Birthing Home was 30-year old Joy Galos-Ayop. Joy is pregnant with her 9th child and planned to

deliver at the Toril Health Center Birthing Home and then access a family planning method suited for her.

Joy

(Left to Right) Davao City Councilor Dr. Mary Joselle D. Villafuerte, City Health Officer and Toril Deputy Mayor Benjamin Dolla lead the cutting of ribbon and blessing that marked the opening of the Toril District Health Center Birthing Home. (Photo by: Councilor Mary Joselle D. Villafuerte and Mcossid/Jhpiego) delivered her eight children at home, oblivious of the looming risks for infections and complications. Fortunately for her, her babies turned out safe and healthy upon delivery. But being well-informed and not wanting to take same risks again, Joy looked forward to delivering her child safely with trained and skilled health providers. “I am thankful that there is a facility close to home where I could safely deliver and access other maternal and newborn health care service for free,” Joy shared.

Joy Galos-Ayop happily receives ger Pregnancy Kit from the Department of Health along with other birthing essentials distributed during the Opening and Blessing of the Toril District Health Center Birthing Home. (Mcossid/Jhpiego)

A Newfound Purpose – A Traditional Birth Attendant’s Story

Traditional Birth Attendant (TBA) Wanita Junairi used to assist deliveries of Badjao women at home oblivious of the serious risks that could unintentionally be inflicted by untrained and non- professional birth attendants like her. In 2014, USAID, through its MindanaoHealth Project with Jhpiego, engaged Badjao (a Philippine indigenous group) traditional birth attendants (TBAs) as key referral agents in bringing more pregnant women to accredited health facilities for prenatal care and deliveries to ensuring the safety of mothers and newborns. TBAs have been mobilized to assist in providing correct messages on maternal and child health as well as on proper hygiene among the Badjao community members, particularly women and the adolescent-youths. To make this possible, 21 Badjao TBAs, including Wanita, were trained on Interpersonal Communication conducted through the collaboration of USAID, the Department of Health-Zamboanga Peninsula, the Zamboanga City Health Office, and the Municipal and Village Government Units.

Now, Wanita is a more empowered community health worker; committed and motivated to help more women have safe pregnancies and deliveries in the hands of skilled providers. Wanita said in Filipino, “Mas maayos ang panganganak ng mga Badjao ngayon. Wala na masyadong namamatay na mga sanggol kasi sa Zamboanga City Medical Center na namin pinapupunta ang mga Traditional Birth Attendant Wanita Junairi (left in yellow shirt) visits Nurisa, naka-schedule pregnant with her second child, at her home within the transitory site in Masepla, manganak.” (Deliveries Zamboanga City, to check on her and provide information on safe motherhood, among pregnant Badjao newborn care and family planning. When Nurisa gave birth to her first baby in an evacuation center during a siege, Wanita primarily assisted the delivery. Now, women are better right Nurisa is pregnant again; but Wanita has been trained. She regularly brings Nurisa now. We hardly have cases to a health facility for prenatal care visits and soon for delivery. She’ll still be by of newborn deaths because Nurisa’s side only for prayers and rituals as culturally practiced. (AGonzales/Jhpiego) we refer pregnant women scheduled for delivery to the Zamboanga City Medical Center.)

Women and Children in one of the Philippines’ Farthest Islands Reached with Health Services

Medical and community health workers travelled 27 hours by ferry boat from Bongao, Tawi-Tawi to reach Mapun, the farthest island municipality of Tawi-Tawi located in the middle of Sulu Sea bordered by Sandakan, Malaysia, Palawan and Pangutaran, Sulu. This island-municipality is seldom visited by health service providers due to its distance and security situation. The Tawi- Tawi Integrated Provincial Health Office (IPHO), with support from Department of Health - Autonomous Region in Muslim Mindanao (DOH ARMM) and USAID’s MindanaoHealth project, worked with the Mapun Rural Health Unit (RHU) to deliver medical-surgical and reproductive health services in Mapun, in celebration of the 43rd Kamardikaan on September 22-26, which marked Tawi-Tawi Province’s independence from Sulu. In support to this Civic Action Program and Medical-Surgical Mission launched by the Provincial Government of Tawi-Tawi, the MindanaoHealth Project assisted in the conduct of 10 Usapan or interactive health discussion sessions done by five USAID-trained health service providers that reached 172 clients with unmet need for family planning (FP). Of these 172 probable clients, seven opted for interval intrauterine device (IUD) insertions; five were referred for bilateral tubal ligation (BTL); and 33 clients provided with short-term FP methods specifically pills (12), injectables (16) and condoms (5), after one-on-one counseling. Immunization and Vitamin A supplementation were also given to 334 infants (0-11 months) and children (12-59 months); while 121 pregnant women were provided with antenatal care services and information on exclusive breastfeeding.

The team from DOH ARMM and the IPHO of Tawi-Tawi are challenged to sustain their support to unreachable island in the region and province, respectively. Follow-through health services will be provided by the Mapun District Hospital and Mapun Rural Health Unit.

Clients from Mapun flock to the health station where outreach services are provided. Said municipality is seldom visited for needed health services due to distance from the main province of Tawi-Tawi. (MSAbdulwahid/Jhpiego)

City Hospital Extends Postpartum Family Planning Services to Clients from Neighboring Provinces

Cagayan de Oro’s JR Borja City Hospital is providing broad range of family planning (FP) services as integral component of their maternal, neonatal and child health services. Strengthened with the training of 11 hospital staff (doctors-5; nurses-4; and midwives-2) on long acting, reversible contraceptive/permanent methods (LARC/PM) by USAID in partnership with the Department of Health in Northern Mindanao, the hospital now caters to an average of 80 deliveries a month from Cagayan de Oro and nearby provinces of Bukidnon and Misamis Oriental. Recognizing the high volume of deliveries a month and confronted with other reproductive health (RH) issues as well as the presence of 11 health workers trained to provide PPIUD, the hospital also opened its Women’s Reproductive Health Clinic (WRHC) in June 2016 to enhance its delivery of RH services. Now, all postpartum women for discharge, regardless of residence, visit the WRHC specifically for follow-up FP counseling, and provision of FP services of choice. To date, the city hospital has provided PPIUD services to 556 clients with prior one-on-one counseling broken down as follows: 482 clients from Cagayan de Oro; 39 clients from Misamis

Oriental; 34 clients from Bukidnon and 1 client from Lanao del Sur. Also, with sustained technical guidance from USAID, the hospital is now benefiting from Philhealth reimbursements for PPIUD to be able to sustain these services. With these initial gains and support from USAID and Northern Mindanao Regional Health Office, the hospital management is confident and challenged to pick the momentum to ensure that they can significantly contribute to the Philippine Health Agenda’s call for Zero FP Unmet Need for Northern Mindanao Region.

Post-delivery, 34-year-old Mirasol Acmad (left) receives family planning counseling from USAID- trained nurse Ruby Navales (right) about her chosen family planning method, PPIUD, and checks if she is medically or physically fit to use said method through the Medical Eligibility Criteria (MEC) Wheel. (GBitoy/Jhpiego)

Young mom makes mature decision for self and for child

A petite, meek and sweet-looking girl was sitting in the corner of a facility in the village of Linaguayan in Vincenzo Sagun, Zamboanga del Sur. No one would notice that she was the teen mother that we were looking for until we saw the baby she was cradling. Ferlyn Jane Lambating was definitely a small 14-year old, but she was already able to make a significant decision for herself and for her seven-month old son. At an early age, Ferlyn was the typical teenager hooked on social media and on meeting friends online. One of them would eventually become her partner and the father of her child. While engaging in risky Teen-mom Ferlyn Jane Lambating, 14, PPIUD acceptor activities, she never received or sought reproductive health and adolescent sexuality education. When she got pregnant, she had no choice but to stop going to school. Ferlyn thought, she would be learning it the hard way. “Young girls should be very careful and avoid risky behaviors. Being pregnant at a young age --- it is physically so difficult,” Ferlyn advised. She recalled how she had to walk for minutes to the village facility for her regular prenatal visits just to make sure she and her baby were safe and healthy. She recounted how boldly she rode a motorcycle down a very rough, rocky and steep road from her home going to Margosatubig Regional Hospital when she was due to give birth. “My family and I decided not go to the hospital early because we knew we would be spending for food and other supplies the hospital would require,” Ferlyn shared. She opted to wait at home until the time when she had to be wheeled into the Emergency Room to deliver.

She was met and assisted by a USAID-trained Midwife, Flora Rajah, who later on took extra time to thoroughly counsel her on family planning to delay immediate high-risk pregnancy. Following this one-on-one counseling, Ferlyn opted to undergo postpartum IUD insertion, a long- acting family planning method that gives protection from unplanned pregnancies for 10 years. Obtaining her mother’s consent and partner’s as well, Midwife Flora performed PPIUD insertion on this teen mother. Ferlyn was among the 15 postpartum mothers in the month of August 2016 who had PPIUD insertion. Midwife Flora has been expertly performing the procedure since 2014. Now as a trainer, she has been helping four other health service providers at the Margosatubig Regional Hospital perform PPIUD insertion to cater to clients opting for such family planning method. To date, Midwife Flora and her team already had 432 PPIUD clients, including Ferlyn. Seven months passed, Ferlyn is satisfied. “Despite the situation I have been in, I have supportive parents and partner. Yes, I stopped school but I am fully aware of what I want to happen with my life. I will focus on taking care of my child and making sure he is healthy. Few months more, when he is big enough, I will definitely go back to school,” Ferlyn resolved. Ferlyn was a girl of few words but there is certainty in them. There is firmness in expressing what she envisions for herself and for her child in the future, and she is determined to make it happen.

Teen mom takes steps to prevent immediate repeat pregnancy

A forced-sex experience at the age of 13, and problems within her family led Shanille Blase to have sexual relations with her boyfriends as forms of rebellion and of finding comfort. In 2016, Shanille was 17 years old and in second year college taking up a business course when her boyfriend, who eventually left her, got her pregnant. Feeling depressed, afraid and alone, she had thoughts of aborting the baby and committing suicide. “I made a big mistake; I was too trusting,” Shanille shared. In April 2016, the 4th month of her pregnancy, fate took a different turn for Shanille when she, through the prodding of her grandmother, participated in one of the community outreach activities conducted by Brokenshire Memorial Hospital. Assisted by USAID, through its MindanaoHealth Project with Jhpiego, this private tertiary hospital in Davao City had by then started implementing its Program for Teens. Shanille undergoes one-on-one counseling with Brokenshire Hospital Program for Teens Resident-in-Charge Dr. Mae Bonguyan during an Through its ‘adopt-a-community’ event organized by said hospital in March 2016 for teens and young adults, including pregnant ones, where free check-up, immunization approach, Brokenshire Memorial and family planning services were given. (AGonzales/Jhpiego) Hospital partnered with the City Government of Davao and held weekly community outreach activities wherein resident physicians from its OB-Gynecology and Pediatrics Departments went on duty at the Buhangin Barangay Health Station in Purok Old San Isidro in Davao City to provide medical, perinatal, and Family Planning counseling and other on-site services. There, she met a team of doctors and nurses who provided her antenatal care, counseling and guidance on sexual and reproductive health as well as on Family Planning. Shanille later got encouraged to enroll at Brokenshire Hospital’s Program for Teens so she could avail of the hospital’s TeenMom Package,

a package that was then offering free ante natal check-up, discounted cost for delivery, postnatal check- up and child care. Shanille delivered a healthy baby boy in August 2016 at Brokenshire Hospital. She is also now an informed acceptor of Progestin Sub-dermal Implant, a family planning method meant to delay repeat pregnancy for two to three years. As a Family Planning method acceptor, Shanille now serves as a personal advocate to teen mothers in their village in Purok Old San Isidro, who, like her, intend to delay repeat pregnancies either to be able to take good care of their children, work, or pursue skills development opportunities available to them. When she would have time, she goes with her grandmother, who is an active community leader, to the village health facility and talks to teen moms whenever there is an opportunity. “I tell the young girls that I meet, or that I know, not to engage in early sexual intimacies, while they can. Resist it. If in case they are already at it, they should seek information on how they could protect themselves to avoid unplanned pregnancies,” Shanille resolutely said. With the continuous guidance and care from the Brokenshire’s Program for Teens, and support from her family, Shanille now works in a restaurant as a service crew, and has made concrete plans to return to school and earn a college diploma.

Shanille maintains a happy disposition despite what she experienced because she looks at her baby as her inspiration to make their lives better. (AGonzales/Jhpiego) During her free time from work, Shanille devotes her time to caring for and playing with her son. (AGonzales/Jhpiego)

Shanille moves on and now works in a restaurant as a service crew in order to support her child. (AGonzales/Jhpiego)

Annex H: Abridged Compendia of Emerging Good FP/MNCHN/AHD Models

I. Service Delivery Network (SDN) Initiatives in Mindanao

Legal Basis for Establishing Service Delivery Network

USAID-Mindanao Health Project support to Service Delivery Network (SDN) in Mindanao is fully anchored on the Department of Health (DOH) Administrative Order # 0029, s.2008: “Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality” that highlights the development of MNCHN Service Delivery Network to deliver integrated MNCHN services as a continuum of care spanning from pre-pregnancy, pregnancy, delivery, post-partum/post-natal and under-five period of life along service delivery modes (community, households and health facilities). This AO draws its legal basis and support from several enabling policies and pronouncements: (i) DOH MNCHN Strategy and 2011 DOH MNCHN Manual of Operations; (ii) the Implementing Rules and Regulations (IRR) of RA 10354 or the Responsible Parenthood and Reproductive Health Act of 2012; and (iii) DOH Department Memorandum No. 2014-0313: “Guidelines in Establishing Service Delivery Network”.

Rationale and Approach

The review of the NDHS data on the maternal and child health indicators in Mindanao reveal that: (i) neonatal, infant and under-five deaths rates have deteriorated except for Davao Region and ARMM; (ii) the proportion of skilled birth attended deliveries has improved in all regions; and (iii) the rate of facility-based deliveries (FBD) has also improved except in ARMM. The 2013 NDHS data further show that the proportion of population at the lowest and 2nd quintiles in Mindanao ranges from 51% to 90% and is higher compared to national average of 40%; and the proportion of 15-49 years old women with no education/some elementary education ranges from 9.6% in CARAGA to 32.6% in ARMM, also higher than national average of 8.2%.

In the 2013 baseline survey conducted by Mindanao Health, it was noted that there were on-going initiatives to establish SDN and Inter-local Health Zones (ILHZs) with support from other development partners such as the USAID-supported projects (PRISM 2 and HealthGov) and DOHROs to help address the fragmentation of health services. Initial results show that establishing functional SDN for MNCHN-FP supports the scaling up of high-impact services to improve maternal, newborn, child health and nutrition (MNCHN) outcomes, and reduce unmet need for family planning (FP) services.

It is in this context that the Mindanao Health Project took the establishment of SDN as one of its core initiatives that cuts across three of its strategies or components.3 Guided by OMC Memorandum Circular #0141 s.2014, MindanaoHealth took the lead in developing the SDN Concept Note, SDN Operational Guide and the SDN Roadmap in 2014. It adopted an “open system,” an extensive process of gathering inputs and ideas from key individuals representing the various levels and sectors (public and private) involved in MNCHN/FP service delivery including those with administrative, policy and legislative functions through a series of consultative meetings, workshops and write shops. The entire development process was carried out with periodic consultations among key officials of the DOH Mindanao Cluster and MindanaoHealth. These resulted in the formulation of the SDN Operational Guide. Its subsequent endorsement by

3 Pages 29-31 of AID-492-A-13-00005: Maximizing Opportunities for Development and Health in Mindanao.

the DOH Regional Offices and DOH ARMM in 2015 provided the impetus for the Mindanao-wide rollout of SDN establishment. MindanaoHealth facilitated the establishment of SDN management structures in six (6) DOH-ROs and trained 60 regional trainers on the use of SDN Operational Guide leading to the development of 21 SDNs involving 68 LGUs with established TWGs and referral pathways for MNCHN/FP services. Four (4) out of six (6) DOH Regional Offices (Region 10, 11, 12, and 13) were able to fully support the roll-out in terms of providing funds, logistics and staff complement. DOH-RO XI took it farther by implementing a region-wide SDN spearheaded by its Team D Champs.

On MCP/NCP accreditation, MindanaoHealth provided capacity building support to SDN health service providers particularly on BeMONC and EINC with supportive supervision. The Project, in partnership with PHIC, assisted health facilities in the conduct of facility survey assessment and guided them in completing the requirements for accreditation. The MCP/NCP status of SDN facilities in 2015 indicated that 49 RHUs/CHOs were not MCP/NCP accredited. With the technical support of the Project and in collaboration with PHIC and DOH-ROs, 43 out of 49 non-accredited facilities achieved MCP/NCP accreditation. Also, out of 74 LGUs in 21 SDN sites, 54 LGUs (70%) adopted reimbursement policies as per PhilHealth guidelines.

SDN Development Experiences in Mindanao

To date, of the 21 supported SDN sites in Mindanao, two are functional namely Iligan City SDN, and BITES SDN in Sultan Kudarat; nine (9) are operational and another 10 are organized. The criteria developed by DOHRO XI is being used to categorize SDN as functional, operational and organized.4 Among others, the SDN initiative was able to facilitate eight (8) public and private partnerships formalizing the cross-sector and cross-border referrals and service delivery provisions; trained 1,013 heath service providers in LARC, BTL-MLLA and PPIUD who were able to provide LARC/PM services to 11,956 clients; nine (9) SDN related policies was approved and implemented and 27 SDN management mechanisms was established/strengthened to improve demand generation, policy & systems development, & service provision.

Six (6) case studies are summarized below to highlight the different entry points, and different processes and requirements involved in SDN establishment, and also their results.

1) Bayugan SDN, Agusan del Sur

In 2013, the Provincial Health Office (PHO) of Agusan del Sur sought the assistance of the USAID-funded PRISM2 Project, to formally engage the private sector as partner in improving delivery and provision of the core package of FP/MNCHN services. Mindanao Health took over this initiative and focused its assistance on the Bayugan SDN made up of the municipalities of Esperanza and Sibagat and Bayugan City. It was then formally organized in January 2016. The area is characterized by health impact and FP MNCHN outcome indicators that are mostly below or barely at par with the program targets. At baseline (2013), aside from family planning

4 Level 3 - Functional SDN - 90% to 100% of the 10 elements are present with policy support and PPP agreements inclusive at the minimum of these three elements: available three levels of care, SDN members from the prospective public and private sectors identified, and SDN technical team organized; Level 2 - Operational SDN – has achieved at least 60 to less than 90 percent of the elements of a functional SDN inclusive at the minimum of these three elements: available three levels of care, SDN members from the prospective public and private sectors identified, and SDN technical team organized; and Level 1 - Organized SDN – has achieved the identified minimum requirements, such as: 3 levels of care available, prospective SDN members from the public and private sectors identified, and SDN Technical Team organized.

counselling services the only other FP method available in the area was limited to the provision of interval IUD. The current assessment reveals that Bayugan SDN made significant strides in making its cadre of BHWs available counseling and navigating households to appropriate health facilities, working on or facilitating the accreditation of some of its health facilities. Improvements were noted on making available community-based transport and communication system for patients coming from hard-to-reach areas, as well as on ensuring that the referral mechanism is in place and working. Long-acting reversible contraceptive (LARC) FP methods have become more available. The SDN has now 17 LARC-PSI and 10 PPFP/PPIUD trained providers from zero and four (4) at baseline, respectively. The number of HSPs trained on the use of adolescent job aides (AJA) grew to five (5) from zero. Also from zero at baseline, the SDN has also now under its employ 11 trained EINC-providers and seven (7) trained LMT providers. A combined total of 19 providers have undergone supportive supervision on LARC-PSI (at 10 providers) and PPFP/PPIUD (at 9 providers). In 2015, a total of 18,429 current FP users were recorded in the SDN area against the previous year’s total of 15,882, corresponding to a positive increment of about 16%.

2) DO Plaza SDN, Agusan del Sur

The DO Plaza SDN, consisting of the municipalities of Rosario, San Francisco and Prosperidad, was formally organized in November 2015. MH assisted the SDN in the organization of its management structure, defining each member’s tasks and responsibilities and crafting agreements and the SDN implementation plan. The area’s health impact indicators are a cause for concern. The area reported four (4) maternal deaths in 2014 compared to only two (2) maternal deaths in 2013. There were 69 cases of infant death in 2014, up from 36 in 2013. The area’s health outcome indicators projected a more balanced scenario. At baseline (2013), aside from family planning counselling services the only other FP method available in the area was limited to the provision of interval IUD and BTL. In 2016 and with the DO Plaza SDN organized, operational and governed by an ILHZ SDN Board, family planning facilities and trained providers became more available. FP-CBT Level 1 and FP CBT Level 2 interval IUD insertions are the FP services that have become available from the 10 SDPs. The number of SDPs providing PPFP and PPIUD now stands at 10 including one (1) private SDP and five (5) including one (1) private SDP, respectively. The SDN has now 18 LARC-PSI and 8 PPFP/PPIUD trained providers from zero at baseline. The number of HSPs trained on the use of adolescent job aides (AJA) also grew to 15 from three (3) at baseline. Also from zero at baseline, DO Plaza SDN has also now under its employ trained providers on BTL-MLLA (8), NSV (1), EINC (11), LMT (9) and Usapan (4). In 2015, a total of 16,709 current FP users were recorded in the SDN area against the previous year’s total of 14,714, corresponding to an increment of about 13.6%.

3) Davao District 3 SDN, Davao City

The City Health Office of Davao initiated the establishment of a service delivery network (SDN) with the signing of Memorandum of Agreement among the CHO, the Davao Medical School Foundation, Inc. (DMSFI), and the City Government of Davao. This public-private partnership (PPP) bound the signatories to collaborate in rehabilitating and revitalizing the Marilog District Hospital as a functional birthing facility to cater to the populace of Marilog. The district is characterized by health impact and outcome indicators that are generally dismally low and sub- standard. Compared to ten (10) maternal deaths in 2014, eight (8) maternal deaths occurred in the following year. The incidence of infant deaths is even more worrying. The results of the FP MNCHN outcome indicators for 2015 were no more than reassuring. With a MOA in 2016 in place for the operationalization of Davao District 3 SDN, FP/MNCHN facilities and trained FP/MNCHN providers have become more available and accessible. The SDN Management Committee that

updated the SDN scorecard established that there were notable improvements in the services of district health centers and private clinics providing MNCHN/FP services in terms of improved availability of community-based transportation support, BHWs, blood service facilities, and fixed and outreach services in partnership with DMSF and MSI. The number of SDPs providing PPFP and PPIUD now stands at 12, six (6) private and six (6) publicly-owned, with capabilities to provide LARC-PSI services. The SDN has now 13 trained LARC-PSI providers, and 14 trained PPFP/PPIUD providers from six (6) at baseline. The number of adolescent job aides (AJA) grew to 10 from zero at baseline.

4) CLAJAVITA SDN, Misamis Oriental

The CLAJAVITA SDN in Misamis Oriental, consisting of Claveria, Jasaan, Tagoloan and Villanueva, was formally launched in June 2013. MH assisted the SDN in the organization of its management structure and defining each member’s tasks and responsibilities. The area reported zero maternal death in 2015 from 2 reported in Claveria in 2014. There were 16 infant deaths in 2015 from nine (9) in 2014. FP-MNCHN outcome indicators for the area all showed increases in 2015 and exceeded the program targets. At baseline (2014), the permanent family planning methods available in the area were limited to the provision of interval IUD. In 2016, the ClaJaViTa SDN reported improvement in the delivery and availability of MNCHN/FP services across the three tiers of care from community level provider, BeMONC and CeMONC. Increase in the number of SDPs was observed in both public and private facilities that are providing fixed and outreach services, and all RHUs are already BeMONC-capable facilities. Further, the engagement of the Tagoloan Polymedic General Hospital (TPGH) as a partner to serve as the end referral facility of the SDN was a major milestone. With TPGH in the network, improvements in the referral mechanism were reported as TPGH agreed to accommodate card holding patients and their dependents of the member LGUs for medical examination, treatment and other hospital services. Blood supply system at the TPGH and in coordination with Red Cross further improved availability and accessibility of blood services. The number of SDPs providing PPFP and PPIUD now stands at 17 including two (2) private SDPs and seven (7) including one (1) private SDP, respectively. The SDN has now five (5) LARC-PSI and 12 PPFP/PPIUD trained providers from zero at baseline. The number of HSPs trained on adolescent job aides (AJA) grew to 29 from zero at baseline. In 2015, a total of 23,198 current FP users were recorded in the SDN area against the previous year’s total of 20,148, corresponding to an increment of about 15%.

5) PALMA+PB SDN, North Cotabato

The PALMA+PB alliance among the municipalities of Pigcawayan, Alamada, Libungan, Midsayap, Aleosan, Pikit and Banisilan of North Cotabato was formed based on the principle that the aggrupation of a number of municipalities has a higher degree of viability than one municipality alone through sharing of resources and expertise to solve a common problem. The area is characterized by health impact and outcome indicators that are generally performing well. Maternal and infant deaths have been decreasing in the last three years. Except for the contraceptive prevalence rate, the results of other MNCHN/FP outcome indicators remain below national standards. The current assessment reveals that PALMA+PB made significant strides in making blood services available and accessible, maintaining the functionality of its BHWs as well as the management structure and guidelines that govern the SDN. The SDN retained in 2016 its acceptable/passable ratings for the other five (5) elements that were obtained at baseline. The trained manpower of PALMA+PB capable of providing FP/MNCHN services includes seven (7) doctors, 17 nurses, 86 midwives, and 919 BHWs. In terms of the number of SDPs providing modern FP services, 19 SDPs are providing PPIUD, 10 SDPs with LARC-SDI, seven (7) with

Interval IUD, five (5) BTL-MLLA and 19 SDPs offering FPCBT1 services. In 2015, a total of 52,050 FP current users were recorded in the SDN area against previous year’s 2014 total of 44,362, which represents an increment of about 17%.

6) BITES SDN, Sultan Kudarat

The BITES Service Delivery Network (SDN) in Sultan Kudarat is composed of the municipalities of Bagumbayan, Esperanza, Isulan, Sen. Ninoy Aquino (SNA) and Tacurong. The LGUs that formed themselves into a SDN contribute annually to support the operation of the network with the provincial government also contributing an amount that matches the pooled contributions of member-LGUs. The BITES is being managed by a Technical Management Committee (TMC) acting as the financial and policy-making authority, and supported by two other bodies: the Provincial Health Team Office as its Technical Secretariat and the Technical Working Group (TWG) serving as the technical advisory group of TMC. The BITES area is characterized by health impact indicators that are generally worrisome especially for three of its member-LGUs. On the other hand, its health outcome indicators as of 2014 projected a much brighter scenario with all indicators showing increases over their previous year’s levels and surpassing their respective program targets except for the rate of fully-immunized children (FIC). In 2016 and with the BITES SDN organized and operational, permanent family planning methods have become more available. The numbers of SDPs providing PPFP and PPIUD now stands at six (6) public and ten (10) private SDPs. The BTL MLLA services are offered at SKPH, while other 6 private hospitals are also providing BTL services. Fourteen (14) public and private SDPs also have the capabilities to provide LARC-PSI services. The SDN has now 105 trained providers on FP counseling and service, 17 trained on LARC PSI, and 50 providers on PPIUD. Health workers trained on adolescent job aides (AJA) also grew to nine (9) from zero in 2013/14. Also from zero at baseline, BITES SDN has also now under its employ trained providers on BTL-MLLA (3), EINC (23), LMT (6) and Usapan (14). In 2015, a total of 34,250 current FP users were recorded in the SDN area against the previous year’s total of 29,414, corresponding to an increment of about 16.4%.

Recommendations for Sustainability:

1) DOH-Central: a. Full implementation of the NBB policy to include private hospitals as members of SDN. This is a potent demand generation strategy; b. Advocate to DILG the integration of “SDN Scorecard” into the DILG Local Governance Performance System (LGPMS); c. Organize/support coordination/consensus meetings at regional/provincial levels with Community Partners and Development Partners; and d. Develop a Quality Assurance (QA) component on SDN in terms of periodic assessment and put up recognition and/or rewards system. 2) DOH-Regional Offices: a. Develop concrete action plan to support provinces/cities in the SDN rollout; b. Assist LGUs in creating/building SDN supportive environment: i.Facilitative and enabling SDN Policies; ii.Promotive multi-sectoral relationships (cross-sector and cross-border); iii.Monitoring and sharing/learning Sessions; and iv.Annual Review of SDN implementation. c. Promote and expand public and private partnerships (PPP); d. Ensure that all SDN member facilities (public and private) are PhilHealth-accredited;

e. Factor in the socio-cultural and faith-based practices in the design and delivery of core package of services; and f. Document SDN experiences. 3) LGUs: a. Integrate planning and budget allocation for SDN implementation in the LGU comprehensive development plan; b. Put SDN in the regular agenda of Local Health Board (LHB), Local Development Council (LDC) and other coordinating mechanisms, like the Regional Implementation Team (RIT), to generate collective support for and sustain the SDN initiatives at all levels; c. Represent the private sector, community-based organization, professional organization, and IP representatives in the SDN structure to promote inclusive partnership and dynamic delivery network; and d. Engage barangay leadership to mobilize community-based organizations to provide communication and transportation services.

II. MindanaoHealth’s Initiatives Towards Enhancing Modern Family Planning Program in Hospital Setting

Legal Mandate

The provisions of the Republic Act No. 10354 of 2012 and E.O. No. 12 dated 9 January 2017 effectively strengthen the authority of the DOH in compelling all government hospitals to provide the full range of family planning services as part of their basic services. While DOH DM No. 2014- 0312 was issued more than two years ago, the responses of regional and local health officials and hospital personnel in terms of seamlessly integrating the DOH-prescribed FP services with existing hospital programs remain varied. In Mindanao, only a limited number of hospitals to date offer a broad menu of FP information, services and products.

Design of the Family Planning Program in Hospital

MindanaoHealth (MH) Project invested in strengthening initially 13 Mindanao-based facilities where this change in approach to FP services provision could be effected initially through various capacity building and advocacy measures. The Project envisioned that by 2017: a) at least 13 Mindanao-based facilities have (i) an integrated demand and supply service provision by department or section; and (ii) established facility-based systems in FP planning, management, policy formulation, financing, health information, recording, documentation and/or reporting; and b) the evolving support of the four health facilities (i.e., SPMC, ZCMC, NMMC and SCPH) to building capacities of potential PPIUD clinical practice sites within their catchment areas through supportive supervision and mentoring are strengthened. Moving forward, seven hospitals (SPMC, SCPH, SKPH, CRH, NMMC, MPH and ZCMC) were identified to represent the USG-assisted regions and serve as possible models for setting up FP program in hospitals initiative of the DOH. These hospitals were found to have high volumes of deliveries and were consequently assessed for their readiness to fully put into action the DOH memorandum. At the time of the assessment, they had already completed their draft Operational Guidelines (OpGuide), and had laid out the needed steps towards the implementing them.

Setting Up of Family Planning Program in Hospital

The efforts or innovations that were carried out to start the integration of FP services provision in the hospitals involved identifying focal persons/teams to oversee FP service delivery in the hospitals, assessing their current capacities to deliver FP services and finally establishing 88

institutional arrangements to support the implementation of FP services in the hospitals. They varied, however, across all hospitals. What remained evident was that all these efforts demanded the full and dedicated cooperation and support of other departments or service delivery units in these hospitals, in addition to the OB-GYN department. Both SPMC and NMMC, have to date no formally organized FP Program Technical Management and Committee as well as FP TMC Members identified and officially designated. The TMCs already established elsewhere were currently anchored on the OB-GYN department. All health facilities had established regular hours for OB-GYN consultations in their outpatient departments. Except for SKPH, these consultations were conducted in FP clinics that had dedicated spaces for information and counseling. Despite this limitation, SKPH had a full-time FP Coordinator who was tasked to oversee the clinic’s information and counseling activities, dispensation of the FP methods to clients, referrals, among other things. Only SPMC had not appointed a full-time coordinator for these tasks. Ensuring the availability of FP services on a 24/7 basis was a function entrusted to the FP Core Implementation Team whose FP-trained members were primarily drawn from the OB-GYN clinic and other service delivery units of the hospitals like the pediatrics, family medicine and internal medicine departments. Of the seven hospitals under study, only ZCMC had yet to put up the said team.

Two (2) hospitals, namely SCPH and SKPH, had established and on-going affiliation arrangements with nursing and midwiferyschools operating within their immediate localities. Another two, SPMC and SCPH, had already set-up their Centers for Teens. All hospitals studied have each yet to develop or formally put in place a continuing and pro-active capacity building program for its personnel, two-way referral system (both interdepartmental and external) and a system for the management ofadverse reaction to certain contraceptives. LGU-managed hospitals’ budgets were lumped with LGU Health Offices’ budgets while the retained hospitals budgets were incorporated in the budgets of the DOH ROs having jurisdiction over them. Chiefs of Hospitals, therefore, had very little control over monies that should go to them or none at all. Their FP operations (for FP providers and supplies) were partly funded and sustained by reimbursements from PhilHealth deposited in Trust Funds. As was the common practice among the hospitals, Trust Funds were pooled funds that include other monies or income retained by hospitals.

Sustainability Initiatives of Hospitals

Sustaining the efforts and/or innovations already undertaken and putting in place all those in the pipeline appeared to be dependent on the OpGuide that each hospital prepared with Mindanao Health’s TA. The OpGuides of the hopsitals, which generally defined the management and implementation structure for a hospital’s family planning program, were in varying stages of the approvals process with the hospital management staffs invoking that the systems that need to be developed for a strengthened and enhanced FP services delivery must be preceded by the formal approval and adoption of the OpGuide in each hospital.

Implementation Results, Challenges and Lessons Learned

Initiatives directed at integrating FP services in a hospital setting took off in earnest in 2013 by building the capacity of service providers to administer or provide such FP methods as BTL-MLLA, PPIUD, FPCBT 2 and LARC-PSI. Over a four-year year from 2013 to 2016, a total 155 service providers were provided with trainings on the different LARC/PM methods of family planning. Of this total, about half underwent training on PPIUD while a third of this number went for BTL-MLLA. As of this writing, at least 52 percent of those trained on PPIUD are now DOH-certified PPIUD trainers. NMMC benefited the most from these trainings with the FP skills of 35 of its service providers being upgraded, followed by SPMC and SCPH with 29 and 20 service providers

undergoing FP skills upgrading, respectively. Like any other capacity-building interventions, however, frequent voluntary as well as involuntary staff movements were issues that had to be contended with particularly in the context of program sustainability.

Along with other interventions from other stakeholders, the improved technical competence of service providers correspondingly manifested in the uptake of FP services during the same four- year period. Focusing particularly on the number of clients who opted for the LARC/PM methods of FP and taking 2012 as the benchmark year, the overall annual trend during the following four- year period for the hospitals studied was clearly very encouraging. The number of LARC/PM clients for 2016 stood at 5,800. Even if only a partial report, this number grew consistently from the baseline estimate of 3,276 clients. For hospitals with reports on the number of clients opting for the short-acting methods of FP, both hospital level and aggregate trends were generally in the opposite directions. It was highly probable that the decline in the number of users of short-acting FP methods as well as NFP could be attributed to some extent to these users shifting to LARC/PM methods.

Several lessons were drawn based on the results of the facility and needs assessments and the initial efforts to set up FP services in hospital settings. All of them have technical, operational and managerial ramifications. Examples of these relate to the need to regularize capacity building activities, managing PhilHealth reimbursements through trust funds, and creating FP champions who could move forward the integration of FP services in hospitals in compliance with the DOH guidelines and FP clinical standards.

Recommendations

The approval and implementation of the OpGuide should be fasttracked to set the pace for integrating FP services in a hospital setting. With the implementation structures (i.e., Technicaland Management Committee, FP Core Implementation Team, etc.) duly staffed and functional, critical systems gaps could be identified and corresponding remedial measures developed. The operational guidelines have to be vigorously followed and monitored. It therefore also becomes incumbent on the hospital management to ensure that the standards of monitoring are sensibly defined, data on accomplishments are judiciously analyzed, compiled and eventually reported to the DOH RO. A Trust Fund exclusively for PhilHealth reimbursements needs to be created to give the hospitals enough flexibility to disburse the funds for hospitals operations and for incentive payments to service providers in accordance with prescribed PhilHealth guidelines.

III. Adolescent and Youth Health and Development: The Path for Innovations and Meaningful Participation

MindanaoHealth is one of four USAID’s implementing partners engaged in AFHS interventions since 2014. These interventions are intended to reduce and prevent adolescent pregnancy and to ensure safe delivery among young mothers in areas with large number of adolescent pregnancies. MindanaoHealth’s adolescent and reproductive health intervention seeks to expand young people’s access to a continuum of RH/FP-MCH care, services and products by enhancing hospital and RHU capacities and operations to provide youth-friendly services. MH strengthens the linkages of these AY-friendly facilities as receiving facilities, with other youth-serving sectors like schools, youth-focused CSOs, other agencies and institutions as referring agents.

MindanaoHealth’s primary engagement with hospitals stem from its natural traffic for male and female AY clients seeking consultations, and hospital capacities to provide specialized FP- MNCH/RH services that increase maternal and child survival and well- being, particularly among 90

young women whose occurrence of pregnancy are considered risky. The Project assisted hospitals in the establishment of Center/Program for Teens and to integrate adolescent health in the hospitals’ daily routine operations. Based on DOH AJA protocol, it emphasized psychosocial and SRH risks assessment, provides young mothers with quality perinatal care for safe delivery and helps them manage their fertility to delay repeat pregnancies. MH has extended TA to six CEmONC capable public hospitals—two in Region 11, three in Region 12 and one in CARAGA. It also assisted a CEmONC private hospital to establish Program for Teens in Region11.

The other related strategy is the transformation of 37community level RHUs/CHOs into youth- friendly facilities based on DOH standards. These RHUs are located in ARMM, Regions 10, 11, 12, and CARAGA. RHUs with its respective barangay health stations are strategically located even in geographically isolated areas throughout Mindanao. Transforming RHUs to be youth- friendly make them largely accessible as “first contact facilities” for young mothers to get ANC and family planning information, services and products, as well as integrating risks assessment and guidance among young males and females seeking medical care. Pregnant teens, particularly those 19 y/o and below, are referred to hospitals for delivery and FP services needing hospital facilities.

IV. USAPAN: Increasing the Demand for Family Planning Services by Improving the IPCC Sub-system

Introduction

The USAPAN approach to information sharing is a carefully structured process for a facilitated group discussion on family planning and maternal health care. The design is more conversational. It seeks to educate participants through providing the amount of information that adults can process in one sitting (based on adult education literature), rather than going into multiple complex details in one session. USAPAN aims to promote FP and MCH care by providing essential information on a particular method or service that most appropriately respond to their needs. At the end of a “USAPAN” group session, the participant who has a method/service in mind is counseled individually by a trained service provider for more thorough discussions of the method or service she or he is interested in.

MindanaoHealth’s Usapan Experience

One of the key challenges in family planning is the weak linkage between demand generation and service provision. To address this, MindanaoHealth in collaboration with the Department of Health (DOH) scaled up the Conversation (USAPAN) Series developed by PRISM2 – a previous USAID Project. MH views USAPAN not as a stand-alone activity but as a process to improve the interpersonal communication and counseling (IPCC) subsystem in FP delivery. Appreciation of USAPAN in this context means improving the IPCC sub-system within the facility, not just the actual conduct of the health class and counseling sessions, such that the technical processes of increasing demand are ingrained in the health facility operations itself which should lead to technical sustainability.

A. Preparation - Capacity Building of Usapan Trainers and Facilitators and FP Service Providers

In PY2, capacity building of HSPs on USAPAN started by improving their knowledge, skills and attitudes in conducting IPC/C sessions. To prepare HSPs on FP counseling and provision, MH

coordinated with the DOHROs in training them on FPCBT1, a prerequisite course for all providers of modern FP, and for would-be USAPAN facilitators. MH then trained 1,244 HSPs from 479 SDPs as facilitators, with 113 more trained as USAPAN trainers. Rollout training of facilitators ensued in SOCCKSARGEN and Davao del Sur for 20 and 38 HSPs, respectively, while two more trainings were conducted for 16 HSPs in Misamis Oriental and Bukidnon, and 20 HSPs in Agusan del Norte (Caraga), Maguindanao and Basilan. In terms of geographic coverage, 72 percent of USG-supported LGUs in Mindanao (241/367) have at least one USAPAN facilitator who has conducted at least one Usapan variant. At the service delivery side, MH supported the clinical skills training of FP providers on BTL-MLLA, SDI, PPIUD.

B. Implementation Phase - Support to Village-level Usapan Sessions

a. FP-focused Usapan sessions

MH-supported the conduct of 2,854 sessions of Usapang Kuntento Na and Usapang Puwede Pa from 2014 to December 2016 that reached a combined total of 43,286 probable clients. Of this number, 8,869 attendees became actual acceptors equivalent to a yield of 21 percent.5 The success of MH’s USAPAN sessions as preparatory social activities for outreach or fixed facility service delivery for LARC/PM is apparent in that the contribution of USAPAN to LAPM reached 30 percent of all LAPM procedures performed in USG-assisted sites.

b. MNCHN-focused Usapan sessions to promote safe motherhood and exclusive breastfeeding (Usapang Buntis)

MH supported 1,073 Usapang Buntis sessions that reached 17,757 pregnant women with key messages on antenatal and postnatal care, EBF, PPFP and on the importance of facility- based delivery. Usapang Buntis coupled with other health events for pregnant women reached another 122,542 women.

c. Male-focused Usapan sessions to promote male involvement in FP and MNCHN (Usapang Bagong Maginoo) and as client generation for NSV outreach

To improve male participation in FP and MNCHN, 6,480 male partners were reached through 478 Usapang Bagong Maginoo Sessions resulting in male partners practicing FP services themselves and others expressing support for their partners’ FP services choices.

C. Innovations in Implementation

a. Usapan as social preparation activity for fixed or ambulatory LARC/PM outreach events

In the third year of USAPAN implementation (PY4), MH placed more emphasis in correcting the inefficiencies of the approach in previous years characterized by low client conversion vis- à-vis actual number of participants per session. In the process, more FP acceptors were observed despite fewer sessions. Client conversion rate in terms of successful counseling for modern FP methods reached 19 percent, and an Efficiency Rating of 2.7, the number of acceptors for every FP-related session conducted. MH’s experience shows that yield from USAPAN is generally good for LARC (PSI) and low for LAPM, but had shown to be effective when clients are selected properly and the sessions kept interactive and engaging.

5MH only tracks clients who were actually provided a method, and do not count intent to practice FP as successful counseling. 92

b. Usapang Teen Moms

Usapang Teen Moms began in the first quarter of Project Year 5 with the training of 167 CSO youth peer educators and support-adults by trained CSO youth peer educators with the following results:

 Buluan RHU reached 69 teen mothers age 15-24 year olds in 3 sessions; 29 received TT2 vaccine, 3 became new acceptors of pills while another 2 opted for DMPA;  HDES peer educators reached a total of 445 young mothers in transitory sites in Zamboanga City;  Isabela Foundation Incorporated assisted 47 teen mothers participate in 2 sessions;  The Mayor of Lamitan City signed an Executive Order establishing the RHU as an AY Friendly Facility; 4 teen moms gave birth at the RHU; 7 teen moms availed of FP services; 3 enrolled and completed the TESDA-sponsored training course; 18 enrolled in DepEd ALS; and 11 others signified interest to enroll in DepEd ALS program and TESDA scholarship;  In Isabela City, the Isabela Foundation Incorporated reached out to 16 teen moms; 9 teen mothers were referred to an FPCBT1 trained HSP for one-on-one FP counselling; and all participating teen moms were directly linked to TESDA and Deped ALS;  In Tawi Tawi, 45 teen mothers participated in 3 sessions; and  Bongao RHU reached some 120 young mothers with FP-MCH information, services and products; 29 non-pregnant teen mothers accepted modern FP methods for spacing their pregnancies; 1 teen mother was counseled on BTL and accordingly referred to an appropriate HSP; 39 registered with TESDA for training; 34 enlisted with DepEd for ALS; and 34 to be enrolled by IPHO for PhilHealth membership.

D. Analyzing the Cost of Usapan vis-à-vis FP Acceptors Produced

On average, MH spends PhP1,500 per USAPAN session or PhP100 per participant. Through the years, cost per FP acceptor went down considerably, from an average of more than PhP3,000 in PY2, to PhP1,150 in PY3, to a little over PhP500 in PY4, down to PhP262 in PY5.

Health workers themselves paid testament to the effectiveness of Usapan. Used by POPCOM during Family Development Sessions (FDS), USAPAN had been able to nudge participants towards accepting an FP method of their choice. At the local level, some LGUs in Compostela Valley, North Cotabato, Davao City, Cagayan de Oro and CARAGA Region had started to allocate funds for USAPAN activities in their Local Investment Plan for Health (LIPH).

E. Utilizing Various Entry Points for Usapan Available in Mindanao

In order to make USAPAN relevant to the work of HSPs, ensure its adoption and eventually help bring up demand for FP services, it is necessary to allow them to see Usapan as: (i) an approach to generate clients for fixed facility LAPM services; (ii) a strategy to MNCHN/FP services to residents of GIDAs and CAAs; (iii) an approach that can be integrated with other health events; (iv) an approach that can be integrated in Preservice Education of nursing and midwifery students; and (v) policy as an entry point for effective USAPAN; and (vi) an approach that can be undertaken in collaboration with private companies.

Challenges and Opportunities

The chief challenge in USAPAN is that out of the 1,244 HSPs trained as Usapan facilitators, only 396 (32%) have actively conducted Usapan sessions; 528 (42%) are inactive for various reasons and constraints. These, however, may be offset by the LGUs’ and POPCOM’s adoption of Usapan as a group education and counseling technique to increase the demand for FP services. That PhilHealth now offers benefit packages for maternity care and family planning that includes BTL, NSV and IUD augurs well not only for its adoption but also for the creation of a win-win environment where facility-based delivery, longer-acting and permanent methods of contraception and incentive system for HSPs could be promoted.

Recommendations and Policy and Program Implications

A. Policy Implications

DOH adoption of Usapan as a group education and counseling technique. The DOH had initially expressed willingness to adopt USAPAN as a group education and counseling technique by including it as a learning module in the Interpersonal Communication and Counseling training it conducts. Adopting the technique under a DOH memorandum order or circular will grant legitimacy and foster compliance.

Reducing barriers to access MFP. Policy issues continue to affect access to MFP by women with unmet need. The TRO issued by the Supreme Court on the use and sale of contraceptive implants affects the ability of women to choose an FP method based on their fertility needs, and the health sector’s capability to provide a broader range of safe and effective methods of FP.

B. Program-level Implications

Improve supportive supervision of Usapan facilitators and mentoring of other providers – Similar to other DOH-mandated clinical skills training, periodic supportive supervision of Usapan-trained HSPs is a requisite to ensure that the sessions are conducted regularly, the quality of information, education and counseling is assured, and the roster of trained facilitators are not depleted for various reasons.

Improve the system of monitoring and tracking of clients – There is a need to ensure that an HUP- based system that would aggregate the Target Clients Lists at the facilities is available, and that quality of data is sufficient to determine unmet needs. Using an HUP-based system of identifying probable clients with unmet need for FP/MNCHN services fits positively with Usapan’s client segmentation scheme. A well-segmented client base means better client targeting, needs identification and delivery of FP services.

Address need for additional job aids and up-to-date IEC materials – The DOH must ensure that RHUs and BHS have adequate supplies of updated IEC materials for probable clients and job aids for Usapan facilitators.

Keeping the Usapan process up to date. There are still areas to improve and keep the Usapan process engaging, e.g., compressing/shortening the process itself and using more adult learning exercises to liven up the proceedings and facilitate easier understanding of topics covered.

Improving the capacity of Community Health Workers to motivate probable clients. CHWs must be provided with the appropriate job aids or training to improve their skills to motivate would–be clients.

Insights and Lessons Learned

1. The effectiveness of demand generation activities in terms of contributing to the expected health outcomes is, among other things, dependent on the access by the targeted beneficiary groups to and the availability of the required services. The inadequacy of functional health facilities and proper application of screening processes by midwives constrain translating demand to service utilization.

2. Specific population groups can be targeted for particular USAPAN types. This fits well into a TCL-based selection of participants for USAPAN Puwede Pa/KuntentoNa.

3. The decision to accept any FP method is facilitated by positive reinforcement from skilled HSPs from the community and the hospital facilities.

4. Using USAPAN for social preparation and client generation for LARC/PM outreach or in fixed facility settings yield positive results.

5. Team teaching approach in USAPAN also is recommended so that the individual concerns of participants are sufficiently covered. The approach also allows the facilitators to provide feedback to one another and improve their skills when conducting group education and counselling sessions.

Annex I: Safety and Security (July 2017 – September 2017)

One of the major security threats in implementing the MindanaoHealth Project in PY5 was the Marawi Seige and the declaration of Martial Law in Mindanao. Major project activities in Lanao Del Norte and Marawi were put on hold from the start of the Maute insurrection in Marawi City on 23 May 2017 to present. Northern Mindanao and ARMM teams were mobilized to facilitate the USAID response to the crisis. To prepare for any eventuality, several safety and security information dissmination and communications were likewise strengthened and conveyed to all staff. Regular calls to the ATTLs were made to support the safety and security needs of the sub- offices. Satellite phone checks were made with Administrative Officers monthly to ensure familiarity of the use of the technology in any case.

Safety and Security Manuals were re-visited to include the Martial Law guide for project staff. Where safer means of transportation and staff movement were required to facilitate project implementation during the 1st quarter of the Martial Law (May-July 2017), staff travels from one region to another with existing plane routes were allowed.

In early August 2017, Zamboanga City, Cagayan de Oro, Cotabato and Butuan City sub-offices were closed in preparation for the project close out. All project equipment and materials were transferred to Davao City for safe keeping until a disposition plan is approved by USAID. Likewise, satellite phone subscriptions were terminated but two (2) units were retained to support emergency project communications in case regular communication channels fail. Table below shows the satellite phone numbers, geo-locations and status.

Satellite phone numbers, geo-location and status.

Geo-location Satellite Number Status Zamboanga 8816-2344-9894 Terminated CDO 8816-2347-6997 Terminated Butuan 8816-2244-5782 Terminated Cotabato 8816-2347-8723 Terminated Davao 8816-2341-6455 Active Davao 8988-2345-9021 Active

The Davao City office particpated in the fire/earthquake drill for all building tenants of Landco Corporate Centre last September 2017. This was the same exercise the Project conducted last October 2016. It was supervised by the Davao City Disaster Risk Reduction and Mitigation Team with the aim of ensuring tall office dwellers are informed of the roles and responsibilities of designated fire evacuation personnel and facilitating an organized escape route for the building tenants.

Over-all, security threats the surfaced during the last quarter of PY5 totaled to 74. Marawi seige was greatest security risk which impacted on operations. The table below summarizes the security threats, risks and natural calamities in MindanaoHealth sites from July to September 2017.

Table 2. Security Threats/Risks and Calamities in the Regions/Provinces and Cities of Mindanao from July 2017 to September 2017.

Region/Province/Cities Nature of Security Threats/Risk Impact on Project Activities Zamboanga Peninsula Zamboanga del Norte July 16 - NPA rebels killed, 6 others Advised staff to be very cautious wounded in Leon B. Postigo when traveling to Zamboanga del Norte. July 16 – 4 killed, 10 wounded as NPA Advised staff to be very cautious rebels & Gov’t troops clash in when traveling to Zamboanga Sindanagan del Norte. September 6 – Armed men abduct Advised staff to be very cautious Mayor’s son in Labason when traveling to Zamboanga del Norte. Zamboanga del Sur July 9, 2017 – 15 heavily-armed Advised staff to be cautious members of the NPA torched heavy when travelling to the area. construction equipment in Barangay Licabang, Dumingag. July 16 – NPA rebels surrendered to Advised staff to be cautious government troops in Guipos when travelling to the area as they are NPA infested. Zamboanga Sibugay August 22 – 4 die and 3 hurt in a Advisory to limit travels to the landslide in Kabasalan area Northern Mindanao Misamis Oriental August 7– Villagers flee as large Advisory to limit travels to the gathering of NPA rebels sighted in area OPOL NPA rebels took 10 construction wokers Advisory to limit travels to the as hostages in Gingoog City area Bukidnon July 6 – Government troops seized NPA Advisory to limit travels to the Camp in Cabanglasan area July 22 – NPA rebels ambushed Staff advised to be extremely soldiers and militiamen along the cautious when traveling to the highway in Barangay Kitobo, Kitaotao Northern Mindanao provinces as military offensives were going on in these areas. July 30 – NPA killed in clash with SAF Advisory to limit travels to the in Kibawe area September 9 – NPA rebels clashed with Advisory to limit travels to the government troops area September 9 – NPA rebels harassed a Advisory to limit travels to the banana plantation area Septemebr 15 – NPA rebels released Advisory to limit travels to the abducted police in Maco area Davao Compostela Valley August 9 – Soldier shot dead by NPA Advised staff to take rebels riding in Tandem in Mabini precautionary measure during travel August 14 – NPA hitmen attacked and Advised staff to take killed a soldier in Mawab precautionary measure during travel Davao Oriental July 28 – NPA released abducted Advised staff to take policeman to the Office of the precautionary measure during Presedential Assistant. travel Davao del Sur September 21 – NPA rebels and Advisory to limit travels to the government trrops clashed in Kiblawan area SOCCSKSARGEN

South Cotabato August 12 – Claymore mines recovered Advisory to limit travels to the in Banga area North Cotabato July 10 – Rogue MILF Gunmen killed Advised staff to limit travels to off-duty militiaman in Pikit, North outskirts of North Cotabato. Cotabato, July 15 - 1 Militia killed, 5 soldiers Advised staff on travel to Central wounded, 1 abducted as NPAs Mindanao, and public places ambushed PSG convoy in Arakan July 21 – 5 wounded including 2 minors Advisory to limit travels outside in a grenade attack in Carmen the area. July 25 – 100 families displaced as Advisory to limit travels in the warring groups clashed in Midsayap area. August 16 - NPA rebels abducted Forego non-essential travel policeman in Kidapawan City August 16 – IED blasts in Arakan Advisory to limit travels to the area September 21 – 3 killed as NPA rebels Advisory to limit travels to the attacked CAFGU detachment in Arakan area Cotabato City July 23 – flood hits 24 barangays, state Advisory to limit travels to the of calamity declared. area Sultan Kudarat August 20 – NPA rebel killed in a clash Travel safety advisory issued in Isulan from 7am to 4 pm only. General Santos City September 10 – Police intel Officer Travel safety advisory issued killed from 7am to 4 pm only. CARAGA Surigao Del Sur July 8 – 3 army militiamen abducted by Not a project site NPA rebels in San Miguel, Surigao del Sur. Agusan del Sur July 22 – NPA rebel killed as clash Staff advised to avoid Siabagat. erupted in Sibagat July 30 – NPAs attacked plantation, cut Staff advised to avoid Bunawan palm oil trees, burned truck in Bunawan September 21 – NPA rebels torched Caution for travel cargo truck in Trento September 29 – NPA rebel killed in Advisory to limit travels to the clash with government troops in area Prosperidad Agusan del Norte July 31 - NPA rebels attacked police Avoid travel to Carmen patrol base in Carmen July 23 – Security Guard beheaded in Staff advised on travel caution Butuan City August 2 – 3 policemen hurt in a clash Staff advised on travel caution with NPA in Carmen August 28 – NPA rebels and Advisory to limit travels to the government troops clashed in Kitcharao area September 5 – NPA rebels shot dead a Advisory to limit travels to the lumad leader in Cabadbaran area ARMM Marawi City July 1 – 10 snipers of Maute group killed No travel to Marawi since the by Joint Task Group Ranao Maute incident Maguindanao July 4 – Roadside bomb exploded in Forego non-essential travel Ampatuan from Maguindanao to Cotabato and vice-versa. July 13 – Grenade attack hurt 2 kids in No travel to Datu Angal, no Datu Anggal impact to project activities.

July 12 – Heavy rains submerged 10 Forego non-essential travel towns in Maguindanao province from Maguindanao to Cotabato and vice-versa. July 19 – BIFF gumen attacked soldiers MindanaoHealth staff advised to in shariff aguak and Datu Salibo take extra precaution when traveling to Shariff Aguak and Datu Salibo July 28 – BIFF’s roadside bomb injured Forego non-essential travel 9 soldiers in Rajah Buayan August 2 – 4 terrorists killed in a clash Forego non-essential travel with MILF in Shariff Saydona August 5 – IED exploded near Vice Forego non-essential travel Governor’s house in DOS August 5 – BIFF bandits attacked police Forego non-essential travel station and 2 army detavhments in Datu Unsay August 6 – 5 MILFfighters and 6 others Forego non-essential travel wounded in IED explosion in DSA August 14 – 25 killed in a week long Forego non-essential travel MILF-BIFF clashes in Maguindanao August 20 – BIFF killed and 3 MILF Advisory to limit travels to the fighters wounded in Salibo area August 30 – 1 bandit killed as troops Advisory to limit travels to the pursued BIFF raiders in Mamasapanao area September 2 – 9 killed, 2 wounded as Advisory to limit travels to the MILF and BIFF clash anew in Datu area Salibo Basilan July 5 – ASG bandits beheaded 2 MindanaoHealth staff advised to Vietnamese hostages in Sumisip take extra precaution when traveling to Isabela, Basilan. Travel to Isabela City requires travel security clearance from the Security Focal Person. July 17 – 4 ASG Bandits involved in the Staff advised to be extremely abduction of Vietnmese sailors arrested cautious when traveling to the in Lamitan island province July 20 – ASG Bandits kidnapped father Staff advised to be extremely and son, 5 others in Maluso cautious when traveling to the island province July 30 – 1000 families left homeless as Avoid unnecessary travel to the fire hits Malamawi island in Isabela island August 3 – ASG ambushed delivery Staff advised to be extremely truck, 2 workers hurt in Lamitan cautious when traveling to the island province August 13 – motorcycle riding man Advised staff to take abducted 18 year old girl in Isabela City precautionary measure during travel August 20 – 5 ASG bandits killed as Advisory to limit travels to the troops overrun 2 ASG Camps in Akbar area August 21 – ASG terrorists killed 9 Advisory to limit travels to the villagers in Maluso area Sulu July 8 – 4 killed, 15 wounded as Staff advised to be extremely government troops and ASG bandits cautious when traveling to the clashed In Patikul island provinces of Sulu

Archipelago with military offensives going on in these areas. July 15 – ASG Bandits kidnapped 5 Staff advised to be extremely construction workers in Patikul cautious when traveling to the island July 16 – 3 killed, 1 wounded as 10 Staff advised to be extremely inmates escaped Jolo jail. cautious when traveling to the island August 10 – 5 ASG bandits and 2 Forego non-essential travel soldiers slain in clash in Kalingalan Caluang August 29 – 7 killed as ASG bandits Advisory to limit travels to the clashed with Moro clan in Talipao area September 2 – Soldier killed as ASG Advisory to limit travels to the bandits attacked Army detachment in area Patikul September 7 – 5 ASG bandits killed in Advised staff to be very cautious a clash with gov’t troops in Talipao when traveling to Zamboanga del Norte. Tawi-tawi July 13 – 2 ASG bandits arrested in Forego non-essential travel Military Operations in Taganak July 15 – wanted ASG bomb expert Staff advised to be extremely arrested in Bongao cautious when traveling to the island provinces of Tawi-tawi Davao Region Davao City September 2 – IED explosion at the city Project refrained from holding night market any official activity near that area. Compostela Valley July 11 – NPA Rebels in Army Unioform Travel safety advisory issued Kidnap Policeman in Compostela from 7am to 4 pm only. July 12 – Government and NPA troops Project refrained from holding clashed in Laak any official activity near that area. Davao Oriental July 18 – 20-minute gunfight between Project refrained from holding government and NPA in Lupon any official activity near that area.

All throughout the year, the Safety and Security Focal Person is actively mentored by the RSM Group (a global safety and security TA provider for Jhpiego). A check-in call every last Thursday of the month is initiated by the group as a community of practice to share viable policies and best practices for implementation.

Overall, no amount of safety and security measures is enough for a volatile environment, thus ensuring business continuity and resiliency is the primordial objective of Jhpiego Global office.

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Annex J: Summary of Capacity Building Activities

A. Number of Health Workers Trained

Total w/ No. of Health Workers Trained Training Course Baseline Baseline

Y1 Y2 Y3 Y4 Total FPCBT1 1311 64 1282 1054 462 2862 4173 FPCBT2 672 0 387 194 69 650 1322 LARC-PSI 0 0 298 365 94 757 757 LARC-PSI REMOVAL 0 0 0 0 22 22 22 PPIUD 45 89 381 312 137 919 964 BTL-MLLA 111 0 61 80 101 242 353 NSV 23 0 0 11 0 11 34 LMT 0 0 153 194 48 395 395 EINC/BEMONC 0 0 322 644 121 1087 1087 EINC 384 0 302 509 106 917 1301 BEMONC 0 0 20 135 15 170 170 CMNC 322 100 186 26 0 312 634 AJA 0 0 41 418 493 952 952 U4U 0 0 24 44 600 668 668 PEER EDUCATORS 0 0 0 152 152 304 304 USAPAN 0 0 365 833 76 1274 1274 IPC 0 0 490 739 134 1363 1363 BCS 0 0 0 0 107 107 107 DQC 0 93 600 791 250 1734 1734

B. Number of Trainers Trained

Total w/ No. of Trainors Trained Training Course Baseline Baseline

Y1 Y2 Y3 Y4 Total FPCBT1 0 0 0 15 26 41 41 FPCBT2 0 0 0 5 18 23 23 LARC-PSI 0 0 0 15 10 25 25 PPIUD 0 0 36 38 39 113 113 BTL-MLLA 0 0 0 0 34 34 34 LMT 0 0 0 17 13 30 30 EINC/BEMONC EINC 0 0 66 0 0 66 66 BEMONC 0 0 0 0 0 0 0 U4U 0 0 0 21 0 21 21 USAPAN 0 0 17 40 0 57 57 BCS TOT 0 0 0 0 30 30 30

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C. No. of Service Delivery Points

No. of Service Delivery Points Total w/ Training Course Baseline Baseline Y1 Y2 Y3 Y4 Total FPCBT1 223 11 198 99 99 407 630 FPCBT2 285 0 81 53 30 164 449 LARC-PSI 0 0 137 204 387 728 728 PPIUD 67 31 199 115 11 356 423 BTL-MLLA 214 0 10 18 15 43 257

D. LGU Coverage (at Least one Trained Provider)

LGUs with a Trained Provider Training Course In USG Sites % in USG In Non-USG Total Sites Sites FPCBT1 327 90% 32 359 FPCBT2 156 43% 9 165 LARC-PSI 269 74% 30 299 PPIUD 241 66% 27 268 BTL-MLLA 54 15% 6 60 LMT 183 50% 4 187 EINC/BEMONC EINC 180 49% 23 203 BEMONC 55 15% 1 56 AJA 172 47% 5 177 USAPAN 275 75% 5 280

F. Supportive Supervision

Total Total w/ % Endorsed DOH Y1 Y2 Y3 Y4 Training Trained SupSup to DOH Certified PPIUD 919 21 138 366 525 57% 104 144 BTL-MLLA 242 0 46 40 86 36% LARC-PSI 757 67 146 23 236 31% FPCBT2 650 3 24 27 4% 15 EINC 917 111 96 207 23% 19 BEMONC (ENHANCED OSCE) 170 2 BEMONC/EINC 0 0 53 0 53 CMNC 312 0 78 32 16 126 40% LMT 395 0 21 36 33 90 23%

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Annex K: Summary of Documented Good Practices by Component A. Demand Generation

1. Toktok Planado Pamilya: A Demand Generation Strategy to Reduce Unmet Need in Agusan del Sur through House-to-House Visits 2. A Health Management Perspective on the Improved Family Planning Performance of Katipunan in Zamboanga del Norte 3. Reaching the Underserved and Unreachable through REACH++ (Reaching Every ARMM Community for Health) in Tawi-Tawi

B. Service Delivery

4. Scaling Up Availability of PPIUD Services in Northern Mindanao Northern Mindanao Medical Center 5. Establishment of FP in Hospital: the JR Borja Experiencee in Cagayan de Oro City/Northern Mindanao 6. Improving PPFP Data Capture and Generation in South Cotabato Provincial Hospital 7. Surmounting Challenges in Improving Access of IP communities to FP/MNCHN Services in Kalamansig, Sultan Kudarat 8. Postpartum Family Planning/Reproductive Health Program in Agusan del Norte Provincial Hospital 9. Acquiring Knowledge, Honing Skills: Establishing DOH SOCCSKSARGEN-Recognized Clinical Practice Sites for PPFP/PPIUD-Trained Service Providers for Skills Application 10. FP Integration in the Hospital: Maguindanao Provincial Hospital Experience 11. FP Integration in the Hospital: Cotabato Regional and Medical Center Experience 12. FP Integration in the Hospital: Southern Philippines Medical Center Experience 13. Improving Access of IP communities to MNCHN, FP and AY Services in Pangantucan Rural Health Unit in Bukidnon

C. Adolescent and Youth Reproductive Health

14. Giving Adolescents-Youths a Niche in the Health Care System: the Davao Regional and Medical Center (DRMC) Experience 15. Strengthening Local Program on Adolescent Health: New Bataan Rural Health Unit Experience 16. Youth Peer Education to Reach Out to Out-of-school Youths and In-school Youths of Cotabato City (Cotabato Regional and Medical Center as Service Provider) 17. Showcasing Rural Health Unit Reaching and Serving Adolescents and Youths Reproductive Health Needs: Upi, Maguindanao 18. Integrating Teen Health in a Hospital in Dr. Jorge P. Royeca Hospital, General Santos City 19. Showcasing Rural Health Unit Reaching and Serving Adolescents and Youths Reproductive Health Needs: Tambayan ng Kabataan sa Maramag, Bukidnon

D. Policy and Health Systems

20. Making numbers work in Compostela Valley Province: Data Quality Check 21. Integrating Local Health Initiatives and Programs through Multi-Stakeholder Partnerships: A Service Delivery Network (SDN) Initiaittve in Agusan del Sur (Democritco O. Plaza SDN Experience)

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22. Strengthening Public-Private Partnership in the Institutionalization and Strengthening of MNCHN Services in Davao City Anchored on the Issuance of MNCHN Ordinance 23. Data Quality Check Success in Agusan del Sur

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Annex L: Informed Choice and Voluntarism Compliance Monitoring Activity

This report covers the Informed Choice & Voluntarism (ICV) compliance performance of MindanaoHealth as of Q4PY5 and for USAID Fiscal Year 2016. Activities ranging from trainings to monitoring with partners from DOH- Regional Offices (DOH-ROs), Population Commission (PopCom) and the Provincial and City Health Offices (P/CHO) are in this report. ICV compliance monitoring activities is one of the direct technical assistance of the Project to ensure the quality of service provided in SDP in Mindanao.

Results of MindanaoHealth’s Technical Assistance on ICV

Part A is a consolidation of all TA, inputs and other activities conducted during Q4PY5. These were a combination of approaches: 1) TA package to institutionalize FP compliance monitoring at the provincial level, and the establishment of FP compliance (ICV) committees at the regional level; and 2) stand-alone trainings and integrated trainings on ICV compliance, consultative meetings and monitoring visits on top of the FP compliance course. ICV orientations/trainings were conducted in each region/province. Disaggregated according to gender, the list of the 741 participants is provided in the following table.

Part B is a listing of the names and location of facilities that were visited, names and designation of service providers who were interviewed and observed for their systems and compliance to policies, and number of family planning clients interviewed on their experiences with the service providers and facilities.

Another table in this report summarizes the number of facilities and service providers monitored and found compliant to ICV policies or with possible vulnerabilities and violations, and number of FP clients who were interviewed. For Q4PY5, there were 67 facilities and 82 HSPs monitored for ICV compliance and 696 clients interviewed by MH LGU Advisors and DOH-RO representatives, and other partners. Respondent-facilities and HSPs were found to be generally compliant to current ICV policies and without vulnerabilities nor violations (i.e., no setting of targets, no coercion and no incentives in exchange for FP services). Privacy and confidentiality were also observed.

Meanwhile, 39 MH took the USAID Abortion and FP compliance global health courses, as follows:

NAME FP COMPLIANCE 2017 DAVAO CENTRAL Dolores C. Castillo, MD, MPH, CESO III completed 09.25.2017 Hendry Del Rosario Plaza, MD, MPH completed 10.11.2017 Emmanuel Lopez Dee completed 11.02.2016 Maharlika Filipina L. Cossid-Gomez completed 09.28.2017 Reynaldo Soriano completed 10.11.2017 Averdin Tugade Bucad completed 05.31.2017 Aldren Gonzales completed 10.18.2017 Gajer Laja Bensali compelted 09.23.2017 Elva G. Pedronio completed 09.20.2017 Janice P. Tacata completed 09.21.2017

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Marie Chris T. Real completed 09.20.2017 Genevieve R. Almondia completed 06.01.2017 Paola Joy A. Fernandez completed 06.01.2017 Renato B. Salada completed 09.19.2017 Elisa L. Esteban completed 09.20.2017 Edren G. Baclado completed 06.02.2017 Vicente Q. Ang, III, RN completed 06.06.2017 Daryl C. Arceo completed 09.26.2017 Janette Inso completed 09.20.2017 Renante Juanitez completed 09.20.2017 Jasmin Coleta D. Zamora completed 06.13.2017 DAVAO REGION Mariele Joyce C. Braganza completed 09.29.2017 Gladys L. Bantilan completed 09.20.2017 ARMM REGION Nayda Nour U. Julkarnain, RN, MPA completed 09.20.2017 Judie Ann R. Sakib completed 09.21.2017 Aldin Aminulla completed 10.17.2017 ZAMBOANGA PENINSULA REGION Noemi Casinillo completed 09.20.2017 SOCCSKSARGEN REGION Al-Zadat Amilassan completed 06.05.2017 NORTHERN MINDANAO Roy Rebudal Gavino, MD completed 09.26.2017 Nahla W. Alfad completed 09.24.2017 John Lancelotte C. Rasonabe, RN completed 09.28.2017 Estrella Moya completed Giovanni N. Bitoy completed 09.27.2017 Llena S. Comoda completed 09.17.2017 Keane Jim T. Agravante completed 06.13.2017 Romancito A. Cabantac completed 09.17.2017 CARAGA REGION Arlys D. Demata, RN completed 09.20.2017 Aileen Jane Lachica completed 09.15.2017 Susan M. Valencia, CPA, MBA completed 01.10.2017

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Part A: Technical Assistance, Inputs and Other Activities

Number of Participants Date Location Specific Activity/Topic or Conducted By Specific Audience Remarks/Results/ Outputs Content Whom M F

ARMM

BASILAN

August 21-25, CT Boulevard Informed Choice and Voluntarism DOH ARMM 2 28 MECA, NDP 2017 Hotel, during FP CBT Training Level Provincial Team Zamboanga City Jhpiego and MindanaoHealth

MAGUINDANAO

July 31-August 4, Em Manor Hotel, During the conduct of FP CBT L evel- IPHO- Maguindanao 3 27 PHNs, RHMs, MECAs Comply with the standard and Protocol on ICV 2017 Cotabato City 1 and MH

TOTAL 5 55 60 ARMM NORTHERN MINDANAO CAGAYAN DE ORO CITY

September 25-29, Pearlmont, Post Training Evaluation for FP CBT DOH ROX, MH, 0 10 Trained Providers on FP 2017 NMMC and JR level 1, FP CBT level 2 and PPIUD PHO Mis Or, CHO CBT Level 1, 2 and Bojra Hospital CDOC PPIUD

September 14, CHO CDOC PPIUD and FP CBT Level 2 PHIC PHIC Region 10 and 2 65 RHMs and PHNs from 2017 Conference Accreditation process MH CHO CDOC Room

August 8-11, 2017 Middleton Hotel PPIUD training for hospital HSPs in DOH ROX, MH, 1 14 HSPs in Region 10 Carmen CDOC Region 10 PHO Mis Or, CHO assigned in an MCP CDOC facility and hospital

TOTAL FOR CDO 3 89 92

BUKIDNON

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Number of Participants Date Location Specific Activity/Topic or Conducted By Specific Audience Remarks/Results/ Outputs Content Whom M F

As part of the PTE sessions, the ICV protocol was discussed to emphasize the role of the WRA and the couple in coming up with their decision to avail the FP services. Likewise, the HSPs were refreshed and reoriented on

September 25 – that all FP clients should be well informed of 29, 2017 Pearlmont Hotel, Giovanni Bitoy and the different benefits, risks, side effects Cagayan de Oro Post Training Evaluation: ICV among others of the broad range of FP Mrs. Hazel Ganas 0 46 Nurses and Midwives City compliance services and that the WRA/couples have fully understood and have decided to avail any modern FP services without coercion, fear of withdrawal of benefits or enticement thru incentives.

TOTAL FOR BUKIDNON 0 46 46

MISAMIS ORIENTAL

September 25-29, Pearlmont Inn, Post-Training Evaluation for FPCBT DOH/PHO 0 17 RHMs ICV was one of the topics discussed 2017 CDOC 1, FPCBT2 and PPIUD

July 18, 2017 Jasaan Municipal LAPM/LARC Outreach with MSI RHU personnel/MH 0 30 Probable LAPM+ clients ICV was emphasized by the RHU personnel Hospital during the counseling of clients conducted in

their respective facilities prior to the actual

conduct of the outreach activity. During the registration of clients, MH made sure that rights of clients were not violated, comprehensible information was provided and no coercion was done in the process of generating clients escorted to the outreach activity by the RHU and BPV partners. Probable LAPM+ clients July 19, 2017 OWWA Alubijid LAPM/LARC Outreach with MSI RHU personnel/MH 0 9 -do- Probable LAPM+ clients July 21, 2017 MOPH Manticao LAPM/ LARC Outreach with MSI RHU personnel/MH 0 59 -do- Probable LAPM+ clients July 25-27, 2017 BHS San Luis, LARC Outreach with MSI RHU personnel/MH 0 77 -do- BHS Brgy 23 & Probable LAPM+ clients August 14, 2017 BHSMOPH San Luis,- LAPM/LARC Outreach with MSI RHU personnel/MH 0 63 -do- Balingasag Probable LAPM+ clients August 16, 2017 MOPHGingoog Gingoog City LAPM/LARC Outreach with MSI RHU personnel/MH 0 71 -do-

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Number of Participants Date Location Specific Activity/Topic or Conducted By Specific Audience Remarks/Results/ Outputs Content Whom M F

Northern Total = 471 (10 Male; 461

Total for Misamis Oriental 0 326 326 Participants Female)

DAVAO REGION

COMPOSTELA VALLEY PSI : 41; IUD : 1; BTL Screened: 0; DMPA: July 13, 2017 RHU Montevista Family Planning Ambulatory MHO/Marie Stopes 0 45 WRA 2; Pills: 1; Condom: 0 Outreach Int./MH Project -IEC on FP prior to the activity WRA PSI : 9; IUD : 2; BTL Screened: 1; DMPA: 1; July 18, 2017 BHS Family-FP Planningservice provision Ambulatory MHO/Marie Stopes 0 47 Pills: 6; Condom: 2; Pregnant (ANC): 26 Camanlangan, Outreach Int./MH Project New Bataan -IEC on FP prior to the activity WRA PSI : 53; IUD : 0; BTL Screened: 0; DMPA: July 20, 2017 RHU Laak Family-FP Planningservice provision Ambulatory MHO/Marie Stopes 0 56 2; Pills: 1; Condom: 0 Outreach Int./MH Project -IEC on FP prior to the activity PSI : 43; IUD : 2; BTL Screened: 0; DMPA: ; Aug. 28, 2017 RHU Maco Family- FPPlanning service schedule provision of RHU MHO 0 45 WRA Pills:0; Condom: 0 Maco PSI : 6; IUD : 12; BTL Screened: 0; DMPA: Sept. 13, 2017 RHU Monkayo FP Ambulatory Outreach MHO/Marie Stopes 0 24 WRA 3 ; Pills:3; Condom: 0 Int. (MSI)

Total for Compostela Valley 0 217 Participants

CARAGA

Total 8 733 PARTICPANTS 741

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Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed

FP CLIENTS INTERVIEWED-BASILAN

August 18, 2017 Lamitan CHO Lamitan City MSI 15 Rachel C. No violation noted Resurreccion

FP CLIENTS INTERVIEWED-LANAO DEL SUR

FP CLIENTS INTERVIEWED-MAGUINDANAO

July 6, 2017 RHU- SSB SSB Mabang Kuit-RHM 1 Health facility compliant to FP policies, with no Soraida Alih indication of vulnerability and violation. FP commodities and services available after FP counselling, except permanent methods Clients were referred to Fixed Facility specially BTL. Target is not set nor quota required. Comprehensive information provided to clients. FP IEC materials strategically posted. There is no denial of benefits for non-FP user or incentives provided to new acceptors. July 17, 2017 RHU-Barira Poblacion Emelita Porras- 1 Health facility compliant to FP policies, with no PHN Soraida Alih indication of vulnerability and violation. FP commodities and services available after FP counselling, except permanent methods Clients were referred to Fixed Facility specially BTL. Target is not set nor quota required. Comprehensive information provided to clients. FP IEC materials strategically posted. There is no denial of benefits for non-FP user or incentives provided to new acceptors.

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as September 4, BDH Buluan Aileen Sangkigay- 1 Soraida Alih Health facility compliant to FP policies, with no possi ble) 2017 Doctor indication of vulnerability and violation. FP commodities and services available after FP counselling, except permanent methods Clients were referred to Fixed Facility specially BTL. Target is not set nor quota required. Comprehensive information provided to clients. FP IEC materials strategically posted. There is no denial of benefits for non-FP user or incentives provided to new acceptors. FP CLIENTS INTERVIEWED-SULU No numerical target given to MECA and NDP FP Focal No existing performance evaluation system for FP Person RHU programs and services - Service providers are not required to achieve any Jolo: assigned specific numbers of acceptors of specific Barangay Alat, Rowena 15-Aug-17 BHS Alat Mederna Saddarani 49 methods Jolo Sulu Undug - Service providers do not get any compensation for /MECA and providing FP services nor get paid for FP referrals NDP Aldin - No financial rewards / incentives provided Aminulla - No evidence of coercion among clients interviewed - No ICV violation noted - Have FP Wall Chart posted on the Wall FP Focal No numerical target Person RHU No existing performance evaluation system for FP Jolo: programs and services BHS Takut Barangay Takut - Service providers are not required to achieve any 31-Aug-17 Mrs. Ulanghutan 32 Rowena Takut Takut assigned specific numbers of acceptors of specific Undug methods /MECA and - Service providers do not get any compensation for NDP Aldin providing FP services nor get paid for FP referrals Aminulla - No financial rewards / incentives provided - No evidence of coercion among clients interviewed - No ICV violation noted - Have FP Wall Chart posted on the Wall - Have available FP FLIPCHART

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as

No numerical target p ossi b l e ) No existing performance evaluation system for FP programs and services FP Focal - Service providers are not required to achieve any assigned specific numbers of acceptors of specific Person RHU methods Jolo: - Service providers do not get any compensation for BHS Bus Bus Barangay Bus Bus/ Rowena 5-Sep-17 Ms. Escabarte 25 providing FP services nor get paid for FP referrals and Asturias Barangay Asturias Undug - No financial rewards / incentives provided /MECA and - No evidence of coercion among clients interviewed NDP Aldin - No ICV violation noted - Have FP Wall Chart posted on the Wall Aminulla - Have available FP FLIPCHART - Information on broad Range FP method was given to all clients during the conduct of Usapan Na Session

No numerical target No existing performance evaluation system for FP programs and services FP Focal - Service providers are not required to achieve any Person RHU assigned specific numbers of acceptors of specific methods Jolo: - Service providers donot get any compensation for BHS Walled Brgy.Walled City Ms. Cleng/Wilma Rowena 7-Sep-17 50 providing FP services nor get paid for FP referrals City/Tulay and Tulay Ho Undug - No financial rewards / incentives provided /MECA and - No evidence of coercion among clients interviewed NDP Aldin - No ICV violation noted Aminulla - Have FP Wall Chart posted on the Wall - Have available FP FLIPCHART - Information on broad Range FP method was given to all clients during the conduct of Usapan Na Session

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as No numerical target p ossi b l e ) No existing performance evaluation system for FP programs and services - Service providers are not required to achieve any Hja. Aida assigned specific numbers of acceptors of specific 9-Sep-17 ARCHES clinic Asturias, Jolo Sulu Indanan/Wheng 39 Kim Laja methods Undug - Service providers donot get any compensation for providing FP services nor get paid for FP referrals - No financial rewards / incentives provided - No evidence of coercion among clients interviewed - No ICV violation noted - Have FP Wall Chart posted on the Wall - Have available FP FLIPCHART -No Information numerical on target broad Range FP method was givenNo existing to all clientsperformance evaluation system for FP programs and services - Service providers are not required to achieve any assigned specific numbers of acceptors of specific methods OB ward OB ward staff and - Service providers donot get any compensation for July-Sept., 2017 IPHO IPHO Sulu 388 staff and providing FP services nor get paid for FP referrals RHCC RHCC - No financial rewards / incentives provided - No evidence of coercion among clients interviewed - No ICV violation noted - Have FP Wall Chart posted on the Wall - Have available FP FLIPCHART - Information on broad Range FP method was given to all clients

ZAMBOANGA PENINSULA

FP CLIENTS INTERVIEWED – ISABELA CITY

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as Ms. Mariapossi Victoriable) July 18, 2017 RHU West- Tabuk , Isabela Yolanda Galvez 2 Rachel C. Facility is compliant / adherence to the principles of Lintag to provide FP Isabela Resurreccion FP program. Wall Chart No numerical target is set for Service providers As per client interview there are no incentives, financial rewards, gratuities and bribes in exchange of or to influence clients’ decision to accept a method or to achieve service provider quota or target FPFacility wall ischart/ compliant Poster / adherencenot available to duringthe principles the visit of • August 17, 2017 Juan S. Alano Isabela City MSI 15 Maria FP program. Birthing Clinic Victoria No numerical target is set for Service providers Isabela Lintag As per client interview there are no incentives, financial rewards, gratuities and bribes in exchange of or to influence clients’ decision to accept a method or to achieve service provider quota or target There are broad range FP Methods Available No existing performance evaluation system for FP programs and services Service providers do not get any compensation for providing FP services nor get paid for FP referrals No financial rewards / incentives provided Family planning clients donot get any rewards in exchange for accepting family planning methods, nor given special benefits offers or preferential treatment, nor deny to any benefits if clients decides not to use Family Planning. Comprehensible information are given to Clients There are available IEC materials

ZAMBOANGA SIBUGAY 8/8/17 Datu Panas Buug, ZSP Felicitas Tolorio/ 2 LGUA FP wall chart, Flip charts and other FP IEC RHM BHS materials are displayed in a well illuminated area. Numerical Targets are used to forecast logistics not as basis for performance target.

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as 8/9/17 Magamay BHS Buug, ZSP Lina Plaza/RHM 4 LGUA possible) No Numerical Targets FP wall chart, Flip charts and other FP IEC materials are displayed in a well illuminated area 8/10/17 Pilar BHS Diplahan ZSP Genalyn 3 LGUA No Numerical Targets Arevalo/RHM FP wall chart, Flip charts and other FP IEC materials are displayed in a well illuminated area 8/11/17 Balangao BHS Diplahan ZSP Rosie 2 LGUA No Numerical Targets Bragnaza/RHM FP wall chart, Flip charts and other FP IEC materials are displayed in a well illuminated area

NORTHERN MINDANAO

FP CLIENTS INTERVIEWED- BUKIDNON

July 3, 2017 RHU Libona Poblacion, Libona Ms. Salvadora 2 Mrs. Maria The facility is providing broad range of FP services Provide more IEC Bukidnon Domingo- PHN Elena and counseling materials on FP Dandasan and John Provided clear Lancelotte C. guidelines on client Rasonabe assessment for FP services

Provided technical inputs on LARC Psi contraception as one of the method of choice

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as possible) July 4, 2017 RHU Manolo Tankulan,Bukidnon Mrs. Milagros 2 Mrs. Maria The facility is compliance to ICV standards Provided technical Fortich Ostrea, Ms. Kattie Elena assistance on FP Jayne Guinayon Dandasan, especially among the Albuladora, Ms. Mrs. youths Sushmita Jacutin Khatraine Mae A. Emphasized the Valdez and importance of John household visits to Lancelotte C. increase demand Rasonabe generation of clients and to clarify myths and misconceptions to increase to FP acceptance. Provided technical guidance on FP inventory and monitoring July 5, 2017 RHU Impasug- Poblacion Mrs.Leonie Baula 2 Mrs. Maria The facility provides counseling ang broad range of Provided additional FP ong Bukidnon and Dr. John Elena FP services job aids and guidance Suazo Dandasan, on commodity tracking Mrs. and monitoring. Khatraine Mae A. Valdez and John August 7, 2017 RHU Maramag North Poblacion, Irah Oledan, Shiela 2 LancelotteJohn C. Broad range of FP services were provided but has Provided guidance on Maramag, A. Dy, Dr. RasonabeLancelotte C. no definite and systematic FP inventory the FP commodity Bukidnon Evangeline Revilla, Rasonabe tracking and inventory Mrs. Crispina Madrid August 8, 2017 RHU Poblacion, Dr. Roston Garces, 2 John The facility follows strictly the ICV guidelines Provide more FP IEC Pangantucan Pangantucan, Ms. Jeanette Lancelotte C. materials and Bukidnon Tubongbanua, Ms. Rasonabe guidelines in the Ailyn Alipio application for FP reimbursable services

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as possible) July 3, 2017 RHU Libona Poblacion, Libona Ms. Salvadora 2 Mrs. Maria The facility is providing broad range of FP services Provide more IEC Bukidnon Domingo- PHN Elena and counseling materials on FP Dandasan and John Provided clear Lancelotte C. guidelines on client Rasonabe assessment for FP services

Provided technical inputs on LARC Psi contraception as one of the method of choice

FP CLIENTS INTERVIEWED- CDO

Evelyn Cubos- MH- August 8, 2017 Moirra’s Angel None Sto Nino Lapasan Midwife/Owner of Giovanni Birthing Clinic the Clinic Bitoy Nestojen FP Jenne Cadelina - MH- August 8, 2017 Tablon Cagayan None and Birthing Midwife/Owner of Giovanni de Oro City Clinic the Clinic Bitoy MH- August 8, 2017 JR Borja Cristela Chavez - None Carmen Giovanni The Health Centers provide FP counseling and Hospital Midwife Bitoy and services on pills, NFP, injectable, IUD, and condom. Mytle Villoria BTL clients are referred to NMMC and Mother’s Haus of German Doctors Hospital. The facility has MH- August 10, 2017 Anadele Tordos- None no targets though the HSPs are aware on the NMMC Capitol Compound Giovanni Midwife number of current users for NFP, injectable, IUD, Bitoy condom. The facilities monitored are ICV compliant. MH- August 10, 2017 Marie Stopes Sherlyn Vicente - Pabayo Street None Giovanni Clinic Midwife Bitoy MH- September 8, Tablon Health Giovanni 2017 Tablon Ken Cabunoc- PHN None Center Bitoy and Mytle Villoria

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as possible) September 8 , Kauswagan Jesusa Nave - MH- Kauswagan None 2017 Health Center RHM Giovanni Bitoy and MH- September 8, Mytle Villoria CugmanHealth Grace Adrias - Giovanni 2017 Cugman None Center RHM Bitoy and Mytle Villoria MH- September 8, Lapasan Chona Chiong - Giovanni 2017 Lapasan None Health Center PHN Bitoy and Mytle Villoria

FP CLIENTS INTERVIEWED- LANAO DEL NORTE

Midwife do not have numerical target, however, July 3, 2017 Austin Austin, Yolanda Nacional/ 2 Nahla Alfad target intended for re-supply commodities to ensure Requested PHN to Barangay Kolambugan RHM of no stock-outs, provide Ms. Yolanda Health Station Cleofe with ICV wall chart Vergerie Her working performance is never focused on FP (PHN) but all of DOH Programs She had her flip chart for counselling but no ICV wall chart She only accompanied her referred clients without receiving any additional incentives for LGUs even for the transportation (her very own) Client interviewed were satisfied with their method of choice, and understood very well both the advantage and disadvantage of their method of choice.

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as Hazel Canoy/ RHM The facility is with dedicated room for FP services possible) July 3, 2017 Baroy, LDN Poblacion, Baroy, 1 Nahla Alfad with IEC, chart and ICV wall chart No violation LDN No numerical target for new acceptor Performance merit is never based on CPR but all DOH Program indicators Actively partnering with LDNPH for referred client opted for BTL and PPIUD just to ensure client with unmet need for long acting have been provided with services, initial counselling done at RHU and reinforced at the hosp. Client interviewed happy with the method of choice (PPIUD); and was ensure for any query, Maam Hazel provided her number and can return for visit to RHU. . Agnes Dando/ July 26, 2017 Dalipuga Dalipuga, Iligan Midwife 2 Nahla Alfad No target or quota set for new acceptors both for No Violations Health Center City . Cherrylyn Midwife and BHWs Padua/ BHW BHW tasked house-to-house not just for FP but also include MCH and all other DOH Programs Performance merit is never depended on FP program alone With ICV wall chart and flip chart Client interviewed opted voluntarily for PSI and well- understood the method of choice both the advantages and disadvantages . Darlyn Sultan/ 8/6/2017 Kapatagan Poblacion, BVP 2 Nahla Alfad The facility offers broad modern FP commodities No violations Provincial Kapatagan clients were voluntarily making decision to accept . Elizabeth Hospital Joromo/ her method of choice based on the counselling provided No numerical target, sole for planning/ Nursing attendant/ logistic purposes Wages of the provider is on daily basis whether with or without client, rate still the trained on FPBCT1 same With ICV wall chart displayed visible to their client BHWs (BNS/BVPs) tasked house-to-house visit to identify client with unmet need, however, No target quota set by POPCOM Client interviewed

freely went to participated after been provided FP information by BHW and activity schedules

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as . Helen Ungab/ possible) August 9, 2017 Tibanga Health Tibanga, Iligan City Midwife 2 Nahla Alfad No quota set, planning intended for request of No violations Center supplies. Zenaid casilac/ CHO Performance merit is never depended on FP FP Coor program alone With ICV wall chart and flip chart Client interviewed opted voluntarily for PSI and well understood the method of choice both the advantages and disadvantages. Client both the non FP and FP acceptors treated equally . Judy P. August 25, 2017 Santiago Santiago, Iligan Pagaling/ 2 Nahla Alfad The facility has ICV wall chart No violations Health Center Midwife Zenaid Do not have quota per month. casilac/ CHO FP Coor Employment performance is never based on the number of client becoming FP acceptors Client interviewed counselled at RHU and final counselling done by MSI prior to the insertion PSI She well understood her method of choice and voluntarily accepted the method.

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Steps Taken/ Service Provider No. of FP Date Name of Monitored Recommendations Location and Clients Results/Findings Monitored Facility by (please provide as Designation Interviewed much detail as . Sorina Beldad/ No violationspossib le) 9/15/2017 Tomas Cabili Tomas Cabili, Midwife 2 Nahla Alfad The facility offers broad modern FP commodities health center Iligan City except for BTL (referring to GTLMH) and PSI (MSI).

clients were voluntarily making decision to accept her method of choice based on the counselling provided. No numerical target, sole for planning/ logistic purposes. Wages of the provider is on daily basis whether with or without client, rate still the same. With ICV wall chart displayed visible to their client. Client interviewed freely went to participated after been provided FP information by BHW and activity schedules And MSI staff had provided number so client can be in touch with her . Lynnie Ancog/ No violations Sept 4, 2017 LDNPH Baroy, LDN Nurse 1 Nahla Alfad With FP clinic located at the OPD Building While with provision of long acting permanent (BTL) and PPFP (IUD), they ensure all other modern contraceptives made available at the FP clinic No quotas as to the number of client becoming FP acceptors. Both clients non-FP and FP users treated equally and are ensure of NBB for all other cases The facility provided reports to respective RHUs ensuring data capture onto FHSIS No incentives been provided to client, The client interviewed voluntarily opted to undergone BTL with the support from the husband

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Date No. of Steps Taken/ Monitored Name of Location Service FP Monitored Results/Findings Recommendations Facility Provider and Clients by (please provide as much Designation Interviewed detail as possible)

FP CLIENTS INTERVIEWED- MISAMIS ORIENTAL

7/18/17 1.RHU-Jasaan Jasaan, Misamis Minda Bade 1 Estrella C. The facility provides comprehensible Oriental Ankone information/services on the broad range of RHM FP services- like pill dispensing, DMPA, and do counseling on NFP (LAM); IUD services, condom dispensing and NFP. BTL clients are referred to NMMC/MSI. No FP targets for HSPs are set , targets are only for planning purposes. No incentives or rewards for service providers nor for FP clients Flip table chart is available FP counseling while FP wall chart is conspicuously posted at the health center. Facility is found to be ICV compliant.

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7/19/17 2.OWWA Alubijid, Misamis Ma. Teresa 1 Estrella C. The health facility provides counseling on Alubijid Oriental Orquillas Ankone the broad range of natural and modern FP. However, only PPIUD insertion services can be provided as the FP Clinic has not been in place yet. Clients needing other types of commodities are referred to RHU Alubijid. BTL clients are referred to NMMC for fixed services or MSI during their regular BTL outreach schedules. No FP targets for HSPs are set. There are no incentives or rewards for service providers nor for FP clients Informed consent is explained to the VSS clients before the ligation procedure with the help of Mh. FP wall chart is conspicuously posted at the facility. Facility is found to be ICV compliant.

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Aug. 14, 2017 3.MOPH Balingasag, Eulalia Fabre 2 Donna Mae The health facility provides counseling on Balingasag Misamis Oriental Tayor, PHO the broad range of natural and modern Midwife FP. However, only PPIUD services can be provided as the FP Clinic is not yet in place. Clients needing other types of commodities are referred to RHU Balingasag. BTL clients are referred to NMMC for fixed services or MSI during their regular BTL outreach schedules. No FP targets for HSPs are set. There are no incentives or rewards for service providers nor for FP clients Informed consent is explained to the VSS clients before the ligation procedure with the help of Mh. FP wall chart is conspicuously posted at the health center. Facility is found to be ICV compliant.

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Aug. 16, 2017 4.MOPH Gingoog, Misamis Berta Galupo 1 Charo The health facility provides counseling on Gingoog Oriental Echalico, the broad range of natural and modern Nursing Attendant PHN FP. However, commodities available are IUD and DMPA. Clients for other services are referred to the CHO. BTL clients are referred to NMMC or MSI during their regular BTL outreach schedules. No FP targets for HSPs are set. There are no incentives or rewards for service providers nor for FP clients Flipchart for FP counseling is available. The facility has ran out of FP brochures that clients can take home. Informed consent is explained to the VSS clients. FP wall chart is conspicuously posted at the facility, at the FP cum breastfeeding counseling room. Facility is found to be ICV-compliant.

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7/17/17 5.CHO, El El Salvador, Jocelyn Letigio 1 Estrella The CHO provides the broad range of FP Salvador Misamis Oriental Ankone services- like pill dispensing, inject RHM DMPA, and do counseling on NFP (LAM); IUD/PPIUD services, condom dispensing and NFP. BTL are referred to NMMC/MSI. No FP targets for HSPs are set , targets are only for planning purposes. No incentives or rewards for service providers nor for FP clients Flip table chart is available FP counseling/ FP wall chart is conspicuously posted at the health center. Informed consent is explained to the VSS clients during outreach services with the help of MH. Facility is found to be ICV-compliant.

DAVAO REGION

FP CLIENTS INTERVIEWED- COMPOSTELA VALLEY

July 13, 2017 RHU Pob. Montevista Melodina Polinar, 2 Gladys L. -All FP methods are available in the -NDPs should also be FP BT1 Montevista RM (Rural Health Bantilan facility except for VSS; PSI removal was trained since they will be Midwife) provided by Marie Stopes Int. (MSI) - VSS handling BHS. July 18, 2017 BHS Brgy. Alma Solonia, RN 2 Gladys L. Screening/interview was done by Camanlangan, Camanlangan, (Nurse) Bantilan New Bataan Montevista

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RHM/PHN to be referred to the Provincial -possible, IEC materials July 20, 2017 RHU Laak Pob. Laak Nancy 3 Gladys L. Hospital for schedules; should be translated to local Quismundo, RN Bantilan dialect (Public Health -IEC on FP was given during the activity Nurse) -reproduce more leaflets that -1 on 1 counselling was done using the FP serve as reminders for women forms using FP methods pertaining -conducive area for counselling to S/Sx to be watched for. -consent were provided & signed Aug. 28, 2017 RHU Maco Pob. Maco Janis Pampilon 4 Gladys L. -All FP methods are available in the -additional trained HSPs on (Public Health Bantilan facility except for VSS; PSI removal was PSI insertion and removal Nurse) provided by MHO & PHN. since only 1 PHN was trained in the facility to provide the -Since there were numerous clients who method. This is to avoid influx wanted to avail PSI (insertion & re- of patients in the main RHU insertion), the clients were initially and also, patient can easily interviewed at the BHS level and brought access the method at the BHS with them the filled FP form 1 as their level. referral. -prior to accepting the method of choice, IEC was given.

Sept. 13, 2017 RHU Monkayo Pob., Monkayo Aneliza Ababa 2 Gladys L. -All FP methods are available in the facility -for clients in barangay Mt. (Public Health Bantilan except for VSS; PSI removal was provided Diwata, ambulatory activity Nurse) by MSI. must be scheduled considering the big population -IEC was provided prior to the actual of the area. PHN will raise the activity; issue to the MHO for - clients were counselled in the BHS level. schedule.

CARAGA REGION

FP CLIENTS INTERVIEWED- AGUSAN DEL SUR

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1 Mr. TP The health service provider was Continue TA support October 10, RHU Dona Ms. Virginita Rafallo- refreshed on the importance of ICV especially on IEC 2017 San luis Maxima Ranoco (Method PopCom Rep compliance and advocacy on San Luis Used: Ms. Aileen Facility based deliveries COC Pills Jane and Deliveries Attended by ) Lachica, RN Skilled Birth Attendants. -MH- JHPIEGO October 10, RHU Poblacion Ms. Jocelyn 2 The service providers were able Continue TA support 2017 Prosperidad Branzuela Ms. Aileen to understand the importance of especially on IEC and (Method Jane ICV advocacy on Used: Lachica,RN - Facility based COC Pills MH- deliveries and Deliveries Ms. Divina and JHPIEGO Attended by Skilled Birth Gracia DMPA) Mr. TP Attendants. Mulig, RN Rafallo- PopCom Rep

October 10, RHU Poblacion Ms. Flordelis 2 Mr. TP The health service provider was Continue TA support 2017 Talacogo Talacogon Espera Rafallo- refreshed on the importance of ICV especially on IEC n PopCom Rep compliance and the importance of and advocacy on Facility Method Ms. Aileen consent of the partners especially based deliveries and Ms. Arlene Used: Jane on the long acting methods. Deliveries Attended Lacag (DMPA and Lachica, RN HSP used the gather method during by Skilled Birth 1 -MH- FP counselling. Attendants. Ms. Nila Madelo PPIUD ) JHPIEGO October 10, RHU Lapaz Poblacion, Ms. Yasin 2 Mr. TP Rafallo- The service providers were able Continue TA support 2017 Lapaz Havana PopCom Rep to understand the importance of especially on IEC -RHM Mr. (Method Ms. Aileen ICV. and advocacy on FP Joel Used: Jane and MCH Jumonong- DMPA and Lachica,RN - PHN IUD) MH- JHPIEGO

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October 11 RHU – Poblacion, Ms. Maricar 1 Ms. Aileen The service providers were able Continue TA support 2017 Loreto Loreto Abanto Jane to understand the importance of especially on IEC and (Method Lachica,RN - ICV advocacy on FP and MCH Used: MH- and JHPIEGO DMPA IUD ensure quality of and BTL ) care initiatives in FP October 11 RHU – Poblacion , Ms. Arlene 1 Mr. TP Rafallo- The service providers were able Continue TA support 2017 Veruela Veruela Cusilit (Meth PopCom Rep to understand the importance of especially on IEC od Ms. Aileen ICV and advocacy on FP Used: IUD Jane and MCH and ensure and PIlls) Lachica,RN - quality of care initiatives in MH- FP JHPIEGO October 11 RHU –Sta. Poblacion , Ms, Susan 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Josefa Sta. Josefa Quijada PopCom Rep understand the importance of ICV especially on IEC and (Method Ms. Aileen advocacy on FP and Used: Pills Jane MCH and ensure Lachica,RN - COC ) quality of care MH- initiatives in FP JHPIEGO October 11 RHU Trento Poblacion Ms. Amelyn 2 Ms. Aileen The service providers were able to Continue TA support 2017 Trento Bungcad-PHN (Method Jane understand the importance of ICV especially on IEC and Used: COC Lachica,RN - advocacy on FP and Ms. Frezalyn and IUD MH- MCH and ensure Bongato JHPIEGO quality of care initiatives in FP October 12 RHU Poblacion Ms. Emelia 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Bunawan Bunawan Barrios (Method PopCom Rep understand the importance of ICV. especially on IEC and Used: Pills Ms. Aileen advocacy on FP and Ms. Janele COC ) Jane MCH Buaya Lachica,RN - MH- JHPIEGO October 12 RHU- Poblacion Ms. Joan 2 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Rosario Rosario Canete (Method PopCom Rep understand the importance of ICV. especially on IEC and Used: Pills Ms. Aileen advocacy on FP and COC and Jane MCH Lachica,RN - PSI ) MH- JHPIEGO 137

October 12 RHU- San B2- San Ms. Evelyn 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Francisco Francisco Belarmino Method PopCom Rep understand the importance of ICV. especially on IEC and Used: Pills Ms. Aileen advocacy on FP and MCH COC ) Jane Lachica,RN - MH- JHPIEGO October 13 RHU- Ms. 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Esperanza Poblacion Fresdisminda (Method PopCom Rep understand the importance of ICV. especially on IEC and Esperanza Tano Used: Pills Ms. Aileen advocacy on FP and COC ) Jane MCH Lachica,RN - MH- JHPIEGO October 13 RHU- Poblacion Ms. 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Sibagat Sibagat GladysJane (Method PopCom Rep understand the importance of ICV. especially on IEC and Gonsaga Used: DMPA Ms. Aileen advocacy on FP and Jane MCH Mr. Kim Bryant Lachica,RN - Pantanosas MH- JHPIEGO

October 13 CHO Poblacion 2 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Bayugan Bayugan (Method PopCom Rep understand the importance of ICV. especially on IEC and Ms. Haidee Used: DMPA Ms. Aileen advocacy on FP and MCH Morata Jane Lachica,RN - MH- JHPIEGO October 13 Angels Poblacion Ms. Ginalyn 1 Mr. TP Rafallo- The service providers were able to Continue TA support 2017 Birthing Bayugan Grumo (Method PopCom Rep understand the importance of ICV. especially on IEC and Clinic Used: DMPA Ms.Aileen advocacy on FP and MCH Jane Lachica,R N -MH- JHPIEGO TOTAL 696

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